Medicaid Managed Care and Infant Health: A National Evaluation

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization and infant health. We obtain separate estimates of the effect of primary care case management (PCCM) managed care programs and HMO managed care plans on prenatal care utilization, birth weight, and cesarean section. The results suggest the following: MMC was associated with a small, clinically unimportant decrease in the number of prenatal care visits; MMC had no statistically significant relationship to the APNCU index of the adequacy of prenatal care; MMC was associated with a significant increase in the incidence of low-birth weight and pre-term birth; and MMC had no association with the incidence of cesarean section. We argue that a causal interpretation of the first and third findings is unsupported by a careful reading of the evidence, and we conclude that Medicaid managed care had virtually no causal effect on, prenatal care use, birth outcomes, and cesarean section.

Is ethnicity a risk for high grade prostate cancer?

Includes bibliographical references.To assess the association between ethnicity and grade of prostatic adenocarcinoma, prostatespecific antigen (PSA) and age, and to determine whether Africans of African descent (AAD) have higher grade cancers than other ethnic groups

Computational exploration of the chemical structure space of possible reverse tricarboxylic acid cycle constituents

The reverse tricarboxylic acid (rTCA) cycle has been explored from various standpoints as an idealized primordial metabolic cycle. Its simplicity and apparent ubiquity in diverse organisms across the tree of life have been used to argue for its antiquity and its optimality. In 2000 it was proposed that chemoinformatics approaches support some of these views. Specifically, defined queries of the Beilstein database showed that the molecules of the rTCA are heavily represented in such compound databases. We explore here the chemical structure space, e.g. the set of organic compounds which possesses some minimal set of defining characteristics, of the rTCA cycle's intermediates using an exhaustive structure generation method. The rTCA's chemical space as defined by the original criteria and explored by our method is some six to seven times larger than originally considered. Acknowledging that each assumption in what is a defining criterion making the rTCA cycle special limits possible generative outcomes, there are many unrealized compounds which fulfill these criteria. That these compounds are unrealized could be due to evolutionary frozen accidents or optimization, though this optimization may also be for systems-level reasons, e.g., the way the pathway and its elements interface with other aspects of metabolism

in silico verification and parallel reaction monitoring prevalidation of potential prostate cancer biomarkers

Purpose: Targeted proteomics of potential biomarkers is often challenging. Hence, we developed an intermediate workflow to streamline potential urinary biomarkers of prostate cancer (PCa). Materials & methods: Using previously discovered potential PCa biomarkers; we selected proteotypic peptides for targeted validation. Preliminary in silico immunohistochemical and single reaction monitoring (SRM) verification was performed. Successful PTPs were then prevalidated using parallel reaction monitoring (PRM) and reconfirmed in 15 publicly available databases. Results: Stringency-based targetable potential biomarkers were shortlisted following in silico screening. PRM reveals top 12 potential biomarkers including the top ranking seven in silico verification-based biomarkers. Database reconfirmation showed differential expression between PCa and benign/normal prostatic urine samples. Conclusion: The pragmatic penultimate screening step, described herein, would immensely improve targeted proteomics validation of ..

Potential of miRNAs in Plasma Extracellular Vesicle for the Stratification of Prostate Cancer in a South African Population

Prostate cancer (PCa) is the most common cause of cancer death among African men. The analysis of microRNAs (miRNAs) in plasma extracellular vesicles (EVs) can be utilized as a non-invasive tool for the diagnosis of PCa. In this study, we used small RNA sequencing to profile miRNAs cargo in plasma EVs from South African PCa patients. We evaluated the differential expression of miRNAs between low and high Gleason scores in the plasma EVs of South African patients and in the prostatic tissue from data available in the Cancer Genome Atlas (TCGA) Data Portal. We identified 7 miRNAs differently expressed in both EVs and prostatic tissues. We evaluated their expression using qPCR in a larger cohort of 10 patients with benign prostatic hyperplasia (BPH) and 24 patients with PCa. Here, we reported that the ratio between two of these miRNAs (i.e., miR-194-5p/miR-16-5p) showed a higher concentration in PCa compared to BPH and in metastatic PCa compared to localized PCa. We explored for the first time the profiling of miRNAs cargo in plasma EVs as a tool for the identification of putative markers in the South African population. Our finding indicated the ratio miR-194-5p/miR-16-5p as a non-invasive marker for the evaluation of PCa aggressiveness in this population

Detection of Cancer-Associated Gene Mutations in Urinary Cell-Free DNA among Prostate Cancer Patients in South Africa

Prostate cancer (PCa) is the most common cause of cancer death among African men. The presence of tumor-specific variations in cell-free DNA (cfDNA), such as mutations, microsatellite instability, and DNA methylation, has been explored as a source of biomarkers for cancer diagnosis. In this study, we investigated the diagnostic role of cfDNA among South African PCa patients. We performed whole exome sequencing (WES) of urinary cfDNA. We identified a novel panel of 31 significantly deregulated somatic mutated genes between PCa and benign prostatic hyperplasia (BPH). Additionally, we performed whole-genome sequencing (WGS) on matching PCa and normal prostate tissue in an independent PCa cohort from South Africa. Our results suggest that the mutations are of germline origin as they were also found in the normal prostate tissue. In conclusion, our study contributes to the knowledge of cfDNA as a biomarker for diagnosing PCa in the South African population

Twenty four-hour urine collection is appropriate in a cohort of South African renal stone formers

Objectives: To report the prevalence of metabolic abnormalities found in an urban South African population of stone formers and thereby determine whether international guidelines on 24-hour urine collection should be recommended for South African stone formers.Methods: A retrospective folder review was conducted on patients who were admitted with renal stones or who had renal stone procedures between 1 November 2014 and 31 March 2020, with a confirmed history of renal calculi and who had 24-hour urine collection at a tertiary centre renal stone clinic. All confirmed stone formers were offered 24-hour urine collection once they were infection-free and stone-free. Demographics, 24-hour urine collection findings and stone analysis results (if available) were recorded. A 24-hour urine collection was performed once patients were stone-free while on their regular diet and routine lifestyle.Results: 175 patients with metabolic studies were included (65 females and 110 males). The mean age was 53.8 ±13.6 years. The commonest metabolic risk factors were hypocitraturia (61.0%), hypomagnesiuria (41.1%), mild hypercalciuria (22.0%), and hyperuricosuria (20.2%). Hyperuricaemia, high urinary sodium excretion, mild hypercalciuria and hyperuricosuria were more common in men. A total of 102 patients had both 24-hour urine collection and stone analysis for comparison. There were no differences between different stone types in the prevalence of metabolic risk factors except for hyperuricaemia and high urinary sodium excretion, which were both higher in uric acid predominant stone formers.Conclusion: The prevalence of risk factors was high and seemed similar to that of other populations, except for a higher prevalence of hypocitraturia. Internationally recommended guidelines for 24-hour urine studies are therefore applicable and appropriate for this population. Risk factors seem similar across stone types; however, a larger study is necessary to clarify whether metabolic risk factors are useful to predict stone composition

Managed care and infant health: an evaluation of Medicaid in the US

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization, infant birth weight, pre-term birth, and use of cesarean section in the United States. We obtain separate estimates of the effect of primary care case management managed care programs and health maintenance organization managed care plans on these outcomes. The results suggest the following: among white, non-Hispanic women, MMC was associated with a 2 percent decrease in the number of prenatal care visits and a 3-5 percent increase the incidence of inadequate prenatal care; MMC was associated with a significant increase in the incidence pre-term birth for non-Hispanic white women, but that this association does not appear to be causal; and MMC had no association with the incidence of cesarean section.Health insurance Infant health Social policy