The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Injury incidence in judokas at the Spanish National University Championship

Background and Study Aim: Understanding injury incidence rates will be a great help with regards to preventing potential future damages. It is for this reason that this study suggests studying a large number of variables. The purpose of research is the relationship of events (empirical variables) that are usually taken into account in developing injury prevention programs during the battles and training in judo tournament. Material and methods: In this research project, 57 male judokas taking part in the Spanish National University Championship in 2009 were asked to complete a retrospective questionnaire. We analysed the following events: the most commonly injured body regions, the medical diagnosis, how and when the injury happened, the type of injury, the side of the body and the type of medical attention received. For the statistical analysis, we used the SPSS statistics programme to apply the Chi-square test in order to determine the significance levels for non-parametric tests from p<.05. Results: Significant differences were found in the most commonly injured body region, the shoulder/clavicle (p<.05), and in the most common diagnosis, the sprain (p<.05). Impact injuries (p<.05) are the most common and training (p<.05) is the most dangerous time. About the type of injury, 78.38% are new injuries (p<.05) and 69.05% affect the right hand side of the body (p<.05). Doctors are the most consulted specialists, but the physiotherapists obtained the best marks. Have been out due to injury for over 21 days 36.36% of the participants, but not for the entire season. Conclusions: The most common diagnosis in university student judokas coincides with those of elite judokas, with the sprain being the most common. University student judokas have a higher rate of shoulder/clavicle injuries, while professional judokas are prone to a higher rate of knee injuries. Training is the most common moment in which injuries occur, both in university student judokas and professional judokas. New injuries are the most common types of injuries in university student judokas and, while doctors are the most consulted specialists, the physiotherapists obtained the best marks.

Report of investigation of summary contempt citation against George W. Crockett, Jr. of the Michigan Bar (Defense Counsel in the Foley Square trial) : presented to the lawyers and judges of Michigan /

Mode of access: Internet.

A practical treatise on the steel square and its application to everyday use ...

Mode of access: Internet.

The impact of visual-verbal relationships on native-nonnative english speakers' reading processes and comprehension

The aim of this study was to comparatively investigate the impact of visual-verbal relationships that exist in expository texts on the reading process and comprehension of readers from different language background: native speakers of English (LI) and speakers of English as a foreign language (EFL). The study focussed, in this respect, on the visual elements (VEs) mainly graphs and tables that accompanied the selected texts. Two major experiments were undertaken. The first, was for the reading process using the post-reading questionnaire technique. Participants were 163 adult readers representing three groups: 77 (LI), 56 (EFL postgraduates); and 30 (EFL undergraduates). The second experiment was for the reading comprehension using cloze procedure. Participants were 123 representing the same above gorups: 50, 33 and 40 respectively. It was hypothesised that the LI readers would make use of VEs in the reading process in ways different from both EFL groups and that use would enhance each group's comprehension in different aspects and to different levels. In the analysis of the data of both experiments two statistical measurements were used. The chi-square was used to measure the differences between frequencies and the t-test was used to measure the differences between means. The results indicated a significant relationship between readers' language background and the impact of visual-verbal relationships on their reading processes and comprehension of such type of texts. The results also revealed considerable similarities between the two EFL groups in the reading process of texts accompanied by VEs. In the reading comprehension, however, the EFL undergraduates seemed to benefit from the visual-verbal relationships in their comprehension more than the postgraduates, suggesting a weak relationship of this impact for older EFL readers. Furthermore, the results showed considerable similarities between the reading process of texts accompanied by VEs and of whole prose texts. Finally an evaluation of this study was undertaken as well as practical implications for EFL readers and suggestions for future research.

Psychosocial variables associated with the co-occurrence of risky sexual behavior with alcohol consumption among university students

This study examined the association of theoretically guided and empirically identified psychosocial variables on the co-occurrence of risky sexual behavior with alcohol consumption among university students. The study utilized event analysis to determine whether risky sex occurred during the same event in which alcohol was consumed. Relevant conceptualizations included alcohol disinhibition, self-efficacy, and social network theories. Predictor variables included negative condom attitudes, general risk taking, drinking motives, mistrust, social group membership, and gender. Factor analysis was employed to identify dimensions of drinking motives. Measured risky sex behaviors were (a) sex without a condom, (b) sex with people not known very well, (c) sex with injecting drug users (IDUs), (d) sex with people without knowing whether they had a STD, and (e) sex with using drugs. A purposive sample was used and included 222 male and female students recruited from a major urban university. Chi-square analysis was used to determine whether participants were more likely to engage in risky sex behavior in different alcohol use contexts. These contexts were only when drinking, only when not drinking, and when drinking or not. The chi-square findings did not support the hypothesis that university students who use alcohol with sex will engage in riskier sex. These results added to the literature by extending other similar findings to a university student sample. For each of the observed risky sex behaviors, discriminant analysis methodology was used to determine whether the predictor variables would differentiate the drinking contexts, or whether the behavior occurred. Results from discriminant analyses indicated that sex with people not known very well was the only behavior for which there were significant discriminant functions. Gender and enhancement drinking motives were important constructs in the classification model. Limitations of the study and implications for future research, social work practice and policy are discussed. ^

The relationship between socioeconomic status, course delivery method, and student success at a state college: A single institution analysis

In an effort to improve instruction and better accommodate the needs of students, community colleges are offering courses delivered in a variety of delivery formats that require students to have some level of technology fluency to be successful in the course. This study was conducted to investigate the relationship between student socioeconomic status (SES), course delivery method, and course type on enrollment, final course grades, course completion status, and course passing status at a state college. ^ A dataset for 20,456 students of low and not low SES enrolled in science, technology, engineering, and mathematics (STEM) course types delivered using traditional, online, blended, and web enhanced course delivery formats at Miami Dade College, a large open access 4-year state college located in Miami-Dade County, Florida, was analyzed. A factorial ANOVA using course type, course delivery method, and student SES found no significant differences in final course grades when used to determine if course delivery methods were equally effective for students of low and not low SES taking STEM course types. Additionally, three chi-square goodness-of-fit tests were used to investigate for differences in enrollment, course completion and course passing status by SES, course type, and course delivery method. The findings of the chi-square tests indicated that: (a) there were significant differences in enrollment by SES and course delivery methods for the Engineering/Technology, Math, and overall course types but not for the Natural Science course type and (b) there were no significant differences in course completion status and course passing status by SES and course types overall and SES and course delivery methods overall. However, there were statistically significant but weak relationships between course passing status, SES and the math course type as well as between course passing status, SES, and online and traditional course delivery methods. ^ The mixed findings in the study indicate that strides have been made in closing the theoretical gap in education and technology skills that may exist for students of different SES levels. MDC's course delivery and student support models may assist other institutions address student success in courses that necessitate students having some level of technology fluency. ^

Psychosocial variables associated with the co-occurance of risky sexual behavior with alcohol consumption among university students

This study examined the association of theoretically guided and empirically identified psychosocial variables on the co-occurrence of risky sexual behavior with alcohol consumption among university students. The study utilized event analysis to determine whether risky sex occurred during the same event in which alcohol was consumed. Relevant conceptualizations included alcohol disinhibition, self-efficacy, and social network theories. Predictor variables included negative condom attitudes, general risk taking, drinking motives, mistrust, social group membership, and gender. Factor analysis was employed to identify dimensions of drinking motives. Measured risky sex behaviors were (a) sex without a condom, (b) sex with people not known very well, (c) sex with injecting drug users (IDUs), (d) sex with people without knowing whether they had a STD, and (e) sex with using drugs. A purposive sample was used and included 222 male and female students recruited from a major urban university. Chi-square analysis was used to determine whether participants were more likely to engage in risky sex behavior in different alcohol use contexts. These contexts were only when drinking, only when not drinking, and when drinking or not. The chi-square findings did not support the hypothesis that university students who use alcohol with sex will engage in riskier sex. These results added to the literature by extending other similar findings to a university student sample. For each of the observed risky sex behaviors, discriminant analysis methodology was used to determine whether the predictor variables would differentiate the drinking contexts, or whether the behavior occurred. Results from discriminant analyses indicated that sex with people not known very well was the only behavior for which there were significant discriminant functions. Gender and enhancement drinking motives were important constructs in the classification model. Limitations of the study and implications for future research, social work practice and policy are discussed.

Analysis of residuals in contingency tables: another nail in the coffin of conditional approaches to significance testing.

Omnibus tests of significance in contingency tables use statistics of the chi-square type. When the null is rejected, residual analyses are conducted to identify cells in which observed frequencies differ significantly from expected frequencies. Residual analyses are thus conditioned on a significant omnibus test. Conditional approaches have been shown to substantially alter type I error rates in cases involving t tests conditional on the results of a test of equality of variances, or tests of regression coefficients conditional on the results of tests of heteroscedasticity. We show that residual analyses conditional on a significant omnibus test are also affected by this problem, yielding type I error rates that can be up to 6 times larger than nominal rates, depending on the size of the table and the form of the marginal distributions. We explored several unconditional approaches in search for a method that maintains the nominal type I error rate and found out that a bootstrap correction for multiple testing achieved this goal. The validity of this approach is documented for two-way contingency tables in the contexts of tests of independence, tests of homogeneity, and fitting psychometric functions. Computer code in MATLAB and R to conduct these analyses is provided as Supplementary Material.

The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery.

BACKGROUND: There are limited data about spinal dosing for cesarean delivery in preterm parturients. We investigated the hypothesis that preterm gestation is associated with an increased incidence of inadequate spinal anesthesia for cesarean delivery compared with term gestation. METHODS: We searched our perioperative database for women who underwent cesarean delivery under spinal or combined spinal-epidural anesthesia with hyperbaric bupivacaine ⩾10.5mg. The primary outcome was the incidence of inadequate surgical anesthesia needing conversion to general anesthesia or repetition or supplementation of the block. We divided patients into four categories: <28, 28 to <32, 32 to <37 and ⩾37weeks of gestation. The chi-square test was used to compare failure rates and a multivariable regression analysis was performed to investigate potential confounders of the relationship between gestational age and failure. RESULTS: A total of 5015 patients (3387 term and 1628 preterm) were included. There were 278 failures (5.5%). The incidence of failure was higher in preterm versus term patients (6.4% vs. 5.1%, P=0.02). Failure rates were 10.8%, 7.7%, 5.3% and 5% for <28, 28 to <32, 32 to <37 and ⩾37weeks of gestation, respectively. In the multivariable model, low birth weight (P<0.0001), gestational age (P=0.03), ethnicity (P=0.02) and use of combined spinal-epidural anesthesia (P<0.0001) were significantly associated with failure. CONCLUSIONS: At standard spinal doses of hyperbaric bupivacaine used in our practice (⩾10.5mg), there were higher odds of inadequate surgical anesthesia in preterm parturients. When adjusting for potential confounders, low birth weight was the main factor associated with failure.

Primary prevention of neural tube defects: data from the portuguese national registry of congenital anomalies (RENAC)

Background: In Portugal folic acid supplementation is recommended to start at least 2-3 months before conception for primary prevention of Neural Tube Defects. The aim of this study was to evaluate, within gestations with at least one congenital anomaly, possible association between maternal socio-demographic factors and the use of folic acid. Methods: Using data from the Portuguese national registry of congenital anomalies, for the 2004-2013 period, the association between folic acid use during pregnancy and maternal characteristics was studied using the chi-square test. Results: Considering all reported cases with congenital anomaly, the use of folic acid before conception was reported by 12.7% (n = 1233) of the women; 47.8% (n = 4623) started supplementation during the 1st trimester, 7% (n = 680) did not take folic acid and 32.5% (3143) of the records had no information on folic acid use. Women with professions that require higher academic differentiation started the use of supplements before pregnancy (p <0.001); women under 19 years old and with Arab ethnicity (p <0.001) did not take folic acid. Mothers with a previous pregnancy reported less use of folic acid (11.5% versus 14.7%) than mothers without a previous pregnancy (p <0.001). Conclusions: The results suggest some degree of association between maternal characteristics and use of folic acid. To increase the consumption of folic acid before pregnancy new measures are need to promote this primary prevention, among couples and health professionals. This study highlights some maternal characteristics and subgroups of mothers for who the measures should be reinforced.

The experience of teaching statistics to non-specialist students in Saudi universities

Undoubtedly, statistics has become one of the most important subjects in the modern world, where its applications are ubiquitous. The importance of statistics is not limited to statisticians, but also impacts upon non-statisticians who have to use statistics within their own disciplines. Several studies have indicated that most of the academic departments around the world have realized the importance of statistics to non-specialist students. Therefore, the number of students enrolled in statistics courses has vastly increased, coming from a variety of disciplines. Consequently, research within the scope of statistics education has been able to develop throughout the last few years. One important issue is how statistics is best taught to, and learned by, non-specialist students. This issue is controlled by several factors that affect the learning and teaching of statistics to non-specialist students, such as the use of technology, the role of the English language (especially for those whose first language is not English), the effectiveness of statistics teachers and their approach towards teaching statistics courses, students’ motivation to learn statistics and the relevance of statistics courses to the main subjects of non-specialist students. Several studies, focused on aspects of learning and teaching statistics, have been conducted in different countries around the world, particularly in Western countries. Conversely, the situation in Arab countries, especially in Saudi Arabia, is different; here, there is very little research in this scope, and what there is does not meet the needs of those countries towards the development of learning and teaching statistics to non-specialist students. This research was instituted in order to develop the field of statistics education. The purpose of this mixed methods study was to generate new insights into this subject by investigating how statistics courses are currently taught to non-specialist students in Saudi universities. Hence, this study will contribute towards filling the knowledge gap that exists in Saudi Arabia. This study used multiple data collection approaches, including questionnaire surveys from 1053 non-specialist students who had completed at least one statistics course in different colleges of the universities in Saudi Arabia. These surveys were followed up with qualitative data collected via semi-structured interviews with 16 teachers of statistics from colleges within all six universities where statistics is taught to non-specialist students in Saudi Arabia’s Eastern Region. The data from questionnaires included several types, so different techniques were used in analysis. Descriptive statistics were used to identify the demographic characteristics of the participants. The chi-square test was used to determine associations between variables. Based on the main issues that are raised from literature review, the questions (items scales) were grouped and five key groups of questions were obtained which are: 1) Effectiveness of Teachers; 2) English Language; 3) Relevance of Course; 4) Student Engagement; 5) Using Technology. Exploratory data analysis was used to explore these issues in more detail. Furthermore, with the existence of clustering in the data (students within departments within colleges, within universities), multilevel generalized linear models for dichotomous analysis have been used to clarify the effects of clustering at those levels. Factor analysis was conducted confirming the dimension reduction of variables (items scales). The data from teachers’ interviews were analysed on an individual basis. The responses were assigned to one of the eight themes that emerged from within the data: 1) the lack of students’ motivation to learn statistics; 2) students' participation; 3) students’ assessment; 4) the effective use of technology; 5) the level of previous mathematical and statistical skills of non-specialist students; 6) the English language ability of non-specialist students; 7) the need for extra time for teaching and learning statistics; and 8) the role of administrators. All the data from students and teachers indicated that the situation of learning and teaching statistics to non-specialist students in Saudi universities needs to be improved in order to meet the needs of those students. The findings of this study suggested a weakness in the use of statistical software applications in these courses. This study showed that there is lack of application of technology such as statistical software programs in these courses, which would allow non-specialist students to consolidate their knowledge. The results also indicated that English language is considered one of the main challenges in learning and teaching statistics, particularly in institutions where English is not used as the main language. Moreover, the weakness of mathematical skills of students is considered another major challenge. Additionally, the results indicated that there was a need to tailor statistics courses to the needs of non-specialist students based on their main subjects. The findings indicate that statistics teachers need to choose appropriate methods when teaching statistics courses.

Use of oral rehydration therapy in the treatment of childhood diarrhoea in Douala, Cameroon

Introduction The use of oral rehydration solutions in our context remains limited. This study was conducted to analyze the rate of this use in Douala, Cameroon and thereby determine the factors associated with it. Method A cross-sectional survey was administered to parents of children aged five years and younger during a six-month study period. The studied variables focused on the socio-demographic data of the population, data on diarrhoea and its severity, data on oral rehydration salts (ORS), and data related to other interventions for diarrhoea. The chi-square test was used to qualify associations between variables, with the significance level being set at 5%. Results Overall, 672 people agreed to participate in the study. Among them, 418 (62.2%) correctly defined diarrhoea. When their children develop diarrhoea, the majority of the parents (348, 51.8%) reported seeking hospital assistance before any intervention, while 225 parents (33.5%) preferred the use of ORS first. Four hundred seventy-five parents (70.7%) had heard of ORS and among them 313 (65.9%) had actually given ORS to their children as treatment during these children’s most recent episodes of diarrhoea. Of the parents who had given their children ORS, 217 (69.3%) knew how to prepare it, and 122 (39.0%) knew how to administer it. One hundred thirty-five parents (20.1%) had administered metronidazole to treat their children’s diarrhoea. The age of the children, the parents’ level of education, and the number of children in the household significantly influenced the use or non-use of ORS (respectively, p < 0.001, p = 0.003 and p < 0.0001). Rehydration was correctly identified by 234 parents (34.8%) as the purpose of administering ORS. Conclusion The knowledge and the use of ORS in diarrhoea by the study sample was insufficient. The role of ORS was poorly known. Awareness campaigns can be carried out in order to improve the use of this effective intervention for diarrhoea.