Biomedical subjects

K A Perry

Publications and source records attributed to K A Perry.

4 recordsLinked to original sources

PubMed2001

Effects of Medicaid managed care on health care use: infant emergency department and ambulatory services.

OBJECTIVE: Many urban children rely on emergency departments (ED) for ambulatory care. The objective of this study was to determine whether enrollment in Medicaid managed care (MMC) alters ED or other ambulatory care compared with fee-for-service Medicaid (FFSM). METHODS: A prospective cohort study of infants born between May 1994 and April 1995 with a 6-month follow-up period was conducted in an urban, teaching hospital and surrounding ambulatory settings. A consecutive sample of 644 infants enrolled in MMC or FFSM was studied; 92% of eligible patients were enrolled, and 94% completed follow-up. The main outcome measures were 1) proportion of patients in each group visiting an ED, primary care practitioner (PCP), or specialist; 2) mean number of visits per group; and 3) ED reliance (EDR) defined as the proportion of all ambulatory visits occurring in an ED. RESULTS: Fifty-six percent of MMC and 54% of FFSM patients visited an ED (relative risk: 1.03; 95% confidence interval [CI]: 0.83, 1.27). More MMC patients had a sick visit to their PCP (relative risk: 1.34; 95% CI: 1.03, 1.74); no difference in proportion with well-child or specialty visits was found. Although the mean number of total ambulatory, ED, and specialty visits was the same, MMC patients had fewer well-child and more sick visits to the PCP than FFSM patients (P =.01). EDR was 21% for both groups (P =.95). After adjustment for other factors in multivariate analysis, insurance status remained unassociated with EDR (adjusted odds ratio [OR]: 0.91; 95% CI: 0.56, 1.69). Factors associated with EDR included United States-born mother (OR: 5.34; 95% CI: 1.61, 17.68) and use of a hospital-based primary care physician (OR: 2.00; 95% CI: 1.34, 2.98). Variables that characterized infants who were less likely to be ED reliant included adequate maternal prenatal care (OR: 0.52; 95% CI: 0.34, 0.78) and having a mother who completed high school (OR: 0.67; 95% CI: 0.45, 0.99). CONCLUSIONS: Enrollment in MMC did not alter ED usage patterns when compared with FFSM. Some variation in use of other ambulatory services was detected.

Ambulatory Care↗

PubMed1984

Simulated responses to intermittent lognormally distributed doses at variable dose rates.

Two previously reported equations for low-LET radiation, R = DmI-n and R = D[a + b(lnI) + h(lnI)2], where the response (R) is expressed in terms of dose (D) and dose rate (I) and the other parameters are constants, were used to compute distributions of response to intermittent, low-level, lognormally distributed doses, administered at different dose rates. The simulations show that the means of the response distributions are affected by both the dose and dose rate distributions. Within certain ranges of their respective values, the influence of the dose and dose rate on the response are in opposite directions, and lead to similar response distributions for numerically different combinations of dose and dose rate. The resolution and mean values of response distributions, when based on nonlinear dose-response relationships, are also affected by dose fractionation.

Animals↗

PubMed1983

Simulated responses to lognormally distributed continuous low radiation doses.

Three previously reported equations, expressing response as a function of both dose and dose rate, for low LET radiation were used to compute distributions of response to continuous, low-level, lognormally distributed doses for populations of variable size up to 5000. The simulations show that, when the response is inversely dependent on dose rate, the mean of the response distribution can either increase or decrease with increasing exposure to radiation, depending on whether or not the dose-dependent term is the dominant one in an equation. In one equation, which defines the response as conjugated hydroperoxide formation in irradiated membranes, the magnitude of the dose-dependent term is reduced the most by superoxide dismutase, an enzymic inhibitor of free radical processes. This results in the means of response distributions decreasing with increasing dose from continuous, low-level radiation.

Animals↗

PubMedDate not supplied

Diapering choices: a critical review of the issues.

Careful consideration is needed to determine which diapering system may be best suited to an institution's or individual's needs. A critical review of five issues--skin care, infection control, other health-related concerns, environmental and safety aspects, and time/cost issues--reveals that: (a) superabsorbent paper diapers reduce the incidence and severity of diaper dermatitis and control the spread of infection in caregiving surroundings; (b) cloth and paper diapers have different effects on the environment and neither type of diaper is clearly superior to the other; and (c) the cost of disposable diapers and reusable commercial-laundered diapers may be comparable, although home-laundered diapers are least expensive if the caregiver's labor is not considered.

Cost-Benefit Analysis↗