Aaron E. Carroll's Blog, page 22

The middle-age update post

I really had no intention of posting an update on some of the middle-age ailments I’ve written about before. But I keep getting questions about them, some by email. Because of ailment number one below, I just can’t respond at length to each email. So, here goes. You asked for this. (No, not all of you. If you didn’t, just stop reading.)

1. Arms: Backstory here. For work, and a little bit for non-work, I spend a lot of time with my hands on a keyboard, to say nothing of my face in a screen. Because I have to manage the tendinitis in my arms (see backstory), I can’t write as much email or other things as I used to or even want to. I just can’t. It hurts. This is also one reason why, more than I used to, I prefer to talk to people than to correspond back and forth by email. So, I’m not responding to your email unless I have to. It’s not you, it’s me.

2. Feet: Backstory here. It’s not plantar fasciitis. It was, as it turns out, never plantar fasciitis. But because I wrote a lot about plantar fasciitis, in part because every doc told me it was plantar fasciitis, people think I had/have plantar fasciitis. I do not have, and never have had, plantar fasciitis. (Yeah, I know I just wrote plantar fasciitis seven times in five sentences, including this one.)

Let’s do a little Q&A:

Q: So, what was/is it?

A: Nobody knows. It’s not important that we know what it is though.

Q: How do you know it was/is not plantar fasciitis?

A: See backstory. None of the data fit. None of the treatments for plantar fasciitis worked. Everything that worked was the opposite of plantar fasciitis advice. It’s not plantar fasciitis. Stop thinking it was.

Q: So what works?

A: Not wearing shoes, particularly not wearing structured shoes (with arch support), or shoes that get all snuggy around my heals. I’ve been barefoot about 98% of the time since the pandemic. When I wear something on my feet, it’s usually sandals or crocs. Even in New England winters, you can do almost anything in the right sandals and waterproof socks. Gradually, I’ve been able to tolerate shoes by Xero. After some years of this, and other things, I’m largely cured.

Q: What other things?

A: Massage (not just of my feet but of trigger points in my legs), toe stretches (look up “Yoga Toes”), and feet strengthening, but also rest.

Q: Whoa, that’s confusing. How do you strengthen and rest?

A: We do this all the time with other body parts. Nobody strengthens their biceps all the time, for example. You strengthen and you rest.

I rest when my feet hurt. I avoid things that make them hurt. Standing hurts more than walking. Walking on concrete hurts more than walking in the woods or on sand. I just do what feels better in every situation. I really work hard at avoiding a lot of standing. It’s awful. Stop standing around at parties for hours. Sit down a little!

But, also, when my feet can take it, I use them. I walk, preferably in ways that use the muscles hard (on sand, on hikes in the woods, not on concrete). I do balancing exercises that strengthen the feet, among other foot strengthening exercises. If you’re interested, look them up. I don’t need to explain them. I can’t tell you exactly what will work for you. If you need foot strengthening, do some trial and error to figure out what feels right to you and do some. Do less when they hurt.

Q: So, basically, you stopped listening to doctors and started listening to your body, right?

A: Yup. This wasn’t a quick cure, but I am largely cured. It’s management, just like my arms. No big deal now.

3. Sleep. Backstory here. (See also, this post.) For nearly three years, I’ve had a poorly understood, barely researched, super rare, sleep movement disorder — a sleep myoclonus. You almost certainly have not heard of it, don’t know what it is, and don’t have it. But if you think you do, the backstory post tells you how to find some support. If you want to study it, contact me. There are people desperate for studies, though fortunately not many (people that is — we’re desperate for as many (good) studies as you are willing to do).

It’s the most challenging thing I’ve ever had to deal with, and I will most likely be dealing with it for years to decades, if not the rest of my life.

I am now expert on sleep hygiene and sleep aids of all types. I have to be. With very high confidence I can say that there is no generic sleep advice out there that I have not seen. I have several specialists to help me, but they don’t know a lot about this either. Nobody does.

Most days are fine. I’ve had months of fine. But there are stretches that can last up to a few weeks that are really hard. It has changed me. Apart from the weeks when I’m very sleep deprived, I’m not necessarily “worse” than I was before I had this. I’m just different. My strengths and limitations are different. What I want to do is different. How I prefer to engage with people is different. My body’s temperature regulation is different. It’s all just different.

I’ve gotten really frustrated with this condition, really sad, really angry. But these feelings are not the norm and pass quickly. Just because it’s hard doesn’t mean I’m unhappy. I’m probably just as happy as anyone else.

I’ve learned a lot about myself and what exacerbates my condition. I cannot take on as much stress as I used to. Life and work has to be slower. I can do a lot, but just not as much. That’s fine. I was probably doing more than a normal amount before. I’m OK with normal.

After all, I am 50. Slowing down is fine. It’s good for my arms and feet too.

The post The middle-age update post first appeared on The Incidental Economist.

Free preventive care under the ACA is under threat again

Supreme Court case, Briarwood Management v. Becerra threatens access to preventative care under the ACA. TIE contributing author, Paul Shafer, describes the threat against preventative care in a piece in The Conversation.

The plaintiffs in Braidwood object to purchasing insurance that covers preexposure prophylaxis (PrEP). Texas Judge Reed O’Connor ruled that the requirement for insurance plans to cover PrEP violated the religious freedom of the plaintiffs.

PrEP is nearly 100% effective in preventing HIV infection. Its utilization has successfully reduced HIV diagnosis rates. If this Texas ruling were to extend nationally, it would impact 170,000 current PrEP users and over 1 million people who can benefit from using PrEP.

Read the full post here!

Research for this piece was supported by Arnold Ventures. 

The post Free preventive care under the ACA is under threat again first appeared on The Incidental Economist.

The end of the public health emergency and impending coverage loss

In a new op-ed for MedPage Today, Paul Shafer and I explain how the end of the public health emergency (PHE) and Medicaid continuous enrollment condition (CEC) will lead to significant coverage loss, specifically among people who are still eligible for coverage. When regular Medicaid redeterminations resume after the end of the PHE, if people don’t update their contact information or respond to state notices within a certain amount of time, they’ll be at risk of losing their coverage, despite still being eligible. The effect of the end of the CEC won’t be felt equally across populations. People of color and those who aren’t a part of the Modified Adjusted Gross Income (MAGI) Medicaid population are more at risk of falling through the cracks because of these onerous requirements.

As we write,

If you dig into the [August report from HHS], you will see that the disenrollment cliff will likely be a disaster for health equity — as if the inequities of the pandemic itself weren’t enough. A majority of those projected to lose coverage are non-white and/or Latinx, making up . . . 61% [of] those losing coverage because of administrative burdens . . . This represents a disproportionate burden of coverage loss, when still eligible, among those already bearing inequitable burdens of the pandemic and systemic racism more generally.

Read the full piece here.

Research for this piece was supported by Arnold Ventures.

The post The end of the public health emergency and impending coverage loss first appeared on The Incidental Economist.

What Does “Good” Qualitative Research Look Like?

Qualitative research uses non-numerical data to explain what, why, and how something happened. It provides a contextual understanding of people, behaviors, and situations that quantitative studies often can’t.

There are ongoing conversations in the scientific community about what a “good” qualitative study entails. While the specific criteria are subject to debate, there are some widely accepted guidelines to consider. These include:

Use of theory to inform research questions, design, and interpretation of findings.Explaining the decision-making process behind choosing study design, methodology, and sampling.Maintaining study quality through transparency and systematicity of the research process, which includes establishing reflexivity, validity, reliability, and generalizability of the research.

Below, each of these are described further.

Theory

Researchers should provide a theoretical or conceptual framework that motivates their study’s research questions, data gathering, and interpretation of results. Research questions should add to existing theory, and sometimes also generate new theory. This article in SAGE provides introductions to some of the theories used in qualitative research.

Study Design, Methodology, and Sampling

Qualitative research should discuss why the study’s design and methodology were chosen. Below are some common approaches, with consideration of inherent tradeoffs.

Interviews: Interviews allow data to be collected from individuals through unstructured and/or semi-structured questions, with flexibility to gain unanticipated knowledge. The researcher has the freedom to structure the interview to be as formal and in-depth based on the needs of the study. Interviews provide information based on what people say but cannot provide insight based on direct observation of how people behave or interact. They can also be time consuming while conducting interviews and during the transcription and analysis process. Transcription costs also increase as the number of participants increase. On the other hand, the amount of time required can be estimated during study design (e.g., one hour per interview times the number of anticipated interviews).Groups: Focus groups, panels, and other group-based interviews provide a larger venue for capturing both verbal information and observations of group dynamics and interactions, including how individuals influence each other. Disadvantages include more difficulty getting truthful responses (since sensitive topics may be more challenging to discuss in a group), social desirability biases, and groupthink. Like interviews, focus groups can also be time consuming and costly during the interviewing, transcribing, and analysis process.Ethnography: Ethnographic research involves observation of people and culture, allowing for description of what individuals do in their natural environments instead of controlled settings. This method could require a large investment of time, since it is unclear how long it may take to capture and understand authentic behaviors.Content/Document Analysis: Content and document analysis reviews a multitude of secondary sources, ranging from written accounts to recorded media. Content analysis examines all sources in which a searched term appears, while document analysis focuses only on written documents. Both methods are particularly good for studying questions of historical significance, including those where participants are no longer living. A significant limitation is that the data were initially collected by others, potentially with unknown biases, errors, and/or omissions.

A qualitative study should also explicitly discuss its sampling strategy, especially if convenience sampling is taking place since it can result in selection bias and sampling error. The goal of sampling should be to reach theoretical saturation, the point at which more participants or documents would not add more unique information.

Study Quality

A qualitative study’s design should be both transparent and systematic. Transparency means providing a clear description of all techniques and processes used to collect, analyze, and interpret data. Systematicity means the use of data collection and analytic methods follow widely accepted research processes and qualitative research guidelines.

A high-quality qualitative study should also address validity, reliability, researcher reflexivity, and generalizability.

Validity : Validity pertains to how a study’s results would apply to similar populations and settings outside of the study. Some methods to address validity include utilizing description to provide behavioral meaning and context, triangulating (by utilizing multiple research methods, sources, or researchers), and negative case analysis by reviewing contradicting data to the study’s findings. Reliability : A study is reliable when stable and consistent results are produced when the research methods are replicated. Researchers should be transparent about their methods and justify them, clarify how the study could be replicated, and ensure data accuracy. Researcher Reflexivity : Researchers should reflect on their own biases, judgments, and belief systems that may have impacted data generation and analysis. This is typically addressed in a statement from the researcher. Generalizability : The need for generalizability in qualitative research is debated amongst experts. It focuses on how well study findings would transfer to different settings and populations. While study replication would most likely produce some new findings, key concepts and themes can be identified that are reasonably expected to apply across contexts, as well as indicate what it is about their findings that may not generalize. This concept is contested since qualitative research may not always aim to be generalizable but rather descriptive about a certain group or individuals.

By considering these factors and general guidelines, researchers can be more mindful of their own research and when reviewing existing qualitative studies, while reviewers can better assess new qualitative research.

The post What Does “Good” Qualitative Research Look Like? first appeared on The Incidental Economist.

The Diversity Problem in Medical Education

Racial bias is pervasive in American medicine. Part of that can be attributed to the way we train doctors, and another part stems from WHO gets trained as doctors. The barriers to entering medical school and going on to become medical faculty are high, and some schools have improved recruitment while neglecting retention. We can do better at making medical training more broadly accessible and helping students succeed once they’re admitted.

 



The post The Diversity Problem in Medical Education first appeared on The Incidental Economist.

Healthcare Triage Podcast: Science Communication Matters

In this episode, Dr. Krista Hoffmann-Longtin and Dr. Tiffany Doherty talk with Dr. Aaron Carroll about the importance of science communication. They discuss some major challenges to effective communication, as well as ways to try to bridge the communication gap and promote better understanding between scientists and the public.

 

 

This Healthcare Triage podcast episode is co-sponsored by Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research, and patient care, and the Indiana Clinical and Translational Sciences Institute, a three way partnership among Indiana University, Purdue University and the University of Notre Dame, striving to make Indiana a healthier state by empowering research through pilot funding, research education and training. More information on the Indiana CTSI can be found by visiting IndianaCTSI.org.

The post Healthcare Triage Podcast: Science Communication Matters first appeared on The Incidental Economist.

Medical Training Can Reinforce Racial Bias

Racial disparities are rampant in healthcare. In addition to structural inequalities, the issues are partly due to racial bias among healthcare workers. These biases stem, in part, from the way race is presented in medical curricula.

 



The post Medical Training Can Reinforce Racial Bias first appeared on The Incidental Economist.

Do Men Face Barriers to Birth Control?

In discussing reproductive health care, men are often left out of the conversation. However, in the wake of recent access restrictions, it is crucial to examine the accessibility of all reproductive health care. A vasectomy, a male sterilization procedure, is safe, non-invasive, and often reversible. But, female sterilization is twice as common in the United States, even though it has more side effects and possible complications.

This article in Public Health Post, I explore why men in the United States rarely utilize vasectomies. I discusses barriers to care such as medical misinformation, limited insurance coverage, and individual provider restrictions. These barriers, as well as social stigma, disproportionately leave female partners with the burden of birth control.

Read the full post here!

Research for this piece was supported by Arnold Ventures. 

The post Do Men Face Barriers to Birth Control? first appeared on The Incidental Economist.

Better Process, Better Health

This article in Tradeoffs discusses a new Notice of Proposed Rulemaking (NPRM) published by the Centers for Medicare and Medicaid in the Federal Register. This notice is part of a larger executive order signed last December aimed at reducing the administrative burdens of public health insurance programs. According to author, Paul Shafer, administrative burdens can impact health by making it more challenging for people to access benefits they are eligible for, doubling down on existing health inequities.

This NPRM, titled “Streamlining the Medicaid, Children’s Health Insurance Program [CHIP], and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes,” aims to shift some of the administrative burdens of applying for CHIP and Medicaid from the applicants back to the government. For example, it allows Medicaid and CHIP to accept each other’s eligibility determinations, requires states to try harder to reach eligible people, and send pre-populated renewal forms.

Read the full article here!

Research for this piece was supported by Arnold Ventures. 

The post Better Process, Better Health first appeared on The Incidental Economist.

Deadline Extension for Call for Abstracts on Aligning Systems for Health

The deadline for the call for abstracts for the Health Services Research special issue on Aligning Systems for Health has been extended to Monday September 26. Additional details on the HSR website.

The post Deadline Extension for Call for Abstracts on Aligning Systems for Health first appeared on The Incidental Economist.