Iowa Federal Family Education Loan Program Division, Iowa College Student Aid Commission, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, June 30, 2004

State Audit Reports

Iowa Turkey Marketing Council, Independent Auditor's Reports, Financial Statements, Schedule of Findings, December 31, 2003 & 2004

State Audit Reports

Beyond Welfare Inc., Independent Auditor's Reports, Financial Statements, Schedule of Findings, Eighteen Months ended June 30, 2004

Other Audit Reports

Iowa State Center Business Office, Iowa State University of Science and Technology, Independent Auditor's Reports, Financial Statements, June 30, 2004 & 2005

State University Audit Report

City of Carter Lake, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2005

City Audit Report

Student Health Facility Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Report, Financial Statements and Supplemental Information, June 30, 2005

State University Audit Report

Quand la peur des dépenses incite au gaspillage humain et financier [When the fear of spending incites a human and financial waste!]

Dans les années 80, la crainte de la pléthore médicale imposait des mesures radicales. En 2002, c'est l'angoisse de l'envahisseur européen qui a justifié un moratoire sur l'ouverture de nouveaux cabinets. Aujourd'hui, alors que la Suisse recrute de plus en plus de médecins étrangers pour ses besoins, le Conseiller fédéral Couchepin brandit la menace d'une augmentation des coûts de la santé de 300 millions par an pour justifier une troisième prolongation du moratoire. Ces mesures ont été dictées par la peur d'une explosion des coûts au point de faire perdre de vue la globalité de la situation. Aujourd'hui pourtant, une gestion rationnelle des ressources impose de tout faire pour qu'un maximum de médecins puissent travailler, car la population en a besoin et a déjà beaucoup investi dans leur formation ! Pour y parvenir, la création de postes d'assistanat à temps partiel, l'adaptation urgente des structures d'accueil en garderie et le respect de conditions de travail raisonnables sont des éléments incontournables mais trop souvent négligés par les politiques et les médecins eux-mêmes !

Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system.

OBJECTIVES: The objectives were to identify the social and medical factors associated with emergency department (ED) frequent use and to determine if frequent users were more likely to have a combination of these factors in a universal health insurance system. METHODS: This was a retrospective chart review case-control study comparing randomized samples of frequent users and nonfrequent users at the Lausanne University Hospital, Switzerland. The authors defined frequent users as patients with four or more ED visits within the previous 12 months. Adult patients who visited the ED between April 2008 and March 2009 (study period) were included, and patients leaving the ED without medical discharge were excluded. For each patient, the first ED electronic record within the study period was considered for data extraction. Along with basic demographics, variables of interest included social (employment or housing status) and medical (ED primary diagnosis) characteristics. Significant social and medical factors were used to construct a logistic regression model, to determine factors associated with frequent ED use. In addition, comparison of the combination of social and medical factors was examined. RESULTS: A total of 359 of 1,591 frequent and 360 of 34,263 nonfrequent users were selected. Frequent users accounted for less than a 20th of all ED patients (4.4%), but for 12.1% of all visits (5,813 of 48,117), with a maximum of 73 ED visits. No difference in terms of age or sex occurred, but more frequent users had a nationality other than Swiss or European (n = 117 [32.6%] vs. n = 83 [23.1%], p = 0.003). Adjusted multivariate analysis showed that social and specific medical vulnerability factors most increased the risk of frequent ED use: being under guardianship (adjusted odds ratio [OR] = 15.8; 95% confidence interval [CI] = 1.7 to 147.3), living closer to the ED (adjusted OR = 4.6; 95% CI = 2.8 to 7.6), being uninsured (adjusted OR = 2.5; 95% CI = 1.1 to 5.8), being unemployed or dependent on government welfare (adjusted OR = 2.1; 95% CI = 1.3 to 3.4), the number of psychiatric hospitalizations (adjusted OR = 4.6; 95% CI = 1.5 to 14.1), and the use of five or more clinical departments over 12 months (adjusted OR = 4.5; 95% CI = 2.5 to 8.1). Having two of four social factors increased the odds of frequent ED use (adjusted = OR 5.4; 95% CI = 2.9 to 9.9), and similar results were found for medical factors (adjusted OR = 7.9; 95% CI = 4.6 to 13.4). A combination of social and medical factors was markedly associated with ED frequent use, as frequent users were 10 times more likely to have three of them (on a total of eight factors; 95% CI = 5.1 to 19.6). CONCLUSIONS: Frequent users accounted for a moderate proportion of visits at the Lausanne ED. Social and medical vulnerability factors were associated with frequent ED use. In addition, frequent users were more likely to have both social and medical vulnerabilities than were other patients. Case management strategies might address the vulnerability factors of frequent users to prevent inequities in health care and related costs.

Memorial Union Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Reports, Financial Statements, June 30, 2005

State University Audit Report

Sheldon Community School District, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2005

Community School District Audit Report

Adair County, Independent Auditor's Reports, Basic Financial Statements and Supplementary Information, Schedule of Findings, June 30, 2005

County Audit Report

Telecommunication Facilities Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Report, Financial Statements and Supplemental Information, June 30, 2005

State University Audit Report

Utility System Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Report, Financial Statements and Supplemental Information, June 30, 2005

State University Audit Report

Regulated Materials Facility Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Reports, Financial Statements, June 30, 2005

State University Audit Report

Parking System Revenue Bond Funds, Iowa State University of Science and Technology, Independent Auditor's Report, Financial Statements and Supplemental Information, June 30, 2005

State University Audit Report