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PubMedDate not supplied

Values underpinning poverty programs for children.

Values create a framework through which the American public gives meaning to particular concepts and events. To better understand the values underlying public support for poverty programs for children, this article examines public attitudes toward children, poverty, and government. Although Americans continue to view helping children as a top policy priority, there is ambivalence with regard to poor children because of their inevitable connection to poor adults and the public's expectation that adults be self-sufficient. Rather than choosing between extreme ideological views of the causes of poverty and the ideal role of government in curbing poverty, the American public takes an integrative perspective that both values individual initiative and supports opportunities for all Americans. Favored are government programs fitted to the practical needs of everyday life. Such programs should support personal efforts but not assume responsibility for individual or particular group outcomes.

Adult↗
PubMed1994

Sequential appearance of muscle-specific proteins in myoblasts as a function of time after cell division: evidence for a conserved myoblast differentiation program in skeletal muscle.

Based on the assumption that a conserved differentiation program governs the assembly of sarcomeres in skeletal muscle in a manner analogous to programs for viral capsid assembly, we have defined the temporal and spatial distribution of 10 muscle-specific proteins in mononucleated myoblasts as a function of the time after terminal cell division. Single cells in mitosis were identified in monolayer cultures of embryonic chicken pectoralis, followed for selected time points (0-24 h postmitosis) by video time-lapse microscopy, and then fixed for immunofluorescence staining. For convenience, the myoblasts were termed x-h-old to define their age relative to their mitotic "birthdate." All 6 h myoblasts that emerged in a mitogen-rich medium were desmin+ but only 50% were positive for a alpha-actin, troponin-I, alpha-actinin, MyHC, zeugmatin, titin, or nebulin. By 15 h postmitosis, approximately 80% were positive for all of the above proteins. The up-regulation of these 7 myofibrillar proteins appears to be stochastic, in that many myoblasts were alpha-actinin+ or zeugmatin+ but MyHC- or titin- whereas others were troponin-I+ or MyHC+ but alpha-actinin- or alpha-actin-. In 15-h-old myoblasts, these contractile proteins were organized into nonstriated myofibrils (NSMFs). In contrast to striated myofibrils (SMFs), the NSMFs exhibited variable stoichiometries of the sarcomeric proteins and these were not organized into any consistent pattern. In this phase of maturation, two other changes occurred: (1) the microtubule network was reorganized into parallel bundles, driving the myoblasts into polarized, needle-shaped cells; and (2) the sarcolemma became fusion-competent. A transition from NSMFs to SMFs took place between 15 and 24 h (or later) postmitosis and was correlated with the late appearance of myomesin, and particularly, MyBP-C (C protein). The emergence of one, or a string of approximately 2 mu long sarcomeres, was invariably characterized by the localization of myomesin and MyBP-C to their mature positions in the developing A-bands. The latter group of A-band proteins may be rate-limiting in the assembly program. The great majority of myoblasts stained positively for desmin and myofibrillar proteins prior to, rather than after, fusing to form myotubes. This sequential appearance of muscle-specific proteins in vitro fully recapitulates myofibrillar assembly steps in myoblasts of the myotome and limb bud in vivo, as well as in nonmuscle cells converted to myoblasts by MyoD. We suggest that this cell-autonomous myoblast differentiation program may be blocked at different control points in immortalized myogenic cell lines.

Animals↗
PubMedDate not supplied

Sovereign immunity and health care: can government be trusted?

When government provides or arranges for health care, it is held to lower legal standards than private parties are, especially when liability is barred by "sovereign immunity". This paper examines sovereign immunity and its implications for health care quality by comparing private-sector and government accountability in several legal contexts. It then considers whether the law should be changed; the possible relationship between limited government accountability and public mistrust of a larger government role in health care; and the potential role of disparate legal standards if a lower tier of care evolves in government programs.

Attitude to Health↗
PubMed1988

A cost-effectiveness analysis of strategies to reduce infant mortality.

This study compares the cost effectiveness of various health inputs and government programs in reducing race-specific neonatal mortality or death in the first 27 days of life. Approximately two thirds of all infant deaths occur within this period. The programs and inputs at issue are teenage family planning use; the supplemental food program for women, infants, and children (WIC); use of community health centers and maternal and infant care projects; abortion; prenatal care; and neonatal intensive care. Using an economic model of the family as the analytic framework, effectiveness is determined by using ordinary least squares and two-stage least squares to estimate infant health production functions across large counties in the United States in 1977. Estimates of costs are from a number of published sources. We find the early initiation of prenatal care to be the most cost-effective means of reducing the neonatal mortality rate for blacks and whites. Moreover, blacks benefit more per dollar of input use than whites. Neonatal intensive care, although the most effective means of reducing neonatal mortality rates, is one of the least cost-effective strategies.

Child Health Services↗
PubMedDate not supplied

Negative growth effectors and cellular senescence.

Current studies suggest a genetic program governs the lifespan of each organism. Using cellular senescence as a model system, components of this program for aging have been sought. Human diploid fibroblasts, upon reaching senescence, express active inhibitors of DNA synthesis. It is believed that such inhibitors could be members of a new family of negative growth effectors involved in the pathway to senescence. Factors capable of inhibiting DNA synthesis in a similar manner have also been identified from human quiescent fibroblasts and liver cells as well as from quiescent rodent liver cells. The relationship of these inhibitors to previously identified negative growth effectors and aging are discussed.

Animals↗
PubMed1987

Radon risk information and voluntary protection: evidence from a natural experiment.

This study examines the perceived risks and mitigating behavior of Maine households who received new information on their exposures to significant health risks from indoor radon. The observed responses of these households illustrate conceptual issues related to designing an effective risk information program. Despite the involvement of generally well-motivated homeowners and well-intentioned researchers and government officials, we conclude that the risk information approach used in Maine failed to induce appropriate, cost-effective voluntary protection. The results indicate that, after receiving radon test results, information on associated health risks, and suggestions on how to reduce exposures: perceived risks tended to understate objective risks by orders of magnitude, and there was no statistically significant relationship between mitigating behavior and objective risks. These results suggest that the formation of risk perceptions and subsequent behavioral adjustments involve complex interactions among information, contextual, socioeconomic, and psychological variables. Therefore, government programs that seek to reduce health and safety risks with information programs, instead of using more conventional enforced standards, must be crafted very carefully to accommodate this complex process.

Air Pollutants↗
PubMed1990

The readiness of health profession students to comply with a hypothetical program of forced migration of a minority population.

The readiness of Jewish Israeli medical, psychology, and social work students to cooperate in a hypothetical government program involving expulsion of Arabs from Israel was explored via research scenarios that pointedly used terms reminiscent of Holocaust events. Strong moral sensitivity was expected on the part of the study subjects as both Jewish Israelis and vocationally committed to human welfare. The authors argue that the readiness of as many as one-third of the sample to "follow orders" is a disturbing sign, calling for greater vigilance in defense of human rights and values.

Attitude of Health Personnel↗
PubMed1976

An evaluation of selected federal categorical health programs for the poor.

We examine evidence regarding the impact of several categorical federal health service programs--neighborhood health centers, maternal and infant care projects, and children and youth projects--on access to and quality of health care for the poor. We conclude that, although conclusive evidence of improved access and quality are lacking, suggestive evidence of improved quality exists. It is difficult to utilize legislative objectives as guidelines for evaluating the success of a federal program; it is also difficult to obtain solid data supporting the effectiveness or ineffectiveness of health care in general, and of other government programs. These difficulties are discussed.

Adolescent↗
PubMed1995

Proposal for Canadian-style single-payer health care receives cool reception in US.

Is health care reform dead in the US? It may be, if the reception given President Clinton's reform plan and a proposal for a single-payer program in California is any indication. There has been a dramatic move to the right south of the border, where people have lined up to oppose "big government" and additional government programs. Still, American proponents of a single-payer program similar to Canada's insist that the battle for reform is not yet over.

Canada↗
PubMed1990

The benefits of animal identification for food safety.

The Center for Veterinary Medicine supports the effort to have a practical, workable form of mandatory animal identification. An animal identification system will make tracing of the source of animals with drug or chemical residues quicker and more effective. One of the best means of addressing and solving the problem of residues is through mandatory livestock identification. A successful traceback benefits both the producer and the industry. The U.S. Department of Agriculture (USDA) has proposed a mandatory nationwide system to require that all swine in interstate commerce be identified. Under the proposal several means of identification are listed and could be used. Additional methods or devices could be requested in writing to USDA. Persons required to keep records under the system would maintain the documents at their place of business for 2 yr. Records would be available to authorized USDA employees during ordinary business hours. FDA has had difficulty tracing tissue residue violations, particularly those involving sulfamethazine residues in swine. Investigations involving culled dairy cows and veal calves also have been closed due to lack of producer identification. The ability for FDA to determine the source of residues is vitally important in a coordinated government program to eliminate illegal tissue residues.

Animal Identification Systems↗
PubMedDate not supplied

A practical guide to establishing vaccine administration services in community pharmacies.

OBJECTIVE: This article describes requisite components of a community pharmacy-based vaccine administration program and provides resources for obtaining training and materials to facilitate implementation in the pharmacy. DATA SOURCES: Published medical literature accessed via Medline; interviews of pharmacists who initiated vaccine administration programs; government publications; professional publications including manuals and newsletters; and the resources of the Washington State Board of Pharmacy. DATA SYNTHESIS: Pharmacists in several states have initiated vaccine-administration programs for adults, adolescents, and children within their pharmacies with acceptance by patients, third party payers, and other health professionals. In some states, collaborative prescribing agreements between physicians or nurse practitioners and pharmacists enable pharmacists to implement high-volume immunization clinics as well as individual patients services. Standardized training is available from several sources, and in most settings vaccine administration services can be implemented with low initial investment. CONCLUSION: Vaccine administration may soon become an integral function in community pharmacists responsibilities for the health and well-being of patients.

Adolescent↗
PubMed1999

Identification of putative programmed -1 ribosomal frameshift signals in large DNA databases.

The cis-acting elements that promote efficient ribosomal frameshifting in the -1 (5') direction have been well characterized in several viral systems. Results from many studies have convincingly demonstrated that the basic molecular mechanisms governing programmed -1 ribosomal frameshifting are almost identical from yeast to humans. We are interested in testing the hypothesis that programmed -1 ribosomal frameshifting can be used to control cellular gene expression. Toward this end, a computer program was designed to search large DNA databases for consensus -1 ribosomal frameshift signals. The results demonstrated that consensus programmed -1 ribosomal frameshift signals can be identified in a substantial number of chromosomally encoded mRNAs and that they occur with frequencies from two- to sixfold greater than random in all of the databases searched. A preliminary survey of the databases resulting from the computer searches found that consensus frameshift signals are present in at least 21 homologous genes from different species, 2 of which are nearly identical, suggesting evolutionary conservation of function. We show that four previously described missense alleles of genes that are linked to human diseases would disrupt putative programmed -1 ribosomal frameshift signals, suggesting that the frameshift signal may be involved in the normal expression of these genes. We also demonstrate that signals found in the yeast RAS1 and the human CCR5 genes were able to promote significant levels of programmed -1 ribosomal frameshifting. The significance of these frameshifting signals in controlling gene expression is not known, however.

Amino Acid Sequence↗
PubMed1997

Setting the stage for health impact assessment.

Defining health impact assessment as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population, we make recommendations about how to evaluate the health impact of all government-initiated policies. Such health impact cannot be assessed in the absence of a conceptual or organizing framework that provides the requisite guideposts--population health goals and targets. Health impact assessment offers an approach to ensuring that governments' program and policy initiatives align, or are congruent with, the agreed-upon health goals. It suggests that proposed national policies should be supported or resisted on the basis of their probable influence on the health of populations. In the current Canadian national policy framework, however, there are no underpinnings on which to situate such a process. The specification of consensus goals and objectives with measurable targets can provide the requisite guideposts and benchmarks for health impact assessment. Such an undertaking can set the stage and provide the necessary foundation for an effective health impact assessment process.

Canada↗
PubMed1996

Evaluation of Public Health Service programs under the Government Performance and Results Act.

The Public Health Service (PHS) is made up of a number of agencies whose collective mission has traditionally been to protect and improve the mental and physical health of the American people and to close the gaps in the health status of disadvantaged populations. However, the Clinton Administration's National Performance Review and its associated "reinventing government" initiatives are beginning to show promise of substantially reshaping the structure and functions of the federal government. Regardless of the final shape that the reinvented government takes, the Government Performance and Results Act (GRPA) will provide the framework within which that government plans, implements, and evaluates its programs. Whereas some have argued that GPRA will strengthen the role of evaluation within federal agencies, GPRA has been seen primarily as a management and budget issue, and limited attention has been paid to important issues of measurement, attribution of outcomes, and reporting time lines. Nevertheless, GPRA provides the opportunity to make the government more effective and efficient and restore the faith of the American people in government.

Humans↗
PubMedDate not supplied

[Comprehensive approach to decrease of neonatal mortality].

Due to united efforts of public health at many levels neonatal mortality in Samara decreased from 17.3 to 7.1% during 5 years. Irish program "Positive Maternity" and outpatient perinatology programs helped decrease the incidence of severe gestosis to 15.9 per 10,000 deliveries. Services engaged in family planning, andrological care, and treatment of couples have been created. Resuscitation of newborns is realized in accordance with the Swiss Government Program on Maternity and Childhood Protection and the USA Protocol of Newborn Resuscitation. Introduction of the Placenta-Fetus-Newborn program is in progress. Six-year activities of a visiting neonatological team decreased neonatal mortality from respiratory distress syndrome almost 3-fold. Activities of Center for Surgical Correction of Congenital Defects are constantly updated. The rate of detection of congenital defects by ultrasonic examination is now as high as 75%. The realization of programs and activities of institutions are financed through obligatory medical insurance, public health budget, and purposeful programs.

Adult↗
PubMed1993

Midwives in the Mexican health system.

The health care system in Mexico was built upon a western model in which curative rather than preventive medicine is emphasized. However, the incorporation of indigenous midwives into maternal and child care and family planning programs by several public health agencies is an exception to the governmental health policies. An analysis of midwife preferences among rural women indicates that primarily poor illiterate women with children, living in remote areas with difficult access, rely on midwives. The continued reliance on midwives by this sector of the population makes the government programs most important. These programs are a unique case in which the incorporation of traditional practitioners in the modern health system has occurred. However, in order to implement programs that have the capability to offer rural women the benefits of both health systems, the incorporation of the traditional midwives requires not only the upgrading of their skills in modern antiseptic techniques, but the recognition of the contributions of traditional health practices, and the research of elements and practices to foster its understanding.

Adolescent↗
PubMedDate not supplied

Health care use among undocumented Latino immigrants.

Using data from a 1996/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of health care services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen. Excluding undocumented immigrants from receiving government-funded health care services is unlikely to reduce the level of immigration and likely to affect the well-being of children who are U.S. citizens living in immigrant households.

Adolescent↗
PubMed2001

What happened to long-term care in the health reform debate of 1993-1994? Lessons for the future.

During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long-term care initiatives. President Clinton proposed creating a large home-care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non-means-tested public programs, the president's plan was a major departure from the Medicaid-dominated financing system for long-term care. In designing the long-term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long-term care during the health reform debate provides lessons for future reform.

Aged↗