No abstract

The U.S. grants asylum to 60,000-70,000 refugees yearly. However, little is known about their healthcare utilization practices. We examined data from emergency department (ED) and primary care (PC) visits of 694 refugees and 738 non-refugee controls over a 3 years period at a large academic medical center, comparing visit frequencies, Emergency Severity Index (ESI) scores, diagnoses, and dispositions. Refugees used emergency care services less frequently than the non-refugee controls (1.19 vs. 2.31, p < 0.0001) while there was no difference in their use of primary care services (8.45 vs. 9.07, p = 0.18). Non-English-speaking refugees were more likely to use the ED than English-speaking refugees (mean ED use in study period 1.50 visits vs. 0.73, p < 0.0001). Refugee patients utilized emergency services less often compared to controls. These results differ from previously studied refugee populations. Refugee-specific primary care services in this study population may reduce unnecessary ED use.

Abnormalities of mineral bone disorder (MBD) parameters have been suggested to be associated with poor renal outcome in predialysis patients. However, the impact of those parameters on decline in residual kidney function (RKF) is uncertain among incident hemodialysis (HD) patients. We performed a retrospective cohort study in 13,772 patients who initiated conventional HD during 2007 to 2011 and survived 6 months of dialysis. We examined the association of baseline serum phosphorus, calcium, intact parathyroid hormone (PTH), and alkaline phosphatase (ALP) with a decline in RKF. Decline in RKF was assessed by estimated slope of renal urea clearance (KRU) over 6 months from HD initiation. Our cohort had a mean AE SD age of 62 AE 15 years; 64% were men, 57% were white, 65% had diabetes, and 51% had hypertension. The median (interquartile range [IQR]) baseline KRU level was 3.4 (2.0, 5.2) mL/min/1.73 m 2 . The median (IQR) estimated 6-month KRU slope was −1.47 (−2.24, −0.63) mL/min/1.73 m 2 per 6 months. In linear regression models, higher phosphorus categories were associated with a steeper 6-month KRU slope compared with the reference category (phosphorus 4.0 to <4.5 mg/dL). Lower calcium and higher intact PTH and ALP categories were also associated with a steeper 6-month KRU slope compared with their respective reference groups (calcium 9.2 to <9.5 mg/dL; intact PTH 150 to <250 pg/mL; ALP <60 U/L). The increased number of parameter abnormalities had an additive effect on decline in RKF. Abnormalities of MBD parameters including higher phosphorus, intact PTH, ALP and lower calcium levels were independently associated with decline in RKF in incident HD patients.

Purpose: This study explores consumers' perceptions of the Affordable Care Act and its role in facilitating health insurance coverage for all Americans. Moreover, this research also examines how Hispanic consumers along the southern border of the United States and Mexico cope with healthcare related challenges. Design/Methodology: Narrative and observation research methods are employed to understand customers' experiences and emotions regarding healthcare issues. We first read the excerpts to develop an initial understanding of the participants' experience about healthcare. Then narrative analysis was conducted to further deconstruct participants' stories. Findings: Results show that although some Hispanic consumers in the United States hold negative views toward the ACA, they perceive the AHCA as a less favorable alternative. Additionally, the study reveals idiosyncratic coping mechanisms of uninsured Hispanic consumers along the Mexican border. Originality: The study explores new servicescape elements that enhance the services marketing literature related to healthcare.

Regular moderate-vigorous physical activity (MVPA) reduces the risk of cardiovascular and other chronic diseases, among other important benefits at all life stages. It is hypothesized that physical activity may alter disease risk via epigenetic modifications, including potentially long-standing changes in DNA methylation as previous research has shown epigenetic changes following exercise interventions. Most existing reports examine global methylation or study acute exercise effects on DNA methylation. To our knowledge, there are no published epigenome-wide association studies (EWAS) of habitual MVPA. In this analysis, we tested associations between leisure time MVPA and genome-wide variation in CpG methylation, an epigenetic mark, in 2,601 African American participants (1,663 women; mean age 56.6 years) in the Atherosclerosis Risk in Communities (ARIC) study. The Illumina HM450K Bead Chip was used to measure methylation in 471,035 CpG sites in stored frozen leukocyte samples, from visit 2 (1990-1992) or 3 (1993-1995). Linear regression models tested the cross-sectional association of DNA methylation M-value with self-reported leisure time MVPA at the visit of sample collection, modeled as minutes of MVPA per week and by category based on the AHA guidelines for physical activity in adults (none, less than 150, or at least 150 minutes MVPA per week), adjusting for age, sex, body mass index, education, alcohol use in grams per week, smoking status, cancer status, white blood cell count, imputed cell-type proportions using the Houseman method, and batch effects with the top 30 HM450K built-in nonnegative control probe principal components. Three CpGs, cg08269485, cg20272155, and cg08966208, upstream of the cathepsin D encoding gene, CTSD, were observed to be significantly inversely associated (q<0.05, FDR) with MVPA minutes/week. This is a strongly imprinted genomic region (chr11p15.5) and the region has also been reported to include DNA methylation variants that changed in response to an exercise training intervention. Additionally, 163 CpGs that we identified in the literature to be associated with habitual MVPA were also tested using the same models. One CpG, cg07863043, upstream of the adenomatosis polyposis coli gene, APC, in the 5q22.2 genomic region, was observed to be significantly positively associated with achieving at least 150 minutes of MVPA per week compared to none (q=0.0001, FDR). APC encodes a tumor suppressor protein that is an antagonist of the Wnt signaling pathway, and is involved in carcinogenesis and embryonic development. Replication in other populations is ongoing to confirm these findings as well as to identify additional physical activity-related DNA methylation variants.