How increasing administrative burdens and means testing in the US safety-net punishes the poor

Millions of Americans rely on safety-net programs such as the Temporary Assistance for Needy Families, the Supplemental Nutrition Assistance Program, and Medicaid. In recent decades, these programs have been reformed with the aim of better targeting those most in need by creating rules and eligibility assessments. In new research. Ashley Fox, Wenhui Feng and Megan Reynolds find that the introduction of these rules has created substantial barriers and often reduced the enrolment of those who need the programs’ support the most. They argue that if we want needy individuals to access benefits, then we need to make it easy for them to do so by relaxing or removing the burdensome rules that serve as barriers to access

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Introduction: Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.Methods: We abstracted data from ClinicalTrials.gov (February 2000 - September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 - September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.Results: We found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.Conclusion: Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research

Social Policy Expenditures and Life Expectancy in High-Income Countries

Introduction The U.S. spends more than any other country on health care, yet Americans have lower life expectancy than people in most industrialized countries. Recent studies suggest that lower expenditures on social policies in the U.S. may contribute to less-favorable trends in life expectancy. This study tests the hypothesis that greater social spending will be positively associated with life expectancy across the countries of the Organisation of Economic Co-operation and Development and that the magnitude of these associations will outweigh those between government healthcare spending and life expectancy. Methods In 2016, longitudinal data on six domains of social expenditures for the U.S. and 19 other wealthy nations between 1980 and 2010 were used to estimate the associations between prior year expenditures on education, family, unemployment, incapacity, old age, and active labor market programs, and period life expectancy using fixed effects models. Results Controlling for a wide set of confounders and government healthcare expenditures, a 1% increase in prior year education expenditures was associated with 0.160 (95% CI=0.033, 0.286) of a year gain in life expectancy, whereas a 1% increase in prior year incapacity benefit expenditures was associated with 0.168 (95% CI=0.003, 0.333) o

Laws Restricting Access to Abortion Services and Infant Mortality Risk in the United States

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and two-visit laws. Multilevel logistic regression was used to determine whether the type or number of state-level restrictive abortion laws during the year of birth were associated with odds of infant mortality. Results: Compared to infants living in states with no restrictive laws, infants living in states with one or two restrictive laws (adjusted odds ratio (AOR) = 1.08; 95% confidence interval [CI] = 0.99–1.18) and those living in states with 3 to 5 restrictive laws (AOR = 1.10; 95% CI = 1.01–1.20) were more likely to die. Separate analyses examining the relationship between parental involvement laws and infant mortality risk, stratified by maternal age, indicated that significant associations were observed among mothers aged ≤19 years (AOR = 1.09, 95% CI = 1.00–1.19), and 20 to 25 years (AOR = 1.10, 95% CI = 1.03–1.17). No significant association was observed among infants born to older mothers. Conclusion: Restricting access to abortion services may increase the risk for infant mortality

Path Dependency and the Politics of Socialized Health Care

Rich democracies exhibit vast cross-national and historical variation in the socialization of health care. Yet, cross-national analyses remain relatively rare in the health policy literature, and health care remains relatively neglected in the welfare state literature. We analyze pooled time series models of the public share of total health spending for eighteen rich democracies from 1960 to 2010. Building on path dependency theory, we present a strategy for modeling the relationship between the initial 1960 public share and the current public share. We also examine two contrasting accounts for how the 1960 public share interacts with conventional welfare state predictors: the self-reinforcing hypothesis expecting positive feedbacks and the counteracting hypothesis expecting negative feedbacks. We demonstrate that most of the variation from 1960 to 2010 in the public share can be explained by a country's initial value in 1960. This 1960 value has a large significant effect in models of 1961-2010, and including the 1960 value alters the coefficients of conventional welfare state predictors. To investigate the mechanism whereby prior social policy influences public opinion about current social policy, we use the 2006 International Social Survey Programme (ISSP). This analysis confirms that the 1960 values predict individual preferences for government spending on health. Returning to the pooled time series, we demonstrate that the 1960 values interact significantly with several conventional welfare state predictors. Some interactions support the self-reinforcing hypothesis, while others support the counteracting hypothesis. Ultimately, this study illustrates how historical legacies of social policy exert substantial influence on the subsequent politics of social policy

Art+Politics

For the exhibition Art + Politics, students worked closely with the holdings of Gettysburg College\u27s Special Collections and College Archives to curate an exhibition in Schmucker Art Gallery that engages with issues of public policy, activism, war, propaganda, and other critical socio-political themes. Each of the students worked diligently to contextualize the objects historically, politically, and art-historically. The art and artifacts presented in this exhibition reveal how various political events and social issues have been interpreted through various visual and printed materials, including posters, pins, illustrations, song sheets, as well as a Chinese shoe for bound feet. The students\u27 essays that follow demonstrate careful research and thoughtful reflection on the American Civil War, nineteenth-century politics, the First and Second World Wars, World\u27s Fairs, Dwight D. Eisenhower\u27s campaign, Vietnam-War era protests, and the Cultural Revolution in China. [excerpt]https://cupola.gettysburg.edu/artcatalogs/1009/thumbnail.jp

Weak Reprocessed Features in the Broad Line Radio Galaxy 3C382

We present a detailed X-ray study of the Broad Line Radio Galaxy 3C382, observed with the BeppoSAX satellite in a very bright state. The continuum emission is well modeled with a power law that steepens at high energies, with an e-folding energy of about 120 keV. At soft energies a clear excess of emission is detected, which can not be explained solely by the extended thermal halo seen in a ROSAT HRI image. A second, more intense soft X-ray component, possibly related to an accretion disk, is required by the data. Both a reflection component (R=0.3) and an iron line (EW \sim 50) are detected, at levels much weaker than in Seyfert galaxies, suggesting a common origin. Combining our measurements with results from the literature we find that the iron line has remained approximately constant over 9 years while the continuum varied by a factor of 5. Thus the fluorescent gas does not respond promptly to the variations of the X-ray primary source, suggesting that the reprocessing site is located away, likely at parsec distances. While the continuum shape indicates that X-rays derive from a thermal Comptonization process, the weakness of other spectral features implies that either the upper layers of the optically thick accretion disk are completely ionized or the corona above the disk is outflowing with mildly relativistic velocity.Comment: 11 pages, 4 figures. Accepted for publication in the Astrophysical Journa

Exposure to Household Air Pollution from Biomass-Burning Cookstoves and HbA1c and Diabetic Status Among Honduran Women

Household air pollution from biomass cookstoves is estimated to be responsible for more than two and a half million premature deaths annually, primarily in low and middle‐income countries where cardiometabolic disorders, such as Type II Diabetes, are increasing. Growing evidence supports a link between ambient air pollution and diabetes, but evidence for household air pollution is limited. This cross‐sectional study of 142 women (72 with traditional stoves and 70 with cleaner‐burning Justa stoves) in rural Honduras evaluated the association of exposure to household air pollution (stove type, 24‐hour average kitchen and personal fine particulate matter [PM2.5] mass and black carbon) with glycated hemoglobin (HbA1c) levels and diabetic status based on HbA1c levels. The prevalence ratio (PR) per interquartile range increase in pollution concentration indicated higher prevalence of prediabetes/diabetes (vs normal HbA1c) for all pollutant measures (eg, PR per 84 μg/m3 increase in personal PM2.5, 1.49; 95% confidence interval [CI], 1.11‐2.01). Results for HbA1c as a continuous variable were generally in the hypothesized direction. These results provide some evidence linking household air pollution with the prevalence of prediabetes/diabetes, and, if confirmed, suggest that the global public health impact of household air pollution may be broader than currently estimated

Risk of Social Isolation as a Contributing Factor to Diet Quality in Community-Dwelling Older Persons Living in the Australian Capital Territory—A Pilot Study

Objectives: Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons. Methods: This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII. Results: Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was −1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = −0.041 (−0.066, −0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001). Conclusion: Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community

Exposure to Household Air Pollution from Biomass Cookstoves and Levels of Fractional Exhaled Nitric Oxide (FeNO) among Honduran Women

Household air pollution is estimated to be responsible for nearly three million premature deaths annually. Measuring fractional exhaled nitric oxide (FeNO) may improve the limited understanding of the association of household air pollution and airway inflammation. We evaluated the cross-sectional association of FeNO with exposure to household air pollution (24-h average kitchen and personal fine particulate matter and black carbon; stove type) among 139 women in rural Honduras using traditional stoves or cleaner-burning Justastoves. We additionally evaluated interaction by age. Results were generally consistent with a null association; we did not observe a consistent pattern for interaction by age. Evidence from ambient and household air pollution regarding FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures (e.g., the flow rate used to measure FeNO)