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Describes the clinical aspects of the Transitions to Better Health™ disease management program for depression developed by Merck-Medco Managed Care L.L.C. Goals of the program; Features of the program; Evaluation of the outcomes of the program.

Serine protease genes (C11, B10 and HF) derived from activated cytolytic T lymphocytes have been shown to be important in CTL-mediated cytotoxicity. In this study, we examined the expression of these genes in fresh natural killer (NK) cells from severe combined immunodeficiency (SCID) and athymic nude mice, as well as in T-cell lines with NK activity. All of these serine protease genes were expressed in NK cells freshly isolated from SCID and athymic nude mice. In addition, all lines showed similar strong levels of expression of C11 and B10 genes, but not the HF gene. However, levels of expression in the T-cell lines did not correlate with levels of NK-like cytotoxicity. These results suggest that C11, B10 and HF serine protease genes are necessary but not sufficient for NK-like cytotoxicity. [ABSTRACT FROM AUTHOR]

Pediatric AIDS is a continuing problem because of maternal transmission. Medical management is often complicated by the loss of one or both parents and adverse home environments. This study explores the cost of inpatient and clinic care of children admitted with AIDS in 1988 or 1989 at Mount Sinai Medical Center in New York City, and also examines the social severity of the cases. Blue Shield allowances were used to price clinic visits and tests, and prices in a drug trade publication were used to determine medication costs. Inpatient costs calculated per person-month at risk amounted to $48,000 per year. Costs per person-month of clinic care averaged $461 (38% of which was for drugs), annualized to around $5,500. These costs are higher than those shown by previous studies. A few cases requiring intensive inpatient services accounted for a large percentage of costs. The social severity analysis, based on the family environment at first admission and later, revealed that households were often stressed by chronic illnesses, drug abuse, marital problems and poor residential quality. Given the circumstances in which pediatric AIDS develops, the activities of social workers to strengthen families are essential to facilitating compliance, maintaining health and minimizing use of the hospital. [ABSTRACT FROM AUTHOR]

The elderly frequently suffer long lengths of hospital stay (LOS). These long stays are often associated with long social care stays which occur when patients no longer require acute care and are awaiting post-discharge services. In this study, actual acute care LOS and social care LOS were studied specifically in hospitalized frail elderly. Our data demonstrate that frail elderly receiving only acute care do not suffer markedly prolonged total LOS (TLOS). However, in hospitalized frail elderly patients who experience acute care and social care stays, social care LOS accounts for over half of all hospital days. When patients were grouped and studied according to the type of post-discharge services being sought by the health care team, significant differences in acute LOS and social care LOS were noted. Subgroups of patients were also identified among the various groups which differed significantly in their LOS parameters. Patients who required more than one discharge plan during the course of hospitalization experienced the longest hospital stays of all groups, and spent almost 70% of these days receiving non-acute social care. In a study of the relationship between the intensity of social work intervention and social care LOS in the frail elderly, a statistically significant relationship was noted between the timing and frequency of social work intervention and the actual length of social care stays. Early and frequent social work interventions were associated with significantly shorter social care LOS. We conclude that the study of TLOS should include acute LOS and social care LOS to obtain a reliable measure of the course and cost of hospital care for the frail elderly. The study of social care subgroups may facilitate future investigations to define the social care problems which contribute most to TLOS, and the patient populations which should be most heavily targeted for early and intensive social work intervention. [ABSTRACT FROM AUTHOR]