The impact of managed care on substance abuse treatment services

OBJECTIVE: To examine the impact of managed care on the number and types of services offered by substance abuse treatment (SAT) facilities. Both the number and types of services offered are important factors to analyze, as research shows that a broad range of services increases treatment effectiveness. DATA SOURCES: The 2000 National Survey of Substance Abuse Treatment Services (NSSATS), which is designed to collect data on service offerings and other characteristics of SAT facilities in the United States. These data are merged with data from the 2002 Area Resource File (ARF), a county-specific database containing information on population and managed care activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. STUDY DESIGN: We estimate the impact of managed care (MC) on the number and types of services offered by SAT facilities using instrumental variables (IV) techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. Due to limitations of the NSSATS data, MC and specific services are modeled as binary variables. PRINCIPAL FINDINGS: We find that managed care causes SAT facilities to offer, on average, approximately two fewer services. This effect is concentrated primarily in medical testing services (i.e., tests for TB, HIV/AIDs, and STDs). We also find that MC increases the likelihood of offering substance abuse assessment and relapse prevention groups, but decreases the likelihood of offering outcome follow-up. CONCLUSION: Our findings raise policy concerns that managed care may reduce treatment effectiveness by limiting the range of services offered to meet patient needs. Further, reduced onsite medical testing may contribute to the spread of infectious diseases that pose important public health concerns.     

Can the Q Link Ally,a form of Sympathetic Resonance Technology (SRT), attenuate acute mobile phone-related changes to neural function?

OBJECTIVES: Exposure to active mobile phones (MP) has been shown to affect human neural function as shown by the electroencephalogram (EEG). Although it has not been determined whether such effects are harmful, a number of devices have been developed that attempt to minimize these MP-related effects. One such device, the Q Link Ally (QL; Clarus Products, International, L.L.C., San Rafael, CA), is argued to affect the human organism in such a way as to attenuate the effect of MPs. The present pilot study was designed to determine whether there is any indication that QL does alter MP-related effects on the human EEG. DESIGN: Twenty-four (24) subjects participated in a single-blind, fully counterbalanced crossover design in which subjects' resting EEG and phase-locked neural responses to auditory stimuli were assessed under conditions of either active MP or active MP plus QL. RESULTS: The addition of QL to the MP condition increased resting EEG in the gamma range and did so as a function of exposure duration, and it attenuated MP-related effects in the delta and alpha range (at trend-level). The addition of the QL also affected phase-locked neural responses, with a laterality reversal in the alpha range and an alteration to changes over time in the delta range, a reduction of the MP-related beta decrease over time at fronto-posterior sites, and a global reduction in the gamma range that increased as a function of exposure duration. No unambiguous relations were found between these changes and either performance or psychologic state. CONCLUSIONS: This pilot study suggests that the addition of the QL to active MP-exposure does affect neural function in humans, altering both resting EEG patterns and the evoked neural response to auditory stimuli, and that there is a tendency for some MP-related changes to the EEG to be attenuated by the QL.     

Comparison of in vivo (Draize method) and in vitro (Corrositex assay) dermal corrosion values for selected industrial chemicals

Skin irritation is a common occupational hazard for employees engaged in the manufacture, transport, and use of industrial chemicals. The most common method used to evaluate dermal irritation and/or corrosion has typically been in vivo tests using rabbits (Draize method). Several in vitro test methods have been developed, with Corrositex being the first to gain approval by a regulatory agency (U.S. Department of Transportation). The purpose of this study was to compare the results of in vitro (Corrositex) assays of dermal irritation/corrosion to in vivo test data for several industrial chemical formulations and to determine the predictability and usefulness of the Corrositex assay for these types of products. Twenty-four (24) formulations were qualified, categorized, and evaluated using the Corrositex method and the results compared to available animal data for each of the formulations. The Corrositex assay accurately predicted a corrosive end point in 8 (57.1%) of the 14 formulations identified as corrosive by the in vivo evaluations. Corrositex accurately predicted a noncorrosive end point for 1 (10%) of 10 formulations determined to be noncorrosive in animal studies. The Corrositex assay overpredicted the packing group for 12 (50%) of the 24 formulations, and underpredicted the packing group for 7 (29.2%) of the 24 formulations. Compared to the in vivo results, Corrositex correctly classified as corrosive or noncorrosive 37.5% of the formulations tested. A concordance of 20.8% for the packing group assignments of the evaluated formulations was calculated. The Corrositex assay did not accurately predict a corrosive end point or packing group assignment for all of the formulations used in this study. Manufacturers should assess the relevance of this method to their products prior to relying on it for compliance with hazardous material and worker safety regulations.     

Melatonin receptor expression in the cornea and sclera

The scornea and sclera have been shown to exhibit circadian rhythms in cellular proliferation, wound healing and extracellular matrix synthesis. The distribution of melatonin Mel1a and Mel1c receptors was examined in the cornea and sclera of the Xenopus laevis eye in order to determine whether melatonin may potentially influence the growth and/or development of these ocular tissues. Sections of adult X. laevis eyes were analyzed by immunocytochemistry and confocal microscopy, using antibodies prepared against specific peptide sequences of the Xenopus Mel1a and Mel1c receptor proteins. Antibodies were pre- incubated with their appropriate antigenic peptides to control for non-specific labelling. Analysis of the distribution of Mel1a and Mel1c receptor immunoreactivity in the Xenopus eye revealed that both the Mel1a and Mel1c receptors were located in the outer fibrous layer (OFL) of the sclera, with Mel1c labelling being the most prominent. Similarly, Mel1a and Mel1c (Mel1c mostly) were also located in cells of the inner fibrous layer (IFL) with Mel1c being most abundant. The chondrocytes of the cartilaginous layer also appeared to express Mel1a, Mel1c, or both receptors. Both Mel1a and Mel1c receptor immunoreactivity were observed in the corneal epithelium and endothelium. Whereas the Mel1a antibody labelled the entire corneal epithelial layer, the Mel1c antibody labelled only the most superficial layer of epithelial cells. Cell processes of fibroblasts of the corneal stroma were immunoreactive for either Mel1a or Mel1c receptors. The identification of Mel1a and Mel1c receptors in restricted distributions in the cornea and sclera suggests that melatonin may play a role in the cellular physiology of these ocular tissues.     

Collaborative Initial Glaucoma Treatment Study: a summary of results to date

PURPOSE OF REVIEW: This review summarizes the key findings from the Collaborative Initial Glaucoma Treatment Study (CIGTS), which was designed to evaluate whether medical therapy or trabeculectomy is the better initial treatment for patients with open-angle glaucoma (OAG). In addition to examining effects on visual field progression, intraocular pressure control, and visual acuity, the study also examined the effects of medical and surgical treatments on quality of life. RECENT FINDINGS: The 4+-year interim outcomes noted no significant difference in visual field loss between the medically and surgically treated patients. Patients assigned to trabeculectomy had lower intraocular pressures, but demonstrated a greater risk for significant loss of visual acuity and a threefold increased rate of cataract progression. Most quality-of-life measurements were similar in the two treatment arms, except local eye symptoms, which were reported more frequently by the surgically treated patients. SUMMARY: Results from CIGTS do not support altering current treatment practices in the initial management of patients with primary open-angle glaucoma.