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The Challenge of Caring for Indigent Children With Rheumatologic Diseases FREE

Michael L. Miller, MD; Patience H. White, MD
[+] Author Affiliations

Accepted for publication December 27, 1990.

Reprint requests to Department of Pediatrics, UTHSC, 7703 Floyd Curl Dr, San Antonio, TX 78284 (Dr Miller).


Am J Dis Child. 1991;145(5):554-558. doi:10.1001/archpedi.1991.02160050080022.
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• Poverty and lack of insurance prevent complete access to tertiary care for many children with rheumatologic diseases. Long-term solutions to provide community based support for local teams and other services are needed. Physicians need to work with colleagues in health care systems and government to make the health care system fully available to all families. Medical schools can act as catalysts in helping government agencies redefine policies to support outreach and other health care programs for the indigent. Governmental agencies must collaborate with insurance companies to change policies so as to cover all aspects of service, including those provided by arthritis health professionals. With coordinated effort, the goal of adequate services to indigent children with rheumatologic and other chronic illnesses can become reality.

(AJDC. 1991;145:554-558)

REFERENCES

McManus MA, Newacheck PW, Greaney AM.  Young adults with special health care needs: prevalence, severity, and access to health services . Pediatrics . 1990;;86:674-682.
Newacheck PW, Halfon N.  Access to ambulatory care services for economically disadvantaged children . Pediatrics . 1986;;78:813-819.
Kleinman JC, Gold M, Makuc D.  Use of ambulatory medical care by the poor: another look at equity . Med Care . 1981;;19:1011-1029.
Link to Article
Newacheck PW, Starfield B.  Morbidity and use of ambulatory care services among poor and nonpoor children . Am J Public Health . 1988;;78:927-933.
Link to Article
Perrin JM, Ireys HT.  The organization of services for chronically ill children and their families . Pediatr Clin North Am . 1984;;31:235-257.
Callahan LF, Pincus T.  Formal education level as a significant marker of clinical status in rheumatoid arthritis . Arthritis Rheum. 1988;;31:1346-1357.
Link to Article
Cassidy JT, ed. Textbook of Pediatric Rheumatology . New York, NY: John Wiley & Sons Inc; 1982;.
Towner SR, Michet CJ Jr, O'Fallon WM, Nelson AM.  The epidemiology of juvenile arthritis in Rochester, Minnesota . Arthritis Rheum. 1983;;26:1208-1213.
Link to Article
Lovell DJ, White PH.  Growth and nutrition in juvenile rheumatoid arthritis . In: Woo P, ed. Pediatric Rheumatology Update . New York, NY: Oxford University Press Inc; 1990;:47-56.
White PH.  Growth abnormalities in children with juvenile arthritis . Clin Orthop . 1990;;259:46-50.
Bacon MC, White PH, Raiten DJ, et al.  Nutritional status and growth in juvenile rheumatoid arthritis . Semin Arthritis Rheum. 1990;;20:97-106.
Link to Article
Miller ML, Chacko JA, Young EA.  Dietary deficiencies in children with juvenile rheumatoid arthritis . Arthritis Care Res. 1989;;2:22-24.
Link to Article
Henderson CJ, Lovell DJ.  Assessment of protein-energy malnutrition in children and adolescents with juvenile rheumatoid arthritis . Arthritis Care Res. 1989;;2:108-113.
Link to Article
Karp RJ.  Undernutrition and the cycle of poverty . Pediatr Ann . 1990;;19:268-271, 274-275.
Karp RJ.  The social context of malnutrition in childhood . Bull N Y Acad Med. 1989;;65:1026-1031.
White PH, Gussak D, Hixson D.  Career maturity of adolescents with juvenile rheumatoid arthritis (JRA) compared to other chronically ill adolescents . Arthritis Rheum. 1989;;32S:29.
Rosch D, Phelps A.  Secondary special education and transition from school to work: a national priority . Except Child. 1987;;53:487-491.
Spencer CH, Zanga J, Passo M, Walker D.  The child with arthritis in the school setting . Pediatr Clin North Am . 1986;; 33:1251-1264.
Stoff E, Bacon MC, White PH.  The effects of fatigue, distractibility, and absenteeism on school achievement in children with rheumatologic diseases . Arthritis Care Res. 1989;;2:49-53.
Link to Article
Lovell D, Arthreya B, Emery H, et al. School attendance patterns, special services, and special needs in pediatric patients with rheumatoid diseases: results of a multicenter study. Arthritis Care Res. In press.
Kovalesky A, Boutaugh M, Erlandson D, et al. Juvenile Rheumatoid Arthritis: A Health Professional's Guide to Teaching Children and Patients . Atlanta, Ga: Arthritis Foundation; 1987;.
Harvey B.  A proposal to provide health insurance to all children and all pregnant women . N Engl J Med. 1990;;323:1216-1220.
Link to Article
Moos RH, Moos BS. Family Environment Scale Manual . Palo Alto, Calif: Consulting Psychologists Press; 1981;.
Myones BL, Williams GF, Billings A, Miller III JJ.  Social environment in families of children with juvenile arthritis . Arthritis Care Res. 1988;;1:17-22.
Link to Article
Lovell DJ, Howe S, Shear E, et al.  Development of a disability measurement tool for juvenile rheumatoid arthritis: the Juvenile Arthritis Functional Assessment Scale . Arthritis Rheum. 1989;;32:1390-1395.
Link to Article
Fries JF, Spitz P, Kraines RG, Holman HR.  Measurement of patient outcome in arthritis . Arthritis Rheum. 1980;;23:137-145.
Link to Article

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

McManus MA, Newacheck PW, Greaney AM.  Young adults with special health care needs: prevalence, severity, and access to health services . Pediatrics . 1990;;86:674-682.
Newacheck PW, Halfon N.  Access to ambulatory care services for economically disadvantaged children . Pediatrics . 1986;;78:813-819.
Kleinman JC, Gold M, Makuc D.  Use of ambulatory medical care by the poor: another look at equity . Med Care . 1981;;19:1011-1029.
Link to Article
Newacheck PW, Starfield B.  Morbidity and use of ambulatory care services among poor and nonpoor children . Am J Public Health . 1988;;78:927-933.
Link to Article
Perrin JM, Ireys HT.  The organization of services for chronically ill children and their families . Pediatr Clin North Am . 1984;;31:235-257.
Callahan LF, Pincus T.  Formal education level as a significant marker of clinical status in rheumatoid arthritis . Arthritis Rheum. 1988;;31:1346-1357.
Link to Article
Cassidy JT, ed. Textbook of Pediatric Rheumatology . New York, NY: John Wiley & Sons Inc; 1982;.
Towner SR, Michet CJ Jr, O'Fallon WM, Nelson AM.  The epidemiology of juvenile arthritis in Rochester, Minnesota . Arthritis Rheum. 1983;;26:1208-1213.
Link to Article
Lovell DJ, White PH.  Growth and nutrition in juvenile rheumatoid arthritis . In: Woo P, ed. Pediatric Rheumatology Update . New York, NY: Oxford University Press Inc; 1990;:47-56.
White PH.  Growth abnormalities in children with juvenile arthritis . Clin Orthop . 1990;;259:46-50.
Bacon MC, White PH, Raiten DJ, et al.  Nutritional status and growth in juvenile rheumatoid arthritis . Semin Arthritis Rheum. 1990;;20:97-106.
Link to Article
Miller ML, Chacko JA, Young EA.  Dietary deficiencies in children with juvenile rheumatoid arthritis . Arthritis Care Res. 1989;;2:22-24.
Link to Article
Henderson CJ, Lovell DJ.  Assessment of protein-energy malnutrition in children and adolescents with juvenile rheumatoid arthritis . Arthritis Care Res. 1989;;2:108-113.
Link to Article
Karp RJ.  Undernutrition and the cycle of poverty . Pediatr Ann . 1990;;19:268-271, 274-275.
Karp RJ.  The social context of malnutrition in childhood . Bull N Y Acad Med. 1989;;65:1026-1031.
White PH, Gussak D, Hixson D.  Career maturity of adolescents with juvenile rheumatoid arthritis (JRA) compared to other chronically ill adolescents . Arthritis Rheum. 1989;;32S:29.
Rosch D, Phelps A.  Secondary special education and transition from school to work: a national priority . Except Child. 1987;;53:487-491.
Spencer CH, Zanga J, Passo M, Walker D.  The child with arthritis in the school setting . Pediatr Clin North Am . 1986;; 33:1251-1264.
Stoff E, Bacon MC, White PH.  The effects of fatigue, distractibility, and absenteeism on school achievement in children with rheumatologic diseases . Arthritis Care Res. 1989;;2:49-53.
Link to Article
Lovell D, Arthreya B, Emery H, et al. School attendance patterns, special services, and special needs in pediatric patients with rheumatoid diseases: results of a multicenter study. Arthritis Care Res. In press.
Kovalesky A, Boutaugh M, Erlandson D, et al. Juvenile Rheumatoid Arthritis: A Health Professional's Guide to Teaching Children and Patients . Atlanta, Ga: Arthritis Foundation; 1987;.
Harvey B.  A proposal to provide health insurance to all children and all pregnant women . N Engl J Med. 1990;;323:1216-1220.
Link to Article
Moos RH, Moos BS. Family Environment Scale Manual . Palo Alto, Calif: Consulting Psychologists Press; 1981;.
Myones BL, Williams GF, Billings A, Miller III JJ.  Social environment in families of children with juvenile arthritis . Arthritis Care Res. 1988;;1:17-22.
Link to Article
Lovell DJ, Howe S, Shear E, et al.  Development of a disability measurement tool for juvenile rheumatoid arthritis: the Juvenile Arthritis Functional Assessment Scale . Arthritis Rheum. 1989;;32:1390-1395.
Link to Article
Fries JF, Spitz P, Kraines RG, Holman HR.  Measurement of patient outcome in arthritis . Arthritis Rheum. 1980;;23:137-145.
Link to Article

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