Biomedical subjects
Publications and source records attributed to C E Yesalis.
Anabolic-androgenic steroid hormones can enhance muscular strength and size in athletes. However, deleterious side effects include transient sterility, gynecomastia, acne, balding, psychological changes, and possibly increased risks of heart disease and liver tumors. These drugs are banned by most sports organizations.
Due to the lack of a standardized methodology to identify agriculturally related fatalities and the inaccuracy of data from death certificates, NSC's and NIOSH's estimates of the level of agriculturally related fatalities conflict, and the validity of both is subject to criticism. A follow-up survey with the next of kin of 107 potential agricultural fatalities, from a pool of 150 Pennsylvania cases, has been conducted. This paper details the methods and success in gaining supplemental information. Next of kin were generally willing to provide the information (67%), with both telephone (66%) and mail (68%) methods generating comparable levels of cooperation. The optimal time frame for finding current addresses and telephone numbers as well as for gaining cooperation appeared to be about 1 year after the fatality. However, a retrospective investigation of up to 3 years past the anniversary of the fatality produced an acceptable rate of cooperation. How the collected data compares with fatality data for agriculture published by NSC and N1OSH has been addressed in another paper.
Agricultural occupational fatalities in Pennsylvania for the years 1985-87 were followed up. Supplemental data concerning the occupation of the deceased and circumstances of the fatal accident were obtained from a family member. The number of fatalities designated as agriculturally and occupationally related by the National Traumatic Occupational Fatality (NTOF) system was compared with the number of fatalities identified by using alternative criteria for classification of agriculturally and occupationally related fatalities. There may be nearly a 30 percent error in the NTOF method resulting in a 20 percent undercount.
The psychological and behavioural effects of endogenous testosterone levels and anabolic-androgenic steroids in males have been investigated for over 50 years in both clinical and nonmedical uses, including the influence of anabolic-androgenic steroids on the nervous system and neuromuscular expression as a mechanism for behavioural and ergogenic effects. The relationship between moods, behaviour and endogenous plasma testosterone levels, as well as anabolic steroids and corticosteroid administration has been studied, including psychological dependence, withdrawal effects, and major methodological issues. While a relationship between endogenous testosterone levels and aggressive behaviour has been observed in various animal species, it is less consistent in humans. It can be concluded that, although the use of exogenous anabolic-androgenic steroids may have psychological and behavioural effects in some patients and athletes, the effects are variable, transient upon discontinuation of the drugs, and appear to be related to type (17 alpha-alkalated rather than 17 beta-esterified), but not dose, of anabolic-androgenic steroids administered. The roles of genetic factors, medical history, environmental and peer influences, and individual expectations are likewise unclear. In general, the evidence at present is limited and much additional research will be necessary for a complete understanding of this relationship.
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The number of foreign medical graduates (FMGs) as reported by the American Medical Association (AMA) has registered increases in recent years far exceeding the Department of Health and Human Services' (DHHS) published forecasts. The DHHS projections of new entrants have been derived from the number of postgraduate year-one positions filled by FMGs. Apparently, the FMG supply is augmented by physicians who enter by other paths. By using AMA data, this study takes the first step in attempting to shed light on the characteristics of these recent FMG additions. It then uses the DHHS model to forecast FMG supply based on a short-run continuation of the AMA-reported changes. The paper also forecasts FMG supply assuming that no new foreign national FMGs (FNFMGs) will enter the pool. The analysis suggests that some FNFMGs may be entering this country with visas granted to family members of United States citizens or permanent immigrants and then establishing practices without exiting directly from graduate medical education (GME). Further restrictions on GME participation for FMGs likely are not going to severely curtail FMG entrance into the medical care delivery system. Rather, they will likely restrict their entrance by way of the most traditional route.
Physical education programs represent an important gateway for encouraging young people to develop life-long exercise habits. In this study of middle school students (N = 603), attitudes toward physical education, knowledge about the benefits of exercise, and beliefs about one's abilities were assessed to determine their influence on exercise intent and current exercise behavior. As predicted, perceived benefits of exercise, current exercise behavior, attitudes toward physical education, self-esteem, and gender contributed significantly and independently to exercise intent (total variance explained = 37%). Exercise intent, outside sports activities, perceived benefits of exercise, gender, and attitudes toward physical education contributed significantly and independently to current exercise behavior (total variance explained = 27%). Programs that make attending physical education a pleasant experience and that explain specific benefits of exercise can influence exercise intent and can enhance students' sense of self-esteem, both of which may increase future exercise behavior.
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The use of anabolic steroids (AS) by adolescent males is argued to be more widespread than currently acknowledged. Although the long-term physiological and psychological ramifications of use are not well established, current research and anecdotal information suggest that there is reason for concern. In addition, very little is known about the attitudes and behaviors of these adolescent AS users. While the debate concerning the physiological versus the psychological dependence liability of various drugs continues to evolve, there seems to be a consensus that drug dependence is not a per se phenomenon and that the characteristics of dependence differ in accordance with the drug being used. The following article attempts to identify characteristics of the adolescent male AS user and suggests that AS use does have a dependence potential. The AS user population was found to be significantly different from nonusers in several areas such as self-perceptions of health and strength, interest in controlling AS use, and perceptions of peer AS use. The AS user group was also found to contain several subgroups (heavy users [greater than or equal to 5 cycles] versus other users, and those who initiated use prior to age sixteen who reported significantly different attitudes and/or behaviors. These differences suggest that prevention efforts will have to focus on different motivations for AS use.
The use of anabolic-androgenic steroids (AS) is perceived by the media, by segments of the sports medicine and athletic communities, and by the public to have grown to epidemic proportions. Unfortunately, the incidence and prevalence of AS use among elite, amateur, and recreational athletes is poorly documented. This study was designed to help identify AS use patterns among the male portion of the general adolescent population. The overall participation rate on a schoolwide basis was 68.7% and on an individual basis reached 50.3%. Participants in this investigation were 12th-grade male students (N = 3403) in 46 private and public high schools across the nation who completed a questionnaire that established current or previous use of AS as well as user and nonuser characteristics. Results indicate that 6.6% of 12th grade male students use or have used AS and that over two thirds of the user group initiated use when they were 16 years of age or younger. Approximately 21% of users reported that a health professional was their primary source. The evidence indicates that educational intervention strategies should begin as early as junior high school; the intervention should not be directed only toward those individuals who participate in school-based athletics.
From January 1 to April 30, 1986, all individuals entering the Iowa prison system were tested for antibody to the human immunodeficiency virus (HIV). Sera were collected on 363 newly incarcerated inmates, 389 inmates returning to prison, and 107 forensic psychiatric patients. Three of the 859 serum samples (0.3 per cent) tested during this study were reactive by ELISA (enzyme-linked immunosorbent assay) testing, but none reactive by the Western blot. Analysis for AIDS risk factors included a high prior IV-drug use rate (22-50 per cent) and a low admitted homosexuality rate in a predominantly young white male population.
This paper discusses the effects of powerful confounding events on the evaluation of an innovative health care payment program--an experiment with capitation payment for pharmacy services for Medicaid recipients. The research, conducted at the University of Iowa from 1975 to 1982, used a sophisticated experimental design; it was funded by the National Center for Health Services Research, the Health Care Financing Administration, and the State of Iowa, representing an investment of over two million dollars. Despite this investment, and the interest of many at the national level, events in the research environment during this period may well have distorted the conclusions of the research. Thus this case study highlights the problems of conducting evaluation research, particularly social experiments, on innovative programs perceived as threatening to the status quo.
Four areas of cost were analyzed in the expanded capitation drug program: total program costs; drug costs, escrow account distribution, and administrative costs. Total program costs were, on average, 9% higher under capitation. Drug costs, however, were 3% lower than under fee-for-service (FFS) reimbursement. This discrepancy is probably because pharmacists were not at financial risk under the program, the capitation rates were higher than intended, there were many emergency claims, and other aspects of the research environment. Although administrative costs were large, almost two thirds of the development cost was for one-time work, which could be transferred to another state at little or no expense. One third of the total administrative costs can be attributed to complying with regulations of the Health Care Financing Administration. Significant refinement of the present capitation model may be necessary before this financing innovation is used elsewhere. Modifications might include limiting the system to nursing home patients, placing pharmacists at partial financial risk, restricting participation to pharmacies that service a large number of Medicaid eligibles, and basing capitation rates in part on the drug use behavior of cash-paying patients.
Results of a two-county pilot study in Iowa revealed that capitation may have significant advantages over fee-for-service (FFS) reimbursement in the Medicaid drug program. Consequently, the capitation program was expanded to 32 counties on April 1, 1981 and continued through December 31, 1981. Another 32 counties were used as part of a before:after/experimental:control design. Pharmacists were paid 80% of projected drug expenditures in advance based on the types of Medicaid eligibles who chose them as their providers. The remaining 20% was withheld in an escrow account to be used for supplemental, emergency, and bonus payments. Pharmacists who participated in this experiment were guaranteed that their gross profits on Medicaid prescriptions would remain at least equal to what they would have been if they had remained under the current FFS payment system. Major differences in drug use levels and pharmacist dispensing behavior under capitation financing were observed in the pilot study. However, no such changes associated with payment type were noted in the expanded program. Relative to these findings, a discussion of pharmacist attitudes is presented.
Although pharmacy organizations have been instrumental in the movement to repeal antisubstitution laws, there is evidence that under the current fee-for-service system pharmacists have not exercised their newly obtained prerogatives freely. A previous study has demonstrated that paying pharmacists on a capitation basis for their Medicaid patients effects a highly significant increase in the rate of generic substitution. The present study was conducted to determine whether the pharmacists' newly acquired generic substitution habits "spill over" from Medicaid prescriptions as a result of capitation reimbursement. The results indicate that pharmacists who participated in the capitation experiment for the Medicaid drug program significantly increased their rate of generic substitution on non-Medicaid prescriptions. It was concluded that the same pharmacies that increased their substitution rate in the Medicaid program under capitation also increased their substitution rate on non-Medicaid prescriptions. Finally, generic substitutions in both the Medicaid and non-Medicaid studies generally involved the same labelers as well as drugs in the same therapeutic categories and with the same generic classifications.
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