Biomedical subjects

S Crystal

Publications and source records attributed to S Crystal.

At least 37 records · Page 2Linked to original sources

PubMed1999

Gender differences in pension wealth: estimates using provider data.

Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women's employment experiences increasingly resemble those of men.

Female↗

PubMed1999

The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States.

OBJECTIVES: To examine whether competing subsistence needs and other barriers are associated with poorer access to medical care among persons infected with human immunodeficiency virus (HIV), using self-reported data. DESIGN: Survey of a nationally representative sample of 2,864 adults receiving HIV care. MAIN INDEPENDENT VARIABLES: Going without care because of needing the money for food, clothing, or housing; postponing care because of not having transportation; not being able to get out of work; and being too sick. MAIN OUTCOME MEASURES: Having fewer than three physician visits in the previous 6 months, visiting an emergency room without being hospitalized; never receiving antiretroviral agents, no prophylaxis for Pneumocystis carinii pneumonia in the previous 6 months for persons at risk, and low overall reported access on a six-item scale. RESULTS: More than one third of persons (representing >83,000 persons nationally) went without or postponed care for one of the four reasons we studied. In multiple logistic regression analysis, having any one or more of the four competing needs independent variables was associated with significantly greater odds of visiting an emergency room without hospitalization, never receiving antiretroviral agents, and having low overall reported access. CONCLUSIONS: Competing subsistence needs and other barriers are prevalent among persons receiving care for HIV in the United States, and they act as potent constraints to the receipt of needed medical care. For persons infected with HIV to benefit more fully from recent advances in medical therapy, policy makers may need to address nonmedical needs such as food, clothing, and housing as well as transportation, home care, and employment support.

Adult↗

PubMed1999

Characteristics of persons with mental retardation and HIV/AIDS infection in a statewide Medicaid population.

Very little is known about the characteristics of people with mental retardation who are infected with HIV. Using a datafile created by a match between the New Jersey HIV and AIDS Registry file through March 1996 and the New Jersey Medicaid eligibility file for the period August 1993 to March 1996, we identified the largest group of HIV-infected persons with mental retardation (N = 119) that has been reported to date. Compared to other HIV-infected New Jersey Medicaid recipients, individuals in this subgroup were more likely to be female, Black, and have injection drug use as a route of infection. Implications for delivery of appropriate services are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey.

OBJECTIVES: This study sought to identify and characterize seriously mentally ill patients with HIV infection. METHODS: Medicaid beneficiaries with HIV/AIDS were identified through the merging of New Jersey HIV/AIDS Registry and Medicaid eligibility files. Claims histories were used to classify individuals as having schizophrenia, major affective disorder, or no serious mental illness. RESULTS: Of 8294 individuals, 476 (5.7%) were classified as having schizophrenia, and 564 (6.8%) were classified as having major affective disorder. Those with serious mental illness were more likely than other groups to be injection drug users and to have claims indicative of substance abuse. CONCLUSIONS: Individuals with serious mental illness are a significant but little-recognized subgroup of those with HIV infection.

Adult↗

PubMed1999

Incidence and duration of hospitalizations among persons with AIDS: an event history approach.

OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Home-care use and expenditures among Medicaid beneficiaries with AIDS.

This article compares the use and cost of home-care services among traditional Medicaid recipients with acquired immunodeficiency syndrome (AIDS) and among participants in a statewide Human Immunodeficiency Virus (HIV)/AIDS-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data. Waiver program participation appears to mitigate racial and risk group differences in the probability of home-care use. However, the program's successes are confined to its enrollees of which subgroups of the AIDS population are underrepresented. Our findings suggest the need to expand access to home-care programs to racial minorities and injection drug users (IDUs) with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Functional status transitions and survival in HIV disease: evidence from the AIDS Costs and Service Utilization Survey.

OBJECTIVE: The authors examined the prevalence of limitations in physical functioning in a large sample of people with human immunodeficiency virus (HIV) infection and the patterns of change in their functional status with time. METHODS: Patients receiving treatment for HIV infection were sampled from 26 providers in 10 cities across the United States; the analytic sample included 1,784 adults with HIV infection. Functional status was measured three times during a 12-month period. Respondents indicated whether they were limited in their ability to perform six activities, ranging from vigorous activities to bathing and dressing. Responses to the six items were combined to form an index of physical functioning. Medical records were used to determine stage of HIV infection, and death records were used to determine vital status. Changes in functional status during a 1-year period were assessed; correlates of change were examined using multinomial logistic regression, with "deceased" included as an outcome state. RESULTS: Limitation was most prevalent for vigorous activities (55%) and least prevalent for activities of daily living (12%). For each activity, the prevalence of limitations rose with increasing disease severity. During 1 year, 43% of respondents did not change in functional status, whereas 42% became worse and 15% reported improved functioning. Controlling for prior functional status, multivariate analyses showed that declines in functioning were related to developing acquired immunodeficiency syndrome (AIDS), to prior reports of fatigue, and to poor self-rated health. These same variables also predicted mortality. CONCLUSIONS: Results suggest that the most prevalent types of home care assistance needed by those with HIV disease involve help with energy-demanding activities, such as shopping, and that nonuniform patterns of change in functioning necessitate flexible programs to meet frequently changing needs.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Stress, social support, and distress in a statewide population of persons with AIDS in New Jersey.

This study examined the effects of stress, social support, and health status on distress in a sample of 79 persons with AIDS in New Jersey. The study used New Jersey's AIDS Registry as a geographically based list sampling frame, with data gathered through in-person interviews. The study examined the effects of health status (operationalized as symptom burden), stress (operationalized with a stressful-life-events scale), social support from friends, and social support from family on depression as measured by the Center for Epidemiological Studies-Depression (CES-D) scale. We examined the differential effects of friend support and of family support at differing levels of stressful life events. Results indicate that health status and stressful life events both have substantial impact on distress. Friend support reduced distress under lower-stress conditions, while family support reduced distress under high-stress conditions. These results suggest that social support from peers is critical for emotional well-being of persons with HIV in many circumstances, but that in periods of crisis family support becomes a more important determinant of emotional well-being.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Health insurance coverage at midlife: characteristics, costs, and dynamics.

Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists.

Age Factors↗

PubMed1996

Later-life economic inequality in longitudinal perspective.

Data from the National Longitudinal Survey of Older Men were used to estimate economic inequality within three 5-year cohorts as they moved from midlife to later life. The Gini index of inequality increased steadily after age 59, supporting the hypothesis that within-cohort inequality increases in late life. However, a transition analysis found considerable mobility in relative status for individuals over a 15-year period. These results suggest the need to develop a longitudinal perspective on later-life economic status which distinguishes between individual-level and population-level outcomes and identifies the life events and characteristics of individuals that predict changes in economic status. Further research is needed on the processes which lead to later-life inequality, and on the distributional impact of public and private pension policies.

Age Distribution↗

PubMed1996

Functional impairment trajectories among persons with HIV disease: a hierarchical linear models approach.

OBJECTIVE: This study investigates the level, time course, and stability of functional impairment in a population of persons with symptomatic HIV disease, and illustrates the application of hierarchical linear modeling (HLM) to trajectories of functional status in unbalanced longitudinal data. STUDY POPULATION: We utilized longitudinal interview data on a demographically diverse cohort of 246 individuals participating in New Jersey's Medicaid waiver program for persons with AIDS or symptomatic HIV disease, with a mean of nine repeated observations per individual. MEASURES AND STATISTICAL METHODS: Impairment in ability to perform 16 activities of daily living (ADL) and instrumental activities of daily living (IADL) was assessed at monthly intervals. To achieve unbiased, efficient estimation of the level and within-individual rate of change of functional status utilizing all observations for each individual, hierarchical linear models were used. Time slopes were compared to those from a single-level model estimated on the pooled observations. Stability of functional status within individuals was also evaluated. PRINCIPAL FINDINGS: A single-level pooled model showed no significant time trend in functional impairment, while the multilevel models did indicate such a trend. In the final HLM model, functional impairment was estimated to increase at a rate of .32 tasks per month. Female gender was associated with impairment in an additional 1.88 tasks and AIDS diagnosis with an additional 1.35 tasks. There was substantial variability within individuals over time, most of which was not explained by time trend. CONCLUSIONS: The multilevel models indicated a significant month-to-month worsening of functional status that was masked in the single-level model by between-person variation. Impairment was found to increase over time, but followed a variable and episodic course rather than a steady or consistent decline. Women appeared to experience special problems in performing ADL and IADL tasks. RELEVANCE/IMPACT: Results demonstrate the need for flexible and responsive systems for authorizing and managing in-home services for persons with HIV disease, systems that can respond to frequent changes in the functional status and level of care needs of these individuals. They suggest further attention to special care needs that may be experienced by women with HIV disease. They illustrate that hierarchical linear modeling can be an important tool in understanding change in functional status over time, providing a multilevel model that disaggregates within-individual and between-individual variation in functional status. This approach can be generalized to a wide variety of problems in health services research in which outcomes are observed over time with unbalanced longitudinal data.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Taste preferences and sensory perceptions in female varsity swimmers.

Taste preferences and sensory estimates of sweetness and fat content of 16 dairy stimuli with varying levels of fat (0%, 3.5%, 10.5% and 37.6%) and sucrose (0%, 5%, 10% and 20%) were compared in members of a Division I college women's swim team and women who did not engage in any organized sports. No differences in taste preferences or sensory estimates were observed for swimmers across the athletic season. However, swimmers had significantly lower preference ratings for high-sucrose and high-fat stimuli than controls. Controls who reported exercising more than 3 h a week also displayed decreased preference ratings for high-sucrose and high-fat stimuli relative to controls who reported exercising less than 3 h a week. With respect to sensory estimates, swimmers reported that high-sucrose stimuli were sweeter, low-fat stimuli were less fatty, and high-fat stimuli were more fatty than controls. The preference ratings and sensory estimates of these athletes were similar to those previously seen in individuals with anorexia nervosa and bulimia.

Adolescent↗

PubMed1995

The impact of coresidence on economic well-being of elderly widows.

Cross-sectional data from the Survey of Income and Program Participation were used to estimate the impact of coresidence on the economic well-being of elderly widows and of coresident family members. Coresidence improves well-being for both the widow and the other participants in 51 percent of cases; improves it for the widow and diminishes it for the others in 28 percent of cases; and improves it for the others while diminishing it for the widow in 21 percent of cases. Among non-Whites, coresidence benefits the widow less, and other members more, than among Whites. A regression model of the economic benefit to elderly widows from coresidence was used to explain why non-White widows receive less benefit from coresidence than Whites. Much of the racial difference can be explained by differences in household composition and the lower earnings of adult males in the households of non-White elders. While coresidence is often thought of as a response to an elderly widow's needs, her presence typically contributes to rather than diminishes the economic well-being of the household, and this is especially true among non-Whites.

Aged↗

PubMed1995

The diffusion of innovation in AIDS treatment: zidovudine use in two New Jersey cohorts.

OBJECTIVE: This study investigates patterns of utilization of zidovudine (ZDV) by gender, race, risk group, and other respondent characteristics following approval of this treatment. STUDY POPULATION: Longitudinal observational data were used on a demographically diverse population participating in New Jersey's Medicaid waiver program for persons with symptomatic HIV disease. DATA EXTRACTION METHODS: Claims data were merged with administrative data on demographic characteristics, risk group, and functional status. Periods of ZDV utilization were determined by analysis of pharmacy claims. DESIGN: The proportion of respondents ever using ZDV (treatment incidence) and the proportion of time on ZDV among users (treatment persistence) were analyzed for a cohort enrolling in 1987 and 1988, and for a cohort enrolling in 1989 and 1990, with follow-up of utilization through August 1992. For each cohort, bivariate analyses were used to compare incidence and persistence by patient subgroup; logistic regression was used to investigate the predictors of incidence in a multivariate model; and OLS regression was used to analyze proportion of time on ZDV among those with any ZDV use. PRINCIPAL FINDINGS: For the 1987-1988 cohort, substantial race, gender, and risk group differences in utilization were observed, even though all participants in this Medicaid population had financial coverage for ZDV treatment. Treatment incidence was significantly lower for blacks than for others in bivariate comparison (45 percent versus 63 percent had any use of ZDV) and in a logistic regression controlling for a variety of demographic and health status indicators (relative risk .46, CI .31 a variety of demographic and health status indicators (relative risk .46, CI .31 to .69). Treatment persistence differences were also substantial in the 1987-1988 cohort: among ZDV users, women, blacks, and injection drug users (IDUs) had significantly less persistence in use, and the gender and risk group differences were significantly in a multivariate model. In the 1989-1990 cohort, however, both incidence and persistence of treatment converged: no significant differences were observed across demographic groups. CONCLUSIONS: Less-advantaged subgroups lagged in access to this new therapy, suggesting the presence of nonfinancial barriers to care. However, these initial differences subsequently converged. RELEVANCE/IMPACT: Socioeconomic differences have been observed in access to newly introduced treatments for a variety of diseases, reflecting nonfinancial as well as financial barriers to care. Such differences may or may not disappear as use of therapies becomes institutionalized. Monitoring patterns of treatment initiation as well as persistence of treatment over time, using merged data from claims and administrative files, can provide important information on the diffusion of treatments and the extent to which initial disparities are or are not reduced over time.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Menstrual cycle and dietary restraint influence taste preferences in young women.

Previous reports indicate that some women increase their consumption of sugar and fat premenstrually. To ascertain whether this is due to differences in taste acuity for sweetness and fatness and/or preference across the menstrual cycle, 25 female and 12 male undergraduates rated the pleasantness, sweetness, and fatness of 16 taste stimuli made of dairy products with varied fat contents (0%, 3.5%, 10%, 36%) and sucrose (0%, 5%, 10%, 20%) over 4 consecutive weeks. There was a marked decline in ratings over the 4 weeks of testing. Taste preferences of women were not uniform across the menstrual cycle. Those who began testing during the luteal and menstrual weeks had increased preference ratings compared to those who began during the follicular or ovulatory weeks. Preference ratings for taste stimuli containing 0% and 5% sucrose were lower in women with higher scores on a restraint of eating scale, than for women with lower scores. No differences in sweetness or fatness ratings were observed across the menstrual cycle, or as a function of dietary restraint. Men had increased preference for taste stimuli containing 10% and 20% sucrose compared to women; however, no differences in ratings of either sweetness or fatness were found as a function of gender. These data indicate that taste preference in women is not homogeneous across the cycle. Instead, many factors, including the menstrual cycle and degree of eating restraint, influence preference ratings.

Adolescent↗

PubMed1994

Risky business: the cultural construction of AIDS risk groups.

AIDS researchers and policy makers have often employed the concept of 'culture' to characterize 'high risk groups' and explain why members of these groups continue to practice 'risky behavior.' We argue that the widespread interest in ethnography tends to reflect a usage of the concept of culture that distances and subordinates. People with AIDS are portrayed as either minority street people abandoned by friends and family or as white gay men who live within a gay community, and in either case as socially deviant. This construction of HIV disease has facilitated distancing and denial of personal risk by persons outside the 'high risk groups,' impeding prevention efforts. Perceptions of subcultures of risk groups are contrasted with data on a random sample of persons with AIDS in New Jersey.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Educational attainment, occupational history, and stratification: determinants of later-life economic outcomes.

Determinants of economic well-being among men 25-44, 45-64, and 65+ were examined using data from the 1984 panel of the Survey of Income and Program Participation. A path analysis explored race, education, and occupational history effects on income adjusted for annuitized assets, household composition, and underreporting of unearned income. Direct and total education effects were undiminished among elderly persons, whose income derived mainly from benefits and assets, as compared with the nonelderly subjects whose income was dominated by earnings; education explained more of the variance in adjusted income for the elderly group than for the nonelderly. While Social Security income exerts an equalizing effect across educational attainment groups, private pensions and other important retirement income sources were highly education-dependent, producing a high overall degree of stratification on early-established socioeconomic characteristics.

Adult↗

PubMed1992

A room of one's own: the SRO and the single elderly.

A survey of 485 single-room occupancy housing (SRO) residents in New York City found elderly residents strongly preferred to remain in centrally located neighborhoods where apartment housing was beyond their means; did not wish to share a housing unit; and had little confidence that they could find acceptable housing if they lost their present unit. For many elderly residents, SROs meet needs not easily met by available alternatives. Results suggest the need to maintain this housing option for older persons and replace losses that have accompanied gentrification in many central city areas.

Aged↗