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PubMed1989

The prospects for prepaid long-term care: the Arizona Medicaid experiment.

Arizona is adding long-term care to its prepaid, capitated alternative to Medicaid. This article discusses the potential for this major cost-control experiment. Experience suggests that those able to quality for long-term care will fare better than the poor did in the previous system. However, limiting eligibility will be the primary means of controlling costs; significant price competition is not likely to develop. The bidding process will serve more to transfer risk to contract providers than to improve program efficiency. Potential cost savings will be more than offset by an increased identification of need.

Arizona↗
PubMed1985

The role of prenatal diagnosis in the perinatal management of urinary tract abnormalities.

The use of ultrasonography is one of the most appropriate and less invasive techniques for the identification of prenatal assessment of urinary tract anomalies. This technique is able to distinguish malformations which are not compatible with life from those which could benefit from appropriate prenatal management treatment in view of a successful outcome after birth. During the past three years, 13 cases of urinary tract anomalies were found and treated. On the basis of our experience, we believe that ultrasonography is especially indicated: to make an early diagnosis of the type of malformation; in the presence of a complex malformation, gives the physician the possibility of showing and explaining to the parents all the aspects involved in reconstructive surgery thus giving them the possibility to decide for abortion or not; to reveal latent malformations: in these cases postnatal treatment may be efficiently programmed. to prepare the mother for early cesarean section, thus avoiding the trauma of vaginal delivery in cases of high risk such as fetuses with hydronephrotic kidneys. Thus, together with more experience in the field of intrauterine microsurgery, the outlook on the future of fetuses with malformations is certainly becoming brighter.

Adult↗
PubMed2003

[Menarche, early pregnancy, and obesity in selected Brazilian women from a health care center in Belo Horizonte, Minas Gerais, Brazil].

The aim of this study was to investigate obstetric variables potentially associated with obesity among 486 Brazilian childbearing-age women aged 15-59 residing in the municipality of Belo Horizonte, Minas Gerais State. Body fat (BF) was measured through impedance analysis, and obesity was defined as BF > 30%. The association between obstetrics factors and obesity was evaluated through multivariate logistic regression. The following variables remained in the logistic regression after adjustments for total income, smoking, alcohol consumption, and physical activity: age at menarche < 12 years (OR = 3.02; 95% CI: 1.62-5.61), age > 30 and < 39 (OR = 1.72; 95% CI: 1.01-2.92), age > 40 years (OR = 3.32; 95% CI: 1.76-6.27), age at first childbirth (OR = 1.99; 95% CI: 1.07-3.68), and the following interaction: age group > 30 and < 39 and age at menarche (OR = 0.27; 95% CI: 0.09-0.83). It appears that obstetric factors affect obesity through a complex network of interrelations that involve the covariates studied above. It is important to support efficient programs to prevent obesity, as well as family planning programs emphasizing a reduction in the prevalence of teenage pregnancies.

Adolescent↗
PubMedDate not supplied

[Children's knowledge of sex behavior and contraception].

INTRODUCTION: Adolescent sexuality is not a new phenomenon, but it has been accepted differently at various times and societies. In modern times, adolescents start sexual life early, not well educated and not prepared for possible consequences. The period between the first sexual relationship, marriage and having children is prolonged with a greater possibility of having artificial abortions or sexually transmitted diseases (STD). It is of great importance to work on proper education of children and adolescents on sexual life and contraception. MATERIAL AND METHODS: An inquiry into the knowledge of sex and contraception was performed in an elementary school in Novi Sad, comprising 134 children from VII and VIII grade (aged 13-14, 77 girls and 57 boys) in order to prepare a lecture on these topics. RESULTS: Most of the knowledge on these topics children aged 13 and 14 got watching TV and reading magazines (44.15% girls and 70.17% boys) and from their friends (42.1%). Communication about sex and contraception exists mostly among friends (51.95% girls and 82.46% boys). One third of girls talk with parents and one quarter got knowledge from them. Only four boys (2.98%) had sexual intercourse without complications: artificial abortion or STD. Almost every child (96.95%) knows about AIDS and 89.25% children know about at least one method of contraception (mostly condom). Three quarters claim artificial abortion is harmful. 50% of children want more education about sex and contraception. DISCUSSION AND CONCLUSIONS: Most of the knowledge on sexual life and contraception children get from various forms of mass-media and from one another which is unreliable and incomplete. Unfortunately, parents and teachers play a minor role in sex education of children. In order to prevent spreading of sexually transmitted diseases and to decrease the percentage of adolescent pregnancy and artificial abortions, it is of great importance to investigate knowledge, attitudes and practice of children and adolescents in regard to sexual life and contraception and to prepare acceptable and efficient programs for education on these topics. However, not only education is important, but also acceptance and behavior of children and adolescents resulting from these programs.

Adolescent↗
PubMed2004

[Improving the surgeon's image: introduction].

The number of medical students who aspire to become surgeons has been decreasing in recent years. With a vicious spiral in the decreasing number and the growing deterioration of surgeons' working conditions, there is fear of deterioration of surgical care and subsequent disintegration of overall health care in Japan. The purpose of this issue is to devise a strategy for improving surgeons' image and their working conditions to attract future medical students. However, we cannot expect a quick cure for the problem of the decreasing number of applicants for surgery since this issue is deeply related to many fundamental problems in the health care system in Japan. The challenge for surgical educators in coming years will be to solve the problem of chronic sleep deprivation and overwork of surgery residents and to develop an efficient program to meet the critical educational needs of surgical residents. To solve this problem it is necessary to ensure well-motivated surgical residents and to develop an integrated research program. No discussion of these issues would be complete without attention to the allocation of scarce medical resources, especially in relation to financial incentives for young surgeons. The authors, who are conscientious representatives of this society, would like to highlight these critical problems and issues that are particularly relevant to our modern surgical practice, and it is our sincere hope that all members of this society fully recognize these critical issues in the Japanese health care system to take leadership in improving the system. With the demonstration of withholding unnecessary medical conducts we may be able to initiate a renewal of the system and eventually to fulfill our dreams of Japan becoming a nation that can attract many patients from all over the world. Furthermore, verification of discipline with quality control and effective surgical treatment is needed to avoid criticism by other disciplines for being a self-centered field. The Japanese Surgical Society appears to be the only medical society that is capable of leading a revolution in the health care system of this country with its autonomy and self-discipline. It is timely for the Japanese Surgical Society to consider a modification of its stated mission by adding "to improve the care of the surgical patient" as dictated by the American College of Surgeons.

Attitude of Health Personnel↗
PubMed2005

The influence of artificial scotomas on eye movements during visual search.

PURPOSE: Fixation durations are normally adapted to the difficulty of the foveal analysis task. We examine to what extent artificial central and peripheral visual field defects interfere with this adaptation process. METHODS: Subjects performed a visual search task while their eye movements were registered. The latter were used to drive a real-time gaze-dependent display that was used to create artificial central and peripheral visual field defects. Recorded eye movements were used to determine saccadic amplitude, number of fixations, fixation durations, return saccades, and changes in saccade direction. RESULTS: For central defects, although fixation duration increased with the size of the absolute central scotoma, this increase was too small to keep recognition performance optimal, evident from an associated increase in the rate of return saccades. Providing a relatively small amount of visual information in the central scotoma did substantially reduce subjects' search times but not their fixation durations. Surprisingly, reducing the size of the tunnel also prolonged fixation duration for peripheral defects. This manipulation also decreased the rate of return saccades, suggesting that the fixations were prolonged beyond the duration required by the foveal task. CONCLUSIONS: Although we find that adaptation of fixation duration to task difficulty clearly occurs in the presence of artificial scotomas, we also find that such field defects may render the adaptation suboptimal for the task at hand. Thus, visual field defects may not only hinder vision by limiting what the subject sees of the environment but also by limiting the visual system's ability to program efficient eye movements. We speculate this is because of how visual field defects bias the balance between saccade generation and fixation stabilization.

Adult↗
PubMed2004

The performance of information technology in a cardiovascular system.

Our paper presents the results of a research study concerning the accuracy of the diagnosis and/or therapy for a cardiovascular patient. From the electronic patient records we have built a special database. The structure of this database offers possibilities for performing research studies on: cardiovascular pathology, risk factors action, medical treatment action, efficiency programs for primary and secondary prevention of diseases. The patient's data can be introduced from all intranet workstations of the cardiology department. The database structure is established to permit: optimal allocation of disk space, robust statistical analyses. The coding scheme can be explained as follows: if the information can have two or more values which exclude each other, the information is represented by a character; if the information can have more values which don't exclude each other, the field contains many characters representing possible values. Our paper shows that this database structure makes it possible to analyze every data piece that is stored. This system makes it possible to obtain a comprehensive summary of the cardiovascular population in real time by using standard reports and graphics, drill-down and roll-up on hierarchical dimensions, and analysis of temporal indicators. The database now contains information on 4000 patients undergoing effort tests as well as 2500 patients in the recovery program, and the system is being tested for all registered patients. We hope that field tests can begin in the near future, in the framework of a national cardiovascular infrastructure program.

Cardiovascular Diseases↗
PubMed1991

General theory of paradigms in health.

In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.

Adult↗
PubMed1991

Current principles of rehabilitation for patients with rheumatoid arthritis.

Rehabilitation is rooted in the comfort and palliation that sufferers of rheumatic symptoms have sought from physical modalities throughout history. In recent decades, several of these empiricisms have been tested scientifically. Furthermore, function has joined comfort as a desirable and measurable outcome. This article highlights some of the more substantive information as it relates to rheumatoid arthritis. It is clear that such information facilitates more effective and efficient programs of intervention. It is equally clear that the therapeutic perspective of rehabilitation for rheumatoid arthritis is more appropriately applied throughout the course of the disease in an ongoing program of habilitation than held in reserve as a form of salvage.

Arthritis, Rheumatoid↗
PubMed1990

[Economic impact of nosocomial infections on the Metropolitan Hospital Complex of the Social Security Fund (from January through December, 1987)].

Nosocomial infections increase the morbidity, mortality and cost of hospitalization. The Hospital Infection Committee of the Metropolitan Hospital Complex of the Caja de Seguro Social de Panama studied the problem of nosocomial infections in 1987 and showed that of 29,576 admissions, 820 patients developed 994 nosocomial infections (an annual incidence of 3.69%). This resulted in 5191 additional days of hospitalization, at a conservatively estimated cost of B/ 840,153, and was responsible for 24 deaths. An adequate and efficient program of control of nosocomial infections in recommended.

Cross Infection↗
PubMedDate not supplied

[Medical indications for abortions induced in the 2d trimester of prenatal life. Epidemiological considerations and prospects of prevention].

A review of more then 20,000 induced abortions led to recognize a series of about 1,500 late abortions induced upon medical indication during the second trimester of pregnancy, in accordance with the 1978 italian Law. About 20% of these abortions were performed in teen-agers. Only 3.5% of these 1.500 abortions corresponded to the classic "therapeutical" motivation due to danger to the physical health of the mother. Eugenic abortions induced by ascertained fetal malformation, chromosomal abnormality or other suspected prenatal pathology, could be identified in 36.9% of cases, even if legal motivation went correlated to the mental health of the mother. In 59.6% of cases motivation was a peculiar psycho-emotional condition of mother suffering, inducing fear for her mental health. Data were analysed and correlated to a series of relevant variables. Considerations of general value regarding the prevalence of the phenomenon of rejected pregnancies, the rate of spontaneous abortions, and the lack of birth control, are based on the comparison of the results with those of the first trimester induced abortions, spontaneous abortions and natality rate recorded in the same Hospital, in the population of Milan and in the italian largest region, Lombardy. Consistently with the recognition, based on biological, medical and ethical ground, of the presence of a new human life during pregnancy, the Author stresses the need for a realistic approach to the problem also from the legal and medical point of view. In particular, the urgent need for comprehensive and efficient programs of prevention of abortion, which still remains all over the world a major challenge for society, human dignity and modern gynaecological science is emphasized.

Abortion, Induced↗
PubMed1989

Costs of treating diarrhoea in a children's hospital in Mexico City.

The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.

Antidiarrheals↗
PubMed1988

Selective screening for abdominal aortic aneurysms with physical examination and ultrasound.

Abdominal aortic aneurysm (AAA) is an important cause of preventable death in older persons. Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of AAA. In an effort to develop an effective and efficient program of AAA detection, we selectively screened a high-risk population. Men aged 60 to 75 years with hypertension and/or coronary artery disease were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected aneurysms, 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 patients, for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these aneurysms, but missed none in patients with an abdominal girth less than 100 cm (n = 6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward AAA detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin patients. We recommend that every two or three years persons over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older men at high risk for AAA have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.

Abdomen↗
PubMed1986

Higher density of mental capacities in the left cerebral hemisphere of man: a quantitative investigation in children with localized cerebral lesions.

51 children with localized cerebral lesions were investigated with the British Ability Scales, Wechsler test, Porteus Mazes, Conners Teacher Rating Scale, and computerized tomography. The extent of the lesions was quantitatively determined. The IQ was 10 points lower in the left hemispheric lesions, although the right hemispheric lesions were larger. When corrected for size of lesions, the IQ is 17 points higher (p less than 0.05) in children with right than with left hemispheric early lesions. The children with left hemispheric lesions had also significantly more behavioural problems (Conners Scale). Children with bilateral lesions had 15 points lower IQ than those with unilateral lesions, although from the slightly larger extent one could expect only 3 points difference. There was no influence of hemiparesis or of epilepsy of the IQ independent of the extent of lesion. There was more plasticity of the hemisphere than of the lobes as shown by Wisconsin Card Sorting data. The higher density of mental capacities in the left cerebral hemisphere of man is explained by more efficient programs, and more dense packing of functions due to more training of the left cerebral hemisphere.

Adolescent↗
PubMed1981

[Mathematical modelling of glycolysis and adenine nucleotide metabolism of human erythrocytes. I. Reaction-kinetic statements, analysis of in vivo state and determination of starting conditions for in vitro experiments].

A mathematical model of energy metabolism of human red cells is presented, which includes besides the glycolytic reactions the adenine nucleotide metabolism. The model is based on the network of chemical reactions, the thermodynamic equilibrium constants of fast reversible reactions and on the kinetic equations for irreversible enzyme reactions. The model consists of a system of 16 differential equations and allows the mathematical evaluation of metabolic levels in the steady state of energy metabolism corresponding to the in vivo state erythrocytes with the kinetic data for the enzymes derived from in vitro experiments. The dependence of the levels of metabolites in the steady state on the activity of some enzymes is analysed to characterize the regulatory properties of the system. The comparison of the steady state levels of the model with experimental data makes it possible to estimate values of some controversial enzyme parameters. Estimates of the kinetic parameters of the following intracellular processes are presented: 1) rate constant of AMP-phosphatase, 2) maximum rate of adenylate deaminase, 3) activity of adenine phosphoribosylpyrophosphate transferase and 4) adenosine transport through the cell membrane. The simulation of the preparatory phase before incubation of erythrocytes indicates, that the model also permits to compute the time course of changes of levels of metabolites. To solve the initial problem the stiff differential equation system is integrated numerically by an efficient program without the application of the quasi-steady-state approximation.

Adenine Nucleotides↗
PubMed1983

Modifications for the Starkey Hearing Science Laboratory.

Directions were given to modify the Starkey HSL for more efficient programming capabilities (Memory Address Modifier), subject response (Response Box), and feedback (Logic Control) functions. These modifications improved classroom demonstrations in that subject response, as in actual experiments, may be demonstrated, and more than one experiment can be programmed prior to class. These changes also improved the HSL potential for clinical and research applications.

Audiology↗