Health surveys generally rely on an omnibus income measure and analysts should be aware that the income estimates derived from it are limited with respect to poverty determination, and the related concept of eligibility estimation. Analysts of health surveys should also consider matching respondents or multiple imputation to improve the usability of the data.

The Robert Wood Johnson Foundation.

Very low-carbohydrate (VLC) diet with intermittent fasting (IF) have been shown to improve glycemic control and promote weight loss. However, their sustainability beyond 12 months has yet to be shown. This observational study aimed to assess sustainable weight loss and improvement in metabolic profile with such strategy in a self-motivated cohort. Subjects were recruited from a social media-based group who had to be on VLC±IF. Participants completed a questionnaire through on online survey tool. Participants voluntarily provided laboratory data pre-and post-lifestyle intervention. 63 patients participated in the study. Mean length on the diet was 35.8 months. Mean weight loss was 16.1 kg (|Z|-value 4.13, p<.0001). 53/63 (84.1%) respondents practiced IF. 18/63 (28.6%) reported fasting for 16 hours and eat within an 8-hour window whereas 15/63 (23.8%) reported fasting for 18 hours and eat within a 6-hour window. Mean carbohydrate intake was 10%. Change in mean glucose level was from 121.6 mg/dl to 90.4 mg/dl (|Z|-value 3.08, p 0.0034) and hemoglobin A1c from 6.87% to 5.2% (|Z|-value 3.96, p .0002). Triglycerides level showed reduction from 159.4 mg/dl to 98.4 mg/dl (|Z|-value 3.39, p 0.0012). HDL levels increased from 50.2 mg/dl to 66.9 mg/dl (|Z|-value 3.46, p<0.001) whereas total cholesterol level and LDL level increased from 206.3 mg/dl to 236 mg/dl (|Z|-value 1.94, p 0.0561) and from 138.4 mg/dl to 156.4 mg/dl (|Z|-value 1.68, p 0.0977) respectively. Participation of social media-based support group provides a unique opportunity to study the effects of different dietary and fasting approaches in real-world situations and is more likely to indicate the durability of such approaches. Although observational in nature with the caveat of self-reporting, the results are promising and call for larger, randomized trials.

Objective. To examine the impact of full‐year versus intermittent public and private health insurance coverage on the immunization status of children aged 19–35 months. Data Source. 2001 State and Local Area Integrated Telephone Survey's National Survey of Children with Special Health Care Needs (NS‐CSHCN) and the 2000–2002 National Immunization Survey (NIS). Study Design. Linked health insurance data from 2001 NS‐CSHCN with verified immunization status from the 2000–2002 NIS for a nationally representative sample of 8,861 nonspecial health care needs children. Estimated adjusted rates of up‐to‐date (UTD) immunization status using multivariate logistic regressions for seven recommended immunizations and three series. Principal Findings. Children with public full‐year coverage were significantly more likely to be UTD for two series of recommended vaccines, (4:3:1:3) and (4:3:1:3:3), compared with children with private full‐year coverage. For three out of 10 immunizations and series tested, children with private part‐year coverage were significantly less likely to be UTD than children with private full‐year coverage. Conclusions. Our findings raise concerns about access to needed immunizations for children with gaps in private health insurance coverage and challenge the prevailing belief that private health insurance represents the gold standard with regard to UTD status for young children.

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Objective Hepatitis E virus (HEV) seropositivity may confer an increased risk of liver fibrosis in immunosuppressed individuals. We studied this effect in HIV-infected individuals in Nepal, a country hyperendemic for HEV. Participants and methods We prospectively evaluated 200 HIV-positive individuals. Serum samples were tested for components of fibrosis scores and cytokeratin-18. Results Of 200 patients, 43% were HEV-immunoglobulin G+. The mean fibrosis-4 score was 8.02 in the HEV-positive and 1.17 in the HEV-negative group (P<0.001). The mean nonalcoholic fatty liver disease score was 2.12 in the HEV-positive and −2.53 in the HEV-negative group (P=0.02). The mean aminotransferase-platelet ratio index score was 0.37 in the HEV-positive and 0.38 in the HEV-negative group (P=0.9). The mean cytokeratin-18 levels were 119.9 in the HEV-positive group and 158.6 in the HEV-negative group (P=0.08). Conclusion We found higher fibrosis-4 and nonalcoholic fatty liver disease scores in HEV-HIV-positive individuals, suggesting an increased liver fibrosis profile in this group. Further studies using liver stiffness measurements should be carried out.

Background Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV)-infected individuals. Aims To evaluate HBV-vaccine response and identify possible factors that may contribute to lower vaccine efficacy in patients infected with HCV. Methods We retrospectively evaluated all patients with chronic HCV infection at Hennepin County Medical Center, in Minneapolis, Minnesota, between 2002 and 2018. We addressed laboratory, liver-related, virus-related as well as vaccine-related variables, and their association to HBV vaccine response. Differences were tested using either a Chi-squared test or a T test to compare means between the two populations. Multivariate regression was modeled as a logistic regression. Results 1506 patients were evaluated, of which 525 received appropriate HBV vaccination and were assessed for response. Among those, 79% were vaccine responders and 21% were nonresponders. On multivariate analysis, cirrhosis was associated with lower response to the vaccine (OR 0.6, CI 0.44-0.94). We found no significant differences for vaccine response in relation to smoking (87% vs 86%), IV drug abuse (74% vs 72%), Diabetes Mellitus (26% vs 22%) being on hemodialysis (2% vs.5%), or virus related variables.

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