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Affordable care

Simnikiwe H Mayaphi, Desmond J Martin, Thomas C Quinn, Oliver Laeyendecker, Steve A S Olorunju, Gregory R Tintinger, Anton C Stoltz
BACKGROUND: Two thirds of the world's new HIV infections are in sub-Saharan Africa. Acute HIV infection (AHI) is the time of virus acquisition until the appearance of HIV antibodies. Early HIV infection, which includes AHI, is the interval between virus acquisition and establishment of viral load set-point. This study aimed to detect acute and early HIV infections in a hyper-endemic setting. METHODS: This was a cross-sectional diagnostic study that enrolled individuals who had negative rapid HIV results in five clinics in South Africa...
2016: PloS One
Christina Ludema, Stephen R Cole, Joseph J Eron, Andrew Edmonds, G Mark Holmes, Kathryn Anastos, Jennifer Cocohoba, Mardge Cohen, Hannah L F Cooper, Elizabeth T Golub, Seble Kassaye, Deborah Konkle-Parker, Lisa Metsch, Joel Milam, Tracey E Wilson, Adaora A Adimora
BACKGROUND: Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. METHODS: We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP...
November 1, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Nicholas Arlas, Harry Jergesen
Factors endemic in safety-net hospitals may breed poor outcomes in hip and knee arthroplasty. This review highlights these challenges and discusses strategies to reduce operative risk and promote better surgical outcomes. Sub-optimally managed medical co-morbidities, poverty, and substance abuse are examples of challenges common in safety-net hospital populations and are associated with poor surgical outcomes. Patient management strategies that positively affect surgical outcomes may be nonexistent, underfunded, or underused...
2016: Journal of Health Care for the Poor and Underserved
Joshua J Fenton, Kevin Fiscella, Anthony F Jerant, Francis Sousa, Mark Henderson, Tonya Fancher, Peter Franks
A diverse physician workforce is needed to increase access to care for underserved populations, particularly as the Affordable Care Act expands insurance coverage. Yet legal restrictions constrain the extent to which medical schools may use race/ethnicity in admissions decisions. We conducted simulations using academic metrics and socioeconomic data from applicants to a California public medical school from 2011 to 2013. The simulations systematically adjusted medical school applicants' academic metrics for socioeconomic disadvantage...
2016: Journal of Health Care for the Poor and Underserved
Denise Dion Hallfors, Bonita J Iritani, Lei Zhang, Shane Hartman, Winnie K Luseno, Elias Mpofu, Simbarashe Rusakaniko
This study examines the association between religious affiliation and reasons for marriage, perceived church attitudes, and reproductive health-seeking behaviors, including HIV testing, among young women in eastern rural Zimbabwe. The sample comprised women (N = 35) who had married by 2012 while participating in a larger randomized controlled trial (RCT) to test the effects of school support on HIV-related risk. The RCT sample was identified in 2007 as all female sixth graders in 25 rural eastern Zimbabwe primary schools whose parents, one or both, had died (N = 328)...
December 2016: SAHARA J: Journal of Social Aspects of HIV/AIDS Research Alliance
Giovanni Ravasi, Beatriz Grinsztejn, Ricardo Baruch, Juan Vicente Guanira, Ricardo Luque, Carlos F Cáceres, Massimo Ghidinelli
INTRODUCTION: Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool...
2016: Journal of the International AIDS Society
Cheryl K Zogg, Fernando Payró Chew, John W Scott, Lindsey L Wolf, Thomas C Tsai, Peter Najjar, Olubode A Olufajo, Eric B Schneider, Elliott R Haut, Adil H Haider, Joseph K Canner
Importance: Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear...
October 19, 2016: JAMA Surgery
Hari Nathan, Justin B Dimick
No abstract text is available yet for this article.
October 19, 2016: JAMA Surgery
Constanze Ciavarella, Laura Fumanelli, Stefano Merler, Ciro Cattuto, Marco Ajelli
BACKGROUND: Nearly every year Influenza affects most countries worldwide and the risk of a new pandemic is always present. Therefore, influenza is a major concern for public health. School-age individuals are often the most affected group, suggesting that the inclusion in preparedness plans of school closure policies may represent an option for influenza mitigation. However, their applicability remains uncertain and their implementation should carefully be weighed on the basis of cost-benefit considerations...
October 18, 2016: BMC Infectious Diseases
Guillermina Natera Rey, Perla Sonia Medina Aguilar, Fransilvania Callejas Pérez, Jim Orford, Guillermo Salinas Escudero, Marcela Tiburcio Sainz
Objective Estimate the cost-effectiveness ratio of a five-step brief intervention aimed at reducing the stress and symptoms of depression caused by living with an alcohol abuser. Methods The cost-effectiveness analysis was carried out with a decision tree, based on symptoms of depression measured on the CES-D scale. The effectiveness of the brief intervention was evaluated by comparing a group of indigenous women who received the intervention (n = 43) with a similar group who did not (n = 30). The groups were evaluated before, immediately after, and 12 months after the intervention, in the state of Hidalgo (Mexico)...
February 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
Charu Kohli, Kalika Gupta
OBJECTIVE: To assess average out of expenditure incurred on hypertension management and treatment seeking behaviour among patients in Delhi, India. DESIGN AND METHOD: A community based cross sectional study was conducted in rural and urban slum areas of Delhi to select a total of 160 (142 rural and 18 urban slum) hypertension patients. These patients were detected from the cross sectional screening survey among 200 adults in urban area and 1005 in rural area selected by systematic random sampling...
September 2016: Journal of Hypertension
Yutaka Imai
It has been confirmed that clinical significance of home blood pressure measurements (HBPM) is higher than clinic BP measurements and ambulatory BP monitoring. However, several drawbacks of HBPM have also been mentioned, e.g. selection and reporting biases, difficulties of calculation of multiple measurements, difficulties of onsite judgement of numerous recordings, etc. Recent devices for HBPM incorporate memory function. This function can overcome such drawbacks of HBPM. These memorized data can transmit, storage, retrieve, be arithmetic and control, be judged based on algorithm and be got feedback...
September 2016: Journal of Hypertension
Curtis Bone, Lilian Gelberg, Mani Vahidi, Barbara Leake, Julia Yacenda-Murphy, Ronald M Andersen
OBJECTIVE: The Affordable Care Act encourages integration of behavioral health into primary care. We aim to estimate the level of under-reporting of drug use in federally qualified health centers (FQHCs) among self-reported risky drug users. METHODS: Adult patients in the waiting rooms of 4 FQHCs who self-reported risky drug use on the screening instrument World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (score 4-26), who participated in the "Quit Using Drugs Intervention Trial," submitted urine samples for drug testing...
October 6, 2016: Journal of Addiction Medicine
Kyle Mikals, Douglas Beakes, Taylor A Banks
Hymenoptera venom allergy accounts for approximately 17% of all cases of anaphylaxis. Insect stings are a common occurrence across the world, with significant impact on active duty personnel. Venom immunotherapy (VIT) provides an effective treatment for those with systemic reactions to insect stings and other similar indications. We present a case of severe reaction to hymenoptera venom requiring an epinephrine drip and provide an overview for primary care providers on who should be referred to allergy or an allergist, carry an epinephrine auto-injector, and be a candidate for VIT...
October 2016: Military Medicine
Marta Erminia Alberto, Jenny Pirillo, Nino Russo, Carlo Adamo
Ru(II) dyads are a class of bioactive molecules of interest as anticancer agents obtained incorporating an organic chromophore in the light-absorbing metallic scaffold. A careful DFT and TDDFT investigation of the photophysical properties of a series of Ru(II)-polypiridyl dyads containing polythiophene chains of different lengths bound to a coordinating imidazo[4,5-f][1,10]phenanthroline ligand is herein reported. The modulation of the crucial chemical and physical properties of the photosensitizer with increasing number of thiophene units has been accurately described by investigating the UV-vis spectra and type I and type II photoreactions, also including spin-orbit coupling values (SOC)...
October 18, 2016: Inorganic Chemistry
Darrell G Kirch, Cori E Ast
The health care system of the United States has been in a period of dramatic transformation since the passage of the Affordable Care Act in 2010, and the rate of change is accelerating. Historically, health care delivery was focused on the efforts of independent individual providers related to single patients, but the future will require interprofessional teamwork to achieve successful transformation. Academic health centers must identify nimble leaders who can harness the expertise of every team member to succeed in yielding the triple aim-better care for individuals, better health for populations, and lower overall cost...
October 17, 2016: Journal of Clinical Psychology in Medical Settings
Derek D Satre, Andrea Altschuler, Sujaya Parthasarathy, Michael J Silverberg, Paul Volberding, Cynthia I Campbell
OBJECTIVES: This study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure and health care utilization after key ACA provisions went into effect in 2014. METHODS: This mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation...
October 3, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
S Vincent Rajkumar, Jean Luc Harousseau
Advances in the diagnosis and treatment of multiple myeloma have come at a rapid pace, especially with several new drugs entering the market in the last few years. However access and affordability to new treatments poses a major challenge, both in the United States and around the world. High costs of life-saving drugs are detrimental to both the personal finances of the individual patient, as well as society which must bear the increasing costs in terms of increased health insurance premiums, taxes, or both...
October 14, 2016: Blood
Dilip V Jeste, Dan G Blazer, Kathleen C Buckwalter, Keri-Leigh K Cassidy, Len Fishman, Lisa P Gwyther, Saul M Levin, Christopher Phillipson, Ramesh R Rao, Ellen Schmeding, William A Vega, Julie A Avanzino, Danielle K Glorioso, John Feather
Older adults consistently prefer aging in place, which requires a high level of community support and services that are currently lacking. With a rapidly aging population, the present infrastructure for healthcare will prove even more inadequate to meet seniors' physical and mental health needs. A paradigm shift away from the sole focus on delivery of interventions at an individual level to more prevention-focused, community-based approaches will become essential. Recent initiatives have been proposed to promote healthy lifestyles and preventive care to enable older adults to age in place...
July 28, 2016: American Journal of Geriatric Psychiatry
Jiwon Sarah Park, Jennifer H Kuo, J Nilas Young, Michael S Wong
BACKGROUND: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT). METHODS: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted...
October 6, 2016: Annals of Plastic Surgery
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