Universal healthcare as pandemic preparedness: The lives and costs that could have been saved during the COVID-19 pandemic.

The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study.

Background: Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance. Methods: We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion. Findings: Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis. Interpretation: Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

Proposal for medical school nutrition education: topics and recommendations.

The mission of increasing the number of physician nutrition experts requires focused nutrition education directed at medical students across the 4-year curriculum and into postgraduate training. Courses should be horizontally and vertically integrated, bridging the basic sciences and clinical medicine. It is anticipated that the Liaison Committee on Medical Education and Association of American Medical Colleges will require competency in nutrition with emphasis on preventive and therapeutic applications. Barriers to implementation of nutrition courses can be overcome by using innovative teaching in association with cooperative course directors. Analysis of prior governmental efforts, through the Nutrition Academic Award, provides a basis for targeting fundamental knowledge and creative methods for achieving educational goals. Recommendations for short-term and long-term ideas for increasing the number of adequate physician nutrition experts are offered.

Microecology, obesity, and probiotics.

PURPOSE OF REVIEW: Description of the role that the microbiota may play in human health, energy harvest, and obesity. RECENT FINDINGS: The adult human gut may contain up to 100 trillion microbial organisms, known as the microbiota. Major advances in defining the quality, quantity, and physiologic activity of the intestinal microbiota were precipitated by the conversion from culture-based techniques to metagenomics. The microbiota may serve various functions including promoting development of the human immune system, modulating inflammation, and affecting calorie extraction. SUMMARY: Recent evidence, in humans and animal models, supports a role for the microbiota in obesity. Not only is the presence of bacteria important, but also the relative proportions of microbial communities, specifically Firmicutes and Bacteriodetes, appear to be important in energy homeostasis. The microbiota may also affect the immune and inflammatory response in human organisms. Although there is limited data supporting the manipulation of the gut microbiota, using probiotics, antibiotics, and/or prebiotics to treat obesity, novel therapeutic agents may be developed.

Advances in paediatric migraine.

Headache is one of the most common complaints of children who present to primary care providers. Although parents are often concerned about sinister pathology, the majority of children with headaches have primary headache syndromes, including migraine and tension-type headaches. Diagnostic criteria for children are currently evolving to better reflect the unique challenges of this group of patients. Advances in migraine pharmacotherapy have been achieved through the understanding of serotonin and its role in migraine pathophysiology. Serotonin agonists, commonly known as 'triptans', are the current standard of care in the management of acute migraine in adults. Recent evidence has confirmed that the efficacy of triptans also occurs in children. The present article focuses on recent advances in the areas of epidemiology, diagnostic criteria and pathophysiology of paediatric migraine. In addition, the present article reviews the evidence of management issues, including neuroimaging and the use of triptans in children.