Health-promoting environments in U.S. medical facilities: physician perceptions, DocStyles 2012.

OBJECTIVE: Medical facilities are natural leaders for health promotion because of their mission, influence, and reach. We sought to determine the frequency of physicians reporting supportive, health-promoting environments in their facility and identify characteristics of physicians and medical practices associated with support. METHODS: We analyzed a sample of 1485 U.S. primary care physicians in DocStyles 2012 survey. Physicians rated their facility's support for healthy nutrition, physical activity, and lactation environments. Frequencies and adjusted odds ratios for supportive environments (rated "Good" or "Very Good") were assessed by select characteristics. RESULTS: The frequency of physicians reporting supportive environments was 70.0% for nutrition, 60.0% for physical activity, 76.0% for lactation, and 40.4% for all 3 environments combined. Supportive nutrition [odds ratio: 2.91 (1.49-5.66)] and physical activity [2.13 (1.19-3.83)] environments were associated with physicians seeing upper middle class to affluent patients versus poor patients. Supportive lactation environments were associated with pediatricians [3.35 (2.14-5.25)] and obstetricians/gynecologists [3.39 (2.15-5.33)] versus internists. CONCLUSIONS: Less than half of physicians reported their facility supportive of all these environments, suggesting there are many missed opportunities for U.S. medical facilities to promote wellness. Facilities serving poor patients and those staffed by internists and family/general practitioners may represent one area of need.

Hitting the target: Lyme or STARI?

Erythema migrans (EM) is a characteristic rash most commonly associated with Lyme disease (LD) in the northeastern and north central United States. EM rash found in the southeastern United States is usually classified as Southern Tick-Associated Rash Illness (STARI). Here we describe an EM rash in a 3-year-old female from central Louisiana, whose laboratory and clinical findings were suspicious for LD. This case report highlights the importance of distinguishing STARI from LD, as LD left untreated can lead to long-term complications.

The impact of recent CHIP eligibility expansions on children's insurance coverage, 2008-12.

Following the reauthorization of the Children's Health Insurance Program (CHIP) in 2009, fifteen states raised their CHIP income eligibility thresholds to further reduce uninsurance among children. We examined the impact of these expansions on uninsurance, public insurance, and private insurance among children who became newly eligible for CHIP after the expansions. Using a difference-in-differences approach, we estimated that the expansions reduced uninsurance by 1.1 percentage points among the newly eligible, cutting their uninsurance rate by nearly 15 percent. Public coverage increased by 2.9 percentage points, with variations in take-up among the states. A better understanding of these state-level differences in take-up could inform efforts to enroll children who remain uninsured but are eligible for CHIP. CHIP is up for reauthorization in 2015, and further funding will be needed to maintain the program, which provides insurance to children who might not have access to affordable private coverage.