Birth and fertility rates for states: United States, 1990.
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Adolescent↗
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Attitudes toward smoking policies in eight states--United States, 1993.
Legislation regulating smoking has at least two functions: to protect nonsmokers from the adverse health effects of environmental tobacco smoke and to prevent young persons from smoking (1). To characterize public attitudes toward such legislation, the National Cancer Institute (NCI) and the American Cancer Society used the Behavioral Risk Factor Surveillance System (BRFSS) to survey persons in eight states during July-August 1993 as part of the American Stop Smoking Intervention Study for Cancer Prevention (2). This report summarizes the survey findings.
Adult↗
Surveillance for smoking-attributable mortality and years of potential life lost, by state--United States, 1990.
PROBLEM/CONDITION: Mortality and years of potential life lost attributable to cigarette smoking. REPORTING PERIOD COVERED: 1990. DESCRIPTION OF SYSTEM: Mortality and years of potential life lost were estimated for each state by using the Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) software. These estimates were based on attributable risk formulas for smoking-related causes of death. Estimates of smoking prevalence were obtained from the Behavioral Risk Factor Surveillance System and the U.S. Bureau of the Census, and mortality data were obtained from CDC. RESULTS: The median estimate for the number of smoking-attributable deaths among states was 5,619 (range: 402 [Alaska] to 42,574 [California]). Within each state, the number of smoking-attributable deaths among males was approximately twice as high as among females. Utah had the lowest mortality rate (218.0 per 100,000 population) and the lowest percentage of all deaths attributable to cigarette smoking (13.4%). Nevada had the highest mortality rate (478.1 per 100,000 population) and the highest percentage of deaths from smoking (24.0%). The number of years of potential life lost ranged from 6,720 (Alaska) to 498,297 (California). INTERPRETATION: The number of deaths attributable to cigarette smoking in 1990 remained high. Efforts are needed to control tobacco use in all states. ACTIONS TAKEN: SAMMEC data are used in many states to assist policymakers in strengthening tobacco control efforts.
Adult↗
The United States--United Kingdom project on diagnosis of the mental disorders.
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Bipolar Disorder↗
The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: results of national population-based samples.
Researchers determining the prevalence of homosexuality in nationally representative samples have focused upon determining the prevalence of homosexual behavior, ignoring those individuals whose sexual attraction to the same sex had not resulted in sexual behavior. We examine the use of sexual attraction as well as sexual behavior to estimate the prevalence of homosexuality in the United States, the United Kingdom, and France using the Project HOPE International Survey of AIDS-Risk Behaviors. We find that 8.7, 7.9, and 8.5% of males and 11.1, 8.6, and 11.7% of females in the United States, the United Kingdom, and France, respectively, report some homosexual attraction but no homosexual behavior since age 15. Further, considering homosexual behavior and homosexual attraction as different but overlapping dimensions of homosexuality, we find 20.8, 16.3, and 18.5% of males, and 17.8, 18.6, and 18.5% of females in the United States, the United Kingdom, and France report either homosexual behavior or homosexual attraction since age 15. Examination of homosexual behavior separately finds that 6.2, 4.5, and 10.7% of males and 3.6, 2.1, and 3.3% of females in the United States, the United Kingdom, and France, respectively, report having had sexual contact with someone of the same sex in the previous 5 years. Our findings highlight the importance of using more than just homosexual behavior to examine the prevalence of homosexuality.
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Health behavior changes in the United States, the United Kingdom, and France.
OBJECTIVE: To determine changes in health behaviors in the United States, the United Kingdom, and France over the previous two years. DESIGN: Cross-sectional survey of nationally representative samples. SETTING/PARTICIPANTS: Surveys conducted between June and November 1988 on persons aged 16 to 50 years in the United States (n = 1,940), the United Kingdom (n = 1,833), and France (n = 2,294) regarding health behaviors, attitudes toward health, and changes in health practices during the previous two years. MEASUREMENTS AND MAIN RESULTS: Using Bonferroni's adjustment for multiple comparisons, residents of the United States had significantly (p < 0.05) higher Quetelet indices and reported higher egg and red meat consumption, but had lower alcohol consumption, than did residents of either the United Kingdom or France. Americans were also significantly more likely to report attitudes accepting personal responsibility for their health and much more often endorsed the role of health behaviors (e.g., exercise) for decreasing the risk of cardiovascular disease. Changes in health behavior over two years were consistently more likely in the United States for weight loss, decreased alcohol consumption, decreased red meat and egg consumption, and increased exercise. Americans were also much more likely to have changed at least three health behaviors in the previous two years (United States 41.5%, United Kingdom 25.5%, France 13.8%, p < 0.002). A multivariate linear model confirmed the high likelihood of health behavior changes in the United States compared with the United Kingdom or France. CONCLUSIONS: The findings confirm that changes in health behaviors are continuing to occur in the United States, but remain comparatively modest in the United Kingdom and France. These international variations in health behaviors parallel differential declines in mortality rates in ischemic heart disease.
Adolescent↗
Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma: a six-month masked, multicenter trial in the United States. The United States Latanoprost Study Group.
PURPOSE: Latanoprost, a new prostaglandin analogue, was compared with timolol for ocular hypotensive efficacy and side effects. METHODS: In a multicenter, randomized, double-masked, parallel group study, 268 patients with ocular hypertension or early primary open-angle glaucoma received either 0.005% latanoprost once daily or 0.5% timolol twice daily for 6 months. All except ten patients from each group successfully completed the study. RESULTS: Intraocular pressure (IOP) was significantly (P<0.001) reduced and maintained by both medications without evidence of a long-term drift over 6 months. Comparing 6-month with baseline diurnal IOP values, the IOP reduction (mean +/- standard deviation) achieved with latanoprost (-6.7 +/- 3.4 mmHg) was significantly (P<0.001) greater than that produced with timolol (4.9 +/- 2.9 mmHg). Four patients treated with timolol and none treated with latanoprost were withdrawn from the study because of inadequate IOP control. Pulse rate was significantly reduced with timolol, but not with latanoprost. Slightly more conjunctival hyperemia appeared in latanoprost-treated compared with timolol-treated eyes. Fewer subjective side effects occurred in latanoprost-treated eyes. Both eyes of a patient with a characteristic, concentric iris heterochromia (darker centrally) at baseline showed a definite, photographically documented increase in pigmentation during latanoprost treatment, making the irides uniformly darker. Three additional patients treated with latanoprost were suspects for this color change. Otherwise, no significant difference between treatment groups occurred visual acuity, slit-lamp examination, blood pressure, and laboratory values. CONCLUSION: Latanoprost has the potential for becoming a new first-line treatment for glaucoma.
Adrenergic beta-Antagonists↗
Validation of venous leg ulcer guidelines in the United States and United Kingdom.
BACKGROUND: Venous leg ulcers account for 85% of all lower-extremity ulcers, with treatment costs of 3 billion dollars and loss of 2 million workdays per year. The purpose of this study was to validate the clinical efficacy and cost effectiveness of multidisciplinary guidelines for the diagnosis and treatment of venous leg ulcers. METHODS: Eighty (40 retrospective, 40 prospective) patients from the United States and United Kingdom were enrolled. RESULTS: United States patients were 6.5 times and United Kingdom 2 times more likely to heal if a guideline was followed (P <0.001). A significant decrease was noted in healing time for both the United States and United Kingdom (P <0.01), and the median cost decreased significantly when the guideline was followed (P <0.01). CONCLUSIONS: Implementation of a guideline for diagnosis and treatment of venous leg ulcers resulted in improvement in diagnosis, decrease in healing time, and an increase in healing rates resulting in lower costs.
Aged↗
The effect of dosing frequency on compliance and persistence with bisphosphonate therapy in postmenopausal women: a comparison of studies in the United States, the United Kingdom, and France.
OBJECTIVES: The aim of this study was to determine the effect of dose frequency on compliance and persistence with bisphosphonate therapy in postmenopausal women and to compare findings from 3 different health care systems. METHODS: Three independently performed retrospective cohort analyses were performed using observational data sources. In the United States, bisphosphonate-naive postmenopausal women were identified from a database providing information on health plan prescription drug claims; in the United Kingdom and France, bisphosphonate-naive postmenopausal women were identified from a database of medical records supplied by general practice physicians. The women were grouped into 2 cohorts: those who were initiated on a weekly regimen of alendronate 70 mg or risedronate 35 mg and those initiated on a daily regimen of alendronate 5 or 10 mg or risedronate 5 mg. Compliance was measured in terms of the medication possession ratio (MPR), which was defined as the proportion of days in the 12-month follow-up period for which patients were covered by prescriptions for bisphosphonates. Persistence was measured as the number of days from the date of the index prescription to the last day of prescription coverage within the followup period. Women were classified as nonpersistent if the gap between prescriptions was > 30 days. RESULTS: The study included 2741 postmenopausal women with osteoporosis from the United States, 7567 from the United Kingdom, and 5332 from France. The mean (SD) age of the women was 73.0, 71.7, and 69.7 years in the 3 countries, respectively. The overall MPR was 61% in the United States, 74% in the United Kingdom, and 58% in France. In all 3 countries, women on a weekly regimen had a significantly greater MPR than women on a daily regimen (69% vs 58%, respectively, in the United States; 76% vs 64% in the United Kingdom; and 59% vs 53% in France; all, P < 0.001). Women on a weekly regimen of bisphosphonates persisted with treatment significantly longer than women on a daily regimen (227 vs 185 days, respectively, in the United States; 249 vs 208 in the United Kingdom; and 179 vs 155 in France; all, P < 0.001). A significantly greater proportion of the women on a weekly regimen persisted with treatment for 12 months compared with those on a daily regimen (44% vs 32%, respectively, in the United States; 52% vs 40% in the United Kingdom; and 51% vs 44% in France; all, P < 0.001). CONCLUSIONS: In all 3 countries, postmenopausal women prescribed a weekly regimen of bisphosphonates had significantly greater rates of compliance than women prescribed a daily regimen, and they persisted longer with treatment. However, compliance and persistence rates were suboptimal for both regimens.
Cohort Studies↗
Why are lung cancer rate trends so different in the United States and United kingdom?
Over the period 1951-1995, lung cancer rates in men aged 35-74 yr more than doubled in the United States but declined slightly in the United Kingdom. In women, rates rose about sevenfold in the United States but only about threefold in the United Kingdom. To investigate whether these very different trends in lung cancer risk could be explained by smoking habits, trends in smoking were compared in the two countries and a multistage model was used to predict lung cancer rates from detailed data on age of starting and stopping smoking, amount smoked per smoker, and sales-weighted average tar levels. In both countries, there was a similar switch to filter cigarettes, reduction in tar levels and the average age of starting to smoke, and decline in prevalence of smoking in women aged under 50 yr and in men. Although some differences were evident, most notably in older women where prevalence of smoking and consumption per adult has increased more in the United States, these trends do not appear to explain the markedly different trends in lung cancer, evident in both sexes and all age groups. The multistage analyses confirmed these tentative conclusions-the differing trends in smoking in the two countries could not explain the markedly differing trends in lung cancer. Lung cancer trends in the United Kingdom were found to be clearly more favorable than expected on the basis of smoking trends, while trends in the United States were less favorable. In sensitivity analyses, these conclusions were found not to be materially dependent on the precise methods used, including whether tar reduction was or was not assumed to be beneficial. The explanation for these findings must lie in changes over time, differing in the two countries, in aspects of smoking not considered in these analyses and/or in exposure to other risk factors. Evidence relating to a number of possible such smoking variables (including type of tobacco, curing, use of pesticides and additives, and butt length) or other risk factors (including air pollution, radon, asbestos, obesity, and marijuana) is discussed, but no clear explanation of the findings is offered. Further research is urgently needed to investigate the causes of these apparently anomalous trends in lung cancer and in smoking habits. Criticism is also presented of the views recently expressed by the authors of NCI Monograph 13 that tar reduction has been ineffective in lowering lung cancer risk and that trends in lung cancer in the United States fit in well with trends in smoking habits.
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Improving performance using indicators. Recent experiences in the United States, the United Kingdom, and Australia.
This article describes recent national performance improvement initiatives in the United States, United Kingdom, and Australia. This comparison is of particular interest because each of these three countries faces similar challenges in delivering health care and improving health. Each has elevated a focus on safety and quality improvement to a national level. Marked differences in the organization and financing of health care across these three countries provide a unique opportunity to compare and contrast approaches. Drawing on the experience of the authors in each of the three countries and publicly available data sources about specific national initiatives, we describe the national context for improvement and outline recent performance improvement initiatives and emerging issues and challenges. Similarities and differences in the current evolution of national performance initiatives are described and conclusions are drawn about challenges that all three countries face, particularly in terms of developing meaningful sets of national indicators of health system performance. The challenges for future work include the importance of information infrastructure, the paucity of accurate and accessible clinical data, the need for effective performance measurement processes at a local level to capture useful data, and the tensions of balancing accountability and improvement agendas for measurement.
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Recent trends in breast surgery in the United States and United Kingdom.
Data on breast surgery from national samples of patients discharged from hospital in the United States and in England and Wales were reviewed for the years 1970-80. In the United States the rate of breast surgery increased dramatically in 1974 and 1975, but in Britain it remained constant and well below the level in the United States. In both countries the proportion of radical mastectomies declined and the proportion of less extensive procedures rose. The increase in mastectomy rates in the United States probably resulted from increased public concern about breast cancer and from the promotion of breast screening in the mid-1970s. The costs, morbidity, and early mortality associated with a higher rate of mastectomy are substantial and the advantages unclear.
Age Factors↗
Pancreas transplantation: report on United States results from United Network for Organ Sharing Registry with comparison to non-United States results from the International Registry.
From December 17, 1966 to December 31, 1990, 3,069 pancreas transplants worldwide (1,806 United States and 1,263 non-United States) were reported to the International Pancreas Transplant Registry, including 606 in 1990. The 2,871 pancreas transplants in the Registry data base as of October 31, 1990 were analyzed. Results worldwide improved in each of 5 successive eras. The recipient and pancreas graft functional survival rates at 1 year for all 1988 to 1990 cases (n = 1,415) were 91% and 68%, respectively. The effect of multiple variables on outcome was determined by analyzing the 2,037 cases in the International Registry data base since 1985. Worldwide, BD (n = 1,566) was used more frequently than DI (n = 327) or ED (n = 174) and was associated with a significantly higher (p less than 0.001) graft functional survival rate, at 1 year 65% versus 56% and 53%, respectively. Worldwide, SPK transplants (n = 1,644) were performed much more frequently than either PAK (n = 223), or PTA (n = 212). The pancreas graft functional survival rate was significantly higher (p less than 0.001) in the SPK than in the other 2 categories, at 1 year being 68% versus 45% and 37%, respectively. The kidney graft survival rate for all SPK cases at 1 year was 80%. Worldwide, a significant effect of HLA-DR matching was seen only in analysis of PTA, graft survival at 1 year being 54% in PTA recipients matched for 2 DR antigens (n = 13), 44% for 1 DR antigen (n = 63) and 29% for 0 DR antigens (n = 97) (p = 0,015 for 2 vs 0 DR). Worldwide, more than half of the pancreas grafts were preserved in UW solution (n = 1,111), and an increasing preservation length was not associated with a significant decrease in functional survival rates, at 1 year being 67%, 73%, 71%, and 60% for those stored less than 12 (n = 563), 12-24 (n = 416), 24-30 (n = 30), and greater than 30 (n = 5) hours. A separate analysis was performed on pancreas transplants in the United States reported to the UNOS Registry from its inception on October 1, 1987 to October 21, 1990 (n = 1,021). Almost all pancreas transplants in the United States during this period were by the BD technique (92%). The overall patient and pancreas graft survival rates were 92% and 72% at 1 year.(ABSTRACT TRUNCATED AT 400 WORDS)
Follow-Up Studies↗
Irritable bowel syndrome in office-based practice in the United States.
United States estimates of the frequency of visits to physicians and patterns of medical care for the diagnosis of the irritable bowel syndrome were derived from the 1975, 1980-1981, and 1985 National Ambulatory Medical Care Surveys. These surveys of office-based physicians allow national estimates of various aspects of ambulatory care. The overall rate of visits with the diagnosis of irritable bowel syndrome in 1980-1981 and 1985 were 10.6 per thousand U.S. population. Women had 2.4 times the rate of visits by men and rates rose in both sexes until middle-age. Irritable bowel syndrome was the leading digestive disease diagnosis among gastroenterologists but only the seventh leading diagnosis among all physicians. Gastrointestinal symptoms, association with mental disorders, prescriptions, and disposition were also examined in patients with visits for irritable bowel syndrome. Among records with digestive tract symptoms and a first listed diagnosis of irritable bowel syndrome, stomach or abdominal pain was listed on only about one half of records and disorders of bowel function were listed on fewer than 40%. In 1975 and 1985, irritable bowel syndrome was noted approximately twice as often as other digestive diseases at visits with mental disorder symptoms and diagnosis, although mental disorder symptoms and diagnoses were noted at fewer than 15% of visits with irritable bowel syndrome. Medications were prescribed at approximately 75% of visits for irritable bowel syndrome; the most common were gastrointestinal medications followed by combination gastrointestinal-psychoactive medications. Subsequent appointments were scheduled following at least 50% of the visits of patients with irritable bowel syndrome.
Adolescent↗
Psychoactive drug advertising: a comparison of technical information from three countries: Brazil, United States and United Kingdom.
CONTEXT AND OBJECTIVE: Studies carried out in the 1970s and 1980s showed that there were country-dependent disparities in the information given for the same drug in medical advertisements. National and international regulations have been published to do away with such disparities and to foster the rational use of drugs. The purpose of this study was to compare the information contained in psychoactive drug advertisements published in psychiatric journals in Brazil, the United States and the United Kingdom, before and subsequent to the publication of the United States Export Act, in 1986, the WHO criteria, in 1988, and the Brazilian Sanitary Surveillance Agency Resolution no. 102, in 2000. TYPE OF STUDY AND SETTING: Content analysis, at Centro Brasileiro de Informações sobre Drogas Psicotrópicas (Cebrid). METHODS: We gathered advertisements from Brazilian, American and British psychiatry periodicals published before and after each ruling. We analyzed a total of twenty-four Brazilian advertisements that were for the same psychoactive drugs as advertised in American and/or British publications from the same period. RESULTS: We observed that Brazilian advertisements omitted information on usage restrictions, such as contraindications, adverse reactions, interactions, warnings and precautions, and that such information was present in American and British advertisements. CONCLUSIONS: The data suggest that disparities in the information given for the same drug still persist. The information depends on the country in which each drug is marketed. The legislation is insufficient for eradicating such disparities.
Advertising↗
Advanced training in pediatric emergency medicine in the United States, Canada, United Kingdom, and Australia: an international comparison and resources guide.
Pediatric emergency medicine is an important subspecialty of pediatrics and emergency medicine. It is a well-established subspecialty in some countries and less well developed or evolving in others. We set out to develop a resource guide and document the current status of pediatric emergency medicine training across 4 countries (United States, Canada, United Kingdom, and Australia). This article also aims to provide a starting point for pediatric or emergency physicians charged with the development of pediatric emergency medicine training programs in countries without such programs.
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Values and policy conceptions of health policy elites in the United States, the United Kingdom, and the Federal Republic of Germany.
This essay presents data on the thinking of health policy elites in the United States, the United Kingdom and the Federal Republic of Germany. These three national groups are compared in terms of the values they perceive health policy should serve and their conceptions of appropriate policies for realizing these values. The different values and policy conceptions are then related to various propositions as to why social policies differ across nations, particularly to the hypothesis that social policies differ as a consequence of elite values and attitudes.
Attitude to Health↗
Serological analysis of feline calicivirus isolates from the United States and United Kingdom.
The antigenic relationship of 181 feline calicivirus (FCV) isolates from the United States (USA) and United Kingdom (UK) to 5 reference viruses, representing 2 vaccine strains (F9 VacNor, 2280) and 3 field strains (H, J, TN) was determined by a neutralization assay using two standardized dilutions of reference sera. A comparison between USA and UK isolates indicated that significantly fewer UK isolates could be neutralized by sera specific for each of the reference strains. Isolates from the USA were also analyzed based on the time period and geographical location from which they were derived. Analysis of the cross-neutralization results for isolates derived from the USA indicated that no single reference strain was predominant in all the geographical locations, however, antisera specific to strains 2280, H and J neutralized the highest number of isolates overall. Analysis of the neutralization patterns based on the time period from which the isolates were derived indicated that F9 VacNor was antigenically similar to 86% of feline caliciviruses isolated in 1958-1979. This number decreased to 43% for isolates derived in 1980-1995. By contrast, the J strain maintained its antigenic relatedness to approximately 75% of representative FCV isolates circulating during the last 40 years.
Animals↗