Understanding the recent growth in Medicare physician expenditures

This study employs several large Health Care Financing Administration data sets for 1983 and 1985 to examine the recent growth in Medicare physician services. The study concludes that the recent growth (approximately 15% in real terms between 1983 and 1985) has been more rapid in areas with higher incomes per capita and suggests that this may be related to faster adoption and diffusion of new medical technologies in these areas. The volume of physician services had grown considerably faster for those specialists who utilize newer procedures and technologies than for those who do not. The study also provides evidence that the sharp increase in assignment rates in recent years because of the introduction of the physician participation program also contributed to the growth in physician services during this period. Medicare's prospective payment system, which controlled hospital payments and encouraged hospitals to become more efficient, had at most a small positive impact on the growth in Part B spending. Finally, the freeze on physician's fees did not seem to have had a major impact on the volume of physician services.     

Nutritional Approaches to Primary Prevention of Atherosclerosis in Childhood

Many risk factors have been identified with the progression of atherosclerotic lesions. Of these hyperglycemia, hypertension, hyperlipidemia, and obesity are amenable to nutritional therapy. Minimal data exist to prove that alteration in these risk factors prevent atherosclerosis in adults and children. This paper discusses nutritional approaches to prevention of atherosclerosis in children.     

Tardive dyskinesia in children treated with atypical antipsychotic medications.

Recent years have witnessed increased antipsychotic treatment of children despite limited long‐term safety data in children. In this study, motor side effects associated with the use of antipsychotic drugs in children were examined in a sample of pediatric psychiatric patients. Child and adolescent psychiatric patients receiving antipsychotics (most were on atypicals) for 6 months or longer (n = 118) were compared with antipsychotic‐naïve patients (n = 80) with similar age, sex ratio, and diagnoses. Only 19% of patients on antipsychotics had ever experienced psychotic symptoms. Eleven children (9%) on antipsychotics exhibited dyskinesia, when compared with 0 in the naïve group (P = 0.003, Fisher's exact test). Nine of 62 African–American children (15%) on antipsychotics exhibited dyskinesia, when compared with only 4% (2 of 52) of European–American children (P = 0.003, Fisher's exact test). Children treated with antipsychotic drugs might experience a significant risk of dyskinesia even when treated only with atypical antipsychotics. Ethnicity might also be a risk factor for dyskinesia in children. Side‐effect profile of the atypical antipsychotic drugs in children may be much different than that in adults. © 2007 Movement Disorder Society     

Developmental and behavioral consequences of prenatal drug and alcohol exposure.

This article summarizes what is known about the effects of cocaine, opiates, marijuana, and alcohol on neonatal and postnatal growth and development. The development of a child affected by prenatal exposure to drugs and alcohol is best understood through a multifactorial model consisting of interrelated prenatal and postnatal factors. The article also describes the prenatal effects of drugs and alcohol on the newborn, especially on central nervous system functioning, which is seen as creating a biologic vulnerability that renders a child more vulnerable to the effects of poor caretaking.     

Iatrogenic factors in "managed" psychotherapy

The clinical implications of the "case-manager" system are explored through a detailed case presentation. It is demonstrated that the introduction of a third person into the therapeutic relationship compromises the therapeutic alliance and the transference. Under such conditions psychotherapy is impossible.     

Ionic analysis of photoreceptor membrane currents

1. Membrane current was derived from simultaneous measurements of interstitial ;dark' voltages and conductivities along the radial axis of frog photoreceptor cells. Membrane current was subsequently resolved into its component ionic currents or fluxes by means of ionic substitution and by the use of inhibitors of active transport.2. The plasma membrane of the frog rod outer segment was found to be permeable to Na(+) and Cl(-), with a ratio of Na(+) to K(+) permeabilities higher than that found in most neuronal cells. A net inward flux of 1.5 x 10(8) Na(+)/sec.rod flows across the outer segment plasma membrane in the dark.3. The proximal portion of the rod receptor, extending from the proximal region of the inner segment to the synaptic terminal, is mainly permeable to K(+), although some degree of Na(+) permeability is also presumed.4. A hyperpolarizing electrogenic Na pump was localized to the base of the outer segment and inner segment of the cell. The pump transfers at least 10(8) charges/sec out of the cell at this level, the pump current dividing and re-entering the cell at both the outer segment and proximal portion of the photoreceptor including the synaptic terminal.5. These findings have been incorporated into an ionic model of the photoreceptor, and its implications for cellular functioning considered.     

Sensation Seeking and Cortical Augmenting-Reducing

The experiment was designed to establish the relationship between the Sensation Seeking Scales (SSS) and cortical augmenting-reducing. Forty-nine male undergraduate Ss were used. Ss were presented with five intensities of light flashes in randomly presented blocks of trials at each intensity. Averaged evoked response (AER) amplitudes were measured at each intensity of light. Augmenting-reducing was measured for each S as the slope of the relationship between stimulus intensity and amplitude of response. This slope measure correlated very significantly (r= .59) with the Disinhibition subscale of the SSS and positively, but not significantly, with other subscales. Comparing the low and high scorers on the Disinhibition scale, a significant interaction between groups and stimulus intensities was found but no main effects of stimulus intensity or groups were found. The high Disinhibitors did not differ from the lows at the low stimulus intensities but did differ significantly at the highest intensity where the lows showed a marked reducing tendency. The results show an interesting convergence between the Disinhibition type of sensation seeking, manic tendencies, and the AER.