bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaccine Coverage Levels after Implementation of a Middle School Vaccination Requirement, Florida, 1997–2000
Authors: Fogarty Kieran J. , Massoudi Mehran S. , Gallo William , Averhoff Francisco M. , Yusuf Hussain , Fishbein Daniel 
Published: January 2017

Objective. Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997. Methods. The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates. Results. During the 1997–1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000–2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county's seventh grade population. Conclusions. The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.
Bridging between Two Standards for Collecting Information on Race and Ethnicity: An Application to Census 2000 and Vital Rates
Authors: Parker Jennifer D. , Schenker Nathaniel , Ingram Deborah D. , Weed James A. , Heck Katherine E. , Madans Jennifer H. 
Published: January 2017

Objectives. The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public. Methods. The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997–2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches. Results. Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters. Conclusion. Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.
The Association of Low Birthweight and Chronic Renal Failure among Medicaid Young Adults with Diabetes and/or Hypertension
Authors: Fan Z. Joyce , Lackland Daniel T. , Lipsitz Stuart R. , Nicholas Joyce S. 
Published: January 2017

Objective. The purpose of this study was to assess the effect of low birthweight on chronic renal failure among young Medicaid patients with diabetes and/or hypertension. Methods. The study included Caucasian and African American young adults, aged 18–50, who enrolled in the Medicaid program from 1993 to 1996 in South Carolina and were diagnosed with diabetes and/or hypertension. The odds of chronic renal failure by low birthweight (<2,500 grams) was estimated using logistic regression. Results. Of the 7,505 Medicaid patients with diabetes and/or hypertension, 179 (2.4%) were diagnosed with chronic renal failure. These patients were younger (mean age of 33.9 vs. 37.6, p=0.0024) and had a higher proportion of low birthweight (15.1% vs. 11.4%, p=0.07) compared with the 7,326 patients without renal failure. The odds ratio of chronic renal failure for low birthweight was significantly higher compared with normal birthweight (2,500-3,999 grams) (adjusted odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.0, 2.4). The association between low birthweight and chronic renal failure was stronger among the 888 patients with both diabetes and hypertension (OR 2.6, 95% CI 1.3, 5.7) than the 1,812 diabetes or the 4,805 hypertension patients. Conclusions. The odds of chronic renal failure by low birthweight was highest in patients with both diabetes and hypertension, suggesting that the mechanism(s) involved in the disease progression to chronic renal failure may have a fetal early life origin.
The Role of Flushing Dental Water Lines for the Removal of Microbial Contaminants
Authors: Rice Eugene W. , Rich William K. , Johnson Clifford H. , Lye Dennis J. 
Published: January 2017

Objectives. This study was designed to determine the role of flushing dental water lines for the removal of heterotrophic plate count bacteria, Legionella spp., and free-living protozoa. Methods. Forty dental offices were surveyed in the study. An initial sample and a sample taken after three minutes of flushing were obtained from the air/water syringe at each location. All samples were quantitatively analyzed for heterotrophic bacteria using three bacteriological procedures. The samples were analyzed for the presence of Legionella spp. using cultural, immunological, and molecular procedures and for the occurrence of free-living protozoa using a killed bacteria plate procedure. Results. The flushing process reduced the level of heterotrophic plate count bacteria by 1.1 to 1.5 log10 CFU/ml. Compliance with recommendations for bacterial levels varied depending on the methodology employed in the analysis. The flushing process did not reduce the occurrence of Legionella spp. or free-living protozoa. Conclusion. The results support recent U.S. Centers for Disease Control and Prevention recommendations that the process of flushing dental water lines cannot be relied upon as a sole means of reliably improving the quality of water used in dental treatment.
Children's Health Services in a “System of Care”: Patterns of Mental Health, Primary and Specialty Use
Authors: Grimes Katherine E. , Kapunan Patricia E. , Mullin Brian 
Published: January 2017

Objectives. This study was designed to investigate demonstrable impacts of the Mental Health Services Program for Youth (MHSPY), a highly coordinated, intentionally integrated “system of care,” on patterns of health service utilization for youth with multiple needs. Methods. The MHSPY intervention is available to a target population of urban youth who face barriers to health care and are at risk for out-of-home placement. These youth are enrolled in a non-profit managed care organization (MCO). Patterns of medical, pharmacy, and mental health and substance abuse service use were compared for children aged 3 to 19 across insurance categories. Results. Despite risks for access and engagement barriers to care, and for greater medical expense due to greater morbidity, MHSPY enrollees received significantly more ambulatory care per person-year than either the privately insured population or the Medicaid Standard population, and medical expense for MHSPY members was significantly lower than expected. During the four years studied, individuals in the privately insured and Medicaid Standard populations were less likely than MHSPY enrollees to have had an ambulatory pediatric visit (odds ratio [OR] 0.833, 95% confidence interval [CI] 0.765, 0.908 and OR 0.823, 95% CI 0.775, 0.897, respectively). Medical expenses per member per month for MHSPY enrollees were significantly less than that for the similarly impaired Medicaid Disabled population with any medical claim ( p<0.001) or with any outpatient mental health claim ( p<0.01). Conclusions. Patterns of health care for subpopulations with known risk are important to identify to evaluate system-of-care effectiveness. The service utilization patterns for youth enrolled in the MHSYP system of care vs. those for similar MCO youth suggest health care access for individuals can be affected by delivery system design variables.
Health Services for HIV/AIDS, HCV, and Sexually Transmitted Infections in Substance Abuse Treatment Programs
Authors: Brown Lawrence S. , Kritz Steven , Goldsmith R. Jeffrey , Bini Edmund J. , Robinson Jim , Alderson Donald , Rotrosen John 
Published: January 2017

The National Drug Abuse Treatment Clinical Trials Network conducted this study to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments. Data from health departments and substance abuse agencies of 48 states and from 269 substance abuse treatment programs revealed that human immunodeficiency virus/acquired immunodeficiency syndrome-related services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor. These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections.
Enrolling in Medicaid through the National School Lunch Program: Outcome of a Pilot Project in California Schools
Authors: Cousineau Michael R. , Wada Eriko O. , Hogan Laura 
Published: January 2017

California has several health insurance programs for children. However, the system for enrolling into these programs is complex and difficult to manage for many families. Express Lane Eligibility is designed to streamline the Medicaid (called Medi-Cal in California) enrollment process by linking it to the National School Lunch Program. If a child is eligible for free lunch and the parents consent, the program provides two months of presumptive eligibility for Medi-Cal and a simplified application process for continuation in Medi-Cal. For those who are ineligible, it provides a referral to other programs. An evaluation of Express Lane shows that while many children were presumptively enrolled, nearly half of the applicants were already enrolled in Medi-Cal. Many Express Enrolled children failed to complete the full Medi-Cal enrollment process. Few were referred to the State Children's Health Insurance Program or county programs. Express Lane is less useful as a broad screening strategy, but can be one of many tools that communities use to enroll children in health insurance.
Modified Directly Observed Therapy for Antiretroviral Therapy: A Primer from the Field
Authors: Goggin Kathy , Liston Robin J. , Mitty Jennifer Adelson 
Published: January 2017

Modified directly observed therapy (mDOT), in which a portion of total doses of a medication regime is ingested under supervision, has demonstrated efficacy as an intervention to assist patients in maintaining adherence to complicated antiretroviral therapy (ART). Although findings are favorable, existing efficacy studies fail to provide sufficient detail to guide others who wish to implement mDOT interventions. The aim of this article is to provide a primer for practitioners and researchers who wish to implement mDOT interventions. Drawing on the experience of 10 federally funded research projects, we provide guidance on critical questions for program implementation, including: who should be targeted, length/duration/content/location/tapering of sessions, staffing, incentives, and approaches to data collection. In addition, guidance on staff training and minimum requirements for mDOT interventions is offered along with real-world examples of mDOT interventions. mDOT is feasible and easily adapted to many settings and target populations. Interventions should match the specific needs of the target population and setting and be flexible in terms of design and delivery. mDOT should be considered among the spectrum of adherence interventions.
Health-Care Use and Expenditures for Children in Special Education with Special Health-Care Needs: Is Dual Classification a Marker for High Use?
Authors: Sices Laura , Harman Jeffrey S. , Kelleher Kelly J. 
Published: January 2017

Objectives. Children with special health-care needs are an important group for policy and research planning. Special education engages a group of children with increased utilization of services related to education. While increased service utilization in education or health-care settings is often used to classify children as having special needs, considerable heterogeneity exists within each group. The extent to which being identified in two functionally defined systems—special education and health care—relates to health-care utilization is unknown. We sought to determine health-care and mental health utilization and expenditures for children dually classified as receiving special education and having special health-care needs (SHCN) compared with those who only have SHCN, only are in special education, or don't fall into either category. Methods. A nationally representative sample of children aged 5–17 years from the Medical Expenditure Panel Survey was used to compare mean health-care and mental health utilization and expenditures for the four groups. Results. Dually classified children had significantly higher mean utilization of health-care services than the other three groups ( p,0.05). Mean 12-month total health-care expenditures were highest for dually classified children ($3,891/year) ( p,0.05) and higher for children classified only as having SHCN ($1,426/year) than for children with neither classification ($644/year, p,0.05). Conclusions. Children dually classified as receiving special education and having SHCN represent a subgroup of children with SHCN with high levels of health-care utilization and expenditures. This information can assist policy makers in identifying characteristics that place children at risk for very high expenditures, and in allocating health-care resources.
How Much Time is Safety Worth? A Comparison of Trigger Configurations on Pneumatic Nail Guns in Residential Framing
Authors: Lipscomb Hester J. , Nolan James , Patterson Dennis , Makrozahopoulos Dimitrios , Kucera Kristen L. , Dement John M. 
Published: January 2017

Objective. Nail gun injuries are among the most common in wood frame construction. Despite evidence that the majority of injuries from unintentional firings could be prevented with a sequential trigger mechanism on the tools, the safer trigger has not been embraced in the fast-paced residential construction industry. An experiment was conducted in an attempt to realistically evaluate the magnitude of productivity concerns. Methods. Ten journeymen carpenters built a yard shed on two occasions, using nail guns with two different trigger configurations, alternately, under controlled conditions. Mean differences in time required, nails used, and proper placement were evaluated considering the trigger used and whether the building was the carpenter's first or second project. Results. The sequential trigger tool required a mean of 10 additional minutes of active nailing time, which represented 10% of mean nailing time (97 minutes) but only 0.77% of the total mean work time (1,298 minutes) to construct each shed. No significant differences were observed in nail count or placement. The majority of the time variability was related to who was using the tool, rather than the type of tool in the person's hand. Conclusions. Productivity concerns should focus more on improving the skill of the carpenter rather than on the trigger mechanism. Failure to place tools with the safer trigger configuration, which requires the nose piece to be depressed before the trigger is pulled, in the hands of workers does not make sense given the frequency and potential repercussions of injuries associated with the use of these tools in wood framing.
Ethnic Disparities in Stroke Recognition in Individuals with Prior Stroke
Authors: Ellis Charles , Egede Leonard E. 
Published: January 2017

Objective. Studies of stroke awareness suggest that knowledge of early warning signs of stroke is low in high-risk groups. However, little is known about stroke knowledge among individuals with a history of prior stroke who are at significant risk for recurrent stroke. Methods. Data from 2,970 adults with a history of prior stroke from the 2003 Behavioral Risk Factor Surveillance System were examined. Recognition of the five warning signs of stroke and appropriate action to call 911 was compared across three racial/ethnic groups: non-Hispanic white, non-Hispanic black, and Hispanic/other. Multiple logistic regression analyses were used to: ( 1) determine the association between race/ethnicity and recognition of multiple stroke signs and appropriate first action and ( 2) identify independent correlates of recognition of multiple stroke signs and taking appropriate action to seek treatment among individuals with prior stroke. Results. Recognition of all five signs of stroke and taking appropriate action to call 911 was lowest among the non-Hispanic black group (22.3%) and Hispanic/other group (16.7%). In multivariate models, Hispanic/other (odds ratio [OR] 0.42 [0.25, 0.71]), age 50–64 (OR 0.64 [0.43, 0.97]), age ≥65 (OR 0.36 [0.23, 0.55]), and >high school education (OR 1.79 [1.22, 2.63]) emerged as independent correlates of recognition of all five signs of stroke and first action to call 911. Conclusions. Less than 35% of people with prior stroke can distinguish the complex symptom profile of a stroke and take appropriate action to call 911. Targeted educational activities that are sensitive to differences in race/ethnicity, age, and education levels are needed for individuals with prior stroke.
Health-Care Reform and School-Based Health Care
Authors: Lear Julia Graham , Barnwell Elizabeth A. , Behrens Donna 
Published: January 2017

There is growing recognition that health and health care at school can significantly impact children's health. From childhood obesity interventions to new immunization mandates, schools are at the forefront of child health discussions. The 2008 presidential campaign and the renewed focus on health-care reform raise the possibility that in 2009 school health will play a larger role in health policy conversations than previously. This article explores the proposition that both school health and national health policy will benefit from closer attention to the role of school health within the U.S. health system. It offers a Maryland case study to suggest both the opportunities and operational challenges of linking school health to the larger community health system.
Current Status of State Policies That Support School-Based Health Centers
Authors: Schlitt John J. , Juszczak Linda J. , Eichner Nancy Haby 
Published: January 2017

Objectives. This study explored the current status of the role of state school-based health center (SBHC) initiatives, their evolution over the last two decades, and their expected impact on SBHCs' long-term sustainability. Methods. A national survey of states was conducted to determine ( 1) the amount and source of funding dedicated by the state directly for SBHCs, ( 2) criteria for funding distribution, ( 3) designation of staff/office to administer the program, ( 4) provision of technical assistance by the state program office, ( 5) types of performance data collected by the program office, ( 6) state perspective on future outlook for long-term sustainability, and ( 7) Medicaid and the State Children's Health Insurance Program (SCHIP) policies for reimbursement to SBHCs. Results. Nineteen states reported allocating a total of $55.7 million to 612 SBHCs in school year 2004–2005. The two most common sources of state-directed funding for SBHCs were state general revenue ($27 million) and Title V of the Social Security Act ($7 million). All but one of the 19 states have a program office dedicated to administering and overseeing the grants, and all mandate data reporting by their SBHCs. Sixteen states have established operating standards for SBHCs. Eleven states define SBHCs as a unique provider type for Medicaid; only six do so for SCHIP. Conclusions. In 20 years, the number of state SBHC initiatives has increased from five to 19. Over time, these initiatives have played a significant role in the expansion of SBHCs by earmarking state and federal public health funding for SBHCS, setting program standards, collecting evaluation data to demonstrate impact, and advocating for long-term sustainable resources.