A coma-free super-high resolution optical spectrometer using 44 high dispersion sub-gratings.

Unlike the single grating Czerny-Turner configuration spectrometers, a super-high spectral resolution optical spectrometer with zero coma aberration is first experimentally demonstrated by using a compound integrated diffraction grating module consisting of 44 high dispersion sub-gratings and a two-dimensional backside-illuminated charge-coupled device array photodetector. The demonstrated super-high resolution spectrometer gives 0.005 nm (5 pm) spectral resolution in ultra-violet range and 0.01 nm spectral resolution in the visible range, as well as a uniform efficiency of diffraction in a broad 200 nm to 1000 nm wavelength region. Our new zero-off-axis spectrometer configuration has the unique merit that enables it to be used for a wide range of spectral sensing and measurement applications.

Demand management: enabling patients to use medical care appropriately.

A rationale is presented for considering demand management as well as supply management (managed care) in the current debate on health care reform. Demand management is the support of individuals so that they may make rational health and medical decisions based on a consideration of benefits and risks. The concept of demand for medical services is examined within a theoretical framework of four components: morbidity, perceived need, patient preference, and nonhealth motives. Two components, perceived need and patient preference, are suggested to offer considerable potential for making utilization more appropriate and reducing costs. Current demand services and potential hazards related to their continued expansion are discussed.

Frequency of exercise and dropouts in a work-site program. Correlates of 6-month activity patterns.

Exercise professionals have little information concerning expected levels of exercise for new participants. This study examined the frequency of exercise of 949 employees during their first 6 months of membership in a work-site health promotion facility, using automated check-in data. Overall, the frequency of exercise declined, the proportion of frequent exercisers declined, and the proportion of employees who dropped out increased. Men exercised more frequently and were less likely to drop out than were women (P < .01). Younger employees exercised more frequently than did older employees. Employees in the middle salary level exercised more frequently than did employees in the lower or upper levels (P < .01). The employee groups that started out with a lower frequency of exercise remained at a lower frequency throughout the 6 months. By their 6th month, women were 50% more likely to drop out and 50% less likely to exercise regularly than were men. These figures provide a basis for comparison with other programs to document expected exercise behavior.

Health risks and health insurance claims costs. Results for health hazard appraisal responders and nonresponders.

The health risks, health perceptions, and health claim costs of health hazard appraisal (HHA) responders and nonresponders were compared in a sample of employees of the Adolph Coors brewery. HHA responders had lower levels of risks than nonresponders. Responders also rated themselves in better health than nonresponders. Despite the health advantage, HHA responders were more likely to file health claims in 1989 than nonresponders and also had significantly greater claims costs. Comparing the top 10% most expensive employees in each group, however, nonresponders had greater claims costs than responders. Distribution patterns also differed based on perceived health status. HHA responders who perceived themselves in poor/fair health status tended to cost less than nonresponders of similar health. Responders perceiving themselves in good/excellent health status cost more than nonresponders. The findings support the "worried well" syndrome in healthy HHA responders.

The effect of physician advice on exercise behavior.

BACKGROUND: Although sedentariness, a prevalent lifestyle, is recognized as a significant risk factor for coronary artery disease and other conditions, little is known about the effectiveness of prevention strategies in the primary care setting. This study examines the impact of brief, exercise advice-giving by family physicians. METHODS: During a 2-month baseline period, patients visiting their family physician and who were age 18 or older were queried about their exercise habits and attitudes and whether their physician had discussed exercise. During the following 2-month experimental phase, the same data were gathered, and half the physicians were trained to give brief exercise advice. All patients were followed for 1 month. Changes in exercise duration and frequency were the primary outcome measures. RESULTS: During baseline, a sizable portion of patients were given exercise advice. This was true also of control group patients during the experimental phase, although trained physicians gave advice almost twice as often. A comparison of the patients receiving advice with those not receiving advice revealed significant increases in exercise duration, but not frequency. Patient attitudes were responsive to exercise advice. CONCLUSION: Members of primary care, adult patient population will increase their duration of physical activity in response to physician advice to exercise.

Attitudes toward and experience in research among family medicine chairs.

BACKGROUND: Productive research environments are important for the development of academic family medicine, yet many of the current family medicine chairs have had little research training or experience and have rated research skills as a low priority for themselves. The younger chairs, however, representing the next generation of academic leadership, may have more traditional academic values, including the promotion of research. METHODS: The 106 active and interim chairs of family medicine academic units were surveyed by mail to determine their characteristics and attitudes toward their work responsibilities. We compared chairs 50 years of age or younger with those over 50 years of age. RESULTS: Before attaining their positions, younger chairs, in general, were more likely than older chairs to have received formal training in management, patient care, and academic skills, but they shared similar work experiences. Specifically, younger chairs were more likely to have had formal research training but did not have a great deal more research experience. Younger chairs were more likely to consider research skills to be essential in their present work activities and to identify faculty with formal training and extensive experience in research as potential chair replacements. CONCLUSIONS: Younger chairs appear to have a greater appreciation for the importance of research, having received more formal training and valuing research skills in themselves and potential replacements. With the impending large turnover in family medicine leadership, there will be an opportunity to recruit chair replacements with similar viewpoints toward research, thus improving the outlook for research in academic family medicine.

Comparing medical costs by analyzing high-cost cases.

Most of the medical care expenses paid by an entire company are generated by a small percentage of employees. The most expensive employee may have costs 100 to 500 times as much as the typical employee. Instead of comparing average costs, it makes sense to investigate whether employees with unhealthy behaviors are more prone to extreme costs. This article describes methods of comparing the costs of health risk groups by examining the proportion of high-cost employees in each group. The article illustrates the methods using a health claims dataset that compares male smokers, ex-smokers, and nonsmokers.

The inadequacy of using means to compare medical costs of smokers and nonsmokers.

The costs associated with health risks have become a primary focus in the field of health promotion. Unfortunately, the nature and quality of medical cost data are not ideal for simple comparisons of health risk groups. Most health promotion professionals have had little or no training on how to interpret cost data and are thus unaware of the limitations and problems inherent in cost comparisons. This report illustrates the problems encountered when using cost data, using examples from a medical claims dataset. Specifically, the potential errors that result from comparing group means are shown. A set of alternatives for practitioners and researchers to consider when comparing costs for different groups are offered.

A characterization of the imminent leadership transition in academic family medicine.

Of the 106 identified chairmen of academic departments, divisions, or sections of family medicine in the United States in 1990, 97 (92%) responded to a survey designed to characterize the current chairmen of family medicine and estimate requirements for future chairmen. Even though 43% had occupied the chair for less than five years, over half, not limited to older chairmen, intended to leave within five years. Reasons for leaving varied, including being required to leave, career choice, personal reasons, and especially dissatisfaction with the job. Only half of current chairmen identified one or more qualified applicants for chairmanship within their own departments. The formal training and experience of these potential chairmen strongly resembled the training and experience of current chairmen, especially the fact that they had little training or experience in research. In the 1990s, the demand for academic chairmen of family medicine is likely to be large, the competition for capable candidates keen, and the challenges great for new chairmen, who will probably be young, residency-trained family physicians with relatively limited academic experience.

Impact of a facility-based corporate fitness program on the number of absences from work due to illness.

This study examined the relationship between participation in a facility-based fitness program and the number of reported absences from work due to illness. Employees who became members had a history of fewer absences before the program began in 1987 than employees who did not become members. Comparing 1988 with 1986, members experienced a significant decrease in absences, whereas nonmembers did not. Male and female members experienced 0.42 and 1.0 fewer days absent in 1988 than in 1986, respectively. Controlling for gender and previous absences, members could be expected to have 1.2 fewer absences in 1988 than nonmembers. On average, those who participated most frequently experienced the greatest improvement in attendance. A significant interaction between participation and 1986 absences indicated that a member's decrease in absences depended both on how many absences the member had to begin with, and how much he or she participated. Members having a high number of absences in 1986 could expect the greatest benefit from frequent participation.

Characteristics of self-selected responders to a health risk appraisal: generalizability of corporate health assessments.

Selected characteristics and total medical claims of health risk appraisal (HRA) responders and non-responders were compared in a sample of employees having a three-year employment and claims history. HRA responders were younger and more likely to file medical claims than non-responders. Although mean medical claims were greater for HRA responders than non-responders, when adjusted for age and sex this difference reflected the proportion of employees reporting claims, not a difference in the claims amount.

Diet, tobacco, alcohol, and stress as causes of coronary artery heart disease: an ecological trend analysis of national data.

The present investigation examined the temporal relationships between changes in coronary artery heart disease (CAHD) mortality rates from whites (1938-1980) and changes in national measures of dietary elements, tobacco consumption, alcohol consumption, and unemployment. The magnitude and latency of the causal relationships were estimated with the use of cross-lagged correlation functions (CCFs) and Granger causality tests. Preliminary CCFs showed consistent correlational patterns between CAHD and tobacco, ethanol, and dietary fats. There was little association between CAHD and dietary cholesterol. Ethanol, tobacco, and the ratio of saturated to polyunsaturated fats (S:P) were analyzed for directional causality using Granger causality tests. The S:P ratio demonstrated a unidirectional Granger causal relationship with CAHD mortality in all sex and age groups. The estimated latency of this relationship was 23 to 30 years. This finding supports a causal relationship between diet, specifically fats, and the risk of CAHD two or three decades later.