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Biomedical subjects

S M Wolfe

Publications and source records attributed to S M Wolfe.

At least 19 recordsLinked to original sources
PubMed1998

Requesting organ donation: an interview study of donor and nondonor families.

BACKGROUND: Approximately half of the families asked to consider donation of a relative's organs decline to give consent. Understanding the difference between stated public support of organ donation and actual behavior is key to decreasing the shortage of donor organs. OBJECTIVES: To gain insight into the experiences of potential donor families and to define features of the donation-request process and other factors that are associated with consent for organ donation. METHODS: A structured telephone interview was conducted with the immediate next of kin of 164 medically suitable potential organ donors. Interviews 30 to 60 minutes long were held with members of both donor and nondonor families 4 to 6 months after the death of the study participant's relative. RESULTS: Several factors were associated with consent for organ donation: characteristics of the patient and the patient's family, beliefs and attitudes about organ donation and transplantation, whether the family knew the deceased's wishes about donation, the family's satisfaction with the hospital care that their relative received, specific aspects of the donation-request process, and the family's understanding of brain death. CONCLUSIONS: Organ donation rates could be increased by enhancing the quality of hospital care and ensuring that the request for donation is handled in a way that meets the families' informational and emotional needs.

Adolescent↗
PubMed1997

Explaining brain death: a critical feature of the donation process.

To examine how a family's understanding of brain death may affect the decision to donate, an interview study was conducted with the immediate next of kin of 164 medically suitable organ donor candidates. Telephone interviews were conducted with members of both donor and nondonor families 4 to 6 months after the relative's death. Only 61% of the donor and 53% of the nondonor respondents said they had received an explanation of brain death. Few respondents reported that the hospital or organ procurement organization staff used visual aids to clarify or reinforce the information they were given. Next of kin who decided against donation had far less understanding of brain death than did those who decided in favor of it. Before making an organ donation request, healthcare providers must inquire about and address common misunderstandings people have about brain death. Healthcare teams should develop and be trained on a clear protocol for communicating with the families of patients who may be potential organ donors.

Adolescent↗
PubMed1995

The growing epidemic of uninsurance: new data on the health insurance coverage of Americans.

Despite a massive expansion of Medicaid and an upswing in the economy, the total number of Americans uninsured in 1993 was 39.7 million, more than at any time since the passage of Medicaid and Medicare in the 1960s. Since 1989, the ranks of the uninsured have swelled by 6.3 million. Millions more would be uninsured if Medicaid enrollment had not risen dramatically, by 10.5 million people since 1989. Loss of health coverage is a growing problem for middle-income families, women, and children, as it has long been for low-income families. Even in Hawaii, whose employer mandate program is often cited as a model of universal coverage, there was a large increase in uninsurance. Nationwide, the sharp upswing in the number of Americans who are uninsured has coincided with government and corporate policies to encourage medical competition and push people into managed care plans. Republican proposals to limit AFDC benefits threaten to further increase uninsurance, particularly among women and children. Only a Canadian-style single-payer reform can assure universal coverage and simultaneously contain costs.

Adolescent↗
PubMed1994

Epidemiology of failed tobacco control legislation.

OBJECTIVE: To evaluate the influence of tobacco industry campaign donations, district location, and political party affiliation on tobacco control legislation among members of the US Congress. DESIGN: Data were obtained from the Federal Election Commission on money contributed by the 10 leading tobacco political action committees and by tobacco industry-aligned individuals to members of the US House of Representatives (1991-1992) and Senate (1987-1992). Logistic regression analyses were performed using recorded votes and cosponsorship activities concerning tobacco control legislation during the 102nd and 103rd Congresses and membership on the House Congressional Task Force on Tobacco and Health as the dependent variables and tobacco money received, party, district location, and caucus or committee membership as the independent variables. SETTING: United States Congress in 1991 and 1992. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Support for federal tobacco control legislation. RESULTS: The tobacco industry donated approximately $2.4 million to members of Congress from January 1991 through December 1992. House members received an average of $2943 (1991-1992) and senators received an average of $11,593 (1987-1992). The more tobacco money a member received, the less likely the member was to support tobacco control legislation. In the Senate, on a vote to end the taxpayer subsidy of tobacco products in military stores, the odds ratio that senators in the top quartile of tobacco money recipients did not support the measure vs senators in the lowest quartile of tobacco money recipients was 42.2 (95% confidence interval, 4.1 to 430.0; P < .001). In the House, on a vote to end a $3.5 million subsidy to promote American tobacco abroad, the odds that House members in the top third of tobacco money recipients would oppose the legislation were 14.4 times greater (95% confidence interval, 5.5 to 39.0; P < .001) than for House members in the lowest third of tobacco money recipients. Receiving more tobacco money, being a member of the Republican party, and representing a tobacco-producing state were all associated with decreased support for tobacco control issues. The amount of tobacco money received was the variable most strongly and consistently associated with a lack of support for tobacco control legislation, even when we controlled for additional factors such as district location and party. CONCLUSION: Tobacco industry contributions to members of the US Congress strongly influence the federal tobacco policy process. Unless this influence is diminished through a combination of members refusing tobacco money and campaign finance reform, this process of contributing to death by thwarting tobacco control will continue to claim hundreds of thousands of lives a year.

Fund Raising↗
PubMed1992

The vanishing health care safety net: new data on uninsured Americans.

New data obtained from the Census Bureau shows that the number of Americans without any health insurance increased by 1.3 million between 1989 and 1990, bringing the total number of uninsured to 34.7 million, more than at any time since the passage of Medicare and Medicaid 25 years ago. This increase coincided with a 10.5 percent increase in health spending, the second largest in the past three decades. The number of people covered by Medicaid grew by 3.1 million, due to a one-time expansion of eligibility mandated by Congress, but this was more than counter-balanced by a population growth of 3 million and a decrease of 1.3 million in people covered by private insurance. Had Medicaid not been expanded, the number of uninsured would have increased by 4.4 million. The increase in the uninsured affected virtually all parts of the nation. Seven states had increases of more than 100,000 persons each. Only Texas experienced a decrease of that magnitude, but still had the second highest rate of uninsurance of any state. Of the 1.3 million additional uninsured in 1990, 77 percent were male, 32 percent had family incomes in excess of $50,000 per year, and 74 percent had annual family incomes above $25,000. Fewer than 9 percent had incomes below the poverty line. The numbers of uninsured children and senior citizens fell slightly (but not significantly), while the number of uninsured working-age adults rose by 1.4 million. The number of uninsured workers in each of four of 20 major industry groups increased by more than 100,000 in 1990. None of the industry groups showed a significant decline in the number of uninsured. Among professionals, there were substantial numbers of uninsured doctors, engineers, teachers, college professors, clergy, and others, but all legislators and judges were insured. The data presented here largely predate the recession and understate current problems. In 1991 the number of uninsured will likely reach nearly 40 million. Also, these estimates are based on the number of people uninsured at a single time during 1990; a far higher number were temporarily uninsured at some point during the year. Moreover the Census Bureau survey ignores the problem of the underinsurance of at least 50 million insured Americans. Patchwork public programs are grossly inadequate to plug the holes. A national health program covering all Americans could assure access to care and contain costs.

Adolescent↗
PubMed1989

Takayasu's arteritis.

Takayasu's arteritis, an inflammatory and obliterative disease of medium and large arteries, is classified as a giant cell arteritis. It has a predilection for the aortic arch and its branches and the pulmonary arteries. Unlike atherosclerotic vascular diseases, Takayasu's arteritis affects young women primarily. Early symptoms may be mainly systemic and may resemble polymyalgia rheumatica. The etiology is unknown, but infectious agents and autoimmunity have been suggested to play a role. Diagnosis is based on symptoms, physical findings, and angiographic findings, because tissue diagnosis rarely is feasible. The two cases reported here represent contrasting phases of Takayasu's arteritis.

Adult↗