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This article focuses on a study which compared patient diagnosis and location of care between for-profit and nonprofit hospices and examined whether number of visits per day and length of stay vary by diagnosis and status. Data from the "2007 National Home and Hospice Care Survey" in the U.S. was used in this study. Results of the study showed that for-profit hospices had a lower proportion of patients with cancer and a higher proportion of patients with dementia. The also found a longer length of stay in for-profit hospices compared with nonprofit hospices. It also notes that patients with dementia or other diagnoses had fewer nurse visits per day compared with cancer patients.

The article focuses on a prospective cohort study which validated and compared the performance of the Advanced Dementia Prognostic Tool (ADEPT) and hospice eligibility guidelines to estimate 6-month survival in nursing home residents with advanced dementia. The residents' mean ADEPT score was 10.1 points at baseline and 65 residents were able to meet hospice eligibility guidelines. Within 6 months, 111 residents died. Study results indicated that the ability of the ADEPT score to identify nursing home residents with advanced dementia at risk of death within 6 months was modest when prospectively validated at the bedside and used as a continuous measure.

The article reports on the results of research which was conducted in an effort to determine the prevalence of Ayurvedic medicines available via the Internet containing detectable lead, mercury or arsenic, and to compare the prevalence of toxic metals in U.S. versus Indian manufactured medicines and between rasa shastra and non rasa shastra medicines. Researchers searched five Internet search engines and determined that one fifth of both U.S. manufactured and Indian manufactured Ayurvedic medicines purchased via the Internet contain detectable lead, mercury or arsenic.

Context Lead, mercury, and arsenic intoxication have been associated with the use of Ayurvedic herbal medicine product (HMPs). Objectives To determine the prevalence and concentration of heavy metals in Ayurvedic HMPs manufactured in South Asia and sold in Boston-area stores and to compare estimated daily metal ingestion with regulatory standards. Design and Setting Systematic search strategy to identify all stores 20 miles or less from Boston City Hall that sold Ayurvedic HMPs from South Asia by searching online Yellow Pages using the categories markets, supermarkets, and convenience stores, and business names containing the word India, Indian cities, and Indian words. An online national directory of Indian grocery stores, a South Asian community business directory, and a newspaper were also searched. We visited each store and purchased all unique Ayurvedic HMPs between April 25 and October 24, 2003. Main Outcome Measures Concentrations (μg/g) of lead, mercury, and arsenic in each HMP as measured by x-ray fluorescence spectroscopy. Estimates of daily metal ingestion for adults and children estimated using manufacturers’ dosage recommendations with comparisons to US Pharmacopeia and US Environmental Protection Agency regulatory standards. Results A total of 14 (20%) of 70 HMPs (95% confidence interval, 11%-31%) contained heavy metals: lead (n = 13; median concentration, 40 μg/g; range, 5-37 000), mercury (n = 6; median concentration, 20 225 μg/g; range, 28-104 000), and/or arsenic (n = 6; median concentration, 430 μg/g; range, 37-8130). If taken as recommended by the manufacturers, each of these 14 could result in heavy metal intakes above published regulatory standards. Conclusions One of 5 Ayurvedic HMPs produced in South Asia and available in Boston South Asian grocery stores contains potentially harmful levels of lead, mercury, and/or arsenic. Users of Ayurvedic medicine may be at risk for heavy metal toxicity, and testing of Ayurve... [ABSTRACT FROM AUTHOR]

Context: Prior to 1997, home health agencies (HHAs) were reimbursed on a fee-for-service basis and had incentives to provide more services. The 1997 Balanced Budget Act (BBA) reduced payments for home care services to help control Medicare spending. Objective: To examine the length of stay in home care before and after the 1997 BBA. Design and Setting: Cross-sectional study of home care patients in the 1996 and 1998 National Home and Hospice Care Surveys, which surveyed 1053 HHAs in 1996 and 1088 HHAs in 1998. Patients: Nationally representative random sample of home care patients with Medicare coverage in 1996 (4127 patients) and 1998 (4051 patients). Main Outcome Measure: Length of stay in home care (based on the number of days a patient was enrolled in home care services). Results: From 1996 to 1998, unadjusted median length of stay decreased by 16 days for all home care patients (60-44 days, P = .002). The decrease affected for-profit HHAs more than not-for-profit HHAs (111-55 days [51% decrease, P = .002] vs 46-36 days [22% decrease, P = .042]). In a Cox proportional hazards model of time to discharge from home care, post-BBA year (1998) was associated with a shorter length of stay in home care (adjusted hazard ratio [aHR] for home care discharge, 1.39 [95% confidence interval {CI}, 1.19-1.61]), and for-profit status was associated with a longer length of stay in home care (aHR, 0.82 [95% CI, 0.71-0.94]) after adjusting for patient demographics, diagnoses, and functional status. Conclusion: After the 1997 BBA, length of stay in home care decreased among Medicare patients, particularly among those receiving care from for-profit HHAs. [ABSTRACT FROM AUTHOR]

Context: For most patients aged 65 years or older with cancer, hospice services are uniformly covered by Medicare. Hospice care is believed to improve care for patients at the end of life. However, few patients use hospice and others enroll too late to maximize the benefits of hospice services. Objectives: Because type of insurance may affect use, we examined whether patients with Medicare managed care insurance enrolled in hospice earlier and had longer hospice stays than patients with Medicare fee-for-service (FFS) insurance. Design and Setting: Retrospective analysis of the last year of life using the Linked Medicare-Tumor Registry Database in 1 of 9 Surveillance, Epidemiology, and End Results program coverage areas. Patients: A total of 260 090 Medicare beneficiaries aged 66 years or older diagnosed with first primary lung (n = 62 117), colorectal (n = 57 260), prostate (n = 59 826), female breast (n = 37 609), bladder (n = 19 598), pancreatic (n = 11 378), gastric (n = 9599), or liver (n = 2703) cancer between January 1, 1973, and December 31, 1996, and who died between January 1, 1988, and December 31, 1998. Main Outcome Measures: Time from diagnosis to hospice entry and hospice length of stay for patients enrolled in FFS vs managed care plans after adjusting for patient demographics, tumor registry, year of hospice entry, and type and cancer stage. Results: Of the 260 090 patients, most were men (59%), white (85%), and enrolled in FFS (89.7%). Only 54 937 patients (21.1%) received hospice care before death. Hospice use varied by type of primary cancer ranging from 31.8% of patients with pancreatic cancer to 15.6% with bladder cancer. Managed care patients were more likely to use hospice than FFS patients (32.4% vs 19.8%, P<.001). Among hospice patients, median (interquartile range) length of stay was longer for managed care vs FFS patients (32 days [11-82] vs 25 days [9-66], P<.001). After adjustment, managed care patients had higher rates of hospice... [ABSTRACT FROM AUTHOR]

Context: Obesity, a leading cause of preventable death and chronic disease, is associated with disability. Little is known about obesity among adults with specific disabilities. Objectives: To determine the prevalence of obesity in adults with physical and sensory limitations and serious mental illness. Design, Setting, and Participants: The 1994-1995 National Health Interview Survey of 145 007 US community-dwelling respondents, 25 626 of whom had 1 or more disabilities. Main Outcome Measures: Likelihood of being obese, attempting weight loss, and receiving exercise counseling among adults with and without disabilities. Results: Among adults with disabilities, 24.9% were obese vs 15.1% of those without disabilities. After adjusting for sociodemographic factors, adults with a disability were more likely to be obese, with an adjusted odds ratio (AOR) of 1.9 (95% confidence interval [CI], 1.8-2.0). The highest risk occurred among adults with some (AOR, 2.4; 95% CI, 2.3-2.5) or severe (AOR, 2.5; 95% CI, 2.3-2.7) lower extremity mobility difficulties. After further adjustment for comorbid conditions, adults with disabilities were as likely to attempt weight loss as those without disabilities, except for adults with severe lower extremity mobility difficulties, who were less likely (AOR, 0.7; 95% CI, 0.5-0.9]), and adults with mental illness, who were more likely (AOR, 1.4; 95% CI, 1.2-1.8). Physician exercise counseling was reported less often among adults with severe lower extremity (AOR, 0.5; 95% CI, 0.4-0.7) and upper extremity (AOR, 0.7; 95% CI, 0.5-1.0) mobility difficulties. Conclusion: Obesity appears to be more prevalent in adults with sensory, physical, and mental health conditions. Health care practitioners should address weight control and exercise among adults with disabilities. [ABSTRACT FROM AUTHOR]

Examines a survey conducted in an effort o document trends in alternative medicine used in the United States between 1990 and 1997, focusing on the high prevalence and costs of alternative medicine. Increase in alternative medicine used and expenditures between 1990 and 1997; Methodology employed in this survey; Total number of persons who participated in the survey; Results of the survey.

Offers the results of a study on the importance of physicians counseling patients about exercise to help combat obesity. Reasons why physicians do not counsel patients, including time constraints; Context; Objectives; Design and Setting; Participants; Main Outcome Measures; Results; Conclusion.

Presents a response to a letter to the editor from an previous issue, which discussed the effects of the 1997 Balanced Budget Act on home services among Medicare patients.