A literature review of health issues of the rural elderly.
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Aged↗
Biomedical subjects
L L Hicks
Publications and source records attributed to L L Hicks.
Role of the nurse in managed care.
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Health Maintenance Organizations↗
Infectious disease manpower in the United States--1986. 1. Description of infectious disease physicians. Manpower and Training Committee, Infectious Diseases Society of America.
A survey designed to assess the number, type, and current practice patterns of all infectious disease (ID) physicians active in the United States in 1986 was carried out in early 1987. Of 4328 mailed questionnaires, 48.3% were returned. One-third of respondents were in private practice, one-third in academics, and the rest in industry or government. Women accounted for 12.4% of the total; they were younger and as a group spent a greater proportion of total effort in ID. Sixty-five percent of all respondents had greater than or equal to 2 years training in ID. Overall, private practitioners worked longer hours than academicians but spent slightly less effort devoted solely to ID. The proportion of total effort devoted to ID has increased among physicians newly entering practice. Seventy-five percent of all respondents held a teaching appointment. Older ID physicians worked less than 50 h/week and tended to have more administrative than patient care responsibilities. In 1986, there were the equivalent of 1792 full-time ID physicians in the United States or 1:134,000 population.
Age Factors↗
Infectious disease manpower in the United States--1986. 2. Changes in practice patterns over time and training needs. Manpower and Training Committee, Infectious Diseases Society of America.
Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.
Communicable Diseases↗
The occurrence and distribution of burnout among infectious diseases physicians.
The occurrence and distribution of the three dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and lowered feelings of personal accomplishment) were studied among infectious diseases physicians. A written survey was mailed to the entire identified US population of infectious diseases physicians (n = 4328); a 46.3% response rate provided 1840 usable surveys. Statistical analyses of the data demonstrated that 43.5% of the physician sample reported high scores on emotional exhaustion, and 40.3% scored high on depersonalization. Personal accomplishment scores remained high, despite burnout levels, with 91.8% reporting high personal accomplishment. The highest percentage of burnout occurred among physicians in private practice settings (55%), followed by government settings (39%), and academia (37%). The high percentage of infectious diseases physicians experiencing burnout suggests the need for further research to establish trends, to determine if other types of physicians experience similar levels of burnout, to identify casual factors, and to develop avenues to reduce stress and facilitate coping.
Adult↗
Physician-hospital networking: avoiding a shotgun wedding.
The erosion of the traditional market is forcing hospitals and physicians to reevaluate their historical relationships. One method for addressing the potential conflicts created by current pressures is the formation of physician-hospital networks. These entities are formed and function on the basis of mutual interests and responsiveness to change.
Economic Competition↗
Rural populations and rural physicians: estimates of critical mass ratios, by specialty.
As physicians and other providers of health care services see their traditional markets erode, an increasingly important element of any provider location decision is the determination of a population base or "critical mass" that can professionally and financially support a given set of health care services. While the size of a local population is not the sole determinant of success, ultimately an adequate population base to support a given spectrum of services must be defined, and providers increasingly need tools for evaluating opportunities in the new economic market. This is especially true in rural areas. An earlier supply and demand model for estimating the critical mass of population needed to support a physician in any one of 25 specialties and subspecialties in urban and suburban areas is adapted to the rural market. The assumptions inherent in the earlier model are examined and the issue of "critical mass" is examined from a rural health care perspective in this paper.
Catchment Area, Health↗
Availability and accessibility of rural health care.
The 1980s saw a retrenchment of the ideology that government intervention could solve the problems of inadequate access to health services in rural areas. Increased emphasis was placed on an ideology that promoted deregulation and competitive market solutions. During the 1980s, the gap in the availability of physicians in metropolitan versus nonmetropolitan areas widened. Also during that time period, the gap between metropolitan and nonmetropolitan populations' utilization of physician services widened. In addition, many indicators of the health status of nonmetropolitan residents versus metropolitan residents worsened during the 1980s. As we enter the 1990s, concern about equitable access to needed health care services and for the vulnerability and fragility of rural health systems has resurfaced. A number of national policies and a research agenda to improve accessibility and availability of health services in rural areas are being considered.
Health Services↗
Too many physicians in the wrong places and specialties? Populations and physicians from a market perspective.
As market forces play a greater role in physician specialty and location decisions, new techniques for illuminating relocation options are needed. The authors propose a model that can be used, among other ways, as a first gross screening mechanism in identifying market opportunities for physicians.
Data Collection↗
Necessary conditions for supporting a general surgeon in rural areas.
Loss of a general surgeon in a rural community cna alter the referral patterns, the image and utilization of the local hospital, and even the market share of local primary care physicians. Prior research has not defined the necessary and/or sufficient conditions for a rural county to be able to support a local general surgeon. Based upon empirical analysis of 96 rural Missouri counties and the limited literature available on rural surgeons and physician referral rates, a first approximation of those conditions are offered. We conclude that a rural county with a hospital, a population base of more than 15,000 people, and at least 11 potential referring physicians has sufficient conditions to enable it to support a local general surgeon. Among those rural Missouri counties not meeting the above conditions but having a general surgeon in 1984, we estimate that 8 to 10 potential referring physicians appear to be the minimum necessary condition for supporting a rural general surgeon through patient referral. From those conclusions, we argue that any rural hospital currently without a surgeon should re-examine its situation. To prepare for a competitive future, such a hospital should take every opportunity to expand the referral base necessary to support a full-time local surgeon rather than place long-term reliance upon itinerant general surgeons.
Catchment Area, Health↗
Increasing role of economic analysis in the health care industry.
As the health care industry continues to absorb an ever-larger portion of society's resources, increasing pressure is being placed on the industry to justify its decisions about the outcomes of the services it renders relative to their costs. Emphasis is being shifted from accessibility to and availability of health care to the cost-effective delivery of those services. This focus on cost effectiveness is creating intense pressure on the various segments of the industry to justify their existence as cost-effective providers of services. To demonstrate cost effectiveness, the various segments are searching for tools to assist them. In this article, an outline of a mechanism for evaluating the cost effectiveness of providing physical therapy services is presented.
Cost-Benefit Analysis↗
The effects of passive inhalation of cigarette smoke on exercise performance.
The purpose of this investigation was to evaluate the effect of passive smoke inhalation on submaximal and maximal exercise performance. Eight female subjects ran on a motor driven treadmill for 20 min at 70% VO2max followed by an incremental change in grade until maximal work capacity was obtained. Each subject completed the exercise trial with and without the presence of residual cigarette smoke. Compared to the smokeless trials, the passive inhalation of smoke significantly reduced maximal oxygen uptake by 0.25 l X min-1 and time to exhaustion by 2.1 min. The presence of sidestream smoke also elevated maximal R value (1.01 vs 0.93), maximal blood lactate (6.8 vs 5.5 mM), and ratings of perceived exertion (17.4 vs 16.5 units). Passive inhalation of smoke during submaximal exercise significantly elevated the CO2 output (1.68 vs 1.58 l X min-1), R values (0.91 vs 0.86), heart rate (178 vs 172 bts X min-1) and rating of perceived exertion (13.8 vs 11.8 units). These findings suggest that passive inhalation of sidestream smoke adversely affects exercise performance.
Adult↗
An economic approach to rationing health care resources.
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Cost-Benefit Analysis↗
Social policy implications of physician shortage areas in Missouri.
A model is used to identify counties in Missouri in which the supply of physician services is inadequate to serve the resident population. In the model, a formula is used to assess the gap between the physician services available in a county and the visits which would be required to serve the residents. Incorporated in the model are adjustments for the age and specialty of the physicians and the age and sex of the population. The model is applied to 1976 and 1981 data in order to analyze the changes which have occurred within the state during that time. The results show that in spite of a 34 per cent increase in the number of physicians practicing in Missouri between 1976 and 1981, 24 of the 115 counties in the state experienced a decrease in their ability to serve their resident populations adequately. Of these 24 counties, 23 had populations of less than 25,000 and 12 had populations of less than 10,000. A factor magnifying the underservice problem is the sharp increase in the proportion of older physicians located in small, rural counties. In 1981, 47 per cent of the primary care physicians located in counties with less than 10,000 people were aged 60 and over, compared to 34 per cent in 1976. This portends major problems in the future in obtaining replacements.
Adolescent↗
Methods for the determination of androgen receptor content in human prostatic tissue.
Human prostatic androgen receptor content can be measured reliably in either fresh or bulk tissue stored in liquid nitrogen using (3H) R 1881 at incubation conditions of 4 C for 20 hr. Powdered tissue stored in liquid nitrogen for more than 12 days shows a marked deterioration in receptor content. Although multiple point dextran coated charcoal assays analyzed by Scatchard plot are preferable for receptor quantitation of bulk tissue, the single saturating dose assay provides useful information on needle biopsy specimens. When this technique is used to evaluate samples with protein concentrations less than 1 mg per ml, the use of hydroxylapatite to separate receptor bound and free steroid is superior to the use of dextran coated charcoal. The addition of sodium molybdate to the homogenization buffers results in a marked increase in cystosolic androgen receptor content and a decrease in extractable nuclear receptor content. The use of a vertical rotor to ensure short centrifugation times enhances the reliability of sucrose density gradient analyses of human prostatic androgen receptor.
Adsorption↗
Androgen- and estrogen-receptor content in spontaneous and experimentally induced canine prostatic hyperplasia.
To gain insight into the mechanism by which steroidal hormones influence the development of canine prostatic hyperplasia, nuclear and cytosolic androgen- and estrogen-receptor content, as measured under exchange conditions by the binding of [(3)H]R1881 (methyltrienolone) and [(3)H]estradiol, respectively, were quantitated in the prostates of purebred beagles of known age. In young dogs with spontaneously arising and experimentally induced (androstanediol plus estradiol treatment) prostatic hyperplasia, nuclear, but not cytosolic, prostatic androgen-receptor content was significantly greater than that determined in the normal prostates of age-matched dogs (3,452+/-222 and 4,035+/-274 fmol/mg DNA vs. 2,096+/-364 fmol/mg DNA, respectively). No differences were observed between the androgen-receptor content of the normal prostates of young dogs and the hyperplastic prostates of old dogs. The cytosolic and nuclear estrogen-receptor content of spontaneously arising prostatic hyperplasia in both young and old animals was similar to that found in normal prostates. The administration of estradiol plus androstanediol to castrate dogs significantly increased the prostatic nuclear androgen-receptor content over that found in dogs treated only with androstanediol. This estradiol-associated increase in nuclear androgen-receptor content was accompanied by the development of benign prostatic hyperplasia. Estradiol treatment of castrate dogs resulted in an increase in prostatic nuclear estrogen-receptor content, in the appearance of a putative prostatic cytosolic progesterone receptor, and in an alteration of the epithelium of the prostate to one characterized by squamous metaplasia. Treatment of castrate dogs with both estradiol and androstanediol resulted in a reduction in prostatic nuclear estrogen-receptor content, disappearance of the progesterone receptor, and loss of squamous metaplasia. An increase in nuclear androgen-receptor content, thus, appears to be an important event in the development of both spontaneously arising and experimentally induced canine prostatic hyperplasia. The mechanism of androgen-estrogen synergism in the experimental induction of canine benign prostatic hyperplasia may be explained by estradiol-mediated increases in nuclear androgen-receptor content. Because androstanediol blocked certain estradiol-mediated events within the prostate, a negative feedback mechanism may exist in which the response of the canine prostate to estrogens is modulated by rising levels of androgen.
Androstane-3,17-diol↗
Estrogen receptors in the human prostate, seminal vesicle, epididymis, testis, and genital skin: a marker for estrogen-responsive tissues?
In an effort to identify those human male sex accessory tissues that may be under the physiological influence of estrogen, cytosolic and nuclear estrogen receptors were measured with two ligand systems that used either [3H]R2858 [moxesterol(11 beta-methoxy-17-ethynyl-1,3,5,(10)-estratriene-3,17 beta-diol)] or [3H]estradiol plus 1 microM dihydrotestosterone with diethylstilbestrol to correct for nonspecific binding. In seminal vesicles, high affinity binding was identified in cytosol (6 of 7 determinations) and nuclear extract (4 of 7 determinations); in the epididymis, high affinity binding was also present in the cytosol (10 of 12 determinations) and nuclear extract (10 of 11 determinations). In contrast, no high affinity binding was demonstrated in cytosol from the testis (0 of 5 determinations) or genital skin (0 of 7 determinations), and only low levels of nuclear receptor (80 fmol/g tissue) were present in the testis (3 of 5 determinations) and genital skin (1 of 7 determinations). In nonhyperplastic prostatic tissue, high affinity binding was present [in the cytosol of periurethral zone tissue (3 of 7 determinations) and nuclear extract (1 of 7 determinations), in cytosol of peripheral zone tissue (7 of 8 determinations) and nuclear extract (4 of 7 determinations), and in prostatic carcinoma cytosol (5 of 12 determinations) and nuclear extract (10 of 13 determinations)]. In contrast, no high affinity binding was present in either cytosol or nuclear extract from benign hyperplastic prostatic tissue. The finding of estrogen receptors in the human epididymis, seminal vesicle, and prostatic carcinoma suggests that estrogen, in addition to androgen, may act in the physiological regulation of these organs. However, the direct role of estrogen in the induction and maintenance of benign prostatic hyperplasia remains to be defined.
Cell Nucleus↗
A microassay for the measurement of androgen receptors in human prostatic tissue.
A microassay utilizing R 1881 (methyltrienolone) has been developed for the measurement of androgen receptor sites in the cytosol and nuclear extract of human prostatic tissue. Binding of R 1881 to the progesterone binding molecule in cytosol was eliminated by the addition of triamcinolone acetonide. Utilizing a six tube, single point assay, the number of binding sites estimated in nuclear extract averaged 95% of the number measured by a full 7 point Scatchard analysis; the number estimated by the microassay in cytosol averaged 91%. When the single point assay was applied to needle biopsy specimens (200 mg of tissue), the estimated number of binding sites in nuclei averageed 83% of the number measured in bulk tissue (2 grams) utilizing a 7 point Scatchard analysis; the number in cytosol estimated by the microassay on needle biopsy specimens averaged 73%. It is hoped that this technique may be useful in correlating receptor content with hormonal responsiveness in men with metastatic carcinoma of the prostate.
Binding, Competitive↗