Health and Medical News and Resources

General interest items edited by Janice Flahiff

[JAMA Perspective] Dead Man Walking

Whether one is for or against all or parts of Obamacare, surely, we as a country can do better in providing needed health care to the poor, especially the poorest of the poor.

Excerpts from the November 2013  JAMA article by Michael Stillman, M.D., and Monalisa Tailor, M.D.

…For many of our patients, poverty alone limits access to care. We recently saw a man with AIDS and a full-body rash who couldn’t afford bus fare to a dermatology appointment. We sometimes pay for our patients’ medications because they are unable to cover even a $4 copayment. But a fair number of our patients — the medical “have-nots” — are denied basic services simply because they lack insurance, and our country’s response to this problem has, at times, seemed toothless.

In our clinic, uninsured patients frequently find necessary care unobtainable. An obese 60-year-old woman with symptoms and signs of congestive heart failure was recently evaluated in the clinic. She couldn’t afford the echocardiogram and evaluation for ischemic heart disease that most internists would have ordered, so furosemide treatment was initiated and adjusted to relieve her symptoms. This past spring, our colleagues saw a woman with a newly discovered lung nodule that was highly suspicious for cancer. She was referred to a thoracic surgeon, but he insisted that she first have a PET scan — a test for which she couldn’t possibly pay.

However unconscionable we may find the story of Mr. Davis, a U.S. citizen who will die because he was uninsured, the literature suggests that it’s a common tale. A 2009 study revealed a direct correlation between lack of insurance and increased mortality and suggested that nearly 45,000 American adults die each year because they have no medical coverage.1 And although we can’t confidently argue that Mr. Davis would have survived had he been insured, research suggests that possibility; formerly uninsured adults given access to Oregon Medicaid were more likely than those who remained uninsured to have a usual place of care and a personal physician, to attend outpatient medical visits, and to receive recommended preventive care.2 Had Mr. Davis been insured, he might well have been offered timely and appropriate screening for colorectal cancer, and his abdominal pain and obstipation would surely have been urgently evaluated.

 

November 16, 2013 Posted by | health care | , , , , | Leave a comment

News that is better or worse than expected influences health decisions

From the 29 October 2013 University of California – Riverside press release

UCR psychologist finds that unrealistic pessimists less likely to take preventive action after receiving good news

 IMAGE: This is Kate Sweeny.

Click here for more information. 

RIVERSIDE, Calif. — Patients who are unrealistically optimistic about their personal health risks are more likely to take preventive action when confronted with news that is worse than expected, while unrealistic pessimists are less likely to change their behavior after receiving feedback that is better than expected, according to researchers at the University of California, Riverside and Grand Valley State University in Allendale, Mich.

This poses a serious dilemma for health care professionals, said study authors Kate Sweeny, assistant professor of psychology at UC Riverside, and co-author Amanda Dillard, assistant professor of psychology at Grand Valley State University: Should they withhold accurate risk information from unrealistic pessimists to avoid undermining their perceptions of the severity of their potential consequences and ultimately their motivation for preventive behavior?

“The question reveals a tension between the goals of health-behavior promotion and informed patient decision-making that has plagued researchers in several health domains, most notably with regard to women’s often overly pessimistic perceptions of their breast cancer risk,” Sweeny and Dillard wrote in “The Effects of Expectation Disconfirmation on Appraisal, Affect, and Behavioral Intentions,” published this month in the online edition of Risk Analysis: An International Journal. The journal is an official publication of the Society for Risk Analysis, a multidisciplinary, interdisciplinary, scholarly, international society based in McLean, Va.

“Our findings cannot resolve this tension, but rather point to the need for further consideration of the potential consequences of risk communication,” the researchers said.

Sweeny and Dillard are the first to demonstrate that how an individual reacts and responds to objective risk feedback may depend on initial expectations prior to the feedback.

The psychologists conducted a series of experiments in which participants were told they would be tested for exposure to toxins found in everyday products. The researchers found that people who received risk feedback that was worse than expected expressed stronger intentions to prevent the threat in the future than did people who received risk feedback that was better than expected. All study participants received the same health feedback; only the expectations of the participants differed.

“Our findings add critical pieces to the previously incomplete picture of the consequences of expectation disconfirmation,” they wrote. “Ours is the first experimental investigation of the relationship between expectation disconfirmation and behavioral intentions in the context of personal risk perceptions, and the first study to examine the process by which intentions might rise or fall in response to unexpected risk feedback.”

Contrary to findings in other recent studies, Sweeny and Dillard determined that when people are faced with objective feedback that differs from their perceptions of health risks, they may adapt their behavior to fit the new risk information.

“In our studies, participants who learned that their risk was higher than they expected … formed relative strong intentions to take preventive action,” they said. They also found that people who learned that their risk was lower than expected felt relatively good in the face of feedback and formed relatively weak intentions to take preventive action. All of the study participants received the same health risk feedback.

“Our findings point to an important tradeoff people face when managing their expectations as they await feedback: maintaining optimism leaves people open to disappointment, but bracing for the worst may undermine future motivation to improve,” they said. “… It seems that people find the emotional consequences of being caught off-guard more compelling than the potential for elation to undermine their motivation to change their behavior in response to feedback.”

 

 

 

 

October 30, 2013 Posted by | health care, Medical and Health Research News | , , , , , | Leave a comment

HHS Announces $750 Million Investment in Prevention

HHS Announces $750 Million Investment in Prevention

New health care law provides new funding to reduce tobacco use, obesity and heart disease, and build healthier communities

From the news release

epartment of Health and Human Services Secretary Kathleen Sebelius today announced a $750 million investment in prevention and public health, funded through the Prevention and Public Health Fund created by the new health care law.  Building on $500 million in investments last year, these new dollars will help prevent tobacco use, obesity, heart disease, stroke, and cancer; increase immunizations; and empower individuals and communities with tools and resources for local prevention and health initiatives.

“Prevention is something that can’t just happen in a doctor’s office.  If we are to address the big health issues of our time, from physical inactivity to poor nutrition to tobacco use, it needs to happen in local communities,” said Sebelius.  “This investment is going to build on the prevention work already under way to help make sure that we are working effectively across the federal government as well as with private groups and state and local governments to help Americans live longer, healthier lives.”

The Prevention and Public Health Fund, part of the Affordable Care Act, is designed to expand and sustain the necessary capacity to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living.  In FY2010, $500 million of the Prevention Fund was distributed to states and communities to boost prevention and public health efforts, improve health, enhance health care quality, and foster the next generation of primary health professionals.  Today, HHS posted new fact sheets detailing how that $500 million was allocated in every state. Those fact sheets are available at www.HealthCare.gov/news/factsheets/prevention02092011a.html.

This year, building on the initial investment, new funds are dedicated to expanding on four critical priorities:

  • Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.
  • Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law.  They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.
  • Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21stcentury challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.
  • Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges.

The Obama Administration recognizes the importance of a broad approach to addressing the health and well-being of our communities. Other initiatives put forth by the Obama Administration to promote prevention include:

  • The President’s Childhood Obesity Task Force and the First Lady’s Let’s Move! initiative aimed at combating childhood obesity.
  • The American Recovery and Reinvestment Act of 2009 that provides $1 billion for community-based initiatives, tobacco cessation activities, chronic disease reduction programs, and efforts to reduce healthcare-acquired infections.
  • The Affordable Care Act’s National Prevention, Health Promotion and Public Health Council, composed of senior government officials, charged with designing a National Prevention and Health Promotion Strategy.

For more information about the FY2011 Prevention and Public Health Fund investments, visithttp://www.HealthCare.gov/news/factsheets/prevention02092011b.html.


February 14, 2011 Posted by | Health News Items | , , , , , | Leave a comment

   

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