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Biomedical subjects

J M Santiago

Publications and source records attributed to J M Santiago.

At least 19 recordsLinked to original sources
PubMed2003

Effect of ham protein substitution on oxidative stress in older adults.

Mediterranean diet has been related to a low risk of coronary hearth disease. In the present study, we have evaluated the effect of substituting 120 g of meat by 120 g of acorn-fed Iberian ham (one of the meat components of the Mediterranean diet) on body weight, blood pressure (MAP), plasma lipids and oxidant-antioxidant equilibrium in 13 males and 8 females with an average age of 71. Study was performed in three periods: basal diet evaluations (BD1), ham diet for 6 weeks (HD), and basal diet again for 6 weeks (BD2). MAP significantly diminished from 96 mmHg in BD1 to 89 mmHg after HD. After BD2, MAP remained in the same value. Plasma total antioxidant substances increased from 0.791 mmol/L in BD1, to 1.525 in HD, and to 1.213 in BD2. Glutathione reductase significantly increased from 49.5 U/L in BD1 to 57 in HD and decreased to 49.2 in BD2. Glutathione peroxidase rose from 33 U/gHb in BD1 to 72 in HD and decreased to 52 in BD2. Superoxide dismutase increased from 401 U/gHb in BD1 to 723 in HD and decreased to 433 in BD2. Plasma thiobarbituric acid reacting substances (TBARS) fall from 1.65 mmol/l in BD1 to 1.38 in HD and to 1.47 in BD2. TBARS in erythrocyte membranes also diminished but only in BD2. It can be concluded that including acorn-fed Iberian ham in the diet increased the antioxidant substances and decrease lipid peroxidation, with its subsequent beneficial effects on the atherogenic risk factors.

Aged↗
PubMed1999

Use of the balanced scorecard to improve the quality of behavioral health care.

As the debate over managed care continues, measuring quality has increasingly become a focus in health care. One approach to measuring quality is the use of a scorecard, which summarizes a critical set of indicators that measure the quality of care. The author describes the Balanced Scorecard (BSC), a tool developed for use in businesses to implement strategic plans for meeting an organization's objectives, and shows how the BSC can be adapted for use in behavioral health care. The scorecard addresses quality of care at five levels: financial, customer, outcomes, internal processes, and learning and growth. No more than four or five realistic objectives are chosen at each level, and an indicator for the achievement of each objective is designed. The BSC integrates indicators at the five levels to help organizations guide implementation of strategic planning, report on critical outcomes, and offer a report card for payers and consumers to make informed choices.

Behavioral Medicine↗
PubMed1999

Health care utilization by persons with severe and persistent mental illness.

Claims for physical health care among 220 Medicaid enrollees with severe mental illness and 166 Medicaid enrollees who were not enrolled in the public mental health system were compared. Claims for the mentally ill group were 18 percent less than for the group without severe mental illness. Twenty-eight percent of claims for mentally ill patients were for treatment in emergency rooms and ambulances, compared with 11 percent for patients without mental illness; 26 percent of claims for patients without mental illness were for care in outpatient surgical and outpatient hospital settings, compared with 14 percent for mentally ill patients. Results suggest inefficient use of the health care system by mentally ill patients and highlight the need for coordination of care.

Adult↗
PubMed1995

Redefining the general psychiatrist: values, reforms, and issues for psychiatric residency education.

The structure and content of general psychiatric residency education must be redesigned to ensure the continued relevance of the profession of psychiatry as managed care and cost containment become more influential in the health care delivery system. The general psychiatrist in this new health care environment must be prepared to participate in a multidisciplinary team of health care professionals, have expertise in treating complex cases that often combine physical and psychological disorders, critically examine the role of psychotherapy, acknowledge patients as active participants in treatment, and integrate clinical and financial decision making. Reformed psychiatric residency curricula should include an expanded range of training settings, preparation for a variety of clinical roles, practice in developing strategies for improved service utilization, and opportunities to develop expertise in neuropsychopharmacology, to work with patients with serious mental illness, and to practice integration of psychotherapy with other core skills. In addition, redesigned curricula should enhance residents' appreciation of the interaction between patients' everyday behavior and mental illness and should provide training in supervision and in utilization review. Redefinition of the structure and organization of psychiatric residency education will depend on the resolution of several key issues such as length of training, financing of graduate medical education, and the role of subspecialization programs.

Cost Control↗
PubMed1994

Cholesterol and violent behavior.

Despite significant decreases [corrected] in the incidence of myocardial infarction, reduction of total mortality as a result of cholesterol-lowering programs has not been demonstrated. This puzzling outcome has led to several hypotheses linking cholesterol levels and mortality due to accidents, suicide, and homicide. We review the proposed explanations for increased mortality due to violent deaths. We discuss the available evidence and conclude that while there are some intriguing findings based on the well-established relationship between violent behavior and serotonin activity, the necessary link between cholesterol, serotonin, and violence has not been demonstrated. The complexity of the observed violent behaviors and their multiple determinants defies a simple explanation at the present time.

Accidents↗
PubMed1992

The fate of mental health services in health care reform: I. A system in crisis.

The U.S. health care system is in the midst of a severe crisis. More than 50 million Americans are uninsured or underinsured. Medicare and Medicaid are not adequately serving populations in need. Analyses and reform proposals are often based on biased interpretations of data, resulting in confusion and heated debate. To avoid jeopardizing psychiatric care in a national health care reform movement, we must understand the causes of the national crisis. In the first part of a two-part paper, the author describes factors such as demographic trends and limitations in public health coverage that have contributed to the crisis. Outcomes of the current system include higher morbidity and mortality among the uninsured and a high prevalence of untreated illness. The author reviews direct and indirect costs of health care and concludes that in attempts to solve the difficult equation of access, cost, and quality, mental health services are in serious jeopardy.

Cost Control↗
PubMed1992

The fate of mental health services in health care reform: II. Realistic solutions.

In the second part of a two-part paper, the three major proposals for U.S. health care reform--the government-sponsored model, the employment-based model, and the market reform model--are reviewed. Barriers to their success include the current economic crisis, the lack of a clear consensus, and the high costs of the proposals. Most proposals limit the extent of psychiatric coverage; some exclude such coverage from minimum benefit packages, an area of concern for clinicians. The author concludes that any substantial health care reform is unlikely in the near future. A thoughtful, realistic, and yet vigorous strategic plan is needed now to forestall the possible exclusion of significant mental health coverage. The basic elements of such a plan are reviewed.

Cost Control↗
PubMed1990

The seriously mentally ill: another perspective on treatment resistance.

There is a subpopulation of the seriously mentally ill who remain acute care recidivists, rarely becoming engaged in follow-up treatment. It has been argued that these individuals are system, rather than treatment resisters. The perceptions they have of their problems are often in conflict with staff evaluations, or with what the system has to offer. In the present study, patients who dropped out of residential care against staff's advice were compared to patients who remained in treatment. The results suggest that the greater the difference between the perceptions a patient and therapist have concerning the patient's problem, the greater the likelihood of the patient dropping out of treatment.

Adult↗
PubMed1990

Homeless mentally ill patients in the community: results of a general hospital emergency room study.

Previous inattention to the specific circumstances of homeless mentally ill individuals in general hospital settings is discussed. Homeless mentally ill individuals who presented for emergency psychiatric care in a public general hospital setting exhibited distinctive patterns of service utilization and showed evidence of being a uniquely disabled, rootless, and impoverished subgroup of mentally ill individuals. The characteristics of homeless users of general hospital psychiatric services may provide some important clues to system-wide deficits in community-based care for the members of this population.

Adult↗
PubMed1990

The evolution of systems of mental health care: the Arizona experience.

Reform in a system of mental health services is the result of a variety of forces that operate synergistically to bring about observed events. This evolutionary process is most likely to yield substantial results through multiple interventions over time rather than a single attempt at reform. A process of change in the mental health service system in Arizona has been evolving in response to the interaction of several key variables: a social movement dedicated to reform, a planned design for change, and the use of litigation. The author reviews each of these factors and assesses the overall process of change within the state.

Arizona↗
PubMed1988

The homeless mentally ill in Tucson: implications of early findings.

Homeless persons who received emergency psychiatric screening in a public general hospital exhibited patterns of gross geographic mobility. They did not uniformly avail themselves of community services, such as soup kitchens, and there were marked sex differences within the sample.

Adult↗
PubMed1988

Involuntary outpatient commitment in Arizona: a retrospective study.

In July 1983 Arizona's commitment statutes were revised to allow the courts to order involuntary outpatient treatment for the mentally ill. Using retrospective data from medical and court records, patients at a county hospital in Tucson for whom involuntary commitment was sought before outpatient commitment was available were compared with similar groups of patients after outpatient commitment was instituted. Patients ordered to receive outpatient treatment did not differ significantly in diagnosis or reason for commitment from patients committed to inpatient treatment before the change in the law. However, shorter inpatient stays were reported after outpatient commitment became available. In addition, the percentage of patients who voluntarily maintained an active relationship with community treatment centers six months after commitment increased significantly after outpatient commitment was instituted.

Adult↗