Impact of Parent’s HIV Status on Their Uninfected Child—A Comparative Analysis of the Child’s Healthcare Utilization, Access and Health Outcomes

With the advent of effective antiretroviral medication and increased expectancy of life span among HIV-infected individuals has lead to an increase in the at-risk population of uninfected children living with their HIV-infected parent(s). The purpose of this study was to investigate the impact of parent’s HIV status on their child’s access to healthcare resources, healthcare utilization and health outcomes. This was a cross-sectional study in which the information on the children of HIV seropositive parent(s) was collected through a face-to-face interview of the HIV-infected parents having children currently residing with them. The comparative group comprising of children of HIV seronegative parents was obtained from the Medical Expenditure Panel Survey (MEPS) 2006 database. HIV seronegative children aged between 2 yrs and 15 yrs of HIV seropositive as well as HIV seronegative parent(s) were included in this study. A parent was identified as HIV seropositive if they had a prior diagnosis of HIV/AIDS (ICD-9-CM 042, 043, V08) by a physician and had at least one record of a HIV positive serological test result in the past 6 months in their medical records. A parent was defined HIV seronegative if there were no diagnosis of HIV/AIDS (ICD-9-CM 042, 043, V08) in their medical records in MEPS 2006 database. Each child of HIV seropositive parent (primary group) was matched with two children of HIV seronegative parents (comparative group) using the Mahalanobis Distance Metric matching including the propensity score technique. Bivariate and two step multivariable logistic and negative binomial regression analysis was conducted to assess the relationship between the parent’s HIV status and potential variables of interest. Upon matching, 89 children of HIV seropositive parent(s) matched with 178 children of HIV seronegative parents (1:2 ratio), thus making the final study sample of 267 participants. No differences were observed between the groups in terms of their mean age (8.47 vs 8.94 yrs, p=0.6265), parent’s age (33.57 vs 34.21 yrs, p=0.9464) and other socio-economic and parent’s health insurance variables. This study found no difference between the children in terms of their access to health insurance (97.75% vs 96.63%, p=0.7227) and access to regular source of medical care (87.64% vs 86.68%, p=0.4453). However, a larger number of children of HIV seropositive parent(s) had prescription insurance (95.51% vs 16.29%, p=\u3c0.0001) compared to children of HIV seronegative parents. Also, children of HIV seropositive parent(s) took more time and expressed having difficulty in getting to a healthcare provider compared to children of HIV seronegative parents. Children of HIV seropositive parent(s) were 1.682 times (95% CI: 1.115-6.453) more likely to have a physician visit and had 49% (p=0.0206) more visits to a doctor than the children of HIV seronegative parents. No differences were observed in the likelihood of the children in having a hospital visit or an emergency room visit. However, among children who had a hospital visit and among those who had an emergency room visit, children living with their HIV seropositive parent had 3.0 times more hospital visits (p=0.0244) and 86% more emergency room visits (p=0.0464) compared to children living with HIV seronegative parents, respectively. No relationship was noted between the parent’s HIV status and the child’s absenteeism in school/daycare due to illness (OR: 0.938, 95% CI: 0.425-2.069). However, children of HIV seropositive parent were 4.041 times more likely (95% CI: 1.887-13.471) to be overweight. Though no difference in the likelihood of these children being currently on prescription medication was observed (OR: 0.918, 95% CI: 0.413-2.042), among those who were currently on any medication, children of HIV seropositive parent(s) were more likely to be on a medication for a mental health problem (OR: 5.520, 95% CI: 1.503-20.276). This study concluded that HIV status of the parent has significant impact on the child’s access in getting to a healthcare provider. It was also found that children of HIVinfected parent(s) had higher utilization of physician’s visits. Higher incidences of obesity and consumption of psychotropic medications among children of HIV seropositive parent(s) signify serious impact of the parent’s HIV status on the nutrition and psychological growth of the child. Further studies are recommended to investigatethe exact cause and long term impacts of the findings observed in this study

Impact of switching from an initial tumor necrosis factor inhibitor on health care resource utilization and costs among patients with rheumatoid arthritis

Onur Başer (MEF Author)Purpose: Despite improved clinical outcomes for the majority of patients, nearly 30% of patients with rheumatoid arthritis (RA) who initiate tumor necrosis factor antagonist (anti-TNF) biologic agents fail to respond to their first-line anti-TNF and switch to another anti-TNF or a non-TNF biologic. How this change affects health care costs and resource utilization is unknown. We therefore compared RA patients taking first-line anti-TNFs who switched to a second anti-TNF versus those patients who switched to an alternate biologic. Methods: Health care claims data were obtained from a large US database for eligible adults with confirmed RA diagnoses who initiated anti-TNF treatment and switched to another biologic. Health care costs and utilization during the first 12 months' postswitch were compared. Generalized linear models were used to adjust for differences in demographic and clinical characteristics before switching. Findings: Patients who switched to a second anti-TNF rather than a non-TNF biologic were generally younger (53.0 vs. 55.3 years; P < 0.0001) and less likely to be female (79.7% vs. 82.7%; P = 0.0490). Of the 3497 eligible patients who switched from first-line anti-TNFs, 2563 (73.3%) switched to another anti-TNF and 934 (26.7%) switched to a non-TNF. Adalimumab was the most frequently prescribed (43.4%) second-line anti-TNF, and abatacept was the most common non anti-TNF (71.4%). Patients who switched to a second anti-TNF remained on their first medication for a significantly shorter period (342.5 vs 420.6 days; P < 0.0001) and had lower comorbidity indices and higher disease severity at baseline than those who switched to a non anti-TNF. After adjusting for baseline differences, patients who switched to second anti-TNFs versus a non-TNF incurred lower RA-related costs ($20,938.9 vs$22,645.2; P = 0.0010) and total health care costs ($34,894.6 vs$38,437.2; P = 0.0010) 1 year postswitch. These differences were driven by increased physician office visit costs among the non-TNF group. Implications: Among the anti-TNF initiators who switched therapy, more patients switched to a second anti-TNF than to a non-TNF. Switching to a second anti-TNF treatment was associated with lower all-cause and RA-related health care costs and resource utilization than switching to a non-TNF. Because switching therapy may be unavoidable, finding a treatment algorithm mitigating this increase to any extent should be considered. These data are limited by their retrospective design. Additional confounding variables that could not be controlled for may affect results. (C) 2015 The Authors. Published by Elsevier HS journals, Inc.WOS:0003593921000082-s2.0-84937640448PMID: 25999184Science Citation Index ExpandedQ2ArticleUluslararası işbirliği ile yapılan - EVETTemmuz2015YÖK - 2014-1

Biologic TNF inhibiting agents for treatment of rheumatoid arthritis: persistence and dosing patterns in Germany

Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as "TNF inhibitor naive" or "TNF inhibitor continuing". For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept

Participation in an innovative patient support program reduces prescription abandonment for adalimumab-treated patients in a commercial population.

Purpose: Nonadherence to indicated therapy reduces treatment effectiveness and may increase cost of care. HUMIRA Complete, a Patient Support Program (PSP), aims to reduce nonadherence in patients prescribed adalimumab (ADA). The objective of this study was to assess the relationship between participation in the PSP and prescription abandonment rates among ADA-treated patients. Patients and methods: This longitudinal study using patient-level data from AbbVie\u27s PSP linked with medical and pharmacy claims data included patients ≥18 years with an ADA-approved indication, ≥1 pharmacy claim for ADA, and available data ≥3 months before and ≥6 months after the index date (defined as the initial ADA claim [01/2015 to 02/2017]). Abandonment was defined as reversal of initial ADA prescription with no paid claim during 3-month follow-up. Abandonment rates were compared between PSP and non-PSP cohorts using multivariable logistic regression controlling for potentially confounding baseline characteristics. Results: In 17,371 patients (9,851 PSP; 7,520 non-PSP), the overall abandonment rate was 10.8-16.8% across indications. The odds of ADA abandonment were 70% less for PSP vs non-PSP patients (5.6% vs 20.4%, odds ratio [OR]=0.30, [95% confidence interval (CI)=0.27-0.33] Conclusion: Participation in the PSP, higher income, and using a specialty pharmacy were associated with lower odds of abandoning ADA therapy, whereas increased copayments were associated with greater abandonment. PSPs should be considered to improve initiation of ADA therapy

CFD Simulations for Performance Enhancement of a Solar Chimney Power Plant (SCPP) and Techno-Economic Feasibility for a 5 MW SCPP in an Indian Context

The use of solar energy for power generation using the innovative solar chimney concept has been explored by many researchers mostly with the help of analytical models as well as CFD simulations while experimental studies for a pilot and bench scale facilities have been carried out. The efficiencies of these chimneys, however, are less than 1% (~0.07% for 50 kW pilot plant similar to Manzanares plant in Spain). In the present study, an effort has been made to make modifications in the chimney design to improve the efficiency of the chimney in terms of power generation. CFD simulations have been carried out for this modified design and the efficiency is seen to improve to 0.12% for a 50 kW chimney. Furthermore, a techno-economic feasibility analysis has been carried out for a conventional 5 MW solar power plant which can be installed on the western part of India, which receives good solar irradiation throughout the year. Two cases with and without government subsidies have been considered. It is observed that a high rate of return (~20.4%) is obtained for a selling price of electricity of Rs 5 per kWh with government subsidy, while a rate of return of ~19% is obtained for Rs 10 per kWh without government subsidy

Hydrodynamics of Liquid-Liquid Flows in Micro Channels and Its Influence on Transport Properties: A Review

Hydrodynamics plays a major role in transport of heat and mass transfer in microchannels. This includes flow patterns and flow regimes in which the micro-channels are operated. The flow patterns have a major impact the transport properties. Another important aspect is the pressure drop in micro-channels. In the present review, the experimental and Computational Fluid Dynamics (CFD) studies covering all the above aspects have been covered. The effect of geometrical parameters like shape of channel, channel size, material of construction of channels; operating parameters like flow velocity, flow ratio and fluid properties have been presented and analyzed. Experimental and analytical work of different pressure drop models has also been presented. All the literature related to influence of flow patterns on transport properties like volumetric mass transfer coefficients (VMTC) and heat transfer coefficients (HTC) have been presented and analyzed. It is found that most works in Liquid-Liquid Extraction (LLE) systems have been carried out in slug flow and T-junctions. Models for coupled systems of flow and mass transfer have been presented and works carried out for different coupled systems have been listed. CFD simulations match experimental results within 20% deviations in quantitative and qualitative predictions of flow phenomena for most research articles referred in this review. There is a disparity in prediction of a generalized regime map and a generalized regime map for prediction of flow patterns for various systems would need the help of Artificial Intelligence

Efficiency Optimized Brushless DC Motor Drive based on Input Current Harmonic Elimination

This paper describes efficiency improvement of a position sensorless brushless DC (BLDC) motor with improved PWM scheme for the inverter compared to existing ones. This is based on Selective Harmonic Elimination (SHE). The proposed method reduces total harmonic distortion (THD) from the input current and armature flux and thereby reducing the core losses. The effectiveness of the proposed scheme is demonstrated through simulation and experimental results

A novel method to improve the efficiency of a cooking device via thermal insulation

We propose a method of finding the transient temperature variation in an insulated cooking device. We also report a means of optimising the thickness of insulation. The cooking device is a double walled cylindrical vessel with spacing of 5–20 mm between the vertical walls (width) and spacing of 560 or 870 mm between top and bottom surfaces (height). The height to width ratio (H/L) is between 28 and 174 and Rayleigh number (Ra) is between 907 and 2.61 × 105. First, an energy balance for the cooking device is established. A correlation is developed to predict the heat transfer coefficient (HTC) as a function of Ra and H/L. The method developed for finding the transient variation in temperature has been tested on two cooking device volumes: 120 and 700 lit. Using the optimised parameters, a reduction in heat loss of 22% and 30%, respectively, is observed

Disparities in care by insurance status for individuals with rheumatoid arthritis: analysis of the medical expenditure panel survey, 2006–2009

<p><b>Objective:</b> Treatment guidelines for rheumatoid arthritis (RA) recommend early, aggressive treatment with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs) to minimize long-term disability. We aimed to assess differences in medical resource utilization, drug therapy, and health outcomes among RA patients by insurance type in the United States.</p> <p><b>Methods:</b> Individuals with a self-reported diagnosis of RA were identified in the Medical Expenditure Panel Survey (MEPS) database, 2006–2009. Data regarding sociodemographic characteristics, insurance type and status, and outcomes (including health care resource utilization, prescription medication use, health status, and patient-reported barriers to health care) were extracted. Multivariable regression analyses were used to examine the impact of insurance type (private, Medicare, Medicaid, or uninsured) on outcome measures while controlling for age group, sex, and race/ethnicity.</p> <p><b>Results:</b> A total of 693 individuals with a self-reported diagnosis of RA during the study period were identified; 423 were aged 18–64 years and 270 were aged ≥65 years. Among patients aged 18–64, those with Medicaid or who were uninsured were less likely than those with private insurance to visit a rheumatologist (adjusted odds ratio [aOR] 0.13 and 0.17, respectively; <i>p</i> < .001) and to receive biologic DMARDS (aOR 0.09 [<i>p</i> < .001] and 0.16 [<i>p</i> < .01], respectively); those with Medicaid were also less likely to receive nonbiologic DMARDS (aOR 0.26 [<i>p</i> < .01]). Those with Medicaid were more likely than those with private insurance to be unable/delayed in getting prescription drugs (aOR 2.9 [<i>p</i> < .05]), to experience cognitive, social, and physical limitations (aOR 8.7 [<i>p</i> < .001], 4.7 [<i>p</i> < .001], and 2.5 [<i>p</i> < .05], respectively); they also reported significantly lower general health and health-related quality of life. Patients aged ≥65 experienced greater equity in care and outcomes.</p> <p><b>Conclusions:</b> Younger RA patients with Medicaid (including those who receive coverage under the Medicaid expansion component of the Affordable Care Act) may be at risk for inadequate treatment.</p