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Friday, April 7, 2023

High inflation and housing costs force many Americans to delay needed care

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At a health-screening event in Sarasota, Florida, people gathered in a parking lot and waited their turn for blood pressure or diabetes checks. The event was held in Sarasota’s Newtown neighborhood, a historically Black community. Local Tracy Green, 54, joined the line outside a pink-and-white bus that offered free mammograms.

“It’s a blessing because some people, like me, are not fortunate, and so this is what I needed,” she said.

Green wanted the exam because cancer runs in her family. And she shared another health worry: Her large breasts cause her severe back pain. A doctor once recommended she get reduction surgery, but she’s uninsured and said she can’t afford the procedure.

In a 2022 Gallup Poll, 38% of American adults surveyed said they had put off medical treatment within the previous year due to cost, up from 26% in 2021. The new figure is the highest since Gallup started tracking the issue in 2001. In a survey by KFF released last summer, 43% of respondents said they or a family member delayed or put off health care because of costs. It found people were most likely to delay dental care, followed by vision services and doctor’s office visits. Many didn’t take medications as prescribed.

The Newtown screening event — organized by the nonprofit Multicultural Health Institute in partnership with a local hospital and other health care providers — is part of an effort to fill the coverage gap for low-income people.

Green explained that her teeth are in bad shape but dental care will also have to wait. She lacks health insurance and a stable job. When she can, she finds occasional work as a day laborer through a local temp office.

“I only make like $60 or $70-something a day. You know that ain’t making no money,” said Green. “And some days you go in and they don’t have work.”

If she lived in another state, Green might be able to enroll in Medicaid. But Florida is one of 10 states that haven’t expanded the federal-state health insurance program to cover more working-age adults. With rent and other bills to pay, Green said, her health is taking a back seat.

“I don’t have money to go to the dentist, nothing,” she said. “It’s so expensive. Now, to get one extraction, one tooth pulled, it’s like $200-$300 that you don’t have. So I don’t know what to do. It’s like fighting a losing battle right now.”

In the KFF poll, 85% of uninsured adults under age 65 said they found it difficult to pay for health care. Nearly half of their insured counterparts said they struggled with affordability as well.

The U.S. inflation rate hit a four-decade peak last year, and parts of Florida, including the Tampa metro area, often fared even worse.

“We see an increasing desperation,” said Dr. Lisa Merritt, executive director of the Multicultural Health Institute.

The nonprofit, which helps people access low-cost care, is based in Newtown, where, inland from Sarasota’s lavish beach communities, many residents live below the poverty line, lack insurance, and face other barriers to consistent and affordable care.

“It’s very difficult for people to be concerned about abstract things like getting screenings, getting regular health maintenance, when they’re contending with the challenges of basic survival: food, shelter, transportation often,” Merritt said.

Merritt and her team of volunteers work to build trust with residents who may not be aware that support is available. They help people apply for low-cost insurance coverage, free medication programs, and other resources that can reduce treatment costs. Volunteer Bonnie Hardy said the people she serves have many financial worries, but one thing tops the list.

“Right now? A place to stay,” said Hardy. “Housing is horrible.”

High housing costs have started to ease in recent months, but data shows rent in Sarasota has risen nearly 47% since the pandemic began in 2020. Hardy helps people find housing and connects them with programs that cover costs like utilities and security deposits. The goal is to stabilize their lives, and she said that can improve health.

“Because they’re more comfortable now,” she said. “They feel like, hey, the rent is paid, I can let my guard down, maybe I can go get the medical attention I need.”

Research shows putting off health care can lead to bigger problems. The Gallup Poll found 27% of respondents delayed treatment due to costs even for “very or somewhat serious” conditions.

Some people may be holding off on treating medical issues because of health care debt. An investigation from NPR and KHN found about 100 million people in America had medical debt. About 1 in 8 of them owe more than $10,000, according to a KFF poll.

Treating cancer or chronic conditions like diabetes early can save lives and be less expensive than treating advanced-stage illnesses, according to the Centers for Disease Control and Prevention.

Doctors at the health screening event in Newtown said it’s critical to help residents obtain preventive care. At the health fair, substitute teacher Crystal Clyburn, 51, got a mammogram on the mammography bus and had her blood pressure checked.

Clyburn doesn’t have health insurance and said she relies on free events to stay on top of her health.

“I just try to take advantage of whatever that’s out there, whatever that’s free,” she said. “You have to take care of yourself because you can look healthy and not even know you’re sick.”

After the cuff came off, a doctor told Clyburn her blood pressure was a little high but not high enough that she needed to take medication. Clyburn smiled, thanked him, and left relieved to know that the cost of prescription drugs was one expense she wouldn’t have to worry about.

This article is from a partnership that includes WUSF, NPR, and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


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Thursday, April 6, 2023

Marburg virus outbreak: What to know about this lethal cousin of Ebola

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Oyewale Tomori is a virologist and fellow at the Nigerian Academy of Science.


In April, the Centers for Disease Control and Prevention warned doctors about two growing outbreaks of deadly Marburg virus in Africa. World Health Organization officials confirmed in February an outbreak in Equatorial Guinea of the highly infectious disease, which is in the same family as the virus that causes Ebola. The Conversation Africa’s Wale Fatade and Usifo Omozokpea asked virologist Oyewale Tomori about its origin and how people can protect themselves against the disease after cases were confirmed in Ghana in July 2022.

What is the Marburg virus and where did it come from?

Marburg virus causes the Marburg Virus Disease, formerly known as Marburg hemorrhagic fever. The virus, which belongs to the same family as the Ebola virus, causes severe viral hemorrhagic fever in humans with an average case fatality rate of around 50%. It has varied between 24% to 88% in different outbreaks depending on virus strain and case management.

It was first reported in 1967 in a town called Marburg in Germany and in Belgrade, Yugoslavia (now Serbia). There were simultaneous outbreaks in both cities. It came from monkeys imported from Uganda for laboratory studies in Marburg. The laboratory staff got infected as a result of working with materials (blood, tissues and cells) of the monkeys. Of 31 cases associated with these outbreaks, seven people died.

After the initial outbreaks, other cases have been reported in different parts of the world. Most were in Africa – Uganda, the Democratic Republic of Congo, Kenya, South Africa, and more recently in Guinea and Ghana. Serological studies have also revealed evidence of past Marburg virus infection in Nigeria.

While the host, or reservoir, of the virus is not conclusively identified, the virus has been associated with fruit bats. In 2008, two independent cases were reported in travelers who had visited a cave inhabited by Rousettus bat colonies in Uganda.

How is it spread?

It is spread through contact with materials (fluids, blood, tissues and cells) of an infected host or reservoir. In the case of the monkeys from Uganda imported into Marburg, laboratory staff obviously got infected through contact with the tissues and the blood of the monkeys.

There can also be human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials. This includes materials like bedding, and clothing contaminated with these fluids.

But there’s a great deal we don’t know: For example, whether contact with bat droppings in caves can cause infections in people.

What are the symptoms? And how bad can they be?

After an incubation period of between 2 to 21 days, there is a sudden onset of the disease marked by fever, chills, headache, and myalgia.

Around the fifth day after the onset of symptoms, maculopapular rash, most prominent on the trunk (chest, back, stomach), may appear. Nausea, vomiting, chest pain, a sore throat, abdominal pain, and diarrhea may appear. Symptoms become increasingly severe and can include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction.

The mortality is around 50%, and could be as high as 88% or as low as 20%.

This tells us it’s quite a severe infection. The two people infected in Ghana both died.

Can it be treated?

Not really, but early supportive care with rehydration, and symptomatic treatment, improves survival.

What can people do to protect themselves?

Avoid exposure to the virus as much as possible, and protect against discharges from infected people.

Also, because of the similarities in the symptoms of many hemorrhagic fever diseases, especially during the early stages, there is a need for reliable laboratory confirmation of a case of Marburg virus infection. And once that is done – as with Ebola – the person must immediately be isolated and avoid contact with other people.

What should be done to ensure the virus doesn’t spread?

There is no holiday from disease outbreaks. That means as a country, surveillance cannot take a break or a holiday.

Given that there have been cases in Ghana, it’s time to be on the alert. Proper screening is called for. Arrivals from Ghana and other West African countries must be checked at the ports of entry.

Unfortunately, it doesn’t appear as if anybody is thinking of that now. The attitude seems to be: oh, there are only two cases in Ghana.

But I think it’s the best time to be on the alert at the ports of entry, especially for people from countries where cases are reported. Studies done in Nigeria in the the 1980s and more recently in the 1990s provide evidence of possible previous infections with Marburg virus – or a related virus – in certain Nigerian populations. This leads me to believe that the virus is probably more widespread than we think it is. We need an improvement in diagnosis which can help us do the detection as quickly, and as efficiently as possible.

On top of this, countries need to improve their disease surveillance and laboratory diagnosis to enhance and improve the capacity for a more definitive diagnosis of viral hemorrhagic fever infections.

The Conversation

This article is republished from The Conversation under a Creative Commons license, where it was originally published in July 2022.


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Carastar Health Opens Diversion Crisis Center In Alabama

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Carastar Health (Montgomery, Ala.), formerly known as the Montgomery Area Mental Health Authority, opened new diversion crisis center for mental health in Montgomery, according to the website wsfa.com.

The new clinic has 10 observation beds, where patients can spend up to 23 hours, and 16 inpatient beds.

The project aims to improve access to services to help reduce visits to hospital emergency rooms for those in crisis.


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Meridian Plans $100M MOB, Cancer Center In New Mexico

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Healthcare real estate developer and owner Meridian (Walnut Creek, Calif.) is planning a 95,000-square-foot multispecialty medical office building (MOB) and comprehensive cancer care center in Santa Fe, N.M.

Situated on 18 acres, the $100 million, three-story building will offer a range of services including primary care, general surgery, cardiology, pulmonary, medical oncology, infusion, imaging, lab, pharmacy, breast surgery, and orthopedics. Nexus Health (Santa Fe, N.M.) will provide the healthcare services for the facility.

Additionally, the project will house up to 50 infusion bays, a lab, and advanced imaging with interventional radiology. A sky bridge, linear accelerator vault, and 520 parking stalls are also planned as well as shell space for future expansion.

The project team comprises Page Southerland Page Inc. (architect; Houston), Skiles Group (general contractor; Richardson, Texas), and Tierra West (civil engineer and surveyor; Albuquerque, N.M.).


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Wednesday, April 5, 2023

Memorial Sloan Kettering Files Plans For 31-Story Pavilion In New York

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Memorial Sloan Kettering Cancer Center (MSKCC) in New York filed plans to construct a new 31-story inpatient building on its main campus on Manhattan’s Upper East Side, according to the website newyorkyimby.com.

The 1 million-square-foot MSK Pavilion will house cancer care, surgery, and medical research and will replace an old building housing medical student residences and administrative offices.

Zoning plans call for 28 operating suites and 202 inpatient beds, as well as a skybridge to connect the new building to MSK’s existing main hospital.

A projected completion date for MSK Pavilion has not been released, according to the article

The project team will include CannonDesign (designer; New York) and Foster + Partners (architect; New York).


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New Strategies On Using Artwork To Alleviate Patient Anxiety

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Positive distractions in hospitals, including playrooms, indoor gardens, and art installations, can help improve the patient experience and promote healing by helping to alleviate worrisome thoughts and focus.

But with hospital budgets stretched thin by lower reimbursement rates and rising labor, equipment, and supply costs, these solutions could easily be deemed as “nice to haves” rather than “need to haves.”

Fortunately, it doesn’t have to be a choice. Here are some ways hospitals are creating positive distractions to ensure engaged communities, happier patients, and better outcomes.

Using artwork to connect to the community

Hospitals are expected to remain under intense financial pressure for the foreseeable future. This means funding for new construction will likely prioritize revenue-generating spaces, such as diagnostics, procedures, and inpatient stays.

Rather than undertaking costly additions or expansions to accommodate things like TV screening rooms or atriums, hospitals should look to ceilings, floors, walls, corridors, and elevator bays that can be transformed into meaningful positive distractions. But instead of adorning this underused real estate with generic art, hospitals can use interactive art installations and experiences to create welcoming experiences that offer comfort and community connection.

One example is the Odessa Brown Children’s Clinic in Seattle. As the new clinic was being designed, community members expressed that they didn’t want the space to feel clinical. They also stressed the idea of “no blank walls.” In response, the design team wrapped the space in murals by local Black and indigenous artists that honor the clinic’s legacy and celebrate its cultural heritage.

Another project utilized the flooring to make an impact as well as connect with the community. In the waiting area of Chief Andrew Isaac Health Center in Fairbanks, Alaska, the flooring is inlaid with a 30-foot diameter circular calendar.

The calendar showcases seasonal events, including planting, hunting, and fishing, as well as traditional celestial milestones, such as the solstices. It’s designed to allow parents to teach children about their culture, while allowing young patients to think about something different than their medical condition.

Interactive displays for waiting rooms and corridors

New technologies, such as high-quality LED screens, motion sensors, and artificial intelligence, are creating opportunities for positive distractions. Examples include interactive art installations, displays, and surfaces.

At a waiting area at an academic medical center in Southern California, children and teens will soon be able to use a touchscreen to create customized animals, including baby bears, rabbits, and deer. These animals are then “released” into a virtual forest where patients can follow their activity.

Motion sensors will detect a child’s movement, prompting actions in the virtual forest, such as fish jumping in a stream or butterflies gathering around the patient.

Healthcare facilities can also use interactive displays and digital media to turn overlooked areas into experiences that evoke natural surroundings, which can help reduce stress and improve well-being.

For example, at Great Ormond Street Hospital for Children in London, interactive digital wallpaper transforms the hallways outside operating rooms into an enchanting forest nature trail. Patients can touch the wall to reveal animated woodland creatures such as deer, hedgehogs, and birds.

Employing technology as positive distractions

With technology rapidly evolving, the possibilities for creating new types of positive distractions are endless. Using an app at home, patients take a photo of something they cherish and upload it to an ever-changing digital mural in the hospital. There, they can see their contributions publicly displayed to create a sense of connection and comfort.

Another options is for a patient to touch the art and leave a mark on it that persists after they leave. This can also help build a sense of community, rather than isolation, in the hospital.

Unlike traditional murals, which can become monotonous after frequent viewing, evolving artwork can be a constant source of surprise and inspiration. This feature is especially important to patients in physical rehabilitation who sometimes need incentives to keep moving.

Embedding digital elements that can be discovered by a visitor over time, aka “Easter Eggs,” within a care environment can offer moments of surprise or daily puzzles that can be solved. In turn, these features create a sense of discovery that can go a long way in buoying feelings, incentivizing movement, and speeding recovery.

Benefits of supporting staff

Studies show that patients also benefit when caregivers can access experiences that enhance their positive well-being. Often times, it’s impossible for staff to leave their unit to walk in an indoor garden or go outside to decompress. Weaving positive distractions into spaces closer to staff ensure they can benefit from artwork as well.

By capitalizing on these technologies and collaborating with innovative designers and artists, hospitals can integrate positive distractions into every part of the patient experience. This will help immerse patients in a care environment that promotes healing from start to finish.

 

Katie Barnard is the head of content strategy at ESI Design, NBBJ’s New York experience design studio. She can be reached at kbarnard@esidesign.com. Eric LeVine is creative director and principal-in-charge of NBBJ’s Seattle Environmental Graphic Design studio. He can be reached at ELevine@nbbj.com. Jessica Radecki, AIA, is a healthcare director at NBBJ (Portland). She can be reached at JRadecki@nbbj.com. Emily Webster is a studio design leader at ESI Design. She can be reached at ewebster@esidesign.com.

 


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E4H Environments for Health Architecture Adds New Team Member

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Healthcare and health sciences firm E4H Environments for Health Architecture (E4H; Boston) has added Andrew Pardue as an associate partner at its office in Charleston, S.C.

Pardue has been a healthcare architect and planner for the last 13 years. His work experience includes the planning and design of large-scale healthcare facilities, academic medical centers, replacement hospitals, ambulatory surgery centers, and medical office buildings.


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