The share of Medicaid for nursing home care

Over one-third of Medicaid dollars go to nursing homes, a share that is decreasing but that varies widely among the states. This paper examines demand, supply, and policy factors explaining interstate variation over time in the nursing home share of state Medicaid dollars. Nursing home bed stock shows strong effects; Medicaid expenditures for acute hospital and for ICF-MR care are important; and various demand factors also explain nursing home share. In this model, residual nursing home share of Medicaid declines over time, which is interpreted to reflect omitted state policy factors explaining state ability to constrain Medicaid nursing home utilization and expenditures.     

Medicare revenue in large medical groups

The aged are the heaviest users of physician services. A ageing population and escalation in medical costs have pressured Medicare budgets, which have increased fastest in Part B physician reimbursement. Policy responses include adoption of the Resource Based Relative Value Scale (RBRVS) for physician payment. This paper considers receipt of Medicare revenues by large medical groups and expectations of how groups will fare under RBRVS. In a 73-percent sample of U.S. large group practices, Medicare coverage accounted for one-fourth of clients, Medicare-related revenues for slightly more than one-fourth of revenues, suggesting a slightly higher revenue intensity for Medicare clients, but showing no evidence of truly disproportionate revenues from Medicare users. Medicare shares of revenues are explained by factors related to Medicare clientele and geriatric service provision. Overly-strict Medicare assignment policy may control costs by limiting access to needed care, rather than by limiting overpayments to physicians. Expectations as to how groups will fare under RBRVS are not found to be related to reliance on Medicare, rather to group auspices and ability to contain costs under Medicare payment. The findings are important not only to physician payment under RBRVS but also under health care reform.     

Characteristics associated with excessive weight gain after smoking cessation in men.

OBJECTIVES. Data from two surveys of the National Academy of Sciences-National Research Council Twin Registry, conducted 16 years apart, were used to determine characteristics of individuals that were predictive of excessive weight gain after smoking cessation. METHODS. Over the follow-up, 2179 men quit smoking and averaged a weight gain of 3.5 kg. Quitters were grouped into four categories of weight change: lost weight, no change, gained weight, and excessive weight gain ("super-gainers"). RESULTS. In comparison with quitters reporting no change in weight, super-gainers were younger, were of lower socioeconomic status, and differed on a number of health habits before quitting (all Ps < .05). At follow-up, super-gainers reported changes in health habits that were significantly different from those seen in quitters reporting stable weight (all Ps < .05). Pairwise concordance for weight change in 146 monozygotic and 111 dizygotic twin pairs in which both twins quit smoking was significantly greater in monozygotic than dizygotic pairs (P < .01). CONCLUSIONS. These results indicate that super-gainers differ in important ways from those who do not gain weight after smoking cessation and that these weight changes may be influenced by underlying genetic factors.     

Caffeine consumption and menstrual function

The relation between caffeine intake and menstrual function was examined in 403 healthy premenopausal women who belonged to Kaiser Permanente Medical Care Program in 1990-1991. A telephone interview collected information about caffeinated beverage intake as well as other lifestyle, demographic, occupational, and environmental factors. Subjects collected daily urine samples and completed a daily diary for an average of five menstrual cycles. Metabolites of estrogen and progesterone were measured in the urine, each cycle was characterized as anovulatory or ovulatory, and a probable day of ovulation was selected when appropriate. Logistic regression and repeated measures analyses were performed on menstrual parameters. Women whose caffeine consumption was heavy (>300 mg of caffeine per day) had less than a third of the risk for long menses (> or =8 days) compared with women who did not consume caffeine (adjusted odds ratio = 0.30, 95% confidence interval 0.14-0.66).Those whose caffeine consumption was heavy also had a doubled risk for short cycle length (< or =24 days) (adjusted odds ratio = 2.00, 95% confidence interval 0.98-4.06); this association was also evident in those whose caffeine consumption was heavy who did not smoke (adjusted odds ratio = 2.11, 95% confidence interval 1.03-4.33). Caffeine intake was not strongly related to an increased risk for anovulation, short luteal phase (< or =10 days), long follicular phase (> or =24 days), long cycle (> or =36 days), or measures of within-woman cycle variability.     

Effect of image sampling frequency on established and smoothing-independent kinematic values of capacitating human spermatozoa

It is known that image sampling frequency affects sperm kinematic values, although no study has considered the relative effect upon hyperactivated and non-hyperactivated spermatozoa. We determined the relative effect of image sampling frequency on the classification of capacitating human spermatozoa, using the established kinematic measures as well as a series of new, smoothing-independent kinematic measures. Spermatozoa were prepared by direct swim-up from semen and sperm movement was recorded using a video system which gave 201 images/s on freeze-frame playback. Trajectories were reconstructed manually and kinematics were determined using the (x, y) co-ordinates of each track point. Lower image sampling frequencies were approximated by considering every second, third, fourth, sixth and eighth track point for each trajectory. Of the 22 kinematic values investigated, only three were not significantly affected by sampling frequency in both hyperactivated and non-hyperactivated spermatozoa. Also, significant differences were observed between hyperactivated and non-hyperactivated tracks at all image sampling frequencies studied for all but four kinematic measures.     

The use of research in local health service agencies.

A critical and often overlooked component of the use and transfer of research in the health care system is the local health and social service delivery agency. There is also very little understanding of the extent to which local community-based agencies conduct research internally to improve their operational capacity. More than ever, these local service organizations require research to guide activity in a rapidly changing health care environment which is characterized by diminishing health and social service budgets, de-institutionalization and concomitant increases and metamorphoses in service demands. This study interviewed 25 executive directors and held a focus group with a group of other directors to examine the use and transfer of research in these organizations. A number of central issues were identified by the directors that affect the contribution of research to the delivery of their programs and services. A conceptual model for developing 'locally-based research transfer' was subsequently outlined that could serve as the basis for enhanced research use and research transfer in other local area contexts.     

Review article: the pharmacokinetics of rabeprazole in health and disease

Rabeprazole, a newly developed proton pump inhibitor, has been shown to be effective for the treatment of gastric and duodenal ulcers and for gastro-oesophageal reflux disease. It is a rapid and potent inhibitor of gastric H⁺,K⁺-ATPase, the gastric acid (proton) pump. The maximum plasma concentration ( C _max) and the area under the plasma concentration time curve ( AUC ) are linearly related to dose, while the time to maximum plasma concentration ( t _max) and elimination half-life ( t _½) are dose-independent. Rabeprazole is extensively metabolized in the liver via the cytochrome P450 enzyme system, and its metabolites are excreted primarily in the urine. Rabeprazole does not accumulate with repeated dosing. Its bioavailability is not influenced by the coingestion of either food or antacids. The pharmacokinetic profile of rabeprazole is substantially altered in the elderly and patients with stable compensated chronic cirrhosis; however, these alterations are not associated with clinically significant abnormalities in laboratory parameters or serious adverse events. The influence of severe decompensated liver disease on the pharmacokinetics of rabeprazole has not been assessed. The pharmacokinetic profile of rabeprazole is not significantly altered by renal dysfunction requiring maintenance haemodialysis. These findings suggest that dosage adjustment is not required in these special patient populations. Caution should be exercised, however, in patients with severe liver disease.