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12. Utilization and clinical outcomes of outpatient physical therapy for Medicare beneficiaries with musculoskeletal conditions

Author

Fritz, Julie M., Hunter, Stephen J., Tracy, Diane M., and Brennan, Gerard P.

Subjects
Medicare -- Usage, Therapeutics, Physiological -- Health aspects -- Usage -- Research, Musculoskeletal diseases -- Care and treatment -- Research, Physical therapy -- Health aspects -- Usage -- Research, Health
Abstract

Background. Medicare beneficiaries frequently receive physical therapy for musculoskeletal conditions. Little information is available about this care. Objective. The purposes of this study were: (1) to describe characteristics, clinical outcomes, and utilization for Medicare beneficiaries receiving physical therapy in outpatient clinics within one integrated health care system; (2) to compare characteristics, outcomes, and utilization based on the body region affected; and (3) to examine factors predictive of outcomes and utilization. Design. This was a prospective, longitudinal study. Methods. Medicare beneficiaries aged 65 years or older (n=1,840 episodes of care) participated in the study. Descriptive statistics were calculated for patient characteristics and outcomes. Comparisons were made based on body region. Regression models evaluated factors associated with change in pain, improved outcome, and utilization. Results. The patients' mean age was 74.2 years (SD=6.3), and 65.3% were female. The most common body regions were the lumbar spine, shoulder, and knee, collectively accounting for 71.3% of the episodes of care. Patients attended a mean of 6.8 visits (SD=4.7), and 63.9% experienced an improved outcome. Episodes of care for lumbar spine conditions had less reduction in pain, whereas shoulder conditions and foot/ankle conditions showed the greatest improvement. Care for hip conditions was least likely to result in an improved outcome. Knee conditions were most likely to have an improved outcome. Care for shoulder and knee conditions had the highest number of visits. Factors associated with greater reduction in pain and improved outcomes included greater initial pain or disability and attending more visits. Factors associated with greater utilization included a postsurgical condition and higher initial pain rating. Limitations. The study was performed in one geographic region within a single health care delivery system. Conclusion. The results provide information on outcomes of physical therapy for Medicare beneficiaries in one health care system. Further research is needed to examine optimal utilization and care for these patients., Musculoskeletal conditions are highly prevalent in the United States and throughout the world. Musculoskeletal conditions can significantly diminish an individual's quality of life and impose a substantial economic burden on [...]

Published
2011
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19. Parental role division predicts avian preen wax cycles

Author

Reneerkens, Jeroen, Almeida, Juliana B., Lank, David B., Jukema, Joop, Lanctot, Richard B., Morrison, R. I. Guy, Rijpstra, W. Irene C., Schamel, Douglas, Schekkerman, Hans, Damste, Jaap S. Sinninghe, Tomkovich, Pavel S., Tracy, Diane M., Tulp, Ingrid, Piersma, Theunis, and Piersma group

Subjects
SANDPIPERS, KNOT CALIDRIS-CANUTUS, SOCIAL-ORGANIZATION, SCOLOPACIDAE, SWITCH, SEX, RED KNOTS, GLAND WAXES, OIL, EVOLUTION
Abstract

Previous studies have shown that preen wax composition in some sandpipers shifts from the usual monoesters to diesters during the breeding season, possibly to reduce the ability of mammalian predators to find nests using olfactory cues. To investigate further the relationship between incubation and wax secretion, we examined seven sandpiper species with different incubation patterns (species in which both sexes incubate, in which only males incubate and in which only females incubate). During the breeding period, diester preen wax was secreted almost exclusively by the incubating sex in species with uniparental incubation, and by both sexes in species with biparental incubation. These findings suggest that diester preen waxes have a function that is directly related to incubation. Unexpectedly, in female-incubating Curlew Sandpiper Calidris ferruginea and Buff-breasted Sandpiper Tryngites subruficollis, some males also secreted diester preen waxes during the breeding period. This suggests that some males may in fact incubate, that these waxes may be a remnant from their evolutionary past when both sexes incubated, or that males need to be olfactorally cryptic because they are involved in the making of nest scrapes. The seasonal pattern of preen wax composition was also studied in captive male, female and female-mimicking male ('faeder') Ruff Philomachus pugnax. Captive female Ruff changed preen wax composition from monoesters to diesters in the spring despite the fact that no incubation took place. This suggests that circannual rhythms rather than actual incubation behaviour may trigger the shift to diester waxes. All captive male Ruff, including the faeders, continued to secrete monoesters, supporting the hypothesis that only the incubating sex secretes diesters.

Published
2007

21. Effects of climate variation on the breeding ecology of Arctic shorebirds

Author

Meltofte, Hans, primary, Piersma, Theunis, additional, Boyd, Hugh, additional, McCaffery,, Brian, additional, Ganter, Barbara, additional, Golovnyuk, Viktor V., additional, Graham, Katherine, additional, Gratto-Trevor, Cheri L., additional, Morrison, R.I.G., additional, Nol, Erica, additional, Rösner, Hans-Ulrich, additional, Schamel, Douglas, additional, Schekkerman, Hans, additional, Soloviev, Mikhail Y., additional, Tomkovich, Pavel S., additional, Tracy, Diane M., additional, Tulp, Ingrid, additional, and Wennerberg, Liv, additional

Published
2007
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26. Mate guarding, copulation strategies and paternity in the sex-role reversed, socially polyandrous red-necked phalaropePhalaropus lobatus.

Author

Schamel, Douglas, Tracy, Diane M., Lank, David B., and Westneat, David F.

Subjects
PHALAROPES, ANIMAL sexual behavior, GENDER role, DNA fingerprinting of animals, POLYANDRY, ANIMAL behavior, BEHAVIOR
Abstract

In a recent review, Westneat and Stewart (2003) compiled evidence that extra-pair paternity results from a three-player interaction in which sexual conflict is a potent force. Sequentially polyandrous species of birds appear to fit this idea well. Earlier breeding males may attempt to use sperm storage by females to obtain paternity in their mate’s subsequent clutches. Later-breeding males may consequently attempt to avoid sperm competition by preferring to pair with previously unmated females. Females may bias events one way or the other. We examined the applicability of these hypotheses by studying mating behavior and paternity in red-necked phalaropes (Phalaropus lobatus), a sex-role reversed, socially polyandrous shorebird. Male red-necked phalaropes guarded mates more strongly than other shorebirds. Males increased within-pair copulation attempts during their mate’s fertile period, and maintained or further increased attempts towards the end of laying, suggesting an attempt to fertilize the female’s next clutch; these attempts were usually thwarted by the female. Paired males sought extra-pair copulations with females about to re-enter the breeding pool. Multilocus DNA fingerprinting showed that 6% of clutches (4/63) each contained one chick sired by a male other than the incubator, producing a population rate of these events of 1.7% (n=226 chicks). Male mates had full paternity in all first clutches (n=25) and 15 of 16 monogamous replacement clutches. In contrast, 3 of 6 clutches of second males contained extra-pair young likely fathered by the female’s previous mate. Previously mated female phalaropes may employ counter-strategies that prevent later mating males from discriminating against them. The stability of this polyandrous system, in which males provide all parental care, ultimately may depend on females providing males with eggs containing primarily genes of the incubating male, and not a previous mate. [ABSTRACT FROM AUTHOR]

Published
2004
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