Comparative costs to the Medicare program of seven prepaid group practices and controls

This research was conducted in order to compare costs to the Medicare program for providing health care service to old people enrolled in two forms of health delivery organization: open market and prepaid group practice (pgp). Two data sources were employed: cost data provided by the Social Security Administration for seven prepaid group practices in five SMSAs and northern California and interviews conducted with administrators of the prepaid groups to determine: organizational sponsorship, incentive structure, pattern of selectivity of patients, and resource availability. Major findings are: (1) Enrollees in prepaid groups incur higher physician costs. This includes services provided by practitioners in and outside the plans. (2) Overall, prepaid groups demonstrate savings to the Medicare program in provider-initiated services- in hospital care and extended care facility services, but not in home health care. (3) Reduced spending in the hospital component does not imply reduction in the extended care facility or home service. (4) Outpatient costs in the hospital are generally higher in the open market modes, probably because this mode of care is viewed as an alternative to physician visits. (5) The greatest cost savings to the Medicare program are demonstrated by groups which are relatively small, yet hospital-based.     

Personality stability and change over a 30-year period—middle age to old age.

A group of physically healthy and emotionally stable men were periodically evaluated over a 30-yr period from middle age (M age?=?49) to old age (M age of surviving group group?=?77). Complete MPPI test results were obtained for 71 men in this group over 4 testing periods spanning the 30-yr interval. The results indicate considerable stability in the group profile configurations and individual scale correlations over the 4 evaluation periods. The relative increase in score with age on Scale 1, Scale 2, and Scale 3 is consistent with previous findings with aged populations. The results of the present investigation suggest that the increase in mean score on the Depression scale may reflect realistic bodily concerns and the presence of actual physical illness. Overall, this group manifested personality strengths in middle age and continued to function reasonably well in old age. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of age on cardiovascular responses to adrenaline in man

Sensitivity to toxicants is a major criterion for selecting organisms for bioassay testing. If a sensitive species is also abundant and occupies a role as prey for many other species within a community, then the species become a valuable tool in environmental monitoring. These features apply to larval midge Chironomus petiolatus in freshwater environments of central Chile. The youngest larval instar is the most sensitive and presents the additional feature of lower survival within control arenas, making it more difficult to discern toxicant-related mortality from background mortality. In this work, we perform acute bioassays with the three larval stages of C. petiolatus and K2Cr2O7 as reference toxicant, with the goal of selecting a particular instar as the best bioassay tool using two criteria: sensitivity and background mortality. Sensitivity is evaluated through Monte Carlo estimation of LC50 and background mortality through bootstrap resampling, and a final Bioassay Performance Index as the product of LC50 and background mortality. For this task we developed a new computationally intensive statistical algorithm. Results show that the best bioassay tool is not the youngest and most sensitive instar but an intermediate one.     

Absence of neuropathic pelvic pain and favorable psychological profile in the surgical selection of patients with disabling interstitial cystitis

PURPOSE: We evaluated the results among patients with disabling interstitial cystitis treated by cystectomy, urethrectomy and creation of a continent colonic urinary reservoir (the Florida pouch). The value of psychological evaluation and pain localization techniques, as well as the use of a team approach in the evaluation of these patients were assessed. MATERIALS AND METHODS: The 20 women and 2 men who underwent surgery for disabling interstitial cystitis ranged from 31 to 75 years old (mean age 48). The duration of symptoms ranged from 2 to 14 years (mean 7). All patients had undergone multiple prior therapies, including vesical hydrodistension, instillations, laser treatments, and use of tranquilizers and a variety of pain medications. Patients underwent a clinical, cystoscopic (with bladder biopsies) and urodynamic evaluation as well as examination by a gynecologist with expertise in vaginal ultrasonography. The last 5 patients underwent psychological evaluation and pain localization techniques. RESULTS: Among the clinical parameters, the presence of a small capacity bladder with the patient under anesthesia (less than 400 cc) was associated with the best surgical results. Among 11 patients evaluated only clinically success was achieved in 64%, while all 5 (100%) who also underwent pain localization techniques and psychological evaluation had a successful outcome postoperatively. The overall surgical success rate in the 22 patients was 73%. Two patients undergoing psychological evaluation and pain localization techniques were not considered to be surgical candidates. Among 7 surgical failures 4 patients underwent postoperative psychological evaluation and pain localization techniques, and they would not have been considered candidates for surgery with the new parameters. CONCLUSIONS: A team approach is essential in the evaluation of these patients. Following the initial selection of patients who had a small bladder capacity while under anesthesia, psychological evaluation and pain localizing techniques may assist surgeons in selecting those who would benefit from a radical operation.     

Evaluating the motions of a semi-submersible platform with respect to human response

The objective of the study was to investigate histological changes in the endometrium in 20 volunteers treated with a low-dose, gestodene-containing triphasic oral contraceptive. Endometrial biopsy specimens were taken before, during a 6-month period of oral contraceptive use and in a post-treatment period. These specimens were evaluated using light microscopy, scanning and transmission electron microscopy. In addition, ultrasound examinations of the uterus, endometrial thickness and ovaries were performed. The low-dose, gestodene-containing triphasic oral contraceptive had no adverse effects on the endometrium (e.g. no proliferation, no polyps, no inflammatory processes), was well tolerated and showed a low side-effect profile. The inhibition of endometrial transformation was demonstrated both by endometrial morphology as well as by endometrial thickness, as measured by transvaginal ultrasound examination.     

Changes in abdominal muscle strength with respect to aging

It has been generally agreed that muscle strength decreases with advance of age in adulthood. In order to study the effect of aging in abdominal muscle strength, abdominal muscle strength, height, body weight and grip strength were measured in 144 healthy subjects aged from 20 to 88 years old. The abdominal muscle strength was measured using a grip dynamometer. Curve between aging and strength revealed that the abdominal muscle strength gradually decreased with aging during many decades, but rapidly decreased in the fifth decade and over in males and seventh decade and over in females. Among these data, significant correlations were observed between abdominal muscle strength and age (only in males; r = -0.64), abdominal muscle strength and grip strength (in males; r = 0.75, in females; r = 0.47), age and grip strength (in males; -0.72, in females; r = -0.60), and, age and height (in males; r = -0.55, in females; r = -0.46). The results suggest that decrease of abdominal muscle strength is due to aging, although the degree of the decrease is affected by the generation studied. The method to measure abdominal muscle strength originally developed by us is easy and useful to understand changes of age-related muscular strength.     

Memorizing while walking: Increase in dual-task costs from young adulthood to old age.

The dual task of memorizing word lists while walking was predicted to become more difficult with age because balance and gait are in greater need of "attentional resources." Forty-seven young (ages 20–30 years), 45 middle-aged (40–50), and 48 old (60–70) adults were trained to criterion in a mnemonic technique and instructed to walk quickly and accurately on 2 narrow tracks of different path complexity. Then, participants encoded the word lists while sitting, standing, or walking on either track; likewise, speed and accuracy of walking performance were assessed with and without concurrent memory encoding. Dual-task costs increased with age in both domains; relative to young adults, the effect size of the overall increase was 0.98 standard deviation units for middle-aged and 1.47 standard deviation units for old adults. It is argued that sensory and motor aspects of behavior are increasingly in need of cognitive control with advancing age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implicit learning of higher order sequences in middle age.

Previous studies have demonstrated age-related implicit learning of higher order sequences in coparisons of college-age and elderly adults (e.g., J. H. Howard & D. V. Howard, 1997). This study examined whether these age deficits begin in middle age. Results showed a reliable age-related deficit in pattern sensitivity in "older" compared with "younger" middle-aged people, and age reliably predicted sensitivity to the sequence by using both speed and accuracy measures. The results are consistent with an age-related decline in a generic cognitive resource as reflected in T. A. Salthouse's (1996) simultaneity mechanism of cognitive aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizophrenia with a favorable course and its significance in forensic psychiatry

A clinico-catamnestical study of 357 schizophrenic patients revealed a necessity for a more careful approach in considering schizophrenic patients responsible. clinically justified such qualifications appeared only in 30.4% (mainly in recurrent schizophrenia and less frequently in attack-like-progressive). A sluggish schizophreinic process irrespective of its rate is a contraindication to acknowledge the patients responsible.     

Factors associated with an atherogenic lipid profile in premenopausal women without clinical cardiovascular disease

BACKGROUND: To investigate different factors associated to a non desirable lipid profile in premenopausal women without cardiovascular disease. To determine the independent factors of lipid profile as a whole of the sample, for planning preventive studies. PATIENTS AND METHODS: We study (March 1994 to June 1996) premenopausal women with alcohol consumption less than 14 g/day and normal serum level of glucose. Group I: women with a non desirable lipid profile (total cholesterol [TCH, mg/dl]/high density lipoprotein cholesterol [HDL-C, mg/dl] > or = 5). Group II: with a desirable lipid profile (TCH/HDL-C < 5). The following factors were analyzed: age, body mass index (BMI), waist/hip ratio (W/H), systolic blood pressure (SBP, mmHg), fasting plasma insulin (fpI, microU/ml), cigarette smoke (CS) and presence of parents with history of non insulin dependent diabetes mellitus (NIDDM) or hypertension. Statistical methods: Mann-Whitney and Student statistics. Contingency-table analysis (chi 2 statistic). Pearson correlation and multiple linear regression. RESULTS: We analyzed 126 women (age = 30 +/- 8.2; 95% CI, 29-32; TCH = 197 +/- 36; 95% CI, 190-203 mg/dl), with 20 women (group I) and 106 (group II). Women from group I had higher values of W/H (0.83 +/- 0.04 vs 0.78 +/- 0.06; p < 0.001), BMI (29.9 +/- 9 vs 24.6 +/- 4.9; p < 0.03), fpI (12.9 +/- 10.4 vs 7.8 +/- 3.5; p < 0.05), SBP (125.9 vs 117; p < 0.02), as well as higher percentage of smokers (75 vs 40%; p < 0.01) and parents with NIDDM (60 vs 26%; p < 0.01) or hypertension (60 vs 49%; NS). No differences of age were detected (32 +/- 7.3 vs 30 +/- 8.3; NS). BMI (0.32; p < 0.01), W/H (0.50; p < 0.01), SBP (0.27; p < 0.01) and fpI (0.33; p < 0.01) were positively correlated with TCH/HDL-C ratio (n = 126). In multiple regression analysis (n = 126), W/H (regression coefficient = 6.1; 95% CI, 3.1-9.1), fpI (regression coefficient = 0.045; 95% CI, 0.018-0.072) and CS (regression coefficient = 0.5; 95% CI, 0.336-0.667) were the only independent predictors (p < 0.01) of the TCH/HDL-C ratio, controlling a 46% of the variance (R2 = 0.46). CONCLUSIONS: Our data indicates that central obesity, hyperinsulinemia and cigarette smoke are independently associated to a high risk cardiovascular lipid profile in premenopausal women without cardiovascular disease. This study suggests the importance of these factors in the management of early lipid control in these women.     

The direct and indirect costs of cardiovascular disease in South Africa in 1991

BACKGROUND: In South Africa, cardiovascular disease (CVD) is the leading cause of death among all population groups, other than blacks, among whom it ranks third. CVD therefore has a severe impact on the South African economy. OBJECTIVES: To ascertain the availability and quality of South African data on the cost of CVD and to estimate the impact of CVD on the South African economy during 1991. METHODS: The direct health care costs and the indirect costs related to loss of productivity were estimated. Where no direct or complete detailed South African data were available, projections were made based on reasonable assumptions of data and models developed in other countries; these were applied to the limited available South African data. The major disease outcomes considered for this cost estimation were: expenditure on ischaemic heart disease, cerebrovascular disease (stroke), venous thrombosis and embolism, and peripheral vascular diseases and related conditions. These diseases are responsible for the majority of fatal cases of CVD reported in South Africa. RESULTS: The estimated total cost of CVD in South Africa in 1991 was between R4.135 billion and R5.035 billion. This does not include the cost of rehabilitation and follow-up of CVD patients since the necessary data were not available to estimate it. About three-quarters of the direct health care costs were carried by the private sector. The direct health care costs were estimated to be approximately 42% of the total cost. The rest reflects the indirect cost of earnings foregone as a result of premature morbidity and mortality. CONCLUSION: To determine accurately the total economic burden of CVD on the South African economy, additional data will have to be collected. The estimated economic burden of CVD in South Africa clearly highlights the need for a broad-based population strategy, part of an overall national effort to prevent, diagnose and cost-effectively treat CVD.     

Short-term course of mental illness in middle age and late life

The heterogeneity in severe mental illnesses means that although some persons exhibit a chronic course in later life, others may recover for long periods or have episodes throughout the lifespan. The challenge to mental health providers is to identify those people most at risk for a chronic or relapsing course in later life. Data described here come from a prospective study of course and adjustment in severe mental illness for persons over age 40. The sample of 313 people, residing in the community and both in treatment and not in treatment, is unique. Six 8-month course patterns were identified; nearly one third of the participants had course patterns that were unstable, and one third were well across the 8 months. Older participants were more stable and less depressed, but otherwise were very similar to those in middle age. Demographic and history variables that predict long-term outcomes were not useful for predicting short-term recovery or relapse.     

Selenium speciation in human milk with special respect to quality control

Selenium- (SE) organo compounds of pooled human milk (7th-14th d after delivery) were separated by centrifugation and subsequent size-exclusion chromatography (SEC) as described in ref. (1). The SEC fractions were used for Se determinations by electrothermal vaporization inductively coupled plasma mass spectrometry (ETV-ICP-MS) in parallel to identification procedures of the organic ligands by two different capillary zone electrophoresis (CZE) methods. Further, the combination of isotachophoresis- (ITP) CZE with ETV-ICP-MS was used for final identifications. Mass balances were carried out at each analytical step for quality assurance. Reinjection experiments were performed to check the stability of Se-organo compounds during the analytical procedure. These quality-control experiments showed that no species transformations took place during the analytical procedure, and the Se species were native in human milk. The identification and quantification of organic ligands were clear and resulted in values of 2 (+/- 0.2) mg/L GSH/GSeH, 2 (+/- 0.22) mg/L cystamine/Se-cystamine, 4 (+/- 0.4) mg/L cystine/ Se-cystine, and 1 (+/- 0.18) mg/L methionine/Se-methionine. Unfortunately, a differentiation between sulfur (S) and Se analogs was not possible with the applied CE methods. The Se values per organic ligand were determined as 2.5 (+/- 0.23) mg/L associated with GSH (as GSeH), 3.1 (+/- 0.31) mg/L associated with cystamine (as Se-cystamine), 5.2 (+/- 0.4) mg/L associated with cystine (as Se-cystine), and 1 (+/- 0.1) mg/L associated with methionine (as Se-methionine).