A Review of The Characteristics of Super-Utilizers and Evidence-Based Approaches to Reduce Healthcare Utilization

A significant fraction of health care resources in the United States of America is utilized by a comparatively small number of people. An examination of the attributes and patterns and associated evidence-based interventions for such high-utilizing patients might aid clinicians to improve interventions to address the distinctive needs of these patients, decrease their risks for numerous hospitalizations, and contribute to reducing the costs. This study aims at exploring the existing literature on the characteristics of super-utilizers and interventions to reduce avoidable use of health care among this population. The method used for this research is a comprehensive literature review. Search from various academic databases, such as Pubmed, SciFinder, Scopus, and CINAHL has been included. Grey literature was also included. This research is restricted to studies and evidence specific to the United States. Literature review results show that super-utilizers are more likely to be female, with lower income, low education status, and suffer from multiple chronic conditions like diabetes, heart diseases, etc. and/or mental health illnesses. Super-Utilization definitions vary by studies. Several studies that included pre‐post evaluations showed significant declines in either health care use or cost or both. It is important to prioritize public policy and investment into the super-utilizer communities to ensure awareness, accessibility to socio-economic and political resources, to ensure their overall well-being and that we target evidence-based interventions aimed at such communities

Y chromosomal noncoding RNAs regulate autosomal gene expression via piRNAs in mouse testis.

Abstract Background Deciphering the functions of Y chromosome in mammals has been slow owing to the presence of repeats. Some of these repeats transcribe coding RNAs, the roles of which have been studied. Functions of the noncoding transcripts from Y chromosomal repeats however, remain unclear. While a majority of the genes expressed during spermatogenesis are autosomal, mice with different deletions of the long arm of the Y chromosome (Yq) were previously also shown to be characterized by subfertility, sterility and sperm abnormalities, suggesting the presence of effectors of spermatogenesis at this location. Here we report a set of novel noncoding RNAs from mouse Yq and explore their connection to some of the autosomal genes expressed in testis. Results We describe a set of novel mouse male-specific Y long arm (MSYq)-derived long noncoding (lnc) transcripts, named Pirmy and Pirmy-like RNAs. Pirmy shows a large number of splice variants in testis. We also identified Pirmy-like RNAs present in multiple copies at different loci on mouse Y chromosome. Further, we identified eight differentially expressed autosome-encoded sperm proteins in a mutant mouse strain, XYRIIIqdel (2/3 Yq-deleted). Pirmy and Pirmy-like RNAs have homology to 5′/3′UTRs of these deregulated autosomal genes. Several lines of experiments show that these short homologous stretches correspond to piRNAs. Thus, Pirmy and Pirmy-like RNAs act as templates for several piRNAs. In vitro functional assays reveal putative roles for these piRNAs in regulating autosomal genes. Conclusions Our study elucidates a set of autosomal genes that are potentially regulated by MSYq-derived piRNAs in mouse testis. Sperm phenotypes from the Yq-deleted mice seem to be similar to that reported in inter-specific male-sterile hybrids. Taken together, this study provides novel insights into possible role of MSYq-derived ncRNAs in male sterility and speciation