RESUMENES

Cuarta Sesión de Presentaciones Orales

R-085

Pilot Study of Risk Factors for Exposure to Abuse and Neglect of Aged Puerto Ricans. A. Irizarry Irizarry. Department of Social Sciences, University of Puerto Rico in Arecibo, Arecibo, Puerto Rico.

Limited research data exists related to exposure of the Puerto Rican aged to abuse and neglect. This study sought to identify those areas of greatest exposure and the socio-demographic variables intervening. It is part of a larger study measuring opinion and exposure of the aged towards abuse and neglect. The exposure segment of the developed questionnaire was made up of eight socio-demographic variables and twenty three situations of abuse and neglect. During the months of August to December of the year 2004 face to face interviews with 430 seniors were carried out. Undergraduate college students were recruited for the interview process. The sample of respondents was based upon availability. An informed consent sheet was signed by the participants before the interview process began. Responses were entered into the SPSS statistical package program. The statistical test of Phi was carried out and analysis is based upon responses of .05 or less. Age cohort was the most significant for exposure to abuse and neglect being the oldest old (80+) those at greatest risk A rural zone of residence and living arrangements were also found to increase risk. Gender and marital status while impacting did so to a lesser extent. Prevention and intervention efforts must be directed at the oldest old and those residing in rural zones of the island. Supported by the Institutional Academic Research Committee of the UPR College of Arecibo.

R-086

El Efecto de la Reforma de Salud sobre el Cuidado Prenatal en Puerto Rico: periodo de 1995 al 2000. H.A. Marín; R. Ramirez; M. Peña; P. Wise; Y. Sanchez. Instituto de Investigacion en Servicios de Salud de Puerto Rico, Escuela Graduada de Salud Publica, UPR., y Stanford University.

I. Objectives
The objective of this study is to asses the effect of Medicaid managed care (MMC) on the access, initiation, utilization, and adequacy of prenatal care services during the implementation period of the health care reform in Puerto Rico from 1995 to 2000.
II. Methodology
The population in this study is all the infants born alive and their mothers in Puerto Rico from the year 1995 to 2000. The dependent variables in this study are the following: use and no use of prenatal care , when the initial care occurred ,the number of visits for prenatal care,and the adequacy of care. The most important independent variable in our study is what type of health insurance the mother had during pregnancy. This variable is divided in four categories: those who had private health insurance, those with traditional Medicaid, those with Medicaid managed care (MMC), and those uninsured.
III. Results
First, the statistical results indicates that even after adjusting for confounders and selection bias MMChad a positive and significant effect on the amount and adequacy of prenatal care compared to those under traditional Medicaid. But, second, after adjusting for confounders and selection bias MMC did not improve acces os the timely initiation of care compared to traditional Medicaid.
IV. Conclussions
At least during the period of 1995 to 2000 the health care reform in Puerto Rico through Medicaid managed care was not able to achieve its objective of equalizing the access, initiation, amount and adequacy of care received by the Medicaid population to that of the private sector.

R-087

Impact of Managed Care on Healthcare Utilization among Adolescents with Asthma. J.A. Capriles-Quirós1; M.H. Rodríguez-Sánchez 1; R. Rios Motta1; R. Dávila-Torres2; Y. Sánchez-Rodríguez2. UPR 1 Graduate School of Public Health, Department of Health Services Administration, and 2 Department of Human Development, and 3 Puerto Rico Health Services Research Institute, UPR Graduate School of Public Health, Department of Health Services Administration

Statement of the problem: Asthma is the most common chronic lung disease diagnosed in adolescents in Puerto Rico (PR), and affects disproportionately low income populations. The Medicaid Program turned to managed care in an effort to reduce costs, and improve access to high quality healthcare services. Objective: To identify healthcare utilization patterns in adolescents under managed care (MC) and fee-for-service (FFS) insurance models. Procedure: This study explores the patterns of healthcare utilization for adolescents aged 13 to 17 years diagnosed with asthma in a group of beneficiaries of the PR Healthcare Reform (MC), and FFS plan. A total of 9,609 insurance claims between 1999 and 2001 were examined. Healthcare utilization was defined as three continuous variables measuring the frequency of visits and use of a specific type of service in a year. Results: The mean of physician office visits in the FFS plan was 6.89 (SD=11.32) and in the MC plan was 1.38 (SD=1.80). The mean of emergency room visits in the FFS group was 3.97 (SD=3.59) and 1.29 (SD=1.16) for the MC group. Hospital admissions presented a similar trend, 4.5 (SD=4.24) in the FFS and 1.11 (SD=0.43) in the MC group. Statistically significant differences were sustained for each year of study (p< .001) in all variables. Conclusion: These results illustrate differences in the way adolescents have access to care according to their insurance status. This may suggest an "insurance effect" on asthma-related management. Further understanding of the impact of these differences on clinical outcomes could guide asthma improvement efforts.

R-088

Comparison of Tooth Size Discrepancies among Malocclusion Groups and Gender Using Bolton's Indexes: UPR Orthodontic Clinic. O. Yau, School of Dentistry, University of Puerto Rico, Medical Sciences Campus.

Orthodontist are challenged at the "finishing" stages of cases by tooth size imabalance that varies among different ethnical and malocclusion groups. There is limited data available regarding the tooth size discrepancies (TSD) among Puerto Ricans (PR). Bolton's index is a measure of TSD obtained from subjects in the USA and used as a standard for treatment planning to achieve: good alignment and intercuspation, ideal overbite and overjet. Awarness of TSD by ethnic group can contribute to the expected outcomes. The specific aims are to: describe the prevalence of anterior and overall TSD, compare the TSD ratios with the Bolton's indexes, gender, and malocclusion groups. 158 casts were evaluated, representing all patients of the Orthodontic Clinic. For each cast the mesiodistal diameters were measured using an electronic digital caliper. A calibration excercise was conducted; the R2 value obtained was 0.99. Results for anterior and overall (ū/CI)by gender and malocclusion groups were: male 78.53(76.54-79.21), 92.47(91.18-93.77); female 77.87(76.54-79.21), 92.41(91.42-93.39). Class I 78.50(76.98-80.02), 93.06(92.01-94.09); Class II 77.53(75.72-79.34), 91.64(92.01-94.09); and Class III 78.32(76.42-80.20), 92.60(91.25-93.94). Using as a statistical indicator a quasi-confidence interval, no differences were detected for gender or malocclusion groups. Using the same interval to detect differences from Bolton's indexes, differences were found for: male anterior, female overall, and Class I overall ratios. Other studies are needed to evaluate the clinical significance of these results.