Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans

Key Findings: In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments

Correlates of Frailty among Aging Residents of upper Selška Valley Villages under Ratitovec Mountain

Frailty, multi-system dysregulation following multiple life stressors, is associated with age and vulnerability to negative health. Our model is that variables such as age and sex affect biocultural changes resulting from lifestyle and alter frailty. We assessed frailty with a four-factor index. We expand understanding of frailty by examining associations with demographic, health, and lifestyle factors in a Slovenian sample. Between 2008 and 2009, 40 residents of the Selska Valley, Slovenia aged 55 to 85 years (x ̅ = 72. 85, sd = 7.24) participated in physical assessments, responded to the SF-36, and self-reported their own and family history of non-communicable diseases. Participants included 26 women (age 59-86) and 14 men (age 57-82). We used linear regression and t-tests to assess associations of these factors with frailty. Frailty was significantly positively associated with age, sex, length of residence in the village, and multiple self-reported health factors. Conversely, frailty was significantly negatively associated with height and showed a borderline significant association with diastolic blood pressure. Controlling for age and sex, significant associations remained between frailty and self-reports of health along with painful and reduced activity levels. Frailty also interacts with lifestyle factors. Results suggest the model proposed by Walston and colleagues (2005) is a valid cross-cultural measure of frailt

Declining Medicaid Fees and Primary Care Availability for New Medicaid Patients

Primary care appointment availability for new Medicaid patients declined when Medicaid fees for providers decreased after the ACA-mandated “fee bump” expired

The Transition to an Energy Sufficient Economy

Nigeria is an energy-rich nation with a huge energy resource base. The country is the largest reserves holder and largest producer of oil and gas in the African continent. Despite this, only about 40% of its 158 million people have access to modern energy services. Around 80% of its rural population depend on traditional biomass. This paper presents an overview of ongoing research to examine energy policies in Nigeria. The aims are: 1) to identify and quantify the barriers to sustainable energy development and 2) to provide an integrated tool to aid energy policy evaluation and planning. System dynamics modelling is shown to be a useful tool to map the interrelations between critical energy variables with other key sectors of the economy, and for understanding the energy use dynamics (impact on society and the environment). It is found that the critical factors are burgeoning population, lack of capacity utilisation, and inadequate energy investments. Others are lack of suitably trained manpower, weak institutional frameworks, and inconsistencies in energy policies. These remain the key barriers hampering Nigeria\u27s smooth transition from energy poverty to an energy sufficient economy

Primary Care Access for new Patients on the eve of Health Care Reform

Importance: Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients. Objective: To assess primary care appointment availability by state and insurance status. Design, Setting, and Particpants: We conducted a simulated patient study. Trained field staff, randomly assigned to private insurance, Medicaid, or uninsured, called primary care offices requesting the first available appointment for either routine care or an urgent health concern. The study included a stratified random sample of primary care practices treating nonelderly adults within each of 10 states (Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas), selected for diversity along numerous dimensions. Collectively, these states comprise almost one-third of the US nonelderly, Medicaid, and currently uninsured populations. Sampling was based on enrollment by insurance type by county. Analyses were weighted to obtain population-based estimates for each state. Main Outcomes and Measures: The ability to schedule an appointment and number of days to the appointment. We also examined cost and payment required at the visit for the uninsured. Results: Between November 13, 2012, and April 4, 2013, we made 12,907 calls to 7788 primary care practices requesting new patient appointments. Across the 10 states, 84.7% (95% CI, 82.6%-86.8%) of privately insured and 57.9% (95% CI, 54.8%-61.0%) of Medicaid callers received an appointment. Appointment rates were 78.8% (95% CI, 75.6%-82.0%) for uninsured patients with full cash payment but only 15.4% (95% CI, 13.2%-17.6%) if payment required at the time of the visit was restricted to $75 or less. Conditional on getting an appointment, median wait times were typically less than 1 week (2 weeks in Massachusetts), with no differences by insurance status or urgency of health concern. Conclusions and Relevance: Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Navigator programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan\u27s network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act

Ethnic variations in falls and road traffic injuries resulting in hospitalisation or death in Scotland: the Scottish Health and Ethnicity Linkage Study (SHELS) Public Health

Objectives: To investigate ethnic differences in falls and road traffic injuries (RTIs) in Scotland. Study design: A retrospective cohort of 4.62 million people, linking the Scottish Census 2001, with self-reported ethnicity, to hospitalisation and death records for 2001–2013. Methods: We selected cases with International Classification of Diseases–10 diagnostic codes for falls and RTIs. Using Poisson regression, age-adjusted risk ratios (RRs, multiplied by 100 as percentages) and 95% confidence intervals (CIs) were calculated by sex for 10 ethnic groups with the White Scottish as reference. We further adjusted for country of birth and socio-economic status (SES). Results: During about 49 million person-years, there were 275,995 hospitalisations or deaths from fall-related injuries and 43,875 from RTIs. Compared with the White Scottish, RRs for falls were higher in most White and Mixed groups, e.g., White Irish males (RR: 131; 95% CI: 122–140) and Mixed females (126; 112–143), but lower in Pakistani males (72; 64–81) and females (72; 63–82) and African females (79; 63–99). For RTIs, RRs were higher in other White British males (161; 147–176) and females (156; 138–176) and other White males (119; 104–137) and females (143; 121–169) and lower in Pakistani females (74; 57–98). The ethnic variations differed by road user type, with few cases among non-White motorcyclists and non-White female cyclists. The RRs were minimally altered by adjustment for country of birth or SES. Conclusion: We found important ethnic variations in injuries owing to falls and RTIs, with generally lower risks in non-White groups. Culturally related differences in behaviour offer the most plausible explanation, including variations in alcohol use. The findings do not point to the need for new interventions in Scotland at present. However, as the ethnic mix of each country is unique, other countries could benefit from similar data linkage-based research

Differences in all-cause hospitalisation by ethnic group: a data linkage cohort study of 4.62 million people in Scotland, 2001–2013

Background: Immigration into Europe has raised contrasting concerns about increased pressure on health services and equitable provision of healthcare to immigrants /ethnic minorities. We assessed hospital use by ethnic group in Scotland. Methods: We anonymously linked Scotland?s Census 2001 records for 4.62 million people, including their ethnic group, to National Health Service general hospitalisation records for 2001-2013. We used Poisson regression to calculate hospitalisation rate ratios (RRs) in 14 ethnic groups, presented as percentages of the White Scottish reference group (RR=100), for males and females separately. We adjusted for age and socio-economic status and compared those born in the United Kingdom or the Republic of Ireland (UK/RoI) with elsewhere. We calculated mean lengths of hospital stay. Results: 9,789,975 hospital admissions were analysed. Compared to the White Scottish, unadjusted RRs for both males and females in most groups were about 50-90, e.g. Chinese males 49 (95% CI 45-53) and Indian females 76 (71-81). The exceptions were White Irish males, 120 (117-124) and females 115 (112-119) and Caribbean females, 103 (85-126). Adjusting for age increased the RRs for most groups towards or above the reference. Socio-economic status had little effect. In many groups, those born outside the UK/RoI had lower admission rates. Unadjusted mean lengths of stay were substantially lower in most ethnic minorities. Conclusions: Use of hospital beds in Scotland by most ethnic minorities was lower than by the White Scottish majority, largely explained by their younger average age. Other countries should use similar methods to assess their own experiences

Pilot study linking primary care records to Census, cardiovascular hospitalization and mortality data in Scotland: feasibility, utility and potential

Background There are substantial ethnic variations in the risk of cardiovascular disease (CVD)-related hospitalization and mortality in Scotland. We piloted extracting and linking primary care risk factors to Scottish Census and health data, to test the feasibility of further investigating these variations.Methods Data extracted from 10 general practices were linked at individual level to Census and hospitalization/death records. Linkage rates, reasons for non-linkage and completeness of primary care data were examined. CVD relative risks were calculated, adjusting for age, socioeconomic status and primary care-derived risk factors.Results Practice enrolment and data extraction proved challenging. Primary care records for 52 975 (55.2%) people were linked to Census data. Completeness and validity of risk variables were similar across ethnic groups. A total of 48 325 (91.2%) records had a valid smoking status recorded and 2900 (5.5%) people had a primary care record of diabetes. Ethnic-specific adjusted estimates of CVD risk were plausible and consistent with previous work.Conclusions Risk factor data extracted from primary care were of good quality and successfully linked to national Census records. Given further methodological refinement, this method illustrates the potential value of linkage using national primary care datasets to contribute to public health surveillance and research.<br/

Reprogramming within Hours Following Nuclear Transfer into Mouse but not Human Zygotes

Fertilized mouse zygotes can reprogram somatic cells to a pluripotent state. Human zygotes might therefore be useful for producing patient-derived pluripotent stem cells. However, logistical, legal and social considerations have limited the availability of human eggs for research. Here we show that a significant number of normal fertilized eggs (zygotes) can be obtained for reprogramming studies. Using these zygotes, we found that when the zygotic genome was replaced with that of a somatic cell, development progressed normally throughout the cleavage stages, but then arrested before the morula stage. This arrest was associated with a failure to activate transcription in the transferred somatic genome. In contrast to human zygotes, mouse zygotes reprogrammed the somatic cell genome to a pluripotent state within hours after transfer. Our results suggest that there may be a previously unappreciated barrier to successful human nuclear transfer, and that future studies could focus on the requirements for genome activation.Stem Cell and Regenerative Biolog