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PubMed2005

Benefits for employees with children with ADHD: findings from the Collaborative Employee Benefit Study.

Parents of most children with attention-deficit hyperactivity disorder (ADHD) are employed. Employers have interest in decreasing employee absenteeism and improving workplace productivity, partly through employee benefits. The authors interviewed employers to (1) determine how they view the needs of employees with children with ADHD and (2) identify benefits that might help employees with children with ADHD. The authors carried out a systematic interview study of mainly family-friendly, large employers in four U.S. urban markets (Boston, Cleveland, Miami, Seattle). Multidisciplinary interview teams used a protocol to gather basic company information, benefit philosophy, current insurance and other employee benefits, and knowledge of ADHD and its impacts on employees. Initially, the interview team and then the larger project team reviewed all protocols for common themes. The authors interviewed staff of 41 employers (human resource managers, work/life program directors, benefits directors). Only 15 of 41 interviewees knew about ADHD, its prevalence, or its effects on parents. They had little knowledge of how differences in managed behavioral health may affect families' access to diagnostic and treatment services for ADHD, although most had experience with primary care management of depression among employees. Employers offer a variety of other benefits, including work/life and employee assistance programs, occasionally providing employees help with caring for a child with a mental health condition, on-site parent training programs, or assistance with child care. Other potentially useful employee benefits include flexible work and leave policies and information and referral services that can link parents with community programs. Although employers have limited awareness of ADHD and its potential effect on employees' work, this study identified opportunities to improve both health insurance and other benefits for employees with children with ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Decrease of signal intensity of myometrium and cervical stroma after ultrasmall superparamagnetic iron oxide (USPIO) particles administration: an MR finding with potential benefits in T staging of uterine neoplasms.

OBJECTIVES: Following the empiric observation of a significant decrease of signal intensity of both myometrium and cervical stroma on ultrasmall superparamagnetic iron oxide (USPIO)-enhanced images, the aim of our study was to evaluate whether USPIO-enhanced T2*-weighted gradient echo (GRE) images might provide any potential advantage on T-staging of uterine malignancies having surgery and histology as standard of reference MATERIALS AND METHODS: Seventeen female patients with known uterine malignancies underwent magnetic resonance (MR) imaging before and 24 hours after the intravenous administration of the USPIO agent. Imaging protocol included proton density-weighted turbo spin echo and T2*-weighted GRE sequences. Each patient underwent surgery within 14 days from the first MR examination, and histologic confirmation of tumor T-stage was obtained. Quantitative (calculation of signal-to-noise and contrast-to-noise ratios) and qualitative (visual assessment of T staging) analyses were performed on unenhanced and USPIO-enhanced images. RESULTS: Quantitative analysis showed a significantly lower (P < 0.05) signal-to-noise ratio of myometrium and cervical stroma on USPIO-enhanced compared with unenhanced images. In 15 of 17 patients (88.2%), the contrast-to-noise ratio between tumor and myometrium and between tumor and cervical stroma was higher on USPIO-enhanced compared with unenhanced images (P < 0.001). Qualitative analysis demonstrated that the GRE T2* USPIO-enhanced MR offers a better definition of the depth of tumor infiltration rather than the unenhanced GRE T2* images. CONCLUSION: The decrease of signal intensity of myometrium and cervical stroma on T2*-weighted GRE images after the intravenous administration of USPIO should be considered a constant and physiologic finding that improves tumor conspicuity in the majority of the cases, allowing more accurate T-staging of neoplastic lesions.

Adult↗
PubMed1988

Aggregated early intervention effects for Down's syndrome persons: patterning and longevity of benefits.

Pooled findings from 21 early intervention demonstration studies for Down's syndrome infants and children yield consistency of short-term benefits in the growth of finer motor skills, simple social repertoire and DQ/IQ scores, but conflicting evidence in support or not of benefits in the gross motor, linguistic and cognitive/academic domains. Support for the tenacity of gains, on follow-up to the early years of primary schooling, is disappointing. It is recommended that: (1) intervention programmers view the key working assumptions and ideological positions governing present practices more critically; (2) intervention curricula reflect the unique biological and behavioural properties of the syndrome, taking into account individual differences which are independent of etiological label; and (3) care delivery systems be based more fully on multidisciplinary collaboration, especially between the health sciences and education fields.

Child Development↗
PubMed2005

Economic benefits of substance abuse treatment: findings from Cuyahoga County, Ohio.

We estimated long-term economic benefits and treatment costs for a sample of substance abuse clients who received treatment in Cuyahoga County, Ohio, using health, criminal activity, and earnings data from the Persistent Effects of Treatment Studies. Clients were interviewed at baseline and 6, 12, 24, and 30 months following baseline. We find positive benefits from substance abuse treatment, almost of all of which were derived from reduced criminal activity and increased real earnings, with overall benefit-to-cost ratios ranging from 2.8 to 4.1. The reductions in costs to society were found to be persistent over the long-term, 30-month follow-up period. On average, treatment was found to be cost beneficial regardless of the number of times a client entered treatment in the baseline or follow-up periods. Clients who entered residential treatment and then step down to less intensive care showed greater treatment benefits than clients who only received residential treatment.

Adolescent↗
PubMed1999

Projecting retirement income of future retirees with panel data: results from the modeling income in the near-term (MINT) project.

Cross-sectional data capture only a point in time and miss individual changes in earnings, labor force participation, marriage, fertility, and health. Because panel data follow individuals over time, they do not have this problem. The problems or concerns with cross-sectional data may be compounded when these data are used to make projections. Iams and Sandell (1997) found that using panel data on earnings explained much more variation in future earnings than using cross-sectional survey data. Panel data are also needed to estimate Social Security benefits, especially for women. Because of auxiliary benefits paid to spouses, ex-spouses, and widow(er)s of entitled workers, an individual's Social Security retirement benefit depends not only on his or her earnings history, but also on his or her marital history and the earnings histories of current and previous spouses. When we compare projected unreduced Social Security benefits with what they would be if we didn't have marital history or earnings history data for men, we find that: Benefits computed using only earnings histories are not very different from benefits computed using both earnings and marital histories. Benefits computed using only current earnings and marital histories underestimate benefits for those in earlier birth cohorts and overestimate benefits for those in the most recent birth cohort. Benefits computed without either marital or earnings histories underestimate benefits for all birth cohorts, but by much more for earlier cohorts than for more recent cohorts. For women we find that benefits computed without marital or earnings histories underestimate benefits in all birth cohorts. The largest differences are for women in earlier birth cohorts. Using both marital and earnings histories to estimate unreduced Social Security benefits, we find that men are projected to continue receiving higher benefits than women, although the gap is expected to narrow as the baby boomers near retirement age. We also look at the composition of projected total income available at retirement for those with incomes in the 45th-55th percentiles of the income distribution and find that: Total income at retirement is projected to be larger for men than for women in every birth cohort. Women are projected to receive the largest share of their total income from Social Security benefits. Men are projected to receive the largest share of their total income from other income sources, although this share declines as the baby boomers near retirement age.

Cohort Studies↗
PubMed2003

Leisure time physical activity and early atherosclerosis: the Los Angeles Atherosclerosis Study.

PURPOSE: Some studies of leisure time physical activity find a cardiovascular benefit for moderate activity, whereas others find benefit only for regular vigorous activity. We examined the relation between physical activity and 3-year progression of carotid atherosclerosis. METHODS: Baseline examinations were conducted during 1995 to 1996 with two follow-up examinations at 1.5-year intervals. Intima-media thickness of the common carotid arteries was determined by B-mode ultrasound in a cohort of 500 randomly sampled women and men, aged 40 to 60 years, who were asymptomatic for cardiovascular disease. Sedentary leisure activity was defined as the lowest quartile of a general activity measure, whereas vigorous activity was defined as aerobic activity > or = 3.5 times per week. The remainder defined the moderate activity group. Analyses were adjusted for confounding variables. RESULTS: The mean (+/- SE) age- and sex-adjusted rates of progression of intima-media thickness declined from 14.3 +/- 1.7 microns per year in sedentary subjects, to 10.2 +/- 1.0 microns per year in moderately active subjects, to 5.5 +/- 1.5 microns per year in vigorously active subjects (P for trend <0.0001), and remained statistically significant after adjustment for other confounding factors (P for trend = 0.0004). Compared with the moderate activity group, the vigorous activity group had lower body mass index and resting heart rate and increased high-density lipoprotein cholesterol level, whereas the sedentary group had an increased resting heart rate. Workplace activity was not protective. CONCLUSION: Physical activity during leisure is inversely related to the progression of atherosclerosis in the carotid artery. This benefit appears to increase throughout the activity continuum.

Adult↗
PubMed2003

The relationship between health promotion program participation and medical costs: a dose response.

The purpose of this research was to determine whether participation in the health risk assessment (HRA) component of a comprehensive health promotion program has an impact on medical costs, and whether the addition of participation in interventions has an incremental impact. Program participants (n = 13,048) were compared with nonparticipants (n = 13,363) to determine program impact on paid medical costs. Overall, HRA participants cost an average of $212 less than eligible nonparticipants. As HRA participation increased, cost savings also increased. Additionally, although participation in either an HRA or activities alone resulted in savings, participation in both yielded even greater benefits. The findings indicate that there is an independent benefit of each of these elements of participation, and that the sum of the elements provides a greater benefit than the impact of either of the individual elements alone.

Adult↗
PubMed2000

Cost-benefit analysis of drug treatment services: review of the literature*

BACKGROUND: How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost-benefit analysis attempts to answer these questions in a standard analytic framework. AIMS: This paper reviews cost-benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes. METHOD: Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports. RESULTS: Cost-benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost-benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost-benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use. DISCUSSION: Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost-benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States. CONCLUSION: Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Finding a positive net social benefit should assist policy-makers with decisions related to drug abuse treatment expenditures. Additional work on allocation of budget dollars across various drug treatment services will be needed. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Government agencies and other stakeholders in national health care systems must realize that cost-benefit studies are an important tool for decision-making. Rational strategies can only be addressed by examining alternatives for the efficient allocation and equitable distribution of scarce resources. IMPLICATIONS FOR FURTHER RESEARCH: Future research should focus on standardizing the methods used in the cost-benefit analysis. Extensions should examine methods related to the willingness-to-pay approach. Studies are needed for drug abuse treatment targeted to adolescents and women. More studies should be published in the scientific literature.

Journal Article↗
PubMed2006

The Cognitive Interview enhances long-term free recall of older adults.

The Cognitive Interview, a retrieval-based mnemonic technique, has received only limited attention in its application with older adults, and based on previous findings, its benefit to older adults is unclear. The authors found that the Cognitive Interview effectively increased older adults' recall relative to standard recall instructions at a 3-week delay. These findings demonstrate the benefit of a standardized (rather than the prototypically interactive) Cognitive Interview as applied to perceptually impoverished, text-based stimuli. Both theoretical and practical implications of the findings are discussed.

Aged↗
PubMed1992

Retrospective findings of the clinical benefits of podophyllum resin 25% sol on hairy leukoplakia. Clinical results in nine patients.

Hairy leukoplakia was first described as an oral marker of human immunodeficiency virus infection in 1984. The clinical significance of this lesion in an otherwise healthy, high-risk symptom-free person is that it can be an early manifestation of human immunodeficiency virus infection. Because of its benign nature and the lack of clinical evidence that treatment of the lesion improves the prognosis of human immunodeficiency virus-infected patients, systemic therapy with antiviral drugs does not seem warranted at this time. Topical retinoids (Retin-A sol) and systemic antivirals such as acyclovir have been previously tried; however, lesions tend to recur a few days after treatment is discontinued. Nine patients with oral hairy leukoplakia seen at the Oral Medicine Clinic, University of California San Francisco were offered treatment with podophyllum resin 25% sol. All patients had a complete remission of their condition within 1 week (5 patients) or after the second application a week later (4 patients). Side effects were transient and reversible. These remissions of oral hairy leukoplakia lasted from 2 to 28 weeks, which suggests that podophyllum may be a relatively safe and cost-effective treatment of this otherwise symptom-free lesion.

Adult↗
PubMed2003

The Tuskegee Legacy Project: history, preliminary scientific findings, and unanticipated societal benefits.

This article is intended to provide a relatively complete picture of how a pilot study--conceived and initiated within an NIDCR-funded RRCMOH--matured into a solid line of investigation within that center and "with legs" into a fully funded study within the next generation of NIDCR centers on this topic of health disparities, the Centers for Research to Reduce Oral Health Disparities. It highlights the natural opportunity that these centers provide for multicenter. cross-disciplinary research and for research career pipelining for college and dental school students; with a focus, in this case, on minority students. Futhermore, this series of events demonstrates the rich potential that these types of research centers have to contribute in ways that far exceed the scientific outcomes that form their core. In this instance, the NMOHRC played a central--and critical, if unanticipated--role in contributing to two events of national significance, namely the presidential apology to the African American community for the research abuses of the USPHS--Tuskegee syphilis study and the establishment of the National Center for Bioethics in Research and Health Care at Tuskegee University. Research Centers supported by the NIH are fully intended to create a vortex of scientific activity that goes well beyond the direct scientific aims of the studies initially funded within those centers. The maxim is that the whole should be greater than the sum of its initial constituent studies or parts. We believe that NMOHRC did indeed achieve that maxim--even extending "the whole" to include broad societal impact. well beyond the scope of important, but mere, scientific outcomes--all within the concept and appropriate functions of a scientific NIH-funded research center.

Black or African American↗
PubMed1996

The HMO-PBM relationship: getting along in today's market.

With the many interesting trends apparent in today's pharmacy benefit management market, it becomes increasingly difficult to find a benefit manager who can meet an HMO's particular needs. What does the HMO need to do when seeking to establish a new relationship or renew an old partnership with the pharmacy benefit manager?

Conflict, Psychological↗
PubMed2006

Electronic patient records and their benefit for patient care. Findings from the Section on Patient Records.

OBJECTIVES: To summarize current excellent research in the field of patient records. METHOD: Synopsis of the articles selected for the IMIA Yearbook 2006. RESULTS: Current research in the field of patient records analyses users' needs and attitudes as well as the potential and limitations of electronic patient record systems. Particular topics are the questions physicians have when assessing patients during ward rounds, the timeliness of results when ordered electronically, the quality of documenting haemophilia home therapy, attitudes towards patient access to health records and adequate strategies for record linkage in dependence on the intended purpose. CONCLUSIONS: The best paper selection of articles on patient records shows examples of excellent research on methods used for the management of patient records and for processing their content as well as assessing the potential, limitations of and user attitudes towards electronic patient record systems. Computerized patient records are mature, so that they can contribute to high quality patient care and efficient patient management.

Awards and Prizes↗