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PubMed1996

Physical and sexual abuse in a middle-class obstetric population.

To evaluate the prevalence of a history of physical and sexual abuse in pregnant, economically stable, middle-class women with access to comprehensive health care, we issued self-report questionnaires to prenatal orientation classes at Wilford Hall Medical Center from October 19, 1992, to March 15, 1993. After identifying women who had been physically or sexually abused, we identified the assailant, the number of occurrences, and injuries resulting from the abuse. Of the 563 women who responded, 100 (18%) reported previous physical or sexual abuse. Seven women (1%) stated that they were physically abused during the pregnancy. Women were more likely to be physically than sexually abused by a spouse or lover (46% versus 13%). To identify women who have a history of abuse and to address their needs, practitioners should incorporate taking a history of physical and sexual abuse during the routine new obstetric visit.

Adult↗
PubMed1991

The Health Security Partnership. A federal-state universal insurance and cost-containment program.

The Health Security Partnership attempts to assure (1) that all Americans have insurance coverage for a set of comprehensive health care benefits, (2) that cost-containment issues are addressed in a manner that does not impinge negatively on the quality of care, and (3) that provider freedom to deliver appropriate clinical care is strengthened. It assigns important responsibilities to the federal government (eg, specification of benefits, review of proposed state health care budgets), while permitting states to select, develop, and administer specific program design features they deem appropriate (eg, states could build on and expand the existing health system infrastructure, including private insurance, and/or extend the role of tax-supported programs). It is estimated that in its first year the program would add about 5% to America's health expenditures, but within a few years, cost-containment efforts and administrative efficiencies would reduce overall expenditures below what they otherwise would be.

Comprehensive Health Care↗
PubMed1977

Experience with an adolescent pregnancy program. A preliminary report.

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical drug. Eighty-one percent of the patients attended 7 or more antenatal visits, one-half did not miss a single clinic appointment, and 95% completed a post-partum visit, indicating that the program was well accepted by the adolescents.

Adolescent↗
PubMedDate not supplied

The Pepper Commission Report and the response.

The recommendations of the "Pepper Commission" [the Bipartisan Commission on Comprehensive Health Care] on health care policy reform (see box on page 20) would cost an estimated $66 billion to implement. As a result, many in Congress already have declared the Pepper report to be politically nonviable. Nevertheless, Commission Chairman John D. Rockefeller IV intends to pursue legislative activity on the report. Recently, Rockefeller said that the Commission's majority recommendations likely will be offered in Congress as one large bill--with the option to break out some of its features for individual consideration. For example, Rockefeller said he will try this year to enact the Commission's recommendations to improve health care coverage for pregnant women and children--as well as suggestions for reform in the health insurance industry. The West Virginia senator said he believes these two proposals will cost about $3.5 billion in new federal funds. The basics of the plan, and the political obstacles facing its enactment, were discussed by several members of the Pepper Commission during the press conference at which the recommendations were unveiled. FAHS Review covered that press conference, and below we reprint excerpts from a tape transcription of the remarks of several Commission members.

Comprehensive Health Care↗
PubMed1996

Understanding equality in health care: a Christian free-market approach.

This paper examines the arguments presented by the Roman Catholic Bishops in their 1993 Pastoral Resolution, Comprehensive Health Care Reform: Protecting Human Life, Promoting Human Dignity, Pursuing the Common Good, concerning health care reform. Focusing on the meaning of equality in health care and traditional Roman Catholic doctrine, it is argued that the Bishops fail to grasp the force of the differences among persons, the value of the market, and traditional scholastic arguments concerning obligatory and extraordinary health care. To attempt to equalize the distribution of health care would be ruinous. A more traditional understanding of Christian thought reveals an acceptance of inequality in health care distribution and a bias against using the secular state to coerce a solution to such concerns for social justice.

Catholicism↗
PubMed2003

Development of an asthma disease management program in a children's hospital.

The incidence, morbidity, and mortality of asthma have been increasing at an alarming rate, making asthma the most common chronic illness of childhood. An asthma disease management program was developed to improve the care and management of patients with asthma--a comprehensive health care delivery model that was designed to improve the management of patients with asthma was designed and implemented. The goal of the program was to provide high-quality interventions for those children diagnosed with asthma. The asthma disease management program at Children's Mercy Hospital improved the care received, decreased costs, and improved the quality of life for those children with asthma.

Asthma↗
PubMed1993

Use of health care services in two rural communities in Tanzania.

This study was undertaken to investigate the pattern of utilization of medical and dental health care services in rural Tanzania. Two hundred adults, 91 men and 109 women aged 20 or over, were interviewed. Nearly all subjects reported using modern dental and medical health care services. Home remedy was the only indigenous method of treatment used for dental problems while for medical problems a traditional healer was the most commonly used indigenous alternative. The use of both indigenous and modern health care services was significantly lower for dental than for medical problems (P < 0.05). It seems that the pattern of utilization of health care services differs for medical and dental problems. This should be taken into account when planning comprehensive health care services for rural African societies.

Adult↗
PubMed1992

[Domiciliary geriatric care: 20 months' experience].

Geriatric home care (GHC) can help elderly patients by providing comprehensive health care and avoiding prolonged hospital admissions. In this article we discuss our experience in this field. METHODS. From February 1990 to October 1991, 171 elderly patients have been followed periodically at their homes by our GHC team, formed by two geriatricians, a nurse, a social worker, an occupational therapist and a driver. RESULTS. Our patients were very old (81.3 +/- 77 years), had multiple medical problems and high levels of disability (48.6% had a katz ADL index worse than E). The frequency of hospital admissions was high (50% of the patients) but the total number of days in hospital was low (16.1 +/- 18.6 days for a 211.7 +/- 162.3 days of follow-up). Total mortality was 33.9%; 56.9% of them happened at home. CONCLUSIONS. Geriatric home care units can reduce long hospital stays of severely disabled or terminally ill elderly patients, and can provide adequate health care to this group at patients.

Aged↗
PubMed1989

Family support and parenting education in the home: an effective extension of clinic-based preventive health care services for poor children.

A study was designed to assess the effect and cost of providing parenting and child care education in the home to inner-city mothers of poor infants receiving comprehensive health care in a large federal Children and Youth Program. Randomly selected, healthy neonates weighing more than 2000 gm and born to black women aged 18 years and older (n = 131) and to comparable control subjects (n = 132) were followed for a mean of 23.4 and 22.9 months, respectively. A community woman, with educational, social service, and medical backup support from the Children and Youth Program, made home visits 7 to 10 days after the birth and between regularly scheduled well-child-care visits. Improved compliance with well-child care, fewer illness visits, and sharp reductions in hospitalization and in neglect or abuse were found in the visited group compared with the control group, and substantial cost was averted. Prerequisite and concomitant to focusing the mother's attention on the infant was the resolution of the numerous crises and survival problems experienced by these poor women. Only then was parenting education accepted by the mother.

Adult↗
PubMed2000

Ambulatory STD management in an inner-city emergency department: descriptive epidemiology, care utilization patterns, and patient perceptions of local public STD clinics.

BACKGROUND AND OBJECTIVES: In conjunction with a lack of primary and preventive care, many patients are treated in emergency departments (EDs) for sexually transmitted diseases (STDs). GOAL: To epidemiologically characterize patients accessing an inner-city ED for treatment of STDs. DESIGN: One hundred patients 17 years or older who were treated for an STD or who had conditions that were given syndromic or presumptive diagnoses of an STD participated in this prospective case series. Cases were identified on the basis of history and physical examination. Patients were interviewed to collect information on demographics, drug and alcohol use, current symptoms, self-medication, and health care access. RESULTS: A total of 98% of patients who were approached participated. Two thirds of the participants were female. Women were more likely than men to have health insurance, Medical Assistance, and a regular source of health care. Injecting drug use was associated with a 5.3 increase in the odds ratio of delayed treatment seeking (P = 0.038). Effort to self-treat was associated with a 3.2 increase in the odds of delayed treatment seeking (P = 0.015). Being female was associated with a 4.1 increase in the odds of self-treatment (P = 0.009). CONCLUSION: This study identifies several potential barriers to appropriate health care access and use. The study also identifies the ED as a potential source of intervention for more comprehensive health care and an entry into the health care system for a difficult-to-reach patient population.

Adult↗
PubMed2006

Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras.

METHODS: Comparisons of death-related variables during the 3 eras were performed. RESULTS: The number of deaths declined over the study period, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era (1997-1999), and 78 deaths in the late HAART era (2000-2003) (P < 0.01). The annual death rate peaked in 1995 (10.3 per 100 patients) and then declined to <2 deaths per 100 persons in the late HAART era (P < 0.01). The proportion of deaths attributable to infection decreased, but infection remained the leading cause of death in our cohort, followed by cancer. Of those who died, there was an increasing proportion of non-HIV-related deaths (32% vs. 9%; P < 0.01), including cardiac disease (22% vs. 8%; P < 0.01) and trauma (8% vs. 2%; P = 0.01) in the post-HAART versus pre-HAART era. Despite the absence of intravenous drug use and the low prevalence of hepatitis C coinfection in our cohort, an increasing proportion of deaths in the HAART era were attributable to liver disease, although the numbers are small. CONCLUSIONS: Despite increasing concerns regarding antiretroviral resistance, the death rate among HIV-infected persons in our cohort continues to decline. Our data show a lower death rate than that reported among many other US HIV-infected populations; this may be the result of open access to health care. A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents.

Adult↗
PubMedDate not supplied

Working on reform. How workers' compensation medical care is affected by health care reform.

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Health Care Costs↗
PubMedDate not supplied

Perinatal health care in Japan.

The maternal and infant health care system and vital statistics in Japan are reviewed. The improvement of socioeconomic conditions, higher education for women, comprehensive health care provided by the government, regionalization for high-risk pregnancy, medical advances in the care of pregnant women and neonates, the significant decline of perinatal and neonatal mortality rates in recent decades are all contributing factors in improved maternal-infant health care. On the basis of recent statistics showing that the survival rate of extremely low birth weight infants increased over 80%, the viability limit defined by Eugenic Protection Act was amended in 1991 from 24 to 22 completed weeks of gestation.

Adolescent↗