Improving WIC Retention in Vermont: Beneficiary attitudes toward co-location in medical homes

Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a national program aimed at improving the nutrition and health of pregnant women and children. Those eligible for Vermont WIC include anyone pregnant or with children under 5 that has an income below 185% of federal poverty level or is enrolled in Vermont Medicaid. WIC has been shown to improve birth outcomes1, breast feeding rates2, infant growth and development, and consumption of important nutrients. Those enrolled in WIC report high levels of satisfaction Despite the benefits of WIC, retention rates of eligible families remain low. Studies have shown that mandatory bi-annual recertification appointments pose logistical problems. Rescheduling missed appointments and long waiting times at the WIC offices were also barriers. Other states have found that integration of WIC recertification appointments with the family’s primary care medical visits may improve retention. A limited scale co-localization of WIC and the medical home in Vermont showed some promise.https://scholarworks.uvm.edu/comphp_gallery/1213/thumbnail.jp

Incremental healthcare resource utilization and costs in US patients with Cushing's disease compared with diabetes mellitus and population controls

Abstract Purpose Resource utilization and costs in Cushing's disease (CD) patients have not been studied extensively. We compared CD patients with diabetes mellitus (DM) patients and population-based controls to characterize differences in utilization and costs. Methods Using 2008-2012 MarketScan Ò database, we identified three patient groups: (1) CD patients; (2) DM patients; and (3) population-based control patients without CD. DM and control patients were matched to CD patients by age, gender, region, and review year in a 2:1 ratio. Outcomes included annual healthcare resource utilization and costs. Results There were 1852 CD patients, 3704 DM patients and 3704 controls. Mean age was 42.9 years; 78.2 % were female. CD patients were hospitalized more frequently (19.3 %) than DM patients (11.0 %, p \ .001) or controls (5.6 %, p \ .001). CD patients visited the ED more frequently (25.4 %) than DM patients (21.1 %, p \ .001) or controls (14.3 %, p \ .001). CD patients had more office visits than DM patients (19.1 vs. 10.7, p \ .001) or controls (7.1, p \ .001). CD patients on average filled more prescriptions than DM patients (51.7 vs. 42.7, p \ .001) or controls (20.5, p \ .001). Mean total healthcare costs for CD patients were $26,269 versus$12,282 for DM patients (p \ .001) and $5869 for controls (p \ .001). Conclusions CD patients had significantly higher annual rates of healthcare resource utilization compared to matched DM patients and population controls without CD. CD patient costs were double DM costs and quadruple control costs. This study puts into context the additional burdens of CD over DM, a common, chronic endocrine condition affecting multiple organ systems, and population controls

Estudo de flebotomíneos (Diptera: Psychodidae) em foco de leishmaniose visceral no Estado de Mato Grosso do Sul, Brasil

INTRODUCTION: In the Americas, Lutzomyia longipalpis has been incriminated as the vector of visceral leishmaniasis in almost all the areas in which this disease has been reported. The notification of human cases of visceral leishmaniasis and the presence of dogs with an appearance suggestive of the disease in the county of Corumbá, Mato Grosso do Sul State, Brazil, led us to undertake an entomological investigation in this area, for the purpose of identifying the phlebotomine vector. MATERIAL AND METHOD: The county of Corumbá is located in the Pantanal region and its urban area is situated at 18° 59’ 44" South and 57° 39’ 16" West. The research project was carried out in peri and intradomiciliary environments, in three urban districts, one of which was central and the other two on the outskirts, and in a cave situated outside the urban perimeter. Most of the captures were made weekly with light automatic traps, in the period from February 1984 to December 1986. Meteorological data for this period were obtained from the city,s meteorological station and those for the period from 1925 to 1982 from the literature. RESULTS: The urban phlebotomine fauna consisted of eight species and was similar to that of the cave, except that in the latter the species were more abundant. Lutzomyia cruzi was predominant in the peri and intradomiciliary environments. Its prevalence in the central district was of 90.3% and lower in the outskirts. Lu. forattinii presented considerable prevalence (39.0%) in one of the outlying districts too. In the cave, Lu. corumbaensis was the predominant species, followed by Lu. sordellii, Lu. forattinii, Lu. peresi and Lu. cruzi. The impact of the climatic condition and the action of insecticides in the urban area on the frequence of the species, as well as the use of the cave as a breeding ground by the phlebotomines, in view of the changes in the sex rate, are commented. Data on anthropophily and captures of Lu. forattinii using dog bait have been added. CONCLUSION: The predominance of Lu. cruzi in the urban area; the great prevalence of Lu. forattinii in most of the outlying areas studied and the anthropophily of this latter species, as well as the strong affinity of these species with Lu. longipalpis, the main vector of visceral leishmaniais in other areas of the Americas, suggest the participation of both in the transmission of the disease in Corumbá.INTRODUÇÃO: Nas Américas, Lutzomyia longipalpis tem sido incriminada como vetora da leishmaniose visceral em, praticamente, todas as áreas de ocorrência dessa parasitose. A notificação de casos humanos a partir de 1980 e a presença de cães com aspecto sugestivo de leishmaniose visceral no Município de Corumbá, Estado de Mato Grosso do Sul, Brasil, levaram a investigações entomológicas na área, com o objetivo de identificar a população de flebotomíneo vetora. MATERIAL E MÉTODO: A pesquisa foi realizada no peri e intradomicílio de três residências urbanas e em ecótopo natural, representado por uma gruta, situado fora do perímetro urbano. As capturas, semanais em sua maioria, foram realizadas com armadilhas automáticas luminosas, no período de 1984 a 1986. Os dados metereológicos desse período foram obtidos junto à Estação Metereológica da cidade e os de 1925 a 1982, de bibliografia. RESULTADOS: A fauna flebotomínea urbana, composta de oito espécies, mostrou-se semelhante à da gruta, porém nesta, a abundância das espécies foi maior. Na área urbana, Lu. cruzi predominou tanto no intra como no peridomicílio: no bairro central, representou 90,3% dos espécimens e nos dois bairros periféricos, os seus percentuais foram menores. Lu. forattinii, também, teve freqüência expressiva em um dos bairros periféricos (39,0 %). Na gruta, Lu. corumbaensis foi a espécie predominante. Comenta-se o impacto das condições climáticas e do inseticida aplicado na área urbana na freqüência das espécies, e da utilização da gruta como criadouro pelos flebotomíneos, com base na evolução da razão entre os sexos ao longo do período. Foram adicionadas informações sobre antropofilia e de coleta com isca canina de Lu. forattinii. CONCLUSÃO: O predomínio de Lu. cruzi na área urbana; a expressiva freqüência de Lu. forattinii na periferia da cidade, bem como a sua antropofilia e o estreito grau de parentesco destas espécies com Lu. longipalpis, a principal vetora da leishmaniose visceral em outras áreas da América, são aspectos que sugerem a participação de ambas na transmissão da doença, em Corumbá

Optimal oxygen saturation in premature infants

There is a delicate balance between too little and too much supplemental oxygen exposure in premature infants. Since underuse and overuse of supplemental oxygen can harm premature infants, oxygen saturation levels must be monitored and kept at less than 95% to prevent reactive oxygen species-related diseases, such as retinopathy of prematurity and bronchopulmonary dysplasia. At the same time, desaturation below 80 to 85% must be avoided to prevent adverse consequences, such as cerebral palsy. It is still unclear what range of oxygen saturation is appropriate for premature infants; however, until the results of further studies are available, a reasonable target for pulse oxygen saturation (SpO2) is 90 to 93% with an intermittent review of the correlation between SpO2 and the partial pressure of arterial oxygen tension (PaO2). Because optimal oxygenation depends on individuals at the bedside making ongoing adjustments, each unit must define an optimal target range and set alarm limits according to their own equipment or conditions. All staff must be aware of these values and adjust the concentration of supplemental oxygen frequently

The Plasma Concentration of the B Cell Activating Factor Is Increased in Children With Acute Malaria

Malaria-specific antibody responses in children often appear to be short-lived but the mechanisms underlying this phenomenon are not well understood. In this study, we investigated the relationship between the B-cell activating factor (BAFF) and its receptors expressed on B cells with antibody responses during and after acute malaria in children. Our results demonstrate that BAFF plasma levels increased during acute malarial disease and reflected disease severity. The expression profiles for BAFF receptors on B cells agreed with rapid activation and differentiation of a proportion of B cells to plasma cells. However, BAFF receptor (BAFF-R) expression was reduced on all peripheral blood B cells during acute infection, but those children with the highest level of BAFF-R expression on B cells maintained schizont-specific immunoglobin G (IgG) over a period of 4 months, indicating that dysregulation of BAFF-R expression on B cells may contribute to short-lived antibody responses to malarial antigens in children. In summary, this study suggests a potential role for BAFF during malaria disease, both as a marker for disease severity and in shaping the differentiation pattern of antigen-specific B cells

Emerging Themes and Future Directions of Multi-Sector Nexus Research and Implementation

Water, energy, and food are all essential components of human societies. Collectively, their respective resource systems are interconnected in what is called the “nexus”. There is growing consensus that a holistic understanding of the interdependencies and trade-offs between these sectors and other related systems is critical to solving many of the global challenges they present. While nexus research has grown exponentially since 2011, there is no unified, overarching approach, and the implementation of concepts remains hampered by the lack of clear case studies. Here, we present the results of a collaborative thought exercise involving 75 scientists and summarize them into 10 key recommendations covering: the most critical nexus issues of today, emerging themes, and where future efforts should be directed. We conclude that a nexus community of practice to promote open communication among researchers, to maintain and share standardized datasets, and to develop applied case studies will facilitate transparent comparisons of models and encourage the adoption of nexus approaches in practice