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Journal of Gastrointestinal and Liver... Jun 2024
Topics: Humans; Glutens; Adult; Male; Healthy Volunteers; Female; Diet, Gluten-Free; Young Adult; Gastrointestinal Diseases
PubMed: 38944854
DOI: 10.15403/jgld-5688 -
Health Economics Jun 2024We exploit a reduction in the minimum legal drinking age (MLDA) in New Zealand from 20 to 18 to study the dynamics of youth risk-taking. Using the universe of road...
We exploit a reduction in the minimum legal drinking age (MLDA) in New Zealand from 20 to 18 to study the dynamics of youth risk-taking. Using the universe of road accidents over 15 years and an event history approach, we find no evidence that lowering the drinking age increased alcohol-related accidents among teens. Complementary results of a cohort analysis suggest that reducing the drinking age even led to a short-term decline in risky driving among youths directly affected by the MLDA change but had no longer-run impacts on youth risky driving and drinking behaviors.
PubMed: 38944845
DOI: 10.1002/hec.4875 -
Clinical Nutrition ESPEN Jun 2024Nutrition plays a crucial role in the development and health of the human brain, from early stages to adulthood. The complex process of neurodevelopment necessitates...
BACKGROUND AND OBJECTIVES
Nutrition plays a crucial role in the development and health of the human brain, from early stages to adulthood. The complex process of neurodevelopment necessitates interaction among various factors, with balance in the concentration of vital macronutrients and micronutrients being essential. Regarding micronutrients, vitamin B12 stands out, playing a vital role in the development and functioning of the motor nervous system. The objective was to investigate the influence of reduced levels of vitamin B12 on infant motor development and analyze the effects of supplementation on this aspect of development.
METHODS
For this purpose, the criteria of the PRISMA method and registration in the PROSPERO database were used. The search was conducted in the following databases: PubMed (Medline), Scopus, PsycINFO, Web of Science, and ScienceDirect. A total of 684 records were initially identified.
RESULTS
Of the eight included articles, there was diversity regarding geographical contexts and study designs. The final sample comprised a total of 1,559 participants of both sexes. Studies aimed at correcting low levels of vitamin B12 opted for supplementation, following various protocols that varied in dose, administration method, and duration. At the end of the studies, the serum level of this vitamin ranged from 131 pmol/L to 1141 pmol/L.
CONCLUSION
There is a complex array of factors contributing to reduced levels of vitamin B12, especially in the early stages of life, which significantly impacts infant motor development. Despite methodological variations among studies, evidence suggests that low levels of vitamin B12 may affect motor development and that supplementation could be an effective means of enhancing motor aspects in healthy children. However, due to the diversity of outcomes, it is important to promote comprehensive public policies to encourage appropriate interventions in this area.
PubMed: 38944829
DOI: 10.1016/j.clnesp.2024.06.026 -
HIV Research & Clinical Practice Dec 2024Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health...
BACKGROUND
Zimbabwe antenatal HIV prevalence rate is 16.1%. HIV-positive pregnant adolescent girls and young women (AYW) are at high risk to experience perinatal mental health challenges, attributed to a combination of factors including HIV status, stigma and perinatal depression. Perinatal depression and stigma among AYW is understudied in Zimbabwe and may affect short- and long-term health of HIV positive mothers and their children, and can impact treatment adherence.
METHODS
Qualitative data was gathered from four focus group discussions with (2 urban and 2 rural) PMTCT providers ( = 17). Focus group discussions were also conducted among AYW clients ( = 20) from two clinics in Mashonaland East.
RESULTS
Qualitative analyses identified patterns related to: (1) drop out and loss to follow up, (2) retention and adherence, (3) recurring feelings of internalized stigma; and (4) acceptability of potential MH interventions. MH services are not available and AYW have limited access to adherence counseling (1-2 times at onset). Psychological support was not available at either clinic, despite both providers and clients perceiving high rates of stigma, discrimination, and challenges with disclosure. Challenges related to long waits for ART distribution and gaps in disclosure support emerged as barriers. Providers noted that AYW present as anxious (non-diagnosed), and attribute depression to those clients who are lost to follow up, stating lack of time to screen for MH related issues or actively refer them for services. Challenges related to the ability to provide strong advice and support for disclosure also emerged among providers.
CONCLUSIONS
This study can contribute to policy and practice recommendations to better integrate MH into HIV services and develop person-centered service models for HIV positive AYW. HIGHLIGHTSPerinatal adolescents and young women (AYW) living with HIV have gaps in retention and care in the current Zimbabwe PMTCT service model.Mental health stigma must be addressed to integrate mental health into HIV services.HIV providers are aware of the need to provide mental health support to reduce loss to follow-up.Mental health screening and referrals for services are not part of standard care for perinatal HIV positive AYW in Zimbabwe.Linkages between disclosure and AYW mental health was identified as a challenge by HIV providers.Context responsive interventions can support integration of mental health screening, services, and referrals.
Topics: Humans; Female; Zimbabwe; Adolescent; HIV Infections; Social Stigma; Young Adult; Focus Groups; Pregnancy; Infectious Disease Transmission, Vertical; Adult; Qualitative Research; Pregnancy Complications, Infectious; Patient Acceptance of Health Care
PubMed: 38944816
DOI: 10.1080/25787489.2024.2371174 -
Journal of Nutrition Education and... Jun 2024Investigate the influence of physical readiness tests (PRTs) on eating behaviors among US Navy Sailors.
OBJECTIVE
Investigate the influence of physical readiness tests (PRTs) on eating behaviors among US Navy Sailors.
DESIGN
Focused ethnography using interviews and military policies.
SETTING
Three US Naval installations.
PARTICIPANTS
Active-duty enlisted Sailors (n = 32).
PHENOMENON OF INTEREST
Eating behaviors.
ANALYSIS
Authors analyzed data iteratively with data collection using domain, taxonomy, and thematic analysis to identify culturally relevant codes, domains, and themes.
RESULTS
Five themes corresponded with PRT timing and Sailors' perceived ability to meet standards: (1) maintain usual eating habits, (2) get ready and switch it up, (3) make weight-damage control, (4) return to baseline-PRT is over, and (5) eat whatever-PRT is canceled. In contrast to the PRT policy's goal for Sailors to maintain standards and a healthy lifestyle, many Sailors modified their usual eating behaviors to pass the test.
CONCLUSION AND IMPLICATIONS
Changes in eating behaviors during PRT cycles highlight a culture of getting ready vs staying ready, suggesting many Sailors do not eat a nutrient-dense diet to maintain the minimum physical fitness and body composition standards. There is a need for nutrition education for healthy weight maintenance, weight gain prevention, and healthy weight loss among military personnel.
PubMed: 38944798
DOI: 10.1016/j.jneb.2024.05.232 -
Journal of the American College of... Jun 2024The aim of this study was to examine radiology's and other specialties' market shares for diagnostic imaging interpretation for Medicare fee-for-service claims by...
PURPOSE
The aim of this study was to examine radiology's and other specialties' market shares for diagnostic imaging interpretation for Medicare fee-for-service claims by modality, body region, and place of service.
METHODS
In this cross-sectional study of Physician/Supplier Procedure Summary data for 2022, the authors examined the proportion of diagnostic imaging interpretation by specialty. All claims for CT, MR, nuclear medicine (NM), ultrasound, and radiography and fluoroscopy (XR) were included. Claims were aggregated into 52 specialty groups using Medicare specialty codes. The market share for each specialty group was computed by modality, body region, and place of service.
RESULTS
For Medicare fee-for-service beneficiaries, there were 122,851,716 imaging studies, of which 88,559,272 (72.1%) were interpreted by radiologists. This percentage varied by modality: 97.3% for CT, 91.0% for MR, 76.6% for XR, 50.9% for NM, and 33.9% for ultrasound. Radiologists interpreted a lower percentage of cardiac (67.6% for CT, 42.2% for MR, 11.8% for NM, and 0.4% for ultrasound) than noncardiac studies (97.6% for CT, 91.4% for MR, 95.6% for NM, and 53.0% for ultrasound). Among noncardiac studies, radiologists interpreted nearly all in the outpatient hospital, inpatient, and emergency department (99.5% for CT, 99.4% for MR, 98.9% for NM, 79.3% for ultrasound, and 97.9% for XR) compared with the office setting (84.4% for CT, 78.7% for MR, 85.4% for NM, 29.2% for ultrasound, and 43.1% for XR).
CONCLUSIONS
Radiologists perform the dominant share of CT and MR interpretation and more so for noncardiac imaging and imaging performed in outpatient hospital, inpatient, and emergency department places of service.
PubMed: 38944790
DOI: 10.1016/j.jacr.2024.05.003 -
Journal of Emergency Nursing Jun 2024It is impossible to fully understand why the United States has consistently failed to protect its citizens from firearm violence until one understands some of the key...
It is impossible to fully understand why the United States has consistently failed to protect its citizens from firearm violence until one understands some of the key discrepancies that exist at the center of the firearm policy debate. Differences in language, data categorization, and research related to firearms and their impacts in the United States contribute to confusion and debate between firearm policy advocates and opponents, ultimately stalling progress toward some common goals. As frontline health professionals, emergency nurses must be aware of these nuances in order to be informed advocates for the safety of their patients and their communities. Emergency nurses can use the information from this article to help inform screening and education related to firearm safety and injury prevention. They can also use this information to inform nursing research as well as local and national advocacy efforts related to firearm injuries and deaths.
PubMed: 38944789
DOI: 10.1016/j.jen.2024.05.005 -
JAMA Health Forum Jun 2024Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households.
IMPORTANCE
Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households.
OBJECTIVE
To estimate the distribution of household health care payments across income under health care reform policies.
DESIGN, SETTING, AND PARTICIPANTS
Cross-sectional study with microsimulation used nationally representative data of the US population in 2030. Civilian, noninstitutionalized population from the 2022 Current Population Survey linked to expenditures from the 2018 and 2019 Medical Expenditure Panel Survey and 2022 National Health Expenditure Accounts were included.
EXPOSURE
Rate regulation of hospital, physician, and other health care professional payments equal to the all-payer mean in the status quo, spending growth target at 4% annual per capita growth, and single-payer health care financed through taxes.
MAIN OUTCOMES AND MEASURES
Household health care payments (out-of-pocket expenses, premiums, and taxes) as a share of compensation.
RESULTS
The synthetic population contained 154 456 records representing 339.5 million individuals, with 51% female, 7% Asian, 14% Black, 18% Hispanic White, 56% non-Hispanic White, and 5% other races and ethnicities (American Indian or Alaskan Native only; Native Hawaiian or other Pacific Islander only; and 2 or more races). In the status quo, mean household health care payments as a share of compensation was 24% to 27% (standard error [SE], 0.2%-1.2%) across income groups (median [IQR] 22% [4%-52%] below 139% of the federal poverty level [FPL]; 21% [4%-34%] for households above 1000% FPL [11% of the population]). Under rate setting, mean (SE) payments by households above 1000% FPL increased to 29% (0.6%) (median [IQR], 22% [6%-35%]) and decreased to 23% to 25% for other income groups. Under the spending growth target, mean (SE) payments decreased from 23% to 26% (SE, 0.2%-1.2%) across income groups. Under the single-payer system, mean (SE) payments declined to 15% (0.7%) (median [IQR], 4% [0%-30%]) for those below 139% FPL and increased to 31% (0.6%) (median [IQR], 23% [3%-39%]) for those above 1000% FPL. Uninsurance fell from 9% to 6% under rate setting due to improved Medicaid access, and to zero under the single-payer system.
CONCLUSIONS AND RELEVANCE
Single-payer financing based on the current federal income tax schedule and a payroll tax could substantially increase progressivity of household payments by income. Rate setting led to slight increases in payments by higher-income households, who financed higher payment rates in Medicare and Medicaid. Spending growth targets reduced payments slightly for all households.
Topics: Humans; Cross-Sectional Studies; Health Expenditures; Female; United States; Male; Adult; Middle Aged; Family Characteristics; Single-Payer System; Financing, Personal; Health Care Reform; Income; Aged
PubMed: 38944764
DOI: 10.1001/jamahealthforum.2024.1932 -
JAMA Health Forum Jun 2024In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how...
IMPORTANCE
In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how health care and prescription medication affordability changed among low-income adults during the COVID-19 pandemic overall and compared with their higher-income counterparts.
OBJECTIVE
To evaluate changes in health care affordability and prescription medication affordability during the COVID-19 pandemic (2021 and 2022) compared with pre-COVID-19 pandemic levels (2019) and whether income-based inequities changed.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study included adults 18 years and older participating in the National Health Interview Survey (NHIS) in 2019, 2021, and 2022. Low-income adults were defined as having a household income of 200% or less of the federal poverty level (FPL); middle-income adults, 201% to 400% of the FPL; and high-income adults, more than 400% of the FPL. Data were analyzed from June to November 2023.
MAIN OUTCOMES AND MEASURES
Measures of health care affordability and prescription medication affordability.
RESULTS
The study population included 89 130 US adults. Among the weighted population, 51.6% (95% CI, 51.2-52.0) were female, and the mean (SD) age was 48.0 (0.12) years. Compared with prepandemic levels, during the COVID-19 pandemic, low-income adults were less likely to delay medical care (2022: 11.2%; 95% CI, 10.3-12.1; 2019: 15.4%; 95% CI, 14.3-16.4; adjusted relative risk [aRR], 0.73; 95% CI, 0.66-0.81) or avoid care (2022: 10.7%; 95% CI, 9.7-11.6; 2019: 14.9%; 95% CI, 13.8-15.9; aRR, 0.72; 95% CI, 0.64-0.80) due to cost, while high-income adults experienced no change, resulting in a significant improvement in income-based disparities. Low-income and high-income adults were less likely to experience problems paying medical bills but experienced no change in worrying about medical bills during the COVID-19 pandemic compared with prepandemic levels. Across measures of prescription medication affordability, low-income adults were less likely to delay medications (2022: 9.4%; 95% CI, 8.4-10.4; 2019: 12.7%; 95% CI, 11.6-13.9; aRR, 0.74; 95% CI, 0.65-0.84), not fill medications (2022: 8.9%; 95% CI, 8.1-9.8; 2019: 12.0%; 95% CI, 11.1-12.9; aRR, 0.75; 95% CI, 0.66-0.83), skip medications (2022: 6.7%; 95% CI, 5.9-7.6; 2019: 10.1%; 95% CI, 9.1-11.1; aRR, 0.67; 95% CI, 0.57-0.77), or take less medications (2022: 7.3%; 95% CI, 6.4-8.1; 2019: 11.2%; 95% CI, 10.%-12.2; aRR, 0.65; 95% CI, 0.56-0.74) due to costs, and these patterns were largely similar among high-income adults. Improvements in measures of health care and prescription medication affordability persisted even after accounting for changes in health insurance coverage and health care use. These patterns were similar when comparing measures of affordability in 2021 with 2019.
CONCLUSIONS AND RELEVANCE
Health care affordability improved for low-income adults during the COVID-19 pandemic, resulting in a narrowing of income-based disparities, while prescription medication affordability improved for all income groups. These findings suggest that the recent unwinding of COVID-19 pandemic-related safety-net policies may worsen health care affordability and widen existing income-based inequities.
Topics: Humans; COVID-19; Cross-Sectional Studies; United States; Male; Female; Middle Aged; Retrospective Studies; Adult; Prescription Drugs; Poverty; Income; Aged; Health Services Accessibility; Young Adult; Adolescent; Pandemics
PubMed: 38944763
DOI: 10.1001/jamahealthforum.2024.1939 -
JAMA Health Forum Jun 2024The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned...
IMPORTANCE
The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.
OBJECTIVE
To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation.
EXPOSURE
Receiving dialysis treatment in a region randomly assigned to the ETC model.
MAIN OUTCOMES AND MEASURES
Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions.
RESULTS
The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.
Topics: Humans; Kidney Transplantation; Female; Male; Cross-Sectional Studies; Hemodialysis, Home; United States; Reimbursement, Incentive; Retrospective Studies; Kidney Failure, Chronic; Aged; Middle Aged; Medicare
PubMed: 38944762
DOI: 10.1001/jamahealthforum.2024.2055