Rural Families More Likely to be Uninsured and Have Different Sources of Coverage

This study used the 2001/2002 Medical Expenditure Panel Survey (MEPS), conducted by the Agency for Healthcare Research and Quality (AHRQ), to examine the patterns of insurance coverage within rural families and to assess differences in family-level insurance status for rural and urban families (including comparisons between rural families living adjacent to and not adjacent to an urban area). Among partially uninsured families, we examined rural-urban differences in the sources of family coverage for insured family members (Medicare, Medicaid/ SCHIP, private, or a combination)

Impact of Employment Transitions on Health Insurance Coverage of Rural Residents

Numerous studies have found that rural residents are more likely to be uninsured than urban residents. This coverage difference is generally due to more limited access for rural workers to employer-sponsored health insurance. Lower wages, and the tendency for rural residents to work for small employers, account for this reduced access. While we have substantial information on static insurance coverage rates for rural residents, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured, and there is some evidence that this risk is even greater for rural workers. Other studies suggest that access to health insurance plays an important role in determining whether a worker decides to change. Whether this relationship is any different for urban versus rural workers has not been well-studied. In the past 20 years, much of the federal-level policy attention related to health insurance coverage has emphasized ensuring continuity of coverage for individuals that experience an employment transition. For example, the Consolidated Omnibus Budget Reconciliation Act (COBRA), passed in 1985, ensured that those with employer-sponsored coverage could retain that coverage even if that employment ceased. Similarly, the 1996 Health Insurance Portability and Accountability Act (HIPAA) guaranteed individual coverage for those who leave a group plan. However, both of these key policy interventions are inapplicable to the smaller employers that are the backbone of rural economies. Thus, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The Patient Protection and Affordable Care Act (ACA) provides a new background against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Understanding how changes in employment status impact insurance coverage for rural workers can help to identify potential challenges and opportunities for implementing ACA in rural areas

Many Urban and Rural Workers Lose Health Insurance During Job Transitions

Numerous studies have found that rural residents are more likely to be uninsured than urban residents, in part because rural workers are more likely to be employed by a small business or have low wages and thus have more limited access to employer coverage.1-5 Yet, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured,6 and there is some evidence that this risk is even greater for rural workers.7 In the past 20 years, much of the federal-level policy attention related to health insurance coverage (e.g. the Consolidated Omnibus Budget Reconciliation Act and the Health Insurance Portability and Accountability Act) has emphasized ensuring continuity of coverage for individuals that experience an employment transition. However, these key policy interventions do not apply to smaller employers that are the backbone of rural economies. !us, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The purpose of this study was to explore the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences. !e Affordable Care Act (ACA) provides a new backdrop against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Our findings provide important information about the health insurance coverage challenges that rural workers may face, and may help to identify potential challenges and opportunities for implementing ACA in rural areas

Health Insurance Profile Indicates Need to Expand Coverage in Rural Areas

Key Findings: A greater percentage of rural residents than urban residents are uninsured, especially those living in remote areas Among adults over age 50, uninsured rates are highest in the most remote rural places Compared to urban adults, rural adults are less likely to be in employment situations where private coverage is offered

Ambient particulate pollution and the world-wide prevalence of asthma, rhinoconjunctivitis and eczema in children: Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC)

Objectives: To investigate the effect of ambient particulate matter on variation in childhood prevalence of asthma, rhinoconjunctivitis and eczema. Methods: Prevalences of asthma, rhinoconjunctivitis and eczema obtained in Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC) were matched with city-level estimates of residential PM10 obtained from a World Bank model. Associations were investigated using binomial regression adjusting for GNP per capita and for clustering within country. For countries with more than one centre, a two stage meta-analysis was carried out. The results were compared with a meta-analysis of published multi-centre studies. Results: Annual concentrations of PM₁₀ at city level were obtained for 105 ISAAC centres in 51 countries. After controlling for GNP per capita, there was a weak negative association between PM₁₀ and various outcomes. For severe wheeze in 13-14-year-olds, the OR for a 10 μg/m³ increase in PM₁₀ was 0.92 (95 CI 0.84 to 1.00). In 24 countries with more than one centre, most summary estimates for within-country associations were weakly positive. For severe wheeze in 13-14-year-olds, the summary OR for a 10 μg/m³ increase in PM₁₀ was 1.01 (0.92 to 1.10). This result was close to a summary OR of 0.99 (0.91 to 1.06) obtained from published multi-centre studies. Conclusions: Modelled estimates of particulate matter at city level are imprecise and incomplete estimates of personal exposure to ambient air pollutants. Nevertheless, our results together with those of previous multi-centre studies, suggest that urban background PM₁₀ has little or no association with the prevalence of childhood asthma, rhinoconjunctivitis or eczema either within or between countries

Prioritizing Environmental Issues around the World: Opinions from an International Central and Eastern European Environmental Health Conference

BACKGROUND: As the next generation of scientists enters the field of environmental health, it is imperative that they view their contributions in the context of global environmental stewardship. In this commentary, a group of international graduate students facilitated by three experienced environmental health scientists present their views on what they consider to be the global environmental health concerns of today. This group convened initially in October 2004 at an international health conference in Prague, Czech Republic. OBJECTIVES: In this report we identify perceived environmental health concerns that exist around the world, with a focus on Central and Eastern Europe. Additionally, we address these perceived problems and offers some potential solutions. DISCUSSION: At the meeting, students were invited to participate in two panel discussions. One group of young international scientists identified several significant global environmental health concerns, including air pollution, occupational hazards, and risk factors that may exacerbate current environmental health issues. The second panel determined that communication, education, and regulation were the mechanisms for addressing current environmental challenges. CONCLUSIONS: In this commentary we expand on the views presented at the meeting and represent the concerns of young investigators from nine different countries. We provide ideas about and support the exchange of information between developed and developing countries on how to handle the environmental health challenges that face the world today

Aedes aegypti salivary gland extract alleviates acute itching by blocking TRPA1 channels

Aedes aegypti (Ae. aegypti) saliva induces a variety of anti-inflammatory and immunomodulatory activities. Interestingly, although it is known that mosquito bites cause allergic reactions in sensitised hosts, the primary exposure of humans to Ae. aegypti does not evoke significant itching. Whether active components in the saliva of Ae. aegypti can counteract the normal itch reaction to injury produced by a histaminergic or non-histaminergic pathway in vertebrate hosts is unknown. This study investigated the effects of Ae. aegypti mosquito salivary gland extract (SGE) on sensitive reactions such as itching and associated skin inflammation. Acute pruritus and plasma extravasation were induced in mice by the intradermal injection of either compound 48/80 (C48/80), the Mas-related G protein-coupled receptor (Mrgpr) agonist chloroquine (CQ), or the transient receptor potential ankyrin 1 (TRPA1) agonist allyl isothiocyanate (AITC). The i.d. co-injection of Ae. aegypti SGE inhibited itching, plasma extravasation, and neutrophil influx evoked by C48/80, but it did not significantly affect mast cell degranulation in situ or in vitro. Additionally, SGE partially reduced CQ- and AITC-induced pruritus in vivo, suggesting that SGE affects pruriceptive nerve firing independently of the histaminergic pathway. Activation of TRPA1 significantly increased intracellular Ca2+ in TRPA-1-transfected HEK293t lineage, which was attenuated by SGE addition. We showed for the first time that Ae. aegypti SGE exerts anti-pruriceptive effects, which are partially regulated by the histamine-independent itch TRPA1 pathway. Thus, SGE may possess bioactive molecules with therapeutic potential for treating nonhistaminergic itch