Adverse events associated with ingestion of gamma-butyrolactone--Minnesota, New Mexico, and Texas, 1998-1999.
Products containing gamma-butyrolactone (GBL) are marketed for many claimed purposes, including to induce sleep, release growth hormone, enhance sexual activity and athletic performance, relieve depression, and prolong life. GBL is converted by the body into gamma-hydroxybutyrate (GHB), a drug banned outside of clinical trials approved by the Food and Drug Administration (FDA). Recognized manifestations of GHB toxicity include bradycardia, hypothermia, central nervous system depression, and uncontrolled movements. This report describes seven cases of GBL toxicity involving the product "Revivarant," which is labeled as containing 1.82 g of GBL per fluid ounce, reported from two hospital emergency departments (EDs) in Minnesota during October-December 1998 and summarizes an additional 34 cases of GBL toxicity reported to poison centers in New Mexico and Texas during October 1998-January 1999. (+info)
Statistical sensitivity for detection of spatial and temporal patterns in rodent population densities.
A long-term monitoring program begun 1 year after the epidemic of hantavirus pulmonary syndrome in the U.S. Southwest tracked rodent density changes through time and among sites and related these changes to hantavirus infection rates in various small-mammal reservoir species and human disease outbreaks. We assessed the statistical sensitivity of the program's field design and tested for potential biases in population estimates due to unintended deaths of rodents. Analyzing data from two sites in New Mexico from 1994 to 1998, we found that for many species of Peromyscus, Reithrodontomys, Neotoma, Dipodomys, and Perognathus, the monitoring program detected species-specific spatial and temporal differences in rodent densities; trap-related deaths did not significantly affect long-term population estimates. The program also detected a short-term increase in rodent densities in the winter of 1997-98, demonstrating its usefulness in identifying conditions conducive to increased risk for human disease. (+info)
A social systems model of hospital utilization.
A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services. (+info)
Using feedback letters to influence the use of antiulcer agents in a Medicaid program.
OBJECTIVE: To determine the impact of printed patient-specific feedback regarding potential misprescribing of antiulcer agents (AUAs). Measures of impact included improvements in patients' dispensing profiles, assessed according to predetermined criteria, and decreases in cost and quantity of AUAs dispensed. DESIGN: Controlled study. After evaluation for compliance with predetermined criteria, prescribers identified as having one or two patient profiles with potential errors were assigned alternatively to control or experimental groups. An intervention was mailed to the experimental group. SETTING: Outpatient setting in the New Mexico Medicaid population. PARTICIPANTS: Patients and prescribers identified as having potential misprescribing of AUAs. INTERVENTION: The intervention consisted of a cover letter describing the purpose of the drug utilization review program, an educational fact sheet regarding prescribing AUAs, patient profiles with potential misprescribing, and physician response forms. MEASUREMENTS AND MAIN RESULTS: There were greater improvements in dispensing to patients in the intervention group (chi2, p <.001). Significant odds ratios for the intervention group were 2.29 for AUAs discontinued, 1.98 for all improvements combined, 13.13 for improvement in listing of proper diagnosis for AUAs, and 2.84 for appropriate indication when prescribing the higher acute daily dosage. Using data from 3 months before and after the intervention, we found greater decreases in mean monthly costs (p =.044) and mean monthly quantity of AUAs dispensed (p =.049) in the intervention group. CONCLUSIONS: This intervention significantly decreased AUA dispensing to patients whose prescribers were mailed the patient-specific feedback intervention. (+info)
PCR detection of Yersinia pestis in fleas: comparison with mouse inoculation.
The "gold standard" for identifying Yersinia pestis-infected fleas has been inoculation of mice with pooled flea material. Inoculated mice are monitored for 21 days, and those that die are further analyzed for Y. pestis infection by fluorescent-antibody assay and/or culture. PCR may provide a more rapid and sensitive alternative for identifying Y. pestis in fleas. To compare these assays, samples were prepared from 381 field-collected fleas. Each flea was analyzed individually by both PCR and mouse inoculation. Sixty of the 381 flea samples were positive for Y. pestis by PCR; 48 of these PCR-positive samples caused death in mice (80.0% agreement). None of the 321 PCR-negative samples caused death. Among the 12 mice that survived inoculation with PCR-positive samples, 10 were later demonstrated by serology or culture to have been infected with Y. pestis. This suggests that death of inoculated mice is less reliable than PCR as an indicator of the presence of Y. pestis in flea samples. Mouse inoculation assays produce results that are comparable to PCR only when surviving as well as dead mice are analyzed for infection. The rapidity and sensitivity (10 to 100 CFU of Y. pestis) of PCR suggest that it could serve as a useful alternative to mouse inoculation for routine plague surveillance and outbreak investigations. (+info)
Relationship of compliance with hormone replacement therapy to short-term healthcare utilization in a managed care population.
OBJECTIVE: To identify healthcare utilization characteristics that distinguish female members of a managed care organization (MCO) who remained compliant with hormone replacement therapy (HRT) from those who had poor compliance during an 18-month period and to estimate the cost of HRT to an MCO. STUDY DESIGN: A retrospective cohort design in a population of continuously enrolled female members of an MCO. METHODS: All female members of the Lovelace Health Plan 40 years of age or older who began HRT between January 1, 1993, and June 30, 1994 (n = 1158). Compliance was determined by calculating an estrogen medication possession ratio based on pharmacy fills over 18 months. "High compliers" (n = 427) were defined as those purchasing at least 80% of their recommended days supply, and "low compliers" (n = 269) as those purchasing less than 20%. Healthcare encounters and costs of high and low compliers were compared. RESULTS: High compliers were younger (P < 0.01), more likely to be non-Hispanic white than Hispanic (P < 0.0001), and had higher costs for obstetric/gynecologic care (P < 0.0001) and non-HRT prescriptions (P < 0.0001). Low compliers had higher point estimates of costs and encounters for all other categories of care, but differences were statistically significant only for emergency department visits (P < 0.001). CONCLUSIONS: The added cost of HRT did not result in higher total healthcare utilization and costs, as women who complied well with therapy had decreased utilization and costs in other categories of care. Differences in subcategories of healthcare utilization suggest that level of HRT compliance reflects differences in how women access healthcare. (+info)
Type 2 diabetes mellitus in Navajo adolescents.
Diabetes mellitus afflicts over one-fifth of the Navajo population aged over 20 years, but the prevalence of diabetes in Navajo adolescents is unclear. We conducted voluntary testing for diabetes mellitus at two high schools on the Navajo reservation to clarify the prevalence as well as to assess the utility of a high-school based screening program. Body mass index measurements (BMI), oral glucose tolerance tests, and hemoglobin A1C measurements were obtained in consenting high school students. Of the 276 students that participated, 234 were Navajo. Only one Navajo student (0.4%) had diabetes mellitus, although eight (3%) had impaired glucose tolerance or impaired fasting glucose. Participant BMI did not differ significantly from nonparticipant BMI. No correlation existed between BMI or impaired glucose handling, and significant overlap existed between the hemoglobin A1C values of students with impaired glucose handling and students without impaired glucose handling. Increased participation in screening programs may reveal higher disease prevalence, but high school-based screening is not justified by this study, despite the high rates of diabetes mellitus in the Navajo population. (+info)
Management of diabetes mellitus in the Lovelace Health Systems' EPISODES OF CARE program.
OBJECTIVE: To design and implement the Lovelace Diabetes EPISODES OF CARE program in a managed care setting. This program is intended to address the complex needs of patients with type 2 diabetes mellitus by using specific physician-provider and patient interventions. DESIGN: Observational study. SETTING: Lovelace Health Systems, the second-largest and most fully integrated health care delivery system in New Mexico. The main facility is located in Albuquerque. PARTICIPANTS: Lovelace Health Plan members with type 2 diabetes. INTERVENTIONS: Physician-provider interventions included practice guidelines medical profile screens, and provider support reports. Patients interventions included diabetes education; improved access to care, with focused diabetes clinic visits and "Diabetes Days"; and reminder systems. MAIN OUTCOME MEASURES: Glycohemoglobin values, dilated eye examination rates, and access to education. RESULTS: Significant lowering of glycohemoglobin values, dilated eye examination rates exceeding benchmark measures, and increases in educational access rates have occurred since the Lovelace Diabetes EPISODES OF CARE program was implemented. CONCLUSIONS: An integrated health care delivery system with a comprehensive, diabetes disease management program can substantially improve outcomes. (+info)