ABSTRACT
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
ABSTRACT
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
Subject(s)
Child Health Services/organization & administration , Medical Records , Pediatrics/standards , Pediatrics/trends , Primary Health Care/organization & administration , Child , Delivery of Health Care/statistics & numerical data , Forecasting , Health Policy , Humans , Practice Patterns, Physicians'/organization & administrationABSTRACT
To examine the skeletal muscle characteristics of power lifters, 5 competitive power lifters (PL; X +/- SE; age = 31.0 +/- 1.5 years, squat = 287.7 +/- 15.7 kg, bench press = 170.5 +/- 17.7 kg, and deadlift = 284.2 +/- 7.5 kg) and 5 untrained control subjects (CON; age = 27.3 +/- 3.3 years) served as subjects. Isokinetic squat force and power was greater (p < 0.05) for the PL at all bar velocities (0.20, 0.82, and 1.43 m;pd s(-1)), as was vertical jump height and estimated power. Muscle biopsies from the vastus lateralis m. revealed significant differences for percent fiber type (PL, IIA = 45.5 +/- 1.6%, IIB = 1.3 +/- 0.8%; CON, IIA = 33.4 +/- 3.1%, IIB = 12.0 +/- 2.4%); percent fiber type area (PL, IIA = 51.8 +/- 1.6%, IIB = 1.3 +/- 0.8%; CON, IIA = 43.5 +/- 3.4%, IIB = 12.4 +/- 2.6%); and percent myosin heavy chain isoform (PL, IIa = 59.5 +/- 6.1%; CON, 46.5 +/- 2.5%). Muscle fiber characteristics were significantly correlated (r = +/- 0.61) with numerous strength and power measures for the PL. These data illustrate the muscle fiber characteristics necessary for the maximal force production requirements of power lifting.
