Biomedical subjects
Publications and source records attributed to B Miller.
A patient with psoriasis and anterior uveitis is described. In her family the two entities of iridocyclitis and psoriasis occurred separately in two generations and appeared associated in the third generation. Tissue typing of the family revealed HL-A 27 antigen in two members and HL-A 17 in the other two members. The possible relevance of HL-A antigens to the two clinical entities is discussed.
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BACKGROUND: The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. METHODS: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. RESULTS: The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. CONCLUSIONS: Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars.
OBJECTIVE: To compare tuberculin screening of all kindergartners and high school entrants (screen-all strategy) vs screening limited to high-risk children (targeted screening). DESIGN: Decision, cost-effectiveness, and cost-benefit analyses. SETTING AND SUBJECTS: Students in a large urban and rural county. DEFINITIONS: High risk of tuberculosis infection was defined as birth in a county with a high prevalence of tuberculosis. Low risk was defined as birth in the United States. OUTCOME MEASURES: Tuberculosis cases prevented for 10, 000 children screened. Net costs, net cost per case prevented, benefit-cost ratio, and incremental cost-effectiveness. RESULTS: The screen-all strategy would prevent 14.9 cases per 10,000 children screened; targeted screening would prevent 84.9 cases per 10,000 children screened. The screen-all strategy is more costly than no screening; the benefit-cost ratio is 0.58. Targeted screening would result in a net savings; the benefit-cost ratio is 1.2. Screening all children is cost saving only if the reactor rate is 20% or greater. The cost per additional case prevented for screening all children compared with targeted screening (+34 666) is more than twice as high as treatment and contact tracing for a case of tuberculosis (+16 392). CONCLUSIONS: Targeted screening of schoolchildren is much less costly than mass screening and is more efficient in prevention of tuberculosis.
Little is known of the extent to which helper networks of frail older persons change over time and what factors are associated with change. Few national estimates of the scope of change exist to aid policy planners. This study provides national estimates of changes in the size of the informal helping network of frail elderly by sociodemographic and functional status subgroups of this segment of the population. The data are drawn from the 1982-84 National Long Term Care Survey, which included longitudinal followup of 4,530 respondents living in the community at both times. Bivariate patterns of change over 2 years in the number of informal helpers were analyzed. Sociodemographic factors (sex, age group, and race) of the frail elderly may be more important influences on change in the number of helpers than functional status expressed in terms of their limitations in activities of daily living.
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This review was undertaken in recognition of the mounting public health and social problems associated with adolescent sexual behavior and the importance of basing school-affiliated programs designed to reduce sexual risk-taking behavior on sound research. The authors were commissioned by the Division of Adolescent and School Health within the Centers for Disease Control and Prevention, Public Health Service, to review carefully the research on these programs and to assess their impact on behavior. The authors identified 23 studies of school-based programs that were published in professional journals and measured program impact on behavior. They then summarized the results of those studies, identifying the distinguishing characteristics of effective programs, and citing important research questions to be addressed in the future. Not all sex and AIDS education programs had significant effects on adolescent sexual risk-taking behavior, but specific programs did delay the initiation of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, or increase the use of condoms or other contraceptives. These effective programs have the potential to reduce exposure to unintended pregnancy and sexually transmitted disease, including HIV infection. These programs should be replicated widely in U.S. schools. Additional research is needed to improve the effectiveness of programs and to clarify the most important characteristics of effective programs.
Radiofrequency catheter-mediated ablation is a recently developed technique of achieving cure of certain rhythm disorders, notably supraventricular tachycardia. In less than a decade, it has evolved from a theoretic concept to first line therapy for many patients, including those in the pediatric age group. The most common types of arrhythmias amenable to catheter ablation include supraventricular tachycardia due either to an accessory pathway or A-V nodal reentry and atrial fibrillation with a rapid ventricular response refractory to medical therapy. Before the development of the technique, the only therapeutic options included either lifelong antiarrhythmic drugs or open heart surgery. The initial experiences with catheter ablative techniques used direct current shocks of up to 400 J, delivered to an intracardiac catheter from a standard defibrillator. This energy source has largely been replaced by radiofrequency current because of the substantially lower morbidity and greater efficacy. The treatment of patients with these tachyarrhythmias is evolving from a palliative approach to a curative one. With the current worldwide experience, complications are relatively rare and do not appear to differ from those associated with routine electrophysiologic testing or cardiac catheterization. The success rate is high, usually exceeding a 90% efficacy, but is dependent on the skill and experience of the operator. The technique, arrhythmias amenable to treatment, and the nursing implications before, during, and after the procedure are discussed in this article.
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