Closing the Coverage Gaps: Reducing Health Insurance Disparities in Massachusetts

Massachusetts has been exemplary in developing health insurance coverage policies to cover its residents. By 2019, the state's uninsurance rate was 3.0 percent, the lowest rate in the nation, representing about 204,000 uninsured residents. While the state's overall uninsured rate at a given point in time is low, more than twice as many people - 503,000, or 7.3 percent of the population - experienced a gap in coverage over the previous twelve months. And importantly, not all groups benefit equally. People who are Black or Hispanic, or who have lower incomes, experience significantly higher rates of uninsurance than the state population overall. As a result, these groups are more likely to face access barriers and financial insecurity associated with being uninsured.The purpose of this report is to begin charting a course toward closing the coverage gaps in Massachusetts, with a particular focus on creating a more racially and ethnically equitable system of coverage. The report and accompanying infographics describe the people in Massachusetts without health insurance and the barriers to coverage they face, including affordability, administrative complexity, and immigration, language, and cultural barriers. It then proposes a menu of policy options that address the specific circumstances in Massachusetts. The proposed options are meant to inform a statewide conversation about the best approaches to closing the remaining coverage gaps in Massachusetts and removing structural barriers that result in racial and ethnic disparities in health insurance coverage

Sexual Behaviours and Sexual Health Among Middle-aged and Older Adults in Britain

Objectives Population-representative studies of the sexual health of middle-aged and older adults are lacking in ageing societies. This study aimed to identify latent patterns of sexual behaviours and health of people aged 45–74 years. Methods We conducted a latent class analysis of the National Attitudes and Sexual Lifestyles Survey (Natsal-3), a nationally representative survey conducted in Britain in 2011. Results Of the 5260 respondents aged 45–74 years, 48.86% of men and 44.91% of women belonged to the Content Caseys class who reported good sexual health. The Infrequent Indigos (30.94% of men, 44.38% of women) were characterised by a lack of sexual activity, reported some dissatisfaction, and were more likely to have a disability. The Low-Functioning Lees (11.65% of men, 8.41% of women) reported some more disability and had issues with sexual functioning and higher levels of distress. The Multiple-Partnered Morgans (8.62% of men, 2.30% of women) were characterised by a greater number of sexual partners and several risk behaviours. Conclusions The use of these four classes can aid in improved targeting of tailored sexual health services to improve sexual function, sexual satisfaction, reduce distress and risky behaviours among middle-aged and older adults. These services should be inclusive of the disabled community

Biochar has no effect on soil respiration across Chinese agricultural soils

This work was supported by NSFC (41371298 and 41371300), Ministry of Science and Technology (2013GB23600666 and 2013BAD11B00), and Ministry of Education of China (20120097130003). The international cooperation was funded under a “111” project by the State Agency of Foreign Expert Affairs of China and jointly supported under a grant for Priority Disciplines in Higher Education by the Department of Education, Jiangsu Province, China; The work was also a contribution to the cooperation project of “Estimates of Future Agricultural GHG Emissions and Mitigation in China” under the UK-China Sustainable Agriculture Innovation Network (SAIN). Pete Smith contributed to this work under a UK BBSRC China Partnership Award. The authors are grateful to Yuming Liu, Bin Zhang, Xiao Li, Gang Wu, Jinjin Qu and Yinxin Ye and Dongqi Liu for their contribution to field experiments, and to Rongjun Bian and Qaiser Hussain for their participation in discussions of the data analysis and interpretation, and to Xinyan Yu and Jiafang Wang for their assistance in lab works.Peer reviewedPostprin

Barriers, Costs, and Attitudes Toward Pediatric Cataract Surgery at Two Large Facilities in China and India.

PURPOSE: To better understand barriers of costs and attitudes toward pediatric cataract surgery in China and India. METHODS: From January 2014 to June 2015, families of children ≤ 10 years old about to undergo or having completed surgery for bilateral, non-traumatic cataract at two tertiary centers in China and India completed questionnaires regarding their demographic characteristics, financial status, living environment, health seeking behaviors, and medical burden. RESULTS: In China, 38 children (23 boys [60.5%], mean age 3.11 ± 2.88 years) were un-operated, and 44 (26 boys [59.1%], mean age 5.09 +/- 2.17 years) had undergone surgery, while in India there were 60 (44 boys [73.3%], mean age 4.61 +/- 3.32 years) and 39 (29 boys [74.4%], mean age 6.45 +/- 2.74 years) children respectively, 181 in total. Chinese children were younger at presentation (p ≤ 0.03 for both operated and un-operated) and also when cataract was detected (median [inter quartile range] 10 [3-34] versus 24 [6-60] months [p = 0.06] for un-operated, 5 [2-12] versus 36 [8-72] months [p < 0.001] for operated). Maternal education levels were lower in India (48.3% and 51.3% with elementary education only among un-operated [p = 0.11] and operated [p = 0.006] families in India versus 27.0% and 20.5% in China), as were rates of consulting medical practitioners for illness (44.7% and 36.4% for un-operated [p < 0.001] and operated [p = 0.001] in China versus 10% and 5.13% in India). CONCLUSIONS: Socioeconomic challenges to securing cataract surgery may be greater, and delays in obtaining surgery longer, in India compared to China, if these facilities are representative

Biochar-based fertilizer: Supercharging root membrane potential and biomass yield of rice

Biochar-based compound fertilizers (BCF) and amendments have proven to enhance crop yields and modify soil properties (pH, nutrients, organic matter, structure etc.) and are now in commercial production in China. While there is a good understanding of the changes in soil properties following biochar addition, the interactions within the rhizosphere remain largely unstudied, with benefits to yield observed beyond the changes in soil properties alone. We investigated the rhizosphere interactions following the addition of an activated wheat straw BCF at an application rates of 0.25% (g·g−1 soil), which could potentially explain the increase of plant biomass (by 67%), herbage N (by 40%) and P (by 46%) uptake in the rice plants grown in the BCF-treated soil, compared to the rice plants grown in the soil with conventional fertilizer alone. Examination of the roots revealed that micron and submicron-sized biochar were embedded in the plaque layer. BCF increased soil Eh by 85 mV and increased the potential difference between the rhizosphere soil and the root membrane by 65 mV. This increased potential difference lowered the free energy required for root nutrient accumulation, potentially explaining greater plant nutrient content and biomass. We also demonstrate an increased abundance of plant-growth promoting bacteria and fungi in the rhizosphere. We suggest that the redox properties of the biochar cause major changes in electron status of rhizosphere soils that drive the observed agronomic benefits

Sexual behaviours and sexual health among middle-aged and older adults in Britain.

OBJECTIVES: Population-representative studies of the sexual health of middle-aged and older adults are lacking in ageing societies. This study aimed to identify latent patterns of sexual behaviours and health of people aged 45-74 years. METHODS: We conducted a latent class analysis of the National Attitudes and Sexual Lifestyles Survey (Natsal-3), a nationally representative survey conducted in Britain in 2011. RESULTS: Of the 5260 respondents aged 45-74 years, 48.86% of men and 44.91% of women belonged to the Content Caseys class who reported good sexual health. The Infrequent Indigos (30.94% of men, 44.38% of women) were characterised by a lack of sexual activity, reported some dissatisfaction, and were more likely to have a disability. The Low-Functioning Lees (11.65% of men, 8.41% of women) reported some more disability and had issues with sexual functioning and higher levels of distress. The Multiple-Partnered Morgans (8.62% of men, 2.30% of women) were characterised by a greater number of sexual partners and several risk behaviours. CONCLUSIONS: The use of these four classes can aid in improved targeting of tailored sexual health services to improve sexual function, sexual satisfaction, reduce distress and risky behaviours among middle-aged and older adults. These services should be inclusive of the disabled community

Economic and environmental potential of biochar: A "win-win" solution for China's straw?

Biochar has often been described as a "win-win" technology for soil fertility, agronomic yields, carbon sequestration and poverty reduction. However, despite a growing body of physical research evidence to support these claims, there is much less socio-economic evidence for biochar's potential to achieve these "winwin" outcomes in real-world systems. Consequently, debates about biochar and its potential to contribute to sustainable development have often been polarised between extremes of opinion, with some claiming it is a key technology for mitigating climate change, and others warning of potentially dire effects for ecosystems and vulnerable populations. This inspired the objective for this PhD, which is to generate research that can inform and moderate the debate on biochar's win-win potential. Guided by the theory of ecological modernisation, this PhD aimed to generate a body of applied, policy-relevant research on the economic and environmental potential of biochar as a win-win use of biomass resources. It was important to adopt geographical and biomass boundaries for the research to provide a meaningful and focused contribution, therefore the research is focused on China and its agricultural straw residues. One of the central claims for biochar is that it can improve crop yields and, consequently, reduce poverty for smallholder farmers. This thesis investigated this from a socio-economic perspective using farm-scale linear programming models with primary data from interviews conducted across four contrasting Chinese agricultural systems. The results suggest that biochar is unlikely to provide even minor economic gains, let alone poverty-reducing change, to smallholder farmers in these systems. If biochar is not economic for farmers, there is a possibility that economies of scale made possible by business ventures could reduce the marginal costs per unit of biochar product and/or that governments/climate finance institutions may be interested in subsidising this technology where it has significant carbon mitigation impacts. Thus the next research question was whether biochar might be a profitable investment for businesses in China, and further whether businesses might also profit from carbon credits/subsidies where biochar's carbon sequestration potential is valued either by carbon markets or by climate conscious governments willing to provide appropriate incentives. Life-cycle and cost-benefit analyses demonstrated that, when compared to the main competing uses for straw feedstocks (briquetting for combustion in boilers, and gasification for electricity generation), pyrolysis of straw to produce biochar makes a financial loss under all subsidy scenarios considered, and is the least cost-effective technology for carbon sequestration. Overall it seems biochar made from China's straw feedstocks is not currently a win-win option for smallholder farmers, business investors or national/international climate mitigation strategies. In light of the relative dominance of bioenergy over biochar production as a financial and climate mitigating option for China's straw, the focus of the thesis shifts to explore win-win scenarios in this domain. Here the results are more promising. Combining a unique geographical dataset of China's coal fired powerstations and straw location with data on energy economics, the model suggests a small tweak to China's bioenergy subsidy system (an extension of the existing feed-in-tariff to include low energy replacement ratio cofiring) could contribute 42-62% of China's 2020 target to install 30GW of renewable energy generation capacity: a classic win-win scenario for the Chinese government's bioenergy targets, bioenergy investors and global climate change. Overall this thesis offers two main findings to the literature. Firstly it demonstrates that, within its current high application rate model, biochar will struggle to compete as a win-win strategy when viewed through financial and carbon sequestration lenses. However, secondly, it suggests that win-win strategies are available for China's straw resources under cofiring bioenergy applications. The thesis concludes with a critical discussion of these results in relation to the theory of ecological modernisation and the concept of win-wins