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1.
J Pediatr Psychol ; 25(8): 557-66, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11085759

RESUMO

OBJECTIVE: To assess age differences in children's beliefs about the long-term health effects of alcohol and cocaine, to use such beliefs to predict attitudes toward and intentions to use these substances, and to establish whether accurate beliefs are more predictive than inaccurate ones. METHODS: Children ages 6 to 12 (N: = 217) responded to an open-ended question about the effects of long-term alcohol and cocaine use and to 12 structured questions asking whether each produces alcohol-like, cocaine-like, and tobacco-like effects. RESULTS: Differentiation among alcohol, cocaine, and tobacco effects was limited but increased with age. Beliefs about health effects had no impact on alcohol attitudes and intentions, but intentions to drink were stronger among older and white children. Anti-cocaine attitudes and intentions were associated with being older and non-White and with having accurate knowledge of cocaine's true health effects-but also with believing falsely that cocaine has tobacco-like effects and that drugs in general have catastrophic effects. CONCLUSIONS: With age, and as predicted by Werner's orthogenetic principle, children differentiated more sharply between substances. Although negative misconceptions can contribute to anti-drug attitudes and intentions, children should nonetheless be taught about the distinct effects of different substances on health.


Assuntos
Consumo de Bebidas Alcoólicas , Atitude Frente a Saúde , Comportamento Infantil/psicologia , Transtornos Relacionados ao Uso de Cocaína , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Transtornos Relacionados ao Uso de Cocaína/prevenção & controle , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
2.
Health Serv Res ; 34(4): 879-900, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10536975

RESUMO

OBJECTIVE: To assess the impact of insurance status on access to kidney transplantation among California dialysis patients. STUDY SETTING: California Medicare and Medicaid dialysis populations. STUDY DESIGN: All California ESRD dialysis patients under age 65 eligible for Medicare or Medicaid in 1991 (n = 9,102) took part in this cohort analytic study. DATA COLLECTION: Medicare and California Medicaid Program data were matched to the Organ Procurement and Transplantation Network Kidney Wait List files. PRINCIPAL FINDINGS: Only 31.4 percent of California Medicaid dialysis patients were placed on the kidney transplant waiting list compared to 38.8 percent and 45.0 percent of dually eligible Medicate/Medicaid and Medicare patients, respectively. Compared to the Medicaid population, Medicare enrollees were more likely to be placed on the kidney transplant waiting list (adjusted Relative Risk [RR] = 2.10, Confidence Interval [CI] 1.68, 2.62) as were dually eligible patients (RR = 1.54, CI 1.24, 1.91). Once on the waiting list, however, Medicare enrollment did not influence the adjusted median waiting time to acquire a first cadaveric transplant (p > .05). CONCLUSIONS: California dialysis patients excluded from Medicare coverage, who are disproportionately minority, female, and poor, are much less likely to enter the U.S. transplant system. We hypothesize that patient concerns with potential subsequent loss of insurance coverage as well as cultural and educational barriers are possible explanatory factors. Once in the system, however, insurance status does not influence receipt of a cadaveric renal transplant.


Assuntos
Acessibilidade aos Serviços de Saúde/economia , Transplante de Rim/estatística & dados numéricos , Medicaid , Medicare , Listas de Espera , Adolescente , Adulto , Viés , Cadáver , California , Estudos de Coortes , Feminino , Humanos , Renda , Cobertura do Seguro , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Transplante de Rim/economia , Masculino , Pessoa de Meia-Idade , Pobreza , Diálise Renal , Estados Unidos
3.
J Allergy Clin Immunol ; 103(3 Pt 1): 401-7, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10069872

RESUMO

BACKGROUND: Previous estimates of the national economic burden of allergic rhinoconjunctivitis (AR/AC) have relied on data analyses in which AR/AC was the primary International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM)-coded diagnosis. These studies ignore the costs when AR/AC was a secondary diagnosis to other disorders such as asthma and sinusitis. OBJECTIVE: We sought to determine the national direct cost of illness for AR/AC. METHODS: An expert panel used the Delphi technique to estimate the proportion of visits coded by other primary ICD-9-CM diagnoses in which AR/AC was a significant secondary comorbid condition. The costs of this proportion were deemed to be "attributable" to AR/AC and were added to the costs when allergic rhinitis and allergic conjunctivitis were the primary diagnoses. RESULTS: The cost when AR/AC was the primary diagnosis was $1.9 billion (in 1996 dollars). The cost when AR/AC was a secondary diagnosis was estimated at $4.0 billion, giving an estimate of $5.9 billion for the overall direct medical expenditures attributable to AR/AC. Outpatient services (63%, $3.7 billion), medications (25%, $1.5 billion), and inpatient services (12%, $0.7 billion) accounted for the expenditures. Children 12 years and younger accounted for $2.3 billion (38.0%). CONCLUSION: Upper airway allergy is an expensive disease process because of its readily apparent manifestations as AR/AC and its contribution to other airway disorders.


Assuntos
Conjuntivite Alérgica/economia , Efeitos Psicossociais da Doença , Rinite Alérgica Perene/economia , Adulto , Criança , Comorbidade , Conjuntivite Alérgica/epidemiologia , Conjuntivite Alérgica/imunologia , Conjuntivite Alérgica/terapia , Técnica Delphi , Custos de Medicamentos , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Pacientes Internados , Masculino , Pacientes Ambulatoriais , Rinite Alérgica Perene/epidemiologia , Rinite Alérgica Perene/imunologia , Rinite Alérgica Perene/terapia , Estados Unidos/epidemiologia
4.
J Allergy Clin Immunol ; 103(3 Pt 1): 408-14, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10069873

RESUMO

BACKGROUND: There have been no recent assessments of the economic burden of sinusitis in the peer-reviewed literature. OBJECTIVE: We sought to estimate the 1996 total direct health care expenditures for the treatment of sinusitis. METHODS: This study determined (1) direct expenditures of medical and surgical encounters in which sinusitis was the primary diagnosis and (2) attributable expenditures when related airway diseases were the primary diagnosis and sinusitis was a comorbid condition. An expert panel used the Delphi consensus-building technique to determine the proportions for the latter. RESULTS: Overall health care expenditures attributable to sinusitis in 1996 were estimated at $5.8 billion, of which $1.8 billion (30.6%) was for children 12 years or younger. A primary diagnosis of acute or chronic sinusitis accounted for 58.7% of all expenditures ($3.5 billion). About 12% each of the costs for asthma and chronic otitis media and eustachian tube disorders were attributed to diagnosis and treatment of comorbid sinusitis. Nearly 90% of all expenditures ($5.1 billion) were associated with ambulatory or emergency department services. CONCLUSION: The economic burden of sinusitis in the United States is significant. However, the limitations of this type of evaluation suggest the $5.8 billion amount may be an underestimate of the true direct costs.


Assuntos
Efeitos Psicossociais da Doença , Sinusite/economia , Adulto , Asma/economia , Asma/epidemiologia , Criança , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Pólipos Nasais/economia , Pólipos Nasais/epidemiologia , Otite Média/economia , Otite Média/epidemiologia , Transtornos Respiratórios/economia , Transtornos Respiratórios/epidemiologia , Rinite/economia , Rinite/epidemiologia , Sinusite/epidemiologia , Estados Unidos/epidemiologia
5.
Med Care ; 36(5): 646-60, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9596056

RESUMO

OBJECTIVES: In February 1994, an National Institutes of Health (NIH) Consensus Development Conference panel unequivocally recommended antimicrobial therapy to eradicate Helicobacter pylori in the treatment of peptic ulcer disease. The goal of this study was to determine if these recommendations resulted in a change in physician prescribing among an underserved population. METHODS: Computerized Pennsylvania Medicaid data from January 1993 through February 1996 were used to evaluate prescribing patterns in the year before and 2 years after the NIH conference. An interrupted time series model, based on 12,737 outpatient peptic ulcer disease encounters, assessed the impact of the conference in influencing physician prescribing. RESULTS: The prescription of antimicrobial agents for the treatment of peptic ulcer disease significantly increased across the study period, from 6.5% in January 1993 to 10.2% in February 1996. Similarly, the prescription rate for the proton pump inhibitor, omeprazole, significantly increased from 9.4% in January 1993 to 25.6% in February 1996. Neither trend, however, could be attributed to the NIH Consensus Development Conference. Stratification by physician specialty, ulcer type, nonsteroidal anti-inflammatory drug use, and patient demographics did not affect these results. The traditional treatment approach, using H2-receptor antagonists, remained the preferred pharmacotherapy (72% of all prescriptions). CONCLUSIONS: Two years after the highly publicized NIH conference on the eradication of Helicobacter pylori, antimicrobial agents were not widely prescribed among the Pennsylvania Medicaid population. In treating this underserved population, physicians do not appear to be using recommendations developed by an NIH expert panel based on recent scientific advances.


Assuntos
Antiulcerosos/uso terapêutico , Conferências para Desenvolvimento de Consenso de NIH como Assunto , Prescrições de Medicamentos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Medicaid/estatística & dados numéricos , Úlcera Péptica/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Coortes , Feminino , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/uso terapêutico , Pennsylvania , Úlcera Péptica/microbiologia , Inibidores da Bomba de Prótons , Estados Unidos
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