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Biomedical subjects

A B Bernstein

Publications and source records attributed to A B Bernstein.

At least 19 recordsLinked to original sources
PubMed1999

Choices in health care: what are they and what are they worth?

This overview article provides a conceptual introduction to this special issue on health care choices, containing four main papers originally commissioned in 1997 for a conference titled "The Power of Choice in the Health Care Marketplace and Its Consequences," sponsored by the Robert Wood Johnson Foundation under its Changes in Health Care Financing and Organization (HCFO) program and conducted by the Alpha Center on November 19, 1997. Drawing on information from these four papers, the authors discuss what factors affect the different choices we face, highlighting the fact that different players in the health care system face diverse and often conflicting choices and trade-offs. The authors then examine the consumer choice model and its premise that when consumers are presented with adequate information about these different choices, they will make selections about plans, providers, and health insurance that will move the health care system toward a higher quality/lower cost equilibrium.

Attitude to Health↗
PubMed1998

Defining competition in markets: why and how?

OBJECTIVE: To examine the variety of perspectives from which to study the measurement of competition in the healthcare marketplace. Based on a meeting held by The Robert Wood Johnson Foundation in 1996, the authors discuss the complications inherent in the way markets and products are defined by key stakeholders, including economists, policymakers, federal antitrust officials, purchasers, and the competitors themselves. CONCLUSION: The consensus among those who study this issue is that the way competitors, markets, and geographic areas are currently defined, and the ways of measuring competition, are inadequate, due mainly to the fact that both the measures and the definitions have been constructed from very limited data. Confounding this is the fact that analyses of competition are undertaken for such a wide variety of uses and that creating one database to solve the problems mentioned can be extremely daunting. RECOMMENDATIONS: Future research should examine ways to develop better definitions of the new healthcare structures that are competing with each other and ways to create measures of competition that include these new structures. To remedy gaps in the ability to measure competition, the field might also benefit from a public use data file, similar to the Area Resource File (ARF), that would contain HMO data according to geographic area, as well as provider data, employer data, payer data, and sociodemographic data.

Antitrust Laws↗
PubMed1991

Cervical cancer screening: who is not screened and why?

BACKGROUND: The decline in death rates from cervical cancer in the United States has been widely attributed to the use of Papanicolaou (Pap) smears for early detection of cervical cancer. METHODS: Pap smear screening rates, beliefs about appropriate screening intervals and factors affecting screening were examined using 1987 National Health Interview Survey data. RESULTS: Results indicate that through age 69, Blacks are screened at similar or higher rates than Whites. Hispanics, particularly those speaking only or mostly Spanish, are least likely to have received a Pap smear within the last three years. Of women who had never heard of or never had a Pap smear, nearly 80 percent reported contact with a medical practitioner in the past two years, while more than 90 percent reported a contact in the past five years. Overall, the most frequently reported reason for not having a recent Pap smear was procrastinating or not believing it was necessary. CONCLUSIONS: Thus, in developing screening programs, Hispanics, particularly Spanish speakers, must be targeted. In addition, educational programs should target unscreened women who forego the test due to underestimating its importance, procrastination, or because their medical care provider did not suggest the procedure. Women must be intensively educated that Pap smears should be scheduled routinely to detect asymptomatic cervical cancer.

Adolescent↗
PubMed1991

Differences in rates of cancer screening by usual source of medical care. Data from the 1987 National Health Interview Survey.

Data from the Cancer Control Supplement of the 1987 Health Interview Survey (NHIS), a nationally representative sample of the United States population, was used to examine rates of six screening tests for cancer. The rates of screening were compared for people who receive their usual source of medical care in an HMO or prepaid group practice versus those who receive it in the fee-for-service sector. The purpose of this article is to determine whether HMOs remain more likely to offer cancer screening examinations than the fee-for-service sector. Results indicate that for five of six screening tests examined (Pap smear, mammography, breast physical examination, digital rectal examination, and blood stool test), members of HMOs are significantly more likely to have received the test within the last 3-year period. These results hold in a multivariate analysis when many factors correlated with selection into HMOs, health status, and use of medical services are controlled for, although results are only generalizable to whites. Future research should focus on why the rates for five of the six cancer screening tests examined are higher in HMO settings, and how we can use the HMO experience to improve consensus as to the usefulness of the tests in the non-HMO physician pool, and ultimately increase rates of screening tests in the non-HMO population.

Adolescent↗
PubMed1990

In-vitro formation of a collagenous matrix upon previously diseased and experimentally treated cemental root surfaces.

A diseased and mechanically treated surface of root cementum is known, clinically, to favor periodontal regeneration. The present investigation was undertaken to test whether previously diseased and experimentally treated root surfaces can support the in-vitro formation of a new collagenous matrix. Three teeth extracted for advanced periodontitis were treated first with 5% sodium hypochlorite for 2 h to remove all organic material from the root surface. After the healthy, apical one third of the root was cut off, the roots were scaled with moderate pressure to remove visible calculus. Non-demineralized root discs were cut and placed on a co-culture of periodontal ligament- and alveolar bone-derived cells. After 7 weeks in culture, either one of two matrix types was found along the root surface. The most frequent matrix consisted of clusters of cells layered within densely aggregated collagen fibrils. The other, less frequent matrix consisted of loosely arranged collagen fibrils adjacent to the cemental surface. The findings support the notion that, in vitro, a collagenous matrix is formed in contact to diseased and experimentally treated root surfaces. However, the smooth, non-demineralized and scaled cemental surface does not appear to be a suitable substrate for interdigitation with newly produced collagen fibrils.

Alveolar Process↗
PubMed1990

Expenditures for unintentional injuries among the elderly.

This article presents national estimates of the probability of having an unintentional injury, the types of medical care associated with unintentional injuries, and the costs of unintentional injuries that occurred in calendar year 1977 for persons aged 65 and older. Data come from the 1977 National Medical Care Expenditure Survey (NMCES) and the 1977 National Nursing Home Survey (NNHS). Among persons aged 65 and older, we found differences in the probability of having an unintentional injury by age, sex, and living arrangement, which suggests that unintentional injuries are not "accidental," or random, events. Our estimates indicate that total medical care expenditures for unintentional injuries for the elderly population in 1977 may have been over $2 billion. Using simple adjustments, we also estimated that the amount expended on injury-related medical care in 1984 might have been as high as $5 billion. Given the large amount of monetary, and presumably nonmonetary, costs associated with unintentional injuries, programs designed to reduce such injuries may well pay off in a cost-benefit or cost-effectiveness framework.

Accidents↗
PubMed1989

Formation of a new fibrous attachment to human dental roots. Effect of co-culturing periodontal ligament-derived and allogenic cortical bone-derived cells.

Human periodontal ligament cells have been shown to produce a new fibrous attachment at the surface of scaled dental root discs in vitro. The purpose of this investigation was to answer the question whether cells derived from human alveolar bone would enhance this attachment. Three partially erupted third molars were extracted and collected from one female patient and used for harvesting periodontal ligament cells as well as for cutting 0.3 mm dental root discs. Cells derived from alveolar bone were obtained by enzymatic digestion of bone chips harvested after extraction of wisdom teeth from three additional patients. Experimental cultures were prepared by seeding 1.0 x 10(6) suspensions of periodontal ligament cells onto five Puropor-200 filters. The following day, root disc pairs were placed on the cell layer, leaving a gap (interdental space) of 0.1-0.3 mm. Five days later, all cultures received equal aliquots of alveolar bone cells. The cultures were terminated and processed for microscopic and morphometric evaluation after 56, 112 and 124 days. All cultures demonstrated a dense fiber-fringe attachment along most of the cementum-lined surfaces of root discs. Adjacent to other root-disc surfaces, cells were surrounded by halos of their collagenous product. Mean diameters of collagen fibrils for the 56-, 112- and the two 124-day cultures were 64.6, 48.9 and 62.6 nm, respectively. Compared to results obtained in this system with periodontal ligament cells alone (Bernstein et al. 1988), the fiber fringe in this experiment was denser, composed of collagen fibrils with a larger diameter, and maintained for longer duration in culture.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones↗
PubMed1989

In-vitro formation of a new fibrous attachment to human dental roots in the presence of autologous serum.

Recent studies have accomplished the establishment of a collagenous fiber-fringe matrix upon dental root surfaces in vitro. The present study was undertaken to follow the development of such a matrix in vitro and to test the possible effects of root surface treatments upon this matrix. Periodontal ligament cells, 0.1 to 0.2-mm thick dental root discs, and alveolar bone cells were derived after extraction from four partially erupted third molars and the accompanying interradicular bony septa of 1 male patient. Autologous serum was obtained by venipuncture. Cultures were initiated by delivering a 1-ml suspension of 50,000 tritiated thymidine-labeled periodontal ligament cells and 50,000 alveolar bone cells onto each of 42 culture sets. The following day, demineralized or non-demineralized root discs treated with autologous serum, fibronectin or complete medium were placed in pairs, separated by a 0.1-1.0 mm gap, upon the initial cell layer. Representative cultures were terminated after 2, 3, 4, 5 and 6 weeks, and processed for light- and electron microscopy, morphometric analysis and autoradiography. An outstanding feature of the early cultures (2, 3 and 4 weeks) was a patchwise, random distribution of matrix making a precise developmental study impossible, although collagen fibrils were produced within the first 2 weeks. Some 3-week cultures already demonstrated a mature fiber-fringe characterized electron-microscopically as oriented, densely packed collagen fibrils closely abutting the cementum-lined root discs. The treatments (including autologous serum) used in this study had no appreciable morphologic or morphometric effect upon the fiber-fringe formed. Because none of the cultures in the present or past studies have demonstrated a true cementoid matrix, this model may not be suitable for the in-vitro study of cementum formation.

Adult↗
PubMed1988

Formation of a new fibrous attachment to human dental roots. A new vitro model for studying periodontal regeneration.

This study was performed to improve currently employed in vitro models for the study of periodontal regeneration by using a porous filter upon which periodontal ligament cells were grown. Periodontal ligament cells were harvested and 0.3 mm root discs cut from three partially erupted and extracted third molar teeth of one patient. Experimental culturing was performed by seeding periodontal ligament cell suspensions on Puropor-200 filters supported by wire-mesh grids in Grobstein Petri dishes. The following day, an interdental space of 0.1 to 0.3 mm was created by gently placing two dental root discs upon the filter. Cultures were terminated after 42, 56, 112 and 124 days, and processed for light- and electron microscopy. Collagen fibril diameters were measured. Adjacent and often attached to large areas of cementum-lined root discs, a dense fiber fringe developed. This fiber fringe was not found on dentin-lined root discs. Although less organized, older cultures demonstrated a similar disc-culture interface, which depended upon the presence or absence of original root cementum. Collagen fibrils of early cultures had a mean diameter of about 42 nm, while in older cultures the diameters ranged from 47 to 68 nm. It is concluded that the fibrous matrix attached to cementum-lined root discs somewhat resembles the initial stages of the formation of dental root cementum in vivo.

Adult↗
PubMed1987

The importance of distinguishing Hispanic subpopulations in the use of medical care.

Rather than analyzing Hispanics as a homogeneous population, this paper uses the 1977 National Medical Care Expenditure Survey in order to make separate national estimates for Cubans, Puerto Ricans, and Mexicans. Utilization of various health services by these three groups is discussed, as well as their insurance coverage, mean annual expenses by source of payment, and health status indicators. The analysis has a descriptive as well as multivariate component and focuses specifically on the use of physician and hospital services and prescribed medicines. It is found that Puerto Ricans are almost twice as likely as Mexicans, and over four times as likely as Cubans, to be covered by Medicaid; Cubans, on the other hand, are most often privately insured. Of the three groups, Puerto Ricans have the highest annual expenses and are most likely to have at least one physician visit. The number of visits for those with a visit, however, is identical across the groups. The paper discusses the policy implications of these findings, as well as the methodologic implications of classifying various Hispanic subgroups into one all-encompassing category.

Adolescent↗
PubMed1985

Preparing an emergency public relations plan.

Many hospital disaster plans, while containing detailed procedures for dealing with an emergency situation, fail to include a well thought out emergency public relations plan. This omission can prove extremely troublesome in an actual emergency when there is little time to decide who is to serve as spokesperson for the institution, what policies should be followed and what conflicts or problems may arise. In this article, the author spells out what is required in advance to develop such a public relations plan.

Disaster Planning↗
PubMed1983

The use and availability of medical care in health manpower shortage areas.

Data from the National Medical Care Expenditure Survey were used to examine access to care and utilization of health services in federally designated health manpower shortage areas (HMSAs). It was confirmed that residents of shortage areas experience some deprivation in access to care and use of services. Further analysis, however, indicated that shortage area designation has little direct effect on indicators of access and use. Factors such as income and health insurance coverage appear to be more closely associated with access and use than is an area's designation as a HMSA. The assumptions concerning access to care in federally designated shortage areas should therefore be reexamined.

Demography↗
PubMed1982

Regular source of care and the minority aged.

Data from the National Medical Care Expenditure Survey are used to examine the access of elderly minorities to a regular source of medical care. The findings suggest that such elderly persons are about as likely as the white elderly to have a routine point of entry into the medical care system. There are, however, difference in the type of setting at which care is received. Compared with the elderly population of whites, the elderly population of minorities is more likely to have a regular source of care in an institutional setting and less likely to have a regular source of care that provides house calls or emergency services. The absence of a usual source of care may be a contributing factor to the difference in use of health services between the white and the nonwhite elderly populations.

Aged↗