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Identifying Unmet Needs of Families With Children and Youth With Special Health Care Needs in a Preparedness Intervention Connected to the Medical Home.
No full textBACKGROUND: Families with children and youth with special health care needs (CYSHCN)-especially those with complex or multiple morbidities-have additional considerations when planning for emergencies. These families can also have health-related social needs that make achieving household emergency preparedness especially challenging. Our objective was to identify and address the unmet social needs and emergency preparedness needs in a diverse sample of families of CYSHCN recruited from a network of medical homes across Pennsylvania as part of a home-focused, virtual emergency preparedness intervention.
METHODS: The study spanned April 2020 to June 2022 and included (1) two sequential CYSHCN-focused interviews addressing medical needs, household emergency preparedness and health-related social needs; (2) core materials on emergency planning and local resources and (3) individualized referrals for unmet needs identified in either interview that were addressed and followed by the medical home team and community partners. Needs identified in the interviews were aggregated, reviewed, inductively categorized and counted sample-wide, per-participant and within sociodemographic subgroups.
RESULTS: Of the 170 participants who completed the first interview, 148 (87%) also completed the second. The CYSHCN in the study (n = 170) had reliance on medical equipment (68%), physical mobility needs (48%), intellectual/communication challenges (79%) and/or vision or hearing loss (36%). Health-related social needs were prevalent and included food insecurity (20%) and housing instability (8%). Sample-wide, 1072 unmet needs were identified and addressed through referrals; 279 of these pertained to emergency preparedness. Other unmet needs fell into each of the Healthy People 2030 Social Determinants of Health domains, mainly Health Care Access and Quality (558 needs; 52%). The sample averaged six unmet needs per participant (median, 5; range, 0-27), and those in the following groups had disproportionately more unmet needs: non-English language speakers, renters, unemployed participants, those with CYSHCN with \u3e 2 comorbidities and participants living with another individual with a disability.
CONCLUSION: Families with CYSHCN experience wide-ranging unmet medical, social and emergency preparedness needs. Our findings suggest that the medical home team may support these crucial areas by incorporating social-needs screening and referrals into an emergency preparedness intervention
Cardiometabolic Outcomes of Novel Therapy Tirzepatide: A Systematic Review
No full textDescription: This systematic review evaluates the efficacy and safety of tirzepatide in improving cardiometabolic outcomes, beyond its glycemic and weight loss effects, in patients with type 2 diabetes and obesity. Objectives: To evaluate the role of tirzepatide in managing cardiometabolic complications associated with type 2 diabetes and obesity. Methods: A systematic review of randomized controlled trials focused on the impact of tirzepatide on lipid profiles, blood pressure, and liver health. Results: Tirzepatide showed significant reductions in hemoglobin A1C, weight loss, and improvements in blood pressure, lipid profiles, and liver health. The most common adverse events were mild gastrointestinal symptoms. Conclusion: Tirzepatide is an effective treatment for managing both glycemic control and cardiometabolic risk factors, supporting its broader role in managing type 2 diabetes and obesity
Is Topiramate Helpful in the Management of Cocaine Use-Related Psychiatric Comorbidities?
No full textIntroduction Cocaine use disorder is a chronic substance use disorder characterized by persistent use of cocaine despite substantial harm and adverse consequences, often developing from patterns of recreational or episodic cocaine use. The pathophysiology of cocaine use is complex, involving the addictive effects on the brain\u27s limbic system, which affects the region of the brain that regulates pleasure and motivation. In this study, we aimed to examine whether topiramate exposure is associated with the incidence of psychiatric comorbidities in patients with cocaine use. Methods This study involved data from 7,325 patients pulled from 66 large healthcare organizations in the TriNetX global health research network and investigated the associations between topiramate exposure and the development of psychiatric comorbidities among patients with cocaine use. The analysis compared patients treated with psychotherapy alone to those treated with psychotherapy and who had topiramate exposure. Results Analysis revealed an increased likelihood of developing a depressive episode [odds Ratio (OR) 1.321, risk ratio (RR) 1.145, p\u3c 0.0001] and anxiety-related disorders (OR: 1.317, RR: 1.124, p\u3c 0.0001) in the topiramate group compared to the group with psychotherapy alone. Although there was a slight increase in suicidal ideation (OR: 1.109, RR: 1.08, p=0.14) and alcohol abuse (OR: 1.005, RR: 1.003, p=0.948) in the topiramate group, these differences were not statistically significant. Conclusions These findings suggest that while topiramate may offer some benefits, its exposure is associated with a higher observed incidence of developing depressive and anxiety disorders in patients with cocaine use. On the other hand, topiramate exposure was not significantly associated with increased incidence of developing suicidal ideation or alcohol abuse in this population. Treatment plans should carefully weigh the potential physiological and psychiatric risks when considering topiramate for managing cocaine use, especially in populations already vulnerable to mental health issues
Trends and disparities in the prevalence of diagnosed arthritis among United States adults from 2019 to 2022.
No full textArthritis is a predominant cause of disability in the United States, imposing substantial economic burdens and public health challenges. This study aimed to analyze the trends and disparities in the prevalence of arthritis among US adults from 2019 to 2022. The National Health Interview Survey (NHIS) database of the Center for Disease Control and Prevention was analyzed, employing Joinpoint regression analysis for determining annual percentage changes (APCs) and prevalence percentages with 95% confidence intervals (CI). The prevalence of diagnosed arthritis among US adults remained relatively stable and slightly increased from 21.4% (95% CI: 20.9, 22.0) in 2019 to 21.6% (95% CI: 21.0, 22.2) in 2022 (APC: 0.4698; 95% CI: -1.0841, 2.0577). Females had a higher prevalence, which also increased from 24.3% to 25.0% (APC: 1.0218; 95% CI: -0.4408, 2.5223) with male prevalence ranging from 18.3% to 18.0% (APC: -0.3254; 95% CI: -2.6590, 2.0817). Age-related differences were particularly evident, with rates peaking in individuals aged ≥ 75 years at 53.9% in 2022. Racial disparities were observed, with White adults having a higher prevalence each year (23.8% in 2022). Geographic factors influenced prevalence, with higher rates noted in areas outside metropolitan areas and in the Midwest. Analysis of the NHIS database indicated a slight rise in arthritis prevalence overall, accompanied by notable demographic disparities. These results emphasize the necessity for tailored public health interventions and efficient disease management approaches tailored to specific populations
Evaluating the Impact of Weight Loss Interventions on Non-Alcoholic Fatty Liver Disease in Pediatric Patients: A Preliminary Analysis Using Transient Elastography
Full text linkTriple Antibiotic Paste Pulpotomy (LSTR: Lesion Sterilization and Tissue Repair Technique) to treat Necrotic Primary Molars
Full text linkCurrent and Emerging Therapies for Prevention and Treatment of Bronchopulmonary Dysplasia in Preterm Infants.
No full textAlthough advances in the care of extremely preterm born infants have yielded improvements in survival and reductions in important morbidities, rates of bronchopulmonary dysplasia (BPD) have remained relatively unchanged. As BPD can have a long-lasting impact on the quality of life for survivors of prematurity and their families, this remains a continuing challenge. Treatments that have consistently shown efficacy in preventing either BPD or the composite outcome of BPD and death prior to 36 weeks post menstrual age (PMA) in large-scale randomized clinical trials (RCTs) include caffeine [adjusted odds ratio aOR for BPD, 0.63; 95% confidence interval (95% CI) 0.52-0.76; p \u3c 0.001)], vitamin A [relative risk (RR) for death or BPD 0.89; 95% CI 0.80-0.99], low-dose hydrocortisone in the first week of life [OR for survival without BPD, 1.45; 95% CI 1.11-1.90; p = 0.007], and post-natal dexamethasone [RR for BPD or mortality; 0.76; 95% CI 0.66-0.87]. Although early caffeine therapy is now a widely used strategy to prevent BPD, the potentially severe side effects of post-natal glucocorticoids and the concerns regarding the cost-benefit of vitamin A have led to inconsistent use of these drugs in clinical practice. Inhaled bronchodilators and diuretics provide differing degrees of symptomatic relief for patients according to their phenotypic pattern of lung injury; however, these medications do not prevent BPD. Currently available pharmaceuticals do not sufficiently address the degree of structural immaturity and immune dysregulation that is present in the growing population of survivors born prior to 25 weeks gestational age. In this article, we provide both an evidence-based summary of pharmacological treatments currently available to prevent and manage BPD and a discussion of emerging therapies that could help preserve normal lung development in infants born preterm
Infertility and Risk of Ovarian Cancer in the Women\u27s Health Initiative.
No full textPURPOSE: There is a consistent relationship with greater ovulation frequency and increased risk of ovarian cancer. However, prior research on infertility, which may be associated with ovulation frequency through multiple mechanisms, and ovarian cancer has yielded conflicting results, possibly due to prior research conflating fertility treatment with infertility and restricting follow-up to premenopausal cases. Our objective was to determine the association between infertility and risk of postmenopausal ovarian cancer, overall and by histotype, in a population that had not received treatment with IVF.
METHODS: We utilized data from the Women\u27s Health Initiative (n = 112,925 postmenopausal participants) with over 25 years of follow-up. At baseline, participants were asked whether they had ever tried to become pregnant for more than one year without becoming pregnant and whether a reason was found. Cox proportional hazards models were used to calculate hazard ratios (HRs) of incident adjudicated ovarian cancer comparing participants with a history of infertility to fertile participants overall and by histotype.
RESULTS: 17% of participants reported a history of infertility at baseline and 1,109 ovarian cancer cases were diagnosed during follow-up. No statistically significant association was observed between infertility and risk of any ovarian cancer (HR: 1.09, 95% CI 0.92-1.29), but those reporting infertility had a 90% higher risk of endometrioid and clear cell ovarian cancers (HR: 1.90 95% CI 1.09-3.34) compared to fertile participants. The reported reason(s) for infertility had no discernable impact on these associations.
CONCLUSIONS: Infertility may be associated with clear cell and endometrioid ovarian cancer but not other ovarian tumor histotypes
Serotonin Norepinephrine Reuptake Inhibitor Is Associated With Lower Mortality Among Patients Presenting With Takotsubo Cardiomyopathy.
No full textBACKGROUND: Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic reuptake of serotonin and norepinephrine and are widely used in the treatment of depression and neuropathic pain. We evaluate the impact of SNRIs use on the clinical outcomes of patients presenting with Takotsubo cardiomyopathy (TCM).
METHODS: We analyzed data from the TriNetX research network. Patients aged ≥18 years with a principal diagnosis of TCM were identified from January 1, 2003, to December 31, 2023. After excluding patients on SSRIs, stimulants, 5-fluorouracil, capecitabine, gemcitabine, and trastuzumab, patients with myocarditis, pheochromocytoma, acute myocardial infarction, cocaine-related disorders, and opioid-related disorders, were also excluded. The final study population was divided into 2 cohorts: patients on SNRIs and patients not on SNRIs. Propensity score matching was used to adjust for potential confounders. The primary outcome was all-cause mortality, and the secondary outcome was Takotsubo cardiomyopathy-related complications.
RESULTS: A total of 16 853 patients with a diagnosis of TCM were identified, of which 2482 (14.7%) were on SNRIs. The SNRIs cohort were older (mean age 64.1 versus 63.4 years,
CONCLUSIONS: The use of SNRIs among patients presenting with TCM is associated with lower mortality and lower TCM-related complications