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Biomedical subjects

F D Wolinsky

Publications and source records attributed to F D Wolinsky.

At least 91 records · Page 5Linked to original sources
PubMed1989

Clinical validation of a nutritional risk index.

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.

Aged↗
PubMed1989

The effect of teaching medical ethics on medical students' moral reasoning.

A study assessed the effect of incorporating medical ethics into the medical curriculum and the relative effects of two methods of implementing that curriculum, namely, lecture and case-study discussions. Results indicate a statistically significant increase (p less than or equal to .0001) in the level of moral reasoning of students exposed to the medical ethics course, regardless of format. Moreover, the unadjusted posttest scores indicated that the case-study method was significantly (p less than or equal to .03) more effective than the lecture method in increasing students' level of moral reasoning. When adjustment were made for the pretest scores, however, this difference was not statistically significant (p less than or equal to .18). Regression analysis by linear panel techniques revealed that age, gender, undergraduate grade-point average, and scores on the Medical College Admission Test were not related to the changes in moral-reasoning scores. All of the variance that could be explained was due to the students' being in one of the two experimental groups. In comparison with the control group, the change associated with each experimental format was statistically significant (lecture, p less than or equal to .004; case study, p less than or equal to .0001). Various explanations for these findings and their implications are given.

Control Groups↗
PubMed1989

A birth cohort analysis of dental contact among elderly Americans.

We applied standard cohort and multiple regression techniques to data on the dental utilization rates of 129,191 elderly individuals taken from the 1972, 1973, 1976, 1977, 1980, and 1981 Health Interview Surveys. The results indicate that the marked variation in dental contact rates is a reflection of cohort succession, and not a function of aging per se. Older cohorts having lower dental contact rates are being replaced by younger cohorts having higher dental contact rates. The dental contact rates of the individual birth cohorts themselves are quite stable over time. The results also indicate that economic barriers (especially liquid assets) have become more important than ever before, especially for the oldest-old. These findings have important implications for public policy about the oral health and health care of elderly Americans.

Age Factors↗
PubMed1989

Ethnic differences in the demand for physician and hospital utilization among older adults in major American cities: conspicuous evidence of considerable inequalities.

Reinterpreting ethnicity's role in the prevailing behavioral model of health services usage reveals among older Americans a patient pattern of inequality favoring the Anglo-American population. Demand for hospital and physicians' care among minority elderly is far more constrained and sensitive to health needs than it is for their Anglo-American counterparts. The findings underscore the importance of examining ethnic differences in determinants of health behavior as well as in health service utilization. Such results also appear to strengthen the grounds for developing new programs aimed at eliminating inequalities of access to health care that older members of minorities now face.

Black or African American↗
PubMed1989

Occupational prestige in the health care delivery system.

In this study ethnic and gender differences in occupational prestige of health care workers are used to measure the extent of inequality in the health care delivery systems of large SMSAs. Aggregate characteristics of these communities and of their health care delivery systems are used to explain variations in occupational prestige among health workers. The analysis is guided by Blau's macrostructural theory of intergroup relations. It employs 1980 U.S. Census information on the number of men, women, whites, blacks, and Hispanics in 19 health occupations in the 31 largest SMSAs. The results include a description of the size of the health care delivery systems and the proportions of women and minority workers in the systems, as well as the average occupational prestige of categories of respondents, their level of concentration among the occupations, and the relative presence of respondents in the occupations of physicians and registered nurses. Multivariate regression analysis is used to explore intergroup differences in occupational prestige. As deduced from Blau's theory, groups with greater relative occupational dispersion, greater political participation, advanced education, and higher sex ratios have greater relative occupational prestige in the health care delivery system.

Delivery of Health Care↗
PubMed1988

Explaining the declining rate of physician utilization among the oldest-old.

This article reports the results of a regression-based cohort analysis of physician utilization rates among eight 4-year cohorts of elderly Americans over an 8-year period. Data on 99,445 noninstitutionalized individuals aged 56-95 were taken from the pooled 1972-73, 1976-77, and 1980-81 Health Interview Surveys. The parameters of the behavioral model of health services utilization were then estimated separately for each cohort within each pooled survey. The partial unstandardized regression coefficients obtained were used to construct standard cohort tables, which were then visually and statistically compared to identify any changes due to aging, period, or cohort effects. The findings suggest that the declining rate of physician utilization among the oldest-old results from an accelerated decreased response to health-related limitations in activity. Six plausible explanations for this changing response are considered.

Aged↗
PubMed1988

The professional dominance perspective, revisited.

The autonomy of the medical profession, exemplified by its ability to direct the substance of its own work, is a central tenet of Freidson's professional dominance perspective. Critics of professional dominance argue that the autonomy of the profession has eroded because of the loss of its monopoly over medical knowledge and its diminishing authority over patients (deprofessionalization), or because of its loss of control over key occupational prerogatives (proletarianization). The professional dominance of medicine may, however, be more valuable to the profession's own neglect of its avowed public promise to regulate itself than to external forces resulting from changes in the health care delivery system.

Delivery of Health Care↗
PubMed1986

Widowhood, sex, labor force participation, and the use of physician services by elderly adults.

This paper investigated the relationships of widowhood, sex, and labor force participation with the use of ambulatory physician services by elderly adults. Data on 18,441 individuals aged 55 and over were taken from the 1978 Health Interview Survey. Hierarchical regression results indicated that although these three factors are related to physician utilization at the zero- and first-partial levels, only sex remained significant when their two- and three-way interactions and other variables from the behavioral model (including living arrangements) were introduced. This suggests that the effects of widowhood and labor force participation are spurious. Widows are simply more likely to live alone and are less likely to work than widowers; those who live alone and do not work are more likely to use health services (and more of them) than those who live with others and are gainfully employed.

Aged↗
PubMed1986

The use of proxies in health surveys. Substantive and policy implications.

It has traditionally been assumed that obtaining health and illness behavior data by proxy on household members who are not present during the actual interview presents no significant threats to the internal validity of subsequent analyses. Using data on the 78,439 adults interviewed in person or by proxy (about 37% of the total adult sample) as part of the 1978 Health Interview Survey, the authors examine whether the use of proxy respondents alters the results of empirical assessments of the behavioral model of health services utilization or the policy implications that can be derived from it. Two important findings emerge from these analyses. On the one hand, failing to consider explicitly the possibility of a proxy effect (i.e., including a proxy variable in the analyses) does not alter the effect parameters estimated for the behavioral model. On the other hand, failing to consider explicitly the effect of using proxies appears to underestimate slightly physician and hospital contact rates (by 4% and 2%, respectively), as well as the volume of physician utilization. The substantive and policy implications of these findings are discussed, as are two alternative explanations that suggest that proxy-respondents simply use fewer health services either because they are "too busy" or because they are in slightly better health.

Adult↗
PubMed1986

Further assessment of the reliability and validity of a Nutritional Risk Index: analysis of a three-wave panel study of elderly adults.

This paper reports on the further assessment of the reliability and validity of a short (16-item), portable method for assessing nutritional risk which is easily administered in the typical social survey setting. Data were obtained from a three-wave panel study of 401 randomly selected, noninstitutionalized elderly persons (age 65 and over) in St. Louis. Reliability was assessed by both internal consistency and test-retest methods. Reliability coefficients (internal consistency) of .603, .544, and .515 were obtained at T-1, T-2, and T-3, respectively. Cross-panel intercorrelations (test-retest) ranged between .67 and .71. Validity was assessed using factor analysis and various outcome measure comparisons for those at risk versus those not at risk. A five-factor orthogonally rotated solution explained 47.9 percent of the variance in the 16 items. Individuals with higher risk scores had significantly poorer health as measured by other standard indexes, and used significantly more health services than those with lower risk scores. These results underscore the potential of the Nutritional Risk Index (NRI) as a screening device for use among the elderly.

Activities of Daily Living↗
PubMed1985

Correlates of change in subjective well-being among the elderly.

This study examines two related issues concerning the subjective well-being of elderly adults: change over time and correlates of that change. Data come from a three-wave panel study of 401 elderly residents in St. Louis. Residualized change score regression analyses indicate: there is change in subjective well-being over 4-5 months and over 12 months; the 4-5 month and 12 month changes are remarkably similar; the effect of subjective well-being over time indicates regression to the mean; and, only socioeconomic status is a significant predictor of change in subjective well-being (net of the effects of subjective well-being itself). The implications of these results for our understanding of subjective well-being in the elderly are discussed, as are the policy implications of the positive effect of socioeconomic status on changes in the subjective well-being of the elderly.

Aged↗
PubMed1985

Veterans' and nonveterans' use of health services. A comparative analysis.

This study compares the use of health services by veterans with that by nonveterans; compares the use of health services by veterans from different service cohorts with each other; and examines the correlates of veterans' use of the VA health care delivery system. After adjusting for differences in the predisposing, enabling, and need characteristics, there were virtually no meaningful differences in the use of health services between veterans and nonveterans. This suggests that health care planning within the VA can proceed similarly to health care planning for the civilian population, albeit taking into consideration the significant difference in the sex distribution between the two populations. Virtually no meaningful or consistent veteran cohort effects on the use of health services were found. This suggests that health care planning within the VA may proceed without regard to changes in the nature of the veteran cohort structure. Finally, although there was a strong and obvious effect of service-connected disabilities (high-priority eligibility due to health status) on the use of the VA health care delivery system for veterans, there was no effect of being 65 years of age and older (high-priority eligibility due to age) on the use of the VA. Aside from service-connected disabilities, limited access to other health care delivery systems was the major factor behind the demand for VA care.

Aged↗