Determinants of risk for cardiovascular disease during school-age/adolescent transition.

During the past two decades, emphasis has been placed on exploring the development of cardiovascular disease (CVD) during childhood. Hypercholesterolemia, the most prevalent of the CVD risk factors among children, has been the focus of some large population-based studies. These studies tend to relate only to the physiological aspect of the school-age/adolescent transitional phase and do not necessarily address the collective contributions of the early adolescent experience, including psychosocial and cognitive factors. Thus, minimal information exists on the determinants of the CVD risk factor during this time of growth and rapid developmental change. Relatively unexplored are the interrelationships among the determinants of hypercholesterolemia (and CVD) observed in studies of adults, including sociodemographic, biodevelopmental and behavioral factors. Since the adolescent transition is a critical period for the formation of health-promoting behaviors, knowledge of these interrelationships is requisite to developing specific and timely preventive interventions. An adaptation of the Health Promotion Model is used to guide the exploration of the knowledge to date regarding the sociodemographic, biodevelopmental and behavioral factors in the school-age/adolescent population.

An assessment of obstetric services in Mississippi.

Seven hundred and six (80.6% response rate) obstetricians, family physicians, and general practitioners responded to a survey designed to elicit information regarding their obstetric practice. Results of the study were compared to a similar survey conducted in 1985. The proportion of obstetricians offering obstetric care has remained relatively constant since 1985. Among family physicians and general practitioners, however, there was a significant decrease in the proportion who practice obstetrics (p < .01), and a significant increase in the proportion who have discontinued obstetric practice in the last five years (p < .01) and who plan to discontinue obstetric care in the next five years (p < .05). Consistent with the 1985 data, cost of malpractice insurance, threat of litigation, and time demand were the three most frequently reasons for discontinuing obstetric care. Without changes in the current system, the provision of obstetric care in rural areas will continue its current dramatic decline.

Awakening child consumerism in health care.

Consumer participation, especially among children and their families, is requisite in bargaining assertively for quality care in today's health care industry. The emergence of self-care behaviors must be evoked, cultivated, and embraced during childhood in order to nurture a discriminating attitude toward health care ventures.

Cost/health effectiveness of home uterine activity monitoring in a Medicaid population.

It has been shown that an intensive system of preterm birth prevention using home uterine activity monitoring can decrease the number of early births. Such a system was employed in 130 public assistance (Medicaid) patients who were at high risk for preterm birth. A retrospective review of the pregnancy outcome in these subjects was conducted and their data exposed to a model for projected patient care cost. The incidence of preterm labor in the at-risk group was 46%, with an average prolongation of pregnancy of 4.9 weeks. The occurrence of preterm delivery for failed tocolysis or advanced cervical dilatation was less than 10%. Based on a cost-analysis model that considered newborn charges and monitoring expenses, nearly [corrected] $3 million (an average of $21,813 [corrected] per patient) was saved using this system.