Biomedical subjects

J P Mullooly

Publications and source records attributed to J P Mullooly.

At least 19 recordsLinked to original sources

PubMed1995

Linkage analysis of malignancy-associated sarcoidosis.

STUDY OBJECTIVE: To determine whether a reported association between sarcoidosis and malignancy can be supported. DESIGN: In this retrospective survey in a general community setting, we crossmatched the Kaiser Permanente Northwest Region (KPNW) Tumor Registry comprising 3 x 10(4) cases observed over 32 years against a sarcoidosis registry of 243 cases observed over 24 years. We used linkage criteria, eg, previously reported associated malignancies, late age onset of sarcoidosis, and close temporal proximity, to identify joint occurrences suggesting an etiologic relationship. We assessed the feasibility of detecting an association of sarcoidosis and Hodgkins disease (HD) by computing the required sample size based on incidence estimates of sarcoidosis and HD in this population. Medical records of 241 persons identified by the Tumor Registry as having HD were reviewed. SETTING: KPNW, a health maintenance organization. POPULATION: We studied 6.8 x 10(6) KPNW member-years from 1960 to 1992 at risk for malignancy; 5.6 x 10(6) member-years from 1971 to 1992 at risk for sarcoidosis. RESULTS: Six of the 11 (55%; 95% confidence interval, 26 to 84) correctly classified sarcoidosis and malignancy (S&M) cases met two or more linkage criteria. A seventh case, incorrectly classified as sarcoidosis, exhibited a necrotizing systemic granulomatous process, believed to represent a response to a fatal lymphoproliferative disorder. The mean age (40 years) of the 11 patients with S&M was 9 years higher than the mean age of the patients with sarcoidosis in the population from which they were drawn. The stage of sarcoidosis at diagnosis among the 11 S&M cases was exclusively 0 and I and thus divergent from expected values in this population. We found no instances of sarcoidosis accompanying HD. CONCLUSION: Linkage analysis provides evidence that S&M may be etiologically related in at least a quarter of cases in which both are present.

Adult↗

PubMed1995

Adolescent drug misuse treatment and use of medical care services.

Research on adults has documented that use of medical services decreases after initiation of treatment for alcohol problems, but little is known about this relationship among adolescents. We studied utilization and costs of care following participation in the Adolescent Chemical Health Program (ACHP) of Kaiser Permanente, Northwest Region, in 1986-88. Three groups of adolescents (and their parents) were identified: adolescents who were assessed and initiated treatment in ACHP (n = 561), adolescents who were assessed and recommended for treatment but did not return for treatment (n = 278), and adolescents with no known substance use problems (n = 381). Medical records were reviewed for 1 year pre- and 1.5 years postassessment. After adjusting for preassessment medical visits, severity of alcohol and drug use, gender, and age, analyses suggested that substance user treatment was not associated with reduced use of medical services or costs by either adolescents or parents.

Adolescent↗

PubMed1994

Influenza vaccination programs for elderly persons: cost-effectiveness in a health maintenance organization.

OBJECTIVE: To estimate the cost-effectiveness and net medical care costs of programs for annual influenza vaccinations for the elderly in a health maintenance organization (HMO). DESIGN: Population-based, case-control study. SETTING: The Northwest Region of Kaiser Permanente, a prepaid group practice HMO in Portland, Oregon. PARTICIPANTS: Kaiser Permanente members 65 years of age and older who had at least 1 month of HMO eligibility during any of nine influenza seasons in the 1980s. MEASUREMENTS: The HMO's costs for providing medical care and conducting vaccination programs were estimated using accounting data. RESULTS: 32% of high-risk elderly persons and 22% of non-high-risk elderly persons received influenza vaccinations. Aggregate vaccine effectiveness in preventing pneumonia and influenza hospitalizations was 30% (95% CI, 17% to 42%) for high-risk and 40% (CI, 1% to 64%) for non-high-risk elderly persons. The net savings to the HMO per vaccination was $6.11 for high-risk elderly persons and $1.10 for all elderly persons. The HMO incurred a net cost of $4.82 per vaccination for non-high-risk elderly persons. CONCLUSIONS: Influenza vaccination rates in this HMO were relatively low for high-risk elderly persons. The medical care costs saved by preventing pneumonia and influenza through vaccination of high-risk elderly persons provide a compelling rationale to increase compliance with recommendations for annual influenza vaccination. Indirect benefits, such as prevention of suffering, incapacity, and lost wages, are likely to compensate for the small net cost of vaccinating non-high-risk elderly persons.

Aged↗

PubMed1992

Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality.

Three social network measures were obtained from a randomly sampled cohort of 2603 HMO members in 1970-71. Mortality and first incidence of ischemic heart disease, cancer, stroke, and hypertension were assessed over the next 15 years. Outcome data were adjusted for age, sex, smoking, SES, and baseline health status. Persons with histories of a given morbidity at or prior to baseline were excluded from the analyses of that morbidity. Social network measures, particularly network scope (a measure of the number of different domains in which a person has social contacts), were powerful predictors of 15-year mortality hazard, but weak predictors of incident disease. Only network scope predicted IHD incidence, and none of the other morbidities was predicted by the social network measures. However, social network measures were strong predictors of both cause-specific and all-cause mortality among persons who had incident cases of IHD, cancer, and stroke. These data suggest that social networks may be more effective in supporting recovery after illness has occurred than in preventing the incidence of new disease.

Adult↗

PubMed1990

The effects of data entry error: an analysis of partial verification.

Modern data entry technology has greatly reduced entry errors by building quality control mechanisms such as cross-field and range edits directly into data entry programs. In many application areas the increased accuracy of modern data entry techniques has made 100% verification unnecessary to assure high standards of data quality. Verification of randomly selected forms combined with 100% verification of critical fields provides a cost efficient alternative to 100% verification of all fields. This paper analyzes the effects of data entry error on study findings and provides a basis for designing a partial verification scheme for achieving quality control goals in a cost efficient manner.

Data Collection↗

PubMed1990

Consistently high users of medical care among the elderly.

This study identified consistently high and low users of medical care services in a group of older HMO members continuously enrolled for six years. Consistently high users made up 26% of the sample, but accounted for more than 50% of total outpatient contacts and hospital admissions. Average ambulatory care costs were more than four times greater for the high users compared with the low users. Consistently high users were older than consistently low users, but did not differ significantly in other sociodemographic characteristics. Compared with the low users, the high users reported more total medical conditions and were more likely to indicate they had arthritis, high blood pressure, heart conditions, and other chronic problems. They perceived themselves to be in poorer health and reported higher levels of psychologic distress. The low users tended to be less satisfied, but the two user groups were not significantly different regarding use of services outside the HMO.

Aged↗

PubMed1990

Acyclovir use and its surveillance in a general population.

This study examined the extent and patterns of use of acyclovir in a health maintenance organization (HMO) population. The development and implementation of a system to survey acyclovir users for possible acute adverse effects is also described. Acyclovir users were members of Kaiser Permanente (KP), Northwest Region, who received one or more prescriptions for acyclovir from an automated outpatient prescription system over a two-year period (1986 and 1987). KP members with genital herpes were identified from the automated Outpatient Utilization System, which abstracts medical record data from a random sample of about two percent of KP members. Acyclovir users with hospital admissions were identified from the automated KP hospital discharge abstract system. During the two years, there were 2940 users who received a total of 6182 prescriptions for acyclovir; 47 percent used oral acyclovir and 56 percent of prescriptions were for the oral dosage form. Females received two-thirds of the prescriptions, and people 15 through 45 years of age received 80 percent of the prescriptions. The estimated incidence density of oral acyclovir usage was 2.3/1000 KP members. Most oral acyclovir prescriptions were for the treatment of genital herpes. More than 60 percent of the prescriptions appeared to be for first treatment, more than 30 percent for repeat treatment, and about 6 percent for continuing treatment. Hospitalizations of oral acyclovir users appeared to be unrelated to the use of the drug.

Acyclovir↗

PubMed1990

Smoking and consistently high use of medical care among older HMO members.

Smoking behavior of consistently high and low users of medical care services were compared in two groups of older health maintenance organization (HMO) members continuously enrolled for five years and a subgroup who were continuously enrolled for 10 years. Smokers and former smokers, combined, were more likely than never-smokers to be consistently high users of ambulatory services (52 percent vs 34 percent in the five-year group, and 45 percent vs 30 percent in the 10-year group).

Aged↗

PubMed1990

Morbidity and medical care utilization of old and very old persons.

This report compares the morbidity, health care and drug utilization, and health status of random samples of HMO-enrolled Medicare beneficiaries ages 65-79, and 80 and over. The population represented 3,683 person-years of Kaiser Permanente eligibility (59.2 percent female). Those 80 and over were 20 percent of the person-years (64.1 percent female). The effects of age and sex on morbidity and utilization were analyzed using log linear models that controlled for eligibility, and using two-way analyses of variance of rates. Few differences were found in the morbidity experiences and utilization rates of the two age groups. Indicators of self-reported health status did differ. The findings support the idea that noninstitutionalized very old persons are the healthy survivors of their cohort. Their health care needs may not be much different than younger old persons in terms of the types and amounts of health care services needed.

Age Factors↗

PubMed1989