A new Amphistome cercaria from

Cercaria truncatuloides n. sp. is described from experimentally infected Lymnaea truncatula. It is characterized by a dorsoventral finfold at the tip of the tail, 44 papillae on the tail and an extraordinary great number of papillae (96) on the acetabulum, and presumably belongs to a Paramphistomum species of cattle in GDR

Chaetotaxy of

The chaetotaxy of P. spiculigerum mature cercariae was studied. Unlike from the known in the literature up to now, the chaetotaxy of the cercariae was complemented as follows :a

Racial/ethnic disparities in mental health treatment in six Medicaid programs

Little is known about ethnic and racial disparities in mental health care among Medicaid beneficiaries. The association between ethnicity and race and the utilization of mental health care was explored in six Medicaid programs. The analysis distinguished between different settings of care, including community-based, outpatient hospital, inpatient, and emergency departments (EDs). Racial and ethnic disparities in mental health care were observed across state Medicaid programs. Hispanic and African American beneficiaries with mental illness were much less likely than Whites to be treated in community-based settings. African Americans were more likely to receive mental health treatment in inpatient, ED, and outpatient hospital settings in some states. The implications of these findings and possible initiatives to enhance community-based mental health care among African American and Hispanic Medicaid beneficiaries are discussed

Impact of substance disorders on medical expenditures for medicaid beneficiaries with behavioral health disorders

OBJECTIVE: This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders. METHODS: Claims for Medicaid beneficiaries with behavioral health diagnoses in 1999 from Arkansas, Colorado, Georgia, Indiana, New Jersey, and Washington were analyzed. Behavioral health and general medical expenditures for individuals with diagnoses of substance use disorders were compared with expenditures for those without such diagnoses. States were analyzed separately with adjustment for confounders. RESULTS: A total of 148,457 beneficiaries met selection criteria, and 43,457 (29.3%) had a substance use diagnosis. Compared with other beneficiaries with behavioral health disorders, individuals with diagnoses of substance use disorders had significantly higher expenditures for physical health problems in five of six states. Approximately half of the additional care and expenditures were for treatment of physical conditions. Differences declined but remained statistically significant after adjustment for higher overall disease burden among beneficiaries with addictions. Medical expenditures for individuals with diagnoses of substance use disorders increased significantly with age in five of six states, whereas behavioral health expenditures were stable or declined. Hospital admissions for psychiatric and general medical reasons were higher for those with diagnoses of substance use disorders. CONCLUSIONS: The impact of addiction on Medicaid populations with behavioral health disorders is greater than the direct cost of mental health and addictions treatment. Higher medical expenditures can be partly attributed to greater prevalence of co-occurring physical disorders, but expenditures remained higher after adjustment for disease burden. Spending estimates based only on behavioral health diagnoses may significantly underestimate addictions-related costs, particularly for older adults

Co-occurring psychiatric and substance use disorders: a multistate feasibility study of the quadrant model

OBJECTIVE: The quadrant model was developed to organize the heterogeneous group of persons with co-occurring psychiatric and substance use disorders and to anticipate differential use of systems of care. The purpose of the study presented here was to test the feasibility of applying the model to classify persons with co-occurring disorders, examine the reliability of quadrant prevalence and distribution, and test the validity of differential service use by quadrant. METHODS: Medicaid claims data from 1999 from six states were analyzed, and 22,912 individuals with co-occurring disorders were classified into quadrants, by severity of substance use and psychiatric disorders. Distribution by quadrant and the utilization of emergency and inpatient services were analyzed. RESULTS: A majority of cases were classified in quadrant IV (52.5%) (high severity of psychiatric and substance use disorders), and fewest were classified in quadrant I (8.2%) (low severity of psychiatric and substance use disorders). There was equivalence in distribution for quadrant III (19.8%) (high severity of substance use disorders and low severity of psychiatric disorders) and quadrant II (19.4%) (high severity of psychiatric disorders and low severity of substance use disorders). Distribution was consistent across states, and service utilization was most associated with quadrant IV. Persons with the more severe psychiatric problems (quadrants II and IV) were more likely to be female, to be older, and to have been hospitalized or to have visited an emergency department. Another important finding is the high rate of persons with substance dependence disorders (quadrants III and IV). CONCLUSIONS: The feasibility of applying the quadrant model was supported. The quadrant model has been well adopted conceptually by community providers and policy makers. The consistency of the findings across six state Medicaid systems supports the potential utility of the model to articulate patient characteristics and service use patterns. Further application and research with this model is proposed

Treatment for co-occurring mental and substance use disorders in five state Medicaid programs

OBJECTIVES: This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with co-occurring mental and substance use disorders in five states. METHODS: Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided into those with and those without a diagnosed substance use disorder. Adjusted odds of treatment in community-based settings, inpatient facilities, emergency departments, and hospital outpatient departments were calculated. RESULTS: A total of 92,355 persons had a psychiatric disorder, 34,158 had a substance use disorder, and 14,256 had co-occurring psychiatric and substance use disorders. In all five states, beneficiaries with severe mental illness (schizophrenia, bipolar disorder, or major depression) and a substance use disorder had higher odds of inpatient, emergency department, and hospital-based outpatient psychiatric treatment, compared with those with severe mental illness alone. In four of five states, both severe and less severe mental illness and a co-occurring substance use disorder were associated with lower odds of community-based treatment compared with those with the respective mental illness alone. Compared with those with less severe mental illness alone, individuals with less severe psychiatric disorders and a co-occurring substance use disorder had higher odds of inpatient treatment in all states and of emergency department use in three of five states. Odds of inpatient and outpatient hospital use and emergency department use for substance abuse treatment were higher for persons with severe mental illness and a co-occurring substance use disorder in most states, compared with odds for those with a substance use disorder alone. CONCLUSIONS: Heavy inpatient and emergency department use by Medicaid beneficiaries with co-occurring substance use disorders is a consistent cross-state problem. Co-occurring disorders may decrease the likelihood of community-based treatment for those with less severe mental disorders and for those with severe mental illness, suggesting that policies focusing only on these settings may miss a significant proportion of people with these co-occurring disorders

Structures argyrophiles superficielles du miracidium et de la cercaire de

Le cycle biologique de Paramphistomum leydeni Näsmark, 1937 est reproduit en laboratoire. Les adultes proviennent de la panse d’un Bos taurus naturellement infesté de Tchécoslovaquie. Des Planorbis planorbis sains infestés expérimentalement émettent les premières cercaires deux mois après l’infestation.Les structures argyrophiles du miracidium et de la cercaire sont décrites. Celles du miracidium sont identiques à celles de tous les miracidiums des espèces du genre Paramphistomum actuellement décrites dont P. togolense, P. phillerouxi, P. daubneyi et P. microbothrium ; elles sont différentes de celles du miracidium de Calicophoron calicophorum. Les structures argyrophiles de la cercaire ont des caractéristiques communes avec celles des autres cercaires de Paramphistomum déjà décrites : P. togolense, P. phillerouxi, P. daubneyi et P. microbothrium en particulier aux niveaux CII et AM V, mais la chétotaxie acétabulaire très particulière permet de différencier P. leydeni des autres cercaires de Paramphistomum connues à ce jour.Ainsi, d’une part, chaque espèce est aisément différenciable des espèces voisines, d’autre part, le genre Paramphistomum tel qu’il est admis par Näsmark (1937) apparaît bien fondé

Les structures argyrophiles tégumentaires des stades larvaires (miracidium, rédie, cercaire) de

Les structures tégumentaires argyrophiles du miracidium et de la cercaire de Fasciola hepatica sont décrites et comparées à celles de F. gigantica.Les miracidiums des deux espèces ont les organites du térébratorium et de la première ceinture identiques. Au contraire, la plaque ciliée médio-ventrale du deuxième étage diffère statistiquement selon l’espèce : elle est, ordinairement, plus longue que les autres plaques de cet étage chez F. hepatica et est plus souvent de la même taille chez F. gigantica.Les cercaires des deux espèces ont un premier cycle céphalique identique et une ché- totaxie corporelle peu différente. Par contre, les terminaisons sensorielles à deux niveaux céphaliques et sur la queue permettent de les différencier.La chétotaxie d’une rédie-fille de F. hepatica est décrite ; elle montre sur le pourtour buccal une forte concentration de sensilles, aux niveaux pharyngien et post-pharyngiens des sensilles plus espacées sur une face supposée ventrale et quelques rares sensilles sur l’autre face présumée dorsale

Structures argyrophiles superficielles du miracidium et de la cercaire de

Le cycle biologique de Paramphistomum microbothrioides est entretenu au laboratoire sur Lymnaea truncatula et Ovis aries. Les hôtes naturels sont Fossaria parva et Bos taurus. Les structures argyrophiles superficielles du miracidium sont identiques par leur nombre et leur disposition à celles des autres espèces déjà décrites du genre Paramphistomum. Par contre, elles diffèrent au niveau du térébratorium de celles observées chez Calicophoron calicophorum. Les papilles de la cercaire sont souvent peu symétriques et en nombre assez variable d’un spécimen à l’autre ; toutefois, les différences entre les espèces sont évidentes. Si les papilles acétabulaires rapprochent Paramphistomum microbothrioides de P. microbothrium et de P. daubneyi, le nombre des papilles latérales et la chétotaxie caudale permettent de distinguer chacune des trois espèces