A wireless device for continuous measurement of brain parenchymal resistance tracks glymphatic function in humans.

Glymphatic function in animal models supports the clearance of brain proteins whose mis-aggregation is implicated in neurodegenerative conditions including Alzheimer's and Parkinson's disease. The measurement of glymphatic function in the human brain has been elusive due to invasive, bespoke and poorly time-resolved existing technologies. Here we describe a non-invasive multimodal device for the continuous measurement of sleep-active changes in parenchymal resistance in humans using repeated electrical impedance spectroscopy measurements in two separate clinical validation studies.

Evidence available and used by the Food and Drug Administration for the approval of orphan and nonorphan drugs.

There are substantial financial incentives to develop orphan drugs for rare diseases, but concerns about the quality and volume of supporting evidence have emerged. We compare evidence used to evaluate orphan and nonorphan drugs approved by the Food and Drug Administration (FDA) between 2016 and 2023. This retrospective cross-sectional analysis utilizes FDA data on approvals and study information from ClinicalTrials.

Establishing Clinically Operational Domains of Multidimensional Frailty: A Consensus Approach to Improve Multidimensional Frailty Diagnosis at Point of Care.

Background And Objectives: Frailty is common among older patients; however, there is a lack of agreement on methods to diagnose and monitor frailty at point of care. The purpose of this study was to establish consensus on important, feasible, and usable domains for point-of-care frailty assessment within all conceptual models of frailty.

Research Design And Methods: We reviewed instruments that assess frailty and extracted the domains measured by each tool.

A health-equity framework for tailoring digital non-pharmacological interventions in aging.

If designed with health equity in mind, digital non-pharmacological interventions (NPIs) represent a cost-effective, scalable means of reducing health disparities associated with age-related mental health disorders in older adults in the USA. However, disparities in technological access, literacy and effectiveness can limit the impact of these interventions in older adults from disadvantaged groups. We present a health-equity-promoting framework for the development of digital NPIs for age-related mental health disorders and provide an example from the literature that highlights how interventions can be targeted at specific groups to increase technological access, literacy and effectiveness to ensure that these interventions can meet their potential of reducing health disparities.

A global context for population mental health: Commentary on Dodge et al. (2024).

Dodge et al. (2024) outlined the gap between population mental health needs and the current capacity of the U.S.

Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health.

An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.

Food and Drug Administration novel drug decisions in 2017: transparency and disclosure prior to and 5 years following approval.

The Food and Drug Administration (FDA) approved 46 novel drugs in 2017. We reviewed availability of results prior to and during the 5 years following each approval. Using the FDA website and ClinicalTrials.

An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods.

Background: The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water.

Design And Setting: This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels.

Intervention: The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination.

PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria.

Background: PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL.

Continuous monitoring of eating and sleeping behaviors in the home environments of older adults: a case study demonstration.

Accurate observation of patient functioning is necessary for rigorous clinical research and for improving the quality of patient care. However, clinic or laboratory environments systematically differ from the contexts of everyday life. Further, assessments that are completed in a single institutional session may not be generalizable.

Sickening: who is protecting pharma consumers?

In 2022, John Abramson published Sickening: How Big Pharma Broke American Healthcare and How We Can Repair It. The book illustrates how large pharmaceutical companies have become misinformation machines that have corrupted peer-reviewed journals, systematic review authors, and guideline committees. Industry influence includes selective reporting of clinical trial results and selection of control groups likely to enhance benefits and disguise side effects.

Explanations for variations in hospital expenditures among four large California counties.

Objective: To investigate competing explanations for why Medicare Fee for Service (FFS) and private sector payments lead to hospital cost variations in Californian counties.

Data Sources: Ratios of private to Medicare hospital costs were obtained from state-based all-payer claims databases. Demographics were estimated from the U.

Depression trial results: A cross-sectional study of ClinicalTrials.gov.

Published clinical trials represent a subsample of the objective information needed to appraise treatments for depression. We characterize the extent of selective and delayed reporting in a systematic review (PROSPERO #CRD42020173606) of depression trial results registered on ClinicalTrials.gov.

Caring for People With Depression: Costs Among 43 Million Commercially Insured Patients With or Without Comorbid Illnesses.

Background: Depression is a common comorbidity for patients with chronic medical conditions. Although the costs of treating chronic medical illness in combination with depression are believed to be significantly higher than the costs of treating each condition independently, few studies have formally modeled the cost consequences of mental health comorbidity.

Purpose: To estimate the relative magnitude of the independent and synergistic contributions to health care costs from depression diagnosis and other chronic physical health conditions.

An evaluation of a care coaching and provider referral intervention for behavioral health needs.

Objectives: To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States.

Study Design: Observational retrospective cohort study with propensity score matching of treated and control groups.

Methods: Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months.

Service discharges among US Army personnel with selected musculoskeletal and skin conditions: a retrospective cohort study.

Objectives: To determine the probability of discharge from military service among soldiers following an incident diagnosis of ankylosing spondylitis (AS), rheumatoid arthritis (RA), psoriasis or systemic lupus erythematous.

Methods: All soldiers on active duty in the US Army between January 2014 and June 2017 were included in a retrospective cohort analysis. Termination from service was ascertained using personnel records.

Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults.

Introduction: In 2020, prior to COVID-19 vaccine rollout, the Brighton Collaboration created a priority list, endorsed by the World Health Organization, of potential adverse events relevant to COVID-19 vaccines. We adapted the Brighton Collaboration list to evaluate serious adverse events of special interest observed in mRNA COVID-19 vaccine trials.

Methods: Secondary analysis of serious adverse events reported in the placebo-controlled, phase III randomized clinical trials of Pfizer and Moderna mRNA COVID-19 vaccines in adults (NCT04368728 and NCT04470427), focusing analysis on Brighton Collaboration adverse events of special interest.

A Novel Explainability Approach for Technology-Driven Translational Research on Brain Aging.

Brain aging leads to difficulties in functional independence. Mitigating these difficulties can benefit from technology that predicts, monitors, and modifies brain aging. Translational research prioritizes solutions that can be causally linked to specific pathophysiologies at the same time as demonstrating improvements in impactful real-world outcome measures.