Biomedical subjects

J Bernstein

Publications and source records attributed to J Bernstein.

367 records · Page 21Linked to original sources

PubMedDate not supplied

Paying surgeons less can cost more.

Fees for physicians' services represent only a small component of total health care costs. Complementary costs (particularly hospital charges for surgical treatment) are a far more substantial portion of total costs, and may be 10 times larger than surgical fees. Because surgeons have considerable influence over the demand for surgery, and because the complementary costs do not cost the surgeon at all, marginally lowering surgeons' fees can, paradoxically, increase total health care costs, even if net payments to surgeons go down. This is because surgeons may respond to a decrease in their per-case reimbursements by performing more surgery to maintain their status-quo income. This phenomenon is known as physician income homeostasis. A health care payer may benefit by paying surgeons more to perform tasks that do not have high associated costs, such as outpatient nonoperative care, research, or teaching. In this fashion, faced with declining surgical fees, the surgeon will maintain his or her income not by performing more expensive surgery, but rather by doing more nonoperative work.

Cost Control↗

PubMedDate not supplied

The hypothermic action of epidural and subarachnoid morphine in parturients.

Sublingual body temperatures were measured before and at 0.5, 1, 2, 3, 4, 8, 12, and 24 hours after administration of epidural or subarachnoid morphine in four groups of patients (n = 15 in each group) undergoing cesarean delivery with regional anesthesia. All patients were acutely hydrated with 1200 ml warmed lactated Ringer's solution. Group 1 received 5 mg epidural morphine; Group 2, 5 ml epidural saline; Group 3, 0.5 mg subarachnoid morphine, and Group 4, 0.5 ml subarachnoid saline. The results were expressed as means +/- SEM and analyzed using analysis of variance at p less than 0.05. Body temperature decreased significantly in all the four groups after anesthesia. The maximum decreases in Groups 1, 2, 3, and 4, respectively, were 0.95 +/- 0.1, 0.9 +/- 0.1, 1.4 +/- 0.2, and 0.8 +/- 0.13 degrees C and occurred at 0.5, 1, 2, and 1 hour, respectively. The decrease was greater in the subarachnoid morphine group than in the other groups (p less than 0.03). At any of the measurement periods, the temperatures in the two epidural groups did not differ from each other. However, the temperature in the subarachnoid morphine group remained significantly lower than the corresponding temperature in the control group for up to 24 hours. It is concluded that subarachnoid morphine intensifies the hypothermic action of spinal anesthesia in parturients.

Adult↗

PubMedDate not supplied

A familial syndrome of growth retardation, severe Fanconi-type renal disease and glomerular changes--a new entity?

Two young siblings had a syndrome of growth retardation, severe rickets, anemia, renal insufficiency, and renal tubular dysfunction, the last including acidosis, aminoaciduria, and polyuria. There was moderate psychomotor developmental delay. Neither child had cystinosis. Renal biopsy in the older child revealed severe glomerular abnormalities, with capillary wall thickening reminiscent of the hemolytic-uremic syndrome. The proximal convoluted tubules were lined with short, cuboidal cells containing mildly abnormal mitochondria. There was also thinning of brush border microvilli and basolateral infoldings, perhaps as the result of regressive changes, and interstitial fibrous tissue was moderately increased. The etiology of the tubular and glomerular changes is uncertain. We believe these patients represent a previously unreported hereditary syndrome sharing certain clinical features with severe nephropathic cystinosis.

Child, Preschool↗

PubMedDate not supplied

Mean and instantaneous expiratory flows, FVC and FEV1: prediction equations from a probability sample of Michigan, a large industrial state.

Prediction equations for FVC, FEV1, FEV1/FVC, FEF25-75%, FEF75-85%, FEF50% and FEF75% were modelled for 396 normal non-obese adult lifetime nonsmokers and continuing smokers. Subjects came from a random cross-section of the white population of Michigan, a large industrial state. In both sexes, linear models utilizing age and height were appropriate for FVC, FEV1/FVC and FEV1; flows were better described by logarithmic transformation. These regression equations provided similar predicted values for FVC and FEV1 in nonsmokers to other models in wide use. Previous equations for instantaneous flows have yielded inconsistent predicted values. It is hoped that the present equations will be useful for these measurements. Duration of cigarette smoking was a significant prediction variable for FEV1, FEV1/FVC and mean and instantaneous flows in these normal men, but not in normal women. For FEV1, the effect of each year of smoking was 40% of the effect of ageing.

Adult↗

PubMedDate not supplied

The influence of age on the response to renal parenchymal loss.

The effect of age on compensatory hypertrophy and functional adaptation to loss of 75 percent of renal mass was studied in canine puppies. In one group of animals the surgery was done between 1-5 days after birth and in another group, at two months of age. All animals were studied six weeks later. Shamoperated littermates served as controls. The newborn puppies in the experimental group were able to grow and maintain homeostasis as well as their controls, whereas the older experimental animals grew poorly and had significantly higher levels of plasma creatinine than their sham-operated counterparts (p < .05). The increase in mass of the remaining kidney was twice as much in the newborn as in the older dogs. Functional adaptation, as expressed by GFR, was nearly complete in the young, but reached only about 45 percent of controls in the older age group (p<.005). The intrarenal blood flow distribution was similar for experimental and control animals in both groups studied. There were, however, marked differences in the pattern of single glomerular perfusion rates: whereas in the older dogs the increase was confined to the deeper nephrons, in the newborn an increase occurred in all zones of the kidney. These studies demonstrate that compensation for massive loss of renal tissue is complete when the injury is sustained in the immediate postnatal period but only partial when it occurs later on in life. A loss in the adaptive capacity of the superficial nephrons appears to account for this age-related difference.

Adaptation, Physiological↗

PubMedDate not supplied

A comparison of the health status of Riverdale residents with residents of the rest of Toronto based on the Toronto Community Health Survey.

OBJECTIVES: To compare the health status of Riverdale residents with residents of the rest of Toronto. DESIGN: Cross-sectional telephone survey. SETTING: Toronto. TIME FRAME: October 1988-June 1989. PARTICIPANTS: Four hundred and fourteen residents of Riverdale, a residential-industrial area of Toronto, and 866 residents of the rest of Toronto, age 15 years and older in households with telephones. MAIN RESULTS: Respondents in Riverdale compared to respondents in the rest of Toronto were more likely to speak languages other than English, have less formal education, and be of Oriental ethnic origin. Perceived health status varied between the two areas, but no significant difference existed in diagnosed morbidity. Riverdale respondents were much more aware of food and soil contamination than respondents from the rest of Toronto.

Adolescent↗

PubMedDate not supplied

The epidemiology of cocaine and opiate abuse in urban Canada.

This study describes the epidemiology of cocaine and heroin abuse in urban Canada as part of an initial report on a national substance abuse surveillance system, the Canadian Community Epidemiology Network on Drug Use. Data pertaining to prevalence of use, law enforcement, treatment, morbidity and mortality of cocaine and heroin were obtained from the appropriate health and law enforcement institutions in six sentinel cities: Vancouver, Calgary, Winnipeg, Toronto, Montreal and Halifax. Cocaine and heroin appear to be more available in Vancouver than in the remaining cities. In all CCENDU cities, large proportions of persons in treatment programs for substance abuse identified cocaine as their major addiction; however, there is considerable variation in treatment utilization regarding heroin. Vancouver ranks first in terms of the per capita number of cocaine- and heroin-related hospital separations and mortality rate. Cocaine abuse appears to be an emerging problem in Calgary, Winnipeg and Halifax, and opiate abuse appears to be an emerging problem in Calgary.

Adolescent↗