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1.
Michael A. Morrisey Meredith L. Kilgore David J. Becker Wilson Smith Elizabeth Delzell 《Health services research》2013,48(3):1039-1056
Objectives
To examine the effects of changes in payment and risk adjustment on (1) the annual enrollment and switching behavior of Medicare Advantage (MA) beneficiaries, and (2) the relative costliness of MA enrollees and disenrollees.Data
From 1999 through 2008 national Medicare claims data from the 5 percent longitudinal sample of Parts A and B expenditures.Study Design
Retrospective, fixed effects regression analysis of July enrollment and year-long switching into and out of MA. Similar regression analysis of the costliness of those switching into (out of) MA in the 6 months prior to enrollment (after disenrollment) relative to nonswitchers in the same county over the same period.Findings
Payment generosity and more sophisticated risk adjustment were associated with substantial increases in MA enrollment and decreases in disenrollment. Claims experience of those newly switching into MA was not affected by any of the policy reforms, but disenrollment became increasingly concentrated among high-cost beneficiaries.Conclusions
Enrollment is very sensitive to payment levels. The use of more sophisticated risk adjustment did not alter favorable selection into MA, but it did affect the costliness of disenrollees. 相似文献2.
Valerie J Rose HFisher Raymond Timothy A Kellogg Willi McFarland 《Harm reduction journal》2006,3(1):29
Background
Despite the leveling off in new HIV infections among men who have sex with men (MSM) in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA). Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours. 相似文献3.
Background
Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program. 相似文献4.
Amrita Mukherjee Bruce A. Dye Jason Clague Thomas R. Belin Vivek Shetty 《Quality of life research》2018,27(12):3179-3190
Purpose
Methamphetamine (MA) is associated with adverse health effects, including the rampant tooth decay condition called “Meth Mouth.” However, the impact of MA use on oral health-related quality of life (OHRQOL) is unknown. This study assessed the relationship between MA use and self-reported OHRQOL.Methods
This cross-sectional study uses information from 545 MA-using participants recruited from Los Angeles County, California. Dental examinations were performed by three calibrated dentists using National Health and Nutrition Examination Survey (NHANES) protocols. Data on socio-demographic, behavioral, and drug-use history were recorded using questionnaires. Participants were categorized as ‘light’ or ‘moderate/heavy’ users based on reported frequency of MA use in the past 30 days. Route of MA administration was categorized as ‘smoking’ or ‘other.’ Self-reported OHRQOL was based on the Oral Health Impact Profile scale.Results
Majority of the participants were male (80.9%). Median age was 45.0 years (IQR-13.0). Median number of days of MA use was 10.0 (IQR-12.0). Smoking was the preferred route of MA use (70.2%). Root caries in ≥?3 teeth were reported in 78% of MA users. More than half of the participants reported having painful aching in mouth, avoidance of particular food items, feeling embarrassed, and discomfort while eating in the last 12 months. In unadjusted logistic models, moderate/heavy MA users were more likely to report an affected sense of taste [OR?=?1.58, 95% CI (1.10–2.27)] and avoidance of particular foods [OR?=?1.45, 95% CI (1.02–2.01)] than light users. Among individuals preferring other MA administration routes, moderate/heavy MA users were 3.09 times as likely to report an affected sense of taste than light users [OR?=?3.09, 95% CI (1.52?6.27)].Conclusion
Oral health and OHRQOL appear to be worse among Methamphetamine users than in the US general population.5.
Jeffrey Marr BA Yaa Akosa Antwi PhD Daniel Polsky PhD 《Health services research》2023,58(5):1035-1044
Objective
To compare the characteristics of dialysis facilities used by traditional Medicare (TM) and Medicare advantage (MA) enrollees with end-stage kidney disease (ESKD).Data Sources
We used 20% TM claims and 100% MA encounter data from 2018 and publicly available data from the Centers for Medicare and Medicaid Services.Study Design
We compared the characteristics of the dialysis facilities treating TM and MA patients in the same ZIP code, adjusting for patient characteristics. The outcome variables were facility ownership, distance to the facility, and several measures of facility quality.Data Collection/Extraction
We identified point prevalent dialysis patients as of July 15, 2018.Principal Findings
Compared to TM patients in the same ZIP code, MA patients were 1.84 percentage points more likely to be treated at facilities owned by the largest two dialysis organizations and 1.85 percentage points less likely to be treated at an independently owned facility. MA patients went to further and lower quality facilities than TM patients in the same ZIP code. However, these differences in facility quality were modest. For example, while the mean dialysis facility mortality rate was 21.85, the difference in mortality rates at facilities treating MA and TM patients in the same ZIP code was 0.67 deaths per 100 patient-years. Similarly, MA patients went to facilities that were, on average, 0.15 miles further than TM patients in the same ZIP code.Conclusion
MA enrollees with ESKD were more likely than TM enrollees in the same ZIP code to use the dialysis facilities owned by the two largest chains, travel further for care, and receive care at lower quality facilities. While the magnitude of differences in facility distance and quality was modest, the direction of these results underscores the importance of monitoring dialysis network adequacy as ESKD MA enrollment continues to grow. 相似文献6.
Jessica N Mittler Bruce E Landon Elliot S Fisher Paul D Cleary Alan M Zaslavsky 《Health services research》2010,45(3):647-669
Objective
Examine associations between patient experiences with care and service use across markets.Data Sources/Study Setting
Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index.Study Design
We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets.Data Collection/Extraction
We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid.Principal Findings
Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care.Conclusions
Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care. 相似文献7.
Anand Tamang Mahesh Puri Sazina Masud Deepak Kumar Karki Diksha Khadka Minal Singh Poonam Sharma Subash Gajurel 《Contraception》2018,97(2):137-143
Objectives
To examine the treatment efficacy, safety and satisfaction of women using medical abortion (MA) pills provided by pharmacists following an education intervention based on a harm reduction approach.Study design
This was an operations research study over a six-month period in 2015, using a non-inferiority design. We provided training to dispense MA pills, based on a harm reduction approach, to a group of pharmacy workers in Makwanpur district (GROUP 2). We compared selected outcomes with women who bought the pills from pharmacy workers in Chitwan district (GROUP 1), who had received similar training in 2010. The primary endpoint measured in 992 women in both districts was complete abortion within 30 days of using the pills. We assessed the efficacy of MA (self-reported complete abortion) and safety (no reported adverse event). To determine complete abortion, we asked women about passage of the products of conception, cessation of abdominal cramps, vaginal bleeding, need for manual vacuum aspiration or repeated doses of misoprostol. We used a four-point Lickert Scale to determine level of satisfaction with MA use. Pearson Chi-Square test was used to examine any differences in proportion of complete abortions between women who were served by the two groups of pharmacy workers.Results
The difference in the rate of complete abortions between the two groups of women, 96.9% and 98.8%, was not statistically significant. The women reported no serious complications, and there was little difference in their satisfaction levels.Conclusions
Trained pharmacy workers dispensed MA safely and effectively to the satisfaction of almost all women clients, and the positive results of training had continued several years later.Implications
The role of pharmacy workers as providers of correct and complete information on safe and effective use of MA needs to be recognized and policies formulated to allow them to provide MA drugs for first trimester use. 相似文献8.
Riley H. Hazard Nurul Alam Hafizur Rahman Chowdhury Tim Adair Saidul Alam Peter Kim Streatfield Ian Douglas Riley Alan D. Lopez 《Population health metrics》2018,16(1):10
Background
Deaths in developing countries often occur outside health facilities, making it extremely difficult to gather reliable cause of death (COD) information. Automated COD assignment using a verbal autopsy instrument (VAI) has been proposed as a reliable and cost-effective alternative to traditional physician-certified verbal autopsy, but its performance is still being evaluated. The purpose of this study was to compare the similarity of diagnosis by Medical Assistants (MA) in the Matlab Health and Demographic Surveillance System (HDSS) with the SmartVA Analyze 1.2 (Tariff 2.0) diagnosis.Methods
This study took place between January 2011 and April 2014 in Matlab, Bangladesh. MA with 3 years of medical training assigned COD to Matlab residents by reviewing the information collected using the Population Health Metrics Research Consortium (PHMRC) long-form VAI. Smart VA Analyze 1.2 automatically assigned COD using the same questionnaire. COD agreement and cause-specific mortality fractions (CSMFs) were compared for MA and Tariff.Results
Of the 4969 verbal autopsy cases reviewed, 4328 were adults, 296 were children, and 345 were neonates. Cohen’s kappa was 0.38 (0.36, 0.40) for adults, 0.43 (0.38, 0.49) for children, and 0.27 (0.22, 0.33) for neonates. For adults, the top two COD for MA were stroke (29.6%) and ischemic heart diseases (IHD) (14.2%) and for Tariff these were stroke (32.0%) and IHD (14.0%). For children, the top two COD for MA were drowning (33.5%) and pneumonia (13.2%) and for Tariff these were also drowning (36.8%) and pneumonia (12.4%). For neonates, the top two COD for MA were birth asphyxia (41.2%) and meningitis/sepsis (22.3%) and for Tariff these were birth asphyxia (37.0%) and preterm delivery (30.9%).Conclusion
The CSMFs for Tariff and MA showed very close agreement across all age categories but some differences were observed for neonate preterm delivery and meningitis/sepsis. Given the known advantages of automated methods over physician certified verbal autopsy, the SmartVA software, incorporating the shortened VAI questionnaire and Tariff 2.0, could serve as a cost-effective alternative to Matlab MA to routinely collect and analyze verbal autopsy data in a HDSS to generate essential population level COD data for planning.9.
Gunilla Wieslander Dan Norbäck 《International archives of occupational and environmental health》2010,83(7):733-741
Purpose
Despite the decreased use of solvent-based paint (SBP) and increased use of water-based paints (WBP) with possible risk for microbial growth, few health studies are available. The aim was to study the symptoms and ocular and nasal biomarkers in house painters in relation to paint use and personal exposure to volatile organic compounds (VOC) and microbial VOC (MVOC) during indoor painting with WBP. 相似文献10.
Background
To compare patterns of use, beliefs, and attitudes related to waterpipe smoking between university students (beginning smokers) and café customers (established smokers) in Aleppo Syria, in order to explore the evolution of this smoking method. 相似文献11.
Nancy C. Elder C. Jeffrey Jacobson Shannon K. Bolon Joseph Fixler Harini Pallerla Christina Busick Erica Gerrety Dee Kinney Saundra Regan Michael Pugnale 《Annals of family medicine》2014,12(2):150-157
PURPOSE
The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician–medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework.METHODS
We conducted an ethnographic study of 5 small family medicine offices (having <5 clinicians) in the Cincinnati Area Research and Improvement Group (CARInG) Network using interviews, surveys, and observations. We interviewed 19 MAs and supervisors and 11 clinicians (9 family physicians and 2 nurse practitioners) and observed 15 MAs in practice. Qualitative analysis used the editing style.RESULTS
MAs’ roles in small family medicine offices were determined by MA career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians’ roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs.CONCLUSIONS
Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting. 相似文献12.
Lisa C. McGuire E. L. Bouldin E. M. Andresen L. A. Anderson 《The journal of nutrition, health & aging》2010,14(5):373-379
Objective
To examine the associations among health behaviors, healthy body weight, and use of preventive services of adults 65 years and older using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) as a function of caregiving status. 相似文献13.
Alessandro Patriarca Gabriella Di Giuseppe Luciana Albano Paolo Marinelli Italo F Angelillo 《BMC public health》2009,9(1):139
Background
This survey determined the practices about television (video inclusive), videogames, and computer use in children and adolescents in Italy. 相似文献14.
Christopher C. Afendulis Mary Beth Landrum Michael E. Chernew 《Health services research》2012,47(6):2339-2352
Objective
To assess the impact of the Patient Protection and Affordable Care Act''s (ACA) changes in Medicare Advantage (MA) payment rates on the availability of and enrollment in MA plans.Data Sources
Secondary data on MA plan offerings, contract offerings, and enrollment by state and county, in 2010–2011.Study Design
We estimated regression models of the change in the number of plans, the number of contracts, and enrollment as a function of quartiles of FFS spending and pre-ACA MA payment generosity. Counties in the lowest quartile of spending are treated most generously by the ACA.Principal Findings
Relative to counties in the highest quartile of spending, the number of plans in counties in the first, second, and third quartiles rose by 12 percent, 7.6 percent, and 5.4 percent, respectively. Counties with more generous MA payment rates before the ACA lost significantly more plans. We did not find a similar impact on the change in contracts or enrollment.Conclusions
The ACA-induced MA payment changes reduced the number of plan choices available for Medicare beneficiaries, but they have yet affected enrollment patterns. 相似文献15.
Maryam Khazaee-Pool Leila Jahangiry Tahereh Pashaei Farhad Ramezani-badr Haidar Nadrian Koen Ponnet 《Substance abuse treatment, prevention, and policy》2018,13(1):38
Background
Drug misuse is a major problem that has an extreme negative effect on people’s health. Methamphetamine (MA) is frequently used by young adults, despite its harmful consequences. The Transtheoretical Model (TTM) has been known to be very effective in explaining both the achievement and cessation of several health-related behaviors. Therefore, in this study, the TTM was used toward the domain of immoderate MA use among young adults. This study aimed to test the validity and reliability of a decisional balance scale for MA use in young adults.Methods
A multi-phase scale development approach was used to develop the scale. First, 41 university students enrolled in a qualitative study that generated content for a primary set of a 40-item instrument. In order to produce a pre-final version of the instrument, face and content validity were calculated in the next step. The instrument validation was assessed with a sample of 250 university students. Then, the construct validity (exploratory and confirmatory), convergent validity, discriminate validity, internal consistency applying test-retest reliability, and Cronbach’s alpha of the scale were measured.Results
Forty items were initially generated from the qualitative data. After content validity, this amount was reduced to 25 items. The exploratory factor analysis revealed four factors (self and other cons, coping and social pros) containing 21 items that jointly accounted for 55.24% of the observed variance. The confirmatory factor analysis indicated a model with appropriate fitness for the data. Cronbach’s alpha coefficient for the dimensions ranged from .74 to .87, and the Intraclass Correlation Coefficient (ICC) ranged from .83 to .91, which is within acceptable ranges.Conclusion
The findings showed that the Methamphetamine Decisional Balance Scale is a valid and reliable scale that increases our ability to study motivational factors related to MA use among young adult. Consequently, the instrument could be applied in both practice and future studies.16.
K. Simpson D. Keen D. Adams C. Alston‐Knox J. Roberts 《Child: care, health and development》2018,44(1):99-107
Background
Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.Method
Caregivers of children on the spectrum aged 5 (n = 90) and 9–10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.Results
Item‐level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age‐appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).Conclusion
The possibility of autism‐specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers. 相似文献17.
Ulrich John Sebastian E Baumeister Henry Völzke Christian Meyer Sabina Ulbricht Dietrich Alte 《BMC public health》2007,7(1):337
Background
Sedative, hypnotic, anxiolytic and opioid medicament (SO) use and its relation to tobacco smoking and alcohol risk drinking is largely unknown. Prevalence data for SO intake and its co-occurrence with tobacco smoking and alcohol risk drinking considering age are presented. 相似文献18.
Nappi RE Sances G Allais G Terreno E Benedetto C Vaccaro V Polatti F Facchinetti F 《Contraception》2011,(3):223-228
Background
Migraine with aura (MA) is a contraindication to the use of combined oral contraceptives (COCs) because of the increased risk of ischemic stroke. Progestogen-only contraceptive pill (POP) is a safe alternative to COCs and it is preferable in women with cerebrovascular diseases or risk factors for stroke.Study Design
Prospective diary-based pilot study. Thirty women with MA (n=15 who have never used COCs and n=15 who had previously used COCs were diagnosed according to the International Headache Society criteria. The observational period lasted 9 months during which women filled in a diary with the clinical characteristics of headache attacks. After a 3-month run-in period, each subject received an estrogen-free desogestrel (DSG) (75 mcg/day)-containing OC (Cerazette®; Schering-Plough, formerly NV Organon, Oss, The Netherlands). Follow-up evaluations were planned at the end of the third and sixth month of treatment.Results
The number (mean±S.D.) of migraine attacks was significantly reduced both in previous COCs users (from 3.9±1.0 to 2.9±0.8; p<.001) and nonusers (from 3.2±0.9 to 2.6±1.3; p<.02) following 6 months of POP use in comparison with the run-in period. Duration of headache pain did not differ significantly in both groups throughout the study. Interestingly enough, a beneficial POP effect on the duration (mean±S.D.) of visual aura (from 16.3±9.5 to 11.4±5.6 min) and on the total duration (mean±S.D.) of neurological symptoms (from 33.6±23.3 to 18.6±18.0 min) was only significantly reported by previous COCs users (p<.001, for both) by the end of the study period. The POP was well tolerated by each woman and the bleeding pattern was variable with a tendency towards infrequent bleeding.Conclusions
The present study supports the use of the POP containing desogestrel in a population of women with MA and underlines a positive effect on symptoms of aura, especially in MA sensitive to previous use of COCs. 相似文献19.
Katherine W Bauer Dianne Neumark-Sztainer Jayne A Fulkerson Peter J Hannan Mary Story 《The international journal of behavioral nutrition and physical activity》2011,8(1):25
Background
The family environment offers several opportunities through which to improve adolescents' weight and weight-related behaviors. This study aims to examine the cross-sectional relationships between multiple factors in the family environment and physical activity (PA), television use (TV), soft drink intake, fruit and vegetable (FV) intake, body mass index (BMI), and body composition among a sample of sociodemographically-diverse adolescent girls. 相似文献20.
Karl Peltzer Natalie Friend-du Preez Shandir Ramlagan Henry Fomundam 《BMC public health》2008,8(1):255