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The impact of the benefit on the poverty rate is calculated as the difference between the actual and the counterfactual poverty rates arthritis back cracking order trental line. We estimated how much higher the poverty rate would be if a program were eliminated but nothing else changed symptoms of arthritis in back of knee order 400 mg trental otc. This cumulative approach began by determining a poverty rate in the absence of all programs or transfers-that is arthritis in dogs licking buy trental 400 mg line, what the poverty rate would be based on private market income alone30-or the pretransfer poverty rate arthritis pain relief in knuckles purchase line trental. Public benefits were then added sequentially to private income, and the poverty rate was recalculated after each addition. Thus, the cumulative approach shows the incremental contribution of each program to the total poverty-reducing impact of government programs. Medicare, Social Security Disability Insurance, and Supplemental Security Income transfer large benefits to people with a disability. To focus on the general low-income population whose members do not receive these benefits, we mostly examined poverty rates for people in households with no recipients of disability payments. Poverty scholars measure the depth of poverty by the poverty gap, defined as the amount by which the resources of the poor fall below the poverty threshold. This is important because all transfer programs combined are not enough to remove some low-income households from poverty. Poverty gap accounting starts with the pretransfer poverty gap (the share of needs that is not met by private income) for people who would be poor in the absence of government transfers. The value of government programs is then added sequentially to resources to show the share of needs that each program meets. Consequently, the order in which benefits are added can influence estimates of their relative contributions to poverty reduction: Resources added later in the accounting process will have smaller effects on the gap than those added earlier. In contrast, order does not matter for the one-at-a-time approach to estimating the effect of a single program on the poverty rate. Employer-sponsored health insurance is considered private income, although it is subsidized by preferential tax treatment-resulting in $155 billion in federal tax expenditures annually. The health insurance need raises the poverty threshold by about $12,000 per household, on average, which represents nearly one-third of the overall healthinclusive poverty threshold. All else being equal, raising the poverty threshold increases the pretransfer poverty rate, while adding health insur- ance benefits to resources decreases the posttransfer rate. To obtain needed health care, insured people must pay for cost sharing, such as deductibles. The pretransfer poverty rate should show whether pretransfer income is sufficient to cover all needs: material (such as food and shelter), health insurance, and cost sharing. Therefore, for poverty gaps and cumulative rate accounting, we added cost-sharing needs to the threshold, instead of subtracting them from resources. Results for posttransfer poverty rates and one-at-a-time accounting would be mathematically identical whether we added cost-sharing needs to the thresholds or subtracted them from resources. First, we were unable to account for the direct impact of cost-sharing subsidies or richer Medicaid plans. Second, our methods did not incorporate behavioral responses to changes in social programs. For example, if Medicaid benefits or premium subsidies were cut, people might be more motivated to seek a job from an employer offering insurance, or employers might be more likely to offer insurance. Overall, the healthinclusive poverty rate was modestly higher than the supplemental and official poverty rates (16. Government Programs Exhibit 1 & Policies Health-inclusive poverty rates and impacts of health insurance and public benefits on those rates for people younger than age 65, by selected characteristics, 2014 Poverty rates Impacts of health insurance and public benefits from cumulative accounting (percentage points) Official poverty rated 15. Cumulative accounting examines how the health-inclusive poverty rate changes as categories of programs are added in turn. Impacts are differences between the health-inclusive poverty rate before and after adding each category of benefits to resources. Threshold includes costsharing needs (expenditures on care, capped at the applicable level). We show the results for the eligible uninsured, both crediting and not crediting them with subsidies.
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This symposium highlights the tailoring methods and outcome data from 3 health programs conducted in partnership with 3 different minority communities (American Muslims arthritis medication enbrel order trental now, Baptist African Americans arthritis medication that starts with l generic trental 400 mg with visa, and Native Hawaiians) arthritis in neck horse buy trental. The projects conducted with American Muslims and African Americians deployed religious tailoring methods to improve cancer screening and healthy eating arthritis pain at rest order trental, while the project with Native Hawaiians entailed cultural adaptation of a weight-loss program for the work setting. Throughout the presentations and in the subsequent discussant commentary the symposium will aim to highlight the cross-cutting nature of the projects and describe generalizable knowledge regarding community-engagement and program development. At the same time presenters will reflect on the critical questions emerging from their experiences about the theoretical bases and practice exercises of "tailoring" so as to spur further development in the field. A particular challenge in eliminating these obesity disparities is improving the maintenance of weight loss and creating costeffective interventions. Participants were recruited from the employees of 15 Native Hawaiian-serving organizations. Employees (n=166) completed the study with the majority being female, Native Hawaiians or other Pacific Islanders, and dollege educated. Measures included weight, height, blood pressure, dietary fat intake, physical activity frequency, and physical functioning. Results will present initial weight loss (baseline to 3-month assessment), weight loss maintenance (3-month to 12-month assessment), and overall predictors of weight loss at 12-month assessment. Moreover, early screening and identification in primary care, along with novel strategies for providing links to mental health services may reduce both the incidence and impact of mental health and behavioral concerns. However, current practices in clinical settings frequently neglect to identify at-risk youth or to provide services early in order to prevent psychosocial factors from interfering in care, health outcomes, and quality of life. In order to address this problem, psychologists and physicians working with a variety of illness populations have identified novel ways in which to identify youth at risk for psychosocial difficulties or at high risk for acquiring preventable illness by virtue of their behavior, and integrate treatment of psychological concerns as part of medical care. The current symposium will address first via a presentation by the chair, how psychosocial factors affect youth with chronic illness or increase risk for disease, and then present a variety of approaches for early identification, referral, and treatment across various populations. Specifically, the first presentation will describe the implementation of mental health screening tools for use by physicians in specialty care clinics such as sickle cell disease and food allergy. The second presentation will describe screening for the presence of neurological disorders amongst high-risk youth. Finally, the third presentation will describe methods for mental health screening in primary care settings, as well as an innovative system for linking high-risk youth with mental health services. Each presentation will highlight innovative strategies for implementing these screenings that could be translated into other settings or across a variety of populations, as well as challenges and directions for future research and clinical efforts. Methods: Interview data from women aged 40 and older sampled from organizations that cater to African American, Arab and S. Asian Muslims was used to map out where religious beliefs and values impact salient behavioral, normative and control beliefs regarding mammography. In concert with a multi-disciplinary and multi-sectoral advisory board, each belief was assessed with regards to the opportunity for religiously tailoring and potential messages discussed. Results: 50 women participated in focus group discussions and 19 in semistructured individual interviews. The majority of salient beliefs, both barriers and facilitators, were amenable to religious tailoring. In general, and in coherence with the Theory of Planned Behavior, religion-related barrier beliefs were addressed by (i) introducing another religious belief that may have greater resonance with participants, (ii) reframing the belief such that it is consistent with the health behavior desired, and (iii) using a religious scholar to "invalidate" the belief. For example, beliefs about physical pain related to mammography (a barrier) was reframed to suggest that related to good deeds are rewarded by God. Similarly, fatalistic notions about health were addressed by discussions of the orthodox and heterodox doctrines of determinism. Discussion: While there is much potential to leveraging religion to promote beliefs that are health promoting and are consonant with religious theology, there also is an opportunity to co-opt religious teachings and religious authorities in the service of health and medicine. As health behavior interventions move from being faith-placed to faith-based, there is great need for conversation about theoretical bases and practical aspects of delivering messages that are embedded within a religious worldview and the ethics of doing so. In the full sample, most patients were African-American (55%), followed by Caucasian (23%) and African (10%). Hardy, PhD Background: Despite decades of research, we do not fully understand the nature of neuropsychological deficits associated with many medical conditions, their relation to disease or treatment variables, when they develop, and how they evolve over time. This has limited our ability to develop appropriate treatments to prevent or mitigate cognitive difficulties in these vulnerable populations. Innovative methods of monitoring neuropsychological functioning over time are critically needed in order to improve psychosocial outcomes. Methods/Results: Based on public health and clinical-decision making approaches to care, we developed a model of neuropsychological evaluation that provides a risk-adapted level of assessment to individuals with medical conditions known to impact the central nervous system.
By demonstrating that transportation barriers lead to missed appointments arthritis paleolithic diet order trental 400 mg, poorer medication adherence arthritis diet gluten free cheap trental 400mg without prescription, and thus poorer diabetes or blood pressure control arthritis in knee support purchase trental with american express, transportation barriers could be more strongly linked to health access and outcomes arthritis in back home remedies buy trental on line amex. Conclusion Transportation barriers to health care access are common, and greater for vulnerable populations. The studies reviewed may help guide both the design of interventions that address transportation barriers and the choice of measures used in assessing their effectiveness. Future studies should focus on both the details that make transportation a barrier. Such studies would help clarify both the impact of transportation barriers and the types of transportation interventions needed. Millions of Americans face transportation barriers to health care access, and addressing these barriers may help transport them to improved health care access and a better chance at improved health . Shannon Zenk and Kathy Korytkowski for their editing and support in the preparation of this manuscript. Studies with an exclusive focus on screening, prevention, and prenatal and pregnancy care were not evaluated and may have different findings. A majority of the studies used cross-sectional designs thus making cause and effect conclusions difficult (Table 1). The diversity of demographic, geographic, social variables, and outcome measures also make study-to-study comparisons difficult. Efforts to generate a valid measure of transportation barriers for consistent measurement may help to perform future meta-analyses across studies. Prospective studies of local changes in transportation options may also help contribute to the evidence, and although randomized trials would help isolate the impact of transportation interventions they would be impractical to execute . Healthcare barriers among severely mentally ill homeless adults: Evidence from the five-site health and risk study. Listening to rural hispanic immigrants in the midwest: A community-based participatory assessment of major barriers to health care access and use. Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Perceived barriers to health care access among rural older adults: A qualitative study. Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation Health services access and use among older adults in North Carolina: Urban vs rural residents. Reported difficulties in access to quality care for children with asthma in the inner city. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. Healthcare disparities for American Indian veterans in the United States: A population-based study. Practical barriers to timely primary care access: Impact on adult use of emergency department services. Cross-disability experiences of barriers to health care access: Consumer perspectives. Barriers and bridges to care: Voices of homeless female adolescent youth in Seattle, Washington. Rural residents with disabilities confront substantial barriers to obtaining primary care. Inpatient to outpatient transfer of diabetes care: Perceptions of barriers to postdischarge followup in urban African American patients. Access to care for children of migratory agricultural workers: Factors associated with unmet need for medical care.