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Biomedical subjects

K Merrell

Publications and source records attributed to K Merrell.

13 recordsLinked to original sources
PubMed2000

Specialty differences in the care of older patients with diabetes.

OBJECTIVES: To determine differences in health status, quality of care, and resource utilization among older diabetic Medicare patients cared for by endocrinologists, internists, family practitioners, and general practitioners. METHODS: The authors analyzed 1,637 patients with diabetes age 65 years or older in the 1994 Medicare Current Beneficiary Survey, a database that links patient surveys to 12 months of Medicare claims data. MEASURES: Measures of morbidity were Basic and Instrumental Activities of Daily Living, health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care markers were measurement of ophthalmologic visit, lipid testing, glycosylated hemoglobin measurement, mammography, influenza vaccination, early hospital readmission, outpatient follow-up, and patient satisfaction. Resource utilization included reimbursement, relative value units, physician and emergency department visits, and hospitalizations. Age, gender, race, and education were adjusted for in multivariable analyses. RESULTS: Compared with patients of family practitioners, patients of endocrinologists and internists had more comorbidity and diabetic complications but similar health perception and deficiencies in activities of daily living. The patients of endocrinologists also had higher utilization of ophthalmologic screening, lipid testing, and glycosylated hemoglobin measurement than the patients of generalist physicians, but similar rates of influenza vaccination. Patients of endocrinologists and internists had higher total reimbursement than those of family practitioners and general practitioners. Patient satisfaction was generally similar. CONCLUSIONS: Older diabetic patients of endocrinologists had higher utilization of diabetes-specific process of care measures and had similar functional status despite more diabetic complications. However, they received a more costly style of care than patients of family practitioners and general practitioners. Future work needs to explore the optimal coordination of care of diabetic patients among different health providers.

Aged↗
PubMed2000

Medicaid managed care in Chicago: changes in utilization.

In 1993, Illinois implemented Healthy Moms/Healthy Kids (HM/HK) in Chicago, a Medicaid managed care program for pregnant women and children. This study examines changes in immunizations for children (n = 134,072), prenatal care use for pregnant women (n = 5,151), and inpatient stays for mothers (n = 5,151) and newborns (n = 2,699) under the HM/HK program as compared with fee-for-service Medicaid in 1992 and 1993. HM/HK children were 10 percent more likely to receive any immunizations, and HM/HK pregnant women were 13 percent more likely to receive some prenatal care. Mothers' inpatient stays at delivery did not change under HM/HK. The length of newborn stays fell between 1992 and 1993, with both the HM/HK and the Medicaid 1993 comparison group deliveries associated with statistically shorter stays. During the early months of the program, improvements in the quantity of expected preventive care received were evident among children and women.

Adult↗
PubMed1999

Maternal minimum-stay legislation: cost and policy implications.

OBJECTIVES: Recently, most state legislatures and Congress have passed laws mandating insurance coverage for a minimum period of inpatient care following delivery. This study analyzed the likely cost implications of one state's law. METHODS: Hospital discharge records for Illinois women who gave birth (n = 167,769) and infants born (n = 164,905) during a 12-month period predating the law were analyzed. RESULTS: As a percentage of total spending on birth-related admissions and readmissions, the net effect of the law ranges from a savings of 0.1% to a cost of 20.2%. CONCLUSIONS: There may be large cost implications to this legislation, even with savings from avoided re-admissions.

Adult↗
PubMed1998

Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.

OBJECTIVE: To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. RESEARCH DESIGN AND METHODS: We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses. RESULTS: Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment. CONCLUSIONS: Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.

Black or African American↗
PubMed1997

The absence of the transcription activator TFE3 impairs activation of B cells in vivo.

TFE3 is a ubiquitously expressed member of the TFE3/mi family of basic helix loop helix zipper transcription factors. TFE3 binds to muE3 sites located in the immunoglobulin heavy-chain (IgH) intronic enhancer, heavy-chain variable region promoters, the Ig kappa intronic enhancer, and regulatory sites in other genes. To understand the role of TFE3 in Ig expression and lymphoid development, we used embryonic stem (ES) cell-mediated gene targeting and RAG2-/- blastocyst complementation to generate mice which lack TFE3 in their B and T lymphocytes. TFE3- ES cells fully reconstitute the B- and T-cell compartments, giving rise to normal patterns of IgM+ B220+ B cells and CD4+ and CD8+ T cells. However, TFE3- B cells show several defects consistent with poor B-cell activation. Serum IgM levels are reduced twofold and IgG and IgA isotypes are reduced three- to sixfold in the TFE3- chimeras even though in vitro, the TFE3- splenocytes secrete normal levels of all isotypes in response to lipopolysaccharide activation. Peripheral TFE3- B cells also show reduced surface expression of CD23 and CD24 (heat-stable antigen).

Alleles↗
PubMed1996

Prostate cancer, race, and socioeconomic status: inadequate adjustment for social factors in assessing racial differences.

BACKGROUND: This paper reviews the state of the art in analyzing race, social factors, and economic factors in cancer research, with an emphasis on prostate cancer and the role of socioeconomic status (SES) in racial differences in mortality. It analyzes the quality of articles in the literature that assess the role of SES in cancer mortality. METHODS: English-language titles were identified using MEDLINE with publication dates from mid-1985 through July 1994. Articles in the references of these articles were also included in the final selection, based originally on title and ultimately on content, dating back to 1978. Articles that included SES information and distinguished between whites and African-Americans were chosen, resulting in a final selection of 21 articles. Articles are summarized with consideration of five criteria considered minimal requirements of a well-designed study of the role of race in cancer mortality: (1) SES measure(s) should be on an individual level, not census level; (2) SES should be controlled for when making comparisons between whites and blacks; (3) SES should include at least (individual level) measures of income and education; (4) sample sizes are sufficient for the relevant populations; and (5) specific cancer sites should be studied separately. RESULTS: Of the articles reviewed, only two meet the minimum standards, neither of which studied prostate cancer. It is not clear whether observed racial differences in prostate cancer are directly attributable to race or reflect underlying social factor differences between whites and African-Americans. CONCLUSIONS: In the future, specific characteristics of SES should be measured at the individual level; there is a need for expansion and standardization of data in terms of social and economic content; other methodological advances are needed in modeling to take into consideration the influence of SES in outcome research related to cancer.

Humans↗
PubMed1995

TFE3 contains two activation domains, one acidic and the other proline-rich, that synergistically activate transcription.

TFE3 is a basic-helix-loop-helix-zipper (bHLHZIP) domain-containing protein that binds mu E3 sites in regulatory elements in the immunoglobulin heavy chain gene. The protein is a transcriptional activator that is expressed in vivo as two alternately spliced isoforms with different activating properties: TFE3L contains an N-terminal acidic activation domain; TFE3S lacks this activation domain and is a dominant negative inhibitor of TFE3L. We show that TFE3L and TFE3S contain a second, C-terminal activation domain rich in proline residues. This pro-rich activation domain has activity in a Gal4 fusion assay comparable to the N-terminal acidic activation domain present in TFE3L. The TFE3 pro-rich activation domain contains regions of strong homology with the related proteins microphthalmia and TFEB, suggesting that these regions are important for function. Using two different assays, we show that the N- and C-terminal activation domains of TFE3 act synergistically. This synergism explains in part the ability of TFE3S to act as a dominant negative. Our domain analysis of TFE3 is incorporated into a general structural model for the TFE3 protein that predicts that the activation domains of TFE3 will be widely separated in space.

3T3 Cells↗
PubMed1995

Genetic analyses of tattered, an X-linked dominant, developmental mouse mutation.

Tattered (Td) is an X-linked dominant mouse mutation that causes prenatal lethality in affected males. To map the locus, we analyzed 199 normal male and affected female progeny from a backcross of Td and Mus castaneus. Pedigree analysis of these animals suggests a gene order of cen-DXWas70-(Td, DXMit26, Gata1, Tcfe3)-(Cybb, Otc)-tel, where Tcfe3 is a transcription factor homologous to a gene involved in the murine microphthalmia (mi) mutation [Hodgkinson et al. Cell 74, 395-404, 1993]. To evaluate Tcfe3 as a candidate for Td, heterozygous tattered females were crossed to xid males to obtain females in which > 95% of B cells expressed genes solely from the Td X Chromosome (Chr). Fluorescent activated cell sorting (FACS) analysis and Western blotting of isolated splenocytes from Td/xid double heterozygotes rule out Tcfe3 as a likely candidate for the Td mutation.

Animals↗
PubMed1993

Transcriptional repressor ZF5 identifies a new conserved domain in zinc finger proteins.

We have cloned a cDNA encoding a new murine C2H2 zinc finger protein, ZF5. The 51.3 kD protein contains five GL1-Kruppel type zinc fingers at the C-terminus. At its N-terminus, ZF5 has a 41 amino acid region which was found to be homologous to the N-termini of several other zinc finger proteins. This region defines a new motif within zinc finger proteins which we have named the Zinc finger N-terminal (ZiN) domain. ZF5 binds to two sites in the c-myc promoter and to the -50 bp site of the herpes simplex thymidine kinase promoter. ZF5 is a transcriptional repressor and its repression domain is located N-terminal to the zinc finger domains. A single 4 kb ZF5 mRNA is expressed widely.

Amino Acid Sequence↗
PubMed1992

Payment areas for physician services.

An important aspect of the Medicare Fee Schedule is defining payment areas for physician services. This paper analyzes the accuracy of alternative geographic configurations in tracking physician practice input price differences among counties. Tradeoffs among accuracy in accounting for input price variation, number and complexity of payment areas, and payment differences across area boundaries are also discussed.

Bias↗
PubMed1990

Activator proteins which regulate immunoglobulin heavy chain gene transcription in B lymphocytes.

While our results do not completely explain the B-cell specificity or other regulated aspects of IgH transcription, they show that IgH transcriptional factors belong to several different DNA-binding families which are capable of dimerization. It may be that formation of heteromultimers provides an additional level of regulation which might confer functional tissue specificity. Our results also suggest that enhancers and promoters may interact through protein-protein interactions, looping out the intervening DNA. Finally, we have shown that the same protein may regulate several genes including IgH and c-myc, indicating that transcriptional regulatory mechanisms for different genes are both complex and interconnected.

Animals↗
PubMedDate not supplied

Medicare beneficiaries covered by Medicaid buy-in agreements.

About 13 percent of Medicare beneficiaries receive some assistance from Medicaid. States "buy in" Medicare coverage for these low-income beneficiaries. For those eligible, states also provide benefits beyond those covered by Medicare. Buy-in beneficiaries are different from other Medicare beneficiaries in many ways. They have lower incomes, which is consistent with the policy intent. They use more health services in general but do not appear to receive timely, appropriate care relative to several disease-specific standards. As policymakers consider restructuring Medicare and Medicaid, careful attention needs to be paid to the effects of changes on these beneficiaries.

Adult↗