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BMC Geriatrics Mar 2022Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have...
BACKGROUND
Mental health conditions among older recipients of public assistance should be considered because it has been reported that public assistance recipients tend to have higher risks of morbidity than non-recipients, and mental health is strongly related to frailty. We aimed to examine whether older recipients of public assistance were more likely to have depressive symptoms compared to non-recipients.
METHODS
Data were obtained from the Japan Gerontological Evaluation Study, a 2016 community-based study of older adults. Poisson regression analyses with a robust error variance using fixed effects were conducted to examine the relationship between receiving public assistance and depressive symptoms controlling for sociodemographic factors. Depressive symptoms were assessed by the Geriatric Depression Scale 15.
RESULTS
We found that the older recipients of public assistance were 1.57 times (95% confidence interval [CI]: 1.47, 1.67) more likely to have depressive symptoms compared to non-recipients. We also found that, when additionally adjusting for indicators of social participation, this relationship was slightly attenuated; however, the recipients still had worse mental health issues (Prevalence ratio: 1.33; 95% CI: 1.25, 1.42).
CONCLUSIONS
Even after controlling for sociodemographic factors, older recipients of public assistance tended to be more depressed than non-recipients. However, our findings also indicated that social participation could slightly attenuate the negative relationship between receiving public assistance and depressive symptoms. Therefore, the public assistance program needs to consider the inclusion of mental healthcare support in addition to financial support.
Topics: Aged; Cross-Sectional Studies; Depression; Humans; Japan; Public Assistance; Social Participation
PubMed: 35236284
DOI: 10.1186/s12877-022-02868-0 -
Inquiry : a Journal of Medical Care... 2022The CMS Innovation Center was created in section 3021 of the Affordable Care Act (ACA) with the promise to test payment and delivery models expected to reduce costs...
The CMS Innovation Center was created in section 3021 of the Affordable Care Act (ACA) with the promise to test payment and delivery models expected to reduce costs while improving or maintaining quality of care for Medicare, Medicaid, and Children's Health Insurance Program (CHIP) beneficiaries. Doug Badger's analysis of the Center for Medicare and Medicaid Innovation (CMMI), published in Inquiry, described how the CMMI has failed to accomplish its goals and makes a case for reforms. As a practicing clinician in private practice who has followed the implementation of the components of the Affordable Care Act, including the CMMI, his conclusions are not surprising. An examination of the clinically unworkable and recently delayed Radiation Oncology Alternative Payment Model demonstrates serious flaws in current CMMI methods. Government agencies have difficulty directing innovation. Clinicians know that real innovation will arise in unpredictable ways from the ingenious communities, providers, and organizations that deliver the care. Innovation will occur when an atmosphere of transparency forces providers to respond to the demands of patients. The CMMI would do well to redesign its processes. If "value" is the goal of CMS, then America deserves a better "value" from its healthcare agencies.
Topics: Aged; Child; Humans; United States; Medicare; Patient Protection and Affordable Care Act; Medicaid; Delivery of Health Care; Health Facilities
PubMed: 36541229
DOI: 10.1177/00469580221141809 -
American Journal of Public Health Oct 2022To examine the effects of childhood participation in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women,...
To examine the effects of childhood participation in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on adult food security in the United States. We used data from the 1984 to 2019 waves of the Panel Study of Income Dynamics to follow a balanced panel of 1406 individuals from birth through ages 20 to 36 years. We measured food insecurity from 1999 to 2003 and 2015 to 2019 among those who resided in low-income households during childhood. Twenty-eight percent of individuals who resided in low-income households during childhood exhibited improved food security status from childhood to adulthood. Those who participated in SNAP and WIC during childhood had 4.16-fold higher odds (95% confidence interval [CI] = 1.91, 9.03) of being more food secure than those who were eligible for but did not receive SNAP or WIC, and those who participated in SNAP alone had 3.28-fold higher odds (95% CI = 1.56, 6.88). Participation in social safety net programs such as SNAP and WIC during childhood helps to improve food security across the life course. Our findings add evidence regarding the long-term benefits of participation in SNAP and WIC during childhood. (. 2022;112(10):1498-1506. https://doi.org/10.2105/AJPH.2022.306967).
Topics: Adolescent; Adult; Child; Dietary Supplements; Female; Food Assistance; Food Security; Food Supply; Humans; Infant; Poverty; United States; Young Adult
PubMed: 35981276
DOI: 10.2105/AJPH.2022.306967 -
BMC Pediatrics May 2021Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social...
BACKGROUND
Children's healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children's health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.
METHODS
We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients' sociodemographic factors from January 2016 and identified the incidence of childhood diseases' diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.
RESULTS
Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16-2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07-1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21-2.70), and dental diseases (IR = 1.79; 95% CI, 1.33-2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children's acute health conditions.
CONCLUSIONS
Among public assistance recipients, living in single-parent households may be a risk factor for children's chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children's health conditions, contents of medical treatments, and broader socioeconomic factors.
Topics: Adolescent; Child; Cohort Studies; Dental Caries; Humans; Japan; Public Assistance; Retrospective Studies
PubMed: 33941113
DOI: 10.1186/s12887-021-02682-4 -
Journal of Nutritional Science and... 2022Cumulative evidence shows that people with lower socioeconomic status (SES) have higher risk of mortality and non-communicable diseases, which are strongly related to... (Review)
Review
Cumulative evidence shows that people with lower socioeconomic status (SES) have higher risk of mortality and non-communicable diseases, which are strongly related to diet. A low diet quality may be related to a rise in chronic non-communicable diseases from childhood onward. This literature review summarizes the food assistance for reducing health disparities among children in Japan. The school lunch program in Japan is important for achieving adequate nutrient intakes in schoolchildren and reducing disparities of adequate nutrient intake by household income levels. Additionally, the number of children's cafeterias, contributing to the support of children suffering from poverty by providing free or low-cost meals in a comfortable environment, as well as being bases for multi-generational community communication, and where local children and adults eat together, has rapidly increased. Those who with lower SES tended to use food supports, such as the children's cafeteria, as well as food pantries and emergency home food deliveries, during the COVID-19 pandemic. It will be necessary to establish a public-private system that can provide information on local food assistance to people whose socioeconomic status has changed rapidly.
Topics: Child; Adult; Humans; Food Assistance; Noncommunicable Diseases; Japan; Pandemics; COVID-19; Lunch
PubMed: 36437028
DOI: 10.3177/jnsv.68.S81 -
BMJ Open Apr 2022Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to... (Review)
Review
OBJECTIVES
Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer.
METHODS
This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles.
RESULTS
A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure.
CONCLUSION
This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
Topics: Delivery of Health Care; Government Programs; Health Facilities; Humans; Lung Neoplasms; Medical Assistance
PubMed: 35393318
DOI: 10.1136/bmjopen-2021-056895 -
Maternal & Child Nutrition Jul 2020To address ongoing food insecurity and acute malnutrition in Somalia, a broad range of assistance modalities are used, including in-kind food, food vouchers, and cash...
To address ongoing food insecurity and acute malnutrition in Somalia, a broad range of assistance modalities are used, including in-kind food, food vouchers, and cash transfers. Evidence of the impact of cash and voucher assistance (CVA) on prevention of acute malnutrition is limited in humanitarian and development settings. This study examined the impact of CVA on prevention of child acute malnutrition in 2017/2018 in the context of the Somalia food crisis. Changes in diet and acute malnutrition were measured over a 4-month period among children age 6-59 months from households receiving household transfers of approximately US$450 delivered either as food vouchers or a mix of in-kind food, vouchers, and cash. Baseline to endline change in children's dietary diversity, meal frequency, minimum acceptable diet (MAD), mid-upper arm circumference (MUAC), and acute malnutrition (MUAC < 12.5 cm) were compared using difference-in-difference analysis with inverse probability weighting. There were no statistically significant changes in dietary diversity, meal frequency, or the proportion of children with MAD for either intervention group. Adjusted change in mean MUAC showed increases of 0.5 cm (confidence interval [CI; 0.0, 0.7 cm]) in the food voucher group and 0.1 cm (CI [-0.1, 0.4]) in the mixed transfer group. In adjusted analysis, prevalence of acute malnutrition among children under 5 years increased by 0.7% (CI [-13.4, 14.4%]) among food voucher recipients and decreased by 4.8% (CI [-9.9, 8.1%]) in mixed transfer recipients. The change over time in both mean MUAC and acute malnutrition prevalence was similar for both interventions, suggesting that cash and vouchers had similar effects on child nutrition status.
Topics: Child Nutrition Disorders; Child, Preschool; Diet; Female; Food Assistance; Humans; Infant; Male; Nutritional Status; Somalia
PubMed: 32141183
DOI: 10.1111/mcn.12966 -
Current Opinion in Supportive and... Sep 2022The COVID-19 pandemic and measures to contain its impact are drastically altering end-of-life and grief experiences around the world, including the practice and... (Review)
Review
PURPOSE OF REVIEW
The COVID-19 pandemic and measures to contain its impact are drastically altering end-of-life and grief experiences around the world, including the practice and experience of medical assistance in dying (MAiD).
RECENT FINDINGS
Recent published literature on the impact of COVID-19 on MAiD can be described under the following categories: studies investigating the impact of COVID-19 on MAiD from the healthcare providers' perspective; studies investigating the impact of COVID-19 on MAiD from the patient/family perspective; and opinion papers that review the impact of COVID-19 on MAiD from a legal-ethical perspective. Most of these studies were either conducted in Canada or included mostly Canadian participants.
SUMMARY
Recent published research on the impact of COVID-19 on MAiD highlights the tensions between COVID-19 restrictions and individual control over the circumstances of dying, and the resulting impact on patient and family suffering and on moral injury for their MAiD providers. These reports may help inform risk mitigation strategies for the current pandemic and future similar public health crises that acknowledge the value of humane, family-centered care at the end of life.
Topics: COVID-19; Canada; Humans; Medical Assistance; Pandemics; Suicide, Assisted
PubMed: 35862889
DOI: 10.1097/SPC.0000000000000607 -
Appetite Sep 2022Fruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC...
INTRODUCTION
Fruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC and whether those barriers and facilitators differ for racially and ethnically minoritized people is imperative for developing effective and equitable public health policies and interventions.
METHODS
A baseline cohort of 390 participants from Central Texas communities historically lacking healthy food retailers completed a survey including FVC, 7 psychosocial barriers and facilitators of FVC, distance to a grocery retailer, participation in government assistance programs, and race/ethnicity.
RESULTS
Not having time to prepare fruits and vegetables was the only significant psychosocial barrier identified (B = -.11, t(390) = 2.04, P = .04), but was not significant after accounting for sociodemographic variables. Significant facilitators of daily FVC were liking F&V (B=.31, t(390) = 6.40, P<.001), participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (B=.14, t(390) = 2.81, P = .005), and Hispanic/Latino(a) ethnicity (B = -.21, t(390) = 4.30, P<.001). The final model accounted for 17% of the variance in daily FVC (R=.17, F(4, 375) = 7.69, P < .001). Black, white and Other race participants were more likely to report having difficulty using F&V before spoiling than Hispanic/Latino(a) participants (P = .003). White and Other race participants were more likely to report that F&V were hard to prepare (P = .006) and that they didn't have time to prepare F&V (P = .005).
DISCUSSION
When designing public health policy and interventions to increase FVC, researchers could prioritize identifying ways to alleviate time constraints, increase F&V liking, and help eligible participants to enroll in WIC. Strategies that reduce the risk of F&V spoiling and make F&V easier to prepare may also benefit some groups.
Topics: Child; Diet; Female; Food Assistance; Fruit; Humans; Infant; Texas; Vegetables
PubMed: 35700839
DOI: 10.1016/j.appet.2022.106130 -
Pediatrics Jan 2021Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated...
BACKGROUND
Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated maltreatment, long-term outcomes of physical abuse in US community samples are unknown. We hypothesized that early childhood physical abuse would prospectively predict adult outcomes in education and economic stability, physical health, mental health, substance use, and criminal behavior.
METHODS
Researchers in two multisite studies recruited children at kindergarten entry and followed them into adulthood. Parents completed interviews about responses to the child's problem behaviors during the kindergarten interview. Interviewers rated the probability that the child was physically abused in the first 5 years of life. Adult outcomes were measured by using 23 indicators of education and economic stability, physical health, mental health, substance use, and criminal convictions reported by participants and their peers and in school and court records.
RESULTS
Controlling for potential confounds, relative to participants who were not physically abused, adults who had been abused were more likely to have received special education services, repeated a grade, be receiving government assistance, score in the clinical range on externalizing or internalizing disorders, and have been convicted of a crime in the past year (3.20, 2.14, 2.00, 2.42, 2.10, and 2.61 times more likely, respectively) and reported levels of physical health that were 0.10 SDs lower. No differences were found in substance use.
CONCLUSIONS
Unreported physical abuse in community samples has long-term detrimental effects into adulthood. Pediatricians should talk with parents about using only nonviolent discipline and support early interventions to prevent child abuse.
Topics: Adult Survivors of Child Abuse; Child; Child Abuse; Criminal Behavior; Education, Special; Female; Health Status; Humans; Internal-External Control; Longitudinal Studies; Male; Physical Abuse; Prospective Studies; Public Assistance; Substance-Related Disorders; Young Adult
PubMed: 33318226
DOI: 10.1542/peds.2020-0873