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At least 37 records · Page 2Linked to original sources
PubMed1986

Mandatory supervised antabuse therapy in an outpatient alcoholism program: a pilot study.

We instituted a program of mandatory supervised antabuse therapy in an outpatient alcoholism clinic for patients who wish to remain connected to the clinic but who have continued to drink repeatedly. Almost 60% of 68 patients who agreed to this regimen achieved significant periods of sobriety. These preliminary findings suggest that a controlled trial of this approach is warranted.

Adult↗
PubMed1991

Impact of a mandatory Medicaid case management program on prenatal care and birth outcomes. A retrospective analysis.

This study examined the impact of Philadelphia's mandatory Medicaid case management program (HealthPASS) on adequacy of prenatal care and birth outcomes among enrollees. A sample of 217 deliveries for HealthPASS patients at the Hospital of the University of Pennsylvania (HUP) during 1988 was compared with a matched sample of 1988 deliveries at HUP for whom the payor was Pennsylvania's traditional fee-for-service Medicaid program. Inpatient charts for all 434 subjects were abstracted for information on sociodemographic characteristics, substance use during pregnancy (cigarettes, alcohol, and drugs), course and extent of prenatal care, and birth outcomes including birth weight, gestational age, and mortality. No significant differences were detected between HealthPASS and Medicaid groups, suggesting that the mandatory managed care program neither improved nor impeded access to needed services. These results were not surprising in view of the fact that HealthPASS actually did little to change provider or patient behavior with respect to obstetrical care. Both the HealthPASS and Medicaid groups experienced low rates of adequate prenatal care (39%) and high rates of low birth weight (20%). Also disturbing was the finding that at least 46% of women smoked during pregnancy, at least 20% drank alcohol, and at least 17% used cocaine. These findings support the need for continued efforts to improve both access to, and content of, prenatal care for the urban poor.

Adolescent↗
PubMed1989

Patients' reactions and physician-patient communication in a mandatory surgical second-opinion program.

To assess patients' reactions to a mandatory second surgical opinion program and to measure the accuracy of communication between these patients and their physicians, questionnaires were sent to New York City municipal employees, retirees, and dependents who had received second-opinion consultations. The most frequent reactions, among 902 respondents, were that the consultations provided reassurance (59%), helped in deciding whether to proceed with surgery (49%), and provided a chance to ask important questions (29%). Relatively few patients felt that the program caused anxiety (12%) or confusion (5%). Patients were generally pleased with the administrative aspects of the program but less satisfied with the consultant physicians they had seen. Twelve percent of patient-physician pairs disagreed about the advice that had been communicated in their second-opinion consultation visits. Nonconcordance rates varied greatly with the nature and complexity of the advice rendered and were higher among patients who stated that their consultants' explanations were not thorough and understandable. In addition to their cost-containment functions, mandatory surgical second-opinion programs can be supportive and informative. Systematic feedback from patients can be used to enhance these strengths, to correct programmatic deficiencies, and to improve the accuracy of communication.

Attitude↗
PubMed1991

Mandatory exercise and heart disease risk in fire fighters. A longitudinal study.

After undergoing initial assessments of percentage of body fat (% fat), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and maximal oxygen consumption (VO2Max), a group of 24 paid male fire fighters (mean age, 30.1 +/- 7.7 years) began a mandatory exercise program. The physiological variables mentioned above were assessed once a year for the subsequent 5 years. A repeated-measures multivariate analysis of variance followed by univariate post hoc techniques showed a minimal but statistically significant improvement in % fat (-1.43% +/- 0.66%) and TG (-27.54 +/- 10.44 mg/dl) over the 5-year period. Significant differences in TC, HDL-C, LDL-C, and VO2Max were noted over the years, but their magnitudes were small and no pattern was demonstrated. Each of the 5-year means for TC, LDL-C, % fat, and VO2Max were outside the desirable ranges. We concluded that mandatory exercise programs do not significantly alter the risk factor status or the aerobic fitness levels of fire fighters and that a significant number of the latter demonstrate a higher than average risk for cardiovascular disease.

Adult↗
PubMed1991

Arguments against mandatory screening for HIV in low-prevalence areas.

With heightened awareness that healthcare professionals may be a potential source of infection for the human immunodeficiency virus, calls for serial, mandatory testing and reporting are increasing. Fear and hysteria are particularly noticeable in rural settings, which are only now experiencing marked increases in the incidence of AIDS cases. While arguments for and against the merits of serial mandatory testing programs can be constructed, this paper presents support to oppose mandatory testing. Evidence for this stance is drawn from several sources, including epidemiologic, economic, and clinical research; as well as medical ethics literature.

AIDS Serodiagnosis↗
PubMed1990

Industry's voluntary program: Community Awareness and Emergency Response Program and the Emergency Planning and Community Right-to-Know Act.

This paper describes the chemical industry's Community Awareness and Emergency Response (CAER) Program, and voluntary and mandatory actions by the chemical industry to comply with the major environmental legislation. The chemical industry started the voluntary CAER Program soon after the Bhopal Disaster in 1984; it is coordinated through the Chemical Manufacturer's Association. This program, which began in March 1985, is a long-term industry commitment to develop a community outreach program and to improve local emergency response planning. The Congress of the United States began, in 1985, to consider proposals for mandatory programs. This led to enactment of the Superfund Amendments and Reauthorization Act of 1986, known as SARA. A portion of this Act, entitled Title III is also known as the Emergency Planning and Community Right-to-Know Act. Although this legislation has many mandatory requirements, it should be emphasized that a significant degree of voluntary industrial participation is needed if the purposes of the statute are to be achieved. Title III has created an intricate and still evolving system that ties together the EPA, industrial plant managers, state emergency response commissions, local emergency planning committees and fire departments with jurisdiction over the facility. Each of these groups has a different role and responsibilities but must work cooperatively with other participants. Because of the intricate network of participants, the magnitude of the information flow, and the continuing evolution of the system, unique public relations problems exist in order to comply with Title III.(ABSTRACT TRUNCATED AT 250 WORDS)

Awareness↗
PubMed1991

[Morbidity among mothers and infants after ambulatory deliveries].

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

Ambulatory Care↗
PubMed1990

AIDS prevention: legislative options.

This article reviews legislative options to prevent the transmission of HIV infection. It distinguishes between pre-exposure measures designed to prevent initial exposure, and post-exposure measures aimed at preventing infected individuals from exposing others. Part I identifies education as the key component of a comprehensive prevention program, and reviews options for pre-exposure education programs designed to avoid or minimize exposure. Part II reviews post-exposure prevention measures, focusing on reporting and contact tracing provisions. Mandatory reporting by name of individuals testing HIV positive and mandatory contact tracing are opposed as counterproductive prevention measures; voluntary partner notification is supported. Part III examines various prevention efforts for settings where there may be either a real or perceived risk of transmission of HIV infection. Part IV sets out conclusions.

Acquired Immunodeficiency Syndrome↗
PubMed1974

The myth of sickle cell trait.

Recently emphasis in the problem of sickle hemoglobinopathy has been on mass screening of the black population. Concern about the alleged danger in having sickle cell trait itself is offered as part of the justification. This danger is disputed and a position developed for the benign status of sickle cell trait and the potentially serious social harm to blacks so identified. Programs are suggested to foster improved medical care availability and early detection for those with sickle cell anemia. It is suggested that mandatory patient programs be avoided, and that research receive greater emphasis.

Anemia, Sickle Cell↗
PubMed1986

Medical surveillance of employees under the Occupational Safety and Health Administration.

This paper will consider medical surveillance in the context of the Occupational Safety and Health Act of 1970. The Occupational Safety and Health Administration (OSHA) has issued (after rule making) health standards covering approximately 24 toxic substances, and all these standards have included medical surveillance programs. OSHA is not only empowered but compelled by law to require medical surveillance programs for exposed employees. At the same time, a number of major legal/policy issues relating to medical surveillance have been raised at the standards rule-making stage and litigated in court. Among the more significant of these are access to medical records, selection of physician, and medical removals. Many of these issues were involved in OSHA's Lead Standard, issued in 1978 and affirmed in relevant part by the Court of Appeals for the District of Columbia in 1980, and in the "medical access" rule, issued in 1980 and upheld by the Court of Appeals for the Fifth Circuit. These two proceedings will be used as a focus for the discussions of medical surveillance programs under the OSHA act.

Federal Government↗