How Could Repealing Key Provisions of the Affordable Care Act Affect Community Health Centers and their Patients?

Analyses of repeal of the Affordable Care Act (ACA) have tended to focus on coverage. This study, which gauges the potential effects of repealing certain ACA provisions, looks at the question of primary health care access itself, with a focus on medically underserved communities. A survey developed and fielded in early 2017 asked community health centers to estimate the impact of ending the Health Centers Fund established under the ACA as well as ending expanded Medicaid coverage and subsidies designed to make private insurance affordable for lower income patients. Forty-one percent of health centers responded; 69 percent were located in Medicaid expansion states and 31 percent in non-expansion states. Responses were weighted to ensure representativeness

I don't care about others' approval: Dysphoric individuals show reduced effort mobilization for obtaining a social reward

Past research on reduced reward responsiveness in depression and dysphoria has mainly focused on monetary rewards. However, social rewards are important motivators and might be especially impaired in depression. The present study tested the hypothesis that nondysphoric individuals would mobilize more effort during a memory task without a clear performance standard when anticipating social approval for good performance. In contrast, dysphoric individuals were expected to be less sensitive to this reward and to mobilize less effort. Effort mobilization in this 2 (dysphoric vs. nondysphoric)×2 (no reward vs. social approval) between-persons study was operationalized by participants' cardiovascular reactivity. Results confirmed that nondysphorics had higher reactivity of systolic blood pressure, diastolic blood pressure, and heart rate when expecting to enter their name in the alleged "best list”, whereas dysphorics had lower cardiovascular reactivity. The present study expands evidence for reduced reward responsiveness in depression and dysphoria from an effort mobilization perspective by demonstrating reduced effort-related cardiovascular reactivity to social rewards

Intégrer la dimension genre dans l’enseignement supérieur : transformation de pratiques au niveau individuel et institutionnel

Les institutions d’enseignement supérieur sont nombreuses à développer l’égalité des chances. Dans ce texte, cette problématique est abordée sous un angle spécifique : le genre comme critère de qualité en enseignement supérieur. Le projet e-qual, mené à l’Université de Fribourg (Suisse), a impliqué divers services de l’institution tout en étant soutenu par le Rectorat. Le projet a développé la sensibilisation au genre du corps enseignant pour améliorer la qualité de l’enseignement en travaillant à un niveau individuel et institutionnel. L’élargissement de l’offre de formation Did@cTIC avec l’élaboration de modules liés à la question du genre ainsi que le développement d’une grille d’autoévaluation concernant la prise en compte du genre dans son enseignement sont des éléments concrets mis en place dans le cadre du projet. Au niveau institutionnel, les changements introduits ont été acceptés, soutenus et reconnus par les différents services concernés. La généralisation de la dimension genre en enseignement par une majorité du corps enseignant doit être poursuivie.Many higher education institutions have been developing equal opportunities programmes. In this text, the topic addresses gender as a dimension of teaching effectiveness. The project e-qual carried out at the University of Fribourg (Switzerland) involved several departments and received the support of the University’s Rector office. The project promotes teachers’ awareness of gender issues in order to improve the quality of education working both at individual and institutional level. Designing new gender-related modules for the university’s training programme Did@cTIC, and elaborating a self-evaluation questionnaire on gender issues in teaching are concrete elements implemented throughout the programme. At the institutional level, changes introduced have been accepted, recognized, and supported by the different departments involved in the project. Nevertheless extending gender issues in teaching for most of the academic staff requires further efforts

Intégrer la dimension genre dans l’enseignement supérieur : transformation de pratiques au niveau individuel et institutionnel

Les institutions d’enseignement supérieur sont nombreuses à développer l’égalité des chances. Dans ce texte, cette problématique est abordée sous un angle spécifique : le genre comme critère de qualité en enseignement supérieur. Le projet e-qual, mené à l’Université de Fribourg (Suisse), a impliqué divers services de l’institution tout en étant soutenu par le Rectorat. Le projet a développé la sensibilisation au genre du corps enseignant pour améliorer la qualité de l’enseignement en travaillant à un niveau individuel et institutionnel. L’élargissement de l’offre de formation Did@cTIC avec l’élaboration de modules liés à la question du genre ainsi que le développement d’une grille d’autoévaluation concernant la prise en compte du genre dans son enseignement sont des éléments concrets mis en place dans le cadre du projet. Au niveau institutionnel, les changements introduits ont été acceptés, soutenus et reconnus par les différents services concernés. La généralisation de la dimension genre en enseignement par une majorité du corps enseignant doit être poursuivie.Many higher education institutions have been developing equal opportunities programmes. In this text, the topic addresses gender as a dimension of teaching effectiveness. The project e-qual carried out at the University of Fribourg (Switzerland) involved several departments and received the support of the University’s Rector office. The project promotes teachers’ awareness of gender issues in order to improve the quality of education working both at individual and institutional level. Designing new gender-related modules for the university’s training programme Did@cTIC, and elaborating a self-evaluation questionnaire on gender issues in teaching are concrete elements implemented throughout the programme. At the institutional level, changes introduced have been accepted, recognized, and supported by the different departments involved in the project. Nevertheless extending gender issues in teaching for most of the academic staff requires further efforts

Community Health Centers: Recent Growth and the Role of the ACA

Community health centers are the nation’s largest source of comprehensive primary care for medically underserved communities and populations. Under the Affordable Care Act (ACA), increased patient revenues due to the expansion of Medicaid and private health insurance, along with substantially increased direct federal investment in the program, have led to growth in the number of health centers and their capacity to provide services. This brief draws on 2015 federal data on health centers and our 2016 Survey of Health Centers’ Experiences and Activities under the Affordable Care Act to provide a snapshot of health centers and their patients, analyze recent changes, and compare the experience of health centers in Medicaid expansion and non-expansion states. This information is germane to the impending debate on the ACA and the potential impact of changes on coverage and access to care for low-income Americans and financing for safety-net providers. Key findings include: Health centers are a core source of primary care in the U.S., particularly for Medicaid beneficiaries and uninsured people. In 2015, 1,375 health centers provided care to 24.3 million patients, including 1 in 12 U.S. residents and nearly 1 in 6 Medicaid enrollees. Almost three-quarters of all health center patients had income below the poverty level. Health center patients are increasingly insured, primarily due to the ACA Medicaid expansion. In 2015, 76% of health center patients were insured (49% through Medicaid), up from 65% in 2013, the year before the ACA coverage expansions took effect. State Medicaid expansion decisions made a large difference in coverage. Over half of health center patients in expansion states had Medicaid, compared to one-third in non-expansion states. About 1 in 5 health center patients in Medicaid expansion states remained uninsured, compared to 1 in 3 in non-expansion states. The Medicaid expansion strengthened health center finances and capacity. Health centers in Medicaid expansion states reported higher total operating revenues than those in non-expansion states, and Medicaid provided a larger share of their revenues. On average, health centers in expansion states served 40% more patients than those in non-expansion states, reported higher staffing ratios for oral and behavioral health care, and were more likely to report increased capacity to provide services. Workforce recruitment and retention are leading challenges for health centers, especially in Medicaid expansion states. Health centers report increased numbers of insured patients who are unable to pay their deductibles and cost-sharing. Nearly two-thirds of health centers in non-expansion states reported an increase in insured patients who could not afford their deductibles and cost-sharing, and over half reported an increase in the share of their privately insured patients who pay sliding fees. The share of health centers in expansion states reporting these trends, though significantly smaller, was also substantial. Federal grant funding remains essential to support health centers. In 2015, federal grants provided close to 20% of health center revenues. This funding enables health centers to finance care for uninsured patients, subsidize insured patients unable to afford their deductibles and copays, and finance services not covered by insurance. Over 70% of federal health center grant funding is from the health center trust fund set up by the ACA. If the ACA were repealed, ending the Medicaid expansion and the health center trust fund, health centers would be challenged to sustain their operations. Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels. The contraction of health centers would likely leave the most medically underserved urban and rural communities in the nation – for which the health center program was created – with reduced access to comprehensive primary health care

Impact and cost of a 2-week community-based screening and awareness program for diabetes and cardiovascular risk factors in a Swiss canton

BACKGROUND: Community-based diabetes screening programs can help sensitize the population and identify new cases. However, the impact of such programs is rarely assessed in high-income countries, where concurrent health information and screening opportunities are common place. INTERVENTION AND METHODS: A 2-week screening and awareness campaign was organized as part of a new diabetes program in the canton of Vaud (population of 697,000) in Switzerland. Screening was performed without appointment in 190 out of 244 pharmacies in the canton at the subsidized cost of 10 Swiss Francs per participant. Screening included questions on risk behaviors, measurement of body mass index, blood pressure, blood cholesterol, random blood glucose (RBG), and A1c if RBG was >/=7.0 mmol/L. A mass media campaign promoting physical activity and a healthy diet was channeled through several media, eg, 165 spots on radio, billboards in 250 public places, flyers in 360 public transport vehicles, and a dozen articles in several newspapers. A telephone survey in a representative sample of the population of the canton was performed after the campaign to evaluate the program. RESULTS: A total of 4222 participants (0.76% of all persons aged >/=18 years) underwent the screening program (median age: 53 years, 63% females). Among participants not treated for diabetes, 3.7% had RBG >/= 7.8 mmol/L and 1.8% had both RBG >/= 7.0 mmol/L and A1c >/= 6.5. Untreated blood pressure >/=140/90 mmHg and/or untreated cholesterol >/=5.2 mmol/L were found in 50.5% of participants. One or several treated or untreated modifiable risk factors were found in 78% of participants. The telephone survey showed that 53% of all adults in the canton were sensitized by the campaign. Excluding fees paid by the participants, the program incurred a cost of CHF 330,600. CONCLUSION: A community-based screening program had low efficiency for detecting new cases of diabetes, but it identified large numbers of persons with elevated other cardiovascular risk factors. Our findings suggest the convenience of A1c for mass screening of diabetes, the usefulness of extending diabetes screening to other cardiovascular risk factors, and the importance of a robust background communication campaign

Performance aux tests d’intelligence : vers une inversion de l’effet Flynn ?

Des nombreuses études ont montré une augmentation des scores aux tests d’aptitudes à travers les générations (« effet Flynn »). Différentes hypothèses d’ordre biologique, social et/ou éducationnels ont été élaborées afin d’expliquer ce phénomène. L’objectif de cette recherche est d’examiner l’évolution des performances aux tests d’aptitudes sur la base d’étalonnages datant de 1991 et de 2002. Les résultats suggèrent une inversion non homogène de l’effet Flynn. La diminution concerne plus particulièrement les tests d’aptitudes scolaires, comme ceux évaluant le facteur verbal et numérique. Cette étude pourrait refléter un changement de l’importance accordée aux différentes aptitudes peu évaluées en orientation scolaire et professionnelle.Several studies indicated an increase across generations in scores to aptitude tests (“Flynn effect”). This phenomenon has been variously attributed to biological, social and/or educational factors. The aim of this research was to study the evolution in performances of those taking aptitude tests using results from standardizations carried out in 1991 and 2002. The results identified a non-homogeneous trend opposite to the Flynn effect. A reduction in performance was observed for the school aptitude tests, like those assessing the verbal and numerical factors. This study may suggest a change in the importance given by our society to aptitudes, which are usually not assessed in vocational guidance

Neuronal Pentraxin 2 Binds PNNs and Enhances PNN Formation.

The perineuronal net (PNN) is a mesh-like proteoglycan structure on the neuronal surface which is involved in regulating plasticity. The PNN regulates plasticity via multiple pathways, one of which is direct regulation of synapses through the control of AMPA receptor mobility. Since neuronal pentraxin 2 (Nptx2) is a known regulator of AMPA receptor mobility and Nptx2 can be removed from the neuronal surface by PNN removal, we investigated whether Nptx2 has a function in the PNN. We found that Nptx2 binds to the glycosaminoglycans hyaluronan and chondroitin sulphate E in the PNN. Furthermore, in primary cortical neuron cultures, the addition of NPTX2 to the culture medium enhances PNN formation during PNN development. These findings suggest Nptx2 as a novel PNN binding protein with a role in the mechanism of PNN formation

A Sweet Talk: The Molecular Systems of Perineuronal Nets in Controlling Neuronal Communication

Perineuronal nets (PNNs) are mesh-like structures, composed of a hierarchical assembly of extracellular matrix molecules in the central nervous system (CNS), ensheathing neurons and regulating plasticity. The mechanism of interactions between PNNs and neurons remain uncharacterized. In this review, we pose the question: how do PNNs regulate communication to and from neurons? We provide an overview of the current knowledge on PNNs with a focus on the cellular interactions. PNNs ensheath a subset of the neuronal population with distinct molecular aspects in different areas of the CNS. PNNs control neuronal communication through molecular interactions involving specific components of the PNNs. This review proposes that the PNNs are an integral part of neurons, crucial for the regulation of plasticity in the CNS