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The travel health insurance has exclusions of benefits that limit insurance coverage and can jeopardize the purpose of the contract. The Federal Court of Justice (BGH) confirmed in a ruling on 10. 7. 2024 the control of benefit exclusions. The ruling deals with recourse claims of a foreign travel health insurer against another insurer after the settlement of an insurance claim. It concerns the effectiveness of an exclusion of benefits for medical treatment costs in the case of a pre-existing medical condition. The BGH declared the clause invalid because it is opaque and unreasonably disadvantages the policyholder. This has implications for multiple insurance coverage and recourse claims. [Extracted from the article]

Objective: Respiratory syncytial virus (RSV) is the primary etiology of lower respiratory tract infection in children. The fluctuating incidence of RSV, particularly in light of the COVID-19 pandemic, has shifted the spotlight onto preventive strategies. Our study aims to investigate both the risk factors and clinical symptoms of RSV. Materials and methods: From February 2015 to February 2023, samples were analyzed during all seasons to identify viral respiratory infections. RSV was identified in a total of 835 individuals. Results: In 2021, following the easing of limitations after the COVID-19 pandemic, the largest number of identified cases was recorded. January was the most commonly used month. The median age were 5 months (min-max: 1-204 months) and 128 (17.7%) cases had a history of prematurity. Around 24.7% of the patients had a preexisting medical condition. Neurological disease patients were followed up in the intensive care unit more often than others (53.3 vs. 35.8% p = 0.036). While the hospital stay of pediatric patients born under the 29th week of gestation is almost twice as long compared to other groups, the hospital stay is almost twice as long as that of patients between 29 and 32 weeks. (p = 0.046, p = 0.012 respectively). Conclusion: RSV was a powerful companion during the pandemic and a persistent reminder of its severity. Our initial data suggest that RSV prevention is difficult for children with pre-existing diseases, notably neurological abnormalities, who are not advised for preventive treatments. Given this outcome, late-premature newborns and children with medical issues should receive RSV prophylaxis first. [ABSTRACT FROM AUTHOR]

Introduction: Serum levels of interleukin-6 (IL-6) are increased in COVID-19 patients. IL-6 is an effective therapeutic target in inflammatory diseases and tocilizumab, a monoclonal antibody that blocks signaling via the IL-6 receptor (IL-6R), is used to treat patients with severe COVID-19. However, the IL-6R exists in membrane-bound and soluble forms (sIL-6R), and the sIL-6R in combination with soluble glycoprotein 130 (sgp130) forms an IL-6-neutralizing buffer system capable of neutralizing small amounts of IL-6. Methods: In this study, we analyzed serum levels of IL-6, sIL-6R and sgp130 in the serum of COVID-19 convalescent individuals with a history of mild COVID-19 disease and in acute severely ill COVID-19 patients compared to uninfected control subjects. Furthermore, we used single cell RNA sequencing data in order to determine which immune cell types are sources and targets of the individual cytokines and whether their expression is altered in severe COVID-19 patients. Results: We find that sIL-6R levels are not only increased in acute severely ill patients, but also in convalescents after a mild COVID-19 infection. We show that this increase in sIL-6R results in an enhanced capacity of the sIL-6R/sgp130 buffer system, but that significantly enhanced free IL-6 is still present due to an overload of the buffer. Further, we identify IL-6 serum levels, age and the number of known pre-existing medical conditions as crucial determinants of disease outcome for the patients. We also show that IL-11 has no major systemic role in COVID-19 patients and that sCD25 is only increased in acute severely ill COVID-19 patients, but not in mild convalescent individuals. Discussion: In conclusion, our study shows long-lasting alterations of the IL-6 system after COVID-19 disease, which might be relevant when applying anti-IL-6 or anti-IL-6R therapy. [ABSTRACT FROM AUTHOR]

Background Since the transcatheter valve-in-valve (ViV) procedure was introduced in 2007, a few cases of infective endocarditis (IE) following the ViV procedure have been reported, which can be predisposed by older age, pre-existing medical conditions, and procedural techniques. Paravalvular abscesses constitute a rare complication of IE, resulting from extending IE beyond the valve annulus, less commonly caused by Klebsiella species. This complication is more common in prosthetic valves, particularly bioprosthetic valves. Case summary We describe a 75-year-old woman with Churg–Strauss syndrome and diabetes mellitus who underwent surgical replacement of bioprosthetic aortic and mitral valves 11 years ago. One year ago, she had a transcatheter mitral ViV procedure due to bioprosthetic mitral valve degeneration. The patient was referred to our centre with fatigue and fever, alongside elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Blood and urine cultures tested positive for Klebsiella oxytoca. Echocardiographic assessments revealed a paravalvular abscess (13 × 8 mm) in the posterolateral side of the bioprosthetic mitral valve, fistulized into the left ventricle. The patient received treatment with vancomycin, meropenem, and colistin and was a candidate for surgery. Eleven days after the patient's admission, she passed away. Discussion This study underscores the novelty of IE complicated with paravalvular abscess following the ViV procedure. In such cases, a multidisciplinary approach and timely surgical interventions are crucial for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: With the population of Australians aged 85 or older expected to double by 2042 and the association of increased age with the greater likelihood of having medical conditions, the potential for an increase in the number crashes caused by medical conditions is of concern. This study aims to understand the prevalence of medical conditions contributing to road crashes and the characteristics of these crashes, in order to guide development of strategies to mitigate the risks and harms involved. Method: The sample consisted of 1,934 active road users (drivers, motorcyclists, cyclists, pedestrians) injured in crashes on South Australian roads who were admitted to the Royal Adelaide Hospital over the period 2014 to 2017. Results: The findings indicate that 9.2% of hospital admission cases were directly caused by a medical condition or acute medical event, with loss of consciousness, attempted suicide, and seizures the most commonly observed. Crashes attributed to a medical condition were more likely to involve older drivers and those with a greater number of preexisting medical conditions. Conclusion: Medical conditions or acute medical events are a significant contributor to road crashes. Common crash types involving medical conditions or events – single vehicle, hit object – indicate that vehicle technologies such as lane keeping assist and autonomous emergency braking, and infrastructure treatments such as roadside barriers, may help to prevent crashes in which a driver experiences a medical event. Monitoring of drivers with medical conditions should continue, while the benefits of social policies that reduce reliance on private motor vehicles for transport should also be explored. [ABSTRACT FROM AUTHOR]

The editorial discusses the challenges in conducting pharmacoepidemiologic research on drug safety during pregnancy, highlighting the historical impact of the thalidomide scandal on clinical trials involving pregnant women. It emphasizes the need for fair inclusion of pregnant women in clinical trials and explores innovative approaches, such as utilizing digital health platforms like social media and pregnancy mobile applications, to collect data on drug utilization and safety during pregnancy. The article concludes by calling for further research to explore the potential of these tools in improving research on maternal and fetal medicine. [Extracted from the article]

Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic process includes a comprehensive patient history, clinical evaluation, laboratory testing, imaging studies, and microbiological investigations. Treatment typically involves joint aspiration and arthroscopy. This study aims to examine and establish correlations between diagnostic criteria and treatment modalities, enhancing the speed and specificity of future therapeutic strategies. Materials and methods: The present study is a retrospective cohort study conducted at a 1200-bed university clinic between 2007 and 2017, with an in-depth examination of patient details, symptoms, treatments, and outcomes. A scoring system was developed to classify the severity of knee joint impairment, categorizing patients on the basis of hospital stay duration, surgeries, and postoperative factors such as recurring symptoms, pain, and range of motion. Results: This study of 116 patients with knee joint infections revealed that clinical symptoms such as pain, swelling, and effusion are common but not definitive for diagnosis. Laboratory analysis revealed no significant differences in CRP or leukocyte counts between cultures positive or negative for pathogens. Hospital stay and disease severity are influenced by factors such as age, sex, presence of polyarthritis, neutrophil count, and type of pathogen, with higher weight and cortisone treatment associated with poorer outcomes. Conclusions: This study highlights the diagnostic challenges in native knee joint infections, revealing the need for comprehensive approaches given the nonspecificity of clinical symptoms and laboratory findings. This underscores the importance of advancing research through standardized methodologies and prospective studies to increase the accuracy of diagnosis and the effectiveness of treatment in this field. [ABSTRACT FROM AUTHOR]

The article explores the impact of traumatic brain injury (TBI) severity on intestinal barrier and gastrointestinal function. TBI can lead to acute gastrointestinal injury (AGI) and systemic effects, affecting patient outcomes. The study analyzed serological markers of intestinal dysfunction in TBI patients and found a correlation between TBI severity and biomarker concentrations. Early recognition and management of intestinal damage in TBI patients could potentially improve outcomes. [Extracted from the article]

Background: The underlying mechanisms of post-COVID syndrome (PCS) are still not fully understood. While pre-existing conditions have been described as a risk factor for severe PCS in the general population, data specific to different occupational groups in this context is lacking. This study aimed to investigate the impact of pre-existing conditions on severe post-COVID syndrome among the occupational group of healthcare and social services employees. Methods: Baseline data from a longitudinal, observational study were analysed. In February 2021, health workers who had a COVID-19 infection in 2020 were surveyed about sequelae of the infection. Factors influencing severe PCS with at least one persistent symptom categorised as severe were subjected to a multivariate logistic regression analysis. Results: Of a total of 2,053 participants, 21.5% had severe PCS. Underlying respiratory (OR 1.94; CI 1.44–2.61), cardiovascular (OR 1.35; CI 1.04–1.77) and urogenital (OR 1.79; CI 1.10–2.91) disease were risk factors for severe PCS overall. Respiratory and mental illnesses had a statistically significant impact on persistent fatigue/exhaustion, concentration/memory difficulties and shortness of breath categorised as severe. Urogenital disease was associated with severe fatigue/exhaustion. Other significant risk factors for severe PCS were female sex, smoking, physical exercise and hospitalisation due to COVID-19 infection. Conclusion: Workers in healthcare and social services with pre-existing conditions may face a higher risk of developing severe PCS. Additional analyses performed as part of the longitudinal study will show if and how this result changes over time. [ABSTRACT FROM AUTHOR]

Failure to use exclusion codes may result in patients being counted against you in quality metrics. [ABSTRACT FROM AUTHOR]

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The study aimed to assess the medical health conditions that could affect oral health care and dental treatment planning among children living in governmental orphanage centers compared to non-orphan children living with their parents. This case-control study included 6- to 12-year-old children residing in five governmental orphanages (cases) matched in gender and age with children living with their parents (controls) in Jeddah, Saudi Arabia. At the scheduled appointment, a trained dentist interviewed the caregiver through a validated Arabic questionnaire consisting of the socio-demographic information of the child and guardian and the medical history of the children. Seventy children in the case group and 155 in the control group were included, with a mean age of 7.47 ± 2.26. Significantly more children living in governmental orphanage centers were diagnosed with medical problems that might affect their dental health, including congenital heart disease (p = 0.029) and mental/cognitive/psychologic and behavioral disorders (p = 0.005). Children living in governmental orphanage centers are more likely to be affected by medical conditions that might impact their dental health care and treatment planning than non-orphan children living with their parents, which calls for special dental care precautions for this population. [ABSTRACT FROM AUTHOR]

The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases. [ABSTRACT FROM AUTHOR]

Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times. [ABSTRACT FROM AUTHOR]

The article "Financial Strain on and Systemic Barriers in Mental Health Treatment" by Michael W. Flores, Ph.D., M.P.H., discusses the challenges faced by individuals with high out-of-pocket spending on outpatient mental health treatment. The study highlights how financial constraints, stagnant wages, and rising costs impact access to mental health care, particularly for low-income individuals. The Affordable Care Act has expanded access to health insurance for low-income individuals, but barriers such as long wait times, limited provider networks, and high out-of-pocket costs still hinder access to mental health services. The article calls for policy changes to address these systemic barriers and promote mental health care as a fundamental right for all individuals. [Extracted from the article]

Objective: To assess the patients for early onset chronic cardiotoxicity who have been taking anthracyclines as part of their cancer treatment. Study Design: Comparative cross-sectional study. Place and Duration of Study: Oncology department, Combined Military Hospital, Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: One hundred patients with solid or hematological malignancies taking anthracyclines for more than three months and less than a year were included in the study. They underwent 2 dimensional echocardiography by consultant cardiac physician to look for cardiotoxicity. Cardiotoxicity was defined as left ventricular ejection fraction less than 60%. Age, gender, duration of anthracyclines use and presence of comorbid illness were correlated with presence of early onset chronic cardiotoxicity in our study participants. Results: Out of 100 cancer patients using anthracyclines for more than three months and less than 12 months included in the study, 55(55%) were males while 45(45%) were females. Sixty-nine (69%) had ejection fraction more than 60% on echocardio-graphy while 31(31%) had <60%. Chi-square test revealed that presence of comorbidities (type 2 DM/ Hypertension) had statistically significant association with presence of cardiotoxicity in our study (p-value 0.002). Conclusion: Cardiotoxicity emerged as a significant adverse effect related to anthracycline use among patients suffering from various types of malignant conditions. Patients with preexisting medical conditions like diabetes or hypertension were more a t risk of developing cardiotoxicity with these agents. [ABSTRACT FROM AUTHOR]

This study examined the strength and durability of antibody responses in 277 adults who received a heterologous third dose of the BNT162b2 vaccine, following two doses of an inactivated vaccine. Neutralizing antibody levels against both the ancestral virus and Omicron BA.2 subvariant decreased from one month to 6 months after the third dose, and were then maintained at 12 months. Participants who received both a fourth dose and reported a SARS-CoV-2 infection had the highest antibody titers at 365 days after the third dose. Individuals with chronic medical conditions had lower antibody levels against the Omicron BA.2 subvariant at 12 months after the third dose. The results suggest that the heterologous third dose provides durable neutralizing antibody responses, which may be influenced by subsequent infection or vaccination and pre-existing medical conditions. These findings may help explain the differences in immune protection between vaccination and natural infection. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease (COVID-19) has infected more than 10 million people globally, and it caused more than 500 thousand deaths. Researchers have highlighted the need for early detection and intervention for psychological ill effect of the pandemic on various population subgroups. Women may be more vulnerable in such a crisis phase. This review addresses the mental health needs of women and the kind of interventions needed to cater to their various psychological issues. All existing literature was searched using PubMed, Google Scholar, and Medline databases for articles published on mental health aspects of women during COVID-19 pandemic. Only English language articles published till June 15, 2020, were considered for the review. Data were extracted by the authors from the selected articles, and the findings were synthesized in a narrative format. From the available literature, following themes were identified for further discussion: sexual health and contraception, pregnancy, lactation, domestic abuse, female healthcare workers, women with pre-existing mental illness, women with substance use disorders, homeless women, refugees, and professional sex workers. Studies have reported a higher burden of mental health issues in females than male counterparts and an increase in domestic violence and crises for those at-risk (such as refugees and women with pre-existing illnesses). Women mental health is compromised in many aspects due to COVID-19 pandemic. Findings stress upon the increased need for early detection and prompt intervention for women in the community to alleviate the long-term psychological consequences of this pandemic. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to get an overview of barriers emerging across the globe from the pandemic that are likely to increase the level of pre-existing disability status of neurologically challenged populations. Database searches (PubMed/MEDLINE, CINAHL, ProQuest, Ovid, Scopus, and Web of Science) updated to December 2020 were conducted. Articles that identified challenges or barriers to neuro-rehabilitation, impact on disability status and health care services were included. Full-text articles limited to the English language with no restrictions on study design were included. Data was synthesized based on recurrent themes that were identified. Thirty-seven studies were included in this review. Neurological populations considered: stroke, multiple sclerosis, amyotrophic lateral sclerosis, parkinson's disease, autism, developmental disabilities, and those who required neurosurgical care. Barriers were grouped into categories as increased disease risk and complications, delayed or restricted access to neuro-rehabilitation, limited hospital access, telerehabilitation limitations, and shutdown of special centers of aid. COVID-19 pandemic has given rise to barriers that affect almost every aspect of healthcare and rehabilitation in neurologically challenged populations prompting an increase in their disability level. This can assist policymakers in designing mitigation strategies to minimize the detrimental effects on this vulnerable population. Pandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations. Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted. Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures. Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease. [ABSTRACT FROM AUTHOR]

Introduction: Women with pre-pregnancy diabetes or pre-pregnancy hypertension have increased risks of complications during pregnancy. Women who obtain prenatal care in the first trimester receive necessary routine testing and disease management tools that aid in controlling such conditions. However, research on the association between pre-pregnancy hypertension and pre-pregnancy diabetes and prenatal care timing among US women is limited. Methods: This study used data from the 2018 National Vital Statistic System (n = 3,618,853). Trained personnel collected information on prenatal care timing, maternal conditions, and demographics. Multivariate logistic regression models evaluated the association between pre-pregnancy hypertension, pre-pregnancy diabetes and prenatal care timing. A stratified analysis was conducted to determine if race/ethnicity modified the associations. Results: After adjustment, women with pre-pregnancy hypertension or pre-pregnancy diabetes had statistically significant increased odds of receiving early prenatal care compared to women without these conditions (OR 1.23; 95% CI: 1.21-1.26 and OR 1.27; 95% CI: 1.24-1.31, respectively). Among non-Hispanic White, non-Hispanic Black, and Hispanic women, those with pre-pregnancy hypertension or pre-pregnancy diabetes had statistically significantly increased odds of receiving early prenatal care compared to women without those pre-existing conditions (P <.001). Discussion: Further research is needed on the transition from preconception care to obstetric care for women with pre-existing diabetes or hypertension. However, these findings suggest that women who have conditions that could cause pregnancy complications are pursuing early prenatal care services to mitigate the development of adverse maternal and infant health conditions. [ABSTRACT FROM AUTHOR]

Background: Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them. Purpose: To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5. Results: The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [ P =.004] and 18 vs 14.5 [ P <.001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [ P =.018] and 62 vs 32 [ P <.001], respectively). Conclusion: During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions. [ABSTRACT FROM AUTHOR]

Background: Kidney cancer is the fastest‐growing cancer diagnosis in the developed world. About 16% of new cases are stage IV, which has a low five‐year survival rate. Many patients with metastatic renal cell carcinoma (mRCC) are older and may have mild cognitive impairment or dementia (MCI/D). Given prior reports of patients with dementia initiating less cancer therapy and the importance of oral anticancer agents (OAAs) in mRCC treatment, we investigated the prevalence of preexisting MCI/D in patients with mRCC and their OAA use. Methods: SEER‐Medicare patients were analyzed who were ≥65 years, diagnosed with mRCC between 2007 and 2015, and had Medicare part D coverage. Patterns and predictors of (a) OAA utilization within the 12 months following mRCC diagnosis and (b) adherence (percent of days covered [PDC] ≥ 80%) during the first 90 days following treatment initiation were assessed. Results: Of the 2792 eligible patients, 268 had preexisting MCI/D, and 907 initiated OAA treatment within 12 months of mRCC diagnosis. Patients with preexisting MCI/D were less likely to begin an OAA than those without MCI/D (fully‐adjusted HR 0.53, 95% CI 0.38–0.76). Among OAA initiators, a preexisting MCI/D diagnosis did not alter the likelihood that a person would be adherent (adjusted RR 0.84, 95% CI 0.55–1.28). Conclusions: Patients with preexisting MCI/D were half as likely to start an OAA during the year following mRCC diagnosis than patients without comorbid MCI/D. The 90‐day adherence of OAA initiators was not significantly different between those with and without preexisting MCI/D. In light of this, clinicians should assess mRCC patients for cognitive impairment and take steps to optimize OAA utilization by those with MCI/D. [ABSTRACT FROM AUTHOR]

Objectives: In January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA.Methods: We identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level [FPL]; middle 139%-400% FPL; and high > 400 FPL).Results: The ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences -$279; 95% confidence interval -$528 to -$29).Conclusions: The ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions. [ABSTRACT FROM AUTHOR]

The article discusses research on reduction of permanent pacemaker (PPM) requirements following concomitant cardiac and ablation surgery for atrial fibrillation (AF). It discusses the variability in the use of PPM implantation with and without surgery for AF and describes the anatomy of the specialized conduction system relevant to concomitant surgery for AF. Ways to avoid PPM implantation after AF surgery include right atrial incision and ablation line placement and rhythm management.

Introduction: Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. Objectives: The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. Methods: Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. Results: The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals. Conclusion: Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients. [ABSTRACT FROM AUTHOR]

Background: Neurological presentations resulting from nitrous oxide (N2O) abuse are increasing in Australia and worldwide. Despite known neuropsychiatric sequelae, N2O canisters remain readily available and its use unregulated. Aims: To examine the demographics, clinical and electrophysiological findings of patients presenting with neurological complications of N2O abuse, and thus inform clinicians and public health decision‐makers of the significant public health concerns of this increasing practice. Methods: Consecutive patients presenting to a tertiary referral metropolitan hospital were included in this series. Patients were identified by a search of discharge summaries of patients admitted with acute or subacute neuropathy or myelopathy and a history of N2O abuse, and from the electrophysiology database. Results: Thirteen patients were identified, most presenting with subacute paraesthesia, sensory ataxia and lower limb weakness. Eleven had low serum vitamin B12. Spinal magnetic resonance imaging was consistent with subacute combined degeneration in eight. Nerve conduction studies revealed a motor or sensorimotor axonal neuropathy (three with motor predominance). There was a bimodal demographic distribution consisting of socially isolated, international university students and local residents with a history of mental illness and polydrug abuse. Conclusions: Recreational N2O use is an emerging health problem in Australia. International university students and patients with pre‐existing mental illness or polydrug use appear to be at increased risk. A severe motor neuropathy may emerge following vitamin B12 replacement. Public health measures are required to limit the availability of N2O and to educate adolescents and young adults about the potential for significant harm. [ABSTRACT FROM AUTHOR]

Mental health disorders are independent risk factors for adverse perinatal and neonatal outcomes. It is estimated that 20% of women may experience symptoms of mental health disorders during or following pregnancy. It is important that obstetricians recognize the presentation of these symptoms and follow pathways for managing these conditions. This article utilizes case vignettes to describe the epidemiology, role of the multi-disciplinary team, clinical presentation, and management of common perinatal mental health disorders both from the obstetric and psychiatric view point. Indications and duration of psychotropic medications including side effects are also discussed as well as safety in pregnancy and lactation. [ABSTRACT FROM AUTHOR]

Objective: Within the last decade, the use of ibrutinib, a first-generation, non-selective, irreversible Burton's tyrosine kinase inhibitor for the treatment of hematological malignancies has proven highly effective in improving patient outcomes. Background: Ibrutinib has been associated with an increase in atrial fibrillation (AF). The predisposing factors are thought to be pre-existing cardiovascular risk factors, but these have not been directly evaluated. Methods: We conducted a nested case-control study, recruiting consecutive ibrutinib treated subjects to evaluate cardiovascular risk factors associated with the development of AF in patients diagnosed with hematological B-cell malignancies. Results: Of the 189 patients treated with ibrutinib and without AF at baseline, 54 (29%) developed AF. Cardiovascular risk factors associated with AF development were, older age, prior hypertension (HTN), history of heart failure (HF) and congenital heart disease. A patient with HF at baseline had a 1, 2, 6, and 12 month cumulative hazard of AF of 40%, 48%, 64%, and 71%, respectively. Patients with prior HTN without HF at baseline had a 1, 2, 6, and 12 month cumulative hazard of AF of 5%, 10%, 23%, and 31%, respectively while on ibrutinib therapy. Conclusions: The relationship between ibrutinib, cardiovascular comorbidities, and AF is through pre-existing cardiovascular disease. An individualized, multidisciplinary approach involving cardiologists should be considered when initiating ibrutinib, particularly when there is a history of HTN, HF or congenital heart disease. In such patients, there should be close cardiovascular monitoring and prompt intervention when AF develops to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Summary: Background. The optimal second and subsequent lines of chemotherapy for patients with non-small cell lung cancer (NSCLC) who have preexisting interstitial lung disease (ILD) are unclear. Hence, we examined the clinical efficacy and safety of second-line chemotherapy in such patients, including any exacerbation of preexisting ILD. Methods. The medical records of patients with NSCLC and preexisting ILD who received both first- and second-line chemotherapy were retrospectively reviewed. Results. Twenty-four patients with a median age of 71 years who were treated between April 2013 and March 2021 were included. The response rate after second-line chemotherapy with S-1 (n = 13), docetaxel (n = 8), pemetrexed (n = 2), or docetaxel plus ramucirumab (n = 1) was 12.5%, with a median progression-free survival (2nd line PFS) of 3.8 months. The overall survival from a start of first-line chemotherapy (1st line OS) and post-progression survival (PPS) post-first-line chemotherapy were 18.7 and 9.7 months, respectively. Spearman rank correlation and linear regression analyses showed that PPS was strongly correlated with 1st line OS (R = 0.85, P < 0.00001). Importantly, the 2nd line PFS was also significantly correlated with 1st line OS (R = 0.71, P = 0.0001). While second-line chemotherapy-related acute exacerbation of ILD was observed in 7 patients (29.2%), there were no treatment-related fatalities. Conslusions. Second-line chemotherapy has a strong positive impact on the OS of patients with NSCLC who have preexisting ILD. Given the findings of this study, second-line chemotherapy may be valuable in terms of prolonging long-term OS. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, South Africa implemented a strict stay-at-home order. The mental health effects of the pandemic and related containment measures are minimally documented in this region. This study examines the association between COVID-19 related stressors and mental health during a strict stay-at-home order in South Africa. A total of 860 self-selected participants residing in the Western Cape province completed an online survey from 20–31 May 2020. This sample consisted mainly of higher socioeconomic and higher educated segments of the population. Structural equation modelling was used to assess how sociodemographic factors, membership of vulnerable groups and COVID-19 related stressors were associated with PHQ-9 (depression) and GAD-7 (anxiety) scores. 46.0% and 47.2% of participants met the diagnostic threshold of anxiety and depressive disorder, respectively. Considerable daily life repercussions were linked to these scores. Among these participants, less than 20% consulted a formal practitioner and this was 12% for participants without a pre-existing mental health condition. Distress related to containment measures and distress about being infected were significantly associated with more anxiety and depressive symptoms. Having a pre-existing mental health condition was associated with poorer mental health, but being an active health worker was not. Younger age, being female, and living in a non-rural area were associated with poorer mental health. Our findings suggest a considerable mental health impact of this pandemic and related containment measures, but low attendance of mental health services. The accessibility to tailored mental health support is essential under these circumstances, especially for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. Aim: To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. Methods: A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. Results: A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant – { r = 0.405, Sig. (two-tailed) = 0.001}. Conclusion: Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms. [ABSTRACT FROM AUTHOR]

Background: Comorbidities increase the risk of death for patients with COVID-19, however, little is known about how it affects the prognosis of migrants who contract the virus. Therefore, this article aims to determine which comorbidities and risk conditions are associated with the probability of death among migrants infected with COVID-19 in Mexico. Methods: We use a sample of migrants with a positive diagnosis for COVID-19 (N = 2126) registered in the public database published in the National Epidemiological Surveillance System of the Mexican Ministry of Health; the technique used was a Probit regression. Results: The findings show that most of the comorbidities commonly associated with death from COVID-19 in the native-born population were actually not significant when present in migrants infected with COVID-19. Additionally, migrants have lower comorbidities than locals. The results further indicate that the factors related to the death of migrants infected with COVID-19 are: age, intubation, nationality group, pneumonia and the Health Care Management of Patients. Conclusions: In contrast to preceding studies with native-born populations with COVID-19, where pre-existing diseases aggravated the diagnosis of COVID-19 and sometimes led to death, in the case of migrants, only pneumonia was the significant comorbidity associated with mortality among migrants diagnosed with COVID-19. [ABSTRACT FROM AUTHOR]

While grief is often perceived as an individual phenomenon, the grievers' family context before and after the death of a family member is always a stage set of their grief reactions. Operating from both meaning reconstruction and systemic perspectives, two case vignettes illustrate how the mourners' grief and adaptation were not only shaped by who they were, by who they lost, and by how they lost the deceased, but also by their familial context. Hence, it is important for grief therapists to process clients' grief with the family system as the holding frame, so as to tackle the stumbling blocks and discover the stepping stones, as they join clients to navigate family complexities in the aftermath of a member's death. [ABSTRACT FROM AUTHOR]