Factors Associated with 5-Year Costs of Care among a Cohort of Alcohol Use Disorder Patients: A Bayesian Network Model / 대한의료정보학회지

ObjectivesTo examine the direct effects of risk factors associated with the 5-year costs of care in persons with alcohol use disorder (AUD) and to examine whether remission decreases the costs of care.MethodsBased on Electronic Health Record data collected in the North Karelia region in Finland from 2012 to 2016, we built a non-causal augmented naïve Bayesian (ANB) network model to examine the directional relationship between 16 risk factors and the costs of care for a random cohort of 363 AUD patients. Jouffe’s proprietary likelihood matching algorithm and van der Weele’s disjunctive confounder criteria (DCC) were used to calculate the direct effects of the variables, and sensitivity analysis with tornado diagrams and analysis maximizing/minimizing the total cost of care were conducted.ResultsThe highest direct effect on the total cost of care was observed for a number of chronic conditions, indicating on average more than a €26,000 increase in the 5-year mean cost for individuals with multiple ICD-10 diagnoses compared to individuals with less than two chronic conditions. Remission had a decreasing effect on the total cost accumulation during the 5-year follow-up period; the percentage of the lowest cost quartile (42.9% vs. 23.9%) increased among remitters, and that of the highest cost quartile (10.71% vs. 26.27%) decreased compared with current drinkers.ConclusionsThe ANB model with application of DCC identified that remission has a favorable causal effect on the total cost accumulation. A high number of chronic conditions was the main contributor to excess cost of care, indicating that comorbidity is an essential mediator of cost accumulation in AUD patients.

Maternal Genetic Variants of IL4/IL13 Pathway Genes on IgE With "Western or Eastern Environments/Lifestyles"

PURPOSE: We investigated maternal genetic effects of four IL-4/IL-13 pathway genes as well as their interactions with the "Western or Eastern lifestyles/environments" on IgE in Karelian children. METHODS: This study included 609 children and their mothers. Total IgE levels in children and mothers were measured and 10 single nucleotide polymorphisms (SNPs) in IL-4, IL-4Ra, IL-13, and STAT6 were genotyped in mothers and their children. RESULTS: The maternal G allele of IL-13 130 (rs20541) was significantly (P=0.001) associated with decreased IgE in children in the Karelian population (Pooling Finnish and Russian children), as well as in Finnish (P=0.030) and Russian children (P=0.018). The IgE levels were significantly (P=0.001) higher in Russian children whose mothers were homozygous for the G allele of the IL-4Ra 50 (rs1805010) SNP than that in Russian children of mothers who were AG heterozygotes or AA homozygotes. After accounting for children's genotypes, we observed interactive effects on children's IgE for maternal IL-13 130 genotypes (P=0.014) and maternal IL-4Ra 50 genotypes (P=0.0003) with "Western or Eastern" lifestyles/environments. With the adjustment for multiple comparisons using a false discovery rate (FDR) of 0.05, the interactive effect of the maternal IL-4Ra50 SNP was significant. CONCLUSION: Maternal genetic variants in IL-4/IL-13 pathway genes, such as IL-13 130 and IL-4Ra50, influenced IgE levels in school children that were independent of the children's genetic effects. These effects differ in "Western or Eastern" environments.

Maternal Genetic Variants of IL4/IL13 Pathway Genes on IgE With "Western or Eastern Environments/Lifestyles"

PURPOSE: We investigated maternal genetic effects of four IL-4/IL-13 pathway genes as well as their interactions with the "Western or Eastern lifestyles/environments" on IgE in Karelian children. METHODS: This study included 609 children and their mothers. Total IgE levels in children and mothers were measured and 10 single nucleotide polymorphisms (SNPs) in IL-4, IL-4Ra, IL-13, and STAT6 were genotyped in mothers and their children. RESULTS: The maternal G allele of IL-13 130 (rs20541) was significantly (P=0.001) associated with decreased IgE in children in the Karelian population (Pooling Finnish and Russian children), as well as in Finnish (P=0.030) and Russian children (P=0.018). The IgE levels were significantly (P=0.001) higher in Russian children whose mothers were homozygous for the G allele of the IL-4Ra 50 (rs1805010) SNP than that in Russian children of mothers who were AG heterozygotes or AA homozygotes. After accounting for children's genotypes, we observed interactive effects on children's IgE for maternal IL-13 130 genotypes (P=0.014) and maternal IL-4Ra 50 genotypes (P=0.0003) with "Western or Eastern" lifestyles/environments. With the adjustment for multiple comparisons using a false discovery rate (FDR) of 0.05, the interactive effect of the maternal IL-4Ra50 SNP was significant. CONCLUSION: Maternal genetic variants in IL-4/IL-13 pathway genes, such as IL-13 130 and IL-4Ra50, influenced IgE levels in school children that were independent of the children's genetic effects. These effects differ in "Western or Eastern" environments.

Sustained gains from a diabetes prevention program and the role of telephone support

An evaluation of the sustainability of lifestyle changes was undertaken for participants completing a 12 month diabetes prevention program. This second part of the study also tested whether regular structured telephone calls could be effective in maintaining lifestyle changes. Originally, 237 participants completed a 12 month group-based lifestyle intervention study. They were aged 40-75 years, with a moderate to high risk of developing type 2 diabetes. Participants were then randomised to telephone support [n = 107] or self-care only [n = 98] for 18 months, and reassessed using anthropometric, clinical, psychological and general health measures. Results: A total of 164 participants [85 telephone support and 79 self-care only] completed the follow-up. Changes between 12 and 30 months for the telephone support group were not significantly different from those found in the self-care only group. Beneficial lifestyle changes achieved by participants were generally sustained after the diabetes prevention program, with the exception of fasting plasma glucose and some psychological measures. Positive outcomes achieved at 12 months were generally maintained after a further 18 months. Telephone support did not appear to produce additional benefits