52 degrees south: mental health services in the Falkland Islands.

This article discusses the factors that have shaped the development of the new mental health legislation within the Falkland Islands. The process of implementing new legislation within this remote island community is discussed, including the aspirations underlying the new legislation, the management of psychiatric emergencies and the needs of the clinical team.

Effect of a 2-week trial of functional electrical stimulation on gait function and quality of life in people with multiple sclerosis.

Background: Footdrop is a common gait deviation in people with multiple sclerosis (MS) leading to impaired gait and balance as well as decreased functional mobility. Functional electrical stimulation (FES) provides an alternative to the current standard of care for footdrop, an ankle-foot orthosis (AFO). FES stimulates the peroneal nerve and activates the dorsiflexor muscles, producing an active toe clearance and a more normal gait.

Physician perspectives on incentives to participate in practice-based research: a greater rochester practice-based research network (GR-PBRN) study.

Objectives: To understand factors associated with primary care physician research participation in a practice-based research network (PBRN) and to compare perspectives by specialty.

Methods: We surveyed primary care internists, family physicians, and pediatricians in Monroe County, New York, regarding their past experience with research and incentives to participate in practice-based research. We performed descriptive and tabular analyses to assess perceptions and used chi(2) and analysis of variance to compare perceptions across the 3 specialties.

Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits.

Pediatric professionals are being asked to provide an increasing array of services during well-child visits, including screening for psychosocial and family issues that may directly or indirectly affect their pediatric patients. One such service is routine screening for postpartum depression at pediatric visits. Postpartum depression is an example of a parental condition that can have serious negative effects for the child.

Physician reimbursement levels and adherence to American Academy of Pediatrics well-visit and immunization recommendations.

Background: There is concern that commercial health insurance reimbursement levels for immunizations and well-child visits may not be meeting the delivery and practice overhead costs within some areas of the country. There is also concern that insufficient physician reimbursement levels may negatively affect the quality of children's health care.

Objective: We examined the relationships between commercial health insurance reimbursement levels to physicians for pediatric services and rates of immunization and well visits for children and adolescents.

The feasibility of universal influenza vaccination for infants and toddlers.

Background: Physicians' opinions on the feasibility of routine influenza vaccination of infants and toddlers are unknown.

Objective: To assess the opinions of primary care providers regarding (1) the feasibility of an expanded influenza vaccination recommendation, (2) potential barriers, and (3) current and projected use of immunization reminder systems for influenza vaccination.

Methods: In February 2001, we mailed a 20-item, self-administered survey to a national random sample of pediatricians and family physicians (FPs).

Improved access and quality of care after enrollment in the New York State Children's Health Insurance Program (SCHIP).

Background: Although many studies have noted that uninsured children have poorer access and quality of health care than do insured children, few studies have been able to demonstrate the direct benefits of providing health insurance to previously uninsured children. The State Children's Health Insurance Program (SCHIP), enacted as Title XXI of the Social Security Act, was intended to improve insurance coverage and access to health care for low-income, uninsured children. With limited state and federal resources for health care, continued funding of SCHIP requires demonstration of success of the program.

Potential burden of universal influenza vaccination of young children on visits to primary care practices.

Objective: To estimate the additional number of visits to primary care practices that would be required to deliver universal influenza vaccination to 6- to 23-month-old children.

Methods: Children who were covered by commercial and Medicaid managed care plans (70% of children in the region; >8000 children in each of 3 consecutive influenza seasons) in the 6-county region surrounding and including Rochester, New York, were studied. An analysis was conducted of insurance claims for visits (well-child care [WCC]; all other visits) to primary care practices during 3 consecutive influenza vaccination seasons (1998-2001).

Time spent by primary care practices on pediatric influenza vaccination visits: implications for universal influenza vaccination.

Objective: To measure the time currently spent by primary care practice personnel, and the examination room occupancy time for childhood influenza vaccination visits, to assess the practicality of annual influenza vaccination of all preschool children.

Setting: Seven primary care practices serving one fourth of the children living in Rochester, NY.

Patients: Ninety-two children seen for influenza vaccination visits in the 2000-2001 vaccination season.

Uninsured children with psychosocial problems: primary care management.

Objective: Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices.

Methods: The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network.

Increasing identification of psychosocial problems: 1979-1996.

Objective: To examine the changes in identification of pediatric psychosocial problems from 1979 to 1996.

Research Design: Comparison of clinician-identified psychosocial problems and related risk factors among large primary care pediatric cohorts from 1979 (Monroe County Study) and 1996 (Child Behavior Study). Data were collected from clinician visit questionnaires developed originally for the 1979 study.

Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks.

Objective: To examine the effect of insurance status on clinician recognition of psychosocial problems for pediatric primary care visits.

Design: A cohort study of 10,250 visits by children 4 to 15 years old for nonemergent care.

Setting: Two large primary care research networks reported data from 172 primary care clinicians in office-based practice.

Increased ambulatory utilization in IPA plans among children receiving hyposensitization therapy.

There is concern that children with chronic conditions are less likely to be enrolled in managed care systems and that they may not receive optimal care. We studied the relationship between enrollment in an Independent Practice Association (IPA) plan and utilization of ambulatory services among children in a suburban pediatric practice with one mild chronic condition--those receiving hyposensitization therapy for allergic diseases. Ambulatory utilization by IPA patients (N = 102) was determined by medical chart review for one year before and one year after each patient switched from Blue Cross to IPA coverage.

The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice.

We compared the use of pediatric ambulatory medical care of 640 children who switched from a traditional Blue Cross plan to more comprehensive independent practice association plans with that of matched patients who remained with Blue Cross in one large, suburban pediatric practice in Rochester, NY. A quasi-experimental, retrospective cohort design was used. Use of pediatric ambulatory medical care by patients in the independent practice association plan and control patients was determined by medical chart review for 1 year before and 1 year after each patient's switch.