Medicine and Health Sciences Commons^™

The Guillain-Barre Syndrome And The 1992-1993 And 1993-1994 Influenza Vaccines, Tamar Lasky, Gina J. Terracciano, Laurence Magder, Carol Lee Koski, Michael Ballesteros, Denis Nash, Shelley Clarke, Penina Haber, Paul D. Stolley, Lawrence B. Schonberger, Robert T. Chen

Publications and Research

Background
The number of reports of influenza-vaccine-associated Guillain-Barré syndrome to the national Vaccine Adverse Event Reporting System increased from 37 in 1992-1993 to 74 in 1993-1994, arousing concern about a possible increase in vaccine-associated risk.

Methods
Patients given a diagnosis of the Guillain-Barré syndrome in the 1992-1993 and 1993-1994 influenza-vaccination seasons were identified in the hospital-discharge data bases of four states. Vaccination histories were obtained by telephone interviews during 1995-1996 and were confirmed by the vaccine providers. Disease with an onset within six weeks after vaccination was defined as vaccine-associated. Vaccine coverage in the population was measured through a random-digit-dialing …

Tractor Driver Killed In Overturn While Mowing, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

A 44-year-old farm owner was killed when the tractor he was driving overturned. Using a rotary mower attached to a Ford 600 tractor, the farmer was mowing an area along the gravel road leading to his home in a very remote area of the county. On the east side was a fence and on the west a brush covered embankment. At the top of the seven-foot embankment was a sloping field that had been mowed earlier in the season. The tractor, having been purchased six weeks earlier, had undergone maintenance work but was not equipped with a Roll Over Protective …

Factory Worker Entangled In Conveyor Belt Rollers, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

An 18-year-old male chop saw operator (the victim) died when his right arm became caught in the roller mechanism underneath a conveyor belt. He was pulled into the roller mechanism and suffered compressional asphyxia and blunt force injuries. The victim had left his usual work station for a break. When he did not return on time, his supervisor began to search for him. He saw the victim's legs hanging from the conveyor belt and immediately ran to him and shut off the power to the conveyor belt, radioing a guard to call for emergency medical services (EMS). He and another …

Tractor Operator Killed By Rotary Mower While Mowing Highway Right-Of-Way, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

A 23-year-old male (the victim) was killed when he fell from the tractor he was operating and was run over by the attached rotary mower. The victim had been mowing near an interstate highway on-ramp at about 1:15 pm, when his right front tractor wheel hit a concrete drainage culvert, apparently jolting him off, into the path of the mower. Although he was working with a crew, none of his co-workers witnessed the event. A passing commercial truck driver saw the victim fall, pulled over, and called emergency medical services (EMS) on his cellular phone. EMS personnel arrived within minutes …

Factory Worker Caught In Overhead Conveyor While Hanging Transformers, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

A 29-year-old male factory worker (the victim) died after his head became caught at the point where an overhead chain conveyor made contact with an idler, or pinwheel, that allowed the conveyor to make a 90-degree turn. The conveyor was over seven feet above the floor, but the victim, who was 6'7" tall, was standing on a platform that enabled him to reach the hooks on the conveyor to hang transformer canisters for delivery to a paint booth. No one saw the victim get caught at the nip point, but his supervisor heard him call out and immediately pushed the …

Retooling Tax Subsidies For Health Coverage: Old Ideas, New Politics, Karl Polzer

National Health Policy Forum

This paper describes the tax treatment of health coverage and health care spending and explores the potential impact of recent tax reform proposals. The paper summarizes the criticisms of the current system and analyzes various alternatives including capping the open-ended tax exclusion of health benefits provided by employers and unions, eliminating the exclusion, and establishing a tax credit.

Physician Organizations Assuming Risk: Market And Policy Implications, Sandra Foote, Lisa Sprague

National Health Policy Forum

This issue brief looks at capitation contracting between physician groups and health plans and ways in which financial risk and functional responsibilities may be apportioned. It traces the evolution of capitation contracting in California and the legislative and regulatory issues that have arisen.

Site Visit To Southern California — Plans And Providers: Risk, Accountability, And Staying Power, Lisa Sprague

National Health Policy Forum

This site visit was the second of two focused on managed care operations and market dynamics in California, a state notable for high HMO market penetration and intense competition. In southern California, large physician groups and independent practice associations were highly visible and influential. They had assumed significant financial risk and care management responsibility for patients in HMO plans. The result was a distinctly different model of managed care than existed in other regions of the country. The visit included meetings with leaders from physician organizations and managed care organizations in San Diego and Orange counties, as well as an …

Logger Fatally Injured By Falling Limb, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

A 60-year-old male logger (the victim) was killed when a falling limb struck him on the head. He had been involved in the logging industry all of his life and had been working for a small logging business for six days when the fatal incident occurred. At about 9 a.m. on the day of the incident, the owner of the company went with the victim to where he would be felling trees. The victim was not wearing any personal protective equipment (PPE). They talked for a few minutes then the owner left on the bulldozer. When he returned 20-25 minutes …

Site Visit To Utah And Nevada — Essential Community Health Services On The Frontier, Karen Matherlee, Michael Anzick

National Health Policy Forum

From the opening dinner to the closing summary, this site visit explored the delivery and financing of essential community services for vulnerable populations in the frontier West. A sequel to the Forum's March 30-31, 1998, urban-centered site visit to Philadelphia, Providing Community-Based Primary Care: Nursing Centers, CHCs, and Other Initiatives, the visit spanned 493 miles. It included overview presentations, bus briefings, facility tours, telehealth demonstrations, panel discussions, and wrap-up reviews. Topics included the Utah health marketplace, the demands of emergency preparedness, the development of a patchwork of services along a continuum ranging from preventive care to tertiary referrals and follow-up, …

53-Year-Old Dies In Tricycle Tractor Overturn While Transporting Round Bale, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

A 53-year-old full-time farmer (the victim) was crushed to death when the tractor he was operating overturned. At 1:45 pm, the victim was moving a large round bale of hay with a hay spike mounted on the front of a tractor. The tractor was not equipped with a rollover protective structure (ROPS) or a seatbelt. The farmer, who was sharecropping, was moving rolled hay from a field to a wagon in preparation for transportation to his farm. Hydraulics were used to lift the approximately 1500-pound spiked bale, and the farmer began driving toward the wagon. He proceeded along a tobacco …

Assessing The Accuracy Of A New Diagnostic Test When A Gold Standard Does Not Exist, Todd A. Alonzo, Margaret S. Pepe

UW Biostatistics Working Paper Series

Often the accuracy of a new diagnostic test must be assessed when a perfect gold standard does not exist. Use of an imperfect test biases the accuracy estimates of the new test. This paper reviews existing approaches to this problem including discrepant resolution and latent class analysis. Deficiencies with these approaches are identified. A new approach is proposed that combines the results of several imperfect reference tests to define a better reference standard. We call this the composite reference standard (CRS). Using the CRS, accuracy can be assessed using multistage sampling designs. Maximum likelihood estimates of accuracy and expressions for …

The State Children's Health Insurance Program: How Much Latitude Do The States Really Have?, Richard Hegner

National Health Policy Forum

The State Children's Health Insurance Program (CHIP) — a major program to cover low-income, uninsured children — was passed as part of the Balanced Budget Act of 1997. Its passage was part of a trend of a shifting balance of power between the federal and state governments, particularly in the policy areas of health and social welfare. This issue brief explores the degree of freedom afforded the states by CHIP, the factors guiding state decision making and planning, and the factors influencing the states' various decisions about CHIP. It also discusses state options in four basic areas: participation or nonparticipation …

Health And Wellness Among Adults With Developmental Disabilities, Ann Szalda-Petree Ph.D., Meg A. Traci Ph.D., University Of Montana Rural Institute Rural Institute

Health and Wellness

In 1988, the National Council on Disability published Toward Independence, which identified the prevention of secondary conditions and health promotion for people with disabilities as a major national goal. During the last ten years this goal has grown in importance, with U.S. service corporations and agencies, researchers, policy makers, and even private industry acknowledging its wisdow. An entire section of Healthy People 2010, the nation’s blueprint for promoting the health of the entire population, addresses disability and health. Previous editions in the series contained no explicit sections on disability. Now, disability has its own section, with 12 specific objectives and …

66-Year-Old Male Dies In Tractor Overturn While Mowing, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

A 66-year-old male (the victim) was killed while mowing his farm land. He was driving a Case tractor model 1212 with a front-end loader and 4-foot rotary mower attachments. The tractor had a homemade canopy attached for sun protection but it was not intended to function as a Rollover Protective Structure (ROPS). Tracks in the field show that he had made several passes and had likely worked for about three hours when the incident occurred. It was about 1 p.m. when he began mowing along the edge of the woods that bordered the field. Although the field was relatively flat, …

Protecting The Confidentiality Of Health Information, Nora Super

National Health Policy Forum

This issue brief focuses on the legislation aimed at protecting the confidentiality of health information. It provides an overview of legislation being considered in 1998 and focuses on three key issues: controlling access to health information, conducting research, and preempting state laws.

Teens Speak Out On Alcohol Abuse, A Photonovel, M. Susan Jones

Nursing Faculty Publications

No abstract provided.

Communicating To Beneficiaries About Medicare+Choice: Opportunities And Pitfalls, Nora Super

National Health Policy Forum

This issue brief explores the opportunities and potential pitfalls in communicating to beneficiaries about Medicare+Choice. This issue brief also looks at the difficulties inherent in communicating complex information to a diverse group of older individuals as well as at communications and programmatic challenges related to information overload, marketing concerns, lack of uniform standards, lack of infrastructure, and the vulnerability of various subpopulations.

Medicare Coverage And Technology Diffusion: Past, Present, And Future, Robin J. Strongin

National Health Policy Forum

This issue brief provides an overview of the Medicare coverage process. Coverage involves deciding whether or not to pay for a particular service or product. This brief examines Medicare's coverage determination process, which includes technology assessment, payment determination, and the demand for evidence. Options for improving the coverage determination process are reviewed.

Erisa Health Plan Denials: Exploring Models For External Review, Karl Polzer

National Health Policy Forum

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Educational Attainment, Non-English Language Usage, And Ability To Communicate In English In 30 Massachusetts Cities/Towns, Edward C. Besozzi, Carole C. Upshur

Gastón Institute Publications

Data regarding an individual's ability, or the ability of members of a household to speak English, primary language spoken at home, educational attainment, and the level of literacy proficiency should be taken into consideration when designing and implementing policies regarding health care initiatives and the publication of health care information. This report highlights data collected from three sources: 1) The National Adult Literacy Survey; 2) The 1990 Federal Census; and 3) The Massachusetts Institute for Social and Economic Research.

Development And Testing Of A Quantitative Food Frequency Questionnaire For Use In Kerala, India, James R. Hébert, Prakash C. Gupta, Ramesh B. Bhonsle, P. R. Murti, Hemali Mehta, Florence Verghese, Mira Aghi, Kamala Krishnaswamy, Fali S. Mehta

Faculty Publications

Objective: To develop and test a food frequency questionnaire (FFQ) for use in rural areas of Kerala, India. Design: Based on food use and market surveys of the study area, a quantitative 81- item interviewer-administered FFQ was developed. A validation study was conducted consisting of 24-h diet recalls (24HR) administered on 8 days randomly selected over an entire year and two administrations of the FFQ, one at the beginning of the l-year period and the other at the end. FFQ and 24HR-derived nutrient scores were compared using correlation and regression analyses and by examining differences in the nutrient scores. Setting: …

Site Visit To New Jersey — State And County Experiences With Welfare Reform And Access To Health Care, Michael Anzick, Richard Hegner

National Health Policy Forum

This site visit was the second in a series to examine what is occurring at the state and local level with respect to welfare reform, Medicaid, public health, and safety net and other supportive services. During this visit, policymaker discovered how state officials, directors, and front-line staff at urban and suburban county welfare offices are working with clients to move them off the welfare rolls into jobs and providing the support services necessary for job retention; heard from clients about how programmatic changes are affecting them and their families; learned how the role of safety net health care and temporary …

Farmer Run Over By Tractor, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Tractors/Logging

An 80-year-old male farmer (the victim) died when he was run over by the right rear wheel of his tractor. He had backed the tractor to the door of a shed in order to hook a tiller to it. After parking the tractor on a slight incline in front of the shed, he left it in neutral while he went inside for the tiller. The parking brake did not hold, however, and the tractor began to roll. He apparently noticed this and tried to remount the tractor, but was knocked down by the wheel and run over. To prevent similar …

How Do Hmos Achieve Savings? The Effectiveness Of One Organization's Strategies., Ann B. Flood, Allen M. Fremont, K Jin, David M. Bott

Dartmouth Scholarship

To examine how a group practice used organizational strategies rather than provider-level incentives to achieve savings for health maintenance organization (HMO) compared to fee-for-service (FFS) patients. A large group practice with a group model HMO also treating FFS patients. Data sources were all patient encounter records, demographic files, and clinic records covering 3.5 years (1986-1989). The clinic's procedures to record services and charges were identical for FFS and HMO patients. All FFS and HMO patients under age 65 who received any outpatient services during approximately 100,000 episodes of the seven study illnesses were eligible.

The Effects Of Managed Care On The Quality Of Dental Hygiene Care, Marybeth Magner

Masters Theses & Specialist Projects

Managed care has become a prominent mechanism for insuring dental care. Empirical research suggests that managed dental plans provide lower quality care to patients. However, few studies have specifically addressed the effects of managed care on the quality of dental hygiene care. Thus, in this study the researcher examines whether dental hygienists deliver a lower level of treatment to managed care patients than to those who are not subject to managed care. Questionnaire data were gathered from 193 members of the American Dental Hygienists' Association residing in the Chicago area. The primary independent variable, managed care, was measured with an …

Dual Diagnoses: The Challenge Of Serving People With Concurrent Mental Illness And Substance Abuse Problems, Richard Hegner

National Health Policy Forum

This paper describes the prevalence of comorbid mental disorders in the population and discusses what is known about causality and relapse. The relationship between dual diagnosis and homelessness and crime is also discussed. The paper also explores options for improving treatment among the dually diagnosed.

Electrician Dies In 6-Foot Fall From Ladder, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

A 51-year-old male electrician (the victim) died after falling approximately six feet to the concrete floor of a fertilizer plant. The victim had been doing electrical work while standing on an aluminum extension ladder at a switch box attached to a steel post near a rear exit of the plant. His co-worker, who was approximately 20 feet away, heard him hit the floor, but did not see him fall. The co-worker ran for help. A 911 call was placed at 8:46 am, and Emergency Medical Services (EMS) personnel arrived in three minutes. The victim was transported to the local hospital, …

Increasing The Federal Cigarette Tax: A Means Of Reducing Consumption?, Lauren Tran, Richard Hegner

National Health Policy Forum

This issue brief probes the economic issues associated with tobacco and cigarettes. It examines the possible effectiveness of a tax increase as a strategy to reduce cigarette consumption, especially among young people, and the likely ramifications of a tax increase for the tobacco industry.

Allopurinol As An Additive To Quinine In The Treatment Of Acute Complicated Falciparum Malaria, P. S. A. Sarma, Anil K. Mandal, Harry Khamis

Population and Public Health Sciences Faculty Publications

The emergence of chloroquine resistance, and a world-wide scarcity of quinine, have resulted in a search for newer antimalarial drugs directed against falciparum malaria. Allopurinol causes virtually complete inhibition of purine biosynthesis of malaria parasites, which may prove lethal to the parasites. This study was designed to examine if allopurinol is additive to quinine in the treatment of acute falciparum malaria. Forty-seven Asian-Indian adults with acute complicated falciparum malaria were assigned to a treatment period of five days. They were randomly assigned to receive either oral allopurinol (12 mg/kg in three divided doses for five days) plus quinine (600 mg …