Right-sided spatial difficulties in ADHD demonstrated in continuous movement control.

Children with Attention Deficit Hyperactivity Disorder (ADHD) often show spatial attentional deficits, exhibiting a subtle rightwards bias, possibly due to dysfunction within the right hemisphere fronto-parietal network. Approximately 50% of children with ADHD also show signs of movement dysfunction. The nature of this movement dysfunction and possible interactions with spatial attention difficulties has not been clearly described. This study compared 31 children with and 31 children without ADHD on a movement kinematic task that tested hand-drawing movement precision. Participants used an electronic pen on a digitizing tablet. The pen tip position was sampled as X and Y coordinates at 200Hz. The task was to join targets of either 10 or 20mm diameter that were separated by a distance of 62.5 or 125 mm. Constant error in the X and Y planes, peak absolute velocity and acceleration, movement time, the number of pauses and pause time were analysed. Apart from a significantly increased rate of acceleration across all conditions, the children with ADHD demonstrated no temporal difficulties with the task; rather they showed subtle spatial difficulties, possibly suggestive of cerebellar involvement. The children with ADHD showed difficulties in accuracy of movement towards the right. They were less accurate in the X plane when moving towards the right-sided targets over the long distance. Greater variability in target accuracy was shown when moving towards the small target on the right side. The children with ADHD made significantly more pauses on the left target, when preparing the right movement, than the control group. These results suggest that the subtle spatial bias towards the right that has been demonstrated in ADHD in spatial attention also extends into the continuous movement domain.

Third-party reimbursement coverage for diabetes outpatient education programs.

The purpose of this study was to report on current third-party reimbursement coverage for diabetes outpatient education programs. In 1986, the Centers for Disease Control began to collect and analyze information about reimbursement of outpatient diabetes education programs. Data compiled in the Diabetes Outpatient Education Reimbursement Database represented various information sources, including contact people in 42 states, surveys, government publications, the American Diabetes Association, the American Association of Diabetes Educators, and Communicating for Agriculture. The purpose of the data base was twofold: 1) to track national reimbursement trends and 2) to support health-care professional efforts in obtaining third-party reimbursement for education services. This article analyzes the Diabetes Outpatient Education Reimbursement Database. This study is a descriptive analysis of the major carriers that reimburse, legislation for reimbursement of education programs, and state risk-sharing insurance pools. Currently, Medicaid (in 37 states), Medicare (in 49 states), Blue Cross/Blue Shield (in 43 states), and private carriers (in 48 states) reimburse diabetes outpatient education programs. Sixteen states have operational pooled risk health insurance plans. This represents an increase in the number of states that report reimbursement from 1986. Progress has been made in procuring reimbursement coverage for diabetes outpatient education programs. However, progress does not imply that third-party reimbursement is uniform nationwide or effortlessly achieved. Many challenges must be addressed before reimbursement is no longer an issue in the management of diabetes education programs and the provision of essential services for people with diabetes.