Medical Insurance Status Research Articles

Influences of demographic changes and medical insurance status on tonsillectomy and adenoidectomy rates in Korea

In Korea, the proportion of the pediatric population is decreasing due to low fertility rates and aging of the society. It is hypothesized that this change in population structure and medical insurance status may affect rates of elective surgeries more significantly than clinical factors. An observational study conducted using data from the Health Insurance Review and Assessment Service for tonsillectomy and adenoidectomy, with 403,924 registered patients from 2007 through 2011. We analyzed longitudinal changes in crude and age-adjusted surgery rates of three surgeries-tonsillectomy without adenoidectomy (T), adenoidectomy without tonsillectomy (A), and tonsillectomy with adenoidectomy (T&A)-according to medical insurance status: health insurance (HI) group (better economic status) versus health aid (HA) group (poorer economic status). Most of the surgeries (51.8 % of T, 93.7 % of A, and 95.1 % of T&A) were performed in patients younger than 15. Over 5 years, the proportion of the child population numbers decreased, from 17.43 to 15.41 % in the HI group and from 21.20 to 13.15 % in the HA group. Thus, crude surgery rates for T, A, and T&A decreased more rapidly in the HA group (7.50, 14.79, and 15.55 %) than the HI group (1.69, 1.49, and 0.90 %) each year. Adjusted surgery rates for T, A, and T&A increased in the HI group (1.01, 2.64, and 3.36 %) and decreased in the HA group (1.39, 2.86, and 2.76 %) each year. These adjusted surgery rates partially explains the sharper decrease in crude surgery rates in the HA group than the HI group. The crude and adjusted rates of surgeries were usually higher in lower economic status groups. In conclusion, surgery rates were affected by changes in the population structure, but by other factors as well. Predictable socioeconomic factors could be used to calculate and predict the rates for other well-established surgeries.

Impact of Project SCOPE on Racial/Ethnic Disparities in Colorectal Cancer Screening

Purpose: During 2005-2009, Stony Brook University Medical Center (SBUMC) led a CDC funded project, Suffolk County Preventive Endoscopy Project (Project SCOPE), to expand colorectal cancer (CRC) screening for Suffolk County (New York) residents (age ≥50 years) who had inadequate or no insurance coverage for CRC screening. We hypothesized that this project significantly expanded CRC screening in racial/ethnic minorities at SBUMC. Methods: We conducted a retrospective analysis of colonoscopies performed at SBUMC, prior to Project SCOPE (2003-2004), during Project SCOPE (2007-2008), and after Project SCOPE (2010-2011). Colonoscopies were excluded for patients aged <50 and >80 or with a history of inflammatory bowel diseases. Clinical metadata (e.g., race/ethnicity, medical insurance) was obtained from the electronic medical record. Multiple logistic regression model was used to compare the likelihood of a patient being Hispanic or African American after adjusting for potential confounders. All marginally significant factors and their first order interactions were considered in the model based on backward selection. Results: During the three time periods, the total number of colonoscopies included in the study was 11,752. The total number of Hispanic patients undergoing colonoscopy was 146 (4.5%) in 2003-2004, 506 (12.3%) in 2007-2008, and 262 (6%) in 2010-2011. The proportion of Hispanic patients undergoing colonoscopy was significantly different between the three time periods after adjusting for potentially confounding variables (patient's age, gender, and medical insurance status [p< 0.0001]). The statistical difference between the three time periods remained significant when we only considered colonoscopies designated as screening procedures. The total number of African-American patients undergoing colonoscopy was 166 (5%) in 2003-2004, 298 (7.2%) in 2007-2008, and 255 (5.9%) in 2010-2011. However, these differences were not statistically significant after controlling for patient's age and medical insurance status. The overall detection rates of adenomas, sessile serrated polyps and adenocarcinoma on colonoscopy were respectively 25%, 0.8%, and 1.2%. Hispanic ethnicity or African-American race was not significantly associated with detection of adenoma, sessile serrated polyp, or adenocarcinoma in this study. Conclusion: Reducing financial and language barriers through Project SCOPE significantly improved CRC screening by colonoscopy among Hispanics and African Americans. Future increases in national health insurance coverage for previously uninsured populations may result in increased minority participation in CRC screening as well as an increased need for language assistance.

Influenza Testing, Diagnosis, and Treatment in the Emergency Department in 2009-2010 and 2010-2011

The objective was to describe patterns of rapid influenza test ordering, diagnosis of influenza, and antiviral prescribing by the treating physician for children and adults presenting to emergency departments (EDs) with fever and acute respiratory symptoms in Winston-Salem, North Carolina, over two influenza seasons. The authors prospectively enrolled patients presenting to the ED with fever and acute respiratory symptoms for two influenza seasons: H1N1 pandemic of September 2009 through mid-May 2010 and November 2010 through April 2011. Enrolled patients had nose or and throat swabs obtained and tested for influenza by viral culture and polymerase chain reaction (PCR) testing. Demographic information and medical history were obtained by patient or guardian report. Testing, treatment, and discharge diagnosis from the ED visit, as well as medical history and insurance status, were ascertained from chart review. Among 2,293 eligible patients approached, 1,657 (72%) were enrolled, of whom 38% were younger than 18 years, 47% were 18 to 49 years, and 15% were 50 years of age and older. Overall, 14% had culture- or PCR-confirmed influenza. The odds of 1) rapid influenza test ordering, 2) a physician diagnosis of influenza, and 3) prescribing antiviral treatment during the ED visit were fourfold higher among patients with than without culture- or PCR-confirmed influenza. The odds of rapid influenza test ordering were threefold lower in 2009/2010 than 2010/2011, whereas the odds of physician diagnosis of influenza and antiviral prescriptions were 2- and 3.5-fold higher, respectively. In 2009/2010 compared to 2010/2011, the odds of rapid influenza test ordering were lower, whereas the odds of influenza-specific discharge diagnoses and antiviral prescriptions were higher among patients presenting to the ED with culture/PCR-confirmed influenza. These results demonstrated a gap between clinical practice and recommendations for the diagnosis and treatment of influenza from the Centers for Disease Control and Prevention (CDC).

Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status

PurposeIn Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy.Materials and MethodsA total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method.ResultsThe median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001).ConclusionsThe medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.

The Changing Relationship Between Obesity and Disability in Middle and Older Adults: 1997 and 2006 China Health and Nutrition Surveys

The Changing Relationship Between Obesity and Disability in Middle and Older Adults: 1997 and 2006 China Health and Nutrition Surveys

The Complex Association of Race and Leaving the Pediatric Emergency Department Without Being Seen by a Physician

This study examined the influence of race and language on leaving the emergency department (ED) without complete evaluation and treatment (LWCET). This retrospective, case-cohort study examined LWCET among patients discharged home from 2 EDs between March 2, 2009, and March 31, 2010. Race and language were obtained by family self-report. We also explored wait time to see a physician as an explanation of racial disparities. One thousand two hundred eighty-five (1.7%) of 76,931 ED encounters ended in LWCET. Factors increasing LWCET were high ED activity, low acuity, and medical assistance (MA) insurance. American Indian, biracial, African American, and Hispanic races were also associated with higher odds of LWCET among visits by MA insurance patients compared with those of white patients on private insurance. Restricting the analysis to visits by MA insurance patients, only American Indian race was associated with LWCET compared with white race. Visits by patients using an interpreter or speaking a language other than English at home had lower odds of ending in LWCET. Sensitivity analyses in subgroups confirmed these findings. We developed a measure of ED activity that correlated well with wait time to see a physician (correlation coefficient = 0.993; P < 0.001). Among non-LWCET visits, wait time to see a practitioner did not correlate with racial disparities in LWCET. Race, language, and insurance status interact to form a complex relationship with LWCET. Medical assistance insurance status appears to account for much of the excessive instances of LWCET seen in nonwhites. After restricting the analysis to MA insurance patients, only visits by American Indian patients had higher odds of LWCET compared with whites on MA insurance. Wait time to see a physician did not explain racial differences in LWCET.

Status and influencing factors of pre-hospital delay behavior of high-risk patients with ischemic stroke

Objective To study the status and influencing factors of pre-hospital delay behavior of high-risk patients with ischemic stroke. Methods The convenient sampling method was used, and 303 high risk ischemic stroke patients were investigated with self-designed questionnaire to found the influencing factors of pre-hospital delay behaviors. Results Among 7 questions about pre-hospital delay behaviors, 29.0% - 73.3% respondents chose the option that benefited to go to hospital timely with the average rate 49.9%. The number of options that benefited to go to hospital timely chosen by 18 -34,35 -64,≥65 years old high-risk patients were 4,4,3, respectively,the differents among groups were significant （H = 11. 484, P = 0. 003 ）. The number of options that benefited to go to hospital timely chosen by rural, suburban and city high-risk patients were 4,3,3, respectively, the differents among gruops were significant （H = 23. 118, P = 0.000 ）. The number of options that benefited to go to hospital timely chosen by junjor middle school and below, high school and secondary school, junior college and above high-risk patients were 3,4,4. 5, respectively, the differents among gruops were significant （H = 31. 105,P = 0. 000）. And respondents with the different age, residence, education degree, marital status, medical insurance status, income, self-perceived health status and physical examination frequency, the number that they chose the option that benefited to go to hospital timely was significantly different （ P 〈 0.05 ）. Conclusions The pre-hospital delay behavior of high-risk patients with ischemie stroke is middle level with several influencing factors, so it is important to manage the pre-hospital delay behavior of the patients from many aspects. Key words: Stroke; High-risk patients; Pre-hospital delay hehaviour; Influencing factors

Pathways to the diagnosis of thyroid cancer in New South Wales: a population-based cross-sectional study

Over the past few decades, an increase in the incidence of thyroid cancer has been recorded in many countries around the world including Australia. Heightened medical surveillance and increased technological sensitivity could be contributing to greater detection of asymptomatic disease. To describe the pathways to diagnosis of thyroid cancer for a cohort of newly diagnosed patients in New South Wales (NSW), Australia, and compare these pathways by age, sex, place of residence, ethnic background, medical insurance status, and disease characteristics. A total of 452 newly diagnosed cases of thyroid cancer were recruited through the population-based NSW Central Cancer Registry. Participants completed a questionnaire and diary of doctor visits and investigations that led to their diagnosis. Tumor characteristics were obtained from pathology reports. Forty percent of patients initially presented to their doctor with a lump or symptom specific to thyroid cancer and 60% had their cancer detected incidentally during a medical encounter. Men were more likely than women to be diagnosed after imaging for another health concern versus reporting a thyroid lump or symptom (p = 0.001). Thyroid cancer diagnosis after imaging for another health concern increased with age (p = 0.023), and larger tumors were less likely to be diagnosed after treatment for a benign thyroid disease (p = 0.040). As the majority of participants had incidental diagnoses, the reported incidence of thyroid cancer is likely to be influenced by diagnostic technology and medical surveillance practices. This, however, probably only partly explains the observed rise in the incidence of thyroid cancer in NSW.

Identifying Barriers to Entering Smoking Cessation Treatment Among Socioeconomically Disadvantaged Smokers

AbstractBackground:Efficacious smoking cessation interventions exist, yet few smokers utilise available resources such as psychosocial treatment programs and pharmacotherapy. The goals of the present study were to (1) identify perceived barriers to entering smoking cessation treatment programs among socioeconomically disadvantaged smokers, who are presently underrepresented in smoking cessation interventions; (2) determine what variables are most important in predicting the barriers identified (i.e., age, gender, ethnicity, income, nicotine dependence level, smoking rate, years smoking, stage of change, presence of smoking-related illness and medical insurance status).Methods:Responses from socioeconomically disadvantaged smokers (N= 343) were collected in 2004–2005 and analysed to develop the Treatment Barriers Questionnaire, a 40-item measure of reasons for not entering smoking cessation programs. Study methods were approved by the Institutional Review Board of Louisiana State University; informed consent procedures were employed.Results:Principal components analysis yielded seven scales named for their theme: (1) Preparedness to Quit Smoking; (2) Work and Time Constraints; (3) Smokers Can or Should Quit on Own; (4) Opinions about Professional Assistance; (5) Mobility Limitations; (6) Insurance Limitations and (7) Misinformation about Professional Assistance. Gender, ethnicity, daily smoking rate, nicotine dependence and stage of change were significant predictors in regression analyses for scales 1,F(10, 201) = 7.83,p&lt; .001,R2= .29, 2F(10, 201) = 2.30,p&lt; .05,R2= .11, and 3,F(10, 201) = 3.58,p&lt; .001,R2= .16. Conclusions: Results can inform efforts to facilitate entry and retention of smokers in cessation programs.

Helicobacter pylori Does Not Infect the Gastric Cardia: Myth or Fact?

Purpose: Anastomotic ulcers are a non peri-operative complication in post roux-en-y gastric bypass surgery patients. The cause of these ulcers is unclear and many theories have been suggested, including cigarette smoking, gastric acid, partial devascularization at the anastomosis of the roux limb to the gastric pouch and weakening of the gastric mucosa by H. pylori infection. We hypothesize that H. pylori cannot be the cause of anastomotic ulcers in bariatric patients because the organism is not known to infect the gastric cardia. Methods: We enrolled 59 adult patients during the period between April 1, 2009 and March 30, 2010 with normal gastrointestinal anatomy. They underwent upper endoscopy at which time biopsies were obtained from both the gastric cardia and antrum. These biopsy samples were tested for the presence of H. pylori by PyloriTek®, a rapid urease test, and histopathology. Demographic data including age, gender, race and medical insurance status was also collected and analyzed. Results are reported as frequencies and percentages, and are presented in tables. Results: The average age of patients in the study was 60 years. 73% (43) were female and 27% (16) were male; 51% (30) were African American, 46% (27) were Caucasian, 2% (1) were Chinese and 2% (1) were Indian. 49% of the study patients had private insurance; 43% had government funded insurance and 9% had no insurance. Of 59 patients tested, the Pyloritek® test results were available for 57 patients. 25% (15) tested positive for H. pylori in the cardia by Pyloritek® and 71% (42) tested negative. Of the 15 biopsy samples that tested positive in the cardia, 5 (33%) were positive in the cardia only and 10 (67%) were positive in both cardia and antrum. Of 59 patients tested, histopathology results were available for 57 patients. 22% (13) tested positive for H. pylori in the cardia and 75% (44) tested negative. Of the 13 positive test results, 16% (2) tested positive in the cardia only while 11 (84%) were positive in both antrum and cardia. No significant correlation was found between the presence of H. pylori in the gastric cardia or antrum and patients' ages, gender, race or insurance status. We found a strong correlation between the two testing methods (Pyloritek® and histopathological analysis) and between the presence of H. pylori in the antrum and cardia. Conclusion: Our study refutes our null hypothesis that H. pylori does not reside in the gastric cardia. It confirms that H. pylori infects both gastric antrum and cardia. Therefore, because the cardia is used in creating the gastric pouch when performing a roux-en-y gastric bypass, this study supports the theory that H. pylori could be an etiologic factor in patients who develop postoperative anastomotic ulcers.

Evaluation of admission characteristics, hospital length of stay and costs for cerebral infarction in a medium‐sized city in China

Stroke is a heavy economic and health burden for the patients and society. This study aimed to evaluate hospital length of stay (LOS) by admission characteristics and costs correlated with medical insurance status for cerebral infarction in a medium-sized city in China. A total of 557 consecutive patients with principal diagnosis of cerebral infarction were enrolled. Admission characteristics, LOS, and costs were retrospectively analyzed. The mean LOS was 18.5 days (median, 16 days). Our analysis demonstrated that medical insurance status, stroke severity (National Institutes of Health Stroke Scale score, Functional Independence Measure cognitive and motor score, Glasgow coma scale), Oxfordshire Community Stroke Project (OCSP) classification, some comorbidities (coronary heart disease, chronic obstructive pulmonary disease, and hyperlipemia), and raised leukocytes were the main explanatory factors for LOS by stepwise multiple regression model. The mean per patient costs were US $983.0, and mean daily costs US $67.0. Drugs were the most expensive cost subtype, all subtypes costs except non-medical care were significantly higher in patients with state medicine than in those with new cooperative medical scheme (NCMS) (P < 0.001). Stroke severity, OCSP classification, raised leukocytes on admission, some comorbidities, and medical insurance status may help to predict LOS for patients with cerebral infarction. Healthcare expenditures were heavy burdens to inhabitants. State medicine patients could shorten unnecessary LOS to improve the resources allocation and cost-efficiency.

Perineal Injury in Nulliparous Women Giving Birth at a Community Hospital: Reduced Risk in Births Attended by Certified Nurse-Midwives

Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse-midwives (CNMs) at a US community hospital. We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity. The odds ratios (ORs) for obstetrician-attended births versus CNM-attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33-2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13-4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01-4.29). We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM-attended births.

Patient and clinic factors associated with adolescent human papillomavirus vaccine utilization within a university-based health system

We reviewed clinical and billing data from a university-based health system to assess HPV vaccine utilization among 9–18-year-old girls by individual, visit and medical specialty characteristics. Our sample included 10,082 adolescent patients with 27,928 visits to outpatient family medicine (FM), pediatric and gynecology clinics between January 2007 and March 2008. Vaccine series completion was low among eligible adolescents (15%), with important disparities in vaccine utilization by medical specialty, age, race and insurance status. Missed opportunities for vaccination were common. Our findings may help to target future interventions aimed at increasing adolescent HPV vaccine utilization.

Bypassing the Local Rural Hospital for Outpatient Procedures

To assess the amount of local rural hospital outpatient department (HOPD) bypass for outpatient procedures. We analyzed data on colonoscopies and upper gastrointestinal endoscopies performed in the state of Florida over the period 1997-2004. Approximately, 53% of colonoscopy and 45% of upper gastrointestinal endoscopy patients bypassed their local rural hospital for treatment at either a free-standing ambulatory surgical center (ASC) or a nonlocal hospital outpatient department. Independent predictors of bypass included risk-adjusted severity of the patient's medical condition, insurance status, and race. Patients treated in ASCs were predominately healthier, white and commercially insured. Nonlocal HOPDs tend to treat a sicker cohort of patients who were publicly insured or under managed care. The results indicate that patients who bypass their local HOPD to an ASC differ from those bypassing to a nonlocal HOPD, and that patient factors influencing bypass for outpatient procedures differ from those influencing inpatient bypass. From a policy perspective, as procedures continue to migrate from the inpatient to the outpatient setting, bypassing the local rural hospital for treatment elsewhere could create conditions that negatively impact rural hospital operations.

Evidence‐based intrapartum care in Cali, Colombia: a quantitative and qualitative study

To measure the rate of use of selected intrapartum obstetric practices and to explore the factors associated with their use. Prospective quantitative and qualitative study. Fifteen public and private hospitals in Cali, Colombia. Quantitative arm: 1,767 low-risk women delivering a single live baby; qualitative arm: 36 intrapartum care providers. Quantitative analysis of women's clinical charts for measuring the rates of obstetric practices. Qualitative analysis of audiotaped semi-structured interviews with intrapartum care providers. Rates of use of ten intrapartum obstetric practices and associated factors and intrapartum care providers' views on evidence-based obstetric practice. Rates for the ineffective practices of enema use, perineal/pubic shaving, and routine intravenous infusion during labour were around 75%. Episiotomy rates for primiparae and multiparae were 70 and 22%, respectively. Rates for the beneficial practices of active management of the third stage of labour and allowing women's choice of position during the first stage of labour were around 45%. Companionship during labour, external cephalic version for breech presentation at term, and absorbable synthetic sutures for episiotomy showed rates of utilisation lower than 15%. Hospital characteristics, type of intrapartum care provider, and women's medical insurance status were associated with use of selected practices. Barriers and opportunities for implementing evidence-based practices in routine obstetric care were identified. Intrapartum care in Cali, Colombia, is not guided by the best available evidence. Effective change strategies should be undertaken to encourage the adoption of obstetric practices clearly demonstrated as effective and to discard those that are ineffective.

Correlates of women's cancer screening and contraceptive knowledge among female emergency department patients

BackgroundLack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1) Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2) Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them.MethodsEmergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models.ResultsOf 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were < age 35, white, single (never married and no partner), Catholic, and had private medical insurance. Participant's recent or current usage of a particular cancer screening or contraceptive method varied by type of method: Pap smear within the past year (69.1%), breast self-exam within the past month (45.5%), mammogram within the past year (65.7% for women age 45–55), condom usage during every episode of sexual intercourse (15.4%), current usage of birth control pills (17.8%), and ever use of emergency contraception (9.3%). The participants correctly answered 87.9% of all survey questions about condoms, 82.5% about birth control pills, 78.5% about breast self-exams, 52.9% about Pap smears, 35.4% about mammograms, and 25.0% about emergency contraception. In multivariable logistic regression models, survey participants who had private medical insurance and those who recently or currently used a given screening or contraceptive method had a greater odds of correctly answering all questions about each cancer screening or contraceptive method.ConclusionAlthough these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

Обязательное медицинское страхование и здоровье населения

Обязательное медицинское страхование и здоровье населения

Do Professional Dancers Have Medical Insurance?

A variety of dance companies were surveyed to document the medical insurance coverage they provide for their dancers. Various dance and theater arts directories available in San Francisco, California, yielded approximately 100 dance companies, ranging from traditional ballet through many ethnic, folk, eclectic, and modern dance forms. Twenty-eight dance companies provided information about their dancers and medical insurance status. The dancers were not contacted directly so no information about outside sources of medical insurance is available. A total of 292 dancers were listed by the 28 companies. Most were ages 21 to 30 (152, 58.7%) and 31 to 40 (64, 24.7%) years. Just over half (157, 53.8%) of the dancers were covered by Workers Compensation (WC) insurance, while slightly less than half (124, 42.5%) were in companies that offered to contribute to a private insurance plan. A expected, dancers in smaller companies were less likely to have medical insurance. If the two large, professional companies are excluded, out of 187 dancers in the remaining 26 companies, only 52 (27.8%) had WC insurance and only 19 (10.2%) had private insurance at least partially provided by their companies. Only 13.5% of the dancers in companies dancing less than half-time in season had WC insurance, and none had even partial support for private insurance. It is clear that dancers performing in small companies and those performing on a part-time basis rarely have medical insurance provided even in part by their dance companies. Some may have had medical insurance provided by outside sources, but this information was not available from our data collection method.

US Physician Adherence to Standards in Asthma Pharmacotherapy Varies by Patient and Physician Characteristics

US Physician Adherence to Standards in Asthma Pharmacotherapy Varies by Patient and Physician Characteristics

Sexual assault history, PTSD, and mental health service seeking in a national sample of women

AbstractThis study examined correlates of posttraumatic stress disorder (PTSD) and mental health service seeking for women sexually assaulted in childhood and/or adulthood (N = 619) identified from the National Comorbidity Survey (1990–1992). Factors related to correlates of PTSD and mental health service seeking varied according to sexual assault history. Ethnic minority women with less formal education, more traumatic and stressful life events, and longer duration of sexual abuse had greater odds of PTSD within certain sexual assault history subgroups. Mental health service seeking was predicted by demographics (e.g., more education, Caucasian race), as well as other psychosocial factors (e.g., life events, social support), and medical insurance status, especially for adult sexual assault victims. Implications for mental health treatment and intervention are drawn for women with different sexual assault histories. © 2002 Wiley Periodicals, Inc.