Supply and segregation of nursing home beds in Chicago communities.

OBJECTIVE: Previous research suggests that a shortage of nursing home beds in Latino communities and segregation within facilities in urban settings may contribute to low utilization patterns that both Latino and African American elders exhibit. In order to explore structural barriers to nursing home care for African American and Latino families, this study examines the supply and ethnoracial composition of nursing homes in Chicago communities. DESIGN: With data from the 1990 US Census of Population and Illinois' 1994 Long-Term Care Facility Survey, regression was used to determine if Latino nursing home residents in Chicago follow neighborhood residential patterns in the same way that African American nursing home residents do. Next the availability of nursing home beds by ethnoracial community is examined using analysis of variance. Finally, we present correlations between the racial/ethnic composition of Chicago's facilities, community demographics and facility characteristics that have been associated with quality outcomes. RESULTS: Both African American and Latino nursing home residents follow residential housing patterns, tending to reside in facilities located in their own communities. Latino communities have the fewest beds. However, Latinos appear to be more mobile in their utilization of nursing facilities in other communities than either African Americans or whites and tend to reside in smaller homes with fewer Medicaid recipients. CONCLUSION: Health policy makers must actively address racial and ethnic differences in access to long-term care or risk reinforcing the effects of poverty and segregation. In order to ensure that Latino elders living alone are not going without needed care city leaders must promote a range of culturally sensitive alternatives to nursing home care within Latino communities while promoting geographic mobility for African Americans.

Concentrated poverty and nursing home bed supply in Chicago.

This study explores whether poverty areas of Chicago have fewer nursing home beds and unique staffing patterns. Using 1990 census data and Illinois's 1994 Long-Term Care Facility Survey, census tracts were compared by need for long-term care, bed supply, and nursing home characteristics. While facilities cluster on the north side, and the number of beds follow the elderly, the supply of beds per elderly is actually greater in tracts with high proportions of poverty, disability, and African American residents due, in part, to the predominance of larger facilities. Ironically, economic segregation may work together with Medicaid's policy of serving the poorest to increase the supply of beds to those who might otherwise remain unserved. Nursing homes in the poorest communities have high percentages of Medicaid residents, are larger, and employ fewer staff per resident; homes with a high Medicaid population are more likely to employ LPNs, which may reflect labor supply differences.

African-American mothers' perception of their residential environment, stressful life events, and very low birthweight.

We performed a hospital-based case-control study of African-American mothers to explore the relation between a mother's perception of her own residential environment and very low birthweight. We administered a structured questionnaire to mothers of very-low-birthweight (<1,500 gm; N = 28) and critically ill non-low-birthweight (>2,500 gm; N = 52) infants. The groups had similar sociodemographic characteristics. The vast majority of participants were unmarried and had no private medical insurance. The odds ratios of very low birthweight fluctuated between 1.7 and 3.2 for African-American mothers who rated their neighborhoods (in terms of police protection, protection of property, personal safety, friendliness, delivery of municipal services, cleanliness, quietness, and schools) unfavorably. Additionally, the odds ratio of very low birthweight for mothers exposed to three or more stressful life events during pregnancy was 3.1 (95% confidence interval = 1.2-8.2). We conclude that African-American mothers' perception of their residential environment and frequency of stressful life events are associated with very low birthweight in their infants.

Effect of dexamethasone therapy on the neonatal ductus arteriosus.

Patent ductus arteriosus (PDA) is believed to be a contributing factor in the etiopathogenesis of bronchopulmonary dysplasia (BPD). We studied the effects of early dexamethasone therapy on persistent ductal patency and the role of PDA in the etiopathogenesis of BPD during the course of a randomized double-blind trial of dexamethasone to prevent BPD. Infants, who weighed between 700 and 999 g, had severe RDS, and had been given surfactant, were randomized to receive a 12-day course of dexamethasone (n = 13) or placebo (n = 17) starting within the first 12 hours of postnatal life. The diagnosis of PDA was made clinically and was confirmed by cardiac ultrasound. The incidence of clinically significant ductus in infants who weighed less than 1000 g was 23% in the dexamethasone-treated group, as compared with 59% in infants who were given placebo. This difference was marginally significant, p = 0.05, odds ratio 0.21, 95% confidence interval 0.04-1.05. None of the infants in the dexamethasone group had recurrence of PDA after indomethacin therapy as compared with three infants in the placebo group. Dexamethasone significantly reduced the number of days infants required ventilator and supplemental oxygen as compared with infants who received placebo. Dexamethasone, as compared with placebo, also reduced the incidence of BPD, p = 0.025, odds ratio 0.08, 95% confidence interval 0.01-0.58. Dexamethasone may reduce the incidence of PDA in premature infants who weigh less than 1000 g at birth and thereby reduce the incidence of BPD.

A prospective randomized trial of feeding methods in very low birth weight infants.

OBJECTIVE: To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage (CNG) would achieve full enteral feedings (100 kcal/kg/d) at an earlier postnatal age and have less feeding intolerance (FI) than infants fed by intermittent bolus gavage (IBG). METHODS: Eighty infants were stratified by birth weight (700 to 1000 g and 1001 to 1250 g) and randomized into CNG or IBG feeding groups. CNG infants were comparable with IBG in birth weight, gestational age, sex, race, and day of onset of feeding (5.7 +/- 2.1 days vs 5.6 +/- 2.2 days, respectively). Feedings were given as undiluted Similac Special Care formula (Ross Laboratories, Columbus, OH) via a specific protocol designed for each 50 to 100 g birth weight category. Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached. An infant whose feedings were withheld for >12 hours based on predetermined criteria was considered to have an episode of FI. RESULTS: Infants in the CNG group reached full enteral feeding at 17.1 +/- 8.9 days compared with 15.5 +/- 5.5 days in the IBG group; these were not statistically different. Secondary outcome variables such as days to regain birth weight (CNG, 12.6 +/- 5 days vs IBG, 12.5 +/- 3.7 days), days to reach discharge weight of 2040 g (CNG, 60 +/- 13.4 days vs IBG, 62 +/- 13.6 days), and number of episodes of FI were not significantly different between feeding methods. FI was primarily associated with birth weight

Laboratorios de control de calidad. Diagrama de organización

Dentro del diagrama se presentan: Sector aguas y Sector cloacales, residuales industriales y medio ambiente con las actividades que se realizan en los mismos. Adjuntan listas con: Referencias y actividades; Firmas y organizaciones que tienen los servicios analíticos que realiza la Institución

Agua de los Andes S.A. de organismo público a sociedad anómina

Se analiza en sus aspectos institucionales, jurídicos y gerenciales la concreción del proceso de transformación de la ex Dirección Provincial de Agua Potable y Saneamiento de Jujuy en una sociedad anónima constituida en el marco de la Ley de Sociedades Privadas y cuyos socios son hoy el Estado Provincial de Jujuy y los trabajadores de la Ex DAPSJ. Incluye descripción analítica de antecedentes y profundiza en las restricciones políticas y humanas propias de toda transformación hasta evolucionar a una empresa de gestión privada en un proceso inédito en la Argentina

Indicadores de contaminación enterococos vs. coliformes totales

Se presenta una recopilación de resultados de exámenes bacteriológicos de control de calidad de agua de procesos de tratamientos y sistemas de distribución de aguas de bebida. El trabajo corrobora que los indicadores de contaminación ideales no existen. En consecuencia puede afirmarse que la combinación de distintos parámetros indicadores de contaminación otorga mayor seguridad al control de calidad de aguas de bebida para consumo humano. Sin embargo los resultados específicos de la tarea realizada muestran que la falla de los enterococos, no acusando contaminación detectada en un 66,3 por ciento por bacterias coliforme total, señala un alto, mayor porcentaje de falsos negativos que no serían marcados por el grupo enterococos

Consequences of hospital financial distress.

This study identifies a group of financially distressed hospitals and tracks them over time to identify the consequences of their financial distress and the factors that may precipitate different events. Of 2,547 that supplied complete financial data to the American Hospital Association for the period 1983-1985, a total of 340 community hospitals met our definition for distress. The most striking finding is that 91.2 percent of hospitals that were distressed in 1983-1985 survived through the end of 1990. Distressed hospitals also had significantly higher rates of system acquisition and merger, as well as higher rates of system divesture. Growing competition in a market appeared to be a major factor in the closure of a distressed hospital. The results of this study suggest that financially distressed hospitals have a remarkable resiliency that allows them to continue operation without dramatic change. This may be good news to local community officials concerned about maintaining financially weakened hospitals. Alternatively, it may be bad news if poor financial performance is a signal of unneeded capacity.

Hospital closure: who will be at risk in the upcoming decade?

Although the number of community hospitals that close in the United States is not large in proportion to the number that remain open, hospital closure is attracting increasing attention. National trends and patterns of closure occurring over the last five years, 1980-1984, can be seen in terms of hospital bed size, control, location, period of operation, and financial characteristics. These trends indicate that those hospitals that close generally are small, urban, and investor-owned or nongovernment, not-for-profit; they have been in existence for quite some time; and have low current ratios, net to gross patient revenue ratios, and total margins.

Difference in composition of personnel among government, voluntary, and investor-owned U.S. community hospitals.

The relationship between an organization's staff structure, particularly the relative proportions of its administrators and line staff, and the organization's size, ownership status, financial condition, and scope of services is a subject that has attracted a good deal of attention from organizational theorists. At the present time, the subject is especially important to the hospital industry because of widespread concern about hospital costs and interest in how personnel expenses contribute to these costs.

Toward a better understanding of hospital occupancy rates.

This article starts out with the premise that a "uniform occupancy rate" for hospitals is not a meaningful concept because the ability of individual hospitals to maintain a certain occupancy rate consistent with a specified "protection level" depends upon several factors. These factors include hospital size, the number of nonsubstitutable patient facilities, the percent of nonurgent (elective) beds, the number of hospitals serving an area, and the relative variation (fluctuation) in the demand for services faced by the hospital. A regression analysis with observed, overall occupancy rate as the dependent variable, and measures that attempt to represent the factors just mentioned as independent variables, tends to substantiate this line of reasoning. However, inasmuch as the status of the independent variables (that is, whether or not they can be regarded as justifiable or uncontrollable) depends largely on the circumstances of each case, the regression model cannot be used as a standard-setting tool. Nonetheless, it offers valuable guidelines for hospital management, planners, and regulators in such areas of decisionmaking as the location and size of hospitals, and acceptable occupancy standards.

A spatial analysis of voting on health care issues. United States House of Representatives, 86th Congress, First Session.

This study examines the spatial patterns of congressional voting on health issues. Thirteen roll call votes on health care issues occurring during the 1st Session of the 96th Congress are factor analyzed. This analysis shows that health care questions cluster around two major issues: health care regulation and health care spending. The factor scores for each Representative are mapped, and a regression model is developed relating health care voting to characteristics of the Representative, the Congressional district, and the hospitals in that district. The most important findings were: (1) support for both health care spending and regulation is strongest in the Northeast and upper Midwest. (2) Although Representatives from most of the Southern states are opposed to health care regulation, they generally favor health care spending. (3) Representatives from a few of the Southern states, however, do not fit this generalization. (4) Although Representatives from the Pacific Coast states are the strongest proponents of regulation, they are opposed to spending (5) Opposition to health care spending is particularly strong among Representatives from suburban districts.