American journal of preventive medicine
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Comparative Study
How does managed care manage the frail elderly? The case of hospital readmissions in fee-for-service versus HMO systems.
This study examined whether hospital readmissions varied among the frail elderly in managed care versus fee-for-service (FFS) systems. ⋯ In this group of frail elderly Medicare beneficiaries, those enrolled in an HMO were more likely to have a preventable hospital readmission than those receiving care under FFS. These results suggest that policies promoting stringent approaches to utilization control (e.g., early hospital discharge, reduced levels of post-acute care, and restricted use of home health services) may be problematic for the frail elderly.
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Cigars have been heavily promoted in recent years. The nature and extent of the resultant increase in cigar smoking needs to be understood before the public health implications can be assessed. ⋯ If more people begin to smoke cigars daily, or if cigar use leads young people to initiate cigarette smoking or leads former cigarette smokers to relapse to cigarette smoking, the recent trends in cigar use may have public health implications.
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Kentucky leads the nation in adult and teen smoking prevalence. Even though Kentucky is one of the most tobacco-dependent states, tobacco policy is subject to change in light of possible national tobacco legislation. ⋯ Kentucky legislators were highly supportive of reducing the state's dependence on tobacco and more supportive of tobacco control policies than expected. The policy Delphi method has the potential for shifting opinions about tobacco policies among state legislators. The findings of this study identify opportunities for public health policy change in one of the most tobacco-dependent states in the United States.
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Review Comparative Study
Effects of physical activity interventions in youth. Review and synthesis.
Physical inactivity has been identified as an important public health concern for youth. School and community settings can be important infrastructures for promoting physical activity (PA). This paper reviews studies of physical activity in school and community settings among preschool through college-aged persons to determine characteristics and effects of interventions. Studies in progress are included. ⋯ The collection of school and community studies is limited for several age groups with none below third grade and only three at college age. There are few community studies. The most is known about upper-elementary-age-students, including the first multicenter randomized trial to report significant results for increasing moderate to vigorous physical activity (MVPA) in physical education (PE) and increase vigorous PA outside of school. A number of older study designs were weak and assessments less than optimal, but studies in progress are stronger. Special attention is needed for girls, middle schools, and community settings for all youth. More objective assessments are needed for measuring PA outside of school and in younger children, since they cannot provide reliable self-report.