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At least 451 records · Page 25Linked to original sources
PubMed2006

Determining dental utilization rates for children: an analysis of data from the Iowa Medicaid and SCHIP programs.

OBJECTIVE: Accessing dental care is a significant problem for children in Medicaid and SCHIP. Evaluating the extent of the access problem is affected by the differential dental utilization rates as calculated by unique approaches used by national organizations. The problem is related to the intermittent enrollment in Medicaid and SCHIP for many children during the year. The objective of this study is to evaluate the effect of four different approaches for calculating dental utilization rates for children in Medicaid and SCHIP programs. METHODS: All Iowa Medicaid and S-SCHIP dental claims and enrollment files for CY 2001 were used to characterize the populations, calculate dental utilization rates and evaluate the types of services received by dental utilizers. Dental utilization rates were calculated four ways using the following different rate denominators: 1) any child enrolled during the year (Center for Medicare and Medicaid Services method), 2) children enrolled for 11-12 months (National Committee for Quality Assurance method), 3) a full-time equivalents (FTE) method, 4) only newly enrolled children. RESULTS: The methodology employed greatly affected the dental utilization rates. Rates varied from 18% for newly enrolled children in Medicaid to 58% for S-SCHIP-enrolled children using the FTE method. Methods that included children who were more likely to be in for more months during the year, such as the NCQA approach, produced the highest rates. CONCLUSIONS: The method used to determine the dental utilization rates for Medicaid and SCHIP enrollees should be clearly stated when these rates are being presented. This will allow the reader to be able to make a careful and appropriate interpretation of the results.

Adolescent↗
PubMedDate not supplied

Increasing access to dental care for medicaid preschool children: the Access to Baby and Child Dentistry (ABCD) program.

OBJECTIVE: Washington State's Access to Baby and Child Dent stry (ABCD) Program, first implemented in Spokane County in 1995, offers extended dental benefits to participating Medicaid-enrolled children and higher fees for certified providers. This study aimed to determine the program's effect on children's dental utilization and dental fear, and on parent satisfaction and knowledge. METHODS: The study used a posttest-only comparison group design. Trained interviewers conducted telephone interviews with 465 parents of chi dren ages 13 to 36 months (49% ABCD, 51% Medicaid-enrolled children not in ABCD). One year later, 282 of 465 parents completed a follow-up survey. Utilization and expenditures were calculated from Medicaid claims. RESULTS: Forty-three percent of children in the ABCD Program visited a dentist in the follow-up year, compared with 12% of Medicaid-enrolled children not in the ABCD Program. An ABCD child was 5.3 times as likely to have had at least one dental visit as a child not in the program. ABCD children were 4 to 13 times as likely to have used specific dental services. Parents of ABCD children were more likely to report having ever tried to make a dental appointment, less likely to report that their children were fearful of the dentist, and were more satisfied, compared to parents of non-ABCD children. CONCLUSION: The authors conclude that the ABCD Program was effective in increasing access for preschool children enrolled in Medicaid, reducing dental fear, and increasing parent satisfaction.

Child, Preschool↗
PubMed2006

Defining participant exposure measures in Web-based health behavior change programs.

BACKGROUND: Published research on the use of Web-based behavior change programs is growing rapidly. One of the observations characterized as problematic in these studies is that participants often make relatively few website visits and spend only a brief time accessing the program. Properly structured websites permit the unobtrusive measurement of the ways in which participants access (are exposed to) program content. Research on participant exposure to Web-based programs is not merely of interest to technologists, but represents an important opportunity to better understand the broader theme of program engagement and to guide the development of more effective interventions. OBJECTIVES: The current paper seeks to provide working definitions and describe initial patterns of various measures of participant exposure to ChewFree.com, a large randomized controlled trial of a Web-based program for smokeless tobacco cessation. METHODS: We examined measures of participant exposure to either an Enhanced condition Web-based program (interactive, tailored, and rich-media program) or a Basic condition control website (static, text-based material). Specific measures focused on email prompting, participant visits (number, duration, and pattern of use over time), and Web page viewing (number of views, types of pages viewed, and Web forum postings). RESULTS: Participants in the ChewFree.com Enhanced condition made more visits and spent more time accessing their assigned website than did participants assigned to the Basic condition website. In addition, exposure data demonstrated that Basic condition users thoroughly accessed program content, indicating that the condition provided a meaningful, face-valid control to the Enhanced condition. CONCLUSIONS: We recommend that researchers conducting evaluations of Web-based interventions consider the collection and analysis of exposure measures in the broader context of program engagement in order to assess whether participants obtain sufficient exposure to relevant program content.

Adult↗
PubMed1994

A quality improvement program for hemodialysis vascular access.

The effective delivery of dialysis requires repeated reliable access to the central circulation capable of providing rapid extracorporeal blood flow. Unfortunately, this access to the circulation continues to be the "weak link" in the effective delivery of long-term hemodialysis therapy. This will likely become an even greater problem in the future as increasing numbers of patients with limited access sites secondary to advanced age and atherosclerosis enter the end-stage renal program. Therefore, the preservation of these limited vascular access sites is imperative. Vascular access thrombosis is the leading cause of graft loss and venous stenosis is the major cause of graft thrombosis. Early detection of venous stenosis through careful inspection of the graft combined with measurements of venous outflow pressure and urea recirculation can identify venous access stenosis. Identification of these lesions combined with preemptive repair improves dialysis efficiency and preserves vascular access. When these techniques are used, a dramatic impact on dialysis fistula patency and function can be seen.

Arteriovenous Shunt, Surgical↗
PubMed1999

Evaluation of the Community Access to Child Health Program.

OBJECTIVE: Increasing attention is being focused on the need for pediatricians to promote child health in their respective communities. The objective of this study was to evaluate, retrospectively, the American Academy of Pediatrics' Community Access to Child Health (CATCH) Program. STUDY DESIGN: Case studies of 12 Community Pediatric projects in existence from 1989 to 1995 with varying degrees of involvement in the CATCH Program. In-person interviews were conducted with 17 pediatricians, 3 CATCH leaders who were not pediatricians, 27 project advisory committee members, 42 project staff, 47 community partners, 22 public health representatives, and personnel in 13 affiliated institutions. RESULTS: These projects established or enhanced child health services. Although most pediatricians' interest in community child health preceded CATCH, mentoring, training, and peer support contributed to ongoing involvement. Community factors that facilitated project development included historical collaborative efforts and active public health agencies. However, across sites, significant barriers related to attitude and resource limitations were noted. Attitudinal barriers included both institutional concerns (eg, competition among providers or distrust among community agencies and organizations) and cultural concerns (eg, general negative perceptions of providers about Medicaid beneficiaries or of members of minority population toward medical or government establishments). CONCLUSIONS: In an era of devolution of responsibility to local communities, there are likely to be more opportunities for pediatricians to work with community members to promote child health. Specific strategies should be refined and expanded to support pediatricians' involvement in community-based activities, particularly because it is recognized that insurance alone will not guarantee children's health.

Child↗
PubMed2002

The role of color flow Doppler ultrasound in dialysis access.

Color flow Doppler provides accurate imaging and access flow volume measurement of the hemodialysis vascular access. It can readily identify subsets of patients at high risk for future thrombosis. It is noninvasive, mobile, and allows convenient clinical evaluation at the dialysis facility. In Europe, Doppler ultrasound has become the standard of care for evaluation of arteriovenous (AV) fistula dysfunction and is essential in the preoperative evaluation for access placement. It also can diagnose the arterial inflow disease that has become more prevalent in our aging, diabetic, end-stage renal disease (ESRD) population. Access management programs based on Doppler ultrasound have been highly successful and have produced outcome data as good or better than provided with other techniques. In light of its proven clinical efficacy, reimbursement and regulatory agencies should allow its appropriate inclusion into integrated access management programs. In conclusion, Doppler ultrasound should be included as a part of an integrated vascular access management program. This is supported by clinical outcome data and direct comparisons with other modalities.

Arteriovenous Shunt, Surgical↗
PubMed2006

A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs.

Increasing access to sterile syringes and new drug preparation materials is an effective means of reducing HIV transmission among injection drug users (IDUs), and a fundamental component of harm reduction ideology. The purpose of this study is to examine changes during a three-year period in syringe acquisition by street-recruited Puerto Rican IDUs characterized by frequent drug injection and high HIV seroprevalence. At baseline (1998-1999) and 36-month follow-up, 103 IDUs recruited in East Harlem, New York (NY), and 135 from Bayamón, Puerto Rico (PR) were surveyed about syringe sources and HIV risk behaviors in the prior 30 days. A majority of participants in both sites were male (NY 78.6%, PR 84.4%), were born in Puerto Rico (NY 59.2%, PR 87.4%), and had not completed high school (NY 56.3%, PR 51.9%). Compared to PR IDUs at follow-up, NY IDUs injected less (3.4 vs. 7.0 times/day, p < .001), and re-used syringes less (3.1 vs. 8.0 times, p < .001). Between baseline and follow-up, in NY the proportion of syringes from syringe exchange programs (SEPs) increased from 54.2% to 72.9% (p = .001); syringes from pharmacies did not increase significantly (0.2% to 2.5%, p = .095). In PR, the proportions of syringes from major sources did not change significantly: private sellers (50.9% to 50.9%, p = .996); pharmacies (18.6% to 19.0%, p = .867); SEP (12.8% to 14.4%, p = .585). The study indicates that NY SEPs became more dominant, while NY pharmacies remained a minor source even though a law enacted in 2001 legalized syringe purchases without prescription. Private sellers in PR remained the dominant and most expensive source. The only source of free syringes, the SEP, permitted more syringes to be exchanged but the increase was not statistically significant. Implications for syringe exchange and distribution programs are discussed.

Adult↗
PubMed2025

E2F1 induces a G0-G1 reentry transcriptional program without changing chromatin accessibility.

Quiescent cells actively repress cell-cycle genes via chromatin-based mechanisms to maintain a non-dividing state, yet remain poised to reenter upon stimulation. E2F1, a canonical activator of cell-cycle genes, is sufficient to induce reentry from quiescence, but how it overcomes chromatin-mediated repression remains unclear. Here, we show that inducible E2F1 expression triggers exit from quiescence and progression through the cycle without changes in chromatin accessibility, by harnessing regulatory elements with limited, pre-existing accessibility. Using time-resolved transcriptomics, we demonstrate that E2F1 induces an accelerated transcriptional program compared to serum. Unlike serum, which triggers broad chromatin remodeling, E2F1-induced activation occurs in a context of limited accessibility. ChIP-seq reveals that E2F1 directly binds target sites in quiescent cells to upregulate canonical genes. Biochemical reconstitution shows that E2F1 binds nucleosomes and accesses internal E2F sites within histone-wrapped DNA. These findings suggest that E2F1 can engage nucleosome-associated DNA and initiate transcription without major chromatin reorganization, redefining transcription factor-chromatin dynamics during cell fate transitions and establishing E2F1 as a potent regulator of cell-cycle reentry.

Journal Article↗
PubMed1994

Comment.

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Abortifacient Agents↗