Systemic sclerosis prevalence and comorbidities in the US, 2001–2002

ABSTRACT

Objective: Large, population-based assessments of systemic sclerosis (SSc) prevalence and comorbidity in the United States (US) are rare. We explored autoimmune disease and other comorbidity patterns among SSc patients in the US from 2001 to 2002 and compared these with controls.

Research design and methods: Two US datasets with patient-level medical and drug claims were used to assess SSc prevalence and comorbidity: IMS Health Integrated Administrative Claims Database (IMS Health) and the MarketScan Commercial Claims and Encounters Database (MarketScan). SSc patients and comorbidities were identified by International Classification of Diseases (ICD), 9th revision diagnostic codes appearing on medical claims. Patients without SSc diagnostic codes (controls) were selected and matched 4?:?1 to SSc patients based on sex, age, Census Bureau region, and previous insurance coverage. The prevalence relative risk (RR) statistic compared comorbidity occurrence between SSc patients and controls, with 95% confidence intervals estimated using the Mantel–Haenszel method. Several sensitivity analyses tested methods used for identifying SSc cases and the prevalence of comorbidities.

Results: In both databases, SSc prevalence was 0.05% using the standard population model, 0.03% under sensitivity analysis. Among SSc patients the risks for inflammatory bowel disease (IBD) and multiple sclerosis (MS) were notably higher across datasets than for those without SSc: RR 3.2–6.6 for MS, RR 2.1–2.2 for IBD, in MarketScan and IMS Health, respectively (?p < 0.05 for all). The chronic disease burden of SSc patients was much higher than that of controls, as confirmed by two chronicity measures (Chronic Disease Score, Elixhauser Comorbidity Index). The risks for cardiovascular, renal, liver and several neuropsychiatric diseases were higher for SSc patients across both datasets. Sensitivity analyses supported these findings.

Conclusions: These data provide a population-based estimate of US prevalence of SSc and document the higher risk for certain other autoimmune diseases among SSc patients when compared to controls. Patients with SSc also had a higher chronic disease burden than those without SSc. These findings are limited by the unknown validity of ICD-9 codes for SSc case identification, unbalanced regional representation, and a likely ‘healthy worker’ effect in these databases.     

Trends in Emergency Department Resource Utilization for Poisoning-Related Visits, 2003–2011

In recent years, there has been an increase in poisoning-related emergency department (ED) visits. This study examines trends in ED resource utilization for poisoning-related visits over time. A retrospective review of data from the National Hospital Ambulatory Medical Care Survey, 2003–2011, was conducted. All ED visits with a reason for visit or ICD-9 code related to poisoning were included. We examined the number of ED visits and resources used including diagnostic studies and procedures performed, medications provided, admission rates, and length of stay. The proportion of visits involving resource use was tabulated and trends analyzed using survey-weighted logistic regression, grouping into 2-year periods to ensure adequate sample size. Of an estimated 843 million ED visits between 2003 and 2011, 8 million (0.9 %) were related to poisoning. Visits increased from 1.8 million (0.8 %) visits in 2003–2004 to 2.9 million (1.1 %) visits in 2010–2011, p = 0.001. Use of laboratory studies, EKGs, plain radiographs, and procedures remained stable across the study period. CT use was more than doubled, increasing from 5.2 to 13.7 % of visits, p = 0.001. ED length of stay increased by 35.5 % from 254 to 344 min, p = 0.001. Admission rates increased by 45.3 %, from 15.0 to 21.8 %, p = 0.046. Over the entire study period, 52.0 % of poisoned patients arrived via ambulance, and 3.0 % of patients had been discharged from the hospital within the previous 7 days. Poisoning-related ED visits increased over the 8-year study period; poisonings are resource-intensive visits and require increasingly longer lengths of ED stay or hospital admission.     

Trends and predictors in methadone maintenance treatment dropout in Shanghai,China: 2005–2011

Abstract

Background:

The methadone maintenance treatment (MMT) program has been implemented in Shanghai since 2005. This study aims to portray the trend of MMT dropout and identify predictive factors that may influence dropout in Shanghai MMT clinics, which could assist in the intervention strategy development.     

Imported disease in emergency departments: an undiscovered country?

BACKGROUND: The incidence of imported disease within the emergency department (ED) is not known, but a significant number of patients present to medical services after return from traveling. Unless practitioners in ED are aware of the potential for nonendemic disease in the population of patients they attend, there is a possibility that imported diseases will not be diagnosed in the acute setting. METHOD: A questionnaire was sent to all medical practitioners involved in assessing patients presenting to the EDs of hospitals. This questionnaire consisted of five clinical scenarios describing acute presentations of imported diseases but without a travel history included. Responses were requested to ascertain whether practitioners would elucidate the travel history and consequently establish the correct diagnosis. RESULTS: A response rate of 96% was achieved. When presented with a clinical scenario suggesting imported disease, travel history is only elicited in 16% of cases by the acute care practitioners. A correct diagnosis was given in 22% of responses. Interestingly, there was generally no significant correlation between eliciting a travel history and establishing the correct diagnosis. CONCLUSIONS: When presented with a clinical scenario that describes an imported disease, medical practitioners in EDs do not routinely establish a travel history or consider the diagnosis of imported disease. There may be a high potential for imported disease to be missed in the ED.     

Artesunate–amodiaquine for the treatment of uncomplicated malaria

Without an effective vaccine for the prevention of malaria, a fundamental component of the strategy for the control of this disease is based on prompt and effective treatment. Due to the high resistance level of Plasmodium falciparum to the most affordable drugs such as chloroquine and sulfadoxine–pyrimethamine, artemisinin-based combination therapies are presently used in many countries or are being developed for registration. One artemisinin combination therapy that is drawing a certain degree of interest is the combination of artesunate (a short half-life drug) plus amodiaquine (a long half-life drug that is presently used in loose combination in many countries). The short half-life drug achieves substantial and rapid parasite killing, while a high concentration of the long half-life drug kills off the remaining malaria parasites. In addition to the effectiveness of 3 days of treatment (rapid clearance of fever and malaria parasites) in western and central Africa, where resistance to amodiaquine is low, the combination of artesunate plus amodiaquine may delay or prevent the emergence of resistance to both drugs. An important step is the recent registration in Morocco (the country where the drug is manufactured) of a fixed combination of artesunate plus amodiaquine by the Drugs for Neglected Diseases initiative with sanofi-aventis as the industrial partner. A prequalification dossier of this fixed combination has been submitted to the WHO. This new co-formulation will almost certainly increase its effectiveness by improving drug compliance.     

UKCPA Symposium on Progress in Practice, Leeds? May 2001, Blackpool? November 2001

Abstract List

UKCPA Symposium on Progress in Practice, Leeds? May 2001, Blackpool? November 2001     

Drugged Driving in the Opioid Era: Spatial Patterns of Oxycodone Use in Fatal Traffic Crashes, 2001–2016

Background: A large and growing body of research and news media reports have documented the recent opioid crisis, which is linked to the emergence of the “Oxy epidemic” in the late 1990s and early 2000s. Since then, oxycodone drugged driving has increased, but spatial characteristics are unknown. Methods: This research analyzes 3,396 locations of oxycodone positivity in drivers involved in fatal traffic crashes from the Fatality Analysis Reporting System (FARS), 2001–2016. Results: There is a consistent pattern of nonrandom spatial clusters of oxycodone drugged driving during the period, as expected. Conclusion: Traffic fatality data are useful in identifying areas for targeted public health and safety interventions.     

Imported poultry meat as a source of extended-spectrum cephalosporin-resistant CMY-2-producing Salmonella Heidelberg and Salmonella Minnesota in the European Union, 2014–2015

Extended-spectrum cephalosporin (ESC)-resistant Salmonella have been described at a low level in the EU, nevertheless the increasing importation of poultry meat could be an important source of epidemic strains carrying ESC resistance genes. This study evaluated ESC resistance and its genetic platform among Salmonella isolates from poultry meat products imported into Portugal as well as clonal relatedness of the isolates. All Salmonella isolates recovered from samples of fresh meat destined for import into the EU in the scope of Portuguese official border control (2014–2015) were studied. Antibiotic susceptibility and β-lactamase production was determined by disk diffusion/microdilution. Molecular studies included detection of genes encoding acquired AmpC and extended-spectrum β-lactamases, plasmid-mediated quinolone resistance and other antibiotic resistance genes by PCR/sequencing, and clonality by MLST and XbaI-PFGE. Plasmid characterisation was assessed by conjugation assays, replicon typing (PCR-PBRT/pMLST) and hybridisation experiments (I-CeuI/S1-PFGE nuclease). Isolates belonged to Salmonella Heidelberg (n?=?6; ST15/eBG26) and Salmonella Minnesota (n?=?1; ST548/eBG77) and presented multidrug-resistant profiles, including to ESCs and/or fluoroquinolones. All but one carried bla_CMY-2, located on two epidemic plasmids, IncA/C (ST2, n?=?5) or transferable IncI1 (ST12, n?=?1). Salmonella Heidelberg was associated with five PFGE types, including one similar to an American epidemic clone. This study reveals imported poultry products as a source of uncommon and/or invasive ESC-resistant Salmonella strains in the EU. The increase of clinically relevant poultry-related serotypes in Europe must be taken into account in the current monitoring of antibiotic resistance trends and in re-evaluation of food regulations.     

Changes in the prevalence and correlates of cocaine use and cocaine use disorder in the United States, 2001–2002 and 2012–2013

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012–2013. Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012–2013 NESARC-III. Between 2001 and 2002 and 2012–2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30–44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012–2013.     

Nutmeg Poisonings: A Retrospective Review of 10 Years Experience from the Illinois Poison Center, 2001–2011

Nutmeg is a commonly consumed spice. The toxic effects of nutmeg have been purported to be due mainly to myristicin oil. Prior poison center series of nutmeg exposures show very few unintentional exposures of nutmeg to children younger than 13. Case series from these centers did not record drug exposures combined with nutmeg. This study is a review of Illinois Poison Center (IPC) data regarding nutmeg exposures from January of 2001 to December 2011. The goal of this study was to compare the Illinois data to the literature as well as look for current trends in nutmeg poisonings. The data were extracted using the code for hallucinogenic plants in the IPC database, and poisonings unrelated to nutmeg exposure were eliminated. Medical outcomes were noted as recorded. Thirty-two cases of nutmeg ingestion were reported. Of the 17 (53.1 %) unintentional exposures, 10 subjects (58.8 %) were under the age of 13. Four of the exposures in children under the age of 13 were ocular exposures. Fifteen exposures (46.9 %) were intentional exposures. Of these intentional exposures, five (33.3 %) were recorded to have combined drug intoxication. All of these were between the ages of 15 and 20. One patient with polypharmaceutical exposure required ventilatory support in the hospital. Our study shows an unexpected percentage of unintentional exposures in juveniles under the age of 13, out of the total exposures to nutmeg. Mixing of nutmeg with other drugs was seen and required more intervention in adolescents. More education about these two factors, i.e., nutmeg exposures as intentional polypharmacy in adolescents and unintentional exposures in young children, is advised.     

Trends in authorship characteristics and collaboration in pharmacy practice publications: 2011–2020

BackgroundResearch and scholarly publications are core expectations in academia that often require collaboration. While the number of authors per document (NAPD) has increased in every discipline, co-authorship culture and collaboration patterns vary among disciplines and countries.ObjectivesTo determine the trends in the patterns and characteristics of authorship and collaborations in United States’ pharmacy practice faculty publications from 2011 to 2020.MethodsSeven pharmacy practice journals were selected based on previous studies and data from Scimago Journal and Country Rank. Articles and reviews (document types) published during the decade were obtained from the Scopus database. Data cleaning and analysis were done using Microsoft Excel, R programming language packages, and VOSviewer. The Mann-Kendall trend test was used to determine the presence of (positive/negative) monotonic trends.ResultsEight thousand and fifty-nine documents published in the selected journals (82.7% articles; 17.3% reviews) by 18,575 unique authors during the decade were analyzed. In most documents (69.3–78.7%), senior/corresponding authors were first authors. There were statistically significant upward trends in the mean NAPD (3.8 ± 2.2 to 4.7 ± 2.4), median NAPD, and related bibliometric indices (degree of collaboration, collaborative index, and collaborative coefficient). Conversely, productivity (document per unique author) significantly trended downward and had a strong, negative correlation with mean NAPD. The proportion of one-author publications also trended downward (12.2%–3.6%). Evidence also supports a downward trend in institutional collaboration and an upward trend in international collaboration.ConclusionsThe assumption that last authors are senior authors does not hold in pharmacy practice publications. The increase in NAPD is not considered as authorship inflation, but rather an authorship “upcreep” that is driven by a survival strategy to publish together, predominantly within institutions rather than across institutions or countries. Therefore, faculty publication benchmarks should be crafted to mitigate the inverse relationship between collaboration and productivity, without discouraging collaboration.