Buy lasix uk

As the House-passed Build Back Better Act moves to the Senate, a http://scoalaromaneasca.ca/lasix-best-price/ new explainer from KFF summarizes the key prescription drug provisions within the broader budget reconciliation bill.These provisions would lower prescription drug costs paid by people with Medicare and buy lasix uk private insurance and curb drug spending by the federal government and private payers. The Congressional Budget Office estimates federal budget savings from the drug pricing provisions buy lasix uk would be $297 billion over 10 years. Although the bill passed the House with no Republican votes, the prescription drug proposals have taken shape amidst strong bipartisan support among the public for the government to address high and rising drug prices.The key prescription drug proposals in the legislation would:Allow the federal government to negotiate prices for some high-cost drugs covered under Medicare Part B and Part D;Require inflation rebates to limit annual increases in drug prices in Medicare and private insurance;Cap out-of-pocket spending for Medicare Part D enrollees and implement other Part D benefit design changes;Limit cost sharing for insulin for people with Medicare and private insurance;Eliminate cost sharing for adult treatments covered under Part D, andRepeal the Trump Administration’s drug rebate rule.KFF will continue to track these and other measures as the bill works its way through the Senate.

A separate explainer summarizes and analyzes a wider array of the health policy provisions in buy lasix uk the budget reconciliation package.For these and other analyses related to the Build Back Better Act, visit kff.org.The Build Back Better Act, H.R. 5376, (BBBA), buy lasix uk adopted by the House of Representatives on November 19, 2021 with the support of President Biden, includes a broad package of health, social, climate change and revenue provisions. The total package includes $1.7 trillion in spending, according to the Congressional Budget Office (CBO), which also projects that three of the health provisions would reduce the number of uninsured by 3.4 million people.

This brief summarizes the version that passed the House, which may be modified as it moves through the Senate.Here, we walk through 11 of the major health coverage and financing provisions of the buy lasix uk Build Back Better Act, with discussion of the potential implications for people and the federal budget. We summarize provisions relating to the following areas and provide data on the people most directly affected by each provision and the potential costs or savings to the federal government.ACA Marketplace SubsidiesNew Medicare Hearing BenefitLowering Prescription Drug Prices and SpendingMedicare Part D Benefit RedesignMedicaid Coverage GapMaternal Care and Postpartum CoverageOther Medicaid / Children’s Health Insurance Changes CHIP ChangesOther Medicaid Financing buy lasix uk and Benefit ChangesMedicaid Home and Community Based Services and the Direct Care WorkforcePaid Family and Medical LeaveConsumer Assistance, Enrollment Assistance, and OutreachA recent KFF poll found broad support for many of these provisions, though it did not probe on the costs or trade-offs associated with them. The poll also found that the vast majority of the public supports allowing the federal government to negotiate drug prices, after hearing arguments made by proponents and opponents.Major Provisions of the Build Back Better Act and their Potential Costs and Impact1.

ACA Marketplace SubsidiesBackgroundUnder the Affordable Care Act, people purchasing Marketplace coverage could buy lasix uk only qualify for subsidies if they met other eligibility requirements and had incomes between one and four times the federal poverty level. People eligible for subsidies would have to contribute a buy lasix uk sliding-scale percentage of their income toward a benchmark premium, ranging from 2.07% to 9.83%. Once income passed 400% FPL, subsidies stopped and many individuals and families were unable to afford coverage.In 2021, the American Rescue Plan Act (ARPA) temporarily expanded eligibility for subsidies by removing the upper income threshold.

It also temporarily increased the dollar value of premium subsidies across the board, meaning nearly everyone on the Marketplace paid lower premiums, and the lowest income people pay zero premium for coverage with very low deductibles buy lasix uk. The ARPA also made people who received unemployment insurance (UI) benefits during 2021 eligible for zero-premium, low-deductible plans.However, the ARPA provisions removing the upper income threshold and increasing tax credit amounts are only in effect for 2021 and 2022. The unemployment provision is only in effect for 2021.Provision DescriptionSection 137301 of The Build Back Better Act would extend the ARPA subsidy changes that eliminate the income eligibility cap and increase the amount of APTC for individuals across the board through the end of 2025.Additionally, Section 30605 of The Build Back Better Act would extend the special Marketplace subsidy rule for individuals receiving UI benefits for an additional 4 years, through the end of 2025.Section 137303 of the Act would, for purposes of determining buy lasix uk eligibility for premium tax credits, disregard any lump sum Social Security benefit payments in a year.

This provision would be buy lasix uk permanent and effective starting in the 2022 tax year. Starting in 2026, people would have the option to have the lump sum benefit included in their income for purposes of determining tax credit eligibility.Finally, Section 137302 modifies the affordability test for employer-sponsored health coverage. The ACA makes people ineligible for marketplace subsidies if they have an offer of affordable coverage from an employer, currently defined as requiring an employee contribution of no more than 9.61% of household income buy lasix uk in 2022.

The Build Back Better Act would reduce this affordability threshold to 8.5% of income, bringing it in line buy lasix uk with the maximum contribution required to enroll in the benchmark marketplace plan. This provision would take effect for tax years starting in 2022 through 2025. Thereafter the affordability threshold would be set at 9.5% of household income with no indexing.People AffectedCBO projects that the enhanced tax credits in Section 137301 would reduce the number of uninsured by buy lasix uk 1.2 million people.

As of buy lasix uk August 2021, 12.2 million people were actively enrolled in Marketplace plans – an 8% increase from 11.2 million people enrollees as of the close of Open Enrollment for the 2021 plan year. HealthCare.gov and all state Marketplaces reopened for a special enrollment period of at least 6 months in 2021, enrolling 2.8 million people (not all of whom were necessarily previously uninsured). Of these, 44% selected plans with monthly premiums of $10 or less.The US Department of Health and buy lasix uk Human Services (HHS) reports that ARPA reduced Marketplace premiums for the 8 million existing Healthcare.gov enrollees by $67 per month, on average.

If the ARPA subsidies are allowed to expire, these enrollees will likely see their premium payments double.HHS also reports that between July 1 and August 15, more than 280,000 individuals received enhanced subsidies due to the ARPA UI provisions. Individuals eligible for these UI benefits can continue to enroll in 2021 coverage through the end of this buy lasix uk year.The ARPA changes made people with income at or below 150% FPL eligible for zero-premium silver plans with comprehensive cost sharing subsidies. 40% of new buy lasix uk consumers who signed up during the SEP are in a plan that covers 94% of expected costs (with average deductibles below $200).

As a result of the ARPA, HHS reports the median deductible for new consumers selecting plan during the hypertension medications-SEP decreased by more than 90% (from $750 in 2020 to $50 in 2021).With the ARPA and ACA subsidies, as well as Medicaid in states that expanded the program, we estimate that at least 46% of non-elderly uninsured people in the U.S. Are eligible for free or nearly-free health plans, often with low or no deductibles.Budgetary ImpactCBO estimates that extension of the ARPA marketplace subsidy improvements through 2025 (Section buy lasix uk 13701) will cost $73.9 billion over the ten-year budget window, with “cost” reflecting both direct spending and on-budget revenue losses. This total also includes the cost of modifying the affordability threshold for employer-sponsored coverage (Section 13602)CBO further estimates the cost of extending the enhanced marketplace subsidies for people receiving unemployment benefits (Section 13705) will be $1.8 billion over the ten-year budget window.The cost of disregarding lump sum Social Security benefits payments for purposes of determining premium tax credit eligibility (Section 13703) is $416 million over buy lasix uk the ten-year budget window.(Back to top)2.

New Medicare Hearing BenefitbackgroundMedicare currently does not cover hearing services, except under limited circumstances, such as cochlear implantation when beneficiaries meet certain eligibility criteria. Hearing services are typically offered as an extra benefit by Medicare Advantage plans, and in 2021, 97% of Medicare Advantage enrollees in individual plans, buy lasix uk or 17.1 million people, are offered some hearing benefits, but according to our analysis, the extent of that coverage and the value of these benefits varies. Some beneficiaries in traditional Medicare may have private coverage or coverage through Medicaid for these services, but many do buy lasix uk not.Provision DescriptionSection 30901 of the Build Back Better Act would add coverage of hearing services to Medicare Part B, beginning in 2023.

Coverage for hearing care would include hearing rehabilitation and treatment services by qualified audiologists, and hearing aids. Hearing aids would be available once per buy lasix uk ear, every 5 years, to individuals diagnosed with moderately severe, severe, or profound hearing loss. Hearing services would be subject to the Medicare Part buy lasix uk B deductible and 20% coinsurance.

Hearing aids would be covered similar to other Medicare prosthetic devices and would also be subject to the Part B deductible and 20% coinsurance. For people in traditional Medicare who have other sources of coverage such as Medigap or Medicaid, their cost sharing for these services might be covered buy lasix uk. Payment for hearing aids would only be on an assignment-related basis.

As with buy lasix uk other Medicare-covered benefits, Medicare Advantage plans would be required to cover these hearing benefits.Effective Date. The Medicare hearing benefit provision would take effect in 2023.People AffectedAdding coverage of hearing services, including hearing aids, to Medicare would help beneficiaries with hearing loss who might otherwise go without treatment by an audiologist or hearing aids, particularly those who cannot afford the cost of hearing aids buy lasix uk. It would also lower out-of-pocket costs for some beneficiaries who would otherwise pay the full cost of their hearing aids without the benefit.

Among beneficiaries who buy lasix uk used hearing services in 2018, average out-of-pocket spending according to our analysis was $914, although many hearing aids are considerably more expensive than the average.While the majority of enrollees in Medicare Advantage plans have access to a hearing benefit, a new defined Medicare Part B benefit could also lead to enhanced and more affordable hearing benefits for Medicare Advantage enrollees. Because costs are often a barrier to buy lasix uk care, adding this benefit to Medicare could increase use of these services, and contribute to better health outcomes.BUDGETARY IMPACTCBO estimates that the new Medicare Part B hearing benefit would increase federal spending by $36.7 billion over 10 years (2022-2031).(Back to top)3. Lowering Prescription Drug Prices and SpendingbackgroundCurrently, under the Medicare Part D program, which covers retail prescription drugs, Medicare contracts with private plan sponsors to provide a prescription drug benefit.

The law that established the Part D benefit includes a provision known as the “noninterference” clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP [prescription drug plan] sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.” For drugs administered by physicians that are covered under Medicare Part B, Medicare reimburses providers 106% of the Average Sales Price (ASP), which is the average price to all non-federal purchasers in the U.S, inclusive of rebates, A recent KFF Tracking Poll finds large majorities support allowing the federal government to negotiate and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate (83% total, buy lasix uk 95% of Democrats, 82% of independents, and 71% of Republicans).In addition to the inability to negotiate drug prices under Part D, Medicare lacks the ability to limit annual price increases for drugs covered under Part B (which includes those administered by physicians) and Part D. In contrast, buy lasix uk Medicaid has an inflationary rebate in place. Year-to-year drug price increases exceeding inflation are not uncommon and affect people with both Medicare and private insurance.

Our analysis shows that half of all covered buy lasix uk Part D drugs had list price increases that exceeded the rate of inflation between 2018 and 2019.provision descriptionDrug Price Negotiations. Sections 139001, 139002, and 139003 of the Build Back Better Act would amend the non-interference clause by adding an exception that would allow the federal government to negotiate prices with drug companies for a small number of high-cost drugs lacking generic or biosimilar competitors covered under Medicare Part B and Part D. The negotiation process would apply to no more than 10 (in 2025), 15 (in 2026 and 2027), and 20 (in buy lasix uk 2028 and later years) single-source brand-name drugs lacking generic or biosimilar competitors, selected from among the 50 drugs with the highest total Medicare Part D spending and the 50 drugs with the highest total Medicare Part B spending (for 2027 and later years).

The negotiation process would also apply to all insulin products.The legislation exempts from negotiation drugs that buy lasix uk are less than 9 years (for small-molecule drugs) or 13 years (for biological products, based on the Manager’s Amendment) from their FDA-approval or licensure date. The legislation also exempts “small biotech drugs” from negotiation until 2028, defined as those which account for 1% or less of Part D or Part B spending and account for 80% or more of spending under each part on that manufacturer’s drugs.The proposal establishes an upper limit for the negotiated price (the “maximum fair price”) equal to a percentage of the non-federal average manufacturer price. 75% for small-molecule drugs more than 9 years but buy lasix uk less than 12 years beyond approval.

65% for drugs between 12 and 16 buy lasix uk years beyond approval or licensure. And 40% for drugs more than 16 years beyond approval or licensure. Part D drugs with prices negotiated under this proposal would be required to be buy lasix uk covered by all Part D plans.

Medicare’s payment to providers for Part B drugs with prices negotiated under this proposal would be 106% of the maximum fair price (rather than 106% of the average sales price under current law).An excise tax would buy lasix uk be levied on drug companies that do not comply with the negotiation process, and civil monetary penalties on companies that do not offer the agreed-upon negotiated price to eligible purchasers.Effective Date. The negotiated prices for the first set of selected drugs (covered under Part D) would take effect in 2025. For drugs covered buy lasix uk under Part B, negotiated prices would first take effect in 2027.Inflation Rebates.

Sections 139101 and 139102 of the Build Back Better Act would require drug manufacturers to pay a rebate to the federal government if their prices for single-source drugs and biologicals covered under Medicare Part B and nearly all covered drugs under Part D increase faster than the rate of inflation (CPI-U). Under these provisions, price changes would be measured based on the average sales price (for Part B drugs) or the average manufacturer price (for Part D buy lasix uk drugs). For price buy lasix uk increase higher than inflation, manufacturers would be required to pay the difference in the form of a rebate to Medicare.

The rebate amount is equal to the total number of units multiplied by the amount if any by which the manufacturer price exceeds the inflation-adjusted payment amount, including all units sold outside of Medicaid and therefore applying not only to use by Medicare beneficiaries but by privately insured individuals as well. Rebate dollars would be deposited in the Medicare Supplementary Medical Insurance (SMI) trust fund.Manufacturers that do buy lasix uk not pay the requisite rebate amount would be required to pay a penalty equal to at least 125% of the original rebate amount. The base year for measuring price changes buy lasix uk is 2021.Effective Date.

These provisions would take effect in 2023.Limits on Cost Sharing for Insulin Products. Sections 27001, 30604, 137308, and 139401 would require buy lasix uk insurers, including Medicare Part D plans and private group or individual health plans, to charge no more than $35 for insulin products. Part D plans would be required to charge no more buy lasix uk than $35 for whichever insulin products they cover for 2023 and 2024 and all insulin products beginning in 2025.

Coverage of all insulin products would be required beginning in 2025 because the drug negotiation provision (described earlier) would require all Part D plans to cover all drugs that are selected for price negotiation, and all insulin products are subject to negotiation under that provision. Private group or individual plans do not have to cover all insulin products, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, buy lasix uk and long-acting) for no more than $35.Effective Date. These provisions buy lasix uk would take effect in 2023.treatments.

Section 139402 would require that adult treatments covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices (ACIP), such as for shingles, be covered at no cost. This would buy lasix uk be consistent with coverage of treatments under Medicare Part B, such as the flu and hypertension medications treatments.Effective Date. This provision would take effect in 2024.Repealing the Trump Administration’s Drug Rebate Rule.

Section 139301 buy lasix uk would prohibit implementation of the November 2020 final rule issued by the Trump Administration that would have eliminated rebates negotiated between drug manufacturers and pharmacy benefit managers (PBMs) or health plan sponsors in Medicare Part D by removing the safe harbor protection currently extended to these rebate arrangements under the federal anti-kickback statute. This rule was slated to take effect on buy lasix uk January 1, 2022, but the Biden Administration delayed implementation to 2023 and the infrastructure legislation passed by the House and Senate includes a further delay to 2026.Effective Date. This provision would take effect in 2026.People affectedThe number of Medicare beneficiaries and privately insured individuals who would see lower out-of-pocket drug costs in any given year under these provisions would depend on how many and which drugs were subject to the negotiation process, and how many and which drugs had lower price increases, and the magnitude of price reductions relative to current prices under each provision.Neither CBO nor the Biden Administration have published estimates of beneficiary premium and out-of-pocket budget effects associated with the provision to allow the HHS Secretary to negotiate drug prices.

An earlier version of the negotiations proposal in H.R.3 that passed the House of Representatives in 2019 buy lasix uk would have lowered cost sharing for Part D enrollees by $102.6 billion in the aggregate (2020-2029) and Part D premiums for Medicare beneficiaries by $14.3 billion. Based on our buy lasix uk analysis of the H.R. 3 version of this provision, the negotiations provision in H.R.

3 would have reduced Medicare Part D premiums for Medicare beneficiaries by an estimated 9% of the Part D base buy lasix uk beneficiary premium in 2023 and by as much as 15% in 2029. However, the effects on beneficiary premiums and cost sharing under the drug negotiation provision in the BBBA buy lasix uk are expected to be more modest than the effects of H.R. 3 due to the smaller number of drugs eligible for negotiation and a different method of calculating the maximum fair price.While it is expected that some people would face lower cost sharing under these provisions, it is also possible that drug manufacturers could respond to the inflation rebate by increasing launch prices for new drugs.

In this case, some individuals could buy lasix uk face higher out-of-pocket costs for new drugs that come to market, with potential spillover effects on total costs incurred by payers as well.In terms of insulin costs, a $35 cap on monthly cost sharing for insulin products could lower out-of-pocket costs for many insulin users with private insurance and those in Medicare Part D without low-income subsidies. While formulary coverage and tier placement of insulin products vary across Medicare Part D plans, our analysis shows that in 2019, a large number of Part D plans placed insulin products on Tier 3, the preferred drug tier, which typically had a $47 copayment per prescription during the initial coverage phase. However, once enrollees reach the coverage gap buy lasix uk phase, they face a 25% coinsurance rate, which equates to $100 or more per prescription in out-of-pocket costs for many insulin therapies, unless they qualify for low-income subsidies.

Paying a flat $35 copayment rather than 25% buy lasix uk coinsurance could reduce out-of-pocket costs for many people with diabetes who use insulin products.In terms of treatments, providing for coverage of adult treatments under Medicare Part D at no cost could help with treatment uptake among older adults and would lower out-of-pocket costs for those who need Part D-covered treatments. Our analysis shows that in 2018, Part D enrollees without low-income subsidies paid an average of $57 out-of-pocket for each dose of the shingles shot, which is generally free to most other people with private coverage.budgetary impactDrug Price Negotiations. CBO estimates $78.8 billion in Medicare buy lasix uk savings over 10 years (2022-2031) from the drug negotiation provisions.Inflation Rebates.

CBO estimates buy lasix uk a net federal deficit reduction of $83.6 billion over 10 years (2022-2031) from the drug inflation rebate provisions in the BBBA. This includes net savings of $49.4 billion ($61.8 billion in savings to Medicare and $7.7 billion in savings for other federal programs, such as DoD, FEHB, and subsides for ACA Marketplace coverage, offset by $20.1 billion in additional Medicaid spending) and higher federal revenues of $34.2 billion.Limits on Cost Sharing for Insulin Products. CBO estimates additional federal spending of $1.4 billion ($0.9 billion for Medicare and $0.5 billion in other federal spending) and a reduction in federal revenues of $4.6 billion over 10 years associated buy lasix uk with the insulin cost-sharing limits in the BBBA.treatments.

CBO estimates that this provision would increase federal spending by $3.3 billion over 10 years (2022-2031).Repealing the Trump Administration’s buy lasix uk Drug Rebate Rule. Because the rebate rule was finalized (although not implemented), its cost has been incorporated in CBO’s baseline for federal spending. Therefore, repealing the rebate rule is buy lasix uk expected to generate savings.

CBO estimates savings of $142.6 billion from the repeal of the buy lasix uk Trump Administration’s rebate rule between 2026 (when the BBBA provision takes effect) and 2031. In addition, CBO estimated savings of $50.8 billion between 2023 and 2026 for the three-year delay of this rule included in the Infrastructure Investment and Jobs Act.(Back to top)4. Medicare Part buy lasix uk D Benefit RedesignbackgroundMedicare Part D currently provides catastrophic coverage for high out-of-pocket drug costs, but there is no limit on the total amount that beneficiaries pay out-of-pocket each year.

Medicare Part D enrollees with drug costs high enough to exceed the catastrophic coverage threshold are required to pay 5% of their total drug costs unless they qualify for Part D Low-Income Subsidies (LIS). Medicare pays 80% of total costs above buy lasix uk the catastrophic threshold and plans pay 15%. Medicare’s reinsurance payments to Part D plans now account buy lasix uk for close to half of total Part D spending (45%), up from 14% in 2006.Under the current structure of Part D, there are multiple phases, including a deductible, an initial coverage phase, a coverage gap phase, and the catastrophic phase.

When enrollees reach the coverage gap benefit phase, they pay 25% of drug costs for both brand-name and generic drugs. Plan sponsors buy lasix uk pay 5% for brands and 75% for generics. And drug manufacturers provide a 70% price discount on buy lasix uk brands (there is no discount on generics).

Under the current benefit design, beneficiaries can face different cost sharing amounts for the same medication depending on which phase of the benefit they are in, and can face significant out-of-pocket costs for high-priced drugs because of coinsurance requirements and no hard out-of-pocket cap.provision descriptionSections 139201 and 139202 of the Build Back Better Act amend the design of the Part D benefit by adding a hard cap on out-of-pocket spending set at $2,000 in 2024, increasing each year based on the rate of increase in per capita Part D costs. It also lowers beneficiaries’ share of total drug costs below the spending cap from 25% to buy lasix uk 23%. It also lowers Medicare’s share of total costs above the spending cap (“reinsurance”) buy lasix uk from 80% to 20% for brand-name drugs and to 40% for generic drugs.

Increases plans’ share of costs from 15% to 60% for both brands and generics. And adds a 20% manufacturer price discount on brand-name drugs buy lasix uk. Manufacturers would also be required to provide a 10% discount on brand-name drugs in the initial coverage phase (below the annual out-of-pocket spending threshold), instead of a 70% price discount.The legislation also increases Medicare’s premium subsidy for the cost of standard drug coverage to 76.5% (from 74.5% under current law) and reduces the beneficiary’s share of the cost to 23.5% (from 25.5%).

The legislation also allows beneficiaries the option of smoothing out their out-of-pocket costs over the year rather than face buy lasix uk high out-of-pocket costs in any given month.Effective Date. The Part buy lasix uk D redesign and premium subsidy changes would take effect in 2024. The provision to smooth out-of-pocket costs would take effect in 2025.people affectedMedicare beneficiaries in Part D plans with relatively high out-of-pocket drug costs are likely to see substantial out-of-pocket cost savings from this provision.

While most Part D enrollees have not had out-of-pocket costs high enough to exceed the catastrophic coverage threshold in a single year, the likelihood of a Medicare beneficiary incurring drug costs above the catastrophic threshold increases over buy lasix uk a longer time span.Our analysis shows that in 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic coverage threshold. Looking over a five-year period (2015-2019), the number of Part D enrollees with out-of-pocket spending above the catastrophic threshold in at least one year increases to 2.7 million, and over a 10-year period (2010-2019), the number of enrollees increases to 3.6 million.Based on our analysis, 1.2 million Part D enrollees in 2019 incurred annual out-of-pocket costs for their medications above $2,000 in 2019, averaging buy lasix uk $3,216 per person. Based on their average out-of-pocket spending, these enrollees would have saved $1,216, or 38% of their annual costs, on average, if a $2,000 cap had been in place in 2019.

Part D enrollees with higher-than-average out-of-pocket costs buy lasix uk could save substantial amounts with a $2,000 out-of-pocket spending cap. For example, the top 10% of beneficiaries (122,000 enrollees) with average out-of-pocket costs for their medications above $2,000 in 2019 – who spent at least $5,348 – would have saved $3,348 (63%) in buy lasix uk out-of-pocket costs with a $2,000 cap.budgetary impactCBO estimates the benefit redesign and smoothing provisions of the BBBA would reduce federal spending by $1.5 billion over 10 years (2022-2031), which consists of $1.6 billion in lower spending associated with Part D benefit redesign and $0.1 billion in higher spending associated with the provision to smooth out-of-pocket costs.(Back to top)5. Medicaid Coverage GapbackgroundThere are currently 12 states that have not adopted the ACA provision to expand Medicaid to adults with incomes through 138% of poverty.

The result is a coverage gap for individuals whose buy lasix uk below-poverty-level income is too high to qualify for Medicaid in their state, but too low to be eligible for premium subsidies in the ACA Marketplace.provision descriptionSection 137304 of the Build Back Better Act would allow people living in states that have not expanded Medicaid to purchase subsidized coverage on the ACA Marketplace for 2022 through 2025. The federal government would fully subsidize the premium for a benchmark plan. People would also be eligible for cost sharing subsidies that would reduce their out-of-pocket costs to 1% of buy lasix uk overall covered health expenses on average.Section 30608 includes adjustments to uncompensated care (UCC) pools and disproportionate share hospital (DSH) payments for non-expansion states.

These states would not be able draw down federal matching funds for UCC amounts for individuals who could otherwise qualify for Medicaid expansion, and their DSH allotments would be reduced by buy lasix uk 12.5% starting in 2023.Section 30609 would increase the federal match rate for states that have adopted the ACA Medicaid expansion from 90% to 93% from 2023 through 2025, designed to discourage states from dropping current expansion coverage.people affectedWe estimate that 2.2 million uninsured people with incomes under poverty fall in the “coverage gap”. Most in the coverage gap are concentrated in four states (TX, FL, GA and NC) where eligibility levels for parents in Medicaid are low, and there is no coverage pathway for adults without dependent children. Half of those in the coverage gap are working and six in 10 are people of color.CBO estimates that provisions to address the coverage gap would result in 1.7 million fewer uninsured people.budgetary impactCBO estimates that the net federal cost of extending Marketplace coverage to certain low-income people buy lasix uk would increase federal spending by $57 billion over the next decade (this reflects $43.8 billion in federal costs and a loss of federal revenues of $13.2 billion).CBO estimates provisions to limit DSH and uncompensated care pool funding for non-expansion states would reduce federal costs by $18.3 billion over 5 years and $34.5 billion over the next 10 years and federal costs would increase by $10.4 billion due to the increase in the match rate for current expansion states from 90% to 93% for expansion states for 2023 through 2025.(Back to top)6.

Maternity Care and Postpartum CoveragebackgroundMedicaid currently covers almost half of births in buy lasix uk the U.S. Federal law requires that pregnancy-related Medicaid coverage last through 60 days postpartum. After that period, some may qualify for Medicaid through another pathway, but others may buy lasix uk not qualify, particularly in non-expansion states.

In an effort to improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act (ARPA) of 2021 gives states a new option to extend Medicaid postpartum coverage to buy lasix uk 12 months. This new option takes effect on April 1, 2022 and is available to states for five years.provision descriptionSection 30721 of the Build Back Better Act would require states to extend Medicaid postpartum coverage from 60 days to 12 months, ensuring continuity of Medicaid coverage for postpartum individuals in all states. This requirement would take effect in the first fiscal quarter beginning one year after enactment and also applies to state buy lasix uk CHIP programs that cover pregnant individuals.Section 30722 would create a new option for states to coordinate care for Medicaid-enrolled pregnant and post-partum individuals through a maternal health home model.

States that take up this option would receive a 15% increase in FMAP for care delivered through maternal health homes buy lasix uk for the first two years. States that are interested in pursuing this new option can receive planning grants prior to implementation.Sections 31031 through 31048 of the Build Back Better Act provide federal grants to bolster other aspects of maternal health care. The funds would buy lasix uk be used to address a wide range of issues, such as addressing social determinants of maternal health.

Diversifying the perinatal nursing workforce, expanding care for maternal mental health and substance use, and supporting research and programs that promote maternal health equity.people affectedLargely in response to the new federal option, at least 26 states have taken steps to extend Medicaid postpartum coverage. Pregnant people in non-expansion states could see the biggest change as they are more likely than buy lasix uk those in expansion states to become uninsured after the 60-day postpartum coverage period. For example, in Alabama, buy lasix uk the Medicaid eligibility level for pregnant individuals is 146% FPL, but only 18% FPL (approximately $4,000/year for a family of three) for parents.Some states have piloted maternal health homes and seen positive impacts on health outcomes.

The federal grant provisions related to maternal health could affect care for all persons giving birth, but the focus of these proposals is on reducing racial and ethnic inequities. There were approximately 3.7 buy lasix uk million births in 2019, and nearly half were to women of color. There are approximately 700-800 pregnancy-related deaths annually, with the buy lasix uk rate 2-3 times higher among Black and American Indian and Alaska Native women compared to White women.

Additionally, there are stark racial and ethnic disparities in other maternal and health outcomes, including preterm birth and infant mortality.budgetary impactCBO estimates that requiring 12 month postpartum coverage in Medicaid and CHIP would have a net federal cost of $1.2 billion over 10 years (new costs of $2.2 billion offset by new revenues of $1.0 billion. CBO estimates that the option to create a maternal health home would increase federal spending by $1.0 billion over 10 years.CBO estimates that federal outlays for the grant sections in the Build Back Better Act related to maternal health care outside of the postpartum extension and maternal health homes are buy lasix uk $1.1 billion.(Back to top)7. Other Medicaid and Children’s Health Insurance (CHIP) ChangesbackgroundUnder current law, states have the option to provide 12-months buy lasix uk of continuous coverage for children.

Under this option, states allow a child to remain enrolled for a full year unless the child ages out of coverage, moves out of state, voluntarily withdraws, or does not make premium payments. As such, 12-month continuous eligibility eliminates coverage gaps due to fluctuations in income over the course of the year.To help support states and promote stability of coverage during the hypertension medications lasix, the Families First hypertension Response Act (FFCRA) provides a 6.2 percentage point increase in the federal share of certain Medicaid spending, provided that states meet maintenance of eligibility (MOE) requirements buy lasix uk that include ensuring continuous coverage for current enrollees.Under current law, Medicaid is the base of coverage for low-income children. CHIP complements Medicaid by covering uninsured children in families with incomes above Medicaid eligibility levels.

Unlike Medicaid, federal funding for CHIP is capped and provided as annual allotments to states buy lasix uk. CHIP funding buy lasix uk is authorized through September 30, 2027. While CHIP generally has bipartisan support, during the last reauthorization funding lapsed before Congress reauthorized funding.provision descriptionSection 30741 of the Build Back Better Act would require states to extend 12-month continuous coverage for children on Medicaid and CHIP.Section 30741 of the Build Back Better Act would phase out the FFCRA enhanced federal funding to states.

States would continue to receive the 6.2 percentage point increase through March 31, 2022, followed by a 3.0 percentage point increase from April 1, 2022 through June 30, 2022, and a 1.5 percentage point increase from July 1, 2022 through September 30, 2022.Section 30741 also would modify the FFCRA MOE requirement buy lasix uk for continuous coverage. From April buy lasix uk 1 through September 30, 2022, states could continue receiving the enhanced federal matching funds if they only terminate coverage for individuals who are determined no longer eligible for Medicaid and have been enrolled at least 12 consecutive months. The legislation includes other rules for states about conducting eligibility redeterminations and when states can terminate coverage.Section 30801 of the Build Back Better Act would permanently extend the CHIP program.people affectedAs of May 2021, there were 39 million children enrolled in Medicaid and CHIP (nearly half of all enrollees).

As of January 2020, 34 states provide 12-month continuous eligibility to at least some children buy lasix uk in either Medicaid or CHIP. A recent MACPAC report found that the overall mean length of coverage for children in 2018 was 11.7 months, and also that rates of churn (in which children dis-enroll and reenroll within a short period of time) were lower in states that had adopted the 12-month continuous coverage option and buy lasix uk in states that did not conduct periodic data checks. Another recent report shows that children with gaps in coverage during a year are more likely to be children of color with lower incomes.As of May 2021, there were 6.9 million people (mostly children) enrolled in CHIP.budgetary impactCBO estimates that Section 30741 would reduce federal costs by a net $3.5 billion over 10 years.

This 10 year number reflects $17.1 billion in federal savings in FY 2022 that is likely related to the provisions buy lasix uk to end the enhanced fiscal relief and the continuous coverage requirements and then federal costs starting in FY 2024. CBO estimates that permanently extending the CHIP program would reduce federal costs by buy lasix uk $1.2 billion over 10 years.(Back to top)8. Other Medicaid Financing and Benefit ChangesbackgroundUnlike in the 50 states and D.C., annual federal funding for Medicaid in the U.S.

Territories is subject to a statutory buy lasix uk cap and fixed matching rate. The funding caps and match rates have been increased by Congress in response to emergencies over time.treatments are an optional benefit for certain adult populations, including low-income parent/caretakers, pregnant women, and persons who are eligible based on old age or a disability. For adults enrolled under the ACA’s Medicaid expansion and other populations for whom the state elects to provide an “alternative benefit plan,” their benefits are subject to certain requirements in the ACA, including coverage of treatments recommended by the Advisory Committee on Immunization Practices (ACIP) with no cost sharing.Under buy lasix uk the Families First hypertension Response Act, coverage of testing and treatment for hypertension medications, including treatments, is required with no cost sharing in order for states to access temporary enhanced federal funding for Medicaid which is tied to the public health emergency.

The American Rescue Plan Act (ARPA) clarified that coverage of hypertension medications buy lasix uk treatments and their administration, without cost sharing, is required for nearly all Medicaid enrollees, through the last day of the 1st calendar quarter beginning at least 1 year after the public health emergency ends. The ARPA also provides 100% federal financing for this coverage.provision descriptionSection 30731 of the Build Back Better Act would increase the Medicaid cap amount and match rate for the territories. The FMAP would be permanently adjusted to 83% for the territories beginning in FY 2022, except that Puerto buy lasix uk Rico’s match rate would be 76% in FY 2022 before increasing to 83% in FY 2023 and subsequent years.

The legislation would also require a payment floor for certain physician services in Puerto Rico with a penalty for failure to establish the floor.Section 30751 of the Build Back Better Act would establish a 3.1 percentage point FMAP reduction from October 1, 2022 through December 31, 2025 for states that adopt eligibility standards, methodologies, or procedures that are more restrictive than those in place as of October 1, 2021 (except the penalty would not apply to coverage of non-pregnant, non-disabled adults with income above 133% FPL after December 31, 2022, if the state certifies that it has a budget deficit).Section 139405 of the Build Back Better Act would require state Medicaid programs to cover all approved treatments recommended by buy lasix uk ACIP and treatment administration, without cost sharing, for categorically and medically needy adults. States that provide adult treatment coverage without cost sharing as of the date of enactment would receive a 1 percentage point FMAP increase for 8 quarters.people affectedIn June 2019 there were approximately 1.3 million Medicaid enrollees in the territories (with 1.2 million in Puerto Rico).From February 2020 through May 2021 Medicaid and CHIP enrollment has increased by 11.5 million or 16.2% due to the economic effects of the lasix and MOE requirements.All states provide some treatment coverage for adults enrolled in Medicaid who are not covered as part of the ACA’s Medicaid expansion, but as of 2019, only about half of states covered all ACIP-recommended treatments.budgetary impactCBO estimates that the changes in Medicaid financing for the Territories would increase federal spending by $9.5 billion over 10 years.CBO estimates that the provision to impose a penalty in the match rate if states implement eligibility or enrollment restrictions through 2025 would increase federal costs by $7.0 billion.CBO estimates that extending treatments to adults on Medicaid would increase federal spending by $2.8 billion over 10 years.(Back to top)9. Medicaid Home and Community Based Services and the Direct Care WorkforcebackgroundMedicaid is currently the primary payer for long-term services and supports (LTSS), including home and buy lasix uk community-based services (HCBS), that help seniors and people with disabilities with daily self-care and independent living needs.

There is currently a great deal of state variation as most HCBS eligibility pathways and benefits are optional for states.PROVISION DESCRIPTIONSections 30711-30713 of the Build Back Better Act would create buy lasix uk the HCBS Improvement Program, which would provide a permanent 6 percentage point increase in federal Medicaid matching funds for HCBS. To qualify for the enhanced funds, states would have to maintain existing HCBS eligibility, benefits, and payment rates and have an approved plan to expand HCBS access, strengthen the direct care workforce, and monitor HCBS quality. The bill includes buy lasix uk some provisions to support family caregivers.

In addition, the Act would include funding ($130 million) for state planning grants and enhanced funding for administrative costs for certain activities (80% instead of 50%).Section 30714 of the Build Back Better Act would require states to report HCBS quality measures to HHS, beginning 2 years after the Secretary publishes HCBS quality measures as part of the Medicaid/CHIP core measures for children and adults. The bill provides states with an enhanced 80% federal matching rate for adopting and reporting these measures.Sections 30715 and 30716 of the Build Back Better Act would make the ACA HCBS spousal impoverishment protections and the Money Follows the Person (MFP) program permanent.Sections 22301 and 22302 of the Build Back Better Act would provide $1 billion in grants to states, community-based organizations, educational institutions, and other entities by the Department of Labor Secretary to develop and implement strategies for direct service workforce recruitment, retention, and/or education and training.Section 25005 of the Build Back Better Act would provide $20 million for HHS and the Administration on Community Living to establish a national technical assistance center for supporting the direct care workforce and family caregivers.Section 25006 of the Build Back Better Act would provide $40 million for the HHS Secretary to award to states, nonprofits, educational institutions, and other entities to address the behavioral health needs of unpaid caregivers of older individuals and older relative caregivers.people affectedThe majority of HCBS are provided by waivers, which buy lasix uk served over 2.5 million enrollees in 2018. There is substantial unmet need for HCBS, which is expected to increase with the growth in the aging population in the coming buy lasix uk years.

Nearly 820,000 people in 41 states were on a Medicaid HCBS waiver waiting list in 2018. Though waiting lists buy lasix uk alone are an incomplete measure, they are one proxy for unmet need for HCBS. Additionally, a shortage of direct care workers predated and has been intensified by the hypertension medications lasix, characterized buy lasix uk by low wages and limited opportunities for career advancement.

The direct care workforce is disproportionately female and Black.A KFF survey found that, as of 2018, 14 states expected that allowing the ACA spousal impoverishment provision to expire would affect Medicaid HCBS enrollees, for example by making fewer individuals eligible for waiver services.Over 101,000 seniors and people with disabilities across 44 states and DC moved from nursing homes to the community using MFP funds from 2008-2019. A federal evaluation of MFP showed about 5,000 new participants in each six month period from December 2013 through December 2016, indicating a continuing need for the program.Budgetary ImpactCBO estimates that all of the Medicaid-related HCBS provisions together will increase federal spending by about $150 billion buy lasix uk in the 10-year budget window. The new HCBS Improvement Program (Section 30712) accounts for most of this spending ($146.5 billion).CBO scores the Department of Labor buy lasix uk direct care workforce provisions according to the amount of spending authorized for each in the bill.

$1 billion for grants to support the direct care workforce (Section 22302), $20 million for a technical assistance center for supporting direct care and caregiving (Section 25005), and $40 million for funding to support unpaid caregivers (Section 25006).(Back to top)10. Paid Family and buy lasix uk Medical LeavebackgroundThe U.S. Is the only industrialized nation without a minimum standard of paid family or medical leave.

Although six states buy lasix uk and DC have paid family and medical leave laws in effect, and some employers voluntarily offer these benefits, this has resulted in a patchwork of policies with varying degrees of generosity and leaves many workers without a financial safety net when they need to take time off work to care for themselves or their families.provision descriptionSection 130001 of the Build Back Better Act would guarantee four weeks per year of paid family and medical leave to all workers in the U.S. Who need buy lasix uk time off work to welcome a new child, recover from a serious illness, or care for a seriously ill family member. Annual earnings up to $15,080 would be replaced at approximately 90% of average weekly earnings, plus about 73% of average weekly earnings for annual wages between $15,080 and $32,248, capping out at 53% of average weekly earnings for annual wages between $32,248 and $62,000.

While all workers taking qualified leave would be eligible for at least some wage replacement, the progressive benefits buy lasix uk formula means that the share of pay replaced while on qualified leave is highest for workers with lower wages. The original Act called for 12 weeks of paid leave for similar qualified reasons, plus three days of bereavement buy lasix uk leave, and benefits began at 85% of average weekly earnings for annual wages up to $15,080 and were capped at 5% of average weekly earnings for annual wages up to $250,000.people affectedAccording to the Bureau of Labor Statistics (BLS), approximately one in four (23%) workers has access to paid family leave through their employer. Data on the share of workers with access to paid medical leave for their own longer, serious illness are limited, although BLS also reports that 40% of workers have access to short-term disability insurance.​It is estimated that 53 million adults are caregivers for a dependent child or adult and 61% of them are women.

Sixty percent (60%) of caregivers reported having to take a leave buy lasix uk of absence leave from work or cut their hours in order to care for a family member. Workers who take leave buy lasix uk do so for different reasons. Half (51%) reported taking leave due to their own serious illness, one-quarter (25%) for reasons related to pregnancy, childbirth, or bonding with a new child, and one-fifth (19%) to care for a seriously ill family member.

In total, four in ten (42%) reported receiving their full pay while on leave, one-quarter (24%) received partial pay, and one-third (34%) received no pay.budgetary impactCBO estimates that the federal cost of these provisions would be about $205.5 billion over the 2022-2031 period buy lasix uk. The estimate accounts for funding the paid buy lasix uk leave benefits and administration, grants for the state administration option for states that already have a comprehensive paid leave law, and partial reimbursements for employers that provide equally comprehensive paid leave as a benefit to all their workers. The CBO estimate is modestly offset by application fees paid by employers participating in the reimbursement option for employer-sponsored paid leave benefits.(Back to top)11.

Consumer Assistance, Enrollment Assistance, and OutreachbackgroundConsumer Assistance in Health Insurance – The buy lasix uk Affordable Care Act (ACA) established a new system of state health insurance ombudsman programs, also called Consumer Assistance Programs, or CAPs. These programs are required to conduct public education about health insurance consumer protections and help people resolve problems with their health plans, including filing appeals for denied claims. By law, private health plans, including employer-sponsored plans, are required to buy lasix uk include contact information for CAPs on all explanation-of-benefit statements (EOB) with notice that CAPs can help consumers file appeals.To help inform oversight, CAPs are also required to report data to the Secretary of HHS on consumer experiences and problems.

The ACA buy lasix uk permanently authorized CAPs and appropriated seed funding of $30 million in 2010. Forty state CAPs were established that year. Since then, Congress has not appropriated CAP funding.Enrollment Assistance and Outreach in the Marketplace buy lasix uk – The Affordable Care Act also requires marketplaces to establish Navigator programs that help consumers apply for and enroll in coverage through the marketplace.

And it requires marketplaces to conduct public education and outreach about the availability of coverage and financial buy lasix uk assistance. As noted above, the Build Back Better Act would create new eligibility for marketplace coverage and financial assistance for low-income adults in states that have not expanded Medicaid.provision descriptionSection 30603 appropriates $100 million for state consumer assistance programs (CAPs) over the 4-year period, 2022-2025.Section 30601(d) appropriates $105 million to conduct public education and outreach in non-expansion states so people will learn about new coverage and subsidy options. $15 million is appropriated for 2022 and $30 million for each of buy lasix uk 2023-2025.

In addition, this section requires the Secretary to obligate no less than $70 million of marketplace user-fee revenues for additional Navigator funding to support enrollment assistance for the new coverage-gap population (at least $10 million in FY 2022 and at least $20 million in each of FY 2023-2025).people affectedCAP Funding – More than 175 million buy lasix uk Americans are covered by private health insurance plans today. Consumers generally find health insurance confusing and have limited understanding of even basic health insurance terms and concepts. Four-in-ten have difficulty understanding what their health plan will cover or how much buy lasix uk they will have to pay out-of-pocket for needed care.

When faced with unaffordable bills, only one-in-ten even try to get providers to lower their price. When claims are denied, buy lasix uk consumers rarely appeal. These are the kinds of buy lasix uk problems CAPs could help address with expanded funding.

Most of the state CAPs established in 2010 continue to operate today, though at reduced capacity without federal financial support. Programs rely on state funding (many CAPs are housed in state Insurance Departments or Attorney General offices) buy lasix uk and philanthropic support today. With recent enactment of the federal No Surprises Act, as well as amendments to the Mental Health Parity and Addiction Equity Act (MHPAEA), CAPS can help consumers understand and navigate new federal health insurance protections and inform oversight by federal and state agencies.Marketplace Enrollment Assistance and Outreach – After years of cuts in funding for Navigator enrollment assistance and outreach, the Biden Administration took steps this year to buy lasix uk restore federal marketplace funding for these activities.

During the 2021 hypertension medications special enrollment opportunity, when expanded subsidies enacted by ARPA first became available, more than 2.2 million people newly signed up for marketplace coverage. However, KFF found only 1 in 4 people buy lasix uk who are uninsured or buy their own health insurance checked to see if they would qualify for affordable coverage. This finding is consistent with earlier KFF surveys that find buy lasix uk 3 in 4 uninsured don’t look for health coverage because they assume it is not affordable.

Investments in public education, outreach, and enrollment assistance can help inform the 2.2 million uninsured adults in the coverage gap of new affordable health coverage options through the marketplace.budgetary impactNew appropriations for Consumer Assistance Programs would cost $100 million over 5 years.New appropriations for marketplace outreach would cost $105 million over 5 years. Additional funding for Navigator enrollment assistance in coverage buy lasix uk gap states would not come from new appropriations. These resources will come from user fee revenue collected by the marketplace.(Back to top).

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William Stork cost of bumex vs lasix http://www.ec-schloessel-ostwald.ac-strasbourg.fr/?p=1234 needs a tooth out. That’s what the 71-year-old retired truck driver’s dentist told him during a recent checkup. That kind of extraction requires an oral surgeon, which could cost him around $1,000 because, like most seniors, Stork does not have dental insurance, and cost of bumex vs lasix Medicare won’t cover his dental bills. Between Social Security and his pension from the Teamsters union, Stork said, he lives comfortably in Cedar Hill, Missouri, about 30 miles southwest of St.

Louis. But that cost is cost of bumex vs lasix significant enough that he’s decided to wait until the tooth absolutely must come out. Stork’s predicament is at the heart of a long-simmering rift within the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people 65 and older — if a benefit can pass at all. Health equity advocates see President Joe Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to those on Medicare, nearly half of whom did not visit a dentist in 2018, well before the lasix paused dental appointments for many.

The rates were even higher for Black cost of bumex vs lasix (68%), Hispanic (61%) and low-income (73%) seniors. The coverage was left out of a new framework announced by President Joe Biden on Thursday, but proponents still hope they can get the coverage in a final agreement. Complicating their push is a debate over how many of the nation’s more than 60 million Medicare beneficiaries should receive it. Champions for covering cost of bumex vs lasix everyone on Medicare find themselves up against an unlikely adversary.

The American Dental Association, which is backing an alternative plan to give dental benefits only to low-income Medicare recipients. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Medicare has excluded dental (and vision and hearing) coverage since its inception in 1965. That exclusion was by cost of bumex vs lasix design. The dental profession has long fought to keep itself separate from the traditional medical system.

More recently, cost of bumex vs lasix however, dentists have stressed the link between oral and overall health. Most infamously, the 2007 death of a 12-year-old boy that might have been prevented by an $80 tooth extraction prompted changes to Maryland’s version of Medicaid, the federal-state public insurance program for low-income people. But researchers have also, for example, linked dental care with reduced health care spending in patients with Type 2 diabetes. When the World Health Organization suggested delaying non-urgent oral health visits last year to prevent the spread of hypertension medications, the American Dental Association pushed back, with then-President Dr cost of bumex vs lasix.

Chad Gehani saying, “Oral health is integral to overall health. Dentistry is essential health care.” The ADA-backed Medicare proposal would cover only seniors who earn up to three times the poverty level. That currently translates to $38,640 a year for an individual, reducing the number of potential recipients from over 60 million people to roughly half that number cost of bumex vs lasix. Medicare has never required means testing, but in a world where Congress is looking to trim the social-spending package from $3.5 trillion over 10 years to $1.85 trillion, the ADA presents its alternative as a way to save money while covering those who need a dental benefit the most.

A Congressional Budget Office analysis estimated the plan to provide dental coverage to all Medicare recipients would cost $238 billion over 10 years. Unlike the ADA, the National Dental Association is cost of bumex vs lasix pushing for a universal Medicare dental benefit. The group “promotes oral health equity among people of color,” and formed in 1913, in part, because the ADA did not eliminate discriminatory membership rules for its affiliates until 1965. Dr.

Nathan Fletcher, chairman of NDA’s board of trustees, said cost of bumex vs lasix he was unsurprised to find his organization at odds with the ADA over this issue of Medicare coverage. €œThe face and demographic of the ADA is a white male, 65 years old. Understand that those who make decisions for the ADA are usually the ones who have been in practice for 25 to 30 years, doing well, ready to retire,” Fletcher said. €œIt looks nothing like the [patients] who we’re talking about.” Between Social cost of bumex vs lasix Security and his pension from the Teamsters union, Stork said, he lives comfortably, but $1,000 for a surgical tooth extraction is significant enough that he’s decided to wait until the tooth absolutely must come out.(Joe Martinez for KHN) Research from the ADA’s Health Policy Institute found cost as a barrier to dental care “regardless of age, income level, or type of insurance,” but low-income older adults were more likely to report it as a barrier.

€œIt would lasix street price be tragic if we didn’t do something for those low-income seniors,” said Michael Graham, senior vice president of government and public affairs for the ADA. Graham is critical of the design of the proposals in Congress for a universal Medicare dental benefit, noting that one includes a cost of bumex vs lasix 20% copay for preventive services that could block low-income patients from accessing the care they would presumably be gaining. €œSomething is better than nothing, but the something [with a copay] almost equals nothing for many seniors,” Graham said. Graham said the ADA backs covering 100% of preventive services for low-income Medicare recipients.

Of course, covering only low-income seniors presents cost of bumex vs lasix its own questions, the biggest being. Will dentists even accept Medicare if they don’t have to?. Low-income patients often seek care at safety-net clinics that schedule out months in advance. Some dentists worry a Medicare benefit limited to low-income older adults would cost of bumex vs lasix be easier to shun, pushing even more newly insured Americans into an already burdened dental safety net.

Fewer than half of dentists overall accept Medicaid, but more than 60% of NDA members do, according to Fletcher. The ADA worries the reimbursement rates and bureaucratic paperwork for a Medicare benefit will be similarly unappealing. But Fletcher, who is dental director for a Medicaid insurance company in Washington, D.C., said participation in Medicaid varies widely across states — and, as with Medicaid, participation in any new Medicare cost of bumex vs lasix dental program would largely depend on the benefit’s design. If the reimbursement rates for a Medicare benefit are high enough, Fletcher said, giving coverage to tens of millions of seniors could be quite lucrative for dentists.

Ultimately, he said, dentists should have a choice in whether to accept Medicare patients, and all Medicare patients should be entitled to dental services since they paid into the program. Health advocates see President Joe Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to people on Medicare, cost of bumex vs lasix like Stork. Complicating their push is a debate over how many of the nation’s more than 60 million beneficiaries should receive it.(Joe Martinez for KHN) Dr. Nathan Suter, William Stork’s dentist, sees adding a dental benefit for all seniors as the right thing to do.

A self-described “proud ADA member,” Suter finds himself at odds with the organization, which cost of bumex vs lasix has showered him with accolades. He was named Dentist of the Year by the affiliated Missouri Dental Association in 2019, and received one of the ADA’s awards for young dentists in 2020. €œI, as an ADA member, think they should be at the table for me, making sure it’s as good a benefit as possible for all of my seniors,” said Suter, who estimated at least 50% of cost of bumex vs lasix patients at his House Springs, Missouri, practice are older adults. But rather than push for a universal benefit, the ADA’s well-funded lobbying operation is pushing against congressional Democrats’ proposed plan to add dental coverage for all Medicare recipients.

The organization has asked its members to contact their congressional representatives on the topic. Graham said more than 60,000 emails have been sent to cost of bumex vs lasix Capitol Hill so far. Suter sees the battle over whom to cover as a generational rift. As an early-career dentist, he prefers adding full dental coverage now so he can adapt his business model sooner.

And the more seniors who get dental coverage, the more his potential client cost of bumex vs lasix base expands. Dentists like him, still building their practices, are less likely to have time to be involved in the ADA’s policymaking process, he said. Caught up in it all are patients such as Stork, who said the possibility of dental coverage in Medicare is one reason he is holding off on the extraction, even though he knows a benefit is unlikely to be implemented for years, if at all. Stork also knows the benefit might not cover a middle-class person like himself even if cost of bumex vs lasix approved.

Still, it sure would be nice to have when his tooth cannot wait any longer to come out. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at cost of bumex vs lasix KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Related Topics Contact Us Submit a Story Tip.

William Stork needs buy lasix uk a tooth where to buy lasix water pill out. That’s what the 71-year-old retired truck driver’s dentist told him during a recent checkup. That kind of extraction requires an oral surgeon, which could cost him around $1,000 because, like most buy lasix uk seniors, Stork does not have dental insurance, and Medicare won’t cover his dental bills. Between Social Security and his pension from the Teamsters union, Stork said, he lives comfortably in Cedar Hill, Missouri, about 30 miles southwest of St.

Louis. But that cost is significant enough that he’s decided to buy lasix uk wait until the tooth absolutely must come out. Stork’s predicament is at the heart of a long-simmering rift within the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people 65 and older — if a benefit can pass at all. Health equity advocates see President Joe Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage to those on Medicare, nearly half of whom did not visit a dentist in 2018, well before the lasix paused dental appointments for many.

The rates were even higher for Black (68%), Hispanic (61%) and low-income (73%) buy lasix uk seniors. The coverage was left out of a new framework announced by President Joe Biden on Thursday, but proponents still hope they can get the coverage in a final agreement. Complicating their push is a debate over how many of the nation’s more than 60 million Medicare beneficiaries should receive it. Champions for covering everyone on Medicare find themselves buy lasix uk up against an unlikely adversary.

The American Dental Association, which is backing an alternative plan to give dental benefits only to low-income Medicare recipients. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Medicare has excluded dental (and vision and hearing) coverage since its inception in 1965. That exclusion buy lasix uk was by design. The dental profession has long fought to keep itself separate from the traditional medical system.

More recently, however, dentists have stressed the link buy lasix uk between oral and overall health. Most infamously, the 2007 death of a 12-year-old boy that might have been prevented by an $80 tooth extraction prompted changes to Maryland’s version of Medicaid, the federal-state public insurance program for low-income people. But researchers have also, for example, linked dental care with reduced health care spending in patients with Type 2 diabetes. When the World Health Organization suggested delaying non-urgent oral health visits last year to prevent the spread buy lasix uk of hypertension medications, the American Dental Association pushed back, with then-President Dr.

Chad Gehani saying, “Oral health is integral to overall health. Dentistry is essential health care.” The ADA-backed Medicare proposal would cover only seniors who earn up to three times the poverty level. That currently translates to $38,640 a buy lasix uk year for an individual, reducing the number of potential recipients from over 60 million people to roughly half that number. Medicare has never required means testing, but in a world where Congress is looking to trim the social-spending package from $3.5 trillion over 10 years to $1.85 trillion, the ADA presents its alternative as a way to save money while covering those who need a dental benefit the most.

A Congressional Budget Office analysis estimated the plan to provide dental coverage to all Medicare recipients would cost $238 billion over 10 years. Unlike the ADA, the National Dental Association is pushing for a universal buy lasix uk Medicare dental benefit. The group “promotes oral health equity among people of color,” and formed in 1913, in part, because the ADA did not eliminate discriminatory membership rules for its affiliates until 1965. Dr.

Nathan Fletcher, chairman of NDA’s board of trustees, said he was unsurprised to find his organization at odds with the buy lasix uk ADA over this issue of Medicare coverage. €œThe face and demographic of the ADA is a white male, 65 years old. Understand that those who make decisions for the ADA are usually the ones who have been in practice for 25 to 30 years, doing well, ready to retire,” Fletcher said. €œIt looks nothing like the [patients] who we’re talking about.” Between Social Security and buy lasix uk his pension from the Teamsters union, Stork said, he lives comfortably, but $1,000 for a surgical tooth extraction is significant enough that he’s decided to wait until the tooth absolutely must come out.(Joe Martinez for KHN) Research from the ADA’s Health Policy Institute found cost as a barrier to dental care “regardless of age, income level, or type of insurance,” but low-income older adults were more likely to report it as a barrier.

€œIt would be tragic if we didn’t do something for those low-income seniors,” said Michael Graham, senior vice president of government and public affairs for the ADA. Graham is critical of the design of the proposals in Congress for a universal Medicare dental benefit, noting that one includes a 20% copay for preventive services that could block buy lasix uk low-income patients from accessing the care they would presumably be gaining. €œSomething is better than nothing, but the something [with a copay] almost equals nothing for many seniors,” Graham said. Graham said the ADA backs covering 100% of preventive services for low-income Medicare recipients.

Of course, covering only low-income seniors presents its own buy lasix uk questions, the biggest being. Will dentists even accept Medicare if they don’t have to?. Low-income patients often seek care at safety-net clinics that schedule out months in advance. Some dentists worry a Medicare benefit limited to low-income older adults would be easier to shun, pushing even more newly insured Americans into an already burdened dental safety net buy lasix uk.

Fewer than half of dentists overall accept Medicaid, but more than 60% of NDA members do, according to Fletcher. The ADA worries the reimbursement rates and bureaucratic paperwork for a Medicare benefit will be similarly unappealing. But Fletcher, who buy lasix uk is dental director for a Medicaid insurance company in Washington, D.C., said participation in Medicaid varies widely across states — and, as with Medicaid, participation in any new Medicare dental program would largely depend on the benefit’s design. If the reimbursement rates for a Medicare benefit are high enough, Fletcher said, giving coverage to tens of millions of seniors could be quite lucrative for dentists.

Ultimately, he said, dentists should have a choice in whether to accept Medicare patients, and all Medicare patients should be entitled to dental services since they paid into the program. Health advocates see President Joe Biden’s Build Back Better agenda as a once-in-a-generation opportunity buy lasix uk to provide dental coverage to people on Medicare, like Stork. Complicating their push is a debate over how many of the nation’s more than 60 million beneficiaries should receive it.(Joe Martinez for KHN) Dr. Nathan Suter, William Stork’s dentist, sees adding a dental benefit for all seniors as the right thing to do.

A self-described “proud ADA member,” Suter finds himself at odds with the organization, which has buy lasix uk showered him with accolades. He was named Dentist of the Year by the affiliated Missouri Dental Association in 2019, and received one of the ADA’s awards for young dentists in 2020. €œI, as an ADA member, think they should be at the table for me, making sure it’s as good a benefit as possible for all of my seniors,” said Suter, who estimated at least 50% of patients at his House Springs, Missouri, practice are buy lasix uk older adults. But rather than push for a universal benefit, the ADA’s well-funded lobbying operation is pushing against congressional Democrats’ proposed plan to add dental coverage for all Medicare recipients.

The organization has asked its members to contact their congressional representatives on the topic. Graham said more than 60,000 emails have been sent to Capitol Hill so buy lasix uk far. Suter sees the battle over whom to cover as a generational rift. As an early-career dentist, he prefers adding full dental coverage now so he can adapt his business model sooner.

And the more seniors who get buy lasix uk dental coverage, the more his potential client base expands. Dentists like him, still building their practices, are less likely to have time to be involved in the ADA’s policymaking process, he said. Caught up in it all are patients such as Stork, who said the possibility of dental coverage in Medicare is one reason he is holding off on the extraction, even though he knows a benefit is unlikely to be implemented for years, if at all. Stork also knows the benefit might not cover a middle-class person like himself even if buy lasix uk approved.

Still, it sure would be nice to have when his tooth cannot wait any longer to come out. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one buy lasix uk of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Related Topics Contact Us Submit a Story Tip.

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News ReleaseTuesday, October 26, 2021New find out program buy lasix 40mg will establish data science research and training network across the continent. The National Institutes of Health is investing about $74.5 million over five years to advance data science, catalyze innovation and spur health discoveries across Africa. Under its new Harnessing Data Science for Health buy lasix 40mg Discovery and Innovation in Africa (DS-I Africa) program, the NIH is issuing 19 awards to support research and training activities. DS-I Africa is an NIH Common Fund program that is supported by the Office of the Director and 11 NIH Institutes, Centers and Offices. Awards will establish a consortium consisting of a data science platform and coordinating center, seven research hubs, seven data buy lasix 40mg science research training programs and four projects focused on studying the ethical, legal and social implications of data science research.

Awardees have a robust network of partnerships across the African continent and in the United States, including numerous national health ministries, nongovernmental organizations, corporations, and other academic institutions. €œThis initiative has generated tremendous enthusiasm in all sectors of Africa’s biomedical research community,” said NIH Director Francis S. Collins, M.D., buy lasix 40mg Ph.D. €œBig data and artificial intelligence have the potential to transform the conduct of research across the continent, while investing in research training will help to support Africa’s future data science leaders and ensure sustainable progress in this promising field.” The University of Cape Town (UCT) will develop and manage the initiative’s open data science platform and coordinating center, building on previous NIH investments in UCT’s data and informatics capabilities made through the Human Heredity and Health in Africa (H3Africa) program. UCT will provide a flexible, scalable platform for the DS-I Africa researchers, so they can find and access data, select tools and workflows, and run analyses through collaborative workspaces buy lasix 40mg.

UCT will also administer and support core resources, as well as coordinate consortium activities. The research hubs, all of which are led by African institutions, will apply novel approaches to data analysis and AI to address critical health issues including. Scientists in Kenya will leverage large, existing data sets to develop and validate AI models to identify women at risk for poor pregnancy outcomes buy lasix 40mg. And to identify adolescents and young healthcare workers at risk of depression and suicide ideation. A hub in Nigeria will study hypertension and HIV with the goal of using data buy lasix 40mg to improve lasix preparedness.

In Uganda, researchers will advance data science for medical imaging with efforts to improve diagnoses of eye disease and cervical cancer. Scientists in Nigeria will also study anti-microbial resistance and the dynamics of disease transmission, develop a portable screening tool for bacterial s and test a potential anti-microbial compound. A project based in buy lasix 40mg Cameroon will investigate ways to decrease the burden of injuries and surgical diseases, as well as improve access to quality surgical care across the continent. From a hub in South Africa, researchers will study multi-disease morbidity by analyzing clinical and genomic data with the goal of providing actionable insights to reduce disease burden and improve overall health. A project in South Africa buy lasix 40mg will develop innovative solutions to mitigate the health impacts of climate change throughout the region, with initial studies of clinical outcomes of heat exposure on pregnant women, newborns and people living in urban areas.The research training programs, which leverage partnerships with U.S.

Institutions, will create multi-tiered curricula to build skills in foundational health data science, with options ranging from master’s and doctoral degree tracks, to postdoctoral training and faculty development. A mix of in-person and remote training will be offered to build skills in multi-disciplinary topics such as applied mathematics, biostatistics, epidemiology, clinical informatics, analytics, computational omics, biomedical imaging, machine intelligence, computational paradigms, computer science and engineering. Trainees will receive intensive mentoring and participate in practical internships to learn how to apply data science concepts to medical and public health areas including the social determinants of buy lasix uk health, climate change, food systems, infectious diseases, noncommunicable buy lasix 40mg diseases, health surveillance, injuries, pediatrics and parasitology. Recognizing that data science research may uncover potential ethical, legal and social implications (ELSI), the consortium will include dedicated ELSI research addressing these topics. This will include efforts to develop evidence-based, context buy lasix 40mg specific guidance for the conduct and governance of data science initiatives.

Evaluate current legal instruments and guidelines to develop new and innovative governance frameworks to support data science health research in Africa. Explore legal differences across regions of the continent in buy lasix 40mg the use of data science for health discovery and innovation. And investigate public perceptions and attitudes regarding the use of data science approaches for healthcare along with the roles and responsibilities of different stakeholder groups regarding intellectual property, patents, and commercial use of genomics data in health. In addition, the ELSI research teams will be embedded in the research hubs to provide important and timely guidance. A second phase of the program is being planned to encourage more researchers to join the consortium, foster the formation of new partnerships and address buy lasix 40mg additional capacity building needs.

Through the combined efforts of all its initiatives, DS-I Africa is intended to use data science to develop solutions to the continent’s most pressing public health problems through a robust ecosystem of new partners from academic, government and private sectors. In addition to the Common Fund (CF), the DS-I Africa awards are being supported by the Fogarty International Center (FIC), the National Cancer Institute (NCI), the National Human Genome Research Institute (NHGRI), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute of Environmental Health Sciences (NIEHS), the National Institute of Mental Health (NIMH), the National Library of Medicine buy lasix 40mg (NLM) and the NIH Office of Data Science Strategy (ODSS). The initiative is being led by the CF, FIC, NIBIB, NIMH and NLM. More information is available at https://commonfund.nih.gov/AfricaData. Photos depicting data science buy lasix 40mg activities at awardee institutions are available for downloading at https://commonfund.nih.gov/africadata/images.

About the NIH Common Fund. The NIH Common Fund encourages collaboration and supports a series of buy lasix 40mg exceptionally high-impact, trans-NIH programs. Common Fund programs are managed by the Office of Strategic Coordination in the Division of Program Coordination, Planning, and Strategic Initiatives in the NIH Office of the Director in partnership with the NIH Institutes, Centers, and Offices. More information is available at the Common Fund website. Https://commonfund.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of buy lasix 40mg the U.S.

Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating buy lasix 40mg the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health®###.

News ReleaseTuesday, October 26, 2021New program will establish data science research and http://oneworldjiujitsu.com/2016/06/15/issac-doederlein-seminar/ training buy lasix uk network across the continent. The National Institutes of Health is investing about $74.5 million over five years to advance data science, catalyze innovation and spur health discoveries across Africa. Under its new Harnessing Data Science for Health Discovery and Innovation buy lasix uk in Africa (DS-I Africa) program, the NIH is issuing 19 awards to support research and training activities.

DS-I Africa is an NIH Common Fund program that is supported by the Office of the Director and 11 NIH Institutes, Centers and Offices. Awards will establish buy lasix uk a consortium consisting of a data science platform and coordinating center, seven research hubs, seven data science research training programs and four projects focused on studying the ethical, legal and social implications of data science research. Awardees have a robust network of partnerships across the African continent and in the United States, including numerous national health ministries, nongovernmental organizations, corporations, and other academic institutions.

€œThis initiative has generated tremendous enthusiasm in all sectors of Africa’s biomedical research community,” said NIH Director Francis S. Collins, M.D., buy lasix uk Ph.D. €œBig data and artificial intelligence have the potential to transform the conduct of research across the continent, while investing in research training will help to support Africa’s future data science leaders and ensure sustainable progress in this promising field.” The University of Cape Town (UCT) will develop and manage the initiative’s open data science platform and coordinating center, building on previous NIH investments in UCT’s data and informatics capabilities made through the Human Heredity and Health in Africa (H3Africa) program.

UCT will provide a flexible, scalable platform for the DS-I Africa researchers, so they can find and access data, select tools and workflows, and buy lasix uk run analyses through collaborative workspaces. UCT will also administer and support core resources, as well as coordinate consortium activities. The research hubs, all of which are led by African institutions, will apply novel approaches to data analysis and AI to address critical health issues including.

Scientists in Kenya will leverage large, existing data sets to develop and validate AI models to identify women at risk buy lasix uk for poor pregnancy outcomes. And to identify adolescents and young healthcare workers at risk of depression and suicide ideation. A hub in Nigeria will buy lasix uk study hypertension and HIV with the goal of using data to improve lasix preparedness.

In Uganda, researchers will advance data science for medical imaging with efforts to improve diagnoses of eye disease and cervical cancer. Scientists in Nigeria will also study anti-microbial resistance and the dynamics of disease transmission, develop a portable screening tool for bacterial s and test a potential anti-microbial compound. A project based in Cameroon will investigate ways buy lasix uk to decrease the burden of injuries and surgical diseases, as well as improve access to quality surgical care across the continent.

From a hub in South Africa, researchers will study multi-disease morbidity by analyzing clinical and genomic data with the goal of providing actionable insights to reduce disease burden and improve overall health. A project in South Africa will develop innovative solutions to mitigate the buy lasix uk health impacts of climate change throughout the region, with initial studies of clinical outcomes of heat exposure on pregnant women, newborns and people living in urban areas.The research training programs, which leverage partnerships with U.S. Institutions, will create multi-tiered curricula to build skills in foundational health data science, with options ranging from master’s and doctoral degree tracks, to postdoctoral training and faculty development.

A mix of in-person and remote training will be offered to build skills in multi-disciplinary topics such as applied mathematics, biostatistics, epidemiology, clinical informatics, analytics, computational omics, biomedical imaging, machine intelligence, computational paradigms, computer science and engineering. Trainees will receive intensive mentoring buy lasix uk and participate in practical internships to learn how to apply data science concepts to medical and public health areas including the social determinants of health, climate change, food systems, infectious diseases, noncommunicable diseases, health surveillance, injuries, pediatrics and parasitology. Recognizing that data science research may uncover potential ethical, legal and social implications (ELSI), the consortium will include dedicated ELSI research addressing these topics.

This will include efforts to develop evidence-based, context specific guidance for the conduct and governance of data science buy lasix uk initiatives. Evaluate current legal instruments and guidelines to develop new and innovative governance frameworks to support data science health research in Africa. Explore legal differences across regions of the continent buy lasix uk in the use of data science for health discovery and innovation.

And investigate public perceptions and attitudes regarding the use of data science approaches for healthcare along with the roles and responsibilities of different stakeholder groups regarding intellectual property, patents, and commercial use of genomics data in health. In addition, the ELSI research teams will be embedded in the research hubs to provide important and timely guidance. A second phase of the program is being planned to encourage more researchers to join the consortium, foster the formation of new partnerships and address buy lasix uk additional capacity building needs.

Through the combined efforts of all its initiatives, DS-I Africa is intended to use data science to develop solutions to the continent’s most pressing public health problems through a robust ecosystem of new partners from academic, government and private sectors. In addition to the Common Fund (CF), the DS-I Africa awards are being supported by the Fogarty International Center (FIC), the National Cancer Institute (NCI), the National Human Genome Research Institute (NHGRI), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute of Environmental Health Sciences buy lasix uk (NIEHS), the National Institute of Mental Health (NIMH), the National Library of Medicine (NLM) and the NIH Office of Data Science Strategy (ODSS). The initiative is being led by the CF, FIC, NIBIB, NIMH and NLM.

More information is available at https://commonfund.nih.gov/AfricaData. Photos depicting buy lasix uk data science activities at awardee institutions are available for downloading at https://commonfund.nih.gov/africadata/images. About the NIH Common Fund.

The NIH Common Fund encourages collaboration and supports a series of exceptionally high-impact, trans-NIH programs buy lasix uk. Common Fund programs are managed by the Office of Strategic Coordination in the Division of Program Coordination, Planning, and Strategic Initiatives in the NIH Office of the Director in partnership with the NIH Institutes, Centers, and Offices. More information is available at the Common Fund website.

Https://commonfund.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical buy lasix uk research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both buy lasix uk common and rare diseases.

For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health®###.

Lasix and water intake

NCHS Data Brief No lasix and water intake. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions lasix and water intake such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes lasix and water intake sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for ScienceTTHealthWatch is a weekly podcast from Texas Tech.

In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.This week's topics include predicting hypertension medications mortality, immunity following hypertension medications vaccination, surgery for recurrent ovarian cancer, and FDA oversight of medical devices.Program notes:0:34 Waning immunity from hypertension medications after vaccination1:34 Who developed breakthrough s?. 2:34 Doesn't address severity of 3:37 Some treatments not directed to the spike protein3:55 Predictors of hypertension medications death4:55 Elevated cytokines and tissue injury markers5:50 Even by day five, vRNA predicts6:36 Scrutiny of medical devices by FDA7:36 Approved using 510K8:36 Device creep9:26 Recurrent ovarian cancer and second surgeries10:26 Surgery with platinum-based chemo11:28 Carefully selected population12:27 Change in chemotherapy?. 13:36 EndTranscript:Elizabeth Tracey. Is there a benefit to additional surgeries when ovarian cancer recurs?.

Rick Lange, MD. Waning hypertension medications vaccination efficacy.Elizabeth. Can we predict who is going to die from hypertension medications ?. Rick.

And medical device safety.Elizabeth. That's what we're talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.Rick. And I'm Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I'm also dean of the Paul L.

Foster School of Medicine.Elizabeth. Rick, how about if we turn first to the BMJ since everybody is top-of-mind regarding, "Oh, no, we have this new variant that's emerged," and that everybody is panic-stricken about. What is the elapsed time since vaccination against hypertension medications and subsequent risk of hypertension ?. Rick.

Elizabeth, you set that up very nicely. How did we do this study?. We have a lot of data from Israel, which really was among the first countries to initiate both a large-scale vaccination campaign and they did it very early on. By July of 2021, more than 5.2 million Israelis were fully vaccinated with the same treatment -- they had gotten both doses of the Pfizer mRNA treatment.

Despite that, they noticed that since June of 2021 there has been a resurgence of individuals with hypertension medications . So their concerns were whether there would be decreasing levels of immunity as a result of just the time since the treatments were given. They looked at those individuals that had developed breakthrough hypertension medications s. They had been fully vaccinated -- this was 3 weeks after the vaccination which was the earliest time point -- and they chopped it up from 0 to 90 days, from 90 to 120, 120 to 150, and 150 to 180, to determine if the time since treatment contributed to a breakthrough hypertension medications case.

What they discovered was that was indeed the case. Those that had their vaccination 90 to 120 days had about a 2 or 2½-fold increased risk of developing a breakthrough . That carried off for the next 150 to 180 days and even greater than 180 days. It looks like that there is waning efficacy and it begins not at 6 months, but as early as 3 months after vaccination.Elizabeth.

I am wondering if we're going to find out that this is the Achilles' heel of mRNA treatments eventually.Rick. The data are pretty clear not only from this study, but from other studies suggesting that there is waning antibody response. Now, what this study doesn't address is the severity of the . But I agree with you that currently this does appear to be the Achilles' heel and hence the recommendation is to get a booster for everybody over the age of 18.

The Pfizer treatment is now petitioning the FDA to do it to individuals as low as 16 years of age. Elizabeth. Well, as Omicron -- I'm sure we are going to detect it here domestically pretty shortly. That's my bet -- in light of that, everyone who isn't boosted really needs to get boosted or what I have called in the past, of course, the third dose.

I am even wondering about, well, what about even more than that for those who are willing?. Rick. As we get more variants, I think what we may be doing is having different types of boosters, ones that target these variants. I am sure we are going to be telling our listeners more about this in the weeks to come.Elizabeth.

I do think that also, and I am going to recall for you this pan-sarbecolasix notion that we talked about relative to the antibody production. And my question, which I subsequently investigated, is about treatments that are targeted against those conserved regions of the spike protein. There is that out there, but it's not as robust as I thought it should be at this point.Rick. Yeah.

But some of these treatments are not even directed towards the spike protein, so stay tuned.Elizabeth. Still speaking about hypertension, let's turn then to Science Advances. Let me just ask you. It's my recollection that this is the first time we have talked about a paper that's in this journal.Rick.

Right, and we have been doing this for about 18 to 19 years, Elizabeth, and so I'm surprised that Science Advances has escaped our reporting before. But this is an important study.Elizabeth. This is entitled "Immunovirological profiling validates plasma hypertension RNA as an early predictor of hypertension medications mortality." Clearly, this is something we all want to know clinically. When somebody comes into the hospital and they need to be ventilated, can we determine which of them is most at risk of death?.

They did these immunovirological tests on plasma from 279 people. They collected samples at what they call DSO11, so days from symptom onset in a discovery cohort. They performed three different assessments in this. Viral RNA that was circulating, low receptor binding domain-specific IGG and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers.

So a constellation of those. They developed this 3-variable model of viral RNA that they actually predefined adjustment by age and sex. By doing this, they were able to very reliably identify patients with fatal outcomes. This model remained really robust in independent validation.

They are suggesting that these are the kinds of assessments that can be done so that we can say, "This person is really at high risk for mortality."Rick. Elizabeth, a lot of people have tried to identify who is going to be at risk of death with hypertension medications so we could direct therapies. They looked at just viral RNA, how many RNA particles were actually in the blood, 26 different cytokines and tissue markers, and six different types of immunologic responses. What they found out is really all we need to do is measure viral RNA by Day 11.

By the way, when they went back and said, "Gosh, can we predict even earlier?. " Even by Day 5, the amount of viral RNA predicted who was likely to die. The downside is this is a fairly small study by most of our standards, but it does need to be validated in a larger cohort.Elizabeth. I thought they were very intellectually honest in taking a look at remdesivir and other things that might interrupt that whole cascade, and kind of speculating we are not really sure if that's going to make a difference and also that this circulating or this plasma viral RNA does not indicate intact virions or infectability either.Rick.

Right. It could be viral particles that have undergone degradation. But what's clear is the more viral particles, the more tissue injury you have, the higher the immunological response. Instead of measuring those other things, just the viral particle number alone can provide insight.Elizabeth.

Now, let's turn to one that I very specifically wanted you to address.Rick. All right, Elizabeth, our listeners may not be aware, but I chair one of the FDA panels for circulatory devices. I have had the privilege of serving on this panel for, gosh, probably 10 to 12 years now. This is a particular article calling for reforms to the medical device safety.

When a device is considered to be low-risk, Class I or Class II, it's going to be approved by the FDA with really minimal involvement of committees. When it may be life-threatening, it's called a Class III device. If it's a new device, we have what's called pre-market approval. They want to look at the device.

They want to have randomized control trials showing that it's both effective and it's safe. But once you have that device, when you have other devices like it to speed things up, but to try to make it safe, we have what's called a 510(K) process. If a device looks like another device that's been effective, then it can be approved. It's called predicate device.

There was a device that was approved using the 510(K) to suck clots out of people that were having strokes. This device was based upon another device. Then this device went through 12 different iterations over the course of time. By 2019, this device, called the Penumbra, was recalled after about 200 adverse reports and 19 deaths associated with it.

What this reform says is, "Gosh, obviously, in this particular case this 510(K) approval device pathway failed."Elizabeth. Yeah. Of course, this reveals both of our biases, your bias toward the FDA and the policies that are employed in these device situations and mine against, where I really feel that there is not enough scrutiny. We have other examples of devices -- hip implants that have caused a lot of harm and were also approved under that same aegis.

The editorialist, of course, says, "Hmm, maybe it's time for a new paradigm here."Rick. I think there are some things within the FDA's control and some things that are not. There is what's called device creep. This was a device that was approved years ago and it went through iteration after iteration after iteration.

But obviously, over the course of those 12 iterations, the device didn't look anything like the original device, so we need to have some way of dealing with that. There are some things the FDA can't do, post-marketing surveillance. It doesn't have the teeth to demand that the company do post-marketing studies, and if they don't, to shut the product down. It just doesn't have that regulatory authority to do that.We have a way of reporting device safety issues, but it's voluntary.

There are some regulatory things that need to be done to give the FDA the information they need and the clout -- regulatory authority -- to enact some of these things. I agree with you, there are glaring holes that can be fixed.Elizabeth. Well, I'm really glad to hear you make that admission and that's, of course, in JAMA Internal Medicine. Let's finally turn to the New England Journal of Medicine, what I served up as, "Is there any benefit to doing second surgeries after women have relapsed and they have already had surgery for ovarian cancer?.

" We will just remind everybody that ovarian cancer has a dismal prognosis, and that's largely many people feel because it doesn't get diagnosed until it's advanced. A lot of women have what's called cytoreductive surgery to remove as much of the cancer as possible and traditionally then they are not offered surgery again at recurrence. This study is an iteration of an ongoing bunch of studies that have been examining this a little bit more closely. They had patients who had recurrent ovarian cancer and had a first relapse after a platinum-free interval.

That's an interval during which no platinum-based chemotherapy is used of 6 months or more to undergo a secondary cytoreductive surgery and then receive platinum-based chemotherapy, or to receive platinum-based chemotherapy alone. Let me just note that some of these women also received some other agents and we can talk about that a little bit later. They have developed a metric that's called the AGO score, which is a performance status score of 0 on a 5-point scale, with those higher scores indicating greater disability for entry to the study, ascites of less than 500 ml, and complete resection at the initial surgeries. They had 407 patients who underwent randomization, about half in each group.

Complete resection was achieved in almost 76% of these patients. Those patients who had the second cytoreduction in this carefully selected group of women lived almost 54 months, while those who only got the platinum-based chemotherapy and did not have a second surgery lived for 46 months.Rick. As you noted, Elizabeth, the prognosis with ovarian cancer is dismal. The key to this particular study is, again, careful selection of women that have recurrent ovarian cancer.

Because there was a previous study that's showing that a second surgery doesn't really increase survival. Now, by the way, this survival increase is meaningful -- it's 8 months -- but it's obviously not what we would like and that is a cure. The other thing that I thought was particularly notable about this study is that it not only looked at survival, but it looked at the quality of life. When these women are carefully selected, they have a good outcome.

Seventy-six percent had what was thought to be another complete resection. They don't have perioperative complications, and the quality of their life was no different than those who didn't have surgery. This is a small, incremental, but nevertheless an advance in the treatment of recurrent ovarian cancer.Elizabeth. I agree.

I wanted to note that, of course, some of these women also received, in addition to the paclitaxel and the carboplatin, they received bevacizumab as part of their second-line therapy. They also, some of them, just very few, received what's called a PARP inhibitor. I am wondering about either the addition, or even substitution, of those agents in women who have recurrences. I think we don't know the answers to that.Rick.

Right. There is at least in a subgroup analysis the evidence that the individual that had cytoreductive surgery and received one of those agents actually did worse. These are called post-hoc analyses. That is you look at the whole picture and you try to carve out small little pieces of it to see who drives the best benefit or who may receive harm.

In this particular case, the numbers are so small I don't want to draw any conclusions about what the best type of chemotherapy is. But woman should be offered cytoreductive surgery if they have recurrence and they fall into that selective group of individuals.Elizabeth. I absolutely agree. Finally, I would applaud the authors for saying that the results of this trial cannot be extrapolated to interval debulking after chemotherapy or to treatment of relapse after later lines of treatment.

So they definitely identify the limitations of this particular strategy. Rick. Right.Elizabeth. On that note, then, that's a look at this week's medical headlines from Texas Tech.

I am Elizabeth Tracey.Rick. And I'm Rick Lange. Y'all listen up and make healthy choices. Please enable JavaScript to view the comments powered by Disqus..

NCHS Data buy lasix uk Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such buy lasix uk as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes buy lasix uk sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for ScienceTTHealthWatch is a weekly podcast from Texas Tech.

In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.This week's topics include predicting hypertension medications mortality, immunity following hypertension medications vaccination, surgery for recurrent ovarian cancer, and FDA oversight of medical devices.Program notes:0:34 Waning immunity from hypertension medications after vaccination1:34 Who developed breakthrough s?. 2:34 Doesn't address severity of 3:37 Some treatments not directed to the spike protein3:55 Predictors of hypertension medications death4:55 Elevated cytokines and tissue injury markers5:50 Even by day five, vRNA predicts6:36 Scrutiny of medical devices by FDA7:36 Approved using 510K8:36 Device creep9:26 Recurrent ovarian cancer and second surgeries10:26 Surgery with platinum-based chemo11:28 Carefully selected population12:27 Change in chemotherapy?. 13:36 EndTranscript:Elizabeth Tracey. Is there a benefit to additional surgeries when ovarian cancer recurs?.

Rick Lange, MD. Waning hypertension medications vaccination efficacy.Elizabeth. Can we predict who is going to die from hypertension medications ?. Rick.

And medical device safety.Elizabeth. That's what we're talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.Rick. And I'm Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I'm also dean of the Paul L.

Foster School of Medicine.Elizabeth. Rick, how about if we turn first to the BMJ since everybody is top-of-mind regarding, "Oh, no, we have this new variant that's emerged," and that everybody is panic-stricken about. What is the elapsed time since vaccination against hypertension medications and subsequent risk of hypertension ?. Rick.

Elizabeth, you set that up very nicely. How did we do this study?. We have a lot of data from Israel, which really was among the first countries to initiate both a large-scale vaccination campaign and they did it very early on. By July of 2021, more than 5.2 million Israelis were fully vaccinated with the same treatment -- they had gotten both doses of the Pfizer mRNA treatment.

Despite that, they noticed that since June of 2021 there has been a resurgence of individuals with hypertension medications . So their concerns were whether there would be decreasing levels of immunity as a result of just the time since the treatments were given. They looked at those individuals that had developed breakthrough hypertension medications s. They had been fully vaccinated -- this was 3 weeks after the vaccination which was the earliest time point -- and they chopped it up from 0 to 90 days, from 90 to 120, 120 to 150, and 150 to 180, to determine if the time since treatment contributed to a breakthrough hypertension medications case.

What they discovered was that was indeed the case. Those that had their vaccination 90 to 120 days had about a 2 or 2½-fold increased risk of developing a breakthrough . That carried off for the next 150 to 180 days and even greater than 180 days. It looks like that there is waning efficacy and it begins not at 6 months, but as early as 3 months after vaccination.Elizabeth.

I am wondering if we're going to find out that this is the Achilles' heel of mRNA treatments eventually.Rick. The data are pretty clear not only from this study, but from other studies suggesting that there is waning antibody response. Now, what this study doesn't address is the severity of the . But I agree with you that currently this does appear to be the Achilles' heel and hence the recommendation is to get a booster for everybody over the age of 18.

The Pfizer treatment is now petitioning the FDA to do it to individuals as low as 16 years of age. Elizabeth. Well, as Omicron -- I'm sure we are going to detect it here domestically pretty shortly. That's my bet -- in light of that, everyone who isn't boosted really needs to get boosted or what I have called in the past, of course, the third dose.

I am even wondering about, well, what about even more than that for those who are willing?. Rick. As we get more variants, I think what we may be doing is having different types of boosters, ones that target these variants. I am sure we are going to be telling our listeners more about this in the weeks to come.Elizabeth.

I do think that also, and I am going to recall for you this pan-sarbecolasix notion that we talked about relative to the antibody production. And my question, which I subsequently investigated, is about treatments that are targeted against those conserved regions of the spike protein. There is that out there, but it's not as robust as I thought it should be at this point.Rick. Yeah.

But some of these treatments are not even directed towards the spike protein, so stay tuned.Elizabeth. Still speaking about hypertension, let's turn then to Science Advances. Let me just ask you. It's my recollection that this is the first time we have talked about a paper that's in this journal.Rick.

Right, and we have been doing this for about 18 to 19 years, Elizabeth, and so I'm surprised that Science Advances has escaped our reporting before. But this is an important study.Elizabeth. This is entitled "Immunovirological profiling validates plasma hypertension RNA as an early predictor of hypertension medications mortality." Clearly, this is something we all want to know clinically. When somebody comes into the hospital and they need to be ventilated, can we determine which of them is most at risk of death?.

They did these immunovirological tests on plasma from 279 people. They collected samples at what they call DSO11, so days from symptom onset in a discovery cohort. They performed three different assessments in this. Viral RNA that was circulating, low receptor binding domain-specific IGG and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers.

So a constellation of those. They developed this 3-variable model of viral RNA that they actually predefined adjustment by age and sex. By doing this, they were able to very reliably identify patients with fatal outcomes. This model remained really robust in independent validation.

They are suggesting that these are the kinds of assessments that can be done so that we can say, "This person is really at high risk for mortality."Rick. Elizabeth, a lot of people have tried to identify who is going to be at risk of death with hypertension medications so we could direct therapies. They looked at just viral RNA, how many RNA particles were actually in the blood, 26 different cytokines and tissue markers, and six different types of immunologic responses. What they found out is really all we need to do is measure viral RNA by Day 11.

By the way, when they went back and said, "Gosh, can we predict even earlier?. " Even by Day 5, the amount of viral RNA predicted who was likely to die. The downside is this is a fairly small study by most of our standards, but it does need to be validated in a larger cohort.Elizabeth. I thought they were very intellectually honest in taking a look at remdesivir and other things that might interrupt that whole cascade, and kind of speculating we are not really sure if that's going to make a difference and also that this circulating or this plasma viral RNA does not indicate intact virions or infectability either.Rick.

Right. It could be viral particles that have undergone degradation. But what's clear is the more viral particles, the more tissue injury you have, the higher the immunological response. Instead of measuring those other things, just the viral particle number alone can provide insight.Elizabeth.

Now, let's turn to one that I very specifically wanted you to address.Rick. All right, Elizabeth, our listeners may not be aware, but I chair one of the FDA panels for circulatory devices. I have had the privilege of serving on this panel for, gosh, probably 10 to 12 years now. This is a particular article calling for reforms to the medical device safety.

When a device is considered to be low-risk, Class I or Class II, it's going to be approved by the FDA with really minimal involvement of committees. When it may be life-threatening, it's called a Class III device. If it's a new device, we have what's called pre-market approval. They want to look at the device.

They want to have randomized control trials showing that it's both effective and it's safe. But once you have that device, when you have other devices like it to speed things up, but to try to make it safe, we have what's called a 510(K) process. If a device looks like another device that's been effective, then it can be approved. It's called predicate device.

There was a device that was approved using the 510(K) to suck clots out of people that were having strokes. This device was based upon another device. Then this device went through 12 different iterations over the course of time. By 2019, this device, called the Penumbra, was recalled after about 200 adverse reports and 19 deaths associated with it.

What this reform says is, "Gosh, obviously, in this particular case this 510(K) approval device pathway failed."Elizabeth. Yeah. Of course, this reveals both of our biases, your bias toward the FDA and the policies that are employed in these device situations and mine against, where I really feel that there is not enough scrutiny. We have other examples of devices -- hip implants that have caused a lot of harm and were also approved under that same aegis.

The editorialist, of course, says, "Hmm, maybe it's time for a new paradigm here."Rick. I think there are some things within the FDA's control and some things that are not. There is what's called device creep. This was a device that was approved years ago and it went through iteration after iteration after iteration.

But obviously, over the course of those 12 iterations, the device didn't look anything like the original device, so we need to have some way of dealing with that. There are some things the FDA can't do, post-marketing surveillance. It doesn't have the teeth to demand that the company do post-marketing studies, and if they don't, to shut the product down. It just doesn't have that regulatory authority to do that.We have a way of reporting device safety issues, but it's voluntary.

There are some regulatory things that need to be done to give the FDA the information they need and the clout -- regulatory authority -- to enact some of these things. I agree with you, there are glaring holes that can be fixed.Elizabeth. Well, I'm really glad to hear you make that admission and that's, of course, in JAMA Internal Medicine. Let's finally turn to the New England Journal of Medicine, what I served up as, "Is there any benefit to doing second surgeries after women have relapsed and they have already had surgery for ovarian cancer?.

" We will just remind everybody that ovarian cancer has a dismal prognosis, and that's largely many people feel because it doesn't get diagnosed until it's advanced. A lot of women have what's called cytoreductive surgery to remove as much of the cancer as possible and traditionally then they are not offered surgery again at recurrence. This study is an iteration of an ongoing bunch of studies that have been examining this a little bit more closely. They had patients who had recurrent ovarian cancer and had a first relapse after a platinum-free interval.

That's an interval during which no platinum-based chemotherapy is used of 6 months or more to undergo a secondary cytoreductive surgery and then receive platinum-based chemotherapy, or to receive platinum-based chemotherapy alone. Let me just note that some of these women also received some other agents and we can talk about that a little bit later. They have developed a metric that's called the AGO score, which is a performance status score of 0 on a 5-point scale, with those higher scores indicating greater disability for entry to the study, ascites of less than 500 ml, and complete resection at the initial surgeries. They had 407 patients who underwent randomization, about half in each group.

Complete resection was achieved in almost 76% of these patients. Those patients who had the second cytoreduction in this carefully selected group of women lived almost 54 months, while those who only got the platinum-based chemotherapy and did not have a second surgery lived for 46 months.Rick. As you noted, Elizabeth, the prognosis with ovarian cancer is dismal. The key to this particular study is, again, careful selection of women that have recurrent ovarian cancer.

Because there was a previous study that's showing that a second surgery doesn't really increase survival. Now, by the way, this survival increase is meaningful -- it's 8 months -- but it's obviously not what we would like and that is a cure. The other thing that I thought was particularly notable about this study is that it not only looked at survival, but it looked at the quality of life. When these women are carefully selected, they have a good outcome.

Seventy-six percent had what was thought to be another complete resection. They don't have perioperative complications, and the quality of their life was no different than those who didn't have surgery. This is a small, incremental, but nevertheless an advance in the treatment of recurrent ovarian cancer.Elizabeth. I agree.

I wanted to note that, of course, some of these women also received, in addition to the paclitaxel and the carboplatin, they received bevacizumab as part of their second-line therapy. They also, some of them, just very few, received what's called a PARP inhibitor. I am wondering about either the addition, or even substitution, of those agents in women who have recurrences. I think we don't know the answers to that.Rick.

Right. There is at least in a subgroup analysis the evidence that the individual that had cytoreductive surgery and received one of those agents actually did worse. These are called post-hoc analyses. That is you look at the whole picture and you try to carve out small little pieces of it to see who drives the best benefit or who may receive harm.

In this particular case, the numbers are so small I don't want to draw any conclusions about what the best type of chemotherapy is. But woman should be offered cytoreductive surgery if they have recurrence and they fall into that selective group of individuals.Elizabeth. I absolutely agree. Finally, I would applaud the authors for saying that the results of this trial cannot be extrapolated to interval debulking after chemotherapy or to treatment of relapse after later lines of treatment.

So they definitely identify the limitations of this particular strategy. Rick. Right.Elizabeth. On that note, then, that's a look at this week's medical headlines from Texas Tech.

I am Elizabeth Tracey.Rick. And I'm Rick Lange. Y'all listen up and make healthy choices. Please enable JavaScript to view the comments powered by Disqus..

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NCHS Data Brief furosemide 40mg lasix http://www.ec-estorck-guebwiller.ac-strasbourg.fr/2021/01/14/episode-neigeux/ No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with furosemide 40mg lasix an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of furosemide 40mg lasix ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this furosemide 40mg lasix analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than furosemide 40mg lasix 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 furosemide 40mg lasix. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, furosemide 40mg lasix 2015image icon1Significant quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal furosemide 40mg lasix if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for furosemide 40mg lasix Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied furosemide 40mg lasix by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 furosemide 40mg lasix. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by furosemide 40mg lasix menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were furosemide 40mg lasix perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf furosemide 40mg lasix icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women furosemide 40mg lasix aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 furosemide 40mg lasix. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p furosemide 40mg lasix <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were furosemide 40mg lasix perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data furosemide 40mg lasix table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling furosemide 40mg lasix well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 furosemide 40mg lasix. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories.

Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status.

A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €.

2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?.

€Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep.

Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone.

Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option.

Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454.

2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB. Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50.

2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N.

Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9.

2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.

J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International.

SUDAAN (Release 11.0.0) [computer software]. 2012. Suggested citationVahratian A.

Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD.

National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data http://www.ec-prot-furdenheim.ac-strasbourg.fr/?p=5992 Brief buy lasix uk No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as buy lasix uk cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the buy lasix uk loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% buy lasix uk are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, buy lasix uk menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 buy lasix uk. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, buy lasix uk 2015image icon1Significant quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they buy lasix uk no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data buy lasix uk table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one buy lasix uk in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 buy lasix uk.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, buy lasix uk 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 buy lasix uk year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf buy lasix uk icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3) buy lasix uk. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 buy lasix uk. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, buy lasix uk 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or buy lasix uk less. Women were premenopausal if they still had a menstrual cycle. Access data table buy lasix uk for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did buy lasix uk not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 buy lasix uk. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. € read here. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.