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PubMed1992

Medicare program; Peer Review Organizations: revised scopes of work for the District of Columbia, Puerto Rico, the Virgin Islands, and all states except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming--HCFA. Final notice.

This notice describes requirements for the review activities of Utilization and Quality Control Peer Review Organizations (PROs) under contract extensions of the Scope of Work for the District of Columbia, Puerto Rico, the Virgin Islands and all States except Delaware, Florida, Missouri, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Carolina, Washington, and Wyoming. Section 1153(h)(1) of the Social Security Act requires us to publish any new policy or procedure adopted by the Secretary that affects substantially the performance of PRO contract obligations at least 30 days before the date the policy or procedure is to be used. Specifically, this notice describes the way in which PRO contract requirements are changed and explains significant changes in the PRO program (e.g., the way in which cases will be selected for review) and also describes continuing requirements. This notice also implements provisions of the Omnibus Budget Reconciliation Act of 1990.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Ingestion of cigarettes and cigarette butts by children--Rhode Island, January 1994-July 1996 .

During 1995, the American Association of Poison Control Centers (AAPCC) received 7917 reports of potentially toxic exposures to tobacco products among children aged < or = 6 years in the United States. Most cases of nicotine poisoning among children result from their ingestion of cigarettes or cigars. Acute nicotine poisoning is characterized by rapid onset of symptoms that may be severe when large amounts have been ingested. During January 1994-July 1996, the Rhode Island Poison Control Center (RIPCC) received 146 reports of ingestion of products containing nicotine by children aged < or = 6 years. To characterize risk factors for and outcomes associated with ingestion of cigarettes and cigarette butts among children aged < or = 6 years, the Rhode Island Department of Health (RIDH) analyzed data from the RIPCC and the 1996 Rhode Island Health Interview Survey (RIHIS). This report summarizes the findings of the study, which indicate that ingestion of cigarettes and cigarette butts by children aged < or = 6 years resulted in minor toxic effects and occurred more frequently in households where smoking was permitted in the presence of children and where cigarettes and cigarette wastes were accessible to children.

Case-Control Studies↗
PubMed1994

Continuing diabetes care--Rhode Island, 1991.

The annual economic impact of diabetes mellitus in the United States is an estimated $92 billion, primarily reflecting the treatment of both acute (e.g., diabetic ketoacidosis and hypoglycemic coma) and chronic (e.g., atherosclerotic cardiovascular disease, blindness, renal failure, neuropathy, and amputation of extremities) complications. The complications of diabetes may be prevented or delayed through intensive treatment and through early detection and treatment of complications. To characterize continuing care of diabetes in Rhode Island in 1991, the Rhode Island Department of Health initiated a Diabetes Care Survey (DCS) in conjunction with its statewide Health Interview Survey (HIS) in 1990. This report summarizes the results of that survey.

Adult↗
PubMedDate not supplied

Smoking rates among Rhode Island physicians: achieving a smoke-free society.

Over a 25-year period, regular surveys of physicians licensed in Rhode Island have recorded their smoking behavior. The six surveys show a decrease in the rate of cigarette smoking from 33% in 1963 to 4.6% in 1988. In the most recent survey, 65% of respondents reported never having smoked, and 87% of those who had ever smoked reported having quit. However, the statistic for the maximum number of cigarettes smoked regularly was higher for current smokers than for former smokers. Among physicians in the 1988 survey, most former smokers (85%) reported using only unassisted personal effort in quitting, whereas nearly half (48%) of current smokers tried methods involving assistance, such as self-help programs, group programs, or nicotine gum. Among former smokers who quit after 1983, the percentage trying assisted methods (34%) was closer to the percentage among current smokers. Apparently, remaining smokers include many heavy smokers who require more potent interventions in order to quit. Physicians in Rhode Island have almost become a smoke-free group. Their experience, coupled with their involvement in smoking prevention and cessation for their patients, can lead the rest of society on its path to becoming smoke-free.

Adult↗
PubMed2004

A comparison of leachate treatment between Rhode Island and Kuwait.

The main objectives of this article were to present data on the characteristics of landfill leachate of Rhode Island Central landfill and those of Kuwait's Sulaibya landfill site, and to compare different experimental pilot plant studies for the treatment of sanitary landfill leachate, which was generally characterized by high concentration of heavy metals. The data obtained on the chemical analysis of leachate generated from two landfills in Rhode Island and Kuwait, identified variations in leachate quality due to landfill composition. Pilot Plant studies using physical/chemical and biological treatments (i.e., rotating biological contractor) were used to examine the treatment efficiency.

Databases, Factual↗
PubMed1985

Economic analysis of regionalized neonatal care for very low-birth-weight infants in the state of Rhode Island.

Cost-benefit analysis was utilized to evaluate the economic outcome of regionalized neonatal care in the state of Rhode Island, with specific reference to newborns weighing less than 1,500 g at birth. Two time periods consisting of two calendar years each, were analyzed: 1974 to 1975 (initiation of perinatal regionalization) and 1979 to 1980 (regionalization established). The neonatal mortality for infants weighing between 501 and 1,500 g decreased significantly between the two time periods. Neurodevelopmental morbidity was unchanged. The costs per survivor (hospital charges plus estimated costs of long-term care of handicapped survivors) were consistent over the time periods studied. The estimated benefits per survivor increased between the time periods, although this increase was not statistically significant. Benefits outweighed costs in both study periods. When one compares the economic data of 1974 to 1975 with that of 1979 to 1980, the increase in the absolute number of normal survivors since the establishment of regionalized neonatal care has resulted in benefits surpassing costs by $2 million (a greater than twofold increase). Regionalized neonatal care in the state of Rhode Island has had a positive economic outcome.

Child Development↗
PubMedDate not supplied

The Rhode Island Medical Emergency Distribution System (MEDS).

The State of Rhode Island conducted an exercise to obtain and dispense a large volume of emergency medical supplies in response to a mass casualty incident. The exercise was conducted in stages that included requesting supplies from the Strategic National Stockpile and distributing the supplies around the state. The lessons learned included how to better structure an exercise, what types of problems were encountered with requesting and distributing supplies, how to better work with members of the private medical community who are not involved in disaster planning, and how to become aware of the needs of special population groups.

Bioterrorism↗
PubMed2006

Associations between health-related quality of life and demographics and health risks. Results from Rhode Island's 2002 behavioral risk factor survey.

BACKGROUND: Health-Related Quality of Life (HRQOL) has received much attention in recent years. HRQOL indicators have been used to track population trends, identify health disparities, and monitor progress in achieving national health objectives for 2010. Prior studies have examined health risks and HRQOL at the national level as well as at the state level. This paper examines multiple indicators of HRQOL by demographic characteristics and selected health behaviors for Rhode Island adults. METHODS: Data from Rhode Island's 2002 Behavioral Risk Factor Surveillance System (BRFSS), a random digit dialled telephone survey, were used for this study. The state wide sample contained a total of 3,843 respondents ages 18 and older. Multiple Imputation (MI) was applied to handle missing data, and data were modelled for each of 10 HRQOL indicators using multivariable logistic regression. RESULTS: By examining HRQOL through a multivariable approach we identified the strongest predictors for multiple indicators of poor HRQOL as well as predictors for specific indicators of poor HRQOL. Predictors for multiple indicators of poor HRQOL were: disability, inability to work, unemployment, lower income, lack of exercise, asthma, and smoking (specifically associated with poor mental health). CONCLUSION: Using multiple measures of HRQOL can help to assess the burden of poor health in a population, identify subgroups with unmet HRQOL needs, inform the development of targeted interventions, and monitor changes in a population's HRQOL over time. Use of these HRQOL measures in longitudinal and intervention studies is needed to increase our understanding of the causal relationships between demographics, health risk behaviors, and HRQOL.

Adult↗
PubMedDate not supplied

Small-area variations in rates of hospitalization and surgery within Rhode Island.

We analyzed variations in the usage rates and costs of 13 surgical procedures among 37 cities and towns in the state of Rhode Island. To compare different operations and years, we defined the deviation index, a percentage indicator similar to the coefficient of variation, but with chance variation removed. Tonsillectomy and disc excision were the procedures for which rates varied most around the state average; their deviation indexes for 1981 were 40.5 percent and 38.9 percent, respectively. In 14 areas, rates for one of these two procedures (standardized for age and sex) were significantly (p less than .01) above or below the state average; such outlying observations would have been expected for only one area if rates had been uniform statewide. To indicate the relative amount of surgery in an area combining rates for all 13 procedures, we computed the area's surgical index. This index, the average of the ratios of observed to expected cases (based on standardized statewide rates), doubled from the lowest- to the highest-rate areas. Overall, surgical hospital days, nonsurgical days, total hospital days, and hospital costs (all per 1,000 population) doubled from lowest- to highest-rate areas. If the rates of these 13 surgical procedures could be lowered in high-rate areas to not more than 20 percent above the state average, usage could drop by 4 percent. We conclude that even within the small state of Rhode Island, surgical practice varies considerably across communities. Identifying and studying areas with extremely high or low rates should enable more explicit consideration of the indications for surgery and perhaps lead to lower costs for medical care.

Adolescent↗
PubMed2002

The importance of routine HIV testing in the incarcerated population: the Rhode Island experience.

Routine HIV testing in the correctional setting offered to all inmates at entry has played an important role in the diagnosis of HIV in Rhode Island. Diagnosis and treatment of HIV in prisons can further public health goals of HIV control, prevention, and education. Routine HIV testing can be incorporated into primary and secondary prevention programs in correctional facilities. In Rhode Island, where HIV testing is routine at entry into the correctional facility, approximately one third of all persons who test positive are identified in the correctional facility. The proportion of males and females testing positive in the correctional facility versus those testing positive in other facilities has shown a gradual decrease, with positive female HIV tests declining more substantially in recent years. Specific groups, such as males, African Americans, and injection drug users continue to be more likely diagnosed in the state correctional facility than in other testing sites. These differences may reflect barriers to health care access that other community initiatives have failed to address.

AIDS Serodiagnosis↗
PubMedDate not supplied

Attention deficit hyperactivity disorder in elementary school children in Rhode Island: associated psychosocial factors and medications used.

This study was undertaken to explore psychosocial factors associated with referral for attention deficit hyperactivity disorder (ADHD) evaluation or ADHD diagnosis among elementary school children in Rhode Island, as well as to examine the extent of drug therapy among this population. A survey was distributed to parents/guardians of 2,800 3rd- to 5th-grade public school students in 4 Rhode Island school districts. The average age of the children was 9.0 +/- 1.0 years with 52% girls. Approximately 12% of the students had been referred for ADHD evaluation (RFE). Of these, 52% (6% of all children in the survey) were receiving psychoactive prescription medications daily. While the male:female ratio in the non-RFE group was almost 1:1, there were more boys than girls in the RFE group (male/female ratio of 3:1, p < 0.0001) and in the medicated group (male/female ratio 4:1, p < 0.0001). RFE children and medicated children were older than classroom peers (p < 0.0001), and had a greater degree of school misconduct (p < 0.0001). RFE children and medicated children were significantly less likely to have parents who completed college (p < 0.05), were significantly more likely to have stepparents (p < 0.05), and to be only children (p < 0.05) when compared with their peers. Amphetamine was the most commonly prescribed drug (used by 54% of the medicated children) followed by methylphenidate (43%). Nearly 18% of the medicated children were receiving 1 to 3 additional psychoactive prescription medications on a daily basis. In conclusion, RFE children and children medicated for ADHD were more likely to have a stepparent, have no siblings, and have parents that had not completed college. Amphetamine rather than methylphenidate accounted for the majority of medications used in this study, and simultaneous use of multiple psychoactive medications was reported in 18% of the medicated children.

Amphetamine↗
PubMed1985

Acceptance of hepatitis B vaccine by Rhode Island dental practitioners.

A questionnaire survey of 575 dentists practicing in Rhode Island in March 1983 disclosed minimal acceptance of the hepatitis B vaccine. A total of 162 practicing dentists returned the questionnaire; only 23 general practitioners and nine specialists had received the first of the three required doses of the vaccine. The most frequently stated reasons for not receiving the vaccine were that the dentists were concerned about potential long-term side effects, including AIDS and Guillain-Barre syndrome, and wanted further information about the vaccine. It appears that a more intensive professional education program is needed if dental practitioners are to accept hepatitis B vaccine.

Dentists↗
PubMed1988

Suicide among social workers in Rhode Island.

Cause-specific mortality patterns, by occupation, were examined among Rhode Island residents who died during the period 1968-1978, using the age-standardized proportionate mortality ratio (PMR) method. Occupation was determined from the usual occupation statement on the death certificate. A noteworthy finding was an elevated PMR for suicide among both male (PMR = 470, observed deaths = 5, P less than .01) and female (PMR = 510, observed deaths = 4, P less than .05) social workers. This is the first report of a high risk of suicide among social workers. Stress, which is associated with social work, may be a risk factor. Due to the relatively small numbers upon which this report is based and the limitations of death certificate data and the PMR method, this should be viewed as an exploratory investigation requiring further follow-up.

Adult↗
PubMed1983

Streptococcal pharyngitis and acute rheumatic fever in Rhode Island.

A comprehensive survey of physicians, laboratories, and hospital records in Rhode Island showed that more than 157,000 throat cultures for a population of 930,000 people were done in 1980. Eighty-seven percent of primary care physicians prescribed antibiotic therapy before culture results were known, and almost 40% continued antibiotic therapy for ten days regardless of culture results. The throat culture positivity rate for beta-hemolytic Streptococcus was 17% statewide in 1980. Only three definite and seven possible cases of acute rheumatic fever were identified by hospital chart reviews and a physician survey covering the five years 1976 through 1980. Current throat culture practices probably have little influence on treatment of streptococcal pharyngitis and control of rheumatic fever in the state.

Acute Disease↗
PubMed2000

Detection of Ehrlichia chaffeensis DNA in Amblyomma americanum ticks in Connecticut and Rhode Island.

Ehrlichia chaffeensis, the causative agent of human monocytic ehrlichiosis, is transmitted by Amblyomma americanum ticks, which are most abundant in the southern United States. Because serologic evidence suggests that residents of Connecticut are exposed to E. chaffeensis, A. americanum ticks were collected in Connecticut and Rhode Island for PCR analysis to detect E. chaffeensis DNA. Eight of 106 (7.6%) A. americanum ticks from Connecticut and 6 of 52 (11.5%) from Rhode Island contained E. chaffeensis DNA. Thus, E. chaffeensis is present in ticks in southern New England and transmission of E. chaffeensis may occur there.

Animals↗
PubMed1989

Capitated payments for mental health care: the Rhode Island programs.

Capitation financing for the delivery of mental health care under public programs is receiving increasing attention from policymakers. Most initiatives in this respect are in the planning or early implementation stages. This paper describes five years of experience with capitated financing for mental health care in the state of Rhode Island. It discusses the motivation for the programs, their design, and the issues that have arisen with respect to their operation. The Rhode Island experience demonstrates that capitated financing for mental health care is feasible and that Community Mental Health Centers can operate effectively as providers of care under these arrangements. It also suggests that capitated programs can have unanticipated impacts on the operation of community-based mental health service delivery programs.

Capitation Fee↗
PubMed1998

Operational intelligence and school problems measured by Piagetian tasks and Rhode Island Pupil Identification Scale.

To explore the relations between operational intelligence rated on several Piagetian tasks and school learning problems identified by the Rhode Island Pupil Identification Scale by Novack, Bonaventura, and Merenda we assumed that Piagetian performances would allow predicting learning problems of first graders. 38 pupils were evaluated by three teachers, who were asked to complete the Rhode Island scale. Then the same children were individually given 8 Piagetian tests (including conservation and logical tasks) by an examiner who had no information about the pupils' other scores. Analysis showed that successful Piagetian performances were associated with ratings of successful schoolwork. Analysis of variance confirmed that difficulties in operational reasoning predict occurrence of learning problems. We concluded that operational intelligence and school learning in children are closely related.

Child↗