Medicine and Health Sciences Commons^™

The Utilization Of Outpatient Laboratory Resources At Ireland Army Community Hospital After Implementation Of Tricare, Susan Seeley

Masters Theses & Specialist Projects

The purpose of this study was to compare out patient laboratory utilization patterns of active duty and retired military personnel and their dependents before and after the implementation of TRICARE. A stratified random sample was taken of patient test results over a two year period resulting in a sample size of 104 observations. The Complete Blood Count (CBC) results were used as indicators for the study. Data was gathered on the patient's rank, active duty/retiree status, age, dependent status, and gender. Additionally, the total number of tests were recorded for the year prior to the introduction of TRICARE and after …

Social Identity And Substance Abuse In The Lesbian Community, Molly Kerby

Masters Theses & Specialist Projects

The purpose of this study was to determine the degree of substance use (alcohol, tobacco, and other drugs) among members of the lesbian community. Additionally, the investigator attempted to determine if there was a relationship between negative social identity and low selfesteem that is reflected in higher rates of substance abuse. The data collection method employed in this study was a type of nonprobability sampling procedure referred to as a purposive sample. The questionnaire was derived from instruments used by other researchers and validated by an expert panel. In order to select respondents from the lesbian population to be included …

Medicare Competitive Pricing: Lessons Being Learned In Phoenix And Kansas City, Nora Super

National Health Policy Forum

Written as policymakers scrutinized two Medicare competitive bidding demonstration projects set to take place in Phoenix and Kansas City, this issue brief analyzes two demonstration projects designed to test whether Medicare could pay health plans in a competitive manner. The brief reviews decisions made by the Competitive Pricing Advisory Commission (CPAC), including design considerations such as plan eligibility and participation, the standard benefit package, the bidding process, and the government contribution to premiums. It also looks at the reasons for opposition to the project and the relationship of this demonstration to broader efforts to reform the Medicare program.

The Public Stake In Biomedical Research: A Policy Perspective, Karen Matherlee

National Health Policy Forum

An introduction to a Forum series on biomedical research policy issues, this paper provides background on the organization and structure of both public and private research entities. It outlines the federal components, from the National Institutes of Health (NIH) to the Department of Veterans Affairs. It also looks at the rapid growth in pharmaceutical, biotechnology, and medical device research and development and the varying responses from managed care plans, practice-based research networks, and contract research organizations. After laying out various tensions in the field, such as competition among disease-oriented advocates, alignment of different priorities, allocation of dollars between basic and …

Intercomparison Of Retrospective Radon Detectors, R. William Field, Daniel J. Steck, Mary Ann Parkhurst, Judy A. Mahaffey, Michael C.R. Alavanja

Physics Faculty Publications

We performed both a laboratory and a field intercomparison of two novel glass-based retrospective radon detectors previously used in major radon case-control studies performed in Missouri and Iowa. The new detectors estimate retrospective residential radon exposure from the accumulation of a long-lived radon decay product, ²¹⁰Pb, in glass. The detectors use track registration material in direct contact with glass surfaces to measure the α-emission of a ²¹⁰Pb-decay product, ²¹⁰Po. The detector's track density generation rate (tracks per square centimeter per hour) is proportional to the surface α-activity. In the absence of other strong sources of α-emission in …

Tracking Of Physical Activity, Physical Inactivity, And Health-Related Physical Fitness In Rural Youth, Russell R. Pate, Stewart G. Trost, Marsha Dowda, Alise E. Ott, Dianne S. Ward, Ruth P. Saunders, Gwen A. Felton

Faculty Publications

This study examined the tracking of selected measures of physical activity, inactivity, and fitness in a cohort of rural youth. Students (N=181, 54.7% female, 63.5% African American) completed test batteries during their fifth- (age=10.7±0.7 years), sixth-, and seventh-grade years. The Previous Day Physical Activity Recall (PDPAR) was used to assess 30-min blocks of vigorous physical activity (VPA), moderate-to-vigorous physical activity (MVPA), TV watching and other sedentary activities, and estimated energy expenditure (EE). Fitness measures included the PWC 170 cycle ergometer test, strength tests, triceps skinfold thickness, and BMI. Intraclass correlation coefficients (ICCs) for VPA, MVPA, and after-school EE …

Validity Of The Previous Day Physical Activity Recall (Pdpar) In Fifth-Grade Children, Stewart G. Trost, Dianne S. Ward, Ben Mcgraw, Russell R. Pate

Faculty Publications

This study evaluated the validity of the Previous Day Physical Activity Recall (PDPAR) self-report instrument in quantifying after-school physical activity behavior in fifth-grade children. Thirty-eight fifth-grade students (mean age, 10.8 ± 0.1; 52.6%; female; 26.3% African American) from two urban elementary schools completed the PDPAR after wearing a CSA WAM 7164 accelerometer for a day. The mean within-subject correlation between self-reported MET level and total counts for each 30-min block was 0.57 (95% C.I., 0.51-0.62). Self-reported mean MET level during the after-school period and the number of 30-min blocks with activity rated at > 6 METs were significantly correlated with the …

The Abcs Of Pbms, Robin J. Strongin

National Health Policy Forum

This issue brief describes the evolution of the pharmacy benefit manager (PBM) industry since the late 1960s and outlines current business practices in the areas of payment, services, drug formularies, and rebates. Tools of the trade, such as cost-sharing and generic substitution, used to control costs and improve quality are also discussed.

Update: West Nile Virus Encephalitis — New York, 1999, Centers For Disease Control And Prevention, Denis Nash

Publications and Research

The West Nile virus (WNV) encephalitis outbreak continues to wane in the Northeast with the onset of cooler temperatures and continued vector-control operations. This report updates the progress of the ongoing investigation. Since the last published update (1), five additional domestic human cases and one international case have been identified. As of October 19, 56 (31 confirmed and 25 probable) cases of WNV infection have been identified, including seven deaths (Figure 1). The date of onset of the latest cases was September 22. The international case was a Canadian citizen who had visited the New York City (NYC) area in …

Chip And Medicaid Outreach And Enrollment: A Hands-On Look At Marketing And Applications, Judith D. Moore

National Health Policy Forum

The State Children's Health Insurance Program (SCHIP or CHIP), enacted as part of the Balanced Budget Act (BBA) in 1997, has enrolled eligible low-income children in innovative ways and tackled a variety of challenges to make sure that families know about the new program. This issue brief describes the outreach, application, and enrollment process for both SCHIP and Medicaid, analyzing the difficulty in simplifying applications, and noting problems that states must solve around systems design, immigration issues, and the stigma sometimes associated with government programs.

Update: West Nile-Like Viral Encephalitis — New York, 1999, Centers For Disease Control And Prevention, Denis Nash

Publications and Research

The outbreak of human arboviral encephalitis attributable to a mosquito-transmitted West Nile-like virus (WNLV) continues to wane in the Northeast (Figure 1). As of October 5, the number of laboratory-positive cases had increased to 50 (27 confirmed and 23 probable), including five deaths. The increase in cases is mainly a result of completed retesting with West Nile virus antigen of specimens previously tested with the related St. Louis encephalitis virus antigen and to intensive retrospective case finding in the ongoing epidemiologic investigations (1,2).

Site Visit To Baltimore And Fort Detrick, Maryland — Preparing For A Bioterrorist Incident: Linking The Public Health And Medical Communities, Robin J. Strongin

National Health Policy Forum

As follow-up to the NHPF's February 1999 session entitled "Biological Terrorism: Is the Health Care Community Prepared?" the Forum organized a site visit on October 4 and 5, 1999, to Baltimore and Fort Detrick, Maryland. The site visit provided federal congressional and agency staff with the opportunity to learn first-hand how one local area is preparing for the possibility of a bioterrorist incident. Several themes were stressed throughout the two days, including the following: distinguishing bioterrorism from chemical terrorism, understanding the relationships between various agencies and institutions and their related funding streams, determining how the federal government can …

Outbreak Of West Nile-Like Viral Encephalitis -- New York, 1999, Centers For Disease Control And Prevention, Denis Nash

Publications and Research

An outbreak of arboviral encephalitis was first recognized in New York City in late August and has since been identified in neighboring counties in New York state. Although initially attributed to St. Louis encephalitis (SLE) virus based on positive serologic findings in cerebrospinal fluid (CSF) and serum samples using a virus-specific IgM-capture enzyme-linked immunosorbent assay (ELISA), the cause of the outbreak has been confirmed as a West Nile-like virus based on the identification of virus in human, avian, and mosquito.

Behavioral Checklist Forms, Unknown Unknown

All Current Publications

No abstract provided.

A Chicken (Nugget?) In Every Pot: What's At Stake In The Budget Debate, Karl Polzer

National Health Policy Forum

This paper explores various aspects of the 1999 budget debate fueled in large part by federal agencies' projection of a $2.9 trillion surplus over 10 years. The tax bill, which would provide about $400 billion in tax relief, is also discussed; special attention is given to the health care provisions of this legislation.

The Nursing Center In Concept And Practice: Delivery And Financing Issues In Serving Vulnerable People, Karen Matherlee

National Health Policy Forum

This issue brief looks at ways in which nurse-managed centers — with support from the Health Resources and Services Administration and private foundations — are carving a role in providing preventive and primary care to vulnerable populations. Two case studies — one in Philadelphia and the other in the Utah-Nevada border area — llustrate nursing centers' mission, outreach, services, workforce, payment concerns, and educational tie-ins.

Race, Gender, And Partnership In The Patient-Physician Relationship, Lisa Cooper-Patrick, Joseph J. Gallo, Junius Gonzales, Hong Thi Vu, Neil R. Powe, Christine Nelson, Daniel E. Ford

Publications from Provost Junius J. Gonzales

Context Many studies have documented race and gender differences in health care received by patients. However, few studies have related differences in the quality of interpersonal care to patient and physician race and gender.

Objective To describe how the race/ethnicity and gender of patients and physicians are associated with physicians' participatory decision-making (PDM) styles.

Design, Setting, and Participants Telephone survey conducted between November 1996 and June 1998 of 1816 adults aged 18 to 65 years (mean age, 41 years) who had recently attended 1 of 32 primary care practices associated with a large mixed-model managed care organization in an urban …

The Hidden Work Of The Farm Homemaker, Deborah B. Reed, Susan C. Westneat, Steven R. Browning, Lana Skarke

Preventive Medicine and Environmental Health Faculty Publications

Despite women’s involvement in agricultural production, the work role of women residing in farm households has not been thoroughly examined. Data collected in 1994-1995 as part of the NIOSH-sponsored Farm Family Health and Hazard Surveillance Project were used to address task issues and health status of farm women in Kentucky. In 1996, the farm woman component of the Kentucky study was replicated in five counties in west Texas, allowing an examination of farm women in two large agricultural states. The Kentucky study employed a two-stage cluster design;the Texas study was based on a systematic quota sample of farms. Both studies …

An Investigation Into The Possibility Of Transmission Of Tick-Borne Pathogens Via Blood Transfusion, P. M. Arguin, J. Singleton, L. D. Rotz, E. Marston, T. A. Treadwell, K. Slater, M. Chamberland, A. Schwartz, L. Tengelsen, J. G. Olson, J. E. Childs

Public Health Resources

BACKGROUND: Tick-borne illnesses were diagnosed in a group of National Guard members, including some who had donated blood a few days before the onset of symptoms. A voluntary recall of those blood components was issued and a multistate investigation was conducted to determine if transfusion-transmitted illness had occurred.

STUDY DESIGN AND METHODS: Donors and recipients were asked to complete questionnaires regarding symptoms and risk factors for infection and to provide blood samples for laboratory analysis.

RESULTS: Among National Guard personnel who donated blood, 12 individuals were found to have a confirmed or probable case of Rocky Mountain …

An Investigation Into The Possibility Of Transmission Of Tick-Borne Pathogens Via Blood Transfusion, P. M. Arguin, J. Singleton, L. D. Rotz, E. Marston, T. A. Treadwell, K. Slater, M. Chamberland, A. Schwartz, L. Tengelsen, J. G. Olson, J. E. Childs, Transfusion-Associated Tick-Borne Illness Task Force

Public Health Resources

BACKGROUND: Tick-borne illnesses were diagnosed in a group of National Guard members, including some who had donated blood a few days before the onset of symptoms. A voluntary recall of those blood components was issued and a multistate investigation was conducted to determine if transfusion-transmitted illness had occurred.
STUDY DESIGN AND METHODS: Donors and recipients were asked to complete questionnaires regarding symptoms and risk factors for infection and to provide blood samples for laboratory analysis.
RESULTS: Among National Guard personnel who donated blood, 12 individuals were found to have a confirmed or probable case of Rocky Mountain spotted fever or …

Mental Health Coverage Parity: Separating Wheat From Chaff, Karl Polzer

National Health Policy Forum

This paper examines the issue of mandating parity in coverage of mental health services in the context of the growing use by private-sector employers of managed behavioral health care providers. Existing parity laws are reviewed, along with estimates of the costs of parity. The tools used by behavioral health care firms to manage care and costs are also discussed.

Quality Of Care In Investor-Owned Vs Not-For-Profit Hmos, David U. Himmelstein, Steffie Woolhandler, Ida Hellander, Sidney M. Wolfe

Publications and Research

Context The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs.

Objective To compare quality-of-care measures for investor-owned and not-for-profit HMOs.

Design, Setting, and Participants Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States.

Main Outcome Measures Rates for 14 HEDIS quality-of-care …

Access To Home Health Services Under Medicare's Interim Payment System, Nora Super

National Health Policy Forum

This issue brief explores the impact of the interim payment system (IPS) for home health agencies established under the Balanced Budget Act of 1997 (BBA). IPS was intended to constrain program outlays by imposing limits on spending per beneficiary and spending per visit in the existing cost-based reimbursement system. This issue brief examines the impact of the IPS on access to home health care, including home health agencies' responses to the payment system and its impact on provider availability and, ultimately, access to care for the sickest or most expensive populations

Implementing The Bba: The Challenge Of Moving Medicare Post-Acute Services To Pps, Karen Matherlee

National Health Policy Forum

This issue brief examines the challenge of putting skilled nursing facilities (SNFs), medical rehabilitation units, and home health under prospective payment, requiring the development of classification systems for each. It looks at the three-year phase-in of SNF resource utilization groups (RUGs) that began July 1, 1998 and the debate over classification systems for medical rehabilitation facilities and home health. The paper goes beyond issues of classification to consider coordination problems in placing these post-acute services under Medicare PPS.

Street-Based Female Adolescent Puerto Rican Sex Workers: Contextual Issues And Health Needs, Margarita Burgos, Donna L. Richter, Belinda Reininger, Ann L. Coker, Ruth Saunders, Margarita Alegria, Mildred Vera

CRVAW Faculty Journal Articles

Adolescent sex workers potentially have many health needs but are included rarely in health assessments; therefore, little is known about their needs or how to reach them. This study examines the motivations, social context, and health needs of street-based adolescent sex workers. The results show these youths are more likely to experience negative health outcomes, such as unintended pregnancies and sexually transmitted infections, when they are using drugs or are depressed. These findings suggest the need for comprehensive programming to include individual, interpersonal, and greater environmental interventions. Examples for reaching adolescent sex workers are discussed.

Dietary Assimilation Of Cadmium Associated With Bacterial Exopolymer Sediment Coatings By The Estuarine Amphipod Leptocheirus Plumulosus: Effects Of Cd Concentration And Salinity, Christian E. Schlekat, Alan W. Decho, G. Thomas Chandler

Faculty Publications

Bacterial extracellular substances (also known as exopolysaccharides, or EPS) may serve as vectors for trophic transfer of metals in benthic systems because these ubiquitous sediment coatings can sorb high concentrations of toxic metals, and because many benthic invertebrates assimilate EPS sediment coatings upon ingestion. We conducted 3 sets of experiments to determine the assimilative bioavailability of EPS-associated Cd to the benthic amphipod Leptocheirus plumulosus as a function of Cd concentration and salinity. Bioavailability was measured as L. plumulosus Cd assimilation efficiency (AE) from EPS-coated silica (EPS●Si) and from uncoated silica (NC●Si) using modified pulse-chase methods with the gamma-emitting radioisotope ^{109 …}

Canada's Generalist Training: Are There Lessons For The United States?, Lee Hawkins

National Health Policy Forum

Addressing the premise of an inappropriate skewing of the U.S. medical education system toward specialty medicine, this issue brief compares and contrasts the U.S. and Canadian graduate medical education (GME) systems, including the organization and financing of each. The issue brief also explores various lessons that might be learned from the Canadian GME system, such as full integration of primary care and GME and the use of incentives to achieve desired policy goals.

Photonovels: Educational Resources To Prevent Agricultural Illnesses And Injuries, M. Susan Jones, Carol A. Koetke

Nursing Faculty Publications

Photonovels use photographs and a story featuring people from the community, familiar settings, and a simple text to deliver an educational message. This unique educational tool lends itself to a wide variety of topics and targets audiences including farmers, farm workers and their families. Information on how to design, create and use photonovels to prevent agricultural injuries and illnesses will be presented.

An Analysis Of Implementation Issues Relating To Chip Cost-Sharing Provisions For Certain Targeted Low Income Children, Sara J. Rosenbaum, Anne Rossier Markus, Dylan Roby

Health Policy and Management Issue Briefs

This analysis, prepared for the Health Care Financing Administration and the Health Resources and Services Administration, examines issues that arise under laws designed to avert excessive cost-sharing in the case of low income families whose children participate in the State Children’s Health Insurance Program (CHIP). High cost-sharing has been shown to significantly affect children’s participation in insurance programs, as well as their utilization of health services. As a result, the Federal CHIP legislation, while permitting cost-sharing under certain circumstances, also places limitations on the total amount of cost-sharing to which families can be exposed for services covered by State CHIP …

Views About Women's Mental Health: Study In A Squatter Settlement Of Karachi., Fauziah Rabbani

Community Health Sciences

OBJECTIVE:

Mental health of women is globally receiving particular attention. This study assessed community's view on certain aspects of women's mental health prior to introducing an intervention.

SETTING:

The study was conducted in an urban squatter settlement located in District West of Karachi in 1997 where the Aga Khan University has set up a Primary Health Care program in partnership with the communities.

METHODS:

Using convenient sampling, door to door household survey was conducted by medical students.

RESULTS:

Two hundred and eighty one residents were interviewed. Respondents were asked to list contributory factors which lead to mental distress in women. …