Introduction Preterm births account for disproportionately high healthcare costs, in large part due to expenses related to length of stay in the hospital neonatal intensive care unit (NICU). It is common for preterm infants to receive human milk fortifier (HMF) while in the NICU. Liquid HMF is available in both acidified and non-acidified formulations. A recent randomized clinical trial found that acidified HMF is associated with an increased incidence of metabolic acidosis, which may contribute to increased costs and longer NICU length of stay. Objective The present study is a secondary analysis of these data, seeking to determine whether additional factors contribute to metabolic acidosis, whether metabolic acidosis is associated with longer hospital length of stay, and whether these associations contribute to the burden of hospital costs. Methods The study sample consisted of 152 infants who were hospitalized in US NICUs. Multiple logistic regression was used to model the NICU length of stay. Data from the 2012 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) were used to calculate the average cost (charge) per day in a NICU. Costs (charges) were adjusted to $US, year 2018 values, using the health Consumer Price Index. Result Results indicated that acidified HMF was a strong predictor of metabolic acidosis, more so than gestational age or birth weight. Furthermore, metabolic acidosis was associated with incremental NICU costs (charges) of $US19,002 ($US65,462) per infant and longer NICU LOS. Conclusion Future studies should further investigate factors that contribute to NICU length of stay and associated costs of care. Trial Registration ClinicalTrials.gov: NCT02307760.
The purpose of this study was to describe changes in hearing, using the permanent threshold shift metric, among United States Air Force servicemembers, including active duty, Reserve and Air National Guard components, for demographics, job categories, and career fields. In the United States Air Force, only servicemembers who are occupationally exposed routinely to hazardous noise are monitored. Audiogram records and demographic variables were analyzed for servicemembers from 2005-2011 using data from the Department of Defense system that captures occupational hearing tests worldwide. Results suggest that occupational hearing loss was larger in males than females, in officers than enlisted populations, and in Reserve and Air National Guard than in active duty. Compared to similar civilian career fields, active duty has lower prevalence rates for occupational hearing loss overall, although Reserve and Air National Guard prevalence rates were more similar to the civilian reported rates. The proportion of personnel with permanent threshold shifts varied between 4.6-16.7% within active duty career fields, which includes 76% of the population for study timeframe. Permanent threshold shift was larger in small job categories, and in jobs that are not considered exposed to hazardous noise routinely which is comparative with results from civilian data analysis of occupational hearing loss. Further investigation into testing practices for Air Force specific groups, use of the system for nonoccupational hearing testing, and challenges to follow-up compliance is warranted. Increased surveillance procedures for occupational hearing loss are needed to address concerns on the prevalence of servicemember hearing loss, the role of recreational and lifestyle factors to contribute the high reported hearing loss prevalence of veterans compared to nonveterans.
Opioid-related oversedation events decreased over the course of the study. Because the perioperative period is an especially likely time for opioid oversedation events, strict opioid prescribing practices, while maintaining adequate pain control and improved sedation assessment during the perioperative period, were emphasised. The restructured pain service and increased visits by pain team experts were also associated with the reduction in oversedation events.
Poor nutrition is linked to frailty and both poor nutrition and frailty are recognized risk factors for falls. This study examined the association between dietary protein intake and subsequent reported falls in community-dwelling older Americans with a history of falls. Other nutritional, functional, and sociodemographic-related variables were also considered in our model. This was a retrospective analysis using data from the U.S. Health and Retirement Study (HRS) and Health Care and Nutrition Study (HCNS), both funded by the U.S. National Institute on Aging. The study population (n=3,859) was community-dwelling older adults, aged >65 years, who reported ever experiencing a fall on the 2012 HRS and had also completed the 2013 HCNS and 2014 HRS. Univariable logistic models were created for all Keywords Very low protein intake; subsequent falls; community living older adults; HRS
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