Papers by Thomas R Konrad
Archives of Pediatrics & Adolescent Medicine, 1994
To determine whether and where universal neonatal screening for hemoglobinopathies, chiefly sickl... more To determine whether and where universal neonatal screening for hemoglobinopathies, chiefly sickle-cell disease, could be performed at socially acceptable costs. We made projections of the cost-effectiveness of nonuniversal and universal sickle-cell disease screening throughout the United States. We then compared the cost-effectiveness of universal sickle-cell disease screening with that of universal phenylketonuria screening. Finally, we asked if "high-cost" states, that is, those in which the cost of finding a case of sickle-cell disease exceeded one half the cost of finding a case of phenylketonuria, could enhance their cost-effectiveness by joining demographically complementary states in screening cooperatives. If all states conducted independent screening and if the value of finding a case of sickle-cell disease were no more than one half that of finding a case of phenylketonuria, seven of the 19 states that do not currently conduct universal screening for hemoglobinopathies would begin to do so, but six of the 34 that currently do so would stop. Of the six that would stop, three have already formed a screening cooperative, reducing their projected average costs for finding either sickle-cell disease or phenylketonuria or both; the other three could similarly improve cost-effectiveness through cooperative arrangements. Nineteen states realize economies of scale in six cooperative groups; more could do so. Universal neonatal hemoglobinopathy screening can be made available at socially acceptable costs to the citizens of demographically various states.
Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restruc... more Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restructured against a backdrop of ideology and inequality. In an effort to make sense of sleeplessness, some scholars have invoked the medicalization framework, which highlights consumerism, managed care, biotechnology, and physicians as key “engines” that foster the transformation of this formerly “normal” condition to one that people view as a medical problem. However, this burgeoning literature has not answered the call of medical sociologists to situate the medicalization process in a political economic context. In this article, we employ the case study of sleeplessness and the creation of the “Sleep Industrial Complex” to expand the medicalization framework and illustrate how American neoliberalism creates an ideal environment for the primary engines of medicalization. We identify three critical features of American neoliberalism—enhancement culture, commodification of health, and a “productivity imperative”—that act in concert with the driving engines to foster an environment wherein medicalization not only survives but also thrives.
Journal of General Internal Medicine, 2008
OBJECTIVE: The health care workforce is evolving and part-time practice is increasing. The object... more OBJECTIVE: The health care workforce is evolving and part-time practice is increasing. The objective of this work is to determine the relationship between part-time status, workplace conditions, and physician outcomes. DESIGN: Minimizing error, maximizing outcome (MEMO) study surveyed generalist physicians and their patients in the upper Midwest and New York City.
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 1997
S155
Archives of family medicine, 2000
To assess relations between self-reported arthritis-related disruptions in sleep, physical activi... more To assess relations between self-reported arthritis-related disruptions in sleep, physical activity, and social functioning and use of medical care, complementary therapies, and self-care for arthritis in older adults. A survey of self-reported arthritis-related disruptions in sleep and daily life as risk factors for use of 15 medical, complementary, and self-care modalities for relief of arthritis symptoms. General community from 38 urban and 12 rural areas in the contiguous United States. Nine hundred thirty-seven older persons reporting arthritis; of the 1925 in the 1993 to 1994 follow-up of the National Survey of Self-care and Aging, a population-based, stratified, random sample of noninstitutionalized Medicare beneficiaries aged 65 years and older. Use of 15 medical, self-care, and complementary modalities for relief of arthritis symptoms. Most respondents reported use of at least 1 medical, complementary, or self-care strategy for arthritis. Arthritis was reported to disrupt s...
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 1995
Using data from the first wave of a new longitudinal data set collected in the late fall and wint... more Using data from the first wave of a new longitudinal data set collected in the late fall and winter of 1990-1991, the National Survey of Self-Care and Aging (NSSCA), we examined older adults' self-care practices in coping with functional status limitations based on in-person interviews with a national probability sample of 3,485 noninstitutionalized adults aged 65 or older selected from Medicare beneficiary files. A composite score of functional status was calculated to reflect the presence and severity of disability in three dimensions: basic, mobility, and instrumental activities of daily living. Three types of self-care coping strategies were defined: use of equipment or devices, changes in behavior, and modifications in one's environment. National estimates of self-care practices, assistance from others, and functional status measures were presented. Data revealed that the likelihood of engaging in self-care coping strategies increased as the severity of disability increased, except among the most severely disabled. Generally, those receiving assistance from others were more likely to engage in self-care activities, suggesting that receiving assistance supplements, rather than supplants, self-care coping strategies.
The Gerontologist, 1996
Using data collected from the first wave of a longitudinal data set collected in the late fall an... more Using data collected from the first wave of a longitudinal data set collected in the late fall and winter of 1 9 9 0 -1 9 9 1 , the National Survey of Self-Care and Aging (NSSCA), we examined the extent and type of assistance older people provided to others. Age, gender, and perceived health status were the most consistent predictors of the four types of assistance: personal care, child care, volunteer work, and listening/offering advice and support. Help with instrumental activities of daily living either alone or in combination with other activities of daily living was the most common type of personal care provided.
The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013
To understand how caring for grandchildren affects the physical and mental health of grandparents... more To understand how caring for grandchildren affects the physical and mental health of grandparents in Taiwan.
American Journal of Public Health, 1984
Surveys of a national sample of 193 subsidized rural primary care programs were conducted in 1981... more Surveys of a national sample of 193 subsidized rural primary care programs were conducted in 1981 and 1982 to determine what adaptations the programs might anticipate making given a reduction in their subsidy and what actual changes they made after the implementation of new federal policies and in the face of severe economic recession. During the period between the two surveys,
Academy of Management Proceedings, 2000
The Journal of family practice, 1996
The purpose of this study was to assess (1) rates of agreement with and adoption of the universal... more The purpose of this study was to assess (1) rates of agreement with and adoption of the universal hepatitis B vaccine recommendation among practicing pediatricians and family physicians in nine selected states; (2) physicians' attitudes related to hepatitis B immunization; and (3) physicians' perceptions of parental attitudes regarding the hepatitis B vaccine series. Self-administered questionnaires were mailed to 3014 pediatricians and family physicians in selected metropolitan areas and non-metropolitan areas of nine states. Outcome variables were agreement with and adoption of the hepatitis B vaccine recommendation. Predictor variables included physicians' characteristics, practice type and location, and proportion of managed care and Medicaid patients. Other variables that were studied include physicians' attitudes related to hepatitis B immunization, sources of immunization recommendation information, personal completion of the hepatitis B immunization series, a...
Health services research, 2001
To examine response rate information from mailed physician questionnaires reported in published a... more To examine response rate information from mailed physician questionnaires reported in published articles. Citations for articles published between 1985 and 1995 were obtained using a key word search of the Medline, PsychLit, and Sociofile databases. A 5 percent random sample of relevant citations was selected from each year. Citations found to be other than physician surveys were discarded and replaced with the next randomly assigned article. Selected articles were abstracted using a standardized variable list. The average response rate for mailed physician questionnaires was 61 percent. The average response rate for large sample surveys (> 1,000 observations) was 52 percent. In addition, only 44 percent of the abstracted articles reported a discussion of response bias, and only 54 percent reported any type of follow-up. (1) Response rates have remained somewhat constant over time, and (2) researchers need to document the efforts used to increase response rates to mailed physicia...
Archives of family medicine, 2000
To assess relations between self-reported arthritis-related disruptions in sleep, physical activi... more To assess relations between self-reported arthritis-related disruptions in sleep, physical activity, and social functioning and use of medical care, complementary therapies, and self-care for arthritis in older adults. A survey of self-reported arthritis-related disruptions in sleep and daily life as risk factors for use of 15 medical, complementary, and self-care modalities for relief of arthritis symptoms. General community from 38 urban and 12 rural areas in the contiguous United States. Nine hundred thirty-seven older persons reporting arthritis; of the 1925 in the 1993 to 1994 follow-up of the National Survey of Self-care and Aging, a population-based, stratified, random sample of noninstitutionalized Medicare beneficiaries aged 65 years and older. Use of 15 medical, self-care, and complementary modalities for relief of arthritis symptoms. Most respondents reported use of at least 1 medical, complementary, or self-care strategy for arthritis. Arthritis was reported to disrupt s...
Academic medicine : journal of the Association of American Medical Colleges, 1998
Revolutionary changes in the nature and form of medical practice institutions are likely to rever... more Revolutionary changes in the nature and form of medical practice institutions are likely to reverberate backward into medical education as leaders of the new practice organizations demand that the educational mission be responsive to their needs, and as these demands are increasingly backed by market power. In the face of this pressure, medical education's traditional response--that it should have autonomy in defining its mission--is no longer viable. Instead, more explicit, formal, and systemic linkages between practice and educational institutions are inevitable. The crucial question is whether these linkages will reflect the values of the market, oriented by economic self-interest, or the values of medical professionalism, oriented by the obligation to sacrifice economic self-interest in the service of patients. The authors maintain that the realization of the normative ideal of professionalism in medical education within the emerging market environment requires that a vision...
The Journal of family practice, 1993
The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections... more The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections and 5000 deaths occur annually in the United States. Because immunization programs that targeted high-risk groups failed to abate this increase, the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation to family physicians, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. A random sample of 300 family physicians in North Carolina was surveyed by mail. Descriptive statistics and chi-square analysis were used to assess the relationship of variables hypothesized to predict physician awareness of, and agreement wit...
Pediatrics, 1993
Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen ... more Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen 37% over the last decade with 300,000 new infections and 5000 related deaths now occurring annually in the United States. As a new strategy to control the spread of hepatitis B, the Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. There was no other federal effort to disseminate this recommendation. On February 14, 1992, the American Academy of Pediatrics (AAP) issued a similar recommendation. The time between the CDC and AAP recommendations presented the opportunity to determine the singular effect on clinical practice of the CDC's dissemination effort. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation, (2) the effect of...
The Journal of family practice, 1993
This cross-sectional study assessed physicians' satisfaction with the current insurance-based... more This cross-sectional study assessed physicians' satisfaction with the current insurance-based reimbursement system and preferences for the two most frequently discussed health care reform proposals, and estimated the association between demographic and practice characteristics and attitudes toward health policy issues and reform plans. A random sample of 300 physicians was drawn from state licensure files of general practitioners, family physicians, and pediatricians practicing in North Carolina. All sample physicians were sent a schematic outline of the two major health reform alternatives and a 1-page self-administered questionnaire to determine their attitudes toward the current health care system and their preferences for health reform alternatives. Sixty-nine percent of physicians responded to the survey. The responses indicated dissatisfaction with the current system and strong beliefs that access to care is inadequate in this diverse state with a large poor and rural popu...
Pediatrics, 1994
In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hep... more In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption. Cohort survey over time. North Carolina. All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992). Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; ...
Experimental and Clinical Endocrinology & Diabetes, 1999
This pilot study was initiated to evaluate factors controlling glucose tolerance in patients with... more This pilot study was initiated to evaluate factors controlling glucose tolerance in patients with hepatitis C virus-induced liver disease before and after therapy with recombinant interferon-alpha (r-INF-alpha). Fifteen patients with histologically and serologically proven hepatitis C infection underwent oral and frequently sampled intravenous glucose tolerance tests (FSIGTT) before and after four months of therapy (6 x 106 U r-INF-alpha, subcutaneously, three times a week). Glucose, insulin and C-peptide data from FSIGTT were analysed using the minimal modeling technique to determine insulin sensitivity, glucose effectiveness and first and second phase insulin secretion. According to the WHO criteria 13 patients, had normal glucose tolerance; diabetes mellitus was diagnosed in 2 patients. In the morning following the last r-INF-alpha injection four months later, insulin sensitivity improved significantly in hepatitis C virus-infected patients with normal glucose tolerance (2.17 +/- 0.37 vs. 6.18 +/- 0.94 10(-4) min(-1) per microU/ml, p < 0.001) and with diabetes mellitus (0.86 to 2.61; 0.46 to 1.06 10(-4) min(-1) per microU/ml). This effect was independent of the extent of fibrosis, virus load before treatment and therapy response. First phase insulin secretion increased in non-diabetic (139.2 +/- 17.1 vs. 200.0 +/- 32.7, p < 0.05) and diabetic patients with HCV infection (55.24 to 118.5; 84.23 to 261.1). Moreover, free fatty acid concentrations in all HCV-infected patients were significantly reduced (0.48 +/- 0.01 vs 0.21 +/- 0.03 mmol/l, p < 0.01). Therapy with recombinant interferon-alpha is associated with an amelioration of glucose tolerance in non-diabetic and diabetic HCV-infected patients.
Physical therapy, 1995
This article is an exploration of the specific application of need-based and demand-based models ... more This article is an exploration of the specific application of need-based and demand-based models for assessing health personnel supply requirements to the field of physical therapy. Definitions and examples of these models are offered. Problems presented in the field of physical therapy in accurately defining need and demand are presented. Specific examples of current data collection at a variety of levels (professional association, private sector, state, and federal) are given.
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Papers by Thomas R Konrad