Biomedical subjects

S R Machlin

Publications and source records attributed to S R Machlin.

9 recordsLinked to original sources

PubMed2001

Being uninsured in 1996 compared to 1987: how has the experience of the uninsured changed over time?

OBJECTIVE: To explore trends in the nonelderly uninsured population between 1987 and 1996 and examine whether the broad disparities in medical care utilization and out-of -pocket spending between the privately insured and uninsured populations that existed in 1987 continued over the following decade. DATA SOURCES/STUDY DESIGN: Data are from the 1996 Medical Expenditure Panel Survey and the 1987 National Medical Expenditure Survey. We used survey data to create descriptive tables examining the characteristics of the uninsured population and the use of medical services, total and out-of -pocket expenditures, and the burden of out-of -pocket spending for the uninsured and the privately insured in 1987 and 1996. Tabulations are presented by demographic and socioeconomic characteristics. PRINCIPAL FINDINGS: The composition of the uninsured population changed somewhat between 1987 and 1996, with adults over age 18 and employed persons making up larger proportions of the uninsured in 1996, and the poor and those in fair or poor health making up smaller proportions. There were few changes in utilization of services by the uninsured over this period and no change in mean expenses, but there was an increase in receipt of at least one preventive service (mammograms) and a decline in the proportion of families with high out-of-pocket burden. Disparities in use and expenses that existed between the uninsured and the privately insured in 1987, however, remained in 1996. CONCLUSIONS: Despite the fundamental changes in the health care system that took place between 1987 and 1996, health care utilization and expenses for the uninsured changed very little. The uninsured are still much less likely to use services than are the privately insured, and they pay for a larger proportion of their medical care expenses out of pocket. There was some improvement in the burden of out-of -pocket spending between 1987 and 1996, but a significant number of the uninsured still have high financial burden.

Adolescent↗

PubMed1996

Normal caudate nucleus in obsessive-compulsive disorder assessed by quantitative neuroimaging.

BACKGROUND: Prior neuroimaging studies have not consistently demonstrated a structural or functional abnormality of the caudate nucleus in patients with obsessive-compulsive disorder (OCD). However, there is theoretical support for some associated dysfunction of the caudate nucleus. METHODS: We examined volumes of the caudate nucleus and putamen with magnetic resonance imaging in 24 patients with adult-onset OCD and 21 control subjects, group-matched on age, race, education, and sex. Patients were relatively free from tics. To evaluate function (metabolism or blood flow) of the caudate nucleus, we performed a quantitative review, including a meta-analysis, of normalized data from functional neuroimaging studies that compared patients who had OCD with normal control subjects. RESULTS: All structural basal ganglia measures failed to exhibit differences between patients with OCD and matched normal control subjects. Patients did not demonstrate evidence of ventricular enlargement. Quantitative meta-analysis of the functional neuroimaging literature did not demonstrate a consistent abnormality of the caudate nucleus. CONCLUSIONS: We did not observe evidence of a structural abnormality of the caudate nucleus in patients with OCD. Prior reports of a structural aberration of the caudate nucleus were mixed. We also did not find strong support for relative caudate metabolic or perfusion dysfunction in the literature, although increased function in the frontal cerebral cortex was identified. The heterogeneous nature of this disorder may account for inconsistencies between studies. For example, ventricular enlargement or reduced caudate volume or blood flow might be evident in patients with soft neurological signs (eg, tics), while patients in the current study were relatively free from tics. Although theories of OCD suggest a dysfunction of the caudate nucleus, the structural and functional neuroimaging literature has not consistently verified this.

Adult↗

PubMed1992

Oculomotor performance in obsessive-compulsive disorder.

OBJECTIVE: Neuroimaging studies have shown abnormalities of the frontal cortex and basal ganglia in persons with obsessive-compulsive disorder. Since lesions in the frontal cortex and basal ganglia areas affect performance on goal-guided saccadic eye movements, this study investigated the relation between the diagnosis of obsessive-compulsive disorder and oculomotor performance. METHOD: Eleven patients with the clinical diagnosis of obsessive-compulsive disorder and 14 normal subjects were assessed with respect to their performance on both visual-guided and goal-guided oculomotor tasks. Fixation performance was also measured. RESULTS: The group with obsessive-compulsive disorder had a very significantly greater error rate and a significantly greater rate of inaccurate saccades on the goal-guided antisaccade task, whereas they were not different from the normal group in reaction time, saccadic velocity, and accuracy on the visual-guided saccade task. The distribution of error rates for the patients with obsessive-compulsive disorder was broad, with more than one-half outside the range of the normal group. Most of the abnormal findings were among male patients. CONCLUSIONS: The results support the hypothesis of a relationship between impaired performance on goal-guided saccadic eye movement tasks and the diagnosis of obsessive-compulsive disorder, but they also suggest a gender-related subgroup within the group with obsessive-compulsive disorder.

Basal Ganglia↗

PubMed1991

Elevated medial-frontal cerebral blood flow in obsessive-compulsive patients: a SPECT study.

Regional cerebral blood flow was measured with single photon emission computed tomography in 10 obsessive-compulsive patients and eight comparison subjects. The patients had a significantly higher ratio of medial-frontal to whole cortex blood flow; this was unrelated to symptom severity but was correlated negatively with anxiety. No differences in orbital-frontal blood flow were found.

Adolescent↗

PubMed1991

Effects of fluoxetine on regional cerebral blood flow in obsessive-compulsive patients.

Six drug-free obsessive-compulsive patients were given single photon emission computerized tomography scans before and during treatment with fluoxetine. The treatment significantly reduced the patients' "hyperfrontality," as determined by the ratio between medial-frontal and whole cerebral cortex blood flow, and significantly lowered ratings of obsessive-compulsive and anxiety symptoms.

Adult↗

PubMed1991

A fluoxetine-induced frontal lobe syndrome in an obsessive compulsive patient.

The authors report the occurrence of apathy, indifference, inattention, and perseveration in an obsessive compulsive patient taking high doses of fluoxetine. These changes were associated with a decrease in cerebral blood flow in the frontal lobes and changes in neuropsychological tests generally associated with frontal lobe impairment. These clinical manifestations disappeared 4 weeks after discontinuation of fluoxetine.

Adult↗

PubMed1989

Validity of mortality analysis based on retrospective smoking information.

We assess the validity of mortality analysis based on retrospective reporting of smoking habits by subjects and proxies after a time lag of approximately ten years. The analysis is based on 2855 subject respondents and 615 proxy respondents to the NHANES I Epidemiologic Followup Survey (NHEFS), a national followup study of persons examined in the National Health and Nutrition Examination Survey (NHANES I). Persons 45-77 years of age at baseline were selected for analysis. Using three categories of smoking at baseline (current, former, never), the retrospective classification (NHEFS) matched the NHANES I classification for 89 per cent of the subject respondents and 83 per cent of the proxy respondents. Agreement levels were higher for women (92 per cent of subjects and 89 per cent of proxies) than for men (85 and 80 per cent). We used Cox regression models to assess the use of retrospective smoking information in an analysis of the relationship between selected risk factors and mortality for persons 45-64 years of age. There were few substantive differences in results with use of NHEFS smoking data versus NHANES I smoking data. In particular, the effects of age, systolic blood pressure, education, and race on mortality were not sensitive to the source of the smoking data (NHANES I or NHEFS) or the form of the smoking variable (two-, three-, or six-level categorization). The effects of body mass index on mortality were sensitive to the form of the smoking variable but results based on NHANES I and NHEFS were quite similar. These results suggest that smoking information obtained from proxy respondents is adequate for analyses of the risk of total mortality associated with smoking and other risk factors. Further assessment is needed to determine the adequacy of such data for analyses of mortality from specific causes that are sensitive to amount smoked or duration of smoking.

Aged↗

PubMed1983

Changing practice in the surgical treatment of breast cancer. The national perspective.

This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

Adult↗

PubMed1981

Differences among hospitals as a source of excess neonatal mortality: the District of Columbia, 1970-1978.

Between 1970 and 1978 the neonatal mortality rate for black infants in the District of Columbia remained essentially constant while the national rate declined steadily. This report examines adjusted hospital-specific neonatal mortality rates in order to determine the extent to which the District's lack of improvement can be explained by excess mortality in a few hospitals. The indirect method of adjustment utilizing standardized morality ratios (SMRs) is used to control for the effect of the birth weight distribution on hospital-specific neonatal mortality rates. A generalized least squares approach is used to model the changes in the SMRs over time. No change was found in the SMRs for any hospital between 1970-72 and 1973-75, and four hospitals experienced no change in the 1973-75 to 1976-78 period (although one of these hospitals had very low SMRs initially). The remaining four hospitals experienced a 37% decline in their SMR's during the second interval (1973-75 to 1976-78). If the three hospitals that had high initial rates and showed no change in mortality rates from 1973-75 to 1976-78 had experienced the 37% decline, the District's SMR in 1976-78 would have been reduced by 20%.

Black or African American↗