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Kinds of Enrollment Terms modified by Enrollment Selected AbstractsCHILD LABOR AND SCHOOL ENROLLMENT IN RURAL INDIA: WHOSE EDUCATION MATTERS?THE DEVELOPING ECONOMIES, Issue 4 2006Takashi KUROSAKI J22; I21; I31; O15 This paper empirically analyzes the determinants of child labor and school enrollment in rural Andhra Pradesh, India. A village fixed-effect logit model for each child is estimated with the incidence of child labor or school enrollment as the dependent variable, in order to investigate individual and household characteristics associated with the incidence. Among the determinants, this paper focuses on whose education matters most in deciding the status of each child, an issue not previously investigated in the context of the joint family system. The regression results show that the education of the child's mother is more important in reducing child labor and in increasing school enrollment than that of the child's father, the household head, or the spouse of the head. The effect of the child's mother is similar on boys and girls while that of the child's father is more favorable on boys. [source] A Prospective Comparison of Ultrasound-guided and Blindly Placed Radial Arterial CathetersACADEMIC EMERGENCY MEDICINE, Issue 12 2006Stephen Shiver MD Abstract Background Arterial cannulation for continuous blood-pressure measurement and frequent arterial-blood sampling commonly are required in critically ill patients. Objectives To compare ultrasound (US)-guided versus traditional palpation placement of arterial lines for time to placement, number of attempts, sites used, and complications. Methods This was a prospective, randomized interventional study at a Level 1 academic urban emergency department with an annual census of 78,000 patients. Patients were randomized to either palpation or US-guided groups. Inclusion criteria were any adult patient who required an arterial line according to the treating attending. Patients who had previous attempts at an arterial line during the visit, or who could not be randomized because of time constraints, were excluded. Enrollment was on a convenience basis, during hours worked by researchers over a six-month period. Patients in either group who had three failed attempts were rescued with the other technique for patient comfort. Statistical analysis included Fisher's exact, Mann-Whitney, and Student's t-tests. Results Sixty patients were enrolled, with 30 patients randomized to each group. Patients randomized to the US group had a shorter time required for arterial line placement (107 vs. 314 seconds; difference, 207 seconds; p = 0.0004), fewer placement attempts (1.2 vs. 2.2; difference, 1; p = 0.001), and fewer sites required for successful line placement (1.1 vs. 1.6; difference, 0.5; p = 0.001), as compared with the palpation group. Conclusions In this study, US guidance for arterial cannulation was successful more frequently and it took less time to establish the arterial line as compared with the palpation method. [source] The Impact of Welfare Reform on Insurance Coverage before Pregnancy and the Timing of Prenatal Care InitiationHEALTH SERVICES RESEARCH, Issue 4 2007Norma I. Gavin Objective. This study investigates the impact of welfare reform on insurance coverage before pregnancy and on first-trimester initiation of prenatal care (PNC) among pregnant women eligible for Medicaid under welfare-related eligibility criteria. Data Sources. We used pooled data from the Pregnancy Risk Assessment Monitoring System for eight states (AL, FL, ME, NY, OK, SC, WA, and WV) from 1996 through 1999. Study Design. We estimated a two-part logistic model of insurance coverage before pregnancy and first-trimester PNC initiation. The impact of welfare reform on insurance coverage before pregnancy was measured by marginal effects computed from coefficients of an interaction term for the postreform period and welfare-related eligibility and on PNC initiation by the same interaction term and the coefficients of insurance coverage adjusted for potential simultaneous equation bias. We compared the estimates from this model with results from simple logistic, ordinary least squares, and two-stage least squares models. Principal Findings. Welfare reform had a significant negative impact on Medicaid coverage before pregnancy among welfare-related Medicaid eligibles. This drop resulted in a small decline in their first-trimester PNC initiation. Enrollment in Medicaid before pregnancy was independent of the decision to initiate PNC, and estimates of the effect of a reduction in Medicaid coverage before pregnancy on PNC initiation were consistent over the single- and two-stage models. Effects of private coverage were mixed. Welfare reform had no impact on first-trimester PNC beyond that from reduced Medicaid coverage in the pooled regression but separate state-specific regressions suggest additional effects from time and income constraints induced by welfare reform may have occurred in some states. Conclusions. Welfare reform had significant adverse effects on insurance coverage and first-trimester PNC initiation among our nation's poorest women of childbearing age. Improved outreach and insurance options for these women are needed to meet national health goals. [source] The Unintended Impact of Welfare Reform on the Medicaid Enrollment of Eligible ImmigrantsHEALTH SERVICES RESEARCH, Issue 5 2004Namratha R. Kandula Background. During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollment of legal immigrants who immigrated before 1996 (pre-1996 immigrants) and who should have remained Medicaid eligible. Objectives. To compare the Medicaid enrollment of U.S.-born citizens to pre-1996 immigrants, before and after welfare reform, and to determine if variation in state Medicaid policies toward post-1996 immigrants modified the effects of welfare reform on pre-1996 immigrants. Data Source/Study Design. Secondary database analysis of cross-sectional data from 1994,2001 of the U.S. Census Bureau, Annual Demographic Survey of March Supplement of the Current Population Survey. Subjects. Low-income, U.S.-born adults (N=116,307) and low-income pre-1996 immigrants (N=24,367) before and after welfare reform. Measures. Self-reported Medicaid enrollment. Results. Before welfare reform, pre-1996 immigrants were less likely to enroll in Medicaid than the U.S.-born (OR=0.55; 95 percent CI, 0.51,0.59). After welfare reform, pre-1996 immigrants were even less likely to enroll in Medicaid. The proportion of immigrants in Medicaid dropped 3 percentage points after 1996; for the U.S.-born it dropped 1.6 percentage points (p=0.012). Except for California, state variation in Medicaid policy toward post-1996 immigrants did modify the effect of welfare reform on pre-1996 immigrants. Conclusions. Federal laws limiting the Medicaid eligibility of specific subgroups of immigrants appear to have had unintended consequences on Medicaid enrollment in the larger, still eligible immigrant community. Inclusive state policies may overcome this effect. [source] Are Patient Preferences for Life-Sustaining Treatment Really a Barrier to Hospice Enrollment for Older Adults with Serious Illness?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006David Casarett MD OBJECTIVES: To determine whether patient preferences are a barrier to hospice enrollment. DESIGN: Prospective cohort study. SETTING: Fifteen ambulatory primary care and specialty clinics and three general medicine inpatient units. PARTICIPANTS: Two hundred three seriously ill patients with cancer (n=65, 32%), congestive heart failure (n=77, 38%), and chronic obstructive pulmonary disease (n=61, 30%) completed multiple interviews over a period of up to 24 months. MEASUREMENTS: Preferences for high- and low-burden life-sustaining treatment and site of death and concern about being kept alive by machines. RESULTS: Patients were more likely to enroll in hospice after interviews at which they said that they did not want low-burden treatment (3 patients enrolled/16 interviews at which patients did not want low-burden treatment vs 47 patients enrolled/841 interviews at which patients wanted low-burden treatment; relative risk (RR)=3.36, 95% confidence interval (CI)=1.17,9.66), as were interviews at which patients said they would not want high-burden treatment (5/28 vs 45/826; RR=3.28, 95% CI=1.14,7.62), although most patients whose preferences were consistent with hospice did not enroll before the next interview. In multivariable Cox regression models, patients with noncancer diagnoses who desired low-burden treatment (hazard ratio (HR)=0.46, 95% CI=0.33,0.68) were less likely to enroll in hospice, and those who were concerned that they would be kept alive by machines were more likely to enroll (HR=5.46, 95% CI=1.86,15.88), although in patients with cancer, neither preferences nor concerns about receiving excessive treatment were associated with hospice enrollment. Preference for site of death was not associated with hospice enrollment. CONCLUSION: Overall, few patients had treatment preferences that would make them eligible for hospice, although even in patients whose preferences were consistent with hospice, few enrolled. Efforts to improve end-of-life care should offer alternatives to hospice that do not require patients to give up life-sustaining treatment, as well as interventions to improve communication about patients' preferences. [source] Economic Disadvantage, Family Dynamics, and Adolescent Enrollment in Higher EducationJOURNAL OF MARRIAGE AND FAMILY, Issue 3 2002Robert Crosnoe This study applies a family process model to the linkage between early economic disadvantage and later enrollment in higher education. Using two waves of data on low-income youth, the authors found that the attitudes and behaviors of their parents, mostly mothers, mediate the impact of disadvantage on enrollment. Economically disadvantaged parents are less optimistic about their adolescents' educational chances and, in turn, engage less in the proactive parenting that promotes enrollment. The authors also found that parents' perceived efficacy buffers against the more negative consequences of disadvantage that can influence their adolescents' educational trajectories. Group comparisons reveal few differences by gender or ethnicity. [source] Emergency Management of Pediatric Skin and Soft Tissue Infections in the Community-associated Methicillin-resistant Staphylococcus aureus EraACADEMIC EMERGENCY MEDICINE, Issue 2 2010Rakesh D. Mistry MD Abstract Objectives:, Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections. Methods:, This was a cross-sectional survey of subscribers to the American Academy of Pediatrics Section on Emergency Medicine (AAP SoEM) list-serv. Enrollment occurred via the list-serv over a 3-month period. Vignettes of equivocal SSTI, cellulitis, and skin abscess were presented to participants, and knowledge, diagnostic, and therapeutic approaches were assessed. Results:, In total, 366 of 606 (60.3%) list-serv members responded. The mean (± standard deviation [SD]) duration of practice was 13.6 (±7.9) years, and 88.6% practiced in a pediatric emergency department. Most respondents (72.7%) preferred clinical diagnosis alone for equivocal SSTI, as opposed to invasive or imaging modalities. For outpatient cellulitis, PEPs selected clindamycin (30.6%), trimethoprim-sulfa (27.0%), and first-generation cephalosporins (22.7%); methicillin-sensitive S. aureus (MSSA) was routinely covered, but many regimens failed to cover CA-MRSA (32.5%) or group A streptococcus (27.0%). For skin abscesses, spontaneous discharge (67.5%) was rated the most important factor in electing to perform a drainage procedure; fever (19.9%) and patient age (13.1%) were the lowest. PEPs elected to prescribe trimethoprim-sulfamethoxazole (TMP-Sx; 50.0%) or clindamycin (32.7%) after drainage; only 5% selected CA-MRSA,inactive agents. All PEPs suspected CA-MRSA as the etiology of skin abscesses, and many attributed sepsis (22.1%) and invasive pneumonia (20.5%) to CA-MRSA, as opposed to MSSA. However, 23.9% remained unaware of local CA-MRSA prevalence for even common infections. Conclusions:, Practice variation exists among PEPs for management of SSTI. These results can be used to measure changes in SSTI practices as standardized approaches are delineated. ACADEMIC EMERGENCY MEDICINE 2010; 17:187,193 © 2010 by the Society for Academic Emergency Medicine [source] Concurrent Enrollment in Arizona: Encouraging Success in High SchoolNEW DIRECTIONS FOR COMMUNITY COLLEGES, Issue 113 2001Donald Puyear This chapter presents a brief history of concurrent enrollment initiatives and then gives an overview of activity in Arizona, including research on student achievement, as well as tracking studies. In spite of growth in the number of programs and successes in student achievement, not everyone in the state understands and appreciates the benefits of the program; the final section of this chapter describes some of the realities of politics and necessary compromises. [source] Concurrent Enrollment and More: Elements of a Successful PartnershipNEW DIRECTIONS FOR COMMUNITY COLLEGES, Issue 113 2001Steven Helfgot Although concurrent enrollment activities provide an opportunity for cooperation between a community collegeand local high schools, they are not the only opportunity. This chapter examines concurrent enrollment in the context of a larger working relationship between one community college and the high school districts it serves. [source] Dual Enrollment in VirginiaNEW DIRECTIONS FOR COMMUNITY COLLEGES, Issue 113 2001Rhonda Catron This chapter traces the ten-year history of the dual enrollment program in Virginia, highlights its successes, and identifies issues that will be examined for the future. It also identifies how dual enrollment can serve the needs of rural as well as urban communities. [source] Practical and Policy Implications of Using Different Rural-Urban Classification Systems: A Case Study of Inpatient Service Utilization Among Veterans Administration UsersTHE JOURNAL OF RURAL HEALTH, Issue 3 2009Ethan M. Berke MD ABSTRACT:,Context: Several classification systems exist for defining rural areas, which may lead to different interpretations of rural health services data. Purpose: To compare rural classification systems on their implications for estimating Veterans Administration (VA) utilization. Methods: Using 7 classification systems, we counted VA health care enrollees who lived in each category, and number admitted to VA hospitals or non-VA hospitals under Medicare. For dual VA-Medicare enrollees over age 65, we compared VA and private sector hospitalizations on numbers of admissions and bed-days of care. We compared VA enrollees' relative proportions across rural to urban categories for each classification system and evaluated discordance between systems at the veterans-integrated service networks (VISN) level. Findings: Enrollment and inpatient utilization counts for rural veterans vary considerably from one classification system to another, though the systems generally agree that admission rates, length of stay, and reliance on the VA for care are lower for rural veterans. Among older dual VA and Medicare enrollees, rural residents rely on non-VA facilities more, though this effect also varies widely depending on the classification scheme. VISNs vary greatly in the proportions of patients who are rural residents, and in the degree to which classification systems are discordant in designating patients as rural. Conclusions: Decisions about allocating VA health care resources to target "rural" patients may be affected greatly by the rural classification system chosen, and the impact of this choice will affect some hospital networks much more than others. [source] Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002BIRTH, Issue 4 2004Andrea Linton MS However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source] A randomized comparison of sirolimus-eluting versus bare metal stents in the treatment of diabetic patients with native coronary artery lesions: The DECODE study,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2008Charles Chan MD Abstract Objective: To compare the effects of sirolimus-eluting (SES) versus bare metal stents (BMS) on 6-month in-stent late luminal loss (LLL) and 1-year major adverse cardiac events (MACE) in diabetics undergoing percutaneous coronary interventions. Background: In studies of unselected patients, coronary restenosis rates have been lower with SES than with BMS. Comparisons of SES versus BMS in diabetics with more than one stenosis or more than one vessel disease are few. Methods: This open-label trial randomly assigned 200 diabetics with de novo coronary artery stenoses to receive up to three SES versus BMS in a 2:1 ratio. The patients underwent repeat coronary angiography at 6 months after the index procedure and were followed-up for 1 year. The primary study endpoint was in-stent LLL at 6 months. Results: Between August 2002 and May 2004, 83 patients (mean age = 60 years) with 128 lesions (mean = 1.5 per patient) were enrolled at four U.S. and seven Asian medical centers. Enrollment was terminated early by the Safety Monitoring Board because of a statistically significant difference in rates of clinical endpoints. The mean in-stent LLL at 6 months was 0.23 mm in SES versus 1.10 mm in BMS recipients (P < 0.001). At 12 months, 8 patients (15%) assigned to SES had experienced MACE versus 12 patients (41%) assigned to BMS (P = 0.006). Conclusions: In diabetics, the mean 6-month in-stent LLL was significantly smaller, and 12-month MACE rate significantly lower, after myocardial revascularization with SES than with BMS. © 2008 Wiley-Liss, Inc. [source] Exception from Informed Consent Enrollment in Emergency Medical Research: Attitudes and AwarenessACADEMIC EMERGENCY MEDICINE, Issue 2 2007Wayne Triner DO Objectives To explore attitudes surrounding exception from informed consent enrollment into research studies. In addition, the authors sought to determine the level of awareness of such an ongoing study among potential subjects, as defined by their presence in an emergency department (ED). Methods A convenience sample of urban academic ED patients and visitors was surveyed during a visit regarding their attitudes and awareness of an emergency exception from informed consent, blood-substitute trial ongoing in the community. Results There was a 13% refusal rate, and 32% of those approached had characteristics that met exclusion criteria. There were 497 surveys analyzed. There was a predominance of women, Caucasians, and persons with at least some college education. Only 39 (8%) of respondents reported awareness of the ongoing blood substitute trial, and only 19 (4%) were able to list a risk or benefit of participation. Education, income, and age were not associated with reported awareness. Male gender, younger age, awareness of the existing exception from informed consent study, and being married were associated with greater acceptability for such enrollment practices. Conclusions The overall awareness of an ongoing exception from informed consent trial after community consultation and notification was low. A population with potential for enrollment in such a study did not demonstrate a high degree of acceptance of such practices. There were differences among certain demographic groups in the degree of acceptance. These differences may guide institutional review boards and investigators in community-consultation strategies for future waiver of or exception from informed consent studies. [source] African-American Students' Opinions About Foreign Language Study: An Exploratory Study of Low Enrollments at the College LevelFOREIGN LANGUAGE ANNALS, Issue 2 2005Zena Moore Abstract: Persistent low numbers of African Americans in the foreign language teacher certification program at the University of Texas at Austin motivated the study reported here. Two groups of students responded to a questionnaire that sought information on foreign language experience at elementary and high school, as well as family experiences in foreign languages. Findings revealed that whereas very few students had the opportunity to study a foreign language at the elementary level, all were exposed to at least a two-year compulsory program at high school. These experiences were not motivating enough to encourage college-level continuation, nor were family experiences. Students' language preferences did not support previous findings that low enrollment figures resulted from language offerings that lacked ethnic and cultural appeal. Rather, the study found that there appeared to be little effort made to encourage African-American high school and college students to consider teaching career paths. Students recommended more aggressive dissemination of information to African-American students at the college level about the advantages on pursuing foreign language study. They overwhelmingly suggested including a foreign language requirement in all discipline areas. [source] Clinical and Hemodynamic Effects of Nesiritide (B-Type Natriuretic Peptide) in Patients With Decompensated Heart Failure Receiving , BlockersCONGESTIVE HEART FAILURE, Issue 2 2005William T. Abraham MD The use of , blockers in congestive heart failure presents a therapeutic challenge for patients with acute episodes of decompensation. Such patients may be less responsive to positive inotropic agents, whereas the beneficial effects of nesiritide, which are not dependent on the ,-adrenergic receptor signal-transduction pathway, may be preserved. This analysis of the Vasodilation in the Management of Acute CHF trial evaluated the safety and efficacy of nesiritide in decompensated congestive heart failure patients receiving , blockers. The Vasodilation in the Management of Acute CHF trial was a multicenter, randomized, controlled evaluation of nesiritide in 489 hospitalized patients with decompensated congestive heart failure. One hundred twenty-three patients were on chronic ,-blocker therapy at enrollment (31 randomized to placebo, 50 to nesiritide, and 42 to nitroglycerin). Primary end points included pulmonary capillary wedge pressure and dyspnea evaluation at 3 hours. Patients receiving nesiritide, but not IV nitroglycerin, had significantly reduced pulmonary capillary wedge pressure vs. placebo at 3 hours regardless of ,-blocker use. The use of , blockers did not alter the beneficial effects of nesiritide on systemic blood pressure, heart rate, or dyspnea evaluation. In nesiritide-treated subjects, safety profiles were similar regardless of ,-blocker use. Thus, the clinical and hemodynamic benefits and safety of nesiritide are preserved in decompensated congestive heart failure patients receiving chronic , blockade. [source] THE EARNINGS EFFECT OF EDUCATION AT COMMUNITY COLLEGESCONTEMPORARY ECONOMIC POLICY, Issue 1 2010DAVE E. MARCOTTE In this paper, I make use of data from the 2000 follow-up of the National Education Longitudinal Survey postsecondary education transcript files to extend what is known about the value of education at community colleges. I examine the effects of enrollment in community colleges on students' subsequent earnings. I estimate the effects of credits earned separately from credentials because community colleges are often used as a means for students to engage in study not necessarily leading to a degree or certificate. I find consistent evidence of wage and salary effects of both credits and degrees, especially for women. There is no substantial evidence that enrollment in vocational rather than academic coursework has a particularly beneficial effect, however. (JEL I2, J24) [source] Multicenter, randomized, double-blind, active comparator and placebo-controlled trial of a corticotropin-releasing factor receptor-1 antagonist in generalized anxiety disorder,DEPRESSION AND ANXIETY, Issue 5 2010Vladimir Coric M.D. Abstract Background: Antagonism of corticotropin-releasing factor (CRF) receptors has been hypothesized as a potential target for the development of novel anxiolytics. This study was designed to determine the safety and efficacy of pexacerfont, a selective CRF-1 receptor antagonist, in the treatment of generalized anxiety disorder (GAD). Method: This was a multicenter, randomized, double-blind, placebo-controlled and active comparator trial. Two hundred and sixty patients were randomly assigned to pexacerfont 100,mg/day (after a 1 week loading dose of 300,mg/day), placebo or escitalopram 20,mg/day in a 2:2:1 ratio. The primary outcome was the mean change from baseline to end point (week 8) in the Hamilton Anxiety Scale total score. Results: Pexacerfont 100,mg/day did not separate from placebo on the primary outcome measure. The half-powered active comparator arm, escitalopram 20,mg/day, demonstrated efficacy with significant separation from placebo at weeks 1, 2, 3, 6, and 8 (P<.02). Response rates for pexacerfont, placebo, and escitalopram were 42, 42, and 53%, respectively. Genetic and psychometric rating scale data was obtained in 175 randomized subjects. There was a significant association between a single nucleotide polymorphism (SNP) of the gene encoding plexin A2 (PLXNA2-2016) with the HAM-A psychic subscale score for the entire cohort at baseline (FDR-adjusted P=.015). Conclusions: Pexacerfont did not demonstrate efficacy compared to placebo for the treatment of GAD. Whether these findings are generalizable to this class of agents remains to be determined. Our preliminary genetic finding of an association between a SNP for the gene encoding plexin A2 and an anxiety phenotype in this study merits further exploration. The trial was registered at clinicaltrials.gov (NCT00481325) before enrollment. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] The Canadian National Outcomes Measurement Study in Schizophrenia: overview of the patient sample and methodologyACTA PSYCHIATRICA SCANDINAVICA, Issue 2006G. Smith Objective:, The Canadian National Outcomes Measurement Study in Schizophrenia (CNOMSS) is a prospective survey of routine clinical practice. Method:, Patients with schizophrenia or a related disorder were consecutively enrolled from all regions of Canada. Both academic and community psychiatric clinics were included and patients were followed up for 2 years. Clinical and functional status, quality of life, medication and economic costs were assessed at enrollment and monitored throughout the follow-up period. Results:, Patients attending an academic clinic tended to be younger and more severely ill than those from community clinics. Both types of sites prescribed atypical neuroleptics to more than three-quarters of the patients. The majority of those enrolled were unemployed and living in poverty. Poor clinical status was associated with poverty. Conclusion:, The CNOMSS provides demographic, clinical and treatment-related information about a large Canada-wide sample of psychiatric patients. The following three articles in this issue of Acta Psychiatrica Scandinavica explore issues related to medication, quality of life and resource utilization. [source] Electronic Medical Record Review as a Surrogate to Telephone Follow-up to Establish Outcome for Diagnostic Research Studies in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2005Jeffrey A. Kline MD Abstract Background: Follow-up for diagnostic research studies might be facilitated if medical record review (MRR) could be used instead of telephone calls. Objectives: The authors hypothesized that MRR would yield similar accuracy to telephone follow-up. Methods: This was a secondary analysis of 2,178 initially disease-free patients who were followed after enrollment in a diagnostic study of either acute coronary syndrome (45 days) or pulmonary embolism (90 days) conducted in an urban teaching emergency department (ED). Disease status (positive or negative) was defined explicitly. Using structured data forms, trained researchers performed MRR using a comprehensive electronic database, and formulated an opinion about disease status. Trained researchers, blinded to the MRR, then dialed telephone numbers, asked questions from a script, and categorized disease status. The criterion standard was adjudication by consensus of two of three physicians who independently determined disease status based on explicit criteria and access to all follow-up data. Results: Adjudicators found that 13 of 2,178 patients developed disease during follow-up; all 13 true positives occurred among the 2,054 (94.3%) of patients who acknowledged intent to return to the study hospital. Telephone follow-up was successful in 81% of patients, and found all 13 true positives (sensitivity 100%) but with three additional false-positive cases. MRR disclosed 12 of 13 cases of disease (sensitivity 92%) with no false-positive cases. Further review of the one false-negative case from MRR revealed that it occurred after the prescribed time limit for follow-up. Conclusions: Under limited circumstances, accurate clinical follow-up for diagnostic studies conducted in the ED can be obtained by medical record review. [source] Combined counseling and bupropion therapy for smoking cessation: identification of outcome predictorsDRUG DEVELOPMENT RESEARCH, Issue 3 2006Maria Caterina Grassi Abstract Because some smoking-induced pathologies improve upon discontinuation, strategies have been developed to help smokers quit. The aim of this study was to measure the rate of smokers still abstinent one year after one cycle of a six-week group counseling given alone or in combination with a seven-week period of daily administration of bupropion. We also evaluated the predictor validity of nicotine dependence intensity at enrollment, administering both the Fageström Tolerance Questionnaire (FTQ) and the Severity of Dependence Scale (SDS). Visual Analogue Scale (VAS), to measure the intensity of "smoke craving," was also administered. Two hundred twenty-nine subjects trying to quit smoking were enrolled. Bupropion therapy was accepted by 110 subjects, but only 50 completed the 7-week cycle of therapy. Abstinence rates at one year were 68.0 and 56.6%, respectively, in the group that used bupropion for the scheduled 7 weeks and in the group that discontinued bupropion, and 35.3% in the group with counseling therapy alone. SDS (but not FTQ) scores at enrollment, VAS values for craving at the end of the program, and bupropion therapy were the variables selected by Linear Discriminant Analysis to assign subjects to the Smoker or Non-smoker group, with a global correctness of 70.9%. In conclusion, the efficacy of bupropion largely depends upon its interaction with psychological factors, such as the level of nicotine dependence, craving for nicotine, and the subject's commitment to quit smoking. Drug Dev. Res. 67:271,279, 2006. © 2006 Wiley-Liss, Inc. [source] Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery DiseaseECHOCARDIOGRAPHY, Issue 1 2009Francesca Innocenti M.D. Background: The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). Methods: The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged ,75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). Results: During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 ± 1.6 METs in G1 vs. 5 ± 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351,0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559,16.833, P = 0.007), viability (HR 3.354, CI 1.162,9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114,0.945, P = 0.039) predicted hard cardiac events. Conclusion: In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE. [source] Enter at your own risk: HMO participation and enrollment in the Medicare risk marketECONOMIC INQUIRY, Issue 3 2000J Abraham We examine HMO participation and enrollment in the Medicare risk market for the years 1990 to 1995. We develop a profit-maximization model of HMO behavior, which explicitly considers potential linkages between an HMO's production decision in the commercial enrollee market and its participation and production decisions in the Medicare risk market. Our results suggest that the payment rate is a primary determinant of HMO participation, while the price of a supplemental Medicare insurance policy positively affects HMO Medicare enrollment. We also find empirical support for the existence of complementarities in the joint production of an HMO's commercial and Medicare products. [source] Improving substance abuse treatment enrollment in community syringe exchangersADDICTION, Issue 5 2009Michael Kidorf ABSTRACT Aims The present study evaluated the effectiveness of an intervention combining motivational enhancement and treatment readiness groups, with and without monetary incentives for attendance and treatment enrollment, on enhancing rates of substance abuse treatment entry among new registrants at the Baltimore Needle Exchange Program (BNEP). Design Opioid-dependent study participants (n = 281) referred by the BNEP were assigned randomly to one of three referral interventions: (i) eight individual motivational enhancement sessions and 16 treatment readiness group sessions (motivated referral condition,MRC); (ii) the MRC intervention with monetary incentives for attending sessions and enrolling in treatment,MRC+I); or (iii) a standard referral condition which directed participants back to the BNEP for referral (standard referral,SRC). Participants were followed for 4 months. Findings MRC+I participants were more likely to enroll in any type of treatment than MRC or SRC participants (52.1% versus 31.9% versus 35.5%; ,2 = 9.12, P = 0.01), and more likely to enroll in treatment including methadone than MRC or SRC participants (40.4% versus 20.2% versus 16.1%; ,2 = 16.65, P < 0.001). MRC+I participants also reported less heroin and injection use than MRC and SRC participants. Conclusions Syringe exchange sites can be effective platforms to motivate opioid users to enroll in substance abuse treatment and ultimately reduce drug use and number of drug injections. [source] Factors associated with incarceration and incident human immunodeficiency virus (HIV) infection among injection drug users participating in an HIV vaccine trial in Bangkok, Thailand, 1999,2003ADDICTION, Issue 2 2009Pravan Suntharasamai ABSTRACT Aims To determine if incarceration was associated with human immunodeficiency virus (HIV) infection and identify risk factors for incarceration among injection drug users (IDUs) participating in an HIV vaccine trial in Bangkok. Design The AIDSVAX B/E HIV vaccine trial was a randomized, double-blind, placebo-controlled study. A proportional hazards model was used to evaluate demographic characteristics, risk behavior and incarceration as predictors of HIV infection and generalized estimation equation logistic regression analysis to investigate demographic characteristics and risk behaviors for predictors of incarceration. Setting The trial was conducted in Bangkok Metropolitan Administration drug-treatment clinics, 1999,2003. Participants A total of 2546 HIV-uninfected IDUs enrolled in the trial. Measurements HIV testing was performed and an interviewer-administered questionnaire was used to assess risk behavior and incarceration at baseline and every 6 months for a total of 36 months. Findings HIV incidence was 3.4 per 100 person-years [95% confidence interval (CI), 3.0,3.9] and did not differ among vaccine and placebo recipients. In multivariable analysis, being in jail (P < 0.04), injecting (P < 0.0001), injecting daily (P < 0.0001) and sharing needles (P = 0.02) were associated with HIV infection and methadone maintenance was protective (P = 0.0006). Predictors of incarceration in multivariable analysis included: male sex (P = 0.04), younger age (P < 0.0001), less education (P = 0.001) and being in jail (P < 0.0001) or prison (P < 0.0001) before enrollment. Conclusions Among IDUs in the AIDSVAX B/E trial, incarceration in jail was associated with incident HIV infection. IDUs in Thailand remain at high risk of HIV infection and additional prevention tools are needed urgently. HIV prevention services, including methadone, should be made available to IDUs. [source] Linking opioid-dependent hospital patients to drug treatment: health care use and costs 6 months after randomizationADDICTION, Issue 12 2006Paul G. Barnett ABSTRACT Aims To conduct an economic evaluation of the first 6 months' trial of treatment vouchers and case management for opioid-dependent hospital patients. Design Randomized clinical trial and evaluation of administrative data. Setting Emergency department, wound clinic, in-patient units and methadone clinic in a large urban public hospital. Participants The study randomized 126 opioid-dependent drug users seeking medical care. Interventions Participants were randomized among four groups. These received vouchers for 6 months of methadone treatment, 6 months of case management, both these interventions, or usual care. Findings During the first 6 months of this study, 90% of those randomized to vouchers alone enrolled in methadone maintenance, significantly more than the 44% enrollment in those randomized to case management without vouchers (P < 0.001). The direct costs of substance abuse treatment, including case management, was $4040 for those who received vouchers, $4177 for those assigned to case management and $5277 for those who received the combination of both interventions. After 3 months, the vouchers alone group used less heroin than the case management alone group. The difference was not significant at 6 months. There were no significant differences in other health care costs in the 6 months following randomization. Conclusion Vouchers were slightly more effective but no more costly than case management during the initial 6 months of the study. Vouchers were as effective and less costly than the combination of case management and vouchers. The finding that vouchers dominate is tempered by the possibility that case management may lower medical care costs. [source] Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care populationEPILEPSIA, Issue 3 2008Keith L. Davis Summary Purpose: This study assessed the extent of refill nonadherence with antiepileptic drugs (AEDs) and the potential association between AED nonadherence and health care costs in an adult-managed care population. Methods: Retrospective claims from the PharMetrics database were analyzed. Inclusion criteria were: age ,21, epilepsy diagnosis between January 01, 2000 and March 12, 2005, ,2 AED prescriptions, and continuous health plan enrollment for ,6 months prior to and ,12 months following AED initiation. Adherence was evaluated using the medication possession ratio (MPR). Patients with an MPR <0.8 were classified as nonadherent. Multivariate regression was used to assess the effect of AED nonadherence on annualized cost outcomes. Regression covariates included patient demographics, Charlson Comorbidity Index (CCI), and follow-up duration. Results: Among patients meeting all inclusion criteria (N = 10,892), 58% were female, mean age was 44 years, mean CCI was 0.94, and mean follow-up was 27 months. Mean MPR was 0.78 and 39% of patients were nonadherent. AED nonadherence was associated with an increased likelihood of hospitalization (odds ratio [OR]= 1.110, p = 0.013) and emergency room (ER) admission (OR = 1.479, p < 0.0001), as well as increased inpatient and ER costs of $1,799 and $260 (both p = 0.001), respectively, per patient per year. Outpatient and other ancillary costs were not significantly affected by nonadherence. A large net positive effect of nonadherence on total annual health care costs remained (+$1,466, p = 0.034) despite an offset from reduced prescription drug intake. Discussion: Adherence with AEDs among adult epilepsy patients is suboptimal and nonadherence appears to be associated with increased health care costs. Efforts to promote AED adherence may lead to cost savings for managed care systems. [source] Recurrence after a First Unprovoked Cryptogenic/Idiopathic Seizure in Children: A Prospective Study from São Paulo, BrazilEPILEPSIA, Issue 2 2004Anna E. Scotoni Summary: Purpose: To evaluate the recurrence risk after a first unprovoked seizure in a large population of children and adolescents of a developing country. Methods: This prospective study was conducted at two tertiary hospitals, between September 1989 and August 1998. Children were enrolled if they had a first unprovoked cryptogenic/idiopathic seizure and maximal interval to the enrollment ,90 days. EEG and computed tomography (CT) were performed in most patients. Potential predictors of recurrence were compared by using the Cox proportional hazards model in univariate and multivariate analyses. Survival analysis was performed by using the Kaplan,Meier curves. Results: Two hundred thirteen children were included. Recurrence occurred in 34% of the patients, and mean time for recurrence was 12 months. Statistical analysis showed significance for seizure recurrence only for patients with abnormal EEGs. CT was performed in 182 patients, and abnormalities were found in 9.5%. Small calcifications were the most frequent finding, and this was not a predictor for recurrence. Conclusions: The risk of recurrence after a first unprovoked seizure in children from a developing country is similar to that found in developed countries. An abnormal EEG is a risk factor for seizure recurrence in children with a cryptogenic/idiopathic seizure. Calcifications on CT do not increase the risk of recurrence. [source] Early Recognition of Benign Partial Epilepsy in InfancyEPILEPSIA, Issue 6 2000Akihisa Okumura Summary: Purpose: The aim of this study is to determine how precisely we can recognize the outcome in infants with epilepsy beginning in the first year of life. Methods: We performed a prospective 5-year follow-up study on 63 patients who developed epilepsy in the first year of life. We first judged that patients met the criteria of "possible benign partial epilepsy in infancy (BPEI)" on enrollment in this study. At 2 years of age, we reevaluated the seizure and developmental outcome in the patients who were diagnosed as having "possible BPEI." We finally judged that patients met the criteria of "definite BPEI" at age 5 years. "Possible BPEI" was defined as epilepsy meeting all the following conditions: (a) complex partial seizures and/or secondarily generalized seizures; (b) normal psychomotor development and neurologic findings before onset; (c) normal interictal electroencephalograms; (d) normal cranial computed tomography (CT) and magnetic resonance imaging (MRI) findings; and (e) no seizures during the first 4 weeks of life. "Definite BPEI" was defined as epilepsy meeting all the following criteria in addition to those of "possible BPEI": (a) normal psychomotor development beyond age 5 years, and (b) no seizures beyond age 2 years. Results: Thirty-two of the 63 patients met the inclusion criteria completely and were included in the "possible BPEI" group. Twenty-five of the 32 patients completed the 5-year follow-up. At age 2 years, four patients were excluded from the "possible BPEI" group because of seizure recurrence and/or delayed development. By age 5 years, one had a recurrence of seizures, and another exhibited mildly delayed psychomotor development. We finally diagnosed 19 patients as having "definite BPEI.""Definite BPEI" accounted for 76% of the patients diagnosed as having "possible BPEI" at the first presentation and 90% of those who met the conditions on reevaluation at age 2 years. Conclusions: Recognition of BPEI is possible, to some extent, at the first presentation, and reevaluation at age 2 years is useful for a more precise diagnosis. [source] A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 6 2009M. I. Berman Abstract The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1,20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17,19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source] | ||||||||||||||||||||||||||||||||||||||||||||||