Biomedical subjects

M Mushinski

Publications and source records attributed to M Mushinski.

32 records · Page 2Linked to original sources

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Teenagers' view of violence and social tension in U.S. public schools.

Results of the latest in the MetLife series of annual surveys of the American teacher showed an encouraging decrease in the level of violence teenagers perceived in their public school. In 1996, 22 percent of 7th to 12th graders thought school violence had decreased during the previous year versus only 14 percent who expressed this belief in 1994. Nonetheless, social tensions are high and violence continues to be a problem in U.S. public schools. Almost half of the students (48 percent) indicated that only some, or hardly any, of their fellow students get along together. However, among students who feel that their teachers teach tolerance and/or who evaluate their education as being of high quality, more than 80 percent perceived positive race/ethnic/religious relations in their schools. Students in urban schools were the most likely to report problems such as gang violence, fights between students, threats or destructive acts or hostile/threatening remarks as being serious issues in their schools. In addition, almost 20 percent of students were at least somewhat fearful of being attacked in or around their schools; this fear was higher in urban (27 percent) than in nonurban schools (15 percent). Gang violence and turf battles were twice as often considered a serious problem by minority students than white.

Adolescent↗

PubMedDate not supplied

Average charges for a radical prostatectomy and a transurethral resection of the prostate (TURP): geographic variations, 1994.

In 1994 MetLife paid claims from group health policy insured for 1,004 radical prostatectomies and 1,597 transurethral resections of the prostate (TURPs). The total average hospital and physician charges were $18,680 and $7,600, respectively, with marked geographic variation evident for both procedures by area and state. The Pacific area led with a total charge of $20,790 for a radical prostatectomy, 11.3 percent above the U.S. average and the South Atlantic area reported the highest average TURP charges, $8,710 (14.6 percent above norm). For both surgeries, the East South Central area reported the lowest average total charge, 21.2 percent lower than the norm for a TURP and 30.9 percent lower than the national prostatectomy average. Charges 20 percent or more above the national average were reported in Illinois, California, Georgia and North Carolina for a TURP and in Illinois, California and Pennsylvania for a radical prostatectomy. Of the study states, Tennessee, Washington, Michigan and Oklahoma had charges 20 percent or more below the national average for a prostatectomy; Washington, Ohio, Tennessee, Alabama and Oregon each had average TURP charges 25 percent or more below the U.S. average. Physician fees differed by more than 95 percent between New York ($3,240) and Michigan ($1,660) for a TURP and by 113 percent between the doctors' charges for a prostatectomy in New York ($8,710) and those in Tennessee ($4,080). On average, patients remained in the hospital for 5.56 days for the radical procedure with lengths of stay ranging from 7.02 days in New York to 4.42 days in Missouri. TURP patients were in the hospital for an average of 3.66 days with Indiana patients staying the longest (5.58 days) and those in Oregon the shortest (2.29 days).

Cost Control↗

PubMedDate not supplied

Average hospital charges for medical and surgical treatment of back problems: United States, 1993.

During 1993, more than 6,000 patients covered by MetLife group health contracts were hospitalized for the surgical or medical treatment of back pain. Among the 3,480 patients aged 21 to 64 with surgically treated back problems, the total charge averaged $13,990, with just over half of this total attributed to the hospital charges. The average length of hospital stay was 3.1 days for these patients. Of the 2,529 nonsurgically treated patients with back problems aged 21 to 64, the average charge totaled $7,120--approximately half the charges of the surgically treated patients. A full 90 percent of this total was accounted for by the hospital portion of the bill, which included an average length of stay of 4.1 days. Of the states with at least 50 admissions, the total charges ranged from a high of $20,040 in California to a low of $10,070 in Washington State for patients with surgical back claims. Among the states with at least 50 admissions, the California total charge was also the highest for the medically treated back problem patients ($11,460), but the lowest total charge was registered in Indiana ($5,490). Total average hospital charges (room and board and ancillary fees) were $7,610 for the surgical back patients and $6,430 for the medically treated back patients. Ancillary fees were 84 and 73 percent of the hospital charges to insurance for surgical back and medical back claims, respectively. Physician fees averaged $6,380 for the surgical category and $690 for the medically treated group of patients.

Adult↗

PubMedDate not supplied

Average charges for cholecystectomy open and laparoscopic procedures, 1994.

Claims to Metropolitan Life Insurance Company by group health insureds and their dependents for an open cholecystectomy averaged $16,260 in 1994 versus $12,930 for a laparoscopic cholecystectomy. Laparoscopic procedures accounted for 71.1 percent of the cholecystectomies charged to MetLife in 1994, up slightly from the 70 percent in 1992. The charges for the open procedure varied by almost twofold among the 10 study states with at least 25 open surgeries; similar between-states variation was also evident among the 16 states in which at least 50 laparoscopic surgeries were performed. Florida, Illinois, Louisiana, California and Texas each reported average total charges above the average for both procedures; whereas Ohio and New Jersey reported the lowest total charges for an open cholecystectomy and Ohio and Michigan had the lowest laparoscopic average total charges. Hospital charges accounted for 77 percent of the total charges for an open procedure and for 69 percent of the laparoscopic surgeries. For both forms of surgery this proportion was the lowest in New York (65 and 48 percent, respectively). Length of stay averaged 6.5 days for the open cholecystectomy and 3.1 days for the laparoscopic procedure.

Age Distribution↗

PubMedDate not supplied

Average charges for a total hip arthroplasty: geographic variations, 1995.

The total replacement of the hip is the most successful operation for patients with debilitating osteoarthritis of the hip. An estimated 124,000 total hip arthroplasties (THAs) were performed in U.S. nonfederal short-stay hospitals in 1994 and approximately 28,000 THA revisions were also reported for that year. In 1995 the average hospital and physician charges to insurance for a THA totaled $23,260 and $27,760 for a revision of the primary THA. The average THA charges ranged from a high of $25,500 in the New England region (10 percent above the U.S. average) to $19,930 in the East South Central region (14 percent below the U.S. average). Illinois reported the highest average total charge and Michigan the lowest. The hospital THA charges averaged $16,810 and accounted for 72 percent of the total charges. Physician fees differed by 101 percent between the high reported in New York and the low in Michigan. THA patients remained hospitalized for an average of 5.9 days, ranging from 8 days in Virginia to 4.6 in Utah. Average total charges for the revision surgeries were the highest in the Middle Atlantic region ($35,660, 28.5 percent above the U.S. average) and the lowest in the East South Central region, where they were less than half, $14,930 and 46 percent lower than that for the United States as a whole. Physician fees accounted for a little more than one-fourth of the total charge and averaged $7,410. THA revision patients remained in the hospital for an average of 6.6 days.

Adult↗

PubMedDate not supplied

Average charges for coronary artery bypass grafts and percutaneous transluminal coronary angioplasties, 1995.

In 1995 the average charge for a coronary artery bypass graft (CABG) among 1,643 patients age 30 and over was $44,820. This charge was more than twice that for 3,569 patients undergoing a percutaneous transluminal coronary angioplasty (PTCA)-$20,370. The Middle Atlantic area reported the highest average charge for a CABG (18 percent above the norm) due mainly to the high charge in Pennsylvania, which was 37 percent higher than the national average. Each of the four regions west of the Mississippi River had higher than average charges for both revascularization procedures. The lowest charge for a CABG was reported in West Virginia-36 percent below the average and less than half the Pennsylvania charge Arizona, California and Illinois had the highest average PTCA charges, each 20 percent or more above that for the U.S. The lowest PTCA charge was reported in Ohio ($14,680), 28 percent lower than the U.S. average and 42 percent lower than in Arizona Hospital charges accounted for 73 percent of the total CABG charge and 77 percent of the PTCA total. Physician charges were the highest in New York and New Jersey for CABGs (each 31 percent above the average) and the lowest in Colorado (37 percent below). For PTCAs, the physicians' fees were the highest in Indiana, Connecticut and New York (between 18 and 21 percent above the norm) and lowest in Washington (25 percent below). CABG patients remained hospitalized for 8.32 days, more than twice the number of days for the PTCA (3.86 days).

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Sexually transmitted diseases: United States, 1995.

Over the past two decades, the United States has experienced some dramatic changes in the rates of three "classic" sexually transmitted diseases (STDs) as well as the introduction of a variety of newer and more complex STD organisms. Rates of primary and secondary syphilis increased through the mid-1980s to a record high of 20.3 cases per 100,000 population in 1990. Since then, rates have dropped 69 percent to 6.3, the lowest rate in 35 years. Gonorrhea rates increased steadily between 1950 and 1975, plateaued between 1975 and 1978, before beginning a gradual but quite steady decline. In 1995 the rate of gonorrhea reached a 30-year low of 149.5 per 100,000. Rates of chlamydial infections, however, have increased more than 55 since 1984 as screening programs proliferated and reporting improved. These infections are commonly found in sexually active adolescents and young adults, and for every case detected in men, there are approximately six detected in women. Rates of syphilis (primary and secondary) and gonorrhea are concentrated primarily in southern states, while chlamydial infections appear to be more widespread geographically. Despite the availability of diagnostic tests and effective treatment regimens for many infectious diseases, STDs continue to target certain populations. They disproportionately affect the poor, inner-city residents and minority groups. The consequences of the diseases are many and varied, and risk of sterility, ectopic pregnancy, fetal death and/or blindness are markedly increased among women with STDs. In addition, risk of HIV infection appears to be increased among persons with a history of having an STD.

Adolescent↗

PubMedDate not supplied

Highway fatalities: leading cause of work-related deaths.

Unintentional-injury deaths predominate among the younger ages and consequently rank number one in terms of years of potential life lost before age 65. Motor vehicles are the major way in which unintentional-injury deaths occur each year, and these deaths have been increasing since 1992. Rates rose 4 percent to 16.7 per 100,000 population in 1995 with the deaths totaling 43,900. Of these, 3 percent were classified as work-related and accounted for 1,329 highway deaths in 1995. According to the Bureau of Labor Statistics, there were 6,210 workplace fatalities in 1995 and 41 percent were related to various means of transportation. Highway travel claims more lives than any other transportation work-related injury (52 percent and its rate and proportion of total workplace fatalities have been trending upward. For the country as a whole, highway injury deaths in 1995 represented 21 percent of the occupational injury mortality. Such deaths accounted for 44 and 37 percent, respectively, of the totals in Maine and Arkansas, but 10 percent or less in Alaska, Oklahoma, and New York City. Home health care workers had a higher rate of disabling highway accidents than the trucking/carrier industry, 76 and 48 per 10,000 workers, respectively. A median of 10 days of missed work was associated with highway injuries in 1995-twice the national figure for workdays lost due to all injuries on the job.

Accidents, Occupational↗

PubMedDate not supplied

Average hospital charges for asthma treatment: United States, 1995.

Asthma is a chronic condition that affects some 14 to 15 million persons in the United States and is one of the most frequent causes for hospitalizations among children as well as adults. Asthma-related morbidity and mortality rates have been increasing for more than a decade in this country as have hospital admissions and visits to doctors' offices for acute episodes of this condition. In 1995, the average total hospital plus physicians' charges for treating 3,559 group health insured hospitalized asthma patients was $5,710. The highest regional charge was reported for the Pacific area states (28 percent above the U.S. average) and the lowest in the East South Central states, where the total was 20 percent below the average and 38 percent below that in the Pacific area. Variation in charges was even more pronounced between study states. Arizona, Colorado and California had average charges from 30 to 47 percent above the U.S. average, whereas Washington, Tennessee and Ohio had averages 32 to 35 percent below. Hospital charges (room and board plus ancillary fees) accounted for 92 percent of the total charge to insurance with the per diem charge averaging $1,640. Physicians' charges were less the $500 for the country as a whole but ranged from $710 in Florida (54 percent above the average) to $260 in Michigan (43 percent below the norm). The average length of stay was 3.48 days, with patients in Washington averaging 2.92 days and those in Pennsylvania and New York 4.10.

Adolescent↗

PubMedDate not supplied

Variations in average charges for strokes and TIAs: United States, 1995.

The 1995 in-hospital charges for 6,628 group health insured stroke victims averaged $11,010 across the country. This total was over twice the average charge for the 1,584 patients hospitalized with a transient ischemic attack (TIA), $4,940. The Mountain and the neighboring Pacific areas of the country reported the highest charges for a stroke, 24 and 16 percent, respectively, higher than the U.S. average. The charges in the East North Central and East South Central areas were the lowest, each under $9,000 and 20 and 25 percent below the norm, respectively. Between study states, the highest stroke charge was reported in Arizona ($17,590) and the lowest in Ohio ($6,670). Hospital charges comprised 81 percent of the total bill to insurance, averaging $8,940. Physicians' charges averaged $2,070, with those in New York 34 percent above the norm and those in Alabama 30 percent below ($1,450). The New Jersey hospital stays averaged 8.1 days, whereas the stay in Oregon was 5.2 days. The total TIA charge was just under $5,000 across the country. Illinois reported the highest TIA in-hospital charge, $6,160, 25 percent above the U.S. average and almost twice the total in Alabama ($3,170). The hospital charges comprised 87 percent of the total, averaging $4,290. Physicians' charges in Pennsylvania were the highest ($890, 37 percent above the U.S. norm of $650) and those in Alabama the lowest ($450, 31 percent below). The average length of stay was 3.7 days for a TIA, ranging from 5.4 days in New York to 2.3 days in Arizona.

Adult↗

PubMedDate not supplied

Variation in in-hospital charges for colorectal cancer treatment.

The total in-hospital charges for the treatment of 1,768 colorectal cancer patients averaged $17,800 across the United States in 1995. The Pacific area charge (driven by that in California) led all nine regions with an average 17 percent above the national norm and 37 percent higher than the lowest average charge in the East South Central area. Among states, the average totals varied by as much as 94 percent, however--Illinois and California had the highest charges (33 and 29 percent, respectively, above the U.S. average) and Ohio, Kentucky and Wisconsin the lowest (each more than 20 percent below the norm). Over three-fourths of the total charge was attributed to the hospital portion of the bill and this proportion varied from 69 percent in Ohio to over 86 percent in Minnesota. Physician charges averaged just under $4,000 across the country and ranged from $5,120 in New York to less than half this amount in Iowa ($2,410). The length of hospital stay averaged 8.8 days with fairly wide variation evident among study states. Patients were hospitalized for almost 11 days in Indiana, Tennessee and New York while for only 6.7 days in Colorado. The per diem charge was the highest in California ($2,875, 42 percent higher than the average) and lowest in Ohio ($1,386, 31 percent below the norm).

Aged↗

PubMedDate not supplied

Variations in charges for two major breast cancer surgeries, United States, 1996.

In 1996 the total in-hospital charges for the primary treatment of breast cancer with a modified radical mastectomy averaged $10,000 throughout the United States. The total charge (hospital plus physician's fees) varied by 95 percent between the high charge reported in New York ($12,690) and the low charge in Michigan ($6,510). The hospital portion of the bill averaged 65 percent of the total and ranged from 51 percent in New York to 74 percent in Virginia. The average length of stay for these women was 2.39 days and ranged from 3.18 days in New York to 1.69 and 1.66 days in Washington and Arizona, respectively. The average charge for a partial mastectomy was $8,760 with notable variations between states. The Texas total charge was the highest ($12,890, some 47 percent above the U.S. norm) and more than twice the low charge in Ohio ($6,080, 31 percent below the U.S. average). The physicians' charges averaged $3,330 for the country as a whole and accounted for 38 percent of the bill. This proportion ranged from 46 percent of the total in New York to 70 percent in Indiana and Colorado. The average length of hospitalization for a partial mastectomy was 1.84 days. On average, women remained in the hospital for the longest time in New Jersey (2.78 days) and for the shortest time in Oregon and Massachusetts (1.40 days and 1.45 days, respectively).

Adult↗

PubMedDate not supplied

Average charges for uncomplicated vaginal, cesarean and VBAC deliveries: regional variations, United States, 1996.

Average charges during 1996 among women insured under MetraHealth group health contracts were analyzed for three methods of childbirth. Among the 40,697 study women who had an uncomplicated vaginal birth with no prior cesarean the total charge to insurance was $7,090. For the 10,305 study women who had a cesarean delivery, the average charge totaled $11,450, in comparison with the 887 women who had a vaginal birth after a previous cesarean (VBAC), whose average charge was $7,730. The Pacific and Middle Atlantic regions reported higher-than-average charges for each of the three delivery methods, whereas the New England area had higher-than-average charges for both vaginal methods of delivery but charges just below the norm for cesarean births. New York and New Jersey had the two highest total charges as well as the two highest average charges by physicians for each method of delivery. North Carolina and Indiana had the lowest charges for vaginal births, Tennessee and Ohio had the lowest cesarean charges and Ohio and Washington reported the lowest total VBAC charges. Ancillary fees accounted for just under two-thirds of the total hospital charges for all three birthing methods. Women with an umcomplicated vaginal delivery. remained in the hospital, on average, for 1.71 days, those with a cesarean birth for 3.01 days and those undergoing a VBAC for 1.76 days. By insurance coverage, the women with an indemnity plan had the longest hospital stays across each method of delivery. Women in HMOs had the shortest average length of stay (ALOS) for routine vaginal as well as cesarean deliveries, while the VBAC women with point-of-service coverage had the shortest ALOS.

Cesarean Section↗

PubMedDate not supplied

Average charges for cholecystectomies in the United States, 1996.

During 1996 average total charge for an in-hospital laparoscopic cholecystectomy (LC) was $13,940 and $15,380 for an open cholecystectomy (OC). Per diem charges averaged $4,130 for the LCs and $2,510 for the OCs. Among the 18 study states, Florida, Illinois and California each had total in-hospital LC charges more than 20 percent above the average, whereas North Carolina and Ohio reported charges 26 and 20 percent lower. Average length of stay for an LC was 3.37 days and ranged from 4.14 days in Tennessee to 2.51 days in Connecticut. The hospital portion of the total charge averaged 70 percent but ranged from 52 percent in New York to 78 percent in Arizona. The doctors' charges in New York and New Jersey were 39 and 26 percent, respectively, higher than the U.S. average of $4,120. Those in Michigan and Arizona were 29 and 20 percent, respectively, below the norm. The hospital and physician total charge for an OC was the highest in Florida and California, 40 percent above the U.S. average, and lowest in Tennessee, Missouri and Virginia, 32 to 24 percent below. The hospital stay for an open cholecystectomy averaged 6.12 days but varied from 8.71 days in New York to 4.84 days in Arizona. Per diem charge was $2,510 and ranged from $3,890 in California (55 percent above the average) to $1,620 in Tennessee (35 percent below). The hospital charges accounted for 76 percent of the total and ranged from 80 percent in Pennsylvania, Florida and Arizona to 66 percent in New Jersey. The physicians' charges averaged $3,750 but were $5,410 in New Jersey, $5,370 in New York vs. $2,720 in Missouri. In contrast, the average professional charge for an LC performed in an outpatient setting was $1,480. This total varied by 31 percent and was the highest in the Middle Atlantic area. The Pacific area reported the lowest regional charge ($1,250), 16 percent below the norm. Among the 16 states with 20 or more outpatient LCs, the average ambulatory LC charge was the highest in New York and Ohio and lowest in Kentucky and Kansas.

Adult↗