How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans?: A 2012 Update

Compares the value of benefits for those age 65 and older under Medicare and under two large employer plans typical of those for which premium support could be offered under reform proposals. Examines share of costs paid by the plan and by individuals

Current Trends and Future Outlook for Retiree Health Benefits

Documents the increasing costs of retiree benefits for large private sector employers and their retirees. Looks at the response of large employers to the Medicare prescription drug law and the subsidies it provides for maintaining retiree drug coverage

Opportunistic detection of atrial fibrillation using blood pressure monitors: a systematic review

Background: Atrial Fibrillation (AF) affects around 2% of the population and early detection is beneficial, allowing patients to begin potentially life-saving anticoagulant therapies. Blood pressure (BP) monitors may offer an opportunity to screen for AF. Aim: To identify and appraise studies which report the diagnostic accuracy of automated BP monitors used for opportunistic AF detection. Methods: A systematic search was performed of the Medline, Medline-in-process and Embase literature databases. Papers were eligible if they described primary studies of the evaluation of a BP device for AF detection, were published in a peer reviewed journal and reported values for the sensitivity and specificity. Included studies were appraised using the QUADAS-2 tool to assess their risk of bias and applicability to opportunistic AF detection. Values for the sensitivity and specificity of AF detection were extracted from each paper and compared. Results and Conclusion: We identified seven papers evaluating six devices from two manufacturers. Only one study scored low risk in all of the QUADAS-2 domains. All studies reported specificity greater than 85% and six reported sensitivity greater than 90%. The studies showed that blood pressure devices with embedded algorithms for detecting arrhythmias show promise as screening tools for AF, comparing favourably with manual pulse palpation. But the studies used different methodologies and many were subject to potential bias. More studies are needed to more precisely define the sensitivity and specificity of opportunistic screening for AF during blood pressure measurement before its clinical utility in the population of interest can be assessed fully

Accuracy of pulse interval timing in ambulatory blood pressure measurement

Blood pressure (BP) monitors rely on pulse detection. Some blood pressure monitors use pulse timings to analyse pulse interval variability for arrhythmia screening, but this assumes that the pulse interval timings detected from BP cuffs are accurate compared with RR intervals derived from ECG. In this study we compared the accuracy of pulse intervals detected using an ambulatory blood pressure monitor (ABPM) with single lead ECG. Twenty participants wore an ABPM for three hours and a data logger which synchronously measured cuff pressure and ECG. RR intervals were compared with corresponding intervals derived from the cuff pressure tracings using three different pulse landmarks. Linear mixed effects models were used to assess differences between ECG and cuff pressure timings and to investigate the effect of potential covariates. In addition, the maximum number of successive oscillometric beats detectable in a measurement was assessed. From 243 BP measurements, the foot landmark of the oscillometric pulse was found to be associated with fewest covariates and had a random error of 9.5 ms. 99% of the cuff pressure recordings had more than 10 successive detectable oscillometric beats. RR intervals can be accurately estimated using an ABPM

Diarrhea-associated micronutrient deficiencies and risk of subsequent diarrhea in admitted children to Hajar hospital in Shahrekord, Iran

Background: Acute infectious diarrhea is still one of the most important causes of death in childhood and malnutrition increases its morbidity and mortality. There is a strong correlation between the nutritional status of the child and the risk of subsequent diarrhea. Micronutrient deficiencies also increase the child’s susceptibility to diarrhea and vitamin A and zinc supplementation has been shown to reduce the incidence and hasten recovery from acute diarrhea episodes. Materials and methods: This study describes the association of nutritional deficiencies and other factors on the risk of subsequent diarrhea in children in Shahrekord, Iran. A cohort of 211 children less than 5 years old admitted with acute diarrhea to Hajar Hospital in Shahrekord, were followed for 14 weeks after hospital discharge. Results: Fifty-eight (27%) of these children developed a new diarrhea episode during the follow up period. Children who were vitamin A and zinc deficient at the time of admission, above 12 months of age, kept animals at home or had weight-for-age and weight-for-height z scores <-1 during the univariate analysis had a higher risk of experiencing subsequent diarrhea. Vitamin A and zinc deficiencies, keeping animals at home, diarrhea duration ≤ 4 days on enrolment and weight-for-age z score <-1 reminded as independent risk factors during multivariate analysis. The aggregation of these factors had a synergistic effect on the risk of subsequent diarrhea. Conclusion: Children with micronutrient deficiencies and in contact with animal had the highest risk of suffering subsequent diarrhea. Our findings support the current approach of providing multiple micronutrient supplements for the prevention of infection in order to reduce mortality in children

Scientific opinion on the safety of selenite triglycerides as a source of selenium added for nutritional purposes to food supplements

© 2020 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.Peer reviewedPublisher PD

Safety of astaxanthin for its use as a novel food in food supplements

Peer reviewedPublisher PD

Conflict in pedestrian networks

Encouraging pedestrian activity is increasingly recognised as beneficial for public health, the environment and the economy. As our cities become more crowded, there is a need for urban planners to take into account more explicitly pedestrian needs. The term that is now in use is that a city should be ‘walkable’. For route planning, whereas much attention has been given to shortest path, in distance or time, much less attention has been paid to flow levels and the difficulties they pose on the route. This paper considers problems posed by conflicting paths, for example cross-traffic. We use network centrality measures to make a first estimate of differing levels of conflict posed at the network nodes. We take special note of the role of collective motion in determining network usage. A small case study illustrates the method