Non-medical use, abuse of, and dependence on prescription drugs : relationship between socio-demographic factors and health insurance coverage

Background: Previous studies have found that health insurance and other socio-demographic factors are important predictors of non-medical use of prescription drugs (NMUPD), their abuse and dependence, and use of substance abuse treatment. However, the effect of health insurance in specific subgroups of population on NMUPD, their abuse and dependence, and use of substance abuse treatment, is largely unknown. Objective: To determine if the effect of health insurance on NMUPD, their abuse and dependence, and use of substance abuse treatment differs by socio-demographic factors. The study also aims to identify prescription drugs that are used non-medically and to assess the relationship between health insurance and use of such drugs. Methods: This study used data from 2007 National Survey on Drug Use and Health (NSDUH). Sample consisted of individuals who were 12 year and older, non-institutionalized. Bivariate and multiple logistic regression analyses were conducted to estimate the relationship between health insurance, socio-demographic factors on NMUPD, their abuse and dependence, and use of substance abuse treatment. Results: In 2007, self-reported prevalence of NMUPD was eight percent (N=5190). NMUPD was higher among uninsured individuals. In multivariate analysis, age, race, education, marital status, type of health insurance, level of income, past year use of tobacco, and alcohol were significantly associated with NMUPD. Hispanic people with private health insurance, high school graduates with public health insurance, privately insured individuals with family income less than $20,000 and$40,000-$74,999 were more likely to use prescription drugs than others. Drugs most likely to be used non-medically were Vicodin/Lortab/Lorcet (pain relievers), Valium /diazepam (tranquilizers), methamphetamine, Desoxyn/Methedrine (stimulants), and Methaqualone/Sopor/ Quaalude (sedatives). Approximately, one percent of the entire sample and 13$20,000 and $40,000-$74,999 are less likely to use prescription drugs non-medically. On the other hand, Hispanics with private health insurance are more likely to use prescription drugs non-medically than the others. These individuals are more likely to have lower education as well as poor physical and financial conditions. It is important that non-medical users, prescription drug abusers/dependents are made aware of the harms of NMUPD, their abuse and dependence and the benefits of using substance abuse treatment to overcome these health problems

Tuberculosis of symphysis pubis in a 17 year old male: a rare case presentation and review of literature

Tuberculosis of symphysis pubis is a rare condition with hardly any report of such cases in the last decade. It is necessary to distinguish the entity from more common ones like Osteitis pubis and Osteomyelitis of pubis symphysis by urgent means in order to start the treatment early and thereby minimize morbidity and prevent complications. A rare case of tuberculosis of symphysis pubis in a 17 year old male is described. A high index of suspicion along with an extensive workup including 3-phase bone scan and fine needle aspiration led to the diagnosis. The patient had an excellent outcome following a complete course of multidrug chemotherapy for tuberculosis

Management outcomes in pubic diastasis: our experience with 19 patients

<p>Abstract</p> <p>Background</p> <p>Pubic diastasis, a result of high energy antero-posterior compression (APC) injury, has been managed based on the Young and Burguess classification system. The mode of fixation in APC II injury has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the posterior pelvic ring elements in these injuries.</p> <p>Methods</p> <p>The study included a total of 19 patients with pubic diastasis managed by us from May 2006 to December 2007. There was a single patient with type I APC injury who treated conservatively. Type II APC injuries (13 patients) were treated surgically with symphyseal plating using single anterior/superior plates or double perpendicularly placed plates. Type III injuries (5 patients) in addition underwent posterior fixation using plates or percutaneous sacro-iliac screws. The outcome was assessed clinically (Majeed score) and radiologically.</p> <p>Results</p> <p>The mean follow-up was for 2.9 years (6 months to 4.5 years). Among the 13 patients with APC II injuries, the clinical scores were excellent in one (7.6%), good in 6 (46.15%), fair in 4 (30.76%) and poor in 2 (15.38%). Radiological scores were excellent in 2 (15.38%), good in 8 (61.53%), fair in 2 (15.38%) and poor in one patient (7.6%). Among the 5 patients with APC III injuries, there were 2 patients each with good (50%) and fair (50%) clinical scores while one patient was lost on long term follow up. The radiological outcomes were also similar in these. Complications included implant failure in 3 patients, postoperative infection in 2 patients, deep venous thrombosis in one patient and bladder herniation in one of the patients with implant failure.</p> <p>Conclusions</p> <p>There is no observed dissimilarity in outcomes between isolated anterior and combined symphyseal (perpendicular) plating techniques in APC II injuries. Single anterior symphyseal plating along with posterior stabilisation provides a stable fixation in type III APC injuries. Limited dissection ensuring adequate intactness of rectus sheath is important to avoid long term post-operative complications.</p

Multiple lumbar transverse process stress fractures as a cause of chronic low back ache in a young fast bowler - a case report

A rare case of multilevel transverse process stress fractures as a cause of low back ache in a professional cricket player has been presented. The report discusses the possible mechanism of such an injury in a cricket player and also highlights the preventive and therapeutic aspects of management in such patients. The report also stresses upon the need for early identification of such sports related injuries to prevent long term morbidity in the athletes

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Comparative Effectiveness of Second Generation Antidepressants on Cognition and Dementia in the Elderly

Objectives: The two primary objectives of this study were: 1) to evaluate the comparative effectiveness of second generation antidepressants classes on cognition in elderly nursing home residents with depression, and 2) to evaluate the comparative effectiveness of second generation antidepressants classes on dementia in elderly nursing home residents with depression. Methods: This study involved retrospective cohort study design conducted using data from Medicare Part D claims and Minimum Data Set (MDS) from 2007-2010. The study population included elderly nursing home residents with depression who initiated treatment with second generation antidepressants classes namely Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs) or Tetracyclics. These patients were followed for one year to examine cognition; and two years to evaluate the risk of dementia. Cognition was identified using the MDS Cognition scale. Time to diagnosis of dementia was ascertained using the chronic condition flag for dementia in Medicare Beneficiary Summary File. The differences in covariate distributions between the antidepressant users and non-users were evaluated using chi-squared (χ2) tests for categorical variables and t-tests for continuous variables. A multiple propensity score-adjusted Repeated Measures Mixed Model was used to evaluate the comparative effectiveness of SSRIs, SNRIs and Tetracyclics with respect to cognition. A multiple propensity score-adjusted Cox Proportional Hazards Model was used to examine comparative effectiveness of SSRIs, SNRIs and Tetracyclics on dementia. Results: For the first objective, the study cohort consisted of 1,518 elderly nursing home residents. Of these, 1,081 received SSRIs (71.21%), 320 received Tetracyclics (21.08%) and 117 received SNRIs (7.71%). After adjusting for multiple propensity scores, the repeated measure mixed model did not find any statistically significant difference in cognition with the use of SSRIs (β = -0.23; 95% Confidence Interval (95% CI), -0.67, 0.22) or Tetracyclics (β = -0.45; 95% CI, -0.96, 0.05) when compared to SNRIs (reference group). Results of multiple sensitivity analyses were consistent with the main findings. For the second objective, the study cohort constituted 13,354 elderly nursing home residents with depression. Of these, 19,952 received SSRIs (79.77%), 2,381 received SNRIs (9.48%) and the rest 2,775 received Tetracyclics (11.05%). The unadjusted incidence of dementia was 8.20% for SSRIs users, 6.01% for the SNRIs users and 7.21% for Tetracyclics users. The propensity score adjusted Cox proportional hazard model did not find any significant difference in the comparative effectiveness of SNRIs [Hazards Ratio, HR, 0.99; 95% CI, 0.84, 1.19] or Tetracyclics [HR, 1.01; 95% CI, 0.87, 1.17] when compared to the SSRIs for the risk of dementia in elderly nursing home residents with depression. Results from the two sensitivity analyses supported the main findings. Conclusion: This multiple propensity score-adjusted retrospective cohort study did not find any statistically significant difference in the comparative effectiveness of three commonly used second generation antidepressant classes on cognition and risk of dementia. Future studies are required to examine the long-term effectiveness of these antidepressants classes on cognition and dementia.Pharmacological and Pharmaceutical Sciences, Department o

Optimization of Intrusion Detection Systems Determined by Ameliorated HNADAM-SGD Algorithm

Information security is of pivotal concern for consistently streaming information over the widespread internetwork. The bottleneck flow of incoming and outgoing data traffic introduces the issues of malicious activities taken place by intruders, hackers and attackers in the form of authenticity obstruction, gridlocking data traffic, vandalizing data and crashing the established network. The issue of emerging suspicious activities is managed by the domain of Intrusion Detection Systems (IDS). The IDS consistently monitors the network for the identification of suspicious activities, and generates alarm and indication in the presence of malicious threats and worms. The performance of IDS is improved by using different machine learning algorithms. In this paper, the Nesterov-Accelerated Adaptive Moment Estimation–Stochastic Gradient Descent (HNADAM-SDG) algorithm is proposed to determine the performance of Intrusion Detection Systems IDS. The algorithm is used to optimize IDS systems by hybridization and tuning of hyperparameters. The performance of algorithm is compared with other classification algorithms such as logistic regression, ridge classifier and ensemble algorithms where the experimental analysis and computations show the improved accuracy with 99.8%, sensitivity with 99.7%, and specificity with 99.5%

Double segmental tibial fractures - an unusual fracture pattern

【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nail