The June 24, 2022 US Supreme Court decision in Dobbs v Jackson Women\'s Health Organization resulted in an expansive restriction on abortion access that had been constitutionally guaranteed for nearly half a century. Currently, 14 states have implemented complete bans on abortion with very limited exceptions, and an additional 7 states have implemented abortion bans at 6 to 18 weeks\' gestation. It has been well demonstrated that restrictive policies disproportionately limit abortion access for minoritized people and people of low socioeconomic status; the financial and geographic barriers of these post-Dobbs restrictions will only exacerbate this disparity. Proponents of abortion restrictions, who identify as pro-life, assert that these policies are essential to protect children, women, and families. We examine whether the protection of these groups extends past conception by evaluating the association between state abortion legislation and state-based policies and programs designed to provide medical and social support for children, women, and families. We found that states with the most restrictive post-Dobbs abortion policies in fact have the least comprehensive and inclusive public infrastructure to support these groups. We suggest further opportunities for advocacy. (Am J Public Health. 2024;114(10):1043-1050. https://doi.org/10.2105/AJPH.2024.307792).

Public Health Consortiums (PHC) in Brazil represent a strategy to enhance regionalization in the Public Health Care System (SUS in Portuguese) and State/interstate/intermunicipal cooperation. The establishment of regional polyclinics aims to improve access to services with greater technological concentration and closer to users\' homes. This study specifically aims to analyze the process of creating PHC and regional polyclinics in Bahia State, based on documental analysis, identifying aspects related to entering the political agenda that facilitate and hinder, the role of state administration, specificities of the composition of these PHC and regional polyclinics. A documental analysis was carried out of the minutes of the Comissão Intergestores Bipartite (CIB-BA) [Bipartite Administrative Commission] from 2015 to 2018 and of constitutive documents of the consortiums established in this state. The Ceará State experience inspired the creation of consortiums in Bahia, especially the structuring of polyclinics. Municipal administrators demonstrated a favorable position regarding the potential of consortiums with cooperation among municipalities. The role of the state government proved to be a facilitating condition, whereas the maintenance of the municipal counterpart in finance constituted a hindering element. The consortiums contributed to the regionalization of health in the state as well as expansion of access to specialized care.
Os consórcios públicos de saúde (CPS) representam uma estratégia para potencializar a regionalização no SUS e a cooperação interfederativa. A implantação de policlínicas regionais visa melhorar o acesso a serviços de maior densidade tecnológica, mais próximos ao município de origem dos usuários. Este estudo objetiva analisar o processo de implantação dos consórcios públicos de saúde e das policlínicas regionais na Bahia, com base em análise documental, identificando aspectos facilitadores e dificultadores relativos à entrada na agenda política, ao papel da gestão estadual e às especificidades da composição dos CPS e das policlínicas regionais no estado da Bahia. Realizou-se análise documental das atas da Comissão Intergestores Bipartite dos anos de 2015 a 2018 e de documentos constitutivos dos consórcios implantados na Bahia. A experiência do Ceará inspirou a criação dos consórcios na Bahia, sobretudo na estruturação das policlínicas. Verificou-se posicionamento favorável dos gestores municipais acerca da potencialidade do consórcio na cooperação entre municípios. A atuação do governo do estado revelou-se condição facilitadora, e a manutenção da contrapartida municipal no financiamento, como elemento dificultador. Os consórcios contribuíram para a regionalização da saúde no estado e a ampliação do acesso à atenção especializada.

Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children\'s Health Insurance Program\'s \"unborn child\" option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. (Am J Public Health. 2024;114(10):1051-1060. https://doi.org/10.2105/AJPH.2024.307750).

暂无摘要。

This letter responds to the article \"Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape,\" by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.

Legislative agendas aimed at regulating nurse staffing in US hospitals have intensified after acute workforce disruptions triggered by COVID-19. Emerging evidence consistently demonstrates the benefits of higher nurse staffing levels, although uncertainty remains regarding whether and which legislative approaches can achieve this outcome. The purpose of this study was to provide a comprehensive updated review of hospital nurse staffing requirements across all fifty states. As of January 2024, seven states had laws pertaining to staffing ratios for at least one hospital unit, including California and Oregon, which had ratios pertaining to multiple units. Eight states required nurse staffing committees, of which six specified a percentage of committee members who must be registered nurses. Eleven states required nurse staffing plans. Five states had pending legislation, and one state, Idaho, had passed legislation banning minimum nurse staffing requirements. The variety of state regulations provides an opportunity for comparative evaluations of efficacy and feasibility to inform new legislation on the horizon.

During the past five years, many states have imposed out-of-pocket spending caps on insulin. In most cases, these reforms have had limited impact, in part because of the limits of state authority. Meanwhile, changes at the federal level and actions by manufacturers and commercial plans have made some of the caps nonbinding. It is not surprising that efforts to measure the impact of these caps yield conflicting results.

This study uses Texas\'s 2017 integration of the state disability and mental health agencies as a case study, combining interviews with Texas agency and advocacy organization leaders to examine perceptions of agency integration and augmented synthetic control analyses of 2014-2020 Medical Expenditure Panel Survey to examine impacts on mental health service use among individuals with co-occurring cognitive disabilities (including intellectual and developmental disabilities) and mental health conditions. Interviewees described the intensive process of agency integration and identified primarily positive (e.g., decreased administrative burden) impacts of integration. Quantitative analyses indicated no effects of integration on receipt of mental health-related services among people with co-occurring conditions. While leaders identified some potentially beneficial impacts of state agency integration, the limited impact of integration beyond the agency suggests that interventions at multiple levels of the service system, including those targeting providers, are needed to better meet the mental health service needs for this population.

UNASSIGNED: Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain.
UNASSIGNED: To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality.
UNASSIGNED: In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023.
UNASSIGNED: Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws.
UNASSIGNED: Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality.
UNASSIGNED: The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates.
UNASSIGNED: In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.

Gun violence is a leading public health concern in the US; subsequently, firearm-related violence prevention is a top priority for policymakers. Extreme risk protection order (ERPO) laws are a state-level attempt to reduce gun-related injuries and deaths. These court-issued orders prohibit people found to be dangerous to themselves or others from temporarily purchasing or possessing a firearm. Six states (Colorado, Connecticut, Hawaii, Maryland, Michigan, New York) and the District of Columbia have passed or amended their laws to include nurses as ERPO petitioners. The study\'s purpose was to conduct a review of state ERPO laws that included nurses as petitioners. Using a legal mapping approach, information on nurse ERPO petitioning was extracted from the seven jurisdictions. ERPO laws with nurse petitioners were passed between 1999 and 2023. Nurse petitioners included advanced practice registered nurse (n = 3), clinical nurse specialists (n = 3), nurse practitioner (n = 3), professional nurse (n = 2), and register nurse (n = 1). Psychiatric/mental health (n = 2) and school nurses (n = 2) were specified. Statutes differed in the handling of disclosed health information as part of the ERPO petition, as well as how health information would be handled by the court (e.g. sealed by the court, confidential by the court, returned to provider/disposed of post-hearing/order.) Three statutes exempted petitioners from civil and/or criminal liability, if petitions were submitted in good faith. Two of these states extended protection from liability to all petitioners, while one only referenced petitioners who were healthcare providers. The study findings have important policy, clinical, and research implications.