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Biomedical subjects

J E Midtling

Publications and source records attributed to J E Midtling.

17 recordsLinked to original sources
PubMed1996

Medicare costs in urban areas and the supply of primary care physicians.

BACKGROUND: The supply of primary care physicians may be important determinants of health care costs. We examined the association between primary care physician supply and geographic location with respect to variation in Medicare Supplementary Medical Insurance (Part B) reimbursement. METHODS: We performed an analysis of data from all US metropolitan counties. Physician supply data were derived from the American Medical Association Masterfile. Medicare Part B reimbursements and enrollment data came from the Health Care Financing Administration. Physician supply was calculated for family practice, general internal medicine, and non-primary care specialties. Linear regression was used to test the association of physician supply and Medicare costs and to adjust for potential confounding variables. RESULTS: The average Medicare Part B reimbursement per enrollee was $1283. After adjusting for local price differences and county characteristics, a greater supply of family physicians and general internists was significantly associated with lower Medicare Part B reimbursements. The reduction in reimbursements between counties in the highest quintile of family physician supply and the lowest quintile was $261 per enrollee. In contrast, a greater supply of general practitioners and non-primary care physicians was associated with higher reimbursements per enrollee. CONCLUSIONS: These results add to the evidence than an increased supply of primary care physicians is associated with lower health care costs. If this association is causal, it supports the theory that increasing the number of primary care physicians may lower health care costs.

Aged↗
PubMed1995

Primary care physicians in underserved areas. Family physicians dominate.

Using the definitions of "medically underserved areas" developed by the California Health Manpower Policy Commission and data on physician location derived from a survey of California physicians applying for licensure or relicensure between 1984 and 1986, we examined the extent to which different kinds of primary care physicians located in underserved areas. Among physicians completing postgraduate medical education after 1974, board-certified family physicians were 3 times more likely to locate in medically underserved rural communities than were other primary care physicians. Non-board-certified family and general physicians were 1.6 times more likely than other non-board-certified primary care physicians to locate in rural underserved areas. Family and general practice physicians also showed a slightly greater likelihood than other primary care physicians of being located in urban underserved areas.

California↗
PubMed1993

Family medicine role models at US medical schools. Why their relative numbers are declining.

A decline in medical student interest in family practice combined with an increasing demand for family physicians by managed care systems and the need to replace family and general practice physicians nearing retirement age make it likely that the future supply of family physicians will not be adequate. Specialty selection by medical students is influenced by the medical education environment, especially the presence of faculty role models. Due to a decline in federal support for family medicine and a growth in sources of medical school support that favor nonprimary care specialties, the proportion of clinical faculty in family medicine has declined. This has occurred simultaneously with declining student interest in family medicine. Suggestions are offered to increase the number and influence of family medicine role models at US medical schools.

Career Choice↗
PubMed1993

Teratogenesis associated with oxydemeton-methyl in the stage 12 chick embryo.

The teratogenic potential of oxydemeton-methyl (ODM) was investigated using a stage specific localized topical method of application to the stage 12 chick embryo. A dose of 0.01, 0.05, 0.10, 0.50, 1.0, or 2.0 mg/embryo was applied to the vitelline membrane directly above the stage 12 embryo. The embryo was then returned to the incubator and monitored daily until stage 41 (15 day). At stage 41 the embryo was autopsied and examined for gross external and internal malformations, wet weight, and crown-rump length. Experimental data was compared to unopened and saline treated controls. At doses less than 0.50 mg/embryo, survival rates were high (> 80%) but when that dose was exceeded, the survival rate fell significantly (P < 0.001). A dose-dependent increase in malformation rate was seen in all treatment groups with 0.10 mg/embryo, producing a maximum malformation rate (19/33) with minimum mortality (3/36). Crown-rump lengths and wet weights were significantly less than controls in all treatment groups (P < 0.001). Anomalies were primarily seen in the musculoskeletal (ventral midline, limb, and neck) and cardiovascular (ventricular septum and aortic arches) systems. Thoracogastroschisis and ventricular septal defects were the most common combination of malformations. Our data suggest that ODM is teratogenic when topically applied to the stage 12 chick embryo.

Abnormalities, Multiple↗
PubMed1991

Drug-nutrient interactions.

Drug-nutrient interactions are a commonly overlooked aspect of the prescribing practices of physicians. As more pharmaceutical agents become available, attention should be focused on interactions of drugs with foods and nutrients. Although drug-nutrient interactions are not as common as drug-drug interactions, they can have an impact on therapeutic outcome. Drugs can affect nutritional status by altering nutrient absorption, metabolism, utilization or excretion. Food, beverages and mineral or vitamin supplements can affect the absorption and effectiveness of drugs. Knowledge of drug-nutrient interactions can help reduce the incidence of these effects. Physicians should question patients about their dietary habits so that patients can be informed about possible interactions between a prescribed drug and foods and nutrients.

Drug Interactions↗
PubMed1990

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.

California↗
PubMed1989

Public policy and the supply of primary care physicians.

The decline in general practice, the arrested growth of family medicine training programs, and the increased subspecialization of internal medicine and pediatrics are responsible for the continuing decrease in the proportion of physicians in the United States who practice a primary care specialty. Since 1963, the number of physicians has more than doubled, but the ratio of office-based primary care physicians to the national population has decreased. This trend has been especially pronounced in rural areas and impoverished urban communities. There is evidence that the proportion of young physicians entering primary care specialties is declining. Medical education has become increasingly reliant on service income, making it difficult to fund training in primary care specialties. Grants for graduate training in primary care specialties have not increased with inflation, and outright elimination of these programs is under consideration. Public programs that fund medical education must be reformed to improve the geographic and specialty distribution of physicians.

Family Practice↗
PubMed1989

Congenital anomalies associated with maternal exposure to oxydemeton-methyl.

Thirty-five workers became ill after they entered a cauliflower field contaminated with residues of three different insecticides, the organophosphates oxydemeton-methyl (Metasystox-R) and mevinphos (Phosdrin), and a carbamate, methomyl (Lannate). One crew member was pregnant with a 4-week-old fetus. At birth, the 3200-g female infant had multiple cardiac defects, bilateral optic nerve colobomas, microphthalmia of the left eye, cerebral and cerebellar atrophy, and facial anomalies. The cardiac defects included ventricular and atrial septal defects, stenosis of the pulmonary artery, and a patent ductus arteriosus. The child died at 14 days of age. There was no family history of birth defects, nor any maternal risk factor present, except that doxylamine (Bendectin) had been prescribed at 9 weeks fetal age. It is unlikely that doxylamine was responsible for the observed anomalies. Of the three chemicals involved, reproductive effects in test organisms have been observed only with oxydemeton-methyl. This case represents the first report of human malformations associated with prenatal exposure to this chemical. Further studies may be warranted to determine if a causal relationship exists.

Abnormalities, Drug-Induced↗
PubMed1989

Cost-benefit analyses of California family practice residencies.

Several national commissions have recommended that family practice residency training be subsidized, but without stating how much support is needed. Financial studies of graduate medical education have used the methods of cost allocation or joint-products cost analysis. Previous cost-allocation studies indicate that one third of family practice residency costs are met by extramural subsidy. Cost reports of eight California public hospitals with a single family practice residency program were evaluated for the 1984-85 fiscal year. Discrepancies in the education costs reported to Medicare and those reported in state hospital disclosure reports demonstrate the arbitrary nature of the cost-allocation method. The Medicare medical education reimbursement was an average of $20,444 per resident. State and federal grants provided an average of $5,190 per resident. The Medicare payments and grants met an average of 35.7% of the education costs reported to Medicare. A joint-products cost analysis was used to estimate the pure cost of education in an 18-resident family practice residency. Replacing the residency with salaried physicians would have decreased the hospital's net return by $143,534. If neither grants nor Medicare education payments had been received, elimination of the program would have increased hospital net return by $428,083.

California↗
PubMed1987

Clinical confirmation of organophosphate poisoning by serial cholinesterase analyses.

Three groups of agricultural workers with a history of exposure to organophosphate pesticides were followed up to evaluate the utility of sequential postexposure cholinesterase analyses to confirm organophosphate intoxication in the absence of baseline cholinesterase values. Three or more cholinergic symptoms were reported by 50 of the 72 patients. Initial plasma and red blood cell cholinesterase values of 45 of the workers were above the lower limit of the laboratory normal range. Follow-up examinations, including cholinesterase analyses, were conducted on 57 patients. When final postexposure cholinesterase determinations were taken as estimates of individual normal baseline values, the plasma and red blood cell activity of the three groups was shown to have been inhibited. The data support the use of sequential postexposure plasma cholinesterase analyses to confirm the diagnosis of organophosphate-induced illness in the absence of baseline values.

Adolescent↗
PubMed1986

Clinical confirmation of organophosphate poisoning of agricultural workers.

A group of 31 lettuce harvesters exposed to the organophosphate pesticide mevinphos presented to a local emergency room with moderate cholinergic symptoms and eye and skin irritation, with 22 of the subjects (76%) reporting three or more symptoms. None had baseline cholinesterase values, and plasma cholinesterase activity for all but two workers was above the lower limit of the laboratory normal range. None of the workers received antidotes and all were released for return to work. Twenty-nine workers sought additional care when symptoms persisted, and were followed by the investigators until 12 weeks after exposure. Plasma and red blood cell (RBC) cholinesterase increased until 14 days after exposure. Plasma cholinesterase was estimated to have been inhibited by an average of 15.6% (p less than 0.01), and RBC cholinesterase by 5.6% (p less than 0.01). These findings support the utility of sequential postexposure plasma cholinesterase analyses in confirmation of suspect organophosphate-induced illness when baseline values are not available.

Adult↗
PubMed1985

Clinical management of field worker organophosphate poisoning.

A group of 16 cauliflower workers poisoned by residues of the organophosphate insecticides mevinphos and phosphamidon was followed in weekly clinics with interviews and determinations of plasma and erythrocyte cholinesterase levels. None had preexposure baseline values. Although six had initial erythrocyte cholinesterase values within the laboratory normal range, subsequent testing showed their erythrocyte activity had been significantly inhibited. While the most severe symptoms of the 16 subjects resolved after 28 days, their erythrocyte cholinesterase levels did not reach a plateau until an average of 66 days after exposure, after which most patients continued to report blurred vision, headache, weakness or anorexia. These findings support the view that the diagnostic utility of single cholinesterase levels is limited in the absence of baseline values.

Adolescent↗