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PubMed1999

Managed care in rural markets: availability and enrollment.

The objective of this research was to test the hypothesis that urban-rural differences in managed care availability and enrollment are primarily due to differences in population socioeconomic and health system characteristics rather than geographic location, population size, or density. These two groups of variables were entered into a regression equation to determine which group could best account for the variance in managed care availability and enrollment. In general, the results of these analyses indicated that socioeconomic and health system characteristics did a much better job of explaining differences in managed care availability and enrollment. Therefore, focusing on factors such as adjacency to metropolitan areas or population size or density in making managed care policy decisions may be less productive than focusing on the socioeconomic and health system characteristics of an area.

Analysis of Variance↗

PubMed1993

Availability and Adequacy of Diagnostic and Therapeutic Equipment for the Morbidly Obese Patient in an Acute Care Setting.

Morbid obesity is a common problem with an estimated three to five million people in the USA being morbidly obese. The likelihood of hospital admission for this population is increased due to their associated diseases. The treatment of the morbidly obese can be hindered by the lack of diagnostic and therapeutic equipment. As a Level I Trauma Center and referral facility for 29 counties in eastern North Carolina, our institution offers advanced clinical services on an annual basis for many morbidly obese patients. An evaluation of the availability of specialized equipment for the morbidly obese was conducted to assure that our institution was prepared to continue to provide high-tech clinical services. Limitations in the availability and adequacy of equipment were identified. A phone survey of companies that supplied equipment designed for the unique needs of the morbidly obese was completed to identify additional products that are available to assist in providing safe and efficient care for the obese patient. Justifying additional capital purchases can be substantiated by survey results. Recommendations for the number and type of equipment needed for specialized services were developed.

Journal Article↗

PubMed2006

Available treatment options for the management of Lambert-Eaton myasthenic syndrome.

Lambert-Eaton myasthenic syndrome is a rare, but reasonably well-understood, antibody-mediated autoimmune disease that is caused by serum auto-antibodies and results in muscle weakness and autonomic dysfunction. One half of the patients have an idiopathic form, the other half a tumour-associated form of the disease. Three randomised trials and a large number of smaller clinical studies have resulted in a number of drugs becoming available for the treatment of Lambert-Eaton myasthenic syndrome. Several drugs are available for the symptomatic treatment of the disease, including guanidine, aminopyridines or acetylcholinesterase inhibitors. Other therapies aim to deplete the serum autoantibodies or to suppress the immune system. For this purpose, immunomodulating strategies, such as intravenous immunoglobulins or plasmapheresis, or several immunosuppressive agents are available. Chemotherapy has successfully ameliorated the course of disease in Lambert-Eaton myasthenic syndrome patients with an underlying tumour.

4-Aminopyridine↗

PubMed1986

Alcohol availability, alcohol consumption and alcohol-related damage. I. The distribution of consumption model.

One of the major approaches to alcoholism prevention is referred to as the distribution of consumption model. This prevention model can be summarized as a causal model whereby the availability of alcoholic beverages has a direct causal effect on the aggregate level of alcohol consumption in the population and, in turn, an indirect effect on the incidence and prevalence of alcohol-related damage. This article summarizes an application of a statistical technique known as the analysis of linear structural relations (LISREL) to a set of Ontario data concerning alcohol availability, alcohol consumption and alcohol-related damage. Results substantiated the existence of specific causal paths consistent with the model. Several procedures for assessing the overall goodness-of-fit of the model suggested that it adequately fit the data. The results provide reasonable statistical evidence that government policies restricting the retail availability of alcoholic beverages will reduce the per capita rates of alcohol consumption and, in turn, reduce the level of alcohol-related mortality and morbidity in the general population.

Adult↗

PubMed1992

Alcohol availability and consumption: Iowa sales data revisited.

Recent changes in Iowa liquor control laws ended the 51-year-old state alcohol monopoly distribution system and turned the sales of bottled wine and spirits over to the private sector. The resulting increase in the availability of these beverages provided a unique opportunity to study the relationship between increased wine and spirits availability and changes in their consumption. Time series analyses of monthly sales (apparent consumption) trends showed that the increased availability had no lasting impact on consumption.

Adult↗

PubMed2005

Medicaid acceptance and availability of timely follow-up for newborns with Medicaid.

OBJECTIVE: Decreased physician participation in Medicaid has been shown to affect adversely timeliness of adult acute care and pediatric specialty care, but it is not clear whether this is the case for newborn follow-up. The objectives of this study were to determine whether there is a difference within clinics in the timeliness of follow-up appointments that are given to newborns with Medicaid compared with newborns with private insurance and to determine whether there is a difference between clinics that do and do not accept Medicaid in the timeliness of appointments that are given for newborn follow-up. METHODS: A randomized crossover study was conducted among general pediatric clinics and practices that were identified from the yellow pages and Internet searches of hospitals and health departments in 8 metropolitan areas from September 2003 to March 2004. A simulated parent telephoned clinics to find the earliest available appointment for a 1-day-old infant who needed routine follow-up after discharge that day. Clinics were randomly assigned to receive a first call from a patient with either Medicaid or private insurance; each clinic received the same call at least 3 weeks later with the patient's insurance status reversed. The main outcome measure was whether the appointment was timely (< or =2 days from the day of the call). RESULTS: Of 401 participating clinics, 22% did not accept Medicaid. Among clinics that accepted Medicaid, availability of a timely appointment for a newborn with Medicaid was similar to that for a newborn with private insurance (87% vs 90%, respectively). Appointments that were provided to privately insured newborns were as likely to be timely in clinics that accept Medicaid as in clinics that do not accept Medicaid (89.5% vs 93.4%, respectively). However, providing timely appointments was significantly less likely in clinics that were in high-poverty locations compared with clinics that were not (86.1% vs 92.7%, respectively). CONCLUSIONS: Although newborns with Medicaid did not have access to >20% of clinics because of their insurance, among clinics that did accept Medicaid, timeliness of available follow-up was similar for newborns with Medicaid compared with newborns with private insurance and similar between clinics that did and did not accept Medicaid. However, to the extent that care for newborns with Medicaid is concentrated in clinics in high-poverty areas, some newborns with Medicaid may not be able to receive timely appointments.

Community Health Services↗

PubMed2006

Currently available ventricular-assist devices: capabilities, limitations and future perspectives.

The continuous progress in ventricular-assist device (VAD) technology and the management of patients with VADs has broadened the treatment options for end-stage heart failure patients. The available line-up of clinical devices provides the current optimal therapies to meet the specific needs of each patient. The extended durability, safety, efficacy and improved quality of life of the patients provides sufficient proof for the VAD to be a likely alternative therapy to heart transplantation. The sequential progress from the first-, to the second- and to the third-generation VAD technology is expected to bring increasing benefits to clinical outcomes. This article reviews the current status, capabilities, limitations and future perspectives of currently available VADs by generally classifying them via support duration, alignment of pump devices and via pulsatile or nonpulsatile mode of perfusion. Furthermore, the future direction of research and development for next-generation VADs is presented based on the lessons learned from currently available VADs.

Clinical Trials as Topic↗

PubMed1997

[Nutritional data: what is available in Brazil?]

Available nutritional information in Brazil, generated by non-periodic population surveys, has scarcely contributed to the development of policies aimed at improving the nutritional status of the Brazilian population, although it has helped establish the magnitude and distribution of this problem. We suggest that data available in the various health information systems be used to feed, monitor, and evaluate nutritional policies, for updating and local follow-up purposes. Deficiencies in the quality of data available in these health information systems can be minimized through validation studies, thus improving the information generated by the system as a whole and consequently the quality of health care.

Journal Article↗

PubMedDate not supplied

Availability, safety, and quality of blood for transfusion in the Americas.

OBJECTIVES: This article has two objectives: (1) to present for countries and territories of the Region of the Americas data on the number of blood donations, proportion of voluntary blood donors versus remunerated blood donors, coverage of screening for infectious agents, and separation of donated blood into its components and (2) to explore the relationships of those characteristics with economic and organizational factors in the countries and territories. METHODS: We carried out comparative analyses using population and health information gathered annually by the Pan American Health Organization (PAHO) from national health officials from the countries in the Americas, as well as economic information (gross national product (GNP) per capita) obtained from publications of the World Bank. RESULTS: There is a direct correlation between the availability of blood for transfusion and GNP per capita. Seven countries with a GNP per capita above US$ 10 000 per year account for 38% of the Regional population but 68% of the Regional blood donations. Voluntary blood donation is more common in the countries with better blood availability. There is no association between GNP per capita and coverage of screening for infectious agents. Nevertheless, of the six countries with a GNP per capita below US$ 1 000, only one of the six screens all units for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B surface antigen (HBsAg). Countries with a higher proportion of voluntary blood donors tend to have lower prevalence rates of infectious markers. Separation of blood into its components is also more common in countries with higher blood donation rates. CONCLUSIONS: The availability, safety, and quality of blood for transfusion in the Americas needs to be improved. As part of that effort, national policies and strategies must be put into place so that the resources already allocated for blood services are better utilized.

Blood Banks↗

PubMed2003

Influence of sugar availability and indoor microclimate on survival of Anopheles gambiae (Diptera: Culicidae) under semifield conditions in western Kenya.

The influence of indoor microclimate on survival of female Anopheles gambiae sensu stricto Giles (Diptera: culicidae) mosquitoes fed on different nutrition sources was evaluated in a semifield experimental hut exposed to ambient climate in western Kenya. Cages of mosquitoes (n approximately 50 per cage) were placed in nine positions within the hut combining three different sides and three different heights. At each height and side, mosquitoes were offered either human blood (once every 2 d), glucose (6% wt:vol) or a combination of the two diets over three experiments so that each cage position received one diet source. The effect of diet on survival was significant with mean survival times of 14 d for mosquitoes fed blood alone, 29 d for sugar alone and 33 d for blood plus sugar. Sugar availability decreased the odds of mortality approximately 85% compared with the blood group. Micro heterogeneities of temperature but not relative humidity also influenced survival although to a much lesser extent. The side but not height within the hut at which mosquitoes were placed, influenced survival but could not be explained by either temperature or relative humidity differences. The potential influence of seemingly minor heterogeneities of indoor microclimate upon vector longevity and vectorial capacity may merit further investigation. Also, the availability of sugar was shown to be a potentially crucial determinant of vectorial capacity. Compared with blood alone, the availability of sugar served to increase survival potential of vectors beyond ages at which they are old enough to transmit malaria.

Animals↗

PubMedDate not supplied

Multicenter drug use evaluation of tamsulosin and availability of guidance criteria for nonformulary use in the veterans affairs health system.

OBJECTIVE: The U.S. Department of Veterans Affairs (VA) Pharmacy Benefits Management Strategic Healthcare Group (PBM-SHG) and its Medical Advisory Panel developed national criteria (guidelines) for the appropriate use of tamsulosin in the VA. Drug use evaluation (DUE) was performed to (a) determine the prescribing patterns (indications and patient follow-up monitoring as measured by a clinician.s note regarding evaluation of therapeutic response or report of adverse drug event) of tamsulosin, (b) assess the impact of the availability (not active dissemination) of national criteria for nonformulary use of tamsulosin, and (c) project the cost avoidance if generic terazosin was substituted for tamsulosin in those patients who were prescribed tamsulosin outside of appropriate use criteria. METHODS: Geographically dispersed VA medical centers were identified for which tamsulosin utilization was significantly above and below the national average (4.8% of all prescriptions for alpha [alpha]-blockers) in January 2001. A data collection form for medical record abstraction was designed to capture the patient.s diagnosis, reported indication for tamsulosin, history of previous alpha-blocker use, tamsulosin follow-up evaluation, and the individual facility.s method of implementation of criteria for nonformulary use. Patients receiving a prescription for tamsulosin during a 3-month period preceding the posting of national criteria, and patients with a first-time prescription for tamsulosin during a 3-month period after the national criteria were posted were randomly selected by the PBM and assigned for chart review at each site. RESULTS: Data for 332 patients were collected from 6 different sites over a 6-month period for each pregroup and postgroup beginning August 2001 and January 2002, respectively. Tamsulosin was prescribed for appropriate indications in 66% of patients, potentially appropriate indications in 4% of patients, and inappropriate indications in 30% of patients. Of the 206 patients (62%) who were prescribed tamsulosin as a result of a reported adverse event with a previous alpha-blocker, only 29% of the cases (N = 59) showed evidence that an attempt was made to reduce the dose of the first alpha-blocker to abate the side effects. Followup monitoring was conducted in 78% of tamsulosin patients, of whom 55% reported effectiveness of tamsulosin, and 6% reported side effects attributable to tamsulosin. No meaningful differences in prescribing patterns were found between the pregroups and postgroups relative to the posting of the criteria for nonformulary use. Two sites had some form of the criteria made available to physicians, while 4 sites had not implemented the national criteria. Extrapolation of the results to the VA system-wide yielded a conservative estimate of 480,993 dollars in potential cost avoidance for 1 quarter (July to September 2002) when corrected for patients prescribed tamsulosin outside of the criteria for nonformulary use. CONCLUSIONS: Despite the availability of national criteria for nonformulary use of tamsulosin, the results reveal that these criteria were not followed by prescribers. The DUE reinforced the need for more effective implementation and dissemination of criteria for appropriate use of tamsulosin. A formal education process is necessary to encourage appropriate use of formulary alpha-blockers and to attenuate the increased cost associated with the inappropriate prescribing of the nonformulary drug.

Adrenergic alpha-Antagonists↗

PubMed2003

The effects of metals and food availability on the behavior of Caenorhabditis elegans.

Caenorhabditis elegans, a nonparasitic soil nematode, was used to assess the combined effects of metal exposures and food availability on behavior. Movement was monitored using a computer tracking system after exposures to Cu, Pb, or Cd while feeding was measured as a change in optical density (deltaOD) of bacteria suspensions over the exposure period. After 24-h exposures at high and low bacteria concentrations, movement was decreased in a concentration-dependent fashion by Pb and Cd but feeding reductions were not directly proportional to exposure concentrations. Copper exposure induced concentration-dependent declines in feeding and movement regardless of bacteria concentration. The impact of 24-h metal exposures was apparently reduced by increasing food availability. Therefore, exposures were shortened to 4 h in an attempt to minimize starvation effects on movement. Although nematodes were immobilized following 24 h of food depravation, worms deprived of food during the 4-h exposure continued to feed and move after exposure. A bead-ingestion assay after 4-h exposures was also used as an additional means of assessing the effects of metals on feeding behavior. Ingestion was significantly reduced by all concentrations of metals tested, indicating its sensitivity as a sublethal assay. Feeding (deltaOD) during exposures exhibited similar trends as ingestion but was slightly less sensitive, while movement was the least sensitive assay of 4-h metal exposures to C. elegans. Assessment of multiple sublethal endpoints allowed for the determination of the separate and interactive effects of metals and food availability on C. elegans behavior.

Animals↗

PubMed2005

Physicochemical characterization of coke-plant soil for the assessment of polycyclic aromatic hydrocarbon availability and the feasibility of phytoremediation.

Coke oven site soil was characterized to assess the particle association and availability of polycyclic aromatic hydrocarbons (PAHs). We identified various carbonaceous materials including coal, coke, pitch, and tar decanter sludge. Most of the PAHs were associated with the polymeric matrix of tar sludge or hard pitch as discrete particles, coatings on soil mineral particles, or complex aggregates. The PAH availability from these particles was very low due to hindered diffusive release from solid tar or pitch with apparent diffusivities of 6 x 10(-15) for phenanthrene, 3 x 10(-15) for pyrene, and 1 x 10(-15) cm2/s for benzo[a]pyrene. Significant concentrations of PAHs were observed in the interior of solid tar aggregates with up to 40,000 mg/kg total PAHs. The release of PAHs from the interior of such particles requires diffusion over a substantial distance, and semipermeable membrane device tests confirmed a very limited availability of PAHs. These findings explain the results from three years of phytoremediation of the site soil, for which no significant changes in the total PAH concentrations were observed in the test plot samples. The observed low bioavailability of PAHs probably inhibited PAH phytoremediation, as diffusion-limited mass transfer would limit the release of PAHs to the aqueous phase.

Acetone↗

PubMed2006

Contaminated sediment testing with the bivalve Mulinia lateralis: culture refinement for organism availability.

Availability of test species for estuarine benthic assessment is limited; therefore, a method was developed by the U.S. Environmental Protection Agency for using the dwarf surf clam (Mulinia lateralis) to identify adverse biological effects of bulk estuarine sediments. A multilaboratory evaluation of the draft method resulted in favorable responses from the participants with respect to general testing and handling of the clam. However, availability of good-quality test organisms was limited. An investigation of culture techniques determined that culture vessel topography dramatically influenced survival, because larvae accumulated in bottom depressions. Conditioning of brood stock was enhanced by algae naturally containing both 20:5n-3 and 22:6n-3 fatty acids. Survival of larvae to metamorphosis at 14 d postspawn was greatly increased by maintenance at a lighting of 734 lux with addition of gradually increasing amounts of Isochyris galbana and Chaetoceros calcitrans. Greater than 50% survival of 600 juveniles to testing size by 14 d postmetamorphosis was accomplished by intermittent delivery of algae 12 times per day in a total of 13 L of seawater. By 21 d postmetamorphosis, an additional 27% achieved testable size. As a result of identification of these culture parameters, test bivalves can be readily available to improve predictions of adverse biological effects on benthic communities beyond those presently determined through amphipod exposures.

Animals↗

PubMed1977

Demand for food on fixed-ratio schedules as a function of the quality of concurrently available reinforcement.

Six rats lever pressed for food on concurrent fixed-ratio schedules, in a two-compartment chamber. In one compartment, mixed diet pellets were delivered on fixed-ratio schedules of 1, 6, 11, and 16; in the other, either no food was delivered, or sucrose or mixed diet pellets were delivered on fixed-ratio 8. The number of pellets obtained in the first compartment declined as a function of fixed-ratio size in that compartment in all three conditions, but the decline was greatest overall with mixed diet pellets concurrently available in the other compartment, and least with no food concurrently available. The result is discussed in terms of economic demand theory, and is consistent with the prediction that elasticity of demand for a commodity (defined in operant terms as the ratio of the proportionate change in number of reinforcements per session to the proportionate change in fixed-ratio size) is greater the more substitutable for that commodity are any concurrently available commodities.

Journal Article↗

PubMed1977

Suppression of ethanol-reinforced lever pressing by delaying food availability.

When food was initially available to rats under a fixed-interval 26-second schedule and each liquid-reinforced lever press delayed food availability 8 seconds, suppression of liquid-reinforced lever pressing and liquid consumption occurred when the liquid presented was 4, 8, 16, 32, and 0% ethanol. Suppression did not occur in yoked-control animals, which received food coincidentally with experimental animals but were not directly exposed to the delay dependency. After exposure to the food schedule, each ethanol solution served as a reinforcer in the absence of food presentation. Delaying food availability for increasingly long periods (8 to 2048 seconds) suppressed ethanol-reinforced lever pressing and consumption relative to baseline levels, with the maximum decrease being below the level maintained in the absence of food. However, degree of suppression did not increase monotonically with delay length. Liquid-reinforced performance of yoked-control animals indicated that suppression did not result from changes in the sequencing of food presentation alone.

Alcohol Drinking↗

PubMed1993

American adults' knowledge of HIV testing availability.

OBJECTIVES: Understanding client needs, knowledge, and preferences about services is necessary to ensure that human immunodeficiency virus (HIV) counseling and testing programs are accessible. This study addressed knowledge of HIV testing availability. METHODS: To study American adults' knowledge of HIV testing availability, we collected data during 1990 by random digit-dialing telephone surveys of adults residing in 44 states and the District of Columbia. RESULTS: Of the 81,557 persons who responded, almost two thirds identified medical doctors as a source of HIV testing. Fourteen percent identified public sites, and 12% said they didn't know where to go for HIV testing. Persons who were older, less educated, and had lower incomes were less likely to know where they could go for testing. Persons identifying public sites shared some characteristics with others who lacked adequate health care coverage. CONCLUSIONS: Physicians will be increasingly called upon to provide HIV counseling and testing to their patients. This may require additional training to provide effective, individualized, risk-reduction messages about sexual and drug use behaviors. Even when persons have adequate information about availability, sociodemographic characteristics are likely to influence preferences for HIV counseling and testing.

AIDS Serodiagnosis↗

PubMed1994

Anonymous HIV testing: the impact of availability on demand in Arizona.

The purpose of this study was to evaluate the impact of anonymous testing availability on human immunodeficiency virus (HIV) test demand in Arizona. Testing patterns before and after the introduction of anonymous testing were compared. Client knowledge of new test policy and delay in testing until an anonymous option was available were assessed. Test numbers among men who have sex with men showed a statistically significant increase after introduction of an anonymous testing option. Arizona continues to maintain anonymous testing availability. Public health agencies should consider how test policy may influence people's HIV test decisions.

AIDS Serodiagnosis↗