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Biomedical subjects

R Feldman

Publications and source records attributed to R Feldman.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Probable amanita phalloides poisoning with pseudo-obstructive, paralytic ileus (Ogilvie's syndrome)].

A man of 52 years was admitted to Warsaw Poison Control Centre because of the suspicion of amanita phalloides poisoning. At admission (on third day of mushrooms ingestion) the patient still suffered from gastroenterocolic symptoms, especially from epigastric pain, nausea and vehement but slowly withdrawing diarrhea. On the next 2 days of hospitalization the typical symptoms of liver damage developed (jaundice, elevated aminotransferases AST and ALT, decrease of Quick index); prolonged epigastric pain was radiating to the right lower quadrant and with local tenderness peritonismus. These clinical symptoms, physical examination and abdominal x-ray suggested a "silent abdomen" due to the of obturative ileus. Therefore laparatomy was performed immediately and the adynamic ileus, not obturation of intestine, was recognized definitely. Subsequently the clinical status of the patient, previously severe, improved, blood parameters of liver damage subsided. After three weeks of hospitalization the patient was dismissed in good condition.

Amanita↗
PubMed2001

Premium rebates and the quiet consensus on market reform for Medicare.

Premium rebates allow beneficiaries who choose more efficient Medicare options to receive cash rebates, rather than extra benefits. That simple idea has been controversial. Without fanfare, however, premium rebates have become a key area of agreement in the debate on Medicare reform. Moreover, in legislation in late 2000, it became official policy: Medicare+Choice (M+C) plans will be allowed to offer rebates beginning in 2003. This article explores the economic rationale for premium rebates, provides a historical perspective on the rebate debate, discusses some of the implementation issues that need to be addressed before 2003, and reviews the implications of premium rebates for current legislative proposals for Medicare reform.

Aged↗
PubMed2000

Primary care physician incentives in medical group practices.

CONTEXT: Although medical groups are adapting to changes in financing health care, little is known about individual physician incentives in this environment. OBJECTIVES: To describe methods group practices use to compensate primary care physicians in a managed care environment and to examine the association of revenue sources for the group practice from all patients and primary care physician incentives. DESIGN: We surveyed by mail group practice administrators for practices that had at least 200 members continuously enrolled in 1995. SETTING: Group practices that had contractual arrangements with Blue Cross/Blue Shield of Minnesota. PARTICIPANTS: One hundred of 129 group practices returned usable surveys. RESULTS: Most groups had some portion of primary care physicians' compensation at risk, although 17 groups compensated them through fully guaranteed annual salary. Seventy-one groups used productivity, 4 groups used quality of care, 1 group used utilization, and 30 used group financial performance. Factors reported to significantly influence primary care physician compensation included billings or charges, overall group practice performance, and net revenue or profit. Groups that had a higher proportion of income from various types of fee-for-service arrangements used lower proportions of base salary for primary care physician compensation and were more likely to relate physician income to measures of productivity. CONCLUSIONS: Substantial variation exists in the types of primary care physician incentives implemented by medical groups. Base salary, individual productivity, and group financial performance were most frequently used to determine compensation. Physician personal financial risk was higher overall in group practices that derived more revenue from fee-for-service contracts.

Adult↗
PubMed2000

Psychosocial factors and intervention-associated changes in those factors as correlates of change in fruit and vegetable consumption in the Maryland WIC 5 A Day Promotion Program.

This study sought to examine: (a) the relative effects of baseline demographic and psychosocial factors and an intensive nutritional intervention on changes in fruit and vegetable consumption in low-income, ethnically diverse women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in Maryland; (b) whether this intervention, designed to modify psychosocial factors associated with fruit and vegetable consumption, was successful in changing these factors; and (c) whether changes in these factors were associated with increased consumption. The same women from 15 WIC program sites were surveyed at baseline and postintervention 8 months later. Women randomized to the intervention group showed significantly greater mean change in self-efficacy, attitudes, social support, and knowledge of national consumption recommendations than control group women. Changes in all psychosocial factors were significantly associated with nutrition session attendance and increased consumption. In a hierarchical model, changes in these factors accounted for most of the intervention effect on increased consumption.

Adolescent↗
PubMed2000

Risk segmentation: goal or problem?

This paper traces the evolution of economists' views about risk segmentation in health insurance markets. Originally seen as a desirable goal, risk segmentation has come to be viewed as leading to abnormal profits, wasted resources, and inefficient limitations on coverage and services. We suggest that risk segmentation may be efficient if one takes an ex post view (i.e., after consumers' risks are known). From this perspective, managed care may be a much better method for achieving risk segmentation than limitations on coverage. The most serious objection to risk segmentation is the ex ante concern that it undermines long-term insurance contracts that would protect consumers against changes in lifetime risk.

Economic Competition↗
PubMed2000

Proteasomal proteomics: identification of nucleotide-sensitive proteasome-interacting proteins by mass spectrometric analysis of affinity-purified proteasomes.

Ubiquitin-dependent proteolysis is catalyzed by the 26S proteasome, a dynamic complex of 32 different proteins whose mode of assembly and mechanism of action are poorly understood, in part due to the difficulties encountered in purifying the intact complex. Here we describe a one-step affinity method for purifying intact 26S proteasomes, 19S regulatory caps, and 20S core particles from budding yeast cells. Affinity-purified 26S proteasomes hydrolyze both model peptides and the ubiquitinated Cdk inhibitor Sic1. Affinity purifications performed in the absence of ATP or presence of the poorly hydrolyzable analog ATP-gamma-S unexpectedly revealed that a large number of proteins, including subunits of the skp1-cullin-F-box protein ligase (SCF) and anaphase-promoting complex (APC) ubiquitin ligases, copurify with the 19S cap. To identify these proteasome-interacting proteins, we used a recently developed method that enables the direct analysis of the composition of large protein complexes (DALPC) by mass spectrometry. Using DALPC, we identified more than 24 putative proteasome-interacting proteins, including Ylr421c (Daq1), which we demonstrate to be a new subunit of the budding yeast 19S cap, and Ygr232w (Nas6), which is homologous to a subunit of the mammalian 19S cap (PA700 complex). Additional PIPs include the heat shock proteins Hsp70 and Hsp82, the deubiquitinating enzyme Ubp6, and proteins involved in transcriptional control, mitosis, tubulin assembly, RNA metabolism, and signal transduction. Our data demonstrate that nucleotide hydrolysis modulates the association of many proteins with the 26S proteasome, and validate DALPC as a powerful tool for rapidly identifying stoichiometric and substoichiometric components of large protein assemblies.

Adenosine Triphosphate↗
PubMed2000

Do consumers use information to choose a health-care provider system?

This study examines the use of information by employees in the Buyers Health Care Action Group, a purchasing coalition of large employers in Minneapolis. BHCAG employers contract directly with multiple health-care provider systems and attempt to inform employees about those choices. Shortly after the close of the 1998 open-enrollment period, a survey of 927 BHCAG employees with single-coverage health insurance was conducted. Seventy-six percent of the employees relied on information from their employer when selecting their current care system. Use of information from the employer was positively related to education and years of residence in the Twin Cities. Previous experience with doctors and hospitals in the care system also was a common information source. Older and low-income workers were more likely to use information from advertisements. The survey results suggest that employers can predict which information sources their employees will use.

Adult↗
PubMed2000

Uses of process evaluation in the Maryland WIC 5-a-day promotion program.

Using a crossover design, the authors conducted a 6-month intervention program aimed at increasing fruit and vegetable consumption among women served by the Women, Infants, and Children program in Baltimore City and six Maryland counties. The theoretical framework for the interventions was the Transtheoretical Model of Change. At 2 months postintervention, mean daily consumption had increased significantly more in intervention participants than in control participants. Extensive process evaluation data were collected to assess the quantity and quality of program services delivered. These included participant nutrition session evaluation forms and attendance logs, focus groups of attenders and nonattenders of sessions, information about peer educators, and postintervention surveys. Many lessons were learned about program delivery, factors affecting attendance, and the obstacles to dietary change. Strategies to increase participants' consumption of fruits and vegetables were modified based on these lessons and the process evaluations.

Adolescent↗
PubMed2000

Predischarge bilirubin screening in glucose-6-phosphate dehydrogenase-deficient neonates.

OBJECTIVE: To assess the validity of predischarge serum bilirubin values in determining or predicting hyperbilirubinemia in glucose-6-phosphate dehydrogenase (G-6-PD)-deficient neonates, and to facilitate appropriate discharge planning. METHODS: Serum total bilirubin values were determined between 44 and 72 hours of life in a cohort of term, healthy neonates at high-risk for G-6-PD deficiency but with no other risk factors for hyperbilirubinemia. Percentile-based bilirubin nomograms were constructed for G-6-PD-deficient infants and normal infants according to age at sampling. The incidence of hyperbilirubinemia (serum bilirubin value > or =256 micromol/L [15 mg/dL]) for each group was determined according to the percentiles for that group. RESULTS: In both G-6-PD-deficient neonates (n = 108) and control neonates (n = 215) with serum bilirubin values <50th percentile for age, the incidence of hyperbilirubinemia was low in the G-6-PD-deficient neonates, with no measurable incidence in the controls. The incidence of hyperbilirubinemia became clinically consequential, and significantly higher in the G-6-PD-deficient groups, when the percentiles were > or =50: for those in the 50% to 74% range the incidence was moderate (23%) for the G-6-PD-deficient and small (7%) for the control infants (relative risk, 3.29; 95% confidence interval, 1.01-10.67). Among those infants > or =75th percentile, 82% of the G-6-PD-deficient infants, compared with 25% of the control infants, were either already hyperbilirubinemic at the time of screening or subsequently developed hyperbilirubinemia (relative risk, 3.23; 95% confidence interval, 1.99-5.24). CONCLUSIONS: Timed, predischarge serum bilirubin screening can be used to identify G-6-PD-deficient neonates at low, intermediate, or high-risk of developing severe neonatal hyperbilirubinemia, and thus offer a selective approach to the discharge and follow-up surveillance of these infants.

Bilirubin↗
PubMed2000

The ability of managed care to control health care costs: how much is enough?

This article argues that moral hazard is the main source of market failure in the health care sector. Cost sharing and managed care both are designed to control the extra costs of moral hazard. Managed care organizations (MCOs) have the potential to control costs by changing provider incentives away from excessive utilization of resources toward less costly and more effective treatments. However, MCOs have been given the wrong instructions by short-sighted employers who have overemphasized cost control. The solution is to give consumers more information and a choice of plans that emphasize different types and levels of cost control.

Cost Control↗
PubMed2000

[Round cells in semen and genital infections].

OBJECTIVE: The correlation between leukocytospermia and genital infections remains controversial. Similarly, it is inaccurate to consider the increase of round cells (RC) in semen as leukocytospermia. The purpose of this study was to determine the possible association between round cells, leukocystospermia and bacterial infections in infertile patients. METHODS: 410 semen samples were analyzed to determine sperm concentration, motility, morphology and round cells according to standard WHO citeria. Immature germ cells were differentiated by the Papanicolau stain, while the Nahoum-Cardozo method was used for polymorphonuclear leukocytes (PMN). Bacteriological studies in semen first urine sprout and urethral secretion were performed. Gram-Nicolle stain was utilized for the direct examination. Cultures were made in enriched blood Columbia agar and Thayer Martin agar was used for common germs. For mycoplasma identification, both A7 Sheppard solid and liquid media were used. Presence of Chlamydia trachomatis in urethral secretion was investigated by direct immunofluorescence. RESULTS: 79% (324) of the samples were dispermic, 9.02% presented more than 10(6) RC/ml. Of these, only 29.7% (11) presented leukocytospermia. Spearman's ranked correlation, used to measure association between RC/field and PMN leukocytes/ml, showed a value of 0.2705 with an associated probability of 0.1046, indicating a non-significant association between variables. Bacteriological studies performed in 32 samples showed 13 were positive, but only 4 (30.7%) presented leukocytospermia. Of the 19 samples with negative bacteriology, 15.78% were leukocytospermic. There was no statistically significant correlation between increased RC and the presence of germs (chi 2: 0.14965, p < 0.05) or between PMN and germs (chi 2: 1.01390, p < 0.05). CONCLUSIONS: These data suggest the convenience of performing bacteriological studies in semen in spite of the presence of RC in the direct examination.

Adult↗
PubMed2000

Case 2. Recurrence of myocardial infarction.

A 50-year-old man arrives in the emergency room with signs and symptoms occurring intermittently over a period of 48 h consistent with a myocardial infarction. He has several major risk factors for a recurrent event. A number of management strategies have already been attempted. Two opinions for further management are presented.

Antihypertensive Agents↗
PubMed2000

ACE inhibitors versus AT1 blockers in the treatment of hypertension and syndrome X.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 (AT1) receptor blockers are two separate classes of drugs. Although they are both effective antihypertensive agents, they exert their effects through different pharmacological mechanisms. Nonetheless, they have often proved indistinguishable in terms of the surrogate endpoints used in short term clinical studies. Considerable data are available on the long term benefits of ACE inhibition; however, studies looking at the long term effects of AT1 receptor blockade are not yet complete. If ACE inhibitors prove to be distinguishable from AT1 receptor blockers in terms of disease-related outcomes, the reason may be the selective effects of ACE inhibitors on insulin resistance and insulin-mediated vascular function.

Angiotensin Receptor Antagonists↗
PubMed2000

The effects of medical group practice and physician payment methods on costs of care.

OBJECTIVE: To assess the effects of payment methods on the costs of care in medical group practices. DATA SOURCES: Eighty-six clinics providing services for a Blue Cross managed care program during 1995. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. STUDY DESIGN: The effects of clinic and physician payment methods on per member per year (PMPY) adjusted patient costs are evaluated using a two-stage regression model. Patient costs are adjusted for differences in payment schedules; patient age, gender, and ACG; clinic organizational variables are included as explanatory variables. DATA COLLECTION: Patient cost data were extracted from Blue Cross claims files, and patient and physician data from their enrollee and provider data banks. Medical group practice data were obtained by a mailed survey with telephone follow-up. PRINCIPAL FINDINGS: Capitation payment is correlated with lower patient care costs. When combined with fee-for-service with withhold provisions, this effect is smaller indicating that these two clinic payment methods are not interchangeable. Clinics with more physician compensation based on measures of resource use or based on some share of the net revenue of the clinic have lower patient care costs than those with more compensation related to productivity or based on salary. Salary compensation is strongly associated with higher costs. The use of physician profiles and clinical guidelines is associated with lower costs, but referral management systems have no such effect. The lower cost clinics are the smaller, multispecialty clinics. CONCLUSIONS: This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected.

Adolescent↗
PubMed2000

[Atrophic gastritis presenting with pulmonary embolism].

Atrophic gastritis is an autoimmune gastropathy in which there is destruction of gastric parietal cells. This results in intrinsic factor deficiency and disturbance in vitamin B12 absorption. Its clinical manifestationa are therefore the consequences of B12 deficiency and include anemia and neurological defect. In addition, lack of B12 results in metabolic changes, including disturbances of methionine metabolism and accumulation of homocysteine. In recent years, there has been increasing evidence suggesting that hyperhomocysteinemia is a risk factor for thrombo-embolic disease. We describe a 51-year-old man with atrophic gastritis, severe B12 deficiency and hyperhomocysteinemia. The initial clinical manifestation was pulmonary embolism, without either anemia or neurological signs. B12 deficiency should therefore be considered in patients being investigated for hypercoagulability.

Gastritis, Atrophic↗
PubMed1999

A model program for the treatment of mentally ill offenders in the community.

There is a new and growing interest among community mental health providers and administrators in the area of correctional psychiatry. From a column in Psychiatric Times to committees and task forces in APA and the American Academy of Psychiatry and the Law, increased attention is being paid to the great need for the treatment of mentally ill offenders. In this article, we will introduce the reader to the magnitude of the correctional system and to the prevalence of mental illness in the correctional population. We will then describe several model programs designed to work with mentally disordered offenders, and outline a novel collaborative approach between a CMHC and a Probation Office designed to help mentally disordered offenders succeed in community treatment. Several barriers to treatment faced by this population will be identified, including double stigma, lack of family/social support, comorbidity, adjustment problems, and boundary issues. Case vignettes designed to illustrate key points will be included.

Adolescent↗
PubMed1999

Mother-infant affect synchrony as an antecedent of the emergence of self-control.

This study examined relations between mother-infant affect synchrony and the emergence of children's self-control. Mother-infant face-to-face play and infant difficult temperament were examined at 3 and 9 months. Maternal and infant affective states at play were coded in 0.25-s frames, and synchrony was computed with cross-correlation functions. Self-control, verbal IQ, and maternal warm discipline were assessed at 2 years. Maternal synchrony with infant affect at 3 months (infant-leads-mother-follows relation) and mutual synchrony at 9 months (cross-dependence between maternal and infant affect) were each related to self-control at 2 years when temperament, IQ, and maternal style were partialed. Infant temperament moderated the relations of synchrony and self-control, and closer associations were found between mutual synchrony and self-control for difficult infants. Shorter lags to maternal synchrony at 3 months were independently related to self-control. The mutual regulation of affect in infancy, as moderated by temperament, is proposed as an important contributor to the emergence of self-regulation.

Adult↗