Figure 1.
Airplane ear.
This present study sought to investigate whether there were factors that could discriminate insured from uninsured rural Americans.
Data for four groups were used: 34 uninsured, 102 government-insured (GP), 324 private- or employer-insured (PEP), and 96 both government- and private- or employer-insured (GPEP). A discriminant analysis was conducted on the four groups, using group membership as the dependent variable; age, education, income, attitude to insurance, emergency room visit, chronic disease prevalence were the independent variables.
The analysis yielded three discriminant functions, however the only significant function was the one that discriminated the PEP-insured individuals from the other groups. About 48% of the cases were classified correctly with the significant discriminant function.
The findings of this study can serve as a baseline for future research seeking to eradicate barriers to getting health insurance among the uninsured in rural America.
Citation: Promise Tewogbola, Norah Aung. Identifying the insured and uninsured in rural America: an empirical discriminant analysis[J]. AIMS Public Health, 2021, 8(3): 421-427. doi: 10.3934/publichealth.2021032
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This present study sought to investigate whether there were factors that could discriminate insured from uninsured rural Americans.
Data for four groups were used: 34 uninsured, 102 government-insured (GP), 324 private- or employer-insured (PEP), and 96 both government- and private- or employer-insured (GPEP). A discriminant analysis was conducted on the four groups, using group membership as the dependent variable; age, education, income, attitude to insurance, emergency room visit, chronic disease prevalence were the independent variables.
The analysis yielded three discriminant functions, however the only significant function was the one that discriminated the PEP-insured individuals from the other groups. About 48% of the cases were classified correctly with the significant discriminant function.
The findings of this study can serve as a baseline for future research seeking to eradicate barriers to getting health insurance among the uninsured in rural America.
Airplane ear or ear discomfort during flight is common irrespective of ticket price we pay for our flights according to class. Whether we get extra leg space or extra facilities during flying in business class, air travelers often face this problem of airplane ear (Figure 1). Airplane ear is also known as ear barotrauma, barotitis media or aerotitis media [1]–[5]. Severe earache affects individuals of varying levels of social determinants of health as it is entirely a physiological phenomenon [3]. Airplane ear is commonly experienced when the airplane is ascending or descending, which makes it one of the commonest health problems for people travelling in air routes.
Generally, airplane ear occurs due to quick changes in altitude and quick changes in air pressure [4]. In normal physiological conditions, the air pressure in our middle ear cavity is nearly equivalent to that of the external ear canal. This equalization of air pressure is maintained physiologically and contributes to regular auditory function and maintenance of normal balance among individuals.
However, the eustachian tube dysfunction may occur with any changes in pressure and failure to ventilate through the middle ear space. This may result in outward bulging of the tympanic membrane causing moderate to severe earache. This phenomenon can be compared with a bread expanding while baking [3],[5].
Conversely, due to the vacuum effect, if the air pressure inside the middle ear space reduces rapidly compared to the external ear pressure, the tympanic membrane may be pulled inside due to the pressure gradient. The eustachian tube becomes flattened during the pressure changes and it necessitates bringing air into the middle ear (Figure 2). During sudden ascend or descend of an aeroplane, ear cavity pressure is often decreased complemented by an increase in the cabin compared to the outside air pressure. In such a scenario, the unusual stretching of the eardrum or tympanic membrane may precipitate pain in the ear. At the same time, individuals may also experience decreased hearing abilities and muffled sounds as the eardrum as it becomes unable to vibrate normally [2]–[4].
The pathophysiology remains the same in cases of scuba diving, in hyperbaric oxygen chambers, and during explosions happening nearby [2].
Airplane ear can in occur unilaterally or in both ears. Signs and symptoms of Airplane air include discomfort, pain, and fullness in ear, and mild to moderate hearing loss in acute cases. Moreover, for severe cases, affected individuals may experience severe pain, moderate to severe hearing loss, tinnitus, vertigo, and hemotympanum (severe form).
The common risk factors for airplane ear include—small eustachian tube (infants and toddlers), common cold, acute or chronic sinusitis, allergic rhinitis, otitis media, and napping on an airplane during rapid pressure change in our middle ear. Permanent damage may occur in the membranous linings of the middle ear or eustachian tube, which agammaavates the problem further [6].
Generally, airplane ear does not pose problems unless there is any structural damage in the middle ear. Rare complications may include permanent hearing loss and chronic tinnitus [6],[7].
It is very surprising that despite being a very common condition, no prior preventive instruction is given by the air hostesses/airplane authority about this phenomenon. Although the airline authorities provide a lot of instructions to the passengers regarding emergency landing in the water, power failures, low oxygen supply to the cabin and so on; airplane ear remains a neglected health issue in aerospace safety measures.
Furthermore, if a baby suddenly cries or elderly adults feel ear discomfort or pain during rapid descent of ascent of an airplane, then the flight attendants would rush to the sufferers and offer instructions/help. Sometimes, they may have to manage emergencies like ear bleeding by apply ear packs. All these health hazards and associated challenges can be easily prevented if airplane authorities include following preventive instructions for airplane air with existing life-saving instructions.
For frequent fliers, surgically placed tube in the eardrums is generally helpful to aid fluid drainage in the middle air, particularly for those who are prone to severe airplane ear. This tube helps in ventilating air to the middle ear, and equalize the pressure between the outer and middle ear.
Airplane ear is a common yet, ignored public health problem. It can be handled effectively if proper precautions/corrective measures are adopted. Previously in the airlines, lozenges were offered, which may have helped the passengers to avoid this problem, but now a days it is less commonly practiced. The airplane authority should explore socio-culturally appropriate and evidence-based strategies and incorporate them with the preventive and curative instructions for the passengers. Moreover, the flight attendants may be trained in recognizing and managing airplane ear alongside other life-saving instructions to their passengers. It may decrease the air discomforts and empower the air passengers during air travel.
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Benitez JA, Seiber EE (2018) US health care reform and rural America: results from the ACA's Medicaid expansions. J Rural Health 34: 213-222. doi: 10.1111/jrh.12284
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Huguet N, Angier H, Hoopes MJ, et al. (2019) Prevalence of pre-existing conditions among community health center patients before and after the Affordable Care Act. J Am Board Fam Med 32: 883-889. doi: 10.3122/jabfm.2019.06.190087
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| [4] | Cha AE, Cohen RA (2020) Reasons for Being Uninsured Among Adults Aged 18–64 in the United States, 2019. NCHS Data Brief 1: 1-8. |
| [5] | Foutz J, Artiga S, Garfield R (2017) The role of Medicaid in rural America Washington, DC: Kaiser Family Foundation. |
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Wippold GM, Nmezi N, Williams JL, et al. (2020) An Exploratory Study to Understand Factors Associated with Health-related Quality of Life Among Uninsured/Underinsured Patients as Identified by Clinic Providers and Staff. J Prim Care Community Health 11: 2150132720949412. doi: 10.1177/2150132720949412
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Fernandez-Lazaro CI, Adams DP, Fernandez-Lazaro D, et al. (2019) Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Res Social Adm Pharm 15: 744-753. doi: 10.1016/j.sapharm.2018.09.006
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Promise Tewogbola, Norah Aung. Identifying the insured and uninsured in rural America: an empirical discriminant analysis[J]. AIMS Public Health, 2021, 8(3): 421-427. doi: 10.3934/publichealth.2021032
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