A pattern of health insurance policy among smokers in the United States

A pattern of health insurance policy among smokers in the United States Abdulrasak Ejiwumi, Nathan Hale and Melissa White, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN Previous research has noted that Medicaid expansion has had a positive impact health care access and the quality of healthcare services among individuals with lower incomes. However, only a few studies have been conducted to describe the association between smoking and having any type of healthcare insurance in the United States. Health insurance provides access to important smoking cessation programs that are critical for enabling quit attempts. This study examines the extent to which insurance is associated with smoking cessation. We obtained data from the 2021 nationally representative Behavioral Risk Surveillance System Dataset. A descriptive analysis was conducted on adult smoking status and enrollment in any health insurance policy and variation based on race, gender, income, marital status, and level of education was examined using a Chi-square test. Current smoking status and any health insurance enrollment was also examined using an adjusted logistic regression analysis controlling for age, sex, income, marital status, and race/ethnic group. Among adult smokers in the United States (Sample size 167,079), 85.7% have health insurance while 10.2% do not have any type of health insurance. Approximately 69.5% of individuals with health insurance reported quitting smoking compared to 42.8% of those who do not have health insurance (p=0.001). Adjusting for additional covariates of interest, the odds of quitting smoking was 1.6 times higher for respondents with any type of health insurance compared to uninsured respondents (AOR 1.55, 95% CI=1.49 – 1.61). This study found that the access to health insurance is an important predictor of quitting smoking, even when adjusting for age, race, gender, marital status, levels of education, and income. Insurance remains an important enabling factor that provides the resources and supports necessary to enable smoking cessation programs and ultimately support smoking cessation. Continued efforts to increase access to health insurance are needed

Magnetically Assisted Capsule Endoscopy: A Viable Alternative to Conventional Flexible Endoscopy of the Stomach?

INTRODUCTION: Oesophagogastroduodenoscopy is the investigation of choice to identify mucosal lesions of the upper gastrointestinal tract, but it is poorly tolerated by patients. A simple non-invasive technique to image the upper gastrointestinal tract, which could be made widely available, would be beneficial to patients. Capsule endoscopy is well tolerated by patients but the stomach has proved difficult to visualise accurately with capsule technology due to its’ capacious nature and mucosal folds, which can obscure pathology. MiroCam Navi (Intromedic Ltd, Seoul, Korea) is a capsule endoscope containing a small amount of magnetic material which has been made available with a handheld magnet which might allow a degree of control. This body of work aims to address whether this new technology could be a feasible alternative to conventional flexible endoscopy of the stomach. METHODS: Four studies were conducted to test this research question. The first explores the feasibility of magnetically assisted capsule endoscopy of the stomach and operator learning curve in an ex vivo porcine model. This was followed by a randomised, blinded trial comparing magnetically assisted capsule endoscopy to conventional flexible endoscopy in ex vivo porcine stomach models. Subsequently a prospective, single centre randomised controlled trial in humans examined whether magnetically assisted capsule endoscopy could enhance conventional small bowel capsule endoscopy by reducing gastric transit time. Finally a blinded comparison of diagnostic yield of magnetically assisted capsule endoscopy compared to oesophagogastroduodenoscopy was performed in patients with recurrent or refractory iron deficiency anaemia. RESULTS: In the first study all stomach tags were identified in 87.2% of examinations and a learning curve was demonstrated (mean examination times for the first 23 and second 23 procedures 10.28 and 6.26 minutes respectively (p<0.001). In the second study the difference in sensitivities between oesophagogastroduodenoscopy and conventional flexible endoscopy for detecting beads within an ex vivo porcine stomach model was 1.11 (95% CI 0.06, 28.26) proving magnetically assisted capsule endoscopy to be non-inferior to flexible endoscopy. In the first human study, although there was no significant difference in gastric transit time or capsule endoscopy completion rate between the two groups (p=0.12 and p=0.39 respectively), the time to first pyloric image was significantly shorter in the intervention group (p=0.03) suggesting that magnetic control hastens capsular transit to the gastric antrum but cannot impact upon duodenal passage. In the last study, a total of 38 pathological findings were identified in this comparative study of magnetically assisted capsule endoscopy and conventional endoscopy. Of these, 16 were detected at both procedures, while flexible endoscopy identified 14 additional lesions not seen at magnetically assisted capsule endoscopy and magnetically assisted capsule endoscopy detected 8 abnormalities not seen by oesophagogastroduodenoscopy. No adverse events occurred in either of the human trials. Finally magnetically steerable capsule endoscopy induced less procedural pain, discomfort and distress than oesophagogastroduodenoscopy (p=0.0009, p=0.001 and p=0.006 respectively). CONCLUSION: Magnetically assisted capsule endoscopy is safe, well tolerated and a viable alternative to conventional endoscopy. Further research to develop and improve this new procedure is recommended

Unrestricted faecal calprotectin testing performs poorly in the diagnosis of inflammatory bowel disease in patients in primary care

BACKGROUND: Faecal calprotectin (FC) measurement distinguishes patients with inflammatory bowel disease (IBD) from those with irritable bowel syndrome but evidence of its performance in primary care is limited. AIMS: To assess the yield of IBD from FC testing in primary care. METHODS: Retrospective review of hospital records to assess the outcome following FC testing in primary care. Investigations for all patients undergoing FC testing in a single laboratory for 6 months from 1 October 2013 to 28 February 2014 were reviewed. RESULTS: 410 patients (162 male; median age 42; range 16-91) were included. FC>50 µg/g was considered positive (FC+). 148/410 (36.1%; median age 44 (17-91)) were FC+ (median FC 116.5 µg/g (51-1770)). 122/148 FC-positive patients (82.4%) underwent further investigation. 97 (65.5%) underwent lower gastrointestinal endoscopy (LGIE), of which 7 (7.2%) had IBD. 49/262 (18.7%) FC-negative (FC-) patients (FC ≤50 µg/g) (median age 47 (19-76)) also underwent LGIE, of whom 3 (6.1%) had IBD.IBD was diagnosed in 11/410 (2.7%; 4 ulcerative colitis, 3 Crohn's disease, 4 microscopic colitis). 8/11 were FC+ (range 67-1170) and 3 FC-. At a 50 µg/g threshold, sensitivity for detecting IBD was 72.7%, specificity 64.9%, positive predictive value (PPV) 5.41% and negative predictive value 98.9%. Increasing the threshold to 100 µg/g reduced the sensitivity of the test for detecting IBD to 54.6%. CONCLUSIONS: FC testing in primary care has low sensitivity and specificity with poor PPV for diagnosing IBD. Its use needs to be directed to those with a higher pretest probability of disease. Local services and laboratories should advise general practitioners accordingly

Differences in Stronger Versus Weaker Firefighters in Selected Measures of Power

International Journal of Exercise Science 15(4): 552-560, 2022. Firefighters are required to perform a wide array of physically demanding job tasks, such as forcible entry, charged hose advances and victim extractions. An adequate level of muscular strength and power are required to successfully perform these tasks. The purpose of this study is to investigate the differences in stronger and weaker firefighters in measures of power. Archived data for twenty-seven (age = 34.3 ± 7.9 yr, body height = 176.3 ± 7.2 cm, body mass = 89.4 ± 15.7 kg) full-time firefighters were analyzed. Participants were placed into one of two groups [i.e., stronger (HIGH) (n = 13) and weaker (LOW) (n = 14)], based on their relative isometric mid-thigh pull (IMTPr) performance. Power measures included counter-movement jump (CMJ) height, and peak anaerobic power in watts (PAPW). Significant mean score differences were not discovered between HIGH and LOW IMTPr groups on any measures of lower-body power. Moderate positive correlations were observed between IMTP and CMJ (r = .519; p = .01). This study identified significant differences in absolute and relative strength between firefighters who were able to lift at least 2.0x their bodyweight versus those who were not. Additionally, absolute strength (as assessed by the IMTP) was significantly and positively correlated to CMJ height when compared to their weaker counterparts. These findings may provide insight into approaches for improving occupational performance and durability through the physical development of firefighters via strength and conditioning programs which focus on developing absolute strength, relative strength, and power

Wind Energy Development: Methods for Assessing Risks to Birds and Bats Pre-Construction

Wind power generation is rapidly expanding. Although wind power is a low-carbon source of energy, it can impact negatively birds and bats, either directly through fatality or indirectly by displacement or habitat loss. Pre-construction risk assessment at wind facilities within the United States is usually required only on public lands. When conducted, it generally involves a 3-tier process, with each step leading to more detailed and rigorous surveys. Preliminary site assessment (U.S. Fish and Wildlife Service, Tier 1) is usually conducted remotely and involves evaluation of existing databases and published materials. If potentially at-risk wildlife are present and the developer wishes to continue the development process, then on-site surveys are conducted (Tier 2) to verify the presence of those species and to assess site-specific features (e.g., topography, land cover) that may inÀ uence risk from turbines. The next step in the process (Tier 3) involves quantitative or scienti¿ c studies to assess the potential risk of the proposed project to wildlife. Typical Tier-3 research may involve acoustic, aural, observational, radar, capture, tracking, or modeling studies, all designed to understand details of risk to specifc species or groups of species at the given site. Our review highlights several features lacking from many risk assessments, particularly the paucity of before-and-aftercontrol-impact (BACI) studies involving modeling and a lack of understanding of cumulative effects of wind facilities on wildlife. Both are essential to understand effective designs for pre-construction monitoring and both would help expand risk assessment beyond eagles

Traditional Owners of the Great Barrier Reef: the next generation of Reef 2050 actions

In short, this Report: Confirms that there are two options for progressing the integration of Traditional Owner interests in the Reef 2050 Plan. Option 1 (Business As Usual) represents a continuation of the current approach of Government-based review and refinement of the (now 23) Traditional Owner actions in the Reef 2050 Plan. Option 2 (Towards Genuine Co-governance) represents Government taking a far more negotiated approach at the GBR-wide level (and subsequently down to local scales) that applies the principles of Free Prior and Informed Consent. Based on extensive engagement concerning the aspirations of Traditional Owners and their support organisations across the GBR, the overwhelming stated desire and demand is for genuine partnership in the overarching governance of the Reef and far deeper ownership of, and participation in, its active day to day management (Option 2). There is an unambiguous view that the foundations set in the Reef 2050 Plan (Option 1), while a step in the right direction, simply reflect Traditional Owner aspirations in someone else’s planning. Meanwhile, a consistent message from Traditional Owners, fuelled by their existing and emerging rights in sea country, is that this more passive form of involvement cannot continue into the future; that a genuine form of agreement making and active implementation (from GBR to local scales) must emerge

Cataclysmic Variables in the First Year of the Zwicky Transient Facility

Using selection criteria based on amplitude, time, and color, we have identified 329 objects as known or candidate cataclysmic variables (CVs) during the first year of testing and operation of the Zwicky Transient Facility. Of these, 90 are previously confirmed CVs, 218 are strong candidates based on the shape and color of their light curves obtained during 3–562 days of observation, and the remaining 21 are possible CVs but with too few data points to be listed as good candidates. Almost half of the strong candidates are within 10 deg of the galactic plane, in contrast to most other large surveys that have avoided crowded fields. The available Gaia parallaxes are consistent with sampling the low mass transfer CVs, as predicted by population models. Our follow-up spectra have confirmed Balmer/helium emission lines in 27 objects, with four showing high-excitation He ii emission, including candidates for an AM CVn, a polar, and an intermediate polar. Our results demonstrate that a complete survey of the Galactic plane is needed to accomplish an accurate determination of the number of CVs existing in the Milky Way

Simulated Basic Skills Training: Graduate Nursing Students Teaching Medical Students: A Work in Progress

For a number of years, Advanced Practice Nursing (APN) students have taught interested 1st year medical students to perform intramuscular injections prior to their participation in community flu clinics. When several 4th year medical students needed documentation of competency in intravenous (IV) cannulation prior to participating in an elective rotation at another institution, the Medical School\u27s Dean of Students called the Director of Interdisciplinary Partnerships in the Graduate School of Nursing to request assistance. In fact, all medical students need IV therapy training prior to graduation, not just those who seek out visiting clerkships at other medical schools. Integration of IV training into the Undergraduate Medical Education Surgery Clerkship Curriculum supports the clinical objectives of the Surgery Clerkship along with the developing use of simulation within in the medical school. This need led to the development of this interdisciplinary simulation education initiative. Presented at the 2008 Society on Simulation in Healthcare Conference

Framework for a Community Health Observing System for the Gulf of Mexico Region: Preparing for Future Disasters

© Copyright © 2020 Sandifer, Knapp, Lichtveld, Manley, Abramson, Caffey, Cochran, Collier, Ebi, Engel, Farrington, Finucane, Hale, Halpern, Harville, Hart, Hswen, Kirkpatrick, McEwen, Morris, Orbach, Palinkas, Partyka, Porter, Prather, Rowles, Scott, Seeman, Solo-Gabriele, Svendsen, Tincher, Trtanj, Walker, Yehuda, Yip, Yoskowitz and Singer. The Gulf of Mexico (GoM) region is prone to disasters, including recurrent oil spills, hurricanes, floods, industrial accidents, harmful algal blooms, and the current COVID-19 pandemic. The GoM and other regions of the U.S. lack sufficient baseline health information to identify, attribute, mitigate, and facilitate prevention of major health effects of disasters. Developing capacity to assess adverse human health consequences of future disasters requires establishment of a comprehensive, sustained community health observing system, similar to the extensive and well-established environmental observing systems. We propose a system that combines six levels of health data domains, beginning with three existing, national surveys and studies plus three new nested, longitudinal cohort studies. The latter are the unique and most important parts of the system and are focused on the coastal regions of the five GoM States. A statistically representative sample of participants is proposed for the new cohort studies, stratified to ensure proportional inclusion of urban and rural populations and with additional recruitment as necessary to enroll participants from particularly vulnerable or under-represented groups. Secondary data sources such as syndromic surveillance systems, electronic health records, national community surveys, environmental exposure databases, social media, and remote sensing will inform and augment the collection of primary data. Primary data sources will include participant-provided information via questionnaires, clinical measures of mental and physical health, acquisition of biological specimens, and wearable health monitoring devices. A suite of biomarkers may be derived from biological specimens for use in health assessments, including calculation of allostatic load, a measure of cumulative stress. The framework also addresses data management and sharing, participant retention, and system governance. The observing system is designed to continue indefinitely to ensure that essential pre-, during-, and post-disaster health data are collected and maintained. It could also provide a model/vehicle for effective health observation related to infectious disease pandemics such as COVID-19. To our knowledge, there is no comprehensive, disaster-focused health observing system such as the one proposed here currently in existence or planned elsewhere. Significant strengths of the GoM Community Health Observing System (CHOS) are its longitudinal cohorts and ability to adapt rapidly as needs arise and new technologies develop