bluuebunny/crossref_metadata_2025 huggingface dataset:
Zileuton: The First 5-Lipoxygenase Inhibitor for the Treatment of Asthma
Authors: Wenzel Sally E , Kamada Alan K
Published: January 2017

OBJECTIVE:

To introduce and review zileuton, an orally active 5-lipoxygenase inhibitor that represents the first of a new class of medications to be used in the treatment of asthma.

DATA SOURCES:

A MEDLINE search (from 1966 to December 1995) was performed to identify pertinent English-language literature.

STUDY SELECTION:

Basic science studies on the pharmacokinetics of zileuton, its pathophysiologic effects on asthma, and clinical efficacy trials were reviewed.

DATA EXTRACTION:

Clinical trials were emphasized. Studies from ex vivo or animal models of pharmacologic and pharmacodynamic effects were considered for review where no in vivo human data were available.

DATA SYNTHESIS:

Zileuton has shown the ability to attenuate induced bronchospasm, produce some degree of bronchodilation, and provide antiinflammatory or steroid-sparing effects with both single doses (800 mg) and chronic treatment (400 and 600 mg qid). Zileuton has been studied in patients requiring daily inhaled beta-adrenergic agonist treatment; however, data from pediatric populations and comparisons with other asthma medications are limited at this time. Adverse effects include dyspepsia and elevated liver enzymes (incidence ∼3%). One case of jaundice has been reported among the more than 5000 patients treated with zileuton. There is also some concern for drug interactions with hepatically cleared medications, such as theophylline.

CONCLUSIONS:

Zileuton represents the first drug of a new treatment category for asthma, the 5-lipoxygenase inhibitors. Some people with asthma may receive considerable benefit, but as it is an entirely new drug entity, zileuton's final place in the hierarchy of asthma medications remains to be determined.
The Future of Medication Information Practice: A Consensus
Authors: Vanscoy Gordon J , Gajewski Lidia K , Tyler Linda S , Gora-Harper Mary Lea , Grant Kathy L , May J Russel
Published: January 2017

OBJECTIVE:

To analyze the current practice of drug information and develop a strategic plan for a “valued” specialty of medication information practice.

DATA SOURCES:

The Consortium for the Advancement of Medication Information, Policy, and Research (CAMIPR) met in June 1994 to initiate a strategic plan for a future of medication information practice. A multidimensional situation analysis and strategic planning process was conducted and the results are discussed.

RECOMMENDATIONS:

Trends in health care (e.g., healthcare reform, managed care) will impact the future of medication information practice, and the medication information specialist must evolve with society's values. Medication information practice must transform and attention will likely focus on medication policy research/ development and information systems. However, new skills, resources, and relationships must be developed to facilitate this evolution. In addition, interest in the practice of drug information has declined. Strategies are presented to enhance the “value” and “image” of future medication information practice.
Abuse of Prescription Medicines in Southwestern France
Authors: Baumevieille Marie , Haramburu Françoise , Bégaud Bernard
Published: January 2017

BACKGROUND:

Few quantitative data are available concerning abuse of medicine in the general population, although dependence on prescription medicines involves a significant proportion of the population. Falsified prescription forms can be used as an indicator of abuse.

METHODS:

Community pharmacists in a representative network were asked to report any falsified prescription form presented over a 1-year period. Sales data were used to express results as abuse rate and abuse rate ratio.

RESULTS:

Two-thirds of the 130 pharmacies in the network reported at least 1 falsified prescription. The reported incidence of falsified prescriptions was 2.3 per 10 000 inhabitants. A total of 392 falsified prescription forms was collected. The abuse rate ratios were 171 (95% CI 140 to 210) for dextroamphetamine–phenobarbital in combination, 168 (95% CI 131 to 216) for fenozolone, 67 (95% CI 53 to 84) for buprenorphine, and 40.5 (95% CI 33 to 50) for clobenzorex.

CONCLUSIONS:

These results show the efficiency of a method for detecting falsified prescriptions forms using community pharmacists. The abuse of medicines already known for their addictive potential can be estimated and alerts can also be detected.
Amlodipine Overdose
Authors: Stanek Eric J. , Nelson Camille E. , DeNofrio David
Published: January 2017

OBJECTIVE:

To report a nonfatal intentional overdose of amlodipine.

CASE SUMMARY:

A 42-year-old woman with a history of hypertension reported ingesting 50–100 mg amlodipine besylate and at least 40 ounces of beer in a suicide attempt. The patient's symptoms were mild; BP ranged from 79/50 to 113/76 mm Hg and HR from 92 to 129 beats/min (sinus tachycardia). Laboratory studies revealed normoglycemia, mild metabolic acidosis, mild hypocalcemia, blood ethanol concentration of 263 mmol/L, and a serum amlodipine concentration of 88 ng/mL (normal 3–11) 2.5 hours after ingestion. Therapy included activated charcoal, whole bowel irrigation, and intravenous NaCl 0.9%. After receiving 1.5 L of NaCl 0.9%, the patient developed signs of mild pulmonary edema that resolved over several hours without intervention. A serum amlodipine concentration obtained 35 hours later was 79 ng/mL. The patient was discharged on day 2 in good condition.

DISCUSSION:

In this case, an amlodipine overdose was associated with sustained hypotension and sinus tachycardia, as well as transient pulmonary edema following relatively low-volume fluid replacement. A previously published report described an amlodipine overdose that was fatal due to refractory hypotension and was complicated by concomitant oxazepam overdose.

CONCLUSIONS:

Amlodipine overdose produces prolonged hemodynamic effects and may lead to pulmonary edema. Due to a long elimination half-life and delayed onset of effects, patients with amlodipine overdose should receive aggressive decontamination therapy and may require extended clinical monitoring and supportive care if they are hemodynamically unstable.
Pharmacokinetic Evaluation of a Case of Massive Sotalol Intoxication
Authors: Gustavsson Carl Gunnar Å , Vinge Ellen , Norlander Björn O. , Pantev Emil
Published: January 2017

OBJECTIVE:

To describe serum concentrations and clearance of sotalol after a massive overdose.

CASE SUMMARY:

A 37-year-old white man took 11.2 g of sotalol hydrochloride tablets in a suicide attempt. The first serum d,l-sotalol concentration 3 hours after taking the first tablet was 20.6 mg/L and the last measured concentration 59 hours later was 1.8 mg/L. Logarithmic transformation of the concentration data indicated two separate monoexponential phases in the elimination curve, with half-lives of 30.1 and 11.6 hours.

DISCUSSION:

The shorter serum half-life in the later phase is comparable with that in four previously reported sotalol intoxications and within the normal range. The elimination rate increased in a temporal manner with an increase in systolic blood pressure about 30 hours after the patient was admitted. Since the sotalol elimination rate depends principally on renal function, we believe the initially slow elimination is due to a temporary reduction of the renal function caused by the systolic hypotension.

CONCLUSIONS:

An initial phase of slow sotalol elimination may occur after severe overdoses. In our patient this was probably due to hypotension. Thus, blood pressure should be monitored carefully.
Digoxin Toxicity Secondary to Clarithromycin Therapy
Authors: Nawarskas James J. , McCarthy David M. , Spinier Sarah A.
Published: January 2017

OBJECTIVE:

To report a case of digoxin toxicity thought to be secondary to clarithromycin therapy.

CASE SUMMARY:

A 78-year-old white woman with congestive heart failure taking digoxin 0.25 mg po qd presented to our hospital with nausea, vomiting, and diarrhea. She had taken clarithromycin 500 mg po bid for 3 days, and a serum digoxin concentration obtained the day of admission was 4.4 μg/L. An electrocardiogram (ECG) done on admission revealed ST segment changes consistent with digoxin effect and later asymptomatic, nonsustained ventricular tachycardia (NSVT). Clarithromycin was discontinued and digoxin was withheld at admission, resulting in the resolution of symptoms, ECG abnormalities, and NSVT on day 3 of hospitalization. On day 5 her serum digoxin concentration was 1.5 μg/L and digoxin therapy was reinstituted at a dose of 0.125 mg/d po.

DISCUSSION:

This is the fourth published case implicating clarithromycin as the cause of digoxin toxicity. This interaction is most likely due to clarithromycin eradication of digoxinmetabolizing gut flora, thereby increasing digoxin bioavailability.

CONCLUSIONS:

Approximately 10% of patients are thought to be extensive presystemic metabolizers of digoxin and may therefore be most susceptible to a drug interaction with clarithromycin. Serum digoxin concentrations in such patients should be monitored closely during clarithromycin therapy.
Delayed Chronic Diarrhea and Weight Loss Possibly Due to Ticlopidine Therapy
Authors: Mansoor George A. , Aziz Khalid
Published: January 2017

OBJECTIVE:

To report a case of delayed-onset chronic diarrhea, anorexia, and weight loss possibly complicating the use of ticlopidine.

CASE SUMMARY:

A 48-year-old white man presented with unremitting diarrhea associated with anorexia and marked weight loss. His history was significant for transient ischemic attack, resistant hypertension, homocystinemia, and chronic renal insufficiency. The patient had tolerated ticlopidine therapy for 2 years without problems, and there had been no changes in his drug regimen for several months. No abnormality was found on detailed digestive system evaluation and all symptoms and signs promptly resolved after ticlopidine therapy was discontinued.

DISCUSSION:

The occurrence of diarrhea early during ticlopidine therapy should make the clinician consider the drug as the most likely cause. However, the appearance of chronic diarrhea, anorexia, and weight loss years after a patient had tolerated the drug is less typical for ticlopidine. In such situations, if no other cause can be identified, cautious withdrawal of the drug should be considered. We believe that all the patient's symptoms reported here were likely due to ticlopidine.

CONCLUSIONS:

Clinicians should be aware that the gastrointestinal adverse effects of ticlopidine may surface years after therapy is begun. The cause of ticlopidine-induced diarrhea remains unknown.
Prevention of Group B Streptococcus Infection in Neonates
Authors: Logsdon Beth A. , Casto Daniel T.
Published: January 2017

OBJECTIVE:

To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention.

DATA SOURCES AND STUDY SELECTION:

MEDLINE searches (1976–1997) of the English-language literature.

DATA SYNTHESIS:

Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor.

CONCLUSIONS:

GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.
Racing to the Bottom? Foreign Investment and Air Pollution in Developing Countries
Authors: Wheeler David
Published: January 2017

Critics of free trade have raised the specter of a "race to the bottom" in which environmental standards collapse because polluters threaten to relocate to "pollution havens" in the developing world. Proponents of this view advocate high, globally uniform standards enforced by punitive trade measures that neutralize the cost advantage of would-be pollution havens. To test the race-to-the-bottom model, the author analyzes recent air quality trends in the United States and the three largest recipients of foreign investment in the developing world: China, Brazil, and Mexico. The evidence clearly contradicts the model's central prediction: The most dangerous form of air pollution has actually declined in major cities of all four countries during the era of globalization. Citing recent research, the author argues that the race-to-the-bottom model is flawed because its basic assumptions misrepresent the political economy of pollution control in developing countries.
Missing the Forest for the Profits: The Role of Multinational Corporations in the International Forest Regime
Authors: Sears Robin R. , Dávalos Liliana M. , Ferraz Gonçalo
Published: January 2017

The international community has placed great hope and invested considerable time in exploring a global forest convention through the United Nations Conference on Environment and Development's Intergovernmental Forum on Forests and the Intergovernmental Panel on Forests process under the Commission on Sustainable Development. Multinational corporations control almost 40% of the world market in forest products, constituting a major stakeholder in global forest policy. The few cases of direct intervention by multinational corporations at international fora suggest their interests are expressed elsewhere. The authors identify and discuss three types of intervention in the existing forest regime: avoidance, enforcement-driven compliance, and performance-driven compliance. The regime has not achieved performance-driven compliance from multinational corporations because the regime itself is weak and has little support from states internationally and domestically. The authors suggest that multinational corporations have been so effective at avoiding or conditioning compliance that incentives for complying fully with the regime are nil.
Environmental Policy in Transition Economies: Will Pollution Charges Work?
Authors: Söderholm Patrik
Published: January 2017

Many economists and analysts claim that extended use of pollution charges in environmental policy will have substantial efficiency advantages in transition economies. This article challenges this view and argues instead that the proposed policy presumes the existence of an already-functioning institutional framework. By focusing on the Russian case, the article discusses a number of reasons why it is difficult to implement pollution charges in an economic system in which Communist behavioral patterns and jurisdictions are still prevalent. The article identifies a number of institutional obstacles related both to enterprise behavior and to environmental regulation and enforcement. These obstacles suggest that it is appropriate to view environmental problems in transition economies primarily as the results of institutional inertia in the economic and political systems. The article ends by discussing alternative ways of controlling pollution in Russia and stresses the importance of improving the legitimacy and basic trust for environmental legislation.
Domestic Politics and International Negotiations: the Politics of Global Warming in the United States
Authors: Hatch Michael T.
Published: January 2017

The United States chose an approach to global warming that came to be viewed by much of the international community as a barrier to effective action. In explaining why, this article analyzes the interaction of the domestic political process and international negotiations. It argues that—while external pressures brought to bear through the negotiations leading up to UNCED pushed the domestic agenda on global warming—the nature of the political process, in combination with the nature of the global warming issue itself, set the general limits for U.S. participation in cooperative international arrangements to manage global warming. That is, given the broad set of interests activated by global warming concerns and the ready access those interests had to decision-making bodies through a pluralist policy process, consensus on an approach to global warming proved impossible. The U.S., unwilling to accept international commitments that obligated it to domestic actions, thwarted efforts to get an international treaty containing firm targets and timetables.
Making Foreign Aid More Relevant and Effective through a Small-Scale Producers Strategy
Authors: Hyman Eric L.
Published: January 2017

The politics of foreign aid favor increased attention to environmentally sustainable, market-based approaches to poverty reduction through small-and micro-enterprise development. A small-scale producers strategy can help ensure food security, maintain incomes and employment during economic structural adjustments, and promote better management of natural resources. Common problems facing small enterprises include limited access to financing and the technology gap. Some institutional implications of this strategy for the structure of development assistance programs are assessed.
Why UNCED Failed on Trade and Environment
Authors: Prudencio Rodrigo J.
Published: January 2017

Despite its unprecedented focus on preserving the environment without sacrificing development, the Earth Summit bypassed an opportunity to discuss reforming the international trading system, and its impact on sustainable development. Instead, the participants in the United Nations Conference on Environment and Development largely accepted the current state of the international trading system, and placed the onus of reform on environmental policy. The result was a failure to address the underlying conflicts between trade and the environment.
Is a Threat to Lloyd's of London Also a Threat to the Environment?
Authors: Spalding Mark J.
Published: January 2017

The insurance industry provides coverage not only for cleanup costs associated with environmental “accidents,” but also for legal defense costs in the event that an insured company is sued. As a mechanism for quantifying environmental risks and internalizing the environmental costs of doing business, the insurance industry plays an important role in addressing environmental problems. Lloyd's of London is the source of much of the world's environmental and pollution insurance and is a major reinsurer for almost all types of risk; its current financial troubles have deep ramifications for the international insurance industry and the global environment. Using recent oil spills and pollution cleanups as a vehicle, this paper examines the history of the insurance crisis, the importance of insurance with regard to environmental risks, and the role of Lloyd's in the environmental insurance arena. Two possible policy responses to this crisis are presented.
Antarctica and the World Park Approach: A Prescription for Change
Authors: Cioppa Thomas J.
Published: January 2017

The challenge of how best to manage the Antarctic is no small task. The fragility and unenforceability of the existing legal arrangement, coupled with the uncertainty of commercial mineral/hydrocarbon extraction and the need to protect an extremely fragile ecosystem, adds up to a series of dilemmas of immense proportion. This paper argues that the best solution for the continent is to make it into a World Park (or nature preserve). Viewing Antarctica as a common-pool resource, this paper outlines a specific set of normative elements that provide the foundation for a World Park Approach–an approach that offers equitable and environmentally sound solutions for both the continent and its suitors.
Development of an Agroforestry Program for Lombok, Nusa Tenggara Barat, Indonesia
Authors: Kesaris Alex G. , Dearth Dennis Price
Published: January 2017

This report describes the development of a pilot agroforestry program for the island of Lombok, Nusa Tenggara Barat (NTB), Indonesia. The primary aim of the program is to increase agricultural production on Lombok by introducing drought-tolerant, productive trees that can ameliorate drought-induced famine experienced by rural farmers in this region. The inclusion of an agroforestry subsystem with supportive and “back-up” capabilities will buttress the existing agricultural system in the event of future drought. The current focus is upon the introduction of hybrid coconut, date, fig, and macadamia nut trees. Major emphasis is placed upon the value of working within the Indonesian culture and agrarian social structure in NTB.
“Smile” Incision: An Approach for Open Reduction and Internal Fixation of Calcaneal Fractures
Authors: Wiley William B. , Norberg Jon D. , Klonk Christopher J. , Alexander Ian J.
Published: January 2017

Materials: A consecutive group of 73 patients (77 calcaneal fractures) treated with open reduction and internal fixation through a smile-shaped lateral approach to the hindfoot were reviewed retrospectively. Inclusion criteria were a closed displaced intra-articular fracture of the calcaneus, no compartment syndrome, and adequate followup. Followup ranged from 4 months to 4 years. Results: One patient had a deep wound infection that required removal of hardware and intravenous antibiotics. No deep dehiscence or flap necrosis occurred. Superficial dehiscence occurred in three patients (4%) and superficial necrosis was seen in nine patients (12%); all resolved with continued casting to protect the wound. Six patients (8%) complained of numbness or pain in the sural nerve distribution. No symptomatic neuromas were seen. Reflex sympathetic dystrophy occurred in three patients (4%); all resolved with sympathetic blocks. Only one patient required an additional procedure for treatment of a wound-related problem or infection. Conclusion: The “smile” incision provides good fracture exposure for reduction without added morbidity.
Treatment of Posttraumatic Adhesive Capsulitis of the Ankle: A Case Series
Authors: Cui Quanjun , Milbrandt Todd , Millington Steven , Anderson Mark , Hurwitz Shepard
Published: January 2017

Background: Adhesive capsulitis of the ankle is a challenging diagnostic and therapeutic problem. Limited information concerning diagnosis and treatment is available in the musculoskeletal literature. Methods: This study retrospectively reviewed a series of patients treated with corticosteroid injections or arthroscopic debridement of posttraumatic adhesive capsulitis of the ankle. The Foot Function Index was used to assess the final treatment outcomes. Results: Forty-one patients with chronic posttraumatic ankle pain were identified. Five were confirmed to have posttraumatic adhesive capsulitis by arthrogram. Four of the five patients failed to respond to steroid injections and three had arthroscopic surgery. Foot Function Index scores indicated that two of these patients treated with arthroscopic debridement had improved function. Conclusions: Results of small series and information from the literature suggest that intra-articular injection of corticosteroid followed by arthroscopic synovectomy and scar resection can be effective as treatment for posttraumatic adhesive capsulitis of the ankle.
Supplementary Axial Kirschner Wire Fixation for Crescentic and Ludloff Proximal Metatarsal Osteotomies: A Biomechanical Study
Authors: Jung Hung-Geun , Guyton Gregory P. , Parks Brent G. , Title Craig I. , Dom Karl J. , Nguyen Augustine , Schon Lew C.
Published: January 2017

Background: Loss of reduction of proximal metatarsal osteotomies may result from poor bone quality, suboptimal fixation, and limitations inherent in the bony geometry of the osteotomy. This study evaluated the mechanical benefit of adding two supplementary Kirschner wires to the crescentic and Ludloff osteotomies. Methods: Eleven and 10 matched pairs of cadaver foot specimens were used for the Ludloff and the proximal crescentic metatarsal osteotomies, respectively. Each metatarsal head specimen was then loaded to failure using a servohydraulic MTS Mini Bionix test frame (MTS Systems Corp, Eden Prairie, MN), and the failure gap was measured with an extensometer. To account for variable bone quality in the study specimens, the failure loads were normalized with the measured bone mineral density (BMD) values of the metatarsal specimens. A paired Student's t-test analysis was used to compare the failure loads between the specimens with the conventional osteotomies and the osteotomies supplemented with two axial Kirschner wires. Results: The load-to-failure of the Ludloff osteotomy with two screws and with one proximal screw and two Kirschner wires was 858.5 N cm 2 /gm and 692.3 N cm 2 /gm, respectively (p > 0.05). The average load-to-failure of crescentic osteotomy with one screw and two axial Kirschner wires (458.8 N cm 2 /gm) was significantly higher than the strength of crescentic osteotomy fixed with one screw only (367.5 N cm 2 /gm) (p = 0.05). For the Ludloff osteotomy, 16 specimens (72.7%) failed by more than 2 mm of gapping. The crescentic osteotomy failures included 16 2-mm gap failures (80%). The Ludloff osteotomy showed a trend toward increased fixation stability as compared with both crescentic osteotomy constructs. Conclusion: The use of two supplemental axial Kirschner wires offers a simple and effective means to improve the initial mechanical stability of the proximal crescentic osteotomy and can be used in the standard Ludloff osteotomy to replace the second screw when screw purchase is poor without significant loss of fixation strength. The possible advantage of Kirschner wire flexibility in restoring position after gapping of the osteotomy site should be investigated.
Three-Dimensional Computer Analysis of the Modified Ludloff Osteotomy
Authors: Beischer Andrew D. , Ammon Peter , Corniou Andrei , Myerson Mark
Published: January 2017

Background: The Ludloff first metatarsal osteotomy is used to correct the increased 1–2 intermetatarsal angle associated with hallux valgus deformity. We studied the spatial geometry of this osteotomy to determine the ideal parameters of the osteotomy saw cut and its rotation to give an optimal correction. Methods: Three-dimensional computer modeling software was used to perform a virtual Ludloff osteotomy of the first metatarsal. Different geometric parameters of the osteotomy were studied. The osteotomy was rotated in virtual space and the geometric changes occurring in the virtual bone were then measured by the software. Results: The optimal Ludloff osteotomy started at the dorsum of the first metatarsal base at the first tarsometatarsal joint and extended distally and plantarly to a point just proximal to the sesamoid articulation. A tilt of 10 degrees in the coronal plane of the osteotomy was necessary to limit first metatarsal head elevation. The best axis of rotation was within 5 mm of the proximal end of the osteotomy. Conclusions: The optimal geometric parameters of a modified Ludloff osteotomy limited first metatarsal shortening, elevation, and sagittal plane rotational malalignment that may occur with the use of this osteotomy.
Race/Ethnicity and Health Insurance Status: 1987 and 1996
Authors: Monheit Alan C. , Vistnes Jessica Primoff
Published: January 2017

Health insurance confers important private and social benefits. Disparities in coverage among the population remain an important public policy issue. The authors focus on the health insurance status of white, black, and Hispanic Americans in both 1987 and 1996 and identify gaps in minority health care coverage relative to white Americans. They also investigate the access of workers in these groups to employment-based health insurance. Identified are factors underlying changes in the insurance status of workers during the past decade in terms of changes in population characteristics and structural shifts underlying the demand for and supply of health insurance. The authors find that while coverage has declined for workers in most racial/ethnic groups, the experience of Hispanic males appears to be unique in that changes in their characteristics as well as structural shifts account for their decline in employment-related coverage. Structural shifts dominated the changes in coverage rates for other groups.
Racial and Ethnic Differences in Access to and Use of Health Care Services, 1977 to 1996
Authors: Weinick Robin M. , Zuvekas Samuel H. , Cohen Joel W.
Published: January 2017

This article focuses on racial and ethnic disparities in health care, describing both absolute differences and relative changes in access to care and the use of health services among whites, blacks, and Hispanics over the past two decades. Using data from a series of three nationally representative medical expenditure surveys, the authors present descriptive statistics on disparities in access and use between minorities and whites over time. They also use multivariate analyses to isolate the extent to which health insurance and income explain those disparities. The authors find that disparities increased between 1977 and 1996, particularly for Hispanic Americans. Results also show that approximately one half to three quarters of the disparities observed in 1996 would remain even if racial and ethnic disparities in income and health insurance coverage were eliminated.
Race and Ethnic Disparities in Health Care Access and Utilization: An Examination of State Variation
Authors: Waidmann Timothy A. , Rajan Shruti
Published: January 2017

Health disparities among racial and ethnic groups have a long history and continue to exist in the United States. The U.S. government has established as a goal for the year 2010 the elimination of racial/ethnic health differences in six areas. This article examines disparities in one of those areas: access to high-quality health care. Several measures of access to and use of health care services are studied both nationally and in 13 diverse states. The authors find that both the magnitude of racial and ethnic disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of outcome measure being studied. Such information can be valuable for state and national policy makers in targeting resources and in designing effective strategies for the elimination of racial and ethnic disparities.
Attitudes about Racism, Medical Mistrust, and Satisfaction with Care among African American and White Cardiac Patients
Authors: LaVeist Thomas A. , Nickerson Kim J. , Bowie Janice V.
Published: January 2017

The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.
The Effect of Race on the Referral Process for Invasive Cardiac Procedures
Authors: Einbinder Lynne C. , Schulman Kevin A.
Published: January 2017

Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and they have poorer prognosis after acute myocardial infarction. Multiple studies have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race on physician and patient decision making in referrals for cardiac procedures. The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these steps, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership. The potential role of communication in race-discordant physician-patient relationships suggests a need for more research in physician decision making and for efforts to promote cultural competency as a core component of medical education.
Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model
Authors: Brach Cindy , Fraserirector Irene
Published: January 2017

This article develops a conceptual model of cultural competency’s potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.
Race, Ethnicity, and the Health Care System: Public Perceptions and Experiences
Authors: Lillie-Blanton Marsha , Brodie Mollyann , Rowland Diane , Altman Drew , McIntosh Mary
Published: January 2017

To assess the public’s perceptions and attitudes about racial and ethnic differences in health care, the Kaiser Family Foundation surveyed a nationally representative sample of 3,884 whites, African Americans, and Latinos in 1999. The survey found that the majority of Americans are uninformed about health care disparities—many were unaware that blacks fare worse than whites on measures susch as infant mortality and life expectancy, and that Latinos are less likely than whites to have health insurance. Views on whether the health system treats people equally were strikingly different by race. For example, most minority Americans perceive that they get lower quality care than whites, but most whites think otherwise. Nonetheless, more minority Americans were concerned about the cost of care than racial barriers. Efforts to eliminate disparities will need to improve public awareness of the problems as well as address racial and financial barriers to care.
Overview: PPO Performance Measurement: Agenda for the Future
Authors: Greenberg Liza
Published: January 2017

This special issue of Medical Care Research and Review features articles developed for a national conference on performance measurement in preferred provider organizations (PPOs). The conference, “PPO Performance Measurement: Agenda for the Future,” was held March 15-16, 2001, in Washington, D.C. It brought together various stake-holders—industry representatives, consumers, purchasers, and regulators—to discuss the state of PPO performance reporting and develop a strategy for future directions. These articles provided the background for an informed dialogue. The American Accreditation HealthCare Commission (URAC), the Consumer Coalition for Quality HealthCare, the Joint Commission on Accreditation of Healthcare Organizations, and the National Committee for Quality Assurance cosponsored the conference with a grant from the Agency for Healthcare Research and Quality to URAC.
Covered Lives in PPOs
Authors: Smith Dean G. , Scanlon Dennis P.
Published: January 2017

Many measures of health plan performance require a count of covered lives to make the results meaningful. For both organizational and economic reasons, many preferred provider organizations (PPOs) do not collect enrollment data. Enrollment can be estimated, but current techniques for estimating enrollment are quite imprecise. Imprecision introduces considerable uncertainty into measures of PPO performance. Furthermore, uncertainty may exist even when enrollment data are available and complete because of challenges that PPOs face in linking enrollment data to claims and administrative data. Efforts to increase accountability through performance reporting may require PPOs to devote additional resources for the collection and management of enrollment data. The authors describe practices in tracking enrollment in PPOs and provide data to illustrate variations at both the regional and company levels. Variations in tracking dependents and lack of information on the demographic characteristics of PPO subscribers affect a PPO’s ability to produce standardized performance measures comparable to health maintenance organization performance measures.
Conceptual and Technical Issues Regarding the Use of HEDIS and HEDIS-Like Measures in Preferred Provider Organizations
Authors: Kleinman Lawrence C.
Published: January 2017

Preferred provider organizations (PPOs) represent a diverse and complex set of arrangements among insurance entities, networks of physicians, network organizers, and purchasers. Opinions differ regarding the degree to which PPOs have responsibility to manage care and to measure and report key aspects of their performance to customers and the public. Technical and operational challenges to performance measurement currently limit public reporting, even when agreement exists that it is appropriate for PPOs to do so. The Health Plan and Employer Data and Information Set (HEDIS) is a health maintenance organization performance measure that could provide standards for PPO reporting. This article explores conceptual and methodological considerations regarding HEDIS and other performance measurement in PPOs and identifies failures of the current marketplace. While using some measures may be premature or inappropriate, there are significant opportunities to apply other measures now and, by doing so, to create a functional health care marketplace.
Choice and Representation in Health Care
Authors: Emanuel Ezekiel J.
Published: January 2017

Choice is often thought to be critical in health care, especially to foster quality improvements and lower costs. However, it is also recognized that in the current system there is significant representation of consumers, members, and patients by physicians, employers, and health plans. Consent, accountability, and protections against conflicts of interest are necessary to ensure legitimate and effective representation. This article discusses the roles and responsibilities of physicians, employers, and other parties with respect to serving as representatives of health care consumers. The author concludes that to make representation more legitimate and effective in health care will require significant changes, which include (1) changing business to a stakeholder theory, (2) involving employees in health care coverage decisions, and (3) involving members of health plans in policy decisions.
What Does It Mean to Be a Girl? Teachers’ Representations of Gender in Supplementary Reading Materials for South African Schools
Authors: Dentith Audrey M. , Sailors Misty , Sethusha Mantsose
Published: January 2017

Education reform, including methods to create greater gender equality, is an ongoing process in post-Apartheid South Africa. Using an African feminism theoretical framework and a critical content analysis approach, we examined the representation of female characters in a subset of supplementary reading titles created under an international development project. Through constant comparison of prepositions in the books, our findings indicated that the authors of these books (South African teachers) depicted females in complex, multifaceted, and, at times, contradictory roles. These panoramic roles created by the authors appeared to be situated in the very practical and lived experiences of children in South Africa. This study has implications for curriculum development in international settings.
Journalism and Professional Education: A Contradiction in Terms?
Authors: Nolan David
Published: January 2017

This article revisits a set of long-standing debates to suggest how the role of universities in providing a ‘professional education’ in journalism might be (re)considered. Existing arguments over journalism education identify a need to move beyond the limiting frame of a presumed ‘industry–academic dichotomy’ to develop a more critical approach to professional education. While supporting this direction, this article draws on work suggesting that a more careful consideration of both the concept of professionalism and its implications for stakeholders is required. It argues that, by approaching professionalism as a discursive and socially valorised basis of identity rather than simply a series of ‘traits’, a more analytical perspective on how universities are both subject to and implicated in processes of ‘professionalisation’ is gained. These processes situate universities as both major stakeholders in, and an increasingly important influence on, emergent formations of journalistic professionalism.
Pleasure, Excess and Self-Monitoring: The Media Worlds of New Zealand Children
Authors: Lealand Geoff , Zanker Ruth
Published: January 2017

This report describes the outcomes of extensive research (questionnaires, focus groups, drawings) on the media use of students aged between eight and 13 years (n=860) in the North and South Islands of New Zealand. The research replicates earlier child-centred research by the authors, but with a greater emphasis on newer media technology, such as cell phones. The various facets of the research, framed within theoretical explorations, produced detailed and often candid insights into the role played by contemporary media in the lives of New Zealand children with respect to the overt and covert use of technology, shifts in relationships between children and adults. It also generated some interesting cautionary tales.
Young Turks and New Media: The Construction of Identity in an Age of Islamophobia
Authors: Hopkins Liza
Published: January 2017

The place of Islam in a multicultural society is high on the agenda of every Western nation at the moment. In the wake of a series of local and global events, Australia's Muslims have found themselves in the glare of media scrutiny over what it means to be Australian and a Muslim. Increasingly, that media discourse contributes to a rising tide of anti-Islamic feeling, also known as Islamophobia, in the community. Diasporic communities across the globe are using new technology to overcome some of the structural difficulties inherent in being cast as ‘outsiders’, even in the country in which they were born. This paper examines the use of communications and media technologies to establish, assert and define social groups and notions of social identity, using a research project with Melbourne's Turkish community as a case study. The qualitative research, which forms part of a broader study of the Turkish community in Melbourne, focuses on the experiences of a small cohort of young people of both first- and second-generation Turkish background, who are completing their education in the Australian university system. The very rapid recent spread of new information and communication technologies has had important repercussions for the way these young people communicate and maintain their interpersonal relationships, as well as the way they organise and communicate with wider networks of acquaintances, peers and communities of interest.
Beyond Broadcasting? TV for the Twenty-First Century
Authors: Meikle Graham , Young Sherman
Published: January 2017

TV is being reshaped, reimagined and reinvented in unpredictable ways. Broadcasting has become only one of a set of options for the distribution of TV content, alongside cable, DVDs, internet downloads, and online video streams. Simultaneously, audiences have embraced new modes of engagement with audio-visual products, with many seamlessly shifting from the role of consumer to that of producer. Broadcasting still reigns, but its place as the normative television form is under greater threat than ever. The articles in this issue of MIA suggest that, while it may no longer be the cultural norm, broadcasting may still have a role to play in whatever television becomes. The current phase of television suggests contested continuities rather than radical seismic shifts, as the new technologies open up possibilities beyond broadcasting. Of most interest is the emerging tension between what newly empowered users want television to be, and the institutional desire to dictate the direction and pace of change.
What is Television? Comparing Media Systems in the Post-Broadcast Era
Authors: Tay Jinna , Turner Graeme
Published: January 2017

This article emerges from the early stages of a large international study of the social, cultural and political role of television in the post-broadcast era where the convergence of media platforms has challenged conventional understandings of how the mass media work. Even though it might be premature to jump on the bandwagon which claims that national media systems are now irrelevant and that television, as the leading ‘old media’ format, is history, there is significant theoretical and empirical work to be done to adjust to the new, and highly contingent, environment — to find out what ‘television is’ today.
Why Do They Call it TV When it's Not on the Box? ‘New’ Television Services and Old Television Functions
Authors: Green Joshua
Published: January 2017

This paper examines a set of ‘new television’ projects and their relationship to existing understandings of the object of television. The rise of online video-sharing has been surrounded by discourse about the decline of broadcast television's role for content delivery and advertising revenue. Amidst discussions of ‘piracy’ and debates about new audience measurement techniques and user-generated content, official and unofficial platforms for the distribution of television content have emerged. Some of these sites — like ‘internet TV’ projects such as the Participatory Culture Foundation's Miro TV player — have positioned themselves directly in opposition to television itself, orienting themselves as alternatives or replacements for the broadcast-and-cable-delivered-to-your-set experience. Others — such as CBS's Innertube — attempt to reapply network logics to the online space. Interrogating how the term ‘television’ succeeds or fails to describe these services helps to contextualise the object of television itself, as well as exploring the insights new services provide into audiencehood, national broadcasting and the community-forming roles television has traditionally played.