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All but six are on the continent. Today, only 10 countries can u buy levitra over the counter still have less than 10 per cent coverage, most of which are facing humanitarian emergencies.  Vaccinations still lagging Although welcoming progress on coverage of high-priority groups, Tedros stressed that more must be done as one-third of the world’s population remains unvaccinated. This includes two-thirds of health workers, and three-quarters of older persons in low-income countries. €œAll countries at all income levels must do more to vaccinate those most at risk, to ensure access to life-saving therapeutics, to continue testing and sequencing, and to set tailored, proportionate policies to limit transmission and save lives.

This is the can u buy levitra over the counter best way to drive a truly sustainable recovery,” he said. © Harun TulunayA man recovers from monkeypox at a hospital in London, UK.Monkeypox reversal Meanwhile, intense Monkeypox transmission continues in the Americas region, although the number of cases globally fell by more than 20 per cent last week. While most cases in the early stage of the can u buy levitra over the counter outbreak were in Europe, with a smaller proportion in the Americas, the situation has now reversed. Currently, less than 40 per cent of reported cases are in Europe and 60 per cent are in the Americas.

There are signs that the outbreak is slowing in Europe, Tedros reported, where a combination of effective public health measures, behaviour change, and vaccination, are helping to prevent transmission. €œHowever, in Latin America in particular, insufficient awareness or public health measures are combining with a lack of access can u buy levitra over the counter to treatments to fan the flames of the outbreak,” he said. Tedros thanked treatment manufacturer Bavarian Nordic, which on Wednesday signed an agreement with WHO’s Regional Office for the Americas to support access to its Monkeypox treatment in Latin America and the Caribbean. He expressed hope that the development will help to bring the outbreak under control in the region..

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Today, only 10 countries still have less than 10 per cent coverage, most of which are facing humanitarian emergencies.  Vaccinations still lagging Although welcoming progress on coverage of how do you get levitra high-priority groups, Tedros stressed that more must be done as one-third of the world’s population remains unvaccinated. This includes two-thirds of health workers, and three-quarters of older persons in low-income countries. €œAll countries at all income levels must do more to vaccinate those most at risk, to ensure access to life-saving therapeutics, to continue testing and sequencing, and to set tailored, proportionate policies to limit transmission and save lives. This is the best how do you get levitra way to drive a truly sustainable recovery,” he said. © Harun TulunayA man recovers from monkeypox at a hospital in London, UK.Monkeypox reversal Meanwhile, intense Monkeypox transmission continues in the Americas region, although the number of cases globally fell by more than 20 per cent last week.

While most cases in the early stage of the outbreak were in Europe, with a how do you get levitra smaller proportion in the Americas, the situation has now reversed. Currently, less than 40 per cent of reported cases are in Europe and 60 per cent are in the Americas. There are signs that the outbreak is slowing in Europe, Tedros reported, where a combination of effective public health measures, behaviour change, and vaccination, are helping to prevent transmission. €œHowever, in Latin America in particular, insufficient awareness or public health measures are combining with a how do you get levitra lack of access to treatments to fan the flames of the outbreak,” he said. Tedros thanked treatment manufacturer Bavarian Nordic, which on Wednesday signed an agreement with WHO’s Regional Office for the Americas to support access to its Monkeypox treatment in Latin America and the Caribbean.

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NCHS Data look at more info Brief levitra dosage 40mg 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 levitra dosage 40mg 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 levitra dosage 40mg “the permanent cessation of menstruation that occurs after the 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% are levitra dosage 40mg 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 levitra dosage 40mg 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 levitra dosage 40mg. 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 levitra dosage 40mg 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 levitra dosage 40mg menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data levitra dosage 40mg 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 levitra dosage 40mg 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 levitra dosage 40mg. 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 levitra dosage 40mg <. 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 levitra dosage 40mg cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf levitra dosage 40mg 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 levitra dosage 40mg 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 levitra dosage 40mg. 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 < levitra dosage 40mg. 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 levitra dosage 40mg was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data levitra dosage 40mg 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 levitra dosage 40mg 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 levitra dosage 40mg. 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 how do you get levitra 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 how do you get levitra with 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 how do you get levitra 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% how do you get levitra 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 how do you get levitra 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 how do you get levitra. 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra.

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 how do you get levitra 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra. 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 how do you get levitra <. 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra 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 how do you get levitra. 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.

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The number of homebound individuals buy levitra online canada who need care in the home is expected to grow rapidly in size, complexity and diversity in both rural and urban areas. This is anticipated for several reasons. A rapidly aging American population, the strong preference of older adults and their families for aging in place, health policies that encourage the use of home- and community-based services, and the changing demographic profile of the American population, with substantial increases in racial and ethnic minorities.

As the buy levitra online canada role of homecare in the health care system grows, researchers are working to better understand how quality varies and whether there are disparities in care based on location, with a goal of optimizing home health care quality and reducing health disparities. In 2018, more than 5 million Medicare beneficiaries received home health care. Of those recipients, about 9% were rural residents that were served by approximately 1,690 home health agencies located in rural areas, according to statistics reported on the home health care sector.

We recently published a longitudinal study analyzing national data buy levitra online canada on home health quality performance measures from the Centers for Medicare &. Medicaid Services over five years (2014 to 2018) to understand differences in care quality between urban and rural home health agencies. The complete findings are published in the Journal of Rural Health.

Data in this study included 7,908 home health buy levitra online canada agencies nationwide, of which nearly 20% were in rural areas. The study measured home health agency quality and performance by looking at timely initiation of care (a measure of care processes) and hospitalization and emergency department visits (two measures of care outcomes). We discovered a number of differences between urban and rural agencies both at individual points in time and over the five year period that we studied.

As Chart 1 shows, rural agencies were less likely than buy levitra online canada those in urban areas to be for-profit organizations and accredited. They were also more likely to be hospital based, enrolled in both Medicare and Medicaid programs and to offer hospice programs. Compared to urban agencies, rural agencies consistently performed better on initiating care in a timely fashion, meaning that they quickly started home health care upon a doctor’s order or within two days of hospital discharge or referral to home health care (Figure 1).

On average, rural agencies had a 1.05% higher annual rate of timely initiation of care, ranging from .88% higher in 2015 to 1.20% higher buy levitra online canada in 2017. Figure 1. Trends in timely initiation of care rate.

Urban vs buy levitra online canada. RuralRural. Urban:2014.

91.89±6.74, range buy levitra online canada. 20.80-100.00 2014. 90.79±8.38, range.

20.00-100.00 buy levitra online canada 2018. 94.78±6.79, range. 44.10-100.00 2018.

93.65±8.15, range buy levitra online canada. 17.20-100.00 Urban agencies consistently performed better on preventing hospitalization and emergency room visits during home health care overtime (Figure 2). Across the five years studied, urban agencies had an average of a .90% lower rate of hospitalization, ranging from .62% lower in 2017 to 1.27% lower in 2014.

Urban agencies also had an average of 2.6% lower rate of emergency department visits, ranging from 2.48% lower in 2016 buy levitra online canada to 2.65% lower in 2014 (Figure 3). Figure 2. Trends in hospitalization rate.

Urban vs buy levitra online canada. RuralRural. Urban:2014.

16.52±3.99, range buy levitra online canada. 3.90-37.20 2014. 15.33±3.62, range.

0.90-40.20 2016 buy levitra online canada. 17.05±3.99, range. 1.40-35.50 2016.

15.99±3.68, range buy levitra online canada. 0.00-41.10 2018. 15.79±3.82, range.

2.40-36.00 2018 buy levitra online canada. 15.11±3.57, range. 0.00-38.40 Figure 3.

Trends in emergency buy levitra online canada department (ED) visits rate. Urban vs. RuralRural.

Urban:2014. 14.30±4.17, range. 2.00-45.70 2014.

11.71±3.70, range. 0.00-31.70 2018. 14.90±4.15, range.

0.60-38.90 2018. 12.28±3.82, range. 0.00-33.00 Importantly, the differences between rural and urban agencies were steady over time except for the gap in hospitalization rate, which narrowed slightly from a difference of 1.19% in 2014 to .68% in 2018.

It should also be noted that the rate of emergency department visits increased over the five-year study period for both settings. This study underscores the persistence of disparities in quality within home health care, related to both care processes and outcomes. The differences in rural and urban disparities in care processes and outcomes also indicate that agencies may choose different strategies given the resources they have and the care or client populations.

This study highlights the importance of considering the unique geographic, staffing and health challenges facing agencies when making investment to reduce rural-urban disparities. For instance, while rural agencies are more likely to have a better relationship with referring care facilities for faster initiation of care, they are often more restrained by staffing and the long commutes providers must make to reach patients’ homes. In addition, rural residents are in poorer health overall compared to their urban counterparts.

It is critically important for policymakers to consider such distinctive challenges to rural and urban agencies when making policies that aim to improve quality of home health care. There needs to be more opportunities for rural and urban agencies to share their strengths and learn from each other to figure out what really works.Start Preamble Centers for Medicare &. Medicaid Services, Health and Human Services (HHS).

Notice. The Centers for Medicare &. Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public.

Under the Paperwork Reduction Act of 1995 (the PRA), Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by April 11, 2022.

When commenting, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1.

Electronically. You may send your comments electronically to https://www.regulations.gov. Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments.

2. By regular mail. You may mail written comments to the following address.

CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention. Document Identifier/OMB Control Number. __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following. 1. Access CMS' website address at website address at https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing.

Start Further Info William N. Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections.

More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES ). CMS-10545 Outcome and Assessment Information Set OASIS-E CMS-10520 Marketplace Quality Standards Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval.

To comply with this requirement, CMS is publishing this notice. Information Collection 1. Type of Information Collection Request.

Revision of a currently approved collection. Title of Information Collection. Outcome and Assessment Information Set OASIS-E.

Use. This request is for OMB approval to modify the Outcome and Assessment Information Set (OASIS) that home health agencies (HHAs) are required to collect in order to participate in the Medicare program. The current version of the OASIS, OASIS-D (0938-1279) data item set was approved by the Office of Management and Budget (OMB) on December 6, 2018 and implemented on January 1, 2019.

We are seeking OMB approval for the proposed revised OASIS item set, referred to hereafter as OASIS-E, scheduled for implementation on January 1, 2023. The OASIS-E includes changes pursuant to the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). And, to accommodate data element removals to reduce burden.

And improve formatting throughout the document. Form Number. CMS-10545 (OMB control number.

Affected Public. Private Sector (Business or other for-profit and Not-for-profit institutions). Number of Respondents.

Total Annual Hours. 13,139,904. (For policy questions regarding this collection contact Joan Proctor at 410-786-0949).

2. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Marketplace Quality Standards. Use.

The Patient Protection and Affordable Care Act establishes requirements to support the delivery of quality health care coverage for health insurance issuers offering Qualified Health Plans (QHPs) in Exchanges. Section 1311(c)(3) of the Patient Protection and Affordable Care Act directs the Secretary to develop a system to rate QHPs on the basis of quality and price and requires Exchanges to display this quality rating information on their respective websites. Section 1311(c)(4) of the Patient Protection and Affordable Care Act requires the Secretary to develop an enrollee satisfaction survey system to assess enrollee experience with each QHP (with more than 500 enrollees in the previous year) offered through an Exchange.

Section 1311(h) requires QHPs to contract with certain hospitals that meet specific patient safety and health care quality standards. This collection of information is necessary to provide adequate and timely health care quality information for consumers, regulators, and Exchanges as well as to collect information to appropriately monitor and provide a process for a survey vendor to appeal HHS' decision to not approve a QHP Enrollee Survey vendor application. Form Number.

CMS-10520 Start Printed Page 7458 (OMB control number. 0938-1249). Frequency.

Annually. Affected Public. Public sector (Individuals and Households).

Private sector (Business or other for-profits and Not-for-profit institutions). Number of Respondents. 314.

Total Annual Responses. 314. Total Annual Hours.

384,014. For policy questions regarding this collection contact Nidhi Singh Shah at 301-492-5110. Start Signature Dated.

Health disparities, how do you get levitra which have been exacerbated by the erectile dysfunction treatment levitra, have become a growing public health Can you get amoxil over the counter concern nationwide. There are also rising disparity concerns in home health care, one of the fastest growing health care sectors within the United States. The number of homebound individuals who need care in the home is expected to grow rapidly in size, complexity and diversity in both rural and urban areas.

This is anticipated for how do you get levitra several reasons. A rapidly aging American population, the strong preference of older adults and their families for aging in place, health policies that encourage the use of home- and community-based services, and the changing demographic profile of the American population, with substantial increases in racial and ethnic minorities. As the role of homecare in the health care system grows, researchers are working to better understand how quality varies and whether there are disparities in care based on location, with a goal of optimizing home health care quality and reducing health disparities.

In 2018, how do you get levitra more than 5 million Medicare beneficiaries received home health care. Of those recipients, about 9% were rural residents that were served by approximately 1,690 home health agencies located in rural areas, according to statistics reported on the home health care sector. We recently published a longitudinal study analyzing national data on home health quality performance measures from the Centers for Medicare &.

Medicaid Services over five years (2014 to 2018) how do you get levitra to understand differences in care quality between urban and rural home health agencies. The complete findings are published in the Journal of Rural Health. Data in this study included 7,908 home health agencies nationwide, of which nearly 20% were in rural areas.

The study how do you get levitra measured home health agency quality and performance by looking at timely initiation of care (a measure of care processes) and hospitalization and emergency department visits (two measures of care outcomes). We discovered a number of differences between urban and rural agencies both at individual points in time and over the five year period that we studied. As Chart 1 shows, rural agencies were less likely than those in urban areas to be for-profit organizations and accredited.

They were also more likely to be hospital based, enrolled in both how do you get levitra Medicare and Medicaid programs and to offer hospice programs. Compared to urban agencies, rural agencies consistently performed better on initiating care in a timely fashion, meaning that they quickly started home health care upon a doctor’s order or within two days of hospital discharge or referral to home health care (Figure 1). On average, rural agencies had a 1.05% higher annual rate of timely initiation of care, ranging from .88% higher in 2015 to 1.20% higher in 2017.

Figure 1 how do you get levitra. Trends in timely initiation of care rate. Urban vs.

RuralRural. Urban:2014. 91.89±6.74, range.

20.80-100.00 2014. 90.79±8.38, range. 20.00-100.00 2018.

94.78±6.79, range. 44.10-100.00 2018. 93.65±8.15, range.

17.20-100.00 Urban agencies consistently performed better on preventing hospitalization and emergency room visits during home health care overtime (Figure 2). Across the five years studied, urban agencies had an average of a .90% lower rate of hospitalization, ranging from .62% lower in 2017 to 1.27% lower in 2014. Urban agencies also had an average of 2.6% lower rate of emergency department visits, ranging from 2.48% lower in 2016 to 2.65% lower in 2014 (Figure 3).

Figure 2. Trends in hospitalization rate. Urban vs.

RuralRural. Urban:2014. 16.52±3.99, range.

3.90-37.20 2014. 15.33±3.62, range. 0.90-40.20 2016.

17.05±3.99, range. 1.40-35.50 2016. 15.99±3.68, range.

0.00-41.10 2018. 15.79±3.82, range. 2.40-36.00 2018.

15.11±3.57, range. 0.00-38.40 Figure 3. Trends in emergency department (ED) visits rate.

14.30±4.17, range. 2.00-45.70 2014. 11.71±3.70, range.

0.00-31.70 2018. 14.90±4.15, range. 0.60-38.90 2018.

12.28±3.82, range. 0.00-33.00 Importantly, the differences between rural and urban agencies were steady over time except for the gap in hospitalization rate, which narrowed slightly from a difference of 1.19% in 2014 to .68% in 2018. It should also be noted that the rate of emergency department visits increased over the five-year study period for both settings.

This study underscores the persistence of disparities in quality within home health care, related to both care processes and outcomes. The differences in rural and urban disparities in care processes and outcomes also indicate that agencies may choose different strategies given the resources they have and the care or client populations. This study highlights the importance of considering the unique geographic, staffing and health challenges facing agencies when making investment to reduce rural-urban disparities.

For instance, while rural agencies are more likely to have a better relationship with referring care facilities for faster initiation of care, they are often more restrained by staffing and the long commutes providers must make to reach patients’ homes. In addition, rural residents are in poorer health overall compared to their urban counterparts. It is critically important for policymakers to consider such distinctive challenges to rural and urban agencies when making policies that aim to improve quality of home health care.

There needs to be more opportunities for rural and urban agencies to share their strengths and learn from each other to figure out what really works.Start Preamble Centers for Medicare &. Medicaid Services, Health and Human Services (HHS). Notice.

The Centers for Medicare &. Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (the PRA), Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action.

Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by April 11, 2022. When commenting, please reference the document identifier or OMB control number.

To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1. Electronically.

You may send your comments electronically to https://www.regulations.gov. Follow the instructions for “Comment or Submission” or “More Search Options” to find the information collection document(s) that are accepting comments. 2.

By regular mail. You may mail written comments to the following address. CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention.

Document Identifier/OMB Control Number. __, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following.

1. Access CMS' website address at website address at https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing. Start Further Info William N.

Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES ).

CMS-10545 Outcome and Assessment Information Set OASIS-E CMS-10520 Marketplace Quality Standards Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C.

3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection 1. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Outcome and Assessment Information Set OASIS-E. Use.

This request is for OMB approval to modify the Outcome and Assessment Information Set (OASIS) that home health agencies (HHAs) are required to collect in order to participate in the Medicare program. The current version of the OASIS, OASIS-D (0938-1279) data item set was approved by the Office of Management and Budget (OMB) on December 6, 2018 and implemented on January 1, 2019. We are seeking OMB approval for the proposed revised OASIS item set, referred to hereafter as OASIS-E, scheduled for implementation on January 1, 2023.

The OASIS-E includes changes pursuant to the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act). And, to accommodate data element removals to reduce burden. And improve formatting throughout the document.

Form Number. CMS-10545 (OMB control number. 0938-1279).

Private Sector (Business or other for-profit and Not-for-profit institutions). Number of Respondents. 11,354.

Total Annual Responses. 18,030,766. Total Annual Hours.

13,139,904. (For policy questions regarding this collection contact Joan Proctor at 410-786-0949). 2.

Type of Information Collection Request. Revision of a currently approved collection. Title of Information Collection.

Marketplace Quality Standards. Use. The Patient Protection and Affordable Care Act establishes requirements to support the delivery of quality health care coverage for health insurance issuers offering Qualified Health Plans (QHPs) in Exchanges.

Section 1311(c)(3) of the Patient Protection and Affordable Care Act directs the Secretary to develop a system to rate QHPs on the basis of quality and price and requires Exchanges to display this quality rating information on their respective websites. Section 1311(c)(4) of the Patient Protection and Affordable Care Act requires the Secretary to develop an enrollee satisfaction survey system to assess enrollee experience with each QHP (with more than 500 enrollees in the previous year) offered through an Exchange. Section 1311(h) requires QHPs to contract with certain hospitals that meet specific patient safety and health care quality standards.

This collection of information is necessary to provide adequate and timely health care quality information for consumers, regulators, and Exchanges as well as to collect information to appropriately monitor and provide a process for a survey vendor to appeal HHS' decision to not approve a QHP Enrollee Survey vendor application. Form Number. CMS-10520 Start Printed Page 7458 (OMB control number.

Affected Public. Public sector (Individuals and Households). Private sector (Business or other for-profits and Not-for-profit institutions).

Number of Respondents. 314. Total Annual Responses.

For policy questions regarding this collection contact Nidhi Singh Shah at 301-492-5110. Start Signature Dated.

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UC Davis Health has opened a monkeypox treatment clinic, with vaccinations available for patients, staff, http://hochzeiteninmiami.com/can-i-buy-viagra-over-the-counter/ faculty, and students who are most at risk for .The CDC recommends a monkeypox vaccination for people who have been exposed to monkeypox and those most at risk for .The monkeypox buy levitra online overnight delivery treatment clinic is open Tuesdays and Wednesdays in Sacramento and Fridays in Rancho Cordova. To receive a monkeypox treatment, UC Davis Health patients, students, faculty or staff should first contact their UC Davis Health primary care physician or schedule an Express Care visit to receive medical approval buy levitra online overnight delivery. With confirmed eligibility of high risk, they can then schedule a monkeypox treatment appointment in the clinic.Community members who do not have a UC Davis Health primary care provider should buy levitra online overnight delivery visit a local Sacramento County clinic for vaccination.What to do if you think you have monkeypoxAs cases of monkeypox continue to rise regionally, many people are still unsure what to do if they suspect they have the disease. UC Davis Health is recommending patients who are concerned about a possible monkeypox contact their primary care physician’s office and ask to speak to an advice nurse. The advice nurse can provide guidance on how to obtain further evaluation and assist with scheduling a test if needed.Patients who do not have a UC Davis Health primary care provider should visit a local buy levitra online overnight delivery county clinic or a community-based urgent care location.In most cases, monkeypox is not a medical emergency, so patients do not need to go to the emergency department.

Evaluation to determine if monkeypox testing is needed can be scheduled by contacting a primary care physician’s office or via urgent care clinics, usually as same day appointments.SymptomsMonkeypox might start with symptoms like the buy levitra online overnight delivery flu, with fever, low energy, swollen lymph nodes, and general body aches. Within one to three days (sometimes longer) after the appearance of fever, the person can develop a rash or sores. The sores will go through several stages, including scabs, before healing.Unusual rashes can be evaluated via video, buy levitra online overnight delivery or by sending a photo. UC Davis Health patients can send a photo of the lesion to their primary care buy levitra online overnight delivery provider through the secure health care mobile app to learn if they should get tested.TransmissionMonkeypox is transmitted through close person-to-person contact with lesions, body fluids and respiratory droplets, and through contaminated materials such as clothing or bedding.Learn MoreTo learn more about monkeypox read this FAQ featuring Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital. He answers frequently asked questions about this disease, what we know so far and how to protect yourself and your family..

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