Care Program (care + program)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Program

  • health care program
  • kaiser permanente medical care program
  • medical care program
  • permanente medical care program


  • Selected Abstracts


    ALL CHILDREN ARE NOT CREATED EQUAL: PRWORA'S UNCONSTITUTIONAL RESTRICTION ON IMMIGRANT CHILDREN'S ACCESS TO FEDERAL HEALTH CARE PROGRAMS

    FAMILY COURT REVIEW, Issue 3 2006
    Hyejung Janet Shin
    The lack of health insurance for children is a serious problem in the United States, especially for those children in families that earn too little to get private health insurance and too much to qualify for Medicare. Even within this subclass of children, immigrant children are particularly vulnerable to the problems faced by lack of health care. Nevertheless, with the passage of the Personal Responsibility and Work Reconciliation Act (PRWORA) by Congress, equality interests of low-income immigrant children are undermined when immigrant children are denied federal benefits for the first 5 years of residency in the United States. The first part of this Note examines the importance of child health care and the long-term problems with uninsured children, especially with uninsured immigrant children and pregnant women. The next part introduces Medicaid as well as State Children's Health Insurance Program, a supplemental federal program designed to increase health care coverage to all children, while contrasting these programs in light of the restrictive anti-immigrant PRWORA provisions. The third part explains the passage of PRWORA, its anti-immigrant provisions, and how these provisions prevent needy immigrant children from receiving federally funded health care. Then, the fourth part uses both the Equal Protection Clause of the Fourteenth Amendment and the Due Process Clause of the Fifth Amendment to argue the unconstitutionality of the anti-immigrant provisions. Finally, the last part lays out the recommendation to amend the Social Security Act so that the PRWORA barriers can be removed and recent immigrant children can receive federally funded health care. [source]


    THE POSITIVE FINANCIAL CONTRIBUTION OF HOME-BASED PRIMARY CARE PROGRAMS: GENERATING REVENUE OR REDUCING HEALTH EXPENDITURE?

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008
    Jeremy M. Jacobs MBBS
    No abstract is available for this article. [source]


    Time to Send the Preemie Home?

    HEALTH SERVICES RESEARCH, Issue 2p1 2009
    Additional Maturity at Discharge, Outcomes, Subsequent Health Care Costs
    Objective. To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources. One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods. Using multivariate matching with a time-dependent propensity score we matched 701 "Early" babies to 701 "Late" babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings. Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late,Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate. Conclusions. In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes. [source]


    Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients

    INTERNATIONAL JOURNAL OF CANCER, Issue 5 2009
    Dejana Braithwaite
    Abstract The objective of this study was to determine whether comorbidity, or pre-existing conditions, can account for some of the disparity in survival between African-American and white breast cancer patients. A historical cohort study was conducted of 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry. Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow-up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics and breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07,1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension-augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18,1.49), competing causes (HR = 1.52, 95%CI 1.32,1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03,1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African-American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. © 2008 Wiley-Liss, Inc. [source]


    Methylphenidate use in children and risk of cancer at 18 sites: results of surveillance analyses,

    PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2007
    Nina Oestreicher PhD
    Abstract Purpose A recent report linked methylphenidate (MPH) use in children to cytologic abnormalities in plasma lymphocytes, a possible cancer biomarker. The purpose of this study was to investigate the association of MPH use and childhood cancer risk. Methods Using automated pharmacy databases and the SEER-affiliated cancer registry of the Kaiser Permanente Medical Care Program (KPMCP), we compared cancer rates at 18 sites among 35 400 MPH users who received it before age 20 to rates among KPMCP membership (age, sex, and calendar year standardized). Medical records of MPH exposed cancer cases were reviewed to identify the presence of established risk factors. Results There were 23 cancers among MPH users, versus 20.4 expected (standardized morbidity ratio, SMR,=,1.13, 95% confidence interval (0.72, 1.70)). Given the small number of cancers, site-specific SMR estimates were imprecise. Only one SMR was statistically significant at the p,<,0.05 level, which given the number of comparisons is consistent with the absence of a true association at any site. MPH use was associated with increased risk of lymphocytic leukemia (SMR,=,2.64 (1.14, 5.20)), based on eight observed cases). The medical records of these exposed cases did not reveal any lymphocytic leukemia risk factors (prior cancer, radiotherapy or chemotherapy, or Down syndrome). Conclusions Our results are consistent with no moderate or strong association between MPH use and cancer risk in children, although our ability to examine dose and duration of use or risk at specific sites was limited by small numbers. Further study of MPH use and lymphocytic leukemia risk is needed to determine whether our results are due to chance alone. Copyright © 2007 John Wiley & Sons, Ltd. [source]


    Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients

    PSYCHO-ONCOLOGY, Issue 10 2006
    Cindy L. Carmack Taylor
    Abstract Background: Active for Life After Cancer is a randomized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program (Lifestyle) for prostate cancer patients to improve quality of life (QOL) including physical and emotional functioning compared to a group-based Educational Support Program and a Standard Care Program (no group). Method: A total of 134 prostate cancer patients receiving continuous androgen-ablation were randomly assigned to one of the three study conditions. Results: Results indicated no significant improvements in QOL at 6 or 12 months. Both group-based programs were positively received and yielded good attendance and retention. Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity. Despite these improvements, no significant changes were found for most physical activity measures. Conclusions: Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients. Copyright © 2006 John Wiley & Sons, Ltd. [source]


    Honesty As Good Policy: Evaluating Maryland's Medicaid Managed Care Program

    THE MILBANK QUARTERLY, Issue 3 2003
    DEBBIE I. CHANG
    Throughout the 1990s, the states launched many large-scale innovations in health care financing and delivery. The demands associated with designing, implementing, and managing such initiatives compete for those resources needed to evaluate the impact of the innovations. But without a good faith effort to launch a credible evaluation, innovative and controversial programs may not be able to be sustained. Striking a balance between advocating for change and honestly determining how well the desired changes have been achieved is a delicate and daunting task, and state policymakers often do not spend much time evaluating their efforts, even though this may be critical to the success of their programs. This article describes one state's assessment of a statewide, prepaid, Medicaid managed care program. We look at the evaluation as both an exercise in policy analysis and an indication of the response to various constituencies' concerns. Three of us either worked for the state or contracted with the state to help evaluate the program. [source]


    Interleukin-6 genotype and risk for cerebral palsy in term and near-term infants,

    ANNALS OF NEUROLOGY, Issue 5 2009
    Yvonne W. Wu MD
    Objective Chorioamnionitis is associated with increased risk for cerebral palsy (CP) in term infants. A functional polymorphism in the interleukin-6 (IL-6) gene has been implicated in newborn brain injury. We studied whether the IL-6 -174 G/C polymorphism confers increased risk for CP in term infants. Methods This population-based case,control study included 334,333 live-born infants born at ,36 weeks gestation within Kaiser Permanente Medical Care Program from 1991 to 2002. Case patients (n = 250) were identified from electronic records and confirmed by chart review, and comprised all infants with spastic or dyskinetic CP not caused by developmental abnormalities who had a neonatal blood specimen available for study. Control patients (n = 305) were randomly selected from the study population. Results Compared with genotype GG, the less common CC genotype was associated with increased risk for overall CP (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.5,4.6), quadriparetic CP (OR, 4.1; 95% CI, 1.8,9.3), and hemiparetic CP (OR, 2.7; 95% CI, 1.3,5.7), after controlling for race. The C allele conferred increased risk for CP in both recessive and additive genetic models. In multivariate analysis controlling for race, independent risk factors for CP included CC genotype compared with GG (OR, 2.4; 95% CI, 1.3,4.4), clinical chorioamnionitis (OR, 4.6; 95% CI, 2.1,10.4), maternal age , 35 (OR, 2.6; 95% CI, 1.6,4.1), and male sex (OR, 1.6; 95% CI, 1.1,2.4). Interpretation Our data suggest that a functional polymorphism in the IL-6 gene is a risk factor for CP among term and near-term infants. Ann Neurol 2009;66:663,670 [source]


    Potential association between infertility and spinal neural tube defects in offspring,,§

    BIRTH DEFECTS RESEARCH, Issue 10 2006
    Yvonne W. Wu
    Abstract BACKGROUND: We examined the possible association between infertility and spinal neural tube defects (NTDs). METHODS: This is a nested case-control study within the Kaiser Permanente Medical Care Program (KPMCP) in Northern California. Among a birth cohort of 110,624 singleton infants ,36 weeks gestation, 1994,1997, we electronically identified cases of spinal NTDs and confirmed the diagnosis by chart review. Controls (n = 1,608) were randomly selected from the birth population. History of infertility was defined as: (1) physician diagnosis of infertility; (2) prescription for an infertility medication noted in the KPMCP pharmacy; and/or (3) evaluation at 1 of 15 infertility clinics in Northern California. RESULTS: Eighteen infants diagnosed with spinal NTDs (prevalence 1.6/10,000) included 13 with spina bifida cystica and 5 with spina bifida occulta. Case mothers were more likely to have a history of infertility (4/18 vs. 96/1,608, OR 4.3, 95% CI 1.01,14.0), and to have been prescribed clomiphene citrate within the window spanning 60 days before to 15 days after conception (3/18 vs. 32/1,608, OR 11.7, 95% CI 2.0,44.8). CONCLUSION: This exploratory study suggests that infertility may be associated with an increased risk of spinal NTDs among liveborn, term infants. Birth Defects Research (Part A), 2006. © 2006 Wiley-Liss, Inc. [source]


    Closing Evidence to Practice Gaps in Emergency Care: The Australian Experience

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
    BAppSci, ICUCert, Susan Huckson RN
    The National Institute of Clinical Studies (NICS) was established in 2000 by the Australian government to improve health care by closing evidence-practice gaps. Improving emergency care through use of evidence is a priority area of work for NICS. This article describes the NICS Emergency Care Program and the current application of a "Community of Practice" to support emergency clinicians to implement best practices research. This approach combines aspects of evidence implementation science, quality improvement techniques, and knowledge management within a social network model to provide a mechanism for rapid sharing of explicit and tacit knowledge. Through the Community of Practice, the clinical community guides the priorities for the Emergency Care Program and is actively engaged in the development and implementation of initiatives. [source]


    Pain Relief and Palliative Care Programs: The WHO and IAHPC Approach in Developing Countries

    PAIN PRACTICE, Issue 1 2003
    Liliana De Lima
    First page of article [source]


    Responsible Care© Programs for Hazardous Chemicals

    ENVIRONMENTAL QUALITY MANAGEMENT, Issue 3 2001
    Ernest D. Weiler
    This article describes the development, use, and learnings of a comprehensive Responsible Care® program as applied to the management of hazardous substances at various stages during the life cycle of the product. The article offers specific examples for stewardship programs in the biocide industry, and discusses the role of the medical community. © 2001 John Wiley & Sons, Inc. [source]


    BENEFITS AND COSTS OF INTENSIVE FOSTER CARE SERVICES: THE CASEY FAMILY PROGRAMS COMPARED TO STATE SERVICES

    CONTEMPORARY ECONOMIC POLICY, Issue 3 2009
    RICHARD O. ZERBE
    The foster care system attempts to prepare children and youth who have suffered child maltreatment for successful adult lives. This study documents the economic advantages of a privately funded foster care program that provided longer term, more intensive, and more expensive services compared to public programs. The study found significant differences in major adult educational, health, and social outcomes between children placed in the private program and those placed in public programs operated by Oregon and Washington. For the outcomes for which we could find financial data, the estimated present value of the enhanced foster care services exceeded their extra costs. Generalizing to the roughly 100,000 adolescents age 12-17 entering foster care each year, if all of them were to receive the private model of services, the savings for a single cohort of these children could be about $6.3 billion in 2007 dollars. (JEL D61, H75) [source]


    Epidemiologic evaluation of pharmaceuticals with limited evidence of carcinogenicity

    INTERNATIONAL JOURNAL OF CANCER, Issue 9 2009
    Gary D. Friedman
    Abstract Thorough review by the International Agency for Research on Cancer (IARC) has resulted in classifying many substances, including pharmaceuticals, as probably or possibly carcinogenic to humans, based on experiments on animals or limited data on humans. We evaluated 9 such pharmaceuticals for evidence of carcinogenicity in patients receiving them in a large medical care program with automated pharmacy records and a cancer registry. Nested case,control analyses were performed in a cohort of 6.5 million subscribers with up to 12 years of follow-up, focusing on cancer sites suggested by previous evidence and other sites with odds ratio of at least 1.50, p < 0.01 and some evidence of dose,response. Unmeasured confounding was estimated in sensitivity analyses. We found some supportive evidence for carcinogenicity of griseofulvin, metronidazole and phenytoin and for the known carcinogen, cyclophosphamide, which was added for validation of our data and analyses. Findings for chloramphenicol, iron-dextran complex, phenoxybenzamine and phenobarbital were essentially non-contributory. Confounding by cigarette smoking and prior thyroid disease could account, respectively, for associations of oxazepam with lung cancer and propylthiouracil with thyroid cancer. Although not definitive, these findings should be considered in the evaluations of these pharmaceuticals. © 2009 UICC [source]


    Reducing Suicidal Ideation in Depressed Older Primary Care Patients

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006
    Jürgen Unützer MD
    OBJECTIVES: To determine the effect of a primary care,based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. INTERVENTION: Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. MEASUREMENTS: Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. RESULTS: At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. CONCLUSION: Primary care,based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients. [source]


    Exploring the relationship between skin property and absorbent pad environment

    JOURNAL OF CLINICAL NURSING, Issue 11 2009
    Yoshie Shigeta
    Aim., The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation. Background., Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area. Design., A cross-sectional design was used. Methods., One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated. Results., The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis. Conclusion., There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting. Relevance to clinical practice., This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health-care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool. [source]


    Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease

    JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2001
    G. Serino
    Abstract Aim: A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy. Material and Methods: Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (6 mm) and with 6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3,4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of 5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of 2 mm at 4 teeth), he/she was exited from the study and given additional treatment. Results: It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1,3 year period following active therapy than SU-treated subjects. Conclusion: In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy. Zusammenfassung Zielsetzung: Eine klinische Studie wurde durchgeführt, um 1.) die Kurzzeitergebnisse nicht-chirurgischer und chirurgischer Therapie von Patienten mit fortgeschrittener marginaler Parodontitis und 2.) das Auftreten von Parodontitisrezidiven im Verlauf von 12 Jahren unterstützender Parodontitistherapie (UPT) zu untersuchen. Material und Methoden: Jeder der 64 Patienten, die in diese Studie aufgenommen wurden, wies 1.) Zeichen generalisierter gingivaler Entzündung auf und hatte 2.) mindestens 12 Zähne, die keine Molaren waren, mit tiefen Taschen (6 mm) sowie 6 mm Knochenabbau. Diese Patienten wurden zufällig auf 2 Therapiegruppen verteilt: 1.) chirurgische (MW: modifizierter Widman-Lappen) und 2.) nicht-chirurgische (SRP: subgingivales Scaling und Wurzelglättung) Therapie. Nach der Anfangsuntersuchung wurden allen Patienten ihre Erkrankung ausführlich erläutert und eine Mundhygieneinstruktion gegeben. Sowohl MW als SRP wurden unter Lokalanästhesie und in 4,6 Sitzungen durchgeführt. Nach der aktiven Therapiephase wurden die Patienten in ein UPT-Programm eingegliedert, das 3,4 Sitzungen pro Jahr umfasste. Stellen, die während der UPT-Sitzungen auf Sondierung bluteten (BOP) und Sondierungstiefen (ST) 5 mm aufwiesen, wurden einer erneuten subgingivalen Instrumentierung unterzogen. Gründliche Nachuntersuchungen wurden in den Jahren 1, 3, 5 und 13 der UPT durchgeführt. Wenn ein Patient zwischen den jährlichen Routineuntersuchungen deutliche Parodontitisprogression zeigte (zusätzlicher Attachmentverlust 2 mm an 4 Zähnen) wurde er/sie aus der Studie herausgenommen und einer weiterführenden Behandlung zugeführt. Ergebnisse: Es wurde beobachtet, dass 1.) die chirurgische Therapie (MW) hinsichtlich Reduktion der mittleren ST (ST nach 1 Jahr: MW: 2.6 mm; SRP: 4.2 mm; p<0.01) und Eliminierung der tiefen Taschen effektiver war als nicht-chirurgische Therapie (SRP) und dass 2.) in den ersten 1,3 Jahren nach aktiver Therapie bei mehr Patienten aus der SRP-Gruppe (8/25%) ein Fortschreiten der Parodontitis auftrat also bei Patienten der MW-Gruppe (4/12%). Schlussfolgerungen: Bei Patienten mit fortgeschrittener marginaler Parodontitis führte chirurgische Therapie zu günstigeren Kurz- und Langzeitergebnissen hinsichtlich ST-Reduktion und scheint deshalb bei weniger Patienten eine zusätzliche unterstützende Therapie erforderlich zu machen als SRP. Résumé But: Un essai clinique a été réalisé pour déterminer (i) le résultat initial des traitements non chirurgicaux et chirurgicaux chez des sujets présentant des parodontites avancées et (ii) l'incidence de maladie récurrente pendant les 12 ans de maintenance qui ont suivi la thérapeutique active. Matériaux et méthodes: Chacun des 64 patients inclus dans cette étude présentait des signes de (i) inflammation gingivale généralisée, (ii) avaient au minimum 12 dents en dehors des molaires avec des poches profondes (6 mm) et avec une perte osseuse 6 mm. Ils furent assignés au hasard à deux groupes de traitement (chirurgical (SU) et non chirurgical (SRP)). Après un examen initial, tous les patients reçurent une mallette de présentation détaillée comportant des instructions d'hygiène bucco-dentaire. Les sujets SU subirent une chirurgie d'accès alors qu'un traitement non chirurgical était donné au groupe SRP. Suite à ce traitement de base, tous les sujets suivirent un programme de maintenance comportant de méticuleux soins parodontaux de soutien (SPT) 3,4 × par an. Les sites qui, lors d'une visite de contrôle saignaient légèrement au sondage et présentatient une valeur de PPD 5 mm étaient à nouveau instrumentés. De nouveaux examens complets êtaient réalisées après 1, 3, 5, 13 ans de SPT. Si un sujet présentait entre deux visites annuelles une progression évidente de la maladie, (par exemple, une perte d'attache supplémentaire 2 mm sur plus de 4 dents), il ou elle était exclu de l'étude et recevait un traitement complémentaire. Resultats: Il fut observé que (i) le traitement chirurgical (SU) était plus efficace que le traitement non-chirurgical (SRP) pour réduire les profondeurs de poche au sondage moyennes générales et pour l'élimination des poches profondes, (ii) et plus de sujets du groupe SRP présentaient des signes de progression de leur maladie avancée dans la période de 1,3 ans suivant le traitement actif. Conclusions: Chez les sujets présentant une maladie parodontale avancée, le traitement chirurgical apporte de meilleures réductions des poches parodontales à court et long terme et pourrait diminuer le nombre de sujets nécessitant une traitement supplémentaire. [source]


    Establishing a standardized dental record-keeping system for a small investigational colony of rhesus monkeys (Macaca mulatta)

    JOURNAL OF MEDICAL PRIMATOLOGY, Issue 2008
    B.W. Gibson
    Abstract Background, Dental hygiene is becoming an increasingly important component of quality health care for laboratory animals, especially non-human primates (NHPs). One key to a successful health care program is an effective and efficient record-keeping system. Methods, To standardize a dental hygiene program for a small colony of NHPs, we developed a dental recording chart specific for rhesus monkeys. This dental chart was developed using the modified Triadan system. This system numbers teeth across species according to location. Results, An illustrative case report was presented to demonstrate the accurate record keeping and spatial relationship generated from this Old World NHP dental chart design. Conclusion, The development and implementation of a standardized dental chart, as part of a dental hygiene program will help minimize variables that may affect research data. [source]


    Haematology and blood chemistry of Cebus apella in relation to sex and age

    JOURNAL OF MEDICAL PRIMATOLOGY, Issue 6 2001
    M. Cristina Riviello
    An effective health care program entails the prevention, diagnosis and treatment of medical problems. A knowledge of baseline values in clinically normal individuals is essential for determining the limits between good health and disease and for understanding the changes produced by pathogenic agents. However, very little information is currently available concerning the blood chemistry and haematological values of different species of monkeys, particularly new-world primates. The values of some haematological and chemical parameters in Cebus apella were determined. The aim of the present work was to verify the effect of age and sex on normal blood values. Blood samples were collected once a year for two successive years from 36 monkeys living in large captive social groups. Significant differences between males and females were found for AST, GGT, urea nitrogen and creatinine, erythrocytes, haemoglobin and haematocrit. Significant differences between juveniles and adults were found for calcium, AST, alkaline phosphatase, inorganic phosphorus, glucose, neutrophils, lymphocytes and serum protein parameters. [source]


    Providing a Dental Home for Pregnant Women: A Community Program to Address Dental Care Access , A Brief Communication

    JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2008
    Peter Milgrom
    Abstract Objective: This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8 percent of pregnant women served by Medicaid in Oregon received care. The long-term goal of the program is to promote preventive oral care for both mothers and their new infants. Methods: Pregnant women received home/Women, Infant and Children visits and were assigned a dental home under a dental managed care program [Dental Care Organization (DCO)]. All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive, and restorative care was provided. Results: Between February 2004 and January 2006, 503 pregnant women were identified; 421 women were contactable. Of these, 339 received home visits (339/421, 80.5 percent) and 235 received care (235/339, 69.3 percent). Overall, 55.8 percent of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9 percent. Conclusion: A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring. [source]


    Health Status of Incarcerated Adolescents: Implications for Juvenile Justice Decision Making

    JUVENILE AND FAMILY COURT JOURNAL, Issue 1 2004
    ROBERT E. MORRIS
    ABSTRACT Adolescents arriving in detention often bring with them significant medical, dental, and psychological problems. These issues have important implications for courts that must decide the best disposition for offending youths. Appropriate treatment benefits the individual by enhancing his/her well-being and improving his/her chances of successful rehabilitation. Society also benefits by avoiding the higher cost of caring for neglected conditions later in life. A comprehensive health care program for detention facilities involves establishing standardized procedures that address both common adolescent problems plus those more peculiar to detainees. Health care professionals working in a correctional setting have unique duties such as clearing youths for boot camp, monitoring injuries, dealing with resistant patients, monitoring for safe activities, and planning aftercare for youths who may face impediments to accessing care such as poor motivation and poverty. Research concerning issues specific to the needs of incarcerated youths remains infrequent and should be undertaken by health care providers. This article provides an overview of medical issues confronting juvenile offenders that should be considered when a juvenile becomes involved in the juvenile justice system. [source]


    Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs

    NEPHROLOGY, Issue 1 2010
    SHU-YI WEI
    ABSTRACT: Aim: Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care. Methods: One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The ,total observation period' was divided into ,6 months before dialysis' and ,at dialysis initiation'. Quality of pre-ESRD care, service utilization and medical costs were evaluated and compared between groups. Results: The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double-lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis ($US1428 ± 2049 vs US$675 ± 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation ($US942 ± 1941 vs $US2410 ± 2481/patient, P < 0.001) and for the total period of observation ($US2674 ± 2780 vs $US3872 ± 3270/patient, P = 0.009). The cost-saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation. Conclusion: CKD care programs significantly improve quality of pre-ESRD care, decrease service utilization and save medical costs. [source]


    Home care for chronic respiratory failure in children: 15 years experience

    PEDIATRIC ANESTHESIA, Issue 4 2002
    L. APPIERTO MD
    Background:,Advances in paediatric intensive care have reduced mortality but, unfortunately, one of the consequences is an increase in the number of patients with chronic diseases. It is generally agreed that home care of children requiring ventilatory support improves their outcomes and results in cost saving for the National Health Service. Methods:,Since 1985, the Children's Hospital Bambino Gesù of Rome has developed a program of paediatric home care. The program is performed by a committed Home Health Care Team (HHCT) which selects the eligible patients for home care and trains the families to treat their child. During the period January 1985 to January 2001, 53 children with chronic respiratory failure were included in the home care program. Of these, seven patients were successively excluded and six died in our intensive care unit (ICU), while one still lives in our ICU since 1997. The results obtained in the remaining 46 children are reported. Results:,The pathologies consisted of disorders of respiratory control related to brain damage (26%), upper airways obstructive disease (26%), spinal muscular atrophy (22%), myopathies and muscular dystrophies (6.5%), bronchopulmonary dysplasia (6.5%), tracheomalacia (6.5%), central hypoventilation syndrome (4.3%) and progressive congenital scoliosis (2.2%). Of these 46 patients, 34 children are mechanically ventilated and the median of their ICU stay was 109.5 days (range 54,214 days), while the remaining 12 children were breathing spontaneously and the median of their ICU stay was 90.5 days (range 61,134 days). We temporarily readmitted six patients to our ICU to perform scheduled otolaryngological surgery, eight patients for acute respiratory infections and two patients for deterioration of their neurological status due to high pressure hydrocephalus for placement of a ventriculoperitoneal shunt; these 16 patients were discharged back home again. Two other patients were readmitted for deterioration of their chronic disease and died in our ICU, while seven patients died at home. Conclusions:,Thirty-seven children are still alive at home and four of them improved their respiratory condition so that it was possible to remove the tracheostomy tube. Our oldest patient has now achieved 15 years of mechanical ventilation at home. [source]


    Honesty As Good Policy: Evaluating Maryland's Medicaid Managed Care Program

    THE MILBANK QUARTERLY, Issue 3 2003
    DEBBIE I. CHANG
    Throughout the 1990s, the states launched many large-scale innovations in health care financing and delivery. The demands associated with designing, implementing, and managing such initiatives compete for those resources needed to evaluate the impact of the innovations. But without a good faith effort to launch a credible evaluation, innovative and controversial programs may not be able to be sustained. Striking a balance between advocating for change and honestly determining how well the desired changes have been achieved is a delicate and daunting task, and state policymakers often do not spend much time evaluating their efforts, even though this may be critical to the success of their programs. This article describes one state's assessment of a statewide, prepaid, Medicaid managed care program. We look at the evaluation as both an exercise in policy analysis and an indication of the response to various constituencies' concerns. Three of us either worked for the state or contracted with the state to help evaluate the program. [source]


    Does Team Midwife Care Increase Satisfaction with Antenatal, Intrapartum, and Postpartum Care?

    BIRTH, Issue 3 2000
    A Randomized Controlled Trial
    Background:Although policymakers have suggested that improving continuity of midwifery can increase women's satisfaction with care in childbirth, evidence based on randomized controlled trials is lacking. New models of care, such as birth centers and team midwife care, try to increase the continuity of care and caregiver. The objective of this study was to evaluate the effect of a new team midwife care program in the standard clinic and hospital environment on satisfaction with antenatal, intrapartum, and postpartum care in low-risk women in early pregnancy.Methods:Women at Royal Women's Hospital in Melbourne, Australia, were randomly allocated to team midwife care (n = 495) or standard care (n = 505) at booking in early pregnancy. Doctors attended most women in standard care, and continuity of the caregiver was lacking. Satisfaction was measured by means of a postal questionnaire 2 months after the birth.Results:Team midwife care was associated with increased satisfaction, and the differences between the groups were most noticeable for antenatal care, less noticeable for intrapartum care, and least noticeable for postpartum care. The study found no differences between team midwife care and standard care in medical interventions or in women's emotional well-being 2 months after the birth.Conclusion:Conclusions about which components of team midwife care were most important to increased satisfaction with antenatal care were difficult to draw, but data suggest that satisfaction with intrapartum care was related to continuity of the caregiver. [source]


    Implant-Supported Fixed Prostheses for the Rehabilitation of Periodontally Compromised Dentitions: A 3-Year Prospective Clinical Study

    CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2001
    Odont(hc), Seung-Won Yi DDS
    ABSTRACT Background: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth-supported fixed partial dentures has demonstrated excellent long-term treatment outcome. Purpose: A clinical and radiographic study was performed to document and evaluate the short- and medium-term result of occlusal rehabilitation by means of implant-supported fixed prostheses (ISFPs) in patients treated for advanced peri-odontal disease. Materials and Methods: Forty-three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6-month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two-stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri-implant conditions, and radiographs. These examinations were repeated annually during the 3-year observation period. Results: No single implant was lost during the 3-year follow-up period. The percentages of plaque-harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft-tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. Conclusions: The present clinical trial demonstrates that, at least during a 3-year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs. [source]


    Assessing the responsiveness of measures of oral health-related quality of life

    COMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 1 2004
    David Locker
    Abstract ,,, Objectives: This paper illustrates ways of assessing the responsiveness of measures of oral health-related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)-14 to change when used to evaluate a dental care program for the elderly. Methods: One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP-14 prior to treatment and 1 month after the completion of treatment. The post-treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post-treatment OHIP-14 scores from pre-treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment. Results: Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre- and post-treatment OHIP-14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t -tests showed no significant differences in the pre- and post-treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP-14 had excellent test,retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP-14 change scores were not good ,diagnostic tests' of improvement. The minimal important difference for the OHIP-14 was of 5-scale points, but detecting this difference would require relatively large sample sizes. Conclusions: OHIP-14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the ,gold standard' for responsiveness studies need to be established. [source]


    Clinical Features and Prognosis of Nonepileptic Seizures in a Developing Country

    EPILEPSIA, Issue 3 2001
    W. Silva
    Summary: ,Purpose: To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs). Methods: One hundred sixty-one consecutive ictal video-EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during video-EEG without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatment, and correlation with outcome on follow-up were examined. Results: The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features were tonic,clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy-three percent of patients with pure NESs received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty-nine percent of the patients received psychological/psychiatric therapy. At follow-up, 23.5% were free of NESs. Conclusions: All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NESs. [source]


    Meeting the Need for Personal Care among the Elderly: Does Medicaid Home Care Spending Matter?

    HEALTH SERVICES RESEARCH, Issue 1p2 2008
    Peter Kemper
    Objective. To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. Data Sources. Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, 1996, and 2000. The sample (n=6,067) includes elderly persons living in the community who have at least one limitation in activities of daily living (ADLs). Study Design. Using a repeated cross-section analysis, the probability of not getting help with an ADL is estimated as a function of Medicaid home care spending, individual income, interactions between income and spending, and a set of individual characteristics. Because Medicaid home care spending is targeted at the low-income population, it is not expected to affect the population with higher incomes. We exploit this difference by using higher-income groups as comparison groups to assess whether unobserved state characteristics bias the estimates. Principal Findings. Among the low-income disabled elderly, the probability of not receiving help with an ADL limitation is about 10 percentage points lower in states in the top quartile of per capita Medicaid home care spending than in other states. No such association is observed in higher-income groups. These results are robust to a set of sensitivity analyses of the methods. Conclusion. These findings should reassure state and federal policymakers considering expanding Medicaid home care programs that they do deliver services to low-income people with long-term care needs and reduce the percent of those who are not getting help. [source]


    Fatigue Predicts Mortality in Older Adults

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2008
    Susan E. Hardy MD
    OBJECTIVES: To determine the association between fatigue and survival over 10 years in a population of older community-dwelling primary care patients. DESIGN: Prospective cohort study. SETTING: Medicare health maintenance organization and Veterans Affairs primary care programs. PARTICIPANTS: Older primary care patients (N=492). MEASUREMENTS: Fatigue, operationalized as feeling tired most of the time, was assessed at baseline. Mortality was ascertained from the National Death Index. Covariates included demographics, comorbidity, cognitive function, depressive symptoms, body mass index, self-rated health, functional status, and gait speed. RESULTS: Mortality rates at 10 years were 59% (123/210) for older adults with fatigue, versus 38% (106/282) for those without fatigue (P<.001). After adjustment for multiple potential confounders, participants who were tired at baseline had a greater risk of death than those who were not (hazard ratio=1.44, 95% confidence interval=1.08,1.93). CONCLUSION: A single simple question "Do you feel tired most of the time?" identifies older adults with a higher risk of mortality. Further research is needed to identify and characterize the underlying mechanisms of fatigue, to develop and test specific treatments, and to determine whether improvement leads to decreased morbidity and mortality. [source]