Correlates of physical activity in children and adolescents with intellectual disabilities: a systematic review.

BACKGROUND: Children and adolescents with intellectual disabilities (ID) participate in low levels of physical activity. To inform the development of interventions, we need to better understand factors associated with physical activity. The aim of this study was therefore to systematically review correlates of physical activity in children and adolescents with ID. METHODS: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ovid MEDLINE, Ovid Embase, Web of Science, ERIC, CINAHL and PsycINFO were searched between 1 January 1990 and 29 February 2020 to identify English-language studies, which examined correlates of free-living physical activity in children and adolescents (0-19 years) with ID. Study quality was assessed. Correlates were analysed using a narrative synthesis and classified using the socioecological model as intrapersonal, interpersonal, organisational or environmental. RESULTS: Fifteen studies published between 2010 and 2019 met the inclusion criteria and were included in the review. Forty-eight individual correlates were identified. Studies were predominantly focused on intrapersonal-level correlates. Of those correlates investigated in more than one study (n = 6), having better motor development was positively associated with physical activity. Inconsistent results were found for age and cardiorespiratory fitness. Sex, percentage body fat and body mass index were not correlated. No interpersonal-level, organisational-level or environmental-level correlates were included in more than one study. CONCLUSIONS: To date, we have limited and inconclusive evidence about correlates of physical activity in children and adolescents with ID. Only when future studies unravel correlates and determinants, across all domains of the socioecological model, will the potential opportunities to improve health by increasing physical activity levels be achievable.

Effect of level of farm mechanization early in life on bone later in life.

OBJECTIVE: To determine whether an active rural lifestyle during childhood and adolescence, defined as low farm mechanization, was associated with bone measures later in life. METHODS: DXA bone data from total body, hip and spine, and pQCT data from 4% and 20% distal radius were obtained on 330 individuals (157 women) aged 20-66 years who farmed at least 75% of their lives. Primary bone outcomes included areal bone mineral density (aBMD), aBMD Z-scores, cortical and trabecular volumetric BMD, cortical thickness and periosteal circumference. Relationship between bone and recall of level of farm mechanization as a child was determined after stratifying by sex and controlling for covariates. RESULTS: Controlling for covariates, females from low mechanized farms had higher femoral neck (FN) bone area (p=0.03) than those on high or moderate mechanized farms. No group differences in pQCT ulna measurements or z-scores were found in either gender. CONCLUSION: A low farm mechanization level (high physical activity) prior to 20 years of age is associated with greater FN bone area in females. Future research that includes type and amount of physical activity performed will contribute to growing knowledge of how and when regular physical activity during childhood and adolescence affects adult bone health.

Effects of application methods and plastic covers on distribution of cis- and trans-1,3-dichloropropene and chloropicrin in root zone.

This study examined the effects of three application methods (chisel injection, Avenger coulter injection, and drip irrigation) and two plastic films (polyethylene film [PE] and virtually impermeable film [VIF]) on distribution of cis- and trans- 1,3-dichloropropene (1,3-D) and chloropicrin (CP) in a Florida sandy soil after application of Telone C35 or Telone In-Line. Regardless of application method, VIF retained greater amounts of cis- and trans-1,3-D and CP in the root zone with longer residential time than PE. There was better retention of the three compounds in the root zone when applied with the Avenger coulter injection rig than chisel injection, especially in combination with VIF. Distribution of the three compounds in the root zone was less predictable when applied by drip irrigation. Following drip irrigation, more than 50% of the three compounds in the PE and VIF-covered beds was found near the end of the drip tapes in one experiment, whereas the distribution was much more uniform in the root zone in a second experiment. Among the three biologically active compounds, CP disappeared from the root zone more rapidly than cis- and trans-1,3-D, especially in the PE-covered beds.

Persistence, distribution, and emission of Telone C35 injected into a Florida sandy soil as affected by moisture, organic matter, and plastic film cover.

With the phase-out of methyl bromide scheduled for 2005, alternative fumigants are being sought. This study of Telone C35, a mixture of (Z)- and (E)-1,3-dichloropropene (1,3-D) with chloropicirin (CP), focuses on its emissions, distribution, and persistence in Florida sandy soil in microplots with different soil-water and organic matter carbon (C) content with and without two different plastic film mulches. The addition of CP did not affect the physical behavior of the isomers of 1,3-D. Slower subsurface dispersion and longer residence time of the mixed fumigant occurred at higher water content. An increase in the percent organic carbon in the soil led to a more rapid decrease for chloropicirin than for 1,3-dichloropene isomers. The use of a virtually impermeable film (VIF) for soil cover provided a more even distribution and longer persistence under all the conditions studied in comparison to polyethylene (PE) film cover or no cover. The conditions of near field capacity water content, low organic matter, and a virtually impermeable film cover yielded optimum conditions for the distribution, emission control, and persistence of Telone C35 in a Florida sandy soil.

Creating more effective health plan quality reports for consumers: lessons from a synthesis of qualitative testing.

OBJECTIVE: Social marketing techniques such as consumer testing have only recently been applied to develop effective consumer health insurance information. This article discusses lessons learned from consumer testing to create consumer plan choice materials. DATA SOURCES/STUDY SETTING: Data were collected from 268 publicly and privately insured consumers in three studies between 1994 and 1999. STUDY DESIGN: Iterative testing and revisions were conducted to design seven booklets to help Medicaid, Medicare, and employed consumers choose a health plan. DATA COLLECTION METHODS: Standardized protocols were used in 11 focus groups and 182 interviews to examine the content, comprehension, navigation, and utility of the booklets. PRINCIPAL FINDINGS: A method is suggested to help consumers narrow their plan choices by breaking down the process into smaller decisions using a set of guided worksheets. CONCLUSION: Implementing these lessons is challenging and not often done well. This article gives examples of evidence-based approaches to address cognitive barriers that designers of consumer health insurance information can adapt to their needs.

Health plan decision making with new medicare information materials.

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

Providing information to help Medicare beneficiaries choose a health plan.

Many Medicare beneficiaries have limited knowledge of the Medicare program and related health insurance options. This is due in part to the complexity of the Medicare program and supplemental health insurance market. A recent congressional mandate through the Balanced Budget Act of 1997 called for broad dissemination of information to educate beneficiaries about their health plan options and to encourage informed health plan decision-making. In response, the Health Care Financing Administration (HCFA) launched the National Medicare Education Program (NMEP) to support the educational objectives of the BBA. This paper provides an overview of the components of the NMEP information campaign. We also review lessons learned from our experience in designing and testing a prototype consumer handbook that explains the different health plan options to Medicare beneficiaries. Through our discussion of the handbook, we highlight several ways to communicate information effectively about a complex publicly funded program to an older adult population.

Beneficiaries' perceptions of new Medicare health plan choice print materials.

This article presents findings from a study involving seven focus groups with aged and disabled Medicare beneficiaries in the Kansas City area regarding their impressions of a pilot version of the Medicare & You 1999 handbook and the Medicare Consumer Assessment of Health Plans Study (CAHPS) survey report. Beneficiaries generally had positive reactions to both booklets and viewed the handbook as an important reference tool. Based on the findings, we present policy recommendations for the development and dissemination of Medicare health plan information to beneficiaries.

Beneficiary survey-based feedback on new Medicare informational materials.

In response to the Balanced Budget Act (BBA) of 1997, the Center for Medicare & Medicaid Services (CMS) initiated a massive information and education campaign to promote effective health plan decision-making. Early results suggest that the pilot version of the Medicare & You handbook and other new Medicare informational materials were viewed favorably overall. Despite their limitations, most beneficiaries found the information useful. The longer, more comprehensive materials were not perceived to be more useful than the shorter, less complicated version. Additional research is needed to determine which subgroups of beneficiaries may need more and, possibly less, information.

Measuring beneficiary knowledge in two randomized experiments.

This article reports results of two studies that measured beneficiaries' knowledge of the Medicare program and related health insurance options using pre- and post-experimental designs. Knowledge was measured using multiple item indexes before and after receiving new informational materials developed by the Centers for Medicare & Medicaid Services (CMS) as part of the National Medicare Education Program (NMEP). Beneficiaries in both studies showed statistically significant gains in knowledge after receiving the new materials. Policy implications for the measurement of knowledge and creation of future versions of the materials are discussed.

Health plan decision making in the Medicare population: results from a national randomized experiment.

OBJECTIVE: To examine the effect of providing the Medicare & You handbook on consumers' attitudes and behavior regarding health plan decision making. DATA SOURCE: A national sample of 3,738 Medicare beneficiaries who were surveyed in late 1999 and early 2000 was employed. Data were collected using a mail survey with telephone follow-up; the response rate was 76 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group that received no Medicare-related in formation as part of the study, or to a treatment group that received a copy of the 2000 version of the Medicare & You handbook as part of a national mailing. Half of the treat men t group (the "re-mail" group) received a second copy of the handbook along wit h their mail survey instrument. PRINCIPAL FINDINGS: The control and treatment groups did not differ regarding their level of satisfaction with or confidence in their current choice of health plan according to predicted mean values. Treatment group beneficiaries had a significantly higher propensity to either change or consider changing health plans relative to beneficiaries in the control group. Controlling for other factors, 5 percent of treatment group members switched health insurance plans during the prior month compared to 3 percent of control group members. there were no significant differences in predicted values between the re-mail and no re-mail groups in any of the models. Type of supplemental insurance was also highly related to all three outcomes. CONCLUSIONS: Findings from this and a prior parallel study suggest th at messages contained in the Medicare & You handbook can have an influence on beneficiaries and the Medicare market . Thus, careful attention should be given to the wording and intent of these messages. This is particularly relevant given the current administration's emphasis on increasing enrollment in Medicare+Choice plans and findings from earlier research reporting that beneficiaries felt the handbook was pressuring them to enroll in managed care.

Medicare spending by beneficiaries with various types of supplemental insurance.

The authors analyzed Medicare spending by elderly noninstitutionalized Medicare beneficiaries with and without supplemental insurance such as Medigap, employer-sponsored plans, and Medicaid. Use of a detailed survey of Medicare beneficiaries and their Medicare health insurance claims enabled the authors to control for health status, chronic conditions, functional limitations, and other factors that explain spending variations across supplemental insurance categories. The authors found that supplemental insurance was associated with a higher probability and level of Medicare spending, particularly for Part B services. Beneficiaries with both Medigap and employer plans had the highest levels of spending ceteris paribus, suggesting a possible moral hazard effect of insurance. Findings from this study are discussed in the context of the overall financing of health care for the elderly.

Access to family planning services: relationship with unintended pregnancies and prenatal outcomes.

Family planning services are important because they can prevent unintended pregnancies and improve prenatal outcomes. This paper uses secondary data to analyze trends in access to family planning services, with a particular focus on poor women and young women. Trends from the 1980s showed a small decline in family planning visits and an upsurge in the percentage of births that were unwanted at the time of conception. These changes were particularly marked for poor women. Over the same decade, public expenditures for contraceptive services declined dramatically. The health insurance system with respect to family planning must be modernized to meet the needs of women and couples today. Future improvements in infant health and survival will depend in large part on ensuring that pregnancies are intended and not the result of lack of access to effective family planning services.

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.

Consumer information development and use.

The availability of informational materials to aid consumer health care purchasing decisions is increasing. Organizations developing and disseminating materials include public- and private-sector employers, providers, purchasing cooperatives, State agencies, counseling programs, and accreditation bodies. Based on case study interviews with 24 organizations, we learned that 10 included consumer satisfaction ratings and performance measures based on medical records. An additional four organizations developed materials with consumer satisfaction ratings exclusively. Printed materials were the most common medium used to convey information to consumers. However, other mechanisms for conveying the information were also employed. On the whole, the materials have not been rigorously evaluated. Evaluations are needed to determine if consumers find the information useful and how different individuals prefer to receive the information.

Medigap reform legislation of 1990: have the objectives been met?

The 1990 medigap reform legislation had multiple objectives: To simplify the insurance market in order to facilitate policy comparison, provide consumer choice, provide market stability, promote competition, and avoid adverse selection. Based on case study interviews with a cross-section of individuals and organizations, we report that most of these objectives have been achieved. Consumers of medigap plans are able to make more informed choices, largely because they can adequately compare policies based on standard benefits. Marketing abuses have apparently declined, as evidenced by a decrease in the number of consumer complaints. Finally, no major detrimental impact on the insurance industry was detected. Beneficiaries still face some confusion in this market, however, such as understanding the rating methodologies used to set premiums and how this may affect their choices. Confusion could increase with the growth of managed care options.

Diffusion of Medicare's RBRVS and related physician payment policies.

In 1992, Medicare reformed its physician payment method by implementing the Medicare fee schedule (MFS), of which the resource-based relative value scale (RBRVS) is a major component. Using a recent survey and case studies, we examine the diffusion of Medicare's RBRVS to non-Medicare payers and how those payers use and perceive the RBRVS and MFS policies. We find that approximately one-third of payers that participated in the survey have adopted RBRVS-based payment systems in varying degrees while another 40 percent were seriously considering its adoption. Prospects for expanded use of Medicare's RBRVS appear favorable.