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J Blustein

Publications and source records attributed to J Blustein.

At least 19 recordsLinked to original sources
PubMed2001

Setting the agenda for urban bioethics.

Urban bioethics has two goals. First, it aims to focus attention on neglected bioethical problems that have particular salience in urban settings. Three problems are highlighted: socioeconomic inequality as a major determinant of health inequality, the foundations of an ethic for public health, and the impact of social context on the therapeutic alliance between patients and physicians. Second, urban bioethics serves as a vehicle for raising deep theoretical and methodological questions about the dominant assumptions and approaches of contemporary bioethics. Demands for cultural sensitivity, so pronounced in the urban context, compel us to reexamine the central commitment in bioethics to personal autonomy. The multiculturalism of urban life also argues for a dialogic approach to bioethical problem solving rather than the monologic approach that characterizes most bioethical thinking. Although my brief for redirecting bioethics will resonate with many critics who do not consider themselves urban bioethicists, I argue that there are special advantages in using urban bioethics to expose the limitations of contemporary bioethical paradigms.

Attitude to Health↗
PubMed2001

Use of preventive care services, beneficiary characteristics, and Medicare HMO performance.

Medicare health maintenance organization (HMO) enrollees use more preventive care services than their fee-for-service (FFS) counterparts. This may be because those who enroll in HMOs have characteristics that make them more disposed to use preventive care. To investigate this possibility, we examined the use of four preventive care services by respondents to the 1996 Medicare Current Beneficiary Survey (MCBS). Unadjusted preventive care use rates for HMO enrollees were slightly higher than rates for non-HMO enrollees with private supplemental insurance. However, after adjusting for enrollee characteristics (sociodemographics, health behaviors, health status, and functioning) we found that preventive care use rates for HMO enrollees were substantially higher--consistent with HMO enrollees being less disposed to use preventive care. In comparing preventive care service rates across groups, managers and policymakers may want to consider taking into account beneficiary characteristics that are correlated with the disposition to use preventive care.

Aged↗
PubMed2000

Socioeconomic status and dissatisfaction among HMO enrollees.

OBJECTIVES: Member satisfaction is commonly used as an indicator of the quality of care delivered by health plans. Yet few contemporary studies have explored the extent to which individual patient characteristics influence dissatisfaction in HMOs. We sought to determine whether socioeconomic status is associated with enrollee dissatisfaction. METHODS: Data are from a cross-sectional, telephone survey of a probability sample of adults enrolled in New Jersey HMOs in 1998 (n = 7,983). Health plan ratings were elicited as part of the Consumer Assessment of Health Plans Study (CAHPS) survey, along with income, education, and race/ethnicity. Other factors known to influence satisfaction (age, gender, health status, extent of plan choice, and payment for plan) were also ascertained. RESULTS: Socioeconomically advantaged enrollees were more likely to give low ratings to their health plans. In a multivariate logistic regression model, those with incomes exceeding $100,000 had 1.65 times the odds of being dissatisfied compared with those with family incomes less than $25,000 (P <0.001); those with a college education had 2.53 times the odds of being dissatisfied than those who had not completed high school (P <0.001). However, among enrollees in their plans for > or =5 years, those in the lowest income group were significantly more dissatisfied than higher-income enrollees. CONCLUSIONS: Among New Jersey HMO enrollees, higher socioeconomic status (SES) is associated with greater dissatisfaction. Although based on cross-sectional data and thus preliminary, the evidence presented here also suggests that the SES-dissatisfaction relationship varies as a function of duration of enrollment. Further research using longitudinal data could shed additional light on the SES-dissatisfaction link.

Adolescent↗
PubMed2000

A cost analysis of community screening for diabetes in the central Wisconsin Medicare population (results from the MetaStar pilot project in Wausau).

CONTEXT: Type 2 diabetes mellitus is often undiagnosed and untreated. OBJECTIVE: To estimate the costs and possible savings of screening for Type 2 diabetes mellitus in the Wisconsin Medicare population from a population health perspective. DESIGN: The costs and benefits of community screening were analyzed using various primary and secondary data sources. Data on the community screening were obtained by MetaStar, collaborators at the screening site, and published material. Results from a Monte Carlo simulation model, developed by the CDC Diabetes Cost-Effectiveness Study Group, and recent developments in diabetes research were used to estimate the incidence levels of major complications for Type 2 diabetes. SETTING AND PARTICIPANTS: Medicare beneficiaries in central Wisconsin residing in the Wausau Hospital Service Area, which is composed of 14 zip codes. RESULTS: Of 826 Medicare patients screened, 32 were diagnosed as having diabetes. If we use the same assumptions offered by the CDC Study Group, we find that the excess lifetime costs from screening and early treatment ($4850) exceed costs saved from preventing complications ($378), costing an average of $4471 per diabetic. However, if we alter assumptions on cardiovascular disease reduction risk and routine care costs, we find that screening could save an average of $619 per diabetic detected. CONCLUSIONS: The costs of community screening, using the CDC Study Group's assumptions, are greater than the costs of diabetes without screening in this population. However, recent evidence on cardiovascular disease risk and routine care costs could alter the results, leading to lower costs and greater benefits in the future. More research is necessary, particularly in the area of quality of life measures, to more accurately reflect the benefits of screening.

Aged↗
PubMed1998

The use of mammography by women aged 75 and older: factors related to health, functioning, and age.

BACKGROUND AND OBJECTIVES: Mammographic screening for breast cancer is of uncertain clinical benefit for women 75 years of age and older. Some have argued against instituting routine screening in this age group, noting that disability and shorter life expectancy may diminish the desirability and cost-effectiveness of screening. We sought to determine the extent to which health, functioning, and age influence mammography use in this cohort. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of a representative sample of women in the US aged 75 and older (n = 2352) who participated in the Medicare Current Beneficiary Survey. MEASURES: Information about general health, level of functioning, medical history, age, and various sociodemographic characteristics elicited in the survey was linked with subjects' Medicare bills for 1991 and 1992 to ascertain patterns of mammography use. RESULTS: Overall, 26.7% of the women had mammograms during the 2-year period. Advanced age was associated with a decreased likelihood of receiving a mammogram. This did not reflect simply the decline in health and functioning that may accompany aging; those aged 85 and older were less likely to receive mammograms than those in the 75 to 79 age group, controlling for general health, medical history, functional status, and sociodemographic factors (adjusted OR = .41; 95% CI = 0.27 to 0.64). ADL limitations were also associated independently with decreased mammography use. For example, controlling for age, women with any limitations in Activities of Daily Living were 0.71 times as likely to have mammograms as women without ADL limitations (95% CI = 0.59 to 0.85). However, several comorbid conditions, including hypertension, diabetes mellitus, and a history of myocardial infarction were not significantly related to mammography use. CONCLUSIONS: Within the cohort of women aged 75 and older, more advanced age and impaired functional status both substantially reduce the likelihood of mammography use. The extent to which this reflects patients' informed decisions, physicians' judgments, or other factors remains to be explored.

Activities of Daily Living↗
PubMed1998

Visits to specialists under Medicare: socioeconomic advantage and access to care.

This study examines the relationship between socioeconomic advantage and the likelihood of receiving specialty care in a nationally representative sample of older Americans participating in fee-for-service Medicare. In 1992, 62.9 percent of Americans aged 65 and older visited a specialist physician at least once. Being white, having more education, and having a higher income were each independently associated with a higher likelihood of visiting a specialist. Having insurance to supplement basic Medicare coverage was also independently associated with an increased likelihood of visiting a specialist; disadvantaged elders are less likely to have such supplemental insurance. Therefore, based both upon socioeconomic disadvantage and a lack of insurance to supplement the basic Medicare benefit, black, less educated and low-income elders are less likely to receive specialty services under fee-for-service Medicare. As the program evolves, it will be important to continue to monitor access to specialty care in vulnerable, socioeconomically disadvantaged populations.

Aged↗
PubMed1998

Occupational exposure to laser surgery generated air contaminants.

The objective of the review is to show that scientific evidence is lacking on the safety of laser-generated air contaminants. Further research and data collection are necessary to characterize the potential dangers associated with exposures of health care professionals to laser generated air contaminants. The article is a review of existing scientific evidence in the area of exposure risks to health care professionals. A careful search of the scientific literature both in medicine and engineering was performed, as well as contact with experts from laser standards advisory sources. These sources include: International Laser Safety Conference, National Institute of Occupational Safety and Health, American National Standard Institute, Laser Safety Institute and Rockwell Laser Industries. The review includes articles in the literature documenting cases of over-exposures to contaminants while using a class IV laser, the same class laser used in surgery. Several studies of case reports of laser-generated air contaminants from cutting on human and animal tissues are included. Articles and guidelines on this subject of laser-generated contaminants from the above listed sources were used in writing this review. The review indicates that lasers used in surgery are potential occupational health risks.

Air Pollutants, Occupational↗
PubMed1997

Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.

Studies have consistently shown that sleep apnea patients have high accident rates, but the generalizability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-disordered breathing. Sleep-disordered breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a statewide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-disordered breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (vs. no sleep-disordered breathing) were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognized sleep-disordered breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-disordered breathing may account for a significant proportion of motor vehicle accidents.

Accidents, Traffic↗
PubMed1997

The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics.

OBJECTIVES: This research studied the relative contribution of diabetes mellitus to the increased prevalence of tuberculosis in Hispanics. METHODS: A case-control study was conducted involving all 5290 discharges from civilian hospitals in California during 1991 who had a diagnosis of tuberculosis, and 37,366 control subjects who had a primary discharge diagnosis of deep venous thrombosis, pulmonary embolism, or acute appendicitis. Risk of tuberculosis was estimated as the odds ratio (OR) across race/ethnicity, with adjustment for other factors. RESULTS: Diabetes mellitus was found to be an independent risk factor for tuberculosis. The association of diabetes and tuberculosis was higher among Hispanics (adjusted OR [ORadj] = 2.95: 95% confidence interval [CI] = 2.61, 3.33) than among non-Hispanic Whites (ORadj = 1.31: 95% CI = 1.19. 1.45): among non-Hispanic Blacks, diabetes was not found to be associated with tuberculosis (ORadj = 0.93: 95% CI = 0.78, 1.09). Among Hispanics aged 25 to 54, the estimated risk of tuberculosis attributable to diabetes (25.2%) was equivalent to that attributable to HIV infection (25.5%). CONCLUSIONS: Diabetes mellitus remains a significant risk factor for tuberculosis in the United States. The association is especially notable in middle-aged Hispanics.

Adult↗
PubMed1996

Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans.

OBJECTIVES: This study examined the impact of duration of physician-patient ties on the processes and costs of medical care. METHODS: The analyses used a nationally representative sample of Americans 65 years old or older who participated in the Medicare Current Beneficiary Survey in 1991 and had a usual source of care. RESULTS: Older Americans have long-standing ties with their physicians; among those with a usual source of care, 35.8% had ties enduring 10 years or more. Longer ties were associated with a decreased likelihood of hospitalization and lower costs. Compared with patients with a tie of 1 year or less, patients with ties of 10 years or more incurred $316.78 less in Part B Medicare costs, after adjustment for key demographic and health characteristics. However, substantial impacts on the use of selected preventive care services and the adoption of certain healthy behaviors were not observed. CONCLUSIONS: This preliminary study suggests that long-standing physician-patient ties foster less expensive, less intensive medical care. Further studies are needed to confirm these findings and to understand how duration of tie influences the processes and outcomes of care.

Aged↗