bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imitation performance in toddlers with autism and those with other developmental disorders
Authors: Rogers Sally J. , Hepburn Susan L. , Stackhouse Tracy , Wehner Elizabeth 
Published: May 2003

Background: The present study sought to examine the specificity, developmental correlates, nature and pervasiveness of imitation deficits very early in the development of autism.Methods: Subjects were 24 children with autism (mean age 34 months), 18 children with fragile X syndrome, 20 children with other developmental disorders, and 15 typically‐developing children. Tasks included manual, oral‐facial, and object oriented imitations, developmental measures, joint attention ability, and motor abilities.Results: Children with autism were found to be significantly more impaired in overall imitation abilities, oral‐facial imitation, and imitations of actions on objects than children in all of the other groups. Imitation skills of young children with fragile X syndrome were strongly influenced by the absence or presence of symptoms of autism. For children with autism, imitation skills were strongly correlated with autistic symptoms and joint attention, even when controlling for developmental level. For comparison groups, imitation was related to other developmental abilities including play, language, and visual spatial skills. Neither motor functioning nor social responsivity accounted for a significant amount of variance in imitation scores, when controlling for overall developmental level, which accounted for much of the variation in imitation ability.Conclusions: Simple imitation skills were differentially impaired in young children with autism, and lack of social cooperation did not account for their poor performance. In autism, imitation skills clustered with dyadic and triadic social interactions and overall developmental level, but were not related to play or language development. For comparison children, all these areas were inter‐related. Hypotheses about a specific dyspraxic deficit underlying the imitation performance in autism were not supported.
The Contribution of Insurance Coverage and Community Resources to Reducing Racial/Ethnic Disparities in Access to Care
Authors: Hargraves J. Lee , Hadley Jack 
Published: May 2003

Objective. To examine the extent to which health insurance coverage and available safety net resources reduced racial and ethnic disparities in access to care.Data Sources. Nationally representative sample of 11,692 African American, 10,325 Hispanic, and 74,397 white persons. Nonelderly persons with public or private health insurance and those who were uninsured.Study Design. Two cross‐sectional surveys of households conducted during 1996–1997 and 1998–1999.Data Collection. Commonly used measures of access to and utilization of medical care were constructed for individuals. These measures include the following: (1) percent reporting unmet medical needs, (2) percent without a regular health care provider, and (3) no visit with a physician in the past year.Findings. More than 6.5 percent of Hispanic and African Americans reported having unmet medical needs compared to less than 5.6 percent of white Americans. Hispanics were least likely to see the same doctor at their usual source of care (59 percent), compared to African Americans (66 percent) and whites (75 percent). Similarly, Hispanics were less likely than either African Americans or whites to have seen a doctor in the last year (65 percent compared to 76 percent or 79 percent). For Hispanics, more than 80 percent of the difference from whites was due to differences in measured characteristics (e.g., insurance coverage, income, and available safety net services). Differences in measured characteristics between African Americans and whites explained less than 80 percent of the access disparities.Conclusion. Lack of health insurance was the single most important factor in white–Hispanic differences for all three measures and for two of the white–African American differences. Income differences were the second most important factor, with one exception. Community characteristics generally were much less important, with one exception. The positive effects of insurance coverage in reducing disparities outweigh benefits of increasing physician charity care or access to emergency rooms.
Length of Stay, Conditional Length of Stay, and Prolonged Stay in Pediatric Asthma
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Even‐Shoshan Orit , Shabbout Mayadah , Zhang Xuemei , Bradlow Eric T. , Marsh Roger R. 
Published: May 2003

Objective. To understand differences in length of stay for asthma patients between New York State and Pennsylvania across children's and general hospitals in order to better guide policy.Data Sources/Study Setting. All pediatric admissions for asthma in the states of Pennsylvania and New York using claims data obtained from each state for the years 1996–1998, n=38,310.Study Design. A retrospective cohort design to model length of stay (LOS), the probability of prolonged stay, conditional length of stay (CLOS or the LOS after stay is prolonged), and the probability of readmission, controlling for patient factors, state, location and hospital type.Analytic Methods. Logit models were used to estimate the probability of prolonged stay and readmission. The LOS and the CLOS were estimated with Cox regression. Model variables included comorbidities, income, race, distance from hospital, and insurance type. Prolonged stay was based on a Hollander‐Proschan “New‐Worse‐Than‐Used” test, corresponding to a three‐day stay.Principal Findings. The LOS was longer in New York than Pennsylvania, and the probabilities of prolonged stay and readmission were much higher in New York than Pennsylvania. However, once an admission was prolonged, there were no differences in CLOS between states (when readmissions were not added to the LOS calculation). In both states, children's hospitals and general hospitals had similar adjusted LOS.Conclusions. Management of asthma appears more efficient in Pennsylvania than New York: Less severe patients are discharged faster in Pennsylvania than New York; once discharged, patients are less likely to be readmitted in Pennsylvania than New York. However, once a stay is prolonged, there is little difference between New York and Pennsylvania, suggesting medical care for severely ill patients is similar across states. Differences between children's and general hospitals were small as compared to differences between states. We conclude that policy initiatives in New York, and other states, should focus their efforts on improving the care provided to less severe patients in order to help reduce overall length of stay.
Hospital Economics of the Hospitalist
Authors: Gregory Douglas , Baigelman Walter , Wilson Ira B 
Published: May 2003

Objective To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program.Data Sources The primary data source was Tufts‐New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records.Study Design The hospitalist admitted and managed all patients during a six‐week period on the general medical unit of Tufts‐New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period.Principal Findings The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to $1,775 from $2,332 (p<.001); costs per day increased to $811 from $679 (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was−$1.44 per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of $1.3 million.Conclusion Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program.
Ability of Medicaid Claims Data to  Identify Incident Cases of Breast Cancer  in the Ohio Medicaid Population
Authors: Koroukian Siran M. , Cooper Gregory S. , Rimm Alfred A. 
Published: May 2003

Background. The use of Medicaid data to study cancer‐related outcomes would be highly desirable. However, the accuracy of Medicaid claims data in the identification of incident cases of breast cancer is unknown.Objectives. (1) To estimate the sensitivity of Medicaid claims data for case ascertainment of breast cancer; and (2) to determine the positive predictive value (PPV) of diagnostic and procedure codes retrieved from Medicaid claims, using the Ohio Cancer Incidence Surveillance System (OCISS) as the gold standard.Methods. The study used the linked OCISS and Medicaid enrollment files, 1997–1998 (n=1,648). The claims search yielded 2,635 incident cases, of which 1,132 were also identified through the OCISS‐Medicaid files. Sensitivity and PPV of Medicaid data were calculated in subgroups of the population.Results. The overall sensitivity was 68.7 percent, but varied greatly across the subgroups of the population. It was lower among women enrolled in Medicaid only for part of the study year than those enrolled in Medicaid for 12 months of the study year (56.7 percent and 78.0 percent respectively, p<0.0001), and lower among those who are dual Medicare‐Medicaid eligible compared to those not participating in the Medicare program (63.1 percent and 78.6 percent respectively, p<0.0001). The overall PPV was 43.0 percent, increasing up to 86.6 percent in the presence of procedure codes indicating the presence of mastectomy and lumpectomy, in addition to that of breast cancer diagnosis.Conclusions. The sensitivity of Medicaid claims for case ascertainment of breast cancer is somewhat low, but improves considerably when accounting for women enrolled in Medicaid for the entire duration of the study year. The PPV is poor due to a high rate of false positives. The higher PPV obtained in the presence of procedure codes, in addition to diagnosis codes, will help researchers to correctly identify incident cases of breast cancer using Medicaid claims data.
Understanding Biased Selection in Medicare HMOs
Authors: Mello Michelle M. , Stearns Sally C. , Norton Edward C. , Ricketts Thomas C. 
Published: May 2003

Objective To investigate the extent of favorable health maintenance organization (HMO) selection for a longitudinal cohort of Medicare beneficiaries, examine whether the extent of favorable selection varies with the degree of Medicare HMO market penetration in a county, and explain conflicting findings in the literature on favorable HMO selection.Data Sources A panel of 1992–1996 data from the Medicare Current Beneficiary Survey (MCBS), supplemented with linked data from the Area Resource File and Medicare administrative datasets.Study Design Using random effects probit estimation, we model a beneficiary's HMO enrollment status as a function of self‐reported health status and Medicare HMO market penetration.Data Extraction Methods The MCBS data for beneficiaries residing in states served by Medicare HMOs in 1992–1996 were linked by county to the supplementary datasets.Principal Findings We find that favorable selection persists in the cohort over time on some, but not all, measures. We find no substantial association between favorable HMO selection and HMO market penetration. We find that conflicting findings in the literature on favorable HMO selection may be explained by several methodological choices, including the choice of health status measure and the structure of the sample.Conclusions Our results support further risk adjustment of the adjusted average per capita cost (AAPCC) payment formula.
Evaluation of decompression safety in an occupational diving group using self reported diving exposure and health status
Authors: Doolette D J , Gorman D F 
Published: May 2003

Background:Many occupational diving groups have substantially different diving patterns to those for which decompression schedules are validated.Aims:To evaluate tuna farm occupational diving practice against existing decompression models and describe a method for collecting and modelling self reported field decompression data.Methods:Machine readable objective depth/time profiles were obtained from depth/time recorders worn by tuna farm occupational divers. Divers’ health status was measured at the end of each working day using a self administered health survey that produces an interval diver health score (DHS) with possible values ranging from 0 to 30. Depth/time profiles were analysed according to existing decompression models. The contribution of diving exposure and between diver variability to DHS was evaluated using linear regression.Results:The mean risk of decompression sickness was calculated as 0.005 (SD 0.003, n = 383). The mean DHS following diving was 3 (SD 2, n = 383) and following non-diving activities was 1 (SD 1, n = 41). After accounting for between diver variability in intercept, DHS was found to increase one unit for every 1% increase in the risk of decompression sickness.Conclusions:A method has been established for the collection and analysis of self reported objective decompression data from occupational diving groups that can potentially be used as the basis for development of purpose designed occupational diving decompression schedules.
Evaluation of the quality of coding of job episodes collected by self questionnaires among French retired men for use in a job-exposure matrix
Authors: Pilorget C , Imbernon E , Goldberg M , Bonenfant S , Spyckerelle Y , Fournier B , Steinmetz J , Schmaus A 
Published: May 2003

Background and Aims:The ESPACES study was intended to identify retirees who may have been, according to their job descriptions, exposed to asbestos during their working lives. As part of this study, we analysed the quality of the occupation and activity sector coding as well as its effect on the subjects’ exposure status.Methods:The occupation and activity sector for a sample of 450 retired men were coded twice (with the second coder blinded to the first result), according to the international codes for industries (ISIC-1975) and occupations (ISCO-1968). For each series, linking the information about a job episode (dates, ISIC code, ISCO code) with the matrix allowed attribution of a probability of asbestos exposure to each episode and each subject. The asbestos exposure in the two series was compared by the kappa reproducibility coefficient.Results:The analysis concerned 425 questionnaires. There was at least one difference in the code for either activity sector (ISIC) or occupation (ISCO) in half the episodes (50.2%). The exposure status estimated by the job-exposure matrix did not change between the series for 84.7% of the subjects. The kappa coefficient was 0.64 for all questionnaires, 0.70 when the questionnaire was coded twice by the same coder, and 0.62 when coded by two different coders.Conclusions:Despite intra- and inter-differences between coders, the coding of job episodes for the ESPACES study appears satisfactory and hence indicates that the assessment of the subjects’ asbestos exposure was assessed without major distortions. This study underlines the usefulness of employing coders specifically trained for this technique.
Lung cancer mortality among chromate production workers
Authors: Luippold R S , Mundt K A , Austin R P , Liebig E , Panko J , Crump C , Crump K , Proctor D 
Published: May 2003

Aims:To assess mortality in 1997 among 493 former workers of a US chromate production plant employed for at least one year between 1940 and 1972.Methods:Cohort members were followed for mortality to 31 December 1997. Standardised mortality ratios (SMRs) were calculated for selected cause specific categories of death including lung cancer. Lung cancer mortality was investigated further by calculation of SMRs stratified by year of hire, duration of employment, time since hire, and categories of cumulative exposure to Cr(VI).Results:Including 51 deaths due to lung cancer, 303 deaths occurred. SMRs were significantly increased for all causes combined (SMR = 129), all cancers combined (SMR = 155), and lung cancer (SMR = 241). A trend test showed a strong relation between lung cancer mortality and cumulative hexavalent exposure. Lung cancer mortality was increased for the highest cumulative exposure categories (⩾1.05 to <2.70 mg/m3-years, SMR = 365; ⩾2.70 to 23 mg/m3-years, SMR = 463), but not for the first three exposure groups. Significantly increased SMRs were also found for year of hire before 1960, 20 or more years of exposed employment, and latency of 20 or more years.Conclusions:The finding of an increased risk of lung cancer mortality associated with Cr(VI) exposure is consistent with previous reports. Stratified analysis of lung cancer mortality by cumulative exposure suggests a possible threshold effect, as risk is significantly increased only at exposure levels over 1.05 mg/m3-years. Though a threshold is consistent with published toxicological evidence, this finding must be interpreted cautiously because the data are also consistent with a linear dose response.
Estimating the health consequences of replacing cigarettes with nicotine inhalers
Authors: Sumner W 
Published: May 2003

Background:A fast acting, clean nicotine delivery system might substantially displace cigarettes. Public health consequences would depend on the subsequent prevalence of nicotine use, hazards of delivery systems, and intrinsic hazards of nicotine.Methods:A spreadsheet program, DEMANDS, estimates differences in expected mortality, adjusted for nicotine delivery system features and prevalence of nicotine use, by extending the data and methods of the SAMMEC 3 software from the US Centers for Disease Control and Prevention. The user estimates disease risks attributable to nicotine, other smoke components, and risk factors that coexist with smoking. The public health consequences of a widely used clean nicotine inhaler replacing cigarettes were compared to historical observations and public health goals, using four different risk attribution scenarios and nicotine use prevalence from 0–100%.Main outcome measures:Changes in years of potential life before age 85 (YPL85).Results:If nicotine accounts for less than a third of smokers’ excess risk of SAMMEC diseases, as it most likely does, then even with very widespread use of clean nicotine DEMANDS predicts public health gains, relative to current tobacco use. Public health benefits accruing from a widely used clean nicotine inhaler probably equal or exceed the benefits of achieving Healthy People 2010 goals.Conclusions:Clean nicotine inhalers might improve public health as much as any feasible tobacco control effort. Although the relevant risk estimates are somewhat uncertain, partial nicotine deregulation deserves consideration as part of a broad tobacco control policy.
Dimensions underlying legislator support for tobacco control policies
Authors: de Guia N A , Cohen J E , Ashley M J , Ferrence R , Rehm J , Studlar D T , Northrup D 
Published: May 2003

Objective:To propose and test a new classification system for characterising legislator support for various tobacco control policies.Design:Cross sectional study.Subjects:Federal and provincial legislators in Canada serving as of October 1996 who participated in the Canadian Legislator Study (n = 553; response rate 54%).Main outcome measures:A three factor model (Voters, Tobacco industry, Other interest groups) that assigns nine tobacco control policies according to legislators’ hypothesised perceptions of which group is more directly affected by these policies.Results:Based on confirmatory factor analysis, the proposed model had an acceptable fit and showed construct validity. Multivariate analysis indicated that three of the predictors (believing that the government has a role in health promotion, being a non-smoker, and knowledge that there are more tobacco than alcohol caused deaths) were associated with all three factor scales. Several variables were associated with two of the three scales. Some were unique to each scale.Conclusions:Based on our analyses, legislator support for tobacco control policies can be grouped according to our a priori factor model. The information gained from this work can help advocates understand how legislators think about different types of tobacco control policies. This could lead to the development of more effective advocacy strategies.
Development of a model of the tobacco industry’s interference with tobacco control programmes
Authors: Trochim W M K , Stillman F A , Clark P I , Schmitt C L 
Published: May 2003

Objective:To construct a conceptual model of tobacco industry tactics to undermine tobacco control programmes for the purposes of: (1) developing measures to evaluate industry tactics, (2) improving tobacco control planning, and (3) supplementing current or future frameworks used to classify and analyse tobacco industry documents.Design:Web based concept mapping was conducted, including expert brainstorming, sorting, and rating of statements describing industry tactics. Statistical analyses used multidimensional scaling and cluster analysis. Interpretation of the resulting maps was accomplished by an expert panel during a face-to-face meeting.Subjects:34 experts, selected because of their previous encounters with industry resistance or because of their research into industry tactics, took part in some or all phases of the project.Results:Maps with eight non-overlapping clusters in two dimensional space were developed, with importance ratings of the statements and clusters. Cluster and quadrant labels were agreed upon by the experts.Conclusions:The conceptual maps summarise the tactics used by the industry and their relationships to each other, and suggest a possible hierarchy for measures that can be used in statistical modelling of industry tactics and for review of industry documents. Finally, the maps enable hypothesis of a likely progression of industry reactions as public health programmes become more successful, and therefore more threatening to industry profits.