The 1995 health policy debate.
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Biomedical subjects
Publications and source records attributed to D Altman.
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While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.
On Day 2 of the joint CDC/SOPHE conference on Creating Capacity: Establishing a Research Agenda for Health Education, the participants were asked to identify research needs or special issues in working with children and adolescents, the elderly, women, men, and underserved groups. This article presents the priority research areas across subgroups identified by the participants. The cross-group priorities are followed by research recommendations for each subgroup.
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Assessment of experiences with health care will continue to be important given the rapid changes in the health care system and retreat from broad national attention on health reform. This paper reports on the findings of the 1993 Kaiser/Commonwealth Survey of Americans and their health insurance. The survey findings highlight the chronic problem of uninsurance as well as concerns among those with insurance, including the worry that benefits will be reduced or become unaffordable. Limited choice of health plans and providers and having to join a managed care plan are further concerns. These findings suggest that many Americans' needs remain unaddressed, but they will have to be considered as the health care system is restructured.
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Patterns of coping and adjustment in 36 low-income, minority women with positive cytologic smears were assessed prior to diagnostic follow-up examination (colposcopy). Subjects were divided into high monitors (who attend to threatening cues) and low monitors (who avoid threatening cues) on the basis of their scores on the Miller Behavioral Style Scale, a well-validated measure of coping style. Multivariate analysis of variance showed that high monitors worried more about the seriousness of their condition, expressed more concern about the immediate sensory and procedural aspects of the diagnostic examination and felt more responsible for the onset and course of their disease as compared to low monitors. However, they were no more likely to be concerned about the overall importance or long-term consequences of their abnormal smears. Finally, high monitors displayed greater symptoms of intrusive and avoidant ideation in relation to their medical status. These results were independent of sociodemographic and medical confounding variables. Consistent with results in other populations, the findings suggest that it may be useful to assess attentional coping dispositions in minority populations with high-risk gynecologic conditions and to target psychosocial interventions accordingly.
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Some health reform proposals include reductions in Medicaid benefits in favor of a more basic health plan that would cover a broader range of Americans, including the uninsured. This study provides data on the implications of such proposals. With current Medicaid coverage, the study finds that one in five adults experienced serious problems getting and paying for health care in the past year. In addition, a substantial number of Medicaid beneficiaries now have trouble paying for the basic necessities of life; the well-being of these beneficiaries (between one-quarter and one-half of all beneficiaries) would be placed in jeopardy by proposed cuts in coverage levels and benefits. Medicaid beneficiaries report worse health status and greater disability level than the general public, suggesting that proposals to link Medicaid coverage with ability to work should be pursued with caution.
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Five cats were treated with an azathioprine suspension (2.2 mg/kg of body weight on alternate days) and 2 cats were given vehicle (controls) for 9 weeks. Complete blood and platelet counts and serum biochemistry variables were monitored weekly. Bone marrow aspirates were evaluated every 3 weeks, and core bone marrow biopsy was performed at the end of the study. Profound neutropenia (less than 600 cells/microliters) was observed in all treated cats, and 1 cat developed pancytopenia. Treatment was discontinued if the WBC count was less than 3,000 cells/microliters. Four weeks after discontinuation of azathioprine, 1 treated cat again was given azathioprine at a lower dosage (1.1 mg of azathioprine/kg on alternate days) and neutropenia recurred within 2 weeks. During treatment, 3 cats developed thrombocytosis, and 2 developed thrombocytopenia. In 4 of 5 cats, neutropenia and thrombocytopenia resolved when azathioprine was discontinued. Bone marrow cytologic examination during treatment revealed reduction of the neutrophil line, with relative increase in monocytes. Core bone marrow biopsy at the completion of the study revealed hypocellular marrow with marked decrease in the myeloid series in cats given azathioprine. One of the cats that was treated with azathioprine had a hypercellular marrow with increased numbers of mature granulocytes and precursors; however, azathioprine had been discontinued 3 weeks prior to biopsy. Alterations in serum biochemical variables were not associated with azathioprine. Two cats that were treated with azathioprine developed respiratory tract infections, and 1 of them was euthanatized during the study.
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With the increasing manufacture of expensive systems for the measurement of ambulatory blood pressure there is a need for potential purchasers to be able to satisfy themselves that the systems have been evaluated according to agreed criteria. The British Hypertension Society has, therefore, drawn up a protocol of requirements for the evaluation of these devices. This protocol incorporates many features of the American National Standard for Non-Automated Sphygmomanometers but includes many additional features, such as strict criteria for observer training, interdevice variability testing before and after a month of ambulatory use, and a new system of analysis which permits the test system to be graded. It is recommended that manufacturers of ambulatory blood pressure measuring devices should obtain an unbiased evaluation according to a recognized standard before a device is marketed.
As HIV/AIDS becomes a chronic illness, understanding all the issues of long-term care and home-based services will be paramount for home care agencies. The Group Health Cooperative of Puget Sound has successfully developed a program specifically for HIV and AIDS case management.