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Howell C, Lane A, Weinkauf C, Armstrong DG, Arias JC, Tan TW. Interruption of Insurance Coverage and the Risk of Amputation in Patients with Pre-Existing Commercial Health Insurance and Peripheral Artery Disease. Ann Vasc Surg 2023; 96:284-291. [PMID: 37023922 DOI: 10.1016/j.avsg.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/24/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is linked with an increased risk of lower extremity amputation and multiple socioeconomic factors attenuate this risk. Prior studies have demonstrated increased rates of amputation in PAD patients with suboptimal or no insurance coverage. However, the impact of insurance loss in PAD patients with pre-existing commercial insurance coverage is unclear. In this study, we evaluated the outcomes of PAD patients who lose commercial insurance coverage. METHODS The Pearl Diver all-payor insurance claims database was used to identify adult patients (>18 years) with a PAD diagnosis from 2010 to 2019. The study cohort included patients with pre-existing commercial insurance and at least 3 years continuous enrollment after diagnosis of PAD. Patients were stratified based on whether they had an interruption of commercial insurance coverage over time. Patients who transitioned from commercial insurance to Medicare and other government-sponsored insurance during follow up were excluded. Adjusted comparison (1:1 ratio) was performed using propensity matching for age, gender, the Charlson Comorbidity Index (CCI), and relevant comorbidities. The main outcomes were major amputation and minor amputation. Cox proportional hazards ratios and Kaplan-Meier estimate were used to examine the association between loss of insurance and outcomes. RESULTS Among the 214,386 patients included, 43.3% (n = 92,772) had continuous commercial insurance coverage and 56.7% (n = 121,614) had interruption of coverage (transition to uninsured or Medicaid coverage) during follow up. In the crude cohort and matched cohort, interruption of coverage was associated with lower major amputation-free survival on Kaplan Meier estimate (P < 0.001). In the crude cohort, interruption of coverage was associated with 77% increased risk of major amputation (OR 1.77, 95% CI 1.49-2.12) and a 41% high risk of minor amputation (OR 1.41, 95% CI 1.31-1.53). In the matched cohort, interruption of coverage was associated with 87% increased risk of major amputation (OR 1.87, 95% CI 1.57-2.25) and a 104% increased risk of minor amputation (OR 1.47, 95% CI 1.36-1.60). CONCLUSIONS Interruption of insurance coverage in PAD patients with pre-existing commercial health insurance was associated with increased risks of lower extremity amputation.
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Affiliation(s)
- Caronae Howell
- Division of Vascular Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - Adelina Lane
- University of Arizona College of Medicine, Tucson, AZ
| | - Craig Weinkauf
- Division of Vascular Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA
| | - Juan C Arias
- Division of Vascular Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA.
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Arias JC, Ramos MI, Cubillas JJ. Predicting emergency health care demands due to respiratory diseases. Int J Med Inform 2023; 177:105163. [PMID: 37517299 DOI: 10.1016/j.ijmedinf.2023.105163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Timely care in the health sector is essential for the recovery of patients, and even more so in the case of a health emergency. In these cases, appropriate management of human and technical resources is essential. These are limited and must be mobilised in an optimal and efficient manner. OBJECTIVE This paper analyses the use of the health emergency service in a city, Jaén, in the south of Spain. The study is focused on the most recurrent case in this service, respiratory diseases. METHODS Machine Learning algorithms are used in which the input variables are multisource data and the target attribute is the prediction of the number of health emergency demands that will occur for a selected date. Health, social, economic, environmental, and geospatial data related to each of the emergency demands were integrated and related. Linear and nonlinear regression algorithms were used: support vector machine (SVM) with linear kernel and generated linear model (GLM), and the nonlinear SVM with Gaussian kernel. RESULTS Predictive models of emergency demand due to respiratory disseases were generated with am absolute error better than 35 %. CONCLUSIONS This model helps to make decisions on the efficient sizing of emergency health resources to manage and respond in the shortest possible time to patients with respiratory diseases requiring urgent care in the city of Jaén.
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Affiliation(s)
- J C Arias
- Group TIC-144 of the Andalusian Research Plan, University of Jaen, Spain
| | - M I Ramos
- Department of Cartographic, Geodetic and Photogrammetric Engineering, University of Jaen, Spain.
| | - J J Cubillas
- Department of Information and Communication Technologies applied to Education, International University of La Rioja, Spain
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Restrepo JM, Torres-Canchala L, Bonventre JV, Arias JC, Ferguson M, Villegas A, Ramirez O, Filler G. Urinary KIM-1 is not correlated with gestational age among 5-year-old children born prematurely. Front Pediatr 2023; 11:1038206. [PMID: 37020658 PMCID: PMC10067877 DOI: 10.3389/fped.2023.1038206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/25/2023] [Indexed: 04/07/2023] Open
Abstract
Background Preterm birth is associated with decreased nephron endowment. Currently, there is no reliable non-invasive biomarker to identify or monitor decreased nephron number in at-risk patients. Urinary Kidney Injury Molecule-1 (KIM-1) is a biomarker of acute and chronic renal injury. We measured urinary KIM-1 among a wide array of other potential biomarkers. Methods We conducted an ambispective cohort study of 5-years-old children born prematurely and healthy controls identified from city schools. Detailed anthropometrics, renal ultrasound dimensions, and biochemical parameters were measured. Urinary KIM-1 was measured using Luminex® technology. Age independent z-scores were calculated and compared. Spearman correlations were used for estimating the association between measures and KIM-1. Results We enrolled 129 children, 97 (75.2%) born pre-term and 32 (24.8%) healthy controls born at full-term. Pre-term patients had significantly lower weight and body surface area than controls. Pre-term patients and controls did not differ in current age, sex, race, height, blood pressure, urinary sodium, fractional sodium excretion, serum creatinine and estimated GFR. All spearman correlation between KIM-1 and gestational age, renal and serum measurements were weak without statistical significance. Conclusion In 5-year-old children born prematurely, KIM-1 was not correlated with gestational age. Further prospective studies need to confirm this finding.
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Affiliation(s)
- Jaime M. Restrepo
- Pediatric Nephrology Service, Fundación Valle del Lili, Cali, Colombia
| | - Laura Torres-Canchala
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Correspondence: Laura Torres-Canchala ;
| | | | | | - Michael Ferguson
- Pediatric Nephrology Service, Boston Children Hospital, Boston, United States
| | - Adriana Villegas
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili, Cali, Colombia
| | - Oscar Ramirez
- Department of Pediatrics, Centro Médico Imbanaco de Cali, Cali, Colombia
- Fundación POHEMA, Cali, Colombia
| | - Guido Filler
- TheLilibeth Caberto Kidney Clinical Research Unit, Western University, London, ON, Canada
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Arias JC, Edwards M, Vitali F, Beach TG, Serrano GE, Weinkauf CC. Extracranial carotid atherosclerosis is associated with increased neurofibrillary tangle accumulation. J Vasc Surg 2022; 75:223-228. [PMID: 34478810 PMCID: PMC8976507 DOI: 10.1016/j.jvs.2021.07.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to determine whether extracranial carotid atherosclerotic disease (ECAD) is associated with increased key neurodegenerative pathology such as neurofibrillary tangle (NFT), beta-amyloid plaque, or cerebral amyloid angiopathy (CAA) accumulation, findings associated with Alzheimer's disease (AD) and other dementias. METHODS Our prospective, longitudinal, clinicopathologic study, the AZSAND (Arizona study of aging and neurodegenerative disorders) and Brain and Body Donation Program, recorded the presence or absence of clinically diagnosed ECAD and performed semiquantitative density estimates of NFT, beta-amyloid plaque, and CAA at death. After adjusting for potential confounding factors determined by logistic regression analysis, histopathology density scores were evaluated in individuals with ECAD (n = 66) and those without ECAD (n = 125). RESULTS We found that the presence of ECAD was associated with a 21% greater NFT burden at death compared with no ECAD (P = .02). Anatomically, an increased NFT burden was seen throughout the brain regions evaluated but was significant in the temporal lobe (P < .05) and entorhinal cortex (P = .02). In addition, we found that subjects who had undergone carotid endarterectomy (CEA), the surgical treatment of ECAD (n = 32), had decreased NFT densities compared with those with ECAD who had not undergone CEA (n = 66; P = .04). In contrast to NFT, ECAD was not associated with beta-amyloid plaques or CAA density. CONCLUSIONS These findings indicate that ECAD is associated with the NFT burden in the temporal lobe and entorhinal cortex, which has clinical significance for AD and non-AD dementias and cognitive dysfunction. Further understanding of whether ECAD increases the risk of neurodegenerative brain changes is highly relevant because ECAD is a treatable disease that has not, otherwise, been evaluated for nor specifically treated as a dementia risk factor.
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Affiliation(s)
- Juan C. Arias
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Mark Edwards
- Department of Surgery, University of Arizona, Tucson, Arizona, USA
| | - Francesca Vitali
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA.,Department of Neurology; University of Arizona College of Medicine, Tucson, Arizona, USA.,Center for Biomedical Informatics and Biostatistics; University of Arizona, Tucson, Arizona, USA
| | - Thomas G. Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
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Lovo EE, Campos FJ, Caceros VE, Minervini M, Cruz CB, Arias JC, Reyes WA. Automated Stereotactic Gamma Ray Radiosurgery to the Pituitary Gland in Terminally Ill Cancer Patients with Opioid Refractory Pain. Cureus 2019; 11:e4811. [PMID: 31403008 PMCID: PMC6682389 DOI: 10.7759/cureus.4811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction We report our initial series of terminally ill cancer patients treated with radiosurgery to the pituitary gland to alleviate pain. Methods A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioid-refractory pain deriving from cancer. Results From November 2016 to November 2018, 11 patients were treated, and 10 were eligible for follow-up evaluation. Pain from bone metastases was present in 70%; others suffered from neuropathic and visceral pain. The median survival was 119.7 days (range: 32 to 370). The visual analogue scale (VAS) was nine (7-10) and standardized to 10; eight patients (80%) responded. The average VAS at the time of response was three (range: 1-6), and the average time to response was 2.8 days (range: 2-5). In the first week, 40% of the patients categorized the result as 'excellent', 30% deemed the result 'good', and 20% reported the result as 'poor'. One patient (10%) referred to the result as 'regular'. Those who responded were able to reduce their medications by at least 25%. The one-month average VAS score was five (range: 1-6), 60% reported a 'good' effect, 20% reported 'excellent' results, and 20% had no response. Of the study participants, 60% maintained their level of medicine consumption at lower than baseline. At the end of life, five patients (50%) presented substantial pain, two (20%) never had a therapeutic effect, and three (30%) died without substantial pain. There were no clinical complications that could be attributed directly to the treatment. Conclusion Radiosurgery to the pituitary gland is effective and safe and warrants further investigation to understand its potential role in palliative care in cancer patients.
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Affiliation(s)
- Eduardo E Lovo
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Fidel J Campos
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Victor E Caceros
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
| | - Mario Minervini
- Neurosurgery, International Cancer Center, San Salvador, SLV
| | - Claudia B Cruz
- Pain Management, International Cancer Center, San Salvador, SLV
| | - Juan C Arias
- Pallative Care, International Cancer Center, San Salvador, SLV
| | - William A Reyes
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Vázquez M, Santos E, Rodriguez I, Pato A, Vilar M, Arias JC, Fernández R, Costas I, Ghioldi A, Sanmartin M, Tardáguila F. Valoración mediante resonancia magnética cerebral de embolias clínicamente silentes en pacientes con fibrilación auricular sometidos a cardioversión eléctrica. Rev Esp Cardiol 2012; 65:139-42. [DOI: 10.1016/j.recesp.2011.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/17/2011] [Indexed: 11/16/2022]
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Borron SW, Arias JC, Bauer CR, Philbeck T, Hass P, Lawson W, Montez D, Fernández M, Jung I, Gordon DJ. Intraosseous line placement for antidote injection by first responders and receivers wearing personal protective equipment. Am J Emerg Med 2011; 29:373-81. [DOI: 10.1016/j.ajem.2009.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 10/22/2009] [Accepted: 10/24/2009] [Indexed: 11/24/2022] Open
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Borron SW, Arias JC, Bauer CR, Sanchez M, Fernández M, Jung I. Hemodynamics after intraosseous administration of hydroxocobalamin or normal saline in a goat model. Am J Emerg Med 2009; 27:1065-71. [DOI: 10.1016/j.ajem.2008.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/15/2008] [Indexed: 11/26/2022] Open
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Borron SW, Arias JC. Carbon monoxide-induced status epilepticus in an adult. J Burn Care Res 2008; 29:559. [PMID: 18388563 DOI: 10.1097/bcr.0b013e318171133b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Arias JC. [Scientific preoccupation in 18th-century Spain]. Cuad Hist Esp 2001; 43-44:374-84. [PMID: 11675745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Cortina A, Reguero J, Segovia E, Rodríguez Lambert JL, Cortina R, Arias JC, Vara J, Torre F. Prevalence of heart failure in Asturias (a region in the north of Spain). Am J Cardiol 2001; 87:1417-9. [PMID: 11397369 DOI: 10.1016/s0002-9149(01)01568-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- A Cortina
- Division of Cardiology, Hospital Central de Asturias, Oviedo University, Asturias, Spain.
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Rubín JM, de la Tassa CM, Arias JC. Cisapride can make Prinzmetal angina worse. Int J Cardiol 1998; 65:315-6. [PMID: 9740492 DOI: 10.1016/s0167-5273(98)00113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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