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PubMedDate not supplied

Predicting needs for special education resources for mental retardation from birth defects records.

Planning of service delivery systems for children with special health care needs would be enhanced by knowledge of numbers of cases anticipated in defined geographic areas. A method is described for predicting numbers of children who will likely have mental retardation sufficient to require special education services, based on the birth prevalence of birth defects and clinicians' estimates of the likelihood of mental retardation associated with each specific birth defect. This method is applied to the 1980-82 birth cohort of a 28-county area of south and central Arkansas, and it is compared with special education enrollment data for children ages 6 to 8 in academic year 1988-89. According to this estimate, children with birth defects may account for 32 to 56 percent of the cases of mental retardation among 6- to 8-year-olds reported by the public schools.

Arkansas↗
PubMed1990

[Women physicians. Developmental tendencies in specialization and career patterns].

An earlier study showed that female doctors were found in specific subgroups of the medical profession. Their choices were probably governed by traditional ideas about feminine versus male role-expectations. This study shows that there still exists marked sex differences within the medical profession. Female doctors are still to be found in specific specialities. Seen in relation to male doctors the degree of specialization among female doctors decreased from 1972 to 1986. This is probably due to the fact that there are many young female doctors who have not yet completed their specialization. In married couples of doctors on the contrary, there is an increasing tendency towards equality of professional career, since the female partner now more often reaches the same career level as her husband, and with less lag in time.

Career Choice↗
PubMed1990

[Economic bases of treatment intensification at specialized oncological facilities].

The purpose of the study was to work out economic rationale for intensifying treatment at specialized oncological establishments. Modern modalities of cancer treatment require patients to be admitted to specialized hospitals. However, at present nearly half of them receive treatment in general medical establishments which, as a rule, do not have facilities for combined and complex treatment. It is estimated that shifting patient examination emphasis from hospital to outpatient clinic might increase the clinical bed turnover by 6.7% which, in turn, will allow to treat 43000 patients more in specialized hospitals every year. The introduction of such scheme will cost 6.8 times less than commission of new beds required for management of the equivalent number of cancer patients.

Cancer Care Facilities↗
PubMedDate not supplied

Health and special education: a study of new developments for handicapped children in five metropolitan communities.

Since the implementation in 1977 of the Education for All Handicapped Children Act (Public Law 94-142), public school systems have provided special education and related services to students with a wide range of handicapping conditions, including some children served previously in hospitals or other institutions. Although the Federal law does not require physician participation in the special education process, it does imply an active new role for the medical care community, both public and private, in helping schools to identify and diagnose children with disabilities and in ensuring that those children have adequate access to health services. This study explores the experience of five nationally dispersed urban school systems in implementing P.L. 94-142, with particular reference to the interaction of physicians and the schools. The findings highlight continued problems with early identification of certain types of childhood handicaps, classification of children's functional disorders, and adequate participation of practicing physicians in the program, especially with regard to developmental and behavioral issues. In addition, inequities in community health services are documented for a substantial number of the children studied. Improved collaboration between the health and education sectors is needed to address these concerns in order to fulfill the intent of national special education policy and to maximize the potentialities of these children and their families.

Child↗
PubMed1978

Primary and specialized care: implications for learning situations.

Existing data suggest that there are differences between primary and specialized (consultant) care in clinical practice and in clinical decision-making. In addition, there are distinctions attributable to the nature of the two functions, the clinical settings, and the use of knowledge and technique. The most important difference, however, centers around the varying prevalence of disease between primary and specialized care and the practitioner's relative use of disease frequency in decision-making. Because of these differences, medical schools should develop primary care situations which are equally as valued as specialty care situations. Although the impact of substantial and attractive primary care curricula is unknown, their potential value in guiding appropriate students to enter primary or specialized care careers could be considerable.

Decision Making↗
PubMed1983

Technology, specialization, and the allied health professions.

Medical specialization has been made possible through the evolution and dominance of the anatomic theory of disease and the growth of technology. Through the view offered by anatomy, the idea of dividing and studying portions of the body seemed natural and desirable. Through technology, diagnostic and therapeutic actions on these parts became possible. Specialization has affected all aspects of medicine, particularly the allied health professions. The narrow perspective on illness that specialization can produce in allied health professionals may be forestalled through systematic educational efforts to broaden their understanding of illness by delineating the ethical dimensions of their relationship to patients, creating a view of their place in the historical evolution of medicine, and examining how technology influences medicine and its role in shaping allied health careers.

Allied Health Personnel↗
PubMed1984

Regular- and special-education teachers' judgments about mentally retarded children in an integrated setting.

A three-way design was used to determine whether teachers' judgments about mentally retarded children would be related to characteristics of the children, characteristics of the teacher, and/or characteristics of an integrated free-play setting. Independent variables were integration ratio, area of teacher's specialization, and target child. The dependent variable was teachers' judgments about handicapped children in an integrated setting. Subjects were 15 regular-education teachers and 15 special-education teachers who taught at the primary school level. Judgment ratings by regular-education teachers depended both on the characteristics of the target child and the integration ratio in the free-play activity. Special-education teachers' judgments also were influenced by characteristics of the child observed but not the integration ratio.

Attitude↗
PubMed1983

[Development of the neurophysiologic department in Rostock--a contribution to the specialization of the specialty of neurology].

The development of the subject of neurology has been stated with special regard to the department of neurology of the university of Rostock--from the time when Sayk took the professorship 22 years ago. The specialization beginning in this period before all concerns the scope of diagnostics (neuroradiology, neuro-electrodiagnostics, cerebrospinal fluid--resp. laboratory diagnostics) and--arising from the requirements of clinical neurology--the concentration upon distinct centres of scientific activities. Beside the representation of the tasks of work are given data about several results of research in the traditional field of cerebrospinal fluid (CSF cytology) and the branch of neuroimmunology (cell-mediated immunity) in Rostock. Some questions of basic research and special subjects as well as the actual trends--relevant for neurology--are presented.

Germany, East↗
PubMed1980

Specialization in general practice.

Ideas about general practitioner specialism may have been hampered in the past because of the three models of general practitioner specialism - in the hospital service, the fee-earning specialoid or the general practitioner obstetrician - none of which is satisfactory.However, general practitioner specialism can be justified in guaranteeing standards by concentrating groups of patients, accepting responsibility, and planning care. Medico-political changes may be needed to achieve improvement in clinical standards.

Family Practice↗
PubMed1980

[Tendency of specialization in medicine].

The evolution of medicine from an applied science to the extension of specialized medical care delivery, has had a bearing on the student's early decision, influenced by a specialist teacher, to chose specialization in a given field. The author gives current explanations of the specialization process in order to conclude that, in Brazil, one of its leading determinants is a policy of the social welfare system that favors the specialist. Other factors cited are the (not always justified) preference of patients--at least of those who can afford it--for physicians who work with sophisticated equipment, the vested interests of the industry that produces or owns that equipment, and the desire of the young physician to escape the stiff competition he would encounter in general practice, while at the same time separating himself from the somewhat negative image of the general clinician who does not keep abreast of developments in medicine. The author examines the question in light of sociological theories of social and technical division of labor, and asserts that the process has led to the atomization of responsibilities among physicians who have become incapable, because of overspecialization, of viewing the patient as a biological, psychological, social and cultural whole.

Brazil↗
PubMedDate not supplied

Prediction of special education placement from birth certificate data.

The overall goal of this research effort was to develop procedures for accurately identifying children at high risk for special education placement, based on information available at the time of birth. A file containing information on all births in New York City between 1976 and 1986 was matched against the 1992 BIOFILE, which contains information on all children enrolled in the New York City public school system in 1992. A matched file containing birth and school information on 471,165 children resulted from this process. Three sets of risk factors were derived from birth certificate data: parental, pregnancy-related, and child-related. Using these risk factors as independent variables, a survival analysis model was developed predicting special education placement for each of three major disability categories: learning disability, emotional disorder, and mental retardation. A model combining all disability categories was also developed. The significant predictors of special education placement were Medicaid payment for birth (a poverty indicator), unmarried status of mother, large family size, low parental education, a mother born in the United States, a low level of prenatal care, male gender, low birthweight, and a low Apgar score. Male gender was the strongest risk factor in all models. Examination of selected survival curves indicated that the predictive power of the models is substantial. The methodology described in this article can be used to identify at-risk children for whom screening and other early interventions, including preschool programs, may be appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1995

Can one patient record accommodate the diversity of specialized care?

Despite a quarter century of developments, few specialists directly use a computerized patient record, that fully replaces the paper chart. Because of the diversity of domains in specialized care, medical decision-making and the continuity of care may suffer from scattering of patient data over various records. The challenge was to develop a computerized patient record, that would be versatile enough to tailor it to specific needs, while keeping it uniform enough to permit physicians to share data on the same patient. In our CPR, the key that reconciles versatility with uniformity lies in the design of the data model. The CPR consists of a mother record with specialized sub-records, that all share the same data model. A physician can enlarge his scope for decision-making by consulting other specialized records on the same patient or by viewing the combined information of all sub-records without the need to convert data or to familiarize himself with different interfaces.

Humans↗
PubMed1996

Effectiveness of special education: is placement the critical factor?

Research indicates that various program models, implemented both in special education and general education, can have moderately positive academic and social impacts for students with disabilities. However, no intervention has been designed that eliminates the impact of having a disability. With few exceptions, students with disabilities have not achieved commensurately with their nondisabled peers; even students with learning disabilities as a group have not been able to achieve at the level of low-achieving nondisabled students. In general, the most effective interventions for students with disabilities, whether in special education or general education settings, have employed intensive and reasonably individualized instruction, combined with careful, frequent monitoring of student progress. There is no compelling evidence that placement rather than instruction is the critical factor in student academic or social success. Further, studies have indicated that typical practice in general education is substantially different from practice in the model programs that showed greatest success for students with disabilities. The interventions that were effective in improving academic outcomes for students with disabilities required a considerable investment of resources, including time and effort, as well as extensive support for teachers. The research does not support full-time inclusion for all students with disabilities. On the contrary, it appears that there is a clear need for special education. At the same time, given adequate resources, schools should be able to assist more students to be more successful in general education settings.

Adolescent↗
PubMed1997

[The role of the N. N. Burdenko Main Military Clinical Hospital in the development of specialized medical care in the Armed Forces of the Russian Federation].

The article give the characteristic of the specialized medical care as the highest form of the medical care, enabling to use more effectively the most advanced achievements of all fields of the clinical medicine and appropriate categories of the experts with the purposes of the successful treatment of the injured and patients. A role of V. A. Oppel', N. N. Burdenko, E. I. Smirnov in origin and development of the specialized medical help in military-field conditions is marked. On example of Burdenko Main Military Clinical Hospital achievement and problems of the specialized medical help at the present stage are shown, prospects and ways of its further development and perfection are planned.

Delivery of Health Care↗
PubMed1976

[Experience with special classes for mildly brain-damaged children with behavior disorders].

Within the framework of a large-scale medical and pedagogical experiment conducted at Rostock, two special education classes for second graders were set up at the start of the 1965/66 school year in an attempt to prevent children with cerebral lesions from failing to pass courses already in the lower grades at elementary schools. As a result of this experiment, it was decided to start a school for special education children, and this school now has two parallel classes each for second, third, and fourth graders as well as one additional class in which pupils are prepared for the fifth normal education school grade. Psychological tests made as part of a longitudinal study in which 48 children who had been to this school from 1965, 1966, and 1967 were included and which spread over years including the 1971/72 school years, showed an improvement in motor development with slightly retarded intellectual development and unchanged lack of concentration power. Average attainments in the various subjects improved while pupils were attending special education classes and did not, after reintegration of such children into normal schools (fifth grade), drop below the general level of proficiency.

Achievement↗
PubMed2005

A national profile of health care utilization and expenditures for children with special health care needs.

OBJECTIVES: To provide the first nationally representative data on total health care expenses, out-of-pocket health care expenses, and information on the extent to which out-of-pocket expenses are financially burdensome for families of children with special health care needs (CSHCN). To also compare utilization and expenditure patterns for children with and without special health care needs. DESIGN: We used data from the 2000 Medical Expenditure Panel Survey (MEPS). We present univariate, bivariate, and multivariate statistics on utilization and expenditures adjusted for the complex sample design. PARTICIPANTS: The 2000 MEPS data set contains 6965 children younger than 18 years. Using the CSHCN definition adopted by the federal Maternal and Child Health Bureau and operationalized using the CSHCN Screener, 949 children (15.6%) were identified as children with special health care needs. MAIN OUTCOME MEASURES: Compared with other children, CSHCN had 3 times higher health care expenditures (2099 dollars vs 628 dollars; P<.01). The 15.6% of CSHCN accounted for 42.1% of total medical care costs (excluding dental costs) and 33.6% of total health care costs (including dental costs) attributed to children in 2000. Families of CSHCN were best protected against inpatient hospital care expenses and most exposed to dental care expenses. Families of CSHCN experiencing high out-of-pocket expenses (exceeding 5% of family income) were approximately 11 times more likely to be from households with incomes below 200% of the federal poverty level (odds ratio, 10.9; 95% confidence interval, 3.55-33.76) than to be from families with incomes at or above 400% of the federal poverty level. CONCLUSIONS: Families with CSHCN experience much higher expenditures, including out-of-pocket expenditures, than other children. Insurance plays an important protective role for families of CSHCN, but it still provides incomplete protection. Health policy changes that would extend the breadth and depth of insurance coverage are needed to ensure that all families of CSHCN are protected against burdensome expenses.

Adolescent↗
PubMed1999

Detectors for polarized skylight in insects: a survey of ommatidial specializations in the dorsal rim area of the compound eye.

Apart from the sun, the polarization pattern of the sky offers insects a reference for visual compass orientation. Using behavioral experiments, it has been shown in a few insect species (field crickets, honey bees, desert ants, and house flies) that the detection of the oscillation plane of polarized skylight is mediated exclusively by a group of specialized ommatidia situated at the dorsal rim of the compound eye (dorsal rim area). The dorsal rim ommatidia of these species share a number physiological properties that make them especially suitable for polarization vision: each ommatidium contains two sets of homochromatic, strongly polarization-sensitive photoreceptors with orthogonally-arranged analyzer orientations. The physiological specialization of the dorsal rim area goes along with characteristic changes in ommatidial structure, providing actual anatomical hallmarks of polarized skylight detection, that are readily detectable in histological sections of compound eyes. The presence of anatomically specialized dorsal rim ommatidia in many other insect species belonging to a wide range of different orders indicates that polarized skylight detection is a common visual function in insects. However, fine-structural disparities in the design of dorsal rim ommatidia of different insect groups indicate that polarization vision arose polyphyletically in the insects.

Animals↗
PubMed1996

Measuring the effect of the Rorschach color cards (VIII-X) on perceptual accuracy and special scores in differentiating borderline from schizophrenic protocols.

In this study, measures were developed that compared conventional Form accuracy and the ratio of Special Scores on Cards VIII-X (Color Cards) with overall Rorschach scores. Two new measures, a Color Card Perception Difference (CCPD) score and a Special Score Difference (SSD) score were used for this purpose. CCPD and SSD scores were calculated by subtracting component X + % scores and weighted Special Score ratios found on the overall Rorschach from those unique to Cards VIII-X. CCPD scores were found to be highly effective in differentiating a previously diagnosed borderline from a schizophrenic group. CCPD and SSD scores were correlated with MMPI scales for profile characteristics.

Adolescent↗