Dental Care Use, Edentulism, and Systemic Health among Older Adults.

Past research suggests there are systematic associations between oral health and chronic illness among older adults. Although causality has not yet been credibly established, periodontitis has been found to be associated with higher risk of both heart disease and stroke. We advance this literature by estimating the direct association between dental care use and systemic health using multiple waves of the 1992 to 2016 Health and Retirement Study. Through the inclusion of individual fixed effects in our regression models, we account for unobservable time-invariant characteristics of individuals that might otherwise bias estimates of the association between dental care use and health. We find statistically significant negative associations between dental care use and the number of health conditions, self-reported overall health, the incidence of heart disease, and the incidence of stroke. In particular, the use of dental care within the past 2 y is associated with a 2.7% reduction in the likelihood of being diagnosed with a heart condition and a reduction in the likelihood of a stroke diagnosis of between 5.3% and 11.6%. We also find large positive correlations between edentulism and the measures of chronic illness. Associations from models estimated separately for men and women are qualitatively similar to one another. These findings provide additional motivation for the consideration of a Medicare dental benefit.

Renal phlebography in diagnosis of poorly vascularized renal malignancies.

Eight cases are presented to demonstrate the value and limitations of renal phlebography in the diagnosis of poorly vascularized renal malignancies. Because of the easier compressibility of the thinner venous channels, malignant tumors may cause more pronounced phlebographic changes than seen in corresponding arteriographic studies. Changes include venous compression and amputation, tumor thrombus, and venous neovascularity. It is believed that the supplementary use of renal phlebography at the same time arteriography is being accomplished may increase the chances of preoperatively diagnosing such hypovascular renal malignancies as papillary-tubular adenocarcinomas, metastatic and necrotic malignancies, and invasive transitional cell carcinomas.

Increase in gonadotropin-releasing hormone (GnRH) levels in CSF after stimulation of the nervus terminalis in Atlantic stingray, Dasyatis sabina.

The nervus terminalis (NT) contains many cells immunoreactive to gonadotropin-releasing hormone (GnRH). The potential of the NT to release GnRH in vivo was investigated by stimulating the peripheral nerve trunk of Atlantic stingrays and collecting cerebrospinal fluid (CSF). The CSF samples from stimulated animals averaged about twice the levels of mGnRH-like peptide as those of unstimulated animals. These results demonstrate that nervus terminalis activity can effect in vivo GnRH levels in the brain.

Medical savings accounts: microsimulation results from a model with adverse selection.

This paper examines medical savings accounts combined with high-deductible catastrophic health plans (MSA/CHPs), exploring the possible consequences of making tax preferred MSA/CHPs available to the entire employment-related health insurance market. The paper uses microsimulation methods to examine the equilibrium effects of MSA/CHPs on health care and non-health care expenditures, tax revenues, insurance premiums, and exposure to risk. If MSA/CHPs are offered alongside comprehensive plans, biased MSA/CHP enrollment can lead to premium spirals that drive out comprehensive coverage. Our estimates also raise concerns about equity, insofar as those who stand to lose the most tend to be poorer and in families with infant children.

Reconciling medical expenditure estimates from the MEPS and the NHA, 1996.

This article compares 1996 estimates of national medical care expenditures from the Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). The MEPS estimate for total expenditures in 1996 was $548 billion; whereas, the NHA estimate for personal health care (PHC) in 1996 was $912 billion. Much of this apparent difference, however, arises from differences in scope between MEPS and NHA--rather than from differences in estimates for comparably-defined expenditures. We adjusted the NHA for differences in included populations and types of services covered, finding a much smaller difference between MEPS and a comparably-defined NHA.

Gainers and losers under a tax-based health care reform plan.

Currently, it appears that health care for the nonpoor and nonelderly in the United States will continue to be financed primarily through a private insurance market rather than a public insurance program. Even if this market-based system achieves maximum efficiency, a premium subsidy for low-income, non-Medicaid-eligible individuals likely will be required to make health insurance affordable for all Americans. There are advantages to carrying out that redistribution at the federal, rather than state or local, level, possibly using credits or deductions within the federal personal income tax system. Which individuals decide to claim these tax credits or deductions, and how much the tax subsidies would have cost in 1993, are examined in this paper. A tax on employer-provided health benefits finances the subsidy, and the paper analyzes characteristics of gainers and losers under the reform. The study uses data from the 1987 National Medical Expenditure Survey (NMES) to develop a microsimulation model of the federal personal income tax system.

Dental services. An analysis of utilization over 20 years.

BACKGROUND: Utilization studies serve as an important tool for oral health policy decision-making. A number of important reports have been published that help to characterize the dental utilization patterns of most Americans. For the most part, these studies have focused on utilization estimates for a particular survey period or year. Fewer studies have examined changing utilization patterns over time. METHODS: This article focuses on dental utilization and the changes in utilization for the civilian, community-based U.S. population during 1977, 1987 and 1996. Using data from the National Medical Care Expenditure Survey, National Medical Expenditure Survey and Medical Expenditure Panel Survey, the authors provide national estimates of dental visits for each of several socioeconomic and demographic categories during 1977, 1987 and 1996. RESULTS: Although the dental use rates for children between 6 and 18 years of age were the highest of any age group in each of the three years studied, the use rate for children and the elderly increased during this same 20-year period. Data also showed that the gap in use rates between lower- and higher-income people widened during the 20-year period. Generally, use rates according to sex and race/ethnicity were unchanged in each of the survey years, except for a narrowing of the gap between whites and nonwhites by 1996. CONCLUSION: These data are unique and comparable and establish a mechanism by which dental visits can be compared during a 20-year period. While aggregate utilization rates generally were stable during this 20-year period, some differences within socioeconomic and demographic groups are notable. For instance, the use rate increased during the 20-year period for people 65 years of age and older and for children younger than 6 years of age. PRACTICE IMPLICATIONS: By understanding these analyses, U.S. dentists will be better positioned to provide care and meet the needs of all Americans.

The impact of insurance coverage on children's dental visits and expenditures, 1996.

BACKGROUND: Health insurance coverage has been shown to relate positively with the use of dental services. The purpose of the authors' study was to describe the level of dental coverage among U.S. children and to assess the impact of dental coverage on children's use of dental services and expenditures for dental care. METHODS: The focus of these analyses is on dental care coverage, use and expenditures for U.S. children during 1996. National estimates are provided for the population with dental coverage, the population with a dental visit, and mean total expenditure for each of several socioeconomic and demographic categories during 1996 using data from the Medical Expenditure Panel Survey. RESULTS: Fifty-two percent of children younger than 18 years of age had private dental coverage during 1996. Approximately 56 percent of children in families with a poverty status level of 133 percent of the federal poverty level or below were covered by Medicaid during 1996. Fifty-six percent of children with private coverage had made at least one dental visit, compared with 28 percent of noncovered children. Twenty-eight percent of children covered by Medicaid had made at least one dental visit compared with 19 percent of noncovered children. CONCLUSION: Medicaid dental coverage seems to have had a lesser effect on the likelihood of a child's having a dental visit than had private coverage. Improving oral health for poorer children may depend partly on improving the design of Medicaid dental coverage programs. PRACTICE IMPLICATIONS: By understanding these analyses, practitioners, advocates and policymakers will be better positioned to provide care, improve access and better meet the needs of all American children.

A comparison of dental care expenditures and office-based medical care expenditures, 1987.

BACKGROUND: This article compares national estimates of utilization of and expenditures for dental care and office-based medical care. The comparison includes respondents in several socioeconomic and demographic categories. METHODS: The focus of the analyses is on dental care and office-based medical care utilization during 1987. Specifically, the authors provide national estimates for numbers of dental and office-based medical visits made, expenditures for and sources of payment for each of several socioeconomic and demographic categories using household survey data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: Data show that out-of-pocket expenditures are greater for dental care than for office-based medical care; that few Medicaid dollars are spent on dental care; that insurance is an important component of dental and office-based medical care; and that dentists provide greater amounts of unreimbursed care than do their office-based physician counterparts. CONCLUSIONS: NMES data show that dental care expenditures are considerable, almost as large as expenditures for office-based medical care, and are a significant component of all nonhospital health care expenditures for noninstitutionalized Americans. PRACTICE IMPLICATIONS: U.S. dentists provide a significant amount of care. By understanding these analyses, practitioners will be better positioned to provide care and to better meet the dental needs of all Americans.

Dental services: use, expenditures and sources of payment, 1987.

BACKGROUND: This article provides per capita estimates of dental care utilization, expenditures, mix of services and sources of payment for each of several socioeconomic and demographic categories. METHODS: The focus of the analyses presented here is on dental care utilization by the U.S. population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. RESULTS: During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. CONCLUSIONS: These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. PRACTICE IMPLICATIONS: Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses, practitioners will be better positioned to meet the dental needs of all Americans.

Pediatric dental visits during 1996: an analysis of the federal Medical Expenditure Panel Survey.

Pediatric health policy articulated by the government, health professions, and child advocates is concerned with eliminating health disparities among children and increasing access to essential pediatric health services. National data are widely available on dental health status and associated disparities by income and race, but little data have been reported on dental service utilization by children. Data from the 1996 federal Medical Expenditure Panel Survey were analyzed to determine the percentage of children who obtained a dental visit and the number of visits children experienced by age, sex, ethnic/racial background, family income, and parental education. Overall, 43% of all children ages birth through 18 obtained at least one dental visit in 1996. Among children who see a dentist, the average number of visits during 1996 was 2.7. Low income, low education, and minority status are all associated with both lower odds of having a dental visit and lower number of visits per utilizer. Children under 6 had less than half the dental visit rate of older children and had fewer visits per person among utilizers.

[Technique, complications, possible misinterpretations and indications of retrograde renal phlebography (author's transl)]. / Technik, Komplikationen, mögliche Fehlinterpretationen und Indikationen der retrograden Nierenphlebographie

A chronological survey is given of the gradual development of retrograde renal phlebography whereby the different techniques are contraste with each other in detail. Today's method of choice is the retrograde selective visualization of renal veins using the Seldinger procedure via the femoral vein, with or without pharmacological influence and applying larger doses of contrast medium (up to 30 ml) and higher injection pressures (up to 6 kg/cm2). Indications for simple and for pharmacophlebography are specified and exemplified by means of a scheme. Possible complications and misinterpretations are discussed.

Orthodontic dental visits during 1987 and 1996.

Americans underwent approximately 355 million dental procedures during 1987, approximately 8% for orthodontic treatment. Individual rates of utilization vary and are not uniform across the population. This article provides estimates of orthodontic utilization for each of several socioeconomic and demographic categories, using household data from the 1987 National Medical Expenditure Survey (NMES) and the 1996 Medical Expenditure Panel Survey (MEPS). These data show that slightly more than 3% of the population, or approximately 39 million Americans, visited a dentist to receive orthodontic care nationwide during 1987 and 1996. For those with an orthodontic visit, the mean number of visits per patient decreased in number from 1987 to 1996.

Growth cone interactions with a glial cell line from embryonic Xenopus retina.

We have isolated a nonneuronal cell line from Xenopus retinal neuroepithelium (XR1 cell line). On the basis of immunocytochemical characterization using monoclonal antibodies generated in our laboratory as well as several other glial-specific antibodies, we have established that the XR1 cells are derived from embryonic astroglia. A monolayer of XR1 cells serves as an excellent substrate upon which embryonic retinal explants attach and elaborate neurites. This neurite outgrowth promoting activity appears not to be secreted into the medium, as medium conditioned by XR1 cells is ineffective in promoting outgrowth. Cell-free substrates were prepared to examine whether outgrowth promoting activity is also associated with the XR1 extracellular matrix (ECM). Substrates derived from XR1 cells grown on collagen are still capable of promoting outgrowth following osmotic shock and chemical extraction. This activity does not appear to be associated with laminin or fibronectin. Scanning electron microscopy was used to examine growth cones of retinal axons on XR1 cells and other substrates that supported neurite outgrowth. Growth cones and neurites growing on a monolayer of XR1 cells, or on collagen conditioned by XR1 cells, closely resemble the growth cones of retinal ganglion cells in vivo. A polyclonal antiserum (NOB1) generated against XR1 cells effectively and specifically inhibits neurite outgrowth on XR1-conditioned collagen. We therefore propose that neurite outgrowth promoting factors produced by these cells are associated with the extracellular matrix and may be glial specific.

[The signification of renal sequential scintigraphy with determination of regions of interest for the therapeutical purpose in urology (author's transl)]. / La signification de la scintigraphie rénale dynamique et la détermination de la clearance tubulaire relative de différentes régions du rein pour le plan théerapeutique en urologie

Sequential scintigraphy with regions-of-interest technique has a firm position in the diagnosis of localized lesions of renal parenchyma. The method is of little annoyance to the patient and is often decisive for the further diagnostic and therapeutical proceedings. The mathematical evaluation process takes little time, an advantage in emergency cases. Main indications are pathological duplex kidneys, staghorn calculi and anomalies of renal form and position. Radiation doses are low, a valuable factor in long-term controls, above all renal trauma and urotuberculosis.

Differential diagnostic importance of retrograde phlebography in cases of unusual ectasia and renal pelvic deformity.

Retrograde renal phlebography is important in the differential diagnosis when carcinoma of the renal pelvis is suspected. Vessel cut-offs, differences in contrast density, variations in vessel caliber, and irregular identations of the vessel wall can be seen with this technique. This seems to be the only method of demonstrating varicositites of the renal veins.

Renal phlebography: an aid in the diagnosis of the absent or non-functioning kidney.

There are clinical situations that may preclude the use of retrograde pyelography and renal arteriography in the differential diagnosis of the absent, dysgenetic and non-functioning kidney. At times these procedures are non-diagnostic. We present 8 cases to demonstrate the efficacy of selective renal phlebography as an aid in the diagnosis of these entities.