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Biomedical subjects

J C Robinson

Publications and source records attributed to J C Robinson.

At least 109 records · Page 6Linked to original sources
PubMed1988

Competition, regulation, and hospital costs, 1982 to 1986.

We used data on 5490 nonfederal, short-term general hospitals to evaluate the relative effectiveness of regulatory and market-oriented cost-control policies on hospital cost inflation between 1982 and 1986. All-payer rate-regulation programs reduced inflation rates by 16.3% in Massachusetts, 15.4% in Maryland, and 6.3% in New York, compared with the control hospitals in 43 states with neither all-payer rate regulation nor an aggressive market-oriented strategy. New Jersey hospitals experienced a rate of cost inflation similar to the control hospitals. Given the effectiveness of its regulatory program in the 1970s, however, New Jersey began and ended the period from 1982 to 1986 with the lowest costs, controlling for wages and patient mix. California's market-oriented cost-control policy reduced inflation rates by 10.1%. Hospitals with large percentages of patients insured by Medicare's prospective payment system experienced cost inflation rates 16.1% lower than hospitals with small percentages of Medicare patients. Investor-owned hospitals experienced rates of cost increase 11.6% higher than private nonprofit hospitals and 15.0% higher than public hospitals.

Cost Control↗
PubMed1988

Hospital competition and surgical length of stay.

The hypothesis that competitive pressures encourage hospitals to accommodate patient and physician preferences for longer lengths of stay was tested. Seven hundred forty-seven nonfederal short-term hospitals were divided in terms of the number of neighboring hospitals within a 24-km radius, and this measure of hospital concentration and competition was measured against length of stay for ten surgical procedures, using 1982 data on 498454 patient discharges. Patient, physician, and hospital characteristics associated with length of stay were controlled for. Competition-related percentage increases in length of stay were identified for all procedures, including total hip replacement (14.8%), transurethral prostatectomy (13.9%), intestinal operations (14.0%), stomach operations (14.7%), hysterectomy (6.9%), cholecystectomy (9.1%), hernia repair (10.5%), appendectomy (8.4%), cardiac catheterization (22.9%), and coronary artery bypass graft surgery (21.2%). It was concluded that there is a strong association between the number of hospital competitors in the local market and the average length of stay in US hospitals.

Catchment Area, Health↗
PubMed1988

Force-displacement properties of a modified cross-linked silicone compared with facial tissues.

A dimethyl siloxane triacetoxy terminated silane, Type A adhesive, was modified with the base component of a medium grade polydimethyl siloxane with vinyl groups, MDX 4-4210, to produce a more pliable maxillofacial prosthesis. Force-displacement curves of various ratios of Type A adhesive/MDX 4-4210 were determined and compared with force-displacement curves obtained from human subjects. Within the force range of 0.4 to 1.2 N, the force-displacement slopes obtained on human subjects compared favourably with some of the Type A adhesive/MDX 4-4210 test specimens. The force-displacement slopes for the elastomers and humans were not in agreement for forces below 0.4 N.

Biocompatible Materials↗
PubMed1988

Labor union involvement in occupational safety and health, 1957-1987.

Right-to-know policies and related market-oriented occupational health policies require an institutionalized means through which workers can interpret and act on information about quality differences among jobs. In principle, labor unions could play this role. However, union coverage has been declining since the 1950s, and the decline has accelerated in recent years. This paper documents the growth in occupational health and safety activities in unionized workplaces from 1957 to 1987 and the decline in union representation in hazardous workplaces from 1971 to 1986. It also analyzes the relationship between right-to-know and right-to-refuse-hazardous-work guarantees under industrial relations and occupational health law.

Accidents, Occupational↗
PubMed1988

The rising long-term trend in occupational injury rates.

Establishment survey data for the United States as a whole and workers' compensation data for the State of California were used to document long-term trends in occupational injury and acute illness rates. After declining throughout the first half of the century, national rates of disabling injuries in manufacturing, construction, and the trade sector have risen sharply in recent decades. Injury rates in mining show no strong trend either up or down since 1960. Increases over recent years have been especially pronounced for strains and sprains, cuts, lacerations and punctures, bone fractures, and acute illnesses. Injury rates in the manufacturing sector are strongly influenced by general economic conditions--rising sharply with business upsurges and declining during recessions. Increases in the rate of unemployment, which decrease worker and labor union bargaining power, are associated with increases in injury rates within manufacturing.

Accidents, Occupational↗
PubMed1988

Hospital competition, cost, and medical practice.

The hospital market in the United States has always been competitive, but the nature of that competition has changed in the last few years. In the past, when most patients had third party coverage which reimbursed hospitals for incurred costs, competition focused on quality and services as hospitals sought to attract physicians and their patients. This competition led to duplication of services and facilities in a "medical arms race" which resulted in higher, rather than lower, costs in areas with many hospitals. Hospitals with many neighbors even had longer lengths of stay for patients undergoing specific surgical procedures. Now, with Medicare's Prospective Payment System offering fixed payments for patients with a given diagnosis, there are strong pressures for cost containment. These pressures will have their greatest impact in areas with the most hospitals, especially when health maintenance organizations and preferred provider organizations contract selectively with some hospitals. Hospitals, in turn, will be less responsive to cost-increasing requests by their medical staffs.

Cost Control↗
PubMed1988

Hospital quality competition and the economics of imperfect information.

Competition in the health care industry has traditionally focused on indices of quality rather than price. Even in a period of vigorous price competition, the issue of quality remains central, given patient uncertainty. Quality in the future will be assessed, however, not only on the basis of structural characteristics--such as the acquisition of new clinical technologies--but also in terms of patient outcomes. Because outcome statistics are influenced by the severity of the patient's disease at the time of treatment, it is likely that health plans and medical care institutions may accelerate their preference for healthier patients. Pure price competition may have only a modest role to play.

Community Participation↗
PubMed1988

Lipid and lipoprotein changes associated with oral contraceptive use: a randomized clinical trial.

To determine the effects of oral contraceptives on lipids and lipoproteins over a six-month period, we randomized 266 women into four oral contraceptive groups: ethinyl estradiol 35 micrograms plus ethynodiol diacetate 1 mg, ethinyl estradiol 30 micrograms plus levonorgestrel 0.15 mg, ethinyl estradiol 35 micrograms plus norethindrone 1 mg, and ethinyl estradiol 35 micrograms plus norethindrone 0.5 and 1 mg (biphasic). For all groups, total cholesterol increased 5.9-9.1% from baseline values over the six months. Triglycerides increased with all preparations, with the ethynodiol diacetate group (37.6%) and the biphasic norethindrone group (45.3%) showing the greatest increase. Low-density lipoprotein cholesterol increased 10-15.6% among the groups; low-density lipoprotein-apolipoprotein B changed proportional to the low-density lipoprotein cholesterol increases. All groups except the ethynodiol diacetate group showed a decrease of high-density lipoprotein cholesterol, with the levonorgestrel group (8.7%) and biphasic norethindrone group (4.5%) showing the largest declines. Apolipoprotein A-1 increased in all groups, with the ethynodiol diacetate preparation (19.3%) showing the greatest increase and the levonorgestrel preparation (3.2%) showing the smallest increase from baseline values. The changes in apolipoprotein A-1 were out of proportion to the changes in high-density lipoprotein cholesterol, suggesting that the high-density lipoprotein particle may be undergoing some type of metabolic alteration.

Adult↗
PubMed1987

Market and regulatory influences on the availability of coronary angioplasty and bypass surgery in U.S. hospitals.

Using 1983 data on 3720 nonfederal short-term hospitals, we analyzed the influence of local market competition and state regulatory programs on the availability of percutaneous transluminal coronary angioplasty and coronary-artery bypass surgery. The degree of competition for patients with heart disease was measured in terms of the number of hospitals in the local market area that maintained a cardiac catheterization laboratory or facility for open-heart surgery. When the patient case mix and the hospital's teaching role were controlled for, institutions with more than 20 competitors in the local area were 166 percent more likely to offer coronary angioplasty (P less than 0.0001) and 147 percent more likely to offer bypass surgery (P less than 0.0001) than hospitals with no competitors in the local market. Four fifths of the hospitals performing bypass surgery whose annual volume was less than 200 had one or more neighboring hospitals with a facility for open-heart surgery. State rate-regulation programs in New York, New Jersey, Connecticut, Massachusetts, and Maryland significantly reduced the availability of both procedures, with the greatest regulatory effects being observed in the most competitive hospital markets. We conclude that in the period under consideration, competition encouraged and regulation discouraged the proliferation of these cardiac services.

Angioplasty, Balloon↗
PubMed1987

Competition and the cost of hospital care, 1972 to 1982.

Using 1982 data from 5732 US hospitals, we found that costs were substantially higher in hospitals operating in more competitive local environments than in hospitals in less competitive environments. After controlling for wage rates, patient case mix, state regulatory programs, and hospital teaching role, average costs per admission were found to be 26% higher in hospitals in the most competitive markets (more than ten hospitals within a 24-km radius) than in hospitals with no competitors within a 24-km radius. Average costs per patient-day were 15% higher in the most competitive markets than in hospitals with no neighbors. These findings on the cost implications of nonprice competition among hospitals suggest that the new modes of hospital payment will have a greater disruptive impact on hospital behavior in areas with many, rather than few, hospitals. In anticipating the effects of new modes of payment on hospital behavior, policymakers should consider the nature of quality competition as well as price competition within local markets.

Economic Competition↗
PubMed1987

Properties of a modified cross-linked silicone for maxillofacial prostheses.

A dimethyl siloxane-triacetoxy terminated silane, Type A adhesive, can be modified with the base component of a medium grade polydimethyl siloxane with vinyl groups, MDX 4-4210, to produce more pliable maxillofacial prostheses. The mechanical properties of samples with various Type A adhesive/MDX 4-4210 ratios were determined. Addition of the MDX 4-4210 base decreased the hardness, modulus, and ultimate tensile strength, while the percentage elongation increased. The initial tear strength was relatively constant for the various ratios except for the 50/50 mix, where a 50% decrease was observed. The ability to obtain different mechanical properties by using various ratios of Type A adhesive and MDX 4-4210 could result in the production of maxillofacial prostheses which will more closely stimulate the properties of facial tissues.

Adhesiveness↗
PubMed1987

Worker responses to workplace hazards.

Recent policy initiatives in occupational safety and health have emphasized strategies that provide workers with information about workplace exposures. It is not clear, however, what effect this new information has had or will have on worker self-help initiatives. This paper analyzes individual and collective worker responses to information on job hazards using five sources of data on workers and industries in the United States. Levels of expressed dissatisfaction, discharges for cause, and strike frequencies are found to be significantly higher in hazardous jobs than in safe jobs. Individual quit strategies are not consistently found to be associated with higher hazard levels. These findings have potentially important implications for the design of future information-oriented health and safety policies.

Accident Prevention↗
PubMed1987

Trends in racial inequality and exposure to work-related hazards, 1968-1986.

Two important public policies of the past 15 to 20 years--equal employment opportunity and occupational health--have been implemented independently, and imperfectly. By combining diverse data sets, a general gain is seen. The excess risk of disabling occupational injury faced by black men has declined, although it remains substantial; relative risks for black women have increased. Opportunity has outpaced safety. Although combined trends are equivocally positive, relative inequities remain, and absolute injury rates for all workers are increasing.

Accidents, Occupational↗
PubMed1987

Appropriate measures of hospital market areas.

As public and private policymakers turn to market-oriented strategies to control hospital prices, it is necessary to understand the conceptual underpinnings of hospital market area measurement. This article provides a framework for evaluating which definitions of hospital market areas are suitable for various types of analyses. Hospital market areas can be defined from two perspectives: an individual hospital perspective and that of the overall market. From each perspective, empirical definitions can be based on geopolitical boundaries, distance between hospitals, and patient-origin data. In this article, market areas are compared based on various descriptions using data on California hospitals and patient discharge abstracts.

California↗
PubMed1987

Effects of adrenergic agents on colonic motility.

Sympathetic hyperactivity has been implicated as an etiologic factor in postoperative ileus. The effects of methoxamine (alpha-agonist) and isoproterenol (beta-agonist) on colon contractions and blood flow were studied in nine monkeys. Phentolamine (alpha-antagonist) and propranolol (beta-antagonist) were used to block the effects of the appropriate agonist. Methoxamine caused a dose-related inhibition of colon contractions and a decrease in inferior mesenteric artery (IMA) blood flow. Isoproterenol caused a dose-related inhibition of colon contractions and an increase in IMA blood flow. The contractile and blood flow effects of methoxamine were blocked by phentolamine and those of isoproterenol by propranolol. Mechanical reduction of IMA blood flow by an amount equivalent to that observed with the highest dose of methoxamine caused no change in contractions in the segment of colon supplied by the IMA. Both alpha- and beta-agonists inhibit colon contractions and have the expected effects on IMA blood flow. The contractile and blood flow responses of the agonists can be blocked by appropriate antagonists. The blood flow changes are not responsible for the contractile changes. These results indicate that sympathetic hyperactivity may play a role in postoperative ileus.

Animals↗
PubMed1986

The role of biofeedback in Kegel exercise training for stress urinary incontinence.

This study examined the effectiveness of teaching pelvic floor exercises with use of bladder-sphincter biofeedback compared to training with verbal feedback based on vaginal palpation in 24 women with stress urinary incontinence. Verbal feedback training consisted of instructing the patient to squeeze the vaginal muscles around the examiner's fingers and providing her with verbal performance feedback. Biofeedback patients received visual feedback of bladder pressure, abdominal (rectal) pressure, and external anal sphincter activity. The biofeedback group improved the strength and selective control of pelvic floor muscles; the verbal feedback group did not. Both groups significantly reduced the frequency of incontinence. The biofeedback group averaged 75.9% reduction in incontinence, significantly greater than the 51.0% reduction shown by the verbal feedback group. Twelve of 13 patients in the biofeedback group improved by 60% or better. Six patients in the verbal feedback group improved by 68% or better, and five were less than 30% improved.

Adult↗
PubMed1986

Estimates of maximum or average cigarette tar, nicotine, and carbon monoxide yields can be obtained from yields under standard conditions.

Average yields of tar, nicotine, and carbon monoxide per liter of smoke and per cigarette were determined for 10 brands of cigarettes smoked under 27 different conditions (one standard and 26 nonstandard). Per cigarette yields were highly variable across smoking conditions due to differences in the total volume of smoke taken for analysis. The results of a simple linear regression analysis indicated that up to 95% of the variation in tar yield per cigarette could be explained by variations in the total volume of smoke produced per cigarette. Per liter yields for tar, nicotine, and carbon monoxide were almost constant over the conditions investigated. Since most smokers inhale less than this amount, yields per liter provide a rough estimate of the maximum amount to which a smoker might be exposed. Yields per liter, taken over all 26 conditions, are highly correlated with per cigarette yields under standard conditions. Consequently, values on one scale can be converted to the other, at least for the 10 brands investigated. The average conversion factor for tar, nicotine, and carbon monoxide is 2.5 when proceeding from milligrams per king-size cigarette under standard conditions to milligrams per liter. This relationship is true for both vented and nonvented cigarettes when ventilation holes are not blocked.

Carbon Monoxide↗