Off-Marketplace Enrollment Remains An Important Part Of Health Insurance Under The ACA.

The introduction of Marketplaces under the Affordable Care Act greatly expanded individual-market health insurance coverage in 2014, but millions of adults continued to purchase individual coverage outside of the Marketplaces. They were more likely to be male, be white, have higher incomes, and be in excellent or very good health, compared to Marketplace enrollees.

Racial and Ethnic Infant Mortality Gaps and the Role of Socio-Economic Status.

We assess the extent to which differences in socio-economic status are associated with racial and ethnic gaps in a fundamental measure of population health: the rate at which infants die. Using micro-level Vital Statistics data from 2000 to 2004, we examine mortality gaps of infants born to white, black, Mexican, Puerto Rican, Asian, and Native American mothers. We find that between-group mortality gaps are strongly and consistently (except for Mexican infants) associated with maternal marital status, education, and age, and that these same characteristics are powerful predictors of income and poverty for new mothers in U.

The changing character of the Black-White infant mortality gap, 1983-2004.

Objectives: We examined how changes in demographic, geographic, and childbearing risk factors were related to changes in the Black-White infant mortality rate (IMR) gap over 2 decades.

Methods: Using 1983-2004 Vital Statistics, we applied inverse probability weighting methods to examine the relationship between risk factors and 3 outcomes: the overall IMR gap, its birth weight component, and its conditional (on birth weight) IMR component.

Results: The unexplained IMR gap (the part not related to observed risk factors) was stable, changing from 5.

Economic outcomes in young adulthood for extremely low birth weight survivors.

Objective: The goal was to compare educational attainment and labor market outcomes in young adulthood (21-26 years of age) for a Canadian, population-based cohort of 149 extremely low birth weight (ELBW) (<1000 g) survivors and a normal birth weight (NBW) cohort of 133 young adults from the same geographic area who were matched to the ELBW cohort in childhood.

Methods: We estimated the effects of ELBW status, according to gender, on continuous outcomes through least-squares regression and those on binary outcomes through logistic regression. We controlled for family background and considered neurosensory impairment and IQ as mediating variables.

Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial.

To determine whether a Nurse-Community Health Worker (CHW) home visiting team, in the context of a Medicaid enhanced prenatal/postnatal services (EPS), would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial resources (mastery, self-esteem, social support) when compared with usual Community Care (CC) that includes Medicaid EPS delivered by professionals. Greatest program benefits were expected for women who reported low psychosocial resources, high stress, or both at the time of enrollment. Medicaid eligible pregnant women (N = 613) were randomly assigned to either usual CC or the Nurse-CHW team.

Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial.

Objective: This study sought to determine whether an intervention for patients with medically unexplained symptoms in primary care reduced total costs, components of cost, and longer-term costs and whether it led to decreased service use outside the health maintenance organization (HMO).

Methods: A randomized controlled trial involving 206 patients with medically unexplained symptoms was conducted in a staff-model HMO. The protocol emphasized the provider-patient relationship and included cognitive-behavioral therapy and pharmacological management.

Comparison of current health, functional limitations, and health care use of young adults who were born with extremely low birth weight and normal birth weight.

Objective: The objective of this study was to compare the current health status, physical ability, functional limitations, and health care use of extremely low birth weight and normal birth weight young adults.

Methods: A longitudinal study was conducted of a population-based cohort of 166 extremely low birth weight survivors (501-1000 g birth weight; 1977-1982 births) and a group of 145 sociodemographically comparable normal birth weight individuals. Current health status, history of illnesses, hospitalizations, use of health resources, and physical self-efficacy were assessed through questionnaires that were administered to the young adults by masked interviewers.

Self-perceived health-related quality of life of former extremely low birth weight infants at young adulthood.

Objectives: The goals were to compare the self-reported, health-related quality of life of former extremely low birth weight and normal birth weight infants at young adulthood and to determine whether there were any changes over time.

Methods: A prospective, longitudinal, population-based study with concurrent control subjects was performed. We interviewed 143 of 166 extremely low birth weight survivors (birth weight: 501-1000 g; 1977-1982 births) and 130 of 145 sociodemographically comparable, normal birth weight, reference subjects.

Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial.

Objective: There is no proven primary care treatment for patients with medically unexplained symptoms (MUS). We hypothesized that a long-term, multidimensional intervention by primary care providers would improve MUS patients' mental health.

Design: Clinical trial.

Transition of extremely low-birth-weight infants from adolescence to young adulthood: comparison with normal birth-weight controls.

Context: Traditionally, educational attainment, getting a job, living independently, getting married, and parenthood have been considered as markers of successful transition to adulthood.

Objective: To describe and compare the achievement and the age at attainment of the above markers between extremely low-birth-weight (ELBW) and normal birth-weight (NBW) young adults.

Design, Setting, And Participants: A prospective, longitudinal, population-based study in central-west Ontario, Canada, of 166 ELBW participants who weighed 501 to 1000 g at birth (1977-1982) and 145 sociodemographically comparable NBW participants assessed at young adulthood (22-25 years).

Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms.

Objectives: Investigators and clinicians almost always rely on Diagnostic and Statistical Manual of Mental Disorder, 4th edition's (DSM-IV) somatoform disorders (and its derivative diagnoses) to characterize and identify patients with medically unexplained symptoms (MUS). Our objective was to evaluate this use by determining the prevalence of DSM-IV somatoform and nonsomatoform disorders in patients with MUS proven by a gold standard chart review.

Methods: In a community-based staff model HMO, we identified subjects for a clinical trial using a systematic and reliable chart rating procedure among high-utilizing MUS patients.

Treating patients with medically unexplained symptoms in primary care.

Background: There are no proven, comprehensive treatments in primary care for patients with medically unexplained symptoms (MUS) even though these patients have high levels of psychosocial distress, medical disability, costs, and utilization. Despite extensive care, these common patients often become worse.

Objective: We sought to identify an effective, research-based treatment that can be conducted by primary care personnel.

Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms.

Patients with medically unexplained symptoms (MUS) often are a source of frustration for clinicians, and despite high quality biomedical attention and frequent diagnostic tests, they have poor health outcomes. Following upon progress in depression treatment approaches, we developed a multidimensional treatment protocol for deployment by primary care personnel. This multi-faceted intervention for MUS patients emphasized cognitive-behavioral principles, the provider-patient relationship, pharmacological management, and treating comorbid medical diseases.

Minor acute illness: a preliminary research report on the "worried well".

Objectives: Our objectives were to determine how patients who make frequent use of the medical system (high users) with medically unexplained symptoms met our chart-rating criteria for somatization and minor acute illness and what the stability of such diagnoses were over time.

Study Design: A chart review was performed at baseline and 1 and 2 years; we re-rated the charts of patients initially rated as having somatization, as well as a 15% sample of those with minor acute illness.

Population: We obtained a random sample of high-use patients (= 6 visits/year) aged 21 to 55 years who were identified from the management information system.