The impact of Medicaid expansion on utilization of mental health services in west Louisville, Kentucky.

Mental health is an essential component of overall health status, and mental illnesses are a leading cause of disability. In addition to expanding insurance coverage, the Affordable Care Act (ACA) reinforced parity for mental health services in insurance plans. This mixed-methods study assessed mental health service utilization by an urban and predominately African-American population following the successful implementation of the ACA and Medicaid expansion in Louisville, KY. Claims data from one Medicaid Managed Care Organization were analyzed to assess mental health care utilization patterns pre- and post- Medicaid expansion and determine differences in utilization rates between the Medicaid expansion population and other Medicaid beneficiaries, as well as differences in use of mental health services by geography across a Metropolitan region. Additionally, both mental health care providers and residents of the local community were interviewed regarding factors influencing use of mental health care. The results of the study demonstrate that beneficiaries of Medicaid expansion have used their new health insurance to access mental health ambulatory care services, counseling, and psychotropic medications, but may be doing so at a lower rate than other Medicaid beneficiaries in their community. Eleven distinct themes emerged from the qualitative data. Both providers and members of the community cited ongoing barriers to accessing and utilizing mental health services, including a lack of providers, stigma, poor health literacy, and the influences of social determinants of health. However, they recognized a need for mental health promotion within the toxic stress of their environment. The results of this study provide evidence supporting the continuation of policies that promote access to mental health care by reducing the burden of cost. This study also informs understanding of specific community needs that include persistent barriers beyond the scope of ACA. Thus, other policies and strategies are also needed to create health system transformation and foster a culture of health that prioritize mental health care

Granular cell tumour of the soft tissues: a case report and literature review

Granular cell tumours (GCT) of the soft tissues are rare benign tumours but some time may be difficult to distinguish from malignant neoplasms. It is important that clinicians are aware of their existence. We present a new case of GCT of the soft tissues followed by a brief review of literature

Educando a la 3ra edad sobre la higiene y adaptación de sus prótesis dentales

En los adultos mayores la pérdida de las piezas dentarias ocasiona deficiencias estéticas, fonéticas, masticatorias, deglutorias y psicosociales. Sabemos que la sola instalación de las prótesis dentales no logra restablecer por completo dichas funciones. De esta manera se pretende capacitar a los adultos mayores sobre la conservación y mantenimiento de sus prótesis dentales como también preservar su salud general y bucal mediante las siguientes acciones: enseñanza de técnica de cepillado, control de placa bacteriana, autodiagnóstico de patologías prevalentes, y conocimiento de agentes químicos aptos para la higiene de las prótesis. Este proyecto surge por requerimiento de centros de jubilados, donde casi en su totalidad los concurrentes son adultos mayores, portadores de prótesis dentales, quienes presentan escaso o nulo conocimiento y entrenamiento sobre la higiene y cuidado de las mismas.Facultad de Odontologí

The epidemiology of enterococci

The enterococci are emerging as a significant cause of nosocomial infections, accounting for approximately 10 % of hospital acquired infections. They are found as normal inhabitants of the human gastrointestinal tract, but may also colonize the oropharynx, vagina, perineal region and soft tissue wounds of asymtomatic patients. Until recently, evidence indicated that most enterococcal infections arose from patients' own endogenous flora. Recent studies, however, suggest that exogeneous acquisition may occur and that person-to-person spread, probably on the hands of medical personnel, may be a significant mode of transmission of resistant enterococci within the hospital. The use of broad-spectrum antibiotics, especially cephalosporins, is another major factor in the increasing incidence of enterococcal infections. These findings suggest that barrier precautions, as applied with other resistant nosocomial pathogens, along with more judicial use of antibiotics may be beneficial in preventing nosocomial spread of resistant enterococci.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47899/1/10096_2005_Article_BF01963631.pd

Tracheal Agenesis: A Clinical Approach

Tracheal agenesis, though seemingly rare and fatal to date, has been reported from multiple institutions with increasing frequency. Establishment of the diagnosis necessitates a high index of suspicion in an infant in respiratory distress at birth, without a cry and in whom intubation is difficult. Following definitive diagnosis by endoscopy, infants have been given a chance at survival on four occasions by prompt surgical intervention. The procedure proposed by Altman is adequate for initial stabilization. Postoperative management is aided by the use of continuous positive airway pressure (CPAP) and rigorous pulmonary toilet. Definitive correction should be considered at an early stage in order to prevent fatal complications