Health Reform in Massachusetts as of Fall 2010: Getting Ready for the Affordable Care Act & Addressing Affordability

Provides updated survey findings about trends since fall 2006 in the insurance coverage, healthcare access and use, costs and affordability, financial difficulties, and attitudes toward state healthcare reform among non-elderly adults in Massachusetts

Almost in the Wild: Student Search Behaviors When Librarians Aren\u27t Looking

Academic libraries offer a variety of tools for students to find information, including discovery systems and traditional library databases. This study contributes to the growing body of knowledge on student information-seeking behaviors by comparing how upper-level students majoring in Social and Behavioral Sciences use these two categories of search tools. Student search behavior and the use of search features, facets in particular, are quantified for each tool. The authors explore with statistical analyses whether these practices aid or hinder students in their search for high quality information. Qualitative data from student interviews is selectively employed to aid in explaining the results. Key findings include the differential use of search features in the discovery system versus the traditional database, and the relationships between the use of certain facets and the quality of sources chosen by students. Implications for instruction, search interface configuration, and default settings are discussed

Pregnancy-Related Lumbopelvic Pain: Listening to Australian Women

Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. Sample population: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy

Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care.

BACKGROUND: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care. METHODS: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models' characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria. RESULTS: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0-32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported. CONCLUSIONS: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Aging Out of Dependent Coverage and the Effects on U.S. Labor Market and Health Insurance Choices

Background/Aims: We examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). Methods: We used National Health Interview Survey data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26. The sample was restricted to unmarried individuals 24 to 28 years old and to a period of time before the ACA’s individual mandate (2011–2013). Models were run separately for men and women to determine if there were differences based on gender. Results: Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women and reports that health insurance coverage was worse than it was one year previously (overall and for young women). Uninsured rates did not increase at age 26, but there was an increase in the purchase of nongroup health coverage, indicating interest in remaining insured after age 26. Conclusion: Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (age 18–29) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays

Identifying the poisonous gases seeping into the coal mine : what women seek to avoid in choosing to give birth at home

In this chapter we review the literature on the medical interventions women are seeking to avoid by choosing to give birth at home. We also report on some of the results of the National Homebirth Survey (NHBS) undertaken in Australia. The literature review revealed that women who choose homebirth are mostly seeking to avoid: caesarean, pain relief medication, induction and augmentation of labour, foetal monitoring and vaginal examinations. Over 1400 Australian women completed the NHBS survey in 2016. While the majority of women said they would prefer to give birth at home with a registered midwife, more than half said they would give birth without a registered midwife or find an unregistered birthworker (UBW) if a midwife was unavailable. Women reported choosing to give birth at home to avoid specific medical interventions such as induction of labour, forceps and episiotomy. Women were also avoiding time pressure, the hospital environment, the risk agenda of the hospital, hospital policies and coercion. Homebirth was chosen because it gave women access to continuity of midwifery care and uninterrupted skin-to-skin contact with their baby. Women’s previous hospital experience(s) were reported as traumatic by 49% of the women surveyed and 9% reported a diagnosis of post-traumatic stress disorder (PTSD) following a traumatic hospital birth. In contrast, only 6% of women considered their homebirth experience to be traumatic and 1% reported having a diagnosis of PTSD. The majority of these were associated with how they were treated when transferred in labour