The Caring Program for Children. The Michigan experience.

Public-private partnerships may offer the best opportunity in the near-term for addressing the problem of the uninsured. In Michigan, a broad spectrum of groups has studied the issue of the uninsured and, despite the diversity of the groups, arrived at a consensus that providing coverage to uninsured children is an urgent priority. The Caring Program for Children, a private program initiated by Blue Cross of Western Pennsylvania to provide primary and preventive health care coverage to children in low-income, uninsured families, gained support from the Michigan legislature and advocacy and provider groups as a means to address the problem. Blue Cross Blue Shield of Michigan and the Michigan Department of Social Services joined to expand the Caring Program for Children from a private program to a public-private venture funded by federal and state funds and private donations that has the potential to provide coverage to more than 12,000 children. The Michigan experience may be instructive to other states attempting to devise immediate local solutions to the problem of the uninsured.

Automating Veterans Administration libraries: II. Implementation at the Kansas City Medical Center Library.

In 1985, the Kansas City Veterans Administration Medical Center began implementation of the Decentralized Hospital Computer Program (DHCP). An integrated library system, a subset of that program, was started by the medical library for acquisitions and an outline catalog. To test the system, staff of the Neurology Service were trained to use the outline catalog and electronic mail to request interlibrary loans and literature searches. In implementing the project with the Neurology Service, the library is paving the way for many types of electronic access and interaction with the library.

Benefit analysis for natural hazards.

The objective of this paper is to develop the ex ante perspective for benefit analysis with natural hazards. It defines an ex ante evaluation of the economic benefits that arise from policies designed to reduce either the risk of or the detrimental effects associated with a natural hazard. In the process the paper compares the ex ante and ex post perspectives and discusses the prospects for implementing the framework by measuring the valuation concepts that are developed.

Effects of clonidine on anxiety disorders.

To examine the role of the noradrenergic system in anxiety disorders, 23 patients (nine with generalized anxiety disorders and 14 with panic disorders) were studied for four weeks with clonidine hydrochloride, a predominantly presynaptic noradrenergic agonist, and with placebo. A double-blind crossover design was used. The effect of clonidine was comparable in both anxiety disorders and superior to placebo in patients who tolerated the drug. The conditions of 17% of the patients became worse with the medication. The main effect of clonidine was a decrease of anxiety attacks and "psychic" symptoms. Somatic symptoms were least affected. The complexity of the results may be explained through the postsynaptic effects of clonidine, which in part neutralize its presynaptic nonadrenergic effects. It may also indicate disturbances in other neurotransmitter systems that are not affected by clonidine.

Drug and psychotherapy interactions in depression.

The authors conducted a series of multiple regression analyses of data from depressed patients. They found that 8 factors consistently predicted treatment response: a lower initial level of distress, imipramine treatment, a positive attitude toward group psychotherapy, and a good employment history predicted lower posttreatment distress levels; estrogen maintenance treatment was related to better response to diazepam, and a low level of intelligence predicted better response to both diazepam and imipramine; and a low initial level of interpersonal sensitivity and a significant other's having an unfavorable attitude toward psychiatric treatment were associated with better response to group psychotherapy.

PIP: Multiple regression analyses of experimental data from emotionally depressed patients were conducted to determine factors bearing on the prediction of response to 6 types of treatment of depression. The following 8 factors were found to consistently predict favorable response to treatment: 1) lower initial level of distress, 2) treatment with imipramine, 3) a good employment history, 4) a positive attitude toward group psychotherapy, 5) estrogen replacement therapy enhanced the response to diazepam, 6) a low level of intelligence was predictive of a better response to diazepam and imipramine, 7) a low initial level of interpersonal intersensitivity, and 8) an unfavorable attitude toward psychiatric treatment was associated with a better response to group psychotherapy.

Rapid analysis of pregnanediol in pregnancy urine.

A simple, inexpensive, and rapid method for the determination of pregnanediol in pregnancy urine by gas liquid chromatography is described. Automatic injection of the samples into the gas chromatograph allows up to 36 samples to be run overnight thus saving valuable technical time.The method described can easily be adopted for use in a routine steroid laboratory. The results obtained by this method have been compared with values obtained by the method of Klopper, Michie, and Brown (1955).