Promoting Access To Hospital Care In Rural Areas: Current Approaches And Ongoing Challenges.

Financial distress among rural hospitals is a significant concern for policy makers. Poor financial performance increases the likelihood of hospital closure and merger, and it can limit hospitals' ability to invest in quality improvements. In response to these challenges, policy makers are actively seeking ways to ensure access to affordable, high-quality care for rural communities.

Understanding categories of postpartum care use among privately insured patients in the United States: a cluster-analytic approach.

The postpartum period is critical for the health and well-being of birthing people, yet little is known about the range of health care services and supports needed during this time. Maternity care patients are often targeted for clinical interventions based on "low risk" or "high risk" designations, but dichotomized measures can be imprecise and may not reflect meaningful groups for understanding needed postpartum care. Using claims data from privately insured patients with childbirths between 2016 and 2018, this study identifies categories and predictors of postpartum care utilization, including the use of maternal care and other, nonmaternal, care (eg, respiratory, digestive).

Upsetting the Balance: How Modifiable Risk Factors Contribute to the Progression of Alzheimer's Disease.

Alzheimer's disease (AD) is a neurodegenerative disorder affecting nearly one in nine older adults in the US. This number is expected to grow exponentially, thereby increasing stress on caregivers and health systems. While some risk factors for developing AD are genetic, an estimated 1/3 of AD cases are attributed to lifestyle.

Kir6.2-K channels alter glycolytic flux to modulate cortical activity, arousal, and sleep-wake homeostasis.

Unlabelled: Metabolism plays an important role in the maintenance of vigilance states (e.g. wake, NREM, and REM).

Playing by the Rules? Tracking U.S. Hospitals' Responses to Federal Price Transparency Regulation.

Goal: As of January 1, 2021, the Centers for Medicare & Medicaid Services requires most U.S. hospitals to publish pricing information on their website to help consumers make decisions regarding services and to transform negotiations with health insurers.

KATP channels are necessary for glucose-dependent increases in amyloid-β and Alzheimer's disease-related pathology.

Elevated blood glucose levels, or hyperglycemia, can increase brain excitability and amyloid-β (Aβ) release, offering a mechanistic link between type 2 diabetes and Alzheimer's disease (AD). Since the cellular mechanisms governing this relationship are poorly understood, we explored whether ATP-sensitive potassium (KATP) channels, which couple changes in energy availability with cellular excitability, play a role in AD pathogenesis. First, we demonstrate that KATP channel subunits Kir6.

Hospital Survival In Rural Markets: Closures, Mergers, And Profitability.

Financial distress among rural hospitals in the US has increased in recent years. Using national hospital data, we investigated how the decline in profitability has affected hospital survival, either independently or with a merger. The answer has direct implications for access to care and competition in rural markets.

Adoption of Innovative Therapies Across Oncology Practices-Evidence From Immunotherapy.

Importance: Immunotherapies reflect an important breakthrough in cancer treatment, substantially improving outcomes for patients with a variety of cancer types, yet little is known about which practices have adopted this novel therapy or the pace of adoption.

Objective: To assess adoption of immunotherapies across US oncology practices and examine variation in adoption by practice type.

Design, Setting, And Participants: This cohort study used data from Medicare fee-for-service beneficiaries undergoing 6-month chemotherapy episodes between 2010 and 2017.

Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US.

Importance: Little is known about the quality of postpartum care or disparities in the content of postpartum care associated with health insurance, rural or urban residency, and race and ethnicity.

Objectives: To examine receipt of recommended postpartum care content and to describe variations across health insurance type, rural or urban residence, and race and ethnicity.

Design, Settings, And Participants: This cross-sectional survey of patients with births from 2016 to 2019 used data from the Pregnancy Risk Assessment Monitoring System (43 states and 2 jurisdictions).

COVID-19 Hospitalization Trends in Rural Versus Urban Areas in the United States.

Since the summer of 2020, the rate of coronavirus cases in the United States has been higher in rural areas than in urban areas, raising concerns that patients with coronavirus disease 2019 (COVID-19) will overwhelm under-resourced rural hospitals. Using data from the University of Minnesota COVID-19 Hospitalization Tracking Project and the U.S.

Association Between Medicaid Expansion And Closure Of Hospital-Based Obstetric Services.

Access to obstetric services has declined steadily during the past decade, driven by the closure of hospital-based obstetric units and of entire hospitals. A fundamental challenge to maintaining obstetric services is that they are frequently unprofitable for hospitals to operate, threatening hospital viability. Medicaid expansion has emerged as a possible remedy for obstetric service closure because it reduces uncompensated care and improves hospital finances.

Taking the Pulse of Hospitals' Response to the New Price Transparency Rule.

As of January 1, 2021, most U.S. hospitals are required to publish pricing information on their website to promote more informed decision making by consumers regarding their care.

Accessing Rights and Mitigating Revictimization: The Role of the Victim's Legal Counsel in the Swedish Criminal Justice System.

Rape victims often face secondary victimization by the criminal justice system, prompting their advocates to promote a variety of procedural changes, including the provision of an independent legal counsel for victims. Sweden implemented a legal counsel for victims of sexual assault and rape in the late 1980s, yet research about their role remains limited. This article draws upon interviews with victim-lawyers in Sweden and suggests that having access to an independent legal counsel can mitigate the risks for secondary victimization by empowering victims to access their rights and providing emotional support and connectedness in the criminal justice system.

The Interaction Between Sleep and Metabolism in Alzheimer's Disease: Cause or Consequence of Disease?

Alzheimer's disease (AD) is the most common form of dementia and affects over 45 million people worldwide. Both type-2-diabetes (T2D), a metabolic condition associated with aging, and disrupted sleep are implicated in the pathogenesis of AD, but how sleep and metabolism interact to affect AD progression remains unclear. In the healthy brain, sleep/wake cycles are a well-coordinated interaction between metabolic and neuronal activity, but when disrupted, are associated with a myriad of health-related issues, including metabolic syndrome, cardiovascular disease, T2D, and AD.

Targeted Deletion of Hepatocyte Abca1 Increases Plasma HDL (High-Density Lipoprotein) Reverse Cholesterol Transport via the LDL (Low-Density Lipoprotein) Receptor.

Objective: The role of hepatocyte Abca1 (ATP binding cassette transporter A1) in trafficking hepatic free cholesterol (FC) into plasma versus bile for reverse cholesterol transport (RCT) is poorly understood. We hypothesized that hepatocyte Abca1 recycles plasma HDL-C (high-density lipoprotein cholesterol) taken up by the liver back into plasma, maintaining the plasma HDL-C pool, and decreasing HDL-mediated RCT into feces. Approach and Results: Chow-fed hepatocyte-specific Abca1 knockout (HSKO) and control mice were injected with human HDL radiolabeled with I-tyramine cellobiose (I-TC; protein) and H-cholesteryl oleate (H-CO).

Cortical zeta-inhibitory peptide injection reduces local sleep need.

Local sleep need within cortical circuits exhibits extensive interregional variability and appears to increase following learning during preceding waking. Although the biological mechanisms responsible for generating sleep need are unclear, this local variability could arise as a consequence of wake-dependent synaptic plasticity. To test whether cortical synaptic strength is a proximate driver of sleep homeostasis, we developed a novel experimental approach to alter local sleep need.

Effects of episode-based payment on health care spending and utilization: Evidence from perinatal care in Arkansas.

We study how physicians respond to financial incentives imposed by episode-based payment (EBP), which encourages lower spending and improved quality for an entire episode of care. Specifically, we study the impact of the Arkansas Health Care Payment Improvement Initiative, a multi-payer program that requires providers to enter into EBP arrangements for perinatal care, covering the majority of births in the state. Unlike fee-for-service reimbursement, EBP holds physicians responsible for all care within a discrete episode, rewarding physicians for efficient use of their own services and for efficient management of other health care inputs.

Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention.

Objective: The aim of this study was to evaluate outcomes for neonates with critical congenital heart disease (CHD) requiring emergent neonatal cardiac intervention (ENCI).

Methods: Neonates < 30 days of age that underwent ENCI at <48 h of age were retrospectively enrolled over a 2-year period.

Results: Forty-seven neonates met inclusion criteria for ENCI comprising nine cardiac defects that underwent 25 catheterizations and 22 cardiothoracic surgeries.

The Affordable Care Act's coverage expansions will reduce differences in uninsurance rates by race and ethnicity.

There are large differences in US health insurance coverage by racial and ethnic groups, yet there have been no estimates to date on how implementation of the Affordable Care Act will affect the distribution of coverage by race and ethnicity. We used a microsimulation model to show that racial and ethnic differentials in coverage could be greatly reduced, potentially cutting the eight-percentage-point black-white differential in uninsurance rates by more than half and the nineteen-percentage-point Hispanic-white differential by just under one-quarter. However, blacks and Hispanics are still projected to remain more likely to be uninsured than whites.