PUBLIC AND ORAL HEALTH

The Affordable Care Act (ACA) expanded health insurance coverage and strengthened incentives for health care organizations to engage in community-wide health improvement initiatives. These incentives include enhanced community benefit requirements for tax-exempt hospitals, adjusted medical loss ratio requirements for health insurers, tax incentives for employers, and competitive federal funding through the Prevention and Public Health Fund. Reduced uncompensated care costs and cost-shifting may allow hospitals and other institutions to increase investments in community health, particularly when coupled with incentives to do so. Prior research is inconsistent regarding how health care organizations have responded to these reforms, due in part to data limitations. This study uses novel longitudinal data from a national cohort of U.S. communities to estimate whether changes in coverage and uncompensated care have led to changes in the implementation of community health activities by hospitals, physicians, insurers, and employers. The National Longitudinal Survey of Public Health Systems (NALSYS) follows a national cohort of approximately 600 communities between 2012 and 2018 to measure the implementation of guideline-recommended community health improvement activities in each community and the network of organizations contributing to each activity. Importantly, these data are reported by local public health officials rather than by hospitals and health care institutions who may inflate reported contributions. Survey data are linked with county-level coverage estimates, demographic and socioeconomic characteristics, health care market structure data, and CMS hospital cost report data on uncompensated care costs. Fixed-effects regression models with instrumental variables (IV) are used to estimate the causal effects of changes in coverage and uncompensated care on implementation of community health activities by hospitals, physicians, insurers, and employers while controlling for unmeasured confounding. Stratified random sample of 600 U.S. counties observed between 2012 and 2018. Coverage increased and uncompensated care costs declined after 2014 in 87% and 73% of communities, respectively, but by widely varying magnitudes. IV estimates indicate that a 10% reduction in uncompensated care costs resulted in a 14% increase in implementation of community health activities by hospitals (P < 0.01), along with an 8% increase in implementation by insurers (P < 0.05). Results for physicians and employers were not statistically significant. The estimated hospital and insurer effects were concentrated in states that expanded Medicaid eligibility under ACA (P < 0.01). Hospitals and insurers have expanded their involvement in community-wide health activities proportionate with the level of decline in demand for uncompensated care in their communities. Incentives for health care institutions to engage in community-wide health improvement initiatives appear effective in communities where gains in coverage lead to savings that can be redeployed for community benefit. This response may be an important but unrecognized pathway through which coverage gains improve population health, but recent erosion in coverage may dampen this effect. The Robert Wood Johnson Foundation.     

Liver tumors in women on contraceptive steroids.

The possible association between oral contraceptives and benign liver tumors has recently been reported. To date the majority of cases have been diagnosed as benign hepatomas (liver cell adenomas). We have had the opportunity to study 13 such cases. Eight have been examples of focal nodular hyperplasia of the liver; however, in addition, there were examples of hepatocellular carcinoma, liver cell adenoma, and possible liver cell hamartoma; all were in women on "the pill." Gynecologists are alerted to the fact that many of the patients present with symptoms of acute abdomen, syncope or shock, and intrahepatic or intraperitoneal bleeding. Prompt diagnosis and treatment may be lifesaving.     

Promotion of radiation-induced liver neoplasia by ethanol.

The risk of americium-induced liver cancer in beagle dogs that received long-term dietary ethanol was two to three times that of their nonalcoholic cohorts, even though the radionuclide retention time in hepatic tissue was shortened by the alcohol treatment. Liver malignancies did not occur in the ethanol-treated, nonirradiated controls. An ethanol-induced tumor-promoting effect was not observed in organs or tissues other than the liver.     

Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey

OBJECTIVES: This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners. METHODS: Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview. RESULTS: A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples. CONCLUSIONS: Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.     

Characterization of electromagnetic interference of medical devices in the hospital due to cell phones.

Concern over electromagnetic interference with medical devices due to cell phone emissions has stemmed from anecdotal reports and unpublished observations of hospital staff. In an effort to characterize electromagnetic interference concerns, representative medical devices from four large teaching hospitals were exposed to standard North American and European communication signal emissions. Of 33 medical devices tested, only 4 showed disruption of critical function due to cell phone emissions at a distance of 25 cm or greater. Although other cases of electromagnetic interference were observed, these were not critically disruptive and mainly occurred when the transmitters were at full power and placed 5 cm or closer to the medical device. Overall, no cell phone signal was exempt from producing electromagnetic interference effects. While sensitive medical devices were often affected by more than one signal type, the effects were not entirely predictable based upon the results of other signals or related medical device units or models. Because a comprehensive analysis of all medical devices in all possible electromagnetic environments was not performed, the data presented here are only intended to provide a general idea of the magnitude of electromagnetic interference effects that might be encountered in a hospital environment, as well as a standard protocol for clinical engineering groups to perform ad hoc electromagnetic interference surveys and methods to manage and/or eliminate electromagnetic interference with appropriate system engineering design including supplementary communication infrastructure, medical device shielding and positioning, and appropriate cell phone user guidelines.     

一种用于筛选降血糖及降血脂药物的动物模型

一种用于筛选降血糖及降血脂药物的动物模型刘京，申竹芳，刘海帆，叶菲，谢明智（中国医学科学院药物研究所，中国协和医科大学北京１０００５０）糖尿病为常见病和多发病，同时伴有多方面的并发症，脂质代谢紊乱即其中之一。这就要求治疗糖尿病时，除控制病人的血糖外，...     

Disposition of aspirin and its metabolites in the semen of man

The study was undertaken to determine the distribution of aspirin and its metabolites in the semen of humans after an oral dose of aspirin. Each of seven healthy male volunteers was given a single oral dose of 975 mg of aspirin on an empty stomach together with 200 mL of water. Timed samples of blood and semen were obtained from each subject, and the concentrations of aspirin, salicylic acid, and salicyluric acid determined by a specific high-performance liquid chromatographic assay. The mean peak concentration of aspirin was 6.5 micrograms/mL in plasma (range, 4.9-8.9 micrograms/mL), reached in 26 minutes (range, 13-33 minutes). The half-life of aspirin was 31 minutes. The concentration ratio of aspirin (semen/plasma) was 0.12 (except for one subject in whom it was 0.025). The mean peak concentration of salicylate in plasma was 49 micrograms/mL (range, 42-62 micrograms/mL), reached in 2.5 hours (range, 2.0-2.8 hours). Salicylate distributed rapidly into semen and maintained a concentration ratio (semen/plasma) of 0.15. Salicyluric acid (the glycine conjugate of salicylic acid) was found in the semen. Its high concentration in some subjects' semen (four times the concurrent plasma concentration) was attributed to contamination of semen sample with residual urine, containing salicylurate, in the urethra of those who urinated after the dose of aspirin. Possible side effects of aspirin and salicylate in semen include adverse effects on fertility, male-medicated teratogenesis, dominant lethal mutations, and hypersensitivity reactions in the recipients.     

Who are health influencers? Characterizing a sample of tobacco cessation interveners

OBJECTIVES: To describe characteristics of health influencers (HIs) prior to training in brief tobacco cessation interventions (BI). METHODS: HIs (n=910) in Arizona were recruited for a randomized controlled trial comparing training modalities. RESULTS: Typically middle-aged (M=43, SD=14), non-Hispanic white (68%), female (77%), non-tobacco users (93%), most identified personal (89%) rather than job-related (3%) motivators for becoming cessation interveners. Confidence about intervention ability was high (93%); knowledge scores, however, were low (M=55%, SD=13%). CONCLUSIONS: HIs exhibiting high motivation to intervene but lacking knowledge about BI strategies may be an untapped resource for tobacco cessation and a variety of other health promotion interventions.