The Trusted Source For Health
As a personal trainer and weight-loss coach, I am constantly answering health and fitness questions from my clients, on social media and in our Start TODAY Facebook group. In this column, I address some of the most common questions and roadblocks that trip people up …
With Thanksgiving dinner just around the corner, health officials across the Gulf South are urging residents to be mindful of COVID-19 precautions while also planning out their menus and activities. After a deadly surge in COVID-19 cases brought on from the Delta variant, hospitalizations and …
In a concerning trend for the health of U.S. children, the rate of underinsured youngsters rose from 30.6{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} to 34{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} — an additional 2.4 million kids — from 2016 to 2019, according to an analysis led by University of Pittsburgh School of Medicine researchers.
In the study, published today in Pediatrics, the researchers found that underinsurance of children was mainly driven by increased rates of inadequate insurance rather than a rise in absent or inconsistent insurance. Notably, they found families who have children with special health care needs and private insurance were hit particularly hard.
“The main takeaway is that the insurance landscape is getting bleaker, and it’s hurting millions of families, specifically those who are the most vulnerable,” said Justin Yu, M.D., lead author of the study and assistant professor of pediatrics in Pitt’s School of Medicine. “We need pediatric organizations and politicians to bring child health insurance to the forefront and make it a priority issue.”
To understand pediatric insurance trends, Yu and his team analyzed data from the National Survey of Children’s Health, an annual survey about the physical and mental health of newborns through 17-year-olds. They defined underinsured children as those who lack continuous and adequate health insurance, with “adequate” meaning that insurance usually or always met a child’s needs, allowed children to see needed providers and protected against what parents felt were unreasonable out-of-pocket expenses.
The increase in underinsured children was driven by rising insurance inadequacy, mainly experienced as high out-of-pocket expenses for health services. According to the researchers, this is concerning because high fees may force families to delay or forgo care for their child.
“Access to health care helps children be as healthy as possible so they can live full and complete lives,” said senior author Amy Houtrow, M.D., Ph.D., M.P.H., professor and vice chair of physical medicine and rehabilitation and pediatrics in Pitt’s School of Medicine, and chief of pediatric rehabilitation medicine services at UPMC Children’s Hospital of Pittsburgh. “I don’t believe that any family should have to choose between paying for medical care for their child or putting food on the table or paying their electric bills.”
The researchers suspect that the rise in unreasonable out-of-pocket expenses reflect broad trends in the insurance landscape: Insurers are increasingly transferring costs to individuals and families through higher copays and premiums and, increasingly, through high-deductible plans. These trends may help explain the finding that children with private health insurance were more likely to be underinsured than those on public plans, such as Medicaid or Children’s Health Insurance Program (CHIP).
Another notable finding was an increase in the rate of underinsurance in kids considered to be more socioeconomically advantaged: white children from middle-income, highly educated families.
“We have this idea that if you have a full-time job with health insurance from your employer that your health care needs will be met,” said Houtrow. “But our data show that, increasingly, that’s not the case, especially for families who may be enrolled in lower premium, high-deductible plans.”
The researchers also examined underinsurance rates in children with chronic health conditions. They found that kids with more complex special health care needs were more likely to be underinsured than those with less complex or no special health needs.
“This is worrisome because, by definition, these children need the most health care,” said Yu.
According to the researchers, tackling the problem of child underinsurance may require large-scale policy reforms such as broadening eligibility for Medicaid or creating a universal health insurance program for all U.S. kids. But smaller policy changes — such as making it easier to apply for and stay on Medicaid or cash assistance programs to help cover out-of-pocket expenses — also could help.
“Rather than providing a clear policy prescription, the goal of this study is to bring the issue of child underinsurance to the forefront of national conversation,” said Yu. “Once people are talking about this issue, we can start thinking about policies to address it.”
“We know there are many possible paths to improving the adequacy of health insurance coverage for children, and this study tells us that the time is now to move forward on that journey,” added Houtrow.
Other authors on the study were James Perrin, M.D., Harvard Medical School and Massachusetts General Hospital for Children, and Thomas Hagerman, M.D., Henry Ford Health System.
A Kansas City Health Department worker tests a resident for COVID-19 during an event last year. Following a letter from Attorney General Eric Schmitt, several health departments in rural Missouri counties have halted their COVID-19 response work. Tammy Ljungblad tljungblad@kcstar.com A growing number of local …
Posted: Dec 10, 2021 / 12:44 PM EST / Updated: Dec 10, 2021 / 01:19 PM EST Southwestern Vermont Health Care (SVHC SVMC) BENNINGTON, Vt. (NEWS10) – Southwestern Vermont Medical Center (SVMC) will be restricting visitation at the hospital due to the increase in COVID-19 …
In patients with multiple sclerosis (MS), lifestyle behaviors concerning diet, wellness, and physical activity had positive associations with quality of life (QOL), suggesting that implementing potential interventions and lifestyle modifications can improve MS management, according to a recent study.
The results of the observational study, published in Journal of Personalized Medicine, highlighted some differences in how lifestyle factors affect patients with relapsing-remitting MS (RRMS) vs progressive MS (ProgMS). The investigators predicted that phenotype-specific lifestyle modifications may be needed for proper MS management.
“Our findings show lifestyle behaviors are associated with QOL and appear to differ based on MS phenotype. Future studies assessing timing, duration, and adherence of adopting lifestyle behaviors may better inform their role in MS management,” wrote the investigators.
On initial diagnosis, 85{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of people with MS receive a diagnosis of RRMS, and 10{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} to 15{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of patients have primary ProgMS. Within 15 to 20 years after diagnosis, 50{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} to 75{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of RRMS cases convert to secondary ProgMS.
Patients with RRMS or ProgMS experience physiological, psychological, and motor symptoms that can affect QOL. Improvement of symptoms through implementation of healthy lifestyle behaviors may improve QOL. However, less is known about whether healthy lifestyle behaviors on quality of life are similar across MS phenotypes, especially for patients with ProgMS, who may be less responsive to therapies, have greater disability, and have more severe symptoms compared with RRMS.
Of the 3374 patients who registered for the iConquerMS study, 1108 patients with MS aged 21 or older were eligible for inclusion. The cohort’s data were collected from November 2014 to July 2020. RRMS cases comprised 67.7{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} (n = 750) of the cohort and 32.3{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} (n = 358) had ProgMS. Among the participants with RRMS, the mean (SD) age was 49.9 (11) years and 83{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} were women. Among the patients with ProgMS, the mean age was 58.3 (9) years and 68{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} were women.
The investigators looked at 13 domains of QOL: 4 physical subdomains (mobility, fine motor, fatigue, and sleep disturbance), 7 mental subdomains (anxiety, depression, positive affect, emotional dyscontrol, stigma, cognitive function, communications), and 2 social subdomains (participation and satisfaction).
For QOL, compared with the general population, patients with MS reported similar T-score difference in 9 of the 13 QOL subdomains. Compared with patients with RRMS, those with ProgMS had significantly worse QOL in 7 of the 13 subdomains: mobility, fine motor, positive affect, participation, satisfaction, fatigue, and stigma. Anxiety was higher in RRMS.
Diet was found to have an association with physical and mental subdomains, but not social subdomains. In those with RRMS, anti-inflammatory, low-carbohydrate, and other diets were positively associated with stigma, fine motor, and/or cognitive function. In patients with ProgMS, anti-inflammatory diets were associated with higher mobility and positive affect. Also, a low-carbohydrate diet was associated with higher positive affect, a low–saturated fat diet was linked with higher ease of communication, and other diets were associated with higher mobility in ProgMS.
Wellness activities were linked with all 3 subdomain categories. In RRMS, mind activities had an association with lower fine motor skills, cognitive function, communication, social participation, and social satisfaction and higher fatigue, anxiety, emotional dyscontrol, and stigma. Mind-body activities were associated with higher positive affect and participation and lower emotional dyscontrol. Other wellness activities were linked with lower values in 10 of the 13 subdomains.
Physical activity was also observed to be linked with the 3 subdomain categories. Phenotype differences were seen for 8 of the 13 subdomains. For RRMS, dose-dependent physical activity was associated with higher mobility, positive affect, and satisfaction and lower anxiety, depression, and stigma. In ProgMS, moderate physical activity was linked with higher positive affect, cognitive function, and lower communication. Additionally, active physical activity was associated with higher mobility and lower fatigue in ProgMS.
The investigators did not observe associations between vitamin D and omega-3 supplements and QOL.
The study had several limitations, including self-reported optional survey responses, a potential selection bias, participant biases, and exclusion of information on socioeconomics, access to health services, and support networks.
Reference
Nag N, Yu M, Jelinek GA, Simpson-Yap S, Neate SL, Schmidt HK. Associations between lifestyle behaviors and quality of life differ based on multiple sclerosis phenotype. J Pers Med. Published online November 17, 2021. doi:10.3390/jpm11111218