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Americans probably know very little about the risk factors and early warning signs of oral cancer despite a 5-year survival rate of 54%, according to a survey by the National Center for Health Statistics. Oral cancers affect all mouth areas, tongue and lips, and cause 8,000 annual deaths in the U.S. In a survey of 41,104 adults, the 1990 Health Promotion and Disease Prevention Supplement measured how knowledgeable the general population was about oral cancer. Sixty-seven percent of participants (67%) identified only smoking and tobacco chewing as substantial cancer risks. Furthermore, only 25% of respondents could easily recognize early cancer symptoms, such as mouth sores and swelling. Lack of knowledge and incorrect answers can be reversed by the educational efforts of oral care providers.

The article analyzes data concerning the use of warfarin and its prevalence of bleeding complications in the United States to support a requirement by the Food and Drug Administration for a boxed warning in the professional product information and for a patient Medication Guide. Warfarin use has increased, and bleeding from warfarin use is a prevalent reaction and an important cause of mortality.

Examines changes in CD4+ and CD8+ cell levels during pregnancy and post partum and to determine whether they differ for human immunodeficiency virus-1-seropositve and seronegative women. Study design; Statistical analysis; Laboratory methods; Characteristics of participants.

Background: For evaluating measles vaccine efficacy (VE) in the field, some investigators have suggested that an overall attack rate level of 5% or more in a randomly mixing population is sufficient to provide equal exposure to the viral agent in both vaccinated and unvaccinated groups. It is not clear, however, if this assumption is valid given the effect of herd immunity.Methods: We created a computer simulation model based on the stochastic extension of the Reed-Frost model and tested for variation in bias in VE estimation due to herd immunity, based on runs of 200 trials.Results: At higher levels of attack rate, the degree of herd immunity decreases, as does the percentage of trials with bias in VE estimation. The two main factors that affect the level of attack rate are the probability of adequate contact and the number of susceptibles. At a given level of attack rate, the number of susceptibles is positively associated with the percentage of biased trials in VE estimation. Since vaccination reduces the number of susceptibles, we also observe that when controlling for attack rate, higher vaccination coverage results in lower bias in VE estimation.Conclusion: The results show that the assumption of no bias when the attack rate is 5% or more becomes increasingly true when a large percentage of a randomly mixing population is immune. [ABSTRACT FROM AUTHOR]

In this report the data regarding coronary heart disease (CHD) from the 1990 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey are used to examine the relationship between risk factor knowledge and health related behaviors among currently employed white collar(N=5,349) and blue collar(N=4,158) men workers. Blue collar employees have less knowledge about CHD risk factors, less favorable risk factors status, and poorer health practices than their white collar workers. Despite these findings within each occupational group, the relationship of knowledge to either risk factor status or health practices is similar. Knowledge is generally related to the attempts to change behaviors. However, for the different risk factors, the associations vary. For example, knowledge of cigarette smoking as a risk factor of CHD is negatively associated with reported ever smoking or current smoking, but not with heavy smoking. In contrast, knowledge of overweight, high serum cholesterol, and high blood pressure as CHD risk factors is not associated with risk factor status. These results suggest that while difference in level of knowledge and risk profiles remain between blue collar and white collar employees, the associations between knowledge and risk profiles are similar. Programs located at worksites must continue to provide education opportunities about the risk factors, especially among blue collar workers. [ABSTRACT FROM AUTHOR]

Abstract: We collected data on all residents of San Diego County, California who were hospitalized for or died from a brain injury in 1981. The objectives were to assess the frequency of blood alcohol concentration (BAC) testing and the associations of BAC prevalence with the external cause of the brain injury and case outcome. We found that high BAC levels were most frequent among brain-injured subjects between the ages of 25 and 44 and among those subjects involved in motor vehicle crashes and assaults. Contrary to expectations, injury severity and hospital mortality were inversely related to BAC level, controlling for other predictors. We believe that these inverse associations might be due to differential rates of BAC testing by severity. Among brain-injured survivors with more severe injuries, however, we found that BAC level was positively associated with the prevalence of physician-diagnosed neurological impairment at discharge and with the length of hospitalization. [ABSTRACT FROM AUTHOR]

Purpose : This article summarizes lessons learned from five AHRQ grants to implement Medication for Opioid Use Disorder (MOUD) in rural primary care practices. Methods : Lessons learned were extracted from quarterly and annual grantee progress reports, minutes from quarterly virtual meetings, and minutes and notes from annual grantee in-person meetings. The lessons learned were drafted by the authors and reviewed by the grantees for accuracy. Results: The experience of these projects suggest that recruiting providers in rural areas and engaging them to initiate and sustain provision of MOUD is very difficult. Innovative approaches and providing supports are required for supporting providers to overcome barriers. Implications : Implementation of MOUD in rural primary care is challenging but success is more likely if implementers are attentive to the needs of individual providers, are flexible and tailor implementation to the local situation, and provide on-going support.

Objective: The objectives of our study were to determine the number, rate, and types of deaths attributed to specific X-ray contrast media on the basis of U.S. death certificates and to attempt to assess the comparative safety of commonly used diagnostic X-ray contrast agents using death certificate information., Conclusion: From 1999 through 2001, deaths attributed to the International Classification of Diseases (ICD) code for contrast media occurred at the rate of 1.1-1.2 per million contrast media packages distributed. An analysis of 1999 death certificates indicated that most deaths attributed to contrast media predictably were associated with renal failure or nephropathy and anaphylaxis or allergic reactions. Risk assessment of the comparative safety of classes or agents was limited by lack of specific contrast media names. Names of administered contrast agents should be recorded in patients' medical records and communicated to primary care physicians and certifiers of death in the event of serious sequelae after an identified recent radiologic procedure.

Background: QT interval prolongation can lead to torsades de pointes, a potentially fatal arrhythmia. Although research exists on the relationship between QT prolongation and clinical outcome, few studies have described risk factors for prolonged QT interval in the general population., Methods: The Third National Health and Nutrition Examination Survey (NHANES III) collected electrocardiogram interval data on 8561 subjects over 40 years of age and projected results to the US population. QT was corrected for heart rate using Fridericia's formula. Logistic regression analyses were performed to identify factors independently associated with prolonged QTc interval, defined as being in the upper 5% of the population QTc interval distribution. Analyses were conducted separately for women and men as a result of differences in the QT distribution between the sexes and also because of potential effect modification. Analytical variables included age, race/ethnicity, electrolyte measurements, body mass index, the recent use of QT-prolonging drugs and past medical histories of stroke, thyroid disease, hypertension, diabetes and myocardial infarction., Results: Age, female sex, hypocalcemia (men), hypokalemia (women), and a history of thyroid disease and myocardial infarction (men) were associated with a prolonged QTc interval. In addition, taking QT-prolonging medications in the past month was associated with more than a twofold increase in the odds of prolonged QTc interval in both men and women., Conclusions: Healthcare practitioners should be aware that a prolonged QTc interval is a potential indicator of cardiovascular risk, and should exercise caution in prescribing potentially QT-prolonging medications to certain patients.

Background: The cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drugs (NSAIDs) celecoxib and rofecoxib (before its removal) are marketed as having fewer gastrointestinal (GI)-related complications than nonselective NSAIDs. However, adverse reaction data suggest that the use of COX-2 selective NSAIDs is associated with clinically significant GI events., Objective: To assess whether patients receiving celecoxib and rofecoxib have a greater underlying disease burden than patients prescribed nonselective NSAIDs., Methods: The study population consisted of members of 11 health plans, aged >34 years, with a pharmacy claim for celecoxib or rofecoxib or a nonselective NSAID dispensed between February 1, 1999, and July 31, 2001, who had been continuously enrolled for >364 days before the dispensing date. Celecoxib and rofecoxib patients were randomly selected without replacement from a pool of eligible users in each of the 30 months. Nonselective NSAID users were randomly chosen without replacement within each month on a 2:1 ratio to cases; they could be chosen in more than one month. Univariate analyses comparing 9000 cases and 18 000 controls were performed, followed by a multiple logistic regression analysis conditioned on time., Results: Increasing age, treatment by a rheumatologist or an orthopedic specialist, treatment with a high number of different medications in the past year, treatment with oral corticosteroids in the past year, and having had a previous GI bleed increased the likelihood of receiving celecoxib or rofecoxib, whereas treatment with a high number of nonselective NSAID prescriptions in the past year decreased it. Treatment with a high number of different medications was a predictor of increased prevalence of underlying diabetes mellitus and cardiovascular disease., Conclusions: Patients having a greater underlying disease burden were more likely to receive COX-2 selective NSAIDs than nonselective ones. Paradoxically, patients at higher risk for cardiovascular disease were channeled toward treatment with COX-2 selective NSAIDs, many of which may confer an increased risk of acute myocardial infarction and other adverse cardiovascular outcomes.