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Biomedical subjects

M J Goodman

Publications and source records attributed to M J Goodman.

87 records · Page 5Linked to original sources
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Multicenter epidemiologic and health services research on therapeutics in the HMO Research Network Center for Education and Research on Therapeutics.

Research and education programs in therapeutics that combine the data, organizational capabilities, and expertise of several managed care organizations working in concert can serve an important role when a single organization is not large enough to address a question of interest, when diversity in populations or delivery systems is required, and when it is necessary to establish consistency of results in different settings. Nine members of the HMO Research Network, a consortium of health maintenance organizations (HMOs) that perform public domain research, have formed a Center for Education and Research on Therapeutics (CERT), sponsored by the Agency for Healthcare Research and Quality, to conduct multicenter research in therapeutics. The CERT uses a distributed organizational model with shared leadership, in which data reside at the originating organization until they are needed to support a specific study. Extraction of data from the host computer systems, and some manipulation of data, is typically accomplished through computer programs that are developed centrally, then modified for use at each site. For complex studies, pooled analysis files are created by a coordinating center, and then analysed by investigators throughout the HMOs. It is also possible to contact HMO members when necessary. This multicenter environment has several benefits, addressing: (1) a wide array of questions about the safety and effectiveness of therapeutics, (2) the impact of efforts to change clinicians' and patients' behavior, and (3) pharmacoeconomic and pharmacogenetic questions.

Community Networks↗
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Maternal diabetes and congenital malformations among live births in Hawaii.

The frequency of congenital malformations in 187,266 live births in Hawaii from 1956 through 1966, was found to be significantly higher among offspring diabetic mothers (0.0175) than in offspring of non-diabetic mothers (0.0086) or mothers with no complications of pregnancy (0.0074). However, the frequency of malformations in offspring of diabetic mothers was not significantly higher than in offspring of mothers with heart conditions of hypertension.

Adult↗
PubMedDate not supplied

Age at first pregnancy in relation to age at menarche and year of birth in Caucasian, Japanese, Chinese and part-Hawaiian women living in Hawaii.

A multiple regression analysis was undertaken to examine the relationship between age at first pregnancy and recollected age at menarche and sociological variables in Caucasian, Japanese, Chinese and part-Hawaiian parous women living in Hawaii. The analysis was conducted using the medical history records of 1198 Caucasian, 1770 Japanese, 453 Chinese and 578 part-Hawaiian women. Age at first pregnancy varied significantly among ethnic groups. Initial results showed an apparent heterogeneity among ethnic groups in the effect of age at menarche on age at first pregnancy. Once appropriate controls for the linear and non-linear effects of year of birth were made, the effects of age at menarche on age at first pregnancy no longer varied significantly among ethnic groups. The observed secular trends in age at first pregnancy have varied widely among the four ethnic groups studied and appear unrelated to genetic background.

Adult↗
PubMedDate not supplied

Recalled characteristics of menstruation in relation to reproductive history among Caucasian, Japanese and Chinese women living in Hawaii.

Characteristics of menstruation and reproductive history were studied in 2331 Caucasian, 4097 Japanese and 1003 Chinese women living in Hawaii and born between 1900 and 1940. Irregular periods, heavy flow and menses lasting more than five days were reported significantly more often in Caucasians than in the other two groups. Canonical correlation and multiple-regression procedures revealed that parity, recalled age at menarche and year of birth were significantly associated to the menstrual descriptions reported, in complex ways, distinctive in each ethnic group. Some similarities in the relationship of reproductive history variables with particular menstruation characteristics were found in the Caucasian and Japanese groups. For example, increased parity was associated with increased menstrual bleeding in both Caucasians and Japanese, and later age at menarche was significantly correlated with irregular menses in these two groups.

Age Factors↗
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Menarche, pregnancy, birth spacing and menopause among the Agta women foragers of Cagayan province, Luzon, the Philippines.

The reproductive histories of 74 post-menarcheal Agta Negrito women, tropical foragers of Cagayan province, north-eastern Luzon, the Philippines are described and analysed in comparison with data collected by Howell on Dobe !Kung hunter-gatherers. Among the Agta, mean age at menarche is 17, mean age at first live birth is 20.14 years, mean completed parity is 6.53 and mean age at menopause is 44. Average height is 141.24 cm and average weight 36.72 kg. No time trends were detected in age at menarche and age at first live birth among the Agta. Average spacing between live births where an infant survives until the birth of the next sibling was 2.85 years. Compared to the Dobe !Kung, Agta women have later menarche, but shorter birth spacing and a longer active childbearing span.

Adolescent↗
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Health-based payment and computerized patient record systems.

Health care information technology is changing rapidly and dramatically. A small but growing number of clinicians, especially those in staff and group model HMOs and hospital-affiliated practices, are automating their patient medical records in response to pressure to improve quality and reduce costs. Computerized patient record systems in HMOs track risks, diagnoses, patterns of care, and outcomes across large populations. These systems provide access to large amounts of clinical information; as a result, they are very useful for risk-adjusted or health-based payment. The next stage of evolution in health-based payment is to switch from fee-for-service (claims) to HMO technology in calculating risk coefficients. This will occur when HMOs accumulate data sets containing records on provider-defined disease episodes, with every service linked to its appropriate disease episode for millions of patients. Computerized patient record systems support clinically meaningful risk-assessment models and protect patients and medical groups from the effects of adverse selection. They also offer significant potential for improving quality of care.

Cost Control↗