Biomedical subjects
D Rowland
Publications and source records attributed to D Rowland.
A five-nation perspective on the elderly.
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Health care for all: comparing proposals for reform. A roundtable discussion: Part 2.
Part 1 of this roundtable discussion [Geriatrics 1992; 47(Sept):34-48] examined the flaws in our current healthcare system and factors that are interfering with our nation's ability to achieve reforms. This month, the panelists discuss the benefits and drawbacks of the major healthcare reform proposals, including managed care, single-payer systems, and so-called "play or pay." The practical aspects of any redistribution of healthcare resources are considered as each panelist outlines a favored approach. The influence of special interests, such as the insurance industry, is also discussed.
Health care for all: long-term care, the missing piece. A roundtable discussion: Part 3.
Long-term care has been described as the "missing piece" in many healthcare reform proposals. Yet the cost of nursing home care often exceeds that of acute care, especially for the elderly with Alzheimer's disease. In this final installment of a three-part roundtable discussion, panelists discuss the options for providing long-term care, such as social insurance, a single-payer system, play or pay, or private insurance models. Alternatives to nursing home care, such as community service centers and home care, are discussed. The panelists conclude with an examination of how these proposed reforms might affect the practices of physicians and the U.S. economy.
Health status in east European countries.
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Soviet health care from two perspectives.
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Financing medical care in the new Soviet economy.
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Measuring the elderly's need for home care.
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Triple jeopardy: rural, poor, and uninsured.
Current knowledge on health care for the rural poor and uninsured demonstrates little descriptive and empirical knowledge on this population. Policy strategies call for a better understanding of the gaps in insurance coverage and the special problems of rural residents, especially those with low incomes.
Tendency to serious sequelae of infection with the human immunodeficiency virus in sibships with hemophilia.
Cofactors for the clinical expression of infection due to the human immunodeficiency virus (HIV) are not well understood. We asked if there was a familial tendency to the development of complications of HIV infection. We examined 35 hemophilic sibships in which at least two brothers with classic hemophilia (factor VIII deficiency) were infected with HIV. Twenty-four (34%) of the 70 patients had serious sequelae of infection, and 46 (66%) were asymptomatic or had only lymph node enlargement. Using Fisher's exact test, we found the concordance among siblings for serious sequelae of HIV infection was greater than would be expected by chance. When analysis was restricted to include only siblings known to be infected for more than two years, this concordance was still present. In the study population, birth order and mean yearly usage of factor VIII concentrate were unrelated to the outcome of HIV infection. The data indicate a familial tendency to serious complications of HIV infection. The factor(s) responsible for this familial tendency are currently under investigation.
Medicaid: health care for the poor in the Reagan era.
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Mandatory HMO care for Milwaukee's poor.
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Health care for black Americans: the public sector role.
Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other federal programs supporting targeted local services have been especially effective in reducing infant mortality. But the redistributive effects have been uneven and unequal across populations; many categorical gaps remain and increasing numbers are potentially without access to essential primary care services.
The effect of Keyes' method of oral hygiene on the subgingival microflora compared to the effect of scaling and/or surgery.
The present study was conducted on 18 individuals to determine if Keyes' method of oral hygiene would present an alternative to traditional periodontal therapy in terms of establishing a subgingival microflora compatible with periodontal health. Oral hygiene, gingival conditions and subgingival microbial proportions assessed by dark field microscopy were measured at baseline, then once every 2 weeks for the remainder of this 8-week study. In addition, probing depths and bleeding on probing were evaluated. Group I (9 patients) was treated non-surgically, while Group II (9 patients) had received surgical therapy within the last 4 years. Both groups received routine scaling and root planing (Sc/RP) on one arch at time 0, and both were instructed to use Keyes' method of oral hygiene on one side of the mouth while the other side served as a control. This yielded a split-plot experimental design which permitted examination of the effects of Keyes' method of oral hygiene, Sc/RP and surgery. The results revealed no statistically significant differences between Keyes' method of oral hygiene and conventional oral hygiene in patients treated with a single session of Sc/RP. When scaling was not employed, Keyes' method was more effective than conventional oral hygiene. Surgical status was found to be the most significant factor in reducing clinical indicator values and establishing control of the subgingival microflora. In summary, oral hygiene alone had only minimal effects on subgingival microbial proportions. The primary antimicrobial effect observed, as evidenced by shifts in subgingival morphotype proportions, was produced by the Sc/RP procedure. This effect was enhanced by improved access (surgical status).
Is cost containment working?
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Initiation of maternal behavior in the rat: possible involvement of limbic norepinephrine.
The dorsal norepinephrine (NE) fiber system was manipulated in pregnant female rats. Brainstem lesions of the dorsal bundle, depleting NE in cortex and hippocampus, resulted in deficits in maternal-behavior onset in primiparous rats. Similarly, fornix-bundle transections, depleting only hippocampal NE, were associated with an absence of pup care. Hypothalamic NE levels, as well as dopamine and serotonin concentrations in cortex, hippocampus and hypothalamus, were not significantly affected by these manipulations. The data are discussed in terms of behavioral specificity, possible hormonal involvement and interactions with diencephalic mechanisms controlling the onset of maternal behavior in the female rat.