Public Health Commons^™

The Federal-State Medicaid Match: An Ongoing Tug-Of-War Over Practice And Policy, Karen Matherlee

National Health Policy Forum

Reviewing Medicaid match issues since the latter 1980s, this issue brief traces ways in which some states have used creative financing to get more Medicaid matching dollars than they otherwise would qualify for from the federal government. It explores the latest mechanism, states' use of so-called intergovernmental transfers of funds (to avoid established upper payment limits) to increase their matches, triggering efforts by the Senate Finance Committee and the federal Medicaid agency to ban such transfers.

European Madness And Mad Cow Disease, Ibpp Editor

International Bulletin of Political Psychology

This article describes some of the psychological factors that might attenuate unadaptive anxieties about the threat of bovine spongiform encephalopathy, mad cow disease.

Risk Factors And Gender Differentials For Death Among Children Hospitalized With Diarrhoea In Bangladesh, Amal K. Mitra, Mohammad M. Rahman, George J. Fuchs

Faculty Publications

To identify risk factors for death among children with diarrhoea, a cohort of 496 children, aged less than 5 years, admitted to the intensive care unit of a diarrhoeal disease hospital in Bangladesh, was studied during November 1992-June 1994, Clinical and laboratory records of children who died and of those who recovered in the hospital were compared, Deaths were significantly higher among those who had altered consciousness, hypoglycaemia, septicaemia, paralytic ileus, toxic colitis, necrotizing enterocolitis, haemolytic-uraemic syndrome, invasive or persistent diarrhoea, dehydration, electrolyte imbalances, and malnutrition, Females experienced a 2-fold higher risk of death than males (p=0.003). Several indices of …

Justice In Health Care Access Measuring Attitudes Of Health Care Professionals, Sandra Blanton

Masters Theses & Specialist Projects

To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved …

Toward Improved Support For Research On Delivery Of Home- And Community-Based Long-Term Care, Francis G. Caro

Gerontology Institute Publications

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research.

An Analysis Of Risk Factors Associated With High Rates Of Cesarean Births In Three Selected Northeast Tennessee Hospitals., Karen Stewart-Hall

Electronic Theses and Dissertations

This study consists of an analysis of hospital discharge data from three Northeast Tennessee hospitals to identify maternal demographic factors that may be linked to higher rates of cesarean sections in this region of Appalachia. Maternal age, race, insurance status, length of stay, and birth weight were evaluated to identify regional trends in the prevalence of these factors over a two-year period.

There were 1,678 (23.3%) singleton live births by cesarean section of which 7.6% were repeat cesarean section deliveries. Less than one percent of the 7,181 births were vaginal births after cesarean (VBAC) delivery. Overall, insurance and maternal age …

Proteolytic Enzymes In The Marine Bacterium Pseudoalteromonas Atlantica: Post-Secretional Activation And Effects Of Environmental Conditions, Monica Hoffman, Alan W. Decho

Faculty Publications

Production and activities of cellular and extracellular proteolytic enzymes associated with the marine bacterium Pseudoalteromonas atlantica were examined in response to physiological state and changing environmental variables under laboratory conditions. Enzymes evidenced by zymography were metalloproteases, as defined by substrate preference and susceptibility to inhibitors (EDTA and 1, 10-phenanthroline). Distinct bands (i.e. molecular-weight [MW] size classes) of enzymes were isolated from within cellular and extracellular compartments. Susceptibility of extracellular enzymes to environmental stressors was related, in part, to the MW size classes of the enzymes. While all bands of enzymes showed some degree of inhibition when pH was decreased, the …

Biomedical Research Leaders: Report On Needs, Opportunities, Difficulties, Education And Training, And Evaluation, Samuel H. Wilson, Deborah Brown, Jay Moskowitz, Dan Hurley, David Brown, David Brown, Byron J. Bailey, Michael Mcclain, Marilyn Misenhimer, Judith Buckalew, Thomas Burks

Faculty Publications

The National Association of Physicians for the Environment (NAPE) has assumed a leadership role in protecting environmental health in recent years. The Committee of Biomedical Research Leaders was convened at the recent NAPE Leadership Conference: Biomedical Research and the Environment held on 1–2 November 1999, at the National Institutes of Health, Bethesda, Maryland. This report summarizes the discussion of the committee and its recommendations. The charge to the committee was to raise and address issues that will promote and sustain environmental health, safety, and energy efficiency within the biomedical community. Leaders from every important research sector (industry laboratories, academic health …

Caring For The Elderly: Oregon's Pioneers (Portland, Oregon), Nora Super, Lisa Sprague

National Health Policy Forum

This site visit looked at the continuum of care for its elderly and disabled citizens in the first state ever to secure Section 1915(c) and (d) waivers under Medicaid to support home- and community-based services. More than three-quarters of Oregon's Medicaid clients now receive care in these settings. Site visitors were briefed on the history and development of long-term care in the state as well as the various care settings available. Panels discussed strategies and partnerships focused on alleviating workforce shortages and highlighted Oregon nurses' authority to delegate certain caregiving tasks to laypeople. Multnomah County staff described county-level activities, especially …

Emerging Issues In The Use Of Binding Arbitration To Resolve Disputes Between Individuals And Health Plans, Karl Polzer

National Health Policy Forum

After briefly describing the federal legal framework fostering the growth of binding arbitration, this paper identifies controversies surrounding arbitration as well as arguments supporting and opposing its use. The paper describes the use of arbitration among certain types of collectively bargained employee health plans regulated under the Employee Retirement Income Security Act of 1974 (ERISA), by health maintenance organizations (HMOs) in California, and by a large employer operating a self-insured ERISA health plan. Evidence cited by the California Supreme Court that the largest HMO in California operated its mandatory arbitration program in an unfair way is presented, along with the …

The Use Of Uniaxial And Triaxial Accelerometers To Measure Children's "Free-Play" Physical Activity, Alise E. Ott, Russell R. Pate, Stewart G. Trost, Dianne S. Ward, Ruth P. Saunders

Faculty Publications

In order to effectively measure the physical activity of children, objective monitoring devices must be able to quantify the intermittent and nonlinear movement of free play. The purpose of this study was to investigate the validity of the Computer Science and Applications (CSA) uniaxial accelerometer and the TriTrac-R3D triaxial accelerometer with respect to their ability to measure 8 "free-play" activities of different intensity. The activities ranged from light to very vigorous in intensity and included activities such as throwing and catching, hopscotch, and basketball. Twenty-eight children, ages 9 to 11, wore a CSA and a heart rate monitor while performing …

Prevalence Of Non-O157:H7 Shiga Toxin-Producing Escherichia Coli In Diarrheal Stool Samples From Nebraska, Paul Fey, R. S. Wickert, M.E. Rupp, T. J. Safranek, S. H. Hinrichs

Public Health Resources

We determined the prevalence of Shiga toxin-producing Escherichia coli (STEC) in diarrheal stool samples from Nebraska by three methods: cefixime-tellurite sorbitol MacConkey (CT-SMAC) culture, enterohemorrhagic E. coli (EHEC) enzyme immunoassay, and stx_1,2 polymerase chain reaction (PCR). Fourteen (4.2%) of 335 specimens were positive by at least one method (CT-SMAC culture [6 of 14], EHEC enzyme immunoassay [13 of 14], stx_1,2 PCR [14 of 14]). Six contained serogroup 0157, while non-0157 were as prevalent as 0157 serogroups.

Analysis Of 200 Food Items For Benzo[A]Pyrene And Estimation Of Its Intake Ίη An Epidemiologic Study, Ν. Kazerouni, R. Sinha, Che-Han Hsu, Α. Greenberg, Ν. Rothman

Public Health Resources

Animal stιιdies have shown that dietary intake of benzo[α]pyrene (BaP), a polycyclic aromatic hydrocarbon (ΡΑΗ), causes increased levels of tumors at several sites, particιιlarly ίη the upper gastrointestinal tract. However, the role of dietary intake of BaP and cancer ίη humans is not clear. We CIeated a BaP database of selected food products that could be lίnl(ed to Food Frequency Qnestionnaires (FFQs) to estimate BaP intake. BaP levels were measnred for each food line-item (composite samples) which consisted of a variety of foods ίη a FFQ. Composite sample parts were derived from the Second National Health and Nutrition Examination Survey …

Clinical Spectrum Of Systemic Lupus Erythematosus At The Aga Khan University Hospital., K. Sulaiman, N. Sohail, A. A. Sheikh, F. Raza, F. Shahzad, A. Siddique, T. Shakir, Fauziah Rabbani

Community Health Sciences

BACKGROUND:

Systemic lupus erythematosus is a disease of unknown etiology, which at onest may involve only one organ system or be multisystemic. The aim of our study is to determine the clinical presentation of SLE patients presenting to AKUH to establish whether guidelines laid down about this disease are in agreement with our experience.

METHODS:

A retrospective log review was carried out at AKUH, based on data obtained from 165 files of individuals admitted to the hospital over a period of 12 years with a confirmed diagnosis of SLE.

RESULTS:

From the sample size of 165, 143 (86.7%) were females …

Dna Ploidy Analysis Of Borderline Epithelial Ovarian Tumours, Saba Lodhi, Sabeen Najam, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective: Borderline epithelial ovarian tumors not uncommonly pose a great difficulty to surgical pathologists as morphologically they may show very similar features as those of malignant epithelial tumors except invasion. However it is important to separate these from their invasive counterparts because of their superior prognosis. Recently, attention has been focussed on the prognostic value of flow cytometric analysis of DNA ploidy in borderline epithelial ovarian tumors. The purpose of this study is to investigate whether flow cytometric analysis of cellular DNA content acts as a useful adjunct to the histopathological diagnosis of borderline malignancy.

Materials and Methods: Fifteen histologically …

Factor Analysis Of The Dsm-Iii-R Borderline Personality Disorder Criteria In Psychiatric Inpatients, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: The goal of this study was to examine the factor structure of the DSM-III-R criteria for borderline personality disorder in young adult psychiatric inpatients.

Method: The authors assessed 141 acutely ill inpatients with the Personality Disorder Examination, a semistructured diagnostic interview for DSM-III-R personality disorders. They used correlational analyses to examine the associations among the different criteria for borderline personality disorder and performed an exploratory factor analysis.

Results: Cronbach’s coefficient alpha for the borderline personality disorder criteria was 0.69. A principal components factor analysis with a varimax rotation accounted for 57.2% of the variance and revealed three homogeneous factors. …

Rubella Vaccine And Medical Policymaking: Fetal Rights And Women's Health, Jacob Heller

New England Journal of Public Policy

U.S. vaccine policies, to all appearances, are based on assumptions about cost effectiveness, safety, and public health needs. Analysis of the peer review health professions’ discourse about rubella vaccine between 1941 and 1999 challenges this view. There were four justifications for the development of the vaccine: (1) cost-benefit projections about vaccine use versus anticipated birth defects; (2) the desire to prevent “fetal wastage” by vaccinating women; (3) a professional imperative to ensure healthy babies; and (4) a bias among vocal vaccine advocates against “unnecessary” abortion. The role of a fifth consideration, the “cultural provenance” of vaccines for American medicine, though …

Schip In The Formative Years: An Update, Judith D. Moore

National Health Policy Forum

This issue brief examines the status of the State Children's Health Insurance Program (SCHIP) three years after authorizing legislation was enacted. Topics addressed include enrollment and retention of children in new programs, funding allotments and expenditures, evaluation activities planned and underway, the interaction of Medicaid and SCHIP, and problems common across many states.

Trends. The Politics Of Psychopathology: Ritalin Conspiracy As Paranoia Or As Good Business?, Ibpp Editor

International Bulletin of Political Psychology

This article discusses the intersection of science, pharmaceuticals, and politics in the context of Ritalin and an alleged over-diagnosis of attention deficit disorder (ADD).

Medicare+Choice: Where To From Here?, Nora Super

National Health Policy Forum

This issue brief examines Medicare+Choice (M+C) plan participation, benefit coverage, and enrollment and the factors that have contributed to plans' decisions to participate in or withdraw from certain markets. In addition, the issue brief explores what has been happening to M+C enrollees in terms of costs, benefits, and continuity of care. Lastly, the issue brief examines the reasons that alternative plan options — such as preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs) — have not taken hold. Legislative proposals that might affect the future of M+C are also discussed.

Community-Based Nursing Education At The Campsite, M. Susan Jones, Donna Bussey, Carrie Morgan

Nursing Faculty Publications

No abstract provided.

The Asthma Epidemic: Prospects For Controlling An Escalating Public Health Crisis, Richard Hegner

National Health Policy Forum

This background paper examines the dimensions of the recent asthma epidemic and what could be done to contain it. Information about the prevalence and consequences of asthma across demographic groups is presented. Factors that impede the control of asthma are also identified. The paper also examines the possible causes of asthma and the asthma epidemic as well as new theories about the relationship of asthma to overall advances in health care and economic development. It also discusses the economic implications of asthma and possible cost avoidances linked to better asthma management. The paper concludes with discussions of asthma and public …

Review Of: Joe Thornton, Pandora's Poison: Chlorine, Health, And A New Environmental Strategy, William Ronnenberg Jr.

RISK: Health, Safety & Environment (1990-2002)

Review of the book Pandora's Poison: Chlorine, Health, and a New Environmental Strategy by Joe Thornton, (M.I.T. Press 2000). Appendices, notes, references, index. LC 99-057011; ISBN 0-262-20124-0 [599 pp. $34.95 cloth, Five Cambridge Center, Cambridge MA 02142-1493] .

Readiness For Health Promotion, Colleen Murphy-Southwick Ph.D., Tom Seekins Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

There is growing interest in health promotion, wellness, and the prevention of secondary conditions among people with disabilities. In rural areas where there is limited access to health care providers knowledgeable about disability, managing one’s own health and wellness and using strategies to prevent secondary conditions may be particularly important (Offner, Seekins & Clark, 1992; Seekins, 1992; Center for Disability Policy and Research, 1995; Seekins, Clay & Ravesloot, 1994; Seekins, et al., 1999).

The Minds Of Mothers: Maternal Mental Health In An Urban Squatter Settlement Of Karachi., Fauziah Rabbani, Furqan Farooq Raja

Community Health Sciences

BACKGROUND:

Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan.

OBJECTIVE:

To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health.

METHODS:

With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity.

RESULTS:

The proportion of probable cases of mental disorder was …

Trends. Blowing Smoke: Tobacco Machinations And The World Health Organization, Ibpp Editor

International Bulletin of Political Psychology

This article discusses actions of agents of the tobacco industry and their attempts to undermine World Health Organization (WHO) tobacco control activities as reported in a WHO report.

Insuring Virginia's Children: Local Outreach And Enrollment (Northern Virginia), Lisa Sprague, Judith D. Moore

National Health Policy Forum

This one-day visit to a nearby jurisdiction was designed to allow participation by federal staff who have been unable to commit the three days required by a typical Forum site visit. Site visitors were given an overview of health care in Virginia and an introduction to the Children's Medical Income Security Program (CMSIP) as well as its proposed replacement, the Family Access to Medical Insurance Security program (FAMIS). A panel representing community organizations and providers shared their experience, touching on provider concerns, coordination of outreach efforts across counties, and assistance for clients after they are enrolled. The group visited the …

Cancer Surveillance Series: Non-Hodgkin’S Lymphoma Incidence By Histologic Subtype In The United States From 1978 Through 1995, Frank D. Groves, Martha S. Linet, Lois B. Travis, Susan S. Devesa

Public Health Resources

Background: Clinical investigations have shown prognostic heterogeneity within the non-Hodgkin’s lymphomas (NHLs) according to histology, but few descriptive studies have considered NHLs by subgroup. Our purpose is to assess the demographic patterns and any notable increases in population- based rates of different histologic subgroups of NHL.
Methods: Using data collected by the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we calculated incidence rates for the major clinicopathologic categories of NHL by age, race, sex, geographic area, and time period.
Results: Among the 60 057 NHL cases diagnosed during the period from 1978 through 1995, total incidence …

The Role Of Pathology In An Investigation Of An Outbreak Of West Nile Encephalitis In New York, 1999, Wun-Ju Shieh, Jeannette Guarner, Marci Layton, Annie Fine, James Miller, Denis Nash, Grant L. Campbell, John T. Roehrig, Duane J. Gubler, Sherif R. Zaki

Publications and Research

An outbreak of encephalitis occurred in New York City in late August 1999, the first caused by West Nile virus in North America. Histopathologic and immunopathologic examinations performed on human autopsy materials helped guide subsequent laboratory and epidemiologic investigations that led to identification of the etiologic agent.

Outdoor Allergens, H A. Burge, Christine A. Rogers

Christine A. Rogers

Outdoor allergens are an important part of the exposures that lead to allergic disease. Understanding the role of outdoor allergens requires a knowledge of the nature of outdoor allergen-bearing particles, the distributions of their source, and the nature of the aerosols (particle types, sizes, dynamics of concentrations). Primary sources for outdoor allergens include vascular plants (pollen, fern spores, soy dust), and fungi (spores, hyphae). Nonvascular plants, algae, and arthropods contribute small numbers of allergen-bearing particles. Particles are released from sources into the air by wind, rain, mechanical disturbance, or active discharge mechanisms. Once airborne, they follow the physical laws that …