Predictors of quality of care in nursing facilities.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
M E Samuels
Publications and source records attributed to M E Samuels.
Rural physicians: a survey analysis of HIV/AIDS patient management.
Primary care physicians in South Carolina were asked about their knowledge, attitudes, beliefs, and services provided to HIV/AIDS patients. The study focused on conditions under which physicians would provide additional services in an effort to develop more effective state policies regarding HIV/AIDS. There was a 66 percent (597/900) response rate. This analysis focuses on a group of 338 physicians that identified themselves as rural (nonurban) physicians. Of the rural physicians responding, 42 percent had not treated a case of HIV/AIDS during the last year and 52 percent had seen only 1 to 9 patients. They identified lack of specialty back-up support, likelihood of losing patients, legal and ethical issues, and lack of community services as the primary barriers to service. Gaps in rural physician knowledge included when to refer HIV/AIDS cases to specialists and information on legal and ethical issues. They, like their urban colleagues, would provide additional services to HIV/AIDS patients with specialty back-up (57 percent), better community and social services support (54 percent), additional training (48 percent), and limited liability (47 percent). The authors conclude that policy changes addressing these areas in the broader contexts of rural health issues would expand access to care for persons with HIV infection in rural states.
Adult↗
Rural primary care program survival: an analysis of financial variables.
This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n = 162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978-1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self-sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self-sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay.
Cohort Studies↗
RNA binding by Sxl proteins in vitro and in vivo.
Sxl has been proposed to regulate splicing of specific target genes by directly interacting with their pre-mRNAs. We have therefore examined the RNA-binding properties of Sxl protein in vitro and in vivo. Gel shift and UV cross-linking assays with a purified recombinant MBP-Sxl fusion protein demonstrated preferential binding to RNAs containing poly(U) tracts, and the protein footprinted over the poly(U) region. The protein did not appear to recognize either branch point or AG dinucleotide sequences, but an adenosine residue at the 5' end of the poly(U) tract enhanced binding severalfold. MBP-Sxl formed two shifted complexes on a tra regulated acceptor site RNA; the doubly shifted form may have been stabilized by protein-protein interactions. Consistent with its proposed role in pre-mRNA processing, in nuclear extracts Sxl was found in large ribonucleoprotein (RNP) complexes which sedimented significantly faster than bulk heterogeneous nuclear RNP and small nuclear RNPs. Anti-Sxl staining of polytene chromosomes showed Sxl protein at a number of chromosomal locations, among which was the Sxl locus itself. Sxl protein could also be targeted to a new chromosomal site carrying a transgene containing splicing regulatory sequences from the Sxl gene, following transcriptional induction. After prolonged heat shock, all Sxl protein was restricted to the heat-induced puff at the hs93D locus. In contrast, a presumptive small nuclear RNP protein was observed at several heat puffs following shock.
Animals↗
AIDS-related knowledge and attitudes of social workers in South Carolina.
This study examines the association between knowledge of acquired immune deficiency syndrome (AIDS) and skill among social workers in South Carolina and attitudes toward people with human immunodeficiency virus (HIV) and AIDS. A stratified random sampling method was used to obtain a representative sample of social workers in South Carolina. Findings show that AIDS-related knowledge and skill were significantly associated with improving the general attitudes of social workers toward HIV/AIDS clients. In addition to knowledge and skill-related measures, other significant covariates of attitudes include levels of contact with HIV/AIDS clients and sensitivity to minorities. As with previous studies, demographic variables such as age and gender were not found to be significantly related to variations in attitudes toward HIV/AIDS clients. Furthermore, locality of practice and supervisory position did not significantly correlate with attitudes. The implications of these findings for social services agencies are discussed.
Acquired Immunodeficiency Syndrome↗
Incentives for physicians to treat HIV-seropositive patients: results of a statewide survey.
We asked primary care physicians in South Carolina about their knowledge, attitudes, and beliefs regarding patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and the services they provide for these patients. In support of an effort to develop more effective state policies regarding HIV/AIDS, the survey focused on conditions under which physicians would provide additional services for such patients; 597 of 900 physicians (66%) responded. Among responding physicians, 40% had not seen a patient with HIV infection/AIDS during the past year and 50% had seen only one to nine. Respondents identified lack of specialty backup support, insufficient clinical knowledge, and lack of available community services as the major barriers to providing care for these patients. Gaps in their knowledge included state and federal policies, available community resources, and clinical issues. Respondents said they would provide additional services if they had specialty backup (54%), better community and social support services (50%), additional training (46%), and limited liability (44%). We concluded that policy changes in these areas could expand access to care for HIV/AIDS patients in South Carolina.
Acquired Immunodeficiency Syndrome↗
The determinants of utilization of nonphysician providers in rural community and migrant health centers.
The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.
Community Health Centers↗
Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews.
The reliability of a five-item Katz's Activities of Daily Living (ADL) scale collected by self-report telephone interview is presented. A random sample of 6,472 South Carolina residents over 55 years of age selected from a statewide population is used. Factor structure, Guttman properties, internal consistency reliability, Mokken's index of test homogeneity, and Spearman's coefficient of rank-order correlation are used to show that ADL data gathered by telephone interview are reliable. Because telephone interviewing methods are faster, cheaper, and safer they are recommended as a viable way for researchers, policymakers, and practitioners to gather ADL information.
Activities of Daily Living↗
Findings from a demonstration outreach project at a community health center.
Outreach using personal contact was a cornerstone of the federally funded Community Health Center (CHC) movement of the 1960s. Funding cuts and changes in federal policy have led to the discontinuation of this activity in most CHCs. This paper assesses aspects of a demonstration outreach project designed to encourage use of a CHC in Orangeburg, South Carolina. The evaluation shows that this type of outreach effort, which includes door-to-door canvassing, can identify specific needs for primary health care services in a poor underserved community, and can enhance community access to Medicaid, although the financial impact of bringing poor patients into CHCs by means of this type of outreach is relatively low.
Community Health Centers↗
The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective.
Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful.
Community Participation↗
Single-use syringes.
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
The complex set of late transcripts from the Drosophila sex determination gene sex-lethal encodes multiple related polypeptides.
Sex-lethal (Sxl), a key sex determination gene in Drosophila melanogaster, is known to express a set of three early transcripts arising during early embryogenesis and a set of seven late transcripts occurring from midembryogenesis through adulthood. Among the late transcripts, male-specific mRNAs were distinguished from their female counterparts by the presence of an extra exon interrupting an otherwise long open reading frame (ORF). We have now analyzed the structures of the late Sxl transcripts by cDNA sequencing, Northern (RNA) blotting, primer extension, and RNase protection. The late transcripts appear to use a common 5' end but differ at their 3' ends by the use of alternative polyadenylation sites. Two of these sites lack canonical AATAAA sequences, and their use correlates in females with the presence of a functional germ line, suggesting possible tissue-specific polyadenylation. Besides the presence of the male-specific exon, no additional sex-specific splicing events were detected, although a number of non-sex-specific splicing variants were observed. In females, the various forms of late Sxl transcript potentially encode up to six slightly different polypeptides. All of the protein-coding differences occur outside the previously defined ribonucleoprotein motifs. One class of Sxl mRNAs also includes a second long ORF in the same frame as the first ORF but separated from it by a single ochre codon. The function of this second ORF is unknown. Significant amounts of apparently partially processed Sxl RNAs were observed, consistent with the hypothesis that the regulated Sxl splices occur relatively slowly.
Amino Acid Sequence↗
The Drosophila female-specific sex-determination gene, Sex-lethal, has stage-, tissue-, and sex-specific RNAs suggesting multiple modes of regulation.
For proper sexual development of females, the Sex-lethal (Sxl) gene must be activated early in development and remain on during the rest of the life cycle. Conversely, in males, Sxl must remain functionally off through development. Here, we show that the Sxl transcription unit spans a DNA segment of greater than 20 kb and encodes at least 10 distinct, but overlapping, RNA species. These RNAs range in size from 4.4 to 1.7 kb and exhibit sex, stage, and tissue specificity. Six RNAs, three female specific and three male specific, are first detected by midembryogenesis and persist through the adult stage: Their expression reflects the on/off regulation of Sxl's activity at the level of sex-specific alternate splicing. Four Sxl RNAs are found in adult females. Two of these RNAs are dependent on the presence of a functional germ line and may be relevant to Sxl's role in adult germ-line development. All four are present in unfertilized eggs. Finally, three Sxl RNAs are found only transiently during very early embryogenesis; we suggest that the expression of these RNAs may reflect an early regulation of Sxl at the level of transcription and that these transcripts are involved in the initial selection of the Sxl activity state in response to the primary sex-determination signal, the X/A ratio.
Animals↗
Osteopathic physician location and specialty choice.
Physician distribution continues as a major national issue despite the projected oversupply of physicians by 1990. Kirksville College of Osteopathic Medicine (KCOM) in Kirksville, Missouri, has a high percentage of its graduates going into rural primary care. In this study of physicians who graduated from KCOM from 1930 to 1974, the authors sought to identify the factors influencing physicians to select rural primary care. The size of the physician's hometown, KCOM curricular experiences, and faculty role models were the most important factors influencing a physician to select rural primary care. While these findings are similar to other studies, this is the first to examine osteopathic medicine.
Career Choice↗
Meeting the health needs of rural America--the Kirksville mission.
Explore the source record for details and available documents.
Hospitals, Special↗
Federal strategy for rural health: a systems approach.
Explore the source record for details and available documents.
Community Health Centers↗
Containing the spread of HIV infection: a world health priority.
The World Health Organization (WHO) estimates that the world total of AIDS cases will reach 300,000 by the end of 1988 and 500,000 to 3 million over the next 5 years. AIDS is of special concern to developing countries with their limited, stressed health care systems and the other serious health problems of their populations. Also, AIDS usually strikes the young and productive adults that the economies of these countries can least afford to lose. The Surgeon General of the Public Health Service has challenged the United Nations to make the world's blood supply safe by 1991. Private and public sector leaders could come together, apply the technology and resources available in industrialized countries, and achieve a victory in this facet of the AIDS pandemic. The WHO's global strategy has led to the establishment of national AIDS committees in 151 countries and the preparation of 70 short-term (6-12 months) plans and 25 medium-term (3-5 years) plans for national AIDS control programs.
Acquired Immunodeficiency Syndrome↗
Need for mental health services in federally funded rural primary health care systems.
Explore the source record for details and available documents.
Community Mental Health Services↗