Medicine and Health Sciences Commons^™

Medicare Coverage: Lessons From The Past, Questions For The Future, Robin J. Strongin

National Health Policy Forum

This paper describes the Medicare coverage process for emerging technologies and the ways it has changed over time. Issues addressed include both the national coverage process and local medical review policies, which account for 90 percent of the coverage determinations. The paper also includes a discussion of the relationship between the coverage process and technology assessment, payment systems and the ongoing debate over coverage criteria and levels of evidence.

A Model For Hiv/Aids Risk Behaviors Of Students In Armenia, Talin Babikian

Loma Linda University Electronic Theses, Dissertations & Projects

Without a cure in now its third decade, AIDS is a concern for both the medical and social science disciplines. Most at risk for a nationwide AIDS epidemic are developing countries, which often lack the necessary resources and knowledge to minimize the spread of the disease. There are an estimated 1500 HIV cases in Armenia, 81.5% of which occur in the 20-39 age group. Armenia’s current economic and political instability, increase in sexually transmitted infections (STI), prostitution, and injecting drug use, and the alarming incidence rates in neighboring countries amplify its risk for a national epidemic.

The goals of this …

Using Treatment Interruptions To Palliate The Toxicity From Concurrent Chemoradiation For Limited Small Cell Lung Cancer Decreases Survival And Disease Control, Gregory Videtic, Karen Fung, Anna Tomiak, Larry Stitt, A. Dar, Pauline Truong, Edward Yu, Mark Vincent, Walter Kocha

Edward Yu

BACKGROUND AND PURPOSE: We analyzed the impact on survival outcomes of treatment interruptions due to toxicity arising during the concurrent phase of chemotherapy/radiotherapy (ChT/RT) for our limited-stage small-cell cancer (LSCLC) population over the past 10 years. MATERIALS AND METHODS: From 1989 to 1999, 215 patients received treatment for LSCLC, consisting of six cycles of alternating cyclophosphamide/doxorubicin or epirubicin/vincristine (CAV; CEV) and etoposide/cisplatin (EP). Thoracic RT was started with EP at either the second or third cycle (85% of patients). RT dose was either 40 Gy in 15 fractions over 3 weeks or 50 Gy in 25 fractions over 5 weeks, …

Income Support Policy And The U.S. Child Support System, Jane Koppelman

National Health Policy Forum

This paper examines the economic profile of custodial and noncustodial parents and the status of the federal/state child support enforcement system. It discusses the reasons for the historically low rate of child support collection; the prospects for new computerized systems to improve the rates of both paternities established and payments collected; ways the system can sustain funding; and the extent to which child support payments can improve the well-being of low-income families.

Pharmacy Benefit Managers: A Model For Medicare?, Veronica V. Goff

National Health Policy Forum

This issue brief uses large-employer experiences with pharmacy benefit managers (PBMs) to shed light on their potential as Medicare outpatient drug benefit administrators. PBM management techniques are discussed, as well as employer perspectives on PBM strengths and weaknesses and lessons learned. Considerations for Medicare policy are also examined. The brief built on a previous NHPF issue brief entitled The ABCs of PBMs.

The Kentucky Plan: An Innovative Approach To Professional Doctoral Education In Public Health., Joel M. Lee, F. Douglas Scutchfield

Preventive Medicine and Environmental Health Faculty Publications

The Doctor of Public Health (Dr.P.H.) degree is designed to prepare graduates for the highest levels of leadership in public health related careers in both public and private settings. The Kentucky School of Public Health has developed an innovative generalist professional degree program offering an extensive battery of courses based on the body of professional public health knowledge. The degree includes extensive supervised field experience as part of the academic training, linking theory with practice. Issues related to professional degrees, curriculum, accreditation and certification, admission, evaluation, plans for institutional cooperation, and demand are addressed.

Teaching | Learning | Investigating | Discovering | Treating | Healing, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2001 Annual report of Thomas Jefferson University.

Mental Health Parity: National And State Perspectives 2001: A Report To The Florida Legislature, Bruce Lubotsky Levin, Ardis Hanson, Richard Coe

Ardis Hanson

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. This report examines actuarial studies, the current state of parity legislation across the nation, cost of treatment issues, and the impact on Florida should parity legislation be passed.

Barrier To Utilization Of Primary Healthcare Resources In Children Two Years Of Age And Under, Ruth A. Waibel

Health Services Research Dissertations

This is a retrospective longitudinal study of health service utilization using the Immunization Practice Data Set obtained from the Center for Pediatric Research, Norfolk, Virginia. Cluster sampling was used to identify a cohort of children (n = 271), aged 0 to 24 months, from the city of Norfolk, Virginia. A two-year abstraction of medical records was used to determine utilization practice patterns for three categories of health: well-baby, acute and chronic care. The purpose of this study was to identify socio-demographic, need, and health system factors associated with under-utilization of primary care services using Aday's model. The proportion of children …

A Longitudinal Study Examining The Stability Of Occupational Stressors Identified By Nursing Home Administrators, Gay Lynne Andrucci-Armstrong

Health Services Research Dissertations

As a result of the ever changing and expanding role of the nursing home administrator in conjunction with the stricter legislation governing nursing facilities over the past decade and the graying of America, a study specific to this population was warranted. The purpose of this study is to determine the relative change in the self-reported occupational stressors of nursing home administrators over a five year period (December 1994 to June 1999) secondary to the increased regulatory climate of the nursing home industry.

This study was carried out in three phases and included all practicing nursing home administrators in Virginia. Phase …

The Effects Of Occupational Ultrasonic Noise Exposure On Hearing In Dental Hygienists: A Pilot Study, Jennifer S. Dunning

Dental Hygiene Theses & Dissertations

The purpose of this case-control study was to determine whether long-term ultrasonic noise exposure via the dental office environment is related to dental hygienists' hearing status. Registered dental hygienists (N = 698) who live in the Hampton Roads area were mailed a Dental Hygiene Work History Questionnaireto determine those meeting the inclusion criteria and willing to participate in the study. Consenting subjects were categorized into one of two groups according to ultrasonic scaler usage rate and matched on age. Persons with known hearing loss due to infection, disease, or congenital defect were excluded from the study. The final sample …

Effects Of Hormonal Changes Throughout The Menstrual Cycle On Joint Laxity In Females, John C. Roberts

Human Movement Sciences & Special Education Theses & Dissertations

The objective of this study was to examine the levels of estrogens, progesterone, LH, FSH, estradiol and testosterone and their relation to ACL laxity throughout the menstrual cycle. Subjects were tested at the onset of menses, the first day of ovulation (days 8–17) and day 23 at the mid-luteal phase. A Pearson Product Moment Correlation Coefficient revealed that there were no statistically significant relationships between laxity measurements, of the KT-2000 or radiographic comparisons, and elevated concentrations of any of the hormones. LH was observed in the follicular phase, at the onset of menses, to have a negative correlation with only …

Trends. The Privileged Status Of The Physical In Health Ideology: The Security Consequences Of Aids, Ibpp Editor

International Bulletin of Political Psychology

The author discusses the importance of recognizing both physical and psychological factors of the AIDS (Acquired Immune Deficiency Syndrome) pandemic on security.

Federal And State Perspectives On Gme Reform, Karen Matherlee

National Health Policy Forum

This issue brief examines financial support of graduate medical education (GME), a standard budget item in the federal Medicare program and in some state Medicaid programs. It looks at objections to the way in which GME dollars are distributed, especially in terms of variations in Medicare GME payments across states. It explores various reform proposals that are circulating to address this and other GME problems and the odds for major reform.

The Outbreak Of West Nile Virus Infection In The New York City Area In 1999, Denis Nash, Farzad Mostashari, Annie Fine, James Miller, Daniel O'Leary, Kristy Murray, Ada Huang, Amy Rosenberg, Abby Greenberg, Margaret Sherman, Susan Wong, Marcelle Layton

Publications and Research

Background In late August 1999, an unusual cluster of cases of meningoencephalitis associated with muscle weakness was reported to the New York City Department of Health. The initial epidemiologic and environmental investigations suggested an arboviral cause.

Methods Active surveillance was implemented to identify patients hospitalized with viral encephalitis and meningitis. Cerebrospinal fluid, serum, and tissue specimens from patients with suspected cases underwent serologic and viral testing for evidence of arboviral infection.

Results Outbreak surveillance identified 59 patients who were hospitalized with West Nile virus infection in the New York City area during August and September of 1999. The median age …

Commencement Program 2001, Loma Linda University

Commencement Programs

CONTENTS

2 | 2001 Events of Commencement

3 | The Academic Procession

4 | The Speakers

10 | The University Honorees

18 | The School Honorees

26 | The Programs

• School of Medicine, 27
• School of Dentistry, 34
• Graduate School, 42
• School of Nursing, 51
• School of Allied Health Professions - Physical Therapy, 56
• School of Allied Health Professions, 63
• School of Public Health, 71

Nurse Workforce: Condition Critical, Wakina Scott

National Health Policy Forum

This issue brief provides an overview of the current nursing shortage. It discusses the multiple factors that make this shortage in the nurse workforce different from earlier ones. It also examines steps taken by nursing schools, the health care industry, the federal government, and states to address this issue.

Youth Violence Prevention: How Does The Health Care Sector Respond?, Anthony S. Raden

National Health Policy Forum

This background paper examines the health care sector's response to the complex problems associated with youth violence, identifies the unique challenges health professionals face in dealing with young victims and perpetrators of violence, and raises questions about the ability of health professionals in various types of practice settings to assume a more proactive role in preventing youth violence.

Targeting Youth And Concerned Smokers: Evidence From Canadian Tobacco Industry Documents, Richard W. Pollay

Richard W. Pollay

No abstract provided.

Enhanced Detection Of Surface-Associated Bacteria In Indoor Environments By Quantitative Pcr, Mark P. Buttner, Patrica Cruz-Perez, Linda Stetzenbach

Environmental & Occupational Health Faculty Publications

Methods for detecting microorganisms on surfaces are needed to locate biocontamination sources and to relate surface and airborne concentrations. Research was conducted in an experimental room to evaluate surface sampling methods and quantitative PCR (QPCR) for enhanced detection of a target biocontaminant present on flooring materials. QPCR and culture analyses were used to quantitateBacillus subtilis (Bacillus globigii) endospores on vinyl tile, commercial carpet, and new and soiled residential carpet with samples obtained by four surface sampling methods: a swab kit, a sponge swipe, a cotton swab, and a bulk method. The initial data showed that greater overall sensitivity was obtained …

Health Status Of Adult Montanans In Supported And Semi-Independent Living Arrangements, Meg A. Traci Ph.D., Sarah Geurts B.S., Tom Seekins Ph.D., Rebecca Burke M.S., Kathleen Humphries, Lisa Brennan M.L.S., University Of Montana Rural Institute

Health and Wellness

This study reports on the prevalence and severity of secondary conditions in adults with developmental disabilities living in 33 Montana counties. "Secondary conditions" are additional health problems acquired by an individual with a disability. Although the personal, social, and financial costs of these secondary conditions are extraordinarily high, they are frequently preventable. Ten of the top twelve secondary conditions reported by survey respondents involved issues that can be addressed by wellness activities or lifestyle management. In particular, survey ratings of “Communication,” “Weight,” and “Physical Fitness” problems suggest that these areas may contribute to other problems. Efforts to improve communication skills, …

Living Well Could Save $31 Million Annually, Craig Ravesloot Ph.D., Catherine Ipsen, Tom Seekins Ph.D., University Of Montana Rural Institute

Health and Wellness

Behavior change can improve health status for many adults. Further, for adults with chronic illness and permanent injuries, a growing body of literature identifies health promotion as both effective in improving health and cost-effective compared to treatment alternatives. Yet third-party payers (Medicaid, Medicare, and private insurance) typically do not reimburse health promotion interventions. This is a problem for many individuals with disabilities who have significant health care costs and cannot pay for health promotion programs. For more than a decade, the Office on Disability and Health at the Centers for Disease Control and Prevention has supported research culminating in the …

The Field Of Disease Management At The Crossroads: An Interview With David B. Nash, Md, Mba, T. J. Basting

College of Population Health Faculty Papers

As David B. Nash, MD, MBA, takes the helm of Disease Management as Editor-in-Chief, the practice of disease management—now a decade old—depends on its practitioners to continue to provide "economic proof of concept." This effort to accrue the credibility needed to design and fund programs will provide further evidence that new technologies can be integrated into care programs across large populations to reduce costs while improving healthcare and access to it.

Quality Improvement Tools In Disease Management, Lisa E. Paddock, Amy L. Phillips, Peter Chodoff

College of Population Health Faculty Papers

Disease management programs require constant monitoring to assure quality and address problems efficiently. To initiate continuous quality improvement in a disease management program, there are several methods available to identify potential problems within the program that may be affecting quality. Some common quality improvement instruments include the Plan-Do-Check-Act model, check sheets, and so forth. Whatever model is used, Statistical Process Control using flow charts, histograms, Pareto diagrams, scatter diagrams, control charts, and cause-and-effect diagrams provides a better understanding about how the organization's processes are functioning. These tools facilitate problem recognition and allow an organization to meet established standards of quality …

Effectiveness Of Germicidal Uv Radiation For Reducing Fungal Contamination Within Air Handling Units, E Levetin, R Shaughnessy, Christine A. Rogers, R Scheir

Christine A. Rogers

Levels of fungi growing on insulation within air-handling units (AHUs) in an office building and levels of airborne fungi within AHUs were measured before the use of germicidal UV light and again after 4 months of operation. The fungal levels following UV operation were significantly lower than the levels in control AHUs.

The Mind-Body Problem: A Tuberculosis/Tobacco Example, Ibpp Editor

International Bulletin of Political Psychology

This article illustrates two conflicts between what is, perhaps, best for the mind and best for the body.

Perceptions Of The Family Mealtime Environment And Adolescent Mealtime Behavior: Do Adults And Adolescents Agree?, Kerri N. Boutelle, Leslie A. Lytle, David M. Murray, Amanda Birnbaum, Mary Story

Department of Public Health Scholarship and Creative Works

The family mealtime environment has great potential to affect the eating behaviors of youth in the family. It is difficult to determine the important elements of a healthy mealtime environment because a valid assessment of the family environment is so difficult to obtain. The objective of this study is to examine the level of agreement between adult and adolescent perceptions of the family mealtime environment and adolescent mealtime behavior. A telephone survey was used to query adult and adolescent family members about how they perceive the family mealtime environment and the adolescent's mealtime behavior. A convenience sample of 282 adult/adolescent …

State Benefit Design Choices Under Schip - Implications For Pediatric Health Care, Sara J. Rosenbaum, Anne Rossier Markus, Colleen Sonosky, Lee Repasch

Health Policy and Management Issue Briefs

This policy brief1 is the second in a series of reports focusing on the design of state SCHIP programs as they near full implementation. It examines the extent to which state agencies adopt conventional insurance norms or adhere to special principles of Medicaid coverage design for children in designing separately administered (or freestanding) SCHIP programs. The issue of coverage design is particularly relevant for children with low prevalence conditions and special health care needs. Increasingly, conventional insurance uses standardized coverage norms to limit coverage and treatment. These standardized norms take the form of across-the-board treatments and exclusions, limited definitions of …

Use Of Recommended Laboratory Testing Methods Among Patients With Tuberculosis In California, Steffi Kellam, Lisa Pascopella, Edward Desmond, Arthur Reingold, Daniel P. Chin

Public and Community Health Sciences Faculty Publications

This study assessed the extent to which laboratory methods recommended by the Centers for Disease Control and Prevention were used in tuberculosis testing of patients in California in 1998. While recommended methods were used for most patients, there was room for improvement by hospital and independent non-health maintenance organization laboratories.

A Preliminary Risk Analysis Of Environmental Tobacco Smoke And Lung Cancer Using A Cohort Of Mormons In New Haven County, Albert Abdul-Barr Wang

Public Health Theses

Environmental tobacco smoke exposure has been recognized as an important source of lung cancer morbidity and mortality. Measuring environmental tobacco smoke exposure for risk analysis depends much on the methodologies for determining ETS levels of nicotine and RSP.

The author decided to measure the linear multistage dose-response curve relating the level of ETS exposure to the lung cancer incidence. The research was conducted using human time-activity patterns and microenvironmental ETS measurements through a self-designed questionnaire. A cohort of New Haven Mormons was selected for a low-dose group and the subjects from the NHAPS study were utilized for the high-dose group. …