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Biomedical subjects

R M Sly

Publications and source records attributed to R M Sly.

At least 19 recordsLinked to original sources
PubMed1994

Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs.

BACKGROUND: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality. OBJECTIVE: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs. METHODS: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased. CONCLUSIONS: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Aerosols↗
PubMed1994

Changing asthma mortality.

BACKGROUND: Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE: To identify recent trends in asthma mortality. METHODS: The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS: The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.

Adolescent↗
PubMed1992

Association of asthma mortality with medical specialist density.

In 1980, rates of death from asthma at 5 to 34 years of age varied from .105 per 100,000 in the East North Central States to .271 in the Mountain States for whites and from .637 in the South Atlantic States to 1.343 in the Middle Atlantic States for blacks. In order to investigate possible relationships between availability of physicians and care for patients with asthma, we determined regional densities of medical specialists in allergy and immunology, emergency medicine, family practice, internal medicine, and pediatrics as listed by the Directory of Medical Specialists. Multiple linear regression analyses indicated that asthma mortality was increased in areas that had more medical specialists, even after adjustment for size of the regional area. Inadequate numbers of medical specialists do not account for higher asthma mortality rates in some regions.

Adolescent↗
PubMed1991

You Can Control Asthma: evaluation of an asthma education program for hospitalized inner-city children.

A self-management education program was designed for staff nurses to offer children while they received medical care for asthma in the hospital. The program uses videotapes, written activity books and nurse discussion with the patient. Evaluation was conducted to assess program feasibility and impact. Pre- and post-tests of 40 children age 6-12 years revealed that the children had statistically significant increases in knowledge of and expected response to early warning signs of acute asthma, and in their sense of personal control (Health Locus of Control). Parents reported an increased use of asthma self-management techniques for acute episodes of asthma. Medical record review for a 15 month pre- and post-period indicated reductions in emergency room use. Inpatient hospital based education offers a critical opportunity to introduce asthma management skills, especially to children not reached by more traditional programs.

Asthma↗
PubMed1989

Lack of effect of geographic elevation on mortality from asthma.

One might expect prevalence of asthma to affect rates of mortality due to asthma. In France, asthma prevalence at 1350 m is less than at sea level. Calculation of asthma mortality rates for blacks and whites 5 to 34 years of age in 1980 for counties in the USA with populated places at elevations of at least 4000 feet disclosed no significant differences from rates at lower elevations. Nevertheless, asthma mortality rates were significantly higher for blacks than whites at both high and low elevations. The asthma death rates per 100,000 general population for elevations less than 4000 feet were .160 for whites and .896 for blacks. Asthma death rates for elevations of at least 4000 feet were .209 for whites and 1.150 for blacks.

Adolescent↗
PubMed1989

Regional distribution of deaths from asthma.

Data from the National Center for Health Statistics indicate rates of death from asthma at 5-34 years of age in the USA in 1980 were .166 per 100,000 general population for whites and .914 for blacks. Rates for blacks were higher in the Northeast (1.313) and North Central Region (1.179) than in the West (.905) and South (.659). The rate for whites was higher in the West (.263) than in the Northeast (.180), South (.149), or North Central Region (.108). During 1981-84 rates remained higher for blacks in the Northeast and North Central Regions than other regions and higher for whites in the West than elsewhere. Most deaths from asthma at 5-34 years of age from 1979-84 in the USA occurred at hospitals (70% of blacks, 77% of whites for the 40 states reporting this detail on death certificates). Rates of discharge from hospitals after admission for the treatment of asthma at 5-34 years of age have also been much higher for blacks than for whites from 1979-86. These rates have been highest in the Northeast and North Central Region for both blacks and whites. Accordingly, neither failure to reach a hospital nor lack of hospitalization can account for regional and racial differences in asthma mortality rates. Median household incomes have been lower for blacks than whites, and unemployment rates have been higher for blacks than whites. From 1980-84 unemployment rates for blacks were highest in the North Central Region. Economic factors may account in part for racial and regional differences in mortality from asthma.

Adolescent↗
PubMed1988

Mortality from asthma, 1979-1984.

Review of data from the National Center for Health Statistics to characterize deaths from asthma disclosed increases in rates of death from 1.2 per 100,000 in 1979 to 1.5 in 1983 and 1984. For black subjects, rates of death from asthma increased from 1.8 in 1979 to 2.5 in 1984; for white subjects, from 1.1 in 1979 to 1.4 in 1984. Age-adjusted rates of death from asthma increased from 1.9 in 1979 to 2.8 in 1983 and 2.6 in 1984 for black subjects, and from 0.8 to 1979 to 1.0 in 1984 for white subjects. Rates for other minority groups have been lower than rates for white subjects. A modest increase in prevalence of asthma among black subjects is insufficient to account for their much higher rate of death from asthma. Increases in rates of death have occurred in both metropolitan and nonmetropolitan areas in all regions of the country and in all but a few states. At least half the deaths from asthma have occurred at hospitals: this proportion did not change from 1979 to 1984. Increases in deaths from asthma have occurred in several other countries as well. Other reviews of deaths from asthma have implicated undertreatment and delays in treatment with bronchodilators and adrenal corticosteroids as factors contributing to death. High rates of death among black subjects suggest underutilization or lack of accessibility of health care. The large proportion of deaths that have occurred at hospitals suggests delays or other inadequacies of treatment at hospitals.

Adolescent↗
PubMed1988

Determination of theophylline concentrations by AccuLevel.

Determination of theophylline concentrations in 29 paired venous samples by AccuLevel and EMIT disclosed excellent correlation. Evaluation of precision of AccuLevel by 20 replicate analyses disclosed a coefficient of variation of 3.5%. AccuLevel is an accurate, precise, rapid method of determination of theophylline concentrations in whole blood.

Blood Chemical Analysis↗