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By: E. Hauke, M.B. B.A.O., M.B.B.Ch., Ph.D.

Co-Director, University of South Alabama College of Medicine

The search strategies required to capture every article that may have had data on each of the questions frequently yielded upwards of 10,000 articles. The difficulty of finding all potentially relevant studies was compounded by the fact that in many studies, the information of interest for this report was a secondary finding for the original studies. Due to the wide variety of methods of analysis, units of measurements, definitions of chronic kidney disease, and methods of reporting in the original studies, it was often very difficult to standardize the findings for this report. The prevalence of microalbuminuria and proteinuria by age, sex, race, and diabetes are tabulated to show the frequency with which these abnormalities are present in the population. Standardized questionnaires were administered in the home, followed by a detailed physical examination at a Mobile Examination Center. Data on physiologic variation in creatinine were obtained in a sample of 1,921 participants who had a repeat creatinine measurement. The percent difference between the two creatinine measurements, a mean of 17 days apart, had a mean of 0. The mean serum creatinine for 20 to 39-yearold participants without hypertension or diabetes was 1. College of American Pathologists Survey data, released with permission of both laboratories, show that creatinine values in the White Sands laboratory measured during 1992 to 1995 using the Hitachi 737 instrument averaged 0. The latter values were similar to the overall mean of all laboratories for creatinine. Statistics focused on percentiles of the distribution to further decrease the influence of such outliers. Proteinuria A random spot urine sample was obtained from each participant aged 6 years and older, using a clear catch technique and sterile containers. Urine samples were placed on dry ice and shipped overnight to a central laboratory where they were stored at 20 C. Urinary albumin concentration was measured by solid-phase fluorescent immunoassay. Sex specific cutoffs were used to define microalbuminuria and albuminuria in a single spot urine. Our estimates reflect the prevalence of albuminuria based on a single untimed urine specimen and include individuals with persistent albuminuria and individuals with inter- 280 Part 10. Agreement between the initial and repeat tests classified as normal, micro, and macro albuminuria was 91. Microalbuminuria persisted in the second visit in 57% and macroalbuminuria was present in another 4% of the 110 participants with microalbuminuria on the first exam. The variation in persistence by age group and sex was: 45% at 20 to 39 (n 22), 59% at 40 to 59 (n 32), 70% at 60 to 79 (n 43), and 44% at 80 years (n 9), 65% among men (n 48), and 52% among women (n 62). Among 1,099 individuals without microalbuminuria at the first visit 5% (n 56) had microalbuminuria or albuminuria on the second visit. Blood Pressure Blood pressure measurements were obtained three times during the home interview and another three times during the examination and averaged. Individuals were classified as hypertensive if they had a mean blood pressure 140 mm Hg systolic, or 90 mm Hg diastolic, or reported being currently prescribed medication for hypertension treatment. The primary analysis stratified individuals based on a history of diagnosed diabetes mellitus since this information was available for nearly all individuals and could be used by physicians for risk stratification. Dietary History Dietary history was collected using a food frequency questionnaire. To derive national estimates, sampling weights are used to adjust for non-coverage and non-response. Appendices 281 (individuals missing data were 4 years older), among men than women (17. To minimize bias the combined Mobile Examination Center and home exam weights were divided by the proportion of participants missing creatinine data in each of the design age, sex, and race ethnicity strata. This corrects differences in missing data across sampling strata but assumes that data are missing randomly within strata.

Diseases

  • Night blindness, congenital stationary
  • Coach syndrome
  • Oculodentoosseous dysplasia recessive
  • Exostoses anetodermia brachydactyly type E
  • Hyperinsulinism in children, congenital
  • Median nodule of the upper lip
  • Cardiomyopathy, fatal fetal, due to myocardial calcification
  • Acrophobia
  • Portal vein thrombosis

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The incidence of Fukuyama congenital muscular dystrophy in Japan is second only to Duchenne muscular dystrophy, but is rare elsewhere. This disorder is named after Yukio Fukuyama from Tokyo, who first described the condition in 1960. The protein product of the responsible gene has been named fukutin,11 but its function is not clear. Of the rarer variants of congenital muscular dystrophy, the responsible genes and their gene products have only been identified for rigid spine syndrome and muscle-eye-brain disease. Duchenne and Becker muscular dystrophy the clinical features of these X-linked disorders have been described in detail. Most patients have enlarged calves, hence a previous term for the disorder was pseudohypertrophic muscular dystrophy; however, calf hypertrophy not only is seen in Duchenne muscular dystrophy but also is present in other dystrophies, such as Becker dystrophy. Weakness is mainly proximal and Clinically defined types of muscular dystrophy On the basis of distribution of predominant muscle weakness, six major forms can be delineated (figure 1), with the addition of congenital dystrophy, in which muscle weakness is more generalised (panel 1). Congenital muscular dystrophy Children with this heterogeneous group of autosomal recessively inherited disorders present with hypotonia and weakness at birth or within the first few months of life. Several different forms have been recognised, some with and some without significant mental retardation. A proportion of cases, as in Duchenne muscular dystrophy, have some degree of mental impairment. In both Duchenne and Becker muscular dystrophies, about 5­10% of female carriers show some degree of muscle weakness, and frequently have enlarged calves-so-called manifesting carriers. Such weakness is often asymmetric, and it can develop in childhood or not become evident until adult life, and could be slowly progressive or remain static. Because weakness is essentially proximal, differentiation from limb-girdle muscular dystrophy is essential for genetic counselling. Most importantly, female carriers might develop dilated cardiomyopathy, which can arise even without apparent weakness. Dystrophin is usually absent in patients with Duchenne muscular dystrophy, but is reduced in amount or abnormal in size in people with Becker muscular dystrophy. First, there are early contractures-before there is any clinically significant weakness-of the Achilles tendons, elbows, and posterior cervical muscles, with initial limitation of neck flexion; later, forward flexion of the entire spine becomes restricted. Second, slowly progressive muscle wasting and weakness with a humeroperoneal distribution-ie, proxD E F imal in the upper limbs and distal in the lower limbs-happens early in the course of the disease. Later, the Figure 1: Distribution of predominant muscle weakness in different types of dystrophy A, Duchenne-type and Becker-type; B, Emery-Dreifuss; C, limb-girdle; D, facioscapulohumeral; proximal limb-girdle musculature E, distal, F, oculopharyngeal. Pneumonia compounded by on electrocardiography should always prompt exclusion of cardiac involvement is the most frequent cause of death, this muscular dystrophy. Evidence with more attention to respiratory care and various forms of cardiac disease is usually present by age 30 years. Immunodisease is more benign, with age of onset around 12 years; histochemistry of skin fibroblasts or exfoliative buccal cells some patients have no symptoms until much later in life. However, apart from one recessive form (Miyoshi type), which is associated with deficiency of the sarcolemmalassociated protein dysferlin, the underlying cause of these dystrophies is unknown. Facioscapulohumeral muscular dystrophy this dystrophy derives its name from the muscle groups that are mainly affected first: facial and shoulder girdle. The heart is not implicated in most cases, though arrhythmias and conduction defects have been described. This autosomal dominant disorder is associated with subtelomeric deletion of chromosome 4q, with loss of 3·3 kb tandem-repeat units. Loss of ten or fewer repeats causes the disorder, and in general, the lower the number of repeats the more clinically serious the disorder. However the function of the particular gene (or genes) that causes the disorder is not clear. Oculopharyngeal muscular dystrophy this disorder has mainly been studied in French Canada, where the disease can be traced back to immigrants from France in 1634. However, although most frequent in Canada, the disorder also occurs in other parts of North America and Europe.

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The Obama administration did not approve waivers that would condition Medicaid eligibility on work on the grounds that they did not meet the waiver test to further the purpose of the program which is to provide health coverage. The Trump Administration has indicated a willingness to approve waivers to require work. Research shows that Medicaid expansion has not negatively affected labor market participation, and some research indicates that Medicaid coverage supports work. In addition, focus Understanding the Intersection of Medicaid and Work 4 groups, state studies, and anecdotal reports highlight examples of Medicaid coverage supporting work and helping enrollees transition into new careers. For example, individuals have reported that receiving medication for conditions like asthma or rheumatoid arthritis through Medicaid is critical in supporting their ability to work. Implementing work requirements can create administrative complexity and put coverage at risk for eligible enrollees who are working or who may be exempt. States can incur additional costs and demands on staff, and some eligible people could lose coverage. While work requirements are intended to promote work among those not working, coverage for those who are working could be at risk if beneficiaries face administrative obstacles in verifying their work status or documenting an exemption. In addition, some individuals who may be exempt may face challenges in navigating an exemption which could also put coverage at risk. We included nonelderly adults (age 19-64) who indicated that they had Medicaid at some point during the year. To match timing of work variables to health insurance coverage, we used measures of work status throughout 2016. Understanding the Intersection of Medicaid and Work 7 Table 3: Characteristics of Working Nonelderly Adult (19-64) Medicaid Enrollees, 2016 Total Work Status Full-Time* Full-Time, Full-Year Full-Time, Part-Year Part-Time Part-Time, Full-Year Part-Time, Part-Year Number of Weeks Worked During the Year 1-12 weeks 13-25 weeks 26-38 weeks 39-51 weeks 52 weeks Firm Size < 50 employees 50 - 99 employees 100+ employees * Full-Time is based on total number of hours worked per week (at least 35 hours). Full-time workers include people working 35 hours or more, those who worked 1-34 hours for noneconomic reasons. Source: Kaiser Family Foundation analysis of March 2017 Current Population Survey. Understanding the Intersection of Medicaid and Work Appendix Table 3: Characteristics of Working Nonelderly Adult Medicaid Enrollees, 2016 Firm Size Industry <50 50-99 100+ Agricult. Burns is an assistant professor in the Department of Population Health Sciences at the University of Wisconsin­ Madison. Laura Dague is an assistant professor in the Bush School of Government and Public Service at Texas A&M University, in College Station. Under a provision of the Affordable Care Act, the state indicated expanded eligibility for Medicaid as of January 1, 2014. Supplementary analyses-including full results of our ordinary least squares logit models, parallel trends tests, and falsification tests-are available in the online Appendix. Although the expansion made people with incomes of up to 138 percent of the federal poverty level eligible for Medicaid, we limited our sample to adults with incomes below 100 percent of poverty. Adults with incomes of 100­138 percent of poverty in nonexpansion states effectively experienced an expansion in insurance availability because they became eligible for Marketplace subsidies in 2014. Finally, we omitted noncitizens who had lived in the United States for less than five years. We next conducted a regression analysis to control for potential confounding economic and demographic factors and to assess the significance of the results. Although many studies have quantified the impacts of the Medicaid expansion on coverage and access, effects on cross-program participation are important secondary outcomes. The last row displays the mean of the outcome variable for nonexpansion states before expansion. Medicaid income eligibility limits for other non-disabled adults, 2011­ 2017 [Internet]. The effect of expanding Medicaid eligibility on Supplemental Security Income program participation. Medicaid expansions for the working age disabled: revisiting the crowd-out effect. The impact of Medicaid on labor market activity and program participation: evidence from the Oregon Health Insurance Experiment.

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