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Participation and crowd-out in a Medicare drug benefit: simulation estimates.

This article provides information on likely participation in the Medicare prescription drug plan and expected crowd-out. We use a microsimulation model based on data from the MCBS to estimate the costs and benefits of a Medicare drug plan, including the benefits from reductions in risk. The simulations are repeated using different combinations of benefits and subsidies. In addition, the simulations explore the effects of different behavioral parameters for moral hazard (the extent to which participants increase drug spending in response to reduced costs) and risk aversion (the extent to which participants would be willing to pay to avoid risk) to identify the impact of these factors on participation and crowd-out.

Aged↗

[Non-extraction approach using RPE to correct Angle Class I malocclusion with moderate crowding: A cephalometric study].

PURPOSE: To study cephalometric changes in Angle Class I malocclusion with moderate crowding treated orthodontically without extraction using rapid palatal expansion (RPE). METHODS: 9 patients with Angle Class I moderate crowding were orthodontically treated with a non-extraction approach using RPE and fixed edgewise appliances.The cephalometric analysis was performed at T1(pretreatment), T2(3 months after RPE) and T3(fixed retention period after active treatment). RESULTS: Lateronasal width, maxillary width, upper and lower first molar width significantly increased after rapid expansion (T1-T2) and after active treatment (T1-T3) with the significant difference in upper first molar width between T2 and T3. Total facial height, upper anterior facial height, the inclination of palatal plane and Y axis increased significantly (T1-T2, T1-T3). There were significant differences in the inclination of mandibular plane among T1, T2 and T3. CONCLUSION: Maxillary transverse width could increase using RPE. Rapid palatal expansion might not result in the anteroposterior changes.

Cephalometry↗

Family income and crowd out among children enrolled in Massachusetts Children's Medical Security Plan.

OBJECTIVE: To assess whether participation in a state publicly financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP) , which is open to children regardless of income, was associated with disenrollment from private insurance. DATA SOURCES/STUDY DESIGN: A survey of participants in CMSP who were enrolled as of April 1998 was used. We conducted analyses to detect differences in access to and uptake of private insurance between Medicaid-eligible and in eligible children, and between children eligible for the State Children's Health insurance Program (SCHIP) and in eligible children. DATA COLLECTION METHODS: A stratified sample of children was drawn from administrative files. the sampling strategy allowed us to examine crowd out among children based on in come and eligibility for publicly funded coverage: those who were Medicaid-eligible (income pound 133 percent of the federal poverty level [FPL]) , those who were SCHIP-eligible (134-200 percent of FPL) , and those with family in comes that exceed SCHIP eligibility criteria (> 200 percent of FPL). The majority of telephone interviews were conducted with the child's parent/guardian between November 1998 and March 1999. The overall response rate was 61.8 percent , yielding a sample of 996 children. PRINCIPAL FINDINGS: Of the children in our sample whose recent health coverage was employer-sponsored insurance (59 percent), 70 percent were no longer eligible. Few children who had employer-sponsored insurance at enrollment dropped this coverage to enroll in CM SP (1 percent, 4 percent, and 2 percent by income). Compared to Medicaid-eligible children, children with incomes > 133 percent of FPL were significantly more likely to be eligible for employer-sponsored insurance but they were no more likely to have purchased offered coverage. Access to employer-sponsored insurance was limited (19 percent), and uptake was low (13 percent). We found no significant difference between SCHIP-eligible children and those whose family incomes exceeded SCHIP guidelines. CONCLUSIONS: The Massachusetts experience suggests that (1) coverage could be expanded to children with incomes up to 200 percent of FPL with little direct substitution of public coverage for private insurance, and (2) substitution among children with incomes > 200 percent of FPL, who paid a premium that may have restrained crowd out, did not differ from that among SCHIP-eligible children.

Adolescent↗

The relation of amyloidosis to social stress induced by crowding in the Syrian hamster (Mesocricetus auratus).

The aim of the presented study was the investigation of a probable influence of social stress on spontaneous amyloidosis. As stress-inducing parameter crowding of the animals was used. 220 Syrian hamsters were kept individually (controls) or with 3, 5, 7 animals per cage. The crowded animals showed a significant decrease in mean survival time. This was linked to a histopathological examined significant increase in the extent and incidence of amyloidosis in several organs of both male and female hamsters. The kidneys and adrenals were most affected. Chronic inflammation as one probable amyloidosis-inducing factor, was not related to the observed morphological alterations. Furthermore the increase of amyloidosis was statistically not connected with an age-dependent development of amyloidosis. Amyloidosis in Syrian hamsters may be not a mere phenomenon of aging and age-related decline of the immune system but rather the results of a complex set of variables, including factors of social environment and social interactions that continuously put stress on the hamsters.

Amyloidosis↗

[Etiological problems of anterior tooth crowding: the role of the third molar].

The authors discussed about the extraction or not of the 3 degrees molar either to prevent or correct the dental crowding. They state that, since there is no definitive evidence of the real importance of the 3 degrees molar in creating dental crowding, it is not possible to perform without discrimination 3 degrees molar germectomy nor the extraction for prevention.

Adolescent↗

Interactions between glycolytic enzymes and cytoskeletal structure--the influence of ionic strength and molecular crowding.

In a study of the interactions between glycolytic enzymes and cytoskeletal structure, the effect of increasing the degree of molecular crowding by the addition of physiological concentrations of saline and protein was studied. Increasing the ionic strength to physiological levels resulted in only a slight decrease in the retention of most of enzymes, whereas the establishment of physiological concentrations of both saline and protein, caused a markedly increased degree of binding of all the glycolytic enzymes. The implications of this data have been discussed in relation to the relative affinities of interaction of the individual components, the influence of molecular crowding and the physiological significance of this phenomenon.

Animals↗

The influence of molecular crowding on the binding of glycolytic enzymes to cytoskeletal structure.

In a study of the interactions between glycolytic enzymes and cytoskeletal structure, the effect of increasing the degree of molecular crowding by the addition of protein was studied. This treatment resulted in an increased degree of binding of all the glycolytic enzymes, but with the most marked increases occurring with phosphofructokinase, enolase and pyruvate kinase. The significance of this data has been discussed in relation to the relative affinities of interaction of the individual components, the influence of molecular crowding and the physiological significance of this phenomenon.

Animals↗

Developmental physiology of cestodes: cyclic nucleotides and the identity of putative crowding factors in Hymenolepis diminuta.

Worm-conditioned saline (WCS) was prepared by incubating Hymenolepis diminuta from crowded infections for 12 hr in a balanced salt solution. The effect of the WCS on the incorporation of [3H] thymidine into DNA in the anterior regions of fresh H. diminuta was compared to effects produced by the cyclic nucleotides in the WCS. Cyclic AMP and cGMP were found in the WCS, and cGMP but not cAMP (at the concentration in WCS) caused some inhibition of DNA synthesis. For further study of the effects of cyclic nucleotides, worms were incubated with theophylline, caffeine, 3-isobutyl-1-methyl xanthine, 2-deoxy cGMP, and L-ascorbic acid, all of which produced some inhibition of [3H] thymidine incorporation. Treatment of WCS with 3',5' cyclic nucleotide phosphodiesterase abolished part of its inhibitory activity, i.e., that part presumed to be due to cGMP. When worms were incubated in the presence of succinate, acetate, D-glucosaminic acid, and cGMP simultaneously and in the concentrations each was found in the WCS, DNA synthesis was inhibited to a degree equal to that found in the WCS. Thus these substances apparently represent the putative crowding factors in the WCS. WCS prepared with worms from different population densities contained the same levels of cAMP but varied in content of cGMP, which decreased as the worm density increased. WCS prepared with patent worms contained high levels of cAMP, but the same amounts of cGMP as WCS prepared with 10-day-old worms. At least some inhibitors of cyclic nucleotide phosphodiesterase inhibited the secretion of cGMP by the worms. Levels of cGMP in the host intestine varied with the presence or absence of worms, number of worms, and area of the intestine.

Animals↗

An examination of the prepatent period and the absence of a crowding effect in Angiostrongylus cantonensis in laboratory rats.

The effects of the size of the infective inoculum on the prepatent period and the effect of crowding on body volume were examined in populations of Angiostrongylus cantonensis (Metastrongyloidea: Angiostrongylidae) in the laboratory rat. Groups of five rats were infected with 5, 10, 20 and 40 L3 of A. cantonensis, respectively. The prepatent period was determined by examination of faeces using a modified Baermann technique. The prepatent period ranged from 37 to 45 days and was best described by a negative logarithmic curve (y = 51.21 + x-3.838). Based on developmental data in the literature, it is suggested that 37 days represents the minimum prepatent period for A. cantonensis in this host. Worm population showed a significant, positive increase with inoculum size, yet there was no relationship between worm volume and population size in females and a slight, but significant, increase in worm volume and population size in males from rats necropsied 76-84 days post-infection. It is concluded that crowding is likely to have little effect on worm size in rats naturally infected with A. cantonensis.

Angiostrongylus↗

Crowding stress induces changes in serum haemolytic and agglutinating activity in the gilthead sea bream Sparus aurata.

Sea bream Sparus aurata were subjected to crowding for 3 weeks and the levels of plasma cortisol and glucose were determined in order to ascertain the occurrence of stress. At the same time, selected indicators of the immune response were monitored through blood lymphocyte counting and selected humoral responses such as the haemagglutination activity (HA) of serum towards rabbit erythrocytes (RaRBC) and the alternative complement pathway (ACP) levels. The results show an initial moderate increase in cortisol followed by hyperglycaemia and recovery to basal levels. A pattern of immunodepression was detected afterwards as shown by decreases in ACP levels after 5 days and haemagglutination titre and circulating lymphocytes after 9 days. Nevertheless, ACP levels showed a significant increase after 9 days, and HA titres and circulating lymphocyte numbers also increased after 15 days. Normal values were recovered after 15 days for lymphocytes and ACP and 21 days for agglutination. Results are discussed in view of the incidence of stress on indicative parameters of endocrine and immune systems.

Agglutination↗

Indolamines in the cockroach Blaberus craniifer Burm. nervous system--II. Fed and crowded young males in comparison with females.

1. Indolamines were assayed by HPLC-ECD in nervous tissue of fed and crowded young males Blaberus craniifer Burm. 2. In males, as in females housed in the same conditions, levels are depending on both age and region (= ganglia) of the central nervous system. 3. Registered sex differences are discussed in terms of anatomical, physiological and behavioral sexual dimorphism.

Animals↗

The effects of larval crowding and food type on the size and development of the blowfly, Calliphora vomitoria.

The use of entomological evidence in the estimation of the post mortem interval (PMI) often depends on the size and developmental stage of blowfly larvae collected from a corpse. Therefore, factors which can have an effect on the larval size and growth rate can have implications for reliable PMI determinations. This study explores the competitive effects of larval overcrowding on Calliphora vomitoria reared on three different pig tissues--liver, brain and muscle. The competitive feeding environment within the more crowded larval cultures resulted in increased development rates and the production of undersized larvae and adults. Variation in the extent of these effects was observed on each of the three body tissues, highlighting the importance of documenting the positions from which entomological evidence is recovered from a corpse.

Animals↗

Impact of environmental sanitation and crowding on infant mortality in rural Bangladesh.

In two villages of Bangladesh, 2471 infants born in 1976 and 1977 were followed up for a year to study the impact of environmental sanitation and crowding on their mortality. Neonatal and postneonatal mortality rates in the study cohort were 100 and 75 per 1000 live-births, respectively. Multiple logistic regression analysis was done to estimate the effects of the selected risk factors while controlling for some socioeconomic, demographic, and biological characteristics. Risk of postneonatal mortality (PNNM) in the households which did not use latrines was 3 X 12 times (p less than 0.01) higher than in those which did and 1.5 times (p less than 0.05) higher in the households with 10 or more persons than in smaller households. PNNM in the households which did not use tube-wells (hand-pump) water was higher, but not significantly so, than in those which used tube-well water for all purposes. Neonatal mortality was completely unrelated to the environmental factors investigated.

Bangladesh↗

Perception of crowding and personal space as a function of locus of control, arousal seeking, sex of experimenter, and sex of subject.

Twelve male and female college students served as Es and individually administered the following tests to a total of 72 male and female college students: Mehrabian and Russell's scale of Arousal-Seeking Tendency (AST), the Nowicki-Strickland scale of locus of control (ANSIE), a crowding perception test (CPT), and a figure placement task measuring perceived comfortable interpersonal distance (CID). Contrary to prediction, zero correlations were obtained between AST and CPT scores and between ANSIE scores and CID distances involving strangers. Low but significant correlations between CPT and CID scores were obtained. Analysis of variance of CID scores revealed a significant interaction between sex of S and locus of control that was not easy to interpret, and significant effects of degree of acquaintance, status, and sex of an approaching peer. A significant sex of E effect indicated that distances were larger with a female than with a male E. AST scores were larger for female than for male Ss, and larger with a male E than a female one.

Adolescent↗

Crowding effects of density and personal space requirements among older people: the impact of self-control and social support.

The authors examined the effects of self-control and social support among a representative sample of 300 older people, 150 in high-density and 150 in low-density households in India. The Self-Control Schedule (M. Rosenbaum, 1980), the Comfortable Interpersonal Distance Test (M. Duke & S. Nowicki, 1972), the Social Support Questionnaire, and the Judgement of Environmental Quality Scale (I. G. Sarason, H. M. Levine, R. B. Basham, & B. R. Sarason, 1983) were the measures. A 2 x 2 x 2 (Density x Social Support x Self-Control) analysis of variance for perceptions of home environment and personal space requirements revealed that the Self-Control x Social Support interaction moderated the crowding effects of density: The participants in high-density households evaluated their home environments more positively and reduced their personal space requirements.

Adaptation, Psychological↗

Heart morphological changes in rats placed in a crowded environment.

A group of rats were stressed by placing them in a crowded environment. Examination of the hearts showed the following anatomic changes: (1) increased weight; (2) occlusion of capillaries by platelet thrombi; (3) endothelial swelling of capillaries; and (4) swelling and deformity of mitochondria.

Animals↗

Oviposition attraction and repellency of Aedes aegypti (Diptera: Culicidae) to waters from conspecific larvae subjected to crowding, confinement, starvation, or infection.

As the biomass of Aedes aegypti (L.) larvae increased in relation to the volume of rearing waters, oviposition attraction of these waters to conspecific, gravid females first rose to a peak and then declined. Further increases in biomass rendered waters strongly repellent. Comparable responses were elicited by a decrease in the volume of rearing waters or an increase in the relative size or number of mosquito larvae. Low volumes of water reduced oviposition attraction and increased repellency, whereas larger volumes increased attraction. Excessively large volumes diluted attraction to neutrality. Constraints imposed by the physical dimensions of the larval environment which interfered with the normal postural movements and behaviors of the larvae also induced repellency, independent of rearing volume. Titration of repellent waters revealed that infection with the digenean Plagiorchis elegans (Rudolphi) generated the most powerful repellent effect, whereas crowding or starvation induced significantly weaker responses. At no time did dilution of repellent waters restore attractive properties. Repellents, even at minute concentrations, overrode attractants. The density-dependent action of oviposition attractants and repellents may help to maintain larval populations near optimal levels through their influence on recruitment. Oviposition repellency induced by sublethal infections with P. elegans may maintain population levels below the carrying capacity of the environment. Persistence of oviposition attraction and repellency varied inversely with temperature. The magnitude of the repellent effect induced by larvae appears to be a good indicator of their probability of survival and may be of selective significance. Repellency may deflect ovipositing females away from sites close to human habitation and may lead to new, and perhaps more effective, method, to control mosquitoes and the diseases they transmit.

Aedes↗