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PubMed2005

Black-white disparities in HIV/AIDS: the role of drug policy and the corrections system.

African Americans in the United States are disproportionately affected by HIV/AIDS. We focus in this paper on the structural and contextual sources of HIV/AIDS risk, and suggest that among the most important of these sources are drug policy and the corrections system. In particular, high rates of exposure to the corrections system (including incarceration, probation, and parole) spurred in large part by federal and state governments' self-styled war on drugs in the United States, have disproportionately affected African Americans. We review a wide range of research literature to suggest how exposure to the corrections system may affect the HIV/AIDS related risks of drug users in general, and the disproportionate HIV risk faced by African Americans in particular. We then discuss the implications of the information reviewed for structural interventions to address African American HIV-related risk. Future research must further our understanding of the relations among drug policy, corrections, and race-based disparities in HIV/AIDS.

Black or African American↗
PubMedDate not supplied

Toxicity of polyacrylamide and acrylamide monomer.

The purpose of this paper is to present information gathered regarding, in general, the physical characteristics, and, in particular, the possible toxic nature of polyacrylamide A short discussion of the properties and toxicity of the acrylamide monomer is also included. The United States government, specifically the Food and Drug Administration and the Environmental Protection Agency, already regulates several uses of polyacrylamide; criteria and standards have been established based on numerous toxicological studies of both polyacrylamide and acrylamide. These studies are reviewed and summarized. The regulations generally restrict both the amount of residual acrylamide monomer in the polyacrylamide and the amount of polymer that may be used in the specified application. By imposing this type of restriction, a maximum limit on the amount of acrylamide in contact with food or drinking water can be indirectly achieved.

Acrylic Resins↗
PubMed1999

Political opportunism and the harassment of homosexuals in Florida, 1952-1965.

This paper examines activities by the state against homosexuals in Florida between 1952 and 1965. At the beginning of this period most of this activity took the form of police raids on gay bars, beaches and other gathering places. By the mid-1950s, however, the state government had established an investigations committee which concentrated on what the legislature saw as the "homosexual problem." The committee was particularly concerned with homosexual school teachers and faculty members in land grant universities in Florida, and attempted to purge state institutions of homosexual employees. This activity followed a similar campaign against homosexuals by the federal government and the article examines this in order to provide background for the Florida campaign. The ideology about homosexuals which was propagated by these campaigns is examined, as are the effects of the campaigns on homosexuals, and their response. Concern about the "homosexual menace" gradually abated and these discriminatory campaigns subsided. The article examines the social and political context of these campaigns and speculates on causes for the rise and demise of these campaigns. Principal among these appear to be political expediency by leaders of campaigns to extend political power by attacking a weak and defenseless target group, and a desire by conservatives to re-establish traditional values.

Faculty↗
PubMed1982

Medicaid program; state residency requirements--HCFA. Proposed rule.

We are proposing amendments to the Medicaid regulations that govern State residency requirements for Medicaid eligibility. Specifically, we would revise the residency rule used for residents receiving out-of-State care, and the policy pertaining to medical documentation when an individual is incapable of acknowledging intent to reside. These proposed rules are part of the Department's regulatory reform efforts that are designed to clarify regulations, delete unnecessary or burdensome requirements, and provide maximum flexibility to States while promoting patient health and safety.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

The government's role in hospital accountability for quality of care.

BACKGROUND: The role of the U.S. government in the accountability of hospitals for quality of care involves shaping the community of those interested in quality, developing methods and infrastructure, standardizing information, providing information and technical assistance, and enforcing standards. The federal government's role in shaping an atmosphere of trust or distrust is critical but underestimated. The research and development of methods and infrastructure is widely acknowledged and many health systems' reform proposals emphasize it. Several state governments have begun standardizing and providing quality information, and this role is also assigned to the federal government in several reform proposals. Enforcing standards, including licensure and certification, is the most widely understood governmental role; states license whereas the federal government certifies compliance with Medicare conditions of participation either directly or through accreditation by the Joint Commission. These standards are evolving rapidly. Only recently has government taken on the role of providing technical assistance for quality improvement. ISSUES: Health system reform legislation may shape hospital accountability by (a) mandating uniform quality performance measurement and disclosure, (b) replacing emphasis on minimum standards with emphasis on improvement, (c) changing the structure of certification requirements, (d) requiring participation in quality improvement activities, and (e) funding new quality improvement structures. Some support a federal role in developing and implementing measures, but there is disagreement on the feasible pace, the uses of the resulting information, and the federal role in quality improvement. There is also disagreement about the future form of Medicare-based federal quality improvement efforts.

Accreditation↗
PubMed1989

New Jersey's "Granny Doe" squad: arguments about mechanisms for protection of vulnerable patients.

A state government official in New Jersey has written to administrators of the state's nursing homes outlining what he understands to be certain implications of the Conroy, Peter and Farrell decisions of the New Jersey Supreme Court. These include mandatory reporting to and investigation by his office of virtually all cases of contemplated withholding or withdrawal of life-sustaining treatment, even decisions not to hospitalize or dialyze. This directive has aroused health professionals and advocates for patient privacy. The resulting urgent effort to fashion an acceptable alternative to decisional review by government agents is reminiscent of the process which was sparked by the federal government's promulgation of the "Baby Doe regulations" some years ago. Now, as then, a consensus is being fashioned by a wide spectrum of participants. The likely candidate for an alternative to "Granny Doe squads" is, once again, some form or forms of the institutional ethics committee. Any acceptable proposals will have to satisfy the requirement of public confidence in the face of a perception that elderly nursing home patients are particularly vulnerable to "abuse." They should, in the view of these participants in the debate, also acknowledge relevant differences among nursing homes and enhance, rather than discourage, the exercise of responsibility by nursing home leaders and staff members.

Advisory Committees↗
PubMedDate not supplied

Alcohol problem resources and services in State supported programs, FY 1987.

During fiscal year 1987, expenditures for alcohol and drug abuse services in facilities receiving at least some funds from State alcohol and drug agencies totaled $1,809,749,013. Of this total, approximately 51.1 percent was contributed by State governments, 17.9 percent by the Federal Government, 9.1 percent by county or local agencies, and 21.9 percent by other sources (for example, private health insurance). Approximately 76.5 percent of the funds was expended for treatment services, 12.6 percent for prevention services, and 10.9 percent for other services (for example, administration, research, training). Between fiscal years 1985 and 1987, total expenditures increased 31.2 percent, although great variability existed among States, with some undergoing significant cuts. The total number of alcohol and drug treatment units that received State funds was 6,632. During fiscal year 1987, admissions for alcoholism treatment in these State-supported facilities totaled 1,317,473. Most admissions were to a nonhospital environment (84.6 percent) and were for outpatient care (44.9 percent). Of the total number of admissions, 76.2 percent were men and 19.8 percent women; the sex of 4.0 percent was not reported. With regard to age, 27.4 percent were 25-34, 21.7 percent were 35-44, 10.7 percent were 21-24, and 4.1 percent were under 18. In terms of race or ethnicity, 69.7 percent of those admitted were white, 15.6 percent black, 5.5 percent Hispanic, 3.6 percent Native American, 0.2 percent Asian or Pacific Islander, 0.3 percent others, and 5.2 percent not reported. Compared with the 1,317,473 admissions for alcoholism, the combined total of all other drug admissions was only 450,553. The highest numbers of other drug admissions were 98,549 for heroin,84,707 for cocaine, and 63,740 for marijuana!hashish. Also, compared with drug treatment admissions,those admitted for alcoholism are more likely to be male, white, and older.

Adolescent↗
PubMed2003

Hospitals play hardball. DMC, others are telling governments they can choose between giving them more money or accepting cutbacks.

Hospitals are applying the same gritty, hard-nosed negotiating tactics they used with commercial payers to a new target: local government. For example, Detroit Medical Center has announced major cuts unless city, county and state governments pledge to boost funding. DMC Chairman Dick Gabrys, left, says the system means business.

Financial Management, Hospital↗
PubMed2004

Social inclusion and the City of Swan public libraries in Western Australia.

The focus of this paper is on an understanding of social exclusion/inclusion: the concept and how a specific public library service, namely the City of Swan Public Library service, has responded to this social issue. The terms social inclusion/exclusion are explored and clarified from an international, Western Australian State Government, and public library perspective. This is followed by a brief overview of Western Australia as an Australian state, and how public libraries operate based on a partnership with the State Library of Western Australia and Local Government. The City of Swan Public Libraries are described in some depth and also portrayed in their local setting namely the City of Swan, a city of extensive growth that offers a unique environment of both rural and urban areas. The concept of social inclusion is then applied to the City of Swan Public Library service and how the library service addresses social inclusion within its physical environment, policies, operations, future planning, programmes and services. This includes the results of a Library Non-user Survey that was conducted in 2001. The aims of this survey were to: ascertain why non-users within the City of Swan do not make use of the library facilities; explore why past members were not using the library services; examine the effectiveness of library promotions; and investigate the access to and usage of the Internet. The paper concludes with a list of the potential social conditions of which public libraries need to be aware in their strategic planning activities so that community members are not excluded from participating and accessing the public library service.

Community Networks↗
PubMed2001

The impact of casemix on the care of the elderly.

The Australian Health care system is a mix of public and private provision. The Federal Government funds medical care and the pharmaceutical benefit scheme while the State Governments are responsible for funding the public hospitals. Geriatric Medical care is provided in the public hospital system. The Australian DRG system has evolved to more adequately explain illness severity by a greater use of the complications and comorbidities. The structure of the Sub-Acute and Non-Acute Patient (SNAP) classification is outlined. While it is anecdotally said that the introduction of DRG-based funding is detrimental to the elderly, the published evidence does not support this. The potential benefits of a casemix system are discussed.

Aged↗
PubMed1975

Model occupational therapy practice act.

The Model Occupational Therapy Practice Act has been assembled by the Government Affairs Department, American Occupational Therapy Association, for use as a guide by affilitate organizations concerned with developing legislation to regulate the practice of occupational therapy. The Model Act must be reviewed and carefully adapted to comply with state legislative requirements and practices. It must also be adapted to reflect the structure of state government of the particular state, and its particular administrative arrangements. The Model Ace leaves blanks,--, or indicates alternatives in brackets-[ ] in instances where further detail needs to be considered or where adaptations are especially necessary.

Legislation as Topic↗
PubMed2001

Getting a grip on arthritis pain can be costly.

Although the scientific community has ushered in a great new era in the control of rheumatoid arthritis (RA) pain with the discovery of new drugs, the advances are futile if those who need these drugs cannot gain access to them because of the incredible cost. Pharmaceutical treatments for RA include nonsteroidal anti-inflammatory drugs and biologic therapy. A means must be found to improve drug coverage options for all of those suffering from this disease. As nurses, we have an important role to play as advocates for those suffering from RA. We can speak for those who have reduced access to these medications because of the increasing costs. We are able to explain to those in government, the pharmaceutical industry, private insurers, employers, the corporate world, Congress, our state and local communities, and our family and friends the many issues involved. We can advocate for further research on cost-effectiveness, and we can lobby those in Congress and state governments for improved benefits.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1991

Public and private donor financing for health in developing countries.

Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing countries. In perspective, the supply of financing for health greatly exceeds the receipt of well-articulated and officially approved proposals from developing countries. The major constraints that produce this imbalance are unfamiliarity of ministries of health with potential donor sources; passive approaches to external financing; unfamiliarity with proposal preparation; increasing competition within developing countries by competing sectors, such as industry and agriculture; limited numbers of trained personnel; and absence of an international system which is able to support developing countries in mobilizing external financing. Tested solutions to these issues have been applied in one geographic region.(ABSTRACT TRUNCATED AT 400 WORDS)

Delivery of Health Care↗
PubMed2006

Survival skills for the political environment of health insurance.

Blue Cross Blue Shield of Michigan asked the Michigan state government for small group market rate reform already adopted in most other states. Officials responded with major restructuring proposals aimed specifically at the Blues. The Michigan Blues fought back with a massive lobbying campaign as vigorous as any mounted by opponents of health reform at the national level. The company was able to prevail over one of the most powerful governors in Michigan history, whose party controlled both houses of the legislature. This amazing political victory shared much in common with the Clinton health reform's defeat by the industry and the more recent success of the prescription drug industry in shaping Medicare prescription drug reform to its liking. The experience suggests that political savvy and lobbying skills have become core competencies in the health care industry.

Blue Cross Blue Shield Insurance Plans↗