Barriers to Influenza Immunization: The Role of Physician Training on Influenza Vaccine Utilization in Six to Twenty-Three Month Old Infants

Digital Preservation

Barriers to Timely Screening Colonoscopy

Objective: Colorectal cancer (CRC) can be largely prevented or effectively treated in its early stages, yet disparities exist in timely screening. The aim of this study was to explore the disparities in CRC screening on the basis of health insurance status including private, Medicare, Medicaid, and State Administered General Assistance (SAGA). Methods: A retrospective chart review for the period January 2000 to May 2007 (95 records) was conducted at two clinic sites; a private clinic and a university hospital clinic. All individuals at these sites who met study criteria (>50 years old with screening colonoscopy) were included. Age, gender, date of first clinic visit when screening referral was made, and date of completed procedure (screening colonoscopy) were recorded. Groups were dichotomized between individuals with private health insurance and individuals with public health insurance. Individuals with any history of CRC, known pre-cancerous conditions as well as family history of CRC requiring frequent colonoscopy were excluded from the study. Linear model analysis was performed to compare the average waiting time to receiving screening colonoscopy between the groups. T-test was performed to analyze age or gender related differences between the two groups as well as within each group. Results: The average waiting time (33 days) for screening colonoscopy in privately insured individuals was significantly lower than publicly insured individuals (200 days). The time difference between the first clinic visit and the procedure was statistically significant (p < 0.0001) between the two groups. There was no statistical difference (p=0.089) in gender between these groups (public vs. private). There were also no statistically significant gender or age related differences found within each group. Conclusions: Disparities exist in timely screening for CRC and one of the barriers leading to delayed CRC screening includes health insurance status of an individual. Even within the insured group, type of insurance plays major role. There is a negative correlation between public health insurance status and timely screening. Differences in access to medical care and delivery of care experienced by patients who are publicly insured through Medicaid, Medicare, and SAGA, suggests that the State of Connecticut needs to implement changes in health care policies that would provide timely screening colonoscopy. It is evident that health insurance coverage facilitates timely access to healthcare. Therefore, there is a need for increased efforts in advocacy for policy, payment and physician participation in public insurance programs. A state-wide comprehensive program involving multiple components targeting different levels of change such as provider, patients and the community should help reduce some of the observed causes of healthcare disparities based on the insurance status.

Ahead of the Game: Middle and Upper Palaeolithic Hunting Behaviors in the Southern Caucasus

Over the past several decades a variety of models have been proposed to explain perceived behavioral and cognitive differences between Neanderthals and modern humans. A key element in many of these models and one often used as a proxy for behavioral “modernity” is the frequency and nature of hunting among Palaeolithic populations. Here new archaeological data from Ortvale Klde, a late Middle–early Upper Palaeolithic rockshelter in the Georgian Republic, are considered, and zooarchaeological methods are applied to the study of faunal acquisition patterns to test whether they changed significantly from the Middle to the Upper Palaeolithic. The analyses demonstrate that Neanderthals and modern humans practiced largely identical hunting tactics and that the two populations were equally and independently capable of acquiring and exploiting critical biogeographical information pertaining to resource availability and animal behavior. Like lithic techno-typological traditions, hunting behaviors are poor proxies for major behavioral differences between Neanderthals and modern humans, a conclusion that has important implications for debates surrounding the Middle–Upper Palaeolithic transition and what features constitute “modern” behavior. The proposition is advanced that developments in the social realm of Upper Palaeolithic societies allowed the replacement of Neanderthals in the Caucasus with little temporal or spatial overlap and that this process was widespread beyond traditional topographic and biogeographical barriers to Neanderthal mobility.