Lymphoedema - a chronic disease, not a side effect

Lymphoedema, soft tissue swelling resulting from obstruction of the lymphatic drainage system, is a chronic illness with immense physical and psychological impact on a patient’s life. Management, while conservative, can be life changing when approached by a co-ordinated multidisciplinary team. Although some patients with lymphoedema will require minimal support, it is vital that patients and healthcare professionals are vigilant for rare but serious complications

Increased use of dental services by children covered by Medicaid: 2000-2010

This report analyzes the use of dental services by children enrolled in Medicaid from federal fiscal years (FFY) 2000 to 2010. The number and percent of children receiving dental services under Medicaid climbed continuously over the decade. In FFY 2000, 6.3 million children ages 1 to 20 were reported to receive some form of dental care (either preventive or treatment); the number more than doubled to 15.4 million by FFY 2010. Part of the increase was because the overall number of children covered by Medicaid rose by 12 million (50%), but the percentage of children who received dental care climbed appreciably from 29.3% in FFY 2000 to 46.4% in FFY 2010. In that same time period, the number of children ages 1 to 20 receiving preventive dental services climbed from a reported 5.0 million to 13.6 million, while the percentage of children receiving preventive dental services rose from 23.2% to 40.8%. For children ages 1 to 20 who received dental treatment services, the reported number rose from 3.3 million in FFY 2000 to 7.6 million in FFY 2010. The percentage of children who obtained dental treatment services increased from 15.3% to 22.9%. In FFY 2010, about one sixth of children covered by Medicaid (15.7%) ages 6-14 had a dental sealant placed on a permanent molar. While most states have made steady progress in improving children’s access to dental care in Medicaid over the past decade, there is still substantial variation across states and more remains to be done

Deteriorating Access to Women\u27s Health Services in Texas: Potential Effects of the Women\u27s Health Program Affiliate Rule

Based on an earlier study and an in-depth analysis of five market areas, the authors find that Texas\u27 plan to bar Planned Parenthood clinics from participating in the state Women\u27s Health Program (WHP) would leave tens of thousands of women without a source of care, because Planned Parenthood clinics are the dominant WHP providers in those areas and other local family planning clinics lack the capacity to absorb a large number of additional patients

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

In 2006, major health care reform legislation was enacted in Massachusetts. In many ways a prototype for the Affordable Care Act (ACA), the Massachusetts law required nearly all state residents to obtain health insurance, and made insurance accessible and affordable by reforming the health insurance market and providing subsidies for coverage through expansions of Medicaid and CHIP and a new program for low-income adults who are not eligible for Medicaid, known as Commonwealth Care. The law also created the “Connector,” which, like the ACA’s health insurance Marketplaces, is designed to facilitate and simplify access to insurance for individuals, families, and small businesses. In addition, the law established a Health Safety Net (HSN) Fund that finances health care for residents who remain uninsured permanently or on an intermittent basis. Understanding that outreach and enrollment assistance would be essential to the health reform law’s success, Massachusetts policymakers launched high-profile public education campaigns, but they also provided for person-to-person, hands-on assistance, especially in low-income communities with large numbers of uninsured residents, many of whom have no previous experience signing up for insurance subsidies or selecting and enrolling in a health plan. Community health centers – a critical source of comprehensive primary health care and many other services for medically underserved populations and communities in Massachusetts – have played a central role in this outreach and enrollment effort. To help inform current outreach and enrollment efforts associated with the ACA’s coverage expansion, the Kaiser Commission on Medicaid and the Uninsured asked researchers at The George Washington University to examine the enrollment assistance experience of Massachusetts health centers six years into that state’s health reform program. Because of their safety-net role, health centers are uniquely aware of and knowledgeable about the challenges and requirements of assisting uninsured individuals and communities disadvantaged by poverty, minority race/ethnicity, poor health status, language barriers, homelessness, and other factors. As states and communities nationwide gear up to provide outreach and enrollment assistance for the first time under the ACA, the experience of Massachusetts health centers offers valuable lessons to health centers nationally, and to other community-based efforts to reach and enroll millions of low-income uninsured Americans in health coverage

Pesticide spraying for West Nile virus control and emergency department asthma visits in New York City, 2000

Pyrethroid pesticides were applied via ground spraying to residential neighborhoods in New York City during July–September 2000 to control mosquito vectors of West Nile virus (WNV). Case reports link pyrethroid exposure to asthma exacerbations, but population-level effects on asthma from large-scale mosquito control programs have not been assessed. We conducted this analysis to determine whether widespread urban pyrethroid pesticide use was associated with increased rates of emergency department (ED) visits for asthma. We recorded the dates and locations of pyrethroid spraying during the 2000 WNV season in New York City and tabulated all ED visits for asthma to public hospitals from October 1999 through November 2000 by date and ZIP code of patients’ residences. The association between pesticide application and asthma-related emergency visits was evaluated across date and ZIP code, adjusting for season, day of week, and daily temperature, precipitation, particulate, and ozone levels. There were 62,827 ED visits for asthma during the 14-month study period, across 162 ZIP codes. The number of asthma visits was similar in the 3-day periods before and after spraying (510 vs. 501, p = 0.78). In multivariate analyses, daily rates of asthma visits were not associated with pesticide spraying (rate ratio = 0.92; 95% confidence interval, 0.80–1.07). Secondary analyses among children and for chronic obstructive pulmonary disease yielded similar null results. This analysis shows that spraying pyrethroids for WNV control in New York City was not followed by population-level increases in public hospital ED visit rates for asthma

Providing Outreach and Enrollment Assistance: Lessons Learned from Community Health Centers in Massachusetts

Six years ago, Massachusetts implemented a broad expansion of health coverage to the uninsured population in the state. Understanding that outreach and enrollment assistance would be essential to the success of the expansion, state policymakers provided for public education campaigns, but also for person-to-person, hands-on assistance, especially in communities with large numbers of uninsured people. Community health centers play a central role in this effort. As states and communities gear up to provide outreach and enrollment assistance under the ACA, the experience of the Massachusetts health centers offers lessons that can help inform current efforts to reach and enroll millions of low-income, uninsured Americans in health insurance. Recent interviews conducted with a sample of Massachusetts health centers point to four key findings: Finding #1: Intensive outreach and enrollment assistance is crucial to connect low-income, uninsured people with coverage. Finding #2: Assistance is not a one-time matter – it is needed at all stages of the enrollment process and to ensure continued coverage. Finding #3: Immediate access to enrollment assistance boosts the effectiveness of outreach efforts. Finding #4: Even when health reform is mature, the need for aggressive outreach and enrollment assistance remains high and the resource demands remain significant. The Massachusetts health center experience demonstrates that, in addition to broad public education about affordable insurance options and how to enroll, intensive one-on-one assistance is a vital complement to help disadvantaged populations and communities obtain and keep coverage that meets their needs. The intensive support they require, and ongoing rather than occasional needs for assistance, suggest the importance of sustained investment in outreach and enrollment efforts conducted by health centers and other organizations

Developing a Comprehensive Pesticide Health Effects Tracking System for an Urban Setting: New York City’s Approach

In recent years, there have been substantial investments and improvements in federal and state surveillance systems to track the health effects from pesticide exposure. These surveillance systems help to identify risk factors for occupational exposure to pesticides, patterns in poisonings, clusters of disease, and populations at risk of exposure from pesticide use. Data from pesticide use registries and recent epidemiologic evidence pointing to health risks from urban residential pesticide use make a strong case for understanding better the sale, application, and use of pesticides in cities. In this article, we describe plans for the development of a pesticide tracking system for New York City that will help to elucidate where and why pesticides are used, potential risks to varied populations, and the health consequences of their use. The results of an inventory of data sources are presented along with a description of their relevance to pesticide tracking. We also discuss practical, logistical, and methodologic difficulties of linking multiple secondary data sources with different levels of person, place, and time descriptors