Efficacy of granular deltamethrin against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidade) nymphs.

A single barrier application of granular deltamethrin to the woodland edges of a forested residential community in late spring significantly reduced the abundance of Ixodes scapularis Say nymphs. The application also suppressed the population of Amblyomma americanum (L.) nymphs, which recently became established in the study area. The efficacy of deltamethrin is compared with other commonly used acaricides.

Reservoir competence of the meadow vole (Rodentia: Cricetidae) for the Lyme disease spirochete Borrelia burgdorferi.

The reservoir competence of the meadow vole, Microtus pennsylvanicus Ord, for the Lyme disease spirochete Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner was established on Patience Island, RI. Meadow voles were collected from 5 locations throughout Rhode Island. At 4 of the field sites, M. pennsylvanicus represented only 4.0% (n = 141) of the animals captured. However, on Patience Island, M. pennsylvanicus was the sole small mammal collected (n = 48). Of the larval Ixodes scapularis Say obtained from the meadow voles on Patience Island, 62% (n = 78) was infected with B. burgdorferi. Meadow voles from all 5 locations were successfully infected with B. burgdorferi in the laboratory and were capable of passing the infection to xenodiagnostic I. scapularis larvae for 9 wk. We concluded that M. pennsylvanicus was physiologically capable of maintaining B. burgdorferi infection. However, in locations where Peromyscus leucopus (Rafinesque) is abundant, the role of M. pennsylvanicus as a primary reservoir for B. burgdorferi was reduced.

Effects of Babesia microti infection on feeding pattern, engorged body weight, and molting rate of immature Ixodes scapularis (Acari: Ixodidae).

Effects of Babesia microti Franca on the pattern of feeding time, the body weight of engorged ticks, and the molting rate of the blacklegged tick, Ixodes scapularis Say, were determined. Using the Syrian golden hamster, Mesocricetus auratus (Waterhouse), as an animal model, we found no significant differences in patterns of feeding time determined for both larvae and nymphs that fed on B. microti-infected and uninfected hamsters. However, an infection of B. microti in hamsters delayed engorgement of the ticks. The presence of B. microti had no adverse effects on the body weight of engorged ticks. The mean body weight of groups of 5 engorged larvae fed on infected hamsters was not significantly different from that on uninfected hamsters. The mean body weight of individual nymphs that fed on infected hosts was significantly higher than that on uninfected hosts. Larvae fed on infected hamsters molted in greater numbers than those fed on uninfected hamsters. However, there was no significant difference in molting rates of nymphs derived from infected and uninfected hamsters. In addition, greater body weights and higher molting rates were observed in both larvae and nymphs that fed on uninfected white-footed mice, Peromyscus leucopus Rafinesque, compared with those on uninfected hamsters. Nymphs fed on mice spent a significantly longer time achieving repletion than those on uninfected hamsters. We suggest a mutualistic relationship in the interactions between B. microti and I. scapularis. This mutualism may potentially enhance the long-term coexistence and survival of both species. Furthermore, we suggest that the pattern of feeding time, the body weight of engorged ticks, and the molting rate of immature I. scapularis are host-dependent.

Spatial distribution of larval Ixodes scapularis (Acari:Ixodidae) on Peromyscus leucopus and Microtus pennsylvanicus at two island sites.

Larval blacklegged ticks, Ixodes scapularis, were collected from white-footed mice. Peromyscus leucopus, on Prudence Island (where Microtus pennsylvanicus were not captured) and from meadow voles. M. pennsylvanicus, on Patience Island (where P. leucopus was absent) in Narragansett Bay, Rhode Island from June to October 1992. Ixodes scapularis larvae were also collected by flagging in the vicinity of host captures. On both islands, the relative density of larvae changed from July to September in samples from hosts, but not in flagging samples. Consequently, different sampling techniques can give different assessments of tick populations. Larvae were highly aggregated on both of the host species throughout the sampling period. As the mean relative density of larvae increased in the environment (based on flagging samples), larvae on the hosts became more dense and more crowded. Increased densities of larvae in the environment were not correlated with increased patchiness in the distribution of larvae among host animals on either island. Changes in the spatial distribution of larval I. scapularis on each host species had similar trends as larval densities and distributions within the environment. These results suggest that M. pennsylvanicus can serve as an alternative host for immature I. scapularis in a P. leucopus-free environment and have similar distributional characteristics.

Diet after pancreas transplantation.

OBJECTIVE: To determine whether discontinuation of insulin therapy and glucose monitoring and instructions to increase dietary salt and water intake after pancreas transplantation (PTX) resulted in changes in food choices. RESEARCH DESIGN AND METHODS: All PTX recipients who had completed a preoperative diet record, had received their PTX > 6 months before, had stable pancreas and kidney function, and were on a stable diet were invited to submit a 3-day post-PTX diet record. Of the 14 eligible, 11 agreed to participate and completed the study (2 women and 9 men). Their pre- and post-PTX diet records were analyzed by computer program. Weight, glycohemoglobin, blood pressure, medications, and fasting lipids both before and after PTX were also analyzed. RESULTS: The recipients were studied 576 +/- 60 days post-PTX, on average. Total calories and BMI were unchanged after PTX. Before PTX, 34% of calories were in fats, 49% in carbohydrate, and 17% in protein with no change in distribution of calories after PTX, although there was a trend toward greater saturated fat intake. Total salt intake was increased after PTX (P < 0.01) because of sodium bicarbonate administration, although dietary salt intake did not change. The HDL cholesterol concentration increased and cholesterol-to-HDL ratio decreased after PTX (P < 0.05), while the remaining lipids were unchanged. CONCLUSION: Weight, total calories and distribution of calories, and dietary salt were unchanged after PTX, and diet did not explain the changes in HDL cholesterol or cholesterol-to-HDL ratio. These preliminary diet results suggest that greater emphasis on dietary instruction may be needed after PTX.

Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension.

A randomised trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription refill compliance with antihypertensive therapy and subsequent health care expenditures. The subjects were 304 Medicaid beneficiaries from the state of Florida, previously untreated for mild to moderate hypertension, prescribed 240 mg of calcium channel antagonist verapamil once daily and monitored regarding prescription refill compliance and health service utilisation for one year. Subjects provided informed consent and were randomly assigned to one of four experimental groups: (1) the control cohort received standard pharmaceutical care with each dispensing of antihypertensive therapy, (2) the second cohort received standard pharmaceutical care and was mailed a medication-refill reminder ten days prior to each sequential refill date, (3) the third cohort received standard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request and (4) the fourth cohort received standard pharmaceutical care, mailed medication-refill reminders and unit-of-use packaging. Analysis of variance (ANOVA) procedures revealed that patients receiving mailed prescription-refill reminders, unit-of-use packaging or a combination of both interventions achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR) for antihypertensive therapy relative to controls. Receipt of both interventions resulted in a significant (P < or = 0.05) improvement in the MPR for antihypertensive therapy relative to all other groups no significant difference was discerned between groups receiving either mailed prescription-refill reminders or unit-of-use packaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of a sustained-release formulation for antihypertensive therapy.

Recent pharmacotherapeutic advances in the treatment of hypertension have included the development of sustained-release (SR) dosage formulations, providing patients with the convenience of once daily administration. A one year retrospective analysis was undertaken to determine the economic utility of providing prescription coverage for the SR formulation of verapamil, a calcium channel antagonist, under the state of Florida's Medicaid programme. Data for this analysis were derived from the state of Florida's Medicaid computer archive. The study population consisted of 274 ambulatory beneficiaries diagnosed with hypertension and prescribed either the SR or immediate-release (IR) formulation of verapamil. Multivariate regression analysis was used to discern the incremental influence of selected demographic characteristics, utilisation of medical services prior to diagnosis for hypertension and prescribed formulation of verapamil on health care expenditures one year post-diagnosis. Patients prescribed the SR formulation of verapamil achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR), an index of compliance, (0.87 +/- 0.13) relative to patients prescribed the IR formulation (0.56 +/- 0.10). Results indicate that receipt of verapamil in an SR formulation was associated with a significant (P < or = 0.05) decrease in aggregate health care expenditures of $110.14 over the one year study period. Receipt of the SR formulation was associated with an increase in expenditures for antihypertensive therapy ($117.83, p < or = 0.05) and a decrease in financial commitments for physician ($50.42, p < or = 0.05), hospital ($153.61, p < or = 0.05) and laboratory ($23.94, p < or = 0.05) services.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of pharmaceutical formulation for diltiazem on health care expenditures for hypertension.

A 1-year retrospective analysis was undertaken to discern the economic utility of providing prescription coverage for the sustained-release (SR) formulation of diltiazem, a calcium-channel antagonist, under the state of South Carolina's Medicaid program. Data for this analysis were derived from the state of South Carolina's Medicaid computer archive. The study population consisted of 347 ambulatory beneficiaries diagnosed with hypertension for whom either the SR or immediate-release (IR) formulation of diltiazem was prescribed. Multivariate regression analysis was used to discern the incremental influence of selected demographic characteristics, use of medical services prior to diagnosis for hypertension, and prescribed formulation of diltiazem on health care expenditures 1-year postdiagnosis. Patients for whom the SR formulation of diltiazem was prescribed achieved a significant (P < or = 0.05) increase in the medication possession ratio, an index of compliance (SR, 0.63 +/- 0.17) relative to patients for whom the IR formulation was prescribed (IR, 0.44 +/- 0.13). Results indicate that receipt of diltiazem in an SR formulation was associated with a significant decrease in aggregate health care expenditures over the 1-year study period ($258.80, P < or = 0.05). Receipt of the SR formulation was associated with an increase in expenditures for antihypertensive therapy ($109.26, P < or = 0.05), and a decrease in financial commitments for physician ($128.70, P < or = 0.05), hospital ($211.84, P < or = 0.05), and laboratory ($27.52, NS) services. At the managerial and policy levels, these data argue for an increased use of therapeutic alternatives that facilitate a reduction in the patient's daily dosing schedule for antihypertensive therapy.

Effect of value-added utilities on prescription refill compliance and Medicaid health care expenditures--a study of patients with non-insulin-dependent diabetes mellitus.

An estimated 20 million Americans suffer from diabetes. Patients with non-insulin-dependent diabetes mellitus (NIDDM) comprise approximately 90% of the diabetic population. An estimated 10-30% of patients with NIDDM withdraw from their prescribed regimen within 1 year of diagnosis, and of the remainder, nearly 20% administer insufficient medication to facilitate an adequate reduction in blood glucose. A randomized trial was undertaken to discern the effect of pharmacy-based value-added utilities on prescription-refill compliance with sulfonylurea therapy and health service utilization. The subjects were 258 Medicaid beneficiaries from the state of South Carolina, previously untreated for NIDDM, prescribed 5 mg of the second-generation sulfonylurea glyburide twice daily, and monitored with regard to prescription-refill compliance and health service utilization for 1 year. Subjects provided informed consent and were randomly assigned to one of four experimental groups: (i) the control cohort received standard pharmaceutical care with each dispensing of glyburide; (ii) the second cohort received standard pharmaceutical care and was mailed a medication-refill reminder 10 days prior to each sequential refill date; (iii) the third cohort received standard pharmaceutical care and was provided unit-of-use packaging with each prescription-refill request; (iv) the fourth cohort received standard pharmaceutical care, mailed medication-refill reminders, and unit-of-use packaging. Analysis of variance (ANOVA) procedures revealed that patients receiving mailed prescription-refill reminders, unit-of-use packaging, or a combination of both interventions achieved a significant (P < or = 0.05) increase in the Medication Possession Ratio (MPR) for sulfonylurea therapy relative to controls.(ABSTRACT TRUNCATED AT 250 WORDS)