Trends in Child Health Insurance Coverage: A Local Perspective

Background: Over the past decade, the percentage of Americans with access to employer-sponsored insurance (ESI) has declined. Dependents, specifically children, are the most likely to bear the burden of lost coverage. Objectives: The objectives of this study were to 1) describe trends in children’s health insurance taking into account the heterogeneity across different sub-populations and 2) assess the associations between individual, local (offers of ESI), and supply side (proximity to safety net hospitals) characteristics and children’s health insurance. Methods: We analyzed locally collected survey data for children living in the 12 counties of greater Houston, Texas (years 2003, 2006, 2008, 2011). For each year, telephone interviews were conducted with caregivers through random digit dialing. Among households with at least one employed caregiver (N=2,508), we performed an adjusted multinomial logistic regression analysis to evaluate the odds of being publicly insured or uninsured, with the option for ESI and proximity to a public hospital as primary independent variables. Results: Low-income and racial/ethnic minority children experienced the largest increases in coverage through public insurance. Children in households without the option for ESI had higher odds (Odds ratio 10.87, 95% confidence interval 7.31-16.17) of being publicly insured or uninsured (Odds ratio 9.50, 95% confidence interval 6.14-14.70) compared to those in households with the option for ESI. Proximity to a public hospital was not associated with being uninsured. Conclusions: As the availability of ESI has declined, public insurance has acted as a safety net for low-income and minority children. While access to free care plays an important role, it may not substitute for insurance coverage

Changes in Sexual Roles and Quality of Life for Gay Men after Prostate Cancer: Challenges for Sexual Health Providers

Introduction Gay men with prostate cancer ( GMPCa ) may have differential health‐related quality of life ( HRQOL ) and sexual health outcomes than heterosexual men with prostate cancer ( PCa ), but existing information is based on clinical experience and small studies. Aims Our goals were to: (i) describe HRQOL and examine changes in sexual functioning and bother; (ii) explore the psychosocial aspects of sexual health after PCa ; and (iii) examine whether there were significant differences on HRQOL and sexual behavior between GMPCa and published norms. Methods A convenience sample of GMPCa completed validated disease‐specific and general measures of HRQOL , ejaculatory function and bother, fear of cancer recurrence, and satisfaction with prostate cancer care. Measures of self‐efficacy for PCa management, illness intrusiveness, and disclosure of sexual orientation were also completed. Where possible, scores were compared against published norms. Main Outcome Measures Main outcome measures were self‐reported sexual functioning and bother on the E xpanded P rostate C ancer I ndex. Results Compared with norms, GMPCa reported significantly worse functioning and more severe bother scores on urinary, bowel, hormonal symptom scales ( P s < 0.015–0.0001), worse mental health functioning ( P  < 0.0001), greater fear of cancer recurrence ( P  < 0.0001), and were more dissatisfied with their PCa medical care. However, GMPCa reported better sexual functioning scores ( P  < 0.002) compared with norms. Many of the observed differences met criteria for clinical significance. Physical functioning HRQOL and sexual bother scores were similar to that of published samples. GMPCa tended to be more “out” about their sexual orientation than other samples of gay men. Conclusions GMPCa reported substantial changes in sexual functioning after PCa treatment. They also reported significantly worse disease‐specific and general HRQOL , fear of recurrence, and were less satisfied with their medical care than other published PCa samples. Sexual health providers must have an awareness of the unique functional and HRQOL differences between gay and heterosexual men with PCa. Hart TL, Coon DW, Kowalkowski MA, Zhang K, Hersom JI, Goltz HH, Wittmann DA, and Latini DM. Changes in sexual roles and quality of life for gay men after prostate cancer: Challenges for sexual health providers. J Sex Med 2014;11:2308–2317.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108360/1/jsm12598.pd

Where is the implementation science? An opportunity to apply principles during the COVID19 pandemic

The coronavirus disease 2019 pandemic represents a global crisis that has received extraordinary response from healthcare workers and scientists. One critical but potentially overlooked field in a pandemic is implementation science-the study of methods to reduce the research-to-practice gap. In this Viewpoint, we discuss the important role of implementation science during this and future pandemics and highlight considerations to maximize the utility of implementation research

Perception of cancer and inconsistency in medical information are associated with decisional conflict: a pilot study of men with prostate cancer who undergo active surveillance

Men with prostate cancer who choose active surveillance may experience anxiety and depression. Higher anxiety related to uncertainty surrounding cancer has been shown to increase the likelihood of choosing active treatment in the absence of a clinical indication. Certain characteristics, including physician influence and a neurotic personality, may also increase the risk of psychological distress. Our study identified particular areas that may affect the degree of satisfaction or uncertainty experienced by men choosing active surveillance. We showed that men with a positive outlook who perceived that they were receiving consistent medical information had improved ability to manage uncertainty and felt more in control of their decision-making. Men who were confident in their ability to manage prostate-related symptoms also had less insecurity with their decision

Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

This find is registered at Portable Antiquities of the Netherlands with number PAN-0007661