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Alcohol and substance abuse problems are now of concern among persons who are deaf. The problems of cultural influence, prevalence of the problem, and factors contributing to isolation and denial are addressed in this article. In addition, the issues of accessibility and service delivery are explored. Current programs that are accessible and provide alcohol and substance abuse recovery are identified.
Interactive laserdiscs are of limited value in large group learning situations due to the expense of establishing multiple workstations. The authors implemented an alternative to laserdisc video by using indexed digital video combined with an expert system. High-quality video was captured from a laserdisc player and combined with waveform audio into an audio-video-interleave (AVI) file format in the Microsoft Video-for-Windows environment (Microsoft Corp., Seattle, WA). With the use of an expert system, a knowledge-based computer program provided random access to these indexed AVI files. The program can be played on any multimedia computer without the need for laserdiscs. This system offers a high level of interactive video without the overhead and cost of a laserdisc player.
BACKGROUND: Americans are enjoying an increasing level of oral health. However, oral health improvements are not being experienced evenly across the population. The poor, some minorities, institutionalized elderly people and other groups do not have adequate access to dental care. OVERVIEW: The author discusses the need to understand clearly the barriers to care affecting underserved populations and presents a framework for designing access-to-care programs. CONCLUSIONS: The author concludes that access-to-care problems are complex and will not be solved easily or quickly. A complete understanding of the barriers to care being experienced by any group under consideration must be achieved, and an improvement plan must be designed to address those specific barriers considering the demand for care, the dental work force and the economic environment. PRACTICE IMPLICATIONS: Failure to understand the barriers to care and address them adequately will result in limited success in enhancing access to dental care for underserved populations.
The purpose of the project here was to develop and test interventions designed to improve access to care and health outcomes for Medicaid-eligible infants during their first 6 months of life. The goal of the intervention was to overcome personal and structural barriers to care by combining the efforts of county health departments and private physicians' offices in 2 counties in North Carolina. The project combined home visits and an office intervention.
Several states are watching how a new pooled loan program works in Maine. It links credit enhancements backed by the state to the pooled borrowings, raising their ratings and lowering borrowing costs for participating hospitals. The program also will help improve access to capital for the state's 40 acute-care hospitals.
Although many dental hygienists have considered pursuing a baccalaureate degree, many barriers intervene to prevent accomplishment of this goal. The external degree is one option that could be available to overcome some of the barriers to accessibility. An external program is one that makes education accessible to students in nontraditional ways. A characteristic of these programs is that students can usually pursue academic credit toward a degree without being physically present on the degree-granting campus for the majority of the program. This paper reports the results of a 1988 survey of certificate and associate degree dental hygienists' interest in an external baccalaureate degree completion program. A questionnaire was mailed to 213 certificate and associate degree dental hygienists in Tennessee who had expressed an interest in degree completion. Two hundred six questionnaires were returned for a response rate of 96.7%. In order to determine the potential success of such programs, the following factors were explored: the motivations or reasons for participating; program design factors that might encourage or deter participation; degree of employer support; and individual characteristics relevant to participation, such as personal commitment and demographic information. Geographic location, flexibility in scheduling, and accessibility to course work were the program design factors most important to the likely participants. Likely participants indicated that they wanted to return to complete their baccalaureate degrees for personal satisfaction, for the status of the degree, and to increase their knowledge and skill in dental hygiene. They indicated that they did not want to change the focus of their careers. The area of study rated as most important was advanced clinical dental hygiene. The likely participants were found to resemble other nontraditional students. They averaged 34 years of age, were married with children living at home, and were able to study on a part-time basis only. The analysis of the data obtained from the questionnaire led to the conclusion that external program design factors would be essential for most certificate and associate degree dental hygienists to participate in a baccalaureate degree completion program.
The purpose of this paper is to examine how physicians respond to changes in payment levels from government insurers. Our analysis focuses on two issues: controlling overall program expenditures, and assuring full access to care for program clients. We review evidence from natural experiments in which payment levels were increased, frozen, or decreased. These studies show that freezing or reducing payment levels is not effective in controlling program expenditures, because physicians responded by increasing the quantity and complexity of services provided. Furthermore, when government programs freeze or reduce their payment levels, physicians are less likely to treat the clients of these programs. We conclude that policymakers must seek alternative strategies for controlling program expenditures.
Recent federal health financing and health care delivery programs have increased access to alcohol and other drug abuse treatment programs for low-income women, and have provided intervention and prevention services for their children and families. The Village South Families in Transition (FIT) in Miami, Florida, implemented a residential treatment program for women and their children that aims to decrease alcohol and other drug use, reduce reliance on social and health welfare systems, improve functioning in specific life-skill and vocational areas, improve parenting techniques and maternal/child relations, and provide intervention and prevention services for the clients' children in a safe and supportive environment. Program implementation required resolutions to numerous barriers, including securing a facility for women and children; recruiting, hiring and training of staff; establishing and maintaining community linkages; treatment considerations; balancing treatment versus evaluation/research; and critical decisions faced by treatment staff as they modify client-centered programs to incorporate gender-specific and family-centered programs.
Despite more than 15 years of extensive scrutiny, adverse drug interactions, especially in the elderly, remain a problem for the clinician. A two-pronged approach is suggested to contend with drug interactions: detection or avoidance of known drug interactions; and predictions and characterization of hitherto unknown interactions. The former approach is aided by critical reference sources on the subject and the use of drug interaction screening aids such as drug interactions alert lists or rotating drug discs. Computers are becoming increasingly important not only for the detection of potential drug interactions but also for the delineation of drug therapy options. Ultimately, computers can be used to predict interactions on the basis of physiochemical, pharmacokinetic, and pharmacodynamic data. For the present, extensive epidemiologic research programs can serve to ferret out interactions. Limited accessibility to such program data bases mandates a high index of suspicion in prepared and well-informed observers if the drug interaction problem is to be dealt with.
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The purpose of this study was to point out the advantages or the computerised evidence in patients with diabetic retinopathy examined in "Diabetic Eye Department" from Ophthalmology Clinic Craiova. This program represents a new national performance regarding the evidence of the diabetic patients clinic examination. The main characteristics of our program are the accessibility and the coherence; the utility of this program has been demonstrated by long term use and the big number of patents recorded.
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BACKGROUND: The authors assessed the likelihood that interceptive orthodontic Medicaid programs would increase access to care for Washington children. METHODS: The authors surveyed 210 Washington state orthodontists, including questions on demographics, attitudes toward early treatment, use of innovations and perceptions of Medicaid. Respondents were either Medicaid participants or nonparticipants. RESULTS: Fifty of 159 respondents were Medicaid participants. Most respondents perceived early orthodontic treatment as beneficial. Medicaid participants were more willing to participate in Medicaid early-treatment programs, had slightly fewer patients in the "other insurance" category, provided more discounted fees, received more Medicaid inquiries, practiced in rural areas with lower household incomes, reported feeling overworked and experienced fewer Medicaid problems. The principal problem reported with the Medicaid system was low fee reimbursement. CONCLUSIONS: Programs offering early orthodontic treatment could increase access. Important barriers would be low fees and unfamiliarity with Medicaid. PRACTICE IMPLICATIONS: Medicaid should design programs aimed at early treatment with reasonable reimbursement and an educational component.
BACKGROUND: We studied availability to mammography among Spanish women aged 40 to 70 years, variation in use of the mammography by autonomous community, and the situation and importance of breast cancer screening programs among other factors, in the access to mammography. SUBJECTS AND METHODS: A cross-sectional population survey was conducted in 1994 in a sample of 3,218 women. A questionnaire was used to collect data on the variable access (receipt of at least one mammogram in the last 2 years) as well as different access-related variables. Information on breast cancer screening programs was collected by contacting the responsible institutions. We considered that a program had total coverage if it included all the municipalities in the province and partial if it did not include all municipalities. RESULTS: Twenty-eight percent of women had performed a mammogram. This proportion varied among autonomous communities (AACC) from 11.5 to 73.8%. Breast cancer screening programs existed in 8 AACC. The multivariant analysis revealed an association between access to mammography and the existence of a screening program, especially when the later had total coverage (OR = 7.64; 95% CI = 5.24-11.10). An association was also found between access to mammography and physician-related factors, place of residence and attitudes of women toward mammography. CONCLUSIONS: Less than one third of women aged 40-70 have performed a mammography in the last 2 years, and this proportion varies among AACC. Gynecologist visits and the existence of breast cancer screening programs are fundamental factors in the access to mammography in Spain.
Vascular access monitoring can identify patients at increased risk of future access thrombosis. When coupled with a program of elective stenosis correction, access thrombosis rates decline approximately 50-75%. This results in arteriovenous (AV) fistula thrombosis rates of 0.1-0.2/patient year (vs. 0.2-0.4 at baseline) and AV graft thrombosis rates <0.5/patient year (vs. 0.8-1.2 thromboses/patient year at baseline). Evaluating the long-term impact on access survival remains problematic. There are no large-scale randomized trials and existing studies exhibit marked differences in target populations, clinical protocols and outcome definitions. Differences in payment systems also significantly influence the efficacy of monitoring and intervention programs. Despite these challenges, the current data support the K/DOQI recommendations that all patients undergo a program of regular access monitoring preferably by access flow measurement coupled with prompt imaging and elective stenosis correction for low flow accesses.
BACKGROUND: In 1999, the Centers for Disease Control and Prevention (CDC) funded Play Across Boston to address disparities in access to physical activity facilities and programs for Boston, Mass, inner-city youths. CONTEXT: Local stakeholders worked with the Harvard School of Public Health Prevention Research Center and Northeastern University's Center for the Study of Sport in Society to improve opportunities for youth physical activity through censuses of facilities and programs and dissemination of results. METHODS: Play Across Boston staff conducted a facility census among 230 public recreational complexes and a program census of 86% of 274 physical activity programs for Boston inner-city youths aged 5 to 18 years during nonschool hours for the 1999 to 2000 school year and summer of 2000. Comparison data were collected from three suburban communities: one low income, one medium income, and one high income. CONSEQUENCES: Although Boston has a substantial sports and recreational infrastructure, the ratio of youths to facilities in inner-city Boston was twice the ratio found in the medium- and high-income suburban comparison communities. The low-income suburban comparison community had the highest number of youths per recreational facility with 137 youths per facility, followed by Boston with 117 youths per facility. The ratio of youths to facilities differed among Boston neighborhoods. Boston youths participated less in school-year physical activities than youths in medium- and high-income communities, and less advantaged Boston neighborhoods had lower levels of participation than more advantaged Boston neighborhoods. Girls participated less than boys. INTERPRETATION: Play Across Boston successfully developed and implemented a rigorous needs assessment with local relevance and important implications for public health research on physical activity and the environment. Boston Mayor Thomas M. Menino called the Play Across Boston report a "playbook" for future sports and recreation planning by the city of Boston and its community partners.
This study was designed to explore the factors regarding unique determinants of repeat childbearing among teens. The influence that key people have on subsequent teen childbearing is examined. Data for this research were gathered in focus groups with teen mothers and parents of teen mothers who access the Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Georgia. Based on the results, repeated childbearing appears to occur within the context of poor parent-child relations, conflicting support for the roles teen mothers are expected to assume, limited social pressures for effective fathering, and limited access to social services for all family members. Pregnancy prevention efforts by agencies for teen mothers should coordinate services for the teen mother, her parent, and her partner.
SUMMARY: In order to obtain an accurate description of the protein interior, we describe a simple and fast algorithm that measures the depth of each atom in a protein (dpx), defined as its distance (A) from the closest solvent accessible atom. The program reads a PDB file containing the atomic solvent accessibility in the B-factor field, and writes a file in the same format, where the B-factor field now contains the dpx value. Output structure files can be thus directly displayed with molecular graphics programs like RASMOL, MOLMOL, Swiss-PDB View and colored according to dpx values. AVAILABILITY: The algorithm is implemented in a standalone program written in C and its source is freely available at ftp.icgeb.trieste.it/pub/DPX or on request from the authors.