Health Insurance Coverage Projections For The US Population And Sources Of Coverage, By Age, 2024-34.

In the Congressional Budget Office's projections of health insurance coverage, 92.3 percent of the US population, or 316 million people, have coverage in 2024, and 7.7 percent, or 26 million, are uninsured. The uninsured share of the population will rise over the course of the next decade, before settling at 8.9 percent in 2034, largely as a result of the end of COVID-19 pandemic-related Medicaid policies, the expiration of enhanced subsidies available through the Affordable Care Act health insurance Marketplaces, and a surge in immigration that began in 2022. The largest increase in the uninsured population will be among adults ages 19-44. Employment-based coverage will be the predominant source of health insurance, and as the population ages, Medicare enrollment will grow significantly. After greater-than-expected enrollment in 2023, Marketplace enrollment is projected to reach an all-time high of twenty-three million people in 2025.

Long-term exposure to PM2.5 air pollution and mental health: a retrospective cohort study in Ireland.

BACKGROUND: Mental illness is the leading cause of years lived with disability, and the global disease burden of mental ill-health has increased substantially in the last number of decades. There is now increasing evidence that environmental conditions, and in particular poor air quality, may be associated with mental health and wellbeing. METHODS: This cross-sectional analysis uses data on mental health and wellbeing from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative survey of the population aged 50+ in Ireland. Annual average PM2.5 concentrations at respondents' residential addresses over the period 1998-2014 are used to measure long-term exposure to ambient PM2.5. RESULTS: We find evidence of associations between long-term exposure to ambient PM2.5 and depression and anxiety. The measured associations are strong, and are comparable with effect sizes for variables such as sex. Effects are also evident at relatively low concentrations by international standards. However, we find no evidence of associations between long-term ambient particulate pollution and other indicators of mental health and well-being such as stress, worry and quality of life. CONCLUSIONS: The measured associations are strong, particularly considering the relatively low PM2.5 concentrations prevailing in Ireland compared to many other countries. While it is estimated that over 90 per cent of the world's population lives in areas with annual mean PM2.5 concentrations greater than 10 µg/m3, these results contribute to the increasing evidence that suggests that harmful effects can be detected at even low levels of air pollution.

The effect of "smoky" coal bans on chronic lung disease among older people in Ireland.

Globally, coal is still widely used for heating. However, there are concerns about its effect on ambient air quality and health. We estimated the effect of bans prohibiting the sale and use of so-called "smoky coal" on the prevalence of chronic lung disease in older people. Our identification strategy relied on the phased extension of smoky coal bans to Irish towns after 2010. We examined five waves of The Irish Longitudinal Study on Ageing (TILDA), a large nationally representative survey containing detailed information on health, housing, and socio-economic status. Controlling for relevant factors, smoky coal bans reduced the probability that an older person reports being diagnosed with chronic lung disease by between three and five percentage points. In models where we estimated the effect of the ban on the incidence of new cases of chronic lung disease, rather than existing cases, we found the effect was between -0.96 and -2.5 percentage points. Our findings were robust to estimating the model using different sub-samples and control variables. Furthermore, to address potential endogeneity of the ban, we examined subsamples defined by whether participants lived in towns within a range of the population threshold at which the ban was imposed. Estimating our model using these subsamples showed a consistently negative effect of the ban. We also showed parallel trends in health outcomes before the treatment, and that the treatment did not affect attrition from the sample.

The Role of Equinus in Flatfoot Deformity.

Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.

Helicopter parenting during emerging adulthood: Consequences for career identity and adaptability.

This study explores the relationship between parental over involvement and the career development of emerging adults. Specifically, it investigates how emerging adults' career meta competencies of vocational identity formation and career adaptability relate to perceived helicopter parenting. Participants included 491 emerging adults studying in a Canadian University (74.1% female, average age = 20.4 years old). We begin by reviewing the commonalities between helicopter parenting and other parenting constructs and styles. Next, using structural equation modeling, we explore the relationships between perceived helicopter parenting and the components of vocational identity (exploration: in depth exploration, in breadth; commitment: career commitment, identification with commitment; and reconsideration: career self doubt, career flexibility) and career adaptability, as well as the relationships between identity components and career adaptability. Third, we explore the association between perceived helicopter parenting and identity status progress (i.e., achievement, foreclosure, moratorium, undifferentiated, and searching moratorium). Results indicate that individuals reporting higher levels of perceived helicopter parenting experience significantly lower levels of career adaptability and in-depth exploration. Furthermore, these individuals report higher levels of career self doubt and are more likely to be in the vocational identity status of searching moratorium. Limitations and future research directions are discussed.

The association between E. coli exceedances in drinking water supplies and healthcare utilisation of older people.

Evidence concerning the effects of indicators of waterborne pathogens on healthcare systems is of importance for policymaking, future infrastructure considerations and healthcare planning. This paper examines the association between the detection of E. coli in water tests associated with drinking water supplies and the use of healthcare services by older people in Ireland. Uniquely, three sources of data are linked to conduct the analysis. Administrative records of E. coli exceedances recorded from routine water quality tests carried out by Ireland's Environmental Protection Agency are first linked to maps of water systems infrastructure in Ireland. Then, residential addresses of participants of The Irish Longitudinal Study of Ageing (TILDA), a nationally representative survey of over 50-year-olds in Ireland, are linked to the water systems dataset which has the associated water quality monitoring information. Multivariate regression analysis estimates a greater incident rate ratio (IRR) of General Practitioner (GP) visits in the previous year where E. coli is detected in the water supply associated with an older person's residence (Incidence Rate Ratio (IRR) 1.118; [95% Confidence interval (CI): 1.019-1.227]), controlling for demographic and socio-economic factors, health insurance coverage, health, and health behaviours. Where E. coli is detected in water, a higher IRR is also estimated for visits to an Emergency Department (IRR: 1.292; [95% CI: 0.995-1.679]) and nights spent in hospital (IRR: 1.351 [95% CI: 1.004-1.818]).

The impact of inpatient bed capacity on length of stay.

OBJECTIVE: Large reductions in inpatient length of stay and inpatient bed supply have occurred across health systems in recent years. However, the direction of causation between length of stay and bed supply is often overlooked. This study examines the impact of changes to inpatient bed supply, as a result of recession-induced healthcare expenditure changes, on emergency inpatient length of stay in Ireland between 2010 and 2015. STUDY DESIGN: We analyse all public hospital emergency inpatient discharges in Ireland from 2010 to 2015 using the administrative Hospital In-Patient Enquiry dataset. We use changes to inpatient bed supply across hospitals over time to examine the impact of bed supply on length of stay. Linear, negative binomial, and hospital-month-level fixed effects models are estimated. RESULTS: U-shaped trends are observed for both average length of stay and inpatient bed supply between 2010 and 2015. A consistently large positive relationship is found between bed supply and length of stay across all regression analyses. Between 2010 and 2012 while length of stay fell by 6.4%, our analyses estimate that approximately 42% (2.7% points) of this reduction was associated with declines in bed supply. CONCLUSION: Changes in emergency inpatient length of stay in Ireland between 2010 and 2015 were closely related to changes in bed supply during those years. The use of length of stay as an efficiency measure should be understood in the contextual basis of other health system changes. Lower length of stay may be indicative of the lack of resources or available bed supply as opposed to reduced demand for care or the shifting of care to other settings.

The disconnected: COVID-19 and disparities in access to quality broadband for higher education students.

The COVID-19 pandemic forced many higher education institutions (HEIs) across the world to cancel face-to-face teaching, close campus facilities, and displace staff and students to work and learn from home. Given the persistent nature of the pandemic, many HEIs have continued to deliver courses online and/or use a blended learning approach. However, there are concerns around differences in student access to digital learning resources while at home, including high quality broadband connectivity. This is important, since variation in connectivity may impact the type of online/blended model that faculty can deliver or constrain student engagement with online content. In this context, this paper combines national data on the domiciles of students enrolled in Irish HEIs with detailed spatial data on broadband coverage to estimate the number of higher education students 'at risk' of poor access to high quality internet connectivity. Overall it finds that one-in-six students come from areas with poor broadband coverage, with large disparities by geography and by HEI. It also finds that students from the poorest broadband coverage areas are more likely to be socioeconomically disadvantaged. As a result, this paper recommends that HEIs use their detailed registration data to help identify and support at-risk students. In particular, the results suggest that some HEIs may need to prioritise access to campus facilities and services to less well-off students living in poor broadband coverage areas. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41239-021-00262-1.

Road traffic noise and cognitive function in older adults: a cross-sectional investigation of The Irish Longitudinal Study on Ageing.

BACKGROUND: The World Health Organization published updated Environmental Noise Guidelines in 2018. Included are recommended limit values for environmental noise exposure based on systematic reviews for a range of health outcomes, including cognitive impairment. There is emerging evidence in the literature that chronic exposure to road traffic noise may affect cognitive function in older adults, but this relationship is not well established. This study spatially linked nationally representative health microdata from The Irish Longitudinal Study on Ageing to building-level modelled noise data for two cities in the Republic of Ireland. This was used to investigate associations between exposure to road traffic noise and cognitive function in a sample of older adults, independent of a range of socio-demographic and behavioural characteristics, as well as exposure to air pollution. METHODS: We used the Predictor-LimA Advanced V2019.02 software package to estimate noise originating from road traffic for the cities of Dublin and Cork in Ireland according to the new common noise assessment methodology for the European Union (CNOSSOS-EU). Noise exposure values were calculated for each building and spatially linked with geo-coded TILDA microdata for 1706 individuals aged 54 and over in the two cities. Ordinary least squares linear regression models were estimated for eight standardised cognitive tests including noise exposure as an independent variable, with standard errors clustered at the household level. Models were adjusted for individual sociodemographic, behavioural and environmental characteristics. RESULTS: We find some evidence that road traffic noise exposure is negatively associated with executive function, as measured by the Animal Naming Test, among our sample of older adults. This association appears to be accounted for by exposure to air pollution when focusing on a sub-sample. We do not find evidence of an association between noise exposure and memory or processing speed. CONCLUSIONS: Long term exposure to road traffic noise may be negatively associated with executive function among older adults.

Area-level deprivation and geographic factors influencing utilisation of General Practitioner services.

Inequities in access to General Practitioner (GP) services are a key policy concern given the role of GPs as gatekeepers to secondary care services. Geographic or area-level factors, including local deprivation and supply of healthcare providers, are important elements of access. In considering how area-level deprivation relates to GP utilisation, two potentially opposing factors may be important. The supply of healthcare services tends to be lower in areas of higher deprivation. However, poorer health status among individuals in deprived areas suggests greater need for healthcare. To explore the relationship of area-level deprivation to healthcare utilisation, we use data from the Healthy Ireland survey, which provided a sample of 6326 respondents to face-to-face interviews. A u-shaped relationship between GP supply and area-level deprivation is observed in the data. Modelling reveals that residing in more deprived communities has a strong, statistically significant positive association with having seen a GP within the last four weeks, controlling for individual characteristics and GP supply. All else equal, residing in an area ranked in the most deprived quintile increases the odds of a respondent having visited the GP in four weeks by 1.43 (95% Confidence Interval: 1.15-1.78), compared to the least deprived quintile (p-value< 0.001). The findings indicate that the level of deprivation in an area may be relevant to decisions about how to allocate primary care resources.

Foliar Photodegradation in Pesticide Fate Modeling: Development and Evaluation of the Pesticide Dissipation from Agricultural Land (PeDAL) Model.

Pesticide dissipation from plant surfaces depends on a variety of factors including meteorological conditions, the pesticide's physicochemical properties, and plant characteristics. Models already exist for describing pesticide behavior in agriculture fields; however, they do not account for pesticide-specific, condition-specific foliar photodegradation and the importance of this component in such models has not yet been investigated. We describe here the Pesticide Dissipation from Agricultural Land (PeDAL) model, which combines (a) multiphase partitioning to predict volatilization, (b) a new kinetics module for predicting photodegradation on leaf surfaces under varying light conditions based on location and timing, and (c) a generic foliar penetration component. The PeDAL model was evaluated by comparing measured pesticide dissipation rates from field experiments, described as the time for the pesticide concentration on leaves to decrease by half (DT50), to ones generated by the model when using the reported field conditions. A sensitivity analysis of the newly developed foliar photodegradation component was conducted. We also showed how the PeDAL could be used by applicators and regulatory agencies. First, we used the model to examine how pesticide application timing affects dissipation rates. Second, we demonstrated how the model can be used to produce emission flux values for use in atmospheric dispersion and transport models.

Local NO2 concentrations and asthma among over-50s in Ireland: A microdata analysis.

BACKGROUND: Links between air pollution and asthma are less well established for older adults than some younger groups. Nitrogen dioxide (NO2) concentrations are widely used as an indicator of transport-related air pollution, and some literature suggests NO2 may directly affect asthma. METHODS: This study used data on 8162 adults >50 years old in the Republic of Ireland to model associations between estimated annual outdoor concentration of NO2 and the probability of having asthma. Individual-level geo-coded survey data from The Irish Longitudinal Study on Ageing (TILDA) were linked to model-based estimates of annual average NO2 at 50 m resolution. Asthma was identified using two methods: self-reported diagnoses and respondents' use of medications related to obstructive airway diseases. Logistic regressions were used to model the relationships. RESULTS: NO2 concentrations were positively associated with the probability of asthma [marginal effect (ME) per 1 ppb of airborne NO2 = 0.24 percentage points asthma self-report, 95% confidence interval (CI) 0.06-0.42, mean asthma prevalence 0.09; for use of relevant medications ME = 0.21 percentage points, 95% CI 0.049-0.37, mean prevalence 0.069]. Results were robust to varying model specification and time period. Respondents in the top fifth percentile of NO2 exposure had a larger effect size but also greater standard error (ME = 2.4 percentage points asthma self-report, 95% CI -0. 49 to 5.3). CONCLUSIONS: Associations between local air pollution and asthma among older adults were found at relatively low concentrations. To illustrate this, the marginal effect of an increase in annual average NO2 concentration from sample minimum to median (2.5 ppb) represented about 7-8% of the sample average prevalence of asthma.

Geographic inequalities in non-acute healthcare supply: evidence from Ireland.

Background: Recent reforms in Ireland, as outlined in Sláintecare, the report of the cross-party parliamentary committee on health, are focused on shifting from a hospital-centric system to one where non-acute care plays a more central role. However, these reforms were embarked on in the absence of timely and accurate information about the capacity of non-acute care to take on a more central role in the system. To help address this gap, this paper outlines the most comprehensive analysis to date of geographic inequalities in non-acute care supply in Ireland. Methods: Data on the supply of 10 non-acute services including primary care, allied health, and care for older people, were collated. Per capita supply for each service is described for 28 counties in Ireland (Tipperary and Dublin divided into North and South), using 2014 supply and population data. To examine inequity in the geographic distribution of services, raw population in each county was adjusted for a range of needs indicators. Results: The findings show considerable geographic inequalities across counties in the supply of non-acute care. Some counties had low levels of supply of several types of non-acute care. The findings remain largely unchanged after adjusting for need, suggesting that the unequal patterns of supply are also inequitable. Conclusions: In the context of population changes and the influence of non-need factors, the persistence of historical budgeting in Ireland has led to considerable geographic inequities in non-acute supply, with important lessons for Ireland and for other countries. Such inequities come into sharp relief in the context of COVID-19, where non-acute supply plays a crucial role in ensuring that acute services are preserved for treating acutely ill patients.

Does formal home care reduce inpatient length of stay?

Formal home care is an appropriate substitute for acute hospital care for many older people. However, limited empirical evidence exists on the extent of substitution between the supply of home care and hospital use. This study examines whether patients from areas with a better supply of home care have lower inpatient length of stay (LOS). We link administrative data on over 300,000 public hospital inpatient admissions in Ireland between 2012 and 2015 to region-year panel data on public home care supply. In addition to modeling average LOS, we estimate unconditional quantile regressions to examine whether home care supply has a disproportionately strong impact on long LOS. We find that inpatients from areas with higher per capita home care supply have lower average LOS; a 10% increase in home care is associated with a 1.2%-2.1% reduction in LOS. This result is driven by the subset of patients with the longest LOS, likely delayed discharges. Stronger results were found for stroke and hip fracture patients, who might be expected to have higher than average propensity to use home care services, and for patients from a region that experienced an unusually large increase in home care supply.

Demographic variation in active consumer behaviour: On-line search for retail broadband services.

Consumers who actively search for better broadband deals may benefit from lower prices or improved service quality compared to those who do not. If, however, consumers differ in their propensity to engage with the market and actively search, these potential benefits may not accrue equally. This paper investigates differences in consumer search activity for telecommunications services across small geographic areas. We exploit rich and novel data from a commercial price comparison site to explore the dispersion of consumer search in the Irish retail broadband market, while controlling for supply-side variations. By linking geo-coded searches to census data on small area socio-economic characteristics, we identify the areas where most search originates and can thus characterise the socio-economic groups to whom the benefits of search are most likely to accrue. We find evidence that areas populated by many highly educated, married people, commuters, mortgage holders, and retirees are among the most active in search. In contrast, those areas in which many older people, farmers, low-skilled workers and students reside give rise to significantly fewer consumer searches.

Characterising urban green space density and footpath-accessibility in models of BMI.

BACKGROUND: While exposure to urban green spaces has been associated with various physical health benefits, the evidence linking these spaces to lower BMI, particularly among older people, is mixed. We ask whether footpath availability, generally unobserved in the existing literature, may mediate exposure to urban green space and help explain this volatility in results. The aim of this study is to add to the literature on the association between urban green space and BMI by considering alternative measures of urban green space that incorporate measures of footpath availability. METHODS: We conduct a cross-sectional study combining data from The Irish Longitudinal Study on Ageing and detailed land use information. We proxy respondents' exposure to urban green spaces at their residential addresses using street-side and area buffers that take account of the presence of footpaths. Generalised linear models are used to test the association between exposure to several measures of urban green space and BMI. RESULTS: Relative to the third quintile, exposure to the lowest quintile of urban green space, as measured within a 1600 m footpath-accessible network buffer, is associated with slightly higher BMI (marginal effect: 0.80; 95% CI: 0.16-1.44). The results, however, are not robust to small changes in how green space is measured and no statistically significant association between urban green spaces and BMI is found under other variants of our regression model. CONCLUSION: The relationship between urban green spaces and BMI among older adults is highly sensitive to the characterisation of local green space. Our results suggest that there are some unobserved factors other than footpath availability that mediate the relationship between urban green spaces and weight status.

Understanding Trends in Pesticide Volatilization from Agricultural Fields Using the Pesticide Loss via Volatilization Model.

The Pesticide Loss via Volatilization model was developed to predict and understand pesticide volatilization rates from a planted agricultural field. The model allows the user to adjust the properties of the pesticide, various soil and plant descriptors, and climatic conditions. A useful output from the model is the 24 h cumulative percentage volatilization (CPV24h) loss. The model was validated by comparing modeled CPV24h values to measured ones compiled from the literature. Sensitivity analysis showed that the plant intercept fraction (%I), leaf area index (LAI), and leaf height (hleaf) strongly affect volatilization rates of plant- and soil-sorbed pesticides whereas LAI, hleaf, and the percent of water on the plant surface strongly affect more water-soluble pesticides. The model showed that most pesticides volatilize more readily from plants than from soil and that volatilization rates vary significantly for certain pesticides (but not all) when applied to plants at different growth stages and for different species of plants. Results are displayed on chemical space diagrams to paint a clear picture of how CPV24h varies for chemicals with different properties under different conditions.

An Examination of Myers-Briggs Type Indicator Personality, Gender, and Career Interests of Ontario Veterinary College Students.

The objectives of this study were to describe the Myers-Briggs Type Indicator (MBTI) distribution of Ontario Veterinary College (OVC) veterinary students (n = 1,249), and to evaluate its associations with gender and career interests. This was achieved by collecting pre-matriculation data from 11 graduating classes. Overall, OVC veterinary students were diverse in their MBTI types and preferences, as well as career interests. Extraversion, Sensing, Thinking, and Judging were the most prevalent preferences. Female veterinary students were 2.96 (95% CI = 2.11-4.17) times more likely to demonstrate the Feeling preference and 1.89 (95% CI = 1.41-2.56) more likely to prefer Judging, compared to male students (who were more likely to prefer the Thinking and Perceiving preferences, respectively). At entry to the veterinary program, students who preferred Intuition (vs. Sensing) were 2.08 (95% CI = 1.33-3.33) times more likely to be interested in a veterinary career other than practice, and 1.92 (95% CI = 1.43-2.56) times more likely to be undecided about their future veterinary career path. Both at entry to the program and in their final-year stream choice, students of the Thinking preference were more likely to select equine or food animal, rather than small animal practice, compared to students of the Feeling preference. There were additional significant associations regarding MBTI preferences and career interests. This study highlights the diversity of veterinary students, and provides an opportunity for educators to potentially expand their teaching methods and career guidance resources to better reach students of all MBTI preferences.

Chronic Toxicities of Neonicotinoids to Nymphs of the Common New Zealand Mayfly Deleatidium spp.

Neonicotinoid insecticides have been shown to have high chronic toxicity relative to acute toxicity, and therefore short-term toxicity tests ≤96 h in duration may underestimate their environmental risks. Among nontarget aquatic invertebrates, insects of the orders Diptera and Ephemeroptera have been found to be the most sensitive to neonicotinoids. To undertake a more accurate assessment of the risks posed by neonicotinoids to freshwater ecosystems, more data are needed from long-term tests employing the most sensitive taxa. Using nymphs of the common New Zealand mayfly genus Deleatidium spp., we performed 28-d static-renewal exposures with the widely used neonicotinoids imidacloprid, clothianidin, and thiamethoxam. We monitored survival, immobility, impairment, and mayfly moulting propensity at varying time points throughout the experiment. Imidacloprid and clothianidin exerted strong chronic toxicity effects on Deleatidium nymphs, with 28-d median lethal concentrations (LC50s) of 0.28 and 1.36 µg/L, respectively, whereas thiamethoxam was the least toxic, with a 28-d LC50 > 4 µg/L (highest concentration tested). Mayfly moulting propensity was also negatively affected by clothianidin (during 3 of 4 wk), imidacloprid (2 of 4 wk), and thiamethoxam (1 of 4 wk). Comparisons with published neonicotinoid chronic toxicity data for other mayfly taxa and larvae of the midge genus Chironomus showed similar sensitivities for mayflies and midges, suggesting that experiments using these taxa provide reliable assessments of the threats of neonicotinoids to the most vulnerable freshwater species. Environ Toxicol Chem 2019;38:2459-2471. © 2019 SETAC.

An investigation of the effect of accessibility to General Practitioner services on healthcare utilisation among older people.

Equity in access to healthcare services is regarded as an important policy goal in the organisation of modern healthcare systems. Physical accessibility to healthcare services is recognised as a key component of access. Older people are more frequent and intensive users of healthcare, but reduced mobility and poorer access to transport may negatively influence patterns of utilisation. We investigate the extent to which supply-side factors in primary healthcare are associated with utilisation of General Practitioner (GP) services for over 50s in Ireland. We explore the effect of network distance on GP visits, and two novel access variables: an estimate of the number of addresses the nearest GP serves, and the number of providers within walking distance of a person's home. The results indicate that geographic accessibility to GP services does not in general explain differences in the utilisation of GP services in Ireland. However, we find that the effect of the number of GPs is significant for those who can exercise choice in selecting a GP, i.e., those without public health insurance. For these individuals, the number of GPs within walking distance exerts a positive and significant effect on the utilisation of GP services.