Bipolar spectrum disorders in a clinical sample of patients with Internet addiction: Hidden comorbidity or differential diagnosis?

Background and aims Behavioral addictions and bipolar disorders have a certain probability of co-occurrence. While the presence of a manic episode has been defined as an exclusion criterion for gambling disorder, no such exclusion has been formulated for Internet addiction. Methods A clinical sample of 368 treatment seekers presenting with excessive to addictive Internet use was screened for bipolar spectrum disorders using the Mood Disorder Questionnaire. Psychopathology was assessed by the Symptom Checklist 90R and a clinical interview was administered to screen for comorbid disorders. Results Comorbid bipolar disorders were more frequent in patients meeting criteria for Internet addiction (30.9%) than among the excessive users (5.6%). This subgroup showed heightened psychopathological symptoms, including substance use disorders, affective disorders and personality disorders. Further differences were found regarding frequency of Internet use regarding social networking sites and online-pornography. Discussion Patients with Internet addiction have a heightened probability for meeting criteria of bipolar disorders. It is not possible to draw conclusions regarding the direction of this association but it is recommended to implement screening for bipolar disorders in patients presenting with Internet addiction. Conclusion Similar to gambling disorder, it might prove necessary to subsume bipolar disorders as an exclusion criterion for the future criteria of Internet addiction

The Rise in Health Care Coverage and Affordability Since Health Reform Took Effect (Biennial 2014)

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the Affordable Care Act's subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey finds declines in the number of people who report cost-related access problems and medical-related financial difficulties. The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014

The Problem of Underinsurance and How Rising Deductibles Will Make It Worse: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year -- or 31 million people -- had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more

Too High a Price: Out-of-Pocket Health Care Costs in the United States

Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one of five 19-to-64-year old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more Adults with low incomes had the highest rates of steep out-of-pocket costs. About three of five privately insured adults with low incomes and half of those with moderate incomes reported that their deductibles are difficult to afford. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible

Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey

By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick

Americans' Experiences with Marketplace and Medicaid Coverage

The latest Commonwealth Fund Affordable Care Act Tracking Survey finds the share of uninsured working-age adults was 13 percent in March–May 2015, compared with 20 percent just before the major coverage expansions went into effect. More than half of adults who currently have coverage either through the Affordable Care Act's (ACA's) marketplace plans or Medicaid expansion were uninsured prior to gaining coverage. Of those, more than 60 percent lacked coverage for one year or longer. More than six of 10 adults who used their new plans to obtain care reported they could not have afforded or accessed it previously. Majorities of people with ACA coverage who have used their plans express satisfaction with the doctors covered in their networks and are able to find physicians with relative ease. Wait times to get appointments with physicians in marketplace plans and Medicaid are comparable to those reported by other working-age adults

Health Care Coverage and Access in the Nation's Four Largest States: Results from the Commonwealth Fund Biennial Health Insurance Survey, 2014

Across the country's four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state's uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics

Influencia de los procesos ambientales predominantes en la cuenca y el embalse Hanabanilla sobre la composición de su sedimento

The Hanabanilla reservoir was built in 1960 in the center-south of Cuba and is used for human supply and power generation. This research was aimed at identifying the important processes affecting sediment composition, through the analysis of particle size, and organic carbon (OC), nutrients, and major trace elements concentrations in sediment samples taken at the outlet point of the reservoir. The documentary review allowed us to identify how the nature and management of the basin and the operation of the reservoir affected sediment quality. The application of principal components analysis (PCA), and the determination of ionic relationships and correlations between the sediment quality variables, allowed for the identification of influential processes on sediment quality. Anthropic activities in the period 1960-2012 produced residues rich in OC, total phosphorus (TP) and total nitrogen (TN) that were stored in reservoir sediments. During the first years of the reservoir (1964-1976) the highest concentrations of sediment TP were recorded and the sediments functioned as a sink. The OC and TN mean concentrations were higher in the last stage of the study (2006-2012). The main influential processes on sediment composition were the operation of the reservoir, the geochemical cycle of P, the mineralization of the substances in the water column, and the weathering of silicates and the contribution of organic matter from the basin. Sediment quality data indicate that OC and TN were of allochthonous origin and TP was of autochthonous origin. Levels of sediment OC and TN also corresponded with an increase in anthropic activities in the basin.El embalse Hanabanilla fue construido en 1960 en el centro-sur de Cuba y sus usos principales son el abastecimiento humano y la generación de energía eléctrica. Esta investigación tuvo como objetivo identificar los procesos fundamentales que afectan la composición del sedimento, mediante el análisis del tamaño de las partículas, y el contenido de carbono orgánico (OC), nutrientes y elementos traza mayoritarios en muestras de sedimento tomadas en la obra de toma del embalse. La revisión documental permitió identificar cómo afectan la naturaleza y el manejo de la cuenca, y la operación del embalse a la calidad del sedimento. El análisis de componentes principales (PCA), las relaciones iónicas, y las correlaciones entre las variables de calidad del sedimento, permitieron identificar los procesos influyentes en la calidad del sedimento. Las actividades antrópicas en el período 1960-2012 produjeron residuos ricos en OC, fósforo total (TP) y nitrógeno total (TN) que se almacenaron en los sedimentos del embalse. Durante los primeros años del embalse (1964-1976), se registraron las más altas concentraciones de TP en el sedimento que actuó como sumidero. Las concentraciones medias de OC y TN fueron más altas en la última etapa del estudio (2006-2012). Los principales procesos que influyeron en la composición del sedimento fueron: la operación del embalse, el ciclo geoquímico del P, la mineralización de las sustancias en la columna de agua, y el lavado de los silicatos, unido a la contribución de la materia orgánica de la cuenca. Los datos indicaron un origen alóctono para el OC y el TN, y autóctono para el TP. Los niveles de OC y TN en el sedimento también se correspondieron con un incremento en la actividad antrópica en la cuenca.Fil: Labaut Betancourt, Yeny. Centro de Estudios Ambientales de Cienfuegos; Cuba. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Betancourt, Carmen R.. Universidad de Cienfuegos Carlos Rafael Rodriguez; CubaFil: Díaz Asencio, Misael. Centro de Estudios Ambientales de Cienfuegos; CubaFil: Beutel, Marc W.. University of California; Estados Unido

Therapeutic Plasma Exchange Decreases Levels of Routinely Used Cardiac and Inflammatory Biomarkers

Therapeutic plasma exchange (TPE) plays a key role in the management of various diseases, from thrombotic thrombocytopenic purpura and Goodpasture's syndrome to cardiac allograft rejection. In many of these disease states cardiac and inflammatory involvement is common and biomarkers are routinely used for diagnosis or assessment of therapeutic success. The effect of TPE on biomarkers used in the clinical routine has not been investigated.TPE was initiated for established clinical conditions in 21 patients. Troponin T, NT-proBNP, C-reactive protein, procalcitonin and routine chemistry were drawn before and after TPE, as well as before and after the 2(nd) TPE. The total amount of these markers in the waste bag was also analyzed.In 21 patients 42 TPEs were performed. The procedure reduced plasma levels of the examined biomarkers: 23% for NT-proBNP (pre vs. post: 4637±10234 ng/l to 3565±8295 ng/l, p<0.001), 64% for CRP (21.9±47.0 mg/l vs. 7.8±15.8 mg/l, p<0.001) and 31% for procalcitonin (0.39±1.1 µg/l vs. 0.27±0.72 µg/l, p=0.004). TPE also tended to reduce plasma levels of troponin T by about 14% (60.7±175.5 ng/l vs. 52.2±141.3 ng/l), however this difference was not statistical significant (p=0.95). There was a significant correlation between the difference of pre TPE levels to post TPE levels of all examined biomarkers and the total amount of the removed biomarker in the collected removed plasma.TPE significantly reduces plasma levels of inflammatory and cardiac biomarkers. Therefore, post TPE levels of cardiac and inflammatory biomarkers should be viewed with caution