Research Roundup: PTSD And Vietnam Vets; Kids’ Use Of Antipsychotic Drugs; Calif.’s Elder Poor
Each week, KHN compiles a selection of recently released health policy studies and briefs.
JAMA Psychiatry:
Course Of Posttraumatic Stress Disorder 40 Years After The Vietnam War
The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). ... Approximately 271 000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms. (Marmar et al., Sept., 2015)
JAMA Psychiatry:
Treatment Of Young People With Antipsychotic Medications In The United States
[Researchers sought to] describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex .... The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence .... Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms. (Olfson, King and Schoenbaum, 9/3)
UCLA Center for Health Policy Research:
More Than Three-Quarters Of A Million Older Californians Are “Unofficially” Poor
More than three-quarters of a million (772,000) older Californians are among the “hidden poor” – older adults with incomes above the federal poverty line (FPL) but below a minimally decent standard of living as determined by the Elder Economic Security Standard Index (Elder Index) in 2011. ... This study finds that the FPL significantly underestimates the number of economically insecure older adults who are unable to make ends meet. Yet, because many public assistance programs are aligned with the FPL, potentially hundreds of thousands of economically insecure older Californians are denied aid. The highest rates of the hidden poor among older adults are found among renters, Latinos, women, those who are raising grandchildren, and people in the oldest age groups. (Padilla-Frausto and Wallace, 8/31)
The Kaiser Family Foundation/Rockefeller Institute of Government:
Economic And Fiscal Trends In Expansion And Non-Expansion States: What We Know Leading Up To 2014
The effects of the Medicaid expansion on state budgets and economies have been key issues for policy makers. This brief ... is designed to provide some insight into the underlying economic and fiscal conditions in [Medicaid] expansion and non-expansion states leading up to 2014. ... Key findings include: The typical expansion state was in a better position across the factors analyzed leading up to the ACA Medicaid expansion in 2014. Median poverty and uninsured rates were higher in non-expansion states. ... Median tax collections per capita have historically been higher in expansion states. ... The typical expansion state spent more per capita on Medicaid and K-12 education prior to the major ACA coverage expansions. (Synder et al., 9/1)
Rand Corp.:
Behavioral Health And Service Use Among Civilian Wives Of Service Members And Veterans
[R]esearchers analyzed the National Study of Drug Use and Health to examine utilization of behavioral health care among current or former wives of service members and veterans who are covered by either TRICARE or CHAMP-VA. Three findings of interest emerged .... First, relative to the comparison group, military wives were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. Third, contrary to expectations, military wives who live more than 30 minutes from a military treatment facility were more likely than military wives who lived closer to receive prescription psychiatric medications but not other types of behavioral health services. (Breslau and Brown, 8/24)
Commonwealth Fund:
How Strong Is The Primary Care Safety Net? Assessing The Ability Of Federally Qualified Health Centers To Serve As Patient-Centered Medical Homes
[T]he Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. (Ryan et al., 9/3)
Health and Human Services Office of the Inspector General:
HHS Oversight of Grantees Could Be Improved Through Better Information Sharing
The Department of Health and Human Services (HHS) is the largest grantmaking agency in the Federal Government. In fiscal year 2014, HHS awarded nearly $402 billion in grants. ... Awarding agencies' grant officials use various sources of information and communication to mitigate grantee risks; however, grant officials noted limitations in some instances. For example, information available in databases assists staff from awarding agencies in managing grantee risks, but lack of integration poses challenges. NEARC memorandums contain important information about grantee risks, but not all awarding agencies receive them. Awarding agencies lack a systematic method of sharing information about grantee risks, and sharing occurs infrequently. (Murrin, 9/2)
Here is a selection of news coverage of other recent research:
Reuters:
Religion Rarely Part Of ICU Conversation
In less than 20 percent of family meetings in the intensive care unit do doctors and other health care providers discuss religion or spirituality a new study finds. For many patients and families, religion and spirituality are important near the end of life, and understanding these beliefs may be “important to delivering care that is respectful of the patient as an individual,” said senior author Dr. Douglas B. White of the University of Pittsburgh School of Medicine, in email to Reuters Health. (Doyle, 8/31)
Medscape:
Ryan White-Funded HIV Programs Offer More Complete Services
Low-income patients with HIV who received care at a facility funded by the Ryan White HIV/AIDS Program (RWHAP) were more likely to achieve viral suppression than those at non-RWHAP-funded facilities, according to a new study. RWHAP-funded facilities were also more likely than others to provide services such as case management and mental health and addiction services. John Weiser, MD, MPH, from the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues report their findings online August 31 in JAMA Internal Medicine. (Frellick, 9/2)
The Associated Press:
A Racial Gap In Kidney Transplants Closes But Work Remains
A racial gap in kidney transplants appears to have closed, a 13-year study found. Rates of such transplants among white patients used to far surpass those in blacks, but U.S. data on nearly 200,000 end-stage kidney disease patients shows that disparity had disappeared by 2010. Rates remained stable in 2011 and that trend likely has continued, said Dr. Jesse Sammon, the senior author and a urologist-researcher at the Henry Ford Health System in Detroit. (Tanner, 8/31)
Reuters:
Kidney Recipients, Donors Want Info About Each Other’s Health
Living kidney donors and their recipients would like to share more health information before the transplant surgery, a new survey indicates. Currently, patients must be informed if they’re at risk for acquiring hepatitis or HIV from a donor organ, researchers write in the Clinical Journal of the American Society of Nephrology. Beyond that, transplant professionals cannot share information without the permission of both parties, senior author Dr. Lainie Friedman Ross of the MacLean Center for Clinical Medical Ethics at the University of Chicago told Reuters Health by email. (Doyle, 9/2)
The New York Times:
Supplements Don’t Fight Cognitive Decline, N.I.H. Study Says
Omega-3 fatty acids and antioxidants are often marketed to promote brain health. But one study to test these supplements has found no evidence that the pills stave off cognitive decline in older people. (Rabin, 8/31)
CNN:
Survey: Mental Health Stigmas Are Shifting
Mental health has a long-standing public perception problem, but the stigma appears to be shifting, at least in the United States, a new survey reveals. Results from a national online survey on mental health, anxiety and suicide indicate that 90% of Americans value mental and physical health equally. (Ansari, 9/1)
Reuters:
Activity Trackers Vary In Accuracy
Wrist-worn activity trackers, increasingly popular among consumers and in healthcare research, can vary considerably in their accuracy, a study from Iowa State University suggests. Researchers pitted consumer devices against a gold-standard metabolic monitor and found the wristbands are more accurate for calories burned while resting or jogging, but have higher error rates for activities like weight lifting and crunches. (Kennedy, 9/1)
MedPage Today:
AAP: Screen Children For Binge Drinking Early And Often
With rates of binge drinking increasing, the American Academy of Pediatrics recommends that physicians screen children as young as 9 years of age for alcohol abuse, according to the most recent clinical report on the subject. Lorena Siqueira, MD, of the AAP Committee on Substance Abuse, and colleagues cited survey results that indicate children start to think positively about alcohol between ages 9 and 13. They also found that almost 15% of children 14 to 20 years old, including almost 5% (4.5%) of 14- and 15-year-olds reported binge drinking (defined as ≥3 to ≥5 drinks on one occasion, depending on age and sex). (Walker, 9/1)
Reuters:
New Guidelines For Cancer Doctors Aim To Make Sense Of Gene Tests
The American Society of Clinical Oncology (ASCO) has issued guidelines on how cancer doctors should approach the use of new genetic tests that screen for multiple cancer genes at the same time, including counseling patients about genes whose contribution to cancer is still poorly understood. The guidelines aim to educate doctors about the risks and benefits of new genetic tests, argue for regulation to assure quality and call for more equitable reimbursement of the cost of the tests from private and public insurers. (Steenhuysen, 8/31)