Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism: findings from health insurance claims data

<p>Abstract</p> <p>Background</p> <p>Thyroid hormone treatment in children with congenital hypothyroidism can prevent intellectual disability. Guidelines recommend that children diagnosed with congenital hypothyroidism through newborn screening remain on treatment to at least 3 years of age, after which a trial off therapy can determine which children have transient hypothyroidism. The purpose of this study was to describe the rate at which children with congenital hypothyroidism in the United States discontinue thyroid hormone treatment in early childhood.</p> <p>Methods</p> <p>Retrospective analysis of the 2002-2006 MarketScan^®Commercial Claims and Encounters research databases and the 2001-2005 MarketScan Multi-State Medicaid databases. Children were classified as having congenital hypothyroidism based on billing codes and having filled a prescription for thyroid hormone treatment. Kaplan-Meier curve analysis was used to determine discontinuation rates.</p> <p>Results</p> <p>There were a total of 412 Medicaid-enrolled children and 292 privately-insured children with presumed congenital hypothyroidism included in this study. The overall birth prevalence of congenital hypothyroidism across both datasets was about 1 per 2,300. By 36 months, the percentage who had discontinued thyroid replacement treatment was 38% (95% Confidence Interval: 32%-44%). Medicaid-enrolled children had a more rapid decline in the first 24 months of treatment compared to those with private insurance (<it>P </it>= 0.02).</p> <p>Conclusions</p> <p>More than one-third of children treated for congenital hypothyroidism discontinued treatment within 36 months, which is inconsistent with current guidelines. It is not known how many of these children required continued treatment or experience adverse effects from discontinuation. These findings emphasize the critical need for follow-up systems to monitor the outcome of newborn screening.</p

Food and Grain Consumption Per Capita in the Qinghai–Tibet Plateau and Implications for Conservation

Background: Grain security is crucial for social stability and ecosystem conservation regionally and globally, and it is particularly concerned widely in the Qinghai-Tibet Plateau (QTP) due to its high altitude and harsh climate for agriculture. Method: In this paper, we calculated and analyzed per capita food and grain consumption, including direct grain consumption, grain for fodder, industry consumption, seeds consumption, and wastage consumption and its changes in the QTP during 1995–2019. Results: The results showed that (1) in 2019, the average food consumption per capita was 333.35 kg, was stable since 1995. The dietary structure of residents was composed of direct grain consumption (44.15%), meat (10.72%), and milk (6.94%). The consumption of meat and milk was higher than the national average. (2) The average daily intake of energy and protein, animal protein, and the ratio of high-quality protein and fat energy were 2156.21 kcal·d−1, 73.53 g·d−1, 23.06 g·d−1, 38.32%, and 27.77% in 2019. Their changes were −342.98 kcal·d−1, −8.91 g·d−1, 11.16 g·d−1, 18.37%, and 11.08%, respectively. (3) The corresponding grain consumption per capita was 284.90 kg·a−1 in 1995, 262.19 kg·a−1 in 2010, and then remained stable until 2019. Conclusion: The study suggested that food consumption per capital was guaranteed at the well-off level since 2010, and food and dietary structure of residents were corresponding to physical geographic and climatic environment in the QTP. The conflict between food security and the ecosystem conservation can be managed without scarifying nature as the total grain consumption was stable since 2010, and the yield per unit area and total grain yield were both increasing since 2003 for agricultural condition improved in the QTP

Differences in Length of Stay and Costs Between Comparable Hospitalizations of Patients with Spina Bifida With or Without Pressure Injuries

Objective To estimate differences in the length of stay and costs for comparable hospitalizations of patients with spina bifida (SB) with and without pressure injuries. Design Retrospective, cross-sectional, observational study. Setting Nationwide Inpatient Sample from years 2010-2014. Participants Hospitalizations of patients with SB (N=7776). Hospitalizations among patients with SB and pressure injuries (n=3888) were matched to hospitalizations among patients with SB but without pressure injuries (n=3888). Interventions Not applicable. Main Outcome Measures Differences in length of stay and total costs between the 2 groups. Results After successful matching, multivariate modeling of costs and length of stay on matched sample showed that hospitalizations with pressure injuries had an increased 1.2 inpatient days and excess average costs of $1182 in 2014 dollars. Conclusions The estimated average cost of hospitalization increased by 10%, and the estimated average length of stay increased by 24% in the presence of pressure injuries among hospitalized patients with SB, compared with their peers without these injuries. These results highlight the substantial morbidity associated with pressure injuries, which are potentially preventable before or during hospitalizations among persons with SB

Labor Market Participation and Productivity Costs for Female Caregivers of Minor Male Children With Duchenne and Becker Muscular Dystrophies

Introduction/Aims Duchenne and Becker muscular dystrophies (DBMD) are X-linked neuromuscular disorders characterized by progressive muscle weakness, leading to decreased mobility and multisystem complications. We estimate productivity costs attributable to time spent by a parent caring for a male child under the age of 18 y with DBMD, with particular focus on female caregivers of boys with Duchenne muscular dystrophy (DMD) who have already lost ambulation. Methods Primary caregivers of males with DBMD in the Muscular Dystrophy Surveillance and Research Tracking Network (MD STARnet) were surveyed during 2011–2012 on family quality of life measures, including labor market outcomes. Of 211 respondents, 96 female caregivers of boys with DBMD were matched on state, year of survey, respondent\u27s age, child\u27s age, and number of minor children with controls constructed from Current Population Survey extracts. Regression analysis was used to estimate labor market outcomes and productivity costs. Results Caregivers of boys with DBMD worked 296 h less per year on average than caregivers of unaffected children, translating to a $8816 earnings loss in 2020 U.S. dollars. Caregivers of boys with DMD with ≥4 y of ambulation loss had a predicted loss in annualized earnings of$23,995, whereas caregivers of boys with DBMD of the same ages who remained ambulatory had no loss of earnings. Discussion Female caregivers of non-ambulatory boys with DMD face additional household budget constraints through income loss. Failure to include informal care costs in economic studies could understate the societal cost-effectiveness of strategies for managing DMD that might prolong ambulation