Hydraulic and hydrogeochemical characteristics of a riverbank filtration site in rural India.

A riverbank filtration (RBF) system was tested along the Kali River in rural part of the state of Karnataka in India. The polluted river and water from open wells served the local population as their principal irrigation water resource and some used it for drinking. Four RBF wells (up to 25 m deep) were installed. The mean hydraulic conductivity of the well field is 6.3 x 10(-3) cm/s and, based on Darcy's law, the water travel time from the river to the principal RBF well (MW3) is 45.2 days. A mixing model based on dissolved silica concentrations indicated that, depending on the distance from the river and closeness to irrigated rice fields, approximately 27 to 73% of the well water originated from groundwater. Stable isotopic data indicates that a fraction of the water was drawn in from the nearby rice fields that were irrigated with river water. Relative to preexisting drinking water sources (Kali River and an open well), RBF well water showed lower concentration of dissolved metals (60.1% zinc, 27.8% cadmium, 83.9% lead, 75.5% copper, 100% chromium). This study demonstrates that RBF technology can produce high-quality water from low-quality surface water sources in a rural, tropical setting typical for many emerging economies. Further, in parts of the world where flood irrigation is common, RBF well water may draw in infiltrated irrigation water, which possibly alters its geochemical composition. A combination of more than one mixing model, silica together with stable isotopes, was shown to be useful explaining the origin of the RBF water at this study site.

Consumer involvement: effects on information processing from over-the-counter medication labels.

The objective of this study was to evaluate the effects of consumer involvement on information processing from over-the-counter (OTC) medication labels. A sample of 256 students evaluated simulated OTC product labels for two product categories (headache and cold) in random order. Each participant evaluated labels after reading a scenario to simulate high and low involvement respectively. A questionnaire was used to collect data on variables such as label comprehension, attitude-towards-product label, product evaluation, and purchase intention. The results indicate that when consumers are involved in their purchase of OTC medications they are significantly more likely to understand information from the label and evaluate it accordingly. However, involvement does not affect attitude-towards-product label nor does it enhance purchase intention.

Effect of sumatriptan on health care resource use among patients with migraine.

Previous investigations examining health care resource utilization in patient populations have shown patients with migraine to consume significantly higher health care resources compared with individuals without migraine. The purpose of this study was to compare health care resource and narcotic use in migraineurs prescribed sumatriptan (oral, subcutaneous, or nasal) with those not prescribed sumatriptan.

Health care utilization by migraine patients: a 1998 Medicaid population study.

BACKGROUND: In the last decade, a number of studies have documented the economic impact of migraine headaches on society. Although previous research has shown that patients with migraine headache consume a greater amount of health care resources than those without migraine, the economic impact of this condition on a Medicaid population has not been assessed. OBJECTIVE: The purpose of this study was to compare the health care resource utilization of-patients with and without migraine headache in the Idaho Medicaid population. METHODS: Idaho Medicaid claims from 1998 were reviewed to identify cases and controls. Four controls, matched for age, sex, race, and residence, were obtained for each case. Physician services, hospital services, emergency room services, and prescription use were compared between the 2 groups. Multivariate analyses were performed to determine differences between the 2 groups after controlling for potential confounders. RESULTS: Eighty percent of the cases were female, and 94% of the patients were white. Patients with migraine headache had statistically significantly higher health care resource consumption than matched controls (P < 0.05). Total log costs for prescription use, physician services, and hospital services were significantly higher (P < 0.001) in the migraine group even after controlling for migraine-associated comorbid conditions and demographic variables. CONCLUSIONS: Total health care costs for migraine patients were 1.6 times higher than for matched controls. The results of this study suggest that migraine is a significant economic burden to the Medicaid program.

An epidemiological case-control study of migraine and its associated comorbid conditions.

BACKGROUND: The economic impact of migraine to society has been well documented. However, few studies have identified the risk of migraine-specific comorbid conditions to explain the higher healthcare resource utilization by migraineurs. Because comorbidity has the potential to increase treatment costs, estimating its risks and its economc impact becomes imperative.OBJECTIVES: To estimate the risk for migraine by presence of a defined set of comorbidities, and to quantify the association of estimated healthcare costs between the case-control groups with and without comorbidity.METHODS: A matched case-control was designed using data from 1998 Idaho Medicaid claims. Cases were identified by physician-diagnoses and migraine-specific medication use. A 1:1 matching was performed on age, race, gender, and residence. Presence of comorbidity was determined by ICD-9 diagnostic categories. Total healthcare resource utilization was estimaed for all physician, hospital (inpatient and outpatient), and emergency services, including prescription medicines paid by Idaho Medicaid. Multivariate logistic regression was used to compute the odds ratio controlling for the matching variables. Multiple-regression models were used to quantify the association of total healthcare costs.RESULTS: Migraine patients were approximately five times more likely (Odds Ratio = 5.34; Confidence Interval(95%)-4.38 to 6.52) than their controls to be diagnosed with comorbid condition(s). A model with variables of age, gender, presence of comorbidity and migraine, explained approximately 21% of the variance in healthcare utilization (p < 0.05).CONCLUSIONS: Migraine patients are at a higher risk for defined comorbid conditions resulting in significantly higher healthcare costs as compared to non-migraine patients.

Positive impact of a follow-up phone call to community pharmacies in a medicaid drug utilization program.

OBJECTIVE: To evaluate the impact of including community pharmacists in strategies to alter excessive prescribing of antiulcer medications (AUMs) in a statewide drug utilization review (DUR) program. Mailing educational materials to physicians is a common intervention strategy of retrospective DUR programs. However, pharmacists are typically left out of this process, ignoring a possibly influential healthcare provider. METHODOLOGY: Patients without gastroesophageal reflux disease who received > or = 1.0 normalized therapeutic equivalents (e.g., 1.0 NTE = ranitidine 300 mg/d or omeprazole 20 mg/d) for five of six prior months were included. The pharmacists and physicians of these patients were divided into one of three geographically distinct groups: group 1 physicians received mailed materials only (pharmacists were not contacted); group 2 physicians and pharmacists received mailed materials only; and group 3 physicians and pharmacists received mailed materials, and the pharmacists were contacted by phone. Mean NTE and AUM costs were analyzed six months before and six months following the intervention. RESULTS: One hundred thirty-eight, 329, and 248 patients were included in G1, G2, and G3, respectively. There was a 12.4%, 8.0%, and 14.0% reduction in NTE for G1, G2, and G3, respectively. G1 AUM cost decreased 7.7% ($7710); G2 decreased 6.8% ($14 037); G3 decreased 20.5% ($26722). The total decrease in AUM cost for the entire cohort from before to after the intervention was $48469 (p < 0.05) in the six months following the intervention. CONCLUSIONS: A follow-up phone call to pharmacists in a statewide DUR intervention enhances the effectiveness of DUR interventions under the conditions studied. Enlisting the support of community pharmacists may improve the cost savings of these interventions.

Readability of over-the-counter medication labels.

OBJECTIVE: This study evaluated information on over-the-counter (OTC) medication labels. Brand-name OTC products were examined to determine compliance with the Label Readability Guidelines recommended by the Nonprescription Drug Manufacturers Association (NDMA). Additionally, the use of pictures on OTC medication labels was assessed. The effect of pictures on other aspects of label design that may affect comprehension was also evaluated. DESIGN: We evaluated 100 OTC medication labels (20 analgesics and 80 cold/cough products). Assessment of label content was based on certain aspects of label design, such as package size, font size of written information, format of information on warnings and indications, use of pictures, and use of advertising claims on product labels. RESULTS: Many products evaluated did not meet NDMA guidelines. Even when font size of product name increased with increase in package size, font size on warnings and indications remained constant at 6 points. Lack of boldface (63%), use of all uppercase font (30%), use of hyphenation (49%), lack of paragraph breaks (19%), and the small font size of 6 points or less (98%) could reduce readability. Packages containing pictures were significantly larger than packages without pictures. Several packages (30%) contained pictures in the indications section. Many products contained advertising claims that were classified as "green" or "quality" (41%) and "free" (38%). Additionally, 43 different advertising claims were identified; some of these may be difficult for patients to interpret. CONCLUSIONS: The findings may help FDA develop specific regulations to improve label readability. Pharmacists who recommend OTC products to consumers should be aware of these issues and evaluate requests by consumers regarding OTC drugs accordingly.

An investigative model evaluating how consumers process pictorial information on nonprescription medication labels.

Currently, marketed over-the-counter (OTC) medication labels were simulated and tested in a controlled environment to understand consumer evaluation of OTC label information. Two factors, consumers' age (younger and older adults) and label designs (picture-only, verbal-only, congruent picture-verbal, and noncongruent picture-verbal) were controlled and tested to evaluate consumer information processing. The effects exerted by the independent variables, namely, comprehension of label information (understanding) and product evaluations (satisfaction, certainty, and perceived confusion) were evaluated on the dependent variable purchase intention. Intention measured as purchase recommendation was significantly related to product evaluations and affected by the factor label design. Participants' level of perceived confusion was more important than actual understanding of information on OTC medication labels. A Label Evaluation Process Model was developed which could be used for future testing of OTC medication labels.

How the elderly and young adults differ in the decision making process of nonprescription medication purchases.

The study compared elderly and young adults in their behavior and involvement in the decision making process of over-the-counter (OTC) medication purchases. Elderly subjects were more involved in the decision making process to purchase OTC medications compared to young adults. The elderly not only purchase and spend more money on medications but also read OTC labels completely. They requested help from the pharmacist more frequently than young adults. Needs of the elderly in making an OTC medication purchase were different compared to young adults. The two age groups differed on importance rating for several attributes regarding OTC medications, such as; ease of opening the package, child resistant package, side effects of medicine, manufacturer of medicine, print size on package labels, and greater choice of medicine.

Atropine and ephedrine adsorption to syringe plastic.

The purpose of this study was to compare daily changes in the concentration of atropine or ephedrine sulfate solutions that had been stored up to 4 days in plastic or glass syringes. Sets of three plastic and one glass syringe were used for each drug; the glass syringes acted as controls. Each set of syringes was labeled as day 0, 1, 2, 3, or 4. Syringes with medication were laid horizontally, had needles attached, and were stored in the dark at an ambient temperature. Each day, the assigned set of syringes was analyzed by high-performance liquid chromatography. Results showed that the change in the ephedrine sulfate concentration in the plastic syringes from day 0 to day 4 was less than 1.4%. Atropine sulfate decreased 52% over 4 days, with the largest single drop occurring during the first 24 hours. It can be concluded that the two brands of ephedrine sulfate stored up to 4 days at ambient temperature in the brand of syringe used do not significantly decrease in concentration. However, this was not the case with the brand of atropine sulfate studied. The practice of storing atropine sulfate in plastic syringes should be discouraged, because of the possibility of loss of potency due to medication adsorption to syringe plastic.

Pilot study--an investigation of the sources and satisfaction of medication information provided to the elderly.

Studies have shown that consumers, in general, do not know everything they should know or would like to know about the medicines they are taking. In addition, several studies report that many older individuals are reluctant to ask questions about the medicines they are taking. This pilot study was conducted to assess the sources from which the elderly obtain their information about prescription and non-prescription medicines and their level of satisfaction with each source. The study results reveal that over half of those surveyed indicated that they received no information about prescription or non-prescription medicines. Further, a large percentage of those surveyed stated that they would like to receive information about non-prescription medicines from a health provider. The findings suggest that pharmacists should routinely provide information to the elderly about all aspects of their medication treatment.

Electrical impedance measurements: rapid method for detecting and monitoring microorganisms.

A conceptually simple and east-to-use technique is described that uses continuous impedance measurements for automated monitoring of microbial growth and metabolism. The method has been applied to a wide range of microorganisms. Optical clarity is not required. The sensitivity and reproducibility of the method are demonstrated. The mechanism whereby microbial growth alters the impedance of the medium is discussed, as well as potential applications of the method to clinical microbiology.

Impedimetric screening for bacteriuria.

A rapid, automated instrumental procedure for distinguishing urine cultures containing greater than 10(5) organism per ml is described. The method is based upon the measurement of changes in impedance that take place as microorganisms alter the chemical composition of the medium. The time required to detect impedance change is inversely related to the initial concentration of microorganisms in the sample. By defining an impedance-positive culture as one that gives detectable impedance change within 2.6 h, 95.8% of 1,133 urine cultures tested were correctly classified as containing more than or fewer than 10(5) organisms per ml. Selection of a longer detection time decreases false negative results at the cost of increased false positive results. Impedance screening is compared with screening data reported in the literature using adenosine-5'-triphosphate detection, microcalorimetry, electrochemical measurements, and optical microscopy.

Automated Impedance Measurements for Rapid Screening of Milk Microbial Content.

The electrical impedance of media is altered with chemical changes brought about by microbial metabolism and growth. Time required to bring about readily detectable change (detection time - DT) is a function of the initial levels of microorganisms in the sample. DTs were compared to Standard Plate Counts for 407 milk samples - homogenized, low fat, skim and raw. Using the criterion that a sample of pasteurized milk with a DT of 7 h or less was indicative of a plate count of 10,000/ml or greater, 323 of 380 samples were correctly classified. For raw milk, the DT was 10 h to resolve samples into greater or less than 10,000 organisms per ml. Results of a preliminary study on estimation of psychrotrophs in pasteurized milk showed that impedance monitoring at 21 C provided a 22-h screen correctly classifying 88% of the samples into categories of more than or less than 1,000 organisms per ml. Better agreement (91%) in a shorter time (13.7 h) was obtained with a screen for 10,000 organisms. Finally, for the first 22 samples analyzed, keeping quality data on pasteurized milk have correlated better with post-pasteurization impedance measurements than with either post-pasteurization total counts or psychrotrophic counts.

Rapid detection of microbial contamination in frozen vegetables by automated impedance measurements.

Automated impedance measurements can be used to rapidly assess whether a sample of frozen vegetables contains greater or less than 10(5) organisms per g. Microorganisms growing pureed food samples cause a change in the impedance of the medium when the organisms reach a threshold concentration of between 10(6) and 10(7) organisms per ml. Estimates of the concentration of microorganisms initially present in the food sample can be made by recording the time required for the organisms in the sample to replicate to threshold levels. In this study, the detection times for 357 samples of frozen vegetables were compared with standard plate counts for each sample. The agreement between the two methods in distinguishing samples containing more than 10(5) organisms per g was 92.6% for 257 assorted frozen vegetables and somewhat higher (93 to 96%) when separate cutoff times were used for each type of vegetable. The time required for analysis was about 5 h, compared to the 48 to 72 h required for standard plate counts.