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Objectives To determine the difference in receipt of activity of daily living ( ADL) assistance between obese and normal-weight older adults. Design Retrospective cohort study. Setting National Health and Aging Trends Study, 2011-2015. Participants U.S. adults aged 65 and older with ADL disability and a body mass index ( BMI) of 18.5 kg/m2 or greater (N = 5,612) Measurements BMI was classified as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Primary outcome was self-reported receipt of help with specific ADLs. Models were adjusted for demographic characteristics (age, sex, race), degree of need (self-reported general health, severity of disability), household resources (income, marriage, people in household, number of children), and cognitive status (dementia, proxy respondent). Results Obese with disabilities had lower rates of receiving assistance with walking inside (odds ratio ( OR) = 0.63, 95% confidence interval ( CI) = 0.50-0.81), walking outside ( OR = 0.76, 95% CI = 0.59-0.97), toileting ( OR = 0.68, 95% CI = 0.52-0.89), and getting in and out of bed ( OR = 0.67, 95% CI = 0.50-0.87) than normal-weight older adults after adjustment for respondent demographic characteristics. Level of need and cognitive status partially explained the associations. In fully adjusted models, older adults with obesity still had significantly lower odds of receiving assistance in getting in and out of bed than normal weight adults ( OR = 0.69, 95% CI = 0.49-0.98). Conclusion Older adults with obesity are less likely to receive assistance for ADL disabilities than their normal-weight counterparts-an important concern because of ongoing demographic changes in the United States. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the different pull-out-force out of the obturator membrane and the obturator internus muscle of 2 mini-sling systems for stress urinary incontinence (SUI) treatment.Material and Methods: In a prospective study, the pull-out-force measurements were performed on 8 female cadaver pelvises, both on the obturator membrane and internal muscle, using the force measurement device PCE-FM50 (PCE Instruments). Tested were the hooks of 2 on the market available mini-sling kits (MiniArc by American Medical System; Ajust by BARD Inc.). Connected to the force measurement device, the hooks were placed into the obturator membrane and the obturator internus muscle. Mean value and SD were documented.Results: On the complete obturator complex, Ajust showed a significantly higher pull-out-force (2,561.75 ± 638.8 g) than did the MiniArc (1,780.69 ± 442.3 g), p = 0.025. No significant differences were performed on the obturator membrane.Conclusions: The Ajust mini-sling hook is, given the objective results, more stably attached to the obturator complex than the MiniArc. Yet, both systems are sufficiently attachable to the evaluated anatomic structures, fulfilling the needed requirements for their use in the treatment of SUI. [ABSTRACT FROM AUTHOR]

Background: Despite substantial financial contributions by the United States President's Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA).Methods and Findings: We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74-0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78-0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86-15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79-12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI -0.07-7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal.Conclusions: PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality. [ABSTRACT FROM AUTHOR]

The authors discuss aspects of the prohibition of direct health care by U.S. Department of Defense (DoD) soldiers in international disaster aid. It mentions that the move was made in response to the outbreak of Ebola virus. It also notes the involvement of the American government in rendering medical assistance to various nations through foreign disaster relief (FDR).

Objectives. To describe results of points of dispensing (POD) medical countermeasure drill performance among local jurisdictions. Methods. To compare POD setup times for each year, we calculated descriptive statistics of annual jurisdictional POD setup data submitted by over 400 local jurisdictions across 50 states and 8 US territories to a Centers for Disease Control and Prevention (CDC) program monitoring database from July 2012 to June 2016. Results. In data collected from July 2012 to June 2015, fewer than 5% of PODs required more than 240minutes to set up, although the proportion increased from July 2015 to June 2016 to almost 12%. From July 2012 to June 2016, more than 60% of PODs were set up in less than 90 minutes, with 60 minutes as the median setup time during the period. Conclusions. Our results yield evidence of national progress for response to a mass medical emergency. Technical assistance may be required to aid certain jurisdictions for improvement. Public Health Implications. The results of this study may inform future target times for performance on POD setup activities and highlight jurisdictions in need of technical assistance. [ABSTRACT FROM AUTHOR]

Summary Do targeted aid programs have unintended consequences outside of the target issue area? We investigate this question with an examination of one of the largest targeted aid programs in the world: the President’s Emergency Plan for AIDS Relief (PEPFAR). Critics of PEPFAR worry that a targeted program focusing on single diseases has a negative externality, in which the influx of massive amounts of target aid damages broader public health systems in countries that receive PEPFAR funds. Using a difference-in-differences identification strategy, we find statistical evidence that supports critics of targeted aid. [ABSTRACT FROM AUTHOR]

During the George W. Bush administration (2000–2008), evangelicals took an active role in the politics of AIDS to combat debt, infectious disease, and extreme poverty in developing nations, especially in Africa. The pastors and religious leaders who joined to influence the legislation of the President's Emergency Plan for AIDS Relief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the Millennium Challenge Account helped to create a new category of evangelicals, ushering in a divide from the former, more conservative leadership. This article takes a Weberian sociological approach to argue that the prophetic voice of Bono, an Irish rock star, moved some leaders of the evangelical movement, particularly those in megachurches, to consider embracing a new, more traditionally liberal issue (i.e., foreign humanitarian assistance). Though many evangelical service providers were campaigning for the same issues, it was, in part, the charisma of Bono that sparked the interest to take a stand in unity for global health issues. The sociopolitical movement to combat HIV/AIDS in Africa was the fault line for the divide of evangelical leaders solidifying a new identity for their followers, labeled “centrist,” particularly for those in Generation Next. [ABSTRACT FROM PUBLISHER]

The article offers the author's insights regarding the use of chester step test (CST) for assessing the physical fitness of field disaster personnel. Topics discussed include the association of increasing risk injury in responders who lacks appropriate physical fitness, the importance of fitness requirements for disaster response, and the deployment of oversees disaster medical assistance teams (DMATs) in federally declared disasters areas.

In this Perspective, Eran Bendavid discusses the broader political and health consequences of US foreign aid in light of the study by Aleksandra Jakubowski and colleagues of the President's Malaria Initiative in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Assuming that budgetary constraints continue over the next several years, the U.S. military's overseas medical activities including medical civic action projects (MEDCAPs) and humanitarian assistance projects could comprise an increasing proportion of the contributions of U.S. government (USG) to improving global health. We have identified several issues with MEDCAPs in Ethiopia since 2009 that resulted in delays or project cancellations. These were mostly related to lack of a plan to develop sustainable capacities. Although there are many obvious medical needs for civilian populations in Ethiopia, the provision of sustainable development assistance involving these Ethiopian populations on behalf of the USG is a complex undertaking involving coordination with many partners and coordination with several other USG agencies. Military medical professionals planning MEDCAPs and other cooperative global health projects would benefit from consultation and close coordination with U.S. Centers for Disease Control and Prevention (CDC) and U.S. Agency of International Development (USAID) experts who are involved in supporting medium- and long-term health projects in Ethiopia. The establishment of durable military medical academic relationships and involvement of overseas military medical research units could also help promote sustainable projects and build robust professional relationships in global health. [ABSTRACT FROM AUTHOR]

In recent decades, the U.S. Department of Defense has become increasingly committed to involvement in nonemergency medical humanitarian and civic assistance. This health policy report reviews the legal and doctrinal justifications behind the U.S. military's participation in nonemergency health engagement, explores whether the aid provided is achieving stated objectives, and provides recommendations on how the military's role could be improved. Legal and doctrinal foundations are threefold: to provide benefit to the recipients, training to the personnel involved, and enhance security for the United States and host nation. A review of the literature reveals serious questions concerning the measurement of the benefit to recipients from the military's short-term health engagement missions. A robust and systematic monitoring and evaluation capability is necessary before the military's success at meeting strategic objectives with HCA can be understood. Regulations should be modified to minimize local capacity displacement. Some of the suggestions in the literature have been adopted and implemented in recent missions. In addition, Department of Defense involvement in disease surveillance appears to be a constructive way for the military to engage with host nations and improve their capacity to detect and respond to outbreaks. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of being assigned in Bamako, Mali to assist the U.S. medical team in carrying out a vaccination program against smallpox and measles in the African country.

Background: The mission of a Forward Surgical Team (FST) is to provide immediate lifesaving surgery to wounded U.S. and coalition forces. The degree of humanitarian surgical care provided to civilians is a topic of controversy. Methods: From May 2011 to November 2011, the surgeons of the 126th FST provided humanitarian surgical care to Afghan civilians. Results: The FST surgeons provided 553 surgical evaluations on 511 Afghan civilians. Of the patients, 95% were male and 38% were children. Forty percent of the clinic visits involved wound care and 20% involved a general surgery diagnosis. Seventeen percent involved an orthopedic diagnosis and 23% involved various surgical subspecialty diagnoses. Of the patients, 11% required a procedure necessitating the use of anesthesia. Interviews with Afghan patients and civic leaders identified a positive impact. Conclusion: This is the first report of humanitarian surgical care provided by surgeons of a FST in Afghanistan. Time and resource investment was minimal with no evidence of a negative impact on the primary mission of the FST. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the use of generic antiretroviral drugs (ARVs) among programs supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in several countries. An annual survey was conducted from 2005 to 2008 in several PEPFAR countries, including Guyana, Haiti, and Vietnam. There has been an increase in ARV expenditures from 116.8 million U.S. dollars in 2005 to 202.2 million U.S. dollars in 2008, confirming an association between generic ARVs and increased ARV procurement.

The Indian Health Care Improvement Act requires the Centers for Medicare and Medicaid Services (CMS) to reimburse states for the cost of services provided to Medicaid-enrolled American Indians and Alaska Natives (AlAN) receiving care through the Indian Health Service (IHS). The Federal Medical Assistance Percentage (FMAP), the rate at which CMS provides funding to the state to cover Medicaid services, is set at 100% for care through an IHS facility. Although much necessary care for AIANs is provided through IHS contracts with health care providers operating outside of traditional IHS facilities, CMS has restricted the application of the 100% FMAP to health care provided in IHS facilities, limiting federal funding for these services. States have begun challenging CMS's narrow interpretation of this statutory provision. This Note examines these state efforts to broaden the application of the 100% FMAP. The Note argues that the 100% FIVIAP provision can and should be read to provide full funding for transportation to and from IHS facilities, referrals from IHS facilities, and care provided in Urban Indian Health Organizations with IHS contracts. The Note provides legislative, administrative, and litigation strategies that can be used by advocates to achieve these goals. [ABSTRACT FROM AUTHOR]

When massive tsunamis affected the coast of Sri Lanka and other Indian Ocean littorals, elements of the Third Force Service Support Group and assigned Navy, Air Force, Army, and Coast Guard units from the U.S. Pacific Command were "task organized" to form Combined Support Group-Sri Lanka (CSG-SL), charged to conduct humanitarian assistance/disaster relief (HA/DR) operations. The specific mission was to provide immediate relief to the affected population of Sri Lanka and the Maldives, to minimize loss of life, and to mitigate human suffering. A 30-person health care team deployed to the northern province of Jaffna and provided medical assistance to that chronically underserved and acutely overstressed region. For a 12-day period, the team served as the principal medical staff of an under-resourced government hospital and conducted mobile primary care clinics at nearby welfare camps housing >7,000 internally displaced persons made homeless by the tsunamis. By every measurable standard, CSG-SL accomplished its assigned HA/DR task in Sri Lanka, including the medical mission. In doing so, the medical team learned many important lessons, including five of particular value to planners of similar relief operations in the future. This article discusses the context in which CSG-SL planned and executed the medical aspects of its HA/DR operations in Sri Lanka, and it describes the most significant medical lessons learned. [ABSTRACT FROM AUTHOR]

The U.S. response to the December 26, 2004 tsunami in Indonesia heralded modifications of our responses to previous natural disasters, modifications that were highly successful and should be refined and repeated. These included seamless hand-off of responsibility from a line response unit to medical; the use of civilian medical practitioners working closely with military and public health service personnel aboard a Navy vessel; close prior communication and planning with the local medical, governmental, and U.N. establishment ashore before the arrival of the military medical unit; and with both line and medical units working closely in support of established ashore U.N. agencies instead of performing independent actions. The success of this total approach was unquestioned, and the lessons learned should be utilized fully in planning future disaster responses, both foreign and domestic. [ABSTRACT FROM AUTHOR]

The article presents perspectives from the medical treatment facility U.S. Navy Ship (USNS) Mercy. It offers details on the previous deployments of USNS Mercy and its staff. It describes the preparations made before the ship sailed for Indonesia in the aftermath of the Asian tsunami in December 2004. It discusses the medical services provided by medical personnel aboard the ship.

On December 26, 2004, an earthquake triggered a massive tsunami in the Indian Ocean, causing an estimated 183,172 deaths and 40,320 missing in 12 countries. In Thailand, six provinces (Krabi, Phang-Nga, Phuket, Ranong, Satun, and Trang) were affected. U.S. government agencies delivered emergency medical assistance from December 30, 2004, to January 6, 2005. A team from the Armed Forces Research Institute of Medical Sciences conducted a rapid health and needs assessment in southern Thailand. Twelve hospitals were referral centers for tsunami-related medical care. None of the hospitals had been damaged during the tsunami; all activated mass casualty plans. As of October 2005, 5,395 deaths were confirmed and 2,817 individuals were missing. The response of the Thai government to the tsunami was rapid and effective in mitigating the health consequences among survivors and helped prioritize public health interventions and the diversion of U.S. assistance to areas with greater need for international emergency humanitarian assistance. [ABSTRACT FROM AUTHOR]

The financial effectiveness of the United States' Medical Assistance Program (Medicaid) depends on sound financial management at all political levels. States receive payments from the Federal Government based on the number, kinds and payment rates of services provided to eligible patients. Because payments can lag services by a considerable time and because claims may be denied, adjusted or re-processed, the state cannot easily predict its total payments for services recently delivered. As a matter of fact, some claims linger as long as 24 months (Arnett & Foster, Pllc., 2002, unpublished data) in the system. This paper presents a procedure to estimate die percentages of payments due in the months following the service delivery month. The procedure relies on the most recent 24 months of services and payments. Service months from die recent past generate fewer monthly payments than those more distant and can have large, unknown outstanding balances. Through a transformation of die available data, our procedure takes into account the dwindling amounts of data available. The procedure, optimal in die sense of constrained least squares, results in estimates of the percentages paid as a function of time elapsed since service. A dynamic programming procedure stabilizes tail area percentages and a hold-out sample provides evidence of good fit. Real-world data illustrate the process. [ABSTRACT FROM AUTHOR]

Analyzes the growth and distribution of expenditures for medical care services provided by the United States (US) to residents of Ontario between the period of 1987 to 1995, while focusing on the Ontario Health Insurance Plan. Type of services sought by Canadians in the US; Information on data collected; Method used in making the analysis; Results of the analysis.

Discusses the health care needs of Africa and areas for United States relief efforts. Problem with HIV infection and AIDS; Sharing of information and expertise among health professionals; Funding education of African physicians as an avenue of interaction.

Although Medicaid is the primary payer for health services provided to people with AIDS, Medicaid eligibility policies can be restrictive. This study presents Medicaid eligibility policies in each state for people with AIDS or HIV infection, including the categorical and medically needy classifications. The study documents that medically needy coverage is an important route to Medicaid coverage for people with AIDS. Because of the importance of this medically needy coverage, extending presumptive disability to any person with HIV and allowing them to spend down would pro- vide a health financing safety net for people infected with HIV. [ABSTRACT FROM AUTHOR]

The article discusses the progress towards the professionalization of disaster response as observed from the international medical response to the Philippines after Super Typhoon Haiyan landed in the country in November 2013. Topics include the need for training and preparation of medical responders, recommendations to address the need for improvements and consistency among disaster-response teams, and the outcome of the humanitarian response to the Philippines.

The Department of Defense (DoD) historically has provided medical assistance after major disasters within the United States but the response is often limited, uncoordinated, and unplanned. Most local jurisdictions understand the value in planning, but lack the resources to consider low probability events, even those of a catastrophic nature. The authors brought together military and civilian emergency response planners from various agencies in the National Capital Region and the Commonwealth of Virginia. Their conclusion was DoD and local jurisdictions should leverage DoD's planning expertise to develop a system of community-based medical response planning. Over the long term, the authors propose a new paradigm in medical response planning away from the traditional "respond-to-requests" approach to a "sense-and-respond" system that is scalable and more responsive to a wider range of national disasters. [ABSTRACT FROM AUTHOR]

The Department of Defense (DoD) Global Emerging Infections Surveillance and Response System (DoD-GEIS) identifies and addresses DoD vulnerabilities to emerging infections through a global network of partners. Following the Indian Ocean tsunami of December 26, 2004, DoD-GEIS facilitated the DoD medical response and coordination with the Centers for Disease Control and Prevention and the World Health Organization. DoD-GEIS partners in Southeast Asia (U.S. Naval Medical Research Unit 2, Jakarta, Indonesia; and Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand) rapidly conducted health assessments and established surveillance for communicable diseases that threatened survivors. Preexisting collaboration with the Centers for Disease Control and Prevention, the World Health Organization, and host countries was critical for the DoD-GEIS tsunami response. [ABSTRACT FROM AUTHOR]