Measuring the Impact of the Affordable Care Act Medicaid Expansion on Access to Primary Care Using an Interrupted Time Series Approach

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care. METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates. RESULTS: The Affordable Care Act\u27s Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: -0.0059, CI -0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care). CONCLUSION: Health policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents. CONTRIBUTION TO KNOWLEDGE: Ambulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers\u27 motivations and objectives, etc.) must be addressed to improve access

An assessment of integrated watershed management in Ethiopia

Sustainable participatory watershed management is an approach promoted by the Ethiopian government to restore natural resources and agricultural productivity across the country. This comparative study between six watershed programs shows that this approach increases farmers’ food security and incomes (around 50% on average), as well as their resilience to drought and other climate shocks. However, the study also confirms that the nature and scale of impact can vary significantly between watershed programs. The success of watershed management depends on multiple factors from the hydrological profile of the watershed to the local social and economic environment. Tailoring watershed interventions to the local context, associating conservation and livelihoods activities, and providing further financial and technical support to watershed committees are among the recommendations of this paper

Predictors of stage of adoption for colorectal cancer screening among African American primary care patients

BACKGROUND: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. OBJECTIVE: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. METHODS: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. RESULTS: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. CONCLUSIONS: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. IMPLICATIONS FOR PRACTICE: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests

Land cover changes in the Upper Great Ruaha (Tanzania) and the Upper Awash (Ethiopia) river basins and their potential implications for groundwater resources

Over the past century, the world has experienced an unprecedented surge in population growth, accompanied by a significant increase in economic activity and fuelled by an intensive utilization of natural resources, including water. This phenomenon has brought about profound alterations in land cover and land use patterns across various regions. Knowledge of land use changes is key to unlocking an understanding of water use changes and associated impacts on water resources, and potential threats to sustainability. However, the pace and nature of land use transitions vary widely across the globe, shaped by a complex interplay of local, regional and global factors, making systematic assessments important. This report presents the results of a land cover change analysis conducted in two river basins in sub-Saharan Africa: the Upper Great Ruaha River Basin (UGRRB) in Tanzania and the Upper Awash River Basin (UARB) in Ethiopia. The spatio-temporal analysis spans a recent 15-20-year period up until 2015/16 and utilizes remote sensing imagery, secondary maps and ground truth information for the two end point times (resolution: 30 m). The basins are significantly different in terms of agricultural development and water resource use. UARB represents an area with emerging commercial farms, urban expansion and diminishing natural vegetation, whereas UGRRB still retains significant natural vegetation but is experiencing an increase in smallholder agriculture as well as intensive commercial irrigation potentially affecting fragile wetland systems. In UGRRB, surface water is the main source of irrigation water, while in UARB, groundwater resources are increasingly used for irrigation by smallholder farmers. The findings reveal a common overall trend in both basins that is similar to many low-income countries, illustrating an expansion of agricultural and irrigated areas and human settlements at the expense of natural land cover. The report presents a detailed systematic remote sensing-based methodology to quantify and compare land cover transitions in time and space with high resolution, within and between agricultural landscapes of larger basins. The study highlights that land cover changes in the basins follow diverse and unique trajectories, providing critical insights into evolving land use patterns. In its conclusion, the study underscores the profound implications of recent land use changes for groundwater resources within these agro-pastoral systems. Overall, the report highlights the importance of sustainable land management and integrated water resources management, and provides valuable insights into the complexities of land use change in these regions

Enhancing individual animal resilience to environmental disturbances to address low productivity in dairy cattle performing in sub-Saharan Africa

The current review examines potential solutions to enhance the sustainability and productivity of the dairy sector in sub-Saharan Africa (SSA) with an emphasis on breeding for resilience. Additionally, the paper explores various indicators for measuring resilience and provides insights into the data that can be utilized to quantify resilience in SSA’s dairy production systems. Dairy production contributes significantly to food and nutritional security and employment in SSA. However, besides the general lack of enabling policy and institutional environments, production is negatively affected by environmental challenges such as high temperatures and heat stress, diseases and parasites, unreliable rainfall patterns, shortages of feeds and forages and undue preference for taurine cattle breeds regardless of their poor adaptability to prevailing local conditions. Fostering the resilience capacity of dairy animals is imperative to combat climate-related adversities and maintain productivity. This can only be achieved if reliable and practical methods for quantifying and analyzing resilience in SSA are described and undertaken. This study has reviewed variance of deviations, root mean square of deviations, autocorrelation of deviations, skewness of deviations, slope of the reaction norm and its absolute value as possible indicators of resilience in SSA. While previous research has reported genetic variation and favorable correlations of these indicators with health, fitness, and fertility traits, their potential in SSA environments requires further investigation. Besides, labor- and cost-effective phenotypic data collection is essential for characterization of resilience using these indicators. Through this study, we propose frequently collected data on milk production traits, body fat-related traits, and activity patterns as suitable in the sub-Saharan Africa context. The African Asian Dairy Genetic Gains Project by the International Livestock Research Institute (ILRI) offers a valuable opportunity to collate data from diverse dairy systems in SSA for testing the potential of these indicators. Insights from this study are helpful in improving resilience of dairy animals in SSA, which would contribute to poverty alleviation, animal welfare improvement, and better preparedness in lieu of climate change in SSA.</p