The validity of Medicaid diagnoses of hip fracture.
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Aged↗
Biomedical subjects
D K Wysowski
Publications and source records attributed to D K Wysowski.
Creutzfeldt-Jakob disease in pituitary growth hormone recipients in the United States.
To assess the magnitude of Creutzfeldt-Jakob disease (CJD) occurrence among recipients of pituitary-derived human growth hormone (HGH), we conducted an epidemiologic follow-up of 6284 recipients of HGH distributed through the National Hormone and Pituitary Program. Seven neuropathologically confirmed cases of CJD have occurred in this population to date: six patients with clinical CJD presented with ataxia and imbalance, rather than with altered mentation, which is the most common initial manifestation in sporadic CJD, and one patient died in the preclinical incubation state of the disease. All seven cases occurred among the nearly 700 HGH recipients who started therapy before 1970. Since only 10% of the cohort has been followed up for the 15-year average incubation interval from midpoint of HGH treatment to onset of symptoms, the great majority of potentially exposed patients have not yet attained the requisite incubation period for expression of CJD. The median duration of HGH therapy of 100 months in the CJD cases was significantly longer than 41 months for all patients starting treatment before 1970; thus, the duration of pituitary HGH therapy is a major risk factor for CJD.
Adult↗
Outpatient use of prescription sedative-hypnotic drugs in the United States, 1970 through 1989.
Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study outpatient use of prescription sedative-hypnotic drugs in the United States from 1970 through 1989. Retail pharmacies dispensed an estimated 62.5 million prescriptions for sedative-hypnotic drugs in 1970. This number declined by half to 31.6 million in 1978. This decline has continued, so that in 1989 there were 20.8 million dispensed prescriptions. From 1970 to 1989, barbiturate and nonbarbiturate-nonbenzodiazepine prescriptions decreased 24-fold and 18-fold, respectively, and benzodiazepine prescriptions increased 26-fold. By 1989, the ultrashort-acting benzodiazepine drug triazolam was the leading sedative hypnotic, with about 40% of the total sedative-hypnotic market in the 6 years since its marketing. Data also indicate shifts from longer to shorter acting, and from higher to lower dose, benzodiazepine prescriptions, increasing use of antidepressant drugs for insomnia, female predominance of use, and increasing use with age.
Ambulatory Care↗
Adverse behavioral reactions attributed to triazolam in the Food and Drug Administration's Spontaneous Reporting System.
Reports of adverse behavioral reactions to triazolam, a triazolobenzodiazepine ultra-short-acting hypnotic, were examined in the postmarketing surveillance Spontaneous Reporting System of the Food and Drug Administration. Reports for triazolam of confusion, amnesia, bizarre behavior, agitation, and hallucinations were compared with reports of these reactions for temazepam, another short-acting hypnotic. Analysis of individual case reports from marketing through 1985 for triazolam vs temazepam showed 133 vs two for confusion, 109 vs three for amnesia, 59 vs two for bizarre behavior, 58 vs four for agitation, and 40 vs one for hallucinations. Considering extent of use, reporting rates for triazolam were 22 to 99 times those for temazepam, depending on the reaction. Reactions to triazolam tended to occur at higher doses and in older patients. This and an updated analysis of aggregate reports for the first 7 years of marketing of each drug with reporting rates and adjustment for various factors suggest a higher occurrence of these reactions with triazolam, but selection factors cannot be completely ruled out. When treating insomnia, physicians should emphasize sleep hygiene practices as alternatives to drug therapy; if drug therapy is required, they should prescribe hypnotics at the lowest recommended doses for the shortest clinically necessary durations and discontinue medication use should any adverse reactions occur.
Adolescent↗
Myopathy and rhabdomyolysis associated with lovastatin-gemfibrozil combination therapy.
The Food and Drug Administration documents the receipt of 12 case reports of severe myopathy or rhabdomyolysis associated with concomitant use of lovastatin and gemfibrozil, including 10 voluntary postmarketing, and 2 required, reports. All patients had serum creatine kinase levels of more than 10,000 U/L, 4 tested showed myoglobinuria, and 5 had acute renal failure. The patients' symptoms resolved when both drugs were discontinued. For the first year of marketing of lovastatin, spontaneous reports of myopathy with documentation of creatine kinase level were reviewed for the use of lovastatin, gemfibrozil, and combination therapy. The median creatine kinase level in reports involving concomitant lovastatin and gemfibrozil use was 15,250 U/L, 20 times that in reports with gemfibrozil use alone and 30 times that in reports with lovastatin use alone. Because of the potential for severe myopathy and life-threatening rhabdomyolysis, and given alternative drug combinations for treating hyperlipoproteinemia, the use of lovastatin in combination with gemfibrozil is to be discouraged.
Acute Kidney Injury↗
Prescribed use of cholesterol-lowering drugs in the United States, 1978 through 1988.
Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in outpatient use of cholesterol-lowering drugs in the United States from 1978 through 1988. Retail pharmacies dispensed an estimated 4.4 million prescriptions for cholesterol-lowering drugs in 1978. This declined to 2.6 million in 1983 and increased dramatically to nearly 13 million in 1988. This fivefold increase between 1983 and 1988 was accounted for primarily by the introduction and use of two new drugs, gemfibrozil and lovastatin, and, to a lesser extent, by the increasing use of some older drugs. In 1988, after 1 full year of marketing, lovastatin was the leading cholesterol-lowering drug, followed closely by gemfibrozil; both drugs are currently considered second-line agents. Clofibrate and dextrothyroxine, drugs that ranked first and second in 1978, declined to ranks of sixth and eighth out of eight in 1988. Cholestyramine, gemfibrozil, and lovastatin accounted for about 75% of all lipid-lowering prescriptions in 1988. From 1978 through 1988, an average 54% of individuals using cholesterol-lowering drugs were 60 years of age or older. The 13 million prescriptions for cholesterol-lowering drugs in 1988 represent a maximum estimate of 13 million treated individuals. This number compares with the 60 million Americans with high cholesterol levels who are candidates for dietary advice, and, if cholesterol levels do not improve, for combined diet and drug intervention.
Anticholesteremic Agents↗
Deaths due to accidents and violence in two recent trials of cholesterol-lowering drugs.
The Helsinki Heart Study and the Lipid Research Clinics Coronary Primary Prevention Trial both reported higher rates of deaths due to homicides, suicides, and accidents in the groups receiving cholesterol-lowering agents compared with the groups receiving placebos. We examined these deaths in the active treatment arms of the two trials to determine if there were some readily explainable causes or if the cholesterol-lowering agents might be a factor. Our examination showed that the two homicides were victims, not offenders, and one had stopped treatment because of myocardial infarction 1 year before his death. Five of the eight suicides had dropped out of the trials and had not taken the cholesterol-lowering drugs for periods of months to years prior to committing suicide. Of the 10 deaths due to accidents, two were dropouts from the trials, three others had high blood alcohol concentrations detectable at autopsy, and another three reported a history of psychiatric symptoms and/or treatment prior to entry. When dropouts and known risk factors for these deaths such as alcohol intoxication and psychiatric histories are considered, little evidence remains to support the hypothesis that cholesterol-lowering drugs are causally associated with deaths due to homicides, suicides, and accidents in these trials.
Accidents↗
Antipsychotic drug use in the United States, 1976-1985.
Data from the National Prescription Audit and the National Disease and Therapeutic Index were used to assess trends in outpatient prescriptions for antipsychotic drugs in the United States from 1976 to 1985. Retail pharmacies dispensed 21 million prescriptions for antipsychotic drugs in 1976 and 19 million in 1985. The three leading antipsychotic drugs-thioridazine, haloperidol, and chlorpromazine-constituted 66% to 69% of antipsychotic prescriptions and, along with trifluoperazine, thiothixene, and fluphenazine, accounted for 90% to 91% of all antipsychotic prescriptions throughout the period studied. Thioridazine was the leading medication, with a consistent third of the market share, while the market share for chlorpromazine decreased from 1976 to 1985 and that for haloperidol increased for the same years. Data also indicate that haloperidol is the antipsychotic drug used most frequently in office-based, private medical practice for patients 60 years of age and older, a declining proportion of women are treated with antipsychotic medications, and use of antipsychotic drugs as monotherapy for the primary diagnosis is increasing. We also obtained data on diagnoses associated with antipsychotic drug use.
Age Factors↗
Sex hormone levels in serum in relation to the development of breast cancer.
In 1974, approximately 13,000 female residents of Washington County, Maryland, donated 15 ml of blood as part of a project to determine if certain serologic factors were related to the development of site-specific cancer. Sera were stored at -73 C. The present study reports the associations of serum levels of estrone, estradiol, estriol, androstenedione, progesterone, and testosterone with breast cancer among 17 premenopausal cases diagnosed 8-132 months after blood was drawn, and 39 postmenopausal cases diagnosed 6-72 months after blood was drawn. Each case was matched to four controls selected from the other serum bank donors. Matching factors were age, race, and time since last menstrual period. Cases and controls who were taking estrogen-containing preparations were excluded from this analysis. Sera were analyzed without knowledge of case-control status. Differences in levels of serum hormones between cases and controls were slight and not statistically significant.
Androgens↗
A study of a possible association between breast cancer and gallbladder disease.
Because gallstones and breast cancer were reported to have several of the same risk factors, a study was conducted in Washington County, Maryland to determine if women with breast cancer have an increased risk of prior gallbladder disease. Living white female breast cancer cases (n = 133), who were diagnosed from 1973 to 1983, were identified from the county's cancer registry and interviewed along with an equal number of sex-, race-, and age-matched controls about a history of gallbladder disease and other risk factors. Medical records were used to verify a history of gallbladder disease in interviewed cases and controls and to search for a diagnosis of gallbladder disease in 52 white female breast cancer cases who were diagnosed and died between 1974 and 1983, and 52 matched controls. No difference was found in gallbladder disease frequency among living or deceased cases and their matched controls. The results confirm the known association of several risk factors with breast cancer and with gallbladder disease, but most of the risk factors hypothesized to be the same for the two diseases were not the same. However, an unexpectedly strong association was found between gallbladder disease and history of myocardial infarction; this result deserves further study.
Aged↗
Rh hemolytic disease. Epidemiologic surveillance in the United States, 1968 to 1975.
Nationwide surveillance of Rh hemolytic disease of the newborn showed that associated infant mortality decreased from 941 deaths in 1968 to 269 deaths in 1975, or from 2.7 to 0.9 per 10,000 live births. The incidence of Rh hemolytic disease declined from 45 per 10,000 total births in 1970 to 21 per 10,000 in 1975. In 1970, an estimated 16,000 infants were affected, whereas in 1975, the number was 6,000. Several state-based Rh disease surveillance programs reported declining mortality and incidence and increasing use of Rh immune globulin. Rh immune globulin was administered to an estimated 80% of eligible Rh-negative women in 1974, eighty-one percent in 1975, and 82% in 1976. More concerted efforts are needed to determine the frequency of maternal sensitization and to identify and correct gaps in postpartum and postabortion use of Rh immune globulin.
Erythroblastosis, Fetal↗
Cadmium exposure in a community near a smelter.
In June, 1976, the authors conducted a cross-sectional survey of a community near a cadmium smelter in Denver, Colorado, to evaluate human cadmium absorption and its possible health effects. In 1975 the mean annual airborne cadmium concentration in an area about 1 km from the smelter was 0.023 microgram/m3; the mean concentration in a comparison area 13 km distant was 0.003 microgram/m3. Whole blood and urine specimens were collected from 250 individuals residing within 2 km of the smelter and from a control population of 105 residents in the comparison area. There were no significant differences (p greater than .05) in whole blood or urine cadmium concentrations, as determined by flameless atomic absorption spectrophotometry, between persons in the two areas. The median blood and urine cadmium concentrations of residents within 1 km of the smelter were 0.05 and 0.09 microgram/100 ml, compared with 0.07 and 0.08 microgram/100 ml for control area residents. However, the difference between blood cadmium levels for smokers and nonsmokers was statistically significant (p less than .01). The median blood cadmium concentration for smokers was 0.21 microgram/100 ml compared with 0.04 microgram/100 ml for nonsmokers. Other laboratory determinations of blood and urine showed no evidence of a cadmium effect on hematopoietic or renal function.
Absorption↗
Epidemic neonatal hyperbilirubinemia and use of a phenolic disinfectant detergent.
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Detergents↗
Mortality attributed to misuse of psychoactive drugs, 1979-88.
To assess mortality attributed to misuse of psychoactive drugs in the United States from 1979 through 1988, the authors obtained from death certificates the annual number of, and age-, sex-, and race-specific data for, deaths in which psychoactive drugs were coded as the underlying or contributing cause. Deaths with psychoactive drugs specified as underlying cause (drug-induced) increased from 6,500 (2.9 per 100,000) in 1979 to more than 10,000 (3.8 per 100,000) in 1988. Deaths with psychoactive drugs specified as either underlying or contributing cause (drug-related) increased from 7,200 (3.2 per 100,000) in 1979 to more than 14,400 (5.5 per 100,000) in 1988. The drugs that primarily accounted for this increase were illicit, in particular, the opiates (heroin) and cocaine, with most of the remainder accounted for by misuse of various legal drugs. The largest increases between 1979 and 1988 occurred among black men ages 35-44 whose drug-induced death rates rose from 8 to 36 per 100,000 and whose drug-related death rates from 10 to 82 per 100,000. These data identify a high-risk group for targeting efforts to prevent deaths due to misuse of psychoactive drugs.
Adult↗