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From Diagnosis To Payment: The Dynamics Of Coding Systems For Hospital, Physician, And Other Health Services, Karen Matherlee

National Health Policy Forum

This background paper reviews the two principal coding systems used to describe health services in the United States: ICD-9-CM and HCPCS, a combination of CPT-4 and national and local codes. It probes the relationships of these coding systems to payment policy, administrative simplification under HIPAA, and other concerns. The paper also addresses four coding issues: governance of CPT; adoption of ICD-10-CM; the appropriateness, accuracy, and responsiveness to change of the codes themselves; and the degree of documentation needed to monitor health services and determine payment.

Estimating Causal Parameters In Marginal Structural Models With Unmeasured Confounders Using Instrumental Variables, Tanya A. Henneman, Mark Johannes Van Der Laan, Alan E. Hubbard

U.C. Berkeley Division of Biostatistics Working Paper Series

For statisticians analyzing medical data, a significant problem in determining the causal effect of a treatment on a particular outcome of interest, is how to control for unmeasured confounders. Techniques using instrumental variables (IV) have been developed to estimate causal parameters in the presence of unmeasured confounders. In this paper we apply IV methods to both linear and non-linear marginal structural models. We study a specific class of generalized estimating equations that is appropriate to these data, and compare the performance of the resulting estimator to the standard IV method, a two-stage least squares procedure. Our results are applied to …

Characteristic Differences Between Parents/Guardians Who Keep Immunization Records And Those Who Do Not, Rebecca Bonilla Mangual

Theses Digitization Project

No abstract provided.

Health Disparities, Neil Macnaughton

International Journal of Global Health

"Americans believe that we are a classless society, largely because just about everyone thinks they are members of the struggling middle class. In actuality the United States is a highly stratified society in terms of wealth, meaning that we have a much more significant problem of poverty than most industrialized nations. Members of ethnic minorities are more likely to be poorer and less powerful. Racist beliefs on the part of the dominant white ethnic groups exacerbate the problem of socioeconomic inequality (Brown, 1998 p. 259)." In healthcare we like to believe that we do not discriminate amongst patient populations and …

Associations Between Water-Treatment Methods And Diarrhoea In Hiv-Positive Individuals, J. N. S. Eisenberg, T. J. Wade, A. Hubbard, D. I. Abrams, R. J. Leiser, S. Charles, M. Vu, S. Saha, C. C. Wright, Deborah A. Levy, P. Jensen, J. M. Colford

Journal Articles: Epidemiology

This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we …

One Year After 9/11: The Impact Of Global Terrorism On Public Health Education, Joseph K. Ogah

International Journal of Global Health

As we mark one year after the September 11 (9/11) attack of the World Trade Center in New York, and the killing or traumatizing of thousands of innocent persons, global terrorism remains an issue of concern for political leaders, the business world and educators. The implications of terrorism to public health education are many and varied. At the minimum, 9/11 increased the immediate need for additional public health education to help people cope and deal with both the immediate and long-term effects of terrorist acts all over the world. Public health education plays a leading role in managing the fear …

Invisible, Underserved, And Diverse: The Health Of Women In Prison, Janette Y. Taylor, Rachel Williams, M. J. Eliason

International Journal of Global Health

In the United States of America, women are the fastest growing segment of the criminal justice system. They are entering the system with far greater physical and mental health problems than men, but with fewer health services. Additionally, within this expanding population of incarcerated women, are disproportionately represented poor women of color with serious health needs. This article: a) uses an ecosocial model to examine and critique the health and healthcare of women in prison, b) examines social structures that influence incarceration and health status, and c) proposes reconsideration of current prison health services and education.

Pick-Me-Up Newsletter - Issue 5 , Volume 1, Nova Southeastern University

Pick Me Up Newsletter

No abstract provided.

Pathogenesis Of Human And Bovine Cryptosporidium Parvum In Gnotobiotic Pigs, Sonia J. Pereira, Norma E. Ramirez, Lihua Xiao, Lucy A. Ward

United States Public Health Resources

To compare the pathogenesis of human genotype 1 (HuGl) and bovine genotype 2 (BoG2) Cryptosporidium parvum, neonatal gnotobiotic pigs were given 1-10 HuGl or BoG2 oocysts. The prepatent and patent periods were significantly longer for HuGl than for BoG2 C. parvum (prepatent, 8.6 vs. 5.6 days; patent, 16.6 vs. 10.3 days). BoG2-infected pigs developed signif- icantly more severe disease than did HuGl-infected pigs. BoG2 parasites were seen micro- scopically throughout the intestines during the prepatent and patent periods. HuGl parasites were only detected during the patent period in the ileum and colon but colonized the mucosal surface in significantly …

A Preliminary Linkage Map Of The Tick, Ixodes Scapularis, Amy J. Ullmann, Joseph Piesman, M.C. Dolan, William C. Black, Iv

United States Public Health Resources

A linkage map of the Ixodes scapularis genome was constructed based upon segregation amongst 127 loci. These included 84 random amplified polymorphic DNA (RAPD) markers, 32 Sequence-Tagged RAPD (STAR) markers, 5 cDNAs, and 5 microsatellites in 232 F₁ intercross progeny from a single, field-collected P₁ female. A preliminary linkage map of 616 cM was generated across 14 linkage groups with one marker every 10.8 cM. Assuming a genome size of ∼10⁹ bp, the relationship of physical to genetic distance is ∼300 kb/cM in the I. scapularis genome.

Anopheles Gambiae Genome: Completing The Malaria Triad, Kathryn S. Aultman, Michael Gottlieb, Maria Y. Giovanni, Anthony S. Fauci

United States Public Health Resources

The genome sequence of Anopheles gambiae, the major mosquito vector of the malaria parasite Plasmodium falciparum, as well as analyses of its gene content and organization, are reported by several teams of investigators in this issue. In addition, the sequence of the P. falciparum genome appears in this week’s issue of Nature. The genomes of these two organisms, along with that of the human, provide a triad of critical genetic information relevant to all stages of the malaria transmission cycle and offer unprecedented opportunities to the scientific and public health communities engaged in the fight against malaria, …

Real-Time Fluorescence Pcr Assays For Detection And Characterization Of Shiga Toxin, Intimin, And Enterohemolysin Genes From Shiga Toxin-Producing Escherichia Coli, Udo Reischl, Mohammad T. Youssef, Jochen Kilwinski, Norbert Lehn, Wen Lan Zhang, Helge Karch, Nancy Strockbine

United States Public Health Resources

PCR assays have proved useful for detecting and characterizing Shiga toxin-producing Escherichia coli (STEC). Recent advances in PCR technology have facilitated the development of real-time fluorescence PCR assays with greatly reduced amplification times and improved methods for the detection of amplified target sequences. We developed and evaluated two such assays for the LightCycler instrument: one that simultaneously detects the genes for Shiga toxins 1 and 2 (stx₁ and stx₂) and another that simultaneously detects the genes for intimin (eae) and enterohemolysin (E-hly). Amplification and sequence-specific detection of the two target genes were …

Increased Hippocampal Volume In Schizophrenics' Parents With Ancestral History Of Schizophrenia, Josette G. Harris, David A. Young, Donald C. Rojas, Ana Cajade-Law, Ann Scherzinger, Safia Nawroz, Lawrence E. Adler, C. Munro Cullum, Jack Simon, Robert Freedman

United States Public Health Resources

Objective: Decreased hippocampal volume is one of the hypothesized pathological features of schizophrenia, but it is not known if this abnormality is familially transmitted. The aim of this study was to measure the hippocampal volume of the parents of schizophrenic probands. in relationship to the apparent transmission of genetic risk.
Method: Eighteen subjects from families consisting of a schizophrenic proband and two clinically unaffected parents were studied. Probands were compared to six control subjects, matched for age, sex, and educational level. The six families were selected so that only one parent had an ancestral family history of schizophrenia. The volumes …

Inhibition Of Hepatic Stellate Cell Collagen Synthesis By N-(Methy1amino)Isobutyric Acid, Thomas L. Freeman, Kusum K. Kharbanda, Dean Tuma, Mark Milliard

United States Public Health Resources

The increased deposition of extracellular matrix by hepatic stellate cells following liver injury, in a process known as activation, is considered a key mechanism for increased collagen content of liver during the development of liver fibrosis. We report that N- (methylamino)isobutyric acid (MeAIB), a specific inhibitor of System A-mediated amino acid uptake, reduces the accumulation of collagen in CFSC-2G hepatic stellate cell cultures and in a rat model of liver injury and fibrosis. Rat CFSC-2G cells were cultured in 0-5 mM MeAIB, and the accumulation and synthesis of collagen were measured by binding to Sirius red F3B and pulse-labeling with …

Effect Of Malondialdehyde-Acetaldehyde-Protein Adducts On The Protein Kinase C-Dependent Secretion Of Urokinase-Type Plasminogen Activator In Hepatic Stellate Cells, Kusum K. Kharbanda, Kris A. Shubert, Todd A. Wyatt, Michael F. Sorrell, Dean J. Tuma

United States Public Health Resources

Previous studies from our laboratory have shown that malondialdehyde-acetaldehyde-protein adducts (MAA adducts) are formed in hepatocytes of ethanol-fed rats and directly influence the hepatic stellate cells (HSCs) to induce their secretion of chemokines and to up-regulate their expression of adhesion molecules. Since protein kinase C (PKC) is known to play a major role in many diverse intracellular signal transduction processes, we investigated whether MAA adducts influence the function of HSCs via a PKC-dependent pathway. HSCs in culture were exposed to MAA adducts, and PKC activity was determined. We observed a time- and concentration-dependent activation of PKC when cultures were exposed …

Ata2-Mediated Amino Acid Uptake Following Partial Hepatectomy Is Regulated By Redistribution To The Plasma Membrane, Thomas L. Freeman, Geoffrey M. Thiele, Dean J. Tuma, Tina K. Machu, Mark E. Mailliard

United States Public Health Resources

System A, the Na⁺-dependent amino acid transport activity, is encoded by the ATA2 gene and up-regulated following partial hepatectomy (PH), and its competitive inhibition interferes with liver regeneration. Rabbit polyclonal antibody was raised against a portion of the ATA2 gene product followed by immunodetection of ATA2 in isolated liver plasma membrane and lysate. The level of ATA2 increased in the plasma membrane following PH, while the relatively high quantity of ATA2 found in liver lysate remained constant. We also have shown that Northern analysis of steady-state ATA2 mRNA revealed no significant change following PH. These data show that …

Hiv/Aids Prevention Guidance For Reproductive Health Professionals In Developing-Country Settings, Helen Epstein, Daniel Whelan, Janneke Van De Wijgert, Purnima Mane, Suman Mehta

HIV and AIDS

While the integration of information, technologies, and services to respond to HIV/AIDS may seem closely related, there are a variety of issues that continue to create obstacles to integration. Among these are the stigmatizing nature of HIV infection and AIDS and discrimination faced by those who are infected or perceived to be infected; sexual practices and identities that remain socially unacceptable; gender roles and relations that make it difficult for women and men to access information, services, and technologies on HIV prevention; reluctance to recognize the special needs of young people; and barriers to service delivery created by broader economic, …

Allocating Health Care Resources To The Elderly, George P. Smith Ii

Scholarly Articles

Health is not an absolute condition, but is assessed by reference to age and other factors. Therefore, a relative scale is necessary to determine whether an elderly person’s right to health care is being satisfied. Today, older Americans are increasingly affected by the growing need to regulate health care delivery. Since 1900, those over the age of 85 years have become twenty-one times as numerous in society, with an eightfold increase in the number of people over the age of 65. Given the need to curb rising health care costs — particularly the expenses related to caring for older individuals …

Social Networks And Hiv Transmission: The Contextual Dynamics Of Hiv Risk Behaviors, Karen L. Robinson

International Journal of Global Health

Despite advances in public health, biomedical, and social sciences, the Human Immunodeficiency Virus (HIV), which causes Acquired Immune Deficiency Syndrome (AIDS), continues to proliferate. HIV is spread by exposure to infected blood, semen, or vaginal secretions. HIV transmission most commonly occurs because of sexual activities, through the sharing of contaminated needles and other drug paraphernalia, and less frequently, from infected mothers to their newborns (CDC, 2001). From the first reported in case in June 1981 through June 2001, the Center for Disease Control and Prevention (CDC) has reported 793,026 cases of AIDS. The CDC estimates that 650,000 to 900,000 Americans …

Introduction To Written Symposium On Public Health And International Law, David P. Fidler

Articles by Maurer Faculty

No abstract provided.

Bioterrorism, Public Health, And International Law, David P. Fidler

Articles by Maurer Faculty

No abstract provided.

How Community Structures Of Time And Opportunity Shape Adolescent Sexual Behavior In South Africa, Carol E. Kaufman, Shelley Clark, Ntsiki Manzini, Julian May

Poverty, Gender, and Youth

Recently, South Africa has led the world in rates of HIV/AIDS infection. Particularly among young adults, the prevalence of HIV has soared, now reaching 25 percent. The statistics suggest a high level of unprotected sex and risky sexual behavior even in the midst of high levels of knowledge. Research has focused on the dynamics of individuals’ and partners’ sexual decisionmaking. Little is known, however, about the larger context in which those decisions are made. What are the everyday experiences that influence risk-taking? Are young people with little to do more likely to engage in risky behavior? Do community opportunities of …

Pregnant Or Positive: Adolescent Childbearing And Hiv Risk In South Africa, Naomi Rutenberg, Carol E. Kaufman, Kate Macintyre, Lisanne Brown, Ali Mehyrar Karim

Poverty, Gender, and Youth

In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model …

The End Of The Fertility Transition In The Developing World, John Bongaarts

Poverty, Gender, and Youth

Fertility declines are now underway in many developing countries, and the focus of the debate about future fertility trends is shifting from the early to the later phases of the transition. This study examines patterns and determinants of fertility in the developing world using UN estimates of the total fertility rates for 143 developing countries from 1950 to 2000. The main objective is to identify regularities in the past record that may provide clues to future trends. Three key findings emerge from this analysis. First, the pace of fertility decline decelerates as countries reach the later stages of the transition. …

What About Us? Bringing Infertility Into Reproductive Health Care, Okonofua Friday, Bishakha Datta

Poverty, Gender, and Youth

Infertility is a major reproductive health problem throughout much of the world. Despite the prevalence and seriousness of infertility, the population and reproductive health field has largely neglected this problem. National policies and international donor organizations have been one-sided in their focus on programs designed to prevent unwanted pregnancies. This issue of Quality/Calidad/Qualité, with clinic-based narratives and case reports from India and Nigeria, illustrates what is involved in trying to address the problem of infertility in developing countries. A possible framework for incorporating limited infertility care into a family planning or reproductive health program includes providing education and counseling, preliminary …

Cancer Dose-Response Modeling Of Low Dose Radiation Exposure, Gizelle Susette Baker

MUSC Theses and Dissertations

Many late effects from exposure to ionizing radiation, including cancers, have been described in the literature. The identification and quantification of radiation-induced health effects is an important and complex issue. Recommendations for radiation safety and protection from the International Commission on Radiological Protection are made using a linear no threshold risk model on epidemiological data. A major obstacle in this process is the limited availability of data to directly measure the health effects of radiation on human populations. One way to circumvent this problem IS to use experimental data from laboratory animals and extrapolate across species to man. The cancer …

Biomarkers Of Bone Turnover In Vegetarians And Omnivores, Susan Kim Louie Lue

Loma Linda University Electronic Theses, Dissertations & Projects

A cross-sectional study on fasting serum and 24-hour urine samples were used to determine whether biochemical markers of bone turnover, resorption and formation, differed in a group of 50 healthy premenopausal Caucasian women eating vegan, lactoovovegetarian(LOV) and omnivorous diets.

The women, ages 20-42, had participated in a study of bone mineral density(BMD). The three groups were comparable in mean age, BMI, calorie intake, calories spent in exercise, kcal/kg body weight, protein/day, protein/kg body weight and urinary creatinine.

Biomarkers included those of bone resorption—pyridinoline, deoxypyridinoline, and N-telopeptides, and of bone turnover—serum and urinary osteocalcin(OC), skeletal alkaline phosphatase, and propeptide-type-I-carboxyterminal-procollagen(PICP). In all …

Predictors Of Young Women's Attitudes Toward Sexual Health Practices, Alison G. Dougall

Theses : Honours

The present study examined whether cognitive (beliefs), affective (emotions) and I or behavioural processes predicted young women's attitudes towards their sexual health practices. For pragmatic reasons, safer sex promotion has largely relied on the provision of factual information to promote behaviour change. Although the importance of emotional and behavioural influences has been indicated, these elements have not traditionally been included in sexual health interventions. In order to examine this issue, Zanna and Rempel's (1988) tripartite model of attitude formation was used. A convenience sample of female participants (N=98) aged 18 to 29 years was asked to rate their attitudes towards …

Detection Of Giardia Duodenalis Antigen In Coprolites Using A Commercially Available Enzyme-Linked Immunosorbent Assay, Marcelo Luiz Carvalho Gonçalves, Adauto Araújo, Rosemere Duarte, Joaquim Pereira Da Silva, Karl Reinhard, Françoise Bouchet, Luis Fernando Ferreira

Karl Reinhard Publications

The objective of this experiment was to assess the utility of a commercially available enzyme-linked immunosorbent assay (ELISA) kit for diagnosis of giardiasis in archaeological human remains. The kit, a monoclonal antibody assay, is used to detect the presence of Giardia-specific antigen 65 (GSA65) in human feces. We utilized the assay in ancient fecal material. The material included desiccated feces found in mummies or in archaeological sites, and sediments from latrines. A total of 83 specimens, previously examined microscopically for parasites, were examined. The ELISA detected 3 positive samples, dated to about 1200 AD, 1600 AD, and 1700 AD. …

Multidisciplinary Coprolite Analysis, Karl Reinhard, Dennis R. Danielson, Mark Daniels, Sérgio Augusto De Miranda Chaves

Karl Reinhard Publications

Coprolite analysis, as reviewed by Reinhard and Bryant (1992), contributes unique and detailed information regarding diet and parasitic disease. We present here an analysis of dietary components of coprolites from Bighorn Cave using macroscopic remains, pollen concentrations, and phytoliths. In addition, we analyzed Bighorn Cave coprolites for evidence of parasitic organisms, especially intestinal worms. Such analyses of coprolites have become important methods for reconstructing past dietary and medicinal practices. Pollen concentration and phytolith quantification techniques have recently been developed, but until this report no known attempt has been made to synthesize pollen, macroscopic, and phytolith data from a single coprolite …