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PubMed1992

Decisions without consequences: cost control and access in state Medicaid programs.

States have implemented a number of strategies to provide services, pay providers, and control Medicaid spending. We test the effects of some differences in state Medicaid policies on program enrollees' access to and use of health care services. Logistic and OLS regression analyses of cross-sectional data indicate that these policies exert significant influences on enrollees' access to health services but have a weaker direct effect on their use of them. However, we find evidence that utilization is affected indirectly (through increased access) by state policy decisions. Somewhat surprisingly, Medicaid policies designed to contain costs by limiting utilization appear to affect neither access nor utilization. Medicaid enrollees have greater access to a private physician in states with higher physician reimbursement and additional Medicare insurance for their enrollees. Other nonpolicy variables with pronounced impacts on access to private office physicians include race and the availability of private insurance.

Cost Control↗
PubMed1987

Integration of geriatric assessment into the community.

The integration of geriatric assessment into the community calls for more than effective communication. There should be a defined approach to comprehensive care, of which the assessment service is a regular part, and the assessment process should have a predictable influence on further care decisions. Three types of integrating approaches are described: the "recognized specialty" approach, which is typical of several other developed countries; the "consolidated model," such as the On Lok program in San Francisco; and the "brokerage" model, such as the ACCESS program in Rochester, New York. Each approach has strengths and limitations. We may expect further evolution toward fully integrated programs.

Aged↗
PubMed1989

Family ecology and child characteristics that predict young children's educational television viewing.

This study investigated how sociological variables, program access, family attributes, and child characteristics influence children's viewing of the most well-established educational television program in the United States--"Sesame Street." 2 cohorts were followed from ages 3 to 5 and 5 to 7, respectively. Each family kept a diary of television viewed during 5 1-week periods over 2 years. Interviews and testing sessions were conducted before and after the 2-year period. "Sesame Street" viewing increased from age 3 to a peak between the ages of 3 1/2 and 4; thereafter, viewing declined. This developmental change appeared to be a function of age-correlated life events and perceived age appropriateness of the program rather than of ontogenetic cognitive change. Individual differences were primarily a function of family ecology--opportunities to view and characteristics of other viewers--rather than of family demographics or individual child attributes. Maternal employment and the amount of time children attended child care or preschool were negatively related to viewing. The presence of older siblings reduced viewing; the presence of younger siblings increased it. Viewing was unrelated to parent education or occupational status, child gender, child's vocabulary level, involvement in television, or interest in print and other media. Parental encouragement to watch the program was positively related to viewing for 3-5-year-olds.

Age Factors↗
PubMed2026

VIJB: a companion of the JBROWSE genome browser for the visually impaired people.

MOTIVATION: The availability of touch-sensitive and haptic devices has been a keystone development for the inclusion of visually impaired people (VIPs) in modern, highly digitized work environments. Braille displays have proven efficient and versatile enough to parse large and complex text files, making bioinformatics and text-heavy programming accessible to VIPs. However, the complex graphical objects -combining numerous datasets- typically generated during data integration remain challenging, even with the aid of descriptive AI. This is particularly true in functional genomics. Here, we present VIJB, a simple application that displays the multilayered output of the JBROWSE genome browser on a Braille reader, enabling VIPs to fully participate in data integration in functional genomics. AVAILABILITY AND IMPLEMENTATION: VIJB is programmed in Python and relies on the scientific library NumPy, the braillegraph and pyBigWig libraries, and the TABIX software. The architecture is summarized in Supplementary Material 1, available as supplementary data at Bioinformatics online. VIJB is available for download at the GitHub repository https://GitHub.com/NiBuMNHN/VIJB and is licenced under the GPL 3.0.

Persons with Visual Disabilities↗
PubMed1979

A computer assisted test assembly system for medical technology examinations.

A descriptive report on the establishment and implementation of a computer assisted test assembly (CATA) system at the University of Iowa Medical Technology Program is presented. This system is an alternative approach to the production of paper and pencil examinations that may be considered for use in other medical technology programs. Access to the system is designed, through coding, to correlate with specific instructional objectives in a variety of subject areas. The CATA system has capabilities for mass production of examinations, correction of examinations, and production of accumulative item analyses. Use of this computerized system has produced savings in terms of money, faculty time, and clerical assistance. Primarily, however, it has served to effectively relate instructional objectives in an educational program to the evaluation process.

Computers↗
PubMedDate not supplied

Socio-biological factors in underfive deaths in a rural area.

In 1985-86, 286 underfive deaths occurred among a population of 30,000 in a rural area of Haryana. Two hundred and eighty one were analysed for socio-biological factors related to under five mortality. Females had a higher mortality. About 2/3 of the deaths were in infants, and 90% in first 3 years. Most of the deaths (94%) occurred in the village itself, 58.4% did not seek any medical care during the terminal illness, 80-90% did not receive even a single dose of BCG, DPT or O.P.V., and 36.7% died in the first attack of illness. Though 68% had at least one episode earlier, 31.0% had been admitted in hospitals for an earlier episode of illness. In 42.8% of deaths, the birth order was IV or above. Deaths in socially and economically disadvantaged cases constituted 77.6%. The triad of diarrhea, ARI and malnutrition claimed 56% deaths. In 93% of the deaths, the mothers were illiterate and 96.4% were house wives. There was a sibling death earlier in the family in 78.3%, and 60.1% deaths were of those living in poor housing conditions. About 50% had radio for communication, 85.8% had bicycle for conveyance, and in 66.9% the family had piped water supply. All these findings have been discussed in the study.

Age Factors↗
PubMed1976

A DATA MANAGER for the health information system Berlin.

The needs for permanently changing the logical and physical structure of a medical datebase during the development of a health information system have initiated the project of implementing a DATA MANAGER. The concept of the DATA MANAGER covers facilities for the development of the logical data structure model including documentation of the model and programming support for application programs accessing the health information system (HIS) database. The outstanding facilities of the INTERLISP system have been found to be appropriate for writing the DATA MANAGER. A first data structure model, on which the DATA MANAGER will operate, is roughly outlined.

Berlin↗
PubMed1990

Characteristics of condom use and associated problems: experience in Bangladesh.

Data from the 1983 Bangladesh Condom User Survey (BCUS) are analyzed for patterns of condom use and various problems directly influencing their effectiveness. The survey was undertaken to explain an apparent gap between reports of the number of condoms distributed in certain areas compared with prevalence of users as reported in contraceptive prevalence surveys. These data are analyzed from behavioral and management perspectives to identify various factors influencing utilization, with potential implications for understanding and improving family planning and AIDS/STD prevention service systems. Patterns of use are related to differences in source of supply through public, free or private-priced systems, differences in urban or semi-rural place of residence, and differences in perceptions of men or women. The problem with condom use most often identified by the respondents was breakage.

Adult↗
PubMed1984

Problems of obstetric care in Nigeria.

The problems of obstetric care in Nigeria are multifactorial, enormous but represent inevitable evolutionary stages through which every community in the world must pass. In a population of around 90 million, there is one doctor for every 11,000 people and only 35% of the population is at present covered by any form of modern health care services. There are fewer than 500 doctors with specialist obstetric qualifications and many of them are concentrated in the large cities. A disquietingly small number (17%) of our women are delivered by personnel with modern obstetric knowledge; 83% are delivered by traditional birth attendants. The maternal mortality rate is around 8/1000, and the perinatal mortality is about 60/1000. Currently less than 20% of the population is educated. Only 3% of the national budget is devoted to health. A proper communication system so vital to the establishment of liaison between doctors and the community of patients is virtually non-existent. These problems are compounded by hostile environmental factors. A mixture of tribal, superstitious and religious practices permit marriages as early as 10 years of age and prevent women in labor from seeking medical attention in a timely fashion. Fortunately programmes for improved obstetric care are being expanded. Thus the present difficulty of working in an unfavorable and challenging situation may well be worthwhile.

Communication↗
PubMed1989

The outcome of labor at the University Teaching Hospital (CHU), Yaounde, Cameroon.

The University Teaching Hospital, Yaounde, Cameroon became operational in 1982. This retrospective study analyses the performance of the maternity unit during the first 5 years. Data was obtained from casenotes, annual reports, delivery and operation registers. The maternal mortality rate (MMR) is one of the lowest in Africa. The perinatal mortality is low but could be improved upon. The reasons for the low MMR is discussed. It is possible to reduce the appalling MMRs of developing countries without sophisticated technologies.

Adolescent↗
PubMed1991

Contraception with progestogens and progesterone during lactation.

The growth and development of breastfed infants whose mothers used the contraceptive implants Norplant containing levonorgestrel and the injectable containing norethisterone enanthate were studied. Each group comprised of 120 women who initiated the use during the 5th to 7th week postpartum and were compared with a similar number of IUD using mothers. The breastfeeding performance did not differ between groups. The infants of the three groups performed similarly as regards their physical growth and health as well as the time of acquisition of the various milestones of psychomental development. A vaginal ring releasing 10 mg of the "natural" progesterone per 24 h was tested in breastfeeding mothers. The continuous use of the ring produced a serum level of progesterone around 4 ng/ml. This was effective in augmenting lactational infertility even through the later phases of breastfeeding when such an effect starts to wane off. The use of the ring proved to be acceptable and had no ill-effect on breastfeeding or infant growth or health. Using the natural progesterone as a contraceptive adds a new measure of safety, since the amount of the steroid secreted in the mother's milk will not be effectively absorbed from the infant's gut. These studies suggest the possibility of using two new methods for breastfeeding mothers; Norplant and the progesterone vaginal contraceptive ring. These can be initiated early postpartum, whenever this is considered needed.

Contraceptive Devices, Female↗
PubMed1992

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

Child, Preschool↗