Stephen J. Williams

Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan.

Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantially more mental health services than males and that enrollees aged 20-44 used more services than those in other age groups. The prepaid group practice generally experienced higher utilization than the prepaid independent plan. Significant racial differences were evident with whites using more services than blacks and black males using strikingly few services. The prepaid independent plan was oriented toward physician providers and emphasized individual psychotherapy while the prepaid group practice employed a diversity of practitioners and therapeutic modalities. The data indicated that the per cent of enrollees using any mental health services was twice as great in the PGP as in the IPP. However, once access to the provider system was achieved, the number of services utilized was greater in the PGP. Inpatient services were also examined. A significantly higher proportion of IPP enrollees were admitted for inpatient care as compared to PGP enrollees. Finally, the cost of mental health services was less than ten per cent of total health service costs in both plans.

On the Nova Rate in M33

As part of an ongoing program to determine the stellar population of novae, a multiepoch Hα survey of the late-type spiral galaxy M33 has been completed. The survey yielded a total of six novae over eight observing seasons in the period between 1995 and 2002. A global nova rate of 2.5 yr-1 is found, which corresponds to a luminosity-specific nova rate of 2.34 ± 0.99 × 10-10 L☉,K yr-1 when the K luminosity is calculated from a B - K color, or 2.17 ± 0.89 × 10-10 L☉,K yr-1 when using the most recent Two Micron All Sky Survey data. Our derived nova rate is significantly different from the previously published rates of 4.6 ± 0.9 and 0.45 yr-1 by Della Valle et al. and Sharov, respectively. When galaxies with measured nova rates are compared, it appears that the Magellanic Clouds (and possibly M87) may have somewhat higher luminosity-specific nova rates than those of M33 and other galaxies. Nevertheless, given the uncertainty in the measured nova rates, we find no compelling evidence that the luminosity-specific nova rate varies strongly or systematically with the Hubble type of the galaxy.

Breast and cervical cancer screening in older women: The San Diego medicare preventive health project

BACKGROUND. This study presents rates and correlates of cancer screening, including mammography, clinical breast exam, breast self-examination, and Pap tests, in older women. Age was the predictor of main interest. RESULTS. Among a sample of female Medicare beneficiaries ages 65 and older, who were members of a health maintenance organization, there was a significant, inverse relationship between age and mammography adherence, while controlling for health status, physician utilization, education, and income. The proportions of subjects ages 65-74 and 75+ never having had a mammogram were 17 and 32%, respectively, and the proportions having had annual mammograms were 40 and 28%, respectively. Pap test frequency showed a trend toward an inverse relationship with age, controlling for demographic and health-related variables. In the youngest age group (65-69), 52% had annual Pap tests, whereas in the oldest group (80+), only 36% had annual Pap tests. Age did not predict frequency of clinical breast exam, and the relationship of age to breast self-examination was inconclusive. The role of the physician in promoting cancer screening is discussed.

RED SUPERGIANTS AS COSMIC ABUNDANCE PROBES: THE SCULPTOR GALAXY NGC 300*

We present a quantitative spectroscopic study of twenty-seven red supergiants in the Sculptor Galaxy NGC 300. J-band spectra were obtained using KMOS on the VLT and studied with state of the art synthetic spectra including NLTE corrections for the strongest diagnostic lines. We report a central metallicity of [Z]= -0.03 +/- 0.05 with a gradient of -0.083 +/- 0.014 [dex/kpc], in agreement with previous studies of blue supergiants and H II-region auroral line measurements. This result marks the first application of the J-band spectroscopic method to a population of individual red supergiant stars beyond the Local Group of galaxies and reveals the great potential of this technique.

Mammography knowledge and intentions among insured women.

UNLABELLED METHOD. A survey was conducted among 1,113 randomly selected insured state university employees to evaluate knowledge of the American Cancer Society mammography guidelines, awareness of insurance coverage for screening mammograms, previous guideline adherence, and future mammography intentions. RESULTS The survey, which included two mailings with follow-up phone cells of nonresponders, had a refusal rate of 6%. Respondents were relatively more likely to know the guideline for older age groups; 77% knew the guidelines for women 50+. Over one-third of the responders were not aware that their insurance policy covered screening mammograms. For women who had never had a mammogram, insurance knowledge was significantly related to intentions to have a mammogram in the future. Previous screening adherence, as well as future intentions, was positively related to the age of the respondent. The results are contrasted with those of previous studies, and the implications for the content of future breast cancer screening campaigns are discussed.

Health Promotion Workshops for Seniors: Predictors of Attendance and Behavioral Outcomes

Abstract The effectiveness of health promotion educational programs in enhancing the elderlys health status and health behaviors is dependent upon their willingness to participate in such programs. The identification of factors that predict their participation is therefore essential. Of equal importance is determining which components of health promotion programs result in enhanced health status through modified health behaviors in order to design future programs for maximum effectiveness. The research reported here focuses on the use and effect of health promotion educational workshops designed to enhance both the physical and psychological well being of a Medicare Health Maintenance Organization population. Sixty-seven percent of eligible participants attended five or more health promotion workshops, while 14 percent failed to attend one workshop. A multivariate regression analysis revealed increasing age and smoking behavior as significant predictors of absenteeism in this group. Limited behavioral ch...

The Relationship Between Utilization of Mental Health and Somatic Health Services Among Low Income Enrollees in Two Provider Plans

Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.

Preventive Services in a Medicare Managed Care Environment

The results of a four year demonstration project of preventive services for Medicare managed care enrollees suggest that health promotion programs can impact health behaviors and outcomes. The study provided selected preventive services to 1,800 Medicare enrollees in a managed care environment. Participants were randomly assigned to control and experimental groups with the experimental group receiving an intervention service package and the control group usual care. The results included enhanced health behavior practices, lower depression, and higher immunization rates among those individuals in the experimental group. This study suggests that selected preventive services can be provided in a managed care environment to Medicare enrollees with likely positive health status and utilization outcomes.

Medical Staff Leadership: A National Panel Survey

Dramatic change in health care has challenged traditional medical staff governance and leadership. The role of medical staff leaders, particularly the chief of staff, and of the medical executive committee is explored through a national panel survey.

A Time‐resolved Photometric Study of the Eclipsing Dwarf Nova RX J0909+1849

Multicolor (BVRI) light curves have been obtained for the newly discovered, 4.21 hr eclipsing dwarf nova RX J0909+1849. The eclipse profiles have been analyzed with a parameter-fitting model to constrain properties of the system. The model assumes four sources of luminosity: the white dwarf primary star and the secondary star (both assumed to radiate as blackbodies) and an accretion disk characterized as a blackbody whose temperature follows a radial power-law distribution: T(r) = Td(Rd/r)α, where Td and Rd are the outer disk temperature and radius, respectively. The model also includes an optically thick bright spot at the intersection of the mass transfer stream and the disk periphery. A matrix of model solutions is computed, which covers an extensive range of plausible parameter values. The solution matrix is then explored to determine the optimum values for the fitting parameters and their associated errors.The mass ratio of RX J0909+1849 is unknown, thus the orbital inclination is not tightly constrained by the model. Five mass ratios have been considered spanning a range of plausible values, 0.3 ≤ q(=M2/M1) ≤ 0.7. Over this range of q, the inclination varies between roughly 74° and 80°. Model parameters include the temperatures of the white dwarf (T1) and the secondary star (T2), the radius (Rd) and temperature (Td) of the disk periphery, the disk power-law temperature exponent (α), and the bright spot temperature (Ts). With the exception of the q = 0.3 models, which required a relatively hot white dwarf (80,000 K), the optimum values of the parameters are nearly constant with mass ratio. For a representative mass ratio of q = 0.5, values of T1 = 26,000±14,000 K, Ts = 18,000±7000 K, Td = 3200±600 K, Rd/RL1 = 0.54±0.08, α = 0.53±0.11, and B–V = 0.45±0.07 are found. A value of T2 = 3400 K has been adopted for all models based on the spectral type of the secondary star (M3-M4).The observed color (B– V = 0.4±0.2) is consistent with the colors given by the model; thus, it is unlikely that RX J0909+1849 suffers significant interstellar absorption. The observed spectral type of the secondary star suggests an absolute magnitude in the range 10.6 < MV(2) < 11.0. After correcting the apparent V magnitude at mideclipse by the fraction of light originating from the secondary star (~94%), a distance of ~200-250 pc is derived for the RX J0909+1849 system.