RESUMEN
BACKGROUND: The aim of the US dialysis Prospective Payment System bundle, launched in January 2011, was reduction and more accurate prediction of costs of services, whilst maintaining or improving patient care. Dialysis facilities could either adopt the bundle completely (100%) in the first year of launch, or phase-in (25%) over four years. Differences in practice patterns and patient outcomes were hypothesized to occur in facilities that phased-in 25% compared to those that did not. METHODS: Data are from STEPPS, a study of 51 small dialysis organization facilities designed to describe trends in dialytic treatment before and after bundle implementation. Baseline was defined as October-December 2010; follow-up as January-December 2011. Facility- and patient-level data were collected at enrollment and regularly thereafter. Cox proportional hazards and linear multi-level models were used to estimate the effect of opting-in 25% (vs. 100%) on practice patterns and clinical outcomes. RESULTS: 12 facilities (patient n = 346) opted-in 25% and 37 facilities (patient n = 1296) opted-in 100% to the dialysis bundle. At baseline, patients at 25% facilities were primarily covered by Medicare, were more likely to be black, and were receiving higher monthly epoetin alfa (EPO) doses. Throughout 2011, patients in 100% facilities received lower monthly EPO doses, and had lower mean hemoglobin concentrations; hospitalization and mortality rates were numerically lower in 25% facilities but not statistically different. CONCLUSIONS: The economic pressure for dialysis providers to work within an expanded composite rate bundle whilst maintaining patient care may be a driver of practice indicator outcomes. Additional investigations are warranted to more precisely estimate clinical outcomes in patients attending facilities enrolling into the bundle 100% relative to the previous fee-for-service framework.
Asunto(s)
Instituciones de Atención Ambulatoria/economía , Anemia/tratamiento farmacológico , Epoetina alfa/uso terapéutico , Hematínicos/uso terapéutico , Fallo Renal Crónico/terapia , Pautas de la Práctica en Medicina , Sistema de Pago Prospectivo , Diálisis Renal/economía , Adulto , Anciano , Anemia/complicaciones , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/mortalidad , Modelos Lineales , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Modelos de Riesgos Proporcionales , Indicadores de Calidad de la Atención de Salud , Diálisis Renal/métodos , Estados UnidosRESUMEN
BACKGROUND: We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). METHODS: Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. RESULTS: Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. CONCLUSION: Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers.
Asunto(s)
Enfermedades de las Arterias Carótidas/epidemiología , Grosor Intima-Media Carotídeo/estadística & datos numéricos , Policia/estadística & datos numéricos , Privación de Sueño/epidemiología , Sueño , Actigrafía , Adulto , Anciano , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/epidemiología , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , New York/epidemiología , Enfermedades Profesionales/epidemiología , Análisis de Regresión , Factores de Riesgo , Autoinforme , Adulto JovenRESUMEN
Given the associations between obesity and cardiovascular disease (CVD), we evaluated a related but less well-established association between waist circumference and brachial artery reactivity (BAR), a functional measurement of subclinical CVD, where lower levels indicate dysfunction. Regression models examined trends in mean BAR across waist circumference tertiles in police officers, a high-stress occupational group with increased risk for CVD. Mean BAR decreased across increasing waist tertiles among men, but not women, and this association was stronger among officers who consumed more alcohol. Larger waist circumference may be associated with lower BAR, providing an opportunity for intervention prior to disease development.
RESUMEN
Our aim was to examine the relationship between the level of the inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and posttraumatic stress disorder (PTSD) symptomology in a random sample of 115 police officers. CRP was measured in citrated plasma using a particle enhanced immunonepholometric assay and IL-6 was measured in serum with a solid-phase quantitative sandwich ELISA. The presence of high PTSD symptomology was defined as having an Impact of Event Scale score (IES) of ≥ 26 compared to<26 (low PTSD symptomology). 28% of the officers had high PTSD symptomology. Mean levels of CRP and IL-6 did not differ significantly between officers with high PTSD symptomology and those with low symptomology (CRP: 0.76 mg/l vs. 0.97 mg/l; IL-6: 2.03 pg/ml vs. 1.74 pg/ml). We found no association of CRP and IL-6 levels with PTSD symptomology. This study was limited by sample size and its cross-sectional study design. A lack of association may occur if either CRP or IL-6 is elevated only at the onset of PTSD symptomology, or if inflammation is related to specific key components that define PTSD. Further research examining these relationships in a larger population may be worthwhile.
Asunto(s)
Proteína C-Reactiva/metabolismo , Ciudades , Interleucina-6/sangre , Policia , Trastornos por Estrés Postraumático/sangre , Adulto , Enfermedades Cardiovasculares/sangre , Demografía , Femenino , Humanos , Masculino , New York , Factores de RiesgoRESUMEN
OBJECTIVE: Police officers were hypothesized to have decreased endothelial function, measured by brachial artery flow-mediated dilation (FMD). METHODS: We compared FMD in police officers (n = 261) and a population sample of men and women (n = 229), all from the same geographical region and free of clinical cardiovascular disease (CVD). RESULTS: Compared with the population sample, police officers had significantly increased age-adjusted CVD risk factors (systolic and diastolic blood pressure, total cholesterol, smoking prevalence, and alcohol consumption). Police officers exhibited lower mean FMD after adjustment for age, gender, and traditional CVD risk factors among those aged 55 years or younger (%dilation: police = 5.49%, population = 6.49%; P = 0.04). CONCLUSIONS: Police officers exhibited decreased endothelial function (lower FMD) compared with the civilian sample, which was not fully explained by traditional CVD risk factors, suggesting that other pathways may contribute to increased CVD risk in law enforcement work.
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Endotelio Vascular/fisiología , Policia , Adulto , Biomarcadores , Enfermedades Cardiovasculares/fisiopatología , Endotelio Vascular/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ultrasonografía , Población UrbanaRESUMEN
PURPOSE: The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study is one of the first population-based studies to integrate psychological, physiological, and subclinical measures of stress, disease, and mental dysfunction. This pilot study was undertaken to establish a methodology and descriptive results for a larger police study. METHODS: A stratified sample of 100 officers was randomly selected from the Buffalo, NY Police Department. Salivary cortisol served as a stress biomarker. Flow mediated dilation (FMD) and carotid intima-media thickness (IMT) were performed with ultrasound. Dual Energy X-Ray Absorptiometry (DEXA) and anthropometric measures assessed body composition. Self-report measures of depression and posttraumatic stress disorder (PTSD) were obtained. RESULTS: Recruitment attained for the study was 100%. Seventy-five percent showed a cortisol increase upon awakening, 90% a negative diurnal slope, and 77% an increased cortisol response after a high protein lunch challenge. Dexamethasone suppression was evident. FMD showed an increase in mean brachial artery diameter of 3.2% in men and 3.9% in women, and mean IMT was lower (male=0.67 mm; female=0.62 mm) compared to populations of similar age. For males, the mean body-mass index (BMI) was 29.8 kg/m2 and total body fat 23.4%. For females, the mean BMI was 26.7 kg/m2 and total body fat 31.5%. For all officers, 16% met criteria for depression; 36% reported elevated PTSD symptoms. CONCLUSIONS: Compared to populations of similar age, police officers had slightly lower FMD, lower carotid IMT, elevated BMI, and higher reported rates of depression and PTSD. Standardized physiological and psychological data collection and descriptive results confirmed that the methodology of the study is feasible in a working police population.