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Callison K, Pesko MF, Phillips S, Sosa JA. Cancer Screening after the Adoption of Paid-Sick-Leave Mandates. N Engl J Med 2023; 388:824-832. [PMID: 36856618 PMCID: PMC10084522 DOI: 10.1056/nejmsa2209197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).
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Affiliation(s)
- Kevin Callison
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Michael F Pesko
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Serena Phillips
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Julie A Sosa
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
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Fracalossi de Moraes R, Russell LB, Santos da Silva LL, Toscano CM. Effects of non-pharmaceutical interventions on social distancing during the COVID-19 pandemic: Evidence from the 27 Brazilian states. PLoS One 2022; 17:e0265346. [PMID: 35298529 PMCID: PMC8929638 DOI: 10.1371/journal.pone.0265346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Despite substantial evidence on the effectiveness of non-pharmaceutical interventions (NPIs), there is still limited evidence on the individual effects of different types of NPIs on social distancing, especially in low- and middle-income countries.
Methods
We used panel data analysis to evaluate the effects of mandatory social distancing rules on social distancing. We obtained data on six different categories of mandatory restrictions implemented in Brazil, by date and state, from state government gazettes (diários oficiais). We then defined a social distancing rules index (SDI) to measure the strictness of social distancing rules, assigning each a value of 2, 1, or 0 depending on whether restrictions were full, partial, or very limited/non-existent at every given time. A separate variable was defined for masking mandates. We tested whether the following variables were associated to social distancing: SDI, masking mandates, COVID-19 incidence, population socioeconomic status, and political orientation. Data is for each day between March 11th and November 10th, 2020 in the 27 Brazilian states (N = 6615).
Findings
Social distancing increased when social distancing rules were stricter, and decreased when the use of face masks became mandatory. The effects of different types of restrictions varied: suspending in-person classes and gatherings, religious/sport/cultural activities had a greater effect than other types of restrictions. Also, the effect of social distancing rules on people’s behaviour decreased over time, especially when rules were stricter.
Interpretation
Mandatory social distancing rules must be adopted to increase social distancing. Stricter rules have a higher impact, but result in decreased compliance over time. Policymakers should prioritize more targeted policies.
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Affiliation(s)
| | - Louise B. Russell
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Lara Livia Santos da Silva
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brasil
| | - Cristiana M. Toscano
- Department of Collective Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brasil
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Abstract
OBJECTIVE Social distancing has been one of the primary interventions used to slow the spread of COVID-19 during the ongoing pandemic. Although statewide stay-at-home orders in the United States received a large degree of media and political attention, relatively little peer-reviewed research has examined the impacts of such orders on social distancing behaviors. METHOD This study used daily GPS-derived movement from 2858 counties in the United States from March 1 to May 7, 2020, to test the degree to which changes in state-level stay-at-home orders were associated with movement outside the home. RESULTS From early March to early April, people in counties with state-level stay-at-home orders decreased their movement significantly more than counties without state-level stay-at-home orders; 3.1% more people stayed within 1 mile of home, and 1.6% fewer vehicle miles were driven per day. From early April to early May, people in counties within states that ended their stay-at-home orders increased their movement significantly more than counties in states whose stay-at-home orders remained in place; 1.2% fewer people remained within 1 mile of home, and 6.2% more vehicle miles were driven per day. The magnitude of changes associated with state-level stay-at-home orders was many times smaller than the total changes in movement across all counties over the same periods. CONCLUSIONS Stay-at-home orders were associated with greater social distancing but accounted for only part of this behavioral change. Research on behavior change would be useful to determine additional interventions that could support social distancing during the COVID-19 pandemic.
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Affiliation(s)
- Kyle J Bourassa
- From the Duke University Medical Center, Duke University, Durham, North Carolina
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He AS, Padyab M, Sedivy JA, Lundgren L. A Swedish national study: Immigrant-country of birth status and child welfare compulsory care among a sample of parents with risky substance use. Child Abuse Negl 2020; 101:104316. [PMID: 31862510 DOI: 10.1016/j.chiabu.2019.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/05/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sweden has a high percentage of foreign-born residents (18.5 %) and one of the highest overdose death rates in Europe. For immigrant parents with risky substance use (RSU), risk factors associated with immigration status (e.g., economic strain and psychological stress) potentially heightening the risk of involvement with the child welfare system (CWS). Using Swedish registry national data, this study explored the relationship between immigration-country of birth status, psychosocial risk factors, and child compulsory care for parents with RSU. METHODS Study sample consisted of 5932 parents from 65 Swedish municipalities assessed for psychosocial problems (including alcohol and drug use) using the Addiction Severity Index (2007-2017). Stepwise multinomial logistic regression models examined the relationship between immigration-country of birth status (Swedish born, Nordic-born, and non-Nordic born), psychosocial problems, and compulsory care in the CWS. RESULTS Compared to Swedish-born parents, parents not born in Sweden, Norway, Denmark or Finland (non-Nordic born parents) had a lower probability of children living in compulsory care (family homes or institutions). However, after accounting for psychosocial problems, immigration status was no longer significantly associated with children's living arrangements. CONCLUSIONS Study findings indicate that parental immigrant status (even among parents dealing with RSU) in itself is not a risk factor for compulsory care in the CWS. Moreover, parental employment and health problems posed greater risk for children being in compulsory care. Receipt of targeted services for employment and health problems may help to maintain stable child living arrangements for immigrant parents dealing with RSU.
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Affiliation(s)
- Amy S He
- Graduate School of Social Work, University of Denver, Denver, CO, USA.
| | - Mojgan Padyab
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden; Centre for Demography and Ageing Research (CEDAR), Umeå University, SE-901 87 Umeå, Sweden
| | - Jennifer A Sedivy
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Lena Lundgren
- Graduate School of Social Work, University of Denver, Denver, CO, USA; Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
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Silva B, Golay P, Boubaker K, Bonsack C, Morandi S. Community treatment orders in Western Switzerland: A retrospective epidemiological study. Int J Law Psychiatry 2019; 67:101509. [PMID: 31785725 DOI: 10.1016/j.ijlp.2019.101509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Community treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care to people affected by severe mental disorders. Nowadays, CTOs are regulated in 75 countries, with important variations in terms of legal criteria and practices. In Switzerland CTOs were introduced on the 1st January 2013, following the amendment of the Swiss Civil Code. The aim of this study was to provide a first understanding of the use of CTOs in Western Switzerland in terms of incidence and prevalence rates, population profile, orders duration and reasons for discharge. METHODS Incidence and prevalence rates of CTOs between 2013 and 2017 were estimated. Survival analysis was used to investigate time to CTO discharge and associated factors. Logistic regression was performed to identify factors associated with CTOs' success as reason for discharge. RESULTS CTOs' incidence rates per 100'000 inhabitants ranged between 4.8 for 2013 and 9.6 for 2017, while their prevalence raised from 4.8 to 19.5. People placed under CTO were mainly male, in their forties, of Swiss origin, single and living independently. Primarily affected by Schizophrenia, schizotypal and delusional disorders (F20-F29), they frequently presented substance use problems, and severe danger for themselves. CTOs were mainly ordered by the guardianship authority as a form of conditional release. The estimated mean time to discharge was almost three years. Not being of Swiss origin and being prescribed to take a medication were associated with longer CTO while living in hospital, as a consequence of a long-lasting hospitalisation, and having a non-medical professional in charge of the order were associated with shorter time to discharge. Neither clinical factors nor legal criteria predicted time to discharge. Moreover, spending more days under CTO increased the likelihood of success at discharge, whereas not being of Swiss origin reduced it. CONCLUSIONS To the best of our knowledge, no previous studies have examined the CTOs' implementation in Switzerland. CTOs prevalence increased rapidly despite the lack of evidence on positive outcomes. Our results suggested that once under CTO, it takes a long time for a patient to be released, in case of both positive and negative outcomes.
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Affiliation(s)
- Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland.
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Karim Boubaker
- Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
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Maltezou HC, Ledda C, Rapisarda V. Mandatory vaccinations for children in Italy: The need for a stable frame. Vaccine 2019; 37:4419-4420. [PMID: 31280946 DOI: 10.1016/j.vaccine.2019.05.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece.
| | - Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
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Hatcher RM, Roberts ALI. Can Completers, Non-Completers, and Non-Starters of Community-Based Offending Behavior Programs be Differentiated by Internal Treatment Readiness Factors? Int J Offender Ther Comp Criminol 2019; 63:1066-1081. [PMID: 30526177 DOI: 10.1177/0306624x18813891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This research aimed to determine whether completers, non-completers, and non-starters of community-based offending behavior programs could be differentiated by their levels of internal "treatment readiness." The Corrections Victoria Treatment Readiness Questionnaire (CVTRQ) measures offenders' Attitudes and Motivation, Emotional Reactions, Offending Beliefs, and Efficacy which, according to the Multifactor Offender Readiness Model (MORM), are internal dimensions of an offender's readiness to engage with treatment. Participants were offenders who had been court-mandated to attend a community-based cognitive skills offending behavior program. There were no significant differences between groups in respect of the CVTRQ total score. After controlling for risk of reconviction, however, the Self Efficacy construct differentiated program non-starters from program completers, while the Emotional Reactions construct differentiated program non-completers from program completers. In conclusion, the CVTRQ failed to differentiate program completion groups with the same success as elsewhere.
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Lee JL. An audit of the practice of electroconvulsive therapy (ECT) in a Victorian Health Service before and after the Mental Health Act 2014. Australas Psychiatry 2019; 27:197. [PMID: 30994031 DOI: 10.1177/1039856218810163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Restivo V, Orsi A, Ciampini S, Messano GA, Trucchi C, Ventura G, Casuccio A, Vitale F. How should vaccination services be planned, organized, and managed? Results from a survey on the Italian vaccination services. Ann Ig 2019; 31:45-53. [PMID: 30994163 DOI: 10.7416/ai.2019.2276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Quality improvement is an increasingly recognized approach to maximize service effectiveness and minimize costs in public health. However, the Italian law never provided for the institutional accreditation of vaccination services. Furthermore, a recently approved law added six more compulsory vaccinations to the original four, which has led to a considerable increase in vaccination efforts, without any previous resources evaluation. The aim of the study was to investigate structural, organizational and managerial characteristics of the Italian vaccination services, in order to suggest the adoption of adequate quality standards. STUDY DESIGN A survey involving the representatives of the Italian Regions and Autonomous Provinces was performed between September 2017 and September 2018. METHODS An online questionnaire, including 26 items, designed to evaluate the structural, organizational and managerial characteristics of vaccination services was administered. The correlation between the number of vaccination centres and the coverage for each region was used to evaluate the performance of the vaccination services. RESULTS Respondents from seven Regions, totaling >15,000,000 inhabitants, answered the questionnaire. Overall, each vaccination service was potentially accessed by an average of 519 children aged zero to 24 months, with a β-coefficient of -0.87 (p = 0.01) for infant vaccination coverage in 2016. Eighty-five percent of vaccination services were provided with architectural features to accommodate the disabled but only 49% provided reserved parking lots. An average of 0.4 physicians and 0.6 other healthcare workers per 10,000 inhabitants were employed in vaccination services, with complete computerization in 74% of them. CONCLUSION The inverse relation between vaccination services' spatial accessibility and vaccination coverage suggests that distance and accessibility of vaccination services should be considered in planning. This survey constitutes a baseline data for Italian vaccination services that could be useful for decision makers in establishing minimum requirements to provide high-quality preventive healthcare service.
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Affiliation(s)
- V Restivo
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Specialties of Excellence "G. D'Alessandro", University of Palermo, Italy
| | - A Orsi
- Department of Health Sciences, University of Genoa, "Ospedale Policlinico San Martino IRCCS" Teaching Hospital, Genoa, Ital
| | | | - G A Messano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Ital
| | - C Trucchi
- Department of Health Sciences, University of Genoa, "Ospedale Policlinico San Martino IRCCS" Teaching Hospital, Genoa, Ital
| | - G Ventura
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Specialties of Excellence "G. D'Alessandro", University of Palermo, Italy
| | - A Casuccio
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Specialties of Excellence "G. D'Alessandro", University of Palermo, Italy
| | - F Vitale
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Specialties of Excellence "G. D'Alessandro", University of Palermo, Italy
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Toffolutti V, McKee M, Melegaro A, Ricciardi W, Stuckler D. Austerity, measles and mandatory vaccination: cross-regional analysis of vaccination in Italy 2000-14. Eur J Public Health 2019; 29:123-127. [PMID: 30215716 PMCID: PMC6345202 DOI: 10.1093/eurpub/cky178] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Italy has experienced a resurgence in measles since 2015. Although much emphasis has been placed on the role of individuals opting out of vaccination, here we test the hypothesis that large budget reductions in public health spending were also a contributing factor. Methods Multi-variate statistical models were used to assess the relationship between measles, mumps and rubella (MMR) coverage and real public health expenditure per-capita across Italy's 20 regions covering the period 2000-14. Results Between 2010 and 2014 Italy's public health expenditure fell by over 2%, although varying among regions. Fixed effects models estimate that each 1% reduction in per-capita public health expenditure was associated with a decrease of 0.5 percentage points (95% CI: 0.36-0.65 percentage points) in MMR coverage, after adjusting for time and regional-specific time trends. The consequences can be illustrated by comparing two regions, Lazio, where public health spending fell by 5% and MMR coverage by over 3 percentage points, and Sardinia, a historically deprived region, where public health spending partly rose and MMR rates remained approximately steady. Conclusion Adoption of austerity policies in the Italian health system was found to be significantly associated with declining vaccination rates for MMR. However, the recent introduction of mandatory vaccination for Italian children may help counteract this trend.
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Affiliation(s)
- Veronica Toffolutti
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Alessia Melegaro
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Walter Ricciardi
- Istituto Superiore di Sanità - National Institute of Health, Rome, Italy
| | - David Stuckler
- “Carlo F. Dondena” Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Social and Political Science, Bocconi University, Milan, Italy
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Abstract
PURPOSE To identify the factors associated with total Hospital-Acquired Condition Reduction Program (HACRP) score and with receiving a Centers for Medicare and Medicaid Services (CMS) penalty (1% reduction in payment to those hospitals in the lowest-performing quartile of HACRP scores) for fiscal years (FYs) 2015-2017 with a particular focus on trends over this period. METHOD The authors evaluated the following variables: (1) type of hospital (teaching vs. nonteaching); (2) disproportionate patient percentage; (3) case mix index (CMI); (4) number of staffed beds; (5) length of stay (LOS); (6) gross patient revenue; and (7) region, using data from CMS and the American Hospital Directory. They conducted multivariate linear and logistic regressions. RESULTS A total of 2,249 hospitals were included. The mean total HACRP scores across hospitals for FY15, FY16, and FY17 were 5.38, 5.35, and 5.18, respectively. In FY15, 21.2% (476/2,249) of hospitals received a penalty compared with 22.6% (508/2,249) in FY16 and 31.3% (704/2,249) in FY17 (P < .001). The logistic regression model showed that teaching hospitals, larger hospitals (> 400 beds), hospitals with high CMI or long LOS, and hospitals in the Northeast and Western United States were more likely to receive a penalty. Teaching hospitals and larger hospitals did not improve their scores over time compared with nonteaching and small hospitals. CONCLUSIONS A reevaluation of the scoring methodology for the HACRP is needed. CMS could stratify hospitals into homogeneous categories and apply penalties to those that have the worst scores in each category.
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Affiliation(s)
- Mayar Al Mohajer
- M. Al Mohajer is associate professor of medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas. K.A. Joiner is professor of medicine and economics, Center for Management Innovations in Health Care, Eller College of Management, University of Arizona, Tucson, Arizona. D.E. Nix is professor of pharmacy, Department of Pharmacy Science and Practices, University of Arizona, Tucson, Arizona
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Segal SP, Hayes SL, Rimes L. The utility of outpatient commitment: acute medical care access and protecting health. Soc Psychiatry Psychiatr Epidemiol 2018; 53:597-606. [PMID: 29626237 PMCID: PMC7336898 DOI: 10.1007/s00127-018-1510-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 03/28/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment-community treatment orders (CTOs) in Victoria Australia-are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness. METHOD For years 2000 to 2010, the study compared acute medical care access of 27,585 severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care. RESULTS Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis. CONCLUSION Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.
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Affiliation(s)
- Steven P Segal
- University of California, Berkeley, Berkeley, CA, USA.
- University of Melbourne, Melbourne, VIC, Australia.
| | | | - Lachlan Rimes
- Victoria Department of Health and Human Services, Melbourne, VIC, Australia
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Candon MK, Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Xie M, Mandell DS. The Differential Effects of Insurance Mandates on Health Care Spending for Children's Autism Spectrum Disorder. Med Care 2018; 56:228-232. [PMID: 29287035 PMCID: PMC5811382 DOI: 10.1097/mlr.0000000000000863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD for any fully-insured plan. METHODS Using insurance claims between 2008 and 2012 from three national insurers, we used a difference-in-differences approach to compare children with ASD who were subject to mandates to children with ASD who were not. To allow for differential effects, we estimated quantile regressions that evaluate the impact of mandates across the spending distributions of three outcomes: (1) monthly spending on ASD-specific outpatient services; (2) monthly spending on ASD-specific inpatient services; and (3) quarterly spending on psychotropic medications. RESULTS The change in spending on ASD-specific outpatient services attributable to mandates varied based on the child's level of spending. For those children with ASD who were subject to the mandate, monthly spending for a child in the 95th percentile of the ASD-specific outpatient spending distribution increased by $1460 (P<0.001). In contrast, the effect was only $2 per month for a child in the fifth percentile (P<0.001). Mandates did not significantly affect spending on ASD-specific inpatient services or psychotropic medications. CONCLUSIONS State-level insurance mandates have larger effects for those children with higher levels of spending. To the extent that spending approximates treatment intensity and the underlying severity of ASD, these results suggest that mandates target children with greater service needs.
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Affiliation(s)
- Molly K Candon
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colleen L Barry
- Leonard Davis Institute of Health Economics
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Andrew J Epstein
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven C Marcus
- Leonard Davis Institute of Health Economics
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | | | - Ming Xie
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David S Mandell
- Leonard Davis Institute of Health Economics
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Buisson Y, Bégué P. [Not Available]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2015; 199:1215-1217. [PMID: 29879341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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15
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Grahn R, Lundgren LM, Chassler D, Padyab M. Repeated entries to the Swedish addiction compulsory care system: a national register database study. Eval Program Plann 2015; 49:163-171. [PMID: 25559948 DOI: 10.1016/j.evalprogplan.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten's Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care.
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Affiliation(s)
- Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden.
| | - Lena M Lundgren
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden; Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Deborah Chassler
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Mojgan Padyab
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
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Abstract
UNLABELLED Drop-out of addiction treatment is common, however, little is known about drop-out of compulsory care in Sweden. Data from two national register databases were merged to create a database of 4515 individuals sentenced to compulsory care 2001-2009. The study examined (1) characteristics associated with having dropped out from a first compulsory care episode, (2) the relationship between drop-out and returning to compulsory care through a new court sentence, and (3) the relationship between drop-out and mortality. METHODS Multivariable logistic regression analysis was used to address Aim 1 and Cox proportional hazards regression modeling was applied to respond to Aims 2 and 3. FINDINGS Age and previous history of crime were significant predictors for drop-out. Clients who dropped out were 1.67 times more likely to return to compulsory care and the hazard of dying was 16% higher than for those who dropped-out. CONCLUSION This study finds that 59% of clients assigned to compulsory care drop-out. Younger individuals are significantly more likely to drop-out. Those who drop out are significantly more likely to experience negative outcomes (additional sentence to compulsory care and higher risk of mortality). Interventions need to be implemented that increase motivation of youth to remain in compulsory care.
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Affiliation(s)
- Mojgan Padyab
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden.
| | - Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
| | - Lena Lundgren
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden; Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
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Hall T, Chassler D, Blom B, Grahn R, Blom-Nilsson M, Sullivan L, Lundgren L. Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: descriptive study. Eval Program Plann 2015; 49:153-162. [PMID: 25577663 DOI: 10.1016/j.evalprogplan.2014.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n=4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR=1.28, narcotic users OR=1.16), gender [males were nearly 3 times more likely to die among narcotics users (p<.000) and 1.6 times more likely to die among alcohol users (p<.01)] and reporting serious health problems (for alcohol users p<.000, for narcotics users p<.05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.
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Affiliation(s)
- Taylor Hall
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
| | - Deborah Chassler
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
| | - Björn Blom
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
| | - Robert Grahn
- Department of Social Work, Umeå University, SE-901 87 Umeå, Sweden
| | | | - Lisa Sullivan
- Boston University School of Public Health, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Lena Lundgren
- Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
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Affiliation(s)
- Rebecca L Haffajee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts3Massachusetts General Hospital, Boston4National Bureau of Economic Research, Cambridge, Massachusetts
| | - Scott G Weiner
- Division of Health Policy Research Translation, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
We develop a model of selection that incorporates a key element of recent health reforms: an individual mandate. Using data from Massachusetts, we estimate the parameters of the model. In the individual market for health insurance, we find that premiums and average costs decreased significantly in response to the individual mandate. We find an annual welfare gain of 4.1% per person or $51.1 million annually in Massachusetts as a result of the reduction in adverse selection. We also find smaller post-reform markups.
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Depew B. The effect of state dependent mandate laws on the labor supply decisions of young adults. J Health Econ 2015; 39:123-134. [PMID: 25497756 DOI: 10.1016/j.jhealeco.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Prior to the Affordable Care Act, the majority of states in the U.S. had already implemented state laws that extended the age that young adults could enroll as dependents on their parent's employer-based health insurance plans. Because of the fundamental link between health insurance and employment in the U.S., such policies may effect the labor supply decisions of young adults. Although the interaction between labor supply and health insurance has been extensively studied for other subpopulations, little is known about the role of health insurance in the labor supply decisions of young adults. I use the variation from the implementation and changes in state policies that expanded dependent health insurance coverage to examine how young adults adjusted their labor supply when they were able to be covered as a dependent on their parent's plan. I find that these state mandates led to a decrease in labor supply on the intensive margin.
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Chatterji P, Decker SL, Markowitz S. The effects of mandated health insurance benefits for autism on out-of-pocket costs and access to treatment. J Policy Anal Manage 2015; 34:328-353. [PMID: 25893237 PMCID: PMC7512023 DOI: 10.1002/pam.21814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As of 2014, 37 states have passed mandates requiring many private health insurance policies to cover diagnostic and treatment services for autism spectrum disorders (ASDs). We explore whether ASD mandates are associated with out-of-pocket costs, financial burden, and cost or insurance-related problems with access to treatment among privately insured children with special health care needs (CSHCNs). We use difference-in-difference and difference-in-difference-in-difference approaches, comparing pre--post mandate changes in outcomes among CSHCN who have ASD versus CSHCN other than ASD. Data come from the 2005 to 2006 and the 2009 to 2010 waves of the National Survey of CSHCN. Based on the model used, our findings show no statistically significant association between state ASD mandates and caregivers' reports about financial burden, access to care, and unmet need for services. However, we do find some evidence that ASD mandates may have beneficial effects in states in which greater percentages of privately insured individuals are subject to the mandates. We caution that we do not study the characteristics of ASD mandates in detail, and most ASD mandates have gone into effect very recently during our study period.
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Affiliation(s)
- Pinka Chatterji
- National Bureau of Economic Research and Department of Economics at the State University of New York at Albany, Albany, NY.
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May T, Silverman RD. Free-Riding, Fairness, and the Rights of Minority Groups in Exemption from Mandatory Childhood Vaccination. Human Vaccines 2014; 1:12-5. [PMID: 17038833 DOI: 10.4161/hv.1.1.1425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authority of government to require participation in mandatory childhood vaccination programs may not target specific groups for either participation or exemption on a discriminatory basis. This poses difficulties when allowing religious or philosophical exemptions to mandatory vaccination, because certain groups are more likely to appeal for exemption. Avoiding loss of herd immunity, then, may require either discrimination against these groups by disallowing an exemption option that is available to others, or by denying the good of an exemption option to the entire population because of the action of certain groups. To avoid this unacceptable choice, steps must be taken now to more stringently enforce exemption requirements.
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Affiliation(s)
- Thomas May
- Center for the Study of Bioethics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Stavrunova O, Yerokhin O. Tax incentives and the demand for private health insurance. J Health Econ 2014; 34:121-130. [PMID: 24513860 DOI: 10.1016/j.jhealeco.2014.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 12/17/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
We analyze the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. With administrative income tax return data, we show that the mandate has several distinct effects on taxpayers' behavior. First, despite the large tax penalty for not having PHI coverage relative to the cost of the cheapest eligible insurance policy, compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply. This effect is most pronounced for young taxpayers, while the middle aged seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions, we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in Australia.
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Duncan A, Melnick G, Ahmed R, Furr-Holden CD. Posttreatment drug use abstinence: does the majority program clientele matter? J Ethn Subst Abuse 2014; 13:185-208. [PMID: 25176115 PMCID: PMC6414054 DOI: 10.1080/15332640.2013.826159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current study examines differences in organizational characteristics and client posttreatment drug use abstinence in residential substance abuse treatment programs serving clients with high or low levels of legal coercion to participate in treatment. The findings show that low legal coercion programs have higher counselor caseloads (Z = 59, p < .05) than high coercion programs. Although the results showed that programs with a large proportion of African American clients (β = 14.26, p < .0001) and high legal coercion programs (β = 19.99, p < .05) predicted longer abstinence posttreatment, the final models suggest organizational factors are the key predictors of client posttreatment abstinence.
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Affiliation(s)
- Alexandra Duncan
- a U.S. Health, Public Health & Epidemiology , Abt Associates, Inc. , Bethesda , Maryland
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25
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Libby TE, Lindley MC, Ahmed F, Stevenson J, Grabowsky M, Strikas RA. Student vaccination requirements of U.S. health professional schools: a national survey. J Allied Health 2014; 43:12-21. [PMID: 24598895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/05/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED To help protect healthcare personnel (HCP) from infection and to prevent possible disease transmission to their patients, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination of all HCP, including students. We sought to gather information on the vaccination policies of U.S. health professional (i.e., non-physician HCP) programs and to compare those requirements to current ACIP recommendations. METHODS A self-administered, internet-based survey sent to 2,779 U.S. health professional programs was used to collect data on program demographics; student vaccination requirements; deadlines for adherence, consequences for non-adherence, and permitted exemptions to these requirements; and factors influencing the program's vaccination policy. RESULT The response rate was 75%. Among 2,077 responding programs, 19% required all ACIP-recommended vaccines for HCP--87% required measles, mumps, and rubella; 84% required hepatitis B; 75% required varicella; 48% required tetanus, diphtheria, and acellular pertussis (Tdap); and 32% required influenza. Programs reviewing requirements at least annually and those that reported the ACIP influenced requirements were significantly more likely to require varicella, Tdap, and influenza vaccine. During the 2009-2010 influenza season, only 59% of programs offered influenza vaccine to students. CONCLUSION Health professional schools should update their vaccination requirements annually to be consistent with ACIP recommendations.
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Affiliation(s)
- Tanya E Libby
- California Emerging Infections Program, 360 22nd St. Suite 750, Oakland, CA 94612, USA. Tel 510-350-3370, fax 510-451-3210.
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Guerrero EG, Campos M, Urada D, Yang JC. Do cultural and linguistic competence matter in Latinos' completion of mandated substance abuse treatment? Subst Abuse Treat Prev Policy 2012; 7:34. [PMID: 22898100 PMCID: PMC3490725 DOI: 10.1186/1747-597x-7-34] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 08/09/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that culturally and linguistically responsive programs may improve substance abuse treatment outcomes among Latinos. However, little is known about whether individual practices or culturally and linguistically responsive contexts support efforts by first-time Latino clients to successfully complete mandated treatment. METHODS We analyzed client and program data from publicly funded treatment programs contracted through the criminal justice system in California. A sample of 5,150 first-time Latino clients nested within 48 treatment programs was analyzed using multilevel logistic regressions. RESULTS Outpatient treatment, homelessness, and a high frequency of drug use at intake were associated with decreased odds of treatment completion among Latinos. Programs that routinely offered a culturally and linguistically responsive practice-namely, Spanish-language translation-were associated with increased odds of completion of mandated treatment. CONCLUSIONS These preliminary findings suggest that concrete practices such as offering Spanish translation improve treatment adherence within a population that is at high risk of treatment dropout.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089-041, USA
| | - Michael Campos
- Gambling Studies Program, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-260, Los Angeles, CA, 90024, USA
| | - Darren Urada
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | - Joy C Yang
- Center for Chinese Studies, University of California, Los Angeles, 11381 Bunche Hall, Los Angeles, CA, 90095-1487, USA
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Pietras SA, Rhodes ET, Meyers A, Goodman E. Understanding pediatricians' views toward school-based BMI screening in Massachusetts: a pilot study. J Sch Health 2012; 82:107-114. [PMID: 22320334 DOI: 10.1111/j.1746-1561.2011.00673.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Massachusetts (MA) mandated body mass index (BMI) screening in schools in 2010. However, little is known about pediatricians' views on school-based screening or how the pediatricians' perspectives might affect the school-based screening process. We assessed MA pediatricians' knowledge, attitudes, beliefs, and practices concerning BMI screening. METHODS An anonymous Web-based survey was completed by 286 members of the MA Chapter of the American Academy of Pediatrics who provided primary care (40% response rate). RESULTS Support for school-based BMI screening was mixed. While 16.1% strongly supported it, 12.2% strongly opposed it. About one fifth (20.2%) believed school-based screening would improve communication between schools and pediatricians; 23.0% believed school-based screening would help with patient care. More (32.2%) believed screening in schools would facilitate communication with families. In contrast, pediatricians embraced BMI screening in practice: 91.6% calculated and 85.7% plotted BMI at every well child visit. Pediatricians in urban practices, particularly inner city, had more positive attitudes toward BMI screening in schools, even when adjusting for respondent demographics, practice setting, and proportion of patients in the practice who were overweight/obese (p < .001). CONCLUSION These data suggest MA pediatricians use BMI screening and support its clinical utility. However, support for school-based BMI screening was mixed. Urban-based pediatricians in this sample held more positive beliefs about screening in schools. Although active collaboration between schools and pediatricians would likely help to ensure that the screenings have a positive impact on child health regardless of location, it may be easier for urban-based schools and pediatricians to be successful in developing partnerships.
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Affiliation(s)
- Stefanie A Pietras
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, MA 02114, USA.
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Oser CB, Harp KLH, O'Connell DJ, Martin SS, Leukefeld CG. Correlates of participation in peer recovery support groups as well as voluntary and mandated substance abuse treatment among rural and urban probationers. J Subst Abuse Treat 2012; 42:95-101. [PMID: 21839606 PMCID: PMC3218255 DOI: 10.1016/j.jsat.2011.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 06/29/2011] [Accepted: 07/05/2011] [Indexed: 11/27/2022]
Abstract
This study explores the correlates of probationers' participation in 12-step programs, voluntary treatment, and mandated treatment, with respect to the geographic location of where the services are being provided as the primary covariate of interest. Data were derived from face-to-face interviews with rural and urban probationers (N = 1,464). Results of the three logistic regression models suggested that even when all the covariates are taken into account, urban probationers were significantly more likely to have been involved in 12-step programs, voluntary treatment, and mandated treatment over their lifespan. Despite high levels of self-reported substance use among all participants, treatment services were underused by rural probationers. These data suggest that individuals residing in rural communities may face additional barriers to receiving treatment services and that criminal involvement is associated with participation in peer recovery support groups and treatment. Future studies can investigate criminal involvement as an avenue to enhance recovery and how to overcome treatment barriers in rural areas.
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Affiliation(s)
- Carrie B Oser
- Department of Sociology, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40506, USA.
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Pedersen IB, Knudsen N, Carlé A, Vejbjerg P, Jørgensen T, Perrild H, Ovesen L, Rasmussen LB, Laurberg P. A cautious iodization programme bringing iodine intake to a low recommended level is associated with an increase in the prevalence of thyroid autoantibodies in the population. Clin Endocrinol (Oxf) 2011; 75:120-6. [PMID: 21521277 DOI: 10.1111/j.1365-2265.2011.04008.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Autoantibodies against the thyroid gland with thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (Tg-Ab) as the most common can often be demonstrated in serum. The effect of public iodization programmes on antibody prevalence is uncertain. AIM To measure the concentrations of thyroid autoantibodies in the Danish population before and after mandatory iodization of salt. METHODS Two identical cross-sectional population studies were performed before (Cohort 1 (C1), year 1997-1998, n = 4649, median urinary iodine 61 μg/l) and 4-5 years after (Cohort 2 (C2), year 2004-2005, n = 3570, median urinary iodine 101 μg/l) mandatory iodine fortification of salt was implemented in Denmark. Blood tests were analysed for TPO-Ab and Tg-Ab using sensitive assays. RESULTS Antibodies were more frequent in C2 than in C1: TPO-Ab > 30 U/ml, C1 vs C2: 14·3 vs 23·8% (P < 0·001) and Tg-Ab > 20 U/ml, C1 vs C2: 13·7 vs 19·9% (P < 0·001). The C2 vs C1 effect was confirmed in multivariate regression models (C1 reference): TPO-Ab: OR (95% CI): 1·80 (1·59-2·04) and Tg-Ab: 1·49 (1·31-1·69). The increase in the frequency of thyroid antibodies was most pronounced in young women and especially observed at low concentrations of antibodies. CONCLUSION The prevalence of both TPO-Ab and Tg-Ab was higher 4-5 years after a cautious iodine fortification of salt was introduced in Denmark. The increase was most pronounced in young women and in the low concentrations of antibody. Further studies are needed to evaluate the long-term effects of increased iodine intake on thyroid autoimmunity in the population.
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Affiliation(s)
- Inge B Pedersen
- Department of Endocrinology and Medicine, Aalborg Hospital, Aarhus University Hospital, AalborgEndocrine Unit, Medical Clinic I, Bispebjerg Hospital, CopenhagenResearch Centre for Prevention and Health, Glostrup University Hospital, GlostrupFaculty of Health Science, University of Copenhagen, CopenhagenDepartment of Gastroenterology, Slagelse Hospital, SlagelseDivision of Nutrition, National Food Institute, Copenhagen, Denmark
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Lahad A. Low influenza vaccination rate over the age of 65: should we increase the pressure on medical teams? Isr Med Assoc J 2011; 13:366-367. [PMID: 21809736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Carmel R. Mandatory fortification of the food supply with cobalamin: an idea whose time has not yet come. J Inherit Metab Dis 2011; 34:67-73. [PMID: 20577903 PMCID: PMC3026896 DOI: 10.1007/s10545-010-9150-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/24/2010] [Accepted: 06/02/2010] [Indexed: 12/25/2022]
Abstract
The success of folic acid fortification has generated consideration of similar fortification with cobalamin for its own sake but more so to mitigate possible neurologic risks from increased folate intake by cobalamin-deficient persons. However, the folate model itself, the success of which was predicted by successful clinical trials and the known favorable facts of high folic acid bioavailability and the infrequency of folate malabsorption, may not apply to cobalamin fortification. Cobalamin bioavailability is more restricted than folic acid and is unfortunately poorest in persons deficient in cobalamin. Moreover, clinical trials to demonstrate actual health benefits of relevant oral doses have not yet been done in persons with mild subclinical deficiency, who are the only practical targets of cobalamin fortification because >94% of persons with clinically overt cobalamin deficiency have severe malabsorption and therefore cannot respond to normal fortification doses. However, it is only in the severely malabsorptive disorders, such as pernicious anemia, not subclinical deficiency, that neurologic deterioration following folic acid therapy has been described to date. It is still unknown whether mild deficiency states, which usually arise from normal absorption or only food-bound cobalamin malabsorption, have real health consequences or how often they progress to overt clinical cobalamin deficiency. Reports of cognitive or other risks in the common subclinical deficiency state, although worrisome, have been inconsistent. Moreover, their observational nature proved neither causative connections nor documented health benefits. Extensive work, especially randomized clinical trials, must be done before mandatory dietary intervention on a national scale can be justified.
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Affiliation(s)
- Ralph Carmel
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, 11215, USA.
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Grinshpoon A, Khawaled R, Polakiewicz J, Appelbaum PS, Ponizovsky AM. Psychiatric hospitalization by court observation order in Israel: a ten year follow up study. Isr J Psychiatry Relat Sci 2011; 48:201-206. [PMID: 22141145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To explore the proportion of defendants hospitalized by court observation order (COO) who were diagnosed as having a psychiatric disorder during: 1) the COO period, or 2) a 10-year follow-up period. METHODS Data on all adult defendants, who underwent psychiatric hospitalization by COO between 1991 and 1995, were extracted from the National Psychiatric Case Registry of the Israel Ministry of Health, and rehospitalizations over the next ten years were identified. ANO VA and Wilcoxon signed-rank test were used for comparing the diagnosed and undiagnosed defendant cohorts. RESULTS Only 17% of defendants hospitalized by COO received a psychiatric diagnosis (N=316), while the remaining referred defendants (N=1,532) were not diagnosed as suffering from any psychiatric disorder. Although 56% of the initially undiagnosed group (N=863) were rehospitalized and received a psychiatric diagnosis during the next ten years, 36% of the original cohort never received a diagnosis subsequent to hospitalization (N=556). Significant median differences in inpatient days associated with a follow-up diagnosis of psychotic disorder were found between the diagnosed and undiagnosed defendant cohorts (z=4.89, p less than .001). CONCLUSIONS The high rate of diagnosis of defendants who were undiagnosed at the index hospitalization suggests that the COO is ineffective and tends to discharge without diagnosis defendants who are later found to be psychotic. Therefore, an independent examination of the accuracy of the forensic psychiatric evaluation (FPE) process is called for, to determine whether actual disorders are being missed. There should be a professional and public debate on the unnecessary use of court-ordered hospitalizations and ways of their prevention.
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Dempsey AF, Mendez D. Examining future adolescent human papillomavirus vaccine uptake, with and without a school mandate. J Adolesc Health 2010; 47:242-8, 248.e1-248.e6. [PMID: 20708562 PMCID: PMC2923402 DOI: 10.1016/j.jadohealth.2009.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/07/2009] [Accepted: 12/08/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a model of adolescent (HPV) human papillomavirus vaccine utilization that explored future HPV vaccination rates, with and without a school mandate, for the vaccine at middle school entry. METHODS A dynamic, population-based, compartmental model was developed that estimated over a 50-year time horizon HPV vaccine uptake among female adolescents living in the United States. The model incorporated data on parental attitudes about this vaccine and adolescent health care utilization levels. RESULTS Without a mandate, our model predicted that 70% coverage, a lower threshold value used in many previous modeling studies of HPV vaccination, would not be achieved until a mean of 23 years after vaccine availability. Maximal coverage of 79% was achieved after 50 years. With a school mandate in place, utilization increased substantially, with 70% vaccination coverage achieved by year 8 and maximal vaccination coverage, 90%, achieved by year 43. CONCLUSIONS Our results suggest that vaccine utilization is likely to be low for several years, though strong school mandates might improve HPV vaccine uptake. These results affect the interpretation of previous modeling studies that estimated the potential clinical effects of HPV vaccination under assumptions of very high vaccine utilization rates.
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Affiliation(s)
- Amanda F Dempsey
- Department of Pediatrics, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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Gagnière B, Le Goff-Mevel D, Marquis M, Guillois-Bécel Y, Mari C, Le Goas A, Salomon J. [Epidemiology of tuberculosis in French Brittany: cases notified between 2000 and 2007]. Med Mal Infect 2010; 41:33-7. [PMID: 20537476 DOI: 10.1016/j.medmal.2010.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 03/01/2010] [Accepted: 04/21/2010] [Indexed: 11/16/2022]
Abstract
The authors studied the reported cases of tuberculosis diseases in Brittany between 2000 and 2007 via the mandatory notification scheme. One thousand nine hundred and seventy-five cases were notified during the study period. The incidence in French Brittany (eight cases per 100,000) was the third highest in France. A statistically significant negative trend was observed later, mainly attributable to a decrease between 2000 and 2001. The mean patient age at notification was 55 in Brittany versus 46 years of age for the rest of France (p<0.001). Eighty per cent of the patients were born in France versus 46% for the rest of the country. The rate of multiresistance to antibiotics was 1.3% versus 4.6% for the rest of France (p<0.001). The estimated completeness of notification was 80% compared to 70% for the whole country. Despite a decrease of tuberculosis incidence in Brittany, the withdrawal of mandatory vaccination suggests strengthening tuberculosis monitoring in the future.
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Affiliation(s)
- B Gagnière
- Cellule interrégionale d'épidémiologie (Cire) Ouest, institut de veille sanitaire, Drass de Bretagne, 20 rue d'Isly, Rennes, France.
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Babcock HM, Gemeinhart N, Jones M, Dunagan WC, Woeltje KF. Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice. Clin Infect Dis 2010; 50:459-64. [PMID: 20064039 DOI: 10.1086/650752] [Citation(s) in RCA: 223] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hilary M Babcock
- Washington University School of Medicine, St Louis, MO 63110, USA.
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Carmena D, Benito-Pérez de Mendiola A, Sánchez-Serrano LP. Reporting of human cystic echinococcosis in Spain: how effective is the epidemiological surveillance system? Enferm Infecc Microbiol Clin 2009; 28:135-6. [PMID: 19664862 DOI: 10.1016/j.eimc.2009.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 03/22/2009] [Accepted: 03/23/2009] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To describe ethics consultations at a single institution that has a mandatory ethics consultation policy. PATIENTS AND METHODS We retrospectively reviewed the medical records of all adult patients who were admitted to the intensive care unit at Columbia University Medical Center and had an ethics consultation between August 1, 2006, and July 31, 2007. All mandatory and nonmandatory ethics consultations were reviewed. Patient diagnosis, prognosis, presence of do-not-resuscitate order, presence of written advance directives, reason for the ethics consultation, and survival data were collected. The number of ethics consultations hospital-wide from January 1, 2000, to December 31, 2007, was collected. RESULTS The total number of mandatory and nonmandatory ethics consultations requested was 168. Of these consultations, 108 (64%) were considered mandatory, and 60 (36%) were considered nonmandatory. Between January 1, 2000, and December 31, 2007, the total number of ethics consultations increased 84%. CONCLUSION The increase in the total number of ethics consultations is interpreted as a positive outcome of the mandatory policy. The mandatory ethics consultation policy has possibly increased exposure to ethics consultant-physician interactions, increased learning for physicians, and raised awareness among physicians and nurses of potential ethics assistance.
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Affiliation(s)
- Megan E Romano
- Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
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Brooks T. Anti-vaccine legislation threatens immunity. J Miss State Med Assoc 2009; 50:23-24. [PMID: 19297942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ferro A, Cinquetti S, Menegon T, Napoletano G, Bertoncello L, Valsecchi M. [Overcoming mandatory vaccination policy: first steps]. Ann Ig 2008; 20:3-8. [PMID: 18773598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Steps toward overcoming mandatory vaccination policy follow two main tracks: scientific and administrative. Scientific course checks starting conditions of the project in Veneto Region and monitors the effects of policy. Thanks to sensibilization regional programs and partecipation to national campaigns of vaccination, Veneto Region has achieved high coverage for all actively promoted vaccinations. Specific projects has been implemented in order to improve vaccination system quality, particularly with regard to infectious diseases and vaccine adverse events surveillance, training workers and informatization. On 23rd March 2007 Veneto Region passed the regional law number 7 called "Sospensione dell'obbligo vaccinale per l'età evolutiva" becoming in force for children born since January 1st 2008. The law provides for the institution of a scientific committee having the task of monitoring both vaccination coverage and preventable infectious diseases incidence after overcoming mandatory vaccination policy.
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Affiliation(s)
- A Ferro
- Servizio Sanità Pubblica e Screening, Direzione Prevenzione, Regione del Veneto, Venezia.
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Abstract
TOPIC Intimate partner violence continues to be a confounding national health problem, especially for women and children. Certified batterers' intervention programs are one means currently being used to combat intimate partner violence. METHOD Existential phenomenology was utilized in this qualitative study to gain an understanding of the perceptions of the perpetrator prior to beginning a batterer intervention program. FINDINGS The batterer's experience is divided into two major themes: lack of justification of behaviors toward him and minimization and justification of his behaviors toward the victim and others. CONCLUSIONS It is hoped that obtaining this understanding will encourage program personnel working in the area of batterers' intervention programs to include more emotional skills training within such programs, thus improving the quality of life for victims, perpetrators, and their families.
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McMillan GP, Timken DS, Lapidus J, C'de Baca J, Lapham SC, McNeal M. Underdiagnosis of comorbid mental illness in repeat DUI offenders mandated to treatment. J Subst Abuse Treat 2007; 34:320-5. [PMID: 17614243 PMCID: PMC2359227 DOI: 10.1016/j.jsat.2007.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/09/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
Repeat offenders for DUI are routinely mandated to undergo alcohol treatment. These individuals have been shown to have high rates of co-occurring psychiatric disorders, which can be important for the conduct and outcomes of alcohol treatment. The extent to which treatment providers are aware of these disorders and modify treatment accordingly is unknown. As part of a larger study to investigate the impact of sanction conditions on probation outcomes, we screened 233 patients for psychiatric conditions and compared the findings with the psychiatric conditions identified during mandatory treatment by independent treatment providers. Adjusted rates of underdiagnosis were commonly high: 97.2% of bipolar disorder cases, 67.5% of major depression cases, 100% of obsessive-compulsive disorder cases, and 37.3% of drug use disorder cases remained undiagnosed during treatment. Rates of overdiagnosis were low for all disorders, with the exception of drug use disorders. These rates of underdiagnosis represent missed opportunities to improve treatment outcomes among repeat DUI offenders.
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Affiliation(s)
- Garnett P McMillan
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM 87102, USA.
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Vere-Jones E. Gaps in the training picture. Nurs Times 2006; 102:18-9. [PMID: 16903298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Landers MR, McWhorter JW, Krum LL, Glovinsky D. Mandatory continuing education in physical therapy: survey of physical therapists in states with and states without a mandate. Phys Ther 2005. [PMID: 16117597 DOI: 10.1093/ptj/85.9.861] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND PURPOSE Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. SUBJECTS AND METHODS A survey questionnaire was sent to 3,000 physical therapists in 7 states--1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. RESULTS Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. DISCUSSION AND CONCLUSION Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists.
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Affiliation(s)
- Merrill R Landers
- Department of Physical Therapy, School of Health and Human Sciences, University of Nevada, Las Vegas, 4505 Maryland Pkwy, Box 453029, Las Vegas, NV 89154-3029, USA.
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Abstract
BACKGROUND Understanding the impacts of Medicaid managed care on pregnant women is critical because Medicaid covers more than a third of all births nationally, many under managed care arrangements. OBJECTIVES We sought to examine the impacts of mandatory Health Maintenance Organization (HMO) enrollment on prenatal care use, smoking, and birth weight for Medicaid-covered pregnant women in Ohio. RESEARCH DESIGN Impact estimates are derived from a pre-post design with a comparison group, using Ohio birth certificate data linked to Medicaid enrollment files. Between April 1993 and April 1995 is the baseline period and October 1997 to June 1998 is the post-period. The treatment group consists of deliveries in 6 counties that implemented mandatory HMO enrollment in the mid 1990s; the comparison group consists of deliveries in 4 counties with voluntary HMO enrollment. SUBJECTS Medicaid-covered deliveries to 24,799 non-Hispanic white women with no college education living in Ohio. MEASURES Seven outcomes are analyzed: first trimester care; last trimester or no care; adequate prenatal care; inadequate prenatal care; smoking during pregnancy; and birth weight. RESULTS Our findings indicate that mandatory HMO enrollment in Ohio's Medicaid program had positive effects on prenatal care and led to reductions in maternal smoking. No effects were found on birth weight. CONCLUSIONS Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.
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Abstract
OBJECTIVE We sought to explore how mandatory Medicaid managed care programs affect access to care and use among full-year Medicaid beneficiaries not receiving SSI or Medicare. RESEARCH DESIGN We used data from the 1997 and 1999 National Survey of America's Families. To establish what Medicaid beneficiaries' access and use would have been in the absence of Medicaid managed care (MMC) and to control for unobserved county differences, we estimated difference-in-difference models using a comparison group of privately insured individuals who we would not expect to be affected by MMC. RESULTS We found weaker effects of MMC programs for children than adults. The strongest result is that mandatory HMO programs lower the probability of Medicaid adults using emergency rooms, when implemented alone or in combination with Primary Care Case Management (PCCM) programs. PCCM programs reduced the number of visits among adults but had little effect on other measures of access and use. There was less preventive care in mandatory HMO counties for women, suggesting that the federally required external quality review may be appropriate. CONCLUSION The effects of Medicaid managed care vary with the type of program, and policy makers should not expect programs that rely on PCCMs to have the same effects as those that incorporate mandatory HMO enrollment. Moreover, none of the program models had strong and consistent effects across the indicators of access and use that we considered.
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Affiliation(s)
- Bowen Garrett
- Health Policy Center, The Urban Institute, Washington, DC 20037, USA.
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McCartt AT, Geary LL, Solomon MG. Requiring belt use as part of a school parking permit program: does it increase students' belt use? Traffic Inj Prev 2005; 6:120-6. [PMID: 16019397 DOI: 10.1080/15389580590931581] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Teenagers have very high motor vehicle crash rates, and their use of seat belts is generally lower than that of adults. A potential school-based strategy to increase teenagers' belt use is a policy making parking privileges contingent on belt use by student drivers and their passengers. This study evaluated the effects of implementing a school belt policy. METHODS The effects of a belt policy were evaluated during the 2003-2004 school year at high schools in two states: Connecticut, a state with a primary enforcement belt law and high belt use rates, and Mississippi, a state with a secondary enforcement law and generally low use rates. Both schools enforced the policy, and violations resulted in a graduated set of penalties leading to the potential loss of parking privileges. Baseline and post-policy belt use rates were obtained from observation surveys of student drivers and their teenage passengers coming to and from school. Changes in belt use were examined relative to belt use trends at comparison schools without a belt policy. Implementation of the policies also was monitored. RESULTS In Mississippi, among students arriving at school in the morning, driver belt use increased from 42% before the policy to 67% about 6 months after; passenger belt use increased from 16% to 61%, although sample sizes were small. These increases were significantly larger than expected, based on belt use trends at the comparison school in Mississippi. In Connecticut, where 86% of drivers and 79% of their passengers already were belted prior to the policy, there was no significant change. Both schools publicized and monitored the belt policy, and most enforcement occurred in the morning as students arrived at school. CONCLUSIONS Based on a small-scale application of a belt policy at two schools in different states, a school belt policy may have stronger effects in states where belt use is low. Strong penalties and enforcement are essential elements of an effective policy. Adequate resources and commitment are needed for schools to implement and monitor the type of strong policy needed to sustain high belt use rates. Replication of this study in additional schools appears warranted.
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Affiliation(s)
- Anne T McCartt
- Insurance Institute for Highway Safety, Arlington, Virginia, USA.
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Trujillo AJ. Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia. Health Econ 2003; 12:231-246. [PMID: 12605467 DOI: 10.1002/hec.711] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper studies the relationship between health status and insurance participation, and between insurance status and medical use in the context of a social health insurance with an equalization fund (SHIEF). Under this system, revenues from a mandatory payroll tax are collected into a single pool (equalization fund) that reimburses for-profit insurance companies according to a capitated formula. Although competition should induce insurers to control costs without reducing the quality of service necessary to attract consumers, limitations in the capitation formula might induce insurers to select against bad risks, and limitations in the contribution system might induce more healthy individuals to evade enrollment. A three-equation model having social health insurance, private health insurance, and using medical services is estimated using a 1997 Colombian household survey. Consistent with similar studies, participation in SHIEF increases medical care use. On the other hand, the evidence on selection is somewhat mixed: individuals who report good health status are more likely to participate in SHIEF, while those without a chronic condition are less likely to participate in SHIEF.
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Affiliation(s)
- Antonio J Trujillo
- College of Health and Public Affairs, University of Central Florida, USA.
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Harris J, Best D, Gossop M, Marshall J, Man LH, Manning V, Strang J. Prior Alcoholics Anonymous (AA) affiliation and the acceptability of the Twelve Steps to patients entering UK statutory addiction treatment. J Stud Alcohol 2003; 64:257-61. [PMID: 12713200 DOI: 10.15288/jsa.2003.64.257] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study investigates levels of affiliation with AA and beliefs about the organization and its philosophy among a cohort of alcoholics entering a UK (non-AA) alcohol treatment service. METHOD A total of 150 consecutive admissions (75% men) were interviewed by an independent researcher within 5 days of their entry into a residential alcohol treatment unit. RESULTS Although about three quarters of these patients had previously attended AA meetings, levels of affiliation were low, with only 16% having worked any of the Twelve Steps. Previous AA attenders were more likely to be older, drinking greater daily quantities prior to treatment and to have first sought alcohol treatment at a younger age. Roughly equal groups expressed "positive," "neutral" and "negative" current attitudes towards AA (38%, 36% and 26%, respectively). Each of these three AA-attitude groups expressed greater endorsement of "Personal Responsibility" steps than of "Higher Power mediated" steps. CONCLUSIONS Few participants were universally negative to AA or the Twelve Steps--most regarded some of the steps as positive, but many rejected those referring to a Higher Power. Most also regarded some aspects of the organization and its philosophy worthwhile, with attitudes spread across the continuum of opinion. As AA remains one of the most widely sought forms of help for alcohol problems, a clearer understanding is needed of its impact on patients and the appropriateness of its integration within substance misuse programs which are not explicitly Twelve Step in orientation.
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Affiliation(s)
- Jennifer Harris
- National Addiction Centre/Institute of Psychiatry, South London and Maudsley NHS Trust, Denmark Hill, London, England
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