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Alberta's provincial Travelling Clinic, 1924-42.

Providing health services to sparsely populated, geographically isolated areas was a major challenge in many Canadian provinces before the advent of universal hospital insurance in the late 1950s, and universal physician insurance in the late 1960s. The task was especially daunting during the interwar depression years. Nonetheless, from 1924 to 1942, Alberta's Department of Public Health sponsored an itinerant Travelling Clinic during the summer which conducted physical examinations, dental examinations and treatment, tonsillectomies and other minor surgery, and vaccination against smallpox to…

The resurgence of sexually transmitted disease in China.

In the early years following the Chinese revolution in 1949, the Chinese mounted mass campaigns against the preventable communicable diseases including the venereal diseases. These were characterized by mass education, a national health insurance system, training and dispersion of the "barefoot doctors," elimination of prostitution, emancipation of women, and full employment. By 1996, the Chinese claimed that they had virtually eliminated venereal diseases. This was confirmed by western visitors in the 1970s. However, following the economic reforms which began in the 1980s, sexually transmitte…

Folliculitis keloidis nuchae.

Keloid scars are an idiopathic result of cuts, bruises, lacerations and often from surgical incisions. Medical therapy has been used with some results, but often surgical excision is necessary when the keloids are located in areas of exposed skin. Often skin grafting is necessary. The problem of keloid formation is more common in African Americans and Asians in the United States. Because surgery of these lesions is sometimes considered cosmetic by HMOs and other insurance carriers, there exists a dispute between the medical profession and insurance carriers regarding the medical necessity of s…

The challenge of caring for indigent children with rheumatologic diseases.

Poverty and lack of insurance prevent complete access to tertiary care for many children with rheumatologic diseases. Long-term solutions to provide community based support for local teams and other services are needed. Physicians need to work with colleagues in health care systems and government to make the health care system fully available to all families. Medical schools can act as catalysts in helping government agencies redefine policies to support outreach and other health care programs for the indigent. Governmental agencies must collaborate with insurance companies to change policies …

Real-World Adherence and Follow-Up Colonoscopy After Multitarget Stool DNA Screening in a Regional Healthcare System.

BACKGROUND: Multitarget stool DNA (mt-sDNA) testing is an established noninvasive colorectal cancer (CRC) screening option for average-risk … dy period. Eligible tests were from patients aged 45 to 85 years with ≥6 months of prior continuous insurance coverage and no high-risk CRC conditions. Outcomes were adherence (kit return within 365 days), test positivity among adherent test kits, and follow‑up colonoscopy within 365 days among eligible positive cases. Multivariable logistic regression and …

Association of first trimester prescription opioid use with congenital malformations in the offspring: population based cohort study.

OBJECTIVE: To evaluate the risk of first trimester exposure to prescription opioids for major congenital malformations, previously reported to be associated with such exposure. DESIGN: Population based cohort study. SETTING: Nationwide sample of publicly and commercially insured pregnant women linked to their liveborn infants, nested in the Medicaid Analytic eXtract (MAX, 2000-14) and the MarketScan Research Database (MarketScan, 2003-15). PARTICIPANTS: 1 602 580 publicly insured (MAX) and 1 177 676 commercially insured (MarketScan) pregnant women with eligibility from at least three months

Сопоставление клинических результатов между пиелоперфюзелями и микроволновой абсорбацией почечных клеток.

Справочная информация: Сопоставимость характерна для пациентов с множественным склерозом (МС), что повышает сложность лечения заболеваний и экономического бремени и ухудшает их прогноз и качество жизни. Не хватает реальных данных, позволяющих сопоставлять коморбиды и модели множественной смертности, характерные для лиц, охваченных системой страхования на коммерческой основе, и лиц, охваченных системой " Medicare " . Цель: Оценка структуры коморбидности и многоженства среди пациентов с НР в американской компании " Компромисс " и " Медикэр аппетит " . Методы: Это ре

Совпадение в аннотации оригинала
Background: Comorbidities are common in patients with multiple sclerosis (MS), thus increasing the complexity of disease management and econ … mpared. Results: Among 5000 patients (mean [SD] age, 52.6 [12.9]; 75.2% female), 53% had commercial insurance and 47% had Medicare Advantage (59.2% disabled age <65). Medicare Advantage patients were older (age <65: 53.3 [7.9]; age ≥65: 70.8 [5.2]) vs commercial (age, 45.7 [10.2]), had greater comorbidity burden (Charlson Comorbidity Index; age <65: 1.17 [1 …

Prevalence and incidence of type 1 diabetes in Ireland: a retrospective cross-sectional study using a national pharmacy claims data from 2016.

OBJECTIVES: The aim of this study is to estimate the prevalence and incidence of type 1 diabetes in the Irish population using a national pharmacy claims database in the absence of a national diabetes register. DESIGN: National, population-based, retrospective, cross-sectional study. SETTING: Community care with data available through the Health Service Executive Pharmacy Claims Reimbursement Scheme from 2011 to 2016. PARTICIPANTS: Individuals with type 1 diabetes were identified by coprescription of insulin and glucometer test strips without any prolonged course (>12 months) of oral hypogl

Measuring and Characterizing Psychiatric Multimorbidity Among Individuals with Mental Illness.

Psychiatric multimorbidity, defined as the co-occurrence of two or more psychiatric diagnoses, is increasingly recognized as a marker of cli … ults aged 21-64 years with at least one psychiatric diagnosis and insured by Medicaid or commercial insurance. Psychiatric disorders were identified using ICD-10-CM codes grouped into diagnostic categories, with complete code listings provided in supplementary material. Psychiatric multimorbidity was defined as ≥ 2 distinct psychiatric diagnoses documented …

Predictors of Loss to Long-Term Follow-up After Shoulder Surgery.

BACKGROUND: Loss to follow-up is among the most important sources of bias in clinical research. Thus, the purpose of this study was to ident … age, and email at 2 years postoperatively. Variables analyzed included demographic characteristics, insurance status, surgical procedure type, Social Deprivation Index (SDI), and distance from the surgical site to home. Multivariable logistic regression analysis was performed to determine which factors were associated with 2-year follow-up. RESULTS: Of the …

Quality, Cost, and Timeliness of Cancer Treatment in Medicare Advantage and Traditional Medicare.

IMPORTANCE: Use of Medicare Advantage (MA) insurance has been associated with lower cancer treatment costs than traditional Medicare (TM). Whether there are differences in guideline-concordant care or treatment costs for beneficiaries insured under MA vs TM is unknown. OBJECTIVE: To assess whether Medicare insurance type is associated with receipt of optimal cancer treatment and costs. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of a population-based sample using Medicare claims and encounter data from 2015 through 2019. Participants were Medicare beneficiaries with continu…

Closing-the-loop: a novel care coordination tool to reduce maternal healthcare utilization postpartum and collaboratively build interventions to address community needs.

BACKGROUND: In August 2020, Sarasota Memorial Health Care System (Sarasota Memorial) invested in Unite Us, a closed-loop referral platform, … ere matched on patient and birth characteristics including age, race and ethnicity, marital status, insurance type, maternal comorbidities, and birth-specific factors. The impact of the Unite Us platform was assessed using conditional logistic regression, and results were stratified by insurance type, delivery method, low birthweight, preterm delivery, marr …

Less invasive surfactant administration with specially designed semirigid catheter: Experience from a tertiary level neonatal unit of a lower middle-income country.

Clinical outcomes of 74 preterm neonates, who received surfactant replacement therapy (SRT), were collected retrospectively, to compare the following modes of administration: (1) less invasive surfactant administration (LISA) via a specially designed semirigid catheter (Surfcath), (2) INtubate-SURfactant-Extubate (INSURE) and (3) through endotracheal tube (ETT), in neonates requiring mechanical ventilation. The primary composite outcome of mortality or bronchopulmonary dysplasia (BPD) at 36 weeks' post-menstrual age was 41% in LISA, 38% in INSURE and 77% in ETT groups (p < 0.01), the differenc

Asthma and geographical altitude: an inverse relationship in Mexico.

Motivated by the great asthma-prevalence variation throughout the world, we analyzed the rate variation of medical services due to asthma in the 32 Mexican states at the Instituto Mexicano del Seguro Social (approximately 24 million insured subjects). In 1993, a total of 406,036 services were due to asthma, and state rates ranged from 53 to 476 x 10,000 insured subjects. A direct correlation (p < 0.05) was found for single-room house, ascariasis, and rubella rates, but the strongest (inverse) correlation was found for geographical altitude (r = -0.73, p < 10(-5)). Thus, in Mexico, geographical

Longitudinal Associations of Neighborhood Food Access with Child Body Mass Index and Obesity.

BACKGROUND: Neighborhood food access is considered a structural determinant of childhood obesity, yet prior studies report inconsistent find … ons between LILV residence and repeated BMI z-scores and obesity risk over follow-up, adjusting for insurance type. Secondary analyses among publicly insured children (n = 3548) explored the association between LILV residence and obesity risk, adjusting for household food insecurity. RESULTS: At baseline, 26.1% of children resided in LILV neighborhoods. No …

Risk Factors Associated With Pediatric Post-Tonsillectomy Complications: A Focus on Racial, Ethnic and Socioeconomic Factors.

OBJECTIVES: Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydrati … tiary care center. Patient records were documented including demographics, race, ethnicity, type of insurance, surgical technique, and post-operative complications. A major post-operative complication was defined as post-surgical hemorrhage, uncontrolled pain, or dehydration requiring medical attention. RESULTS: There were 1751 patients included in the stu …

Power of public health advice: Effectiveness and spillover effects of federal vaccine recommendations.

OBJECTIVES: This paper focuses on the national-level, inexpensive, demand-side vaccine policy-federal recommendations. It evaluates the effectiveness of 2008 and 2010 influenza vaccine recommendations, the spillover effect of the 2009 H1N1 vaccine recommendation on influenza vaccination, and heterogeneous policy effects across individual characteristics. STUDY DESIGN: Observational study with before-after comparison assessing changes in vaccination following policy implementation. METHODS: We used nationally representative 2004-2015 NHIS data on 77,361, 23,653, and 238,866 individuals in age

The Financial Sustainability of Programs to Initiate Medications for Opioid Use Disorder in Emergency Department Settings.

BACKGROUND: The US is experiencing an epidemic of opioid misuse and mortality. Effective treatments are available, including medications for opioid use disorders (MOUD), but they are greatly underused due to a variety of barriers. In response, some US hospitals have established programs to identify emergency department (ED) patients with opioid use disorders (OUD) and begin treatment with MOUD ("ED induction"). For this model to be widely adopted, financial sustainability for hospitals is critical. Little is known about the financial aspects of ED-based treatment models, including insurance bi…

Measuring food insecurity among a national sample of children with recurrent acute otitis media.

INTRODUCTION: Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past stu … (19.0-22.6 %) were food insecure. Age, race/ethnicity, percentage of federal poverty level status, insurance status, and self-reported health status were significant and were not independent of food insecurity status. Using multivariable regression, this study found the following sociodemographic risk factors: age 6-10 and age > 10 (reference: age 0-2); Bl …

Out-of-Pocket Costs for Patients Undergoing Thyroid Surgery.

OBJECTIVE: The aim of this study was to determine out-of-pocket costs (OOPC) in patients undergoing thyroidectomy for benign and malignant c … ore surgery to 360 days after surgery was $2434 [interquartile range (IQR) $1273-$4226], the median insurance reimbursement was $15,520 (IQR $7653-$29,149). Patients undergoing thyroidectomy for malignant conditions had a median OOPC of $3019 (IQR $1596-$5021) compared to $2271 (IQR $1201-3954) for benign conditions ( P < 0.0001).Patients with preferred pro …