The effectiveness of consumer choice in the Medicare supplemental health insurance market.

This article examines the factors that affect Medicare beneficiaries' choices in the supplemental health insurance market. Data include detailed survey information as well as copies of the health insurance policies owned by a sample of approximately 2,500 Medicare beneficiaries in six states during 1982. Logit analysis is employed to analyze the determinants of four dependent variables: whether a person owns (1) one or more private supplemental insurance policies, (2) two or more policies, (3) at least one policy that we define as "effective," and (4) a policy we define to be "less effective." Those who are better off from a socioeconomic standpoint appear to be making more effective choices in the supplemental health insurance market. However, there does not appear to be a relationship between consumer ignorance or vulnerability and the purchase of multiple supplemental insurance policies. Study results imply an important role for public policy in helping to provide the information necessary to ensure that the most vulnerable beneficiaries make insurance choices that are in their best interest.     

Effect of Paget's disease of bone on areal lumbar spine bone mineral density measured by DXA, and density of cortical and trabecular bone measured by quantitative CT

Although bone density may be increased in bone that is affected by Paget's disease, density changes in cortical and trabecular bone and the effect on bone that is apparently unaffected by Paget's disease are relatively unexplored. We have investigated 81 vertebrae (28 affected, 53 unaffected) in 27 patients with Paget's disease, by dual X-ray absorptiometry (DXA) and by quantitative CT (QCT) bone density measurements of trabecular and cortical bone. DXA bone density was high (mean z-score = 1.62, p < 0.001) in vertebrae affected by Paget's disease, but not significantly different from normal in unaffected vertebrae (mean z-score = 0.07, ns). Mean QCT z-score in Paget's vertebrae was 2.07 (p = 0.009) for cortical bone and 1.37 (p = 0.008) for trabecular bone. DXA correlated with QCT cortical values in affected and unaffected bone (r = 0.8 and 0.56, respectively), and with QCT trabecular values (r = 0.72 and 0.48, respectively). There was no significant difference in the slopes for the correlations in affected or unaffected bone. Cortical QCT values are underestimated in Paget's disease compared with physical measurements of density, owing to the computer algorithm used. High DXA values may alert to the possibility of Paget's disease, especially if the value deviates from the expected normal sequence in lumbar vertebrae. Osteoporotic vertebrae may be overlooked if the average value of bone mineral density is taken in the lumbar spine without reviewing each vertebra.     

Intra-articular ganglion cysts of the cruciate ligaments

Intra-articular ganglion cysts of the cruciate ligaments are associated with non-specific clinical signs and symptoms. Familiarity with the MR appearances in particular is important to make an accurate diagnosis, exclude associated abnormalities, and avoid misdiagnosis. Received: 6 August 1999; Revised: 23 November 1999; Accepted: 23 November 1999     

Oxidative stress and HNE conjugation of GLUT3 are increased in the hippocampus of diabetic rats subjected to stress

Recent studies demonstrate that cellular, molecular and morphological changes induced by stress in rats are accelerated when there is a pre-existing strain upon their already compromised adaptive responses to internal or external stimuli, such as may occur with uncontrolled diabetes mellitus. The deleterious actions of diabetes and stress may increase oxidative stress in the brain, leading to increases in neuronal vulnerability. In an attempt to determine if stress, diabetes or stress+diabetes increases oxidative stress in the hippocampus, radioimmunocytochemistry was performed using polyclonal antisera that recognize proteins conjugated by the lipid peroxidation product 4-hydroxy-2-nonenal (HNE). Radioimmunocytochemistry revealed that HNE protein conjugation is increased in all subregions of the hippocampus of streptozotocin (STZ) diabetic rats, rats subjected to restraint stress and STZ diabetic rats subjected to stress. Such increases were not significant in the cortex. Because increases in oxidative stress may contribute to stress- and diabetes-mediated decreases in hippocampal neuronal glucose utilization, we examined the stress/diabetes mediated HNE protein conjugation of the neuron specific glucose transporter, GLUT3. GLUT3 immunoprecipitated from hippocampal membranes of diabetic rats subjected to stress exhibited significant increases in HNE immunolabeling compared to control rats, suggesting that HNE protein conjugation of GLUT3 contributes to decreases in neuronal glucose utilization observed during diabetes and exposure to stress. Collectively, these results demonstrate that the hippocampus is vulnerable to increases in oxidative stress produced by diabetes and stress. In addition, increases in HNE protein conjugation of GLUT3 provide a potential mechanism for stress- and diabetes-mediated decreases in hippocampal neuronal glucose utilization.     

Seizure threshold rise during electroconvulsive therapy in schizophrenic patients

A rise in seizure threshold during a course of electroconvulsive therapy (ECT) has been demonstrated in patients with depression and mania, but no information has been available as to whether the same result occurs in schizophrenia. Ninety-three patients with schizophrenia underwent estimation of the seizure threshold by the dose-titration method, at the first and second, seventh, fourteenth, and twentieth treatments over an index ECT course. The 3-week stabilization period was used as a response criterion. Eighty-six patients (92%) showed a rise in threshold. The magnitude of increment was 269+/-244%. The rise in seizure threshold could be predicted by the number of treatments, initial seizure threshold and EEG seizure duration, and these factors explained 42% of the variance.     

Effects of hallucinogenic drugs on serotonergic neuronal systems

Studies indicate that hallucinogens markedly suppress the discharge of serotonin containing neurons in the dorsal raphe nucleus. Forebrain neurons receiving a major serotonergic input are relatively insensitive to hallucinogens. These actions of hallucinogens are not sufficient to explain the psychoactive effects of these drugs. Evidence is presented to indicate that hallucinogens sensitize serotonin and norepinephrine receptors in the facial nucleus. This receptor sensitizing effect is common to all, and specific for, hallucinogens. It is suggested that a mechanism of receptor sensitization might account for the altered perceptual reactivity produced by hallucinogens.     

Integration or specialization? Similarities and differences between Sweden and the United States in gerontology education and training

ABSTRACT

This article examines the similarities and differences in the education and training of gerontologists and others who work with older people in Sweden and the United States. It outlines the aging trends in both countries and assesses the level of training for those who provide care in a variety of fields. Both countries are aging, but the programs for gerontological training are quite different in the two countries, reflecting underlying cultural values. Sweden’s education is generally more oriented toward the integration of some aging education in more disciplinary fields, such as nursing and social work and thus could benefit from more specialized, aging-specific courses. The United States is highly specialized, with multiple programs in various subfields of aging (e.g., geropsychology; aging services administration) and could benefit from integrating more aging knowledge into courses in other disciplines. The authors challenge professionals to consider if there is a basic but global curriculum and/or set of competencies in gerontology that could be agreed upon. As an increasingly global village, the ability to share and learn is more easily achievable. Sweden and the United States have much to learn from each other in terms of appropriately educating and training those who support our older people.