Use of disposable negative pressure wound therapy in 16 podiatry clinic patients with chronic wounds.

BACKGROUND: Disposable mechanical negative pressure wound therapy (dNPWT) can help manage lower extremity wounds in the outpatient clinic. PURPOSE: We assessed dNPWT use in 16 patients at a podiatry clinic. METHODS: Patients were treated between October 31, 2019 and December 16, 2021. All patients received dNPWT with dressing changes every 2 to 3 days. Demographics, baseline wound and subsequent wound visit data, and treatments were recorded. Wound healing outcomes were assessed. RESULTS: Average patient age was 59.6 ± 8.9 years old. Patient comorbidities included poor nutritional status, diabetes, and hypertension. Wound types consisted of 6 diabetic foot ulcers, 9 surgical wounds, and 1 pressure injury. At baseline, the average wound age was 15.6 weeks, average area was 5.5 cm2, and average volume was 3.3 cm3. The average time from presentation to end of dNPWT was 45.5 days. In this timeframe, wounds improved in granulation tissue amount (81%), reduced in area (63%), and reduced in volume (69%). By the end of treatment, a majority of patients (88%) displayed 76% to 100% wound bed coverage with healthy granulation tissue. The remaining 12% showed <76% coverage with granulation tissue. CONCLUSIONS: In this retrospective study, 14 of 16 patients displayed improvement in wound area, volume, and granulation tissue amount during dNPWT treatment.

Decreased health care expenditure and average length of therapy with facilitated transition discharge program for patients receiving negative pressure wound therapy.

This study compares LOT between patients discharged from hospitals with FT discharge programs providing NPWT to patients at/before discharge versus those without (non-FT). FT facilities were further segmented: active-FT (≥1 transition order during past 90 days) versus inactive-FT (FT set up but no orders during past 90 days). There were 82 543 billable orders and 92 008 patients analyzed. LOT was 1.8 days shorter for FT versus non-FT facilities (potential per-patient savings of $5071 for FT facilities). LOT was 1.2 days shorter in active-FT versus inactive-FT facilities. This study shows shorter stays and LOT for patients in facilities actively using FT.

Validation of the What Matters Index: A brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models.

INTRODUCTION: Current health care delivery relies on complex, computer-generated risk models constructed from insurance claims and medical record data. However, these models produce inaccurate predictions of risk levels for individual patients, do not explicitly guide care, and undermine health management investments in many patients at lesser risk. Therefore, this study prospectively validates a concise patient-reported risk assessment that addresses these inadequacies of computer-generated risk models. METHODS: Five measures with well-documented impacts on the use of health services are summed to create a "What Matters Index." These measures are: 1) insufficient confidence to self-manage health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5) adverse medication effects. We compare the sensitivity and predictive values of this index with two representative risk models in a population of 8619 Medicaid recipients. RESULTS: The patient-reported "What Matters Index" and the conventional risk models are found to exhibit similar sensitivities and predictive values for subsequent hospital or emergency room use. The "What Matters Index" is also reliable: akin to its performance during development, for patients with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence intervals) for subsequent hospitalization within 1 year, relative to patients with a score of 0, are 1.3 (1.1-1.6), 2.0 (1.6-2.4), and 3.4 (2.9-4.0), respectively; for emergency room use, the corresponding odds ratios are 1.3 (1.1-1.4), 1.9 (1.6-2.1), and 2.9 (2.6-3.3). Similar findings were replicated among smaller populations of 1061 mostly older patients from nine private practices and 4428 Medicaid patients without chronic conditions. SUMMARY: In contrast to complex computer-generated risk models, the brief patient-reported "What Matters Index" immediately and unambiguously identifies fundamental, remediable needs for each patient and more sensibly directs the delivery of services to patient categories based on their risk for subsequent costly care.

Development of a care guidance index based on what matters to patients.

INTRODUCTION: Targeting resources for a designated higher-risk subgroup is a strategy for chronic care management. However, risk-designation has several limitations: it is inaccurate, seldom helpful for care guidance, and potentially misallocates care away from many patients. METHODS: To address limitations of risk designation, we tested a "what matters index" (WMI) in 19,593 adult patients with chronic conditions. The WMI contains five binary measures: insufficient confidence to manage health problems, level of pain, emotional problems, polypharmacy, and adverse medication effects. We examined its sum for association with patient-reported quality of life and prior emergency or hospital use. We compared its accuracy to a prototypic risk-designation model. RESULTS: The WMI was a good indicator for quality of life and in three diverse test populations it was strongly associated with the use of hospital and emergency services. For example, a sum of WMI ≥2 was associated with twice as many average uses as none; for ≥3, uses were three times higher. However, since relatively few patients use costly care, both the WMI and a prototypic risk-designation model had comparably low-positive predictive values. The WMI uses the patient voice to identify needs strongly associated with quality of life. Akin to risk designation models, the WMI can be used to place patients into groups associated with levels of costly services, but neither is likely to forecast costly service use for individuals. However, unlike risk-designation models, the WMI is based on measures that will immediately guide care for every patient.

Misclassification of sex in central cancer registries.

BACKGROUND: Intrarecord edits on site-sex combinations are a standard tool to identify errors in the coding of sex in cancer registry data. However, the percentage of sex-specific cancers, like cervix, is low (20 percent of total invasive cases). Visual review and follow-back to improve the quality of the sex coding is labor intensive and typically only performed as a special project on subsets of data. The New York State Cancer Registry (NYSCR) created an edit for identifying potential sex misclassification in cancer registry data and has made its components available for use through the North American Association of Central Cancer Registries (NAACCR). The edit uses the most popular male and female first names based on decade of birth to identify potentially miscoded cases. This paper provides a summary of 3 independently conducted assessments of the sex edit at the central cancer registry level and includes a focus on misclassification of sex for breast cancer. METHODS: The sex edit was applied in 3 state cancer registries: Alabama, Alaska, and Florida. Alabama applied the edit to their entire database for 1996-2004 (N = 190,614) and compared the results to external databases available to most cancer registries. Alaska applied the edit to their entire database (N = 46,645) and were able to compare the results to 2 unique, state-based databases (Alaska Permanent Fund Dividend database and State Troopers database). Florida applied the sex edit to a sample of sites (n = 953,074) with particular attention to breast cancer. RESULTS for breast cases were compared to results from an a priori quality control project on Florida male breast cancer cases. Using the Florida data, issues specific to male breast cancer were evaluated. RESULTS: In Alabama, 45 percent of 977 cases flagged as potentially miscoded sex were determined to be miscodes. In Alaska, 19 percent of 88 cases flagged as potentially miscoded sex were determined to be miscodes but the percent of miscoded cases identified by the edit more than doubled in the most recent years of data. For the Florida male breast cancer comparison, the sex edit correctly identified 729 of 903 cases known to be miscoded (81 percent) and was unable to assign a potential sex on the remaining 174 cases-but did not incorrectly flag any cases as miscodes. IMPLICATIONS: The sex edit is a useful tool for identifying cases that require further review to confirm the reported sex code is correct. However, it only assesses 69 percent to 84 percent of cases based on name and, of those flagged, only 19 percent to 45 percent are true misclassifications. But for breast cancer, a site with a skewed male to female ratio, the verified misclassification rate was 100 percent of the male breast cancer cases flagged as potential females. The proper application of the sex edit can improve the quality of the sex variable and can greatly reduce the impact of miscoded sex on gender-skewed sites like male breast cancer.

Behavioral risk factors for obesity during health transition in Vanuatu, South Pacific.

UNLABELLED: The South Pacific archipelago of Vanuatu, like many developing countries, is currently experiencing a shift in disease burdens from infectious to chronic diseases with economic development. A rapid increase in obesity prevalence represents one component of this "health transition." OBJECTIVE: To identify behaviors associated with measures of obesity in Vanuatu. DESIGN AND METHODS: Five hundred and thirty four adults from three islands varying in level of economic development were surveyed. Height, weight, waist, and hip circumferences; triceps, subscapular and suprailiac skinfolds; and percent body fat (%BF) by bioelectrical impedance were measured. Diet through 24-h dietary recall and physical activity patterns using a survey were assessed. We analyzed prevalence of obesity and central obesity based on multiple indicators (body mass index, %BF, waist circumference, and waist-to-height ratio), and analyzed differences among islands and associations with behavioral patterns. RESULTS: Obesity prevalence was lowest among rural and highest among suburban participants. Prevalence of central obesity was particularly high among women (up to 73.9%), even in rural areas (ranging from 14.7 to 41.2% depending on the measure used). Heavier reliance on animal protein and incorporation of Western foods in the diet-specifically, tinned fish and instant noodles-was significantly associated with increased obesity risk. CONCLUSIONS: Even in rural areas where diets and lifestyles remain largely traditional, modest incorporation of Western foods in the diet can contribute to increased risk of obesity. Early prevention efforts are thus particularly important during health transition. Where public health resources are limited, education about dietary change could be the best target for prevention.

A changing pattern of childhood BMI growth during the 20th century: 70 y of data from the Fels Longitudinal Study.

BACKGROUND: The BMI distribution shifted upward in the United States between the 1960s and the 1990s, but little is known about secular trends in the pattern of BMI growth, particularly earlier in the century and early in childhood. OBJECTIVE: The objective was to examine differences in BMI growth in children born in 1929-1999. DESIGN: BMI curves from ages 2 to 18 y were produced for 855 European-American children in the Fels Longitudinal Study born in 1929-1953, 1954-1972, and 1973-1999. Age (A(min)) and BMI (BMI(min)) at adiposity rebound and age (AV(max)), BMI (BMIV(max)), and velocity (V(max)) at maximum velocity were derived; multivariable regression was used to examine whether maternal BMI, infant weight gain, and other covariates mediated the cohort effects on these traits. RESULTS: BMI curves showed that children born in 1973-1999 had the lowest BMI values until age 5 y but had the largest values from age 8 y onward. In adjusted models, boys and girls born in 1973-1999 had a 0.15-kg/m(2) per year faster V(max) and a 1-kg/m(2) higher BMIV(max) than did children of the same sex born in 1929-1953, and girls had a 0.8-y earlier A(min) (P < 0.01). Maternal BMI and infant weight gain were associated with an obesity-prone pattern of BMI growth but did not account for the observed trends. CONCLUSIONS: Shifts in the BMI growth rate around the time of pubertal initiation were apparent starting after 1973. The BMI growth curve did not increase monotonically over time; rather, children born during the obesity epidemic were characterized by lower BMI values before the adiposity rebound and by rapid subsequent BMI gain.

Eighty-year trends in infant weight and length growth: the Fels Longitudinal Study.

OBJECTIVES: To investigate secular trends in weight and length growth from birth to 3 years of age in infants born from 1930 to 2008, and to assess whether these trends were associated with concurrent trends in pace of infant skeletal maturation and maternal body mass index. STUDY DESIGN: Longitudinal weight and length data from 620 infants (302 girls) were analyzed with mixed effects modeling to produce growth curves and predicted anthropometry for infants born from 1930 to 1949, 1950 to 1969, 1970 to 1989, and 1990 to 2008. RESULTS: The most pronounced differences in growth occurred in the first year of life. Infants born after 1970 were approximately 450 g heavier and 1.4 cm longer at birth, but demonstrated slower growth to 1 year of age than infants born before 1970. Growth trajectories converged after 1 year of age. There was no evidence that relative skeletal age, maternal body mass index, or maternal age together mediated associations between cohort and growth. CONCLUSIONS: Recent birth cohorts may be characterized not only by greater birth size, but also by subsequent catch-down growth. Trends over time in human growth do not increase monotonically, and growth velocity in the first year may have declined compared with preceding generations.

Patterns of childhood and adolescent overweight and obesity during health transition in Vanuatu.

OBJECTIVE: Rapid economic development and subsequent changes in lifestyle and disease burdens ('health transition') is associated with increasing prevalence of obesity among both adults and children. However, because of continued infectious diseases and undernutrition during the early stages of transition, monitoring childhood obesity has not been prioritized in many countries and the scope of the problem is unknown. Therefore we sought to characterize patterns of childhood overweight and obesity in an early transitional area, the South Pacific archipelago of Vanuatu. DESIGN: We completed an anthropometric survey among children from three islands with varying levels of economic development, from rural areas (where adult obesity prevalence is low) to urban areas (where adult obesity prevalence is high). SETTING: The islands of Ambae (rural), Aneityum (rural with tourism) and Efate (urban). SUBJECTS: Boys and girls (n 513) aged 6-17 years. RESULTS: Height-, weight- and BMI-for-age did not vary among islands, and prevalence of overweight/obesity based on BMI was low. However, girls from Aneityum - a rural island where the tourism industry increased rapidly after malaria eradication - had increased central adiposity compared with girls from the other islands. This is contrary to adult patterns, which indicate higher obesity prevalence in urban areas. Multiple factors might contribute, including stunting, biological responses after malaria control, sleeping patterns, diet and physical activity levels. CONCLUSIONS: Measures of central adiposity highlight an emerging obesity risk among girls in Vanuatu. The data highlight the synergistic relationship among infectious diseases, undernutrition and obesity during the early stages of health transition.

Thyroid cancer incidence in highly observant Jewish neighborhoods in metropolitan New York City.

BACKGROUND: Thyroid cancer incidence in New York State has increased rapidly in recent years, particularly in New York City and its surrounding metropolitan area. In 2007 among white non-Hispanics, incidence rates were about 40% higher in the New York City metropolitan area than in the rest of the state. Here we explore the extent to which living in neighborhoods with a high percentage of highly observant Jews may be associated with this pattern. METHODS: We identify neighborhoods with concentrations of highly observant Jewish persons based on the use of Yiddish among children and the location of Orthodox synagogues. Thyroid cancer risk is modeled as a function of living in such a neighborhood, adjusting for age, sex, and other factors. The model was repeated for small (<2 cm) and large (≥2 cm) tumors to assess the role of diagnostic improvements in driving the spatial-temporal patterns. RESULTS: A moderate association with thyroid cancer was found among those living in Jewish neighborhoods and downstate New York. A lesser association was found among those who live in neighborhoods of high levels of people born in Russia, Belarus, or Ukraine. Similar elevated rate ratios were seen for small and large tumors in Jewish neighborhoods, providing evidence against differences in diagnostic practices in this group. Smaller tumors were more pronounced among women and persons diagnosed more recently. CONCLUSIONS: The associations found do not seem to be diagnostically driven, but rather due to environmental, genetic, or cultural factors in the highly observant population of New York State.

Behavioral changes associated with economic development in the South Pacific: health transition in Vanuatu.

UNLABELLED: Health patterns are changing in developing countries; as diet and activity patterns change with economic development, chronic disease prevalence increases, which is a characteristic of health transition. The islands of Vanuatu (South Pacific) have varying rates of economic development and provide a natural experimental model of health transition. OBJECTIVES: To characterize behavioral changes associated with modernization. METHODS: We surveyed 425 children and 559 adults on three islands varying in degree of economic development. We assessed diet (24-h dietary recall), physical activity (mode of transport, work activities, and recreation), substance use, and other behavioral patterns. RESULTS: Spending patterns and access to Western foods followed modernization gradients in our sample, whereas occupational patterns and ownership of technological goods were poor markers of modernization. With increasing economic development, participants consumed more animal proteins and simple carbohydrates. Physical activity levels were high; most participants were active in gardening, and sports were popular, especially in urban areas. However, urban participants spent more time in sedentary recreation. Men's use of alcohol and tobacco increased with economic development, but we observed marked differences in substance use patterns between two rural islands-one with and one without tourism. CONCLUSIONS: Economic development in Vanuatu is accompanied by nutrition transition and increased sedentary recreation, although physical activity levels remain high. Differences in substance use patterns between rural islands with and without tourism indicate a need for more research in rural areas. These findings might inform research in other communities in the early stages of health transition.

Relationships between body size and percent body fat among Melanesians in Vanuatu.

Obesity is a global epidemic, and measures to define it must be appropriate for diverse populations for accurate assessment of worldwide risk. Obesity refers to excess body fatness, but is more commonly defined by body mass index (BMI). Body composition varies among populations: Asians have higher percent body fat (%BF), and Pacific Islanders lower %BF at a given BMI compared to Europeans. Many researchers thus propose higher BMI cut-off points for obesity among Pacific Islanders and lower cut-offs for Asians. Because of the great genetic diversity in the Asia-Pacific region, more studies analyzing associations between BMI and %BF among diverse populations remain necessary. We measured height; weight; tricep, subscapular, and suprailiac skinfolds; waist and hip circumference; and %BF by bioelectrical impedance among 546 adult Melanesians from Vanuatu in the South Pacific. We analyzed relationships among anthropometric measurements and compared them to measurements from other populations in the Asia-Pacific region. BMI was a relatively good predictor of %BF among our sample. Based on regression analyses, the BMI value associated with obesity defined by %BF (>25% for men, >35% for women) at age 40 was 27.9 for men and 27.8 for women. This indicates a need for a more nuanced definition of obesity than provided by the common BMI cut-off value of 30. Rather than using population-specific cut-offs for Pacific Islanders, we suggest the World Health Organization's public health action cut-off points (23, 27.5, 32.5, 37.5), which enhance the precision of assessments of population-wide obesity burdens while still allowing for international comparison.

Rapid postnatal weight gain and visceral adiposity in adulthood: the Fels Longitudinal Study.

Rapid infant weight gain is associated with increased abdominal adiposity, but there is no published report of the relationship of early infant growth to differences in specific adipose tissue depots in the abdomen, including visceral adipose tissue (VAT). In this study, we tested the associations of birth weight, infant weight gain, and other early life traits with VAT, abdominal subcutaneous adipose tissue (ASAT), and other body composition measures using magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry in middle adulthood (mean age = 46.5 years). The sample included 233 appropriate for gestational age singleton white children (114 males) enrolled in the Fels Longitudinal Study. Multivariate-adjusted general linear models were used to test the association of infant weight gain (from 0 to 2 years), maternal BMI, gestational age, parity, maternal age, and other covariates with adulthood body composition. Compared to infants with slow weight gain, rapid weight gain was associated with elevated risk of obesity (adjusted odds ratio = 4.1, 95% confidence interval = 1.4, 11.1), higher total body fat (+7 kg, P = 0.0002), percent body fat (+5%, P = 0.0006), logVAT mass (+0.43 kg, P = 0.02), logASAT mass (+0.47 kg, P = 0.001), and percent abdominal fat (+5%, P = 0.03). There was no evidence that the increased abdominal adipose tissue was due to a preferential deposition of VAT. In conclusion, rapid infant weight gain is associated with increases in both VAT and ASAT, as well as total adiposity and the risk of obesity in middle adulthood.

Blood pressure and lifestyle on Saba, Netherlands Antilles.

During the 20th century, infectious disease morbidity and mortality generally waned whereas chronic degenerative diseases posed a growing burden at the global level. The population on Saba, Netherlands Antilles has recently experienced such an epidemiologic transition, and hypertension was reported to be extraordinarily high, although no prevalences have been reported and relationships with lifestyle factors associated with rapid modernization have not been explored. In this study, a medical and demographic questionnaires, as well as body composition and blood pressure measures were collected from 278 Saban men and women aged 18-91 years. When age and sex adjusted, 48% of the population was hypertensive. Age, BMI, and Afro-Caribbean descent were all associated with higher blood pressures. In a second phase, 124 individuals of the 278 were invited to receive a longer questionnaire on individual exposure to modernizing influences such as travel and education. Higher blood pressure was associated with having lived in fewer different places in the past; those who stayed only on Saba or Statia had higher blood pressures than those who had also lived in more modernized areas. However, this was no longer statistically significant after adjustment for age and BMI. Lifestyle incongruity was positively associated with higher blood pressure in that those with more discord between material wealth and income were more likely to be hypertensive, and this remained statistically significant after adjustment for age and adiposity. In summary, hypertension is highly prevalent on Saba and tended to be associated with greater age, adiposity, Afro-Caribbean ancestry, and lifestyle incongruity.