Massachusetts Department of Public Health. Spending on local public-health services in Massachusetts.
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Community Health Services↗
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Massachusetts Department of Public Health. The Massachusetts Hospital School.
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Adolescent↗
The 97th meeting of the Acoustical Society of America. Massachusetts Institute of Technology, Cambridge, Massachusetts. 11-15 June 1979. Abstracts.
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Acoustics↗
The closure of maternity services in Massachusetts. The causes, process, and hospital impact.
There has been a decline in the number of maternity services in Massachusetts from 120 in 1960 to 65 in 1975. Further consolidation must be carefully thought out with all options and possible outcomes thoroughly explored. The Massachusetts Maternity and Newborn Regionalization Project and the Massachusetts Hospital Association conducted a preliminary survey of Massachusetts Maternity services that had closed to understand the causes, process,, and hospital impact. The findings of this preliminary investigation, in addition to identifying areas for more intensive future research, provide some observations that should be of assistance to those considering a maternity service closure.
Female↗
Community participation in the certificate-of-need process: a look at ten-taxpayer groups in Massachusetts.
Certificate-of-need statutes give designated state agencies veto power over investment in health care facilities. Some states have sought to temper the arbitrary character of this power by expanding the opportunities for community input into the certificate-of-need process. Massachusetts, for example, has enacted a statute that allows groups of ten taxpayers to petition for a public hearing on any certificate-of-need application. Some observers question whether the benefits of taxpayer-group participation are substantial enough to compensate for the delays and abuses that the statute allegedly invites. To help resolve this question, this Comment examines historical data on Massachusetts taxpayer groups and on their activities and assesses the significance of their composition and tactics to the certificate-of-need process. Although flaws exist in the Massachusetts ten-taxpayer mechanism, in this writer's view it has succeeded partially in making the certificate-of-need process responsive to community opinion. Many groups lack the skills and qualities needed to make constructive use of the ten-taxpayer mechanism. Nevertheless, it serves a valuable purpose by creating a public forum for and by encouraging public participation in the certificate-of-need process, especially by those who might otherwise try to circumvent that process through use of special legislation, of private pressure, or of other similar means.
Certificate of Need↗
A follow-up study of residents in internal-medicine, pediatrics and obstetrics-gynecology training programs in Massachusetts. Implications for the supply of primary-care physicians.
A questionnaire survey of physicians who had been residents in internal medicine, pediatrics or obstetrics-gynecology in Massachusetts during the years 1967-1972 was undertaken to determine that specialties they now practice and the extent to which they deliver primary care. Over 600 physicians (74 per cent) responded. Devoting more than half their practice to a primary-care specialty were only 28 per cent of the former residents in internal medicine as compared with 56 per cent of those in pediatrics and 74 per cent of those in obstetrics-gynecology. For each group the fraction of full-time equivalent primary-care physicians produced was 0.27, 0.42 and 0.39 for the internal-medicine, pediatrics and obstetrics-gynecology programs respectively. These findings indicate that, although Massachusetts is meeting the requirements of PL 94-484 concerning the percentage of residency positions in the primary-care specialties, such compliance does not guarantee an adequate future supply of primary-care practioners.
Certification↗
The uses of multiple causes of death data to clarify changing patterns of cirrhosis mortality in Massachusetts.
Evaluation of death rates from cirrhosis of the liver in Massachusetts since 1950 indicate a changing pattern suggestive of a substantial increase in the frequency with which cirrhosis is being recorded as the underlying cause of death. By comparing the relationship between the frequency with which cirrhosis is mentioned on the death certificate with its occurrence as the underlying cause of death, it would appear that the increase in death rate represents a real change. Additional evidence is presented to indicated that the increase is occuring in the urban center of the state. Males aged 40-49 and females aged 50-59 have shown the greatest changes. In spite of similar changes occuring on the national scene, the increase appears to be substantially greater in Massachusetts. The evaluation of multiple cause of death as mentioned on death certificates can allow for assessment of significant co-factors contributing to a fatal outcome in a disease like cirrhosis of the liver.
Adult↗
The Massachusetts Poison Control System.
State and federal law provided the impetus to develop a coordinated statewide poison system in Massachusetts. To achieve this objective the Commissioner of the Department of Public Health established a Statewide Poison Committee, composed of poison control representatives, physicians, nurses, and pharmacists. After a year of regular meetings, a structure for a statewide poison system was developed, meetings, a structure for a statewide poison system was developed, and as January 1978 this System has been operational in Massachusetts. The structure is based on the Department of Public Health contracting with an incorporated institution to implement the Statewide System, which consists of one information center available to the public and professionals as well as a network of all 112 acute care hospitals in the State as "member institutions." Educational institutions" are further designated with a responsibility of professional and public education in various geographic areas throughout the State. The System is responsible for providing comprehensive poison information, treatment, public education, professional education, data collection, and research. A senior Advisory Board representing institutions with major contributions to the System as well as a Coordinating Committee representing diverse geographic and professional interests serve in an advisory capacity to the System. Funding is broad-based and includes federal, state, and private institutional support.
Health Education↗
The founding and early years of the Massachusetts Eye and Ear Infirmary.
The Massachusetts Eye and Ear Infirmary, one of America's first such institutions, was founded on October 1, 1824, and incorporated on February 23, 1827, by Edward Reynolds, John Jeffries, and a group of charity-minded Bostonians. The Boston men looked, as did the founders of other early U.S. eye infirmaries, to John Cunningham Saunders' London Eye Infirmary for guidance. During its first years the Massachusetts Eye and Ear Infirmary knew economic insecurity, but once it earned in the Boston community the reputation of being a worthy charity, its fiscal affairs ceased to be a pressing problem, and it went on to know a growth worthy of the motives of its founders.
Boston↗
Coordinated home care: the Massachusetts General Hospital experience.
The problem of post-hospital care remains a continued challenge, as many patients who no longer require expensive acute care facilities continue to occupy these beds, awaiting appropriate placement. The Massachusetts General Hospital Coordinated Home Care program, under the central administration of the Boston Visiting Nurse Association, has demonstrated that home care can be a viable, economically feasible alternative to institutionalization for carefully selected patients, when the appropriate medical and social needs can be met. Three major groups of patients have been effectively cared for: 1) patients with multi-system chronic illness; 2) patients with terminal malignancies; and 3) patients with catastrophic neurologic disease. The organization of the Coordinated Home Care program, the criteria for patient selection, and the issue of funding are reviewed. The impact of this program is examined in terms of its potential for better utilization of the Massachusetts General Hospital facilities, as well as the more appropriate coordination and use of existing health care resources in the community.
Adolescent↗
Alumni of the Massachusetts mental health center residency training.
In a preliminary survey, 484 alumni of the Massachusetts Mental Health Residency Training Program from 1912 to 1967 were surveyed. Approximately 80% were found to have devoted half or more of their professional time to the nonprivate practice of psychiatry for at least one year. These data suggest that a training program with strong academic traditions might produce a preponderance of publicity of oriented psychiatrists. Since previous surveys have indicated a greater proportion of psychiatric time spent in private practice, we suggest that future surveys of psychiatric manpower need to consider the orientation of residency training programs in order to accurately assess the need for future psychiatric manpower.
Internship and Residency↗
Frequency of Down syndrome in livebirths by single-year maternal age interval: results of a Massachusetts study.
An analysis of rates of intra-state Down syndrome livebirths to Massachusetts residents by single-year maternal age interval in 1958-1965 inclusive was carried out. A gradual increase of rate of the Down syndrome occurred from age 20 to about age 31, and a steeper increase thereafter. Different regression equations were derived in the 20-31 and the 33-45 age group. The regression equations were ln y = 0.04515 x -1.45759 for those age 20-31 and ln y = 0.24302x-7.57870, for those age 33-45, where y = rate per 1,000 and x = maternal age. The regression-derived rates are slightly lower than those reported in similar analyses of data from Sweden and New York State, but they are not markedly discrepant.
Adolescent↗
Non-effect of Massachusetts cement kiln dust upon the food intake, body weight, or activity of female rats.
The addition of Georgia cement kiln dust to the diet of cattle or weanling male rats has been reported to increase body weight and feed efficiency. We attempted to replicate these effects by adding kiln dust to the Purina laboratory chow of adult female rats. Massachusetts cement kiln dust caused no significant change in food intake, weight gain, or activity. The kiln dust effect appears, therefore to depend upon (a) ingredients peculiar to Georgia kiln dust, (b) age (juveniles vs. adults), (c) sex and/or (d) deficiencies of the control diet.
Animals↗
Certification-of-need: The Massachusetts experience.
Massachusetts, like 22 other states, regulates its health-care industry in part through a certification and changes in service. As a basis for assessing the program's impact, data from the first 19 months are aggregated. A total of 209 determinations were made during the period, 21 involving beds in general hospitals, and 107 beds in long-term-care facilities. They apparently forestalled the addition of 478 beds in the general-hospital sector and of 1885 long term-care beds. Most of the 40 "facility-improvement" and 35 of 37 clinic proposals were approved. Fifteen determinations were appealed. Hindrances to assessment certification-of-need are formidable. As a consumer-oriented regulatory tool, it is valuable though limited since it can only react to proposals and can neither initiate nor provide positive incentives for new programs.
Acute Disease↗
Can the psro's be cost effective? A study of the effect of the Commonwealth Health Agencies monitoring program on the length of stay of Medicaid patients in Massachusetts.
To analyze the effect of the Commonwealth Health Agencies Monitoring Program on the length of stay of a sample of Massachusetts Medicaid patients, we compared their experience with that of non-Medicaid patients. We found a consistently decreasing trend in the length of stay of Medicaid patients during the 2 1/2-year period studied. The average length of stay of Medicaid patients decreased by 11.9 per cent relative to the norm, whereas the non-Medicaid length of stay decreased by only 6.6 per cent. We infer that the Program may be credited within the 5.3 per cent differential decrease. The consistency and reliability of the data suggest that similar results may be extrapolated to the hospitals not sampled. We conclude that Professional Standards Review Organizations, of which this program was a precursor, can be cost effective, given an expanded review mandate and the application of suibable evaluative processes.
Cost-Benefit Analysis↗
Emergence of rifampin-resistant Mycobacterium tuberculosis in Massachusetts.
Tests of sensitivity to rifampin of over 2,200 strains of Mycobacterium tuberculosis demonstrated a progressive increase in the number of rifampin-resistant isolates during the past four years in Massachusetts. No resistant strains were isolated in 1971, but two strains resistant to 1 mug of rifampin/ml were isolated in 1972. Nine rifampin-resistant strains were isolated in 1973 and 16 were isolated in 1974. All but two of the resistant strains were isolated from patients who had received therapy for tuberculosis and had demonstrated resistance to other antituberculous agents. Rifampin-resistant strains were isolated from two patients, however, who had not received prior chemotherapy. Both strains were fully susceptible in vitro to other antituberculous drugs.
Drug Resistance, Microbial↗
Eastern equine encephalitis in Massachusetts, 1957-1976. A prospective study centered upon analyses of mosquitoes.
Reappearance of eastern equine encephalitis (EEE) in Massachusetts residents in the 1970's provided an opportunity to assess the predictive value of data on rainfall, EEE in horses, and carriage of EEE virus (EEEV) by mosquitoes, factors which had been studied annually since the last EEE outbreak in 1955-1956. The cycle of multiple cases during 1973-1975 started in a second consecutive year of rainfall that exceeded the annual mean by more than 20 cm, conditions recapitulating the 1955-1956 experience. In 1973, widespread EEE fatalities in horses presaged human cases, another recapitulation of the 1955-1956 experience. However, in 1974, when horses were immunized extensively, no equine cases were seen even though three human fatalities occurred. An unseasonably early appearance of EEEV in mosquitoes was the only basis upon which the threat to humans could have been recognized. These changes in the recognition and distribution of EEEV activity from season to season illustrate the difficulty in making rational decisions regarding widespread aerial insecticide applications for mosquito control.
Animals↗
The reappearance of a classical epidemic of infectious hepatitis in Worcester, Massachusetts.
Worcester, MA, experienced an outbreak of hepatitis during 1969-1970, an expected event which had occurred previously at eight-year intervals since reporting of the disease began in 1950. Other Massachusetts communities of similar character and the nation did not experience an epidemic during that same period. An extensive epidemiologic study of the disease illustrated that the epidemic followed the classical pattern in which individuals 5-14 years old were most affected irrespective of sex. During the interepidemic years from 1968-1972 in Worcester, and in all years (1968-1972) in both New Bedford and Springfield, MA, those primarily affected were young adults 15-30 years old, with male cases predominating. Sociodemographic statistical analyses also indicated the classical pattern of the less affluent, less educated, and sometimes the more crowded populations being at greater risk of contracting the disease. This outbreak of hepatitis was comparable to another in Greenland two years later in which immunologic methods differentiated between type A and type B viral infections. The data from both studies support the conclusion that the type B virus, often associated with parenteral drug use, is the predominate infectious agent during the interepidemic (endemic) periods. The type A virus is most likely responsible for the periodic epidemics.
Adolescent↗