The health care crisis and the American family : hearing before the Committee on Labor and Human Resources, United States Senate, One Hundred Second Congress, first session ... January 10, 1991.

Item 1043-A, 1043-B (MF)

Comprehensive health care reform and cost containment : hearings before the Committee on Finance, United States Senate, One Hundred Second Congress, second session.

"June 9, 17, and 18, 1992"--Pt. 2.

Health care costs and lack of access to health insurance : hearings before the Committee on Finance, United States Senate, One Hundred Second Congress, first session.

"April 9 and 16, 1991"--Pt. 1; "June 6, 1991"--Pt. 2.

COMPARATIVE STUDY OF INFORMAL HEALTH CARE NETWORKS AND ELDERLY HEALTH STATUS IN ARGENTINA AND CUBA

This study will explore familial and friend support networks and living arrangements among elderly individuals in Latin America and the impact that this type of support has on the health of the elderly individuals in the countries of interest. Using data from the Survey on Health and Well-Being of Elders (SABE) from 1999-2000, I will explore which type of support has a larger impact on overall health. I will also measure differences in unmet needs for certain health services. This topic is particularly interesting because it will help to uncover what policies are best for aiding in the healthcare of the elderly in aging population. Lastly, the investigation of this topic will allow me to draw conclusions about the most effective means of social and public policy for the elderly community and provide me with information about the role of both informal provisions of support from family and friends, and formal provisions of support from the government. My primary focus will be on Argentina, using Buenos Aires as the sample city, and Cuba, using Havana as the sample city. These two countries have increasingly aging populations, poorer resources and vast inequalities, but, extremely different political, economic and cultural situations. Comparing the two countries will further allow me to determine correlations between health and the existence of support networks, as well as provide me with information to make more general claims that may be of use in the United States. Argentina is particularly interesting to me because of my abroad experience and homestay experience with an older Argentine woman who lived alone but depended upon her family for many healthcare needs, doctors’ visits and general well-being. In Argentina, I experienced a different form of living than I am used to in the United States, where many older individuals or couples live in nursing homes or assisted living facilities rather than alone or with family. The changing economic climate of the two countries coupled with labor patterns of women returning to work at rapid rates indicates that policies cannot just rely on either the formal or informal sector but require a combination of the two sectors working together.This paper will first give background on the difference in the economies and the health care systems in Argentina and Cuba and will show why it interesting to study and compare these two countries. I will then discuss the health status of the elderly in each population as well as discuss the informal care networks and the role of family in each country. This section will then be followed by a description of the data and methods used. I will end by drawing conclusions about the study and the outcomes, and then I will attempt to make suggestions about effective health care policies for the elderly.

Current health status and the future demand for health care programs and social support services : follow-up analyses from the survey of aging veterans /

"March 1985."

Agricultural Policy and Nest Success of Prairie Ducks in Canada and the United States

The Prairie Pothole Region of North America has been modified by agriculture during the past 100 yr, resulting in habitat loss, fragmentation, and degradation that have reduced the abundance and productivity of many wildlife species. The 1985 U.S. Farm Bill provided economic incentives to agriculture that are considered by many to be beneficial to nesting waterfowl and other wildlife. Canada has not experienced an equally comprehensive legislative initiative, which would seem to indicate that benefits to waterfowl in Canada should lag behind those in the United States. However, with the removal of some agricultural subsidies in Canada during the 1990s, the amount of perennial cover in the Canadian prairies increased to levels similar to those of the 1970s. Therefore, it is unclear whether and how the U.S. and Canadian prairies might differ with regard to habitat quality for nesting waterfowl. We used historical and contemporary data to compare temporal trends in duck nest success between the United States and Canada and to assess how mean nest success varied with proportion of cropland and wetland density. The data best supported models with nonlinear temporal trends that varied between the two countries and suggested that mean nest success in Canada declined from its high point in 1930s and remained below the long-term value of 0.16 until the end of the time series in 2005. Mean nest success in the United States also declined from its high point in the 1930s, but increased to above the long-term value of 0.25 during the early 2000s. Mean nest success varied negatively with proportion of cropland in both the United States and Canada. Mean nest success was positively correlated with pond density at Canadian sites, but showed only a weak association with pond density at U.S. sites. All models explained the low proportions of the variation in nest success, suggesting that unmeasured factors such as the abundance and identity of nest predators may have strong effects on nest success. Nonetheless, these results support earlier suggestions that agricultural policy that encourages permanent cover positively influences duck reproductive success. We also found that, for reasons that are not entirely clear, nest success for the same intensity of row cropping was generally higher in the United States than in Canada. Further research is required to elucidate the exact nature of the composition, size, and distribution of permanent cover that coincides with greater average nest success by dabbling ducks in the United States. In addition, the data suggest that the benefits that might accrue from increases in the amount of perennial cover in Canada would be better realized if these efforts are accompanied by strong measures to conserve wetlands.

Health care policy analysis of Medicaid's early and periodic screening, diagnosis, and treatment (EPSDT) benefit in Colorado

The purpose of this thesis is to identify "best practice" recommendations for successful implementation of the EPSDT outreach program at Memorial Health System's Hospital for Children in Colorado Springs through a policy analysis of Medicaid EPSDT services in Colorado. A successful program at Memorial will increase education and awareness of EPSDT services, enrollment, and access to and utilization of health care services for eligible children. Methodology utilized in this study included questionnaires designed for the EPSDT contract administrator and outreach coordinators/workers; analysis of current federal and state policies; and studies conducted at the federal and state level, and by various advocacy groups. The need for this analysis of EPSDT came about in part through an awareness of increasingly high numbers of children in poverty and who are uninsured. Though the percentage of children living in poverty in Colorado is slightly below the national average (see Table 2), according to data analyzed by The Annie E. Casey Foundation, the percentage of children (0-18) living in poverty in Colorado increased from 10% in 2000 to 16% in 2006, a dramatic increase of 60% surpassed by only one other state in the nation (The Annie E. Casey Foundation, 2008). By comparison, the U.S. percentage of children in poverty during the same time frame rose from 17% to 18% (The Annie E. Casey Foundation, 2008). What kind of health care services are available to this vulnerable and growing group of Coloradans, and what are the barriers that affect their enrollment in, access to and utilization of these health care services? Barriers identified included difficulty with the application process; system and process issues; a lack of providers; and a lack of awareness and knowledge of EPSDT. Fiscal restraints and legislation at the federal and state level are also barriers to increasing enrollment and access to services. Outreach services are a critical component of providing EPSDT services, and there were several recommendations regarding outreach and case management that will benefit the program in the future. Through this analysis and identification of a broad range of barriers, a clearer picture emerged of current challenges within the EPSDT program as well as a broad range of strategies and recommendations to address these challenges. Through increased education and advocacy for EPSDT and the services it encompasses; stronger collaboration and cooperation between all groups involved, including providing a Medical Home for all eligible children; and new legislation putting more money and focus on comprehensive health care for low-income uninsured children; enrollment, access to and utilization of developmentally appropriate and quality health care services can be achieved. ^

The medical companion, or family physician; treating of the diseases of the United States, with their symptoms, causes, cure and means of prevention: common cases in surgery, as fractures, dislocations, &c. the management and diseases of women and children. A dispensatory, for preparing family medicine, and a glossary explaining technical terms. To which are added, a brief anatomy and physiology of the human body, shewing, on rational principles, the cause and cure of diseases: an essay on hygiene, or the art of preserving health, without the aid of medicine: an American materia medica, pointing out the virtues and doses of our medicinal plants. Also, the nurse's guide,

Mode of access: Internet.

A manual of psychological medicine and allied nervous diseases : containing the description, etiology, diagnosis, pathology and treatment of insanity, with especial reference to the clinical features of mental diseases and the allied neuroses and its medico-legal aspects with a carefully prepared digest of the lunacy laws in the various states relating to the care, custody and responsibility of the insane /

Includes bibliographical references and index.

Foreign policy choices for the seventies and eighties : hearings before the Committee on Foreign Relations, United States Senate, Ninety-fourth Congress, first and second sessions ...

Hearings held Sept. 10, 1975-Mar. 16, 1976

Traffic safety and health care : state and national estimates of employer costs /

"DOT HS 808 234"--P. [4] of cover.

Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders

Objectives The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. Methods This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. Results Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. Conclusions MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.

A Framework to Support the Sharing and Reuse of Computable Phenotype Definitions Across Health Care Delivery and Clinical Research Applications.

INTRODUCTION: The ability to reproducibly identify clinically equivalent patient populations is critical to the vision of learning health care systems that implement and evaluate evidence-based treatments. The use of common or semantically equivalent phenotype definitions across research and health care use cases will support this aim. Currently, there is no single consolidated repository for computable phenotype definitions, making it difficult to find all definitions that already exist, and also hindering the sharing of definitions between user groups. METHOD: Drawing from our experience in an academic medical center that supports a number of multisite research projects and quality improvement studies, we articulate a framework that will support the sharing of phenotype definitions across research and health care use cases, and highlight gaps and areas that need attention and collaborative solutions. FRAMEWORK: An infrastructure for re-using computable phenotype definitions and sharing experience across health care delivery and clinical research applications includes: access to a collection of existing phenotype definitions, information to evaluate their appropriateness for particular applications, a knowledge base of implementation guidance, supporting tools that are user-friendly and intuitive, and a willingness to use them. NEXT STEPS: We encourage prospective researchers and health administrators to re-use existing EHR-based condition definitions where appropriate and share their results with others to support a national culture of learning health care. There are a number of federally funded resources to support these activities, and research sponsors should encourage their use.

[strategies For Integration Of Health Care Practices And Sanitary Surveillance In The Context Of The Implementation Of Rede Cegonha - A Brazilian Mother And Infant Health Care Network].

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of São Paulo/Brazil: Campinas, Indaiatuba, Jaguariúna and Santa Bárbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.