Aim. To assess the state of pharmaceutical provision for patients with cardiovascular diseases (CVD) using ABC, VEN and complex ABC/VEN analyses.Materials and methods. The study was performed according to the data of the medical records of outpatients who were registered in the Public Health Institution (PSI) "Kharkiv City Clinical Hospital No. 27". The methods of ABC, VEN and complex ABC/VEN analysis were used.Results and discussion. The results of the study using the ABC-analysis method allowed us to determine that the largest number of drugs was in the group C, which included 25 drugs, or 51.02 % of the total number of prescriptions. During the VEN analysis it was found that the vast majority of drugs (41 drugs) belong to the group V – vital essential medicines. The complex ABC/VEN analysis showed that drugs with the A/V status (the most costly and vital essential medicines) had the highest percentage (32.20 %) of the total consumption. It should be separately noted that the A/N group (the most costly and nonessential medicines) took the second position by percentage after the A/V group. A high percentage (31.05 %) in the A/N group is explained by the fact that the group includes the drug Magnikor, which has the highest frequency of prescription although this drug is not included in the National List of Essential Medicines (NLEM) and in the "Available medicines" program.Conclusions. The results of the studies of the state of pharmaceutical care for patients with CVD make it possible to draw attention to the urgency of the problems of drug availability to the population, namely expanding the list of medicines that are reimbursed in the framework of the government programs, in particular by including the drug Magnikor in the "Available medicines" program. ; Цель работы – оценка состояния фармацевтического обеспечения больных сердечно-сосудистыми заболеваниями (ССЗ) с помощью АВС, VEN и комплексного АВС/VEN анализов.Материалы и методы. Исследование проведено по данным медицинских карт амбулаторних больных, состоявших на учете в Коммунальном учреждении здравоохранения (КУЗ) «Харьковской городской клинической больнице №27». Методами были выбраны: АВС, VEN и комплексный АВС/VEN анализ.Результаты. Результаты исследования с помощью метода АВС-анализа позволили установить, что наибольшее количество по препаратам включала в себя группа С в которую было включено 25 лекарственных средств (ЛС) или 51,02% от общего количества назначений препаратов. При проведении VEN-анализа было установлено, что подавляющее большинство ЛС относится к группе V – жизненно необходимые - 41 препарат. Комплексный АВС/VEN анализ показал, что препараты со статусом А/V (наиболее затратные и жизненно необходимые препараты) имели наибольший удельный вес 32,20 - % от общего потребления. Отдельно следует отметить, что группа А/N (наиболее затратные и второстепенные ЛС) занимала вторую позицию по удельному весу после группы А/V. Высокий процент - 31,05% в группе А/N объясняется тем, что в группу попало ЛС Магникор, которое имеет наибольшую частоту врачебных назначений, хотя данный препарат не включен в Национальный перечень основных лекарственных средств и в программу «Доступные лекарства».Выводы. Результаты проведенных исследований состояния фармацевтической помощи больным ССЗ позволяют подчеркнуть актуальность проблем доступности лекарств для населения, а именно расширения перечня препаратов, которые реимбурсируются в рамках правительственных программ, в частности, включением в программу «Доступные лекарства» препарата Магникор. ; Мета роботи – оцінка стану фармацевтичного забезпечення хворих на серцево-судинні захворювання (ССЗ) за допомогою АВС, VEN та комплексного АВС/VENаналізів.Матеріали та методи. Дослідження проведено за даними медичних карток амбулаторних хворих, які перебували на обліку у Комунальному закладі охорони здоров'я (КЗОЗ) «Харківській міській клінічній лікарні №27». Методами були обрані: АВС, VEN та комплексний АВС/VEN аналіз.Результати. Результати дослідження за допомогою методу АВС-аналізу дозволили встановити, що найбільшою за кількістю препаратів була група С до якої було включено 25 лікарських засобів (ЛЗ) або 51,02% від загальної кількості призначень препаратів. При проведенні VEN-аналізу було встановлено, що переважна більшість ЛЗ відноситься до групи V – життєво необхідні – 41 препарат. Комплексний АВС/VEN аналіз показав, що препарати зі статусом А/V (найбільш витратні та життєво необхідні препарати) мали найбільшу питому вагу – 32,20% від загального споживання. Окремо слід зазначити, що група А/N (найбільш витратні та другорядні ЛЗ) займала другу позицію за питомою вагою після групи А/V. Високий відсоток – 31,05% у групі А/N пояснюється тим, що до групи потрапив ЛЗ Магнікор, який має найбільшу частоту лікарських призначень, хоча даний препарат не включений до Національного переліку основних лікарських засобів та до програми «Доступні ліки».Висновки. Результати проведених досліджень стану фармацевтичної допомоги хворим на ССЗ дозволяють наголосити про актуальність проблем доступності ліків для населення, а саме розширення переліків препаратів, що реімбурсуються у рамках Урядових програм, зокрема, включенням до програми «Доступні ліки» препарату Магнікор.
Paper 3 of this thesis is not available in Munin: 3. Brondbo PH, Mathiassen B, Martinussen M, Handegard BH and Kvernmo S.: 'Agreement on diagnoses and severity of mental health problems between a research and a naturalistic clinical setting' (manuscript). ; During the last decade, child psychiatry has been a focus of the Norwegian government's plan to improve mental health care. Psychiatric assessment of children and adolescents is more complex than that of adults, and rating scales and diagnostic instruments have become increasingly important tools in both research and clinical practice. This dissertation investigates standardized assessment instruments used in routine clinical practice to assign diagnoses and severity of mental health problems. Both the reliability and the validity of some instruments were examined, and a main focus was the clinical usefulness of these instruments and their potential for more effective use of limited clinical resources. In paper 1 the agreement between diagnoses and severity ratings assigned by clinical specialists who were trained Child and Adolescent Mental Health Service (CAMHS) researchers examined. Information on 100 youths was obtained from multiple informants through a webbased Development and Well-Being Assessment (DAWBA). Based on this information, four experienced clinicians independently diagnosed (according to the International Classification of Diseases Revision 10) and rated the severity of mental health problems according to the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the Children's Global Assessment Scale (C-GAS). Agreement for diagnosis was - =0.69-0.82. Intra-class correlation for single measures was 0.78 for HoNOSCA and 0.74 for C-GAS, and 0.93 and 0.92, respectively for average measures. Information obtained with the online DAWBA may be a sound basis on which to establish reliable clinical diagnoses and severity ratings for common mental health disorders in a clinical setting. A clinical practice that includes systematic, multiple independent assignments of diagnosis and severity, is preferable due to the resulting improved reliability of the severity ratings. In paper 2 the application of specific scoring algorithms for the Strengths and Difficulties Questionnaire (SDQ) was examined. Could available online norms be useful in screening for mental health disorders among children and adolescents in the CAMHS North Study? A total of 286 outpatients, aged 5 to 18 years, were assigned diagnoses based on the DAWBA. The main diagnostic groups (emotional, hyperactivity, conduct and other disorders) were then compared to the SDQ scoring algorithms using two dichotomisation levels: 'possible' and 'probable' levels. Sensitivity for the diagnostic categories included was 0.47-0.85 ('probable' dichotomisation level) and 0.81-1.00 ('possible' dichotomisation level). Specificity was 0.52-0.87 ('probable' level) and 0.24-0.58 ('possible' level). The discriminative ability, as measured by ORD, was in the interval for potentially useful tests for hyperactivity disorders and conduct disorders when dichotomised on the 'possible' level, but outside the interval for potentially useful tests for all diagnostic categories when dichotomised on the most common used 'probable' level. In conclusion, the ability of the SDQ to detect mental health disorders among patients referred to CAMHS is not sufficient for clinical purposes. When used as a screening instrument to determine whether further evaluation is warranted in a clinical CAMHS sample, the SDQ seems best suited to identify children and adolescents who do not require further psychiatric evaluation, although this also is problematic from a clinical point of view. In paper 3 the agreement between diagnoses and severity assigned by clinical specialists trained as CAMHS researchers, based only on DAWBA information collected online, and the routine clinical assignments by CAMHS clinicians was examined. Routine clinical assignment of diagnoses was compared to online clinical assignment of diagnoses for 286 patients from the CAMHS North study. Chi square analysis, kappa statistics and multinomial logistic regression analyses were performed. Raw agreement for diagnostic categories varied between 74% and 90%, resulting in kappa values of 0.41-0.49. The final multinomial regression models were significant. Agreement on mental health diagnoses can be fair when online clinical assignments and routine clinical assignments of mental health diagnoses are compared. This may be sufficient to replace the routine clinical assignment of diagnoses with an online clinical assignment in order to save time and resources. We also examined factors contributing to agreement or disagreement on the diagnoses. Age, gender and number of informants significantly contributed to the explanation of agreement and disagreement for 'emotional diagnosis' and 'hyperkinetic/conduct diagnosis'. However, the changes in odds were small in magnitude and the factors probably do not consistently contribute to the understanding of agreement or disagreement in any clinically meaningful way. Lastly, implications for further research on reliable and effective assessment methods are discussed.
Purpose: studying of life quality indicators at elderly patients with osteoarthritis using international EuroQol questionnaire for evaluate of efficiency of sanatorium treatment.Materials and methods. 72 patients have been included in study at the age from 60 till 78 years, mean age was 67,6±8,7 years. Patients have been divided by method of randomization on two groups. Patients of one of groups in addition passed rehabilitation in sanatorium conditions for 18–21 days. Assessment of life quality related to health was conducted with use of international questionnaire EuroQol-5D-European Quality of Life instrument (EQ-5D).Results. At all patients with osteoarthritis health problems of varying degree have been revealed. In 12 months according to the questionnaire, reliable positive dynamics of life quality was observed at patients passing sanatorium treatment at the expense of improvement of ability to movement, reduce pain and discomfort and increase daily activity.Conclusions. Having of sanatorium stage of rehabilitation in complex treatment of osteoarthritis allows affect quality of life and keep remission for a longer period in comparison with outpatient treatment.KEY WORDS: quality of life, sanatorium treatments, osteoarthritis.Osteoarthritis (OA) is one of the most common disorders of the muscle-skeletal system, especially in the elderly age group ( in every third elderly person, reaching 70% among those who have over 65 years). During the natural aging occurs involutional changes in the connective tissue, especially in the tendons, ligaments, cartilage, bone tissue, in the walls of blood vessels, muscles [2]. Thus aging of body contributes to the accumulation of diseases. During the examination in elderly and senile patients were diagnosed from three to five different diseases. Modern elderly person is - a unique clinical phenomenon from the point of view on availability and the combination of its diverse in character and course of diseases that are competing for their prognostic significance and impact on quality of life. OA attributed to diseases with high comorbidity, and founded that patients with OA have a significantly higher risk of comorbid conditions than patients who do not suffering from OA [4].Clinical experience and numerous publications data suggest that OA is often associated with subsequent somatic disorders: hypertension, coronary heart disease, obesity, diabetes, lung diseases (chronic obstructive pulmonary disease) and gastro- intestinal tract diseases. The greatest burden on society observed in cases of combination OA and osteodeficiency (osteopenia, osteoporosis (OP)), which significantly decreses the quality of life [5].Quality of life - integrated description of physical, psychological, emotional and social functioning of a person based on its subjective perception. Assessment of quality of life at modern stage have more increasing strong position in medicine, reflecting on the one hand, the presence of new medical technologies that do not affect the life expectancy, but significantly improve its quality, and from the other hand - expanding activity of the patient, increasing of its role in choice of methods of diagnostic and treatment [9].When selecting the questionnaires it is important to consider that to be used in a clinical studying suitable only those that give results of the evaluation quality of life in a form of a single summary score from 0 to 1.0. These includes a generic questionnaire EQ-5D (EuroQol) [8]. This general questionnaire is easy to fill , widely used in different countries and gives during the processing of collected data single score to measure the quality of life, represented by values between 0 and 1, which also provides the possibility of its using in clinical trials. This questionnaire is widely used in various clinical situations , including in assessing the quality of life patients with rheumatic diseases [7].The aging process is controversial, because on the background of regression processes - atrophy, degradation, etc., develops progressive trends of creating the new compensatory-adaptive mechanisms to maintain homeostasis in an aging body, which, however, does not fully offset the growing phenomena of degradation [2]. It should be noted that the adaptive capacity of the aging body is reduced, the possibility of development various diseases increases. In this context, particularly important in cases of illness in the elderly patient is the role of sanogenetic mechanisms, their stimulation and support. A special interest belongs to the sanatorium stage of rehabilitation, whose mission is the prevention of disease progression, stimulation of compensatory capacity of the muscle-skeletal system and the possible restoration of joint function.Spa treatment has a special place in the treatment and preventive care of elderly patients , as a stage in the system of rehabilitation of many chronic diseases. Multi-disciplinary nature of medical rehabilitation in spa conditions, a wide range of rehabilitation methods can embrace patients of all age groups with the most common diseases [1].Compared with medication treatment, natural and artificial physical factors, when they are properly used, characterized by the absence of allergies, lower incidence and severity of side effects, the ability of positively influencing on the number of pathological processes and the whole body, thus helping to improve the quality of life and are important in the prevention of premature aging [2]. In the resort conditions further rehabilitation is indicated for patients with initial stages of OA, disabled (groups I and II), patients with resistant synovitis and comorbidity with the possibility of self-servicing (including general contraindications for a spa treatment) [3].The aim of the study. To investigate the quality of life in elderly patients with osteoarthritis using international EuroQol questionnaire to evaluate the effectiveness of spa treatment.Materials and methods. In study were included 72 patients aged from 60 to 78 years, middle age was 67,6 ± 8,7 years. Among the patients predominates women - 88.4 %. I radiographic stage of osteoarthritis by J.H. Kellgren-Lawrence [ 6] was diagnosed in 23,3 % of patients , II stage - in 76,7 %. In the view of modern geriatric approaches applying of the physical factors in patients with OA who were in the spa rehabilitation stage in the appointment of balneotherapeutic procedures we gave preference to ultrasonic inhalation of mineral waters and baths , from physiotherapy usually prescribed magnetic-lazer therapy, interferential therapy, patients also performed massage and physical rehabilitation . In order to prevent climate-adaptational and reaclimate-adaptational reactions and optimization process of climate-adaptation were included into the treatment complex ( based on established risk factors) adaptogens and treatment procedures that have adaptogenic action ( phytoaeroionisation , singlet-oxygen therapy). In the process of rehabilitation treatment in sanatorium conditions , we have selected the most effective combination of different methods of rehabilitation , which caused the most significant treatment effectiveness : a combination of balneotherapy , physiotherapy and exercise therapy. To improve continuity during medical rehabilitation, at discharging from the sanatorium patients were given written (in the form of special attractions ) recommendatitons about further treatment, lifestyle, physical activity, diet etc.By the method of randomization, patients were divided into two groups. A marked difference for the main source of clinical and functional parameters between the groups were not observed. The control group consisted of 14 patients of the same age without joint pathology. Treatment regimens differed between the studying groups the presence in one of the groups sanatorium stage of rehabilitation. In the first group (n=34) patients received Structum 500 mg 2 times a day ( within 6 months of the year ) and courses of NSAID, including mainly patients treated with meloxicam ( at a dose of 7,5 mg/d) or nimesulide (in dose of 100-200 mg/d) for 7-10 days during worcening. The patients of the second group (n=38) during the 18-21 day were on spa treatment ( once a year ), in the scheme of rehabilitation were: sitting hydrogen sulfide baths, a concentration of 80 mg/L for 10 minutes at a temperature of 360C , the course of 8 procedures every other day or ultrasonic inhalation by hydrogen sulfide water, period of 5 minutes; blue clay applications every other day at 260C temperature; interferential therapy and magnet-lazer therapy on the affected joints to 8 treatments alternately every other day ; pneumomassage ; classes of physical rehabilitation therapy, aromatherapy , singlet -oxygen therapy . After the sanatorium stage of rehabilitation patients are taking drugs containing chondroitin sulfate (within 6 months of the year), at worcening of NSAIDs.Assessment quality of life related to health , was conducted using an international EuroQol-5D-European Quality of Life instrument (EQ-5D), which consists of two parts. At first part the patient self- assessed his condition by 5 parameters: mobility, self-care , usual activities, pain and discomfort , anxiety and depression. In each variant patients could give three possible answers : No problem - 1 , there is some problem - 2, much of the problem - 3. In the second part of the questionnaire , patients assessed their health on a scale from 0 to 100 on the VAS, the so-called thermometer , where 0 means the worst condition , 100 - the best state of health of the patient. This part of the questionnaire is a quantitative assessment of general health.Statistical analysis of the results was done in the department of statistical system research at SHEE "Ternopil State Medical University by I. Y. Gorbachevsky Ministry of Health of Ukraine" in the software package Statsoft STATISTIC. To determine the reliability of the differences in the change of certain indicators were used parametric and non-parametric methods: criterion Wilkoksona, two-sided Fisher's criterion. A significant differences were considered when the degree of probability of error-free prognosis is (p) 95% (p <0.05). Results and discussion. General description of the health status of patients studied with OA according to EQ-5D questionnaire is given in the table.In all patients with osteoarthritis were found health problems of different severity degrees. Mostly suffers ability to travel and daily activity . This data confirms that the OA in the elderly age reduces quality of life. After 12 months, according to questionnaire, health status was different in two groups . Reliable positive trend was in patients from the second group 57,9 % (p < 0,05), as a result of improving the ability to travel in space , reducing pain and discomfort and increasing of daily activity.According to the second part of the questionnaire EQ-5D, at baseline, most patients had reduced general health assessment : the first group to 51,91 ± 1,07 ( median for «thermometer» EQ 52 points ) in the second group to 50,65 ± 1,17 ( median 48,5 points) in comparison with the best state of possible health. 12 months after the sanatorium stage of rehabilitation of patients with repeated testing were produced the following results : The average index quality of life on the " thermometer " EQ-5D questionnaire in the first group of patients was 54,76 ± 1,23 ( median - 56 points), the second group was 69,28 ± 0,89 ( median - 70 points), reliability differences is high : p < 0,001.In the category quality of life most of all patients reacted on the presence of sanatorium stage of rehabilitation in the category " movement in space " ( GPA retesting 1,60 ± 0,08, p < 0,001), " daily activity " ( GPA retesting 1 68 ± 0,07, p < 0,001), " pain / discomfort " ( GPA retesting 1,92 ± 0,08, p < 0,001), " anxiety / depression ( GPA retesting 1 52 ± 0,08, p < 0,05).Thus, the data suggested that in elderly patients with OA who were once a year on a spa treatment and took over 6 months structure-modification drugs significantly upgraded quality of life during 12 months.Conclusions1. Based on the analysis were founded that elderly patients with OA who underwent rehabilitation treatment in sanatorium- health resorts have continued improving quality of life in comparison with patients who were treated only in outpatient conditions.2. Availability sanatorium stage of rehabilitation in the treatment of elderly patients with OA contributes more complex influence on the human organism.3. Multi-disciplinary nature of medical rehabilitation in spa conditions , a wide range of used restorative treatment methods can affect the quality of life and maintain remission for more longer period in comparison with outpatient treatment.4. Monitoring the quality of life can not only control the functional state of the organism in the elderly aged people at various stages of treatment , but also to properly evaluate the effectiveness of treatment , and, if necessary, to carry out the correction of rehabilitation activities .Perspectives for future research. Aimed at studying the impact of rehabilitative and preventive measures on the quality of life in elderly patients with osteoarthritis at other stages of rehabilitation. Further work in this direction is reasonable and economically justified.REFERENCES1. Golyachenko A.O., Martynyuk V.I., Bakalyuk T.G. Medical rehabilitation in the spa conditions // Journal of research. - 2007 . - № 4. - P. 8-9.2. Kazymyrko V.K., KovalenkoV.N., Flehontova V.V. Involutional osteoarthritis and osteoporosis. - Donetsk: Publisher Zaslavsky A.J., 2011. - 724 p.3. Kovalenko V.N., Bortkiewicz A.P. Osteoarthritis . Practical guidance . - K.: Moryon , 2005. - 592 p.4. Mendel O.I., Naumov A.V., Alekseeva L.I. et al Osteoarthritis as a factor of risk in cardio-vascular catastrophes // Ukrainian Journal of Rheumatology . - 2010 . - № 3. - P. 68-73.5. Povoroznyuk V.V. Osteoarthritis // Art of treatments. - 2004 . - № 3. - P.16 -23.6 . Altman R., Asch E., Bloch D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee // Arthritis Rheum. - 1986 . - № 29. - P. 1039-1049 .7 . Harrison M.J., Davies L.M., Bansback N.J. et al. The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis // Qual Life Res. - 2009 . - № 18. - P. 1195-1205.8 . Herdman M., Gudex C., Lloyd A., et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) // Qual Life Res. - 2011 . - № 20 . - P. 1727-1736.9 . Langley P., Muller-Schwefe G., Nicolaou A., Liedgens H., Pergolizzi J., Varrassi G. The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization // J. Med Econ. - 2010 . - № 1. - P. 571-581. ; Мета: вивчення показників якості життя у хворих похилого віку на остеоартроз з використанням міжнародного запитальника EuroQol для оцінки ефективності санаторно-курортного лікування.Матеріали і методи. У дослідження було включено 72 пацієнти віком від 60 до 78 років, середній вік склав 67,6±8,7 року. Методом рандомізації пацієнтів було розподілено на дві групи. Пацієнти однієї з груп додатково проходили реабілітацію в умовах санаторію протягом 18-21 дня. Оцінка якості життя, пов'язаного зі здоров'ям, проводилась з використанням міжнародного запитальника EuroQol-5D-European Quality of Life instrument (EQ-5D).Результати. У всіх хворих на остеоартроз виявлено проблеми зі здоров'ям різного ступеня. Через 12 місяців за даними запитальника достовірна позитивна динаміка якості життя спостерігалася у пацієнтів, що проходили санаторно-куротне лікування, за рахунок покращення здатності до пересування, зменшення болю і дискомфорту та збільшення повсякденної активності.Висновки. Наявність санаторно-курортного етапу реабілітації у комплексному лікуванні остеоартрозу дозволяє вплинути на якість життя та зберегти ремісію на більш тривалий термін порівняно з амбулаторним лікуванням.КЛЮЧОВІ СЛОВА: якість життя, санаторно-курортне лікування, остеоартроз.
Purpose: studying of life quality indicators at elderly patients with osteoarthritis using international EuroQol questionnaire for evaluate of efficiency of sanatorium treatment.Materials and methods. 72 patients have been included in study at the age from 60 till 78 years, mean age was 67,6±8,7 years. Patients have been divided by method of randomization on two groups. Patients of one of groups in addition passed rehabilitation in sanatorium conditions for 18–21 days. Assessment of life quality related to health was conducted with use of international questionnaire EuroQol-5D-European Quality of Life instrument (EQ-5D).Results. At all patients with osteoarthritis health problems of varying degree have been revealed. In 12 months according to the questionnaire, reliable positive dynamics of life quality was observed at patients passing sanatorium treatment at the expense of improvement of ability to movement, reduce pain and discomfort and increase daily activity.Conclusions. Having of sanatorium stage of rehabilitation in complex treatment of osteoarthritis allows affect quality of life and keep remission for a longer period in comparison with outpatient treatment.KEY WORDS: quality of life, sanatorium treatments, osteoarthritis.Osteoarthritis (OA) is one of the most common disorders of the muscle-skeletal system, especially in the elderly age group ( in every third elderly person, reaching 70% among those who have over 65 years). During the natural aging occurs involutional changes in the connective tissue, especially in the tendons, ligaments, cartilage, bone tissue, in the walls of blood vessels, muscles [2]. Thus aging of body contributes to the accumulation of diseases. During the examination in elderly and senile patients were diagnosed from three to five different diseases. Modern elderly person is - a unique clinical phenomenon from the point of view on availability and the combination of its diverse in character and course of diseases that are competing for their prognostic significance and impact on quality of life. OA attributed to diseases with high comorbidity, and founded that patients with OA have a significantly higher risk of comorbid conditions than patients who do not suffering from OA [4].Clinical experience and numerous publications data suggest that OA is often associated with subsequent somatic disorders: hypertension, coronary heart disease, obesity, diabetes, lung diseases (chronic obstructive pulmonary disease) and gastro- intestinal tract diseases. The greatest burden on society observed in cases of combination OA and osteodeficiency (osteopenia, osteoporosis (OP)), which significantly decreses the quality of life [5].Quality of life - integrated description of physical, psychological, emotional and social functioning of a person based on its subjective perception. Assessment of quality of life at modern stage have more increasing strong position in medicine, reflecting on the one hand, the presence of new medical technologies that do not affect the life expectancy, but significantly improve its quality, and from the other hand - expanding activity of the patient, increasing of its role in choice of methods of diagnostic and treatment [9].When selecting the questionnaires it is important to consider that to be used in a clinical studying suitable only those that give results of the evaluation quality of life in a form of a single summary score from 0 to 1.0. These includes a generic questionnaire EQ-5D (EuroQol) [8]. This general questionnaire is easy to fill , widely used in different countries and gives during the processing of collected data single score to measure the quality of life, represented by values between 0 and 1, which also provides the possibility of its using in clinical trials. This questionnaire is widely used in various clinical situations , including in assessing the quality of life patients with rheumatic diseases [7].The aging process is controversial, because on the background of regression processes - atrophy, degradation, etc., develops progressive trends of creating the new compensatory-adaptive mechanisms to maintain homeostasis in an aging body, which, however, does not fully offset the growing phenomena of degradation [2]. It should be noted that the adaptive capacity of the aging body is reduced, the possibility of development various diseases increases. In this context, particularly important in cases of illness in the elderly patient is the role of sanogenetic mechanisms, their stimulation and support. A special interest belongs to the sanatorium stage of rehabilitation, whose mission is the prevention of disease progression, stimulation of compensatory capacity of the muscle-skeletal system and the possible restoration of joint function.Spa treatment has a special place in the treatment and preventive care of elderly patients , as a stage in the system of rehabilitation of many chronic diseases. Multi-disciplinary nature of medical rehabilitation in spa conditions, a wide range of rehabilitation methods can embrace patients of all age groups with the most common diseases [1].Compared with medication treatment, natural and artificial physical factors, when they are properly used, characterized by the absence of allergies, lower incidence and severity of side effects, the ability of positively influencing on the number of pathological processes and the whole body, thus helping to improve the quality of life and are important in the prevention of premature aging [2]. In the resort conditions further rehabilitation is indicated for patients with initial stages of OA, disabled (groups I and II), patients with resistant synovitis and comorbidity with the possibility of self-servicing (including general contraindications for a spa treatment) [3].The aim of the study. To investigate the quality of life in elderly patients with osteoarthritis using international EuroQol questionnaire to evaluate the effectiveness of spa treatment.Materials and methods. In study were included 72 patients aged from 60 to 78 years, middle age was 67,6 ± 8,7 years. Among the patients predominates women - 88.4 %. I radiographic stage of osteoarthritis by J.H. Kellgren-Lawrence [ 6] was diagnosed in 23,3 % of patients , II stage - in 76,7 %. In the view of modern geriatric approaches applying of the physical factors in patients with OA who were in the spa rehabilitation stage in the appointment of balneotherapeutic procedures we gave preference to ultrasonic inhalation of mineral waters and baths , from physiotherapy usually prescribed magnetic-lazer therapy, interferential therapy, patients also performed massage and physical rehabilitation . In order to prevent climate-adaptational and reaclimate-adaptational reactions and optimization process of climate-adaptation were included into the treatment complex ( based on established risk factors) adaptogens and treatment procedures that have adaptogenic action ( phytoaeroionisation , singlet-oxygen therapy). In the process of rehabilitation treatment in sanatorium conditions , we have selected the most effective combination of different methods of rehabilitation , which caused the most significant treatment effectiveness : a combination of balneotherapy , physiotherapy and exercise therapy. To improve continuity during medical rehabilitation, at discharging from the sanatorium patients were given written (in the form of special attractions ) recommendatitons about further treatment, lifestyle, physical activity, diet etc.By the method of randomization, patients were divided into two groups. A marked difference for the main source of clinical and functional parameters between the groups were not observed. The control group consisted of 14 patients of the same age without joint pathology. Treatment regimens differed between the studying groups the presence in one of the groups sanatorium stage of rehabilitation. In the first group (n=34) patients received Structum 500 mg 2 times a day ( within 6 months of the year ) and courses of NSAID, including mainly patients treated with meloxicam ( at a dose of 7,5 mg/d) or nimesulide (in dose of 100-200 mg/d) for 7-10 days during worcening. The patients of the second group (n=38) during the 18-21 day were on spa treatment ( once a year ), in the scheme of rehabilitation were: sitting hydrogen sulfide baths, a concentration of 80 mg/L for 10 minutes at a temperature of 360C , the course of 8 procedures every other day or ultrasonic inhalation by hydrogen sulfide water, period of 5 minutes; blue clay applications every other day at 260C temperature; interferential therapy and magnet-lazer therapy on the affected joints to 8 treatments alternately every other day ; pneumomassage ; classes of physical rehabilitation therapy, aromatherapy , singlet -oxygen therapy . After the sanatorium stage of rehabilitation patients are taking drugs containing chondroitin sulfate (within 6 months of the year), at worcening of NSAIDs.Assessment quality of life related to health , was conducted using an international EuroQol-5D-European Quality of Life instrument (EQ-5D), which consists of two parts. At first part the patient self- assessed his condition by 5 parameters: mobility, self-care , usual activities, pain and discomfort , anxiety and depression. In each variant patients could give three possible answers : No problem - 1 , there is some problem - 2, much of the problem - 3. In the second part of the questionnaire , patients assessed their health on a scale from 0 to 100 on the VAS, the so-called thermometer , where 0 means the worst condition , 100 - the best state of health of the patient. This part of the questionnaire is a quantitative assessment of general health.Statistical analysis of the results was done in the department of statistical system research at SHEE "Ternopil State Medical University by I. Y. Gorbachevsky Ministry of Health of Ukraine" in the software package Statsoft STATISTIC. To determine the reliability of the differences in the change of certain indicators were used parametric and non-parametric methods: criterion Wilkoksona, two-sided Fisher's criterion. A significant differences were considered when the degree of probability of error-free prognosis is (p) 95% (p <0.05). Results and discussion. General description of the health status of patients studied with OA according to EQ-5D questionnaire is given in the table.In all patients with osteoarthritis were found health problems of different severity degrees. Mostly suffers ability to travel and daily activity . This data confirms that the OA in the elderly age reduces quality of life. After 12 months, according to questionnaire, health status was different in two groups . Reliable positive trend was in patients from the second group 57,9 % (p < 0,05), as a result of improving the ability to travel in space , reducing pain and discomfort and increasing of daily activity.According to the second part of the questionnaire EQ-5D, at baseline, most patients had reduced general health assessment : the first group to 51,91 ± 1,07 ( median for «thermometer» EQ 52 points ) in the second group to 50,65 ± 1,17 ( median 48,5 points) in comparison with the best state of possible health. 12 months after the sanatorium stage of rehabilitation of patients with repeated testing were produced the following results : The average index quality of life on the " thermometer " EQ-5D questionnaire in the first group of patients was 54,76 ± 1,23 ( median - 56 points), the second group was 69,28 ± 0,89 ( median - 70 points), reliability differences is high : p < 0,001.In the category quality of life most of all patients reacted on the presence of sanatorium stage of rehabilitation in the category " movement in space " ( GPA retesting 1,60 ± 0,08, p < 0,001), " daily activity " ( GPA retesting 1 68 ± 0,07, p < 0,001), " pain / discomfort " ( GPA retesting 1,92 ± 0,08, p < 0,001), " anxiety / depression ( GPA retesting 1 52 ± 0,08, p < 0,05).Thus, the data suggested that in elderly patients with OA who were once a year on a spa treatment and took over 6 months structure-modification drugs significantly upgraded quality of life during 12 months.Conclusions1. Based on the analysis were founded that elderly patients with OA who underwent rehabilitation treatment in sanatorium- health resorts have continued improving quality of life in comparison with patients who were treated only in outpatient conditions.2. Availability sanatorium stage of rehabilitation in the treatment of elderly patients with OA contributes more complex influence on the human organism.3. Multi-disciplinary nature of medical rehabilitation in spa conditions , a wide range of used restorative treatment methods can affect the quality of life and maintain remission for more longer period in comparison with outpatient treatment.4. Monitoring the quality of life can not only control the functional state of the organism in the elderly aged people at various stages of treatment , but also to properly evaluate the effectiveness of treatment , and, if necessary, to carry out the correction of rehabilitation activities .Perspectives for future research. Aimed at studying the impact of rehabilitative and preventive measures on the quality of life in elderly patients with osteoarthritis at other stages of rehabilitation. Further work in this direction is reasonable and economically justified.REFERENCES1. Golyachenko A.O., Martynyuk V.I., Bakalyuk T.G. Medical rehabilitation in the spa conditions // Journal of research. - 2007 . - № 4. - P. 8-9.2. Kazymyrko V.K., KovalenkoV.N., Flehontova V.V. Involutional osteoarthritis and osteoporosis. - Donetsk: Publisher Zaslavsky A.J., 2011. - 724 p.3. Kovalenko V.N., Bortkiewicz A.P. Osteoarthritis . Practical guidance . - K.: Moryon , 2005. - 592 p.4. Mendel O.I., Naumov A.V., Alekseeva L.I. et al Osteoarthritis as a factor of risk in cardio-vascular catastrophes // Ukrainian Journal of Rheumatology . - 2010 . - № 3. - P. 68-73.5. Povoroznyuk V.V. Osteoarthritis // Art of treatments. - 2004 . - № 3. - P.16 -23.6 . Altman R., Asch E., Bloch D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee // Arthritis Rheum. - 1986 . - № 29. - P. 1039-1049 .7 . Harrison M.J., Davies L.M., Bansback N.J. et al. The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis // Qual Life Res. - 2009 . - № 18. - P. 1195-1205.8 . Herdman M., Gudex C., Lloyd A., et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) // Qual Life Res. - 2011 . - № 20 . - P. 1727-1736.9 . Langley P., Muller-Schwefe G., Nicolaou A., Liedgens H., Pergolizzi J., Varrassi G. The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization // J. Med Econ. - 2010 . - № 1. - P. 571-581. ; Мета: вивчення показників якості життя у хворих похилого віку на остеоартроз з використанням міжнародного запитальника EuroQol для оцінки ефективності санаторно-курортного лікування.Матеріали і методи. У дослідження було включено 72 пацієнти віком від 60 до 78 років, середній вік склав 67,6±8,7 року. Методом рандомізації пацієнтів було розподілено на дві групи. Пацієнти однієї з груп додатково проходили реабілітацію в умовах санаторію протягом 18-21 дня. Оцінка якості життя, пов'язаного зі здоров'ям, проводилась з використанням міжнародного запитальника EuroQol-5D-European Quality of Life instrument (EQ-5D).Результати. У всіх хворих на остеоартроз виявлено проблеми зі здоров'ям різного ступеня. Через 12 місяців за даними запитальника достовірна позитивна динаміка якості життя спостерігалася у пацієнтів, що проходили санаторно-куротне лікування, за рахунок покращення здатності до пересування, зменшення болю і дискомфорту та збільшення повсякденної активності.Висновки. Наявність санаторно-курортного етапу реабілітації у комплексному лікуванні остеоартрозу дозволяє вплинути на якість життя та зберегти ремісію на більш тривалий термін порівняно з амбулаторним лікуванням.КЛЮЧОВІ СЛОВА: якість життя, санаторно-курортне лікування, остеоартроз.
The formation of Ukrainian statehood is related to the solution of critical social issues on the legislative and regulatory legal maintenance of reforming the pharmaceutical industry, in particular, to ensure the physical and price affordability of medicines in all localities of the country. Particularly pressing problem has developed with the drug provision for the rural population. The objective was to study the problem of drug provision for the rural population and to make accordingly the proposals for optimizing its organization and solving the most pressing problems of rural pharmacy. The studies were based on results of drug monitoring service provision in localities of a few regions. There were used the methods of survey of experts and residents in rural areas, and statistical data. Traditionally Ukraine used to have the well-organized and effective legal system of drug provision for the rural population. The pharmacies were opened in all the rural outpatient clinics and rural health posts. Subsequently, we failed to maintain a broad rural network of pharmacies. The rural pharmacies in many villages are closed as unprofitable, besides in some feldsher's stations and rural health posts there are no pharmacies, and a shortage of medicines. In some rural areas, there are no organizational forms of providing the population with drugs. The introduction of the government 7% of VAT on imported drugs in 2014 led to the rise in the cost of medicines from 50% to 200% which caused reducing the drugs sale and this was the reason for closing rural pharmacies because of their unprofitability. The lack of proper medical care is one of the negative factors affecting the rural population. During the years of independence in Ukraine there have disappeared 600 villages and 400 rural settlements. The scientific publications present different forms of drug providing in the rural areas like special automatic dispensers in retail outlets for over-the-counter drugs, «Pharmacy on wheels» organizations and others. During this period, it is impossible to solve the problem of the medicinal maintenance of the rural population only on the basis of commercial approaches. There fore, legislative and governmental levels must be involved as well as social approaches and the specific measures for proper functioning of the rural pharmacy network must be developed. The heads of the rural communities and the State Service of Ukraine on Medicinal Products should be responsible for organizing the drug provision for the population in specific localities and it should be regulated at the legislative level. Studying the drug provision service for the rural population proves the necessity to adopt state legislative regulation on the problem and take practical measures by the communities for improving this field of healthcare. It is advisable to include the regulation on exemption the rural pharmacies from real estate taxes in the new Law «On the local self-administration» to be planned to adopt by the Verkchovna Rada of Ukraine as well as the regulation on state budget financing the local communities to pay over residential premises for the rural pharmacies, irrespective of the form of ownership, utilities services. Should be substantiated the proposals for the government to abolish VAT on medications which are provided in the rural pharmacies. ; Становление украинской государственности связано с решением чрезвычайно важных социальных проблем законодательного и нормативно-правового обеспечения, в частности относительно необходимости реформирования фармацевтической отрасли для обеспечения физической и ценовой доступности приобретения лекарственных средств во всех населенных пунктах страны. Особо острая проблема сложилась в лекарственном обеспечении сельского населения. Целью работы было изучение состояния лекарственного обеспечения сельского населения и на основе исследования формирование предложения по оптимизации его организации и решения наиболее острых проблем сельской фармации. Исследования проводили на основе изучения состояния лекарственного обеспечения в населенных пунктах нескольких областей. Применены методы опроса специалистов и жителей сельской местности, использовали статистические данные. В Украине традиционно действовала четкая и эффективная правовая система лекарственного обеспечения сельского населения. При всех врачебных амбулаториях функционировали сельские аптеки, а при всех фельдшерско-акушерских пунктах – аптечные пункты. Впоследствии не смогли сохранить разветвленную сельскую аптечную сеть. Сельские аптеки во многих населенных пунктах были закрыты как нерентабельные, к тому же не при всех фельдшерских и фельдшерско-акушерских пунктах сейчас организованы аптечные пункты, а в функционирующих – незначительный ассортимент лекарств. В ряде сельских населенных пунктов отсутствуют какие-либо организационные формы обеспечения населения лекарственными средствами. Введение правительством в 2014 г. 7% НДС на импортные лекарственные средства привело к удорожанию лекарств от 50% до 200%, вследствие чего уменьшилась реализация лекарств, и это явилось причиной нерентабельности сельских аптек и их закрытия. Отсутствие необходимой лекарственной помощи является одним из негативных факторов, отрицательно влияющих на популяцию сельского населения. За годы независимости с карты Украины исчезло 600 сел и 400 сельских поселков. В научных публикациях предлагают разные формы обеспечения сельского населения: размещение специальных устройств – диспенсеров-автоматов в торговых точках для реализации лекарственных средств, подлежащих отпуску без рецептов врачей, организацию «Аптеки на колесах» и др. В данный период решить проблему надлежащей организации лекарственного обеспечения сельского населения лишь на основе коммерческих подходов невозможно. Поэтому на законодательных и правительственных уровнях должны быть задействованы социальные подходы и предусмотрены конкретные меры для функционирования сельской аптечной сети. Ответственность за организацию обеспечения населения в конкретных населенных пунктах должна быть регламентирована на законодательном уровне и возлагаться на руководителей сельских громад и государственную службу лекарственных средств. Исследование состояния обеспечения сельского населения лекарственными средствами свидетельствуют о необходимости принятия на государственном уровне законодательных норм и осуществления громадами практических мер по корректному улучшению дел в этом разделе здравоохранения. Целесообразно включить в новый закон о местном самоуправлении, который планируется принять Верховной Радой, норму об освобождении сельских аптек от уплаты налога на землю и норму, по которой предусматриваются средства в бюджете местных громад на оплату расходов, связанных с арендой помещений для аптек, независимо от формы собственности, содержания жилища и оплаты коммунальных услуг работникам аптек, а также направить правительству страны научно-обоснованные предложения в части отмены НДС на лекарственные средства, реализуемые из сельских аптек.
The aim. To conduct a structural analysis of the volume of government spending on the purchase of antituberculosis drugs (anti-TB D) within 2014–2018. Materials and methods. In the study, we used information on public procurement of anti-TB D for 2014–2018 presented on the website of the Ministry of Health of Ukraine in the section "Procurement of Medicines", as well as statistical data of the "Center for Public Health of the Ministry of Health of Ukraine" on the incidence of multi-drug resistant tuberculosis (MDR-TB) in the population. Analytical and comparative, system, and logical methods, as well as economic analysis were used. With the help of synthesis the conclusions and recommendations were formed. Results. It was found that in 2014-2018, the MDR-TB incidence rate increase had a positive dynamics in reducing the number of registered cases. For example, in 2015 this indicator was 2.56 %, and in 2018 it was -7.93 %. It was proven that public procurement of anti-TB D in physical terms was chaotic. Thus, in 2015/2014, the growth rate of anti-TB D number was 35.55 %, in 2016/2015 – -31.59 %, in 2017/2016 – 15.31 %, in 2018/2017 – 6.13 %. It was found that the dynamics of the growth rate of purchases of TB D in the national currency and USD had some differences. For example, in 2015, expenses increased by 55.02 % in the national currency, while in dollar terms this indicator decreased by 15.64 % compared to 2014. At the same time, in 2018 there was a positive trend of increasing the volume of public spending in monetary terms. Thus, in 2018, the growth rate in the national currency was 53.16 %, and in USD – 49.83 %. It was found that in the structure of public spending there was a tendency for an insignificant predominance of foreign anti-TB D. Based on the comparative analysis of government spending on groups of anti-TB D by the priority of their use in treatment regimens according to the standards it was determined that the process of anti-TB D purchasing did not meet the priority criteria for treatment. It complicates the implementation of the process of reforming TB care in connection with the construction of an outpatient model. ; Цель: проведение структурного анализа объемов государственных расходов на закупку противотуберкулезных лекарственных препаратов в период 2014-2018 гг. Материалы и методы. В исследованиях использованы данные государственных закупок противотуберкулезный лекарственных препаратов с 2014 по 2018 гг., которые представлены на сайте, МОЗ Украины в разделе «Закупки лекарств», а также статистические данные «Центра общественного здоровья МОЗ Украины» относительно показателей заболеваемости населения мультирезистентным туберкулезом. Применялись аналитико-сравнительной, системный, логический, а также методы экономического анализа. С помощью синтеза сформированы выводы и рекомендации. Результаты исследования. Установлено, что за 2014-2018 гг. темп прироста заболеваемости мультирезистентным туберкулезом имеет положительную динамику по уменьшению количества зарегистрированных случаев. Так, в 2015 г. этот показатель имел значение 2,56 %, а в 2018 г. составил -7,93 %. Доказано, что государственная закупка лекарственных препаратов в натуральном выражении имеет хаотичный характер. Так, за 2015/2014 гг. темп прироста количества ПТЛП составил 35,55 %, 2016/2015 гг. – 31,59 %, 2017/2016 гг. – 15,31 %, 2018/2017 гг. – 6,13 %. Установлено, что динамика темпов прироста объемов закупок ПТЛП в национальной валюте и долл. США имеет определенные различия. Так, в 2015 г. в национальной валюте происходил прирост расходов на 55,02 %, а в долларовом эквиваленте этот показатель уменьшился на 15,64 % по сравнению с 2014 г. В то же время, в 2018 г. наблюдалась положительная тенденция увеличения объемов государственных расходов в денежном выражении. Так, в 2018 г. темп прироста в национальной валюте составил 53,16 %, а в долл. США – 49,83 %. Доказано, что в структуре государственных расходов наблюдается тенденция незначительного превалирования противотуберкулезных лекарственных препаратов иностранного производства. По данным сопоставительного анализа государственных расходов на группы противотуберкулезных лекарственных препаратов по приоритетности их применения в схемах лечения в соответствии со стандартами установлено, что процесс закупок противотуберкулезных лекарственных препаратов не соответствует критериям приоритетности при лечении, что усложняет процесс реформирования противотуберкулезной помощи, в связи с построением амбулаторной модели. Выводы. Результаты анализа свидетельствуют, что существует необходимость принятия ряда организационно - экономических решений для повышения уровня доступности противотуберкулезных лекарственных препаратов в лечении больных мультирезистентным туберкулезом. К решающим мерам можно отнести осуществление контроля за программами закупок на основе реальной региональной потребности с учетом показателей заболеваемости. Кроме этого, актуальным является пересмотр перечней ЛП, закупка которых включает ЛП отечественного производства, которые принадлежат к средствам второй линии в схемах фармакотерапии. Также в перечень мероприятий можно отнести проведение мониторинга цен с учетом инфляционных процессов в государстве и прогнозирования их влияния на объемы государственных расходов на закупку противотуберкулезных ЛП ; Мета: проведення структурного аналізу обсягів державних витрат на закупівлю протитуберкульозних лікарських препаратів у період 2014–2018 рр. Матеріали і методи. У дослідженнях використовувалися дані державних закупівель протитуберкульозних лікарських препаратів за 2014–2018 рр., що представлені на сайті МОЗ України у розділі «Закупівлі ліків», а також статистичні дані «Центру громадського здоров'я МОЗ України» щодо показників захворюваності населення на мультирезистентний туберкульоз. Застосовувалися аналітико-порівняльний, системний, логічний, а також методи економічного аналізу. За допомогою синтезу сформовані висновки та рекомендації. Результати дослідження. Встановлено, що за 2014–2018 рр. темп приросту захворюваності на мультирезистентний туберкульоз має позитивну динаміку щодо зменшення кількості зареєстрованих випадків. Так, у 2015 р. цей показник мав значення 2,56 %, а у 2018 р. склав -7,93 %. Доведено, що державна закупівля лікарських препаратів у натуральному вимірі має хаотичний характер. Так, за 2015/2014 рр. темп приросту кількості ПТЛП склав 35,55 %, 2016/2015 рр. – -31,59 %, 2017/2016 рр. – 15,31 %, 2018/2017 рр. – 6,13 %. З'ясовано, що динаміка темпів приросту обсягів закупівель ПТЛП у національній валюті та дол. США має певні розбіжності. Так, у 2015 р. у національній валюті відбувався приріст витрат на 55,02 %, а у доларовому еквіваленті цей показник зменшився на 15,64 % порівняно з 2014 р. Водночас, у 2018 р. спостерігалась позитивна тенденція збільшення обсягів державних витрат у грошовому виміру. Так, у 2018 р. темп приросту у національній валюті склав 53,16 %, а у дол. США – 49,83 %. Доведено, що у структурі державних витрат спостерігається тенденція незначного превалювання протитуберкульозних лікарських препаратів іноземного виробництва. За даними співставного аналізу державних витрат на групи протитуберкульозних лікарських препаратів за пріоритетністю їх застосування у схемах лікування відповідно до стандартів встановлено, що процес закупівель протитуберкульозних лікарських препаратів не відповідає критеріям пріоритетності при лікування, що ускладнює впровадження процесу реформування протитуберкульозної допомоги у зв'язку із побудовою амбулаторної моделі.
The aim. To conduct a structural analysis of the volume of government spending on the purchase of antituberculosis drugs (anti-TB D) within 2014–2018. Materials and methods. In the study, we used information on public procurement of anti-TB D for 2014–2018 presented on the website of the Ministry of Health of Ukraine in the section "Procurement of Medicines", as well as statistical data of the "Center for Public Health of the Ministry of Health of Ukraine" on the incidence of multi-drug resistant tuberculosis (MDR-TB) in the population. Analytical and comparative, system, and logical methods, as well as economic analysis were used. With the help of synthesis the conclusions and recommendations were formed. Results. It was found that in 2014-2018, the MDR-TB incidence rate increase had a positive dynamics in reducing the number of registered cases. For example, in 2015 this indicator was 2.56 %, and in 2018 it was -7.93 %. It was proven that public procurement of anti-TB D in physical terms was chaotic. Thus, in 2015/2014, the growth rate of anti-TB D number was 35.55 %, in 2016/2015 – -31.59 %, in 2017/2016 – 15.31 %, in 2018/2017 – 6.13 %. It was found that the dynamics of the growth rate of purchases of TB D in the national currency and USD had some differences. For example, in 2015, expenses increased by 55.02 % in the national currency, while in dollar terms this indicator decreased by 15.64 % compared to 2014. At the same time, in 2018 there was a positive trend of increasing the volume of public spending in monetary terms. Thus, in 2018, the growth rate in the national currency was 53.16 %, and in USD – 49.83 %. It was found that in the structure of public spending there was a tendency for an insignificant predominance of foreign anti-TB D. Based on the comparative analysis of government spending on groups of anti-TB D by the priority of their use in treatment regimens according to the standards it was determined that the process of anti-TB D purchasing did not meet the priority criteria for treatment. It complicates the implementation of the process of reforming TB care in connection with the construction of an outpatient model. ; Цель: проведение структурного анализа объемов государственных расходов на закупку противотуберкулезных лекарственных препаратов в период 2014-2018 гг. Материалы и методы. В исследованиях использованы данные государственных закупок противотуберкулезный лекарственных препаратов с 2014 по 2018 гг., которые представлены на сайте, МОЗ Украины в разделе «Закупки лекарств», а также статистические данные «Центра общественного здоровья МОЗ Украины» относительно показателей заболеваемости населения мультирезистентным туберкулезом. Применялись аналитико-сравнительной, системный, логический, а также методы экономического анализа. С помощью синтеза сформированы выводы и рекомендации. Результаты исследования. Установлено, что за 2014-2018 гг. темп прироста заболеваемости мультирезистентным туберкулезом имеет положительную динамику по уменьшению количества зарегистрированных случаев. Так, в 2015 г. этот показатель имел значение 2,56 %, а в 2018 г. составил -7,93 %. Доказано, что государственная закупка лекарственных препаратов в натуральном выражении имеет хаотичный характер. Так, за 2015/2014 гг. темп прироста количества ПТЛП составил 35,55 %, 2016/2015 гг. – 31,59 %, 2017/2016 гг. – 15,31 %, 2018/2017 гг. – 6,13 %. Установлено, что динамика темпов прироста объемов закупок ПТЛП в национальной валюте и долл. США имеет определенные различия. Так, в 2015 г. в национальной валюте происходил прирост расходов на 55,02 %, а в долларовом эквиваленте этот показатель уменьшился на 15,64 % по сравнению с 2014 г. В то же время, в 2018 г. наблюдалась положительная тенденция увеличения объемов государственных расходов в денежном выражении. Так, в 2018 г. темп прироста в национальной валюте составил 53,16 %, а в долл. США – 49,83 %. Доказано, что в структуре государственных расходов наблюдается тенденция незначительного превалирования противотуберкулезных лекарственных препаратов иностранного производства. По данным сопоставительного анализа государственных расходов на группы противотуберкулезных лекарственных препаратов по приоритетности их применения в схемах лечения в соответствии со стандартами установлено, что процесс закупок противотуберкулезных лекарственных препаратов не соответствует критериям приоритетности при лечении, что усложняет процесс реформирования противотуберкулезной помощи, в связи с построением амбулаторной модели. Выводы. Результаты анализа свидетельствуют, что существует необходимость принятия ряда организационно - экономических решений для повышения уровня доступности противотуберкулезных лекарственных препаратов в лечении больных мультирезистентным туберкулезом. К решающим мерам можно отнести осуществление контроля за программами закупок на основе реальной региональной потребности с учетом показателей заболеваемости. Кроме этого, актуальным является пересмотр перечней ЛП, закупка которых включает ЛП отечественного производства, которые принадлежат к средствам второй линии в схемах фармакотерапии. Также в перечень мероприятий можно отнести проведение мониторинга цен с учетом инфляционных процессов в государстве и прогнозирования их влияния на объемы государственных расходов на закупку противотуберкулезных ЛП ; Мета: проведення структурного аналізу обсягів державних витрат на закупівлю протитуберкульозних лікарських препаратів у період 2014–2018 рр. Матеріали і методи. У дослідженнях використовувалися дані державних закупівель протитуберкульозних лікарських препаратів за 2014–2018 рр., що представлені на сайті МОЗ України у розділі «Закупівлі ліків», а також статистичні дані «Центру громадського здоров'я МОЗ України» щодо показників захворюваності населення на мультирезистентний туберкульоз. Застосовувалися аналітико-порівняльний, системний, логічний, а також методи економічного аналізу. За допомогою синтезу сформовані висновки та рекомендації. Результати дослідження. Встановлено, що за 2014–2018 рр. темп приросту захворюваності на мультирезистентний туберкульоз має позитивну динаміку щодо зменшення кількості зареєстрованих випадків. Так, у 2015 р. цей показник мав значення 2,56 %, а у 2018 р. склав -7,93 %. Доведено, що державна закупівля лікарських препаратів у натуральному вимірі має хаотичний характер. Так, за 2015/2014 рр. темп приросту кількості ПТЛП склав 35,55 %, 2016/2015 рр. – -31,59 %, 2017/2016 рр. – 15,31 %, 2018/2017 рр. – 6,13 %. З'ясовано, що динаміка темпів приросту обсягів закупівель ПТЛП у національній валюті та дол. США має певні розбіжності. Так, у 2015 р. у національній валюті відбувався приріст витрат на 55,02 %, а у доларовому еквіваленті цей показник зменшився на 15,64 % порівняно з 2014 р. Водночас, у 2018 р. спостерігалась позитивна тенденція збільшення обсягів державних витрат у грошовому виміру. Так, у 2018 р. темп приросту у національній валюті склав 53,16 %, а у дол. США – 49,83 %. Доведено, що у структурі державних витрат спостерігається тенденція незначного превалювання протитуберкульозних лікарських препаратів іноземного виробництва. За даними співставного аналізу державних витрат на групи протитуберкульозних лікарських препаратів за пріоритетністю їх застосування у схемах лікування відповідно до стандартів встановлено, що процес закупівель протитуберкульозних лікарських препаратів не відповідає критеріям пріоритетності при лікування, що ускладнює впровадження процесу реформування протитуберкульозної допомоги у зв'язку із побудовою амбулаторної моделі.
The World Bank has produced this policy Toolkit in response to a growing demand from our government clients and partners for advice on how to create and implement effective policies for at-risk youth. The author has highlighted 22 policies (six core policies, nine promising policies, and seven general policies) that have been effective in addressing the following five key risk areas for young people around the world: (i) youth unemployment, underemployment, and lack of formal sector employment; (ii) early school leaving; (iii) risky sexual behavior leading to early childbearing and HIV/AIDS; (iv) crime and violence; and (v) substance abuse. The objective of this Toolkit is to serve as a practical guide for policy makers in middle-income countries as well as professionals working within the area of youth development on how to develop and implement an effective policy portfolio to foster healthy and positive youth development.
In2009 inUkrainereimbursement was started as a new means of economic-legal regulation of relations in the health care system. But for today in our country there are many difficulties in the implementation of National System for reimbursement of medical expenses.Aim. To evaluate the availability of medicines with reference pricing, specific categories of outpatient patients and analysis of drug release within the framework of the "Available Medicines" program in the context of changes in the current legislation.Materials and methods. In our work we used the following methods of scientific analysis: information-analytical, methods of grouping, comparison, content analysis, retrospective method, questionnaires, statistical.Results. This year, compared to the previous year, there is an increase in the number of population groups receiving drugs free of charge, the largest contingent among which are victims of the Chernobyl accident of the I category. The privilleged population in Vinnytsia, which receives medicines with payment of 50 % of their value, did not increase, and the largest number of recipes falls on disabled people of the I and II groups. Among the diseases as of 1.10.2017, the largest contingent is represented by cancer (39.21 %) and Parkinson's disease (23.72 %). Under the "Available Medication" program, the largest number of recipe free reimbursements and partial reimbursement for ambulatory patients is taken by cardiovascular disease (75.88 %). The main problems of implementation of the program "Available medicines" are outlined in the example of pharmacies of Vinnytsia.Conclusions. The analysis of modern legislative and regulatory documents on the provision of pharmaceutical assistance to preferential categories of the population ofUkraine has shown the need to expand the list of medicines for the treatment of these nosologies and the introduction of a combination of drugs. Steady growth dynamics (2015-2017 years) of availability of medicines for privilleged population groups in the city ofVinnytsia has been established. It has also been noted that within the period from 2015 to 1.10.2017, the number of recipes issued to cancer patients make up the largest share. Among the privilleged categories receiving prescription medications with a 50 % value for the largest contingent during the years studied, disabled persons of Groups I and II remain free of charge – victims of the accident at the Chernobyl Nuclear Power Plant of the I category, and for nosologies – oncological diseases. The tendency to increase the number of prescription recipes for patients with hypertension due to subsidies provided on the regional level. In 2017, the monthly increase in the release of drugs that are included in the "Available Medications" program has been noted. The problems that we discovered with the implementation of the "Available Medications" program can be overcome by further improvement of the regulatory documents. In order to increase the socio-economic efficiency of pharmaceutical assistance, we consider it necessary to introduce electronic registers of patients and electronic recipes within the framework of the electronic health system (E-health) for other preferential categories, which will improve the quality of provision of pharmaceutical services and the registry system of such categories of population. ; Метою роботи є оцінка забезпечення лікарськими засобами, на які запроваджено референтне ціноутворення, окремих категорій амбулаторних хворих та аналіз відпуску лікарських засобів у рамках програми «Доступні ліки» в розрізі змін сучасного законодавства. Результати. У поточному році, порівняно із попереднім, спостерігається ріст кількості груп населення, які отримують ліки безплатно, найбільшим контингентом серед яких є постраждалі внаслідок аварії на ЧАЕС I категорії. Пільговий контингент населення м. Вінниця, який отримує ліки з оплатою 50 % від їх вартості, не зріс, а найбільша кількість рецептів припадає на інвалідів I і II груп. Серед захворювань станом на 1.10.2017 р. найбільший контингент представлений онкологічними захворюваннями (39,21 %) та хворобою Паркінсона (23,72 %). За програмою «Доступні ліки» найбільша кількість відпущених безплатних рецептів та з частковим відшкодуванням амбулаторним хворим припадає на серцево-судинні захворювання (75,88 %). Виокремлено основні проблеми реалізації програми «Доступні ліки» на прикладі аптек м. Вінниці.Висновки. Проведений аналіз сучасних законодавчих та нормативно-правових документів з надання фармацевтичної допомоги пільговим категоріям населення України засвідчив про необхідність розширення переліку лікарських засобів для лікування зазначених нозологій та введення до переліку комбінованих лікарських засобів. Встановлена стійка динаміка росту (2015–2017 рр.) забезпеченості лікарськими засобами за пільговими категоріями населення м. Вінниці. Встановлено, що за період з 2015 по 1.10.2017 рр. за захворюваннями кількість рецептів, виданих онкологічним хворим, становить найбільшу частку. Серед пільгових категорій хворих, які отримували ліки за рецептами з 50 % вартістю, найбільшим контингентом протягом досліджуваних років залишаються інваліди I і II груп, з безплатним відпуском – постраждалі внаслідок аварії на ЧАЕС I категорії, а за нозологіями – онкологічні хворі. Виявлена тенденція до росту кількості відпущених рецептів хворим на гіпертонічну хворобу за рахунок наданих субсидій на регіональному рівні. У 2017 р. відмічений помісячний ріст відпуску лікарських засобів, які включені до програми «Доступні ліки». Виявлені нами проблеми, що супроводжують впровадження програми «Доступні ліки», можуть бути подолані шляхом подальшого удосконалення нормативно-правових документів. З метою підвищення соціально-економічної ефективності фармацевтичної допомоги вважаємо за необхідне введення електронних реєстрів хворих та електронних рецептів у рамках електронної системи охорони здоров'я (E-health) для інших пільгових категорій, що приведе до покращення якості надання фармацевтичних послуг і вдосконалення системи обліку реєстру таких категорій населення. ; Целью работы является оценка обеспечения лекарственными средствами, на которые введено референтное ценообразование, отдельных категорий амбулаторных больных и анализ отпуска лекарственных средств в рамках программы «Доступные лекарства» в разрезе изменений современного законодательства. Результаты. В текущем году, по сравнению с предыдущим, наблюдается рост количества групп населения, получающих лекарства бесплатно, наибольшим контингентом, среди которых есть пострадавшие вследствие аварии на ЧАЭС I категории. Льготный контингент населения г. Винница, который получает лекарства с оплатой 50 % от их стоимости, не вырос, а наибольшее количество рецептов приходится на инвалидов I и II групп. Среди заболеваний по состоянию на 1.10.2017 г. наибольший контингент представлен онкологическими заболеваниями (39,21 %) и болезнью Паркинсона (23,72 %). По программе «Доступные лекарства» наибольшее количество отпущенных бесплатных рецептов и с частичным возмещением амбулаторным больным занимают сердечно-сосудистые заболевания (75,88 %). Выделены основные проблемы реализации программы «Доступные лекарства» на примере аптек г. Винницы.Выводы. Проведенный анализ современных законодательных и нормативно-правовых документов по предоставлению фармацевтической помощи льготным категориям населения Украины показал необходимость расширения перечня лекарственных средств для лечения указанных нозологий и введения в перечень комбинированных лекарственных средств. Установлена устойчивая динамика роста (2015–2017 гг.) обеспеченности лекарственными средствами льготных категорий населения г. Винницы. Установлено, что среди заболеваний с 2015 по 1.10.2017 гг. количество рецептов, выданных онкологическим больным, составляет наибольшую долю. Среди льготных категорий, получавших лекарства по рецептам с 50 % стоимости, наибольшим контингентом в течение исследуемых лет остаются инвалиды I и II групп, а с бесплатным отпуском – пострадавшие в результате аварии на ЧАЭС I категории, а по нозологиям – онкологические больные. Выявлена тенденция к росту количества отпущенных рецептов больным гипертонической болезнью за счет предоставленных субсидий на региональном уровне. В 2017 г. отмечен помесячный рост отпуска лекарственных средств, включенных в программу «Доступные лекарства». Выявленные нами проблемы, сопровождающие внедрение программы «Доступные лекарства», могут быть преодолены путем дальнейшего совершенствования нормативно-правовых документов. С целью повышения социально-экономической эффективности фармацевтической помощи считаем необходимым введение электронных реестров больных и электронных рецептов в рамках электронной системы охраны здоровья (E-health) для других льготных категорий населения, что приведет к улучшению качества оказания фармацевтических услуг и совершенствованию системы учета реестра таких категорий населения.
In2009 inUkrainereimbursement was started as a new means of economic-legal regulation of relations in the health care system. But for today in our country there are many difficulties in the implementation of National System for reimbursement of medical expenses.Aim. To evaluate the availability of medicines with reference pricing, specific categories of outpatient patients and analysis of drug release within the framework of the "Available Medicines" program in the context of changes in the current legislation.Materials and methods. In our work we used the following methods of scientific analysis: information-analytical, methods of grouping, comparison, content analysis, retrospective method, questionnaires, statistical.Results. This year, compared to the previous year, there is an increase in the number of population groups receiving drugs free of charge, the largest contingent among which are victims of the Chernobyl accident of the I category. The privilleged population in Vinnytsia, which receives medicines with payment of 50 % of their value, did not increase, and the largest number of recipes falls on disabled people of the I and II groups. Among the diseases as of 1.10.2017, the largest contingent is represented by cancer (39.21 %) and Parkinson's disease (23.72 %). Under the "Available Medication" program, the largest number of recipe free reimbursements and partial reimbursement for ambulatory patients is taken by cardiovascular disease (75.88 %). The main problems of implementation of the program "Available medicines" are outlined in the example of pharmacies of Vinnytsia.Conclusions. The analysis of modern legislative and regulatory documents on the provision of pharmaceutical assistance to preferential categories of the population ofUkraine has shown the need to expand the list of medicines for the treatment of these nosologies and the introduction of a combination of drugs. Steady growth dynamics (2015-2017 years) of availability of medicines for privilleged population groups in the city ofVinnytsia has been established. It has also been noted that within the period from 2015 to 1.10.2017, the number of recipes issued to cancer patients make up the largest share. Among the privilleged categories receiving prescription medications with a 50 % value for the largest contingent during the years studied, disabled persons of Groups I and II remain free of charge – victims of the accident at the Chernobyl Nuclear Power Plant of the I category, and for nosologies – oncological diseases. The tendency to increase the number of prescription recipes for patients with hypertension due to subsidies provided on the regional level. In 2017, the monthly increase in the release of drugs that are included in the "Available Medications" program has been noted. The problems that we discovered with the implementation of the "Available Medications" program can be overcome by further improvement of the regulatory documents. In order to increase the socio-economic efficiency of pharmaceutical assistance, we consider it necessary to introduce electronic registers of patients and electronic recipes within the framework of the electronic health system (E-health) for other preferential categories, which will improve the quality of provision of pharmaceutical services and the registry system of such categories of population. ; Целью работы является оценка обеспечения лекарственными средствами, на которые введено референтное ценообразование, отдельных категорий амбулаторных больных и анализ отпуска лекарственных средств в рамках программы «Доступные лекарства» в разрезе изменений современного законодательства. Результаты. В текущем году, по сравнению с предыдущим, наблюдается рост количества групп населения, получающих лекарства бесплатно, наибольшим контингентом, среди которых есть пострадавшие вследствие аварии на ЧАЭС I категории. Льготный контингент населения г. Винница, который получает лекарства с оплатой 50 % от их стоимости, не вырос, а наибольшее количество рецептов приходится на инвалидов I и II групп. Среди заболеваний по состоянию на 1.10.2017 г. наибольший контингент представлен онкологическими заболеваниями (39,21 %) и болезнью Паркинсона (23,72 %). По программе «Доступные лекарства» наибольшее количество отпущенных бесплатных рецептов и с частичным возмещением амбулаторным больным занимают сердечно-сосудистые заболевания (75,88 %). Выделены основные проблемы реализации программы «Доступные лекарства» на примере аптек г. Винницы.Выводы. Проведенный анализ современных законодательных и нормативно-правовых документов по предоставлению фармацевтической помощи льготным категориям населения Украины показал необходимость расширения перечня лекарственных средств для лечения указанных нозологий и введения в перечень комбинированных лекарственных средств. Установлена устойчивая динамика роста (2015–2017 гг.) обеспеченности лекарственными средствами льготных категорий населения г. Винницы. Установлено, что среди заболеваний с 2015 по 1.10.2017 гг. количество рецептов, выданных онкологическим больным, составляет наибольшую долю. Среди льготных категорий, получавших лекарства по рецептам с 50 % стоимости, наибольшим контингентом в течение исследуемых лет остаются инвалиды I и II групп, а с бесплатным отпуском – пострадавшие в результате аварии на ЧАЭС I категории, а по нозологиям – онкологические больные. Выявлена тенденция к росту количества отпущенных рецептов больным гипертонической болезнью за счет предоставленных субсидий на региональном уровне. В 2017 г. отмечен помесячный рост отпуска лекарственных средств, включенных в программу «Доступные лекарства». Выявленные нами проблемы, сопровождающие внедрение программы «Доступные лекарства», могут быть преодолены путем дальнейшего совершенствования нормативно-правовых документов. С целью повышения социально-экономической эффективности фармацевтической помощи считаем необходимым введение электронных реестров больных и электронных рецептов в рамках электронной системы охраны здоровья (E-health) для других льготных категорий населения, что приведет к улучшению качества оказания фармацевтических услуг и совершенствованию системы учета реестра таких категорий населения. ; Метою роботи є оцінка забезпечення лікарськими засобами, на які запроваджено референтне ціноутворення, окремих категорій амбулаторних хворих та аналіз відпуску лікарських засобів у рамках програми «Доступні ліки» в розрізі змін сучасного законодавства. Результати. У поточному році, порівняно із попереднім, спостерігається ріст кількості груп населення, які отримують ліки безплатно, найбільшим контингентом серед яких є постраждалі внаслідок аварії на ЧАЕС I категорії. Пільговий контингент населення м. Вінниця, який отримує ліки з оплатою 50 % від їх вартості, не зріс, а найбільша кількість рецептів припадає на інвалідів I і II груп. Серед захворювань станом на 1.10.2017 р. найбільший контингент представлений онкологічними захворюваннями (39,21 %) та хворобою Паркінсона (23,72 %). За програмою «Доступні ліки» найбільша кількість відпущених безплатних рецептів та з частковим відшкодуванням амбулаторним хворим припадає на серцево-судинні захворювання (75,88 %). Виокремлено основні проблеми реалізації програми «Доступні ліки» на прикладі аптек м. Вінниці.Висновки. Проведений аналіз сучасних законодавчих та нормативно-правових документів з надання фармацевтичної допомоги пільговим категоріям населення України засвідчив про необхідність розширення переліку лікарських засобів для лікування зазначених нозологій та введення до переліку комбінованих лікарських засобів. Встановлена стійка динаміка росту (2015–2017 рр.) забезпеченості лікарськими засобами за пільговими категоріями населення м. Вінниці. Встановлено, що за період з 2015 по 1.10.2017 рр. за захворюваннями кількість рецептів, виданих онкологічним хворим, становить найбільшу частку. Серед пільгових категорій хворих, які отримували ліки за рецептами з 50 % вартістю, найбільшим контингентом протягом досліджуваних років залишаються інваліди I і II груп, з безплатним відпуском – постраждалі внаслідок аварії на ЧАЕС I категорії, а за нозологіями – онкологічні хворі. Виявлена тенденція до росту кількості відпущених рецептів хворим на гіпертонічну хворобу за рахунок наданих субсидій на регіональному рівні. У 2017 р. відмічений помісячний ріст відпуску лікарських засобів, які включені до програми «Доступні ліки». Виявлені нами проблеми, що супроводжують впровадження програми «Доступні ліки», можуть бути подолані шляхом подальшого удосконалення нормативно-правових документів. З метою підвищення соціально-економічної ефективності фармацевтичної допомоги вважаємо за необхідне введення електронних реєстрів хворих та електронних рецептів у рамках електронної системи охорони здоров'я (E-health) для інших пільгових категорій, що приведе до покращення якості надання фармацевтичних послуг і вдосконалення системи обліку реєстру таких категорій населення.
Sickle cell disease (SCD) is a common blood disease caused by a single nucleotide substitution (c.20T>A, p.Glu6Val) in the beta globin gene on chromosome 11. The prevalence of the disease is high throughout large areas in sub-Saharan Africa, the Mediterranean basin, the Middle East, and India due to the level of protection that the sickle cell trait, provides against severe malaria. Approximately 300,000 infants are born per year with sickle cell anemia, which is defined as homozygosity for the sickle hemoglobin (HbS). The majority (nearly 75%) of these births occur in sub-Saharan Africa, particularly in two countries: Nigeria, and the Democratic Republic of the Congo where there are poorly resourced healthcare systems. Early diagnosis, penicillin prophylaxis, blood transfusions, hydroxyurea, and hematopoietic stem-cell transplantation can dramatically improve survival and quality of life for patients with SCD. However, our understanding of the role of genetic and clinical factors in explaining the complex phenotypic diversity of this disease is still limited. Early prediction of the severity, and patients' responses to specific therapeutics of SCD could lead to more precise treatment and management. Beyond well-known modifiers of disease severity, such as fetal hemoglobin (HbF) levels and αthalassemia, other genetic variants might influence specific sub-phenotypes. New treatments and management strategies accounting for these genetic and nongenetic factors could substantially and rapidly improve the quality of life and reduce health care costs for patients with SCD. Patients with SCD are subjected to long term administration of drugs and there is a limited data on pharmacogenomics of SCD therapeutics. Vaso-occlusive crisis (VOC) are the main clinical events of SCD and are associated with recurrent and long-term use of antalgics/opioids and HU. This project aimed to investigate the clinical and genetic predictors of painful vaso-occlusive crisis (VOC) among SCD Cameroon patients by exploring pharmacokinetic determinants of treatment responses as well as post-transcriptional signatures triggered by hydroxyurea treatment, particularly, miRNA expression. SCD patients were recruited from Yaounde Central Hospital and Laquintinie Hospital in Douala (Wonkam et al., 2018, Mnika et al., 2019 (b)), and recent migrants SCD patients from the DRC, recruited at the Haematology Clinic, Groote Schuur Hospital in Cape Town, South Africa (Mnika et al., 2019 (a) and Mnika et al., 2019 (b)). Sociodemographic and clinical data were collected by means of a structured questionnaire. Patients' medical records were reviewed to extract their clinical features over the past 3 years. Specifically, the occurrences of VOC, hematological parameters, hospital outpatient visits, hospitalisation, overt strokes, blood transfusions, and administration of hydroxyurea were recorded. Height, weight, body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP) were measured. Detailed descriptions of patients and sampling methods used in the Cameroonian patients have been reported previously (Wonkam et al., 2018 Mnika et al., 2019 (a) and Mnika et al., 2019 (b)). For the purpose of comparing frequencies of variants, ethnically matched Cameroonian controls were randomly recruited from apparently healthy blood donors in Yaounde for participation in the study. All blood samples were collected for genomic characterisation and analysis. DNA was extracted from peripheral blood, following instructions on the available commercial kit [QIAamp DNA Blood Maxi Kit ® (Qiagen, United States)]. Genotyping (TaqMan and MassArray) was performed for 40 variants in 17 pain-related genes, three fetal haemoglobin (HbF)-promoting loci, two kidney dysfunction-related genes, and HBA1/HBA2 genes for 436 patients. A subset of these samples was also genotyped to analyse 32 core and 267 extended pharmacogenes using commercially available PharmacoScan® platform for characterisation of pharmacokinetic determinant of response. We also compared the pharmacogenes variants from these African groups, to data extracted from the 1000 genomes Project. Moreover, association studies were carried out on pharmacogenes variants with SCD clinical variability. Additionally, protein-protein interaction (PPI) network and enriched biological processes and pathways were investigated. For association studies, statistical models using regression frameworks to analyse 40 variants were performed in R®. For miRNA expression, total RNA was isolated using the miRNeasy kit according to protocol of the Manufacturer (QIAGEN, Hilden, Germany); and sequenced by the Genomic and RNA Profiling Core at Baylor College of Medicine, United States, using the NanoString Platform (NanoString Technologies, Inc., Seattle, WA, United States), according to manufacturer's instructions. Genes with statistically significant changes in expression were analysed using the significance analyses of microarrays (SAM) tools. Female sex, body mass index, Hb/HbF, blood transfusions, leucocytosis and consultation or hospitalisation rates significantly correlated with VOC. Three painrelated gene variants correlated with VOC (CACNA2D3-rs6777055, P = 0·025; DRD2- rs4274224, P = 0·037; KCNS1-rs734784, P= 0·01). Five pain-related gene variants correlated with hospitalization/consultation rates (COMT-rs6269, P = 0·027; FAAHrs4141964, P = 0·003; OPRM1- rs1799971, P = 0·031; ADRB2-rs1042713; P < 0·001; UGT2B7-rs7438135, P = 0·037). The 3·7 kb HBA1/HBA2 deletion correlated with increased VOC (P = 0·002). HbF-promoting loci variants correlated with decreased hospitalisation (BCL11A-rs4671393, P = 0·026; HBS1L-MYB-rs28384513, P = 0·01). APOL1 G1/G2 correlated with increased hospitalisation (P = 0·048). A commercial genotyping array platform (PharmacoScan®) with 4627 markers located in 1191 genes was used to investigate 299 pharmacogenes (32 ADME core and 267 extended pharmacogenes). Based on the PharmacoScan analyses, no statistically significant differences in allele frequencies were detected between SCD cases and controls from Cameroon. A principal component analysis (PCA) revealed that Cameroonians' data clustered with other Africans, but this population is significantly distinct from American, European and Asian populations data. Variant allele frequencies in 21/32 core pharmacogenes were significantly different between the two SCD groups (Cameroon vs. Congo). No correlation between clinical variability and variants in the core genes was detected for both populations under study. An association study of the core and extended PharmacoScan variants to VOC identified statistically significant associations between two single nucleotide polymorphisms (SNPs) to VOC after correction of multiple testing. These two SNPs mapped to 50 genes, with two SNPs located in core pharmacogenes (SLCO4A1- rs118042746, p=1.21e-07; UGT1A10, UGT1A8- rs10176426, p=1.22e-07). Functional enrichment analyses revealed that these 50 genes are involved in three biological processes and four pathways relevant to SCD pathophysiology, including xenobiotic glucuronidation (GO:0052697, p = 2.3e-03), and drug metabolism - other enzymes (p = 2.1e-02). Further analyses of the 50 genes, identified key genes in human proteinprotein networks: NTSR1, LRMDA, SMAD SMAD4 and CDH2. These four genes also interacted with three core pharmacogenes associated with VOC: UGT1A8, UGT1A10 and SLCO4A1. We found 22/798 miRNAs to be differentially expressed under HU treatment, with the majority (13/22) being functionally associated with HbF-regulatory genes, including BCL11A (miR-148b-3p, miR-32-5p, miR-340-5p, miR-29c-3p), MYB (miR-105-5p), KLF-3 (miR-106b-5), and SP1 (miR-29b-3p, miR-625-5p, miR-324-5p, miR-125a-5p, miR-99b-5p, miR-374b-5p, miR-145-5p). The present thesis started by highlighting the scarcity of studies investigating variable responses to pain in SCD patients and then proceeded to addressing this research gap. To our knowledge this is the first body of from Africa to provide evidence supporting the possible development of a genetic risk model for pain in SCD. This is also the first body of work to report an association between these two SNPs and VOC in core and extended pharmacogenes. Our data reveals that the commercial pharmacogenes arrays investigated might need additional evidence for appropriateness among Africans. Therefore, it advocates the need to invest in research exploring population-specific arrays, drug design, targeting, and efficacy, for improved clinical management of patients of African descent. Previous studies have investigated various mechanisms to understand the genomic variations affecting responses to HU, but full understanding of the variable HU-mediated HbF production among individuals affected by SCD remains elusive. The present study showed that mechanisms of HbF production in response to HU, could particularly be mediated through miRNA regulation. The data reveals some alternative perspectives and routes towards identifying new therapeutic targets and approaches for SCD. However, this study needs to be replicated in larger samples in multiple African populations.
Der vorliegende Beitrag führt in die Thematik ein und erörtert zunächst 10 Gründe für die Psychotherapie in Österreich (z.B. gesundheits- und versorgungspolitische, berufsethische, Konsumentenrechte; Sicherung von Ausbildungsstandards etc.), sich in Hinkunft intensiver mit dem Thema der Qualität und Qualitätssicherung auseinanderzusetzen. Daran anschließend werden Aspekte der Ausbildungs- und der Behandlungsqualität im ambulanten Sektor und deren Sicherstellung erörtert. Die Ausbildung ist ein besonders qualitätsrelevanter Sektor der Psychotherapie. Eine Integration von Qualitätskonzepten hätte wichtige Konsequenzen für ihn (z.B. stärkere Ziel- und Kompetenzorientierung, Überprüfung der Zielerreichung, Einführung von Qualitätszirkeln für Ausbildner zur Verbesserung der Qualität der Ausbildung).Für niedergelassene Psychotherapeuten sind sowohl Aspekte der Struktur- (z.B. Praxisausstattung; eigene Kompetenzentwicklung), vor allem aber der Prozeß-(kontrollierte Gestaltung des therapeutischen Prozesses und des Einsatzes psychotherapeutischer Strategien und Methoden; Dokumentation) und Ergebnisqualität (regelmäßige Kontrolle des Fortschrittes und der Ergebnisse einer Therapie) relevant. Für die weitere Entwicklung sollten die einzelnen Schulen Standards der Behandlungsqualität entwickeln, parallel dazu wären systematische Programme zur Qualitätssicherung einzuführen; Einzelpraktiker sollten sich zu Qualitätszirkeln zusammenschließen, um dort systematisch an der Entwicklung und Verbesserung ihrer Behandlungsqualität zu arbeiten. Praxisbezogene Forschung ist ein integraler Bestandteil des Qualitätssicherungsprozesses in Ausbildung und Praxis.SchlüsselwörterQualität, Qualitätssicherung, Qualitätsmanagement, Psychotherapie, Gesundheitsversorgung. ; Introducing into the special issue on quality assurance of psychotherapy the present paper is divided into three parts. In the first one the main reasons for the necessity to integrate quality assurance into psychotherapy in Austria are discussed (professional standards of psychotherapy, consumer rights, the assurance of education and training in psychotherapy and the necessity to continually improve efficacy and practice in psychotherapy). The second part is dealing with quality assurance of education and training in psychotherapy. It is proposed that introducing conceptions of quality assurance would change psychotherapy-training very much. It should become more goal-oriented, more effective and more controlled. Additionally, it would be necessary to evaluate the courses and trainings continuously and to establish quality circles for the teaching staff to improve their quality.The main focus of part three is on structure-, process-and outcome-quality of ambulatory and outpatient-psychotherapy. The most important components of each of the three quality-conceptions are discussed (e.g. the necessity to continuosly evaluate the outcome of psychotherapy, and to rationally control the psychotherapeutic process and the application o/ psychotherapeutic strategies and methods). At the end of the paper it is concluded that away from now much work and many different steps are necessary to integrate quality assurance into psychotherapy in our country (establishing organizational structures, developing programs and methods, and conducting pilot projects). The psychotherapists by themselves however need not wait for such a long time; they actually should join to quality circles and so should try to improve the quality of their work. Empirical research will be a necessary and integrative component of all quality assurance-projects.KeywordsQuality, quality assurance, quality management, psychotherapy, health care. ; Le présent numéro thématique est le produit d'un projet visant à attribuer des priorités à la recherche en psychothérapie en Autriche, projet soutenu par le Ministère de la science, de la recherche et des affaires culturelles. Il s'agissait, dans son cadre, d'étudier le degré auquel des travaux de recherche dans les domaines de la garantie et de la gestion de qualité de la psychothérapie en Autriche peuvent être pratiqués. En vue de concrétiser cette tâche, nous avons organisé deux rencontres, au cours desquelles les quatre contributions publiées ci-dessous ont été présentées.Quant au présent article, il doit servir d'introduction. Nous cernons d'abord dix raisons pour lesquelles la psychothérapie autrichienne devra se préoccuper plus intensément à l'avenir du thème 'garantie de qualité'. Les principaux arguments en faveur de la mise en œuvre de structures visant à garantir la qualité des traitements psychothérapeutiques sont liés aux aspects suivants: politique de la santé publique (objectifs de santé de l'OMS), obligation au niveau de l'éthique professionnelle de fournir une offre adéquate en traitements garantis de bonne qualité, droits des consommateurs à recevoir des traitements correspondant aux derniers développements en la matière, garantie de la qualité de la formation et besoin d'évaluer les applications de routine de la psychothérapie. Garantir la qualité de la psychothérapie implique donc deux éléments: qualité de la formation et qualité du traitement. La seconde partie de l'article traite de quelques aspects pertinents à ce niveau, ainsi que de la manière dont ils peuvent être garantis et améliorés. La question de la qualité des traitements est examinée en fonction essentiellement des psychothérapies ambulatoires.Le secteur de la formation joue un rôle particulièrement important au niveau de la qualité, puisque c'est de la qualité de cette formation que dépendent les qualifications des futurs thérapeutes. Et pourtant, jusqu'à maintenant, on a trop peu examiné ce secteur sous l'angle de la qualité et de sa garantie. Des conséquences importantes au niveau de la formation résulteraient d'une intégration à ce secteur de concepts relatifs à la qualité, avec entre autres un travail mieux centré sur des objectifs et une recherche accrue des méthodes adéquates et efficaces permettant d'atteindre ces objectifs. On devrait aussi constamment vérifier que ces derniers ont été acquis aux différents niveaux (ceux des différentes étapes de la formation comme celui de l'ensemble de la formation). De plus, l'enseignement et la qualité de la formation s'amélioreraient à partir du moment où les formateurs seraient tenus au courant des résultats des évaluations et auraient l'occasion de débattre entre eux de la qualité de leur travail.Du point de vue de la qualité des traitements offerts par les psychothérapeutes ayant leur propre cabinet, ce sont certains aspects de la qualité des structures, mais surtout de celle des processus et des résultats, qui devraient avoir de l'importance. S'il est vrai que la qualité des structures est surtout I' affaire des administrations publiques et des responsables des assurances sociales, il reste qu'un aspect qualité structurelle se rattache aux psychothérapeutes individuels; il se manifeste au niveau des tâches et domaines suivants: collaboration à une gestion optimale de l'offre, standards concernant l'aménagement et l'équipement des cabinets (par ex., appareils, informations, littérature); responsabilité de chaque thérapeute pour un haut standard de qualification professionnelle et pour son amélioration continue; application de méthodes dont les effets sont connus.Dans le cadre de la qualité des processus le psychothérapeute a pour mission et pour devoir d'élaborer un plan de traitement mûrement réfléchi, incluant également des mesures alternatives et complémentaires, et de contrôler le déroulement du processus thérapeutique. Les méthodes et stratégies psychothérapeutiques doivent être appliquées de manière adéquate, en fonction de critères rationnels et selon les règles de l'art. L'élaboration régulière de rapports sur le déroulement du traitement constitue un moyen particulièrement utile de contrôle et de vérification, parallèlement à la supervision et à l'Intervision, ainsi qu'à la collaboration à des groupes s'intéressant spécifiquement à l'axe qualité.Concernant la qualité des résultats le/la psychothérapeute doit évaluer à intervalles réguliers l'avancement de la thérapie et son évolution; il/elle doit noter les résultats de cette évaluation. 11 s'agit également de rechercher les causes des évolutions négatives ou problématiques et d'appliquer des mesures d'intervention adéquates, permettant d'obtenir une amélioration ou de résoudre les problèmes.L'aspect garantie de qualité constitue un secteur relativement neuf de la psychothérapie. Pourtant, de nombreuses raisons existent de l'intégrer à la profession, en Autriche en particulier puisque ce pays dispose du cadre juridique requis. Cette démarche permet d'accomplir une étape importante vers une plus grande professionnalisation de la psychothérapie. A cette fin, il serait actuellement important de créer d'abord les conditions-cadres nécessaires au niveau logistique et conceptuel. Il faut demander aux associations professionnelles comme aux instances de l'Etat (université, ministère) de se charger de cette tâche. Il faudrait en outre que les différentes écoles formulent des standards et des directives concernant la qualité des traitements, ainsi que des programmes visant à garantir et à améliorer systématiquement la qualité. Lors d'étapes ultérieures, ces programmes pourraient être intégrés à l'offre sous forme de projets pilotes et leurs effets pourraient être évalués. Alors seulement il sera possible de mettre définitivement en œuvre des mesures visant à garantir la qualité sur le plan essentiellement interne (dans le secteur ambulatoire). La recherche scientifique doit être part intégrante de ce processus; sans elle, il n'est pas possible d'appliquer des modèles de qualité. 11 serait également important que les psychothérapeutes eux-mêmes deviennent mieux conscients du thème qualité de la psychothérapie et des problèmes y relatifs, et qu'ils commencent dès maintenant à élaborer des idées quant à la manière dont elle pourrait être garantie. Les thérapeutes travaillant dans leur propre cabinet pourraient organiser maintenant déjà des groupes intéressés, travaillant ainsi systématiquement à l'amélioration de leurs standards de traitement et intervenant, le cas échéant, pour que leur qualité s'améliore. ; unknown ; publishedVersion
Der vorliegende Beitrag führt in die Thematik ein und erörtert zunächst 10 Gründe für die Psychotherapie in Österreich (z.B. gesundheits- und versorgungspolitische, berufsethische, Konsumentenrechte; Sicherung von Ausbildungsstandards etc.), sich in Hinkunft intensiver mit dem Thema der Qualität und Qualitätssicherung auseinanderzusetzen. Daran anschließend werden Aspekte der Ausbildungs- und der Behandlungsqualität im ambulanten Sektor und deren Sicherstellung erörtert. Die Ausbildung ist ein besonders qualitätsrelevanter Sektor der Psychotherapie. Eine Integration von Qualitätskonzepten hätte wichtige Konsequenzen für ihn (z.B. stärkere Ziel- und Kompetenzorientierung, Überprüfung der Zielerreichung, Einführung von Qualitätszirkeln für Ausbildner zur Verbesserung der Qualität der Ausbildung).Für niedergelassene Psychotherapeuten sind sowohl Aspekte der Struktur- (z.B. Praxisausstattung; eigene Kompetenzentwicklung), vor allem aber der Prozeß-(kontrollierte Gestaltung des therapeutischen Prozesses und des Einsatzes psychotherapeutischer Strategien und Methoden; Dokumentation) und Ergebnisqualität (regelmäßige Kontrolle des Fortschrittes und der Ergebnisse einer Therapie) relevant. Für die weitere Entwicklung sollten die einzelnen Schulen Standards der Behandlungsqualität entwickeln, parallel dazu wären systematische Programme zur Qualitätssicherung einzuführen; Einzelpraktiker sollten sich zu Qualitätszirkeln zusammenschließen, um dort systematisch an der Entwicklung und Verbesserung ihrer Behandlungsqualität zu arbeiten. Praxisbezogene Forschung ist ein integraler Bestandteil des Qualitätssicherungsprozesses in Ausbildung und Praxis.SchlüsselwörterQualität, Qualitätssicherung, Qualitätsmanagement, Psychotherapie, Gesundheitsversorgung. ; Introducing into the special issue on quality assurance of psychotherapy the present paper is divided into three parts. In the first one the main reasons for the necessity to integrate quality assurance into psychotherapy in Austria are discussed (professional standards of psychotherapy, consumer rights, the assurance of education and training in psychotherapy and the necessity to continually improve efficacy and practice in psychotherapy). The second part is dealing with quality assurance of education and training in psychotherapy. It is proposed that introducing conceptions of quality assurance would change psychotherapy-training very much. It should become more goal-oriented, more effective and more controlled. Additionally, it would be necessary to evaluate the courses and trainings continuously and to establish quality circles for the teaching staff to improve their quality.The main focus of part three is on structure-, process-and outcome-quality of ambulatory and outpatient-psychotherapy. The most important components of each of the three quality-conceptions are discussed (e.g. the necessity to continuosly evaluate the outcome of psychotherapy, and to rationally control the psychotherapeutic process and the application o/ psychotherapeutic strategies and methods). At the end of the paper it is concluded that away from now much work and many different steps are necessary to integrate quality assurance into psychotherapy in our country (establishing organizational structures, developing programs and methods, and conducting pilot projects). The psychotherapists by themselves however need not wait for such a long time; they actually should join to quality circles and so should try to improve the quality of their work. Empirical research will be a necessary and integrative component of all quality assurance-projects.KeywordsQuality, quality assurance, quality management, psychotherapy, health care. ; Le présent numéro thématique est le produit d'un projet visant à attribuer des priorités à la recherche en psychothérapie en Autriche, projet soutenu par le Ministère de la science, de la recherche et des affaires culturelles. Il s'agissait, dans son cadre, d'étudier le degré auquel des travaux de recherche dans les domaines de la garantie et de la gestion de qualité de la psychothérapie en Autriche peuvent être pratiqués. En vue de concrétiser cette tâche, nous avons organisé deux rencontres, au cours desquelles les quatre contributions publiées ci-dessous ont été présentées.Quant au présent article, il doit servir d'introduction. Nous cernons d'abord dix raisons pour lesquelles la psychothérapie autrichienne devra se préoccuper plus intensément à l'avenir du thème 'garantie de qualité'. Les principaux arguments en faveur de la mise en œuvre de structures visant à garantir la qualité des traitements psychothérapeutiques sont liés aux aspects suivants: politique de la santé publique (objectifs de santé de l'OMS), obligation au niveau de l'éthique professionnelle de fournir une offre adéquate en traitements garantis de bonne qualité, droits des consommateurs à recevoir des traitements correspondant aux derniers développements en la matière, garantie de la qualité de la formation et besoin d'évaluer les applications de routine de la psychothérapie. Garantir la qualité de la psychothérapie implique donc deux éléments: qualité de la formation et qualité du traitement. La seconde partie de l'article traite de quelques aspects pertinents à ce niveau, ainsi que de la manière dont ils peuvent être garantis et améliorés. La question de la qualité des traitements est examinée en fonction essentiellement des psychothérapies ambulatoires.Le secteur de la formation joue un rôle particulièrement important au niveau de la qualité, puisque c'est de la qualité de cette formation que dépendent les qualifications des futurs thérapeutes. Et pourtant, jusqu'à maintenant, on a trop peu examiné ce secteur sous l'angle de la qualité et de sa garantie. Des conséquences importantes au niveau de la formation résulteraient d'une intégration à ce secteur de concepts relatifs à la qualité, avec entre autres un travail mieux centré sur des objectifs et une recherche accrue des méthodes adéquates et efficaces permettant d'atteindre ces objectifs. On devrait aussi constamment vérifier que ces derniers ont été acquis aux différents niveaux (ceux des différentes étapes de la formation comme celui de l'ensemble de la formation). De plus, l'enseignement et la qualité de la formation s'amélioreraient à partir du moment où les formateurs seraient tenus au courant des résultats des évaluations et auraient l'occasion de débattre entre eux de la qualité de leur travail.Du point de vue de la qualité des traitements offerts par les psychothérapeutes ayant leur propre cabinet, ce sont certains aspects de la qualité des structures, mais surtout de celle des processus et des résultats, qui devraient avoir de l'importance. S'il est vrai que la qualité des structures est surtout I' affaire des administrations publiques et des responsables des assurances sociales, il reste qu'un aspect qualité structurelle se rattache aux psychothérapeutes individuels; il se manifeste au niveau des tâches et domaines suivants: collaboration à une gestion optimale de l'offre, standards concernant l'aménagement et l'équipement des cabinets (par ex., appareils, informations, littérature); responsabilité de chaque thérapeute pour un haut standard de qualification professionnelle et pour son amélioration continue; application de méthodes dont les effets sont connus.Dans le cadre de la qualité des processus le psychothérapeute a pour mission et pour devoir d'élaborer un plan de traitement mûrement réfléchi, incluant également des mesures alternatives et complémentaires, et de contrôler le déroulement du processus thérapeutique. Les méthodes et stratégies psychothérapeutiques doivent être appliquées de manière adéquate, en fonction de critères rationnels et selon les règles de l'art. L'élaboration régulière de rapports sur le déroulement du traitement constitue un moyen particulièrement utile de contrôle et de vérification, parallèlement à la supervision et à l'Intervision, ainsi qu'à la collaboration à des groupes s'intéressant spécifiquement à l'axe qualité.Concernant la qualité des résultats le/la psychothérapeute doit évaluer à intervalles réguliers l'avancement de la thérapie et son évolution; il/elle doit noter les résultats de cette évaluation. 11 s'agit également de rechercher les causes des évolutions négatives ou problématiques et d'appliquer des mesures d'intervention adéquates, permettant d'obtenir une amélioration ou de résoudre les problèmes.L'aspect garantie de qualité constitue un secteur relativement neuf de la psychothérapie. Pourtant, de nombreuses raisons existent de l'intégrer à la profession, en Autriche en particulier puisque ce pays dispose du cadre juridique requis. Cette démarche permet d'accomplir une étape importante vers une plus grande professionnalisation de la psychothérapie. A cette fin, il serait actuellement important de créer d'abord les conditions-cadres nécessaires au niveau logistique et conceptuel. Il faut demander aux associations professionnelles comme aux instances de l'Etat (université, ministère) de se charger de cette tâche. Il faudrait en outre que les différentes écoles formulent des standards et des directives concernant la qualité des traitements, ainsi que des programmes visant à garantir et à améliorer systématiquement la qualité. Lors d'étapes ultérieures, ces programmes pourraient être intégrés à l'offre sous forme de projets pilotes et leurs effets pourraient être évalués. Alors seulement il sera possible de mettre définitivement en œuvre des mesures visant à garantir la qualité sur le plan essentiellement interne (dans le secteur ambulatoire). La recherche scientifique doit être part intégrante de ce processus; sans elle, il n'est pas possible d'appliquer des modèles de qualité. 11 serait également important que les psychothérapeutes eux-mêmes deviennent mieux conscients du thème qualité de la psychothérapie et des problèmes y relatifs, et qu'ils commencent dès maintenant à élaborer des idées quant à la manière dont elle pourrait être garantie. Les thérapeutes travaillant dans leur propre cabinet pourraient organiser maintenant déjà des groupes intéressés, travaillant ainsi systématiquement à l'amélioration de leurs standards de traitement et intervenant, le cas échéant, pour que leur qualité s'améliore.
Consists of thesaurus used in indexing the public papers of Leonor K. Sullivan, housed in the Saint Louis University School of Law Library. ; SAINT LOUIS UNIVERSDY GE JK1323 1952 .S34 1989 c.3 THE HONORABLE Leo nor K. (Mrs. John B.) Sullivan A Guide to the Collection St. Louis University Law Library Saint Louis University Schoo( of Law 3700 Lirufeff B(vd., St. Louis, MO 63108 LEONOR K. SULLIVAN 1902-1988 A Guide to the Collection Researched and prepared by: Joanne C. Vogel Carol L. Moody Loretta Matt LAW LIBRARY ST. LOUIS UNIVERSITY 3700 LINDtLL BLVD. ST. LOUIS, MO 63108 Copyright 1989 Saint Louis University Law Library 00 ' ()) THE HONORABLE LEONOR K. SULLIVAN 1902-1988 TABLE OF CONTENTS I. Portrait of Leonor K. Sullivan II. Biography III. Sullivan Plaques and Awards IV. The Leonor K. Sullivan Collection V. List of Subject Headings LEONOR K. SULLIVAN Leonor K. Sullivan, the first woman from Missouri to serve in the United States House of Representatives, was born Leonor Alice Kretzer, August 21, 1902, in St. Louis. She attended public and private schools in St. Louis, including Washington University. Prior to her marriage, Mrs. Sullivan pursued a business career and eventually became the director of the St. Louis Comptometer School. She married Missouri Congressman John B. Sullivan on December 27, 1941, and served as his administrative assistant and campaign manager until his death in January, 1951. Following her husband's death, Mrs. Sullivan unsuccessfully attempted to win the local Democratic party's nomination to succeed Congressman Sullivan in the special election. The seat was lost to a Republican candidate. In 1952, Leonor K. Sullivan running on her own, without party support, defeated six opponents in the primary election to become the Democratic nominee for the Third Congressional District. In the general election, she defeated her Republican opponent and recaptured the seat once held by her husband. Mrs. Sullivan represented the Third Congressional District until her retirement in 1976. While in Congress, Leonor K. Sullivan was known as a champion of consumer issues and she had a key role in enacting legislation to improve the quality of food. The Poultry Inspection Law and the Food Additives Act are just two of her important triumphs. As chairman of the Subcommittee on Consumer Affairs of the House Committee on Banking and Currency, Mrs. Sullivan was responsible for the Consumer Credit Protection Act of 1968, which included the Truth in Lending Act, and the Fair Credit Reporting Act of 1970. Mrs. Sullivan also authored the original food stamp plan to distribute government surplus food to the needy and she worked to solve the housing problems in our cities. At the time of her retirement, she was the senior member of the House Committee on Banking, Currency, and Housing. She was a member of the National Commission on Food Marketing, 1964-66; the National Commission on Mortgage Interest Rates, 1969; the National Commission on Consumer Finance, 1969-72; and she helped found the Consumer Federation of America in 1966. Mrs. Sullivan served as chairman of the House Committee on Merchant Marine and Fisheries. Her support of the American Merchant Marine earned her the American Maritime Industry's Admiral of the Ocean Seas Award (AOTOS) in 1973. The men and women who served in the Coast Guard and the Merchant Marine continuously honored Mrs. Sullivan for her support, understanding, and dedication. Always active in waterways projects, she fought to allow the 51 year old DELTA QUEEN to continue as an overnight excursion vessel. Mrs. Sullivan's work as chairman of the Subcommittee on Panama was especially important as she became involved with the political, economic, and social challenges of the Canal Zone and the people who lived and worked there. Leonor K. Sullivan worked hard for St. Louis. She sponsored legislation to fund the development of the Jefferson National Expansion Memorial on the St. Louis Riverfront, to keep St. Louis a well managed port city on the Mississippi trade route, and to preserve the buildings so important to the history and heritage of St. Louis. Wharf Street has been renamed Leonor K. Sullivan Boulevard to honor her support of the Gateway Arch project and the Jefferson National Expansion Memorial. Following her retirement, Mrs. Sullivan returned to her river bluff home which overlooked the Mississippi River. She remained active in civic affairs, serving on numerous boards and committees. She became a director of Southwest Bank, chairman of the Consumer Advisory Council to the Board of Governors of the Federal Reserve System, a member of the Board of Directors of Downtown St. Louis, Inc., a member of the Lay Advisory Board of Mount St. Rose Hospital and Rehabilitation Center, and she sponsored a consumer award program through the Better Business Bureau. Mrs. Sullivan was always in demand as a featured speaker at business, educational, and social functions. In 1980, Mrs. Sullivan married Russell L. Archibald, a retired vice president of the American Furnace Company. Mr. Archibald died March 19, 1987. Leonor K. Sullivan died, in St. Louis, on September 1, 1988. SULLIVAN PLAQUES AND AWARDS The Sullivan Collection includes many awards, citations, plaques, letters of recogn1tlon, pictures, and other memorabilia. During her career, Mrs. Sullivan received over 200 awards, some of which are permanently displayed in the Law Library. 1. Missouri State Labor Council, AFL-CIO - a proclamation designating Leonor K. Sullivan as organized labor's First Lady. Presented September 8, 1976. 2. Robert L. Hague Merchant Marine Industries Post #1242 - Distinguished Service Citation for Mrs. Sullivan's work as Chairman of the House Merchant Marine and Fisheries Committee. 3. Oceanographer of the Navy - presented by RADM J. Edward Snyder, Jr., USN, Special Assistant to the Under Secretary or the Navy. 4. Panama Canal Gavel - made from one of the original beams of the Governor's House, the gavel was presented to Mrs. Sullivan by Governor W. E. Potter as a "token of appreciation for demonstrated interest in the Panama Canal and the Canal Zone Government." 5. Consulting Engineers Council of Missouri - expresses appreciation for Mrs. Sullivan's concern and understanding of the role of the consulting engineer. 6. St. Louis Democratic City Central Committee - Special Award recognizes Leonor K. Sullivan's "dedicated service to the people of Missouri, the United States of America, and the Democratic Party . ," presented September, 19, 1976. 7. Consumer Federation of America - CFA Distinguished Public Service Award, June 14, 1972. 8. Reserve Officers' Association, Missouri - President's Award recognizing Mrs. Sullivan's service to the nation during her 24 years in Congress. 9. American Waterway Operators, Inc. - recognizes Mrs. Sullivan's " . Instrumental Role in the Development of the Inland Waterways of the United States." I 0. American Institute of Aeronautics and Astronautics, St. Louis Section - 1976 Civic A ward for Outstanding Contributions to Communities and Nation during 24 years in the House of Representatives, May 11, 1976. 11. Federal Land Banks 50th Anniversary Medal - " . awarded in 1967, to Leon or K. Sullivan for outstanding contributions to American Agriculture." 12. St. Louis Board of Aldermen - Resolution #101 (March 12,1976) honoring Mrs. Sullivan for her 24 years in Congress. 13. Human Development Corporation of Metropolitan St. Louis - Certificate of Recognition, September 29, 1978. 14. Older Adults Special Issues Society (OASIS) - Confers honorary membership upon Leonor K. Sullivan, August 22, 1974. 15. National Health Federation - Humanitarian Award, October 11, 1958 - especially recognizes Mrs. Sullivan's efforts for protective legislation against injurious additives in food and beverages. 16. U.S. Merchant Marine Academy, Kings Point, New York - an award presented to Mrs. Sullivan by the Alumni of Kings Point. 17. American Numismatic Association - a 1972 award presented to Mrs. Sullivan for her generous support. 18. Official Hull Dedication for New Steamboat - replica of the dedication plaque unveiled by Mrs. Sullivan in Jeffersonville, Indiana, November 11, 1972. Hull 2999 was the official designation of the new passenger riverboat being built for the Delta Queen Steamboat Company. The dedication also recognized Leonor K. Sullivan's successful legislative efforts on behalf of the DELTA QUEEN. 19. Jewish War Veterans of the United States, Department of Missouri - 1963 Americanism Award for "her unselfish devotion and untiring efforts on behalf of all Missourians regardless of race or creed." 20. National Marine Engineers' Beneficial Association, AFL-CIO - recognizes Mrs. Sullivan's service and support of the U.S. Merchant Marine, February 26, 1975. 21. Child Day Care Association - 1973 award for sponsoring child welfare legislation. 22. St. Louis Democratic City Central Committee - 1973 Harry S. Truman Award. 23. Seal of the Canal Zone Isthmus of Panama - a wooden copy of the Seal "presented in appreciation to Hon. Leonor K. Sullivan . " Canal Zone; Masters, Mates, and Pilots Association; National Maritime Union; Central Labor Union; Joint Labor Committee, 1969. 24. Atlantic Offshore Fish and Lobster Association - recognizes Leonor K. Sullivan's efforts to preserve and protect the Northwest Atlantic Fishing Industry, June, 1973. 25. Photographic portrait of President and Mrs. Johnson inscribed to Leonor K. Sullivan. 26. Photographic portrait of Lyndon Johnson inscribed to Leonor Sullivan. 27. Photographic portrait of Hubert H. Humphrey inscribed to Congressman (sic) Leonor K. Sullivan 28. H.R. I 0222 - Food Stamp Act of 1964 - first page of the engrossed copy of the bill, signed by John McCormack, Speaker of the House. 29. St. Louis University School of Law - Dedication of the New Law School, October 17-18, 1980 - recognizes Mrs. Sullivan's leadership gift. 30. West Side Baptist Church Meritorious Achievement Award, 1974. 31. Inaugural visit to St. Louis of the MISSISSIPPI QUEEN, July 29, 1978. 32. Gold-framed reproduction of a portrait of Mrs. Sullivan which hangs in the Longworth House Office Building. 33. Flora Place Association, November 4, 1976 - an award recognizing Mrs. Sullivan's 24 years in Congress. 34. St. Louis Police Relief Association, July 24, 1974. 35. St. Louis Argus Distinguished Citizen's Award, 1978. 36. George M. Khoury Memorial Award- "Woman of the Year," February 2, 1974. 37. Distinguished Service to the United States Coast Guard, February, 1976. 38. National Association of Mutual Insurance Agents - Federal Woman of the Year, October 12, 1974. 39. Chief Petty Officers Association, United States Coast Guard - Keynote speaker at Sixth Annual Convention, October 7-12, 1974, in St. Louis, MO. 40. Home Builders Association - Distinguished Service A ward, November 7, 1970. 41. Young Democrats of St. Louis - Distinguished Service Award, 1964. 42. Bicentennial Year Award, 1976 - a Waterford crystal bell and base presented to Mrs. Sullivan during the nation's Bicentennial. 43. Cardinal Newman College - Mrs. Sullivan's Cardinal Newman College Associates membership certificate presented during her tenure as Chairman, Board of Trustees, November 3, 1981. THE LEO NOR K. SULLIVAN COLLECTION Before her retirement, Leonor K. Sullivan made arrangements to donate her congress ional papers, correspondence, and memorabilia to St. Louis University Law Library. Mrs. Sullivan chose St. Louis University Law Library because her husband, Congressman John B. Sullivan (1897 -1951 ), was a graduate of the law school, having received his LL. B. degree in 1922, and his LL. M. degree in 1923. In 1965, Mrs. Sullivan founded a scholarship at St. Louis University for young women interested in studying political science. The collection covers Mrs. Sullivan's 24 years in the U.S. House of Representatives and is arranged according to her own subject headings. In this way, the materials provide insight into the way her office files and correspondence were organized. Mrs. Sullivan was known as one of the hardest working members of Congress and the wealth of materials in her collection attests to this. She had a tremendous concern for the average American family and much of her work dealt with their needs. Mrs. Sullivan often said the · best legislative ideas came from constituents, so she read every letter ever sent to her. Not only did she learn how the voters felt about current issues, but where there were problems which needed to be current issues. Papers from Leonor K. Sullivan's years as a member of the House Merchant Marine Committee and the Banking and Currency Committee provide background information for much of the legislation proposed during the period. Mrs. Sullivan was known as a consumer advocate long before such a position was popular and her efforts to improve the quality of food, drugs, and cosmetics are well documented. Materials are also available on Mrs. Sullivan's struggle for credit protection for the consumer, truth-in-lending, and fair credit reporting. Mrs. Sullivan was a strong supporter of the American Merchant Marine, the U.S. supervision of the Panama Canal, and the development of America's inland waterways. Her collection includes in-depth information on all these areas. Local St. Louis concerns are well represented in Leonor K. Sullivan's papers. She spent untold hours on the development of the Gateway Arch, the Jefferson National Expansion Memorial, and the port of St. Louis. She worked hard to maintain and increase the river traffic which is so important to St. Louis. After her retirement, Mrs. Sullivan continued to receive letters from former constituents and friends. She was active in civic affairs and her opinion on current issues was frequently solicited. The collection includes newspaper clippings, letters, and personal materials from this post-retirement period. Persons interested in using the Leonor K. Sullivan Collection should contact Joanne C. Vogel or Eileen H. Searls at St. Louis University Law Library, (314)658-2755. Written requests for information may be sent to: St. Louis University Law Library Leonor K. Sullivan Collection 3700 Lindell Blvd. St. Louis, MO 63108 Arthritis Research Arts Arts and Humanities see also Grants--National Endowment for the Arts Grants-- National Endowment for the Humanities Assassination of John F . Kennedy see Kennedy, John F. - -Assassination Assassinations--Select Committee to Investigate see Select Committee to Investigate Assassinations Atlantic Convention Atlantic Union Atomic Accelerator Laboratory Atomic Bomb--Fallout Shelter see a/ SO Nuclear Weapons-- Radioactive Fallout Atomic Energy see also Nuclear Energy Nuclear Weapons Auto Inspection Safety Auto Insurance Auto Insurance and Compensation Study Automotive Industry Automotive Transport Research and Development Act Aviation see a/ SO Airlines, Airport and Airway B-1 Program Development Act Airports Civil Aeronautics Board Concorde Supersonic Tra nsport Federal Aviation Administration Banking and Currency Committee Banking and Currency Committee-- Aluminum Penny Bill Banking and Currency Committee--Area Redevelopment Program Banking and Currency Committee Failures see a/so Independent Bankers Association of America Banking and Currency Committee- -Bank Holdings Company Act see a/so Banking and Currency Committee-Citicorp Banking and Currency Committee--Bank Holding Company Issues Banking and Currency Committee--Bank Lobbying Banking and Currency Committee--Bank Mergers 83nking and Currency Committee- -Bank Protection Act of 1968 Banking and Currency Committee- -Bank Safety Regulations Banking and Currency Committee--Bank Security Measures Banking and Currency Committee--Banking Act of 1965 Banking and Currency Committee -- B a nk i11~ Changes Banking and Currency Committee- Bankruptcy B:mking and Currency Committee--Taxation Banking and Currency Committee--Trust Activities Ban king and Currency Committee-- Certificates of Deposit Banking and Currency Committee--Citicorp see also Bank Holding Company Banking and Currency Committee-- Committee Business Banking and Currency Committee-Committee Notices Banking and Currency Committee-- Conferee Banking and Currency Committee-Congressional Record Entries Banking and Currency Committee-Consumer Credit see also National Commission on Consumer Finance Banking and Currency Committee-Correspondence with Boyd Ewing Banking and Currency Committee--Credit Information Ban king and Currency Committee-- Credit Union Financial Institutions Act Banking and Currency Committee--Credit Unions see also General Accounting Office- - Credit Unions Banking and Currency Committee- - Credit Unions--Insurance on Deposits Banking and Currency Committee- - Credit Unions--National Credit Union Bank Bill Banking and Currency Committee--Credit Uses Reporting Act of 1975 Banking and Currency Committee- - Debt Collection Banking and Currency Committee -- Defense Production Act see a[ so Joint Committee on Defense Production Banking and Currency Committee-Democratic Caucus Banking and Currency Committee-Disclosure Act Banking and Currency Committee-- Economic Development Act ee a[ SO Economic Development Banking and Currency Committee-- Economic Stabilization Act --Amendments B3nking and Currency Committee -- Economic Stabilization Act -- Correspondence Banking and Currency Committee-- Economic Stabilization Act--Mark-Up Session Banking and Currency Committee-- Economic Stabilization Subcommittee Banking and Currency Committee-- Emergency Financial Assistance Act see a[ so Banking and Currency Committee- lntergovermental Emergency Assistance Act Banking and Currency Committee--New York City-- Correspondence Banking and Currency Committee--New York City- -Legislation Banking and Currency Committee--Energy Conservation Legislation see also Energy Conservation Banking and Currency Committee--Export Control see a/so Export Administration Act Export Control Act International Trade Commission Banking and Currency--Export/Import Bank Banking and Currency Committee- -FINE Study (Financial Institutions and the Nation's Economy) Banking and Currency Committee- -FINE Study--Hearings Banking and Currency Committee--Farmers Home Administration- Low Interest Loans Banking and Currency Committee-- Financial Reform Act of 1976 Banking and Currency Committee--Gold Backing and Federal Reserve Notes Banking and Currency Committee- -Gold Price Banking and Currency Committee- Insurance see also Insurance Banking and Currency Committee-Interamerican Bank see also Agency for International Development Banking and Currency Committee--Interest Rates see also Interest Rates Banking and Currency Committee--Prime Interest Rate Banking and Currency Committee- -Savings and Loans- - Interest Rates Banking and Currency Committee-- Interest Rates-- Hearings Banking and Currency Committee- Intergovernmental Emergency Assistance Act see a/so Banking and Currency Committee-Emergency Financial Assistance Act Banking and Currency Committee- International Banking Act Banking and Currency Committee-- International Development Association Banking and Currency Committee-- International Monetary Policy see a/ o Banking and Currency Committee- - Monetary Policy Banking and Currency Committee--Laws of the State of Missouri Relating to Banks and Trust Companies Banking and Currency Committee-Lockheed Case Banking and Currency Committee-Monetary Policy see also Banking and Currency Committee-International Monetary Policy Banking and Currency Committee-Subcommittee on Domestic Monetary Policy Banking and Currency Committee-- Mortgage Interest Rates see also Federal National Mortgage Association Banking and Currency Committee-Mortgage Interest Rates--District of Columbia Banking and Currency Committee-Mortgage Interest Rates--Hearings Banking and Currency Committee--Mutual Savings Banks Banking and Currency Committee--National Commission on Productivity and Work Quality Banking and Currency Committee--National Consumer Cooperative Bank Act see also Consumer Interest--Miscellaneous Banking and Currency Committee--National Consumer Cooperative Bank Act see a/so Consumer Interest--Miscellaneous Banking and Currency Committee--New York City-Correspondence see also Banking and Currency Committee- Emergency Financial Assistance Banking and Currency Committee--New York City- - Legislation see also Banking and Currency Committee-Emergency Financial Assistance Banking and Currency Committee--NOW Account Banking and Currency Committee--One Bank Holding Company Bill Banking and Currency Committee--One Bank Holding Company Bill- -Clippings Banking and Currency Committee--One Bank Holding Company Bill- - Committee Information Banking and Currency Committee--One Bank Holding Company Bill--Letters Banking and Currency Committee--One Bank Holding Company Bill--Reports from Interested Groups Banking and Currency Committee--One Dank ll nlclinR c: . np:111y Bill-- Reports from Other Agencies Banking and Currency Committee--Penn Central see a/so Railroad Legislation Banking and Currency Committee--Prime Interest Rates see a/so Interest Rates Banking and Currency Committee--Record Maintenance in Banking Institutions Banking and Currency Committee-- Recurring Monetary and Credit Crisis Banking and Currency Committee-- Reven ue Bonds Banking and Currency Committee--Safe Banking Act Banking and Currency Committee- - St. Louis Banking Banking and Currency Committee-- Savings and Loan Companies see a/so Housing-- Savings and Loans Housing--Savings and Loans Bill Housing--Loans Banking and Currency Committee- -Savings and Loan Companies-Holding Companies Banking and Currency - - Savings and Loan Companies-- Interest Rates see a/so Interest Rates Banking and Currency Committee--Interest Rates Banking and Currency Committee-- Savings and Loan Companies-Investigation Banking and Currency Committee--Silver Banking and Currency Committee--Small Business see a/so Sma ll Business Administration Poverty Program-- St . Louis Small Business Development Center St . Louis--Small Business Administration Banking and Currency Committee- - Steering Committee Banking and Currency Committee-Subcommittee on Domestic Monetary Policy ,,,.,. also Banking and Currency Committee- Monetary Policy Banking and urrt!ncy Committee--Swiss Bank Accounts Uanking and Currency Committee--Taxing of National Banks Banking and Currency Committee- - Variable Interest Rate Mortgage Loans Bankrupt see Banking and Currency Committee -Bankruptcy Barge Lines see also Federal Barge Lines Dccf Research and Information Act n ct•J" Ucllcr Communities Ad see Housing--Better Communities Act Bicentennial Civic Improvement Association see a/ SO American Revolution Bicentennial Bicentennial Civic Improvement Bicentennial Coinage see also Coinage Bicentennial Material Billboards Association-- Clippings see Highways-- Beautification- - Billboards Birth Control see also Family Planning Illegitimacy Population Growth Sex Education Black Lung Act see also Coal Black Militants see Militants Mine Safety Act see also Negroes--Black Militants Bl ackman's Development Center Blind see also Handicapped Blood ::,ee Health -- Blood Banks Blumeyer P roject see Housing-- Blumeyer Project Boating see also Coast Guard Boggs , Hale Bookmobile National Safe Boating Week Recreation see Education --Bookmobile Books Sent to Libraries and Schools see also Lib raries Bowlin Project see Housing -- Bowlin Project for the Elderly Braceros see National Commission on Food Marketing Bracero Study Brazil see Foreign Affairs- - Brazil Bretton Woods Agreement Bride's Packet see Publications --Packets for the Bride Bridges see Martin Luther King Bridge Buchanan, Mrs. Vera Budget see also Management and Budget, Office of Budget and Impoundment Control Act Budget Material Building Sciences Act see Housi ng-- Building Sciences Act Bur"r'u of Standards see Food and Drug Administration--Bureau of Standards Bus Service see also Transi t -- Bi- State Business and Professional Women's Clubs see also Women's Organizations Busing see Education- - Busing Buy American Act Care see Foreign Affairs--Care Cabanne Turnkey Project see Housing--Cabanne Turnkey Project Calley, William L. Cambodia see Foreign Affairs - -Cambodia Campaign Conference for Democratic Women see a/so Women in Politics Campaigns Campus Riots see also Education--Campus Unrest Cancer see a/ SO Medical Insurance for Radiation Treatment Cannon Dam see Conservation--Cannon Dam Capital Punishment Capitol- - United States Carpentry see Housing--Building Sciences Act Catalog of Federal Assistance Programs Cattle see Food and Drug Administration- -Cattle Cemeteries see National Cemeteries Census see also Population Growth Central Intelligence Agency Century Electric Company see National Labor Relations Board-Century Electric Company Chain Stores see National Commission on Food Chamber of Commerce Cha rities Marketing- -Chain Stores Child Abuse and Neglect Child and Family Services Act see a/so Comprehensive Child Development Act Child Care see Poverty Program--Day Care Centers see also Poverty Program--Head Start Centers Poverty Program- -St. Louis Day Care St. Louis Day Care Child Protection Act Children , Youth , Maternal, and Infant Health Care Programs Chile see Foreign Aff:1irs--Chile Chirm sec Foreign Affairs--Red China China's Art Exhibit Cigarette Advertising Cities see Urban Affairs see a/so Housing--Urban Renewal Revenue Sharing Citizenship see Immigration -- Naturalized Citizens City Planning see a/ 0 Urban Affairs Civil Aeronautics Board see a/so Federal Aviation Administration Aviation Civil Air Patrol Civil Defense see also Emergency Preparedness Missouri--Disaster Area Civil Rights- -Clippings see also Integration Militants Negroes--Black Militants Negroes--National Assocation for the Advancement of Colored People Civil Rights- -Discharge Petition Civil Rights-- Equal Employment Opportunity see a/so Equal Employment Opportunity Equal Opportunity Civil Rights- -Equality for Women see a/so Women- -Equal Rights Amendment Civil Rights-- Housing see a/so Housing--Fair Housing Housing--Open Negroes--Housing Civil Rights- -Ireland's Roman Catholics Civil Rights--Legislation Civil Rights--Mississippi Seating Civil Rights --Pro Civil Rights-- Webster Groves Incident Civil Service Health Benefits Civil Service Legislation see also Federal Employees Civil Service Retirement Clara Barton House Clean Air Act see also Air Pollution Pollution Coal see a/ SO Black Lung Act Energy Crisis Mine Safety Act Mineral Resources Coal Mine Surface Area Protection Act see a/ so Mining Coal Slurry Pipeline Act Coal Tar Products see Food and Drug Administration- - Hair Dye Coast Guard see also Boating National Safe Boating Week Coastal Areas see a/so Outer Continental Shelf Lands Coca-Cola Bottling Company Cochran Apartments see Housing--Public Housing-Cochran Apartments Coinage Sl!l' a/ SO Bicentennial Coinage National Stamping Act Colleges and Universities see Education- - College Loan Program see a/so Schools--College Debate Color Additives see Food and Drug Administration--Color Additives Commemorative Postage Stamp for Jeannette Rankin Commemorative Stamps see a/so Kennedy, John F . First Day Cover Issues see Food and Drug Administration-Cranberries Creating a Joint Committee to Investigate Crime Credit Unions see Banking and Currency Committee- Credit Unions see a/so General Accounting Office- - Credit Unions Crime--Bail Reform Act Crime--General see a/so J oint Committe to Investigate Crime Juvenile Delinquency Law Enforcement Assistance Administration Prisons Crime--Gun Control Crime--Riots see a/so Housing--Insurance--Riots Crime--Riots- - Clippings Crime- - Switch - -Blades Cruelty to Animals Current River see Conservation--Current River Power Line Customs Bureau Cyprus see Foreign Affairs - -Cyprus Czechoslovakia see Foreign Affairs--Czechoslovakia Daily Digest see Panama Canal--Daily Digest Dairy Products see Milk see a/so Food and Drug Administration-Milk Dams see Lock and Dam 26 Conservation- - Cannon Dam Danforth Foundation see a/ 0 Foundations Darst- -Webbe Public Housing see Housing- - Public Housing--Darst-Web be Davis- -Bacon Act see Labor- - Davis-Bacon Day Care Centers see Poverty Program--Day Care Center see a/ 0 Poverty Program--St. Louis Day Care St. Louis Day Care Daylight Savings Time Deafness see Hearing Aids Death with Dignity Debt Ceiling Bill See a/so Goverment Debt National Debt Decontrol of Certain Domestic Crude Oil see a/so Oil Leases Defense ee a/ 0 Nation:1l Defense Defense Appropriations see a/ SO Military Construction Appropriation Bill Military Expenditures Military Pay Military Procurement Defense Contracts See a/so Federal Government Contract Legislation Military Procurement Defense Mapping Agency Sl!£' n/so Aeronautical Chart and Information Center Defense Production Act see Banking and Currency Committee-Defense Production Act .\Ce a/ so Joint Committee on Defense Production Defense Production, Joint Committee see Joint Committee on Defense Production Delta Queen Delta Queen-- Clippings Delta Queen--Correspondence Delta Queen- -Extend Exemption Delta Queen/Mississippi Queen--Clippings Delta Queen/Mississippi Queen-- Correspondence Democratic City Central Committee Democratic Clubs Democratic Coalition Party Democratic Convention--1972 Democratic Convention--1976 Democratic National Committees Democratic Organizations Democratic Party see a/so Banking and Currency Committee-Democratic Caucus Campaign Conference for Democratic Women Democratic State Committees Democratic Cities see Housing- - Democratic Cities Dental Health see Health--Dental Deodorant see Food and Drug Administration-Deodorant Department of Housing and Urban Development see Housing- -HUD Department of Labor see Grants--Department of Labor--St . Louis Department of Peace see Peace, Dept. of Department of the Interior see Grants--Department of the Interior-- St. Louis Department of Transportation see Grants--Department of Transportation-- St. Louis Desoto-- Carr Project see Housing- - Desoto-Carr Project Detention see Emergency Detention Act Development Bank ·ce Housing--Na tional Development Bank Diabetes Research see a/so National Diabetes Advisory Board Diet Foods see Food and Drug Administration--Diet Foods Digestive Diseases :,ee National Digestive Disease Act of 1976 Direct Popular Election of the President Disabled American Veterans see Veteran's Organizations Disarmament see also Arms Control Postal Boutique Commission of Consumer Finance see National Commission on Consumer Finance Commission on Federal Paperwork Commission on Food Marketing sec National Commission on Food Marketing Commission on History and Culture :see Negroes-- Commission on History and Culture Commission on Neighborhoods see National Commission on Neighborhoods Committee on Political Education see Political Education, Committee On Committee on P opulation Crisis see Population Crisis Committee Committee on Standards of Official Conduct Committee Reform Commodity Exchange Act see also Re- Pricing Commodities Commodity Futures see a/so Re- Pricing Commodities Common Cause Communications see also Federal Communications Commission Communism Radio Telecommunications Television Community Development Act Community Services Administration Comprehensive Child Development Act see a/so Child and Family Services Act Comprehensive Employment and Training Act see also Employment Compton--Grand Association see Housing Compton-Grand Association Comptroller General of the United States Concorde Supersonic Transport see also Aviation Concentrated Industries Anti - Inflation Act see also Inflation Congress- - 91st Congress--9lst--Senate Subcommittees Congress- -92nd Congress- -93rd Congress--94th Congress--94th--Majority Rpt . Congress--94th--Member's Pay Raise see a/ so Congressional and Civil Service P ay Raise Congress- -Committee on House Administration Congress-- Economic Committee see J oint Economic Committee Congress-- House Beauty Shoppe Congress--House Budget Committee Congress- - House Unamerican Activities Committee see a/ so Internal Security Congress- - Redistricting SC'(' Missou ri - - Redistricting Congress--Rules of Congressional and Congress--Scandals see a/ 0 Powell, Adam Clayton Congressional and Civil Service Pay Raise see a/ o Congress- - 94th- -Member Pay Raise Federal Pay Raise Congressional Fellowship Congressional Office--Payroll Congressional Pay Raise Congressional Record Inserts see a/so Jefferson National Expansion Memorial Congressional Record Inserts Congressional Reorganization see a/ 0 Legislative Reorganization Act of 1970 Congressional Travel Conservation --Cannon Dam see a/so National Park Service Parks Conservation --Current River Power Line Conservation --Eleven Point River Conservation-- Harry Truman Dam Conservation- -Lock Dam 26 see Lock and Dam 26 Conservation--Meramec Basin Conservation--Meramac Park Reservoir Conservation- -Meramac Recreation Area Conservation- -Mineral Resources see Mineral Resources Conservation --Miscellaneous see a/so Recycling Waste Conservation- - Recreation Area Conservation--Redwood National Park Conservation--Upper Mississippi River National Recreation Area see a/so Upper Mississippi River Basin Commission Conservation-- Water Resources see a/so Water Resources Planning Act Conservation-- Wild Rivers Conservation - - Wilderness Conservation -- Wildlife .\ee a/ :so Lacey Act Constitutional Changes Consumer Credit see Banking and Currency Committee--Consumer Credit see also National Commission on Consumer Finance Right to Financial Privacy Act Consumer In terest Miscellaneous see a/so Banking and Currency Committee- National Consumer Cooperative Bank Act National Commission on Food Marketing-- Consumer Information Publications-- Packet for the Bride Consumer Prod uct Information Bulletin see a/so Publications- -Consumer Product Information Copyright Legislation Copyrights Cosmetics see Food and Drug Administration- - entries Cosmetologists see National Hairdressers and Cosmetologists Cost of Living Council Cost of Living Task Force Council of Catholic Women see a/so St. Louis Archdiocesan Council of Catholic Women Women-- Organizations Cranberries Diseased Pets District of Columbia see also Home Rule-- District of Columbia Doctors see Immigration--Foreign Doctors see a/so Education--Nurses and Medical Students/Medical Schools Health Manpower Bill Douglas, William 0 . see Impeachment (Justice Douglas) Draft Dru'g Abuse see a/so Alcoholism, Narcotics Drug Abuse Office and Treatment Act Drug Advertising Drug Cases Drug Cost Drug Legislation Drug Regulation Drug Testing and New Drugs Drugs, Baby Asprin Drugs, Chemical Names Drugs, Factory Inspection Drugs, Habit- Forming Drugs, Interstate Traffic Drugs, Krebior:en see a/so Krebiozen Drugs, Strontium 90 see a/so Strontium 90 Drugs, Thalidomide see also Thalidomide Earthquakes East - West Gateway Coordinating Council see a/so St. Louis--East West Gateway Coordinating Council East St. Louis Convention Center Ecology see also Environmental Education Act Economic Committee see Joint Economic Committee Economic Development see a/so Banking and Currency-- Economic Development Act Economic Development Administration see a/so Grants--Economic Development Administration Economic Program Economic Summit Conference Economics--Joint Economic Committee see Joint Economic Committee Editorials--KMOX-TV see Radio and T elevision --Editorials Education see a/ so Schools Ed ucntion --Adult see a/ SO Adult Education Missouri - -Adult Education Act Education--Aid to Parochial Schools see a/so Aid to P arochial Schools Education --Federal Aid to Education Parochial Schools Education- - Aid to Private Schools See a/ 0 Aid to Private Schools Education --Federal Aid to Education Private Schools Education--Appropriations Education -- Bookmobile see a/ 0 Bookmobile Libraries Education--Busing see also Busing Integration Education--Campus unrest see also Campus riots Militants Education -- Clippings see ah;o Schools - - Clippings Education--College Loan Program see a/so Colleges and Universities Education--Higher Education Education--St udent Aid Bill Loans- - Student Student Loans Education- -Elementary and Secondary see also Schools Education--Federal Aid to Education see a/so Education--Aid to Parochial Schools Education-- Student Aid Bill Federal Aid to Education Education-- F ederal Charter for Insurance and Annuity Association see ah;o Insurance Education -- Food and Nutrition Program see a/ SO School Lunch Program School Milk Program Education--HEW Appropriations see also Health , Education and Welfare Education--Higher Education see also Education-- College Loan Program Education --Student Aid Bill Higher Education Missouri -- University Education- - Miscellaneous see also Quality Education Study Education--National Defense Education Act see a/so National Defense Education Act Education- - Nurses and Medical Students see also Doctors Heal t h Manpower Bill Medical Education Medical Schools Nurse Training Act Nurses Education-- Residential Vocational Education see also Education- - Vocational Education Vocational Education Education--Student Aid Bill see also Education- - College Loan Program Education--Higher Education Education --Federal Aid to Education Loan-- Student Student Loans Education --Tax Deductions for Education see a/ SO Taxes- - Deduction for Education of Dependents Education- - T eachers Corps see a/ ·o Teachers Corps Education-- Upward Bound Branch see also Upward Bound Education--Vocational Education see also Vocational Education Educational Grants Grants - - Educational Grants--HEW-- Public Schools Egypt see Foreign Affairs--Egypt Eisenhower, Dwight David Eisenhower College Elderly see also Aging National Institute on Aging Older Americans Act Elderly-- Employment Opportunities see also Employment Opportunities for the Elderly Older Americans Act Elderly - - Housing see Housing--Bowlin Project for the Elderly see also Housing--Elderly Election Laws see Missouri--Election Laws Election Reform see also Voting Rights Act Election Reform--Post Card Registration see alSO Post Card Registration Voter Registration Elections Commission Electoral College see also Direct Popular Election of the President Electric and Hybrid Research, Development and Demonstration Act of 1976 ee also Energy Conservation and Electric Power Electricity see Lifeline Rate Act Conversion Act of 1976 Elementray and Secondary Education Eleven Point River see Conservation- -Eleven Point River Elk Hills Oil Reserve see also Oil Leases Emergency Detention Act see also Detention Emergency Employment see also Employment Emergency Livestock Credit Act See a/so Agriculture Emergency Rail Transportation Improvement and Employment Act See Railroads--Emergency Rail Transportation Improvement and Employment Act Emergency Rooms see Medical Emergency Transportation and Services Act Emergency Security Assistance Act Emergency Telephone Number see a/ 0 Nine One One Emergency Unemployment Compensation Assistance ·ee a/so Unemployment Compensation Emergency Utility Loans and Grants for Witerizing Homes see a/ o Utility Loans Employment See a/ 0 Comprehensive Employment and Training Act Immigration Labor entries Manpower Minimum Wage Unemployment Employment- - Equal Opportunity Employment of the Handicapped see also Handicapped Labor--Handicapped Workers Employment Opportunities for the Elderly see Elderly --Employment Opportunities Endowment for the Arts see Grants--National Endowment for the Arts Endowment for the Humanities see National Endowment for the Humanities Energy-- Correspondence Energy Conservation see also Banking and Currency Commission--Energy Conservation Federal Power Commission Natural Gas Act Protection of Independent Energy Conservation and Conversion Act of 1976 see also Electric & Hybrid Research, Development & Demonstration Act of 1976 Energy Crisis SC'e also Coal Fuel for Cars Gas and Gasoline and Oil Allocations Oil Imports Oil Leases Energy Crisis-- Correspondence Energy Crisis--Material Energy Excerpts Energy Independence Act of 1975 Energy- - Information & Material see also Arctic Gas Project Energy Research and Development Environmental Education Act see also Ecology Environmental Pesticide Control Act of 1976 see alSO Pesticides Environmental Policy Act Environmental Protection Agency see also Grants--Environmental Protection Agency-- St. Louis Equal Employment see a/so Civil Rights- -Equal Employment Opportunity Minority Groups Women--Employment Opportunities Equal Employment Opportunity Commission Equal Opportunity see a/so Civil Rights-- Equal Employment Opportunity Equal Pay for Equal Work !:>Cl! also Women--Employment Opportunities Equal Rights- - Clippings Equ al Rights for Women see a/so Women--Equal Rights--Material Equal Time ee a/ ·o Federal Communications Commission Euclid Piau Radio Television see Housing--Euclid Plaza Excess Property see Missouri - - Excess Property see Federal Excess Property Executive Reorgan ization Export Administration Act see a/so Banking and Currency--Export entries Export Control Act see a/so Banking and Currency Committee -Export Control FBI see Federal Bureau of Investigation FCC see Federal Communications Commission FDIC see B & C Federal Deposit Insurance Corporation Fair Labor Standards Act see Labor--Fair Labor Standards Fair Plan see Insurance --Fair P lan Fair Trade see also Trade--Expor ts and Imports Fallout Shelters see Atomic Bomb--Fallout Shelters see Nuclear Weapons--Radioactive Fallout Family Assistance Act see also Welfare Welfare--Family Support Family Assistance Material and Clippings See a/so Welfare--Clippings Family Assistance Plan Family Fare see Publications--Family Fare Family Planning see a/ so Birth Control Illegitimacy P opulation Growth Sex Education Family Planning Services Act Family Week see National Family Week Farm Bill see Agriculture--Farm Bill Farm Workers see also Agriculture National Commission on Food Marketing--Bracero Study Federal Advisory Committee Act Federal Aid to Education see Education --Federal Aid to Education Federal Aviation Administ ration see also Aviation Civil Aeronautics Board Federal Barge Lines see a/ so Barge Lines Federal Buildi ngs see a/ so Public Buildings Federal Bureau of Investigation Federal Communications Commission see also Communications Equal Time Radio and Television Television Federal Deposit Insurance Corp see also FDIC Federal Employees See a/ SO Civil Service Legislation Federal Excess Property see a/so Excess Property Missouri --Excess Property Fede ral Government Contract Legislation see a/so Defense Contracts Federal Home Loan Bank Board Federal Housing Administration see Housing-- Federal Housing Administration Federal Judical Center see also J udiciary Federal Land Bank of St. Louis see also Land Bank Federal National Mortgage Association see a/so Banking and Currency--Mortgage Interest Rates Mortgages and Interest Rates Federal Pay Raise see a/so Congressional and Civil Service Pay Raise Federal Power Commission see a/so Energy Conservation Fuel and Energy Resources Commission Lifeline Rate Act Federal Reserve System Federal Trade Commission Federal Voting Assistance Program see a/so Voter Registration Federation of Independent Business see National Federation of Independent Business Feed Grain see a/so Agriculture Food and Drug Administration-- Grain Grain Purchases Fetal Experimentation see Health , Education and Welfare--Fetal Experimentation Fi nancial Disclosure see a/so Right to Financial Privacy Act Financial Institutions Act Fire Protection see a/so National Academy for Fire Prevention & Central Site Selection Board Fish and Fish Products see a/so Food and Drug Administration-Fish Fish Inspection Food and Drug Administration-- Trout Trout see a/so Inspection , Food Fl ag Day Flood Control Meat Inspection Poultry Inspection see a/so St. Louis- - U.S. Army Corps of Engineers Flood, Daniel J. Upper Mississippi River Basin Commission see P anama Canal--Correspondence- - Flood, Daniel J . Flood Insurance Program see a/so Insurance--Flood National Flood Insurance Program Flood Protection Project see also St. Louis--U.S. Army Corps of Engineers Floods see a/so Missouri - - Disaster Area Missouri- - Flood National Flood Insurance Program Rivers Fluoridation of Water Fonda, Jane Food see also Agriculture National Commission of Food Marketing P oultry Food and Drug Administration Index Code Food and Drug Administration Appropriations Food and Drug Administration-- Botulism Food and Drug Administration--Bread Prices Food and Drug Administration--Bureau of Standards Food and Drug Administration --Cattle-General Food and Drug Administration- -Cattle-Legislation Food and Drug Administration--Color Additives Food and Drug Administ ration-Confectionery Food and Drug Administration - -Copy of Bill Food and Drug Administ ration - -Cranberri•·> Food and Drug Administ ration -- DeodorauL Food and Drug Administration -- Diet Foods see a/ o Nut rition Food and Drug Administration --Eye Make-up Food and Drug Administration--Facial Creams Food and Drug Administration-- Fish Flour Food and Drug Administ ration--Food Additives Cases See a/ 0 Addi tives Food and Drug Administration -- Food Additives -- General ee also Nutrition Food and Drug Administration- - Food Additives-- Legislation Food and Drug Amdinistration-- Freezone Food and Drug Administration-- General Commentary Food and Drug Administration-- General Information Food and Drug Administration -- General Letters Food and Drug Administration-- Grain see a/ 0 Feed Grain Food and Drug Administration--Hair Dye Food and Drug Administration -- Hair Preparations Food and Drug Administration -- Hai r Remover Food and Drug Administration- - Hair Sprays Food and Drug Administration -- Ice Cream Food and Drug Administration -- Investigation Food and Drug Administration-- Legislation Food and Drug Administration- - Lipsticks Food and Drug Administration--Medical Devices see Medical Device Amendments Food and Drug Administration--Milk Food and Drug Administration-- Miscellaneous Food and Drug Administration- - Nail Polish Food and Drug Administration--Packaging Food and Drug Administration--Packaging (Wax) Food and Drug Administration--Pesticide Cases Food and Drug Administration--Pesticide Legislation and General Information Food and Drug Administration--Pesticides Food and Drug Administration-Preservatives Food and Drug Administration--Pre- testing Food and Drug Administration-- Request for Copy of Research Food and Drug Administration--Soap Food and Drug Administration--Special Dietary Foods see also Nutrition Food and Drug Administration--Sun-tan Lotion Food and Drug Administration--Trout Food and Drug Administration--Vaporizers Food and Drug Administration--Varnish Food and Drug Administration--Vitamin Supplements see a/so Nutrition Food and Drug Administration- - Water see also Water Food Assistance Act see Foreign Aid- -Food Assistance Act Food Crisis see a/ SO Agriculture Food for Peace Hunger and Malnutrition Nutrition Population Crisis Committee Population Growth Right to Food Resolution see also Agriculture Food Prices see also Agriculture Food Stamp Plan 1954--Bills see a/ SV Agriculture Hunger and Malnutrition Food Stamp Plan 1954--Comments and Criticism Food Stamp Plan 1954-- Correspondence Food Stamp Plan 1954--Food Surplus Food Stamp Plan 1954--St. Louis Food Stamp Plan 1954--Speeches and Testimony Food Stamp Plan 1955--Correspondence and Legislation Food Stamp Plan 1955--Food Surplus Food Stamp Plan 1956--Bills and Hearings Food St amp Plan 1956--Commodity Credit Corp. Food St amp Plan 1956- - Correapondence, Speeches, Testimony Food Stamp Plan 1956- - Food Surplus Distribution Food Stamp Plan 1956--Personal Letters Food Stamp Plan 1957-- Bills Food Stamp Plan 1957--Correspondence Food Stamp Plan 1957--Food Surplus and Food Stamp Plan Food Stamp Plan 1957--Hearings Food Stamp Plan 1957--Speeches Food Stamp Plan 1957--Testimony Food Stamp Plan 1958--Activities Carried on Under PL 63 -4RO Food Stamp Plan 1958--Bills Food Stamp Plan 1958--Comments and Criticism Food Stamp Plan 1958--Correspondence Food Stamp Plan 1958--Hearings and Reports Food Stamp Plan 1958--Personal Letters Food Stamp Plan 1958- - Speeches and Testimony Food Stamp Plan 1958--Study and Procedure Food Stamp Plan 1959- - Bills Food Stamp Plan 1959--Comments and Criticism Food Stamp Plan 1959--Congressional Record Entry Food Stamp Plan 1959--Correspondence Food Stamp Plan 1959-- Hearings and Reports Food Stamp Plan 1959--Personal Letters Food Stamp Plan 1959--Releases Food Stamp P lan 1959-- Speeches and Testimony Food Stamp Plan 1959- -Studies and Procedure Food Stamp Plan 1960- -Activities Carried on Under PL-480 Food Stamp Plan 1960-- Bills, Hearings, Reports Food Stamp Plan 1960-- Correspondence Food Stamp Plan 1960-- Personal Letters Food Stamp Plan 1961-- Correspondence and Clippings Food Stamp Plan 1961--Personal Letters Food Stamp Plan 1962--Bills, Correspondence, Testimony Food Stamp Plan 1962-- Clippings Food Stamp Plan 1962--Personal Letters Food Stamp Plan 1963--Bills Food Stamp Plan 1963--Comments and Criticism Food Stamp Plan 1963--Correspondence Food Stamp Plan 1963- - Hearings Food Stamp Plan 1963-- Releases Food Stamp Plan 1963--Speeches Food Stamp Plan 1963--Studies and Procedures Food Stamp Plan 1964--Appropriations Food Stamp Plan 1964--Bills Food Stamp Plan 1964--Comments and Criticism Food Stamp Plan 1964--Correspondence Food Stamp Plan 196-t -- Hearings Food Stamp Plan Hl64 --Minority Views Food Stamp Plan 1964--Releases Food Stamp Plan 196-t -- Speeches Food Stamp Plan 196-t -- Studies and Procedures Food Stamp Plan 1965 --Appropriations Cut Food Stamp Plan 1965- - Correspondence Food Stamp Plan 1965 - -District of Columbia Food Stamp Plan 1965--Expansion Food Stamp Plan 1965--Kinlock MO Food Stamp Plan 1965 --Missouri Food Stamp Plan 1965--Personal Letters Food Stamp Plan 1965--St. Louis MO Food Stamp Plan--Legislative History Food Stamp Plan--Miscellaneous Statistics Food Stamp Plan--Petition 1967 Food Stores see National Commission on Food Ford Foundation see also Foundations Ford, Gerald Marketing- -Chain Stores see Nixon, Richard M.-- Pardon Foreign Affairs--Amnesty Foreign Affairs--Angola Foreign Affairs- -Brazil Foreign Affairs--CARE Foreign Affairs--Cambodia see a/so Moratorium War Protest Foreign Affairs--Chile Foreign Affairs-- Cyprus Foreign Affairs- - Czechoslovakia Foreign Affairs-- Egypt see also Foreign Affairs - -Middle East Foreign Affai rs - - General Countries Foreign Affairs-- Genocide Treaty Foreign Affairs- - Indochina Foreign Affairs -- Israel see a/ 0 Foreign Affiars --Middle East Foreign Affairs-- Israel-Arab War see a/so Foreign Affairs- -Middle East Foreign Affairs - -Jordan see also Foreign Affairs--Middle East Foreign Affairs --Lebanon see a/so Foreign Affairs--Middle East Foreign Affairs --Middle East see also Foreign Affairs- - Egypt Foreign Affairs -- Israel Foreign Affairs -- Israel Arab War Foreign Affairs --Jordan Foreign Affairs--Lebanon Oil Imports Foreign Affairs- -Mid-East Sinai Pact Foreign Affairs --Non-Proliferation Treaty Foreign Affai rs --Peru Foreign Affairs- - Pueblo Foreign Affaris- -Puerto Rico see a/ SO Puerto Rico Foreign Affairs--Red China Foreign Affairs--Republic of China see Republic of China Foreign Affairs -- Rhodesia Foreign Affairs - - Soviet Union Foreign Affairs--Turkey Foreign Affai rs --United Nations Foreign Affairs -- United Nations Development Program Foreign Affairs -- Vietnam ee a/ SO Missing in Action Prisoners of War Select Committee to Investigate Missing in Action Foreign Affairs -- Vietnam- - Mrs. Sullivan 's Voting Record (as of 1972) see a/so Sullivan, L.K. Voting Record Foreign Affairs Legislation Foreign Aid Foreign Aid- - Food Assistance Acl Foreign Policy Foreign Visitors Forest Park Blvd. Turnkey Project see Housing--Forest Park Blvd. Turnkey Project Forestry Legislation see also Lumber Fort San Carica see Jefferson National Expansion Memorial--Building a Replica of Fort San Carlos Foster Grandparents see Poverty Program--Foster Grandparents Foundations see also Ford Foundation Danforth Foundation Grants Grants--National Science Foundation National Science Foundation Four Freedoms Study Group Franchises Franchising Practice Reform Act Freedom of Information Act see also Sunshine Bill Freedom of the Press see also Newspapers Radio Television Fuel and Energy Resources Commission see a/so Energy Conservation Federal Power Commissron Fuel for Cars see also Energy Crisis Gas and Gasoline and Oil Allocation Fur see also Laclede Fur Co. GAO see General Accounting Office GPO see Government Printing Office GSA see General Services Administration Gambling see also Lotteries Gas--Laclede Gas see also Natural Gas Gas--Natural Gas and Gasoline and Oil Allocation see also Energy Crisis Fuel for Cars Gateway Arch see Jefferson National Expansion Memorial General Accounting Office General Accounting Office--Credit Unions see also Banking and Currency--Credit General Electric General Motors Unions General Services Administration see also Grants--General Services Administration- - St . Louis Genocide Treaty see Foreign Affairs--Genocide Treaty Georgetown University Gerontology Cold Star Wives Goldenrod Showboat see Jefferson National Expansion Memorial- -Showboat Goldenrod Government Debt see also Debt Ceiling Bill National Debt Government Insurance Government Operations Government Printing Office Government Regional Offices Government Reorgani~:ation Program see Reorganiution Program Grace Hill Area see Housing--Grace Hill Grading, Meat see Meat Grading Grain Purchases ee also Agriculture Feed Grain Grand Canyon see Conservation--Grand Canyon Grandparents, Foster see Poverty Program--Foster Grandparents Grants see also Foundations National Science Foundation Grants- - Clippings Grants-- Dept. of Housing and Urban Development see Housing- - St . Louis--Grants from HUD Grants-- Department of Labor--St . Louis Grants-- Department of the Interior- -St. Louis and MO Grants-- Department of Transportation--St. Louis see also Transportation Grants - -Economic Development Administration- - St. Louis see also Economic Development Administration Grants-- Educational see also Educational Grants Learning Business Centers Grants- -Environmental Protection Agency-St. Louis Grants--General Services Administration -St. Louis Grants- - Health, Education and Welfare-- Miss& uri Grants--HEW--Public Schools Grants--HEW--St. Louis Grants--HEW--St. Louis University Grants--HEW-- Washington University see also Washington University Grants to Hospitals G r·an ts- - Housing see Housing-- St. Louis- - Grants from HUD Grants--Law Enforcement Assistance Administration -Missouri ee also Law Enforcement Assistance Administration Grants--Law Enforcement Assistance Administratiou - - SL . Louis see also Law Enforcement Assistance Administration Gran ta--M any Sou rcea-- Colleges Grants--Many Sources- -Missouri Grants--Many Sources--St. Louis University Grants--Many Sources--Universities Grants--Many Sources- -University of Missouri Grants--Many Sources- - Washington University see also Washington University Grants- - Miscellaneous Grants--National Endowment for the Arts see also Arts and Humanities Grants--National Endowment for the Humanities see also Arts and Humanities Grants--National Science Foundation see also National Science Foundation Foundations G ranta--OEO- - Missouri Poverty Program--Office of Equal Opportunity Grants- -Post Office--St. Louis see also Postal Service St . Louis - -Post Office -Operations Grants--Roth Study Grocery Stores see National Commission on Food Marketing--Chain Stores Guam Guatemalan Earthquake Gun Control see Crime--Gun Control HUAC See Congress-- House Unamerican Activities Committee Hair Car Products see Food and Drug Administration H ai rd ressers see National Haridressers and Cosmetologists Halpern, Seymour see Resignations Handicapped see also Blind Herman, Philip Employment of the Handicapped Labor--Handicapped Workers see Panama Canal--Correspondence-Harry Flannery Herman, Philip See Radio and Television- -Harry Flannery Harry Truman Dam See Conservation--Harry Truman Dam Hatardous Material see a/so Transportation -- Dept. of Proposed Regulations Hazardous Occupational Safety and Health Act see a/ 0 Mine Safety Act Occupational Safety and Health Administration Head Start Center See Poverty Program--Head Start Centers Health -- Blood Banks Sl!<' (1/ SO Medical Care Health--Dental Health and Welfare Council of Greater St. Louis see a/ SO Welfare Health Education and Welfare see also Grants--Health Education and Welfare- -Missouri Housing--Public--HEW Task Force Health, Education and Welfare--Fetal Experimentation see also Human Experimentation Health Insurance see a/so Medical Insurance for Radiation Treatment National Health Insurance Health Insurance for the Unemployed see a/so Unemployment Health Legislation see a/so National Health Care Act Health Manpower Bill see also Education--Nurses and Medical Health, Mental Students Immigration--Foreign Doctors Manpower Nurse Training Act !!JI!<' Mental Health Health Program Health- - Polio Vaccine Health Security Act Hearing Aids Higher Education see a/so Education -- Higher Education Higher Education Act Highway Beautification see a/so Anti--Billboard Law High way-- Clippings Highway Patrol ee Missouri- -Highway Patrol Highway Safety see a/so National Bicentennial Highway Safety Year Highway Through St. Louis see a/so St . Louis Highways Highway Trust Fund Highways see a/so Martin Luther King Bridge High ways- - Beautification-- Billboards The Hill see Housing--The Hill Hill-Burton Act see Hospitals--Hill-Burton Historic Preservation see a/so National Historic Preservation Act HolidaJ.s see a SO Kennedy, John F, Holiday Home Owners Mortgage Loan Corp see Housing--Home Owners Mortgage Loan Corp Home Rule--D.C. see a/ SO Distict of Columbia Hospitals- - Closing ·ee a/ so Public Health Services Hospi tals Hospitals--Emergency Rooms ee Medical Emergency Transportation and Services Act Hospitals--General Hospitals--General MAST Program Hospitals- - Grants see Grants--Hospitals Hospitals- -Hill-Burton Hospitals- -Non-profit House Administration, Committee on House Beauty Shoppe see Congress. House Beauty Shoppe House Budget Committee House Un - American Activities Committee see also Congress. House Un-American Acitivities Comm1 Ll ee Household P ets Housing Housing and Community Development Act of 1974 Housing and Urban Development Act of 1968 see also Housing--HUD Housing--Anonymous letters Housing--Arson-- Clippings Housing--Better Communities Act Housing Bills Housing Bills- - Letters Housing--Bingham's Bill Housing--Blumeyer Project Housing- - Blumeyer Project--Clippings Housing-- Bowlin Project for the Elderly Housing- - Building Sciences Act see also Lumber Housing--Cabanne Turnkey see also Housing--Forest Park Blvd Turnkey Project Housing--Turnkey Projects Housing- -College Loan Programs Housing- - Community Development Block Grants Housing--Compton Grand Association Housing--CR Excerpts Housing- -Correspondence- -Out of State Housing-- Demonstration Cities Housing- - Dept. of Community Developmt!IIL Housing--DeSoto- Carr Housing-- Elderly see also Nursing Homes Housing--Emergency Housing--Energy Conservation see also Energy Conservation Housing- - Euclid Plan Housin~r - -Fair Housing see also Civil Rights--Housing Housing- - Open Housing- - Fair House Enforcement in Missouri Housing- -Federal Housing Administration Housing--Forest Park Blvd .--Turnkey Project see also Housing- -Cabanne Turnkey Project Housing- -Turnkey P rojects Housing-- General Housing- -Grace Hill Housing- -The Hill Housing- -Home Owners Mortgage Loan Housing- -HUD Corps. see also Housing and Urban Development Housing and Urban Development Act of 1968 Houiang--St. Louis -Applications to Jill f) Housing- -St. Louis - -Grants from HUD Housing--Missouri-- Grants from HUD Housing--HUD- - Consolidated Supply Program Housing--HUD --Housing Material Housing- -Housing Authoriution Act Housing-- Inspection Housing-- Insurance--Riots see also Crime- -Riots Insurance Housing-- Jeff- Vander-Lou Housing--KMOX Editorials see also Radio and Television Editorials Housing--Laclede Town Housing--Laclede Town-- Clippings Housing-- LaFayette Square Housing- - LaSalle Park Housing-- Lead Paint Housing-- Lead Poisoning see also P oisons Housing-- Loans see also Banking and Currency- -Savings and Loan Entries Interest Rates Housing--Low Income see also Housing-- President's Task Force on Low Income Housing Poverty Program- -General Housing--Mansion House Housing--Maryville Housing--Mill Creek Valley Housing--Miscellaneous Clippings Housing--Miscellaneous Letters Housing--Missouri Housing--Mobile Homes Housing- -Model Cities Housing- -Model Cit ies- - Clippings Housing--Mullanphy Project Housing--National Development Bank Housing--National Housing Act Housing-- National Tenants Organir;ation Housi ng--Negro see also Civil Rights--Housing Housing--Open Negroes- - General Housing- - Neighborhood F acilities Grant Housing- -Newcastle Project Housing- -O'Fallon Housi ng- -Ombudsman Housi ng- -Open see also Civil Rights--Housing Housing--Fair Housing Negroes- -Housing Housing--Open- -Against (District) Housing-- Open- -For (District) Housing- -Open--Against (Out of District) Housing--Open--For (Out of Dist rict) Housing- -Open- -Clippings Housing- -Operation Breakthrough Housing--Operation Breakthrough-- Clippings Housing--Operation Rehab ee also Housing-- Rehabilitation Housing--Rock Springs Rehabilitation Association Housing Panel Housing- - Para Quad Housing--Peabody- -Clippings Housing--President's T ask Force on Low Income Housing see also Housing--Low Income Housing Program Cute Housing--Public Housing Bills Proposed Housing-- Public Housing--Cochran Apts.-- Clippings Housing--Public Housing-- Darst-W ebbe Public Housing Housing- -Public Housing- -Darst- Web be Clippings Housing- - Public Housing-- General- - Clippings Housing--Public Housing--General Letters Housing--Public--HEW Task Force see also Health, Education,&: Welfare Housing--Public Housing--Kosciuksko St. Housing- - Public Housing- -Mailing List Housing--Public Housing- - Neighborhood Gardens Housing- - Public Housing- -Pruitt- lgoe Housing--Public Housing- - Pruitt - Igoe-Clippings Housing- - Public Housing-- Pruitt- lgoe-Proposals Housing- - Public Housing-- Rent Strike-see also Strikes Clippings Housing--Public Housing- -Rent Strike-- Reports Housing--Public Housing--Reports Housing--Red Tape Housing- -Rehabilitation see also Housing-- Operation Rehab Housing--Rock Springs Rehabilitation Association Housing-- Rent Supplements Housing-- Reports and Materials Housing-- Rock Springs Rehabilitation Association see also Housing--Operation Rehab Housing-- Rehabilitation Housing- - St. Louis Housing--St. Louis-- Applications to HUD see also Housing--HUD Housing- -St. Louis--Area Expeditar Housing--St. Louis--Code Enforcement Housing--St. Louis- -Code Enforcement-- Clippings Housing-- St. Louis--Grants from HUD see also Housing--HUD Housing- -St . Louis Housing and Land Clearance Authority Housing- - St. Louis Housing Plan Housing-- St. Louis Meeting Housing-- St. Louis-- Workable Program Housing -- Savings and Loans See a/ 0 Banking and Currency Committee- Savings and Loan Companies Housing- - Savings and Loan Bill see also Banking and Currency Committee-Savings and Loan entries Housing- - Section 8 Housing-- Section 22l(d)(2) Housing- - Section 221(d)(3) Housing-- Section 221(h) Housing- - Section 235 Housing- - Section 236 Housing- -Section 701 Housing- -Soulard Area see a/so National Historic Preservation Act Housing--South Broadway Housing-- South Side Housing- - State of Missouri Housing-- State of Missouri- - Grants from HUD see also Housing--HUD Housing--Subcommittee Notices Housing - -Ten Park Improvement Association Housing- -Town House Project Clippings Housing-- Turnkey Projects see a/so Housing- - Cabanne Turnkey Project Housing- - Forest Park Blvd Turnkey Project Housing- -Turnkey Projects--Clippings Housing--Twelfth and Park Housing-- Union--Sarah Housing-- Urban Reports Housing-- Urban Renewal Housing-- Urban Renewal- - Clippings Housing-- Urban Renewal-- Letters Housing- -Urban Renewal--Material Housing-- Vaughn Area- - Clippings Housing-- Villa de Ville Housing- -Washington University Medical Housing-- Wellston Housing--West End Center Housing--West End- - Clippings Housing- - West Pine Apartments Human Development Corporation see Poverty Program- - Human Development Corporation see also Poverty Program- - St. Louis Human Development Corporation Human Experimentation see also Health, Education and Welfare-- Fetal Experimentation Humanities see National Endowment for the Humanities Hunger and Malnutrition see a/so Food Crisis ICC Food Stamp Plan entries Right to Food Resolution see Interstate Commerce Commission Ice Cream see Food and Drug Administration--Ice Cream Ill egitimacy see also Birth Control Immigration Family Planning Sex Education ee a/so P opulation Growth Employment Immigration and Naturalir.ation Service Immigration-- Foreign Doctors Immigration- -Material Immigration--N aturalir.ed Citizens Immunity (Nixon) Against see also Nixon, Richard Milhouse Immunity (Nixon) For Immunity (Nixon) Out of State Impeachment (Justice Douglas) see also Supreme Court Judiciary Impeachment see also Nix on , Rich ard M Impeachment- -Against Impeachment Bill Impeachment-- Clippings Impeachment-- For Impeachment --Not Answered Impoundment Control/ Spending Ceiling Independent Bankers Association of America see also Banking and Cu rrency Committee-Bank-- Entries Independent Business Federation see Nation al Federation of Independent Business Independent Meat P ackers see also Meat P ackers Indians see also Minority Groups Indochina see Foreign Affai rs-- Indochina Industry Funds Inflation see also Concentrated Industries Anti- Infl ation Act Inflation--House Resolution Inspection--Food see F ish Inspection see also Meat Inspection Poultry Inspection Institute of Psychiatry see Missouri-- Instit ute of Psychiatry Insurance see also Banking and Currency Committee- Insurance Education- - Federal Charter for Insu rance and Amminty Association Goverment Insurance Housing--Insurance- -Riots Insurance Coverage for Women see also Women Insurance--Fair Plan Insurance - -Floods see National Flood Insurance P rogram Insurance, Health see Health Insurance Insurance--No Fault Insurance--Shoppers Guide Integration see also Civil Rights entries Education --Busing Negroes - - entries Interest Rates ee also Banking and Currency Commitr.·c Interest Rates Banking and Currency Committee--Prime Interest Rate Banking and Currency Committe--Savings and Loan Interior (Dept. Of} Interior (Dept . of}--Oil Shale Program see also Energy Crisis Oil Leases Intelligence, Select Committee See Select Committee on Intelligence Internal Security see also Congress--House Unamerican Activities Committee Wire Tapping and Bugging Intern ational Development Association see Banking and Currency Committee-International Development Association International Security Assistance and Arms Export Control Act see also Arms Control Internation al Trade Commission see also T rade--Exports and Imports In ternat ional T rade Subcommittee Not ices In te rstate Commerce Commission see also Movers of Household Goods Interstate Horseracing Act In terviews see also News Releases--Radio Press Comments Press and News Reporters Intra-Ut erine Devices see Medical Device Amendments Invi tations Israel see Foreign Affairs--Israel Jeanette Rankin see Commemorative Postage Stamp for Jeanette Rankin J efferson Barracks J efferson Barracks- - Landmark Status J efferson Barracks--National Cemetery Memorial Chapel J effe rson Barracks Park J efferson Nation al Expansion Memorial see also Lewis and Clark National Park Services St. Louis- -Arch St . Louis--Jefferson Nation al Expansion Memorial Jefferson National Expansion Memorial- - Bills J efferson Nat ional Expansion Memorial- Brochure J efferson Nat ional Expansion Memorial-Budget Material Jefferson National Expansion Memor ial-Building a Replica of Fort San Carlos J efferson Nat ional Expansion Memorial-Clippings J efferson Nat ional Expansion Memorial-Congressional Record Inserts J effe rson National Expa nsion Memorial-Dedication Jefferson National Expansion Memorial-File for Hearing J effe rson Nat ional Expansion Memorial-Ground Breaking Ceremonies Jefferson National Expansion Memorial-Releues, etc. J efferson National Expansion Memorial-River Music Barge J efferson National Expansion Memori al-Showboa t Goldenrod J effe rson National Expansion Memorial-Testimony of Mrs. Sullivan Jefferson National Expansion Memorial - Visitors Center Jeff-- Vander-Lou see Housing--Jeff- Vander-Lou Jewish War Veterans see also Veterans' Administration Job Training Program see also Labor- -Manpower Development and Training Poverty Program- - St. Louis Job Corps Center St. Louis Job Corps Center Johnson, Lyndon Baines Joint Committee on Defense Production See also Banking and Currency Committee-- Defense Production Act Joint Committee to Investigate Crime see also Crime- - General Joint Economic Committee Jordan see Foreign Affairs--Jordan Judge Oliver see Oliver, Judge Judiciary see also Federal Judicial Center Impeachment (Justice Douglas) Supreme Court Justice Department Junior Village Juvenile Delinquency see also Crime--General Prisons KMOX see Radio and Television entries see also Housing KMOX Editorials News Releases--Radio KWK, Radio Station see Radio Station KWK Kansas-Texas RR see Missouri-Kansas-Texas RR Kennedy, John F . Kennedy, John F .--Assasination Kennedy, Jonn F .- -Eulogies Kennedy, John F .- -Holiday see a/ so Holidays Kennedy, John F .--Inaugural Address Kennedy, John F .--First Day Cover Issues see a/so Commemorative Stamps Kissinger, Henry see also State, Dept. of Kluxzynski Federal Office Building Korea see Foreign Affairs --Korea Koscuisko St. see Housing--Public--Kosciusko St. Krebiozen see Drugs, Krebiozen Labor see a/ 0 Employment Entries National Labor Relations Board -- Century Electric Company Postal Union Recognition Railroads - -Shopcraft Unions Strikes Unions Labor- - Davis-Bacon Labor-- Fair Labor Standards Labor-- Farm Labor See also Agriculture Labor--Handicapped W orkera see also Employment of the Handicapped Handicapped Labor Legislation see also Right to Work Labor--Manpower Development Training see also Job Training Corps Center Poverty Program--St. Louis Jobs Corps Center St. Louis Job Corps Center Labor Organizations--AFL-CIO Labor Orgnaizations--Misc. Labor- -Railroads see Railroads--Shopcraft Unions Labor- - Situs P icketing Labor Unions--Homes for the Aged Labor-- Workmen's Compensation Laws Lacey Act see also Conservation--Wildlife Laclede Fur Company Laclede Gas see Gas--Laclede Gas Laclede Town see Housing- - Laclede Town Lafayette Square see Housing--Lafayette Square Land Bank see Federal Land Bank of St . Louis Land Clearance see Housing--St. Louis Housing and Land Clearance Authority Land Management Organic Act Land Use Bill--Against Land Use Bill- - For LaSalle Park see Housing--LaSalle Park Lead Poisoning see Housing-- Lead Poisoning Law Enforcement Assistance Administratiom see also Crime--General Grants--Law Enforcement Assistance Administration Missouri--Highway Patrol League of Women Voters see also Voters Women Learning Business Centers see also Grants--Educational Unemployment Lebanon see Foreign Affairs- - Lebanon Legal Aid Society see also Crime--General Legal Services Corporation Legislative Activities Disclosure Act Legislative Proposals Legislative Reorganization Act of 1970 see also Congressional Reorganization Lettuce see National Commission on Food Marketing--Lettuce Study Lewis and Clark see also Jefferson National Expansion Memorial Libraries see also Bookmobile Books sent to Libraries and Schools Education--Bookmobile Libraries--Depository Library Extension, Congressional Library of Congress Library Services Lifeline Rate Act see a/so Energy Conservation Federal Power Commission Union Electric Company Lincoln Sesquicentennial Commission Loans--Student see Education- - College Loan Program see a/so Education--Student Aid Bill Lobby Groups Lobbying Local Public Works Capital Development and Investment Act see a/so Public Works Lock and Dam 26 at Alton, Ill. Lock and Dam 26--Clippings Lockheed Corp. see Banking and Currency Committee-Lockheed Case Lotteries see also Gambling Low Income Housing see Housing--President 's Task Force on Low Income Housing Lumber see a/ 0 Forestry Legislation Housing--Building Sciences Timber Supply Lumber Preservation Legislation see a/so T imber Supply Harry Lundeberg School see a/so Maritime Academies MAST Program MIA see Missing in Action See a/ SO Foreign Affairs -- Vietnam Magna Carta Select Committee to Investigate Missing in Action see a/so American Revolution Bicentennial Malpractice see Medical Malpractice Claims Settlement Assistance Act Management and Budget, Office of see also Budget Manpower see also Employment Labor- -Manpower Development and Training Health Manpower Bill Poverty Program-- Office of Economic Opportunity Mansion House Maritime Academies see a/ so Harry Lundeberg School Martin Luther King Bridge see a/ 0 Highways St. Louis- -Highways Maryville see Housing--Maryville Meals on Wheels see also Aging Meat Grading ee Grading, Meat Meat Imports see a/so Trade--Imports and Exports Meat Inspection see also Fish Inspection Inspection, Food Poultry Inspection Meat Inspection Bill Meat Inspection--St. Louis Independent Packing Company Meat Packers see a/so Independent Meat Packers Medical Care see a/so Health entries National Health Care Act Medical Device Amendments Medical Education see Education--Nurses and Medical Students see a/so Medical Schools Military Medical Schools Medical Emergency Transportation and Services Act Medical Insurance for Radiation Treatment see also Cancer Health Insurance Medical Malpractice Claims Set tlement Assistance Act Medical Schools see also Education--Nurses and Medical Students Mental Health Health Manpower Bill Nurse Training Act see also Health- -Mental Meramec Basin News Stories see also Conservation Meramec Basin or River see Conservation--Meramec Entries Merchant Marine see Harry Lundeberg School see also Coast Guard Maritime Academics Metric System Metropolitan Youth Commission see a/so Youth Affairs Middle East see Foreign Affairs- - Middle East Militants see also Civil Rights-- Clippings Education--Campus Unrest Negroes--Black Militants Military Construction Appropriation Bill see also Defense Appropriations Military Expenditures see a/so Defense Appropriations Military Medical School Military Pay see alSO Armed Forces Defense Appropriations Military Procurement see a/so Defense Appropriations Defense Contracts Military Retirement Milk see a/so Agriculture FDA--Milk Mill Creek Valley see Housing--Mill Creek Valley Mine Safety Act see a/so Black Lung Act Coal Hazardous Occupational Safety and Health Act Mining Mine Safety and Health Act Mineral Resources see also Coal Minimum Wage see a/so Employment Wage and Price Controls Mining see a/so Coal Mine Surface Area Protection Act Mine Safety Act Missouri Bureau of Mines Mink Ranchers Minority Groups see also Equal Employment Indians Negroes--Minority Groups Women Miscellaneous Organintions see a/so National Organintions Questionable Organizations Missiles see Nike Base Aeronautics and Space Arms Control Missini in Action ee also Foreign Affairs --Vietnam Missing in Action, Select Committee to Investigate ee Select Committee to Investigate Missing in Action Mississippi Queen see Delta Queen/Mississippi Queen Missouri, State of Missouri --Adult Education Act see a/ 0 Education--Adult Missouri--Area Redevelopment Missouri, Bureau of Mines see also Mining Missouri --Disaster Area see also Civil Defense Floods Missouri - - Election Laws see a/so Missouri-- Redistricting Missouri --Excess Property see a/so Federal Excess Property Missou ri - - Flood see also Floods National Flood Insurance Program Missouri -- Grants see Grants entries Missouri --Highway Patrol see a/ 0 Law Enforcement Assistance Administration Missouri--Housing see Housing--Missouri Missouri - - Institute of Psychiatry Missouri --Kansas-Texas RR see a/ o Railroad entries Missouri --Motor Vehicles Missouri -- Ozarks Regional Commission Missouri - - Redistricting ee al o Missouri --Election Laws Redistricting Missouri - - Sesquicentennial Miaaouri - - State Politics see a/ SO St. Louia-- Politica Women in Politics Missou ri State Society Missouri-- University see also Education- -Higher Education Grants--Many Sources-University of Missouri Missouri-- Missouri A Missouri B Missouri C-Com Missouri Con-Dept. of D Missouri Dept. of EMissouri Dept of F-G Missouri H Missouri 1-N Missouri 0-P Missouri 0 -Z Mobil Homes see Housing- - Mobil Homes Model Cities see Housing--Model Cities Moratorium see a/so Foreign Affairs--Cambodia Foreign Affairs-- Vietnam Mortgages and Interest Rates see a/so Banking and Currency Committee-Variable Interest Mortgage Rates Federal National Mortgage Association Movers of Household Goods see also Interstate Commerce Commission Mullanphy Project see Housing- -Mullanphy Project NAACP see Negroes - - National Association for the Advancement of Colored People NLRB ee National Labor Relations Board- Century Electric Company National A-National H see also Miscellaneous Organiroations National !- National Q National R-National Z National Academy for Fire Prevention and Central Site Selection Board see a/ SO Fire Prevention National Aeronautics and Space Act see also Aeronautics and Space--Space Program National Air Guard Employment see a/so National Guard National Association for the Advancement of Colored People see Negroes--National Association for the Advancement of Colored People National Bicentennial Highway Safety Year see also American Revolution Bicentennial Highway Safety National Cemeteries (Jefferson Barracks) National Cemeteries . ee Jefferson Barracks National Cemetery Memorial Chapel National Center for Women ee also Women National Commission of Consumer Finance Appendices ee al 0 Banking and Currency Committee-Consumer Credit National Commission on Consumer Finance Chapter I National Commission on Consumer Finance Chapter II National Commission on Consumer Finance Chapter Ill National Commission on Consumer Finance Chapter IV National Commission on Consumer Finance Chapter VI National Commission on Consumer Finance Chapter VIII National Commission on Consumer Finance Chapter IX National Commission on Consumer Finance Chapter X National Commission on Consumer Finance Chapter XI National Commiaaion on Consumer Finance Chapter XII National Commission on Consumer Finance--Clippings National Commission on Consumer Finance-Correspondence National Commission on Consumer Finance--Press Kat National Commission on Consumer Finance-- Speeches National Commission on Consumer Finance- -Studies National Commission on Food Marketing see also Agriculture National Commission on Food Marketing -Attempt to Form Commission see also National Commission on Food Marketing- - Creation of the Commission National Commission on Food Marketing-Background Material National Commission on Food Marketing-Congratulatory Notes to Mrs. Sullivan National Commission on Food Marketing-- Hearings National Commission on Food Marketing-Bracero Study see also Farm Workers National Commission on Food Marketing-Chain Stores National Commission on Food Marketing-Clippings National Commission on Food Marketing-Commission Meetings National Commission on Food Marketing · Consumer lnformata on see a/ SO Consumer Interest - - Miscellaneous National Commission on Food Marketing- Correspondence National Commission on Food Marketing-Creation of the Commission See al;o,o Batuibak Commission on Food Marketing- -Attempts to Form the Commission National Commission on Food Marketing- Formal Interviews National Commission on Food Marketing-General Info National Commission of Food Marketing-Individual Views of the Report National Commission on Food Marketing-Lettuce Study National Commission on Food Marketing-Press Releases National Commission on Food Marketing-Questionaire Correspondence National Commission on Food Marketing-Report Status National Commission on Food Marketing-Speeches National Commission on Food Marketing-Staff Changes National Commission on Food Marketing-Staff Selection National Commission on Food Marketing National Commission on Food Marketing-Chapter 13 of Final Report National Commission on Neighborhoods National Commission on Productivity see also Banking and Currency entries National Consumer Cooperative Bank Act see Banking and Currency Commission-- National Debt National Consumer Cooperative Bank Act see also Debt Ceiling Bill Government Debt National Defense see a/ SO Armed Services Defense National Defense Education Act see Education- -National Defense Education Act National Development Bank see Housing--National Development Bank National Diabetes Advisory Board see also Diabetes Research National Digestive Disease Act of 1976 National Endowment for the Arts see Grants--National Endowment for the Arts National Endowment for the Humanities see Grants--National Endowment for the Humanities National Energy and Conservation Corporation see also Energy Conservation National Family Week National Federation of Independent Business see also Small Business Administration National Flood Insurance Co see also Flood Insurance Program Floods Missouri--Flood National Good Neighbor Day National Guard see also Air Guard Armed Services National Air Guard Employment National Hairdressers and Cosmetologists National Health Care Act see also Health Legislation Medical Care National Health Insurance Health Insurance National Historic Preservation Act Historic Preservation Housing--Operation Rehab Housing- - Soulard Area National Housing Act see Housing--National Housing Act National Institute on Aging see also Aging Elderly Older Americans Act Select Committee on Aging National Labor Relations Board- - Century Electric Company see also Labor National Opportunity Camps National Park Service see a/so Conservation entries Jefferson National Expansion Memorial Parks National Safe Boating Week see also Boating Coast Guard National Saint Elizabeth Seton Day National Service Corps see a/so Peace Corps National Science Foundation see a/so Foundations Grants--National Science Foundation National Stamping Act see also Coinage National Summer Youth Program see Poverty Program- - National Summer Youth Program National Tennants Organization see Housing--National Tenants Organization Natural Gas see a/so Energy Conservation Laclede Gas Natural Gas Act see a/so Energy Conservation Natural Gas Act--Amendments Naturalized Citir.ens See Immigration --Naturalir.ed Citizens Negroes --Black Militants see also Civil Rights--Clippings Militants Negroes--Commission on History and Culture Negroes - - General see a/so Housing--Negroes-- Integration Negroes--Minority Group see a/so Minority Groups Negroes-- National Association for the Advancement of Colored People ee a[ SO Civil Rights entries Neighborhood Facilities Grant see Housing- -Neighborhood Facilities Grant Neighborhoods ee National Commission on Neighborhoods See a/so National Good Neighbor Day National Historic Preservation Act Nerve Gas see a/so Arms Control New York City Financial Crisis See Banking and Currency Committee-- Emergency Financial Assistance Act Newcastle Project see Housing-- Newcastle Project News Releases --Radio see a/so Interviews Press and News Reporters Presa Comments Radio Radio and Television--Press Releases and Interviews Sullivan, Leonor K., Press Releases Sullivan, Leonor K., Publicity Newspaper Preservation Act Newspapers see a/so Pulitr;er, Joseph Freedom of the Press Nike Base see a/so Arms Control Nine One One see Emergency Telephone Number Nixon, Richard M see also Agnew, Spiro T . Immunity (Nixon) Impeachment Vice President Watergate Nixon, Richard M.- -Pardon, Against Nixon, Richard M.--Pardon, For Nixon, Richard M.--Transition Allowance No-Fault Insurance see Insurance--No- Fault Noise Control Act Nuclear Energy see a/so Atomic Energy Energy Crisis entries Panama Canal- - Nuclear Technology Nuclear Non- Proliferation Treaty see Foreign Affain-- Non- Proliferation Treaty Nuclear Weapons see a/su Arms Control Atomic Bomb--Fallout Shelters Atomic Energy Weapons Nuclear W capons--Radioactive Fallout see a/so Atomic Bombs--Fallout Shelters Nuclear Weapons- -Testing Nurse Training Ad see a/so Education--Nurses Medical Students Health Manpower Medical Schools Nurses see a/so Education--Nurses and Medical Students Nursin!{ Homes see also Housing--Elderly Aging Nut rition see a/so FDA--Diet Foods OEO FDA--Special Dietary Foods FDA--Vitamin Supplements Food Crisis ee Grants--OEO-- Missouri see also Poverty Program entries OSHA see Hazardous Occupational SafeLy and Health Act see a/so Occupational Safety and Health Administration Obscene Literature Obscenity Occupational Safety and Health Administration see a/ SO Hazardous Occupational Safety and Health Act O'Fallon Area see Housing--O'Fallon Office of Economic Opportunity see Granta--OEO--Miuouri see a/so Poverty ProiJ'am--Office of Economic Opportunity Office of Management and Budget see Management and Budget, Office of Office of Technology Alleaament see a/so Technology Aaaeasment Office Official Gazette-- List Oil lmporta see also Energy Crisis Oil Leases Foreign Affairs--Middle East Trade--Imports and Exports ee a/ 0 Elk Hills Oil Reserve En rgy Crisis Interior (Dept. of) - - Oil Shale Program Older Americans Act ee a/ o Aging Oliver, Judge Olympic Games Olympics Ombudsman Elderly- -Employment Opportunitiea Nation I Institute on Aging Select Committee on Aging see Housing--Ombudsman Omnibus Operation Breakthrough see Housing- - Operation Breakthrough Opportunity Camps see National Opportunity Campa Outer Continental Shelf Landa see a/ o Coaat Coa~tal Area~ Overseaa Private Investment Corporation Onrk Lead Company Onrka Regional Commisaion Ozone Protection Act Pow·. ee Foreign Affaira-- Vietnam P cemakers See Medical Device Amendments Pacific Air Routes ee a/ 0 Airlines Panama Canal- - Clipping• Panama Canal--Congressional Record Jnaerta Panama Canai--Corr apondence-Armatrong, Anthony Pan am a Canal--Correspondence--Flood, Daniel J Panama Canal--Correspondence--General Panama Canal Correspondence--Harman, Philip Panama Canal Correspondence- - Raymond , David Panama Canal--Daily Digest Panama Canal--Finance Panama Canal--Hearings Panama Canal--Inspection Visit Panama Canal-- Legislation Panama Canal--Legislative Correspondence Panama Canal--Living Conditions Panama Canal --Military Penonnel Panama Canal--Miscellaneous and Reports Panama Canal--Nuclear Technology see also Nuclear Energy Panama Canal- -Operations Panama Canal--Panama and Treaty Panama Canal--Sea Level Canal Study Commission-Correspondence Panama Canal--Sea Level Canal Study Commission--Legislation Panama Canal--Sea Level Canal Study Commission--Reports P anama Canal Tolla Pam- medica see Medical Emergency Transportation and Services Act P ara-quad Housing see Housing- -Para-quad P ardon of Richard Nixon see Nixon, Richard M. --Pardon Parks see a/so Conservation entries National Park Service P arochial Schools see Education- -Aid to Parochial Schools Passports Patents Peabody Area see Housing--Peabody--Clippings Peace Corpa see also National Service Corps Peace, Dept. of Penn Central Railroad ee Banking and Currency Committee--Penn Central P ension Plan Pension Reform Peru see Foreign Affain--Peru Pesticides see Environmental Pesticide Control Act of 1976 ee a/so FDA--Pesticide entries Pets see Household Peta Photograph Request see Sullivan, Leonor K.--Photograph Request Physicians--Malpractice ee Medical Malpractice Claims Settlement Assistance Act Poelker, J ohn H see also St. Louis--Mayor Poisons see a/ so- -Housing--Lead Poisoning Polio Vaccine see Health --P olio Vaccine Political Education, Committee On Politics see Missouri --State Politica see also St. Louis--Politics Women in Politics Pollution Sl!£' a/so Air Pollution Clean Air Act Solid Waste P ollution Water Pollution Pollution--Noise see Noise Control Act Pollution--Solid Waste see Solid Waste Pollution see also Air Pollution Water Pollution Poor People 's Campaign Pope John XX:IIl Population Crisis Committee see also Food Crisis Population Growth see also Birth Control Census Family Planning Food Crisis Immigration Sex Education Portraits--Presidents see Presidents' P ortraits Post Card Registration see a/so Election Reform--Post Card Registration Voter Registration Post-Dispatch see Pulitzer, Joseph Newspapers Post Office Closings Post Office Department Post Office Regulations Postage Increase Postal Boutiuqea see also Commemorative Stamps Postal Clippings Postal Legislation Postal Pay Raise Postal Rate Commission Postal Rates Postal Rates --REA Postal Reform Legislation Postal Reform Material Postal Reorganization and Salary Postal Service Adjustment Act see a/so Grants--Post Office-- St . Loui£ Postal Strike see also Strikes Postal Union Recognition see a/ so Labor Unions Potato Bill Poultry- - Application to Make St. Louis see a/ o Food Poultry Indemnity Bill Poultrr Inspection see a/. 0 Fish Inspection Meat Inspection Poverty Program- -Clippings Poverty Program--Day Care Center see also Poverty Program-- Head Start Centers Poverty Program- -St. Louis-Daycare St. Louis Day Care Poverty Program- - Foster Grandparents Poverty Program--General see also Housing--Low Income Poverty Program--Head Start Centers see a/so Poverty Program--Day Care Centers Poverty Program--St. Louis -Day Care Centers St. Louis Day Care Poverty Program--Human Development Corporation see also Poverty Program--St. Louis-Human Development Corp Poverty Program--Material Poverty Program--Micellaneous Poverty Program--National Summer Youth Program see also Poverty Program--Summer Youth Program Summer Youth Employment and Recreation Poverty Program--Office of Economic Opportunity see also Grants--OEO--Missouri Labor--Manpower Development and Training Manpower Poverty Program--Office of Economic Opportunity-Amendments Poverty Program--Office of Economic Opportunity--Cuts Poverty Program--St. Louis--Day Care see also Poverty Program--Day Care Centers Poverty Program- - Head Start Centers St. Louis Day Care Poverty Program--St. Louis Human Development Corporation see a/so St. Louis Human Development Corp. Poverty Program--St. Louis Job Corps Center see also Job Training Program Labor--Manpower Development and Training St. Louis Job Corps Center Poverty Program--St. Louis Small Business Development Center see also Banking and Currency-- Small Business Administration St. Louis--Small Business Administration Small Business Administration Poverty Program--St. Louis Workers Poverty Program--Summer Youth Programs see also Poverty Program--National Summer Youth Program Summer Youth Employment and Recreation Poverty Program--Total Bay Project Poverty Program- - VISTA Powell , Adam Clayton see also Congress--Scandala Prayer in School see Religion- - Prayer in School Preservatives see Food and Drug Adminislralion-- Preserv atives President Ford see Nixon, Richard M.--Pardon President Johnson see Johnson, Lyndon Baines President Kennedy see Kennedy, John Fihgerald President Nixon see Nixon, Richard M Presidential Pardon see Nixon, Richard M.,--Pardon Presidents' Portraits President.' Task Force on Low Income Housing see Housing--President'• Taak Force on Low Income Housing "Presidio 27" see also Armed Service• Press Comments see a/so Interviews News Releaaes --Radio Preas and News Reporters Sullivan, Leonor K.--Press Releases Sullivan, Leonor K.-- Reaction to Presidenti al Statements Press and News Reporters see a/ SO Interviews Price Freeze News Releases--Radio Press Comments Sullivan, Leonor K.-- Press Releases Sullivan, Leonor K.--Reaction to Presidental Statements see also Wage and Price Controls Prisoners of War See Foreign Affaire --Vietnam Prisons ee also Crime- - General Juvenile Deliquency Privacy See a/so Right to Financial Privacy Act Private Schools See Education--Aid to Private Schools Productivity See Banking and Currency Committee-National Commission on Productivity Protection of Independent Service Station Operators see also Energy entries Pruitt - Igoe See Housing--Public Housing-- Pruitt - lgoe Public Buildings see alSO Federal Buildings Public Health Service Hospitals see also Hospitals --Closing Public Housing See Housing--Public Housing Public Relations See also FDA--Cranberries Public Works see a/ 0 Local Public Works Capital Development and lnveatment Act Publications--Consumer Product Info See al 0 Consumer Product Information Bulletin Publications-- Family Fare Publications-- Packet for the Bride see a/so Consumer Interest --Miscellaneous Publications Request Publications Request for Seal Plaques Pueblo Affair see Foreign Affairs--Pueblo Puerto Rico see a/so Foreign Affaire--Puerto Rico Pulitzer, Joseph see also Newspapere Quality Education Study see also Education--Miscellaneous Queen Isabella Questionable Organizations see also Miscellaneous Organizations REA see Postal Rates--REA ROTC see Reserve Officere Training Program Radiation Treatment see Medical Insurance for Radiation Treatment Radio see a/ SO Communications Equal Time Federal Communications Commission Freedom of the Press News Releases- -Radio Sullivan, Leonor K.--Publicity Radio and Television--Clippings Radio and Television Correspondence Radio and Television Editorials see a/so Housing--KMOX Editorials Radio and Television--Harry Flannery Radio and Television--Press Releases and Interviews see also Sullivan, Leonor K.--Press Releases News Releases--Radio Radio and Television--Broadcasts which Demean Radio Station KWK Radioactive Fallout see Nuclear Weapons-- Radioactive Fallout Rail pax Railpax--Material and Information Railroad Brotherhoods and Organizations see a/ SO Railroad Strikes Railroads--Shopcraft Unions Strikes Unions Railroad Legislation see also Banking and Currency Committee-Penn Central Missouri-Kansas and Texas RR Railroad Passenger Service ee a/so Railroads--Discontinuance of Passenger Trains Railroads-- Rail fax/ Amtrak Railroad Retirement Legislation Railroad Safety Railroad Strikes see a/so Railroad Brotherhoods and Organizations Railroads- -Strikes Strikes Railroads see Miuouri-Kanau Texas RR see also Bankinc and Currency CommiLLee-Penn Central Rock Island Railroad Railroads--Discontinuance of Paasanger Tram Serv1ce see also Railroad P aaaencer Service Railroad•-- Rail pax/ Amtrak Railroads--Emercency Rail T ransportation Improvement and Employment Act Railroada--Railpax/ Amtrak see also Railpax Railroad P aaaenger Service Railroada--Discontinuance of Passenger T rain Service Railroads- - Strikea see also Railroad Brotherhoods and Organir.ations Railroad Strikes Strikes Unions Railroads - -Sbopcraft Unions see also Labor Rat Cont rol R ilroad Brotherhoods and Organir.ations Uniona Strike• see a/ 0 St. Louis Rat Control Raymond, David see Panama Canal - - Correspondence -Raymond, David Recipes Recreat ion ee a/ SO Boating Recycling Waste ee also Conservation --Misc. Red China Energy Conservation Solid Wute Pollution See Foreicn Affai re -- Red China Redistricting See a/so Missouri --Redist ricting Redwood National Parka see Conservation Redwood Nat ional P ark Referrals Regulat ion Q see Banking and Currency Commission -Citicorp Rehabilit ation See Housing- - Rehabilitation See a/so Housinc- -Operation Rehab Housing- - Rock Springs Rehabilitation Association Religion Religion -- Prayer in School Renegotiation Act of 1951 Rent Strikes see Housing--P ublic Housing--Rent Strike Rent Supplements See Housing--Rent Supplements Reorganir.ation P rogram Re-- Pricing Commodities ee a/so Commodity Exchange Act Commodity Futures Republic of China See For ign Affairs-- Republic of China Republican National Convention Reserve Officers Training Program Resignations Retirement :;ee Military Retirement see a/so Railroad Retirement Legislation Revenue Sharing see a/so Urban Affairs Revenue Sharing Information Rhodesia see Foreign Affairs- - Rhodesia Richards- -Gebaur Air Force Base see a/ SO Air Force Re.location to Scott AFB Rice see Agriculture--Rice Bill Right to Food Resolut ion see a/so Food Crisis Hunger and Malnutrition Right to Financial Privacy Act see a/so Consumer Credit Financial Disclosure Privacy Right to Work ee a/ ·o Labor Legislation Riots see Crime- -Riots ee a/so Housing--Insurance --Riots Rivers ee Floods Missouri--Flood National Flood Insurance Program Robinson- -Patman Act see a/ 0 Anti--Trust Laws Rock Island Railroad Rock Spring Rehabilitation Association see Housing--Rock Springs Rehabilitation Association Roth Study see Grants- -Roth Study Rural Development Act Rural Electr ification Administration Russia ·ee Foreign Affairs- - Soviet Union SALT Safe Drinking Water Act Safety - -Highway see Highway Safety Safety- -Railroad see Rai lroad Safety Sailors see Harry Lundeberg School see a/so Maritime Academies Saint Elizabeth Seton see National Saint Elir.abeth Seton Day St . Joesph 's Hospital St . Louis A-Me St . Louis My-Z Saint Louis St . Louis - -Airport see a/ 0 Airports St . Louis - -Arch see J effe rson National Expansion Memorial St. Louis- -Aldermanic Affairs St. Louis Archdiocesan Council of Catholic Women see Council of Catholic Women St. Louis Area Council of Governments St . Louis--Banking see Banking and Currency--St. Louia Banking St . Louis Beautification Commia1ion St. Louis Bicentennial St. Louis--Bi-State Development Agency St. Louis--Bi-State Re(ional Medical Program St. Louis Board of Aldermen St. Louis Board of Education St. Louis- -Board of Education- -Property at 4100 Forest Park Ave St. Louis- -Board of Election Commiasioners St. Louis--Boards of Directors of Local St. Louis Bridges St. Louis Cardinal• Companies St. Louis - -Challenge of the 70's St. Louis - -City- County Consolidation St. Louis- -City Employees St. Louia--Civil Defenae St. Louis- - Clippings St. Louis--Comptroller's Report St. Louis- -Consumer Affairs Board see also Conaumer St. Louis Consumer Federation St . Louis Convention Center St. Louis Convention Piasa Land St. Louis - - Coroner St . Louis County St. Louis County- - Clippings St. Louis Courthouse St. Louis Day Care ee a/ 0 Poverty Program- -Day Care Centers Poverty Program- -Head Start Center Poverty Program--St. Louis Day Care St. Louis - -Dea Perea Project St. Louis--Downtown St . Louis - -East - West Gateway Coordinating Council see East - West Gateway Coordinating Council St. Louis--Federal Building St. Louis-- Federal Building- -Clippings St . Louis --Gateway Army Ammunition St. Louis--Grants see Grants- - Entries Plant St. Louis--Health & Welfare Council see Health & Welfare Council of Greater St. Louia St. Louis--Highwaya See a/so Highway through St. Louis Martin Luther King Bridge St . Louis Housing see Housing- - St . Louis entries St. Louis Housing and Land Clearance Authroity ·ee Housing-- St. Louis and Land Clearance Authority St . Lou1s Housing Code Enforcement See Housing--St . Louis Code Enforcement St . Louis Housing Plan see Housing- -St . Louis Housing Plan St. Louis Human Development Corporation see Poverty Program--St . Louis Human Development Corp. ee a/ 0 Poverty Program- -Human Development Corp. St. Louis Independent Packing Company see Meat Inspection--St . Louis Independent Packing Company St. Louis- - Indian Cultural Center St. Louis--Jefferson National Expansion Memorial see Jefferson National Expansion Memorial St. Louis Jobs Corps Center see also Job Training Program Labor--Manpower Development and Training Poverty Program--St. Louis Jobs Corps Center St. Louis--Labor Relations--St. Louis Plan St. Louis Layoffs St. Louis Levee St. Louis- -Mansion House see Mansion House St. Louis--Mayor see also Poelker, John H St. Louis- -Mayor- -Clippings St. Louis--Mayor's Council on Youth St. Louis --Municipal Opera St . Louis--National Museum St. Louis--National Park System St . Louis- -Old Post Office Building see a/so St. Louis Federal Building St. Louis Ordinance Plant see a/so St. Louis--Gateway Army Ammunition St. Louis--Parks St . Louis--Police St . Louis--Politics see a/so Missouri- -State Politics Women in Politics St . Louis --Port St. Louis--Port--Clippings St. Louis - -Port--Correspondence St. Louis Post- -Dispatch see Pulitr;er, Joseph Newspaper St . Louis Post Office--Curtailment of Service St . Louis--Post Office Discontinuance of Railway Post Office Service St . Louis Post Office--Operations see also Grants--Post Office--St. Louis St. Louis Post Office--Postal Data Center St . Louis --Poverty Program see Poverty Program--St. Louis entries St. Louis Public Service Employment St . Louis Rat Control see also Rat Control St. Louis Regional Industrial Development Corp. St . Louis Residential Manpower Center St . Louis--Revenue Sharing ee a/so Reven'ue Sharing St. Louis- -Savings and Loan Associations ee a/ so Banking and Currency Committee-Savings and Loan St. Louis School Lists St. Louis School Tax St . Louis Senior Citizens see also Elderly St . Louis -- Small Business Administration see a/so Banking and Currency--Small Business Administration Poverty Program--St. Louis Small Business Development Center Small Business Administr:oL1on St. Louis--Solomon Rooks St. Louis--Symphony St. Louis- - Union Station St. Louis--U.S. Army St. Louis--U.S. Army--Automates Logistics Management Agency St. Louis--U.S. Army Aviation Research Center St. Louis--U.S. Army Aviation Systems Command St. Louis--U.S. Army Corps of Engineers see also Flood Control Flood Protection Project St. Louis U.S. Army Corps of Engineers-Correspondence St. Louis U.S. Army Corps of Engineers- Newsletters St. Louis--U.S. Army Corps of Engineers-North St. Louis Harbor St. Louis--U.S. Army Corps of Engineers-Installations St. Louis--U.S. Army Corps of Engineers-Material Command St. Louis- - U.S. Army Mobility Equipment Center St. Louis--U.S. Army Publications Center St. Louis--U.S. Army Reserve St. Louis- - U.S. Army Support Center St. Louis- - U.S. Department of Agriculture Laboratory St. Louis--U.S. Medical Laboratory St. Louis--U.S. Military Installations St. Louis--U.S. Military Personnel Record Center St. Louis Records Center St. Louis University St. Louis University--Agency for International Development St. Louis University--Commemorative Stamp St. Louis University--Fordyce Conference St. Louis University--Grants see Grants- -HEW- - St. Louis University see al 0 Grants--Many Sources--St. Louis University St. Louis University Medical School St. Louis University--One Hundred Fiftieth Anniverary of Its Founding- -Resolution St. Louis University - - Scott Shipe Case St. Louis Witholding Tax Sales Representative Protection Act Salk Vaccine see Health--Polio--Vaccine Savings and Loan Companies see Banking and Currency Committee-Savings and Loan ee a/so Housing--Savings and Loan Scholarships and Fellowships School Lunch Program see also Education--Food and Nutrition Program School Milk Program see a/so Education--Food and Nutrition School Students Schools Program see a/ o Education entries Schools--Chrisiian Brothers ROTC Program Schools--Clippings see also Education--Clippings Schools--College Debate Topic Schools--Exchange Students Schools- -Grants see Grants--HEW- -Public Schools--High School Debate Topic Schools- - Integration see Integration Schools--Junior College District School Prayer see Religion --Prayer in Schools Schoir Investigation Scullin Steel Sea Level Canal see P anama Canal--Sea Level Canal Study Commission Seals see Publications Request for Seal Plaques Secret Service Securities Securities and Exchange Commission Security Assistance and Arms Export Control Act Security Contract Guards Select Committee on Aging see also National Institute on Aging Older Americana Act Select Committee on Intelligence Select Committee to Investigate Assaainations Select Committee to Investigate Missing in Action see also Foreign Affairs--Vietnam Select Committee to Reform Congress see also Congress Selective Service Separation of Presidential Powers Series E Bonds Sesquicentennial of Missouri see Missouri--Sesquicentennial Seaton, Elizabeth see National Saint Elizabeth Seton Day Seven Day War see Foreign Affairs--Israel-Arab War Sex Education see also Birth Control Family Planning Illegitimacy Population Growth Shoe Imports Shoe Workers Silver . see Banking and Currency Committee- Silver Situs Picketing Against Situs Picketing For "Slug" Law see a/so Banking and Currency Coins Small Boat Owners see a/ so Boats Small Business Administration . see also Banking and Currency ~ommlttee-Small Buamess National Federation of Independent Business Poverty Program--St. Louis Small Business Devl. Center St. Louis- -Small Busm h Administration Smnll Businese Growth and Job Creation Act Smithsonian Snoapers Sonp see Food and Drug Admini1tration--Soap Soccer Team Social & Rehabilitation Services Social Security--ADC Social Security--Amendments Social Security--Benefits at Age 72 Social Security--Deduction for Education Social Security--Dis bility Social Security--Divorced Widows Social Security--Earning Limitations Social Security- - Equipment Rental & Purchase Social Security--General Social Security- - Health Insurance Social Security--Hospitallnaurance see also Social Security--Medicaid Social Security- - Include Qualified Drugs Social Security- - Increased Benefits Social Security-- Derr--Milla Social Security- -King/ Anderson Social Security- - Legislation Social Security Legislation--ADC Social Security-- Limitations on Earnings Social Security--Material and Reports Social Security--Medicaid see also Socinl Security- - Hospital Insurance Social Security--Medicare Social Security- - Medicare- -Clippings Social Security- -Medicare- -Coverage of Cancer Test Social Security- - Medicare for Physicians Social Security--Medicare-- Independent Laboratoriea Social Security- - Medicare- -Newaletter from HEW Social Security- - Medicare--Nursing Homes see a/so Nursing Homes Social Security--Medic re--Optometric and Medical Vision Care Soci al Security- -Medicare- -Profeseional Standards Review Organization Social Security- -Medicare- - Prescription Drugs Social Security--Medicare Reform Act Social Security- -Miniaters Social Security--Old Age Assistance Social Security--Old Age Insurance Social Security--Petitions Social Security Programs Social Security -- Proof of Age Social Security--Public As1istance see a/so Welfare Social Security --Reader'• Digest Soci al Security --Reducing Age Limit Social Security--Retirement at 62 Social Security--Supplementary Benefits Social Security--Widow'a Benefit• Social Service Regulations Soft Drink lnduatry Solar Energy Information Solar Heating Legislation Solid Waate Pollution see also Air Pollution Soula.rd Area Pollution Recycling Wute Water Pollution ee Housing-- Soulard Area South St. Louis see Housing--South Broadway see a/so Housing--South Side Soviet Jews--Foreign Affairs Soviet Union see Foreign Affairs--Soviet Union Space--Apollo 11 Space- - Apollo 13 Space Program see a/so Aeronautics and Space National Aeronautics and Space Act Space Program-- Russian Spanish Pavilion Special Prosecutor Spending Ceiling Sports Stamps ee Commemorative Stamps Postage lncreaae Postal Boutique Stamps, Food see Food Stamp Plan State, Dept. of ee also Kissinger, Henry State Department Authorization Bill State Dept.--Danny the Red's . . . Stockpile Strikes see also Housing-- Public Housing- - Rent Stip Mining Strontium 90 Strikes Labor Entries Postal Strike Railroad Brotherhoods and Organizations Railroads- -Strikes Taft-Hartley Billa see Drugs, Strontium 90 Student Loans see Education -- College Loan Program see a/ so Education- -Student Aid Bill Student Militants see Militants Subsidy Programs Sugar Act Sullivan, Leonor K.--Appointmenta Sullivan, Leonor K.--Billa Sullivan, Leonor K.--Conferee Appointments Sullivan, Leonor K.--Congressional Record Items Sullivan, Leonor K.- -Dura Letter Sullivan, Leonor K.--Election Material Sullivan, Leonor K.--House Subcommittees Sullivan, Leonor K.--lnterviews Sullivan, Leonor K.--lnvitations see Invitations Sullivan, Leonor K. - -Letters Sent in Multiple Copies Sullivan, Leonor K. --Letters to Other Members of Congress Sullivan, Leonor K.-- &en Sullivan, Leonor K.--Oftlce AdmiaiHra&ioa Sulliv n, Leonor K.--P Req t SullivM, Leonor K - -Por&raU Sullivan, Leonor K.- -P ~ Jg(IU see also Praa and • lleponen PreMCommeau Radio aad Televiaion --P . a.~a . aad lntervie a Sulliv n, Leonor K.--P.- Rele UNil-66 Sullivan, Leonor K.--P.- lUI•- Ul67-72 Sullivan, Leonor K -- P.- 1•- UI73- Sullivan, Leonor K.--PubllcitJ see also e • Rele --Radio Radio Sullivan, Leonor K.--Qu.UOnn.U. Sullivan, Leonor K.--R.edpee see Recipea Sulliv n, Leonor K.--Rerernb see Referrala Sullivan, Leonor K.--Scholanhip A arcl Sullivan, Leonor K.--Reaction ~ Presidential St tementa see a/ 0 Praa Commenta Preu and e 1 Reporters Sulhv n, Leonor K --Speech Inform tion R.equ . t Sullivan, Leonor K --Speech., Sulliv n, Leonor K --Speech., on the Floor ol the House Sullivan, Leonor K.--Speech., to Outaide Groupa Sullivan, Leonor K.--Tatimony Before CommiuSuJUvan, Leonor K.--Tributa Upon Retirement Sullivan, Leonor K.--Votinc Record See a/ 0 Foreicn Afrain--Vietnam- -Mn. Sullivan'• Voting Record Sullivllll, Leonor K.--Workinc Woman of the Year Award Summer Youth Employment and Recre tton see a/ 0 Poverty Program--National Summer Sun T n Lotion Youth Procram ee Food and Drug Adminiatration--Sun Sunshine Bill Tan Lotion See a/so Freedom of Information Act Superaonic Tranaport Supplemental Security Income Supreme Court see a/ o Impeachment (J uatice Douglu) Judiciary Surplua Property Swiss B nk Account. .see Banking and Currency- -Swiu Bank Account• Synthettc Fuela Loan Guarantee Bill Tart-Hartly Ad Taft -Hartly Billa see Strikea Tariffa Tariffa -- Canadian Tar~ffa -- Koken Comp niea, Inc. Tanff•--Reciprocal Trade Tariffa- -Shoe Import. Tariffa- -Shoe lmporta Congreaaion I Record lnHrtl and Background M teriala Tax IUbate ee a/ o Internal Revenue Service Tax a.duction Ad Tax Reform T:.x nerorm Correapondence Tax IUform- -Material Tax Study Legialation Taxa- -Airline Taxa--Airport Taxa--City Eaminp Tax Taxa- -Clippinp Taxa--Deduction for Dependent. Taxa--Deduction of Education of Dependents .)ee a/so Education--Tax Deduction for Education Taxea--Dividenda Taxea--Eatate Taxea--Exciae Taxea--Excise Can Taxes-- Excise Handbap Taxea- -Exise- -Truckl Taxe•·-Gu Taxea--Gu and Oil Depletion TI\Xet--Home Owners Tax Deductions Taxn-- lncome Taxa- -Single Persons Taxes-- Income Taxa Taxes-- Inspection of Tax Returns Taxes- - lnve•tment Tax Credit Taxn- -Mi•cellaneou• Taxes- -Municipal Bonds Taxes--Prnidential Election Campaign Taxn- -Self-Employed Person Taxe1--State Taxation of Interstate Commerce Taxes- -Surtax Taxes--Transportation of Household Goods Teachera Corps ee Education--Teacher'• Corps Teacher '• Ret irement Teamsters Teamsters- -Monitorship Teamsters - -Strike• Technology Asseament Office see a/ SO Office of Technology Aueasment Telecommunication• ee a/ o Communication• Telephone Rates Television ee a/ so Communications Equal Time Federal Communications Commi1sion Freedom of the Preas Televiaion and Radio Programa Television--CBS-- Selling of the Pentagon Televi1ion-- Education Television --Educational Television--KTVI Ten Park• Improvement Auociation see Housing--Ten Park Improvement Aaaociation Tennants' Organization see Hou•ing-- National Tennenta' Organization Thailidomide see Drugs, Thalidomide Thanks Youa Thomas J efreraon Day Till, Emmet Timber Supply see a/ o Lumber Lumber PreaervaLion Le(ialalion Total Boy Project see Poverty Program--Total Boy Program Tourism-- Legislation Town House Project see Housing- -T own Houae Project-Clipping Toxic Substances Control Act Trade--Imports and Exports ee a/ 0 Fair Trade Trade Bill International Trade Commiuion Oillmporta Trade- - Import/Export Clippinp Trade--Import/Export Rhodnian Chrome Trade Reform Act Trade--Shoe Import Trading Stamps Transit- - Bi- State ee a/ SO Bus Services Transit- - Bi-State Meeting Transit --Mass Transit- -Maaa- - St. Louis Transition Allowance for Rich rd Nixon see Nixon, Rich rd M.--Transition Allowance Transportation see a/so Grants-- Dept. of Transportation-St. Louis Transportation, Dept. of-- Proposed Regulations see a/ 0 Har;ardous Material Transportation Trust Fund Transportation- -Miscellaneous Treasury Treasury Bonds Troublemakers Truck Bill Trout See Food and Drug Administration--Trout Truman , Harry S.--Medal of Honor Truman, Harry S.--Memorial Scholarship Fund Turkey See Foreign Affai rs--T urkey Turnkey Projects see Housing--Cabanne T urnkey Project see also Housing--Forest Park Blvd Turnkey Project Housing--Turnkey Projects Twelfth and Park Area see Housing--Twel fth and P ark Unemployment 1.'1! also Employment Health Insurance for the Unemployed Learning Business Centers • Unemployment Compenaation see a[ 0 Emerg ncy Unemployment Compenaation Aesistance Unemployment Compensation Form Letter and Material Unidentified Flyinc Objecta Union Electric Company See a/ 0 Lifeline Rate Act Union - Sarah Area see Housing- - Union- Sarah Unions ~l'e a/so Labor Entriee United Nations Poetal Union Recognition Railroad Brotherhoods and Organisations Railroads- -Strikes Railroads--Shopcrart Unions see Foreign Affairs- - United Nations United Nations--Reception United States- - Dept. of Agriculture U.S. Forces Oversea& United States Information Agency United Steel Workers of America University of Missouri see Missouri- - University Upper Missippi River Baain Commission see a/so Conservation--Upper Missisaippi River National Recreation Area Flood Control Upward Bound see Education-- Upward Bound Urban Affairs see a/ 0 City Planning Revenue Sharing Urban Coalition Urban League Training Program Urban Renewal ee Housing- -Urban Renewal see also Housing--Rehabilitation USS Pueblo see Foreign Affairs--Pueblo Utility Regulation ee Lifeline Rate Act Utility Loans see Emergency Utility Loans VISTA see Poverty Program--VISTA Vaporir;ers see Food and Drug Administration-- Vaporir;ers Varnish see Food and Drug Administration--Varnish Vaughn Area see Housing--Vaughn Area Veteran 's Administration see also Jewish War Vetrans Veterans ' Administration- - St. Louis Regional Office Veterans ' Benefits--Miscellaneous Veterans' Day Veterans' Employment Legislation Veterans--GI Bill Veterans --General Veterans Hospitals Veterans Hospitals --Closing Veterans Hospital-- Cochran Veterans Hospital- - Cochran--Admissions Waiting List Veterans Hospitals- - Consolidation of Outpatient Clinic Veterans of Foreign Wars see Veterans ' Organisations Veterans Hospitala--Harry S. Truman Memorial Hospital Veterans Hospitals--Jefferson Barracks Veterans Hospitala--Jeffenon Barracks- Admissions Waiting List Ve ~erana Hoapitala- -Miacellaneoua Veterana' Hoapitali- - Nunin& Horne Care for V eteran• Veterans--St. Louia Conaolidation Veterana' - - Houainc Ve ~erans '-- Lecialation Veteran• - -Military Retirement Veterans-- National Cemeteriea see also Jefferaon Barraclu Veterans-- National Life lnauranee Service Veterans Orcanir.ationa Veterana Penaiona Veterans P naiona- - Miacellaneoua Veterans Pensiona- -Spaniah American War Widowa Veterans Penaiona--War Widowa Veterans Pensiona- -World War I Vice President see a/ SO Agnew, Spiro Nixon, Richard M. Vietnam see Foreign Affain- -Vietnam Vietnam--Miaaing in Action Vietnam--Prisionen of War see also Foreign Mfain Villa de Ville see Houaing-- Villa de Ville Vitamin Supplement• see Food and Drug Adminiatration -- Vitamin Supplement• Vocational Education see also Education--Residential Vocational Education Education- - Vocational Education Vocational Rehabilitation Voter Registration see also Election Reform--Post Card Voters Registration Federal Voting Assistance Program See also League of Women Voters Voting Age Voting Rights Act see also Election Reform Wage and Price Controls see also Minimun Wage Price Freer:e War Claims War Claims--Foreign War Insurance War Powers War Protest see Foreign Mfain--Vietnam see a/so F oreign Affaira--Cambodia Washington D.C. see District of Columbia Washington University see also Grants--HEW--Washington D.C. Grants--Many Sources-Washington University Washington University Medical Center see Housing--Washington University Medical Center Water see also Food and Drug Administration -Water Water Diveraion of the Misaiuippi River to Texas Water Flouridation :,ee Flouridation of Water Water Pollution see a/so Air Pollution Pollution Solid Waste Pollution Water Pollution Laboratory Water Resources Planning Act see Conservation--Water Resources Water,ate ee at so Nixon, Richard M Waterway User Changes see a/so Lock and Dam 26 Weapons see Arms Control see also Disarmament Nerve Gas Nuclear Weapons Nuclear Weapons--Testing Weather Weatherir.ation Assistance Act Welfare see also F amily Assistance Health and Welfare Council of Greater St . Louis Welfare-- Clippings ee also Family Assistance Material and Clippings Welfare--Family Support see also Family Assistance Act Wellston, MO see Housing--Wellston West End see Housing- -West End West Pine Apartments see Housing--West Pine Apartments Wheat Research and Promotion White House Conference on Aging White House Conference on Children White House Releases by President Wild Rivers Bill see Conservation--Wild Riven Wilderness see Conservation-- Wilderness Wire T apping and Bugging see also Internal Security Women see also Advisory Council on Women's Educational Programs Anthony, Susan B. Insurance Coverage for Women League of Women Voters Minority Groups National Center for Women Women--Clippings Women- - Commissions on the Status of Women Women- -Employment Opportunities see also Equal Employment Equal Pay for Equal Work Women--Equal Rights Amendment see also Civil Rights--Equality for Women Women--Equal Rights--Clippings Women- - Equal Rights- - Congressional Material Women- - Equal Rights--Correspondence Women - - Equal Rights--Material Women--Higher Education Women in Military Academies Women in Politics see also Campaign Conference for Democn&ic Women Miaouri- -Sta&e Poli\ica St. Louia--Politica Women in Politica--Requ.ta for Jnfonnation Women in Public Service Women--Jnaurance see Jnaurance Covenc• for Women Women--International Women'• Year Women--Media Editorall and Repli• Women--Neweletten Women--Orcaniaatione see also Bueineu and Prof-ional Women'• Club Council of Catholic Women Workmen'• Compeneation Lawa see Labor- - Workmen'• Compeneation Lawa World Affaire Council World Federation Y oun1 Adult Coneervation Corpe Youn, American• for Freedom Youn& Democrat. of St. Louia Youth Affain see a/so Metropolitan Youth Commiuion Youth Appreciation Week Youth Camp Safety Act Youth Opportunity Unlimited 220-002738559 sro
Mipres is a web application created in December 2016 by the Ministry of Health and Social Protection of Colombia to authorize the prescription of biomedical technologies not included in the Health Benefits Plan such as: medicines, devices, procedures, services, and nutritional products. Mipres emerges as the solution both of these technologies access restrictions and the uncontrollable increase in health spending. The thesis developed a critical analysis grounded on Critical Health Information Systems perspectives and Science and Technology Studies, which problematizes the idea that Mipres is an indisputable 'solution' and unfortunately it may be producing an important series of problems. I conducted a multi-sited device ethnography of the Mipres as a socio-material artifact from a critical reading in public health. This hoped to serve as a reflection and alternative way to uncritical digitizing phenomena and their effects on human health and life. Until December 2019, more than 15 million prescriptions have been made by Mipres to more than ten million people affiliated to the contributory regime, with an estimated cost that could mean between four and five billion pesos in recoveries for the State in 2020. Mipres has ended up becoming a window of opportunity for the Ministry of health to modify Colombia's information infrastructure, achieving the digital penetration of the government in the health care institutions (hospitals and insurance companies), through a certain kinds of algorithmic governance. Mipres emphasis has been on exercise a centralized and distant digital regulation in health based on data, believing that this would be part of the solution to the structural problems of the system and, incidentally, paving the way for the emergence of complex bureaucratic data-processes that transfer the financial, administrative and health pressure to the health-providing institutions (hospitals, clinics, outpatient and home services), disturbing the exercise of medical practice and the health of patients. Mipres became a digital platform that, due to the technological ingenuity of its design process, nurtured and amplified new financial responses, pressures from the biomedical industry, limited doctors' autonomy, etc. Mipres digital adjustments change Colombian health system step by step without transforming the structural conditions that perpetuate its financial emphasis and systematic violence against people, imposing new technological and data barriers to access and provision of health services that affected and endangered people's lives. ; Introducción: En esta tesis desarrollé un análisis crítico a los Sistemas de Información en Salud problematizando la idea de que éstos son las 'soluciones' a los más apremiantes problemas sanitarios en los modos de vida contemporáneos. Para esto, partí de una lectura crítica en salud pública de cara a las tecnologías de información, que espera servir como reflexión y vía alterna a los fenómenos digitalizadores acríticos y sus efectos sobre la salud y vida humanas. Durante un poco más de dos años elaboré una etnografía multisituada de un artefacto digital ensamblado en el marco del Sistema de Salud de Colombia para la 'protección' del derecho a la salud en su ámbito individual: el Mipres. El Mipres es un aplicativo web creado en diciembre de 2016 por el Ministerio de Salud y Protección Social para autorizar la prescripción (formulación) a los pacientes por parte de los médicos tratantes de tecnologías: medicamentos, dispositivos, procedimientos, servicios y productos nutricionales no incluidos en el Plan de Beneficios en Salud –PBS- con cargo a la Unidad de Pago por Capitación; y que, para ser reintegrados esos dineros a las Entidades Promotoras de Salud –EPS-, esto es, a las aseguradoras de estos pacientes, deben ser recobrados al Estado a través de la Administradora de los Recursos en Salud, la ADRES. Mipres surge, entonces, como respuesta a los mandatos de la Corte Constitucional de Colombia que, apoyada en la jurisprudencia nacional e internacional, reglamenta en la Ley Estatutaria en Salud –LES 1751 de 2015- la salud como un derecho humano fundamental en el Estado colombiano y, requiere a las autoridades competentes, entre otros asuntos, modificar el proceso de provisión de las tecnologías de alto costo que había sido, hasta la fecha, una de las barreras insalvables para la garantía del derecho a la salud de los colombianos. En ese orden de ideas y teniendo en mente los cambios necesarios en el proceso para el acceso a las tecnologías de alto costo ordenados por la Corte Constitucional de Colombia, el Ministerio de Salud empieza una serie de modificaciones al sistema de salud en lógica gradualista, con la finalidad de resolver, además, dos problemas emergentes de la configuración mercantil del sistema (sin cambiar su estructura, por supuesto). El primero responde a la profunda asimetría de información entre los operadores (prestadores de servicios y aseguradoras) y el Gobierno, donde este último, desde la creación del Sistema General de Seguridad Social en Salud en 1993, sólo obtiene aquellos datos que son enviados por los primeros a través de reportes obligatorios específicos produciendo una infraestructura de información retrospectiva, desactualizada y fragmentada, que permite una comprensión, y por extensión podría pensarse que, una regulación similar del sistema de salud. El segundo, la necesidad de modificar y regular los procesos y acuerdos relacionados con la compra y el pago de los servicios y tecnologías de alto costo y/o complejidad clínica necesarios para la atención de los pacientes, en los cuales se había identificado corrupción financiera, mala administración y/o sobrecostos; por lo que se hacía mandatorio resolver, ante todo, la brecha de información. Estas situaciones constituyeron el caldo de cultivo adecuado para la génesis del Mipres, como un sistema de prescripción electrónica centralizado en el Ministerio de Salud y Protección Social, en el cual la/el médico tratante o profesional de la salud prescriptor debe realizar su formulación electrónica de aquellas tecnologías y servicios de alto costo (casi siempre) para ser proveídas por los operadores del sistema a los pacientes. Así, de acuerdo con la norma, los pacientes deben ser direccionados por la Aseguradora (Entidad Promotora de Salud –EPS-) a su red de prestación de servicios en unos tiempos específicos, 'garantizando' el acceso a lo prescrito por el médico y 'eliminando' las barreras en la prescripción. En el ámbito hospitalario, si el paciente está hospitalizado, la tecnología debe ser provista sin dilaciones para garantizar la continuidad del tratamiento y, en el caso de algunas tecnologías específicas, se debe someter ante una Junta de profesionales que evalúa la pertinencia clínica de esa prescripción. Todos esos trámites se registran en el Mipres y viajan desde el lugar y momento de la atención hacia las bodegas de datos del Ministerio de Salud, que los dispone en un servicio web de consulta para que las mismas instituciones de salud, las EPS y la ADRES puedan descargarlos y tener el control del proceso de provisión, cobro y recobro. Esta es la apuesta digital del Mipres y lo que se conoce hoy, grosso modo. Objeto de la Tesis: Considerando estos antecedentes, en el país se han realizado un par de aproximaciones al Mipres que lo asumen como una herramienta tecnológica más del ecosistema digital del país que termina invisibilizándolo en los análisis a los problemas estructurales del sistema de salud. De hecho, casi cualquier artefacto tecnológico del país en el sector salud y en la mayoría de los sectores sociales ha sido simplemente 'cajanegrizado' , esto es, dado por sentado, ignorado, invisibilizado. Por eso, con esta tesis decido aproximarme al fenómeno del Mipres acudiendo a una apuesta un poco más 'indisciplinada' teóricamente que invitó a los Estudios sociales de ciencia y tecnología, a la literatura sobre sistemas de información -con un espacial énfasis en la teoría del ensamblado como herramienta conceptual y metodológica para armar el espacio del problema/solución-; acompañado, en todo momento, de una lectura del fenómeno desde la medicamentalización de la vida en clave de salud pública. Quiere decir esto que, estudié el Mipres no como un simple artefacto tecnológico; sino y principalmente, como un heterogéneo ensamblado sociomaterial de cuerpos, objetos y espacios físicos y virtuales que constituye unas formas particulares, situadas, múltiples y fluidas de sistema de salud, derecho a la salud y de sistemas de información en salud como soluciones y soporte de gestión en Colombia. Métodos: Para esto conduje una etnografía multisituada de seguimiento a un artefacto, esto es, un shadowing del dispositivo Mipres donde compilé y analicé cuatro fuentes de información en relación con el proceso de ideación, adopción e implementación del mismo en instituciones de salud de Colombia del régimen contributivo (donde empezó su operación en diciembre de 2016). La información se obtuvo, entonces, a través de 40 entrevistas semiestructuradas; 63 horas de observación etnográfica en instituciones de salud; una etnografía digital mediante el seguimiento, captación y análisis de contenido relacionado con Mipres en redes sociales colombianas en español durante 2017 y 2018 y la obtención de 110 documentos relacionados; complementado con una exploración descriptiva de los datos de Mipres disponibles en el repositorio de información del Ministerio de Salud para el periodo comprendido entre diciembre de 2016 a diciembre de 2019. Resultados: A grandes rasgos encontré que, a diciembre de 2019 se habían realizado más de 15 millones de prescripciones por Mipres a más de diez millones de personas afiliadas al régimen contributivo, con un costo estimado que podría significarle al Estado entre cuatro y cinco billones de pesos en recobros en el 2020 . Durante su desarrollo e implementación, Mipres ha terminado convirtiéndose en una ventana de oportunidad para que el Ministerio modifiqué gran parte de su infraestructura de información, digitalizando nuevos procesos, actualizando otros y logrando el despliegue de una robusta plataforma de penetración del Gobierno en las instituciones del sistema (hospitales y aseguradoras), a través de lo digital, desde una apuesta de gobernanza algorítmica que no se ve aún muy clara en sus funcionarios y parece más un producto incidental. Así, esta presencia digital del Estado en las organizaciones debería ser loable y no problemática, de no ser porque el Gobierno se comporta como una 'gran aseguradora' que aplica reglas financieras y de contención de costos, reordenando el sistema de salud e incentivando lógicas de auditoría a los servicios y tecnologías, no por su efectividad sino por su impacto económico, desde esquemas que corresponden más a un gobierno corporativo que a un gobierno de lo público por la salud pública. Además, el énfasis del Mipres se ha concentrado en ejercer una centralizada y distante regulación digital en salud basada en datos, creyendo que esta sería parte de la solución a los problemas estructurales del sistema y, de paso, abonando el terreno para el surgimiento de complejos procesos burocráticos datificados que trasladan la presión financiera, administrativa y sanitaria, cada vez más hacia las instituciones prestadoras de salud (hospitales, clínicas, servicios ambulatorios y domiciliarios) perturbando el ejercicio de la práctica médica y la salud de los pacientes. El efecto de esta presión en las EPS no se pudo conocer con claridad, pero pareciera que opera con algunas particularidades por los resultados presentados más adelante. En ese sentido, estas lógicas de un gobierno por algoritmos sitúan la tenencia de datos en el centro de la preocupación estatal con la promesa de un sistema transparente y conectado; aunque, a la final, solo se logra un sistema de salud mercantil, utilitariamente conectado solo en su capa digital, con unos potentes efectos demarcadores de lo que puede y de cómo puede 'ser' algorítmicamente la atención sanitaria, la autonomía médica, el derecho a la salud y, por ende, la salud de los pacientes. Una salud que se 'hace' con y de datos (con marcado énfasis financiero) y con grandes implicaciones para la vida de los pacientes, los actores sanitarios y el funcionamiento del sistema. Así, Mipres se constituyó en una plataforma digital que, por la ingenuidad tecnológica con la que se diseñó y las vacuas promesas de un gobierno digital, nutre y amplifica nuevas respuestas mercantiles, presiones de la industria, reacciones de los médicos, límites del derecho a la salud y arreglos institucionales para que el sistema cambié paso a paso a través de su interfaz, sin transformar las condiciones estructurales que perpetúan su énfasis mercantil y la violencia sistemática hacia las personas, imponiendo nuevas barreras tecnológicas y datificadas de acceso y prestación de los servicios de salud que afectan o ponen en peligro la vida. Finalmente, Mipres es una solución que se ha convertido en todo un nuevo problema en el sistema de salud que la tesis espera 'descajanegrizar' . En ese sentido, el trabajo abre nuevas vías metodológicas, teóricas, ónticas y ético-prácticas sobre los procesos de inserción tecnológica en salud que superan la preocupación y pregunta inicial por los efectos sobre el sistema, la salud de las personas y las características habituales de una investigación salubrista con enfoque en los servicios y las tecnologías. Espera rescatar, controvertir y ayudar en la apertura y análisis de un artefacto -con su correspondiente infraestructura de información- en relación con el arreglo institucional en que se ensambla, de cara a los retos que significa para la salud pública como práctica social y campo del saber y para los salubristas y profesionales del sector, como quienes nos enfrentamos a estas nuevas configuraciones sanitarias más que humanas. ; Doctorado
