What Can Health Communication Science Offer for ACA Implementation? Five Evidence-Informed Strategies for Expanding Medicaid Enrollment

Context: Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage.Methods: From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA.Findings: We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps.Conclusions: Health communication science can inform the development and execution of strategies to increase the public''s understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.     

Prediction of lethal pulmonary hypoplasia and chorioamnionitis by assessment of fetal breathing

Summary. Twenty-three pregnancies with fetuses at risk for pulmonary hypoplasia were studied weekly until delivery. The amount of time spent in fetal breathing activity was recorded under controlled conditions during 1 h using real-time ultrasound. An amniotic fluid index was determined. The clinicians and the pathologist were unaware of the ultrasound findings. Eight of 23 fetuses did not breathe at the last ultrasound examination. Three babies died of pulmonary hypoplasia and two of these showed fetal breathing before birth. The three deaths were associated with rupture of the membranes at <20 weeks gestation and of ≥44 days duration. One infant developed bronchopulmonary dysplasia. The amniotic fluid index in these four pregnancies was low and the newborn infants had limb contractures. Chorioamnionitis/funisitis was noted in 13 placentas. Eight fetuses were assessed for fetal breathing within 2 days of birth. The lack of fetal breathing had sensitivity, specificity, positive and negative predictive values of 0.75 for chorioamnionitis/funisitis. In this pilot study the absence of fetal breathing was of no value in predicting lethal pulmonary hypoplasia, but was related to chorioamnionitis/funisitis. We recommend further studies of fetal breathing in relation to fetal/neonatal infections.     

Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies

Summary. In a retrospective, controlled, follow-up study of 326 women who had a primary preterm caesarean section, the risks of postoperative maternal morbidity and uterine rupture or dehiscence in subsequent pregnancies were investigated in relation to the mode of incision (classical compared with low-segment transverse incision). The classical incision was associated with a higher frequency of postpartum fever in the immediate postoperative period (16% compared with 6%, P<0·01). Of the 326 patients reviewed 286 (88%) were contacted for information about subsequent pregnancies. Information was obtained for 70 pregnancies subsequent to a classical caesarean section, and 71 pregnancies subsequent to a low-segment transverse caesarean section, which had continued for more than 20 weeks gestation. Of the pregnancies after the classical operation 13% had abnormal scars compared with none of those after the low-segment transverse operation ( P =0·0014). The frequency of scar dehiscence was 6% after a classical scar compared with none after a low-segment transverse scar (P=0·0581).     

The teaching of interviewing skills: comparison of experienced and novice trainers

During a clerkship in psychiatry thirty-six medical students were randomly allocated to one of three teachers who differed widely in their experience of teaching essential interviewing skills. Each teacher taught two groups of six medical students using videotape feedback and discussion of practice interviews. Independent raters who were blind to the teachers to whom the students had been assigned rated pre and post-training interviews. All three teachers proved effective in teaching interviewing skills and it is concluded that most teachers could probably be taught to carry out this training.     

The effect of treatment with 13-cis-retinoic acid on the metabolic burst of peripheral blood neutrophils from patients with acne

The N-formylmethionyl-leucyl-phenylalanine (f-MLP)-induced metabolic burst activity of peripheral blood neutrophils isolated from acne patients undergoing treatment with 13-cis-retinoic acid at a dose of 1.0 mg/kg/day was investigated using a luminol-enhanced chemiluminescence assay. The mean and median chemiluminescence response were significantly greater (P less than 0.05) in patients receiving 13-cis-retinoic acid than in untreated acne patients or age-matched controls. Pre-incubation of neutrophils with 13-cis-retinoic acid (10 nmol/l) did not affect the chemiluminescence response to formyl peptide. A sequential study over 20 weeks in seven patients demonstrated that chemiluminescence peaked after 2-8 weeks of treatment. In three patients this was accompanied by a worsening of their acne. These studies suggest that, in the initial phase, treatment with 13-cis-retinoic acid may exacerbate, through pro-inflammatory priming of neutrophils, certain neutrophil-mediated inflammatory processes in acne.     

IMMUNE HEMOLYSIS AFTER AN ABO MISMATCHED RENAL TRANSPLANT

We describe a case of immune hemolysis due to anti-B occurring in a blood group B patient 16 days after a cadaveric renal transplantation from a blood group O donor. Transfusional support was initially required and the direct antiglobulin test (DAT) remained positive for 80 days. Cyclosporin A (CSA), which was used for rejection prophylaxis in this case, has unique immunosuppressive capabilities which protects transplanted organs from rejection, but which might permit this type of ‘graft versus host’ reaction.     

Economics of low-flow anaesthesia in children

We have measured the consumption of isoflurane and fresh gas flows in 77 infants and children during 20 all-day operating sessions using either the enclosed Mapleson A or the circle absorber mode of the Garden'Ventmasta'ventilator. The average consumption (SD) of isoflurane in 37 patients anaesthetised using the A mode of the Garden system with a mean fresh gas flow of 2.6l.min⁻¹ was 11.1 (4.2)g.h⁻¹, while that in 40 patients anaesthetised using the circle absorber mode with a mean fresh gas flow of 1.21.min⁻¹ was 4.7 (1.0)g.h⁻¹. These figures represent an overall saving of 58% in the use of isoflurane (p < 0.0001) and a mean reduction in fresh gas flow of 54% (p < 0.0001) as a result of using low-flow anaesthesia. With the addition of small bore breathing hoses the adult circle absorber system was practical to use in both infants and children. These findings should stimulate interest in the use of low-flow techniques in children.     

DOUBLE-BLIND RANDOMIZED MULTICENTRE TRIAL OF ACAMPROSATE IN MAINTAINING ABSTINENCE FROM ALCOHOL

A prospective placebo-controlled, randomized double-blind studyof Acamprosate at two dose levels in alcohol-dependent patientsfollowed up for 12 months was performed. After detoxification,each of the 538 patients included was randomly assigned to oneof three groups: 177 patients received placebo, 188 receivedAcamprosate at 1.3 g/day (low dose group) and 173 received 2.0g/day(high dose group) for 12 months. This was followed by a singleblind 6 month period on placebo. The patients' mean age was43.2 ± 8.6 years. Their mean daily alcohol intake washigh (nearly 200g/day) and of long duration (9.5 ± 7.1years). Abstinence figures followed the order high dose>lowdose>placebo. The difference was significant at 6 months(P