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The Future of U.S. Health Care Spending

April 18, 2014 Comments off

The Future of U.S. Health Care Spending
Source: Brookings Institution

For several decades health spending in the United States rose much faster than other spending. Forecasters predicted the health sector, already 17% of GDP, would soon exceed 20 to 25% of GDP, driving out other necessary public and private spending. However, in recent years health spending growth dropped dramatically and surprisingly, to a record slow pace for the fourth straight year in 2012. It is not clear why this turn around occurred or how long it will last.

On Friday, April 11th the Engelberg Center for Health Care Reform at Brookings brought together several experts to discuss three questions that will also be addressed in a forthcoming series of Brookings papers. The discussion and papers address the causes of the slowdown and the likelihood it will continue; its impact on federal and state budgets, and private spending; and identify reforms that will ensure slow cost growth while improving health.

Papers presented:

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New From the GAO

April 18, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Nuclear Weapons: Technology Development Efforts for the Uranium Processing Facility. GAO-14-295, April 18.
http://www.gao.gov/products/GAO-14-295
Highlights – http://www.gao.gov/assets/670/662665.pdf

2. Maritime Infrastructure: Key Issues Related to Commercial Activity in the U.S. Arctic over the Next Decade. GAO-14-299, March 19.
http://www.gao.gov/products/GAO-14-299
Highlights – http://www.gao.gov/assets/670/661762.pdf

3. Medicare Imaging Accreditation: Effect on Access to Advanced Diagnostic Imaging Is Unclear amid Other Policy Changes. GAO-14-378, April 18.
http://www.gao.gov/products/GAO-14-378
Highlights – http://www.gao.gov/assets/670/662659.pdf

4. Large Partnerships: Characteristics of Population and IRS Audits. GAO-14-379R, March 19.
http://www.gao.gov/products/GAO-14-379R

UNODC — Global Study on Homicide 2013 (released 4/10/14)

April 18, 2014 Comments off

Global Study on Homicide 2013
Source: United Nations Office on Drugs and Crime (UNODC)
From press release (PDF):

Almost half a million people (437,000) across the world lost their lives in 2012 as a result of intentional homicide, according to a new study by the United Nations Office on Drugs and Crime (UNODC).

Launching the Global Study on Homicide 2013 in London today, Jean-Luc Lemahieu, Director for Policy Analysis and Public Affairs, said: “Too many lives are being tragically cut short, too many families and communities left shattered. There is an urgent need to understand how violent crime is plaguing countries around the world, particularly affecting young men but also taking a heavy toll on women.”

Globally, some 80 per cent of homicide victims a nd 95 per cent of perpetrato rs are men. Almost 15 per cent of all homicides stem from domestic violence (63,600). However, the overwhelming majority – almost 70 per cent – of domestic violence fatalities are women (43,600). “Home can be the most dangerous place for a woman,” said Mr . Lemahieu. “It is particularly heart-breaking when those who should be protecting their loved ones are the very people responsible for their murder.”

Over half of all homicide victims are under 30 years of age, with children under the age of 15 accounting for just over 8 per cent of all homicides (36,000), the Study highlighted.

Health Literacy and Numeracy: Workshop Summary (2014)

April 18, 2014 Comments off

Health Literacy and Numeracy: Workshop Summary (2014)
Source: Institute of Medicine

Although health literacy is commonly defined as an individual trait, it does not depend on the skills of individuals alone. Health literacy is the product of the interaction between individuals’ capacities and the health literacy-related demands and complexities of the health care system. Specifically, the ability to understand, evaluate, and use numbers is important to making informed health care choices.

Health Literacy and Numeracy is the summary of a workshop convened by The Institute of Medicine Roundtable on Health Literacy in July 2013 to discuss topics related to numeracy, including the effects of ill health on cognitive capacity, issues with communication of health information to the public, and communicating numeric information for decision making. This report includes a paper commissioned by the Roundtable, “Numeracy and the Affordable Care Act: Opportunities and Challenges,” that discusses research findings about people’s numeracy skill levels; the kinds of numeracy skills that are needed to select a health plan, choose treatments, and understand medication instructions; and how providers should communicate with those with low numeracy skills. The paper was featured in the workshop and served as the basis of discussion.

Recent Declines in Adolescent Inhalant Use

April 18, 2014 Comments off

Recent Declines in Adolescent Inhalant Use (PDF)
Source: Substance Abuse and Mental Health Services Administration

+ In 2012, almost 650,000 adolescents aged 12 to 17 used inhalants in the past year.

+ Past year inhalant use among adolescents generally has been declining since about 2006; most recently, rates decreased from 3.3 percent in 2011 to 2.6 percent in 2012.

+ Rates of past year inhalant use among adolescents decreased between 2011 and 2012 for several demographic groups, including males, whites, those living in the Northeast and West, and those living in metropolitan areas.

Barriers to Psychiatric Care among Military and Veteran Populations in the US: The Effect of Stigma and Prejudice on Psychological and Pharmacological Treatment

April 18, 2014 Comments off

Barriers to Psychiatric Care among Military and Veteran Populations in the US: The Effect of Stigma and Prejudice on Psychological and Pharmacological Treatment
Source: International Journal of Advances in Psychology

This paper addresses the importance of understanding veterans’ individual beliefs and the effects of stigma on pharmacological and psychological treatment among active military personnel and veterans. The discussion can assist treating clinicians in reducing barriers to treatment and increasing compliance with effective psychological and pharmacological interventions for this population. The author has conducted more than 3000 interviews with veterans from World War II (WWII), the Korean War, the Vietnam War, Gulf War, and the wars in Iraq and Afghanistan who applied for service connected Veterans Administration compensation due to mental health conditions. A summary of the responses from veterans regarding their reaction to psychiatric treatment is given and compared to the findings of other provided preliminary studies regarding the effect of individual beliefs and stigma on treatment compliance.

FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids

April 18, 2014 Comments off

FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids
Source: U.S. Food and Drug Administration

In a safety communication notice issued today, the U.S. Food and Drug Administration discouraged the use of laparoscopic power morcellation for the removal of the uterus (hysterectomy) or uterine fibroids (myomectomy) in women because, based on an analysis of currently available data, it poses a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas, beyond the uterus.

Laparoscopic power morcellation is one of several available treatments for fibroids. It is a procedure that uses a medical device to divide the uterine tissue into smaller pieces or fragments so it can be removed through a small incision in the abdomen, such as during laparoscopy.

Uterine fibroids are non-cancerous growths that originate from the smooth muscle tissue in the wall of the uterus. According to the National Institutes of Health, most women will develop uterine fibroids at some point in their lives. While most uterine fibroids do not cause problems, they can cause symptoms, such as heavy or prolonged menstrual bleeding, pelvic pressure or pain, and frequent urination, sometimes requiring medical or surgical therapy.

Based on an analysis of currently available data, the FDA has determined that approximately 1 in 350 women who are undergoing hysterectomy or myomectomy for fibroids have an unsuspected type of uterine cancer called uterine sarcoma. If laparoscopic power morcellation is performed in these women, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival.

Optimal Schedules of Light Exposure for Rapidly Correcting Circadian Misalignment

April 18, 2014 Comments off

Optimal Schedules of Light Exposure for Rapidly Correcting Circadian Misalignment
Source: PLoS Computational Biology

Jet lag arises from a misalignment of circadian biological timing with the timing of human activity, and is caused by rapid transmeridian travel. Jet lag’s symptoms, such as depressed cognitive alertness, also arise from work and social schedules misaligned with the timing of the circadian clock. Using experimentally validated mathematical models, we develop a new methodology to find mathematically optimal schedules of light exposure and avoidance for rapidly re-entraining the human circadian system. In simulations, our schedules are found to significantly outperform other recently proposed schedules. Moreover, our schedules appear to be significantly more robust to both noise in light and to inter-individual variations in endogenous circadian period than other proposed schedules. By comparing the optimal schedules for thousands of different situations, and by using general mathematical arguments, we are also able to translate our findings into general principles of optimal circadian re-entrainment. These principles include: 1) a class of schedules where circadian amplitude is only slightly perturbed, optimal for dim light and for small shifts 2) another class of schedules where shifting occurs along the shortest path in phase-space, optimal for bright light and for large shifts 3) the determination that short light pulses are less effective than sustained light if the goal is to re-entrain quickly, and 4) the determination that length of daytime should be significantly shorter when delaying the clock than when advancing it.

See: Using mathematics to beat jetlag effectively (Science Daily)

Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems

April 18, 2014 Comments off

Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems
Source: BMC Psychiatry

Background
E-mental health and m-mental health include the use of technology in the prevention, treatment and aftercare of mental health problems. With the economical pressure on mental health services increasing, e-mental health and m-mental health could bridge treatment gaps, reduce waiting times for patients and deliver interventions at lower costs. However, despite the existence of numerous effective interventions, the transition of computerised interventions into care is slow. The aim of the present study was to investigate the acceptability of e-mental health and m-mental health in the general population.

Methods
An advisory group of service users identified dimensions that potentially influence an individual’s decision to engage with a particular treatment for mental health problems. A large sample (N = 490) recruited through email, flyers and social media was asked to rate the acceptability of different treatment options for mental health problems on these domains. Results were analysed using repeated measures MANOVA.

Results
Participants rated the perceived helpfulness of an intervention, the ability to motivate users, intervention credibility, and immediate access without waiting time as most important dimensions with regard to engaging with a treatment for mental health problems. Participants expected face-to-face therapy to meet their needs on most of these dimensions. Computerised treatments and smartphone applications for mental health were reported to not meet participants’ expectations on most domains. However, these interventions scored higher than face-to-face treatments on domains associated with the convenience of access. Overall, participants reported a very low likelihood of using computerised treatments for mental health in the future.

Conclusions
Individuals in this study expressed negative views about computerised self-help intervention and low likelihood of use in the future. To improve the implementation and uptake, policy makers need to improve the public perception of such interventions.

CRS — Assistance to Firefighters Program: Distribution of Fire Grant Funding

April 17, 2014 Comments off

Assistance to Firefighters Program: Distribution of Fire Grant Funding (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

The Assistance to Firefighters Grant (AFG) Program, also known as fire grants or the FIRE Act grant program, was established by Title XVII of the FY2001 National Defense Authorization Act (P.L. 106-398). Currently administered by the Federal Emergency Management Agency (FEMA), Department of Homeland Security (DHS), the program provides federal grants directly to local fire departments and unaffiliated Emergency Medical Services (EMS) organizations to help address a variety of equipment, training, and other firefighter-related and EMS needs. A related program is the Staffing for Adequate Fire and Emergency Response Firefighters (SAFER) program, which provides grants for hiring, recruiting, and retaining firefighters.

The fire grant program is now in its 14th year. The Fire Act statute was reauthorized in 2012 (Title XVIII of P.L. 112-239) and provides new guidelines on how fire grant money should be distributed. There is no set geographical formula for the distribution of fire grants—fire departments throughout the nation apply, and award decisions are made by a peer panel based on the merits of the application and the needs of the community. However, the law does require that fire grants be distributed to a diverse mix of fire departments, with respect to type of department (paid, volunteer, or combination), geographic location, and type of community served (e.g., urban, suburban, or rural).

Unemployment among Doctoral Scientists and Engineers Increased but Remained Below the National Average

April 17, 2014 Comments off

Unemployment among Doctoral Scientists and Engineers Increased but Remained Below the National Average
Source: National Science Foundation

In 2010, an estimated 805,500 individuals in the United States held research doctoral degrees in science, engineering, and health (SEH) fields, an increase of 6.2% from 2008. Of these individuals, 709,700 were in the labor force, which includes those employed full time or part time and those actively seeking work (i.e., unemployed). The unemployment rate for SEH doctorate recipients was 2.4% in October 2010, up from 1.7% in October 2008 and similar to the rate in October 2003 (table 1). Moreover, the 2010 unemployment rate of the SEH doctoral labor force was about one-third of the October 2010 unemployment rate for the general population aged 25 years or older (8.2%).

CRS — Sanitary and Phytosanitary (SPS) and Related Non-Tariff Barriers to Agricultural Trade

April 17, 2014 Comments off

Sanitary and Phytosanitary (SPS) and Related Non-Tariff Barriers to Agricultural Trade (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

Sanitary and phytosanitary (SPS) measures are the laws, rules, standards, and procedures that governments employ to protect humans, animals, and plants from diseases, pests, toxins, and other contaminants. Examples include meat and poultry processing standards to reduce pathogens, residue limits for pesticides in foods, and regulation of agricultural biotechnology. Technical barriers to trade (TBT) cover technical regulations, product standards, environmental regulations, and voluntary procedures relating to human health and animal welfare. Examples include trademarks and patents, labeling and packaging requirements, certification and inspection procedures, product specifications, and marketing of biotechnology. SPS and TBT measures both comprise a group of widely divergent standards and standards-based measures that countries use to regulate markets, protect their consumers, and preserve natural resources.

According to the World Trade Organization (WTO), SPS and TBT measures have become more prominent concerns for agricultural exporters and policy makers, as tariff-related barriers to trade have been reduced by various multilateral, regional, and bilateral negotiations and trade agreements. The concerns include whether SPS and TBT measures might be used to unfairly discriminate against imported products or create unnecessary obstacles to trade in agricultural, food, and other traded goods. Notable U.S. trade disputes involving SPS and TBT measures have included a European Union (EU) ban on U.S. meats treated with growth-promoting hormones and also certain pathogen reduction treatments, and an EU moratorium on approvals of biotechnology products, among other types of trade concerns with other countries. Foreign countries have also objected to various U.S. trade measures.

The Five Most Costly Children’s Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17

April 17, 2014 Comments off

The Five Most Costly Children’s Conditions, 2011: Estimates for U.S. Civilian Noninstitutionalized Children, Ages 0-17
Source: Agency for Healthcare Research and Quality

This Statistical Brief presents data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) regarding medical expenditures associated with the top five most costly conditions for children in 2011. These top five conditions–mental disorders; asthma/chronic obstructive pulmonary disease (COPD); trauma-related disorders; acute bronchitis and upper respiratory infections (URI); and otitis media (ear infections)–were determined by totaling and ranking the expenses for all medical care delivered in 2011.

CRS — Drinking Water State Revolving Fund (DWSRF): Program Overview and Issues

April 17, 2014 Comments off

Drinking Water State Revolving Fund (DWSRF): Program Overview and Issues (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

In the Safe Drinking Water Act (SDWA) Amendments of 1996, Congress authorized a drinking water state revolving loan fund (DWSRF) program to help public water systems finance infrastructure projects needed to comply with federal drinking water regulations and to meet the act’s health objectives. Under this program, states receive annual capitalization grants to provide financial assistance (primarily subsidized loans) to public water systems for drinking water projects and other specified activities. Through June 2012, Congress had provided $14.7 billion for the DWSRF program, and combined with the 20% state match, bond proceeds, and other funds, the program generated $23.6 billion in assistance and supported 9,990 projects.

The latest Environmental Protection Agency (EPA) survey of capital improvement needs for public water systems indicates that these water systems need to invest $384.2 billion on infrastructure improvements over 20 years to ensure the provision of safe tap water. EPA reports that, although all of the identified projects promote the public health objectives of the SDWA, just $42.0 billion (10.9%) of reported needs are attributable to SDWA compliance.

CRS — Air Quality Issues and Animal Agriculture: A Primer

April 17, 2014 Comments off

Air Quality Issues and Animal Agriculture: A Primer (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

From an environmental quality standpoint, much of the public and policy interest in animal agriculture has focused on impacts on water resources, because animal waste, if not properly managed, can harm water quality through surface runoff, direct discharges, spills, and leaching into soil and groundwater. A more recent issue is the contribution of air emissions from animal feeding operations (AFOs), enterprises where animals are raised in confinement. This report provides background on the latter issue.

CRS — Table Egg Production and Hen Welfare: Agreement and Legislative Proposals

April 17, 2014 Comments off

Table Egg Production and Hen Welfare: Agreement and Legislative Proposals/strong> (PDF)
Source: Congressional Research Service (via National Agricultural Law Center)

The United Egg Producers (UEP), the largest group representing egg producers, and the Humane Society of the United States (HSUS), the largest animal protection group, have been adversaries for many years over the use of conventional cages in table egg production. In July 2011, the animal agriculture community was stunned when the UEP and HSUS announced that they had agreed to work together to push for federal legislation to regulate how U.S. table eggs are produced. The agreement between UEP and HSUS called for federal legislation that would set cage sizes, establish labeling requirements, and regulate other production practices. As part of the agreement, HSUS agreed to immediately suspend state-level ballot initiative efforts in Oregon and Washington.

Hooked on Smartphones: An Exploratory Study on Smartphone Overuse among College Students

April 16, 2014 Comments off

Hooked on Smartphones: An Exploratory Study on Smartphone Overuse among College Students (PDF)
Source: Association for Computing Machinery

The negative aspects of smartphone overuse on young adults, such as sleep deprivation and attention deficits, are being increasingly recognized recently. This emerging issue motivated us to analyze the usage patterns related to smartphone overuse. We investigate smartphone usage for 95 college students using surveys, logged data, and interviews. We first divide the participants into risk and non-risk groups based on self-reported rating scale for smartphone overuse. We then analyze the usage data to identify between-group usage differences, which ranged from the overall usage patterns to appspecific usage patterns. Compared with the non-risk group, our results show that the risk group has longer usage time per day and different diurnal usage patterns. Also, the risk group users are more susceptible to push notifications, and tend to consume more online content. We characterize the overall relationship between usage features and smartphone overuse using analytic modeling and provide detailed illustrations of problematic usage behaviors based on interview data.

Social Host Liability for Underage Drinking Statutes

April 16, 2014 Comments off

Social Host Liability for Underage Drinking Statutes
Source: National Conference of State Legislatures

Enacted in 1984, the National Minimum Drinking Age Act set the minimum drinking age at 21. To comply with federal law, states prohibit persons under 21 years of age from purchasing or publicly possessing alcoholic beverages.

According to the 2012 National Survey on Drug Use and Health, about 9.3 million persons aged 12 to 20 (24.3 percent of this age group) reported drinking alcohol in the past month and an estimated 11.2 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year.

In an effort to combat underage drinking, state legislators have enacted laws that assign responsibility to adults who allow minors to drink alcohol at social gatherings. Thirty-one states allow social hosts to be civilly liable for injuries or damages caused by underage drinkers. Twenty-six states and the Virgin Islands have criminal penalties for adults who host or permit parties with underage drinking to occur in the adults’ homes or in premises under the adults’ control. These social host statutory provisions do not apply to licensed establishments such as restaurants, bars, and liquor stores, which are covered by dram shop laws.

Health Care — Report Card on State Price Transparency Laws

April 16, 2014 Comments off

Report Card on State Price Transparency Laws (PDF)
Source: Catalyst for Payment Reform and Health Care Incentives Improvement Institute

Some states have robust price transparency laws and regulations, requiring them to create a publicly available website with price information based on real paid claims information; but in reality, the public can’t readily access that information because the website is poorly designed, or poorly functioning. Given that so many state-mandated websites are inadequate, once we included websites into our review and grading, no state received an “A” in this year’s Report Card. Unfortunately, New Hampshire—a state that received an A in last year’s Report Card—dropped to an F this year, because its website is inoperative and may remain so for an extended period.

Several states have “voluntary price transparency websites,” hosted by hospital associations, foundations, or nonprofits. While these sites can be a valuable resource to consumers, if they are not legislated they can be short-lived, dependent on the good will and resources of the organization that hosts them. For this reason, we did not factor in these websites when awarding the 2014 state grades; however, we did provide a review of them in Appendix I for comparison purposes.

New Directions in Child Abuse and Neglect Research (2014)

April 16, 2014 Comments off

New Directions in Child Abuse and Neglect Research (2014)
Source: National Research Council

Each year, child protective services receive reports of child abuse and neglect involving six million children, and many more go unreported. The long-term human and fiscal consequences of child abuse and neglect are not relegated to the victims themselves — they also impact their families, future relationships, and society. In 1993, the National Research Council (NRC) issued the report, Understanding Child Abuse and Neglect, which provided an overview of the research on child abuse and neglect. New Directions in Child Abuse and Neglect Research updates the 1993 report and provides new recommendations to respond to this public health challenge. According to this report, while there has been great progress in child abuse and neglect research, a coordinated, national research infrastructure with high-level federal support needs to be established and implemented immediately.

New Directions in Child Abuse and Neglect Research recommends an actionable framework to guide and support future child abuse and neglect research. This report calls for a comprehensive, multidisciplinary approach to child abuse and neglect research that examines factors related to both children and adults across physical, mental, and behavioral health domains–including those in child welfare, economic support, criminal justice, education, and health care systems–and assesses the needs of a variety of subpopulations. It should also clarify the causal pathways related to child abuse and neglect and, more importantly, assess efforts to interrupt these pathways. New Directions in Child Abuse and Neglect Research identifies four areas to look to in developing a coordinated research enterprise: a national strategic plan, a national surveillance system, a new generation of researchers, and changes in the federal and state programmatic and policy response.

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