Replication of a managed health care initiative for people with mental retardation living in the community.

To improve understanding of the cost-effectiveness of a managed health care program for individuals with mental retardation, we have described financing, utilization, and outcomes of the Developmental Disabilities Center at Morristown Memorial Hospital. The costs and benefits of health care coordination, a key feature of this program, were discussed. Under this model, annual, unreimbursed costs of health care coordination in 1989 averaged $668 for people with severe mental retardation. However, the total reimbursable costs of inpatient care were reduced. In addition, medical outcome data from ongoing research projects suggest that the program has been an important vehicle for improving the health of people with mental retardation in the community. The costs, revenues, and financing of this program were presented in order to assist candidate sites in the replication of this model. The role of this type of program in health care reform was discussed.

Managed health care services for people with mental retardation: impact on inpatient utilization.

All admissions of people with mental retardation to a community hospital during one year were examined to determine the effects of a managed-care model on selected outcome variables. Hospitalization outcomes for patients receiving health care services through the program (care coordination group) were compared to those not enrolled (usual care group). Patients in the care coordination group were found to have shorter hospital stays, when adjusted for diagnosis-related groups; fewer readmissions; and were less severely ill upon admission. Cost data were extrapolated to show that costs of care coordination activities were partially offset by reductions in inpatient utilization.

Children's testimony and their perceptions of stress in and out of the courtroom.

Modifications of the courtroom environment have been proposed to reduce stress and enhance truth-telling of child witnesses. The present study examines the premise that courtroom environment affects the quality of children's evidence and children's perceptions of their own stress. Thirty-four 8- to 10-year-olds participated in an activity and 2 weeks later, their memory for the activity was tested. Half the children were questioned in a mock courtroom in the law school of a major university, and half at their school, both by the same interviewer. Children questioned at court showed impaired memory performance when compared with agemates questioned at school. They also rated certain court-related experiences as more stressful than peers interviewed at school. Furthermore, children's perceptions of courtroom stress were negatively correlated with completeness of accurate free recall, suggesting a relation between court-related stress and eyewitness memory worthy of further study.

Mortality among individuals with mental retardation living in the community.

Mortality in a population of more than 1,300 people with mental retardation who live in the community was studied utilizing a case-by-case review and sentinel health event methodology. Death was noted in 14 people over a 4-year period. Cause of death was identified as avoidable (3 patients), potentially avoidable (3), unavoidable (3), sudden unexplained death with a history of epilepsy (3), or other unexplained deaths (2). Factors influencing mortality and the delivery of health care services were described. The sentinel health event methodology and case-by-case mortality reviews are recommended for monitoring avoidable deaths in community residential settings for people with mental retardation.

A statewide public and professional education program on fragile X syndrome.

Fragile X syndrome is reported to be the most common inherited cause of mental retardation known, but the majority of affected individuals are as yet undiagnosed. The project described in this paper was developed to increase the public and professional awareness of fragile X syndrome in the state of New Jersey. As a result there were increased efforts at diagnostic screening, provision of client and family support services, and prevention. This educational program proved to be a cost-effective method for increasing community awareness of a genetic disease on a statewide level.

Pertussis immunization patterns in special care nursery graduates.

Controversy exists regarding immunization with pertussis vaccine of high-risk special care nursery graduates. Our study compared the immunization status of 38 high-risk, 30 low-risk, and 57 normal infants utilizing an immunization response form. Comparison of the three infant groups revealed that complete or incomplete immunization varies, depending on group status. Of 38 infants at high risk for developmental delay, 22 (57.9%) were not immunized against pertussis by age one. Physicians cited concerns related to previous neurologic injury and increased liability for vaccine-related injury as major reasons for deferring vaccination. Recommendations for improving current guidelines and practice are outlined.

AIDS and state developmental disability agencies: a national survey.

A survey of state developmental disability agencies was undertaken in October 1987 regarding AIDS policy development, education, and training and service provision. Of 44 states responding to the 27-item questionnaire, only 21 had formal AIDS policies. Policies varied considerably from state to state. Twenty-five of the responding states include information on AIDS in their staff training curriculum, with such training more likely to be provided to institutional staff than to community-based staff. Only 10 states reported AIDS prevention to be part of their client training programs, with training more likely to be found in institutional settings. Eleven states reported HIV positive cases, with such cases found more often in institutions than in community settings. Several states reported some type of segregation of HIV positive individuals. Policies, educational programming, and services to meet the special needs of persons with developmental disabilities are called for.

HIV infection and developmental services for adults.

The achievement of community living and greater personal independence has placed adults with developmental disabilities in a potentially vulnerable position regarding acquisition of HIV infection. Early surveys have identified a limited number of individuals who have become infected. Few states have undertaken planning for assurance of appropriate services. Program managers must consider the diverse educational and ethical issues involved; advisory committees can be of assistance. Strong antidiscrimination measures will be required for the protection of adults with developmental disabilities and HIV infection.

AKR/J gene(s) unlinked to H-2 determines dominant inheritance of lymphocyte hyporesponsiveness to acetylcholine receptor.

Mice with the H-2b major histocompatibility complex haplotype are high immune responders to nicotinic acetylcholine receptors (AChR), whereas mice with the H-2k haplotype are generally low responders. F1 progeny of C57BL/6 (H-2b) mice crossed with mice of most H-2k strains are high responders to AChR in standard conditions of testing helper T cell proliferation in vitro (4 X 10(5) lymph node cells/microwell, 1 wk after primary challenge in vivo). In contrast, the F1 progeny of AKR/J (H-2k) crossed with high responder (H-2b) strains (B6, A.BY, or C3H.SW) were all hyporesponsive to AChR when lymphocytes were tested at 4 X 10(5) cells/well. However, at a density of 1 X 10(6) or greater/well, a high level of antigen-specific responsiveness was demonstrable in the F1 hybrid lymphocytes. A shift from low to high responsiveness to AChR at high cell densities was observed also in the H-2b strain AKR.B6. Other strains previously demonstrated to be low responders to AChR did not become responsive to AChR when lymphocyte numbers were increased to 1.4 X 10(6)/well. The N2 generation yielded by backcrossing (AKR X B6)F1 mice to AKR/J were all low responders, whereas N2 progeny derived by backcrossing F1 to B6 were high or low responders in a ratio of approximately 1:1 (independent of their H-2 phenotype). Results consistent with this observation were obtained in (AKR X B6) F2 mice. These data suggest that at least one AKR/J gene outside of the H-2 complex exerts a hyporesponsive influence on the I-A-dependent helper T cell response to AChR in H-2b mice.

Transformation of chicken lymphocytes stimulated by concanavalin A: response parameters.

The culture conditions for obtaining the maximum transformation of chicken lymphocytes stimulated by the mitogen Concanavalin A are described in this paper. Lymphocytes were cultured in round bottom microtiter tissue culture plates and the incorporation of 3H-methyl-thymidine (3H-TdR) into lymphocyte deoxyribonucleic acid was used to quantitatively evaluate transformation. Maximum incorporation of 3H-methyl-thymidine occurred when 2 x 10(6) lymphocytes and 4 micrograms of Concanavalin A were added to each culture. Deoxyribonucleic acid synthesis was greatest during the period of 18 to 36 hours after addition of mitogen. Differences between chicken and mammalian lymphocyte cultures are discussed.

Pasteurella multocida: antibody-mediated resistance to virulent challenge exposure in vaccinated turkeys.

Aspects of antibody-mediated resistance to Pasteurella multocida infection in vaccinated turkeys were investigated. Pasteurella immune serum obtained from vaccinated turkeys was shown to confer temporary protection to nonvaccinated turkey poults. Recipients given immune serum were free of clinical signs of disease for at least 8 days after IM challenge exposure with virulent P multocidae 1059. All turkeys given normal serum died within 36 hours of challenge exposure. Vaccinated bursectomized turkeys were more susceptible to IM challenge exposure than were vaccinated nonbursectomized turkeys. In two of three trials, mortality also occurred earlier in the bursectomized groups when compared with mortality in the control groups. The presence of specific antibody may be an important determinant in resistance to Pasteurella infection.

Uridine uptake inhibition in Novikoff hepatoma cells by perturbants of intracellular Ca2+ and K+ levels.

The rate of uptake of uridine into the acid-soluble fraction of Novikoff hepatoma cells is inhibited by low concentrations of the ionophores A23187 and gramicidin and other perturbants of intracellular cation levels. Inhibition of uridine uptake by A23187 is dependent on Ca2+ and is reduced by serum and high levels of Mg2+. The effectiveness of A23187 is dependent on the Ca2+/Mg2+ ratio rather than the absolute concentration of either ion. Inhibition of uridine uptake by gramicidin is not significantly affected by serum or divalent cations. Other effectors of monovalent cation flux such as ouabain and valinomycin also inhibit uridine uptake. These results indicate that net uptake of uridine may be influenced by intracellular levels of certain monovalent and divalent inorganic cations.

Modification of photocarcinogenesis by two immunosuppressive agents.

The carcinogenic effect of ultraviolet radiation (UVR) on the skin of hairless (hr) mice was modified by two immunosuppressive agents, rabbit anti-mouse lymphocytic serum (ALS), and 6-mercaptopurine (6MP). Daily exposure of mice to UVR resulted in multiple tumor production. Carcinogenesis was measured in terms of affected mice (prevalence) and numbers of tumors produced. By both criteria, photocarcinogenesis was enhanced by ALS but inhibited by 6MP.