Women's Affordability, Access, and Preventive Care After the Affordable Care Act.

INTRODUCTION: Women historically have had difficulty maintaining health insurance, obtaining preventive care, and affording care. The objectives of this study were to describe changes in insurance affordability, healthcare access, and preventive care for women of different income levels after implementation of the Affordable Care Act. METHODS: This was a difference-in-differences analysis of data about U.S. women aged 19-64years from the National Health Interview Survey. This study examined self-reported insurance affordability, access to health care, and preventive services. Changes before (2010-2013) and after (2014-2017) the Affordable Care Act insurance expansions were compared by income (≤138% federal poverty level vs≥400% federal poverty level). Multivariate difference-in-differences analyses adjusting for demographics were expressed as risk differences. RESULTS: The sample represented an estimated 41,106,929 women. After the Affordable Care Act, women with incomes ≤138% federal poverty level, compared with ≥400% federal poverty level, had less difficulty finding affordable insurance (adjusted difference-in-differences: -27.18, 95% CI= -36.37, -18.00); were more likely to have seen/talked to a doctor in 12 months (adjusted difference-in-differences: 3.08, 95% CI=1.29, 4.87), had blood pressure screening (adjusted difference-in-differences: 3.27, 95% CI=1.94, 4.60), cholesterol screening (adjusted difference-in-differences: 5.05, 95% CI=2.45, 7.64), and mammograms (adjusted difference-in-differences: 6.87, 95% CI=3.94, 9.79). CONCLUSIONS: After implementation of the Affordable Care Act, women in all income groups, especially the lowest, reported greater affordability of coverage, access to health care, and receipt of preventive services. Efforts to alter the Affordable Care Act should consider the impact of policy changes on women's health and preventive care.

Epidemiology of Pedestrian-Motor Vehicle Fatalities and Injuries, 2006-2015.

INTRODUCTION: Pedestrian road safety remains a public health priority. The objective of this study is to describe trends in fatalities and injuries after pedestrian-motor vehicle collisions in the U.S. and identify associated risk factors for pedestrian fatalities. METHODS: This is a cross-sectional study of U.S. pedestrian-motor vehicle collisions from 2006 to 2015 (performed in 2017). Pedestrian fatality and injury data were obtained from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and National Automotive Sampling System General Estimates System. Frequencies of fatalities, injuries, and associated characteristics were calculated. Multivariable logistic regression was performed for risk of fatality, controlling for demographic and crash-related factors. RESULTS: There were 47,789 pedestrian fatalities and 674,414 injuries during the 10-year study period. Fatality rates were highest among the elderly aged 85 years and older (2.95/100,000 population), whereas injury rates were highest for those aged 15-19 years (35.23/100,000 population). Predictors associated with increased risk for death include the following: male sex (AOR=1.36, 95% CI=1.15, 1.62), age ≥65 years (AOR=3.44, 95% CI=2.62, 4.50), alcohol involvement (AOR=2.63, 95% CI=1.88, 3.67), collisions after midnight (AOR=5.21, 95% CI=3.20, 8.49), at non-intersections (AOR=2.76, 95% CI=2.21, 3.45), and involving trucks (AOR=2.15, 95% CI=1.16, 3.97) and buses (AOR=5.82, 95% CI=3.67, 9.21). CONCLUSIONS: Potentially modifiable factors are associated with increased risk of death after pedestrian-motor vehicle collisions. Interventions including elder-friendly intersections and increasing visibility of pedestrians may aid in decreasing pedestrian injuries and deaths.

A computerized child passenger safety screening program in the emergency department.

OBJECTIVES: The emergency department (ED) can be an effective site for pediatric injury prevention initiatives, including child passenger safety. The objectives of this study were to evaluate the implementation of an ED child passenger safety program and to analyze the effectiveness of a computerized screening tool to identify car seat-related needs for children younger than 8 years. METHODS: An ED-based group developed a child passenger safety program including (1) a computerized screening tool to assess the use of car seats in children younger than 8 years; (2) child passenger safety education, including state law; and (3) distribution of appropriate car seats for patients discharged from the ED. In July 2011, the screening tool was added to the initial nursing assessment. In January 2012, nursing education was performed to increase compliance with screening. In April 2012, the tool was made a mandatory field in the computerized initial nursing assessment. RESULTS: From August 1 to December 31, 2011, 17 % (2270/13,637) of eligible children had computerized screenings performed; 18 car seats were distributed. From January 15 to March 15, 2012, 32% (2017/6270) of eligible children were screened; 9 car seats were distributed. From March 16 to May 19, 2012, 56% (3381/6063) were screened; 22 car seats were distributed. Screenings increased further from May 20 to July 25, 2012, with 87% (5077/5827) completed; 31 car seats were distributed. CONCLUSIONS: A child passenger safety program can be successfully implemented in the ED. A computerized nursing screening tool increases compliance with screening and providing needed car seats.

An Inpatient Child Passenger Safety program.

Background. Our institution implemented an Inpatient Child Passenger Safety (CPS) program for hospitalized children to improve knowledge and compliance with the Massachusetts CPS law, requiring children less than 8 years old or 57 inches tall to be secured in a car seat when in a motor vehicle. Methods. After the Inpatient CPS Program was piloted on 3 units in 2009, the program was expanded to all inpatient units in 2010. A computerized nursing assessment tool identifies children in need of a CPS consult for education and/or car seat. Results. With the expanded Inpatient CPS Program, 3650 children have been assessed, 598 consults initiated, and 325 families have received CPS education. Car seats were distributed to 419 children; specialty car seats were loaned to 134 families. Conclusions. With a multidisciplinary approach, we implemented an Inpatient CPS Program for hospitalized children providing CPS education and car seats to families in need.

The modern paediatric injury pyramid: injuries in Massachusetts children and adolescents.

The objective of this study was to develop a modern version of the paediatric injury pyramid, a visual classification of injury severity, and to present mechanism-based pyramids. As the original paediatric injury pyramid was described in 1980, the injury epidemiology from 1980 was compared with 2004. Comprehensive emergency department, hospital discharge and death data for Massachusetts in 2004 were used to determine injury rates for residents aged 0-19 years. Injury pyramids were constructed on the basis of the number of injuries resulting in death, hospitalisations and emergency department visits. In 2004, unintentional and intentional injuries accounted for 197 deaths, 7120 hospitalisations and 199,814 emergency department visits giving a ratio of 1:36:1014. The 2004 injury pyramids differed by mechanism and intent. Compared with 1980, there were lower rates for overall injury and for most major injury mechanisms in Massachusetts in 2004.