Who is your prenatal care provider? An algorithm to identify the predominant prenatal care provider with claims data.

BACKGROUND: Using claims data to identify a predominant prenatal care (PNC) provider is not always straightforward, but it is essential for assessing access, cost, and outcomes. Previous algorithms applied plurality (providing the most visits) and majority (providing majority of visits) to identify the predominant provider in primary care setting, but they lacked visit sequence information. This study proposes an algorithm that includes both PNC frequency and sequence information to identify the predominant provider and estimates the percentage of identified predominant providers. Additionally, differences in travel distances to the predominant and nearest provider are compared. METHODS: The dataset used for this study consisted of 108,441 live births and 2,155,076 associated South Carolina Medicaid claims from 2015-2018. Analysis focused on patients who were continuously enrolled throughout their pregnancy and had any PNC visit, resulting in 32,609 pregnancies. PNC visits were identified with diagnosis and procedure codes and specialty within the estimated gestational age. To classify PNC providers, seven subgroups were created based on PNC frequency and sequence information. The algorithm was developed by considering both the frequency and sequence information. Percentage of identified predominant providers was reported. Chi-square tests were conducted to assess whether the probability of being identified as a predominant provider for a specific subgroup differed from that of the reference group (who provided majority of all PNC). Paired t-tests were used to examine differences in travel distance. RESULTS: Pregnancies in the sample had an average of 7.86 PNC visits. Fewer than 30% of the sample had an exclusive provider. By applying PNC frequency information, a predominant provider can be identified for 81% of pregnancies. After adding sequential information, a predominant provider can be identified for 92% of pregnancies. Distance was significantly longer for pregnant individuals traveling to the identified predominant provider (an average of 5 miles) than to the nearest provider. CONCLUSIONS: Inclusion of PNC sequential information in the algorithm has increased the proportion of identifiable predominant providers by 11%. Applying this algorithm reveals a longer distance for pregnant individuals travelling to their predominant provider than to the nearest provider.

On the geographic access to healthcare, beyond proximity.

This study examined the incongruence of travel distance between the nearest provider and the provider that pregnant woman actually chose to visit. Using a dataset of South Carolina claims including rural and urban areas for the period 2014-2018 based on live births of 27,290 pregnant women, we compared the travel distance and travel time for two providers of health: the nearest facility and the main one for the area in question. The number of the former type was counted for every case. The mean travel distance/time to the nearest provider was 3.2 miles (5.2 km) and 5.0 minutes, while that to the main (predominant) provider was 23.0 miles (37.0 km) and 31.7 minutes. Only 21.6% of pregnant women chose one of the closest facilities as their provider. The mean travel distance and time to the nearest provider for women in rural areas were more than twice that for urban women but only 1.2 times for the main provider. Rural women had one third fewer providers situated closer than the main in comparison to number available for urban women. Thus, we conclude that proximity is not the only factor associated with access to healthcare. While evaluating geographic access, the number of available health providers within the mean travel distance or time would be a better indicator of proximate access.

Benefits of a Three-Day Bamboo Forest Therapy Session on the Physiological Responses of University Students.

Studies have indicated that natural environments have the potential to improve the relationship between a stressful life and psychological well-being and physical health. Forest therapy has recently received widespread attention as a novel solution for stress recovery and health promotion. Bamboo is an important forest type in many countries, especially in East and Southeast Asia and in African countries. Bamboo is widespread throughout southwestern China. Empirical field research on the physiological effects of bamboo forest therapy is currently lacking. To explore the benefits of bamboo forest therapy on the physiological responses of university students, 120 university volunteers between the ages of 19 and 24 participated in this study (60 males and 60 females) and were randomly divided into four groups of equal size (15 males and 15 females in each). Four sites were selected for the experiment, including two natural bamboo forests (YA and YB), a bamboo forest park (DJY), and an urban environment (CS). During the testing period, all participants were asked to view the landscape for 15 min in the morning and then walk in the testing area for 15 min in the afternoon. Blood pressure (BP), heart rate (HR), and peripheral oxygen saturation (SpO2) were measured as the physiological indexes, and the semantic differential method (SDM) questionnaire was completed for the environmental satisfaction evaluation. The SDM for the subjective environmental evaluation differed significantly among the university students; they obtained a better environmental experience, in terms of sensory perception, atmosphere, climate, place, and space, in the bamboo forest sites. The three-day bamboo forest therapy session improved the physiological well-being of university students. First, the blood pressure and heart rate of the university students decreased, and the SpO2 increased, after the three-day viewing and walking activities of the three-day bamboo forest therapy session. The viewing activities had a more pronounced effect on decreased heart rate in university students. Additionally, three-day bamboo forest therapy had a positive impact on decreased systolic blood pressure and heart rate in the university students, and it was significantly decreased in females, while peripheral oxygen saturation (SpO2) remained relatively low. Finally, compared with the urban site (CS), the bamboo forest sites effectively improved the university students' physiological state of health, decreased their physical pressure, and stabilized their physiological indicators. These findings provide scientific evidence that a three-day bamboo forest therapy session can increase positive physiological responses. The potential for a longer-term effect on human physiological health requires further investigation.

Geographic disparities in residential proximity to colorectal and cervical cancer care providers.

BACKGROUND: Persistent rural-urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural-urban differences in residential proximity to cancer specialists. METHODS: Using the 2018 Physician Compare data concerning physician practice locations and the 2012 to 2016 American Community Survey, the current study estimated the driving distance from each residential zip code tabulation area (ZCTA) centroid to the nearest cancer provider of the following medical specialties involved in treating patients with colorectal and cervical cancer: medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology, and colorectal surgery. Using population-weighted multivariable logistic regression, the authors analyzed the associations between ZCTA-level characteristics and driving distances >60 miles to each type of specialist. ZCTA-level residential rurality was defined using rural-urban commuting area codes. RESULTS: Nearly 1 in 5 rural Americans lives >60 miles from a medical oncologist. Rural-urban differences in travel distances to the nearest cancer care provider(s) increased substantially for cancer surgeons; greater than one-half of rural residents were required to travel 60 miles to reach a gynecological oncologist, compared with 8 miles for their urban counterparts. Individuals residing within ZCTAs with a higher poverty rate, those of American Indian/Alaska Native ethnicity, and/or were located in the South and West regions were more likely than their counterparts to be >60 miles away from any of the aforementioned providers. CONCLUSIONS: The substantial travel distances required for rural, low-income residents to reach a cancer specialist should prompt a policy action to increase access to specialized cancer care for millions of rural residents.

A systematic review of anxiety across smoking stages in adolescents and young adults.

BACKGROUND: In adolescence and young adults, inconsistence of the association between anxiety and smoking remains to be investigated and clarified. The aim of this study is investigated and clarified the association between anxiety and smoking stages in adolescence and young adults. METHODS: The data on the causal influence of anxiety on smoking in adolescents and young adults aged 14 to 25 years old was retrieved from electronic databases. RESULTS: Nineteen of 668 articles were subjected to a systematic review. Definitional differences with respect to smoking stages constrained homogeneity across the nineteen analyzed reports. Anxiety appears to play a more consistent risk role for nicotine dependent (ND) smokers than for non-nicotine dependent (non-ND) regular or daily smokers. Anxious non-ND smokers are at higher risk to become nicotine dependent. CONCLUSIONS: A ununified definition of smoking stages is responsible for the production of inconsistent results. The analysis reinforced anxiety as a significant risk factor for smoking in one's lifetime. Anxious non-ND smokers are the key target for interventions aimed at preventing nicotine dependence and smoking-related health problems.

Comparison of visceral and body fat indices and anthropometric measures in relation to untreated hypertension by age and gender among Chinese.

BACKGROUND: The aim of the study was to compare the efficiency of bioelectrical indices (percentage body fat, PBF; visceral fat index, VFI) and various anthropometric measures (body mass index, BMI; waist circumference, WC; waist-to-height ratio, WHtR) on determining hypertension in Chinese. METHODS: We conducted the community-based cross-sectional survey during August of 2013 to August of 2015 in 66 sample sites selected by multistage random sampling method from Henan province. 14,364 residents were included in the study. RESULTS: In both genders, VFI and PBF tended to rise with age. However, for each age-specific group, men consistently had significantly greater VFI than women (all P<0.0001) and women had considerably higher PBF (all P<0.0001). The odds ratios and area under the ROC curves (AUCs) for hypertension associated with adiposity indices decreased with age. In younger (15~34year) men and women, VFI had the highest crude (2.43-7.95) and adjusted (2.40-11.63) odds ratio for hypertension. The AUCs for PBF, VFI and WHtR were significantly larger than those for BMI and WC (all P<0.01). Whereas no statistically significant difference were found in AUCs among PBF, VFI and WHtR (all P>0.10). Additionally, VFI and PBF yielded the greatest Youden index in identifying hypertension in men (0.27) and women (0.34), respectively. Optimal cutoffs for VFI/PBF were 11.70/24.45 and 7.55/33.65 in men and women, respectively. CONCLUSIONS: VFI and PBF could be better candidates for identifying hypertension in men and women, respectively. Adolescents and young adults should be highlighted in preventing hypertension by control of excess body and visceral fat.

Quality Control and Validation of Oscillometric Blood Pressure Measurements Taken During an Epidemiological Investigation.

This study aims to validate blood pressure (BP) values measured by an oscillometric BP monitor and seek possible calibration methods if discrepancies exist. Noninvasive BP measurement outcomes were determined using an oscillometric BP monitor (Omron HBP-1300) versus a mercury sphygmomanometer (standard device). Two percent of subjects enrolled in an epidemiological investigation were systematically sampled in this study. Intraclass correlation coefficient (ICC) was used to evaluate measurement reliability, paired t-test was used to evaluate trueness, and linear regression was used for calibration. The Association for the Advancement of Medical Instrumentation (AAMI) standards and British Hypertension Society (BHS) protocols were used for validation quality assessment. Both mercury sphygmomanometer (standard device) and oscillometric BP monitor (test device) displayed high reliability. A significant difference in systolic blood pressure (SBP) was observed between devices. SBP calibration was achieved by using an effective linear regression model (B = 0.803 and constant = 19.592, P < 0.001). The calibrated model was corroborated by verification samples (P = 0.120) and was found to pass AAMI standards and BHS protocol requirements. Calibrated SBP measurements from the Omron HBP-1300 device were valid. Use of a combination of statistical methods, such as ICC for reliability assessment as well as paired t-test for trueness evaluation can be used to validate data from the oscillometric BP monitors.

Genetic epidemiological analysis of esophageal cancer in high-incidence areas of China.

Genetic epidemiological studies have shown that genetic susceptibility to esophageal cancer (EC) is an important cause of its high incidence within families in some areas of China. The purpose of this study was to obtain evidence of a genetic basis of EC in Xin-an and Xin-xiang counties in China. Familial aggregation and complex segregation analyses were performed of 79 EC families in these counties. The heritability of EC was examined using Falconer's method and complex segregation analysis was conducted with the SEGREG program in Statistical Analysis for Genetic Epidemiology (SAGE version 5.3.1). The results showed that the distribution of EC in families did not fit well into a binomial distribution. The heritability of EC among first-degree and second- degree relatives was 67.0±7.31% and 43.1%±9.80%, respectively, and the summing up powered heritability was 53.2±6.74%. The segregation ratio was 0.045. Complex segregation analysis showed that the genetic model of EC was additive. The current results provide evidence for an inherited propensity to EC in certain high-risk groups in China, and support efforts to identify the genes that confer susceptibility to this disease.