Search PubMed⌕ Search

Biomedical subjects

M Crane

Publications and source records attributed to M Crane.

At least 199 records · Page 11Linked to original sources
PubMed1985

Possibilities of detecting health effects by studies of populations exposed to chemicals from waste disposal sites.

Factors affecting the design of an epidemiologic study assessing possible health effects from chemical waste disposal sites are reviewed. Such epidemiologic studies will most likely be prompted either by a known release of chemicals into the environment around the site, or by an unusual disease cluster in a population near the site. In the latter situation, a method for evaluating the health effects is needed, and one possible approach is discussed. In the former situation, it may not be obvious what health outcomes are relevant. Reported associations between health effects and chemicals in humans were reviewed. Studies from the occupational and environmental literature were classified by chemical and target organ affected and presented in tabular form. No attempt was made to critically evaluate the quality of evidence for each health effect, although bibliographic documentation was provided where possible. Episodes of chemical contamination of food, drinking water and other media were also reviewed and presented in a separate table. The organ sites likely to be affected by toxic chemicals from waste disposal sites depend heavily on the route of exposure and the dose that is received. Ingestion is the most frequently reported route of exposure in episodes of environmental contamination. These have affected the hepatic, renal, hematopoietic, reproductive, and central nervous systems. The type and severity of effects were dose-dependent. Direct skin contact is important in the occupational environment where dermal and central nervous system effects have been reported but seems less likely as a route of exposure for populations around waste disposal sites. Inhalation, unless at relative high concentrations or as a result of fire, is unlikely to be important, although hematopoietic, reproductive, and central nervous system effects have been reported in occupational studies.

Environmental Pollutants↗
PubMed1985

Evaluation of the Arizona health care cost-containment system.

This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Care Financing Administration, assignment of gatekeepers, beneficiary copayment, private administration, inclusion of private and public employees and county financed long-term care. An assessment of implementation during the second 18 months of the program reporting on more recent developments and is now being prepared by SRI International.

Arizona↗
PubMedDate not supplied

Critical pathway approach to diabetic pedal infections in a multidisciplinary setting.

The purpose of this investigation was to evaluate, utilizing clinical and financial outcomes, the critical pathway approach to diabetic foot infections in an inpatient setting. All patients admitted with a primary diagnosis of a diabetic foot infection over an 18-month period from 1995 through 1996 were included in this retrospective study. Comparison is made between the podiatry-established critical pathway and nonpathway patient groups. Then comparison is made between these groups and a similar patient group from 1993 to confirm the validity of the overall results. There was a significant decrease in hospital stay and charges for pathway patients in 1995 and 1996 as compared to nonpathway patients in 1993 as well as 1995 and 1996 (p < .05). The authors also noted a significant decrease in major amputations (BKA or AKA) in pathway patients as compared to baseline values (1993 = 23%, 1995-1996 = 7%, p = .02) and as compared to patients not treated with this approach in 1995 and 1996 (pathway = 7%, nonpathway = 29%, p < .001). The data suggest that the use of a critical pathway approach allows earlier recognition, evaluation, and expedient treatment of potentially limb-threatening infections, improving patient outcomes by decreasing pedal morbidity, while encouraging judicious use of hospital resources.

Adult↗
PubMedDate not supplied

Elderly, homeless and mentally ill: a study.

This article describes a study of people aged 60 and over who were homeless and sleeping on the streets in Central London. The author spent 334 hours on the streets of London between July and October 1990, and attempted interviews with 130 elderly homeless people before finding 50 who were able to give a full interview. Information about this client group was then collected, including mental health problems they reported or that were observed during the interviews. The results suggest that the link between mental health problems and homelessness among elderly people may be profound.

Aged↗
PubMedDate not supplied

Project MotherCare: one hospital's response to the high perinatal death rate in New Haven, CT.

Starling national statistics indicate that New Haven, CT, is the seventh poorest city of its size, in terms of per capita income, in the United States. In 1989, it was reported to have the highest rate of infant mortality--18.5 infant deaths per 1,000 live birth--in the nation for a city with more than 100,000 people. Seventy-five percent of all perinatal deaths are attributed to low birth weight infants. Adequate prenatal care is a proven means of reducing this risk. To further compound the problem, substance abuse among pregnant women has increased dramatically. Census tract data revealed that many of the infant deaths were localized to several well-defined areas of the city. Forty-four percent of the infant deaths were ascribed to extreme immaturity or other causes related to low birth weight. Approximately 21 percent of the pregnant population had either no prenatal care or care was begun late--after the first trimester. The traditional avenues for prenatal care have been ineffective; an innovative approach, one that can be replicated, was initiated. The Hospital of Saint Raphael's "Project MotherCare" embarked on an initiative to address these problems by reducing the access barriers to prenatal care regardless of insurance status or ability to pay. The mission was twofold: (a) to bring prenatal care to underserved neighborhoods of New Haven and (b) to identify the substance-abusing pregnant woman and deliver a continuum of services including prenatal care, counseling, social services, and referral to a drug treatment program. Community need caused the program to expand beyond prenatal services and provide additional primary care services to other residents of these neighborhoods.

Adult↗