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Daily Archives: December 1, 2013

Covered California Faulted For Failing To Reach More Spanish Speakers

LOS ANGELES -Latino lawmakers and health leaders in California are sounding alarms about the insurance marketplace’s preparation and tactics for enrolling Spanish speakers and are urging changes following the recent announcement that fewer than 1,000 signed up in the health law’s first month.

“This is completely unacceptable,” said state Sen. Norma Torres, a Democrat who represents parts of San Bernardino and eastern Los Angeles counties. “Obviously their plan for reaching this demographic is not working. They should reevaluate and come up with a new strategy.”

The success of the California health exchange, known as Covered California, depends on robust enrollment of Latinos, who make up about 60 percent of the state’s uninsured population and are generally younger and healthier than other potential enrollees. The marketplace and nonprofit groups have poured millions of dollars into advertising and outreach aimed at Latinos.

Naama Pozniak, right, helps Edgar Loya compare plans at an enrollment fair in Pasadena, Calif., in November (Photo by David McNew/Getty Images)

Yet Spanish-speaking consumers made up just 3 percent of the 31,0Ǡ enrollees in October. Many more people were enrolling in November, according to Covered California, which has been largely free of the glitches plaguing its federally-run counterparts in other states. But a breakdown of that data by ethnic group isn’t expected until the middle of December.

California’s experience could bode ill for other heavily Latino states, where the barriers to Spanish-language consumers are even greater. On the federal website, consumers won’t even be able to enroll in their native language until at least early December. Enrollment continues until March 31, but the deadline for coverage that begins Jan. 1 is Dec. 23, three weeks away.

Advocates said several problems have contributed to California’s lagging Latino enrollment: There is no paper application in Spanish for a population that often doesn’t have access to computers or isn’t comfortable using them. Not enough bilingual phone operators were hired to guide consumers through the online process. And there is still a shortage of on-the-ground enrollment counselors, who can explain the process in person in clinics and other community settings.

Covered California requires those who want to become certified enrollment counselors to complete a training course and undergo a criminal background check that includes submitting fingerprints. Exchange officials said they underestimated how long those checks would take.

State Sen. Ed Hernandez, a Los Angeles-area Democrat and chairman of the Senate Committee on Health, said he is concerned about the low number of Spanish-speaking enrollees but remains optimistic that will improve. Covered California needs to make a Spanish-language paper application available as soon as possible and boost enrollments at community clinics and nonprofits, he said.

“It needs to be ramped up very quickly,” he said. “If it isn’t addressed, it is going to be a huge issue.”

Covered California’s Executive Director Peter Lee said more enrollment counselors are being certified each week. At this point, more than 60 percent of the counselors speak Spanish, according to Covered California.

In addition, a call center with numerous bilingual operators recently opened in Fresno and a paper application in Spanish is scheduled to be available in mid-December.

“These are not ideal numbers but we know the numbers will change,” said Covered California spokesman Santiago Lucero.

Consumers can apply online through a Spanish-language version of the California website. But the site has had numerous problems, including asking security questions in English and misspelling Spanish words such as “si”, said Daniel Zingale, a senior vice president at The California Endowment, a philanthropy that has invested heavily in Latino enrollment.

Covered California is responding quickly to problems but should have been ready on Oct. 1 to serve consumers whose first language is Spanish, he said. “You don’t need a plan and then a Plan B for Latinos. You need a Plan A for Latinos.”

There have also been issues with the telephone system, which has guided Spanish-speakers to English-language prompts, according to advocates and enrollers. And the average wait time to receive help is still about 18 minutes.

Ampelia Lopez, 50, said she desperately wants insurance coverage so she can stop going to the emergency room every time she needs to see a doctor for her asthma. Lopez said she doesn’t have a computer so she tried to call Covered California. She waited for more than a half hour before giving up.

“I am frustrated,” she said. “It’s like the DMV.”

Lopez said she doesn’t know where to go to sign up, but she plans to ask a friend who works at a hospital in Los Angeles. She knows that if she doesn’t get covered she will have to pay a fine. For now, she said, “I am just waiting.”

Spanish speakers often prefer the phone to a computer – and the system wasn’t set up to accept all of those calls, said Hector Flores, chairman of the Latino advisory committee for the Los Angeles County Medical Association. “If there is a long line, that creates a barrier,” he said.

In California, an estimated 1.7 million Latinos are eligible for Medi-Cal and 1.2 million are expected to be eligible for subsidies when they purchase insurance plans through the exchange.

Zingale said he believes the demand for health coverage is there but first Covered California needs to clear up the glitches in the website and telephone system. “Obamacare will not succeed without paying attention to these issues that are impeding enrollment among Latinos,” he said.

Flores said most of his patients have seen the commercials and the ads in Spanish. But they still have lots of questions and need to go to someone they trust for help. Many of the enrollment counselors at those places – clinics, nonprofits and hospitals – are still waiting for final certification from Covered California.

Jose Rodriguez, an insurance agent in South Pasadena, was able to get his certification and has helped some Spanish speakers sign up for coverage. He guides them through an application in English and says the fact that there is no Spanish-language application is “garbage.” Because the website is not very user-friendly, he often prints out applications and mails them in, he said.

Rodriguez also has noticed cultural barriers: Some of his clients are hesitant to turn over personal and financial information to the government. Others prefer to rely on home remedies rather than pay for insurance.

Throughout the state, some of those eligible are worried about calling attention to family members who are here illegally and don’t qualify for coverage. The potential applicants either don’t know about or trust promises from immigration authorities that they will not use information from the health exchanges for deportations or other sanctions.

Aware of some of these challenges months ago, Covered California began running ads in Spanish and awarded outreach grants to organizations that work in heavily Latino communities. Officials also partnered with The California Endowment and Spanish-language media to educate Latino consumers, many of whom had never had insurance before.

But the recent numbers show more resources are needed to demystify the Affordable Care Act, health leaders and lawmakers said. And that must involve community health workers and outreach in neighborhoods. Raquel Donoso, chief executive of the Latino Community Foundation, which funds programs for Latinos in the Bay Area and Central Valley, said there isn’t much time left.

Without adequately staffed call centers and a paper application in Spanish, Donoso said it’s not surprising that enrollment has been low. “It’s definitely a problem,” she said. “The state needs to take another look at what’s the next step of the strategy.”

Torres, the state senator, said the marketplace’s ability to establish affordable insurance rates in the future could be in jeopardy if more Latinos don’t sign up. “You can’t just buy up a bunch of Spanish language advertisements and expect success,” she said.

agorman@kff.org | @annagorman

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UnitedHealthcare Dropping Hundreds Of Doctors From Medicare Advantage Plans

Dorathy Senay’s doctor had some bad news after her last checkup, but it wasn’t about her serious blood disorder called amyloidosis. Her Medicare Advantage managed care plan from UnitedHealthcare/AARP is terminating the doctor’s contract Feb. 1. 

She is also losing her oncologist at the prestigious Yale Medical Group — the entire 1,200 physician practice was axed.

Senay, 71, of Canterbury, Conn., is among thousands of UnitedHealthcare Medicare members in 10 states whose doctors will be cut from their plan network. 

The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members.  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s network of providers.  

“I have a rare incurable disease and these doctors have saved my life,” said Senay.  “I am in good hands and I will not change doctors.”

UnitedHealthcare has begun telling members about the network changes. But there is now less than two weeks before the Dec. 7 deadline for choosing new coverage next year. Timing is crucial since once they sign up, most Advantage beneficiaries are locked into their plans for the year.  Losing a doctor does not constitute an exception to the rule. Insurers can drop providers any time with 30 days advance notice to members.

Several medical associations are encouraging doctors to appeal the cancelations, which could make it more difficult for seniors to choose a plan in the time remaining.  Neither Medicare, which oversees the Advantage plans, nor UnitedHealthcare would disclose how many providers will be dropped.

The American Medical Association and 39 state affiliates along with 42 medical specialty and patient advocacy groups have urged Medicare chief Marilyn Tavenner to extend the enrollment deadline and require insurers to reinstate the doctors for another year. Medicare has told the Connecticut attorney general that it will not postpone the deadline.    

UnitedHealthcare spokeswoman Jessica Pappas said in a written response to questions, “While these changes can be difficult for patients and their doctors, they are necessary to meet rising quality standards, slow the increase in health costs and sustain our plans in an era of Medicare Advantage funding cuts.” However, the doctors dropped from Medicare Advantage plans can still treat patients covered under other UnitedHealthcare policies.

The Affordable Care Act phases in reductions in government payments to Medicare Advantage plans — $156 billion over 10 years — to bring the program into line with the costs of caring for seniors in traditional Medicare.

Medicare officials review the private plans every year to make sure they comply with network adequacy and other requirements, but the agency did not approve the reconfigured networks resulting from the new provider cancelations. Spokesman Raymond Thorn said the agency “is currently reviewing UHC and other plans’ provider networks and closely monitoring all areas that have experienced disruptions to ensure that beneficiaries have full, transparent and timely information and access to needed care.”

While Medicare officials would not disclose how many provider terminations they are scrutinizing, state medical groups have provided some tips for investigators.

The Ohio State Medical Association estimates that UnitedHealthcare has canceled contracts with hundreds of Ohio doctors effective Jan. 1.

The cancelations include most of the orthopedic surgeons in Dayton, the only hand specialty practice serving the Cincinnati area, a large gastroenterology practice with 2,500 patients that also provides most of the inpatient care at five Cincinnati area hospitals, and the largest practice of retina specialists serving 600 UnitedHealthcare members, many with macular degeneration, in central and southern Ohio.

In Connecticut, UnitedHealthcare is terminating about 2,250 physicians, including 810 specialists, Feb. 1, said Mark Thompson, executive director of the Fairfield County Medical Association, prompting the medical associations in Fairfield and Hartford counties to file a federal lawsuit to stop the cancelations.

In New York City, UnitedHealthcare’s contracts with about 2,100 physicians will be canceled, affecting some 8,000 patients, according to the Medical Society of New York.

In Florida, UnitedHealthcare has dropped the state’s only National Cancer Institute-designated cancer treatment facility, the Moffitt Cancer Center and its 250 physicians in Tampa. 

Senay was able to find another Advantage plan that includes her doctors, with the help of Tammy Harris, a Medicare counselor with CHOICES, Connecticut’s senior health insurance information program.

Harris said not everyone will be so lucky. Elderly patients worry about traveling long distances to reach new ones, she said.

“If they have to drive to New Haven,” she said, “it’s like going to the moon.”   

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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Administration Gives Postive Progress Report On Health Care Website Fixes

Obama administration officials announced Sunday morning that they had met their deadline in terms of making improvements to healthcare.gov.

The Washington Post: HealthCare.gov Meets Deadline For Fixes, White House Says
Administration officials announced Sunday that they had met their Saturday deadline for improving HealthCare.gov after completing a series of hardware upgrades and software fixes to the troubled Web site. A progress report released Sunday morning by the U.S. Department of Health and Human Services said: “While we strive to innovate and improve our outreach and systems for reaching consumers, we believe we have met the goal of having a system that will work smoothly for the vast majority of users” (Sun, 12/1).

The New York Times: Obama Administration Says Health Care Web Site Is Vastly Improved
In effect, the administration gave itself a passing grade. Because of hundreds of software fixes and hardware upgrades in the past month, it said, the website — the main channel for people seeking to buy insurance under President Obama’s health care law — is now working more than 90 percent of the time, up from 40 percent during some weeks in October. … Much of the progress in the past five weeks resulted from radical changes in the management of HealthCare.gov, according to the report. Technology experts concluded in mid-October that “HealthCare.gov was fixable, but only with significant changes to the management approach and a relentless focus on execution,” it said (Pear, 12/1).

Reuters: Obama Administration Declares Victory On Fixing HealthCare.gov
The new performance levels mark significant improvement after the Obamacare website’s disastrous October 1 launch, when it crashed in the face of high traffic volumes and remained down 60 percent of the time for weeks. But officials remain concerned about high volumes this month, with the potential for large numbers of people entering the site to apply for insurance coverage beginning JanuaryŁ (Morgan, 12/1).

Los Angeles Times: HealthCare.gov Website Working For Most Users, Officials Say
Web pages on the site now load in less than a second, down from eight seconds in late October. The system now operates more than 90% of the time. For some weeks in October, the site was up for only 40% of the time. And the average rate of time-outs or other Web-page failures on the site has dropped to around three-quarters of a percent. It was as high as 6% in October (Levey, 12/1).

USA Today: White House Announces HealthCare.gov Met Repair Goals
“The bottom line is health care.gov on December first is night and day from where it was October first,” said Jeffrey Zients, the president’s appointee to fix the website’s problems. “The site is now stable and operating at its intended capacity at greatly improved performance.” When the site — which allows people to compare private plan benefits and costs before buying an insurance policy — launched Oct. 1, millions of people were disappointed by slow or frozen pages, an inability to log in, and incorrect or missing information. The White House tapped Zients to lead a team to fix the site (Kennedy, 12/1).

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Medicare Seeks To Curb Spending On Post-Hospital Care

After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital.

Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix.

Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years, according to an analysis health care economist Chapin White conducted for Kaiser Health News.

Last year $62 billion — one out of every six dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.  

Most of them got those services after coming out of the hospital. Some of these providers earn double-digit profits from Medicare through a hodgepodge of payment methods that health experts say encourages unnecessary and disjointed care, wastes taxpayer money and makes fraud easier. More than a quarter of Medicare spending in Louisiana, Texas, Mississippi, Oklahoma and Massachusetts was for post-acute care in 2011, Medicare records show.  

Hospitals are often the gatekeepers to this world. But analysts say they do not take costs—or sometimes patients’ best interests—into account when discharging patients. “They have not had to think remotely about costs or quality or anything except where’s a bed available,” said Anne Tumlinson, a consultant at Avalere Health in Washington. “Often doctors have very little to do with the discharge decision. Largely it has to do with the supply of providers and type of providers in the area.” 

Now, Medicare is experimenting with new payment methods in which hospitals and post-acute providers would be given a lump sum to take care of a patient, forcing them to become more efficient if they want to make money. In addition, President Barack Obama has proposed reducing payments for some conditions to post-acute providers and beginning to pay the same rates for similar patients.  

Stephen Parente, a health care economist at the University of Minnesota, says the changes are likely to upend much of the industry. “It’s going to be a fairly ugly transition to get to a more efficient, streamlined system,” Parente said. “It’s going to be a consultant’s bonanza.” 

Many Options For Care

Ironically, the growth of the post-hospital industry can be traced back to actions Medicare took in the 1ᚔs to clamp down on long inpatient hospital stays. Medicare started paying hospitals set sums for each patient stay, giving them a financial impetus to discharge patients as soon as possible. New services sprung up in response around the country to take these patients, often with business models that sought to maximize the money they could earn from Medicare. 

State-By-State

Table: Medicare Spending By State And Category

The vagueness of the term “post-acute” reflects the wide array of ways Medicare patients can be treated after they leave the hospital. Those robust enough to return home can receive intermittent visits from nurses, physical therapists and aides who monitor their condition and assist in basic tasks. These services are known as home health. Patients needing closer oversight can end up in nursing homes or the more intense inpatient rehabilitation facilities, where people suffering strokes, major joint replacements and fractures often end up. The sickest patients, such as those who need ventilators to breathe for weeks, may be admitted to long-term care hospitals, where the average stay is 26 days. 

Medicare pays each type of facility different rates — even when they are treating the same kinds of patients. Medicare’s cost for treating stroke patients, including time in the hospital and three months of subsequent care, averages $40,000 if the patient is discharged to an inpatient rehabilitation facility, according to an analysis by Congress’s Medicare Payment Advisory Commission (MedPAC). Medicare’s cost averages $33,000 for stroke patients discharged instead to a nursing home, and only $13,000 for those cared for at home with the assistance of health aides, the analysis found.  

These varying payment rates were created under the assumption that many sicker patients would need to be in facilities that could provide more intensive care. But researchers have found evidence that the same types of patients can end up in different types of facilities for no apparent medical reason.  

Jim Prister, president of RLM Specialty Hospital in Chicago and Hinsdale, Ill., said that his long-term care hospitals turn down about half the patients hospitals refer because they do not meet Medicare’s criteria. “We don’t rely on what the [hospital’s] care coordinator says,” Prister said. “We have a pretty large team of RNs that go out and see every patient.”  

An Institute of Medicine study released in July concluded that post-hospital services are the primary reason that Medicare spends much more in some parts of the nation than elsewhere. Uneven spending on post-acute care around the country accounts for 73 percent of the variation in Medicare spending. White’s analysis of Medicare records for Kaiser Health News found that home health spending in 2011 accounted for a quarter of the reason that some areas were more costly than others. 

In McAllen, Texas, doctors and hospitals have received most of the criticism for the region’s high Medicare spending, which is greater than in any other part of the country except Miami. Medicare records, however, show inpatient hospital use and spending in 2011 was around the national average, and outpatient care was significantly below average. McAllen’s post-acute spending was the true outlier. McAllen beneficiaries were more than 2 1/2 times as likely to use home health services, long-term care hospitals and rehab facilities than were the average Medicare beneficiary in 2011. As a result, Medicare spent $4,752 per capita on post-acute services, while the national per capita spending average was $1,894. 

Much post-hospital use is determined by which facilities are around. A third of all home health care cases took place in Florida, Louisiana, Mississippi, Oklahoma and Texas even though only 17 percent of Medicare beneficiaries live in those states, says MedPAC.  

Aggressive marketing plays a role in where patients get sent, said Jared Landis, a consultant at The Advisory Board, a consulting company for health care providers. “Anecdotally, it is a market where post-acute discharge is heavily affected by personal relationships, traditional sales and marketing—just building those personal relationships around those small gifts, those cookies,” he said.  

Substantial Profits

For many companies, these patients translate into substantial profits. Nursing homes are expected to earn betweenಌ and 14 percent this year on their Medicare patients, MedPAC estimates. Home health margins are expected to average 12 percent, and intensive rehabilitation facilities margins are around 8.5 percent, MedPAC estimates. Long-term care hospitals, the laggard of the post-acute groups in profits, are earning almost 6 percent.  

The post-acute care industry has defended these profit margins by saying that they counterbalance the losses their facilities receive from lower Medicaid payments in many states. “If you start targeting the one healthy aspect of skilled nursing that pays for the services provided, that’s going to pose real jeopardy to the entire profession,” said Greg Crist, a spokesman for the American Health Care Association, which represents nursing homes. 

Policy experts say providers tailor their approaches to wring the most money out of Medicare’s payment methods. Nursing homes, for instance, are paid per day, encouraging homes to keep patients for as long as possible up to the 100-day limit Medicare set. Medicare picks up the entire tab for the first 20 days.
MedPAC calculates that even including money-losing Medicaid patients, nursing homes earned profits between 4 to 6 percent in 2011, the most recent year for which they have data. 

Home health agencies are paid set sums for 60 days with no regard for how many nursing and aide visits are made. The number of visits in the average 60-day period dropped from 32 in 1998 to 19 in 2011, while the number of patients being enrolled in home health soared, with the majority no longer coming straight from the hospital, according to MedPAC.

“The incentive is to sign up patients who need hardly anything and sign them up for as long as you can get them,” said Judy Feder, a professor at the Georgetown Public Policy Institute.   

At times, efforts to game Medicare have veered into outright fraud, particularly in home health.  The Centers for Medicare & Medicaid Services this summer placed a temporary moratorium on new home health agencies in Miami and Chicago. In testimony before a congressional budget writing panel in June, CMS deputy administrator Jonathan Blum said agency auditors had discovered nursing homes billing for services that were never provided and home health agencies billing for people who were well enough to leave their homes. “Some of these improper billing practices point to potential overtreatment of Medicare beneficiaries, with patients receiving more intensive care than is medically warranted,” Blum testified. 

Even though the transition out of hospitals can be one of the most perilous times for patients, many hospitals have not forged close relationships with post-acute facilities. Avalere’s Tumlinson analyzed where patients from 10 different Chicago hospitals in񎧚 went after discharge. She found that on average the hospitals sent patients to 130 different nursing homes. She said, “How on earth can a hospital ever get a handle on this and have a relationship with the patient post discharge if they’re dealing with this many different skilled nursing facilities?” 

Bundling Payments

Experiments authorized by the federal health law and now being conducted by the Center for Medicare & Medicaid Innovation aim to alter the financial calculus for both hospitals and post-acute providers. The center has received proposals for 178 “bundled payment” experiments in which hospitals and post-acute providers will work together to treat Medicare patients for a fixed sum, instead of being paid separately. Another 157 experiments involving only the post-acute providers have also been created, many by private companies that have recruited medical providers. 

One company is NaviHealth, created by former CMS administrator Tom Scully. NaviHealth evaluates hospitalized patients to determine where they should be discharged afterward, and then birddogs their care along the way. NaviHealth has proposed Medicare bundled payment experiments with hospitals in Tennessee, Oklahoma, New Mexico and New Jersey. 

“We catch patients in their second day in the hospital and come up with a very detailed evaluation of their functional status,” Scully said. “Maybe you should be in the rehab hospital for 14 days, or nursing home for 10 days instead of 20 days,” which is the most days before Medicare starts charging patients a co-payment. Otherwise, he said, “the nursing home will keep you for the maximum days they can. It’s nobody’s fault, it’s just the incentives.”

NaviHealth is already managing the post-acute treatment for patients in private Medicare Advantage plans and Medicare supplemental plans. After John Alzapiedi, an 85-year-old retired technical service representative from Clinton, Mass., fractured his ankle, NaviHealth oversaw his care last summer as he moved to a nursing home to recover from surgery and a subsequent infection.

“Once I got home, there were four of them who started visiting, one for physical therapy,” Alzapiedi said. The others were a nurse, a case manager and a coach to help him with his medication. “I’d say overall things are going pretty good,” he said.

Companies such as NaviHealth are betting that similar services will be in high demand. Obama wants to cut payments for post-acute providers, pay rehabilitation facilities and nursing homes the same rates, and penalize nursing homes when their patients end up back in the hospital. He also has proposed making paying lump sums for a patient’s post hospital care, just as Medicare does with hospitals. 

But just as the hospital lump payment system led to the explosion in post-acute care, some experts are warning that the ideas now being touted as improvements for this sector could have unintended consequences. “The incentive is to avoid the sick and skimp on services,” Feder said. 

See More: Medicare Spending By State And Category

jrau@kff.org

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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Poor limb motor function recovery following stroke

Negative motor evoked potentials after cerebral infarction, indicative of poor recovery of limb motor function, tend to be accompanied by changes in fractional anisotropy values and the cerebral peduncle area on the affected side, but the characteristics of these changes have not been reported. As reported previously, the lower limit value of fractional anisotropy of the cerebral peduncle in healthy volunteers is 0.36, and the lower limit of the asymmetry of the cerebral peduncle area is 0.83.

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Treating cerebral ischemia using dl-3n-butylphthalide

Dl-3n-butylphthalide can effectively treat cerebral ischemia; however, the mechanisms underlying the effects of dl-3n-butylphthalide on microcirculation disorders following diffuse brain injury remain unclear. According to a study by Prof. Jianmin Li and team from Hebei United University of China, models of diffuse brain injury were established in Sprague-Dawley rats with the vertical impact method, and dl-3n-butylphthalide at 80 and 160 mg/kg was given via intraperitoneal injection immediately after diffuse brain injury.

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Discovery of gene mutation for excessive alcohol drinking

UK researchers have discovered a gene that regulates alcohol consumption and when faulty can cause excessive drinking. They have also identified the mechanism underlying this phenomenon.The study showed that normal mice show no interest in alcohol and drink little or no alcohol when offered a free choice between a bottle of water and a bottle of diluted alcohol.However, mice with a genetic mutation to the gene Gabrb1 overwhelmingly preferred drinking alcohol over water, choosing to consume almost 85% of their daily fluid as drinks containing alcohol.

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Linking transfer of fewer embryos to reimbursing 6 IVF cycles doesn't reduce delivery rates

Research from Belgium has shown that if governments legislate to restrict the numbers of embryos transferred during fertility treatment, but combine it with a policy of reimbursing six cycles of assisted reproduction technology (ART), there is no detrimental impact on pregnancy and delivery rates. However, there is a greatly reduced risk of multiple births, which have associated health risks for mother and babies and are an increased cost to the state.

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In British Columbia disputed asthma drugs have safe record

A popular combination asthma therapy dogged by safety concerns has not harmed British Columbians and should remain in use, according to researchers at the University of British Columbia and Vancouver Coastal Health Research Institute.The therapy combines an inhaled corticosteroid to reduce swelling in the airways with “long-acting beta agonists” (LABAs) to ease breathing and reduce the risk of a severe asthma attack. The U.S.

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Link between social and economic status and childhood ADHD in the UK

ADHD linked to social and economic disadvantageA team led by the University of Exeter Medical School analysed data from the Millennium Cohort Study, a database of more than 19,500 UK children born between 2000 and 2002.The study, published in the Journal of Child Psychology and Psychiatry, was funded by the ESRC’s Secondary Data Analysis Initiative. The team also acknowledge funding from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (PenCLAHRC).

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