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Biomedical subjects

R B Gold

Publications and source records attributed to R B Gold.

At least 37 records · Page 2Linked to original sources
PubMed1989

Conservative management of second-trimester post-amniocentesis fluid leakage.

During a 32-month period, 603 genetic amniocenteses were performed in our institution, and seven patients (1.2%) experienced fluid leakage within 24 hours of the procedure. All seven patients were hospitalized for strict bed rest and expectant management. Cessation of amniotic fluid leakage and reaccumulation of normal amniotic fluid occurred within 7 days in all cases. Six patients were delivered at term of appropriately grown infants without complication. One patient experienced an intrauterine death at 25 weeks' gestation (6 weeks after the occurrence of fluid leakage secondary to genetic amniocentesis). Although limited by the small number of patients, our experience suggests the following: 1) Appropriate respect for potential complications of genetic amniocentesis is still warranted; 2) expectant management of patients who experience membrane rupture after genetic amniocentesis may be associated with a good perinatal outcome; and 3) membrane rupture after genetic amniocentesis may represent a fundamentally different etiologic entity than spontaneous rupture of the membranes in the second trimester not associated with genetic amniocentesis.

Amniocentesis↗
PubMedDate not supplied

Family planning funding through four federal-state programs, FY 1997.

CONTEXT: The maternal and child health (MCH) and the social services block grants have long played an important role in the provision of family planning services in the United States. The extent to which states have incorporated family planning services into the newer federally funded, but state-controlled, programs--Temporary Aid to Needy Families (TANF) and the State Children's Health Insurance Program (CHIP)--has yet to be identified. METHODS: The health and social services agencies in all U.S. states, the District of Columbia and five federal jurisdictions were queried regarding their family planning expenditures and activities through the MCH and social services block grants and the TANF program in FY 1997. In addition, the states' CHIP plans were analyzed following their approval by the federal government. Because of differences in methodology, these findings cannot be compared with those of previous attempts to determine public expenditures for contraceptive services and supplies. RESULTS: In FY 1997, 42 states, the District of Columbia and two federal jurisdictions spent $41 million on family planning through the MCH program. Fifteen states reported spending $27 million through the social services block grant. Most of these jurisdictions indicated that they provide direct patient care services, most frequently contraceptive services and supplies. Indirect services--most often population-based efforts such as outreach and public education--were reported to have been provided more often through the MCH program than through the social services program. MCH block grant funds were more likely to go to local health departments, while social services block grant funds were more likely to be channeled through Planned Parenthood affiliates. Four states reported family planning activities funded under TANF in FY 1997, the first year of the program's operation. Virtually all state plans for the implementation of the CHIP program appear to include coverage of family planning services and supplies for the adolescents covered under the program, even when not specifically required to do so by federal law. CONCLUSIONS: Joining two existing--but frequently overlooked--block grants, two new, largely state-controlled programs are poised to become important sources of support for publicly funded family planning services. Now more than ever, supporters of family planning services need to look beyond the traditional sources of support--Title X and Medicaid--as well as beyond the federal level to the states, where important program decisions are increasingly being made.

Adolescent↗
PubMedDate not supplied

Reproductive health services for adolescents under the State Children's Health Insurance Program.

CONTEXT: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services. METHODS: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures. RESULTS: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers. CONCLUSIONS: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.

Adolescent↗
PubMedDate not supplied

States' implementation of the Section 510 abstinence education program, FY 1999.

CONTEXT: As part of its reworking of the nation's welfare system in 1996, Congress enacted a major new abstinence education initiative (Section 510 of Title V of the Social Security Act), projected to spend $87.5 million in federal, state and local funds per year for five years. The new program is designed to emphasize abstinence from sexual activity outside of marriage, at any age, rather than premarital abstinence for adolescents, which was typical of earlier efforts. The actual message and impact of the program, however, will depend on how it is implemented. METHODS: Program coordinators in all 50 states, the District of Columbia and Puerto Rico were surveyed concerning implementation of the Section 510 abstinence education program in FY 1999. The questionnaire asked about expenditures and activities performed, about policies established for a variety of specific situations and about how the term "sexual activity" is defined and what specific components of the federal definition of "abstinence education" are emphasized. RESULTS: Forty-five jurisdictions spent a total of $69 million through the Section 510 program in FY 1999. Of this total, $33 million was spent through public entities, $28 million was spent through private entities and $7million (in 22 jurisdictions) was spent through faith-based entities. Almost all jurisdictions reported funding school-related activities, with 38 reporting in-school instruction and presentations. Twenty-eight jurisdictions prohibited organizations from providing information about contraception (aside from failure rates), even at a client's request, while only six jurisdictions prohibited information about sexually transmitted diseases. Few reported having a policy or rendering guidance about providing services addressing sexual abuse, sexual orientation or existing pregnancy and parenthood. Only six respondents said they defined "sexual activity" for purposes of the program, and 16 reported focusing on specific portions of the federal definition of "abstinence education." CONCLUSIONS: More than one in 10 Section 510 dollars were spent through faith-based entities. Programs commonly conducted in-school activities, particularly instruction and presentations, not only through public entities, but also through private and faith-based entities. Most jurisdictions prohibited the provision of information about contraception, about providers of contraceptive services or about both topics, even in response to a direct question and when using other sources of funding. Most also left definitions of "abstinence" and "sexual activity" as local decisions, thus not clearly articulating what the program is designed to encourage clients to abstain from.

Adolescent↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, fiscal year 1990.

In FY 1990, the federal and state governments spent $504 million to provide contraceptive services and supplies, according to results of a survey of state health, social services and Medicaid agencies conducted by The Alan Guttmacher Institute. Medicaid accounted for 38 percent of all public funds spent on contraceptive services, Title X provided 22 percent, and two federal block-grant programs--Social Services and Maternal and Child Health--together were responsible for 12 percent of public expenditures. State governments accounted for the remaining 28 percent of public funding. Although public expenditures for contraceptive services have risen by $154 million over the past decade, when inflation is taken into account, expenditures have actually fallen by one-third. Since 1980, the proportion of public contraceptive expenditures contributed by Title X has been cut virtually in half, while the proportion contributed by state governments has nearly doubled. When inflation is taken into account, Title X expenditures for contraceptive services have fallen by almost two-thirds since 1980. The federal and state governments together spent $95 million to subsidize sterilization services in 1990, and $65 million to provide abortion services. The federal government was the major source of funding for sterilization services but provided less than one percent of the cost of abortion services. Because of changes over time in survey methodology and the difficulties some states had in separating out expenditures by type of care, these data are approximations.

Abortion, Legal↗
PubMedDate not supplied

Fetal research under fire: the influence of abortion politics.

Since 1973, fetal research has repeatedly been used as a weapon in the war against abortion, miring important research in seemingly endless controversy. Government funding of fetal research has been suspended several times: A 1974 moratorium was lifted in 1975 after regulations concerning such research were promulgated; in 1985, a moratorium was placed on some federally funded fetal research; and in 1988, the assistant secretary for health halted all federally funded research on fetal tissue transplantation while an outside advisory panel examined related ethical, legal and scientific issues. The panel deemed such research acceptable, while also recommending that safeguards be established to separate abortion from transplantation research and to prevent profiteering from or encouragement of abortion. Although the report was forwarded to the assistant secretary in January, the moratorium has not yet been lifted by the new administration.

Abortion, Legal↗
PubMedDate not supplied

Public funding of family planning, sterilization and abortion services, 1987.

In FY 1987, the federal and state governments spent +386 million to provide family planning services. Medicaid was the leading source of public funding, accounting for 36 percent of all public monies spent on family planning. Title X of the Public Health Service Act provided 34 percent of total public funds, and two block-grant programs--Social Services and Maternal and Child Health--together were responsible for 17 percent of public support in this area. State governments, which spent a total of +50 million of their own revenues for family planning services, accounted for the remaining 13 percent of public funding. The federal and state governments together spent +65 million to subsidize contraceptive sterilization services in FY 1987. The federal government provided 97 percent of the funding, 88 percent through the Medicaid program. In addition, the federal and state governments spent +64 million to provide 189,000 abortions to poor women; less than one percent of these funds were contributed by the federal government. These data come from a survey of state health, welfare and Medicaid agencies carried out by The Alan Guttmacher Institute and should be viewed as approximations rather than as precise figures.

Abortion, Legal↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, 1985.

In FY 1985, the federal and state governments spent $398 million to provide contraceptive services and supplies. The two leading sources of funding were the Medicaid program and Title X of the Public Health Service Act. The former accounted for $137 million, or 34 percent of all public expenditures; and the latter program accounted for $133 million, also 34 percent. Two blockgrant programs--Social Services and Maternal and child Health--provided $40 million and $23 million, respectively; together, they were responsible for 16 percent of public support for contraceptive services. State governments, which spent $64 million of their own revenues, accounted for another 16 percent of funding. The federal and state governments together spent $64 million to subsidize sterilizations in FY 1985. The federal government provided 94 percent of the funding--84 percent through the Medicaid program. In addition, the states and the federal government spent $66 million to subsidize 188,000 abortions; in this case, however, the federal government contributed less than one percent of the funds used. These data come from a survey of state agencies, and should be viewed as approximations rather than as precise figures.

Abortion, Induced↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, 1983.

In 1983, the federal and state governments spent +340 million to provide contraceptive services--four percent more than they spent during the previous year. Title X of the Public Health Service Act, still the leading source of funding, accounted for +117 million, or 34 percent of all public expenditures. Almost as important was the +108 million (32 percent of total expenditures) provided through Title XIX of the Social Security Act (Medicaid). Two block-grant programs--Social Services and Maternal and Child Health--provided +38 million and +19 million, respectively; together, the two were responsible for 17 percent of public support for contraceptive services. State governments, which spent +58 million of their own revenues, provided an additional 17 percent of funding. Some public expenditures for contraceptive services were made in all the states. Nearly all of the four percent increase in total public funds between 1982 and 1983 was due to a 15 percent rise in Medicaid reimbursements. The federal and state governments together spent +69 million to provide about 73,000 sterilizations in 1983. Ninety percent of sterilization expenditures were made by the federal government--86 percent through the Medicaid program. In addition, the states and the federal government spent +71 million to provide 216,000 abortions in 1983. Unlike public funding for either contraceptive services or sterilization, almost all of the funding for abortion came from the states rather than from the federal government.

Abortion, Legal↗
PubMedDate not supplied

Public funding of contraceptive, sterilization and abortion services, 1982.

The federal government and the states spent $328 million to support the provision of contraceptive services in fiscal 1982, 13 percent less than they had spent the previous year. Federal funds for family planning services came from Title X of the Public Health Service Act, Title XIX of the Social Security Act (Medicaid), and the Maternal and Child Health (MCH) and Social Services block grants, which are administered by the states. Title X continued to provide the largest, although a diminishing, share of public funds for contraceptive services--36 percent of all such funds in 1982. (In 1980, Title X had accounted for 44 percent of public funding.) Medicaid expenditures for family planning totaled $94 million; $17 million was spent under the MCH block grant, and $46 million under the Social Services block grant. State governments contributed an additional $53 million, about the same figure reported for the previous year, indicating that the states did not use their own funds to soften the impact of cuts in federal expenditures for contraceptive services in 1982. The federal government and the states spent an estimated $55 million, almost all of it through Medicaid, to provide sterilization services for poor women. The states spent $67 million and the federal government spent $1 million to provide abortions for 210,000 indigent women. These figures come from the 11th annual survey of state health and welfare agencies and state Medicaid programs by The Alan Guttmacher Institute (AGI). The AGI conducted this survey in January 1983 to determine the levels and sources of public funding for contraceptive, sterilization and abortion services in each state during FY 1982.

Abortion, Legal↗