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Biomedical subjects

R G Frank

Publications and source records attributed to R G Frank.

At least 91 records · Page 5Linked to original sources
PubMed1992

Trends in publicly financed prenatal and related services, 1975-1984.

We studied trends in Title V and health department financed prenatal and related services in U.S. countries from 1975-1984, years during which Medicaid and health insurance coverage for poor women were eroding. Information on prenatal services was obtained from background reports and telephone interviews with staff of State Maternal and Child Health programs. The number of counties providing prenatal care, particularly comprehensive care, rose considerably from 1975 to 1984; the largest rise occurred between 1982 and 1984. Federal initiatives accounted for about 25 percent of the increase in comprehensive care, while state-funded initiatives were responsible for the modest rise in counties offering routine care. The number of counties providing related components of care such as risk assessment and referral, obstetric or pediatric linkage with prenatal care, and outreach also rose markedly during the study years. Despite these secular trends, forty percent of U.S. counties did not offer prenatal care in health department operated or funded sites in 1984.

Adolescent↗
PubMed1992

Primary prevention of catastrophic injury.

Motor vehicle crashes are a leading cause of injury and death until age 45. Efforts to prevent these injuries have largely followed the dictates of the public health movement focusing on interventions for entire communities or regulatory statutes. Individual interventions, more congruent with traditional psychological approaches, have been rare. This article argues that a blending of these two approaches is warranted. Evaluation of prevention programs should focus on multiple levels including the individual, the community, and regulatory processes. Identification of subgroups of adolescents and young adults with unique psychological and behavioral dispositions regarding injury must be paired with realistic interventions of adequate duration.

Accidents, Traffic↗
PubMed1991

Benefit flexibility, cost shifting and mandated mental health coverage.

This paper presents a policy analysis of options for making a state's mandated mental health benefit more flexible while maintaining insurance premiums at a constant level. The analysis illustrates the difficult choices facing legislatures that attempt to balance improved coverage for mental health care with concerns about rising health care costs. A sophisticated simulation model is used to assess the costs of four alternative insurance benefit design options.

Ambulatory Care↗
PubMed1991

Primary carcinoid tumor of the testis.

Primary carcinoid tumors of the testis are exceedingly rare. Thirty-one primary tumors have been reported in the literature, none of which have been diagnosed preoperatively. We present a case report demonstrating the sonographic features of a testicular carcinoid which may contribute to an early preoperative diagnosis.

Adult↗
PubMed1991

Speed of processing within semantic memory following severe closed head injury.

This study investigated the effects of severe closed head injury (CHI) on the speed of information processing within semantic categories. The question of whether subjects were able to benefit from priming was also investigated. Survivors of severe CHI who were less than 1 year postinjury and survivors who were greater than 1 year postinjury were compared with neurologically normal matched controls utilizing a category judgement task. The results demonstrated slower processing within semantic memory for both groups of CHI patients compared to normal controls. Furthermore, individuals with CHI were able to benefit from priming to the same relative degree as control subjects. Overall, the results suggested semantic organization remains intact after severe CHI, but accessing semantic information is slowed.

Adult↗
PubMed1991

Adjustment to spinal cord injury: stage theory revisited.

To better understand adjustment following spinal cord injury (SCI), 106 subjects from two samples (N = 53 each) were administered the SCL-90-R, a symptom checklist, and the Multidimensional Health Locus of Control scales. Sample 1 subjects were admitted for rehabilitation during 1981 to 1982 and sample 2 subjects were admitted during 1984 to 1986. Sample 2 subjects entered rehabilitation programs more quickly after injury and reported more anxiety, phobic anxiety, and hostility than sample 1 subjects. Within each sample, there was no evidence for a relationship between age or time since injury and health beliefs or psychological distress. This study does not support stage theory for adjustment after catastrophic injury, but does suggest the importance of understanding the impact of social policy changes in adjustment following spinal cord injury.

Adaptation, Psychological↗
PubMed1991

Dispersion of refractoriness in canine ventricular myocardium. Effects of sympathetic stimulation.

In 18 dogs on total cardiopulmonary bypass, the average interval between local activations during artificially induced ventricular fibrillation (VF interval) was measured from extracellular electrograms, simultaneously recorded from up to 32 ventricular sites. VF intervals were used as an index of local refractoriness, based on the assumption that during ventricular fibrillation, cells are reexcited as soon as they have recovered their excitability. In support of this, microelectrode recordings in two hearts during ventricular fibrillation did not show a diastolic interval between successive action potentials. Refractory periods determined at a basic cycle length of 300 msec with the extrastimulus method correlated well with VF intervals measured at the same sites. Thus, this technique allows assessment of spatial dispersion of refractoriness during brief interventions such as sympathetic stimulation. The responses to left, right, and combined stellate ganglion stimulation varied substantially among individual hearts. This was observed both in dogs with an intact (n = 12) and decentralized (n = 6) autonomic nervous system. Individual ventricular sites could show effects of both left and right stellate ganglion stimulation (42% of tested sites) or show effects of left-sided stimulation only (31%) or right-sided stimulation only (14%). In 13% of sites, no effects of stellate stimulation were observed. Apart from these regional effects, the responses could be qualitatively different; that is, within the same heart, the VF interval prolonged at one site but shortened at another in response to the same intervention, although shortening was the general effect and prolongation the exception. Whenever sites responded to stellate ganglion stimulation with a shortening of VF interval, this shortening was approximately 10% for left, right, or combined stimulation, whether the autonomic nervous system was intact or decentralized. In six of 12 hearts in the intact group, there was a distinct regional effect of left stellate ganglion stimulation; in the other six hearts, the effects were distributed homogeneously over the ventricles. In three hearts, the effect of left stellate ganglion stimulation was strongest in the posterior wall, and in the other three hearts, in the anterior wall. The effects of right stellate ganglion stimulation were restricted to the anterior or lateral part of the left ventricle. Dispersion of VF intervals increased after left and combined stellate ganglion stimulation in the intact group and after right stellate ganglion stimulation in the decentralized group, but not significantly in every heart. This points to a marked individual variation with regard to the effects of sympathetic stimulation on electrophysiological properties of the heart.

Action Potentials↗
PubMed1991

The supply of charity services by nonprofit hospitals: motives and market structure.

This article studies provision of charity care by private, nonprofit hospitals. We demonstrate that in the absence of large positive income effects on charity care supply, convex preferences for the nonprofit hospital imply crowding out by other private or government hospitals. Extending our model to include impure altruism (rivalry) provides a possible explanation for the previously reported empirical result that both crowding out and income effects on indigent care supply are often weak or insignificant. Empirical analysis of data for hospitals in Maryland provides evidence of rivalry on the supply of charity care.

Altruism↗
PubMed1990

Torsion of an intraabdominal testis tumor presenting as an acute abdomen.

Torsion of an intraabdominal testicular tumor is a rare preoperative diagnosis. An increased diagnostic yield is dependent on an expedient and comprehensive preoperative evaluation. This consists of a detailed past surgical history, a thorough physical examination, and close inspection of the preoperative abdominal films. An illustrated case report is presented.

Abdomen, Acute↗
PubMed1990

Economic aspects of patterns of mental health care: cost variation by setting.

The paper examines the evidence regarding the extent to which differences exist in health and mental health status of psychiatric patients treated in the specialty mental health, general medical, and informal care sectors. Differences in types of patients treated in the three sectors are important to identify since there are dramatic differences in the average costs of treatment. We use data from the Baltimore Epidemiological Catchment Area Survey to estimate a statistical model of treatment setting choice. Our results suggest that there is little support for attributing major differences in treatment costs across sectors to differences in the health and mental health status of patients.

Costs and Cost Analysis↗