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Watch: In Emergencies, First Comes the Ambulance. Then Comes the Bill.

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Caresse Jackman, InvestigateTV
Wed, 13 Sep 2023 09:00:00 +0000

When her 9-year-old daughter was trouble breathing, Yvette Hammonds took her to a local emergency room. It quickly became clear that girl needed to be transferred to the 's hospital about 40 minutes away in Atlanta, so her daughter was loaded into an ambulance.

Months later, Hammonds received a bill for nearly $1,000: the cost of the ground ambulance ride from one in-network hospital to another.

In this installment of InvestigateTV and KFF ' “Costly Care” , Caresse Jackman, InvestigateTV's national consumer investigative reporter, probes the lack of cost protections for who find themselves needing an ambulance ride to care.

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Jackman's story features an interview with Elisabeth Rosenthal, KFF Health News' senior contributing editor. “When you need an ambulance, you need an ambulance,” Rosenthal said. “And that's the worst time in your to be a consumer, when you have no choice.”

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By: Caresse Jackman, InvestigateTV
Title: Watch: In Emergencies, First the Ambulance. Then Comes the Bill.
Sourced From: kffhealthnews.org/news/article/ground-ambulance-bill-atlanta-investigatetv-costly-care/
Published Date: Wed, 13 Sep 2023 09:00:00 +0000

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Older Women Are Different Than Older Men. Their Health Is Woefully Understudied.

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Judith Graham
Tue, 18 Jun 2024 09:00:00 +0000

Medical research has shortchanged women for decades. This is particularly true of older women, leaving physicians without critically important information about how to best manage their health.

Late last year, the Biden administration promised to address this problem with a new effort called the White House Initiative on Women's Health Research. That inspires a compelling question: What priorities should be on the initiative's list when it to older women?

Stephanie Faubion, director of the Mayo Clinic's Center for Women's Health, launched into a critique when I asked about the current of research on older women's health. “It's completely inadequate,” she told me.

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One example: Many widely prescribed to older adults, including statins for high cholesterol, were studied mostly in , with results extrapolated to women.

“It's assumed that women's biology doesn't matter and that women who are premenopausal and those who are postmenopausal respond similarly,” Faubion said.

“This has got to stop: The FDA has to require that clinical trial data be reported by sex and age for us to tell if drugs work the same, better, or not as well in women,” Faubion insisted.

Consider the Alzheimer's drug Leqembi, approved by the FDA last year after the manufacturer reported a 27% slower rate of cognitive decline in people who took the medication. A supplementary appendix to a Leqembi study published in the New England Journal of Medicine revealed that sex differences were substantial — a 12% slowdown for women, with a 43% slowdown for men — raising questions about the drug's effectiveness for women.

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This is especially important because nearly two-thirds of older adults with Alzheimer's disease are women. Older women are also more likely than older men to have multiple medical conditions, disabilities, difficulties with activities, autoimmune illness, depression and anxiety, uncontrolled high blood pressure, and osteoarthritis, among other issues, according to scores of research studies.

Even so, women are resilient and outlive men by more than five years in the U.S. As people move into their 70s and 80s, women outnumber men by significant margins. If we're concerned about the health of the older population, we need to be concerned about the health of older women.

As for research priorities, here's some of what physicians and medical researchers suggested:

Heart Disease

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Why is it that women with heart disease, which becomes far more common after menopause and kills more women than any other — are given less recommended care than men?

“We're notably less aggressive in treating women,” said Martha Gulati, director of preventive cardiology and associate director of the Barbra Streisand Women's Heart Center at Cedars-Sinai, a health system in Los Angeles. “We delay evaluations for chest pain. We don't give blood thinners at the same rate. We don't do procedures like aortic valve replacements as often. We're not adequately addressing hypertension.

“We need to figure out why these biases in care exist and how to remove them.”

Gulati also noted that older women are less likely than their male peers to have obstructive coronary artery disease — blockages in large blood vessels —and more likely to have damage to smaller blood vessels that remains undetected. When they get procedures such as cardiac catheterizations, women have more bleeding and complications.

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What are the best treatments for older women given these issues? “We have very limited data. This needs to be a focus,” Gulati said.

Brain Health

How can women reduce their risk of cognitive decline and dementia as they age?

“This is an area where we really need to have clear messages for women and effective interventions that are feasible and accessible,” said JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women's Hospital in Boston and a key researcher for the Women's Health Initiative, the largest study of women's health in the U.S.

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Numerous factors affect women's brain health, including stress — dealing with sexism, caregiving responsibilities, and financial strain — which can fuel inflammation. Women experience the loss of estrogen, a hormone important to brain health, with menopause. They also have a higher incidence of conditions with serious impacts on the brain, such as multiple sclerosis and stroke.

“Alzheimer's disease doesn't just start at the age of 75 or 80,” said Gillian Einstein, the Wilfred and Joyce Posluns Chair in Women's Brain Health and Aging at the University of Toronto. “Let's take a course approach and try to understand how what happens earlier in women's lives predisposes them to Alzheimer's.”

Mental Health

What accounts for older women's greater vulnerability to anxiety and depression?

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Studies suggest a variety of factors, including hormonal changes and the cumulative impact of stress. In the journal Nature Aging, Paula Rochon, a professor of geriatrics at the University of Toronto, also faulted “gendered ageism,” an unfortunate combination of ageism and sexism, which renders older women “largely invisible,” in an interview in Nature Aging.

Helen Lavretsky, a professor of psychiatry at UCLA and past president of the American Association for Geriatric Psychiatry, suggests several topics that need further investigation. How does the menopausal transition impact mood and stress-related disorders? What nonpharmaceutical interventions can promote psychological resilience in older women and help them recover from stress and trauma? (Think yoga, meditation, music therapy, tai chi, sleep therapy, and other possibilities.) What combination of interventions is likely to be most effective?

Cancer

How can cancer screening recommendations and cancer treatments for older women be improved?

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Supriya Gupta Mohile, director of the Geriatric Oncology Research Group at the Wilmot Cancer Institute at the University of Rochester, wants better guidance about breast cancer screening for older women, broken down by health status. Currently, women 75 and older are lumped together even though some are remarkably healthy and others notably frail.

Recently, the U. S. Preventive Services Task Force noted “the current evidence is insufficient to assess the balance of and harms of screening mammography in women 75 years or older,” leaving physicians without clear guidance. “Right now, I think we're underscreening fit older women and overscreening frail older women,” Mohile said.

The doctor also wants more research about effective and safe treatments for lung cancer in older women, many of whom have multiple medical conditions and functional impairments. The age-sensitive condition kills more women than breast cancer.

“For this population, it's decisions about who can tolerate treatment based on health status and whether there are sex differences in tolerability for older men and women that need investigation,” Mohile said.

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Bone Health, Functional Health, and Frailty

How can older women maintain mobility and preserve their ability to take care of themselves?

Osteoporosis, which causes bones to weaken and become brittle, is more common in older women than in older men, increasing the risk of dangerous fractures and falls. Once again, the loss of estrogen with menopause is implicated.

“This is hugely important to older women's quality of life and longevity, but it's an overlooked area that is understudied,” said Manson of Brigham and Women's.

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Jane Cauley, a distinguished professor at the University of Pittsburgh School of Public Health who studies bone health, would like to see more data about osteoporosis among older Black, Asian, and Hispanic women, who are undertreated for the condition. She would also like to see better drugs with fewer side effects.

Marcia Stefanick, a professor of medicine at Stanford University School of Medicine, wants to know which strategies are most likely to motivate older women to be physically active. And she'd like more studies investigating how older women can best preserve muscle mass, strength, and the ability to care for themselves.

“Frailty is one of the biggest problems for older women, and learning what can be done to prevent that is essential,” she said.

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By: Judith Graham
Title: Older Women Are Different Than Older Men. Their Health Is Woefully Understudied.
Sourced From: kffhealthnews.org//article/older-women-understudied-health-needs-longevity/
Published Date: Tue, 18 Jun 2024 09:00:00 +0000

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¿Cómo Se Dice? California Loops In AI To Translate Health Care Information

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Paula Andalo
Tue, 18 Jun 2024 09:00:00 +0000

Tener gripe, tener gripa, engriparse, agriparse, estar agripado, estar griposo, agarrar la gripe, coger la influenza. In Spanish, there are at least a dozen ways to say someone has the flu — depending on the country.

Translating “cardiac arrest” into Spanish is also tricky because “arresto” means getting detained by the police. Likewise, “intoxicado” means you have food poisoning, not that you're drunk.

The examples of how translation could go awry in any language are endless: Words take on new meanings, idioms come and go, and communities adopt slang and dialects for everyday .

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Human translators work hard to keep up with the changes, but California plans to soon entrust that responsibility to technology.

State policy want to harness emerging artificial intelligence technology to translate a broad swath of documents and websites related to “health and social services information, programs, benefits and services,” according to state records. Sami Gallegos, a spokesperson for California's Health and Human Services Agency, declined to elaborate on which documents and languages would be involved, saying that information is “confidential.”

The agency is seeking bids from IT firms for the ambitious initiative, though its timing and cost is not yet clear. Human editors supervising the will oversee and edit the translations, Gallegos said.

Agency officials said they hope to save money and make critical health care forms, applications, websites, and other information available to more people in what they call the nation's most linguistically diverse state.

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The project will start by translating written material. Agency Secretary Mark Ghaly said the technology, if successful, may be applied more broadly.

“How can we potentially not just transform all of our documents, but our websites, our ability to interact, even some of our call center inputs, around AI?” Ghaly asked during an April briefing on AI in health care in Sacramento.

But some translators and scholars fear the technology lacks the nuance of human interaction and isn't ready for the . Turning this sensitive work over to machines could create errors in wording and understanding, they say — ultimately making information less accurate and less accessible to .

“AI cannot replace human compassion, empathy, and transparency, meaningful gestures and tones,” said Rithy Lim, a Fresno-based medical and legal interpreter for 30 years who specializes in Khmer, the main language of Cambodia.

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Artificial intelligence is the science of designing computers that emulate human thinking by reasoning, problem-solving, and understanding language. A type of artificial intelligence known as generative AI, or GenAI, in which computers are trained using massive amounts of data to “learn” the meaning of things and respond to prompts, is driving a wave of investment, led by such companies as Open AI and Google.

AI is quickly being integrated into health care, including programs that diagnose diabetic retinopathy, analyze mammograms, and connect patients with nurses remotely. Promotors of the technology often make the grandiose claim that soon everyone will have their own “AI doctor.”

AI also has been a changer in translation. ChatGPT, Google's Neural Machine Translation, and Open Source are not only faster than older technologies such as Google Translate, but they can huge volumes of content and draw upon a vast database of words to nearly mimic human translation.

Whereas a professional human translator might need three hours to translate a 1,600-word document, AI can do it in a minute.

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Arjun “Raj” Manrai, an assistant professor of biomedical informatics at Harvard Medical School and the deputy editor of New England Journal of Medicine AI, said the use of AI technology represents a natural progression in medical translation, given that patients already use Google Translate and AI platforms to translate for themselves and their loved ones.

“Patients are not waiting,” he said.

He said GenAI could be particularly useful in this context.

These translations “can deliver real value to patients by simplifying complex medical information and making it more accessible,” he said.

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In its bidding documents, the state says the goal of the project is to increase “speed, efficiency, and consistency of translations, and generate improvements in language access” in a state where 1 in 3 people speak a language other than English, and more than 200 languages are spoken.

In May 2023, the state Health and Human Services Agency adopted a “language access policy” that requires its departments to translate all “vital” documents into at least the top five languages spoken by Californians with limited English proficiency. At the time, those languages were Spanish, Chinese, Tagalog, Vietnamese, and Korean.

Examples of vital documents include application forms for state programs, notices about eligibility for benefits, and public website content.

Currently, human translators produce these translations. With AI, more documents could be translated into more languages.

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A survey conducted by the California Health Care Foundation late last year found that 30% of Spanish speakers have difficulty explaining their health issues and concerns to a doctor, with 16% of English speakers.

Health equity advocates say AI will help close that gap.

“This technology is a very powerful tool in the area of language access,” said Sandra R. Hernández, president and CEO of the foundation. “In good hands, it has many opportunities to expand the translation capability to address inequities.”

But Hernández cautioned that AI translations must have human oversight to truly capture meaning.

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“The human interface is very important to make sure you get the accuracy and the cultural nuances reflected,” she said.

Lim recalled an instance in which a patient's daughter read preoperative instructions to her mother the night before surgery. Instead of translating the instructions as “you cannot eat” after a certain hour, she told her mom, “You should not eat.”

The mother ate breakfast, and the surgery had to be rescheduled.

“Even a few words that change meaning could have a drastic impact on the way people consume the information,” said Sejin Paik, a doctoral candidate in digital journalism, human-computer interaction, and emerging media at Boston University.

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Paik, who grew up speaking Korean, also pointed out that AI models are often trained from a Western point of view. The data that drives the translations filters languages through an English perspective, “which could result in misinterpretations of the other language,” she said. Amid this fast-changing landscape, “we need more diverse voices involved, more people thinking about the ethical concepts, how we best the impact of this technology.”

Manrai pointed to other flaws in this nascent technology that must be addressed. For instance, AI sometimes invents sentences or phrases that are not in the original text, potentially creating false information — a phenomenon AI scientists call “hallucination” or “confabulation.”

Ching Wong, executive director of the Vietnamese Community Health Promotion Project at the University of California-San Francisco, has been translating health content from English into Vietnamese and Chinese for 30 years.

He provided examples of nuances in language that might confuse AI translation programs. Breast cancer, for instance, is called “chest cancer” in Chinese, he said.

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And “you” has different meanings in Vietnamese, depending on a person's ranking in the family and community. If a doctor uses “you” incorrectly with a patient, it could be offensive, Wong said.

But Ghaly emphasized that the opportunities outweigh the drawbacks. He said the state should “cultivate innovation” to help vulnerable populations gain greater access to care and resources.

And he was clear: “We will not replace humans.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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By: Paula Andalo
Title: ¿Cómo Se Dice? California Loops In AI To Translate Health Care Information
Sourced From: kffhealthnews.org/news/article/california-artificial-intelligence-translate-health-information-language/
Published Date: Tue, 18 Jun 2024 09:00:00 +0000

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Americans With HIV Are Living Longer. Federal Spending Isn’t Keeping Up.

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Sam Whitehead
Mon, 17 Jun 2024 09:00:00 +0000

DECATUR, Ga. — Malcolm Reid recently marked the anniversary of his HIV diagnosis on Facebook. “Diagnosed with HIV 28 years ago, AND TODAY I THRIVE,” he wrote in a post in April, which garnered dozens of responses.

Reid, an advocate for people with HIV, said he's happy he made it to age 66. But growing older has come with a host of health issues. He survived kidney cancer and currently juggles medications to treat HIV, high blood pressure, and Type 2 diabetes. “It's a lot to manage,” he said.

But Reid's not complaining. When he was diagnosed, HIV was sometimes a death sentence. “I'm just happy to be here,” Reid said. “You weren't supposed to be here, and you're here.”

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More than half of the people living with HIV in the United States are, like Reid, older than 50. Researchers estimate that 70% of people living with the virus will fall in that age range by 2030. Aging with HIV means an increased risk of other problems, such as diabetes, depression, and heart disease, and a greater chance of developing these conditions at a younger age.

Yet the U.S. health care system isn't prepared to handle the needs of the more than half a million people — those already infected and those newly infected with HIV — who are 50 or older, say HIV advocates, doctors, officials, people living with HIV, and researchers.

They worry that constraints, an increasingly dysfunctional Congress, holes in the social safety net, untrained providers, and workforce shortages leave people aging with HIV vulnerable to poorer health, which could undermine the larger fight against the virus.

“I think we're at a tipping point,” said Melanie Thompson, an Atlanta internal medicine doctor who specializes in HIV care and prevention. “It would be very easy to lose the substantial amount of the progress we have made.”

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People are living longer with the virus due in part to the of antiretroviral therapies — drugs that reduce the amount of virus in the body.

But aging with HIV with a greater risk of health problems related to inflammation from the virus and the long-term use of harsh medications. Older people often must coordinate care across specialists and are frequently on multiple prescriptions, increasing their risk for adverse drug reactions.

Some people face what researchers call the “dual stigma” of ageism and anti-HIV bias. They also have high rates of anxiety, depression, and substance use disorders.

Many have lost friends and family to the HIV/AIDS epidemic. Loneliness can increase the risks of cognitive decline and other medical conditions in older adults and can lead to stop treatment. It isn't an easy problem to solve, said Heidi Crane, an HIV researcher and clinician at the University of Washington.

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“If I had the ability to write a prescription for a friend — someone who's supportive and engaged and willing to go walking with you twice a — the care I provide would be so much better,” she said.

The complexity of care is a heavy lift for the Ryan White HIV/AIDS Program, the federal initiative for low-income people with HIV. The program serves more than half of the Americans living with the virus, and nearly half of its clients are 50 or older.

“Many of the people aging with HIV were pioneers in HIV treatment,” said Laura Cheever, who oversees the Ryan White program for the Health Resources and Services Administration, or HRSA. Researchers have a lot to learn about the best ways to meet the needs of the population, she said.

“We are learning as we go, we all are. But it certainly is challenging,” she said.

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The Ryan White program's core budget has remained mostly flat since 2013 despite adding 50,000 patients, Cheever said. The Biden administration's latest budget request asks for less than half a percent bump in program funding.

Local and state public health officials make the bulk of the decisions about how to spend Ryan White money, Cheever said, and constrained resources can make it hard to balance priorities.

“When a lot of people aren't getting care, how do you decide where that next dollar is spent?” Cheever said.

The latest infusion of funding for Ryan White, which has totaled $466 million since 2019, came as part of a federal initiative to end the HIV epidemic by 2030. But that program has come under fire from Republicans in Congress, who last year tried to defund it even though it was launched by the Trump administration.

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It's a sign of eroding bipartisan support for HIV services that puts people “in extreme jeopardy,” said Thompson, the Atlanta physician.

She worries that the increasing politicization of HIV could keep Congress from appropriating money for a pilot loan repayment program that aims to lure infectious disease doctors to that have a shortage of providers.

Many people aging with HIV are covered by Medicare, the public insurance program for people 65 and older. Research has shown that Ryan White patients on private insurance had better health than those on Medicare, which researchers linked to better access to non-HIV preventive care.

Some 40% of people living with HIV rely on Medicaid, the state-federal health insurance program for low-income people. The decision by 10 states not to expand Medicaid can leave older people with HIV few places to seek care outside of Ryan White clinics, Thompson said.

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“The stakes are high,” she said. “We are in a very dangerous place if we don't pay more attention to our care systems.”

About 1 in 6 new diagnoses are in people 50 or older but public health policies haven't caught up to that reality, said Reid, the HIV advocate from Atlanta. The Centers for Disease Control and Prevention, for instance, recommends HIV testing only for people ages 13 to 64.

“Our systems are antiquated. They, for some reason, believe that once you hit a certain number, you stop sex,” Reid said. Such blind spots mean older people often are diagnosed once the virus has destroyed the cells that help the body fight infection.

In acknowledgment of these challenges, HRSA recently launched a $13 million, three-year program to look at ways to improve health outcomes for older people living with HIV.

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Ten Ryan White clinics across the United States participate in the effort, which is testing ways to better track the risk of adverse drug interactions for people taking multiple prescriptions. The program is also testing ways to better screen for conditions like dementia and frailty, and ways to streamline the referral process for people who might need specialty care.

New strategies can't come quickly enough, said Jules Levin, executive director of the National AIDS Treatment Advocacy Project, who, at age 74, has been living with HIV since the 1980s.

His group was one signatory to “The Glasgow Manifesto,” in which an international coalition of older people with HIV called on policymakers to ensure better access to affordable care, to ensure patients get more time with doctors, and to fight ageism.

“It's tragic and shameful that elderly people with HIV have to go through what they're going through without getting the proper attention that they deserve,” Levin said. “This will be a disaster soon without a solution.”

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By: Sam Whitehead
Title: Americans With HIV Are Living Longer. Federal Spending Isn't Keeping Up.
Sourced From: kffhealthnews.org//article/aging-with-hiv-medication-health-issues-federal-funding-legislation/
Published Date: Mon, 17 Jun 2024 09:00:00 +0000

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