The safety net of the safety net: how federally qualified health centers "subsidize" Medicaid managed care

In this article, I examine the impact of neoliberalism and welfare reform on the delivery of Medicaid, specifically how the advent of Medicaid managed care (MMC) has been wrought with contradictions, placing increased burdens on primary safety-net organizations and impacting the many communities they serve. I argue that federally qualified health centers (FQHCs) operate as a primary safety net among safety-net providers, supporting and subsidizing New Mexico's MMC program financially and administratively. By presenting ethnographic data, I will demonstrate how FQHCs pay many of the hidden financial and institutional costs of the shift to managed care. Such findings uncover paradoxes inherent to neoliberal ideologies and privatization, raising questions about the efficacy of a managed care system for Medicaid as well as the future of the health care safety net and access to health care for the diverse populations it serves.     

De facto disentitlement in an information economy: enrollment issues in Medicaid managed care

This article discusses enrollment issues in New Mexico's Medicaid managed care (MMC) system and seeks to illuminate reasons for persistent problems reported by workers and clients. It argues that between 1997 and 2000, the MMC and welfare reforms raised enrollment barriers by complicating and dehumanizing the system, thus "technically disenfranchising" workers and clients. Specifically, the new system increased the need for professional, in-person enrollment assistance precisely when the state decreased its provision of it. Some aspects of the State Child Health Insurance Program (SCHIP) reforms indirectly aggravated those same problems, and though they also significantly lowered barriers in some areas, overall the new system was plagued with preexisting barriers as well as new, unmet needs that produced "de facto disentitlement" to health services.     

Development of an index to measure oral health care priority among nursing staff

Objective: To develop an index to measure oral health care priority among nursing staff. Background: Nursing staff, working on hospital wards, at nursing homes and at other facilities, have to deal with oral health care and there are many reports about the low priority that is given to oral health care by nursing staff. It is difficult to measure oral health care priority among nursing staff. A Dental Coping Beliefs Scale (DCBS) index was used in an intervention study and was found to be easy to handle but did not have the ability to reveal significant differences in small study samples. A development process consisting of added items and item numbering by chance was carried out. During this process, different nursing staff test groups were used. The aim was to develop an oral health care priority index that can be used both on hospital wards and at special facilities to measure oral health care priority among nursing staff over time and between groups. Material and methods: Nursing staff at both special facilities and hospital wards and nursing students. Results: It was found that the index, the nursing DCBS, was more stable compared with the version that was used in the initial intervention study. It was also noted that its ability to discriminate between the items was improved. Conclusion: The nursing DCBS index is a suitable tool for use in further studies where the aim is to measure how different nursing staff groups give priority to and allocate responsibility for oral health care, even where study samples are small.     

Concomitant detection of mucosal mast cells and eosinophils in the intestines of normal and nippostrongylus-immune rats

Summary The granules of mucosal mast cells (MMC) in the rat and man apparently poorly fixed with formaldehyde and special fixation techniques are normally used to demonstrate MMC glycosaminoglycans (GAG) in these two species. However such techniques do not permit the study of MMC granule enzyme cytochemistry or the demonstration of eosinophils. We have, therefore, examined some histochemical and immunocytochemical properties of MMC and eosinophils in normal and parasitised rats following various fixation procedures. Immersion fixation of rat intestine in 4% paraformaldehyde for 6 h not only facilitated the demonstration of MMC glycosaminoglycans with basic dyes but also permitted the concomitant staining of cosinophils with acidophilic dyes. A MMC granule-associated serine esterase was also demonstrated by enzyme cytochemistry and rat mast cell protease II was detected within MMC granules by immunocytochemistry. This new methodology obviates the requirement for separate fixation procedures in the identification and characterisation of MMC/eosinophil interactions in normal and parasitised rat intestinal mucosa.     

Denture loss: an 8-month study in a community dental setting

Objective: Lost dentures can be a frustrating scenario for both patients and clinicians. This study aimed to find out where dentures were being lost and the level of assistance patients received with denture care. Results: The results showed most dentures were lost in the hospital environment, and in many cases patients were not provided with pots in which to store their dentures or offered help or advice on denture care. The provision of new dentures to this patient group is complicated by the fact that in many cases the dentures were over ten years old and many of the patients were over eighty five years old. This makes adaptation to new dentures difficult. Conclusions: It is imperative that protocols are developed and staff trained to minimise the risk of lost dentures and improve the standard of denture care.     

Ideologies of aid, practices of power: lessons for Medicaid managed care

The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.     

Transforming the Safety Net: Responses to Medicaid Managed Care in, Rural and Urban New Mexico

In this article we examine the impact of Medicaid managed care on safety net organizations in New Mexico and their ability to maintain their traditional mission of charity care. We address two particular areas of concern that have arisen in the literature on Medicaid managed care. First, analysts have debated under what circumstances safety net organizations are better positioned to survive under market competition without abandoning their social orientation. Second, analysts have suggested that populations in rural areas may be more disadvantaged under Medicaid managed care due to its intensification of already-existent barriers to access. By comparing the differential ability of safety net organizations in rural and urban New Mexico to buffer their patients from potentially harmful effects of Medicaid managed care, we identify factors that place these safety nets particularly at risk. We find that a rural location, lack of affiliation with a larger organization, and lack of recourse to charitable funding are "risk factors" determining who sinks—and who floats—in this new competitive health care system, [privatization of health care, Medicaid safety net organizations, managed care, resistance, ruralurban]     

Minority politics in the Middle East and North Africa: the prospects for transformative change

This special issue explores the prospects for what Jacob Mundy calls ‘transformative minority politics’ in the Middle East and North Africa (MENA) region – that is, a form of minority politics that strengthens democratic reform in the region, and that helps deepen a culture of human rights and democratic citizenship. The cases examined in the special issue include the Amazigh in North Africa, the Copts in Egypt, the Kurds in Iraq, the Palestinians in Israel, the ‘minoritarian’ regimes in Syria and Bahrain, and the various ethnic minorities in Iran. In this introduction, we try to situate this debate in a larger historical and international context, identifying some of the factors that might help support a new transformative minority politics in the region, while also emphasizing the factors that have inhibited it in the past, and why they remain powerful.     

Genotoxicological studies in aquatic organisms: an overview

Substantial progress has been made in the lat two decades to evaluate the impact of physical and chemical genotoxins in aquatic organisms. This overview (a) summarises the major high lights in this stimulating area of research, (b) compares the developments in this field with the developments in mammalian genotoxicological studies, where appropriate, (c) introduces 18 different articles presented in this special issue of Mutation Research in the backdrop of main advances and , (d) hypothesises on future directions of research in this exciting field.     

Lateral stabilization improves walking in people with myelomeningocele

Muscle weakness and sensory deficits in people with myelomeningocele (MMC) make their walking control a greater challenge. We know little about how people with MMC optimize their walking balance. Recently, researchers have argued that medial-lateral control of gait requires more active neural input than the anterior-posterior direction, which is more passive. Our goal was to investigate the effect of providing external lateral stabilization (ELS) on walking patterns in people with MMC. We examined 12 people with MMC who could perform at least 4-6 independent steps. We found that the normalized step width (SW) was decreased 20% from without stabilizer to with stabilizer, where as the normalized step length (SL) was increased 4.17% from without stabilizer to with stabilizer. The ELS resulted in 25.10% reduction in centre of mass (COM) ranges of motions in the medial-lateral direction and 13.43% reduction in pelvic range of motions in the frontal plane. Our results suggested that by decreasing the medial-lateral control demands in people with MMC, we could improve gait with smaller SW, longer SL as well as reduced COM and pelvic ranges of motion in the frontal plane. In addition, ELS decreased energy cost and muscle co-activation of soleus and vastus lateralis that may help in diminishing the chances of pain and fatigue in people with MMC. Exploring the effect of the ELS provided us information that might be used to increase mobility safety and to develop a superior rehabilitation intervention for people with MMC.     

高师院校微生物实验教学改革的实践与思考

针对中学新课改下的微生物学实验教学体系对高师院校现行微生物实验教学进行了改革,提出以培养学生的动手能力为出发点,从实验内容改革,实验教学手段改革和实验教学人员等方面入手,尝试建立一套适合高师院校生物科学专业本科生的微生物实验课程的创新教学体系。     

Letter from Chile: Re-establishing health care in Chile

Chile''s long term social policy has produced very impressive outcomes in general health indicators, with a national health service established as early as 1952. During the years of the Pinochet dictatorship (1973-89) public health institutions were greatly affected, with sharp diminution in financing which affected investment and salaries. The democratic government initiated in 1990 faced a difficult situation, with underpaid staff and decrepit hospitals. The ministry took immediate action to improve salaries and start an ambitious health sector reform including investment in infrastructure, technology, and modern management. Decentralisation and autonomy, changes in payment for service mechanisms, and a public-private mix are the main objectives of this reform, keeping the public role as predominant in the proposed structure. This process has been affected by union unrest and public opinion dissatisfaction, which tend to present obstacles to progress in this complicated issue.     

Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists

doi: 10.1111/j.1741‐2358.2011.00513.x Health care professionals’ perspectives on oral care for long‐term care residents: Nursing staff, speech–language pathologists and dental hygienists Background: Oral health has been identified as a key factor in general health and systemic disease in long‐term care populations. To optimise oral health of this population, it is important to understand the oral care perspectives held by health care professionals involved in oral care provision. Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language pathologists (SLPs) and dental hygienists (DHs) in long‐term care institutions and to understand how their perspectives impact activities and processes involved in the delivery of oral care. Methods: A focus group methodology was utilised. Separate focus groups for each targeted profession were held. Transcribed data were analysed using constant comparative analysis. Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs and DHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursing staff to provide oral care, whereas factors related to the general health consequences of poor oral health underlined the motivations of SLPs and DHs. Conclusions: Education and training initiatives incorporating social aspects of oral health may be more effective for motivating nursing staff than approaches emphasising physical risk factors. Organisations can foster environments that support collaboration and communication amongst the members of multidisciplinary teams in order to promote oral health as a priority.     

X-ray- and mitomycin C (MMC)-induced chromosome aberrations in spermiogenic germ cells and the repair capacity of mouse eggs for the X-ray and MMC damage

Chromosome aberrations induced at the first-cleavage metaphase of eggs fertilized with sperm recovered from spermiogenic cells which had been X-irradiated and treated with mitomycin C (MMC) at various stages were observed using in vitro fertilization and embryo culture technique. Furthermore, the repair capacity of the fertilized eggs for X-ray- and MMC-induced DNA damage which was induced in the spermiogenic cells and retained in the sperm until fertilization was investigated by analysis of the potentiation effects of 2 repair inhibitors, 3-aminobenzamide (3AB) and caffeine on the yield of chromosome aberrations. The frequency of chromosome aberrations observed in the eggs fertilized with sperm recovered from the early spermatid to late spermatocyte stage with X-irradiation of 4 Gy (16-20 days after X-irradiation) was markedly higher than that in the eggs fertilized with sperm recovered from spermatozoa to late spermatid stage (0-8 days after X-irradiation). The induced chromosome aberrations predominantly consisted of chromosome-type aberrations, the main type being chromosome fragment followed by chromosome exchange through all the spermiogenic stages. On the other hand, a high frequency of chromosome aberrations was not induced through all the stages with MMC treatment of 5 mg/kg. The remarkable potentiation effects of 3AB and caffeine were found in the eggs fertilized with sperm recovered from almost all the spermiogenic stages after X-irradiation. In the MMC treatment, a remarkable caffeine effect was observed occasionally in mid-early spermatids to late spermatocytes where a large amount of MMC damage could be induced. These results suggest that the large amount of DNA lesions induced in spermiogenic cells by X-rays and MMC persist as reparable damage until sperm maturation and are effectively repaired in the cytoplasm of the fertilized eggs.     

Response of fanconi anemia fibroblasts to adenine and purine analogues

Fanconi anemia (FA) fibroblasts are known to be exceptionally sensitive to the cytotoxic action of mitomycin C (MMC). The survival of FA cells was enhanced significantly when 0.5 mM caffeine or 0.5 mM adenine was added for 72 h after the cells were exposed to MMC. In other experiments in which MMC was not used, FA fibroblasts were shown to be significantly more sensitive than control cells to 6-mercaptopurine (6-MP), 6-thioguanine (6-TG), and 6-azauridine (6-AU). These observations offer a new approach to defining the basic biochemical defect in FA.     

Mucosal mast cell responses in the small intestine of rats infected with Echinostoma hortense

Mucosal mast cell (MMC) responses and worm recovery rates in rats infected with Echinostoma hortense were investigated from day 3 to day 56 post-infection (p.i.). Experimental infected group showed apparently higher number of MMC in each part of the small intestine than that of the control group. The number of MMC in the duodenum increased gradually after the infection and reached a peak on day 35 p.i. Thereafter, the number of MMC continued to decrease at a slow pace. The kinetics of MMC responses in the upper and lower jejunum were similar to that of the duodenum, but the number of MMC in the jejunum was lower. The worm recovery rate decreased with respect to time of which it was markedly reduced on day 49 and 56 p.i. The duration in which a high number of MMC appeared was similar to that in which a low rate in worm recovery was recorded. These results indicate that intestinal mastocytosis may play an important role in the expulsion of E. hortense.     

丝裂霉素C对Erwinia herbicola表达及运转冰核活性蛋白方式的影响

利用添加丝裂霉素C(MMC)于不同培养基中,并在不同培养条件下对草生欧文氏菌10025A(E．herbicola 10025A)诱导培养,首次证实该菌表达冰核活性蛋白的活性及运转分泌冰核活性蛋白方式是不同。研究结果显示,MMC的加入可以提高细菌培养物的冰核活性,该现象可以解释为MMC对E．herbicola的作用能够激活细胞SOS应急系统的反应,诱导细胞合成部分参与修复DNA损伤的酶和蛋白因子,达到对E．herbicola诱导表达冰核蛋白通过高尔基体形成小液泡,向膜外分泌的方式,同时对E．herbicola细胞分裂后的形态也发生明显的影响。这对研究细胞在恶劣环境的生存机制以及获取该条件下的蛋白具有重要的意义,对低温生物的研究也将产生积极地影响。     

县级公立医院人才队伍建设存在的问题及路径探讨

新医改背景下,如何引进优秀医学毕业生到县级医院工作,加强对县级医院人才队伍的培养,改革其人事制度,是县级医院亟需解决的问题。县级医院应牢牢抓住新医改中加强基层医疗服务体系建设的机遇,制定科学的人才引进、培养规划,改革人事分配制度,营造尊重知识、尊重人才的良好氛围,走可持续发展之路。     

Confronting utilization review in New Mexico's Medicaid mental health system: the critical role of "medical necessity"

The insertion of managed care into Medicaid services for the mentally ill has created contention about clinical decision making. At the center of this debate is the matter of what constitutes a medical necessity. Employing ethnographic methodology, this study examines utilization review (UR), the context in which decisions concerning the authorization of mental health care services are made. Interviews carried out in the study contrast ideological underpinnings of providers and advocates of the mentally ill, on the one hand, with employees and administrators of managed care institutions, on the other. The result is an exploration into the ways discourses surrounding the mental health care needs of New Mexico's Medicaid population are being constructed and are determining the actual care they receive.