Incident depression in patients diagnosed with multiple sclerosis: a multi-database study.

BACKGROUND AND PURPOSE: Data on rates of newly diagnosed depression after multiple sclerosis (MS) diagnosis are sparse. Here, incident, treated depression in MS patients after diagnosis compared with matched non-MS patients is described. METHODS: A matched cohort study was conducted in two separate electronic medical databases: the US Department of Defense (US-DOD) military healthcare system and the UK's Clinical Practice Research Datalink GOLD (UK-CPRD). The study population included all patients with a first recorded diagnosis of MS and matched non-MS patients. Patients with a history of treated depression were excluded. Incidence rates and incidence rate ratios with 95% confidence intervals for treated depression after MS diagnosis/matched date were estimated. RESULTS: Incidence rate ratios of treated depression amongst MS patients compared with non-MS patients were 3.20 (95% confidence interval 3.05-3.35) in the US-DOD and 1.90 (95% confidence interval 1.74-2.06) in the UK-CPRD. Incidence rate ratios were elevated across age and sex. Rates were higher in females than males but, compared to non-MS patients, males with MS had a higher relative risk than females with MS. CONCLUSIONS: Multiple sclerosis patients in the UK and the USA have a two- to three-fold increased risk of new, treated depression compared to matched non-MS patients.

Infections in patients diagnosed with multiple sclerosis: A multi-database study.

BACKGROUND: Recent data on the rates of infections among patients with multiple sclerosis (MS) are sparse. The objective of this study was to quantify incidence of infections in patients with MS compared with a matched sample of patients without MS (non-MS). METHODS: This study was conducted in two separate electronic medical databases: the United States Department of Defense (US-DOD) military health care system and the United Kingdom's Clinical Practice Research Datalink GOLD (UK-CPRD). We identified patients with a first recorded diagnosis of MS between 2001 and 2016 (UK-CPRD) or 2004 and 2017 (US-DOD) and matched non-MS patients. We identified infections recorded after the MS diagnosis date (or the matched date in non-MS patients) and calculated incidence rates (IRs) and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by infection site and type. RESULTS: Relative to non-MS patients, MS patients had higher rates of any infection (US-DOD IRR 1.76; 95% CI 1.72-1.80 and UK-CPRD IRR 1.25; 95% CI 1.21-1.29) and a two-fold higher rate of hospitalized infections (US-DOD IRR 2.43; 95% CI 2.23-2.63 and UK-CPRD IRR 2.00; 95% CI 1.84-2.17). IRs of any infection were higher in females compared with males in both MS and non-MS patients, while IRs of hospitalized infections were similar between sexes in both MS and non-MS patients. The IR of first urinary tract or kidney infection was nearly two-fold higher in MS compared with non-MS patients (US-DOD IRR 1.88; 95% CI 1.81-1.95 and UK-CPRD IRR 1.97; 95% CI 1.86-2.09) with higher rates in females compared with males. IRs for any opportunistic infection, candidiasis and any herpes virus were increased between 20 and 52% among MS patients compared with non-MS patients. IRs of meningitis, tuberculosis, hepatitis B and C were all low. CONCLUSION: MS patients have an increased risk of infection, notably infections of the renal tract, and a two-fold increased risk of hospitalized infections compared with non-MS patients.

Consistency in maintaining contact with HIV-related service providers: an analysis of the AIDS Cost and Services Utilization Study (ACSUS).

Patients (n = 1949) infected with HIV were recruited for the AIDS Cost & Service Utilization Survey (ACSUS) from ten U.S. cities and administered face to face interviews at three month intervals over an 18 month period from March 1, 1991 to August 31, 1992. The interview was designed to obtain information at each wave of data collection on the use of the following services: ambulatory care, hospitalization, emergency room use, support groups/counseling, drug and alcohol treatment, and dental care. Patients were found to be highly consistent in their patterns of utilization across time, regardless of the service in question. Of the patients who reported using an emergency room (ER) at Time 1, 52% also reported using an ER during the next three months later at Time 2. Of those who reported having been hospitalized during the Time 1 reporting period, almost 58% reported a hospitalization again at Time 2. Next, use of a service at Time 6 (n = 1404, 72.2%) was regressed onto whether the person received the service at Time 2 and the personal, financial, and medical variables. Except for dental services, utilization of a service one year in the past (Time 2) was the strongest predictor of Time 6 use. The findings indicated that the one factor consistently related to service use within this sample is a factor (as opposed to education, race, or even insurance) that is amenable to intervention: previous use of that service. The individuals studied established patterns of service utilization that are of reasonably long duration once they began use of a service. This continuity of care becomes more critical as the initiation of treatments begins with the diagnosis of HIV rather than AIDS. Findings suggest that HIV outreach efforts be targeted to increasing early use of medical and behavioral services in ambulatory care settings.

Intentional and unintentional injury in the State of Nevada: 1989-1992.

INTRODUCTION: Data from a large population-based trauma registry were used to assess risk factors and outcomes associated with injuries that were either caused unintentionally, were self-inflicted, or resulted from an assault. DESIGN: A retrospective analysis was conducted of all cases of serious trauma (N = 19,505) occurring in the State of Nevada during the 4-year period from January 1, 1989, through December 31, 1992. The outcome measures of interest were Injury Severity Score, hospitalization, and mortality. RESULTS: Of all patients with unintentional injuries, 9.9% died compared with 44.8% of those whose injuries were intentionally caused. Nearly half (49.0%) of all deaths occurred in persons who were intentionally injured. Of the intentional injuries, 70% were from assaults. Self-inflicted injuries accounted for 5.2% of all injuries but 28.2% of the deaths in the registry. Firearms were most often used in both assaults (38.8%) and self-inflicted injuries (87.4%). Logistic regressions showed that, compared with unintentional injuries, assaults were more likely to occur in urban counties, among males, African Americans, and young adults. Also, compared with unintentional injuries, self-inflicted injuries were more likely to occur in urban counties, among Caucasian, and the 65+ age group. CONCLUSION: Although the overwhelming number of injuries in the registry were unintentionally caused, deaths from intentionally caused injuries accounted for almost half of all deaths. The data from Nevada's registry provided the ability to identify who is at risk for trauma-related injury and death. Prevention programs should be designed to target these populations. As prevention programs are implemented, trauma registries such as Nevada's will provide a sound source of data for assessing long-term trends in injury patterns.

Considerations in presenting, interpreting, and reviewing research findings.

By disseminating reports of well-conducted research in peer-reviewed journals, investigators regularly provide valuable information and insights to other professionals. Prospective authors of such reports should be aware that submitted manuscripts undergo considerable scrutiny and analysis by reviewers and editors as part of the publication cycle and, later, by readers for whom the information is intended. Therefore, when a researcher becomes an author, he or she should attempt to be as complete as possible in meeting the needs of those audiences. In this article, we discuss problems often found in research reports submitted to peer-reviewed journals so that investigators may improve the quality of their manuscripts.

Motor vehicle crashes, restraint use, and severity of injury in children in Nevada.

INTRODUCTION: Data from the population-based Nevada State Trauma Registry were used to examine rates and determinants of restraint use in children who were involved in a car crash and seriously injured. Patterns of injuries in these children are also assessed. METHODS: Data were obtained from children 14 years of age or younger who entered the Nevada State Trauma Registry because of a serious injury caused by a car crash. The study period was from January 1, 1989, to December 31, 1992. RESULTS: Average annual age-specific crash injury rates per 100,000 were higher in rural areas than in urban areas. In children younger than two years old, 61% were restrained at the time of the crash; however, only about one third of all children over the age of three were restrained. In ages 0-4 years, only 5.3% of the African-American children were restrained at the time of the crash compared with 47.2% of the Caucasian children. Children who were not restrained were more likely to have more adverse outcomes and to have different types of injury compared with their restrained counterparts. CONCLUSIONS: The use of restraining devices in children who suffer a serious injury in a motor vehicle crash continues to be low and appears to be related to specific demographic characteristics. The findings indicated that restraint use at the time of the crash was related to less severe injury as indicated by certain outcome variables.

Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

First year of AIDS services delivery under Title I of the Ryan White CARE Act.

This is a review of (a) the emergency assistance for ambulatory HIV medical and support services provided in the first year by eligible metropolitan areas (EMAs) funded under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, (b) the varied responses and processes by which the 16 urban areas receiving Title I funds in 1991 met legislative mandates, (c) the central nature of planning councils under Title I and their formation and functioning, and (d) issues related to current implementation and future expansion of Title I to additional eligible metropolitan areas. Integral to the review is a brief discussion of the history of AIDS and HIV infection, particularly in cities receiving CARE Act funding, an overview of Title I requirements, and a description of the organizational structures cities are using to implement Title I. Information on Title I EMAs is based on analysis of their 1991 applications, bylaws of their HIV service planning councils, intergovernmental agreements between Title I cities and other political entities, and contracts executed by Title I grantees with providers for the delivery of services. Interviews with personnel in several Title I EMAs, including planning council members and grantee staff members, provided additional information. This is the first descriptive accounting of activities related to the 1991 applications for and uses of Title I funds, and the administrative and service issues related to this process.

Geographic and gender variations in total tobacco use.

This study is the first to provide complete information on prevalence rates by gender and geographic variation for each type of tobacco product used in the United States. Results indicate that, in nearly half of all states, total tobacco use in men exceeded 40% and, in four states, exceeded 50%. In women, only Nevada, Kentucky, and Michigan reported prevalence exceeding 33%. Results also indicate, however, that concurrent use of multiple tobacco forms is relatively rare. Substantial regional variation in male total tobacco use was evident, with southern males exhibiting the highest prevalence rate (44.6%). As a result, this region represents a target group in special need of comprehensive and effective tobacco use interventions.

An evaluation of the efficacy of postoperative blood salvage after total joint arthroplasty. A prospective randomized trial.

The efficacy of a postoperative blood salvage system was assessed in 239 consecutive patients undergoing total knee or total hip arthroplasty. Patients were randomly allocated to either a control group using a standard drainage system or to the study group using the Solcotrans blood salvage canister. The median amount of homologous blood required after operation by the study group was reduced by 74% from the amount required by the control group (mean, 67 ml vs 256 ml, respectively; P less than .0001). Thirteen percent (13%) of the study group required postoperative homologous blood transfusions, as compared to 39% of the control group (P less than .0001). Additionally, patients in the study group had higher hemoglobin levels beginning on the first postoperative day. This study indicates that a postoperative blood salvage system safely and effectively reduces the amount of homologous blood required and sustains higher hemoglobin levels after operation.

Empirical considerations in orthopaedic research design and data analysis. Part III: Multivariable analysis.

To make a contribution to a base of knowledge, research design must be sound and the data must be analyzed by the most efficient, powerful method available. In conducting orthopaedic research as well as when interpreting the orthopaedic literature, knowledge of multivariable analysis is essential in evaluating the effects of variables that may confound or influence the relationship of interest. An understanding of the basic tenets, underlying assumptions, and purposes of frequently used types of multivariable analysis is necessary for an accurate, critical evaluation of a study's results.

Empirical considerations in orthopaedic research design and data analysis. Part II: The application of data analytic techniques.

To assure that a hypothesis is tested as rigorously as possible, the proper statistical method must be used to analyze the data. But without a strong background in statistics, it may be difficult to determine the efficacy of the data analytic technique used in the study. This paper describes several widely used data analytic techniques and offers examples of their proper application in orthopaedic research design.

Empirical considerations in orthopaedic research design and data analysis. Part I: Strategies in research design.

Empirical investigations have a direct effect on future therapeutic interventions. Thus, the advancement of any field of medicine is dependent upon the critical evaluation of research. Careful research design by investigators is necessary to yield meaningful, significant data. A clear understanding of basic statistical relationships is necessary for the clinician to evaluate the significance and quality of the scientific literature.

Spouse similarities in high blood pressure knowledge: implications for control of high blood pressure.

This study describes the general knowledge about high blood pressure of husbands and wives using data from all 1,260 white spouse pairs from the 1982 Connecticut Blood Pressure Survey and examines the relationship between high blood pressure knowledge and control of hypertension. We found the average level of knowledge to be high; about 70% of the items were answered correctly. The correlation between spouses' knowledge about high blood pressure was significantly high (r = .41). Multiple regression analysis was used to control for other variables that might influence the spousal correlation in knowledge. When controlling for education, age, socioeconomic status, and hypertension status of both spouses, the correlation between spouses' knowledge remained significant (r = .24). Respondents' knowledge and spouses' knowledge about high blood pressure were significantly related to high blood pressure control among hypertensive persons, particularly to being aware of hypertension and being in current treatment.

Psychosocial correlates of hemoglobin Alc in young adults with type I diabetes.

To determine whether psychosocial variables are related to long-term glycemic control; trait anxiety, depression, loneliness and life stress were assessed in 48 Type I diabetic patients. Hemoglobin A1c (HbA1c), an indicator of long-term glycemic utilization, was assayed from blood samples drawn shortly before the self-report instruments were administered. Of the psychosocial variables, anxiety was significantly related to current values of HbA1c. The association between anxiety and current HbA1c remained after statistically controlling for potentially confounding variables, including the previous value of HbA1c. Despite the stability of HbA1c values over time, anxiety scores were not significantly correlated with follow-up HbA1c. The implications of the significant relationships between psychological constructs and glycemic control are discussed.

Type A, amicability and injury: a prospective study of air traffic controllers.

Recent research has suggested that only a subset of Type A's may be at higher risk for negative health outcomes. The present prospective study of 416 air traffic controllers attempted to determine if a sub-group of Type A's who were disliked by their co-workers had significantly higher risk of injury than liked A's and all Type B's over a 27-month period. Liked B's were not different in terms of injury incidence from their not liked B counterparts (mean annualised rates of injury = 1.9 and 2.1 respectively); not liked Type A's had the highest rates of injuries of any group (8.5) including liked Type A's (3.8). Some psychological instruments were useful in discriminating the Type A not liked group from their liked counterparts and from the Type B's. These discriminating variables were used as covariates to determine if the relationship between being classified a not liked Type A and elevated injury incidence remained. Multiple regression analysis showed that distress from life events and being a not liked Type A remained significantly correlated with later injury (standardised coefficients 0.16 and 0.25 respectively).

A scale for the estimation of sleep problems in clinical research.

Problems in sleeping are widely prevalent in modern society and are often one of the presenting complaints of patients consulting physicians. In addition, there is scattered epidemiologic evidence and considerable clinical support that disturbed or inadequate sleep may be a risk factor for clinical emergence of cardiovascular disease and for total mortality. The role of sleep problems both as a precursor and as a sequela of disease states could be better delineated in large groups by the availability of a brief, reliable and standardized scale for sleep disturbance. Such a scale could also be used to evaluate the impact of different therapies upon sleep problems. This paper presents data from two study populations responding to three and four item self-report scales. From 9 to 12% of air traffic controllers reported various sleep problems to have occurred on half or more of the days during the prior month, whereas 12-22% of patients 6 months after cardiac surgery reported such frequent sleep problems. Utilizing data from the 6 and 12 month follow-ups, test-retest reliability of the three-item scale in cardiac surgery patients was found to be 0.59. Internal consistency coefficients for the three and four-item scales were 0.63 and 0.79 respectively.

The prospective impact of psychosocial variables on rates of illness and injury in professional employees.

From a prospective study of health changes in air traffic controllers, it was determined that high scores on self-report measures of work-related life change distress, other life changes outside the work setting, the type A behavior pattern, and dissatisfaction with management were positively related to future rates of injuries and physician-diagnosed acute illness episodes. Depending on the risk factor involved, high scorers on these psychosocial risk predictors incurred from 80% to 252% more future accidental injuries and from 38% to 69% more future total morbidity over a 27-month follow-up period than the men in the low scoring groups. Moreover, coworker-rated amicability, probably an indication of the amount of social support available to an individual, was significantly protective against these outcome variables, with the rarely or never chosen group experiencing 60% more total morbidity and 174% more injuries than the often chosen group. A multiple-regression equation revealed that stress, amicability, type A, and satisfaction with management had an additive effect on the outcome variables. Work- and non-work-related life change distress subscales were similar in their ability to predict later morbidity. Prediction was stronger for 27-month follow-up than for only the first 9-month period. The findings, if replicated, raise the possibility of screening programs to identify employees at high risk of future illness and injury.