Structure, Health Benefits, Mechanisms, and Gut Microbiota of Dendrobium officinale Polysaccharides: A Review.

Dendrobium officinale polysaccharides (DOPs) are important active polysaccharides found in Dendrobium officinale, which is commonly used as a conventional food or herbal medicine and is well known in China. DOPs can influence the composition of the gut microbiota and the degradation capacity of these symbiotic bacteria, which in turn may determine the efficacy of dietary interventions. However, the necessary analysis of the relationship between DOPs and the gut microbiota is lacking. In this review, we summarize the extraction, structure, health benefits, and related mechanisms of DOPs, construct the DOPs-host axis, and propose that DOPs are potential prebiotics, mainly composed of 1,4-ß-D-mannose, 1,4-ß-D-glucose, and O-acetate groups, which induce an increase in the abundance of gut microbiota such as Lactobacillus, Bifidobacterium, Akkermansia, Bacteroides, and Prevotella. In addition, we found that when exposed to DOPs with different structural properties, the gut microbiota may exhibit different diversity and composition and provide health benefits, such as metabolism regulations, inflammation modulation, immunity moderation, and cancer intervention. This may contribute to facilitating the development of functional foods and health products to improve human health.

The Joint Distribution Of High Out-Of-Pocket Burdens, Medical Debt, And Financial Barriers To Needed Care.

Health care financial pressures in the US can manifest themselves in a variety of ways. Some families face high out-of-pocket spending on insurance premiums and medical care relative to income and assets. Some face medical debt that must be paid off over time. And some face delays or go without needed care for reasons involving cost. Whereas prior research has generally focused on these problems separately, a more complete picture of the challenges facing US families can be obtained by examining the joint distribution of these three financial problems. Applying relatively strict definitions of financial problems to data from the 2018-19 Medical Expenditure Panel Survey, we found that 27.0 percent of nonsenior adults lived in families with at least one of the three financial strains assessed. The share of participants facing more broadly defined financial problems was 45.4 percent. Prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources. The wide distribution of financial strain provides context for ongoing reforms in billing, coverage, and medical debt, as well as for the urgency felt across the country for health care financing reform.

Patient factors that affect opioid use among adults with and without chronic pain.

BACKGROUND: In recent years, inappropriate use of prescription opioids has become a national crisis. Prescription opioids can be an important tool for managing pain, but excessive dosages or extended use may lead to drug dependence, overdoses and mortality. Since the early 2000s, increased prescribing of opioids has been associated with marked increases in these adverse outcomes. OBJECTIVE: To determine patient characteristics associated with opioid use among adults with and without chronic pain treatment. METHODS: The study is based on a nationally representative sample of civilian noninstitutionalized adults without cancer from the Medical Expenditure Panel Survey (2014-2017). A multinomial logit regression analysis is used. Key patient characteristics are health attitudes. Self-reliant health attitude is agreement with the following statements: "I do not need health insurance," and "I can overcome illness without help from a medically trained person." RESULTS: Health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes are less likely to start and more likely to discontinue opioid use. Exercise is associated with higher probability of choosing no analgesic treatments over using opioids. Similarly, among adults who are using opioids for pain treatment, exercise is associated with higher probability of discontinuing opioid use in the year following opioid initiation. CONCLUSIONS AND RELEVANCE: Health related attitudes, self-reported mental health, and lifestyle choices such as exercise and smoking are associated with patients' choices among opioid and non-opioid treatments. These results can help clinicians guide patients towards non-opioid treatments.

The Risk Of Severe COVID-19 Within Households Of School Employees And School-Age Children.

Across the United States, school districts are grappling with questions of whether and how to reopen and keep open elementary and secondary schools in the 2020-21 academic year. Using household data from before the pandemic (2014-17), we examined how often people who have health conditions placing them at risk for severe coronavirus disease 2019 (COVID-19) were connected to schools, either as employees or by living in the same households as school employees or school-age children. Between 42.0 percent and 51.4 percent of all school employees met the Centers for Disease Control and Prevention's (CDC's) definition of having or potentially having increased risk for severe COVID-19. Among all adults with CDC-defined risk factors for severe COVID-19, between 33.9 million and 44.2 million had direct or within-household connections to schools.

Financial Burdens and Barriers to Care Among Nonelderly Adults With Heart Disease: 2010-2015.

Background We examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Methods and Results The participants were aged 18 to 64 years from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) for 2010-2015. High burden is out-of-pocket spending on care and insurance premiums >20% of income. Barriers to care are forgoing and delaying care for financial reasons. Logistic regressions were used to estimate the odds of having high burdens and barriers. Adults treated for heart disease have odds ratios (ORs) of 2.18 (95% CI, 1.91-2.50) for having high burden, 2.51 (95% CI, 2.23-2.83) for forgoing care, and 3.57 (95% CI, 3.8-4.13) for delaying care compared with adults without any chronic condition. Among adults treated for heart disease compared with adults with private group coverage, ORs for having high burdens were significantly lower among those with public insurance (OR: 0.17; 95% CI, 0.10-0.26) or the uninsured (OR: 0.58; 95% CI, 0.36-0.92) and higher among those with private nongroup insurance (OR: 5.30; 95% CI, 3.26-8.61). Compared with adults with private group coverage, ORs for delaying care were 2.07 (95% CI, 1.37-3.12) for those with public insurance, 2.64; 95% CI, 1.70-4.10) for those without insurance, and 2.16 (95% CI, 1.24-3.76) for those with private nongroup insurance. Conclusions Public insurance provides protection against high burdens but not against forgoing or delaying care. Future research should investigate whether and to what extent barriers to care are associated with worse health outcomes and higher costs in the long term.

Most Americans Have Good Health, Little Unmet Need, And Few Health Care Expenses.

The distribution of health care expenditures remains highly concentrated, but most Americans use few health care resources and have low out-of-pocket spending. More than 93 percent of "low spenders" (those in the bottom half of the population) believe they have received all needed care in a timely manner. The low spending by the majority of the population has remained almost unchanged during the thirty-seven-year period examined.

Educational attainment and health outcomes: Data from the Medical Expenditures Panel Survey.

OBJECTIVES: Using data from the nationally representative Medical Expenditures Panel Survey (MEPS), we explored the extent to which health care utilization and health risk-taking, together with previously examined mediators, can explain the education-health gradient above and beyond what can be explained by previously examined mediators such as age, race, and poverty status. METHOD: Health was measured using the Physical Component Score (PCS) from the Medical Outcomes Study 12-Item Short Form (SF-12). Educational attainment was self-reported and categorized as 1 (less than high school), 2 (high school graduate or GED), 3 (some college), 4 (bachelor's degree), and 5 (graduate degree). RESULTS: In bivariate analysis, we found systematic graded relationships between educational attainment and health including, SF-12 PCS scores, self-rated health, and activity limitations. In addition, education was associated with having more office visits and outpatient visits and less risk tolerance. Those with less education were also more likely to be uninsured throughout the year. Multivariate regression analysis suggested that adjustment for age, race, poverty status and marital status explained part, but not nearly all, of the relationship between education and health. Adding a variety of variables on health care and attitudes to the models provided no additional explanatory power. This pattern of results persisted even after stratifying on the number of self-reported chronic conditions. CONCLUSIONS: Our findings provide no evidence that access to and use of health care explains the education-health gradient. However, more research is necessary to conclusively rule out medical care as a mediator between education and health. (PsycINFO Database Record

Providers' advice concerning smoking cessation: Evidence from the Medical Expenditures Panel Survey.

IMPORTANCE AND OBJECTIVE: We estimate how often adult smokers are advised to quit using a nationally representative sample of adults in the United States. DESIGN AND PARTICIPANTS: Data are from the 2012-2013 household component of the United States (US) Medical Expenditures Panel Survey (MEPS). MAIN OUTCOME MEASURE: Current smoking and advice to quit offered by providers. RESULTS: Smoking was reported by 18.26% (CI 17.13%-19.38%) of 2012 MEPS respondents. Less than half of adult smokers (47.24%, CI 44.30%-50.19%) were advised to quit by their physicians although 17.57% (CI 15.37%-19.76%) had not seen a doctor in the last 12months. Advice to quit was given significantly less often to respondents classified as: aged 18-44 (40.29%), men (40.20%), less educated (42.26%), lower family income (43.51%), Hispanic (33.82%), never married (39.55%), and living outside the northeast. Smoking status at year 2 for patients who had received advice to quit was similar (85.13%: SE 1.62%) to those who had seen a physician but were not advised to quit (81.95%: SE 2.05%). Advice to quit smoking was less common than the use of common medical screening tests. CONCLUSIONS AND RELEVANCE: Smoking cessation advice is given to less than half of current cigarette smokers and it is least likely to be given to the most vulnerable populations. Efforts to reduce smoking are deployed less often than other preventive practices. The rate of advice to quit has not changed over the last decade. Health care providers are missing an important opportunity to affect health behaviors and outcomes.

Young Adult Insurance Coverage And Out-Of-Pocket Spending: Long-Term Patterns.

The Affordable Care Act appears to have improved health insurance coverage for young adults (ages 18-30). But data from twenty national surveys conducted between 1977 and 2013 paint a more complex picture, showing coverage rates lower in 2013 than they were thirty-six years earlier. Racial and ethnic disparities in coverage have declined recently, while out-of-pocket expenditures remain low for most young adults.

Out-of-pocket healthcare expenditure burdens among nonelderly adults with hypertension.

OBJECTIVES: To examine the prevalence of high out-of-pocket burdens and self-perceived financial barriers to care among patients receiving hypertension treatment. STUDY POPULATION: Persons 18 to 64 years receiving treatment for hypertension from a nationally representative sample of the US population from the 2007 to 2009 Medical Expenditure Panel Survey. MAIN OUTCOME MEASURES: The proportion of persons living in families with high a out-of-pocket burden associated with medical spending relative to income, defining high healthcare burden as spending on healthcare greater than 20% of income and high total burden as spending on healthcare and insurance premiums greater than 20% of income. RESULTS: The prevalence of high total burdens was significantly greater for persons receiving treatment for hypertension (13.1%) compared with other chronically ill (10.5%) and well patients (5.3%). Among hypertension patients with high total burdens, 15.7% said they were unable to get care and 13.6% said they delayed care due to financial reasons. Self-perceived financial barriers were highest among the uninsured and those with public coverage: 35.2% among the uninsured and 23.9% among those with public coverage said they were unable to get care due to financial reasons. CONCLUSIONS: High burdens may deter patients from getting needed care. Our findings have 2 distinct policy implications. First, raising awareness among providers regarding the prevalence of high out-of-pocket burdens and financial barriers to care may encourage physicians to discuss healthcare coverage and associated costs with their patients. To the extent that patients' perceptions about their ability to pay are incorrect, physicians can help patients overcome barriers to treatment. Second, health plans could reduce patient cost sharing on drugs for which there is a strong body of evidence documenting cost-saving treatment such as antihypertensive medication. Addressing financial barriers to care may improve treatment adherence among patients with hypertension.

National estimates of out-of-pocket health care expenditure burdens among nonelderly adults with cancer: 2001 to 2008.

PURPOSE: To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer. METHODS: The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums). RESULTS: The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions. CONCLUSION: High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.