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Ticket to ride for vulnerable patients

Many patients have trouble getting to my clinic for appointments because of lack of access to transportation. What can you tell me about the new ride-sharing options for healthcare appointments?-S.A., N.J.

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Because of a lack of access to transportation, about 3.6 million U.S. patients miss or experience delays in medical care every year.1 These transportation barriers disproportionately affect patients with lower income and those with inadequate or no healthcare insurance.2 Transportation barriers can cause patients to miss or delay appointments, receive delayed care, and miss medications or receive them late. Overall, these factors add up to inadequate management of their chronic diseases.2


Now a new service is available to help patients get to their medical appointments. Two ride-sharing companies have begun a service that lets staff at physicians' offices and other healthcare organizations reserve a ride for patients any time up to 30 days before the appointment. The companies will send the patient a text or call the patient's mobile or landline phone with details of the trip ahead of time and then again shortly before the vehicle's arrival. The patient needn't have a smart phone or app to use the service, which is paid for by hospitals, medical offices, and other organizations such as Medicaid. The service for these nonemergency trips is compliant with the Health Insurance Portability and Accountability Act.3 Perhaps your clinic can look into setting up this service for your patients who need a lift. It's available 24/7 wherever these ride-sharing services are available.3



1. National Conference of State Legislatures. Non-emergency medical transportation: a vital lifeline for a healthy community. 2015. http://www.ncsl.org/research/transportation/non-emergency-medical-transportation. [Context Link]


2. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-993. [Context Link]


3. Sullivan E. Uber launches service to get people to the doctor's office. 2018. NPR.org. http://www.npr.org/2018/03/01/589464779/uber-launches-service-to-get-people-to-t. [Context Link]



When dad drinks, is his baby affected?

Does a father's alcohol use before conception affect the infant's health, either directly or indirectly?-T.F., NEV.


Studies show that maternal and paternal alcohol use are correlated.1 Bakhireva and colleagues found that heavy paternal drinking was associated with continued maternal drinking.2 These studies suggest that partner-based interventions should be developed as a strategy to prevent fetal alcohol spectrum disorders (FASDs).


Alcohol is a teratogen that causes embryo malformation and can result in FASDs, which include fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders.3 The foremost preventable cause of birth defects and disabilities in the United States is alcohol use.3


A 2016 study by Day and colleagues shows that up to 75% of children with FASD were fathered by men who are alcoholics.4 They cite a Kaiser epidemiologic study that correlates the frequency and severity of some congenital abnormalities, such as ventricular septal defects in neonates, with the father's alcohol use. Although more research is needed to sort out maternal, paternal, and other factors, these studies suggest that paternal lifestyle changes could lower the risk of certain congenital disorders in children.4



1. Russell M, Martier SS, Sokol RJ, Mudar P, Jacobson S, Jacobson J. Detecting risk drinking during pregnancy: a comparison of four screening questionnaires. Am J Public Health. 1996;86(10):1435-1439. [Context Link]


2. Bakhireva LN, Wilsnack SC, Kristjanson A, et al Paternal drinking, intimate relationship quality, and alcohol consumption in pregnant Ukrainian women. J Stud Alcohol Drugs. 2011;72(4):536-544. [Context Link]


3. Kane I, Mitchell AM, Finnell D, et al Screening and brief intervention to prevent fetal alcohol spectrum disorders. Nursing. 2018;48(3):26-31. [Context Link]


4. Day J, Savani S, Krempley BD, Nguyen M, Kitlinska JB. Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype. Am J Stem Cells. 2016;5(1):11-18. [Context Link]



Does zapping your food sap your health?

In my role as a community health educator, patients have asked me if cooking food in a microwave oven negatively affects its nutritional value. How should I respond?-H.W., N.C.


Microwaves are a form of electromagnetic radiation; in other words, they're waves of electrical and magnetic energy moving together through space. When absorbed by food, this energy produces heat that cooks the food.1 Microwave cooking doesn't reduce the nutritional value of food any more than conventional cooking. In fact, foods cooked in a microwave oven may keep more of their vitamins and minerals. For instance, boiling vegetables in water leaches nutrients out of them.


Source: FDA. Microwave oven radiation. 2017. http://www.fda.gov/Radiation-EmittingProducts/ResourcesforYouRadiationEmittingPr.