Healthcare utilization and cost burden among women with endometriosis by opioid prescription status in the first year after diagnosis: a retrospective claims database analysis.

Aims: Opioids do not represent standard therapy for endometriosis; however, women with endometriosis are frequently prescribed an opioid to manage related abdominal or pelvic pain. The aim of this study was to evaluate the impact of opioid use on endometriosis-related economic and healthcare burden in the United States.Materials and methods: We performed a retrospective, propensity-matched cohort analysis of the Truven MarketScan Commercial database from 1 January 2011 to 31 December 2016. Eligible women had at least 1 inpatient or 2 outpatient codes for endometriosis and 12 months of continuous enrollment before and after the index date (i.e. first recorded endometriosis diagnosis). The primary analysis examined healthcare costs and utilization for 12 months after the index date in women who filled at least 1 opioid prescription versus those who did not. The secondary analysis examined healthcare costs and utilization by the pattern of opioid use.Results: The primary analysis matched 43,516 women across 2 groups and the secondary analysis matched 13,230 women across 5 groups. In the primary analysis, total 12-month healthcare costs were significantly higher in the opioid group compared to the non-opioid group ($29,236.00 vs. $18,466.00, respectively; p < .001); the same pattern was observed for all healthcare utilization parameters. In the secondary analysis, higher morphine equivalent daily dose and proportion of days covered were associated with the highest healthcare costs and utilization compared to the non-opioid group.Limitations: Retrospective design and inability to confirm whether filled opioid prescriptions were actually taken.Conclusions: Filling an opioid prescription within 1 year after an endometriosis diagnosis was associated with significant excess healthcare burden. Patients prescribed an opioid may experience inadequate symptom management and benefit from the use of disease-specific, non-opioid therapies.

Persistent Pulmonary Hypertension and Histologic Chorioamnionitis in Preterm Infants: Controlled Study.

Persistent pulmonary hypertension (PPHN) of the newborn is one of the most challenging acute disorders of postnatal transition with substantial morbidity and mortality. The aim of the study was to find if there is an association between persistent pulmonary hypertension and histologic chorioamnionitis in preterm infants. 27 preterm infants with echocardiographic evidence of PPHN within the first 3 days of life were eligible for the study. A matched control group of 27 patients was chosen according to gestational age, date of birth, and gender. Data collection included the need for respiratory support, use of nitric oxide oxygen supplementation, duration of rupture of membranes, blood culture, blood count, and C-reactive protein levels at birth and 12 h. Maternal clinical and laboratory data suggesting clinical chorioamnionitis Placentas of both groups were examined. Differences between groups were analyzed using two-tail t test, Kolmogorov-Smirnov test, Chi-square test. No statistically differences were found in all parameters compared between groups, except for a higher number of patients in the PPHN group who were treated by oxygen supplementation. An association was not found between the incidence of HCA and echocardiographic PPHN in preterm infants in the first 3 days of life.

Defining oliguria during cardiopulmonary bypass and its relationship with cardiac surgery-associated acute kidney injury.

BACKGROUND: While urine flow rate ≤0.5 ml kg-1 h-1 is believed to define oliguria during cardiopulmonary bypass (CPB), it is unclear whether this definition identifies risk for acute kidney injury (AKI) . The purpose of this retrospective study was to evaluate if urine flow rate during CPB is associated with AKI. METHODS: Urine flow rate was calculated in 503 patients during CPB. AKI in the first 48 h after surgery was defined by the Kidney Disease: Improving Global Outcomes classification. Adjusted risk factors associated with AKI and urine flow rate were assessed. RESULTS: Patients with AKI [n=149 (29.5%)] had lower urine flow rate than those without AKI (P<0.001). The relationship between urine flow and AKI risk was non-linear, with an inflection point at 1.5 ml kg-1 h-1 Among patients with urine flow <1.5 ml kg-1 h-1, every 0.5 ml kg-1 h-1 higher urine flow reduced the adjusted risk of AKI by 26% (95% CI 13-37; P<0.001). Urine flow rate during CPB was independently associated with the risk for AKI. Age up to 80 years and preoperative diuretic use were inversely associated with urine flow rate; mean arterial pressure on CPB (when <87 mmHg) and CPB flow were positively associated with urine flow rate. CONCLUSIONS: Urine flow rate during CPB <1.5 ml kg-1 h-1 identifies patients at risk for cardiac surgery-associated AKI. Careful monitoring of urine flow rate and optimizing mean arterial pressure and CPB flow might be a means to ensure renal perfusion during CPB. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00769691 and NCT00981474.

dc and ac magnetic properties of thin-walled Nb cylinders with and without a row of antidots.

dc and ac magnetic properties of two thin-walled superconducting Nb cylinders with a rectangular cross-section are reported. Magnetization curves and the ac response were studied on as-prepared and patterned samples in magnetic fields parallel to the cylinder axis. A row of micron-sized antidots (holes) was made in the film along the cylinder axis. Avalanche-like jumps of the magnetization are observed for both samples at low temperatures for magnetic fields not only above H c1, but in fields lower than H c1 in the vortex-free region. The positions of the jumps are not reproducible and they change from one experiment to another, resembling vortex lattice instabilities usually observed for magnetic fields larger than H c1. At temperatures above [Formula: see text] and [Formula: see text] the magnetization curves become smooth for the patterned and the as-prepared samples, respectively. The magnetization curve of a reference planar Nb film in the parallel field geometry does not exhibit jumps in the entire range of accessible temperatures. The ac response was measured in constant and swept dc magnetic field modes. Experiment shows that ac losses at low magnetic fields in a swept field mode are smaller for the patterned sample. For both samples the shapes of the field dependences of losses and the amplitude of the third harmonic are the same in constant and swept field near H c3. This similarity does not exist at low fields in a swept mode.

Elevated C-reactive protein levels in schizophrenia inpatients is associated with aggressive behavior.

BACKGROUND: An association between inflammation and behavioral domains of mental disorders is of growing interest. Recent studies reported an association between aggression and inflammation. In this study, we investigated the association between aggressive behavior and inflammatory markers in schizophrenia inpatients. METHODS: Adult schizophrenia inpatients without affective symptoms (n=213) were retrospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP>1 mg/dL; n=57) or normal (CRP<1 mg/dL; n=156). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization. Univariate comparisons between elevated and normal CRP levels were performed and multivariate analysis was conducted to control for relevant covariates. RESULTS: CRP levels significantly correlated with other laboratory markers indicating increased inflammation including leukocyte count and neutrophil to lymphocyte ratio (r=0.387, P<0.0001 and r=0.356, P<0.0001) respectively. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<1 mg/dL). This was manifested by higher rates of restraint during hospitalization (χ(2)=5.22, P=0.031) and increased PANSS-EC score (U=5410.5, P=0.012). Elevated CRP levels were not associated with suicidal behavior. Multivariate analysis revealed that higher PANSS-EC score was associated with elevated CRP after controlling for the covariates age, sex, BMI and smoking. CONCLUSION: This study identified a potential biological correlate (inflammation) of a specific behavioral endophenotype (aggression) in schizophrenia inpatients.

What are the correlates of cognition and participation to return to work after first ever mild stroke?

BACKGROUND: The percentage of working age people with mild stroke has risen. Evidence indicates that even mild stroke impact cognition, executive functioning, and daily functioning, consequently affecting participation, quality of life (QoL) and return to work (RTW). OBJECTIVES: (1) Compare cognition, participation and QoL between people 3 months post-mild stroke who RTW and those who did not; and (2) To determine the correlates of these variables to RTW of participants 3 months post-stroke. METHODS: We visited at home 163 stroke survivors (117 men, 46 women) 3 months post-mild stroke ranging from 50 to 89 years. Participants who returned to work (n = 114) and those who did not (n = 49). Data collection at home included measures for cognitive status (MoCA), executive functions (EFPT, DEX), depression (GDS), participation (RNL), and QoL (SIS recovery). RESULTS: Significant differences were found between RTW participants and those who did not RTW in measures of cognition, depression, participation and QoL (t = 2.36 to - 5.62, P < 0.022-0.001). No difference was found on age or gender. Stepwise regression showed that significant correlates of RTW were participation (RNL), executive functions (EFPT), and QoL (SIS recovery). CONCLUSIONS: To enable RTW after mild stroke, participation, executive functions and QoL must be considered in planning interventions.

Maternal immunization in Argentina: A storyline from the prospective of a middle income country.

The importance of vaccination during pregnancy lies not only in directly protecting vaccinated women, but also by indirectly protecting small infants during the first few months of life. Vaccination against the flu and whooping cough is a priority within the comprehensive care strategy for pregnant women and small infants in Argentina, in the context of transitioning from child vaccination to family vaccination. In 2011, the flu vaccine was included in the National Immunization Schedule (NIS) as mandatory and free of charge, with the aim of decreasing complications and death due to influenza in the at-risk population in Argentina. The national vaccination coverage attained in pregnant women in the past 4 years (2011-2014) has been satisfactory; 88% coverage was attained in the year this program was introduced to the schedule. In the following years, coverage was maintained at greater than 95%. In February 2012, Argentina became the first country in Latin America to have universal vaccination strategy for pregnant women against whooping cough. This recommendation was implemented throughout the country by vaccination with the diphtheria toxoid, tetanus toxoid, and acellular pertussis (Tdap) vaccine starting at 20 weeks of pregnancy, with the aim of decreasing morbimortality due to whooping cough in infants under 6 months of age. The vaccine was incorporated into the NIS in 2014. More than 1,200,000 doses were applied in this period. Both vaccines showed a suitable safety profile and no serious events were reported. Argentina is an example of a middle-income country that has been able to implement a successful strategy for primary prevention through vaccines, making it a health policy.

Participation in Physical Activity, Fitness, and Risk for Obesity in Children with Developmental Coordination Disorder: A Cross-cultural Study.

Decreased physical activity has been linked to poor fitness and obesity, resulting in increased risk for health concerns. The objective is to study the relationships between children's motor coordination and their physical activity, sedentary behaviour, fitness and weight status in a cross-cultural study in the United States and Israel. Participants included 118 children 6-11 years of age: 53 children with developmental coordination disorder (DCD) and 65 typical children. The US sample included 31 DCD children and 44 typical children. The Israeli sample included 22 DCD children and 21 typical children. Participants were assessed on Movement Assessment Battery for Children 2, strength test of the Bruininks-Oseretsky Test of Motor Proficiency 2 and Six-minute Walk Test and wore an accelerometer. Parents completed physical activity questionnaires and demographic information. Body mass index was calculated based on height and weight. Testing took place in two sessions. Findings are that in both Israel and the United States, children with DCD demonstrated significantly reduced physical activity, increased sedentary behaviour, poorer fitness and increased overweight compared with typical children. No significant differences were found for country. With relevance to clinical practice, fitness and obesity are major concerns for children with DCD in both countries. Inclusion of occupational therapy in health promotion for this population is critical. Additional studies with testers blind to group, larger samples and other countries are recommended.

Relationship between motor skills, participation in leisure activities and quality of life of children with Developmental Coordination Disorder: temporal aspects.

The study examined the relationship between motor skills, participation in leisure activities and quality of life (QOL), within a temporal context (school year vs. summer vacation and school days vs. weekends). Parents of 22 children with Developmental Coordination Disorder (DCD) and of 55 typically developing children, aged 6-11, filled out two questionnaires relating to their children's participation in leisure activities (vigorous, moderate and sedentary) and QOL. The Movement Assessment Battery for Children-2 (MABC-2) was administered to their children. Results showed that among the children with DCD, balance scores positively correlated with participation in sedentary activities, and in both groups both balance and aiming and catching were related to the physical and school aspects of QOL. Furthermore, participation in vigorous activities in the summer was positively correlated with social and school QOL. In contrast, among typically developing children, participation in vigorous activities during the school year was negatively correlated with school QOL. Finally, in both groups, participation in sedentary activities during school days was negatively correlated with school QOL. These results suggest that the parents' perceptions of their children's QOL may be related to the level of activeness of the leisure activities but also to temporal aspects. Therefore, it is important that therapists and educators consider the temporal aspects, when consulting with parents and their children regarding participation in leisure activities.

Central or peripheral delivery of an adenosine A1 receptor agonist improves mechanical allodynia in a mouse model of painful diabetic neuropathy.

Diabetic peripheral neuropathy is a common complication of diabetes mellitus, and a significant proportion of individuals suffer debilitating pain that significantly affects their quality of life. Unfortunately, symptomatic treatment options have limited efficacy, and often carry significant risk of systemic adverse effects. Activation of the adenosine A1 receptor (A1R) by the analgesic small molecule adenosine has been shown to have antinociceptive benefits in models of inflammatory and neuropathic pain. The current study used a mouse model of painful diabetic neuropathy to determine the effect of diabetes on endogenous adenosine production, and if central or peripheral delivery of adenosine receptor agonists could alleviate signs of mechanical allodynia in diabetic mice. Diabetes was induced using streptozocin in male A/J mice. Mechanical withdrawal thresholds were measured weekly to characterize neuropathy phenotype. Hydrolysis of AMP into adenosine by ectonucleotidases was determined in the dorsal root ganglia (DRG) and spinal cord at 8 weeks post-induction of diabetes. AMP, adenosine and the specific A1R agonist, N(6)-cyclopentyladenosine (CPA), were administered both centrally (intrathecal) and peripherally (intraplantar) to determine the effect of activation of adenosine receptors on mechanical allodynia in diabetic mice. Eight weeks post-induction, diabetic mice displayed significantly decreased hydrolysis of extracellular AMP in the DRG; at this same time, diabetic mice displayed significantly decreased mechanical withdrawal thresholds compared to nondiabetic controls. Central delivery AMP, adenosine and CPA significantly improved mechanical withdrawal thresholds in diabetic mice. Surprisingly, peripheral delivery of CPA also improved mechanical allodynia in diabetic mice. This study provides new evidence that diabetes significantly affects endogenous AMP hydrolysis, suggesting that altered adenosine production could contribute to the development of painful diabetic neuropathy. Moreover, central and peripheral activation of A1R significantly improved mechanical sensitivity, warranting further investigation into this important antinociceptive pathway as a novel therapeutic option for the treatment of painful diabetic neuropathy.

Physical fitness and overweight in Israeli children with and without developmental coordination disorder: gender differences.

Physical fitness and overweight among children has become paramount in the general population and more so in children with developmental coordination disorder (DCD). The purpose of the current study was to examine the association between physical fitness and overweight in a sample of Israeli children in comparison to typical children, and to examine gender differences. DCD was identified through total scores on the movement assessment battery for children 2 (MABC-2) equal to or less than the 16th percentile as well as parents' report that the child's deficits in motor skills interfered with at least two daily life activities. The sample included a group of children with DCD (n=22, M age=8.70 [SD=1.36], 16 boys [73%]) and a control group of typical children (n=47, M age=8.90 [SD=1.52], 34 boys [72%]). Measures included the strength subtest of the Bruininks-Oseretsky test of motor proficiency (BOT-2), the six minutes' walk test (6MWT) with heart rate measure, BMI and the percentage of body fat. Significant differences between DCD and typical children were found on all variables of physical fitness and weight. A two-way analysis of variance (ANOVA) analysis (group/gender) also revealed significant interactions for the percentage of body fat (F=8.51, p<.005) and BMI (F=4.50, p<.038) meaning that less fit children are more obese. The current study supports previous findings that children with DCD are less physically fit and more overweight compared to typically developing children. Moreover, in comparing between the genders, the girls in the study sample weighed more and had a significantly higher percentage of body fat than boys, it is essential to further our understanding of the relationships between obesity, physical fitness and gender among children with and without DCD.

Metabolic profiles in adults with autism spectrum disorder and intellectual disabilities.

INTRODUCTION: Low levels of blood cholesterol have been found in some children with autism spectrum disorders (ASD). Psychotropic medications, commonly used by people with ASD and people with intellectual disabilities (ID) are frequently associated with altered metabolic profiles. PURPOSE: We aimed to compare metabolic features of adults with ASD or ID with those of a community-based population. SUBJECTS AND METHODS: Data on blood fasting glucose (FBG), lipid profile, liver enzyme profile, TSH, BMI, medications and diagnoses of 80 adults with ASD, 77 adults with ID and 828 control adults were drawn from medical charts/database. Candidates that used glucose or lipid lowering medications were not included. RESULTS: Total-cholesterol levels of people with ASD and ID were significantly lower than those of the controls (168.3 ± 32.78, 168.2 ± 32.91, 185.4 ± 40.49 mg/dL, respectively, P<0.001) but after adjusting for gender, age and BMI and using Bonferroni correction, the significance was lost. Compared to controls, ASD and ID had significantly lower FBG (by -14.45 ± 1.81, -14.58 ± 1.54 mg/dl, respectively; P<0.001 for both) and liver enzymes, despite using psychotropic medications. DISCUSSION AND CONCLUSION: In contrast to other psychiatric patients receiving similar medications, people with ASD and ID have unaltered lipid profiles and lower glucose and liver enzyme levels compared to a community-based population.

The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA.

Compliance with CPAP is the major limiting factor in treating patients with OSA. The novel SomnuSeal mask is an oral self-adaptable mask located between the teeth and the lips ensuring that there are no air leaks or skin abrasions. Fifty patients with AHI > 20, who failed previous CPAP trials, were asked to sleep with the mask for one month. In all patients, the mask was connected to an AutoPAP machine with a heated humidifier. Efficacy, convenience, and compliance (average usage for 4 or more hours per night) were monitored. Fifty patients (41 m and 9 f, mean age 57 ± 12 years, BMI 33.6 ± 4.9 kg/m(2), and AHI 47 ± 23/h) participated. Eleven were classified as compliant (average mask usage of 26 nights, 4.7 hours per night), five were only partially compliant (average usage of 13 nights, 2.9 hours per night), and 34 could not comply with it. In all patients who slept with it, the efficacy (assessed by residual AHI derived from the CPAP device) was good with an AHI of less than 8/hour. Interestingly, the required optimal pressure decreased from an average of 9.3 cmH2O to 4.6 cmH2O. The SomnuSeal oral interface is effective and may result in converting noncompliant untreated patients with OSA into well-treated ones.

Stirring unmagnetized plasma.

A new concept for spinning unmagnetized plasma is demonstrated experimentally. Plasma is confined by an axisymmetric multicusp magnetic field and biased cathodes are used to drive currents and impart a torque in the magnetized edge. Measurements show that flow viscously couples momentum from the magnetized edge (where the plasma viscosity is small) into the unmagnetized core (where the viscosity is large) and that the core rotates as a solid body. To be effective, collisional viscosity must overcome the ion-neutral drag due to charge-exchange collisions.

The large, oxygen-rich halos of star-forming galaxies are a major reservoir of galactic metals.

The circumgalactic medium (CGM) is fed by galaxy outflows and accretion of intergalactic gas, but its mass, heavy element enrichment, and relation to galaxy properties are poorly constrained by observations. In a survey of the outskirts of 42 galaxies with the Cosmic Origins Spectrograph onboard the Hubble Space Telescope, we detected ubiquitous, large (150-kiloparsec) halos of ionized oxygen surrounding star-forming galaxies; we found much less ionized oxygen around galaxies with little or no star formation. This ionized CGM contains a substantial mass of heavy elements and gas, perhaps far exceeding the reservoirs of gas in the galaxies themselves. Our data indicate that it is a basic component of nearly all star-forming galaxies that is removed or transformed during the quenching of star formation and the transition to passive evolution.

Outcome measures in placebo-controlled trials of osteoarthritis: responsiveness to treatment effects in the REPORT database.

INTRODUCTION: Treatment response in randomized clinical trials (RCT) of osteoarthritis (OA) has been assessed by multiple primary and secondary outcomes, including pain, function, patient and clinician global measures of status and response to treatment, and various composite and responder measures. Identifying outcome measures with greater responsiveness to treatment is important to increase the assay sensitivity of RCTs. OBJECTIVE: To assess and compare the responsiveness of different outcome measures used in placebo-controlled RCTs of OA. SEARCH STRATEGY: The Resource for Evaluating Procedures and Outcomes of Randomized Trials database includes placebo-controlled clinical trials of pharmacologic treatments (oral, topical, or transdermal) for OA identified from a systematic literature search of RCTs published or publicly available before August 5, 2009, which was conducted using PubMed, the Cochrane collaboration, publicly-available websites, and reference lists of retrieved publications. DATA COLLECTION AND ANALYSIS: Data collected included: (1) pain assessed with single-item ratings and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale; (2) patient and clinician global measures of status, improvement, and treatment response; (3) function assessed by the WOMAC function subscale; (4) stiffness assessed by the WOMAC stiffness subscale; and (5) the WOMAC and Lequesne Algofunctional Index composite outcomes. Measures were grouped according to the total number of response categories (i.e., <10 categories or ≥10 categories). The treatment effect (difference in mean change from baseline between the placebo and active therapy arms) and standardized effect size (SES) were estimated for each measure in a meta-analysis using a random effects model. RESULTS: There were 125 RCTs with data to compute the treatment effect for at least one measure; the majority evaluated non-steroidal anti-inflammatory drugs (NSAIDs), followed by opioids, glucosamine and/or chondroitin, and acetaminophen. In general, the patient-reported pain outcome measures had comparable responsiveness to treatment as shown by the estimates of treatment effects and SES. Treatment effects and SESs were generally higher for patient-reported global measures compared with clinician-rated global measures but generally similar for the WOMAC and Lequesne composite measures. CONCLUSIONS: Comparing different outcome measures using meta-analysis and selecting those that have the greatest ability to identify efficacious treatments may increase the efficiency of clinical trials of treatments for OA. Improvements in the quality of the reporting of clinical trial results are needed to facilitate meta-analyses to evaluate the responsiveness of outcome measures and to also address other issues related to assay sensitivity.

Use of fluorescent probes as a useful tool to identify resistant Schistosoma mansoni isolates to praziquantel.

The use of chemotherapy on a mass scale in endemic areas may lead to the appearance of resistant isolates through the mechanism of selective drug pressure. Studies have demonstrated that praziquantel (PZQ) is able to inhibit the excretory activity and to cause tegumental damage in Schistosoma mansoni adult worms. The use of the probe resorufin to evaluate excretory activity, as well as the probe Hoechst 33258 to detect tegumental damage in adult worms, may represent a method to identify resistant (or less susceptible) isolates. The purpose of the present work was to compare the changes caused by PZQ in the function of the excretory system and in the integrity of the tegument of adult worms from the LE isolate (susceptible to PZQ) and the LE-PZQ isolate (less susceptible to PZQ). Worms from the isolate LE-PZQ showed less severe tegumental lesions, in both in vitro and in vivo experiments, detected by labelling with Hoechst 33258 and continued to have a functional excretory system as shown by labelling with resorufin in vitro.

ADQI 7: the clinical management of the Cardio-Renal syndromes: work group statements from the 7th ADQI consensus conference.

Many patients with heart failure have underlying renal dysfunction, and similarly, patients with kidney failure are prone to cardiac failure. This has led to the concept of cardio-renal syndromes, which can be an acute or chronic cardio-renal syndrome, when cardiac failure causes deterioration in renal function, or acute and/or chronic Reno-Cardiac syndrome, when renal dysfunction leads to cardiac failure. Patients who develop these syndromes have increased risk of hospital admission and mortality. Although there are clinical guidelines for managing both heart failure and chronic kidney disease, there are no agreed guidelines for managing patients with cardio-renal and/or Reno-Cardiac syndromes, as these patients have typically been excluded from clinical trials. We have therefore reviewed the currently available published literature to outline a consensus of current best clinical practice for these patients.