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Biomedical subjects

J C Kleinman

Publications and source records attributed to J C Kleinman.

At least 91 records · Page 5Linked to original sources
PubMed1978

A comparison of 1960 and 1973--1974 early neonatal mortality in selected states.

Linked birth and infant death records from six states provided the opportunity for comparison of 1960 and 1973--1974 early neonatal mortality rates by weight, maternal age and live birth order. The data were analyzed by fitting linear models to the logarithm of the ratio of 1960 to 1973--1974 early neonatal mortality rates. Although there was substantial variability in these ratios by maternal age and birth order, the ratios were nearly constant for birth weights between 1001 and 4500 gm. The decline in mortality among low birth weight infants (2500 gm or less) accounted for over half of the overall decline in early neonatal mortality. The results obtained here are compared with earlier national studies and possible explanations for the decline are discussed.

Adolescent↗
PubMed1978

Use of out-of-plan services by Medicare members of HIP.

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.

Aged↗
PubMed1977

Age-adjusted mortality indexes for small areas: applications to health planning.

This study compares four age-adjusted mortality indexes and their standard errors among United States counties using 1969-1971 mortality data. It is shown that the direct and indirect methods of age adjustment give nearly identical results (correlation coefficients over .97). Two other indexes which indirectly adjust for age are then compared with the usual indirect method: one is the relative mortality index and the other an index of productive years of life lost. The three indirect indexes are substantially different in the are groups emphasized. This results in substantial differences in those counties identified as having "excess" mortality. Implications of the results for health planning applications are discussed.

Adolescent↗
PubMed1977

Mortality.

Explore the source record for details and available documents.

Age Factors↗
PubMed1977

Are "medically underserved areas" medically underserved?

A comparison of medically underserved areas (MUAs) and adequately served areas (ASAs) is presented. Nonmetropolitan areas represented in the Health Interview Survey (HIS) are classified as MUAs or ASAs by the official criterion of their scores on the Index of Medical Underservice (IMU), and HIS data from the two types of areas are examined for differences. Standard metropolitan statistical areas are also compared with the nonmetropolitan MUAs and ASAs. Results show no difference between MUA and ASA residents in number of physician visits per year or proportion with at least one visit in the past year, although MUA residents reported poorer health status, used some preventive services less, and used nonsurgical hospitalization more than did ASA residents. In gereral, most MUA-ASA differences tend to be similar in size to differences between ASAs and SMSAs. An alternative to the IMU, using HIS data to identify underserved areas, is discussed.

Adolescent↗
PubMed1975

Evaluation of review courses for the ECFMG examination.

In this paper three review courses for the Educational Council for Foreign Medical Graduates (ECFMG) examination are described. A comparison of the pass rates on the January 1973 ECFMG examination for examinees taking the courses with those not taking the courses shows a statistically significant difference (47 percent passing for those taking the courses in contrast to 18 percent passing for those not taking the courses). Although the courses appear to be effective, the limitations of the ECFMG examination as a screening device for foreign medical graduates (FMGs) make it unwise to expand the number of such courses. The cramming of basic medical knowledge into students is not a useful solution to the problem of physician shortages. The focus of attention on the FMG in the health care system must shift from a search for expedient ways of providing for greater utilization of FMGs to the deleterious effects of this utilization on the quality of patient care.

Achievement↗
PubMed1975

Postgraduate training and work experience of non-ECFMG certified physicians in the U.S.

Data on postgraduate training and work experience of a sample of 850 Foreign Medical Graduates (FMGs) taking the January 1973 ECFMG examination in the U.S. are presented. It was found that 485 (57%) of the respondents had specialty training and, of these 485, 59 per cent were certified in a specialty. In addition, 81 per cent reported that they had worked as a physician prior to entering the U.S. The proportions with specialty training and work experience varied by country of medical education and year of graduation. The proportions with training or experience among those not currently employed in the health system are significantly lower than among those employed in the health field. Of the 186 respondents who reported passing the ECFMG examination, 92 per cent plan further training and 84 per cent of this group plan to specialize. More detailed information on the length and content of this training and work experience for different groups of FMGs is needed.

Achievement↗
PubMed1975

Proportions with extraneous variance: two dependent samples.

Data which appear to be binomial proportions sometimes exhibit heterogeneity which results in greater variation than would be exhibited under the binomial distribution. Previous work by the author (Kleinman [1973]) in which estimates of the heterogeneity variances are obtained and used in weighting is extended to the case of comparing means in two dependent samples. The resulting empirical weighting estimates are asymptotically equivalent to exact least squares estimates and Monte Carlo studies for sample size 10 indicate high efficiency relative to exact least squares estimates.

Analysis of Variance↗
PubMedDate not supplied

Is weight loss a modifier of the cholesterol-heart disease relationship in older persons? Data from the NHANES I Epidemiologic Follow-up Study.

The relationship between cholesterol and 14-year incidence of coronary heart disease was compared for men and women of two age groups, 25 to 64 years and 65 to 74 years. While cholesterol levels of 6.2 mmol/L or higher were associated with a risk of coronary heart disease in the younger group, this was not true for either men or women aged 65 to 74. Further analyses for older persons showed that weight loss modified the cholesterol-heart disease relationship. Those with stable weight showed a positive relationship between cholesterol and coronary heart disease, similar to the younger age group (relative risk [RR] = 1.8 [95% confidence interval: 1.1, 2.9] for men; RR = 1.6 [.7, 3.4] for women). Among those with a weight loss of 10% or more, the relationship of cholesterol to heart disease was inverse (RR = .8 [.5, 1.2] for men; RR = .6 [.3, 1.0] for women). These data suggest that the relationship of cholesterol to coronary disease in healthier older persons may be similar to that in younger persons, and that health status should be considered in analyses of cholesterol risk in old age.

Adult↗
PubMedDate not supplied

10 years after NHANES I: report of initial followup, 1982-84.

The NHANES I Epidemiologic Followup Study (NHEFS) was jointly initiated by the National Center for Health Statistics and the National Institute on Aging in collaboration with other National Institutes of Health and Public Health Service agencies. The goal of NHEFS is to examine the relationship of baseline clinical, nutritional, and behavioral factors assessed in the first National Health and Nutrition Examination Survey (NHANES I-1971-75) to subsequent morbidity and mortality. Data collection for the initial phase of followup took place between 1982 and 1984 and included tracing of all NHANES I participants, determining their vital status, conducting in-depth interviews with surviving participants or with proxies for those who were deceased or incapacitated, conducting selected physical measurements, obtaining facility records for stays in hospitals or nursing homes that occurred during the period of followup, and obtaining death certificates for decedents. Ninety-three percent of the original cohort was successfully traced. Interviews were conducted for 93 percent of traced, surviving participants and 84 percent of traced, surviving participants and 84 percent of traced, deceased subjects. Physical measurements were obtained for approximately 95 percent of surviving, interviewed subjects. Death certificates are available for more than 95 percent of the decedents, and 18,136 facility records were received for 6,477 subjects.

Adolescent↗
PubMedDate not supplied

10 years after NHANES I: mortality experience at initial followup, 1982-84.

The NHANES I Epidemiologic Followup Study (NHEFS) was initiated jointly by the National Center for Health Statistics and the National Institute on Aging in collaboration with other National Institutes of Health and Public Health Service agencies. The goal of NHEFS is to examine the relationship of baseline clinical, nutritional, and behavioral factors assessed in the first National Health and Nutrition Examination Survey (NHANES I-1971-75) to subsequent morbidity and mortality. Tracing for the initial followup began in 1981 and ended in 1984. This article compares the mortality experience of the NHEFS cohort with survival probabilities and cause-of-death distributions derived from U.S. vital statistics data. The analysis was done for 28 age-race-sex specific subgroups. The survival of each group of the NHEFS cohort corresponds quite closely to that expected on the basis of the U.S. life table survival probabilities. Mortality differentials by age, race, and sex are also quite similar between NHEFS and U.S. vital statistics. In addition, the cause-of-death distributions among NHEFS participants are quite similar to those expected based on national vital statistics. Thus, there do not seem to be any serious biases in the mortality data. The NHEFS, therefore, provides a unique resource for assessing the effects of baseline sociodemographic, health, and nutritional factors on future mortality in a large, heterogeneous sample that is representative of the nation's population.

Actuarial Analysis↗
PubMedDate not supplied

Birth weight-specific infant mortality, United States, 1960 and 1980.

National statistics on the risk of infant mortality by birth weight were collected most recently in 1980 and 1960. (Infant mortality risk is the number of deaths of infants under 1 year of age per 1,000 live births.) In this 20-year period, the infant mortality risk (IMR) for single-delivery infants declined 53 percent, from 23.3 deaths per 1,000 live births to 11.0; 91 percent of this decline was due to lower IMRs within birth weight categories, and 9 percent was due to reduced frequency of low birth weight. The greatest reduction in neonatal mortality (under 28 days)--73 percent--occurred among infants of 1,500-1,999 grams (g) birth weight, whereas the greatest reductions in postneonatal mortality (28 days to under 1 year)--51 percent to 54 percent--occurred among infants of 3,500 g or more birth weight. Trends in IMR for black and white infants were similar, and the twofold gap between the races in IMR persisted from 1960 to 1980. For whites, reductions in the frequency of low birth weights contributed to the decline in the IMR. For blacks, the percentage of infants with birth weights of less than 1,500 g increased, and the total reduction in the IMR was attributable to lower birth weight-specific mortality risks. In some regions of the United States, failure to observe an increase in birth weight for blacks may be a reporting artifact, reflecting improved reporting of births of very small black infants in 1980. Examination of changes in perinatal mortality risks (from 20 weeks gestation to less than 28 days of life) did not suggest that infant mortality trends were substantially affected by changes in the distinction between fetal and neonatal deaths over the 20-year period. Reducing the number of low birth weight infants remains the greatest potential for future reductions in infant mortality.

Birth Weight↗