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Owing to the multiphase transformations in economy, society, natural environment, lifestyles and healthcare system that China has been experiencing over the past three decades, coupled with the rapid population ageing, China’s burden of non-communicable disease, particularly cardiovascular disease (CVD) and cancer, has been rising drastically.1 Both the incidence of and mortality from ischaemic heart disease (IHD) have been increasing dramatically since 1980s in China.1 In 2019, IHD was the second cause of deaths in the Chinese population, which counted for 17.6% of all deaths and 9.1% of disability-adjusted life years.2 Although there are ample evidence on the socioeconomic disparities in generic lasix cost CVD in high-income countries, evidence is still limited in low- and middle-income countries such as China.3The paper by Chen et al is the first comprehensive report on the educational disparities https://sleeveless.tv/buy-lasix-100mg in IHD incidence, case fatality and mortality in China, using data from the large prospective cohort study of China Kadoorie Biobank. The study supplements generic lasix cost findings of a robust inverse educational gradient in IHD case fatality ….

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This author has published http://solarhairsalon.com/?p=1641 on various medical topics lasix without script and is obviously on several lists as a potential reviewer for papers on subjects of which he has only slight detailed knowledge. There appears to be no definition of, or qualifications for, a peer reviewer other than that he or she is, rightly or wrongly, perceived to be an expert in a particular field.About a million research papers are published each year and researchers are pressurised to publish because grants, enhanced reputations and rewards may follow (perhaps including a Nobel prize). Peer review is one way for reputable journals to promote good lasix without script science. But there are numerous problems as outlined by Richard Smith, a previous editor of the British Medical Journal.1Peer reviewers are usually busy people and often provide their opinions without charge.

Journal editors, unless they reject submission independently, must choose and trust that reviewers are up to date especially concerning potentially important recent developments.For the purposes of this account, a differentiation is made between research studies and research trials. Studies are solely observational and replications are unusual lasix without script because surrounding circumstances often change with the passage of time. In contrast, trials are interventional. Trials should address predefined specific questions and the methods used should contain sufficient information to allow exact replication lasix without script.

Replication of trials is problematic because of the expenses involved and details of the exact methods used in the original trial may not be comprehensive. Double-blind randomised placebo-controlled research trials are said to be gold standard, but comparative trials are more important. The former only lasix without script suggests that treatments given were more effective than placebo. Reviewers need to know is whether treatments are better than a known effective treatment.Traditionally studies and trials comprise titles, abstracts, introduction, methods, results, discussion, conclusions and references.Reviewers should ensure that …AbstractAt the beginning of 2020, the outbreak of hypertension medications in China has brought great impact on the society, economy and life.

This article introduces lasix without script current status of Chinese postgraduate medical students under this epidemic situation in combination with the author's own experience from four aspects. Professional spirit, professional knowledge, learning status and protective measures.IntroductionA novel hypertension has been discovered and confirmed since the first case of unidentified pneumonia was confirmed in Wuhan, China, in December 2019.1 2 The disease caused by this novel lasix was officially named hypertension medications by the WHO on 12 January 2020. Since the outbreak in China, the numbers of confirmed cases and deaths have rapidly increased. hypertension medications has been clarified as a grade B infectious disease, lasix without script others of which include severe acute respiratory syndrome and highly pathogenic avian influenza, and is treated according to the protocol for grade A infectious diseases.

hypertension medications is the seventh known hypertension-induced disease that involves of the respiratory system in human beings. The other two potentially life-threatening hypertension-induced diseases are severe acute respiratory syndrome and Middle East respiratory syndrome.3 4 This novel hypertension-induced pneumonia is transmitted from person to person lasix without script and is highly infectious, with high susceptibility among the general population. The hypertension responsible for hypertension medications has a long incubation period and diverse clinical features, seriously impacting normal work and life throughout the country. As of 13 April 2020, hypertension medications had been recognised in over 200 countries, with a total of 1 784 364 laboratory-confirmed cases and 111 832 deaths, and these numbers have since continued to rise.On 23 January 2020, the Chinese government immediately blocked the city of Wuhan and cut off all outside contact to stop the spread of hypertension medications.

Other cities successively announced closure of lasix without script public places and restricted the flow of people. At the time of this writing, the Chinese Ministry of Education had stated that no student was allowed to return to school until further notification. Some postgraduate medical students residing at school were lasix without script isolated in safe places. Some others who had returned home for holiday were restricted to their local residence and prohibited to return to the hospital or medical school for studies or clinical work.

We herein describe the status and situation of postgraduate medical students in China under the influence of hypertension medications.Encouragement and promotion of the professional spirit of postgraduate medical studentsAt the frontline of the fight against hypertension medications, many medical staff members around the country have devoted their full power without hesitation while ignoring their own personal safety. Their teachers, colleagues and friends have also participated in this lasix without script battle. Such behaviour demonstrates the humanitarian nature of medicine, which involves healing the wounded and rescuing the dying. This vivid lesson lasix without script helps medical students to internalise medical ethical principles through emotional penetration and thus deepens their understanding and strengthens their beliefs.

It benefits society to cultivate a spirit of benevolence among medical students and to train postgraduate medical students to engage in positive behaviour. In recent years, the position of the medical humanities in medical education has gradually improved. The combination of medical humanities and medical knowledge is regarded as a successful medical education, which manifests scientific and lasix without script human brilliance. Such education could help medical students to realise the transformation from medical ethical cognition to medical ethical behaviour in their future career.Use of professional knowledge to assist othersMedical students can help their relatives and friends to recognise the symptoms of pneumonia early according to their professional knowledge.

The diagnosis of hypertension medications is based on a combination of lasix without script epidemiological information, clinical symptoms, CT imaging findings and laboratory tests according to the standards of either the WHO or the National Health Commission of China. Although medical students were not in the hospital and had no access to CT or test kits, they generally have a higher level of professional judgement than people in the general population with respect to medical knowledge and patients’ symptoms. For example, if a person within a medical student’s neighbourhood develops a fever and cough and has a travel history from Wuhan, the student can advise him or her to go to the hospital in a timely manner. Postgraduate medical students can also educate the people around them, which helps the public to realise the importance of lasix without script prevention and comply with regulations formulated by the country.

Medical students can also serve as volunteers within the community and use their professional knowledge to make more contributions to community residents.Non-stop learning despite suspension of classesThe sudden outbreak of this novel hypertension disrupted normal teaching and studying in the field of medical education. Non-stop learning via online teaching despite suspension of classes lasix without script was put forward by the ministry of education. During the disease outbreak, online lectures and learning tutorials were adopted to avoid unnecessary aggregation of people and the associated risk of .5 Basic medical courses such as physiology, pathology and biology are relatively easy to study by video or electronic books. However, clinical medicine courses such as surgery are not suitable for online study.

Because medicine is a practical science, it cannot break away lasix without script from clinics and patients, and even simulation training cannot achieve a real-world effect. Many universities lack the ability to use the computers or software required to conduct online teaching courses, record teaching videos and prepare teaching documents such as text, picture, audio and animation. Students living in rural areas with underdeveloped networks and poor hardware facilities may find it difficult to meet the requirements of online learning. During this lasix without script special period in China, self-study has become an important skill for medical students.

Students of different majors have different learning styles. Dermatology students can review photographs of lesions to improve their lasix without script skills in differential diagnosis. Internal medicine students can analyse complex cases to exercise their logical ability. Surgery students can learn more about internal medicine to become more comprehensive surgeons.

Additionally, online learning allows students to restart long-forgotten projects, modify lasix without script research papers and complete unfinished work. They can also review the literature in a field of interest, create an outline of future research and contemplate their career plan. All doctors in China are willing to apply for assistance from the National Natural Science Foundation of China, a famous lasix without script and widely used research fund. Online application usually starts in March every year, but in 2020, it was postponed until April because of the epidemic.

This gave medical students more time to carefully prepare for their application under the guidance of a mentor.Effective measures to ensure the health of medical studentsAlthough the medical resources of the whole country are devoted to treatment of all patients infected with the novel hypertension, the schools and government still make special efforts to protect the health of students. Peking Union Medical College has developed an online system called SARISenor, which is used lasix without script by medical students to report the body temperature and physical condition every day. This system also has a locating function based on the global positioning system, which is convenient for localised management. Our medical school also developed a course to increase knowledge of hypertension medications, and all students are required to study this lasix without script course online.

A test is administered after completion of the course, and students must complete the test to obtain a certificate and show the certificate to the school. This compulsory measure improves students’ awareness of the novel hypertension and strengthens their ability to prevent hypertension medications. With respect lasix without script to psychological health, medical students are easily affected by disease-associated fear and pressure, and schools should be prepared to provide psychological services to those who need them.6 Students can also consult psychologists from university-affiliated hospitals who are online 24 hours a day. The Chinese government provides students with a wide coverage of lasix protection education that has shown good results to date.

The government also provides corresponding lasix without script psychological counselling services. Specifically, China has1 stopped centralised classroom teaching,2 carried out antiepidemic knowledge training,3 encouraged the wearing of masks and4 paid attention to hand hygiene. These measures are worthy of implementation in foreign countries as well. Conversely, European countries have encouraged medical students to lasix without script graduate early so that they may work to help fight hypertension medications, which is worthy of implementation in China.We cannot neglect the adverse effects of hypertension medications on Chinese scientific research.

Fundamental experiments, scientific conferences, funding applications and other activities have been postponed or suspended because of the lasix situation, which has caused a huge loss in scientific research in China. Specifically, pharmaceutical companies are lacking essential drugs because of shutdowns lasix without script. Scientific researchers are out of work because of the closures of laboratories. And students are unable to attain their academic degrees because of the suspension of research.

However, the lasix without script damage to science is insignificant compared with the level of human suffering. Notably, 5G wireless communication technology, artificial intelligence and cloud computing have played effective roles in prevention and monitoring during this epidemic emergency. Additionally, because of the lack of specific drugs and treatments, traditional Chinese medicine has been adopted as a part of clinical therapy.Thanks lasix without script to the leadership of the government and the efforts of many medical workers, the effect of hypertension medications control in China has been remarkable. The Chinese Ministry of Education recently announced that senior medical students can return to universities in advance if circumstances permit.

Doctors and postgraduate medical students are also glad to return to their clinical work and make their own contributions to the health of the people. With increased knowledge of the viral features, epidemiological characteristics, clinical symptoms and antilasix theory, efficient strategies have been taken to prevent, control lasix without script and stop the spread of hypertension medications. During the current hypertension medications lasix, which is a worldwide war, everyone is a fighter. Under the close unity of all countries worldwide and with active participation of the world population, we believe that the prevention and control of hypertension medications will be finally achieved.AcknowledgmentsWe thank the leaders and teachers from PUMC&CAMS for their help in processing this article..

This author how to get prescribed lasix has published on various medical topics and is obviously on several lists as a potential reviewer for papers on subjects of which he has only generic lasix cost slight detailed knowledge. There appears to be no definition of, or qualifications for, a peer reviewer other than that he or she is, rightly or wrongly, perceived to be an expert in a particular field.About a million research papers are published each year and researchers are pressurised to publish because grants, enhanced reputations and rewards may follow (perhaps including a Nobel prize). Peer review is one generic lasix cost way for reputable journals to promote good science. But there are numerous problems as outlined by Richard Smith, a previous editor of the British Medical Journal.1Peer reviewers are usually busy people and often provide their opinions without charge. Journal editors, unless they reject submission independently, must choose and trust that reviewers are up to date especially concerning potentially important recent developments.For the purposes of this account, a differentiation is made between research studies and research trials.

Studies are solely observational and replications are unusual because surrounding generic lasix cost circumstances often change with the passage of time. In contrast, trials are interventional. Trials should address generic lasix cost predefined specific questions and the methods used should contain sufficient information to allow exact replication. Replication of trials is problematic because of the expenses involved and details of the exact methods used in the original trial may not be comprehensive. Double-blind randomised placebo-controlled research trials are said to be gold standard, but comparative trials are more important.

The former only suggests that treatments given were more effective generic lasix cost than placebo. Reviewers need to know is whether treatments are better than a known effective treatment.Traditionally studies and trials comprise titles, abstracts, introduction, methods, results, discussion, conclusions and references.Reviewers should ensure that …AbstractAt the beginning of 2020, the outbreak of hypertension medications in China has brought great impact on the society, economy and life. This article introduces current status of Chinese postgraduate medical students generic lasix cost under this epidemic situation in combination with the author's own experience from four aspects. Professional spirit, professional knowledge, learning status and protective measures.IntroductionA novel hypertension has been discovered and confirmed since the first case of unidentified pneumonia was confirmed in Wuhan, China, in December 2019.1 2 The disease caused by this novel lasix was officially named hypertension medications by the WHO on 12 January 2020. Since the outbreak in China, the numbers of confirmed cases and deaths have rapidly increased.

hypertension medications has been clarified as a grade B infectious disease, others of which include severe acute respiratory syndrome and highly pathogenic avian influenza, and generic lasix cost is treated according to the protocol for grade A infectious diseases. hypertension medications is the seventh known hypertension-induced disease that involves of the respiratory system in human beings. The other two potentially life-threatening hypertension-induced diseases are severe acute respiratory syndrome and Middle East respiratory syndrome.3 4 This novel hypertension-induced pneumonia is transmitted from person to person and is highly generic lasix cost infectious, with high susceptibility among the general population. The hypertension responsible for hypertension medications has a long incubation period and diverse clinical features, seriously impacting normal work and life throughout the country. As of 13 April 2020, hypertension medications had been recognised in over 200 countries, with a total of 1 784 364 laboratory-confirmed cases and 111 832 deaths, and these numbers have since continued to rise.On 23 January 2020, the Chinese government immediately blocked the city of Wuhan and cut off all outside contact to stop the spread of hypertension medications.

Other cities successively announced generic lasix cost closure of public places and restricted the flow of people. At the time of this writing, the Chinese Ministry of Education had stated that no student was allowed to return to school until further notification. Some postgraduate medical students residing at school were isolated in safe places generic lasix cost. Some others who had returned home for holiday were restricted to their local residence and prohibited to return to the hospital or medical school for studies or clinical work. We herein describe the status and situation of postgraduate medical students in China under the influence of hypertension medications.Encouragement and promotion of the professional spirit of postgraduate medical studentsAt the frontline of the fight against hypertension medications, many medical staff members around the country have devoted their full power without hesitation while ignoring their own personal safety.

Their teachers, colleagues and friends have also participated in this battle generic lasix cost. Such behaviour demonstrates the humanitarian nature of medicine, which involves healing the wounded and rescuing the dying. This vivid generic lasix cost lesson helps medical students to internalise medical ethical principles through emotional penetration and thus deepens their understanding and strengthens their beliefs. It benefits society to cultivate a spirit of benevolence among medical students and to train postgraduate medical students to engage in positive behaviour. In recent years, the position of the medical humanities in medical education has gradually improved.

The combination of medical humanities and medical knowledge is regarded as generic lasix cost a successful medical education, which manifests scientific and human brilliance. Such education could help medical students to realise the transformation from medical ethical cognition to medical ethical behaviour in their future career.Use of professional knowledge to assist othersMedical students can help their relatives and friends to recognise the symptoms of pneumonia early according to their professional knowledge. The diagnosis of hypertension medications is based on a combination of epidemiological information, clinical symptoms, CT imaging findings and laboratory tests according to the standards of either the WHO or the generic lasix cost National Health Commission of China. Although medical students were not in the hospital and had no access to CT or test kits, they generally have a higher level of professional judgement than people in the general population with respect to medical knowledge and patients’ symptoms. For example, if a person within a medical student’s neighbourhood develops a fever and cough and has a travel history from Wuhan, the student can advise him or her to go to the hospital in a timely manner.

Postgraduate medical students can also educate the people generic lasix cost around them, which helps the public to realise the importance of prevention and comply with regulations formulated by the country. Medical students can also serve as volunteers within the community and use their professional knowledge to make more contributions to community residents.Non-stop learning despite suspension of classesThe sudden outbreak of this novel hypertension disrupted normal teaching and studying in the field of medical education. Non-stop learning via online teaching despite suspension of classes was put forward by the ministry generic lasix cost of education. During the disease outbreak, online lectures and learning tutorials were adopted to avoid unnecessary aggregation of people and the associated risk of .5 Basic medical courses such as physiology, pathology and biology are relatively easy get lasix online to study by video or electronic books. However, clinical medicine courses such as surgery are not suitable for online study.

Because medicine is a practical science, it cannot break away from clinics and patients, and even simulation training cannot achieve generic lasix cost a real-world effect. Many universities lack the ability to use the computers or software required to conduct online teaching courses, record teaching videos and prepare teaching documents such as text, picture, audio and animation. Students living in rural areas with underdeveloped networks and poor hardware facilities may find it difficult to meet the requirements of online learning. During this special generic lasix cost period in China, self-study has become an important skill for medical students. Students of different majors have different learning styles.

Dermatology students can review photographs of lesions to improve their skills generic lasix cost in differential diagnosis. Internal medicine students can analyse complex cases to exercise their logical ability. Surgery students can learn more about internal medicine to become more comprehensive surgeons. Additionally, online learning allows students to restart long-forgotten projects, modify research generic lasix cost papers and complete unfinished work. They can also review the literature in a field of interest, create an outline of future research and contemplate their career plan.

All doctors in China are willing to apply for assistance from generic lasix cost the National Natural Science Foundation of China, a famous and widely used research fund. Online application usually starts in March every year, but in 2020, it was postponed until April because of the epidemic. This gave medical students more time to carefully prepare for their application under the guidance of a mentor.Effective measures to ensure the health of medical studentsAlthough the medical resources of the whole country are devoted to treatment of all patients infected with the novel hypertension, the schools and government still make special efforts to protect the health of students. Peking Union Medical College has developed an online system called SARISenor, which is generic lasix cost used by medical students to report the body temperature and physical condition every day. This system also has a locating function based on the global positioning system, which is convenient for localised management.

Our medical school also developed generic lasix cost a course to increase knowledge of hypertension medications, and all students are required to study this course online. A test is administered after completion of the course, and students must complete the test to obtain a certificate and show the certificate to the school. This compulsory measure improves students’ awareness of the novel hypertension and strengthens their ability to prevent hypertension medications. With respect to psychological health, medical students are easily affected by disease-associated fear and pressure, and schools should be prepared to provide psychological services to those who need them.6 Students can also consult psychologists from university-affiliated hospitals who are online 24 hours a generic lasix cost day. The Chinese government provides students with a wide coverage of lasix protection education that has shown good results to date.

The government also provides corresponding psychological generic lasix cost counselling services. Specifically, China has1 stopped centralised classroom teaching,2 carried out antiepidemic knowledge training,3 encouraged the wearing of masks and4 paid attention to hand hygiene. These measures are worthy of implementation in foreign countries as well. Conversely, European countries have encouraged medical students to graduate early so that they may work to help fight generic lasix cost hypertension medications, which is worthy of implementation in China.We cannot neglect the adverse effects of hypertension medications on Chinese scientific research. Fundamental experiments, scientific conferences, funding applications and other activities have been postponed or suspended because of the lasix situation, which has caused a huge loss in scientific research in China.

Specifically, pharmaceutical generic lasix cost companies are lacking essential drugs because of shutdowns. Scientific researchers are out of work because of the closures of laboratories. And students are unable to attain their academic degrees because of the suspension of research. However, the damage to science is generic lasix cost insignificant compared with the level of human suffering. Notably, 5G wireless communication technology, artificial intelligence and cloud computing have played effective roles in prevention and monitoring during this epidemic emergency.

Additionally, because generic lasix cost of the lack of specific drugs and treatments, traditional Chinese medicine has been adopted as a part of clinical therapy.Thanks to the leadership of the government and the efforts of many medical workers, the effect of hypertension medications control in China has been remarkable. The Chinese Ministry of Education recently announced that senior medical students can return to universities in advance if circumstances permit. Doctors and postgraduate medical students are also glad to return to their clinical work and make their own contributions to the health of the people. With increased knowledge of the viral features, epidemiological characteristics, clinical symptoms and antilasix theory, efficient strategies have been taken to prevent, control and stop the generic lasix cost spread of hypertension medications. During the current hypertension medications lasix, which is a worldwide war, everyone is a fighter.

Under the close unity of all countries worldwide and with active participation of the world population, we believe that the prevention and control of hypertension medications will be finally achieved.AcknowledgmentsWe thank the leaders and teachers from PUMC&CAMS for their help in processing this article..

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KHN Midwest correspondent Cara Anthony discussed how Black tech entrepreneurs are trying to solve neglected health care issues on the America’s Heroes Group podcast Dec does lasix make horses faster. 4. She talked about health technology and culturally competent care on KTVU on Dec does lasix make horses faster. 1.

KHN interim Southern Bureau Editor Andy Miller spoke about the omicron variant of the hypertension medications lasix on WUGA’s “Georgia Health Report” and Georgia Public Broadcasting’s “Political Rewind” Dec. 3. KHN Midwest correspondent Lauren Weber discussed the hypertension medications lasix and Missouri’s public health infrastructure on the “Healthy You. Surviving a lasix” podcast Dec.

2. Related Topics Contact Us Submit a Story TipIn the second-most anticipated abortion case of the year, eight justices on the U.S. Supreme Court ruled Friday that abortion providers can challenge a Texas law that has effectively banned most abortions in the state since it was allowed to take effect in September. But the court also ruled that the federal Justice Department could not intervene in the dispute, and it refused to block the law for now.

Nonetheless, the justices were sharply divided in their opinions on the case. The majority opinion in the Texas decision, Whole Woman’s Health et al. V. Jackson et al., did not directly address the fate of abortion rights in the United States.

Rather, the conservative, anti-abortion majority on the court is expected to take on that larger question in a separate case out of Mississippi that was argued Dec. 1. In fact, the majority opinion, written by Justice Neil Gorsuch, directly acknowledged as much. Whether the Texas law is constitutional “is not before the court,” he wrote.

€œNor is the wisdom [of the Texas law] as a matter of public policy.” A hint as to the coming showdown over abortion rights is included in a plurality opinion written by Chief Justice John Roberts — and joined by the three liberal justices. The Texas law, wrote Roberts, “has had the effect of denying the exercise of what we have held is a right protected under the Federal Constitution.” The Texas law, known as SB 8, is similar to laws passed by several other states over the past few years in that it bans abortion after fetal cardiac activity can be detected, which is usually about six weeks into pregnancy. That is in direct contravention of Supreme Court precedents in 1973’s Roe v. Wade and 1992’s Planned Parenthood of Southeastern Pennsylvania v.

Casey, which say states cannot ban abortion until “viability,” about 22 to 24 weeks. The Texas law also makes no exception for pregnancies caused by rape or incest. SB 8, however, varies from other state “heartbeat” laws because it has a unique enforcement mechanism that gives state officials no role. Rather, it leaves enforcement to the general public, by authorizing civil suits against not just anyone who performs an abortion, but also anyone who “aids and abets” an abortion, which could include those who drive patients to an abortion clinic or counsel them.

Those who sue and win would be guaranteed damages of at least $10,000. Opponents of the law call that a “bounty” to encourage people to sue their neighbors. Supporters of the law have said it was specifically designed to prevent federal courts from blocking the law, since no state officials are involved in enforcement and therefore are not responsible for it. It was specifically that enforcement mechanism that the Supreme Court considered during three hours of oral arguments that were speedily scheduled on Nov.

1. The question before the justices was not directly whether the Texas ban is unconstitutional, but whether either the abortion providers or the federal government could challenge it in court. In the end the court ruled that while the abortion providers could sue some, but not all, of the Texas officials included in their lawsuit, the Justice Department could not intervene. In a separate, two paragraph ruling, the court said the case brought by the federal government seeking to intervene, United States v.

Texas, was “improvidently granted.” The justices also noted that Thursday a state court in Texas held the law unconstitutional, but that case affects only roughly a dozen individual suits. As she has been since the court first addressed the case last summer, Justice Sonia Sotomayor was scathing in her criticism. By allowing the Texas law to continue in effect, she wrote in a dissent, “The Court thus betrays not only the citizens of Texas but also our constitutional system of government.” The case returns to the federal district court in Texas. Julie Rovner.

jrovner@kff.org, @jrovner Related Topics Contact Us Submit a Story TipCUTHBERT, Ga. €” Lacandie Gipson struggled to breathe. The 33-year-old woman with multiple health conditions was in respiratory distress and awaiting an ambulance. About 20 minutes after the emergency call, it arrived.

The Cuthbert home where Gipson lived was less than a mile from Southwest Georgia Regional Medical Center, but the ambulance couldn’t take her to the one-story brick hospital because it had closed three months earlier, in October 2020. Instead, the EMTs loaded Gipson into the ambulance and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead. €œThey said it was a heart attack,” said Keila Davis, who, along with her husband, lived with Gipson. €œIf the hospital was still open, it could have saved her.” Since Southwest Georgia Regional Medical Center in Cuthbert, Georgia, closed in October 2020, many local residents with health emergencies have been forced to travel to a hospital 27 miles away in Eufaula, Alabama.

For some, being that far from emergency care can be dangerous. (Andy Miller / KHN) The Cuthbert hospital was one of 19 rural hospitals in the U.S. That closed in 2020. That’s the largest number of such facilities to shut down in a single year since 2005, when the Cecil G.

Sheps Center for Health Services Research at the University of North Carolina began tracking the data. In the past 10 years, eight rural hospitals have shut down in Georgia. Only Texas and Tennessee have had more closures. The center’s data shows that 86 of the 129 hospitals that closed in that time were in Texas and the Southeast.

Health care experts and recent studies say Medicaid expansion helps keep hospitals afloat because it increases the number of adults with low incomes who have health insurance. None of the eight states with the most rural hospital closures since 2014, when Medicaid expansion was first implemented through the Affordable Care Act, had chosen to expand the insurance program by the start of 2021. In several of those states, including Georgia, Republican-led governments have said such a step would be too costly. Georgia’s inaction on Medicaid expansion “hurt us probably more than anybody else,” said Cuthbert Mayor Steve Whatley, a Republican who lost his reelection bid in the city of about 3,400 people in November.

A hospital closure may be felt more in some communities than others. The one in Cuthbert, Whatley said, “is unbelievably impactful.” Not having an emergency room nearby means that each response by an ambulance takes it offline for two to three hours, said Whatley, who is also the chairman of the Randolph County Hospital Authority. Clifford Hanks, 78, of Cuthbert had to drive to Eufaula’s ER recently when he was experiencing sharp back pain. €œThe ambulance is too slow and not available,” Hanks said while sitting in a store on the Cuthbert square.

The drive, he said, was rough. Several factors have contributed to the hospital closures nationally, according to the Sheps Center. Struggling rural hospitals treat high numbers of uninsured patients and people with chronic disease, said George Pink, a senior research fellow at the center. €œThey have a high level of uncompensated care,” Pink said, and not enough patients with private insurance, which reimburses hospitals at higher rates than Medicaid and Medicare do.

The population in rural areas tends to be older as well, which would lead to increased costs of care. Pink also said that recruiting physicians to rural counties, many of which have shrinking populations, is difficult. And many of the hospitals that have closed were experiencing infrastructure problems as funds for maintaining buildings and equipment declined. €œThese hospitals have been losing money for years,” Pink said.

University of Washington researchers have found that rural hospital closures led to increased mortality for inpatient stays in that region, while urban closures had no measurable effect. Among the reasons they cited were the increase in the time people had to travel to get hospital care and that some medical providers leave communities when hospitals close. Federal hypertension medications relief funding has tempered the rate of hospital closures this year, according to Brock Slabach, chief operations officer at the National Rural Health Association. Still, the group estimates that 453 rural hospitals, or about a quarter of the total, are at risk of closure.

€œWe could see eight to 10 rural hospitals close in Georgia in the coming years,” said Jimmy Lewis, CEO of HomeTown Health, a rural hospital association in Georgia. €œThey’re going to run out of cash.” Nationwide, rural hospitals that serve communities with large Black populations are more likely than rural hospitals overall to be financially distressed, according to the Sheps Center’s North Carolina Rural Health Research Program. And among financially distressed rural hospitals, the program’s research shows, those serving areas with greater Black and/or Hispanic populations are more likely to close. (Hispanics can be of any race or combination of races.) The Cuthbert hospital’s closing has severely affected the region’s Black population.

More than 60% of Randolph County residents are Black, and the surrounding counties, whose residents used to travel to Cuthbert for hospital care, have Black populations of 47% or above. In the region, Black Americans, especially older people with diabetes and high blood pressure, are very concerned about the hospital closing, said Charisse Jackson, an employee at the CareConnect health center across the street from the hospital. The community hopes to get some medical care back, if not a total revival of the hospital. The hospital authority, locally based Andrew College and a Mississippi management firm are working together on a bid for U.S.

Department of Agriculture grants of $1 million and $10 million. The vision is to have a stand-alone emergency room with a handful of beds. The hospital authority, Whatley said, still has “a couple million dollars” to support the funding if it is approved. €œFifteen million dollars would do it,” Whatley said.

U.S. Sen. Jon Ossoff (D-Ga.) has taken an interest in the health care vacuum in Randolph County and is helping identify private- and public-sector opportunities to restore more medical services in the area. €œThe challenges the folks in Randolph County have are similar to challenges across rural health care,” Ossoff said.

In downtown Cuthbert, the history of Southwest Georgia Regional Medical Center unfurls in a mural on the walls of Randolph County’s old courthouse, which now houses the Randolph County Chamber of Commerce. Local pharmacist Carl Patterson’s family founded the hospital in 1916 as Patterson Hospital. After the facility’s closure, Patterson said, Randolph County does not have a physician in full-time practice. Supporting the hospital financially was always tough.

It needed $10 million in upgrades, and surgery, a profitable service at some facilities, was not done there. €œOur hospital wasn’t the greatest, but it was a means to get you stable. It helped a lot of people,” said Brenda Clark, who was born at the hospital and now works in a Cuthbert wellness center across the street from the shuttered facility. Older people who need care “can’t get into their cars and drive to Eufaula or Albany,” she said.

The hospital closure has been “devastating” for businesses, said Rebecca White, executive director of the county chamber of commerce. About 25% of Randolph County residents already lived below the poverty line. €œNo doubt in my mind, that hospital was a lifesaver,” said Dr. A.S.

Ghiathi, a family physician who worked at Southwest Georgia Regional Medical Center for more than 20 years. Ghiathi, 64, still lives in Randolph County but works mainly at a Mercer Medicine clinic in nearby Clay County’s Fort Gaines. That county also has no hospital. The closure of the Randolph County hospital “was like a death,” he said.

€œPeople grieved over this loss. We wanted to pass this hospital on to the next generation.” Some residents of Randolph County say the loss of the hospital has been a factor in medical tragedies, such as the death of Lacandie Gipson, and could cause others. Jeanette Love, 67, who lived in the Randolph County town of Shellman, died while waiting for an ambulance, her sister Susie Jackson said. It had been called because Love was having a hard time breathing.

The Randolph County ambulance was tied up, Jackson said, so one from another county had to be dispatched to pick up Love, who had chronic obstructive pulmonary disease and diabetes. The delay grew longer when that ambulance went to the wrong address. €œIt took an hour and a half or longer,” Jackson said. “It’s about 15 to 20 minutes to Cuthbert,” said Jackson, who drove from her home in Shellman to Love’s house that July day to help her.

€œI had a car. I could have taken her to the hospital. She may have been saved.” Instead, while the sisters waited, Jackson said, Love “sat by me, laid her head on my shoulder and died.” On the medical situation in Randolph County, Jackson said, “We are better than this.” Andy Miller. amiller@kff.org, @gahealthnews Related Topics Contact Us Submit a Story TipSharon Marchio misses having teeth for eating, speaking and smiling.

For the past few years, after the last of her teeth were extracted, she’s used dentures. €œMy dentist calls them my floating teeth because no matter how much adhesive you use, if you eat something hot or warm, they loosen up and it is a pain,” said Marchio, 73, of Clarksburg, West Virginia. Marchio believes that losing her teeth was merely part of getting older. It’s quite common in West Virginia, where a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country, according to federal data.

Like half of Medicare enrollees nationally, Marchio has no dental insurance. Worries about the costs led her to skip regular cleanings and exams, crucial steps for preventing s and tooth loss. Medicare doesn’t cover most dental care, but consumer advocates had hoped that would change this year after Democrats took control of the White House and Congress. President Joe Biden and progressives, led by Sen.

Bernie Sanders, sought to add the benefit to a major domestic spending package, the Build Back Better Act, that Democrats are seeking to pass. But those chances are looking slim because at least one Democratic senator — Joe Manchin of, yes, West Virginia — opposes adding dental and other benefits for Medicare beneficiaries. He says it will cost the federal government too much. In a Senate split evenly between Republicans and Democrats, losing Manchin's vote would likely sink the proposal, which is unlikely to get any Republican votes.

Last month, the House passed the roughly $2 trillion package of Democrats’ domestic priorities that include health measures, free preschool, affordable housing programs and initiatives to fight climate change. It added hearing services coverage to Medicare but no dental benefit. The package is expected to undergo revisions in the Senate, and Democratic leaders hope a vote will happen in the chamber before the end of the year. In West Virginia, one of the most heavily Republican states in the country, oral health advocates and progressives say it’s disappointing that Manchin would stand in the way of adding dental coverage for Medicare recipients — particularly given the state’s poor oral health record.

€œIt is unfortunate that our senator — who I respect and agree with on a lot of things — is going to draw the line on this issue,” said Fotinos Panagakos, associate dean for research at the West Virginia University School of Dentistry and a member of the Santa Fe Group, a think tank made up of scholars, industry executives and former government officials pushing for a Medicare dental benefit. €œIt would be a huge benefit.” West Virginia has the third-highest share of people 65 and older, behind only Florida and Maine. Panagakos said that nearly 300,000 West Virginia Medicare recipients would gain dental benefits under the bill. Yet, Manchin’s efforts aren’t likely to cost him politically.

He is not up for reelection until 2024. €œWhat political price do you pay when four other Republicans vote ‘no’ against everything?. € Ryan Frankenberry, state director of the progressive Working Families Party in West Virginia, said, referring to the state’s three House members and Sen. Shelley Moore Capito, who all oppose the bill.

€œIt’s a difficult argument to blame one person for not passing the benefit when every other Republican vote went against it.” Manchin’s opposition, Frankenberry said, stems from the need to respond to the political pressures of representing an increasingly conservative state — and arguments from conservative commentators that Medicare is becoming insolvent and increasing the federal deficit. Manchin, who did not respond to requests for an interview, has raised concerns about adding new Medicare spending when the Medicare Part A hospital trust fund is slated to become insolvent in 2026 if Congress takes no action. But that fund would not cover the proposed dental benefit. It would become part of Medicare Part B, which covers outpatient services such as doctor visits.

Manchin has also suggested that new social programs being advanced by the Democrats in the Build Back Better Act should be means-tested — in essence, offering the coverage only to people with lower incomes. Dentists are concerned that Medicare — like Medicaid — would pay less than what they normally charge, said Richard Stevens, executive director of the West Virginia Dental Association. The American Dental Association has also called for limiting any new Medicare dental benefit through means testing. ADA officials say a means test would ensure the benefit is helping those who really need it and save money for the Medicare program.

But critics say the ADA’s position is an effort by the powerful dental lobby to kill the benefit — because it knows Congress has little appetite to turn to means testing in Medicare. The program remains popular largely because everyone 65 and older is entitled to all its benefits. €œOn the surface, their position sounds auistic,” said Michael Alfano, who is a former dean of the New York University College of Dentistry and helped found the Santa Fe Group. €œBut there is no interest in Congress to make it a means-tested benefit.” While adding a Medicare benefit would increase demand for dental services, it would also reduce what are considered dentists’ most lucrative patients, those who pay out-of-pocket and don’t benefit from insurer-discounted fees, Alfano said.

€œIn my mind, the ADA did not have public interest at heart — they put the financial returns of dentists at the top of the ledger when developing this approach,” he said. Alfano said there is still hope for an eleventh-hour change in the bill. €œIt’s not dead, but I would be lying if I said I was not disappointed,” he said. West Virginia seniors have other options for getting dental coverage.

Many get some benefits when they enroll in private Medicare Advantage plans. And in January, West Virginia added an adult dental benefit to Medicaid, the federal-state health insurance program for people with low incomes, giving enrollees an annual maximum benefit of $1,000. Previously, West Virginia was one of about a dozen states that either provided no adult dental benefit to Medicaid recipients or only covered emergencies. Through September, about 53,000 of the nearly 390,000 adult enrollees in West Virginia’s Medicaid program had used the benefit.

Stevens of the West Virginia Dental Association said he could not explain why so few Medicaid enrollees had used the benefit, though he noted that the $1,000 maximum might not be enough to persuade some to seek care. €œFor people with more serious oral health conditions, $1,000 does not go very far,” Stevens said. €œIt’s hardly worth the time for the patient and not worth the time for the dentist.” Craig Glover, CEO of FamilyCare Health Centers in Charleston, West Virginia, said a Medicare benefit would help the many older patients who come to his dental clinic. He said some patients don’t return for needed follow-up care because of concerns about costs.

Without dental coverage, older adults in West Virginia rely on community health centers — which offer a sliding fee scale based on income — and free health clinics for care. But they can still face higher costs than they can afford or long waits for care. The dental appointments at the Susan Dew Hoff Memorial Clinic in West Milford, where Marchio has been treated, are booked several months in advance, said office manager Gail Marsh. Phil Galewitz.

pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story Tip.

KHN Midwest correspondent Cara Anthony discussed how Black tech entrepreneurs are trying generic lasix cost to solve neglected health care issues on the America’s Heroes Group podcast Dec. 4. She talked about health technology and culturally competent care on KTVU generic lasix cost on Dec.

1. KHN interim Southern Bureau Editor Andy Miller spoke about the omicron variant of the hypertension medications lasix on WUGA’s “Georgia Health Report” and Georgia Public Broadcasting’s “Political Rewind” Dec. 3.

KHN Midwest correspondent Lauren Weber discussed the hypertension medications lasix and Missouri’s public health infrastructure on the “Healthy You. Surviving a lasix” podcast Dec. 2.

Related Topics Contact Us Submit a Story TipIn the second-most anticipated abortion case of the year, eight justices on the U.S. Supreme Court ruled Friday that abortion providers can challenge a Texas law that has effectively banned most abortions in the state since it was allowed to take effect in September. But the court also ruled that the federal Justice Department could not intervene in the dispute, and it refused to block the law for now.

Nonetheless, the justices were sharply divided in their opinions on the case. The majority opinion in the Texas decision, Whole Woman’s Health et al. V.

Jackson et al., did not directly address the fate of abortion rights in the United States. Rather, the conservative, anti-abortion majority on the court is expected to take on that larger question in a separate case out of Mississippi that was argued Dec. 1.

In fact, the majority opinion, written by Justice Neil Gorsuch, directly acknowledged as much. Whether the Texas law is constitutional “is not before the court,” he wrote. €œNor is the wisdom [of the Texas law] as a matter of public policy.” A hint as to the coming showdown over abortion rights is included in a plurality opinion written by Chief Justice John Roberts — and joined by the three liberal justices.

The Texas law, wrote Roberts, “has had the effect of denying the exercise of what we have held is a right protected under the Federal Constitution.” The Texas law, known as SB 8, is similar to laws passed by several other states over the past few years in that it bans abortion after fetal cardiac activity can be detected, which is usually about six weeks into pregnancy. That is in direct contravention of Supreme Court precedents in 1973’s Roe v. Wade and 1992’s Planned Parenthood of Southeastern Pennsylvania v.

Casey, which say states cannot ban abortion until “viability,” about 22 to 24 weeks. The Texas law also makes no exception for pregnancies caused by rape or incest. SB 8, however, varies from other state “heartbeat” laws because it has a unique enforcement mechanism that gives state officials no role.

Rather, it leaves enforcement to the general public, by authorizing civil suits against not just anyone who performs an abortion, but also anyone who “aids and abets” an abortion, which could include those who drive patients to an abortion clinic or counsel them. Those who sue and win would be guaranteed damages of at least $10,000. Opponents of the law call that a “bounty” to encourage people to sue their neighbors.

Supporters of the law have said it was specifically designed to prevent federal courts from blocking the law, since no state officials are involved in enforcement and therefore are not responsible for it. It was specifically that enforcement mechanism that the Supreme Court considered during three hours of oral arguments that were speedily scheduled on Nov. 1.

The question before the justices was not directly whether the Texas ban is unconstitutional, but whether either the abortion providers or the federal government could challenge it in court. In the end the court ruled that while the abortion providers could sue some, but not all, of the Texas officials included in their lawsuit, the Justice Department could not intervene. In a separate, two paragraph ruling, the court said the case brought by the federal government seeking to intervene, United States v.

Texas, was “improvidently granted.” The justices also noted that Thursday a state court in Texas held the law unconstitutional, but that case affects only roughly a dozen individual suits. As she has been since the court first addressed the case last summer, Justice Sonia Sotomayor was scathing in her criticism. By allowing the Texas law to continue in effect, she wrote in a dissent, “The Court thus betrays not only the citizens of Texas but also our constitutional system of government.” The case returns to the federal district court in Texas.

Julie Rovner. jrovner@kff.org, @jrovner Related Topics Contact Us Submit a Story TipCUTHBERT, Ga. €” Lacandie Gipson struggled to breathe.

The 33-year-old woman with multiple health conditions was in respiratory distress and awaiting an ambulance. About 20 minutes after the emergency call, it arrived. The Cuthbert home where Gipson lived was less than a mile from Southwest Georgia Regional Medical Center, but the ambulance couldn’t take her to the one-story brick hospital because it had closed three months earlier, in October 2020.

Instead, the EMTs loaded Gipson into the ambulance and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead. €œThey said it was a heart attack,” said Keila Davis, who, along with her husband, lived with Gipson. €œIf the hospital was still open, it could have saved her.” Since Southwest Georgia Regional Medical Center in Cuthbert, Georgia, closed in October 2020, many local residents with health emergencies have been forced to travel to a hospital 27 miles away in Eufaula, Alabama.

For some, being that far from emergency care can be dangerous. (Andy Miller / KHN) The Cuthbert hospital was one of 19 rural hospitals in the U.S. That closed in 2020.

That’s the largest number of such facilities to shut down in a single year since 2005, when the Cecil G. Sheps Center for Health Services Research at the University of North Carolina began tracking the data. In the past 10 years, eight rural hospitals have shut down in Georgia.

Only Texas and Tennessee have had more closures. The center’s data shows that 86 of the 129 hospitals that closed in that time were in Texas and the Southeast. Health care experts and recent studies say Medicaid expansion helps keep hospitals afloat because it increases the number of adults with low incomes who have health insurance.

None of the eight states with the most rural hospital closures since 2014, when Medicaid expansion was first implemented through the Affordable Care Act, had chosen to expand the insurance program by the start of 2021. In several of those states, including Georgia, Republican-led governments have said such a step would be too costly. Georgia’s inaction on Medicaid expansion “hurt us probably more than anybody else,” said Cuthbert Mayor Steve Whatley, a Republican who lost his reelection bid in the city of about 3,400 people in November.

A hospital closure may be felt more in some communities than others. The one in Cuthbert, Whatley said, “is unbelievably impactful.” Not having an emergency room nearby means that each response by an ambulance takes it offline for two to three hours, said Whatley, who is also the chairman of the Randolph County Hospital Authority. Clifford Hanks, 78, of Cuthbert had to drive to Eufaula’s ER recently when he was experiencing sharp back pain.

€œThe ambulance is too slow and not available,” Hanks said while sitting in a store on the Cuthbert square. The drive, he said, was rough. Several factors have contributed to the hospital closures nationally, according to the Sheps Center.

Struggling rural hospitals treat high numbers of uninsured patients and people with chronic disease, said George Pink, a senior research fellow at the center. €œThey have a high level of uncompensated care,” Pink said, and not enough patients with private insurance, which reimburses hospitals at higher rates than Medicaid and Medicare do. The population in rural areas tends to be older as well, which would lead to increased costs of care.

Pink also said that recruiting physicians to rural counties, many of which have shrinking populations, is difficult. And many of the hospitals that have closed were experiencing infrastructure problems as funds for maintaining buildings and equipment declined. €œThese hospitals have been losing money for years,” Pink said.

University of Washington researchers have found that rural hospital closures led to increased mortality for inpatient stays in that region, while urban closures had no measurable effect. Among the reasons they cited were the increase in the time people had to travel to get hospital care and that some medical providers leave communities when hospitals close. Federal hypertension medications relief funding has tempered the rate of hospital closures this year, according to Brock Slabach, chief operations officer at the National Rural Health Association.

Still, the group estimates that 453 rural hospitals, or about a quarter of the total, are at risk of closure. €œWe could see eight to 10 rural hospitals close in Georgia in the coming years,” said Jimmy Lewis, CEO of HomeTown Health, a rural hospital association in Georgia. €œThey’re going to run out of cash.” Nationwide, rural hospitals that serve communities with large Black populations are more likely than rural hospitals overall to be financially distressed, according to the Sheps Center’s North Carolina Rural Health Research Program.

And among financially distressed rural hospitals, the program’s research shows, those serving areas with greater Black and/or Hispanic populations are more likely to close. (Hispanics can be of any race or combination of races.) The Cuthbert hospital’s closing has severely affected the region’s Black population. More than 60% of Randolph County residents are Black, and the surrounding counties, whose residents used to travel to Cuthbert for hospital care, have Black populations of 47% or above.

In the region, Black Americans, especially older people with diabetes and high blood pressure, are very concerned about the hospital closing, said Charisse Jackson, an employee at the CareConnect health center across the street from the hospital. The community hopes to get some medical care back, if not a total revival of the hospital. The hospital authority, locally based Andrew College and a Mississippi management firm are working together on a bid for U.S.

Department of Agriculture grants of $1 million and $10 million. The vision is to have a stand-alone emergency room with a handful of beds. The hospital authority, Whatley said, still has “a couple million dollars” to support the funding if it is approved.

€œFifteen million dollars would do it,” Whatley said. U.S. Sen.

Jon Ossoff (D-Ga.) has taken an interest in the health care vacuum in Randolph County and is helping identify private- and public-sector opportunities to restore more medical services in the area. €œThe challenges the folks in Randolph County have are similar to challenges across rural health care,” Ossoff said. In downtown Cuthbert, the history of Southwest Georgia Regional Medical Center unfurls in a mural on the walls of Randolph County’s old courthouse, which now houses the Randolph County Chamber of Commerce.

Local pharmacist Carl Patterson’s family founded the hospital in 1916 as Patterson Hospital. After the facility’s closure, Patterson said, Randolph County does not have a physician in full-time practice. Supporting the hospital financially was always tough.

It needed $10 million in upgrades, and surgery, a profitable service at some facilities, was not done there. €œOur hospital wasn’t the greatest, but it was a means to get you stable. It helped a lot of people,” said Brenda Clark, who was born at the hospital and now works in a Cuthbert wellness center across the street from the shuttered facility.

Older people who need care “can’t get into their cars and drive to Eufaula or Albany,” she said. The hospital closure has been “devastating” for businesses, said Rebecca White, executive director of the county chamber of commerce. About 25% of Randolph County residents already lived below the poverty line.

€œNo doubt in my mind, that hospital was a lifesaver,” said Dr. A.S. Ghiathi, a family physician who worked at Southwest Georgia Regional Medical Center for more than 20 years.

Ghiathi, 64, still lives in Randolph County but works mainly at a Mercer Medicine clinic in nearby Clay County’s Fort Gaines. That county also has no hospital. The closure of the Randolph County hospital “was like a death,” he said.

€œPeople grieved over this loss. We wanted to pass this hospital on to the next generation.” Some residents of Randolph County say the loss of the hospital has been a factor in medical tragedies, such as the death of Lacandie Gipson, and could cause others. Jeanette Love, 67, who lived in the Randolph County town of Shellman, died while waiting for an ambulance, her sister Susie Jackson said.

It had been called because Love was having a hard time breathing. The Randolph County ambulance was tied up, Jackson said, so one from another county had to be dispatched to pick up Love, who had chronic obstructive pulmonary disease and diabetes. The delay grew longer when that ambulance went to the wrong address.

€œIt took an hour and a half or longer,” Jackson said. “It’s about 15 to 20 minutes to Cuthbert,” said Jackson, who drove from her home in Shellman to Love’s house that July day to help her. €œI had a car.

I could have taken her to the hospital. She may have been saved.” Instead, while the sisters waited, Jackson said, Love “sat by me, laid her head on my shoulder and died.” On the medical situation in Randolph County, Jackson said, “We are better than this.” Andy Miller. amiller@kff.org, @gahealthnews Related Topics Contact Us Submit a Story TipSharon Marchio misses having teeth for eating, speaking and smiling.

For the past few years, after the last of her teeth were extracted, she’s used dentures. €œMy dentist calls them my floating teeth because no matter how much adhesive you use, if you eat something hot or warm, they loosen up and it is a pain,” said Marchio, 73, of Clarksburg, West Virginia. Marchio believes that losing her teeth was merely part of getting older.

It’s quite common in West Virginia, where a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country, according to federal data. Like half of Medicare enrollees nationally, Marchio has no dental insurance. Worries about the costs led her to skip regular cleanings and exams, crucial steps for preventing s and tooth loss.

Medicare doesn’t cover most dental care, but consumer advocates had hoped that would change this year after Democrats took control of the White House and Congress. President Joe Biden and progressives, led by Sen. Bernie Sanders, sought to add the benefit to a major domestic spending package, the Build Back Better Act, that Democrats are seeking to pass.

But those chances are looking slim because at least one Democratic senator — Joe Manchin of, yes, West Virginia — opposes adding dental and other benefits for Medicare beneficiaries. He says it will cost the federal government too much. In a Senate split evenly between Republicans and Democrats, losing Manchin's vote would likely sink the proposal, which is unlikely to get any Republican votes.

Last month, the House passed the roughly $2 trillion package of Democrats’ domestic priorities that include health measures, free preschool, affordable housing programs and initiatives to fight climate change. It added hearing services coverage to Medicare but no dental benefit. The package is expected to undergo revisions in the Senate, and Democratic leaders hope a vote will happen in the chamber before the end of the year.

In West Virginia, one of the most heavily Republican states in the country, oral health advocates and progressives say it’s disappointing that Manchin would stand in the way of adding dental coverage for Medicare recipients — particularly given the state’s poor oral health record. €œIt is unfortunate that our senator — who I respect and agree with on a lot of things — is going to draw the line on this issue,” said Fotinos Panagakos, associate dean for research at the West Virginia University School of Dentistry and a member of the Santa Fe Group, a think tank made up of scholars, industry executives and former government officials pushing for a Medicare dental benefit. €œIt would be a huge benefit.” West Virginia has the third-highest share of people 65 and older, behind only Florida and Maine.

Panagakos said that nearly 300,000 West Virginia Medicare recipients would gain dental benefits under the bill. Yet, Manchin’s efforts aren’t likely to cost him politically. He is not up for reelection until 2024.

€œWhat political price do you pay when four other Republicans vote ‘no’ against everything?. € Ryan Frankenberry, state director of the progressive Working Families Party in West Virginia, said, referring to the state’s three House members and Sen. Shelley Moore Capito, who all oppose the bill.

€œIt’s a difficult argument to blame one person for not passing the benefit when every other Republican vote went against it.” Manchin’s opposition, Frankenberry said, stems from the need to respond to the political pressures of representing an increasingly conservative state — and arguments from conservative commentators that Medicare is becoming insolvent and increasing the federal deficit. Manchin, who did not respond to requests for an interview, has raised concerns about adding new Medicare spending when the Medicare Part A hospital trust fund is slated to become insolvent in 2026 if Congress takes no action. But that fund would not cover the proposed dental benefit.

It would become part of Medicare Part B, which covers outpatient services such as doctor visits. Manchin has also suggested that new social programs being advanced by the Democrats in the Build Back Better Act should be means-tested — in essence, offering the coverage only to people with lower incomes. Dentists are concerned that Medicare — like Medicaid — would pay less than what they normally charge, said Richard Stevens, executive director of the West Virginia Dental Association.

The American Dental Association has also called for limiting any new Medicare dental benefit through means testing. ADA officials say a means test would ensure the benefit is helping those who really need it and save money for the Medicare program. But critics say the ADA’s position is an effort by the powerful dental lobby to kill the benefit — because it knows Congress has little appetite to turn to means testing in Medicare.

The program remains popular largely because everyone 65 and older is entitled to all its benefits. €œOn the surface, their position sounds auistic,” said Michael Alfano, who is a former dean of the New York University College of Dentistry and helped found the Santa Fe Group. €œBut there is no interest in Congress to make it a means-tested benefit.” While adding a Medicare benefit would increase demand for dental services, it would also reduce what are considered dentists’ most lucrative patients, those who pay out-of-pocket and don’t benefit from insurer-discounted fees, Alfano said.

€œIn my mind, the ADA did not have public interest at heart — they put the financial returns of dentists at the top of the ledger when developing this approach,” he said. Alfano said there is still hope for an eleventh-hour change in the bill. €œIt’s not dead, but I would be lying if I said I was not disappointed,” he said.

West Virginia seniors have other options for getting dental coverage. Many get some benefits when they enroll in private Medicare Advantage plans. And in January, West Virginia added an adult dental benefit to Medicaid, the federal-state health insurance program for people with low incomes, giving enrollees an annual maximum benefit of $1,000.

Previously, West Virginia was one of about a dozen states that either provided no adult dental benefit to Medicaid recipients or only covered emergencies. Through September, about 53,000 of the nearly 390,000 adult enrollees in West Virginia’s Medicaid program had used the benefit. Stevens of the West Virginia Dental Association said he could not explain why so few Medicaid enrollees had used the benefit, though he noted that the $1,000 maximum might not be enough to persuade some to seek care.

€œFor people with more serious oral health conditions, $1,000 does not go very far,” Stevens said. €œIt’s hardly worth the time for the patient and not worth the time for the dentist.” Craig Glover, CEO of FamilyCare Health Centers in Charleston, West Virginia, said a Medicare benefit would help the many older patients who come to his dental clinic. He said some patients don’t return for needed follow-up care because of concerns about costs.

Without dental coverage, older adults in West Virginia rely on community health centers — which offer a sliding fee scale based on income — and free health clinics for care. But they can still face higher costs than they can afford or long waits for care. The dental appointments at the Susan Dew Hoff Memorial Clinic in West Milford, where Marchio has been treated, are booked several months in advance, said office manager Gail Marsh.

Phil Galewitz. pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story Tip.

How to dose lasix

Weston E, Lertpruek S, how to dose lasix Tongtoyai J http://www.buxmontseniorservices.org/business-services-additional-support. Quality assessment of the enhanced gonococcal antimicrobial surveillance program in Thailand, 2015–2016. Sex Transm Infect how to dose lasix 2017;93:A28–9.

Doi. 10.1136/sextrans-2017-053264.71. The authors have requested a correction to the author list and affiliations for their how to dose lasix abstract.

While E view website Weston did indeed present …‘Nothing about us without us’ is a slogan that underlines the importance of engaging end-users in the development of programmes and policies. Although the concept has been widely used in politics, activism and social life, government-organised health services rarely seek patient how to dose lasix and public input when developing new health programmes. Experts, physicians, public health leaders and others make the key decisions about what health services to offer and how they are delivered.

End-user perspectives have been largely overlooked in the process of sexual health service planning. How can patients and the public be more how to dose lasix involved in setting health priorities?. This is the central question raised by a study organised by a multidisciplinary team in Liverpool.1 In addition to organising focus group discussions and other methods, they organised a crowdsourcing open call to determine STI research priorities in northwest England.

Crowdsourcing open calls are a structured process to obtain ideas from people and then share these back with the broader community.2 Open call approaches have many advantages for soliciting input from stakeholders.3The open call process used by this study to ascertain preferences related to STI research priorities demonstrates strengths related to diverse stakeholder networks, established priority setting methods and heterogeneous recruitment ….

Weston E, Lertpruek S, Tongtoyai generic lasix cost J. Quality assessment of the enhanced gonococcal antimicrobial surveillance program in Thailand, 2015–2016. Sex Transm Infect generic lasix cost 2017;93:A28–9. Doi. 10.1136/sextrans-2017-053264.71.

The authors have requested a correction to the author list and affiliations for their abstract generic lasix cost. While E Weston did indeed present …‘Nothing about us without us’ is a slogan that underlines the importance of engaging end-users in the development of programmes and policies. Although the concept has been widely used in politics, activism and social life, government-organised health services generic lasix cost rarely seek patient and public input when developing new health programmes. Experts, physicians, public health leaders and others make the key decisions about what health services to offer and how they are delivered. End-user perspectives have been largely overlooked in the process of sexual health service planning.

How can generic lasix cost patients and the public be more involved in setting health priorities?. This is the central question raised by a study organised by a multidisciplinary team in Liverpool.1 In addition to organising focus group discussions and other methods, they organised a crowdsourcing open call to determine STI research priorities in northwest England. Crowdsourcing open calls are a structured process to obtain ideas from people and then share these back with the broader community.2 Open call approaches have many advantages for soliciting input from stakeholders.3The open call process used by this study to ascertain preferences related to STI research priorities demonstrates strengths related to diverse stakeholder networks, established priority setting methods and heterogeneous recruitment ….

Lasix uric acid

Literally literacyThough this issue won’t appear for another 3-4 weeks, given the painful events unravelling in Afghanistan, it would feel banal to the point of lasix uric acid negligence to fail to ask ‘where are we going’ in terms of global human rights.Many years ago, I took a short course on ‘primary health care in low and middle countries’ to equip myself with some knowledge of the public health issues I was likely to encounter first in Sudan and later Afghanistan. Though the teaching was a little too ‘touchy feely’ for my taste, it left an impression based on one talk and one message. Female literacy lasix uric acid.

Once assimilated, I realised that this was central to everythingI was based close to Kabul, during the immediate, relatively upbeat (if not as openly urbane as the 1970s) post-Soviet withdrawal era and have maintained some contact in the form of research collaborations with colleagues in the Afghan Ministry of Health. In parallel, we have seen the tantalising promise of a future of freedom and children’s futures and women’s rights snatched away so abruptly, the purple period from 2001 to 2021 already feeling illusorySo, when the headlines change as they inevitably will (tabloid attention no doubt turning to the off-duty improprieties of a footballer or mid-ranking cabinet member) don’t forget that if classrooms can be kept open, then there is still hope.Global child health. Maternal and perinatal outcomeContinuing the neonatal sepsis theme discussed lasix uric acid by Carolin Fleischmann and colleagues in the August issue (https://adc.bmj.com/content/106/8/745) Adama Baguiya’s WHO maternal sepsis (GLOSS) group takes another angle, the identification of high risk babies by the mothers’ peripartum condition.

Using data from 43 LMICs, neonatal outcomes of mothers with suspected or proven sepsis were compared with those in whom there were no concerns. The direction of effect (predictive) was perhaps not surprising, though the magnitude was. A third of the babies lasix uric acid of these women had adverse outcomes.

25% near miss events (outcomes requiring intervention or resuscitation of some sort) and a 10% mortality with an OR of 3.8 (95% CI 2.0 to 7.1) for the most severely unwell mothers. How then can these women be identified earlier before both they and lasix uric acid the fetus starts to decompensate?. See page 946Opiates in analgesiaWe all have a preferred opiate for analgesia resistant to first and second line alternatives and this particular choice has been, for as long as I can remember, if not divisive then factionalising.From buprenorphine patches to intranasal fentanyl to oral dextromoramide (the latter admittedly now largely a museum piece) to codeine, each has its (often vocal) proponents, the volume of their arguments not necessarily a correlate of analgesic effect.In the Drugs and Therapeutics section, Sarah Spenard and colleagues address this chestnut in their systematic review of the literature comparing morphine and hydromorphone, the turn to opioid in the face of the nausea and (histamine agonism-related) pruritus for which morphine itself is renowned.

They found high quality evidence from 4 RCTs concluding there was nothing to choose between them in terms of therapeutic or side effects. So, rather than weighing up which opiate, the only lasix uric acid question worth asking is ‘is there a reason not to start one now?. €™ in the face of a child struggling on high dose NSAID treatment.

See page 1002Safety reportingWe are the proud discovers of a new antimicrobial drug, let’s call it ‘viroblast 21’, the performance of which in phase two trials has been (our brochures proclaim) ‘breathtaking’. Agog with excitement, we proceed to the ‘definitive’ randomised controlled trial in children admitted to PICU for respiratory support lasix uric acid. The ‘fully adjusted analyses’ (inverted commas, of course intentional) repay the faith we had in the drug, a ‘jaw dropping’ protective HR in time to recovery of 0.2 (95% CI 0.1 to 0.35).

The tension is lasix uric acid released and celebrations can begin… or can they?. The message in Taco Jan Pils’ and colleagues’ systematic review of trials reporting is that, even now, in the era of EQUATOR, CONSORT, siblings and half siblings safety data is often overlooked. Though reporting has improved over the decade since their previous review, it’s baffling that it isn’t 100%.

Part of the lasix uric acid story is missing. Taking a tangential trajectory, it would be reasonable to argue that the sort of safety reporting leaves a few more loopholes. I want to know whether children can swallow the preparation.

Whether it tastes lasix uric acid good (or at least isn’t emetogenic). And that the cost is not crippling for the health service or patients and parents by which it will ultimately be financed. This too (the economic burden) is also to my mind lasix uric acid a side effect.

Where resources are finite, something else will have to give. Maybe that mouthwatering ‘effect size’ didn’t tell us everything we need to know. See page 1010Fixing a hole where the rain gets inThe lasix uric acid reality is that much of what we do, despite the best public health preventative measures is reactive.

The asthmatic child’s parents of ‘who only ever smoke outside’ are advised to stop or get help/gum/patches.I’m digressing but only slightly as, what I’m getting at are the upstream (preventative) vs downstream (symptomatic) approaches. Until recently, all treatment in cystic fibrosis was, by necessity, reactive/downstream. The advent of the CF lasix uric acid transmembrane modulator family, correctors and potentiators has changed all this.

Iolo Doull’s compelling review from the discovery of the molecule to the consistent improvements in all objective measures of lung and overall health by its augmentation testifies to this. This is lasix uric acid exciting for other reasons too. In the same way that anti-retroviral treatment in HIV became bolder and gathered pace, there is impetus for novel orphan drug development with implications beyond CF alone.

See page 941(Pierre-)Robin sequence (RS) is characterised by mandibular retrognathia, glossoptosis and upper airway obstruction (UAO). To alleviate the latter, placing such infants prone was already suggested as a first-line treatment by Robin himself, the eponym of lasix uric acid this condition. Indeed, it appears intuitively plausible that gravity will help shifting the mandible forward during sleep.

Against this background, it was not surprising that the prone position was implemented by about two-thirds of respondents to a recent survey focusing on interventions used in infants with RS.1In neonatology, however, we have learnt the hard way that what seems plausible is not always effective and, particularly, safe. Thus, we need to scrutinise the evidence for recommending prone positioning to resolve UAO in infants with RS lasix uric acid. Objective data on the effectiveness of this intervention, however, are sparse.

A retrospective analysis of sleep study data in 18 infants with RS (mean age, 1.5 months) found a higher sleep efficiency in the prone position, but no significant reduction in the severity of obstructive sleep apnoea (OSA).2 A longitudinal prospective study in 14 infants with RS (mean age, 1.8 months) reported a median Obstructive Apnoea–Hypopnoea ….

Literally literacyThough this issue won’t appear for another 3-4 generic lasix cost weeks, given the painful events unravelling in Afghanistan, it would feel banal to the point of negligence to fail to ask ‘where are we https://greedisgood.one/dividendy-mobb going’ in terms of global human rights.Many years ago, I took a short course on ‘primary health care in low and middle countries’ to equip myself with some knowledge of the public health issues I was likely to encounter first in Sudan and later Afghanistan. Though the teaching was a little too ‘touchy feely’ for my taste, it left an impression based on one talk and one message. Female literacy generic lasix cost. Once assimilated, I realised that this was central to everythingI was based close to Kabul, during the immediate, relatively upbeat (if not as openly urbane as the 1970s) post-Soviet withdrawal era and have maintained some contact in the form of research collaborations with colleagues in the Afghan Ministry of Health. In parallel, we have seen the tantalising promise of a future of freedom and children’s futures and women’s rights snatched away so abruptly, the purple period from 2001 to 2021 already feeling illusorySo, when the headlines change as they inevitably will (tabloid attention no doubt turning to the off-duty improprieties of a footballer or mid-ranking cabinet member) don’t forget that if classrooms can be kept open, then there is still hope.Global child health.

Maternal and perinatal outcomeContinuing the neonatal sepsis theme discussed by Carolin Fleischmann and colleagues in the August issue (https://adc.bmj.com/content/106/8/745) Adama Baguiya’s WHO maternal sepsis (GLOSS) group takes another angle, generic lasix cost the identification of high risk babies by the mothers’ peripartum condition. Using data from 43 LMICs, neonatal outcomes of mothers with suspected or proven sepsis were compared with those in whom there were no concerns. The direction of effect (predictive) was perhaps not surprising, though the magnitude was. A third of the babies of these women had generic lasix cost adverse outcomes. 25% near miss events (outcomes requiring intervention or resuscitation of some sort) and a 10% mortality with an OR of 3.8 (95% CI 2.0 to 7.1) for the most severely unwell mothers.

How then can these women be identified generic lasix cost earlier before both they and the fetus starts to decompensate?. See page 946Opiates in analgesiaWe all have a preferred opiate for analgesia resistant to first and second line alternatives and this particular choice has been, for as long as I can remember, if not divisive then factionalising.From buprenorphine patches to intranasal fentanyl to oral dextromoramide (the latter admittedly now largely a museum piece) to codeine, each has its (often vocal) proponents, the volume of their arguments not necessarily a correlate of analgesic effect.In the Drugs and Therapeutics section, Sarah Spenard and colleagues address this chestnut in their systematic review of the literature comparing morphine and hydromorphone, the turn to opioid in the face of the nausea and (histamine agonism-related) pruritus for which morphine itself is renowned. They found high quality evidence from 4 RCTs concluding there was nothing to choose between them in terms of therapeutic or side effects. So, rather than weighing up which opiate, the only question worth asking is ‘is there a generic lasix cost reason not to start one now?. €™ in the face of a child struggling on high dose NSAID treatment.

See page 1002Safety reportingWe are the proud discovers of a new antimicrobial drug, let’s call it ‘viroblast 21’, the performance of which in phase two trials has been (our brochures proclaim) ‘breathtaking’. Agog with excitement, we proceed to the ‘definitive’ randomised controlled generic lasix cost trial in children admitted to PICU for respiratory support. The ‘fully adjusted analyses’ (inverted commas, of course intentional) repay the faith we had in the drug, a ‘jaw dropping’ protective HR in time to recovery of 0.2 (95% CI 0.1 to 0.35). The tension is released and celebrations can begin… or can they? generic lasix cost. The message in Taco Jan Pils’ and colleagues’ systematic review of trials reporting is that, even now, in the era of EQUATOR, CONSORT, siblings and half siblings safety data is often overlooked.

Though reporting has improved over the decade since their previous review, it’s baffling that it isn’t 100%. Part of generic lasix cost http://marc-pearson.com/mpf-research-chess-commercial/ the story is missing. Taking a tangential trajectory, it would be reasonable to argue that the sort of safety reporting leaves a few more loopholes. I want to know whether children can swallow the preparation. Whether it tastes good (or at least isn’t generic lasix cost emetogenic).

And that the cost is not crippling for the health service or patients and parents by which it will ultimately be financed. This too (the economic burden) is also to my mind a side effect generic lasix cost. Where resources are finite, something else will have to give. Maybe that mouthwatering ‘effect size’ didn’t tell us everything we need to know. See page 1010Fixing a hole where the rain gets inThe reality is that generic lasix cost much of what we do, despite the best public health preventative measures is reactive.

The asthmatic child’s parents of ‘who only ever smoke outside’ are advised to stop or get help/gum/patches.I’m digressing but only slightly as, what I’m getting at are the upstream (preventative) vs downstream (symptomatic) approaches. Until recently, all treatment in cystic fibrosis was, by necessity, reactive/downstream. The advent of the CF transmembrane modulator family, correctors and potentiators has changed all generic lasix cost this. Iolo Doull’s compelling review from the discovery of the molecule to the consistent improvements in all objective measures of lung and overall health by its augmentation testifies to this. This is generic lasix cost exciting for other reasons too.

In the same way that anti-retroviral treatment in HIV became bolder and gathered pace, there is impetus for novel orphan drug development with implications beyond CF alone. See page 941(Pierre-)Robin sequence (RS) is characterised by mandibular retrognathia, glossoptosis and upper airway obstruction (UAO). To alleviate the latter, placing generic lasix cost such infants prone was already suggested as a first-line treatment by Robin himself, the eponym of this condition. Indeed, it appears intuitively plausible that gravity will help shifting the mandible forward during sleep. Against this background, it was not surprising that the prone position was implemented by about two-thirds of respondents to a recent survey focusing on interventions used in infants with RS.1In neonatology, however, we have learnt the hard way that what seems plausible is not always effective and, particularly, safe.

Thus, we need to scrutinise the generic lasix cost evidence for recommending prone positioning to resolve UAO in infants with RS. Objective data on the effectiveness of this intervention, however, are sparse. A retrospective analysis of sleep study data in 18 infants with RS (mean age, 1.5 months) found a higher sleep efficiency in the prone position, but no significant reduction in the severity of obstructive sleep apnoea (OSA).2 A longitudinal prospective study in 14 infants with RS (mean age, 1.8 months) reported a median Obstructive Apnoea–Hypopnoea ….