Health Care: How Can We Reduce Costs and Still Get the Care We Need?

Healthcare, a top domestic policy agenda in Congress and across the country since the passage of the Affordable Care Act in 2010, is a bellwether issue leading up to the 2016 presidential election. Public deliberation on the topic can provide the public voice necessary for policy makers to make sound decisions and this guide is designed to stimulate those types of discussions.The guide presents three options for addressing this complex public issue, which were researched and compiled by the Kettering Foundation, a nonpartisan research institute that studies the public's role in democracy. It provides an alternative means for moving forward in order to avoid polarizing rhetoric. They are as follows:As a Nation and as Individuals, We Need to Live within Our Means: raise Medicare eligibility age to 67 and base it on financial need, make greater use of hospice care, have employees take on a greater portion of the costs, and encourage more doctors to go into primary care;Make the Healthcare System More Transparent, Efficient, and Accountable: the US healthcare system suffers from a lack of design, making it impossible for citizens to make good decisions -- it needs transparency on cost/price, regulations and/or incentives to instill financial discipline and end greed and abuse; andTake Responsibility for Lowering Healthcare Costs by Focusing on Wellness: Unhealthy behaviors drive up healthcare costs by an estimated $147 billion a year -- collective and individual efforts to improve healthy behaviors can lower those costs.Each option is rooted in a shared concern and proposes several distinct strategies for addressing the problem. This guide does not favor any one option over another. Download your guide today for use in your classroom, research or policy organization or community to help citizens and those interested in policy better understand today's public policy challenges. It also includes some of the strategic facts needed to understand the context of the topic such as:Other technically advanced countries spent 33% to 66% less per person and 12% less of their economies on healthcareThe US ranked last among 26 other high income countries in infant mortality and life expectancyDespite spending far more on healthcare, we trail other countries in life expectancy and have higher rates of obesity, diabetes, heart diseases, and other ailment

The development of understanding of selected aspects of pressure, heat and evolution in pupils aged between 12 and 16 years

The study is founded on the belief that knowledge based on an individual's prior experience contributes to scientific learning. This is contrasted with a perspective in which it is assumed that concepts have a reality completely independent of the learner. The research is a description of pupils' personal scientific knowledge about several aspects of pressure, heat and evolution. Eighty-four children (aged between 12 and 16 years) were interviewed and asked to give their explanations of scientific problems set in everyday contexts. Categories of response were identified from pupils' words; some of these recurred across different question contexts testing the same scientific concept. They represent frameworks of thought which pupils employ, though they may completely contradict the currently-acceptable scientific notion. Pupil frameworks were identified for the nature of pressure (including a molecular explanation), aspects of fluid pressure, the distinction between heat and temperature, the idea of conduction of heat, aspects of inheritance (including the notion of non-inheritance of acquired characteristics) and for biological adaptation. Their frequencies across three age groups are reported. There was some stability of the frameworks of individual pupils across questions testing the same scientific idea, though the pattern varied from idea to idea. Fifty-eight pupils were re-interviewed after a 20-month interval and the change or stability in thinking of individual pupils was monitored over this period. These results were equivocal. Pupil frameworks relating to some scientific ideas appeared to remain fairly stable overtime, whereas for others pupils drew on different frameworks on the two occasions, frequently on different alternative frameworks. The implications for pedagogy are discussed and it is tentatively suggested that more effective learning might occur if teachers took serious account of pupils' alternative frameworks in their classrooms and laboratories

Intention to Read to Newborns Following a Brief Reading Promotion Intervention among Low-Income Pregnant Women

Introduction. Reading to children can increase word knowledge andsuccess in school. The American Academy of Pediatrics recommendsbeginning reading at birth. However, children from low-incomefamilies are exposed to less words, including reading exposure, thanchildren from high-income families.Methods.xPregnant women attending a community prenatal educationprogram targeted at high-risk and low-income populationswere recruited into this study. Participants completed a pre-survey,engaged with a brief educational intervention, then completed amatched post-survey. Surveys assessed perceived benefits, intendedbehaviors, and self-efficacy regarding reading to their child.Results. Of 61 eligible participants, 54 (89%) completed the study.Participants reported being Black (33%), White (30%), Hispanic(28%), and other race (9%). Average gestational age at enrollmentwas 27 weeks (range 13 to 38 weeks). The average age of respondentswas 26 years (SD = 7.2); 46% reported being pregnant for the firsttime. Following the intervention, no change in knowledge regardingbenefits of reading was observed, however, baseline knowledge washigh (58% - 94%). At post-test, significantly more women reported itwas important to start reading to their child at birth (83% vs 56%; p< 0.001) and that they planned to start reading to their child at birth(70% vs 50%; p = 0.001).Conclusions. A brief educational intervention showed promise inincreasing pregnant women’s intentions to read to their children andshould be considered in conjunction with other reading promotionprograms. Follow-up to assess actual reading behavior is needed.Kans J Med 2019;12(2):50-52

Safe Sleep Practices of Kansas Birthing Hospitals

Introduction. Sleep-related death is tied with congenital anomaliesas the leading cause of infant mortality in Kansas, and externalrisk factors are present in 83% of these deaths. Hospitals can impactcaregiver intentions to follow risk-reduction strategies. This projectassessed the current practices and policies of Kansas hospitals withregard to safe sleep. Methods. A cross-sectional survey of existing safe sleep practicesand policies in Kansas hospitals was performed. Hospitals were categorizedbased on reported delivery volume and data were comparedacross hospital sizes. Results. Thirty-one of 73 (42%) contacted hospitals responded. Individualsurvey respondents represented various hospital departmentsincluding newborn/well-baby (68%), neonatal intensive care unit(3%) and other non-nursery departments or administration (29%).Fifty-eight percent of respondents reported staff were trained oninfant safe sleep; 44% of these held trainings annually. High volumehospitals tended to have more annual training than low or mid volumebirth hospitals. Thirty-nine percent reported a safe sleep policy,though most of these (67%) reported never auditing compliance. Thetop barrier to safe sleep education, regardless of delivery volume, wasconflicting patient and family member beliefs. Conclusions. Hospital promotion of infant safe sleep is being conductedin Kansas to varying degrees. High and mid volume birthhospitals may need to work more on formal auditing of safe sleeppractices, while low volume hospitals may need more staff training.Low volume hospitals also may benefit from access to additional caregivereducation materials. Finally, it is important to note hospitalsshould not be solely responsible for safe sleep education.KS J Med 2018;11(1):1-4

Response Regarding the Bureau’s Consumer Complaint and Consumer Inquiry Handling Processes (Docket No. CFPB-2018-0014)

Response discussing whether the Consumer Federal Protection Bureau should change its processes for dealing with consumer complaints and consumer inquiries

Causal Inference Considerations for Endocrine Disruptor Research in Children's Health

Substantial population exposure to endocrine disrupting chemicals, combined with available biomarkers and public concern, has resulted in an explosion of human health effects research. At the same time, remarkable shifts in the regulations governing the composition of some consumer products that contain endocrine disruptors (EDs) has occurred. However, important questions remain as to the weight of evidence linking EDs to human health end points. In this review, we critically examine the literature linking ED exposures to child neurodevelopment, focusing in particular on two model exposures to demonstrate issues related to bioaccumulative [e.g., polychlorinated biphenyls (PCBs)] and rapidly metabolized (e.g., phthalates) compounds, respectively. Issues of study design, confounding, and exposure measurement are considered. Given widespread exposure to these compounds, the potential public health consequences of even small effects on human health are substantial. Therefore, advancing our understanding of any impact calls for careful attention to the principles of causal inference

Maternal Knowledge, Attitudes, and Practices Concerning Interpregnancy Interval

Introduction. Few studies have examined maternal intentions andpractices related to interpregnancy interval (IPI). IPI less than 18months has been linked to increased preterm birth and infant mortality.This manuscript reports on a cross-sectional survey of mothersconducted to understand maternal knowledge, attitudes, and practiceof IPI in Sedgwick County, Kansas. Methods. New and expectant mothers and mothers of neonatalinfant care unit (NICU) graduates (n = 125) were surveyed regardingthe issues surrounding IPI. Front desk staff handed out self-administeredsurveys, which were returned to a nurse upon completion.NICU participants were emailed a link to the survey hosted on SurveyMonkey®. Results. Fewer than 30% of mothers reported previously receivinginformation about IPI from any source. When asked about risks associatedwith IPI, women frequently (n = 58, 45%) identified increasedrisk for birth outcomes with no known association with short IPI.Findings regarding maternal attitudes surrounding optimal IPI weremixed with many mothers defining ideal IPI as less than 18 months(n = 52, 42%), while broadly reporting they believed that a woman’sbody needs time to heal between pregnancies. Respondents from theNICU sample generally reported shorter optimal IPI values than theother participants. When IPI was estimated from participants’ pastpregnancies, half of IPIs were less than 18 months. Mothers reportedthey favored healthcare providers as a source for IPI education. Faceto-face discussions or printed materials were the preferred modes ofeducation. Conclusions. Women were aware of the need for spacing betweenpregnancies, however, that knowledge was unassociated with pastbehavior. These findings should be taken into consideration whenformulating future interventions. Kans J Med 2018;11(4):86-90

Prenatal exposure to environmental phenols and childhood fat mass in the Mount Sinai Children's Environmental Health Study

Early life exposure to endocrine disrupting chemicals may alter adipogenesis and energy balance leading to changes in obesity risk. Several studies have evaluated the association of prenatal bisphenol A exposure with childhood body size but only one study of male infants has examined other environmental phenols. Therefore, we assessed associations between prenatal exposure to environmental phenols and fat mass in a prospective birth cohort. We quantified four phenol biomarkers in third trimester maternal spot urine samples in a cohort of women enrolled in New York City between 1998 and 2002 and evaluated fat mass in their children using a Tanita scale between ages 4 and 9 years (173 children with 351 total observations). We estimated associations of standard deviation differences in natural log creatinine-standardized phenol biomarker concentrations with percent fat mass using linear mixed effects regression models. We did not observe associations of bisphenol A or triclosan with childhood percent fat mass. In unadjusted models, maternal urinary concentrations of 2,5-dichlorophenol were associated with greater percent fat mass and benzophenone-3 was associated with lower percent fat mass among children. After adjustment, phenol biomarkers were not associated with percent fat mass. However, the association between benzophenone-3 and percent fat mass was modified by child’s sex: benzophenone-3 concentrations were inversely associated with percent fat mass in girls (beta = −1.51, 95% CI = −3.06, 0.01) but not boys (beta = −0.20, 95% CI = −1.69, 1.26). Although we did not observe strong evidence that prenatal environmental phenols exposures influence the development of childhood adiposity, the potential antiadipogenic effect of benzophenone-3 in girls may warrant further investigation