Lack of health insurance among juvenile offenders: a predictor of inappropriate healthcare use and reincarceration?

OBJECTIVES: Relationships between the health insurance status and healthcare use among justice-involved youths transitioning into adulthood is an underexplored topic, even if transition to adulthood is a crucial time period for healthcare outcomes. To fill in these knowledge gaps, this study had two aims: (1) to examine trajectories of health insurance coverage and healthcare use among serious juvenile offenders transitioning into adulthood; and (2) to explore associations between the lack of health insurance, healthcare use and reincarceration. STUDY DESIGN: We conducted a secondary analysis on the data of the US longitudinal Pathways to Desistance study between ages 20 and 23 years (2000-2010). METHODS: Participant data on health insurance coverage, healthcare use, reincarceration and sociodemographic variables (n = 1215) were extracted and analysed using descriptive statistics, generalized linear regressions and cross-lagged panel models. RESULTS: About half of the young offenders had no health insurance coverage or intermittent coverage between the age of 20 and 23 years. Emergency services were used (≥17.4%), notably more by insured participants and were increasingly used over time. Being uninsured at the age of 20 years was associated with reincarceration at the age of 23 years (b = -0.052, p = 0.014, odd-ratio = 0.95), but incarceration at the age of 20 years did not predict the insurance status at the age of 23 years (b = 0.009, p = 0.792). CONCLUSIONS: Serious juvenile offenders, especially if uninsured, faced major barriers to accessing health care and often reported an inappropriate healthcare use. This likely led to reincarceration. The lack of continuity of care and of access to health care may, therefore, increase health disparities, and efforts are needed to mitigate detrimental outcomes, by effective in and out of detention coordination of health insurance coverage and among health services.

[Psychological stress in patients with environmentally-induced disorders. A comparison between self concept and expert assessment]. / Seelische Belastung bei Menschen mit umweltbezogenen Störungen Ein Vergleich zwischen Selbstbild und Fremdeinschätzung.

Environmental illnesses raise diagnostic and therapeutic conflicts in scientific discussions and clinical practice. When a patient's health-belief model, based on environmental origins, does not match that of the expert, the therapeutic relationship can be endangered. Our study investigates this discrepancy, which has not been empirically evaluated so far. Patient (n=61) and expert disease concepts were systematically investigated. Our results indicate that in cases in which both concepts are favourable, the patient suffered minor psychiatric disorders with stable psychic structures and the symptoms were associated with medical or environmental causes. If both concepts were unfavourable, a higher proportion of psychiatric disorders with unstable psychic structures were present. In the case of incongruent concepts, the expert evaluations allow a more accurate assessment of the psychiatric diagnoses, psychic states and the psychic attribution of somatic and psychic burden.

Safety, efficacy and cost of three cervical cytology sampling devices in a prenatal clinic.

OBJECTIVE: To evaluate and compare the safety, efficacy and cost of three cervical cytology sampling devices in pregnant women presenting for prenatal care to the obstetrics clinic, at Medical College of Pennsylvania Hospital. STUDY DESIGN: From September 7, 1993, to November 5, 1993, 61 cervical cytologic smears were obtained using the Cell-Sweep. From November 8, 1993, to January 7, 1994, 66 smears were obtained using the Ayre spatula/Cytobrush, and from January 10, 1994, to February 18, 1994, 55 smears were obtained using the Ayre spatula/cotton swab. The rate of smears with no endocervical component or with epithelial cell abnormality was determined for each group. The patients' medical records were reviewed retrospectively to determine complications occurring within two weeks of smear collection. RESULTS: Fifteen (25%) smears in the Cell-Sweep group, one (1.5%) in the Cytobrush group and nine (16%) in the cotton swab group were satisfactory but limited by absence of an endocervical component (P < .0006). None of the smears were unsatisfactory. Eleven (18%) smears in the Cell-Sweep group, eight (12%) in the Cytobrush group and nine (16%) in the cotton swab group revealed an epithelial cell abnormality (P = .643). For all three groups there was a low rate of spontaneous abortion, preterm spontaneous rupture of membranes or preterm labor occurring within two weeks of collection. There was no statistically significant difference in these complications between the three groups (P = .7). The Ayre spatula/cotton swab is the least expensive device. CONCLUSION: The Ayre spatula/cotton swab was the most satisfactory of the three methods tested for obtaining cervical cytology during pregnancy. It is safe and cost-effective and identifies the same proportion of epithelial cell abnormalities as the Ayre spatula/Cytobrush and the Cell-Sweep.

Socioeconomic status, ethnicity, psychological distress, and readiness to utilize a mental health facility.

The effects of minority status versus ethnic culture on Mexican-Americans' underutilization of mental health services were reassessed through development and testing of an analytic path model that proposes a sequence of factors, including Mexican-American ethnicity, socioeconomic status, degree of social and institutional support, and depression, which culminate in a person's decision to utilize mental health facilities. The model also predicts that life stress will affect utilization through its influence on depression. Data from 783 subjects generally supported the model's predictions. A multifactorial approach to the causes of mental health problems and utilization behavior in the Mexican-American population is suggested.

Class, perceptions of 'disordered' behaviour, and suggestions for therapy: a tri-cultural comparison.

This paper presents findings from a tri-cultural study in which we argue that class differences pertain not only to rates of mental illness but also to recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting 'disordered behaviour'. It is hypothesized that regardless of respondent's cultural background, the extent to which a deviant behaviour will be defined as a mental health problem, and professional therapy will be suggested as a source of help for that problem, will be positively related to class. Findings from a sample selected from two small West Texas communities, and samples selected from Durango, Mexico, and Juiz de Fora, Brazil, indicate strong support for the first prediction only among the West Texas sample, whereas the second hypothesis concerning therapy suggestions is strongly supported among respondents in all three cultural settings. We conclude that these class differences in perceptions and suggestions concerning five examples of 'disordered' behaviours read to respondents relate to conditions of lower-class life in general. Particularly, structural support found for our hypothesis leads us to suggest a need for informal, nonbureaucratic mental health care systems created to serve lower-class populations residing in class-oriented societies, regardless of cultural differences which may exist among these societies.

A model of the demand for medical and health services in Peninsular Malaysia.

This paper provides an empirical analysis of the determinants of the demand for medical services in Peninsular Malaysia. After elaborating a theoretical model of household demand for medical care in Section II an econometric model is specified and estimated in Sections III, IV, and V. The results indicate that total medical demand, as measured by the absolute volume of outpatient and inpatient consumption, is highly inelastic to the cash price and to the cost in time of utilization. Total medical demand is also inelastic with respect to income. Yet consumers are clearly responsive to the relative prices of alternative sources of medical care. Consumers are also sensitive to the way in which the time of utilization is spent, with high travel and treatment time causing reduced demand for services.

Socio-economic class, classification of 'abnormal' behaviour and perceptions of mental health care: a cross-cultural comparison.

This paper is a replication of a study in which we argue that class differences pertain not only to rates of mental illness but also to the recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting 'disordered behaviour'. Our previous findings from a sample of two small West Texas communities indicated that class differences did hold for both recognition of an recommendations fo9r help regarding behaviours which are commonly considered as 'disordered' by professional mental health personnel. We concluded that these differences were related to conditions of lower-class life, particularly a sense of powerlessness. In this paper we hypothesize that in societies where the two classes share high powerlessness, the differences in response to disordered behaviour will be less pronounced. To test this thesis, we obtained data from lower- and middle-class samples in Durango, Mexico, where both classes have been found to possess a high degree of powerlessness compared with the American sample. Findings lend support to our hypothesis.

Malnutrition, child morbidity and the family decision process.

PIP: A microeconomic model of the process by which infants and preschoolers are subject to malnourishment, diarrhea and other illnesses in developing countries is given. The model is econometrically based of a cross-section time-series for 1200 children from Candelaria, Colombia. Four primary issues are addressed: economic constraints and intra-family resource allocation decisions impacting on a child's nutritional and health status; the interrelationship between malnutrition, diarrhea, and other diseases; specific policy interventions (maternal-child health education, food supplementation and the encouragement of breast feeding) impacting on health and nutritional status; and the need to distinguish between the effect of different policy variables on a child's height and weight during infancy and preschool age. The observations were taken over a 7 year period during the Promotora maternal-child health program in Colombia.^ieng

[Histometric studies of thyroid glands of swine with treated and untreated strumata with special reference to the importance of morphological findings for the assessment of thyroid function]. / Histometrische Untersuchungen an Schilddrüsen von Schweinen mit behandelten und unbehandelten Strumen unter besonderer Berücksichtigung der Bedeutung der morphologischen Befunde für die Funktionsbeurteilung der Schilddrüse.

Thyreocyte measurements were applied to 20 thyroids each of three groups of pigs for slaughter kept in the region of the Baltic coast. The first group consisted of clinically intact animals, the second of animals with untreated goiters, and the third of animals with goiters and potassium-iodine treatment. Hundred cells were measured in each of the animals, the magnification factor being 2,000. Mean values were calculated for each animal and group. The mean epithelial levels were 7.34 +/- 0.71 micrometer in Group 1, 13.77 +/- 1.97 micrometer in Group 2, and 4.25 +/- 0.52 micrometer in Group 3. The follicles recorded from the third group were one-a-half to three times as large as those recorded from the first. The mean thyroid weights were 11.8 +/- 5.0 g in the first group, 46.3 +/- 28.9 g in the second, and 23.5 +/- 7.9 g in the third. The relevance of such morphological findings to assessment of thyroid function is discussed. It is proposed to include such tests in any assessment of a problem situation in the context of thyroid function and in any evaluation of therapeutic success.

Sociocultural barriers to medical care among Mexican Americans in Texas: a summary report of research conducted by the Southwest Medical Sociology Ad Hoc Committee.

This paper summarizes research findings from members of the Southwest Medical Sociology Ad Hoc Committee concerning sociocultural barriers to medical care among Mexican Americans in Texas. Committee members individually, or in two-person groups, studied a number of factors concerning Mexican-American medical care in Texas such as: 1) mortality, morbidity, and other health status indicators; 2) health manpower and educational needs; 3) political factors impeding economical health care; 4) alienation, familism, and their relationship to utilization of the health services; 5) language and communication barriers; and 6) folk medicine. Findings include documentation that structural alienation of Mexican-Americans from mainstream Anglo-American middle-class society is carried over into their relation with utilization of the health care delivery system; that their emphasis on familism works alternatively to encourage and discourage their seeking access to health care; the language differences serve to perpetuate certain cultural differences that are inimical to health care delivery; and that curanderismo can be seen as complementing other types of health care. The report concludes with a number of recommendations for accomplishing cultural integration that will lead to better care for this segment of the health population.