Introduction: Early detection of Alzheimer's disease and related dementias allows clinicians and patients to prepare for future needs and identify treatment options. Medicare's Annual Wellness Visit (AWV) requires detection of cognitive impairment and may increase dementia diagnosis. We estimated the relationship between AWV receipt and incident dementia.
Methods: Using a retrospective cohort of Medicare Fee-For-Service (FFS) beneficiaries enrolled for at least 3 years from 2009 to 2016 and two-stage least squares, we quantified the relationship between AWV and incident diagnosis of cognitive impairment/dementia, and by race/ethnicity. The county-level change in percent of beneficiaries receiving AWVs was used as an instrumental variable to account for unobserved factors associated with individuals' AWV receipt and diagnosis. Sample included 3,333,617 beneficiaries ages 67 years and older, without dementia at the beginning of the study.
Results: Beneficiaries included 2,713,573 White, 251,958 Black, 196,845 Hispanic, 95,719 Asian, 11,727 American Indian/Alaska Native, and 63,795 of other race/ethnicity. Using ordinary least squares, dementia incidence was -0.79 percentage points (95% CI -0.81 to -0.76) lower for persons receiving an AWV compared to no AWV. Using instrumental variables reversed the direction of the effect: AWV receipt increased dementia diagnoses by 0.47 percentage points (95% CI 0.14 to 0.80), 15% over baseline. AWVs increased diagnoses 2.0 percentage points (95% CI 0.05 to 3.94) among Blacks, 0.40 percentage points (95% CI 0.05 to 0.75) among Whites, but est were imprecise for Hispanics and Asians.
Discussion: Increasing AWV take-up and supporting physicians' performance of cognitive assessment may further improve dementia detection in the population and among groups at higher risk of undiagnosed dementia.
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http://dx.doi.org/10.1002/dad2.12357 | DOI Listing |
Int J Life Cycle Assess
March 2024
Center for Environmental Solutions and Emergency Response, US Environmental Protection Agency, Cincinnati, OH, USA.
Purpose: Limited availability of life cycle assessment (LCA) data poses a significant challenge to its mainstream adoption, rendering it a central issue within the LCA community. The Global LCA Data Access (GLAD) network aims to increase the accessibility and interoperability of LCA data and offers benefits for different use cases. GLAD is an intergovernmental collaboration involving different stakeholders organized into working groups.
View Article and Find Full Text PDFCureus
December 2024
Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, GBR.
Adult intussusception is an uncommon condition that constitutes a small percentage of cases of bowel obstruction in adults. Unlike its paediatric counterpart, it is often linked to an underlying pathology, necessitating surgical interventions for diagnosis and treatment. This report discusses a case involving a 54-year-old woman who presented with symptoms of small bowel obstruction, including abdominal pain, nausea, and constipation, along with a one-month history of weight loss.
View Article and Find Full Text PDFJ Subst Use Addict Treat
December 2024
Mathematica, Inc., 1100 1st Street, NE, 12th Floor, Washington, DC 20002, United States of America. Electronic address:
Introduction: To examine if Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) practices had a greater decrease in the potential overuse of prescription opioids relative to beneficiaries attributed to other primary care practices. Primary care practices that participated in CPC+ received enhanced Medicare payment to support five functions: access and continuity of care, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health. CPC+ practices participated within two tracks starting in 2017; Track 2 practices received larger payments to support more enhanced care delivery than Track 1 practices.
View Article and Find Full Text PDFPol J Vet Sci
June 2024
Department of Animal Biochemistry and Biotechnology, University of Warmia and Mazury in Olsztyn, Oczapowskiego 5, 10-718 Olsztyn-Kortowo, Poland.
The aim of this study was to evaluate the quality parameters and selected biochemical markers of canine semen sampled at 24-h intervals over a period of 5 days, preceded by 6 months of sexual abstinence. Full ejaculates were obtained from 6 dogs. Ejaculate volume and total sperm counts in the ejaculate decreased gradually on successive sampling days.
View Article and Find Full Text PDFIndian J Orthop
January 2025
Department of Orthopaedics, Apollo Hospitals, Greams Road, Chennai, 600006 India.
Background: Ultracongruent (UC) total knee replacement (TKR) designs, serving as alternatives to posterior stabilized (PS) and cruciate retaining (CR) designs, lack conclusive evidence regarding posterior femoral rollback. This study aimed to compare intraoperative posterior femoral rollback and maximal knee flexion between UC and PS inserts, addressing the paucity of literature on femoral rollback achieved with UC designs in total knee replacement.
Methods: A consecutive cohort of 20 patients undergoing robotic-assisted primary total knee replacement, posterior femoral rollback and maximal intraoperative knee flexion were assessed.
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