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1.
Medicine (Baltimore) ; 100(20): e25998, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011094

RESUMO

ABSTRACT: To examine the impact of inadequate health insurance coverage on physician utilization among older adults using a novel quasi-experimental design in the time period following the elimination of cost sharing for most preventative services under the US Affordable Care Act of 2010.The Medical Expenditure Panel Survey full year consolidated data files for the period 2010 to 2017 were used to construct a pooled cross-sectional dataset of adults aged 60 to 70. Regression discontinuity design was used to estimate the impact of transitioning between non-Medicare and Medicare plans on use of routine office-based physician visits and emergency room visits.For the overall population, gaining access to Medicare at age 65 is associated with a higher propensity to make routine office-based visits (2.94 percentage points [pp]; P < .01) and lower out-of-pocket costs (-23.86 pp; P < .01) Similarly, disenrollment from non-Medicare insurance plans at age 66 was associated with more routine office-based visits (3.01 pp; P < .01) and less out-of-pocket costs (-8.09 pp; P < .10). However, some minority groups reported no changes in visits and out-of-pocket costs or reported an increased propensity to make emergency department visits.Enrollment into Medicare from non-Medicare insurance plans was associated with increased use of routine office-based services and lower out-of-pocket costs. However, some subgroups reported no changes in routine visits or costs or an increased propensity to make emergency department visits. These findings suggest other nonfinancial, structural barriers may exist that limit patient's ability to access routine services.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicare/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Idoso , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/legislação & jurisprudência , Custo Compartilhado de Seguro/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Estados Unidos
2.
Health Serv Res ; 56(5): 854-863, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33491211

RESUMO

OBJECTIVES: To examine the health effects of the Supplemental Nutritional Assistance Program (SNAP) and the differential impact of SNAP across race/ethnicity among older adults. DATA SOURCE/STUDY SETTING: 2008-2013 Medical Expenditure Panel Survey, a nationally representative population-based complex sample survey. STUDY DESIGN: A difference-in-regression-discontinuity (DRD) design is used to assess the impacts of SNAP on diet-related disease morbidity. The primary outcomes were the prevalence rate of hypertension, coronary heart disease, stroke, diabetes, and cancer. We also conducted supplemental analysis to examine potential co-occurring trends in medical utilization. DATA COLLECTION/EXTRACTION METHODS: Data are publicly available. PRINCIPAL FINDINGS: In the full sample, SNAP eligibility was associated with a significant decline in diabetes (-3.71 percentage points [pp]; P < .05). Non-Hispanic (NH) White respondents reported trends similar to the full sample; however, NH Black respondents reported large declines in hypertension (-13.95 pp; P < .01) and Hispanic respondents reported declines in the prevalence of angina (-6.94 pp; P < .05) and stroke (-4.48 pp; P < .05). CONCLUSIONS: Supplemental Nutritional Assistance Program eligibility was associated with the reduced prevalence of diet-related disease among older adults. These observed declines in the prevalence of diet-related disease do not appear to be attributable to increased medical visits or spending on medical services and prescriptions.


Assuntos
Dieta/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Mortalidade/etnologia , Pobreza/estatística & dados numéricos , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/etnologia , Diabetes Mellitus/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Neoplasias/mortalidade
3.
Soc Sci Med ; 258: 113136, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32585543

RESUMO

RATIONALE: Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market. OBJECTIVE: The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance use, and improvements in self-efficacy and economic security. METHOD: From October 2015 to May 2018, 369 caregivers were enrolled in the 16-week Building Wealth and Health Network Phase II single-group cohort study. Participants responded to questions regarding their socio-demographic characteristics, mental health, economic security, and use of drugs and alcohol at baseline and four three-month follow-up surveys. Associations between the trauma-informed peer support curriculum and health outcomes were assessed using maximum likelihood estimation. RESULTS: Using class attendance records, participants were separated into a low-exposure group (

Assuntos
Alcoolismo , Transtornos Relacionados ao Uso de Substâncias , Estudos de Coortes , Currículo , Depressão/terapia , Humanos , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia
4.
J Child Fam Stud ; 27(5): 1594-1604, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29657515

RESUMO

Temporary Assistance for Needy Families (TANF) has limited success in building self-sufficiency, and rarely addresses exposure to trauma as a barrier to employment. The objective of the Building Wealth and Health Network randomized controlled trial was to test effectiveness of financial empowerment combined with trauma-informed peer support against standard TANF programming. Through the method of single-blind randomization we assigned 103 caregivers of children under age six into three groups: control (standard TANF programming), partial (28-weeks financial education), and full (same as partial with simultaneous 28-weeks of trauma-informed peer support). Participants completed baseline and follow-up surveys every 3 months over 15 months. Group response rates were equivalent throughout. With mixed effects analysis we compared post-program outcomes at months 9, 12, and 15 to baseline. We modeled the impact of amount of participation in group classes on participant outcomes. Despite high exposure to trauma and adversity results demonstrate that, compared to the other groups, caregivers in the full intervention reported improved self-efficacy and depressive symptoms, and reduced economic hardship. Unlike the intervention groups, the control group reported increased developmental risk among their children. Although the control group showed higher levels of employment, the full intervention group reported greater earnings. The partial intervention group showed little to no differences compared with the control group. We conclude that financial empowerment education with trauma-informed peer support is more effective than standard TANF programming at improving behavioral health, reducing hardship, and increasing income. Policymakers may consider adapting TANF to include trauma-informed programming.

5.
Sci Rep ; 3: 1184, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23378916

RESUMO

We report that terahertz (THz) irradiation of mouse mesenchymal stem cells (mMSCs) with a single-frequency (SF) 2.52 THz laser or pulsed broadband (centered at 10 THz) source results in irradiation specific heterogenic changes in gene expression. The THz effect depends on irradiation parameters such as the duration and type of THz source, and on the degree of stem cell differentiation. Our microarray survey and RT-PCR experiments demonstrate that prolonged broadband THz irradiation drives mMSCs toward differentiation, while 2-hour irradiation (regardless of THz sources) affects genes transcriptionally active in pluripotent stem cells. The strictly controlled experimental environment indicates minimal temperature changes and the absence of any discernable response to heat shock and cellular stress genes imply a non-thermal response. Computer simulations of the core promoters of two pluripotency markers reveal association between gene upregulation and propensity for DNA breathing. We propose that THz radiation has potential for non-contact control of cellular gene expression.


Assuntos
Regulação da Expressão Gênica/efeitos da radiação , Células-Tronco Mesenquimais/efeitos da radiação , Radiação Terahertz , Animais , Diferenciação Celular , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Camundongos , Análise de Sequência com Séries de Oligonucleotídeos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Tempo
6.
Biomed Opt Express ; 2(9): 2679-89, 2011 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-21991556

RESUMO

In recent years, terahertz radiation sources are increasingly being exploited in military and civil applications. However, only a few studies have so far been conducted to examine the biological effects associated with terahertz radiation. In this study, we evaluated the cellular response of mesenchymal mouse stem cells exposed to THz radiation. We apply low-power radiation from both a pulsed broad-band (centered at 10 THz) source and from a CW laser (2.52 THz) source. Modeling, empirical characterization, and monitoring techniques were applied to minimize the impact of radiation-induced increases in temperature. qRT-PCR was used to evaluate changes in the transcriptional activity of selected hyperthermic genes. We found that temperature increases were minimal, and that the differential expression of the investigated heat shock proteins (HSP105, HSP90, and CPR) was unaffected, while the expression of certain other genes (Adiponectin, GLUT4, and PPARG) showed clear effects of the THz irradiation after prolonged, broad-band exposure.

7.
ACS Nano ; 4(6): 3222-6, 2010 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-20469843

RESUMO

We have observed large-amplitude coherent phonon oscillations of radial breathing modes (RBMs) in single-walled carbon nanotubes excited through the lowest-energy (E(11)) interband transitions. In contrast to the previously studied coherent phonons excited through higher-energy (E(22)) transitions, these RBMs show comparable intensities between (n-m) mod 3 = +1 and -1 nanotubes. We also find the novel observation of RBMs excited over an excitation range of approximately 300 meV above the E(11) transition, which we attribute to possible resonance with phonon sidebands of the lowest optical transition, arising from strong exciton-phonon coupling.


Assuntos
Cristalização/métodos , Nanotecnologia/métodos , Nanotubos de Carbono/química , Nanotubos de Carbono/ultraestrutura , Luz , Substâncias Macromoleculares/química , Teste de Materiais , Conformação Molecular , Tamanho da Partícula , Fótons , Espalhamento de Radiação , Propriedades de Superfície
8.
Nano Lett ; 9(7): 2610-3, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19492842

RESUMO

We describe a film of highly aligned single-walled carbon nanotubes that acts as an excellent terahertz linear polarizer. There is virtually no attenuation (strong absorption) when the terahertz polarization is perpendicular (parallel) to the nanotube axis. From the data, the reduced linear dichrosim was calculated to be 3, corresponding to a nematic order parameter of 1, which demonstrates nearly perfect alignment as well as intrinsically anisotropic terahertz response of single-walled carbon nanotubes in the film.


Assuntos
Nanotubos de Carbono/química , Anisotropia , Teste de Materiais , Microscopia de Polarização , Propriedades de Superfície
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