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PubMedDate not supplied

The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers.

Head Start centers were randomly assigned to intervention (parent training) or control conditions, and the role of maternal mental health risk factors on participation in and benefit from parent training was examined. Parenting was measured by parent report and independent observation in 3 domains: harsh/negative, supportive/positive, inconsistent/ineffective parenting. Structural equation modeling showed that parent engagement training was associated with improved parenting in a dose-response fashion. Mothers with mental health risk factors (i.e., depression, anger, history of abuse as a child, and substance abuse) exhibited poorer parenting than mothers without these risk factors. However, mothers with risk factors were engaged in and benefited from the parenting training program at levels that were comparable to mothers without these risk factors.

Antisocial Personality Disorder↗
PubMed2000

Physician orders for life-sustaining treatment (POLST): outcomes in a PACE program. Program of All-Inclusive Care for the Elderly.

OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life-Sustaining Treatment (POLST), a preprinted and signed doctor's order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes. DESIGN: Retrospective chart review. SETTING: ElderPlace, a Program of All-Inclusive Care for the Elderly (PACE) site in Portland, Oregon. PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n = 58). Reasons for exclusion were no POLST (1), missing POLST (1), and insufficient documentation of care (2). MEASUREMENTS: POLST instructions for each participant and whether or not each of the treatments addressed by the POLST was administered in the final 2 weeks of life. RESULTS: The POLST specified "do not resuscitate" for 50 participants (93%); CPR use was consistent with these instructions for 49 participants (91%). "Comfort care" was the designated level of medical intervention in 13 cases, "limited interventions" in 18, "advanced interventions" in 18, and "full interventions" in 5. Interventions administered were at the level specified in 25 cases (46%); at a less invasive level in 18 (33%), and at a more invasive level in 11 (20%). Antibiotic administration was consistent with POLST instructions for 86% of 28 subjects who had infections in the last 2 weeks of life, and less invasive for 14%. Care matched POLST instructions in 84% of cases for IV fluids and 94% for feeding tubes. CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, IV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life-sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.

Advance Directives↗
PubMed1989

Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group.

The Hypertension Detection and Follow-up Program followed up 10,940 persons for 5 years in a community-based, randomized, controlled trial of treatment for hypertension. Participants were randomized to one of two treatment groups, stepped care and referred care. The primary end point of the study was all-cause mortality, with morbid events involving the heart, brain, and kidney as secondary end points. Loss of renal function, ascertained by a change in serum creatinine, was among these secondary events. Baseline serum creatinine concentration had a significant prognostic value for 8-year mortality. For persons with a serum creatinine concentration greater than or equal to 1.7 mg/dl, 8-year mortality was more than three times that of all other participants. The estimated 5-year incidence of substantial decline in renal function was 21.7/1,000 in the stepped-care group and 24.6/1,000 in the referred-care group. Among persons with a baseline serum creatinine level between 1.5 and 1.7 mg/dl, the 5-year incidence of decline was 113.3/1,000 (stepped care) and 226.6/1,000 (referred care) (p less than 0.01). The incidence of decline in renal function was greater in men, blacks, and older adults, as well as in those with higher entry diastolic blood pressure. Among persons with a baseline serum creatinine level greater than or equal to 1.7 mg/dl, serum creatinine concentration declined by 25% or more in 28.6% of stepped-care and 25.2% of referred-care participants. Although the incidence of clinically significant hypercreatininemia in a hypertensive population is low, an elevated serum creatinine concentration is a very potent independent risk factor for mortality. The slightly lower rate of development of hypercreatininemia and the higher rate of improvement in stepped-care compared with referred-care participants is consistent with the belief that aggressive treatment of hypertension may reduce renal damage and the associated increased risk of death.

Adult↗
PubMed1999

Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs.

Three types of treatment-behavioral skills training, a 12-step recovery model, and intensive case management-provided to 132 clients at four facilities were identified as being robustly or not robustly implemented, depending on whether core elements of these treatments were emphasized. Outcomes and costs of services to clients were examined over 18 months. Clients receiving robustly implemented behavioral skills training had significantly higher psychosocial functioning and lower costs for supportive services than those receiving nonrobustly implemented training. Clients receiving robustly implemented case management also exhibited significantly higher psychosocial functioning and lower costs for intensive services than those in the nonrobust intervention. To be effective, dual diagnosis programs should better manage the robustness of implementation of planned interventions.

Adolescent↗
PubMedDate not supplied

Kidney Early Evaluation Program (KEEP). Findings from a community screening program.

PURPOSE: The Kidney Early Evaluation Program (KEEP), which was started in 1997, aims to identify persons at risk for chronic kidney disease (CKD) and encourage at-risk persons to seek evaluation and management from a healthcare provider. METHODS: Community screening was conducted using a standardized questionnaire and test panel that was administered by local affiliates of the National Kidney Foundation (NKF) using volunteer lay and medical personnel. The screening was limited to persons at high risk for CKD, which was defined as those with a personal history of diabetes or hypertension, or a first-order relative with diabetes, hypertension, or kidney disease. The KEEP Data Coordinating Center was established to maintain a de-identified database of demographic information and test results on the screened persons. RESULTS: Data on the first 11,246 participants were analyzed. As expected, the KEEP population was enriched with African Americans and was older than the general population. Diabetes was determined by self-report or abnormal blood glucose levels at screening and was present in 2690 of the persons screened. Chronic kidney disease was identified in 47.4% of this population. CONCLUSIONS: Targeted community screening for kidney disease in a high-risk population can identify a significant number of persons with CKD, enhance awareness of the disease, and may improve health-seeking behavior.

Chronic Disease↗
PubMed1990

Development of a collaborative geriatric program between the legal system and a social work-directed program of a community hospital.

This paper details the development of a unique program developed between a social work-directed service of a community hospital and the probate system. It documents the value of combining the skills of these two systems to enhance the care, service delivery and quality of life of older persons involved in conservatorship matters. It suggests that such models will become increasingly necessary as the American population ages.

Aged↗
PubMed1987

Survival analysis in drug program evaluation. Part I. Overall program effectiveness.

Survivorship analysis is a statistical technique used here in a summative evaluation that compares outcome data from multiple-site methadone maintenance programs in three California counties. Multiple outcome measures were obtained from retrospective interviews with 297 heroin addicts 6-8 years after admission to treatment. These measures were rates of retention, incarceration, addiction, crime, dealing, and loss of employment. Survival curves for all six measures are consistent in showing that Los Angeles County had the best outcomes, followed by San Bernardino County and then Orange County.

Adult↗
PubMed1999

The International Health Program: the fifteen-year experience with Yale University's Internal Medicine Residency Program.

The purpose of this study was to assess the impact of international health electives on physicians-in-training. A retrospective study was conducted using an anonymous, self-administered mailed survey to internal medicine residents who trained at Yale from 1982 to 1996 based on their experience with our International Health Program (IHP). The response rate was 61%, with 96 completed surveys in the participant group and 96 completed surveys in the nonparticipant group. Participants were more likely than nonparticipants to care for patients on public assistance (77 versus 49; P < 0.001) and immigrant patients (41 versus 23; P = 0.006). Among residents who changed their career plans, participants (22) were more likely than nonparticipants (14) to switch from subspecialty medicine to general medicine (P = 0.02). Participants were significantly more likely to have a positive view of health care delivery in developing countries. Compared with nonparticipants (64), IHP participants (74) believed that the physical examination is under-used by physicians from the United States as a diagnostic skill (P = 0.03). International health experiences appeared to have an important impact on the decisions and attitudes of residents.

Adult↗
PubMed1999

The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group.

The Childhood Asthma Management Program (CAMP) is a multicenter, randomized, double-masked clinical trial designed to determine the long-term effects of three inhaled treatments for mild to moderate childhood asthma: budesonide (a glucocorticoid used daily) and albuterol (a short-acting beta-agonist bronchodilator used as needed); nedocromil (a nonsteroid anti-inflammatory agent used daily) and albuterol; and placebo and albuterol. One thousand forty-one children (32% from ethnic minority groups), aged 5 to 12 years at screening, are currently participating. The primary outcome measure is lung growth as indicated by postbronchodilator forced expiratory volume in 1 second (FEV1) percent of predicted, observed over 5- to 6-year period. The trial also assesses differences between treatment groups with respect to airway responsiveness, morbidity, physical growth and development, and psychological growth and development. This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial.

Albuterol↗
PubMed1990

Medicaid program; state plan requirements and other provisions relating to state third party liability programs--HCFA. Final rule.

This final rule implements certain Medicaid State plan requirements and other provisions relating to State third party liability (TPL) programs. Its provisions deal with: (1) The integration of a State's pursuit of third party claims with its Mechanized Claims Processing and Information Retrieval System; (2) exceptions to the cost avoidance method of claims payment in TPL situations; and (3) provider restrictions and penalties related to attempts at collection of cost sharing or portions of those amounts from Medicaid recipients when TPL has been established. These regulations implement portions of section 9503 of the Consolidated Omnibus Budget Reconciliation Act of 1985.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicare program; quarterly listing of program issuances and coverage decisions--HCFA. General notice.

This notice lists HCFA manual instructions, regulations and other Federal Register notices, and statements of policy that were published during July, August and September 1990 that relate to the Medicare program. Section 1871(c) of the Social Security Act requires that we publish a list of our Medicare issuances in the Federal Register at least every three months. We also are providing the content of revisions to the Medicare Coverage Issues Manual published during this quarter. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicare program; quarterly listing of program issuances and coverage decisions--HCFA. General notice.

This notice lists HCFA manual instructions, substantive and interpretative regulations and other Federal Register notices, and statements of policy that were published during January, February, and March 1991 that relate to the Medicare program. Section 1871(c) of the Social Security Act requires that we publish a list of our Medicare issuances in the Federal Register at least every three months. We are also providing the content of the revision to the Medicare Coverage Issues Manual published during this quarter. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilities identification of coverage and other changes in our manuals.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicare and Medicaid programs; nurse aide training and competency evaluation programs--HCFA. Final rule.

This rule amends the Medicare and Medicaid regulations pertaining to facilities to incorporate Federal requirements that States have training and competency evaluation by Medicare participating skilled nursing facilities and Medicaid participating nursing facilities and also have a nurse aide registry. The purpose of these provisions is to ensure that nurse aides have the education, practical knowledge, and skills needed to care for residents of facilities participating in the Medicare and Medicaid programs. These requirements implement, in part, sections 4201(a) and 4211(a) of the Omnibus Budget Reconciliation Act of 1987, section 6901(b) of the Omnibus Budget Reconciliation Act of 1989, and sections 4008 and 4801 of the Omnibus Budget Reconciliation Act of 1990.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Medicare program; swing-bed program changes--HCFA. Final rule.

This final rule responds to comments we received on an interim final rule relating to hospital swing beds that was published on September 7, 1989 (54 FR 37270). The interim rule expanded the swing-bed program to encompass rural hospitals with 50 to 99 beds. It established requirements that approved swing-bed hospitals with more than 49 beds must meet. This rule establishes the interim rules as final regulations with changes. These changes are based on our review and consideration of the public comments.

Bed Conversion↗
PubMed1991

Medicare program; quarterly listing of program issuances and coverage decisions--HCFA. General notice.

This notice lists HCFA manual instructions, substantive and interpretative regulations and other Federal Register notices, and statements of policy that were published during April, May, and June 1991 that relate to the Medicare program. Section 1871(c) of the Social Security Act requires that we publish a list of our Medicare issuances in the Federal Register at least every three months. We also are providing the content of the revisions of the Medicare Coverage Issues Manual published during this quarter. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals.

Humans↗
PubMed1992

Medicare Program; quarterly listing of program issuances and coverage decisions--HCFA. General notice.

This notice lists HCFA manual instructions, substantive and interpretative regulations and other Federal Register notices, and statements of policy that were published during July, August, and September 1991 that relate to the Medicare program. Section 1871(c) of the Social Security Act requires that we publish a list of our Medicare issuances in the Federal Register at least every three months. Wefd also are providing the content of the revisions to the Medicare Coverage Issues Manual published during this quarter. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Medicare program; quarterly listing of program issuances and coverage decisions--HCFA. General notice.

This notice lists HCFA manual instructions, substantive and interpretative regulations and other Federal Register notices, and statements of policy that were published during October, November, and December 1991 that relate to the Medicare program. Section 1871(c) of the Social Security Act requires that we publish a list of our Medicare issuances in the Federal Register at least every three months. We also are providing the content of the revisions to the Medicare Coverage Issues Manual published during this quarter. On August 21, 1989 (54 FR 34555), we published the content of the Manual and indicated that we will publish quarterly any updates. Adding the Medicare Coverage Issues Manual changes to this listing allows us to fulfill this requirement in a manner that facilitates identification of coverage and other changes in our manuals.

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