Consumer Operated and Oriented Plans (CO-OPs): An Interim Assessment of Their Prospects

Provides an overview of nonprofit, member-governed plans that will create innovative care delivery and payment models to compete in states' individual and small group health insurance markets. Outlines challenges and potential effect on the market

England's Approach to Improving End-of-Life Care: A Strategy for Honoring Patients' Choices

Outlines England's evidence-based End of Life Care Strategy, its impact, and possible lessons for palliative care in the United States, such as the use of death at home as a metric for progress and Web-based training for clinical and caregiving personnel

Health Care for Undocumented Migrants: European Approaches

European countries have smaller shares of undocumented migrants than does the United States, but these individuals have substantial needs for medical care and present difficult policy challenges even in countries with universal health insurance systems. Recent European studies show that policies in most countries provide for no more than emergency services for undocumented migrants. Smaller numbers of countries provide more services or allow undocumented migrants who meet certain requirements access to the same range of services as nationals. These experiences show it is possible to improve access to care for undocumented migrants. Strategies vary along three dimensions: 1) focusing on segments of the population, like children or pregnant women; 2) focusing on types of services, like preventive services or treatment of infectious diseases; or 3) using specific funding policies, like allowing undocumented migrants to purchase insurance

Health Policy Research and Foundation Grantmaking

The Foundation Center's report on health policy grantmaking in 1995 and 2002, Update on Foundation Health Policy Grantmaking, provides a fascinating window into the philanthropic sector's activities during a period in which health policy vastly declined as a central governmental concern. An important role of the nonprofit sector is to complement government, undertaking activities that are out of favor or overlooked by government. This report and its predecessor, which traced trends in health policy grantmaking between 1990 and 1995, show foundations' activities during a particularly interesting time in the health policy history of the United States

Electronic Health Records: An International Perspective on "Meaningful Use"

Examines the extent of meaningful use of electronic health records in Denmark, New Zealand, and Sweden, including sharing information with organizations, health authorities, and patients. Outlines challenges of and insights into encouraging U.S. adoption

ParkinsonNet: An Innovative Dutch Approach to Patient-Centered Care for a Degenerative Disease

Key features Multidisciplinary networks of allied health professionals in the Netherlands use evidence-based practice guidelines for treating Parkinson's disease, facilitated by a web-based platform through which patients can provide feedback about their care.Target population Adults with Parkinson's disease, an age-related neurodegenerative disorder for which no cure exists.Why it's important Many patients with degenerative chronic diseases have difficulty accessing the range of specialty medical, nursing, and supportive services they need, and available personnel often lack expertise with particular conditions. Care practices vary, and care coordination can be challenging.Benefits Lower rates of hip fractures and hospitalizations and better self-reported quality-of-life outcomes; greater knowledge of Parkinson's treatment among providers and higher job satisfaction; generally lower treatment costs where model has been implemented.Challenges Provider payment often does not cover care coordination services. The model might work best with a global payment approach

Home Care by Self-Governing Nursing Teams: The Netherlands' Buurtzorg Model

The Dutch home-care provider Buurtzorg Nederland has attracted widespread interest for its innovative use of self-governing nurse teams. Rather than relying on different types of personnel to provide individual services—the approach taken by most home health providers—Buurtzorg expects its nurses to deliver the full range of medical and support services to clients. Buurtzorg has earned high patient and employee ratings and appears to provide high-quality home care at lower cost than other organizations. This case study reviews Buurtzorg's approach and performance thus far and considers how this model of care might be adapted for the United States

Explaining Racial/Ethnic Disparities in Use of High-Volume Hospitals: Decision-Making Complexity and Local Hospital Environments

Racial/ethnic minorities are less likely to use higher-quality hospitals than whites. We propose that a higher level of informationrelated complexity in their local hospital environments compounds the effects of discrimination and more limited access to services, contributing to racial/ethnic disparities in hospital use. While minorities live closer than whites to high-volume hospitals, minorities also face greater choice complexity and live in neighborhoods with lower levels of medical experience. Our empirical results reveal that it is generally the overall context associated with proximity, choice complexity, and local experience, rather than differential sensitivity to these factors, that provides a partial explanation of the disparity gap in highvolume hospital use

Fluid intelligence and brain functional organization in aging yoga and meditation practitioners

Numerous studies have documented the normal age-related decline of neural structure, function, and cognitive performance. Preliminary evidence suggests that meditation may reduce decline in specific cognitive domains and in brain structure. Here we extended this research by investigating the relation between age and fluid intelligence and resting state brain functional network architecture using graph theory, in middle-aged yoga and meditation practitioners, and matched controls. Fluid intelligence declined slower in yoga practitioners and meditators combined than in controls. Resting state functional networks of yoga practitioners and meditators combined were more integrated and more resilient to damage than those of controls. Furthermore, mindfulness was positively correlated with fluid intelligence, resilience, and global network efficiency. These findings reveal the possibility to increase resilience and to slow the decline of fluid intelligence and brain functional architecture and suggest that mindfulness plays a mechanistic role in this preservation

Enhanced insulin sensitivity associated with provision of mono and polyunsaturated fatty acids in skeletal muscle cells involves counter modulation of PP2A

International audienceAims/Hypothesis: Reduced skeletal muscle insulin sensitivity is a feature associated with sustained exposure to excess saturated fatty acids (SFA), whereas mono and polyunsaturated fatty acids (MUFA and PUFA) not only improve insulin sensitivity but blunt SFA-induced insulin resistance. The mechanisms by which MUFAs and PUFAs institute these favourable changes remain unclear, but may involve stimulating insulin signalling by counter-modulation/repression of protein phosphatase 2A (PP2A). This study investigated the effects of oleic acid (OA; a MUFA), linoleic acid (LOA; a PUFA) and palmitate (PA; a SFA) in cultured myotubes and determined whether changes in insulin signalling can be attributed to PP2A regulation. Principal Findings: We treated cultured skeletal myotubes with unsaturated and saturated fatty acids and evaluated insulin signalling, phosphorylation and methylation status of the catalytic subunit of PP2A. Unlike PA, sustained incubation of rat or human myotubes with OA or LOA significantly enhanced Akt-and ERK1/2-directed insulin signalling. This was not due to heightened upstream IRS1 or PI3K signalling nor to changes in expression of proteins involved in proximal insulin signalling, but was associated with reduced dephosphorylation/inactivation of Akt and ERK1/2. Consistent with this, PA reduced PP2Ac demethylation and tyrosine 307 phosphorylation-events associated with PP2A activation. In contrast, OA and LOA strongly opposed these PA-induced changes in PP2Ac thus exerting a repressive effect on PP2A.Conclusions/Interpretation: Beneficial gains in insulin sensitivity and the ability of unsaturated fatty acids to oppose palmitate-induced insulin resistance in muscle cells may partly be accounted for by counter-modulation of PP2A