Journal of Health & Medical Informatics

Objectives: Physician payments from public and private payers are still largely paper-based, so significant payment lags are prevalent across all reimbursement systems. Electronic Medical Record use has the potential to reduce payment lag and improve health system performance. Methods: We use a claims data set of 100,000 covered lives from a national employer to examine mean accounts receivable (AR) payment times by provider type, physician specialty, and state. Eleven physician specialty disciplines are included in the analysis of mean AR and days of payment lag. We also include a coefficient of variation (CV) of physician claims processed by place of delivery and correlation (R2: r-squared) values between mean days of AR and mean CV. Results: We find significant variation in mean AR days by provider type and physician specialty. There is also a great deal of variation in payment processing lags by state. We find a range of correlations between mean AR days and mean CV by provider type of service (R2=0.6288), physician specialties (R2=0.662), and the state of service (R2=0.1247). Conclusions: Low EMR adoption rates impact how all payer types pay physicians. The elimination of paper-based claims (and their associated lag times) could be achieved through the adoption of basic practice management systems bundled with EMRs. There is sufficient health savings from shortening the AR lag time period for insurer payment to providers to finance EMR adoption even with without federal HITECH incentives to practices.

Whereas many health disparities interventions targeting African Americans (AAs) have been designed and implemented through collaborations between African American (AA) churches and academic institutions using principles of Community Based Participatory Research (CBPR), apparent disconnect between needs, resources, socio-cultural and socio-political church factors and research practices of collaborating institutions has hindered identification of best practices. This study investigated a collaborative framework that apportioned responsibilities of program design and implementation solely to church leaders of predominantly AA churches while restricting the collaborating institution to supportive roles. 15 church leaders completed 4 weeks of awareness/sensitization support training and thereafter independently created and implemented health promotion action plans in their churches. Post training evaluations confirmed that church leaders sensitized through pertinent trainings can independently design and implement viable health promotion programs in their churches. Howbeit, further studies are required to validate health impacts on church members and compare outcomes with other collaborative participatory designs.

Aims: To clarify the feasibility to arrest preterm labor to prevent the periventricular leukomalacia (PVL) and Cerebral Palsy (CP) by the study on the developing mechanism of labor contractions. Rational: Fetal periventricular echo density (PVE) precedes preterm neonatal PVL and CP in 18% of preterm fetuses whose PVE persisted until preterm births. Since no treatment of neonatal PVE appeared immediately after preterm birth was established, another strategy is proposed to prevent preterm neonatal PVE to cease preterm labor until the full term delivery, because no CP developed in full term delivery in our report. Recently, we studied the positive feed-back loop of uterine contraction to the brain by nerves between the uterus and hypothalamus, developing regular labor contractions. Proposal: The suppression of the nerves of positive feed-back loop by anesthesia or analgesia is our proposal to cease preterm labor until the full term delivery, where no CP was reported, i.e. the CP, corresponding to 0.2% of total births, will be reduced. Conclusion: Regular preterm labor contractions will be ceased by the paralysis of nerves in the positive feed-back loop between the uterus and hypothalamus and the full-term delivery prevents CP, due to disappeared PVE in the neonates born in full term delivery. Clinical feasibility should be investigated in further studies.

Practicing obstetricians are constantly facing new challenges regarding prenatal diagnosis, as knowledge on this field increases exponentially. Continuous medical education in this area as in others is essential for a good clinical practice and appropriate counseling to patients.

Although no adverse effect of ultrasound diagnosis has been reported, the safety of diagnostic ultrasound has been discussed since its introduction into clinical study in 1950s, because real-time 2D, 3D, 4D ultrasound imaging, pulsed Doppler flow wave, color Doppler, fetal monitor, fetal movement, are indispensable in obstetric and gynecologic studies, particularly in the studies on the fetus.

Abstract Aims: The actocardiogram (ACG), which recorded fetal heart rate (FHR) and movements, was quantitatively analyzed, due to its advantage to the FHR patterns diagnosis, to recognize the effect of fetal movement on FHR, to solve controversial FHR problems, to correctly evaluate fetal disorders, and to evaluate the loss of variability and acceleration. Methods: FHR changes were diagnosed by the FHR score, fetal movements were evaluated by 4 ACG parameters, fetal behavior and abnormal FHR were quantitatively determined, physiologic sinusoidal FHR was diagnosed by the ACG and FHR frequency analysis, the developing mechanism of FHR acceleration and variability were studied to diagnose the brain damage in the loss of FHR variability. 1.3 Results: The FHR score, neural network analysis and A/B ratio predicted short and long term outcomes in the 1st stage of labor or even in pregnancy. The ACG and frequency analysis differentiated physiologic sinusoidal from the true one, Contoversial problems in FHR were solved by the quantitative ACG analysis. The loss of FHR variability was the sign of fetal brain damage even in fetal non-hypoxic insults. Results: The FHR score, neural network analysis and A/B ratio predicted short and long term outcomes in the 1st stage of labor or even in pregnancy. The ACG and frequency analysis differentiated physiologic sinusoidal from the true one, Contoversial problems in FHR were solved by the quantitative ACG analysis. The loss of FHR variability was the sign of fetal brain damage even in fetal non-hypoxic insults. Conclusion: Quantitative analyses of FHR and fetal movements in ACG were indispensable in the fetal diagnosis even in general insults. Since cerebral palsy (CP) could develop in the loss of FHR variability, C-section is recommended to perform before the loss of FHR variability.

Abstract Background: Female genital mutilation/cutting is the partial or total removal of the femaleexternal genitalia for various reasons using different cutting materials. It is estimated that more than 130 million girls and women alive today had undergone Female genital cutting, primarily in Africa and to a lesser extent in the Middle East. The prevalence of female genital cutting practices in Ethiopia is 74.3% and in Amhara region, it is 68.5%. Methods: A cross sectional study using both quantitative and qualitative approaches wasconducted to assess the prevalence and associated factors for female genital cutting. Pretested structured self-administered questionnaire and interview guidelines were used to collect the required data on different variables. Bivariate and multivariate logistic regression analyses were used to identify then determinants of female genital cutting. Strength of the association was assessed using odds ratio with 95% Confidence Level. Results: A total of 730 mothers with the mean Standard Deviation age of 29 ± 7 standarddeviation were participated in the study. The prevalence of Female genital cutting was higher, 62.7% on under five daughters in the study area. Health education (AOR=0.19; 95%, CI=0.08-0.45), age 15-24 years [AOR (95%CI)=0.20 (0.06-0.64)], women’s educational status [AOR (95%CI)=5.43 (1.88, 55.68)], women themselves circumcised [AOR (95%CI)=3.45 (1.35, 8.79)] and criminal [AOR (95%CI)=0.37 (0.16, 0.86)] were found significantly associated with female genital cutting. Conclusions: Female genital cutting was highly practiced among rural women than urban. Age,educational status, residence, being circumcised, health education, knowledge on female denial cutting and believing it as criminal were found to be determinants of female genital cutting.

The evaluation of voice quality and the perception of its degradation through various acoustic clues are major concerns for voice professionals involved in the process of vocal rehabilitation. In this context, it is necessary to pay particular attention to the set of indices capable of delivering relevant information to help diagnose and assess the effects of vocal re-education proposed. Therefore, the contribution of experimental phonetics in clinical practice is a proven fact. If the study we propose is part of the evaluation of voice quality, our problem is to develop a system dedicated to the objective characterization of chronic dysphonia of tumor or inflammatory origin. The aim of the telemedicine device that we develop is threefold: diagnosis, treatment and monitoring of disease. For this we proceed initially to the remote recording and archiving of an acoustic speech signal voiced in this case “a” sustained for three seconds. We then apply at the ENT department of the University Hospital of Tlemcen, different algorithms of objective assessment of three parameters in this case the fundamental frequency, jitter and DFT-RD that allow experts to assess the development of chronic dysphonia of tumor or inflammatory origin (larynx cancer, inflammatory polyp of the vocal cords, chronic laryngitis).