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Larry H Bernstein, MD, FCAP, Curator

https://pharmaceuticalintelligence.com/6/7/2014/Health benefit of anthocyanins from apples and berries noted for men

After significant studies have been completed, particularly on a relationship between anthocyanins consumption and decreasd risk of Parkinson’s Disease in men, it is unclear why a comparable effect is not seen in women.  This would lead one to ask questions about predominant time course of development in relationship to androgen activity.  Pre- and postmenopausal status would seem to make no difference. It is reported that the anthocyanins cross the blood brain barrier.  There are other questions that need to be raised.  There is a decline in the production of transthyretin by the choroid plexus in the elderly – not sex related – with an elevation of homocysteine that is reciprocal to decline in transthyretin-RBP complex, that is related to AD.  This is mediated by cystathionine-beta synthase, and involves matrix metalloproteinases.  A mechanism for Parkinson’s Disease has been postulated to be related to Parkin gene expression, but how does this work, and why do we see the sex assymetry?

Eating flavonoids protects men against Parkinson’s disease

General DietMissed – Medical Breakthroughs • Tags: AnthocyaninFlavonoidHarvard University,HealthNeurologyParkinsonParkinson DiseaseUniversity of East Anglia

http://healthresearchreport.me/       07 Apr 2012

Men who eat flavonoid-rich foods such as berries, tea, apples and red wine significantly reduce their risk of developing Parkinson’s disease, according to new research by Harvard University and the University of East Anglia (UEA).

Published today in the journal Neurology ®, the findings add to the growing body of evidence that regular consumption of some flavonoids can have a marked effect on human health. Recent studies have shown that these compounds can offer protection against a wide range of diseases including heart disease, hypertension, some cancers and dementia.

This latest study is the first study in humans to show that flavonoids can protect neurons against diseases of the brain such as Parkinson’s.

Around 130,000 men and women took part in the research. More than 800 had developed Parkinson’s disease within 20 years of follow-up. After a detailed analysis of their diets and adjusting for age and lifestyle, male participants who ate the most flavonoids were shown to be 40 per cent less likely to develop the disease than those who ate the least. No similar link was found for total flavonoid intake in women.

The research was led by Dr Xiang Gao of Harvard School of Public Health in collaboration with Prof Aedin Cassidy of the Department of Nutrition, Norwich Medical School at UEA.

“These exciting findings provide further confirmation that regular consumption of flavonoids can have potential health benefits,” said Prof Cassidy.

“This is the first study in humans to look at the associations between the range of flavonoids in the diet and the risk of developing Parkinson’s disease and our findings suggest that a sub-class of flavonoids called anthocyanins may have neuroprotective effects.”

Prof Gao said: “Interestingly, anthocyanins and berry fruits, which are rich in anthocyanins, seem to be associated with a lower risk of Parkinson’s disease in pooled analyses. Participants who consumed one or more portions of berry fruits each week were around 25 per cent less likely to develop Parkinson’s disease, relative to those who did not eat berry fruits. Given the other potential health effects of berry fruits, such as lowering risk of hypertension as reported in our previous studies, it is good to regularly add these fruits to your diet.”

Flavonoids are a group of naturally occurring, bioactive compunds found in many plant-based foods and drinks. In this study the main protective effect was from higher intake of anthocyanins, which are present in berries and other fruits and vegetables including aubergines, blackcurrants and blackberries. Those who consumed the most anthocyanins had a 24 per cent reduction in risk of developing Parkinson’s disease and strawberries and blueberries were the top two sources in the US diet.

The findings must now be confirmed by other large epidemiological studies and clinical trials.

Parkinson’s disease is a progresssive neurological condition affecting one in 500 people, which equates to 127,000 people in the UK. There are few effective drug therapies available.  Dr Kieran Breen, director of research at Parkinson’s UK said: “This study raises lots of interesting questions about how diet may influence our risk of Parkinson’s…   there are still a lot of questions to answer and much more research to do before we really know how important diet might be for people with Parkinson’s.”

 

Eating berries may lower risk of Parkinson’s

Missed – Medical Breakthroughs • Tags: BerryDoctor of PhilosophyFlavonoidParkinson,Parkinson DiseaseXiang Gao

http://healthresearchreport.me/    Public release date: 13-Feb-2011

ST. PAUL, Minn. –New research shows men and women who regularly eat berries may have a lower risk of developing Parkinson’s disease, while men may also further lower their risk by regularly eating apples, oranges and other sources rich in dietary components called flavonoids. The study was released today and will be presented at the American Academy of Neurology’s 63rd Annual Meeting in Honolulu April 9 to April 16, 2011.

Flavonoids are found in plants and fruits and are also known collectively as vitamin P and citrin. They can also be found in berry fruits, chocolate, and citrus fruits such as grapefruit.

The study involved 49,281 men and 80,336 women. Researchers gave participants questionnaires and used a database to calculate intake amount of flavonoids. They then analyzed the association between flavonoid intakes and risk of developing Parkinson’s disease. They also analyzed consumption of five major sources of foods rich in flavonoids: tea, berries, apples, red wine and oranges or orange juice. The participants were followed for 20 to 22 years.

During that time, 805 people developed Parkinson’s disease. In men, the top 20 percent who consumed the most flavonoids were about 40 percent less likely to develop Parkinson’s disease than the bottom 20 percent of male participants who consumed the least amount of flavonoids. In women, there was no relationship between overall flavonoid consumption and developing Parkinson’s disease. However, when sub-classes of flavonoids were examined, regular consumption of anthocyanins, which are mainly obtained from berries, were found to be associated with a lower risk of Parkinson’s disease in both men and women.

“This is the first study in humans to examine the association between flavonoids and risk of developing Parkinson’s disease,” said study author Xiang Gao, MD, PhD, with the Harvard School of Public Health in Boston. “Our findings suggest that flavonoids, specifically a group called anthocyanins, may have neuroprotective effects. If confirmed, flavonoids may be a natural and healthy way to reduce your risk of developing Parkinson’s disease.”
May 10, 2013

Could eating peppers prevent Parkinson’s?

Missed – Medical Breakthroughs • Tags: American Neurological AssociationAnnals of Neurology,Group Health CooperativeNicotineParkinsonParkinson’s diseaseSolanaceaeUniversity of Washington

Contact: Dawn Peters sciencenewsroom@wiley.com 781-388-8408 Wiley

Dietary nicotine may hold protective key

New research reveals that Solanaceae—a flowering plant family with some species producing foods that are edible sources of nicotine—may provide a protective effect against Parkinson’s disease. The study appearing today inAnnals of Neurology, a journal of the American Neurological Association and Child Neurology Society, suggests that eating foods that contain even a small amount of nicotine, such as peppers and tomatoes, may reduce risk of developing Parkinson’s.

Parkinson’s disease is a movement disorder caused by a loss of brain cells that produce dopamine. Symptoms include facial, hand, arm, and leg tremors, stiffness in the limbs, loss of balance, and slower overall movement. Nearly one million Americans have Parkinson’s, with 60,000 new cases diagnosed in the U.S. each year, and up to ten million individuals worldwide live with this disease according to the Parkinson’s Disease Foundation. Currently, there is no cure for Parkinson’s, but symptoms are treated with medications and procedures such as deep brain stimulation.

Previous studies have found that cigarette smoking and other forms of tobacco, also a Solanaceae plant, reduced relative risk of Parkinson’s disease. However, experts have not confirmed if nicotine or other components in tobacco provide a protective effect, or if people who develop Parkinson’s disease are simply less apt to use tobacco because of differences in the brain that occur early in the disease process, long before diagnosis.

For the present population-based study Dr. Susan Searles Nielsen and colleagues from the University of Washington in Seattle recruited 490 patients newly diagnosed with Parkinson’s disease at the university’s Neurology Clinic or a regional health maintenance organization, Group Health Cooperative. Another 644 unrelated individuals without neurological conditions were used as controls. Questionnaires were used to assess participants’ lifetime diets and tobacco use, which researchers defined as ever smoking more than 100 cigarettes or regularly using cigars, pipes or smokeless tobacco.

Vegetable consumption in general did not affect Parkinson’s disease risk, but as consumption of edible Solanaceae increased, Parkinson’s disease risk decreased, with peppers displaying the strongest association. Researchers noted that the apparent protection from Parkinson’s occurred mainly in men and women with little or no prior use of tobacco, which contains much more nicotine than the foods studied.

“Our study is the first to investigate dietary nicotine and risk of developing Parkinson’s disease,” said Dr. Searles Nielsen. “Similar to the many studies that indicate tobacco use might reduce risk of Parkinson’s, our findings also suggest a protective effect from nicotine, or perhaps a similar but less toxic chemical in peppers and tobacco.” The authors recommend further studies to confirm and extend their findings, which could lead to possible interventions that prevent Parkinson’s disease.

###

This study is published in Annals of Neurology. Media wishing to receive a PDF of this article may contact sciencenewsroom@wiley.com.

Full citation: “Nicotine from Edible Solanaceae and Risk of Parkinson Disease.” Susan Searles Nielsen, Gary M. Franklin, W.T. Longstreth Jr, Phillip D. Swanson and Harvey Checkoway. Annals of Neurology; Published May 9, 2013 (DOI:10.1002/ana.23884).

URL Upon Publication: http://doi.wiley.com/10.1002/ana.23884

Author Contact: To arrange an interview with Dr. Susan Searles Nielsen, please contact Leila Gray with the University of Washington Health Sciences News Office at +1 206-685-0381 or at leilag@uw.edu.

About the Journal

Annals of Neurology, the official journal of the American Neurological Association and the Child Neurology Society, publishes articles of broad interest with potential for high impact in understanding the mechanisms and treatment of diseases of the human nervous system. All areas of clinical and basic neuroscience, including new technologies, cellular and molecular neurobiology, population sciences, and studies of behavior, addiction, and psychiatric diseases are of interest to the journal. The journal is published by Wiley on behalf of the
American Neurological Association and Child Neurology Society. For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/ana.

Flavonoids from berries shown to protect men against Parkinson’s disease

December 19, 2013 · by MrT

by: John Phillip, John is a Certified Nutritional Consultant and Health Researcher

(NaturalNews) Past research bodies have confirmed the health-protective effect of a natural diet rich in flavonoids to protect against a wide range of diseases including heart disease, hypertension, some cancers, and dementia. Researchers from Harvard University and the University of East Anglia have published the result of a study in the journalNeurology that demonstrates how these plant-based phytonutrients can significantly lower the risk of developing Parkinson’s disease, especially in men.

Flavonoids from healthy foods such as berries, tea, apples, and red wine cross the delicate blood-brain barrier to protect neurons against neurologic diseases such as Parkinson’s. This large scale study included more than 130,000 men and women participants that were followed for a period of twenty years. During this time, more than 800 individuals developed Parkinson’s disease.

A diet high in flavonoids from berries lowers Parkinson’s disease risk by forty percent

After a detailed analysis of their diets and adjusting for age and lifestyle, male participants who ate the most flavonoids were shown to be forty percent  less likely to develop the disease than those who ate the least. No similar link was found for total flavonoid intake in women.

This was the first study to examine the connection between flavonoid consumption and the development of Parkinson’s disease. The findings suggest that a sub-class of flavonoids called anthocyanins may exhibit neuroprotective effects. Participants consuming one or more portions of berry fruits each week were around twenty-five percent less likely to develop Parkinson’s disease, relative to those who did not eat berry fruits.

Flavonoids are the bioactive, naturally occurring chemical compounds found in many plant-based foods and drinks.

This study demonstrated the main protective effect was from the consumption of anthocyanins, which are present in berries and other fruits and vegetables including aubergines, blackcurrants, and blackberries. Strawberries and blueberries are the two most common sources of flavonoids in the US diet, contributing to a twenty-four percent lowered risk in this research.

Parkinson’s disease is among a group of chronic diseases presently affecting one in 500 people, with new cases on the rise. Drug therapies are ineffective and bear significant side effects.

Nutrition experts recommend adding a minimum of three to five servings of flavonoids to your diet each week. Include all varieties of berries, apples, and green tea to guard against Parkinson’s disease and other neurodegenerative illnesses.

 

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Information Security and Privacy in Healthcare is part of the 2nd Annual Medical Informatics World, April 28-29, 2014, World Trade Center, Boston, MA

Reporter: Aviva Lev-Ari, PhD

Concurrent Tracks

  • Provider-Payer-Pharma Cross-Industry Data Collaboration
  • Coordinated Patient Care Engagement and Empowerment
  • Population Health Management and Quality Improvement
  • Information Security and Privacy in Healthcare

Dinner Workshop

Advancing the Use of EHR/EMR for Clinical Research and Drug Development

About the Conference

Cambridge Healthtech Institute and Bio-IT World’s Second Annual Medical Informatics World builds upon last year’s successful inaugural launch by delivering timely programming focused on the cross-industry connections and innovative solutions needed to take biomedical research and healthcare delivery to the next level.

The 2014 meeting will bring together more than 300 senior level executives and industry leaders from each side of the discussion – providers, payers and pharma – in the fields of healthcare, biomedical sciences, health informatics, and IT. Over two days of insightful discussions and engaging presentations, leading experts will share emerging trends and solutions in population health management, payer-provider-pharma data collaborations, optimizing patient care and engagement, leveraging mobile technologies, sustaining innovation within the rapidly changing care delivery models, enhancing clinical decision support, controlling costs and improving quality, and maintaining security-privacy in healthcare. Led by key decision makers and senior executives at the forefront of healthcare information technology, the conference is a must-attend for all involved in this evolving industry.

Co-located with CHI’s flagship Bio-IT World Expo, a premier event showcasing the myriad applications of IT and informatics to the life sciences enterprise, Medical Informatics World completes the week of scientific content by bridging the healthcare and life science worlds. As Bio-IT World Expo attracts more than 2,500 delegates from dozens of countries as well as more than 130 exhibiting companies, networking opportunities abound at the two events.

KEY NOTES

John Halamka, M.D., MS, CIO, Beth Israel Deaconess Medical Center
Bryan Sivak, CTO & EIR, U.S. Department of Health and Human Services
Roy Beveridge, M.D., Senior Vice President and CMO, Humana
Mark Davies, M.D., Executive Medical Director, Health & Social Care Information Centre, National Health Service
Sachin Jain, M.D., MBA, Vice President and Chief Medical Information & Innovation Officer, Merck & Co.
Jacob Reider, M.D., Acting Principle Deputy National Coordinator, Office of the National Coordinator for Health Information Technology (ONC), U.S. Department of Health and Human Services

AGENDA

http://www.medicalinformaticsworld.com/

PROGRAM in PDF

http://www.medicalinformaticsworld.com/uploadedFiles/Medical_Informatics_World/Agenda/14/2014-Medical-Informatics-World-Conference-Brochure.pdf

 

2014 Agenda at a Glance

REAL CHALLENGES OF UNAUTHORIZED DISCLOSURE OF PHI Patient Privacy and Security: What Recent Benchmarks of Healthcare Providers Revealed Larry Ponemon, Chairman and Founder, Ponemon Institute Fair Information Practice for Cyber ID Adrian Gropper, M.D., CTO, Patient Privacy Rights Should I Trust You With My Patient’s Data? Rick Moore, CIO, National Committee for Quality Assurance (NCQA)

HITECH REGULATIONS AND THE FUTURE OF TRANSPARENCY A Practical Look at the HITECH Proposed Regulations and Federal Information Transparency Policies: The Payer Perspective Marilyn Zigmund Luke, Senior Counsel and Compliance Officer, America’s Health Insurance Plans (AHIP) Just Added! Omnibus HIPAA Rulemaking and a New Era of Privacy and Security: Don’t be an Ostrich Lassaad Fridhi, Information Privacy & Security Officer, Commonwealth Care Alliance

PUTTING HEALTHCARE DATA IN THE CLOUD Can PHI and the Cloud Coexist? Paul Connelly, Vice President, CISO, Hospital Corporation of America (HCA) Just Added! U Mass Medical College-NIH Case Study: A Privacy Solution for Sharing and Analyzing Healthcare Data Luvai Motiwalla, Ph.D., Professor, Operations and Information Systems (OIS), Manning School of Business, U Mass Lowell

BYOD: BALANCING PRIVACY, SECURITY AND FLEXIBILITY BYOD: Job Security for Privacy and Information Security Professionals Marti Arvin, Chief Compliance Officer, David Geffen School of Medicine, UCLA Health System

BYOD: BRING YOUR OWN DEVICE OR BRING YOUR OWN DISASTER? Mobile Security and BYOD in a Large Hospital System Jennings Aske, CISO, Partners HealthCare System Just Added! A Modern CISO’s Role is More than Tech: Achieving the Elusive Balance Between Information Security and Human Factors SumitSehgal, Chief Information Security & Privacy Officer, Boston Medical Center Can a Company with More than Two Million Employees Successfully Implement BYOD? Anthony Martin, Senior Associate General Counsel, Privacy & Information Security, Walmart

OVERCOMING THE INTEROPERABILITY-PRIVACY STANDOFF “Mind the Gap”: Lessons from London on Using Information to Improve English Healthcare Samantha Meikle, Director, London Connect Overcoming the Interoperability-Privacy Standoff Peter Madras, M.D., Senior Staff, Lahey Health and Hospitals; Founder, Medical Record Bank

KEYNOTE SESSION: CONNECTING PATIENTS, PROVIDERS, AND PAYERS Health Delivery Reform and the Future of Health IT-Enabled Quality Improvement Jacob Reider, M.D., Acting Principle Deputy National Coordinator, Office of the National Coordinator for Health Information Technology (ONC), U.S. Department of Health and Human Services Healthcare IT Innovations that are Connecting Patients, Providers, and Payers John Halamka, M.D., MS, CIO, Beth Israel Deaconess Medical Center Three Patients: How Health Information Technology Will Enable the Pharmaceutical Industry to Improve Patient Care Sachin Jain, M.D., MBA, Vice President and Chief Medical Information & Innovation Officer, Merck & Co. Keynote Panel: Deploying Information Technology to Enable Innovation within the Future State of Care Susan Dentzer, Senior Policy Adviser, Robert Wood Johnson Foundation

KEYNOTE SESSION: TRANSFORMING GOVERNMENT & HEALTHCARE THROUGH INNOVATION Startup Mentality: Transforming Government & Health Bryan Sivak, Chief Technology Officer & EIR, U.S. Department of Health and Human Services Humana’s Approach to Medicare Advantage Roy Beveridge, M.D., Senior Vice President and Chief Medical Officer, Humana The English Patient, a Story of NHS Informatics Mark Davies, M.D., Executive Medical Director, Health & Social Care Information Centre, National Health Service Keynote Panel: What are the Remaining Policy and Technology Barriers to Information Sharing with Patients? Daniel Sands, M.D., MPH, Assistant Clinical Professor, Harvard Medical School; Co-Founder, Society for Participatory Medicine To learn more, view the brochure or visit MedicalInformaticsWorld.com/Information-Security-Privacy.

 

————————————————————————

 

Information Security and Privacy in Healthcare is part of the Second Annual Medical Informatics World, to be held April 28-29, 2014 at the World Trade Center in Boston, MA. The event builds upon last year’s successful inaugural launch by delivering timely programming focused on the cross-industry connections and innovative solutions needed to take biomedical research and healthcare delivery to the next level. The 2014 meeting will bring together more than 300 senior level executives and industry leaders from each side of the discussion – providers, payers and pharma – in the fields of healthcare, biomedical sciences, health informatics, and IT.  Medical Informatics World Conference Tracks     Provider-Payer-Pharma Cross-Industry Data Collaboration Coordinated Patient Care, Engagement and Empowerment Population Health Management and Quality Improvement Information Security and Privacy in Healthcare   Also Available On-Site, A Dinner Workshop Advancing the Use of EHR/EMR for Clinical Research and Drug Development: A Platform that Reuses EHRs across Hospitals to Support Clinical Research supported by Sustainability Measures* (Details) > Download the full program. > For the latest speaker additions and presentation updates, visit MedicalInformaticsWorld.com. > Register now to join 300+ colleagues! > Learn more about sponsorship and exhibit opportunities.

 

SOURCE

From: Medical Informatics World 2014 <jaimeh@healthtech.com>
Date: Wed, 26 Mar 2014 11:59:00 -0400
To: <avivalev-ari@alum.berkeley.edu>
Subject: Just Added! NIH Health Privacy Case Study, Balancing Security & Human Factors, Omnibus HIPAA Rulemaking

 

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Pathophysiological Effects of Diabetes on Ischemic-Cardiovascular Disease and on Chronic Obstructive Pulmonary Disease (COPD)


Pathophysiological Effects of Diabetes on Ischemic-Cardiovascular Disease and on Chronic Obstructive Pulmonary Disease (COPD)

Curator:  Larry H. Bernstein, MD, FCAP

This is a multipart article that develops the pathological effects of type-2 diabetes in the progression of a systemic inflammatory disease with a development of neuropathy, and fully developing into cardiovascular disease.  It also identifies a systemic relationship to the development of chronic obstructive pulmonary disease (COPD).

The more we learn about diabetes, we learn about its generalized systemic effects.

This article has the following SIX Parts:

Part 1. Role of Autonomic Cardiovascular Neuropathy in Pathogenesis of ischemic heart disease in patients with diabetes mellitus

Part 2. A Longitudinal Cohort Study of the Cardiovascular Experience of Individuals at High Risk for Diabetes

Part 3.  Clinical significance of cardiovascular dysmetabolic syndrome

Part 4.   Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease

Part 5.   How to use C-reactive protein in acute coronary care

Part 6.  Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony

INTRODUCTION

Type 2 diabetes mellitus is a common chronic disease which develops insidiously over time, and is associated with obesity, nutritional imbalance (high fructose beverages, high starch and processed foods, carbohydrate excess intake, and an imbalance of proinflammatory to anti-inflammatory polyunsaturated  fatty acids), which makes it an acquired and manageable disease.  The long term effects of T2DM is played out on cardiovascular disease and stroke-risk, obstructive sleep apnea, progressive renal insufficiency, development of neuropathy, congestive heart failure and chronic obstructive pulmonary disease, all of which are occuring related to an systemic inflammatory condition that proceeds for some time prior to the identification of overt diabetes.
A detailed story of a significant part of these associations continues in the SIX Part series.

Part 1. Role of Autonomic Cardiovascular Neuropathy in Pathogenesis of ischemic heart disease in patients with diabetes mellitus

This article is an abstract only of a related publication of the pathogenesis of autonomic neuropathy in diabetics leading to ischemic heart disease.

Subjects: Medicine (General), Medicine, Medicine (General),
Health Sciences Authors: Popović-Pejičić Snježana, Todorović-Đilas Ljiljana, Pantelinac Pavle
Publisher: Društvo lekara Vojvodine Srpskog lekarskog društva
Publication: Medicinski Pregled 2006; 59(3-4): Pp 118-123 (2006) ISSN(s): 0025-8105  Added to DOAJ: 2010-11-11
http://dx.doi.org/10.2298/MPNS0604118P  http://www.doiserbia.nb.rs/img/doi/0025-8105/2006/0025-81050604118P.pdf

Keywords: diabetes mellitus, autonomic nervous system diseases, heart diseases, myocardial ischemia, comorbidity

Introduction.

Diabetes is strongly associated with macrovascular complications, among which

  • ischemic heart disease is the major cause of mortality.

Autonomic neuropathy increases the risk of complications, which calls for an early diagnosis. The aim of this study was to determine

  • both presence and extent of cardiac autonomic neuropathy,

in regard to the type of diabetes mellitus, as well as

  • its correlation with coronary disease and
  • major cardiovascular risk factors.

Material and methods. We have examined 90 subjects, classified into three groups, with 30 patients each: those with type 1 diabetes, type 2 diabetes and control group of healthy subjects. All patients underwent

  • cardiovascular tests (Valsalva maneuver, deep breathing test, response to standing, blood pressure response to standing sustained, handgrip test),
  • electrocardiogram,
  • treadmill exercise test and
  • filled out a questionnaire referring to major cardiovascular risk factors: smoking, obesity, hypertension, and dyslipidemia.

Results. Our results showed that cardiovascular autonomic neuropathy was

  • more frequent in type 2 diabetes,
  • manifesting as autonomic neuropathy.

In patients with autonomic neuropathy, regardless of the type of diabetes,

  • the treadmill test was positive, i.e. strongly correlating with coronary disease.

In regard to coronary disease risk factors,

  • the most frequent correlation was found for obesity and hypertension.

Discussion

Cardiovascular autonomic neuropathy is considered to be the principal cause of arteriosclerosis and coronary disease. Our results showed that the occurrence of cardiovascular autonomic neuropathy increases the risk of coronary disease due to dysfunction of autonomic nervous system.

Conclusions

Cardiovascular autonomic neuropathy is a common complication of diabetes that significantly correlates with coronary disease. Early diagnosis of cardiovascular autonomic neuropathy points to increased cardiovascular risk, providing a basis for preventive and therapeutic measures.

Part 2. A Longitudinal Cohort Study of the Cardiovascular Experience of Individuals at High Risk for Diabetes

This second part is a description of a longitudinal cohort study of individuals at high-risk for diabetes.  Unlike the SSA study, the study is not focused on protein-energy malnutrition.

Protocol for ADDITION-PRO: a longitudinal cohort study of the cardiovascular experience of individuals at high risk for diabetes recruited from Danish primary care

Subjects: Public aspects of medicine, Medicine, Public Health, Health Sciences
Authors: Johansen NB, Hansen Anne-Louise S, Jensen TM, Philipsen A, Rasmussen SS, Jørgensen ME, Simmons RK, Lauritzen T, Sandbæk A, Witte DR
Publisher: BioMed Central    Date of publication: 2012 Dec Published in: BMC Public Health 2012; 12(1): 1078    ISSN(s): 1471-2458   Added to DOAJ: 2013-03-12 http://dx.doi.org/10.1186/1471-2458-12-1078       http://www.biomedcentral.com/1471-2458/12/1078

Keywords: Diabetes, Cardiovascular disease, Primary care, Complications, Microvascular, Impaired fasting glucose, Impaired glucose intolerance, Aortic stiffness, Physical activity, Body composition

Background

Screening programmes for type 2 diabetes inevitably find more individuals at high risk for diabetes than people with undiagnosed prevalent disease. While well established guidelines for the treatment of diabetes exist, less is known about treatment or prevention strategies for individuals found at high risk following screening. In order to make better use of the opportunities for primary prevention of diabetes and its complications among this high risk group, it is important to

  • quantify diabetes progression rates and to examine
  • the development of early markers of cardiovascular disease and
  • microvascular diabetic complications.

We also require a better understanding of the

  • mechanisms that underlie and drive early changes in cardiometabolic physiology.

The ADDITION-PRO study was designed to address these issues among individuals at different levels of diabetes risk recruited from Danish primary care.

Methods/Design

ADDITION-PRO is a population-based, longitudinal cohort study of individuals at high risk for diabetes. 16,136 eligible individuals were identified at high risk following participation in a stepwise screening programme in Danish general practice between 2001 and 2006.

  • All individuals with impaired glucose regulation at screening,
  • those who developed diabetes following screening, and
  • a random sub-sample of those at lower levels of diabetes risk

were invited to attend a follow-up health assessment in 2009–2011 (n = 4,188), of whom 2,082 (50%) attended. The health assessment included

  • detailed measurement of anthropometry,
  • body composition,
  • biochemistry,
  • physical activity and
  • cardiovascular risk factors including aortic stiffness and central blood pressure.

All ADDITION-PRO participants are being followed for incident cardiovascular disease and death.

Discussion

The ADDITION-PRO study is designed to increase

  • understanding of cardiovascular risk and
  • its underlying mechanisms among individuals at high risk of diabetes.

Key features of this study include

  • (i) a carefully characterised cohort at different levels of diabetes risk;
  • (ii) detailed measurement of cardiovascular and metabolic risk factors;
  • (iii) objective measurement of physical activity behaviour; and
  • (iv) long-term follow-up of hard clinical outcomes including mortality and cardiovascular disease.

Results will inform policy recommendations concerning cardiovascular risk reduction and treatment among individuals at high risk for diabetes. The detailed phenotyping of this cohort will also allow a number of research questions concerning early changes in cardiometabolic physiology to be addressed.

Part 3.  Clinical significance of cardiovascular dysmetabolic syndrome

This study also addresses the issue of diabetes insulin resistance leading to cardiovascular dysmetabolic syndrome.

Subjects: Diseases of the circulatory (Cardiovascular) system,
Specialties of internal medicine, Internal medicine, Medicine, Cardiovascular, Medicine (General), Health Sciences
Authors: Deedwania Prakash C Publisher: BioMed Central            Date of publication: 2002 Jan
Published in: Trials 2002; 3: 1(2)   ISSN(s): 1468-6708  Added to DOAJ: 2004-06-03
http://dx.doi.org/10.1186/1468-6708-3-2   http://cvm.controlled-trials.com/content/3/1/2

Keywords: cardiovascular dysmetabolic syndrome, coronary heart disease, diabetes mellitus, hyperinsulinemia, insulin resistance

Although diabetes mellitus is predominantly a metabolic disorder,

  • recent data suggest that it is as much a vascular disorder.
  • Cardiovascular complications are the leading cause
    • of death and disability in patients with diabetes mellitus.

A number of recent reports have emphasized that

  • many patients already have atherosclerosis in progression
  • at the time they are diagnosed with clinical evidence of diabetes mellitus.

The increased risk of atherosclerosis and cardiovascular complications in diabetic patients is related to

  • the frequently associated dyslipidemia, hypertension, hyperglycemia, hyperinsulinemia, and endothelial dysfunction.

The evolving knowledge regarding the variety of

  • metabolic,
  • hormonal, and
  • hemodynamic abnormalities in patients with diabetes mellitus

has led to efforts designed for early identification of individuals at risk of subsequent disease. It has been suggested that

  • insulin resistance, the key abnormality in type II diabetes,
  • often precedes clinical features of diabetes by 5–6 years.

Careful attention to the criteria described for the cardiovascular dysmetabolic syndrome

  • should help identify those at risk at an early stage.

The application of nonpharmacologic as well as newer emerging pharmacologic therapies can have beneficial effects

  • in individuals with cardiovascular dysmetabolic syndrome and/or diabetes mellitus
  • by improving insulin sensitivity and related abnormalities.

Early identification and implementation of appropriate therapeutic strategies would be necessary

  • to contain the emerging new epidemic of cardiovascular disease related to diabetes.

Part 4.   Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease

Subjects: Public aspects of medicine, Medicine, Public Health, Health Sciences
Authors: Siren Reijo, Eriksson Johan G, Vanhanen Hannu
Publisher: BioMed Central      Date of publication: 2012 Aug
Published in: BMC Public Health 2012; 12: 1(631)    ISSN(s): 1471-2458   Added to DOAJ: 2013-03-12
http://dx.doi.org/10.1186/1471-2458-12-631    http://www.biomedcentral.com/1471-2458/12/631

Keywords: Waist circumference, Type 2 diabetes, Cardiovascular disease, Middle-aged men

Background

Abdominal obesity is a more important risk factor than overall obesity in

  • predicting the development of type 2 diabetes and cardiovascular disease.

From a preventive and public health point of view it is crucial that

  • risk factors are identified at an early stage,
  • in order to change and modify behaviour and lifestyle in high risk individuals.

Methods

Data from a community based study was used to assess

  • the risk for type 2 diabetes,
  • cardiovascular disease and
  • prevalence of metabolic syndrome in middle-aged men.

In order to identify those with increased risk for type 2 diabetes and/or cardiovascular disease

  • sensitivity and specificity analysis were performed, including
  • calculation of positive and negative predictive values, and
  • corresponding 95% CI for eleven different cut-off points,
    • with 1 cm intervals (92 to 102 cm), for waist circumference.

Results

A waist circumference ≥94 cm in middle-aged men,

  • identified those with increased risk for type 2 diabetes
  • and/or for cardiovascular disease

with a sensitivity of 84.4% (95% CI 76.4% to 90.0%), and a specificity of 78.2% (95% CI 68.4% to 85.5%). The positive predictive value was 82.9% (95% CI 74.8% to 88.8%), and negative predictive value 80.0% (95% CI 70.3% to 87.1%), respectively .

Conclusions

Measurement of waist circumference in middle-aged men

  • is a reliable test to identify individuals at increased risk for type 2 diabetes and cardiovascular disease.

This measurement should be used more frequently in daily practice in primary care

  • in order to identify individuals at risk and when planning health counselling and interventions.

Part 5.  How to use C-reactive protein in acute coronary care

Luigi M. Biasucci, Wolfgang Koenig, Johannes Mair, Christian Mueller, Mario Plebani, Bertil Lindahl, Nader Rifai,Per Venge,Christian Hamm, and the Study Group on Biomarkers in Cardiology of the Acute Cardiovascular Care Association of the European Society of Cardiology
Department of Cardiology B, Aarhus University Hospital, Tage Hansens Gade2, Aarhus DK-8000,Denmark; Germany, U.K., U.S., Italy
European Heart Journal Advance Access published Nov 7, 2013.  Current Opinion.  http://dx.doi.org/10.1093/eurheartj/eht435

Introduction

 C-reactive protein (CRP) is an acute phase protein and an established marker for detection, risk stratification, and monitoring of infections, and inflammatory and necrotic processes.. Because C-reactive protein is sensitive but not specific, its values must be nterpreted  in the clinical context. Inpatients with acute myocardial infarction (AMI), CRP increases within 4–6h of symptoms, peaks 2–4 days later,and returns to baseline after 7–10 days.

CRP has gained interest recently as a marker for risk stratification in acute coronary syndrome (ACS) when measured by high-sensitivity CRP assays. These assays have greater analytical sensitivity and reliably measure CRP concentrations within the reference range with low imprecision (5–10%). Because of evidence that atherosclerosis is an inflammatory disease, high-sensitivity CRP can be used as a biomarker of risk
in primary prevention and in patients with known cardiovascular disease. The aim of this review is to evaluate the use of CRP in patients with acute coronary disease.

The in-vitro stability of high-sensitivity C-reactive protein is excellent. Specific blood sampling conditions aren’t necessary.  However, retesting may be necessary with some assays if there is marked lipaemia.  Baseline and subsequent measures are in good for agreement for risk stratification despite biological variability of 30–60%.

The upper reference limit is method-dependent but usually 8mg/L for standard assays. The distribution of high-sensitivity CRP concentrations is skewed in both genders with a 50th percentile of_1.5mg/L (excluding women on hormone replacement therapy). Race differences have been reported. Most studies have reported no relationship with age,  but to circadian and seasonal variation. CRP concentrations are increased by smoking, obesity, and hormone replacement therapy and reduced by exercise, moderate alcohol drinking, and statin use. Correction for these factors is essential in reference range studies. CRP assays are not standardized. We recommend  the use of third-generation high-sensitivity CRP assays that combine features of standard and high-sensitivity CRP assays.  Required assay precision should be < 10% in the range of 3 and 10 mg/L.

Biochemical and analytical issues

Critical clinical concepts

(1) CRP concentrations are reported in mg/L
(2) CRP test results are method-dependent

  •  classification of patients into risk categories is usually comparable
(3) Third generation CRP assay are recommended
(4) No specific patient preparation before blood sampling is necessary
(5) The in-vitro stability of CRP is high

This is only a portion of the published concensus document. What is relevant to this discussion is that the hs-CRP is an extremely valuable marker for inflammatory disease.  It is not ordered often enough because of the broad range of values that we have become accustomed to for years, and it is elevated in rheumatologic conditions, but even then, it is widely used in pediatrics because children may present with rapidly emergent sepsis with very minimal sympoms.
The hs-CRP has opened a window to subliminal inflammatory disease that is diabetes, with accompanied arteriolar endothelial inflammation.

Part 6.  Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony

Subjects: Diseases of the circulatory (Cardiovascular) system,
Specialties of internal medicine, Internal medicine, Medicine, Cardiovascular, Medicine (General), Health Sciences
Authors: Mirrakhimov Aibek E
Publisher: BioMed Central      Date of publication: Oct 2012   ISSN(s): 1475-2840
Published in: Cardiovascular Diabetology 2012; 11(1):132   Added to DOAJ: 2013-03-12
http://dx.doi.org/10.1186/1475-2840-11-132      http://www.cardiab.com/content/11/1/132

Keywords: COPD, Dysglycemia, Insulin resistance, Obesity, Metabolic syndrome, Diabetes mellitus endothelial dysfunction, Vasculopathy

Chronic obstructive pulmonary disease, metabolic syndrome and diabetes mellitus

  • are common and underdiagnosed medical conditions.

It was predicted that chronic obstructive pulmonary disease

  • will be the third leading cause of death worldwide by 2020.

The healthcare burden of this disease is even greater

  • if we consider the significant impact of chronic obstructive pulmonary disease on
    • the cardiovascular morbidity and mortality.

Chronic obstructive pulmonary disease

  • may be considered as a novel risk factor for new onset type 2 diabetes mellitus via

multiple pathophysiological alterations such as:

  1. inflammation and oxidative stress,
  2. insulin resistance,
  3. weight gain and
  4. alterations in metabolism of adipokines.

On the other hand, diabetes may act as an independent factor,

  • negatively affecting pulmonary structure and function.

Diabetes is associated with an increased risk of

  1. pulmonary infections,
  2. disease exacerbations and
  3. worsened COPD outcomes.

On the top of that, coexistent OSA

  • may increase the risk for type 2 DM in some individuals.

The current scientific data necessitate a greater outlook on chronic obstructive pulmonary disease and

  • chronic obstructive pulmonary disease may be viewed as a risk factor for
  • the new onset type 2 diabetes mellitus.

Conversely, both types of diabetes mellitus should be viewed as

  • strong contributing factors for the development of obstructive lung disease.

Such approach can potentially improve the outcomes and medical control for both conditions,

  • and, thus, decrease the healthcare burden of these major medical problems.

CONCLUSIONS

This discussion  presents a spectrum of cardiovascular risk associated with type 2 diabetes mellitus, with high risk for CVD, stroke, endothelial dysfunction, and an association with obesity, measured by waist circumference, and an underlying proinflammatory state that can be measured by CRP.

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Burden of Depressive Disorders

Reviewer and Curator: Larry H Bernstein, MD, FCAP

 

This article is an important contribution to the literature on depression, substantiation the cardiovascular burden of depression on cardiovascular disease.

Burden of Depressive Disorders by Country, Sex, Age, and Year:Findings from the Global Burden of Disease Study 2010

AJ Ferrar*,FJ Charlson,RE Norman,SB Patten, G Freedman, CJL.Murray,T Vos

1Universityof Queensland, School of Population Health,Herston, Queensland, Au
2Queensland Centre for Mental Health Research, Wacol, Queensland, Au
3University of Queensland, Queensland Children’s Medical Research Institute,Herston,Queensland, Au
4Universityof Calgary, Department of Community Health Sciences,Calgary, Alberta, Ca
5University of Washington,Institute for Health Metrics and Evaluation, Seattle, Wash

Abstract

Background

Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000  studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions ,burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor fo rsuicide and ischemic heart disease.

Methods and Findings

Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of  epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data

  • quantified the severity of health loss from depressive disorders.

These weights were used to calculate

  • years lived with disability (YLDs) and
  • disability adjusted life-years (DALYs).

Separate DALYs were estimated for

  • suicide and
  • ischemic heart disease

attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010.

  • MDD accounted for 8.2% (5.9%–10.8%) of global YLDs and
  • dysthymia for 1.4% (0.9%–2.0%).

Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause.

  • MDD accounted for 2.5% (1.9%–3.2%) of global DALYs and
  • dysthymia for 0.5% (0.3%–0.6%).

There was more regional variation in burden for MDD than for dysthymia; with

  • higher estimates in females, and
  • adults of working age.

Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained

  • 16 million  suicide DALYs and
  • almost 4 million ischemic heart disease DALYs.

This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs.

Conclusions

GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden

  • allocated to suicide and ischemic heart disease.

These findings emphasize the importance of including depressive disorders as a public-health priority and

  • implementing cost-effective interventions to reduce its burden.

Please see later in the article for the Editors’ Summary.

Citation:Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G,etal.(2013) Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010. PLoS Med 10(11):e1001547. http://dx.doi.org/10.1371/journal.pmed.1001547

Abbreviations: CRA, comparative risk assessment; DALY, disability adjusted life years; DSM, Diagnostic and Statistical Manual of Mental Disorders; GBD, global burden of disease; ICD, International Classification of Diseases; MDD, major depressive disorder; MEPS, US Medical Expenditure Panel Survey; NESARC, US National Epidemiological Survey on Alcohol and Related Conditions 2000–2001 and 2004–2005; NSMHWB, Australian National Survey of Mental Health and Well being of Adults 1997; RR, relative risk; YLD, years lived with disability;YLL,years of life lost.

Figure1.YLDs by age and sex for MDD and dysthymia in 1990 and 2010.  http://dx.doi.org/10.1371/journal.pmed.1001547.g001

Figure1.YLDsbyageandsexforMDDanddysthymiain1990and2010.

Figure2.YLD rates (per100,000) by region for MDD and dysthymia in 1990 and 2010. 95%UI, 95% uncertainty interval; AP-HI, Asia Pacific, high income; As-C, Asia Central; AS-E, Asia East; AS-S, Asia South;A-SE, Asia Southeast; Aus, Australasia; Caribb, Caribbean; Eur-C, Europe Central; Eur-E, Europe Eastern; Eur-W, Europe Western; LA-An, LatinAmerica, Andean; LA-C, Latin America, Central; LA-Sth, LatinAmerica, Southern; LA-Trop, Latin America, Tropical; Nafr-ME, NorthAfrica/MiddleEast; Nam-HI, North America, high income; Oc, Oceania; SSA-C, Sub-Saharan Africa, Central; SSA-E, Sub-Saharan Africa, East; SSA-S, Sub-Saharan Africa Southern; SSA-W, Sub-Saharan Africa,West.  http://dx.doi.org/10.1371/journal.pmed.1001547.g002

Figure2. YLD rates (per100,000) by region for MDD and dysthymia in 1990 and 2010

Plot 1  age dtandardized YLD rates

Editors’ Summary

Background.

Depressive disorders are common mental disorders that occur in people of all ages across all world regions. Depression—an overwhelming feeling of sadness and hopelessness that can last for months or years—can make people feel that life is no longer worth living. People affected by depression lose interest in the activities they used to enjoy and can also be affected by physical symptoms such as disturbed sleep. Major depressive disorder (MDD, also known as clinical depression) is

  • an episodic disorder with a chronic (long-term) outcome and increased risk of death.

It involves at least one major depressive episode in which the affected individual experiences

  • a depressed mood almost all day, every day for at least 2 weeks.

Dysthymia is a milder, chronic form of depression that lasts for at least 2 years. People with dysthymia are often described as constantly unhappy. Both these subtypes of depression (and others such as that experienced in bipolar disorder) can be treated with antidepressant drugs and with talking therapies.

Why Was This Study Done? Depressive disorders were a  leading cause of disease burden in the 1990 and 2000 Global Burden of Disease (GBD) studies, collaborative scientific efforts that quantify the health loss attributable to

  • diseases and injuries in terms of disability adjusted life years (DALYs; one DALY represents the loss of a healthy year of life).

DALYs are calculated by adding together the years of life lived with a disability (YLD, a measure that includes a disability weight factor reflecting disease severity) and the years of life lost because of disorder-specific premature death. The GBD initiative aims

  • to provide data that can be used to improve public-health policy.

Thus, knowing that depressive disorders are a leading cause of disease burden worldwide has helped to prioritize depressive disorders in global public-health agendas. Here, the researchers analyze the burden of MDD and dysthymia in GBD 2010 by country, region, age, and sex, and

  • calculate the burden of suicide and ischemic heart disease attributable to depressive disorders (depression is a risk factor for suicide and ischemic heart disease).

GBD 2010 is broader in scope than previous GBD studies and quantifies the direct burden of 291 diseases and injuries and the  burden attributable to 67 risk factors across 187 countries.

What Did the Researchers Do and Find? The researchers collected data on

  • the prevalence, incidence, remission rates, and duration of MDD and dysthymia and on deaths caused by these disorders from published articles.

They pooled these data using a statistical method called Bayesian meta-regression and calculated YLDs for MDD  and dysthymia using disability weights collected in population surveys. MDD accounted for 8.2% of global YLDs in 2010, making it the second leading cause of YLDs. Dysthymia accounted for 1.4% of global YLDs. MDD and dysthymia were also leading causes of DALYs, accounting for 2.5% and 0.5% of global DALYs, respectively. The regional variation in the burden was greater for MDD than for dysthymia, the  burden of depressive disorders was higher in women than men, the largest proportion of YLDs from depressive  disorders occurred among adults of working age, and the  global burden of depressive disorders increased by 37.5%  between 1990 and 2010 because of population growth and ageing. Finally, MDD explained an additional 16 million  DALYs and 4 million DALYs when it was considered as a risk factor for suicide and ischemic heart disease, respectively.  This ‘‘attributable’’ burden increased the overall burden of depressive disorders to 3.8% of global DALYs.

What Do These Findings Mean? These findings update and extend the information available from GBD 1990 and  2000 on the global burden of depressive disorders. They confirm that

  • depressive disorders are a leading direct cause of the global disease burden and show that
  • MDD also contributes to the burden allocated to suicide and ischemic heart disease.

The estimates of the global burden of depressive disorders reported in GBD 2010 are likely to be more accurate than those in previous GBD studies but are  limited by factors such as the sparseness of data on depressive disorders from developing countries and, consequently,

  • the validity of the disability weights used to calculate YLDs.

Even so, these findings reinforce the importance of treating  depressive disorders as a public-health priority and

  • of implementing cost-effective interventions to reduce their  ubiquitous burden.

Additional Information. Please access these websites via  the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001547.

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Patient Protection and Affordable Care Act Featured at RAND

Reporter: Aviva Lev-Ari, PhD, RN

Below the reader will find a compilation of all the articles related to Affordable Care Act Featured at RAND

The Patient Protection and Affordable Care Act (ACA)—the sweeping health care reform sometimes known as “Obamacare”—was enacted in 2010. The law aims to expand access to health coverage for uninsured Americans.

The ACA does this through several provisions: an individual mandate requiring adults to have health insurance or pay a fine; an employer mandate requiring firms with 50 or more employees to offer coverage or pay a fine; a requirement that each state establish a health insurance exchange or accept a federally established exchange in which individuals and small businesses can buy coverage; an expansion of Medicaid eligibility to cover greater numbers of lower-income people. (A 2012Supreme Court decision held that states could not be required to expand Medicaid, thus leaving expansion up to the states.)

In addition, the ACA makes changes to Medicare intended to cut costs, shore up the program’s fiscal solvency, and improve delivery of care.

What’s Next for the ACA

With most of the ACA’s provisions taking full effect in 2014, the complex process of implementing the law is underway across the country. RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing decisionmakers at many levels: federal and state governments, employers, families, and individuals.Our recent work has examined the likely impact of the ACA in four key policy areas:

Patient Protection and Affordable Care Act
Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.

Featured at RAND

The RAND Health Reform Opinion Study

group opinionsThe RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.

The Affordable Care Act: Four Key Policy Areas

Obama signing the ACAWith the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.

All Items (123)

Fotolia_52964211_Subscription_Monthly_XXLThe latest data from the RAND Health Reform Opinion Study indicates that positive opinion of the ACA continues to increase. The overall favorable rating is now as high as it was in late September, prior to the opening of the health insurance exchanges.

BLOG

RAND Health Reform Opinion Study Update: Positive Opinion on ACA Grows, Negative Opinion Stabilizes— Dec 23, 2013

President Barack Obama and First Lady Michelle Obama discuss the Affordable Care Act with mothersLast week we introduced the RAND Health Reform Opinion Study, a new way to measure public opinion of the Affordable Care Act. Negative opinion about the ACA seems to be stabilizing, while positive opinion is increasing. Those undecided about the ACA are decreasing.

COMMENTARY

A New Way to Measure Public Opinion of Health Reform — Dec 18, 2013

Obama healthcare law supporters rally during the third and final day of legal arguments over the Patient Protection and Affordable Care Act at the Supreme Court in Washington, March 28, 2012Whether the public will begin to settle on an overall positive or negative perception of the Affordable Care Act (ACA) is very much an open question. But understanding how opinion of the law evolves over time could offer valuable insight into Americans’ appetite both for the ACA and for health reform more broadly.

RESEARCH BRIEF

Will the Affordable Care Act Make Health Care More Affordable? — Dec 11, 2013

Fotolia_48436515_Subscription_Monthly_XLFor most lower-income people who obtain coverage as a result of the Affordable Care Act, health care spending will fall. But spending by some newly insured higher-income people will increase because they will be now paying insurance premiums.

COMMENTARY

Is There Really a Physician Shortage? — Dec 5, 2013

Fotolia_51436665_Subscription_Monthly_XLLarge coverage expansions under the ACA have reignited concerns about physician shortages. These estimates result from models that forecast future supply and demand for physicians based on past trends and current practice. While useful exercises, they do not necessarily imply that intervening to boost physician supply would be worth the investment.

PERIODICAL

Ramifications of Health Reform — Nov 26, 2013

doctor listens to a heartbeat of a 5-year-old patient 2014 will be an important year for the Patient Protection and Affordable Care Act. Health insurance exchanges will offer people new ways to buy insurance. Medicaid will expand in many states. And people without “minimum essential coverage” may have to pay a fee.

COMMENTARY

Employer-Provided Health Insurance: Why Does It Persist, and Will It Continue after 2014? — Nov 25, 2013

health insurance claim form, pen, calculatorAs the ACA is implemented, policy makers should be attuned to potential inefficiencies and inequities created by a system with different regulatory and tax rules for small employers, large employers, and individual health plans. Attempts to equalize the playing field may be difficult.

COMMENTARY

Can the Affordable Care Act Help Asthma Sufferers Breathe Easier? — Nov 20, 2013

Fotolia_52973064_Subscription_Monthly_XLACA reforms can potentially address barriers that get in the way of individuals with asthma getting the care they need. At the population level, the law has the potential to improve outcomes and efficiency and equity of services for chronic conditions such as asthma for which cost-effective preventive treatments exist.

COMMENTARY

Four Questions on Canceled Insurance Policy Fix — Nov 14, 2013

U.S. President Barack Obama talks about the Affordable Care Act in the Brady Press Briefing Room at the White House in Washington, November 14, 2013David Mastio, Forum editor at USA TODAY, asked RAND’s Christine Eibner four questions about President Obama’s plan to fix the problem with people getting their insurance canceled.

BLOG

The Future of the Health Care Workforce: RAND Researchers Well Represented in Health Affairs Special Issue— Nov 7, 2013

Fotolia_52420884_Subscription_Monthly_XXLIn “Redesigning the Health Care Workforce,” a new special issue of the journal Health Affairs, RAND researchers contribute to several timely examinations of challenges, opportunities, and potential solutions relating to the future of health care staffing in the U.S. and abroad.

COMMENTARY

Quick Takes: Health Literacy and ACA Enrollment — Nov 7, 2013

Fotolia_44089855_Subscription_Monthly_XXLThe Affordable Care Act (ACA) expands coverage to millions of Americans. But the newly eligible may face challenges enrolling if they lack understanding of how the health care system itself works. Laurie Martin explains the role of health literacy in determining how successful the ACA will be in providing coverage for America’s uninsured.

COMMENTARY

Quick Takes: The Math of Medicaid Expansion — Oct 21, 2013

blonde boy getting checkupExpanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.

COMMENTARY

Medicaid Access for the Formerly Incarcerated Under the ACA: Helping the Oft-Forgotten — Oct 3, 2013

male patient wearing white shirt talking to psychiatristAmerica’s prison population tends to be sicker than the general population. While Medicaid eligibility under the ACA offers an historic opportunity, enrolling the formerly incarcerated into the health exchanges or Medicaid will be neither simple nor straightforward.

COMMENTARY

Understanding the Affordable Care Act — Oct 2, 2013

Fotolia_54387258_Subscription_Monthly_XLOne of the chief aims of the Affordable Care Act (ACA) is the expansion of insurance coverage to individuals who at present either cannot afford it or choose not to purchase it. Unfortunately, many Americans lack the financial literacy needed to navigate the numerous and complex options thrust upon them by the ACA.

COMMENTARY

Will the Affordable Care Act Make Health Care More Affordable? — Oct 1, 2013

Fotolia_49599013_Subscription_Monthly_XXLOut-of-pocket spending on health care will decrease for both the newly insured as well as for those changing their source of insurance. These decreases will be largest for those who would otherwise be uninsured.

BLOG

Ask Me Anything: Carter Price on the Affordable Care Act — Oct 1, 2013

Fotolia_56040470_Subscription_Monthly_XLAs of October 1, many Americans can now shop for health insurance through state exchanges created as part of the Affordable Care Act (ACA)—the sweeping health care reform often referred to as “Obamacare.” To provide some insight into the ACA, RAND’s Carter Price hosted an “Ask Me Anything” session on Reddit today.

NEWS RELEASE

Affordable Care Act Will Reduce Out-of-Pocket Medical Spending for Many Americans — Oct 1, 2013

The Affordable Care Act will have a varied impact on health spending by individuals and families, depending primarily on their income and whether they would have been uninsured in 2016 without the program.

REPORT

Affordable Care Act Will Reduce Out-of-Pocket Medical Spending for Many Americans — Oct 1, 2013

a middle aged woman checking out at a medical reception counterThe Affordable Care Act will have a varied impact on health spending by individuals and families, depending primarily on their income and whether they would have been uninsured in 2016 without the program.

Patient Protection and Affordable Care Act

Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.

Featured at RAND

The RAND Health Reform Opinion Study

group opinionsThe RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.

The Affordable Care Act: Four Key Policy Areas

Obama signing the ACAWith the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.

All Items (123)

Will ACA Implementation Lead to a Spike in Demand for Care? — Sep 26, 2013

Fotolia_48335019_Subscription_Monthly_XXLThe growing number of Americans newly-insured under the ACA will undoubtedly lead to a surge in demand for care, whether through Medicaid or insurance exchanges. But, if predictions hold, the increase won’t be as dramatic as some may fear, writes David I. Auerbach.

COMMENTARY

Data Points: Why Delay of the Employer Mandate May Not Actually Mean That Much — Aug 29, 2013

health insurance policy and reading glassesThe bottom line is that the employer mandate does not provide a large inducement for firms to change their health insurance offerings, but it does raise a substantial amount of money to pay for the ACA’s coverage provisions over time.

REPORT

No Widespread Increase in Cost of Individual Health Insurance Policies Under Affordable Care Act— Aug 29, 2013

calculator, pills, and stethoscopeAn analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.

NEWS RELEASE

No Widespread Increase in Cost of Individual Health Insurance Policies Under Affordable Care Act— Aug 29, 2013

An analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.

NEWS RELEASE

Delay of Employer Insurance Mandate Will Not Cause Major Problems for Affordable Care Act — Aug 19, 2013

A one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.

REPORT

Delay of Employer Insurance Mandate Will Not Cause Major Problems for Affordable Care Act — Aug 19, 2013

stethoscope and clockA one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.

MULTIMEDIA

The Math of State Medicaid Expansion — Jul 17, 2013

Carter PriceMathematician Carter Price discusses the potential impacts to low-income populations and local economies in states that choose not to expand Medicaid under the Affordable Care Act.

COMMENTARY

Health Care Spending: What’s in Store? — Jul 16, 2013

illustration of weighing medical costsResolving the question of whether or not the U.S. has finally gotten a handle on health care spending is vitally important, because the choices we make going forward will have profound implications for our economy, the financial wellbeing of millions of American families, and ultimately America’s standing in the world.

REPORT

Helping Decisionmakers Implement the ACA’s Medicaid Provisions — Jun 26, 2013

A stethoscope atop a United States flagThe Affordable Care Act (ACA) contains many Medicaid-related provisions. RAND is working closely with decisionmakers at the federal and state levels to help resolve challenges associated with implementing the ACA’s sweeping reforms.

CONTENT

The Impact of RAND’s Work for the Centers for Medicare & Medicaid Services (CMS) — Jun 26, 2013

stethoscope on American flagRAND’s work for the Centers for Medicare & Medicaid Services reflects the diverse, widespread nature of CMS’s programs. Major topics examined by our health policy experts include improving Medicare payment policies, implementation of the ACA’s Medicaid provisions, Medicare demonstration projects, measuring quality of care, and assessing patients experience.

JOURNAL ARTICLE

How Well Do Medicare’s Pay-for-Performance (P4P) Programs Match Desirable P4P Design Criteria?— Jun 25, 2013

ear exam on senior patientAlignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.

REPORT

Revenue, Spending Reductions Will Offset Costs of Expanding Medicaid in PA — Jun 24, 2013

Harrisburg, Pennsylvania panoramaWhile the expansion of Medicaid under the Affordable Care Act will require additional spending by the Commonwealth of Pennsylvania, these costs will be more than offset by additional revenue or reductions in other spending in the 2014-2020 timeframe.

COMMENTARY

Will Small Firms Self-Insure After Jan. 1, 2014? — Jun 17, 2013

 Doctor with young womanBecause of the ACA’s regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.

RESEARCH BRIEF

The Math of State Medicaid Expansion — Jun 7, 2013

Fotolia_45672516_Subscription_Monthly_XXLRAND researchers have analyzed how opting out of Medicaid expansion would affect insurance coverage and spending and whether alternative policy options—such as partial Medicaid expansion—could cover as many people at lower costs to states.

BLOG

Covering Emergency Care for Young Adults: Is the ACA Doing Its Job? — Jun 5, 2013

A woman is wheeled through an emergency department on a gurney.The dependent coverage provision of the Affordable Care Act is working as intended, say Andrew Mulcahy and Katherine Harris. In 2011, it spared individuals and hospitals from $147 million in emergency room costs.

CONTENT

Should States Expand Medicaid Under the ACA? — Jun 3, 2013

U.S. state map with stethoscopeSome governors have stated publicly that their states will not participate in Medicaid expansion. A recent RAND study explores how this could affect government costs and coverage.

NEWS RELEASE

Expanding Medicaid Is Best Financial Option for States — Jun 3, 2013

States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.

JOURNAL ARTICLE

Expanding Medicaid Is Best Financial Option for States — Jun 3, 2013

Nuns On The Bus rally and Texas Capitol visit about MedicaidStates that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.

REPORT

Labor Market Outcomes of Health Shocks and Dependent Coverage Expansions — Jun 1, 2013

machine_shop_workerA series of studies on sources of variation in individual valuation of employer-provided group health care found that the effects of bundling health insurance with employment in the U.S. can vary significantly within different population groups.

NEWS RELEASE

Health Reform Shields Young Adults from Emergency Medical Costs — May 29, 2013

A new federal law allowing young adults to remain on their parents’ medical insurance through age 25 has shielded them, their families, and hospitals from the full financial consequences of serious medical emergencies.

Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.

Featured at RAND

The RAND Health Reform Opinion Study

group opinionsThe RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.

The Affordable Care Act: Four Key Policy Areas

Obama signing the ACAWith the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.

Infographic: How Pennsylvania May Fare Under the ACA — May 15, 2013

Pennsylvania capitol buildingThis infographic presents findings from a RAND analysis of the economic and other effects of Medicaid expansion on the commonwealth of Pennsylvania.

COMMENTARY

Governors Missing the Point on Medicaid — Apr 29, 2013

6170068425_b192a9d867_bWhile a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states’ economies seem misguided given the full range of projected economic impacts on the states, writes Carter C. Price.

RESEARCH BRIEF

Infographic: How Arkansas May Fare Under the Affordable Care Act — Apr 8, 2013

Arkansas state quarterThis infographic presents findings from a RAND analysis of the economic and other effects of the Affordable Care Act on the state of Arkansas.

COMMENTARY

Helping Obama—and Other Americans—Weigh Which Health Insurance Exchange to Pick — Apr 1, 2013

a health insurance claim form and a silver penMultistate plans are most likely to appeal to out-of-state students, interstate migrants, out-of-state workers, seasonal movers (e.g., “snowbirds”), and similar groups that require improved access to health care across state lines.

NEWS RELEASE

Expanding Medicaid in Pennsylvania Would Sharply Increase Federal Revenue to State — Mar 28, 2013

Expanding Medicaid in Pennsylvania under the Affordable Care Act would boost federal revenue to the state by more than $2 billion annually and provide 340,000 residents with health insurance.

REPORT

The Economic Impact of Medicaid Expansion on Pennsylvania — Mar 28, 2013

Pennsylvania state flagIf Pennsylvania opts into Medicaid expansion under the Affordable Care Act, more residents would have health coverage and the state would enjoy a positive economic effect. However, benefits would have a long-term cost, with uneven regional results.

REPORT

Multistate Health Plans in the ACA’s State Insurance Exchanges — Mar 20, 2013

blue and pink pillsThe ACA requires the government to work with insurance issuers to establish at least two multistate plans (MSPs) in each state’s health insurance exchange. MSPs may be especially attractive to those interested in issuers that operate in multiple states, such as out-of-state students or temporary workers.

REPORT

Efforts to Reform Physician Payment by Tying Payment to Performance — Feb 14, 2013

pediatrician with patient and motherPublic and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.

BLOG

In Brief: Amelia M. Haviland on Consumer-Directed Health Plans — Jan 23, 2013

In this video, Amelia Haviland presents the results of several new RAND studies on cost and quality in consumer-directed health plans, and explores how switching plans affects the quality of care.

BLOG

Modeling the Effects of the Affordable Care Act in Arkansas — Jan 7, 2013

patients sitting in waiting roomThe Medicaid expansion under the ACA will result in about 400,000 people newly insured in Arkansas by 2016. Of these, about 190,000 would be newly enrolled in Medicaid and the rest would be newly insured through the new insurance exchanges. The state is likely to save about $67 million for reduced uncompensated care costs for the uninsured.

REPORT

The Economic Impact of the ACA on Arkansas — Jan 3, 2013

Arkansas flagFor Arkansas, the Affordable Care Act will result in an increase in GDP of around $550 million and the creation of about 6,200 jobs. The new law will also increase health insurance coverage by 400,000 newly insured individuals.

JOURNAL ARTICLE

Implications of New Insurance Coverage for Access to Care, Cost-Sharing, and Reimbursement — Jan 1, 2013

Many physician practices will face a set of critical decisions in the coming years that may contribute to the ultimate success or failure of the ACA.

CONTENT

Four Strategies to Contain America’s Growing Health Care Spending — Nov 15, 2012

pills and coinsIn its second term, the Obama Administration can restrain further health care spending growth—without compromising quality—by employing four broad strategies: fostering efficient and accountable providers, engaging and empowering consumers, promoting population health, and facilitating high-value innovation.

COMMENTARY

Health Care Costs Must Be Curbed, No Matter Who Wins — Oct 16, 2012

money and pillsRegardless of which candidate wins in November, and regardless of whether “Obamacare” is repealed, amended, or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year, writes Arthur Kellermann.

COMMENTARY

California Improves on Affordable Care Act by Letting RNs Dispense Birth Control — Oct 8, 2012

birth control pillsAs we look for ways to provide efficient, high-quality and cost-effective healthcare to more Americans, states may study California as a potential model for how to do more to deliver on what the Affordable Care Act has to offer women, while saving money at the same time, writes Chloe Bird.

PERIODICAL

The Fate of ACA Is a Major Issue in Upcoming Congressional and Presidential Elections — Sep 21, 2012

stethoscope on 50 dollar billsWhether the Affordable Care Act is repealed, defended, or weakened will hinge on who holds the balance of power next January. Regardless of what happens with the ACA, the spiraling cost of health care in the United States will remain a huge challenge.

CONTENT

Retail Clinics Play Growing Role in Health Care Marketplace — Sep 11, 2012

man getting his arm wrappedRetail health care clinics provide treatment for acute conditions like bronchitis as well as vaccinations and other preventive care. With the role of retail clinics expanding and U.S. health care entering a dynamic period of change, it is important to consider what we know about this emerging health care setting.

COMMENTARY

Supporting Comprehensive Healthcare for Women Makes Dollars, and Sense — Sep 5, 2012

As we look for ways to provide efficient, high-quality, and cost-effective health care to more Americans, we can’t afford to ignore women’s health issues, including reproductive health care and the cost savings that contraceptive access provides, writes Chloe Bird.

JOURNAL ARTICLE

Medicare Postacute Care Payment Reforms Have Potential To Improve Efficiency Of Care, But May Need Changes To Cut Costs — Sep 1, 2012

ACA-mandated payment reforms need to achieve more than a one-time cost saving.

COMMENTARY

Will More Employers Drop Coverage Under the ACA? Don’t Bet on It — Jul 27, 2012

A problem with using surveys to predict behavior is that they measure employer sentiment toward the ACA today, rather than the economic decisions employers typically make when the time comes, writes Art Kellermann.

COMMENTARY

Time to Focus on Healthcare Costs — Jun 29, 2012

The bottom line is this: With or without the Affordable Care Act, the nation can no longer kick the can down the road on costs, writes Arthur Kellermann.

CONTENT

Supreme Court Upholds the Affordable Care Act: What the Experts Are Saying — Jun 28, 2012

Supreme Court pillarsNow that the Supreme Court has upheld key provisions of the Affordable Care Act, what lies ahead for health care in America? RAND experts sound off in the wake of this momentous decision.

COMMENTARY

Time to Shift Talk to Health Care Costs — Jun 28, 2012

The U.S. Supreme Court’s ruling on the Affordable Care Act is unquestionably historic, but there is a critical aspect of health care reform that still needs to be fixed. The nation needs to take decisive action to address the rising costs of health care, writes Arthur Kellermann.

RESEARCH BRIEF

Consumer-Directed Plans Could Cut Health Costs Sharply, but Also Discourage Preventive Care — Jun 28, 2012

pills and moneySwitching to a consumer-directed health plan (CDHP) could save families 20 percent or more on their health care costs. Families with CDHPs initiate less episodes of care and spend less per episode, however, they also tend to scale back on high-value preventive care, such as child vaccinations.

PERIODICAL

Eliminating Individual Mandate Would Decrease Coverage, Increase Spending — May 11, 2012

If the individual mandate requiring all Americans to have health insurance were eliminated, it would sharply reduce the number of people gaining coverage and slightly increase the cost for those who do buy policies through the new insurance exchanges.

JOURNAL ARTICLE

Expanding Consumer-Directed Health Plans Could Help Cut Overall Health Care Spending — May 7, 2012

If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.

BLOG

Would the Affordable Care Act Lead to Reductions in Employer-Sponsored Coverage? — May 4, 2012

As the U.S. Supreme Court considers the constitutionality of the Affordable Care Act’s (ACA) individual mandate, one of the questions being debated is what effect the mandate would have on employer-sponsored health insurance coverage. A factor to consider in this is the effect the ACA would have on small businesses, which employ the majority of America’s private-sector workforce.

COMMENTARY

What Happens Without the Individual Mandate? — Mar 21, 2012

If the individual mandate were ruled unconstitutional, subsidies and the age structure of premiums should keep enough healthy people in the insurance exchanges to prevent huge spikes in premiums, write Carter C. Price and Christine Eibner.

PAST EVENT

The Affordable Care Act’s Individual Mandate in Play — Mar 20, 2012

RAND economist Christine Eibner spoke at a Bloomberg Government and RAND Corporation event in Washington, D.C. Eibner briefed the attendees on the results of her recent study, How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?

PROJECT

Will Health Care Reform Impact Applications for Disability Benefits? — Mar 12, 2012

As the Affordable Care Act expands health insurance coverage in the U.S., the “cost” of applying for SSDI will decline for many. Studying the effect of Massachusetts health care reform in 2006 may provide insights into the impact the ACA may have on SSDI applications and awards.

NEWS RELEASE

Ending Individual Mandate Would Cut Health Coverage, but Not Dramatically Hike Insurance Price— Feb 16, 2012

Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.

RESEARCH BRIEF

How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs? — Feb 16, 2012

An analysis of the effects of implementing the Affordable Care Act without an individual mandate found that over 12 million people who would have otherwise signed up for coverage will be uninsured and premium prices will increase by 2.4 percent.

REPORT

Ending Individual Mandate Would Cut Health Coverage, but Not Dramatically Hike Insurance Price— Feb 16, 2012

Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.

CONTENT

How Will Eliminating the Individual Mandate Affect Health Coverage and Premium Costs? — Feb 15, 2012

doctor showing patient xrayThe individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA) requires that most Americans either obtain health coverage or pay an annual fine. How much will overturning the individual mandate affect costs and coverage?

JOURNAL ARTICLE

Rules Allowing Small Businesses to Opt Out of Health Reform Should Have Minor Impact on Insurance Cost— Feb 8, 2012

health insurance formRules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.

NEWS RELEASE

Rules Allowing Small Businesses to Opt Out of Health Reform Should Have Minor Impact on Insurance Cost— Feb 8, 2012

Rules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.

COMMENTARY

How Will the Effects of the Affordable Care Act Be Monitored? — Jan 4, 2012

Most will agree with the undeniable fact that a new era in US medicine and US health care begins in less than two years. The key question is what potential measures should be monitored to determine both anticipated and unanticipated effects of the new law on the health of the US population, writes Robert H. Brook.

OURNAL ARTICLE

Two Years and Counting: How Will the Effects of the Affordable Care Act Be Monitored? — Jan 1, 2012

The Affordable Care Act marks a new era in US health care and US medicine. This commentary suggests ways to monitor the act’s effect on the health of the US population.

RESEARCH BRIEF

How Does Health Reform Affect the Health Care Workforce? Lessons from Massachusetts — Dec 13, 2011

Since Massachusetts enacted health reform legislation in 2006, health care employment in the state has grown more rapidly than in the rest of the United States, primarily in administrative positions.

CONTENT

What Are the Public Health Implications of Prisoner Reentry in California? — Dec 1, 2011

Fotolia_54591532_Subscription_Monthly_XXLCalifornia, the state with the nation’s largest prison population, is releasing increased numbers of inmates under its 2011 Public Safety Realignment Plan. RAND was asked to study the public health implications of returning prisoners for the communities they return to and has found both challenges and opportunities.

REPORT

Addressing Medicare Payment Differentials Across Ambulatory Settings — Oct 12, 2011

bill payment calculatorMedicare’s payment for physician work and malpractice liability expenses is the same regardless of where a service is provided, but payments differ for facility-related components of care.

REPORT

Power to the People: The Role of Consumer-Controlled Personal Health Management Systems in the Evolution of Employer-Based Health Care Benefits — Sep 13, 2011

The Patient Protection and Affordable Care Act has piqued employers’ interest in new benefit designs. This paper reviews consumer-controlled personal health management systems that could help individuals control and manage their health care.

JOURNAL ARTICLE

Health Care Reform and the Health Care Workforce — The Massachusetts Experience — Sep 1, 2011

Analysis of the Massachusetts Health Care Reform Plan suggests national health care reform may require larger numbers of support personnel, rather than requiring greater numbers of physicians and nurses themselves.

PROJECT

Comprehensive Assessment of Reform Efforts (COMPARE) — Jul 20, 2011

thermometer graphPolicymakers are facing new challenges as they implement the Patient Protection and Affordable Care Act (ACA). RAND COMPARE is a modeling tool that simulates the impact of implementation decisions on insurance coverage, premiums, and health care spending.

REPORT

Employer Self-Insurance Decisions and the Implications of the Patient Protection and Affordable Care Act as Modified by the Health Care and Education Reconciliation Act of 2010 (ACA) — May 25, 2011

Implications of the Patient Protection and Affordable Care Act of 2010 (as Modified by the Health Care and Education Reconciliation Act) for small firms’ decisions to offer self-insured health plans and consequences of self-insurance for enrollees.

REPORT

How Community and Faith-Based Organizations Can Help Improve Community Well-Being — May 9, 2011

Content for a toolkit was designed to help community and faith-based organizations take advantage of opportunities presented in the Patient Protection and Affordable Care Act and engage leaders in promoting health in their communities.

NEWS RELEASE

How National Health Reform Will Affect a Variety of States — Apr 5, 2011

A series of new reports by the RAND Corporation outlines the impact that national health care reform will have on individual states, estimating the increased costs and coverage that are expected in five diverse states once reform is fully implemented in 2016.

NEWS RELEASE

Health Reform Will Add Coverage for 6 Million Californians; State Health Spending to Grow by 7 Percent— Apr 5, 2011

National health care reform will help 6 million California residents obtain health insurance and increase health care spending by state government by about 7 percent when it is fully implemented in 2016.

NEWS RELEASE

Health Reform Will Add Coverage for 170,000 in Connecticut; State Health Spending to Drop by 10 Percent— Apr 5, 2011

National health care reform will help 170,000 Connecticut residents obtain health insurance and decrease health care spending by state government by about 10 percent when it is fully implemented in 2016.

NEWS RELEASE

Health Reform Will Add Coverage for 1.3 Million in Illinois; State Health Spending to Grow by 10 Percent— Apr 5, 2011

National health care reform will help 1.3 million Illinois residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.

NEWS RELEASE

Health Reform Will Add Coverage for 125,000 in Montana; State Health Spending to Grow by 3 Percent— Apr 5, 2011

National health care reform will help 125,000 Montana residents obtain health insurance and increase health care spending by state government by about 3 percent when it is fully implemented in 2016.

NEWS RELEASE

Health Reform Will Add Coverage for 5 Million in Texas; State Health Spending to Grow by 10 Percent— Apr 5, 2011

National health care reform will help 5 million Texas residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.

RESEARCH BRIEF

High-Deductible Health Plans Cut Spending but Also Reduce Preventive Care — Apr 5, 2011

High-deductible plans significantly reduce health care spending but also lead consumers to cut back on their use of preventive health care — even though high-deductible plans waive the deductible for such care.

RESEARCH BRIEF

How Will Health Care Reform Affect Costs and Coverage? Examples from Five States — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in five states.

REPORT

The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Illinois: An Analysis from RAND COMPARE — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.

REPORT

The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Texas: An Analysis from RAND COMPARE — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.

REPORT

The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in California: An Analysis from RAND COMPARE — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.

REPORT

The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Montana: An Analysis from RAND COMPARE — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.

REPORT

The Impact of the Coverage-Related Provisions of the Patient Protection and Affordable Care Act on Insurance Coverage and State Health Care Expenditures in Connecticut: An Analysis from RAND COMPARE — Apr 1, 2011

Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.

REPORT

Investment in New Health Care Quality Measures Needed as Cost-Cutting Strategies Grow — Feb 23, 2011

stethoscope chartHealth care spending reforms should be met with new efforts to develop and refine quality of care and other performance measures in order to assure that any changes will improve medical care and not harm patients.

JOURNAL ARTICLE

Small Firms’ Actions in Two Areas, and Exchange Premium and Enrollment Impact — Feb 1, 2011

An analysis of two rules that allow small businesses to avoid participating in health reform concludes they will have only a minor impact because relatively few businesses are likely to take advantage of the options.

RESEARCH BRIEF

How Will the Affordable Care Act Affect Employee Health Coverage at Small Businesses? — Sep 8, 2010

Finds that the Affordable Care Act will increase the percentage of employers that offer health coverage to workers: from 57 percent to 80 percent for firms with 50 or fewer workers, and from 90 percent to 98 percent for firms with 51 to 100 workers.

JOURNAL ARTICLE

The Effects of the Affordable Care Act on Workers’ Health Insurance Coverage — Sep 1, 2010

The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.

REPORT

Establishing State Health Insurance Exchanges: Implications for Health Insurance Enrollment, Spending, and Small Businesses — Aug 11, 2010

The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.

REPORT

Grandfathering in the Small Group Market Under the Patient Protection and Affordable Care Act: Effects on Offer Rates, Premiums, and Coverage — Jun 2, 2010

To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.

JOURNAL ARTICLE

Patient Protection and Affordable Care Act: Laying the Infrastructure for National Health Reform — Jun 1, 2010

This article discusses the range of health information technology initiatives included in the 2009 economic stimulus legislation that collectively are known as the Health Information Technology for Economic and Clinical Health (HITECH) initiative; these include proposed regulations on

RESEARCH BRIEF

RAND COMPARE Analysis of President Obama’s Proposal for Health Reform — Mar 3, 2010

Compares President Obama’s Proposal for Health Reform, the U.S. House and Senate health care reform bills, and the status quo on changes in number of uninsured and government and national costs, as estimated by the RAND COMPARE microsimulation model.

RESEARCH BRIEF

Coverage, Spending, and Consumer Financial Risk: How Do the Recent House and Senate Health Care Bills Compare? — Feb 12, 2010

Compares how two health care reform bills, HR. 3962 and H.R. 3590, passed by the U.S. House and Senate, respectively, in late 2009 compare on a variety of projections made using the RAND COMPARE microsimulation model.

RESEARCH BRIEF

Analysis of the Patient Protection and Affordable Care Act (H.R. 3590) — Feb 11, 2010

Using the COMPARE microsimulation model, estimates the effects of the Patient Protection and Affordable Care Act (H.R. 3590) on the number of uninsured, the costs to the federal government and the nation, and consumers’ health care spending.

NEWS RELEASE

The Potential Impact of House Health Reform Legislation — Jan 8, 2010

Health reform as set forth in legislation passed by the U.S. House of Representatives in November would cut the number of uninsured Americans to 24 million by 2019 (a 56 percent decrease) and increase personal spending on health care by about 3.3 percent cumulatively between 2013 and 2019.

RESEARCH BRIEF

Analysis of the Affordable Health Care for America Act (H.R. 3962) — Jan 7, 2010

Using the COMPARE microsimulation model, estimates proposed health care reform legislation’s effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers’ health care spending.

JOURNAL ARTICLE

Bending the Curve Through Health Reform Implementation — Jan 1, 2010

Cost savings can be achieved while improving health care quality by speeding payment reforms, implementing insurance reforms, and reforming coverage.

JOURNAL ARTICLE

Could We Have Covered More People at Less Cost? Technically, Yes; Politically, Probably Not — Jan 1, 2010

Using the COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model, this study evaluated how the recently enacted health reform law performed compared with alternative designs on measures of effectiveness and efficiency and found that only a few different approaches would cover more individuals at a lower cost to the government; however, these appeared politically untenable because they included substantially higher penalties, lower subsidies, or less generous Medicaid expansion.

JOURNAL ARTICLE

The Science of Health Care Reform — Jun 17, 2009

Another health policy window has opened; through it will stream proposals to reform the US health care system. President Obama has demanded that reform proposals improve both coverage and quality of care and make health care more affordable for all Americans. Extending coverage without worrying about costs would be relatively easy. Improving quality of care without worrying about costs might also be achievable. But extending coverage and improving quality while also making coverage more affordable will be difficult.

PEOPLE

David I. Auerbach

Policy Researcher; Professor, Pardee RAND Graduate School
Ph.D. in health economics, Harvard University; M.S. in environmental science & policy, MIT; M.S. in chemistry, University of California, Berkeley; B.S. in chemistry, MIT

PEOPLE

Christine Eibner

Economist
Ph.D. in economics, University of Maryland, College Park

PEOPLE

Peter S. Hussey

Policy Researcher; Professor, Pardee RAND Graduate School
Ph.D. in health policy and management, Johns Hopkins Bloomberg School of Public Health

PEOPLE

Sarah A. Nowak

Associate Physical Scientist; Professor, Pardee RAND Graduate School
Ph.D. and M.S. in biomathematics, University of California, Los Angeles; B.S. in physics, MIT

PEOPLE

Jeanne S. Ringel

Director, Public Health Systems and Preparedness Initiative, RAND Health; Senior Economist; Professor, Pardee RAND Graduate School
Ph.D. in economics, University of Maryland, College Park; M.A. in economics, University of Maryland, College Park

PEOPLE

Kristin R. Van Busum

Project Associate, Behavioral & Policy Sciences
M.P.A. in health policy analysis, New York University; B.A., Butler University

SOURCE

http://www.rand.org/topics/patient-protection-and-affordable-care-act.all.0.html

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Curation, HealthCare System in the US, and Calcium Signaling Effects on Cardiac Contraction, Heart Failure, and Atrial Fibrillation, and the Relationship of Calcium Release at the Myoneural Junction to Beta Adrenergic Release


Curation, HealthCare System in the US, and Calcium Signaling Effects on Cardiac Contraction, Heart Failure, and Atrial Fibrillation, and the Relationship of Calcium Release at the Myoneural Junction to Beta Adrenergic Release

Curator and e-book Contributor: Larry H. Bernstein, MD, FCAP
Curator and BioMedicine e-Series Editor-in-Chief: Aviva Lev Ari, PhD, RN

and 

Content Consultant to Six-Volume e-SERIES A: Cardiovascular Diseases: Justin Pearlman, MD, PhD, FACC

This portion summarises what we have covered and is now familiar to the reader.  There are three related topics, and an extension of this embraces other volumes and chapters before and after this reading.  This approach to the document has advantages over the multiple authored textbooks that are and have been pervasive as a result of the traditional publication technology.  It has been stated by the founder of ScoopIt, that amount of time involved is considerably less than required for the original publications used, but the organization and construction is a separate creative process.  In these curations we amassed on average five articles in one curation, to which, two or three curators contributed their views.  There were surprises, and there were unfulfilled answers along the way.  The greatest problem that is being envisioned is the building a vision that bridges and unmasks the hidden “dark matter” between the now declared “OMICS”, to get a more real perspective on what is conjecture and what is actionable.  This is in some respects unavoidable because the genome is an alphabet that is matched to the mino acid sequences of proteins, which themselves are three dimensional drivers of sequences of metabolic reactions that can be altered by the accumulation of substrates in critical placements, and in addition, the proteome has functional proteins whose activity is a regulatory function and not easily identified.  In the end, we have to have a practical conception, recognizing the breadth of evolutionary change, and make sense of what we have, while searching for more.

We introduced the content as follows:

1. We introduce the concept of curation in the digital context, and it’s application to medicine and related scientific discovery.

Topics were chosen were used to illustrate this process in the form of a pattern, which is mostly curation, but is significantly creative, as it emerges in the context of this e-book.

  • Alternative solutions in Treatment of Heart Failure (HF), medical devices, biomarkers and agent efficacy is handled all in one chapter.
  • PCI for valves vs Open heart Valve replacement
  • PDA and Complications of Surgery — only curation could create the picture of this unique combination of debate, as exemplified of Endarterectomy (CEA) vs Stenting the Carotid Artery (CAS), ischemic leg, renal artery stenosis.

2. The etiology, or causes, of cardiovascular diseases consist of mechanistic explanations for dysfunction relating to the heart or vascular system. Every one of a long list of abnormalities has a path that explains the deviation from normal. With the completion of the analysis of the human genome, in principle all of the genetic basis for function and dysfunction are delineated. While all genes are identified, and the genes code for all the gene products that constitute body functions, there remains more unknown than known.

3. Human genome, and in combination with improved imaging methods, genomics offers great promise in changing the course of disease and aging.

4. If we tie together Part 1 and Part 2, there is ample room for considering clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.

Curation

Curation is an active filtering of the web’s  and peer reviewed literature found by such means – immense amount of relevant and irrelevant content. As a result content may be disruptive. However, in doing good curation, one does more than simply assign value by presentation of creative work in any category. Great curators comment and share experience across content, authors and themes.
Great curators may see patterns others don’t, or may challenge or debate complex and apparently conflicting points of view.  Answers to specifically focused questions comes from the hard work of many in laboratory settings creatively establishing answers to definitive questions, each a part of the larger knowledge-base of reference. There are those rare “Einstein’s” who imagine a whole universe, unlike the three blindmen of the Sufi tale.  One held the tail, the other the trunk, the other the ear, and they all said this is an elephant!
In my reading, I learn that the optimal ratio of curation to creation may be as high as 90% curation to 10% creation. Creating content is expensive. Curation, by comparison, is much less expensive.  The same source says “Scoop.it is my content marketing testing “sandbox”. In sharing, he says that comments provide the framework for what and how content is shared.

Healthcare and Affordable Care Act

We enter year 2014 with the Affordable Care Act off to a slow start because of the implementation of the internet signup requiring a major repair, which is, unfortunately, as expected for such as complex job across the US, and with many states unwilling to participate.  But several states – California, Connecticut, and Kentucky – had very effective state designed signups, separate from the federal system.  There has been a very large rush and an extension to sign up. There are many features that we can take note of:

1. The healthcare system needed changes because we have the most costly system, are endowed with advanced technology, and we have inexcusable outcomes in several domains of care, including, infant mortality, and prenatal care – but not in cardiology.

2. These changes that are notable are:

  • The disparities in outcome are magnified by a large disparity in highest to lowest income bracket.
  • This is also reflected in educational status, and which plays out in childhood school lunches, and is also affected by larger class size and cutbacks in school programs.
  • This is not  helped by a large paralysis in the two party political system and the three legs of government unable to deal with work and distraction.
  • Unemployment is high, and the banking and home construction, home buying, and rental are in realignment, but interest rates are problematic.

3.  The  medical care system is affected by the issues above, but the complexity is not to be discounted.

  •  The medical schools are unable at this time to provide the influx of new physicians needed, so we depend on a major influx of physicians from other countries
  • The technology for laboratories, proteomic and genomic as well as applied medical research is rejuvenating the practice in cardiology more rapidly than any other field.
  • In fields that are imaging related the life cycle of instruments is shorter than the actual lifetime use of the instruments, which introduces a shortening of ROI.
  • Hospitals are consolidating into large consortia in order to maintain a more viable system for referral of specialty cases, and also is centralizing all terms of business related to billing.
  • There is reduction in independent physician practices that are being incorporated into the hospital enterprise with Part B billing under the Physician Organization – as in Partners in Greater Boston, with the exception of “concierge” medical practices.
  • There is consolidation of specialty laboratory services within state, with only the most specialized testing going out of state (Quest, LabCorp, etc.)
  • Medicaid is expanded substantially under the new ACA.
  • The federal government as provider of services is reducing the number of contractors for – medical devices, diabetes self-testing, etc.
  • The current rearrangements seeks to provide a balance between capital expenses and fixed labor costs that it can control, reduce variable costs (reagents, pharmaceutical), and to take in more patients with less delay and better performance – defined by outside agencies.

Cardiology, Genomics, and calcium ion signaling and ion-channels in cardiomyocyte function in health and disease – including heart failure, rhythm abnormalities, and the myoneural release of neurotransmitter at the vesicle junction.

This portion is outlined as follows:

2.1 Human Genome: Congenital Etiological Sources of Cardiovascular Disease

2.2 The Role of Calcium in Health and Disease

2.3 Vasculature and Myocardium: Diagnosing the Conditions of Disease

Genomics & Genetics of Cardiovascular Disease Diagnoses

actin cytoskeleton

wall stress, ventricular workload, contractile reserve

Genetic Base of Atherosclerosis and Loss of Arterial Elasticity with Aging

calcium and actin skeleton, signaling, cell motility

hypertension & vascular compliance

Genetics of Conduction Disease

Ca+ stimulated exostosis: calmodulin & PKC (neurotransmitter)

complications & MVR

disruption of Ca2+ homeostasis cardiac & vascular smooth muscle

synaptotagmin as Ca2+ sensor & vesicles

atherosclerosis & ion channels


It is increasingly clear that there are mutations that underlie many human diseases, and this is true of the cardiovascular system.  The mutations are mistakes in the insertion of a purine nucleotide, which may or may not have any consequence.  This is why the associations that are being discovered in research require careful validation, and even require demonstration in “models” before pursuing the design of pharmacological “target therapy”.  The genomics in cardiovascular disease involves very serious congenital disorders that are asserted early in life, but the effects of and development of atherosclerosis involving large and medium size arteries has a slow progression and is not dominated by genomic expression.  This is characterized by loss of arterial elasticity. In addition there is the development of heart failure, which involves the cardiomyocyte specifically.  The emergence of regenerative medical interventions, based on pleuripotent inducible stem cell therapy is developing rapidly as an intervention in this sector.

Finally, it is incumbent on me to call attention to the huge contribution that research on calcium (Ca2+) signaling has made toward the understanding of cardiac contraction and to the maintenance of the heart rhythm.  The heart is a syncytium, different than skeletal and smooth muscle, and the innervation is by the vagus nerve, which has terminal endings at vesicles which discharge at the myocyte junction.  The heart specifically has calmodulin kinase CaMK II, and it has been established that calmodulin is involved in the calcium spark that triggers contraction.  That is only part of the story.  Ion transport occurs into or out of the cell, the latter termed exostosis.  Exostosis involves CaMK II and pyruvate kinase (PKC), and they have independent roles.  This also involves K+-Na+-ATPase.  The cytoskeleton is also discussed, but the role of aquaporin in water transport appears elsewhere, as the transport of water between cells.  When we consider the Gibbs-Donnan equilibrium, which precedes the current work by a century, we recall that there is an essential balance between extracellular Na+ + Ca2+ and the intracellular K+ + Mg2+, and this has been superceded by an incompletely defined relationship between ions that are cytoplasmic and those that are mitochondrial.  The glass is half full!

 

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The Cost to Value Conundrum in Cardiovascular Healthcare Provision


The Cost to Value Conundrum in Cardiovascular Healthcare Provision

Author: Larry H. Bernstein, MD, FCAP

I write this introduction to Volume 2 of the e-series on Cardiovascular Diseases, which curates the basic structure and physiology of the heart, the vasculature, and related structures, e.g., the kidney, with respect to:

1. Pathogenesis
2. Diagnosis
3. Treatment

Curation is an introductory portion to Volume Two, which is necessary to introduce the methodological design used to create the following articles. More needs not to be discussed about the methodology, which will become clear, if only that the content curated is changing based on success or failure of both diagnostic and treatment technology availability, as well as the systems needed to support the ongoing advances.  Curation requires:

  • meaningful selection,
  • enrichment, and
  • sharing combining sources and
  • creation of new synnthesis

Curators have to create a new perspective or idea on top of the existing media which supports the content in the original. The curator has to select from the myriad upon myriad options available, to re-share and critically view the work. A search can be overwhelming in size of the output, but the curator has to successfully pluck the best material straight out of that noise.

Part 1 is a highly important treatment that is not technological, but about the system now outdated to support our healthcare system, the most technolog-ically advanced in the world, with major problems in the availability of care related to economic disparities.  It is not about technology, per se, but about how we allocate healthcare resources, about individuals’ roles in a not full list of lifestyle maintenance options for self-care, and about the important advances emerging out of the Affordable Care Act (ACA), impacting enormously on Medicaid, which depends on state-level acceptance, on community hospital, ambulatory, and home-care or hospice restructuring, which includes the reduction of management overhead by the formation of regional healthcare alliances, the incorporation of physicians into hospital-based practices (with the hospital collecting and distributing the Part B reimbursement to the physician, with “performance-based” targets for privileges and payment – essential to the success of an Accountable Care Organization (AC)).  One problem that ACA has definitively address is the elimination of the exclusion of patients based on preconditions.  One problem that has been left unresolved is the continuing existence of private policies that meet financial capabilities of the contract to provide, but which provide little value to the “purchaser” of care.  This is a holdout that persists in for-profit managed care as an option.  A physician response to the new system of care, largely fostered by a refusal to accept Medicaid, is the formation of direct physician-patient contracted care without an intermediary.

In this respect, the problem is not simple, but is resolvable.  A proposal for improved economic stability has been prepared by Edward Ingram. A concern for American families and businesses is substantially addressed in a macroeconomic design concept, so that financial services like housing, government, and business finance, savings and pensions, boosting confidence at every level giving everyone a better chance of success in planning their personal savings and lifetime and business finances.

http://macro-economic-design.blogspot.com/p/book.html

Part 2 is a collection of scientific articles on the current advances in cardiac care by the best trained physicians the world has known, with mastery of the most advanced vascular instrumentation for medical or surgical interventions, the latest diagnostic ultrasound and imaging tools that are becoming outdated before the useful lifetime of the capital investment has been completed.  If we tie together Part 1 and Part 2, there is ample room for considering  clinical outcomes based on individual and organizational factors for best performance. This can really only be realized with considerable improvement in information infrastructure, which has miles to go.  Why should this be?  Because for generations of IT support systems, they are historically focused on billing and have made insignificant inroads into the front-end needs of the clinical staff.

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