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We conducted a secondary analysis of the evaluations of 22 sites participating in four primary care redesign initiatives funded by the Centers for Medicare and Medicaid Services or the Center for Medicare and Medicaid Innovation. Our objectives were to determine the overall impact of the initiatives on Medicare expenditures and whether specific site-level program features influenced expenditure findings. Averaged over sites, the mean intervention effect was a statistically insignificant US$26 per beneficiary per year. Policy implications from meta-regression results suggest that funders should consider supporting technical assistance efforts and pay for performance incentives to increase savings. There was no evidence that paying for medical home transformation produced savings in total cost of care. We estimate that in future evaluations, data from 35 sites would be needed to detect feature effects of US$300 per beneficiary per year. [ABSTRACT FROM AUTHOR]

Among 1,208 Puerto Rican women in Boston and Hartford responsible for adolescents, the age-adjusted prevalence of current smokers was 29.4%, higher than rates for all adult women. Nonsmoking status was associated with higher educational attainment, presence of a spouse or partner, and regular church attendance. (SV)

Among 424 urban Puerto Rican high school students, 12 percent of males and 10 percent of females had smoked in the previous month. Past smoking and intentions to smoke were associated with exposure to smokers during recreation and smoking behavior of close friends but not family members. Contains 27 references. (SV)

Abstract: This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes. Keywords: Adolescents, alcohol, consequences, managed care, substance abuse, INTRODUCTION Managed Care and Behavioral Health Services Managed care has become a common approach for delivering behavioral health services. As of 1999, 41 states operated some form of managed behavioral [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2005.02.003 Byline: Bret E. Fuller (a), Traci Rieckmann (a), Dennis McCarty (a), Kevin W. Smith (b), Helen Levine (c) Abstract: Three surveys (1997, 1999, and 2001) of outpatient substance abuse treatment centers in Connecticut, Massachusetts, Rhode Island, Maine, Vermont, and New Hampshire examined organizational characteristics that influenced the adoption of naltrexone. Structural equation modeling with manifest variables assessed predictors related to the use of naltrexone. Use of naltrexone increased over time from 14% in 1997 to 25% in 2001. In 1997, programs funded by managed care were more likely, and clinics that provided only substance abuse services were less likely to use psychiatric medication and naltrexone. In subsequent years, counselor education level and organization size also influenced use of naltrexone. Author Affiliation: (a) Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR 97239, USA (b) Survey Research Center, New England Research Institutes, Watertown, MA 02472, USA (c) Levine and Associates, Boston, MA, USA Article Note: (footnote) [star] This research was made possible by a grant from NIAAA (RO1-AA11363).

ABSTRACT Objective To develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures [...]

The 24-hour recall is a dietary assessment technique often used to measure nutrient intakes of children and adolescents. Because children often have difficulty accurately describing foods, ingredients, and preparation methods, [...]

The kinetic phase behavior and phase transformation paths of tripalmitoylglycerol (PPP) and 1,3‐dipalmitoyl‐2‐stearoyl‐sn‐glycerol (PSP) mixtures are investigated at 10.0 °C min−1 (fast cooling) and 1.0 °C min−1 (slow cooling) cooling rates, and re‐heating at 5.0 and 1.0 °C min−1. Mixtures with 0.1 XPSP increments are studied in terms of polymorphism, crystallization, and melting. At the higher cooling rate, all samples crystallized in the α polymorph, while at the lower cooling rate, samples containing XPSP ≤ 0.3 crystallized in the α polymorph and samples containing XPSP > 0.3 crystallized in the β′ polymorph. During heating, all samples transformed to a more stable β′ form and melted finally in the β form (XPSP ≤ 0.3) or in the β′ form (XPSP > 0.3). Kinetic phase diagrams are determined from the DSC heating thermograms and XRD patterns obtained during cooling and heating and displayed an eutectic behavior with an eutectic point at XPSP = 0.3 irrespective of the rate at which the samples are cooled and re‐heated. The eutectic temperature is independent of the cooling and heating rates used. This study shows that PSP has a strong effect on the physical properties of PPP–PSP mixtures and dominates a large part of the phase behavior of the PPP–PSP binary system. At lower PSP concentration, the mixtures transform to the most stable β form, but at increasing PSP concentration the mixtures stabilize in the β′‐phase which is preferred in many food application because this results in a smooth texture. Practical Application: The results of this study are useful for the food industry as they can help in understanding the functionality of hard fat‐based structuring agents in end applications and in developing new triacylglycerol‐based crystallization and structuring agent for specific food applications PPP–PSP mixtures, either cooled or heated at lower or higher rate, all samples display different type of phase behavior: α‐ to β′‐phase development via recrystallization from the melt for mixtures having low PSP concentration, an α‐ to β′‐phase development via solid–solid transformation, a β′2‐ to β′1‐phase development via solid–solid transformation, and a β′‐ to β‐phase development via solid–solid transformation with an apparently typical eutectic behavior, with an eutectic concentration (XE) of about XPSP = 0.3. The eutectic temperature is not affected by the processing conditions applied. In the XPSP ≤ XE side of the phase diagram, the transition is different, being more β stable and is strongly affected by increasing PSP content (XPSP > XE side), which are more β′ stable. [ABSTRACT FROM AUTHOR]