Quality-of-life questionnaire for patients taking antihypertensive medication.

This study was undertaken to construct a health-related quality-of-life (QOL) questionnaire for hypertensive patients from preexisting instruments and to validate its use in full form and in a shortened version. Two hundred seventy hypertensive patients who were stable while taking antihypertensive medication (control group), changing medication because of side effects, or newly treated for hypertension were enrolled in a prospective, observational, longitudinal study. At baseline and at months 1, 2, and 3, patients completed a questionnaire covering 7 domains of QOL. The criteria for evaluating the scales were internal consistency, test-retest reliability, construct validity, and responsiveness to change. Data were analyzed for the full questionnaire and the shortened version. Internal consistency and test-retest correlation values were 0.69 to 0.95 for scales in the full questionnaire and 0.57 to 0.92 in the shortened version. Construct validity was supported by statistically significant, positive correlations with a global QOL item for all but 1 scale in both versions. Responsiveness to change was supported by increases in scores between baseline and month 3 for all scales in patients changing their medication because of side effects; scores remained unchanged (on all but 1 scale) in the stable (control) group. By uniformly applying standard validation criteria to a set of preexisting instruments, we created a new QOL questionnaire. Results were similar in both the full form and shortened version.

The naloxone test for opiate dependence.

Naloxone tests for opiate dependence were given to 296 applicants for treatment with the surrogate opiate levomethadyl acetate (LAAM, levo-alpha-acetylmethadol) and to 103 applicants for treatment with the opiate antagonist naltrexone. Thirty-five of the 296 LAAM applicants applied first for LAAM, then following detoxification, for naltrexone. There was a dramatic decrease in withdrawal signs and symptoms when the subject went from opiate-dependent to a nondependent state. From our experience, we devised a scoring guide and testing procedure based on objective signs. We propose a 2-step test, with an initial intramuscular dose, then (if necessary) an intravenous dose, to determine an applicant's eligibility for surrogate opiate or narcotic antagonist treatment.

Measurement of urine temperature as an alternative to observed urination in a narcotic treatment program.

Upper and lower limits have been determined for the temperature of freshly voided ur;ne. When specified procedures are followed, more than 99% of measurements lie between 32.5 and 36.7 degrees C. This provides a basis for monitoring urine collection in a drug abuse treatment program in a manner that does not invade privacy. The method is not foolproof, but it provides sufficient control if there are no penalties for illicit drug use so that there is no strong incentive to turn in a fraudulent urine sample.

Cigarette smoking during pregnancy and the occurrence of spontaneous abortion and congenital abnormality.

A multiple logistic regression analysis of 12,914 pregnancies and 10,523 live births, based on a mail survey of professional women in medicine, was carried out to determine the relationship between maternal cigarette smoking, and spontaneous abortion and congenital abnormality. After controlling for interfering variables (age, exposure to trace anesthetic gases, pregnancy history, and mailing response), a statistically significant increase in risk associated with maternal cigarette smoking was found for spontaneous abortions and congenital abnormalities. The risk of spontaneous abortion for the heavy smoker is estimated to be as much as 1.7 times that of the nonsmoker in certain risk groups. The risk for congenital abnormality for babies born of smoking mothers is estimated to be as much as 2.3 times that of the nonsmoker, depending on age, pregnancy history, and other factors.

PIP: In an effort to determine the relationship between maternal cigarette smoking, and spontaneous abortion and congenital abnormality, a multiple logistic regression analysis of 12,914 pregnancies and 10,523 live births, based on a mail survey of professional women in medicine, was conducted. The multiple logistic regression model, with certain interactions, appears to fit the spontaneous abortion and abnormality data well. The model provides an efficient method for adjusting for many variables, and on the basis of this approach, the following conclusions are drawn: 1) the survey data provide statistically significant indication that the risk of spontaneous abortion is substantially higher for women who smoke during pregnancy; 2) an analysis of the congenital abnormality data shows a statistically significant risk associated with maternal smoking - the relative risk ranges from 0.8 to 2.3 times that of the non-smoker, depending on age, previous pregnancy history, and exposure to the operating room. Despite the fact that the findings are retrospective survey data, obtained by mail and subject to variation in response due to the experience and background of the participant, the study confirms previous reports indicating that smoking is positively correlated with spontaneous abortion and provides evidence of a large increase in the risk of congenital abnormalities for the child born of a smoking mother.

Occupational hazards for operating room-based physicians. Analysis of data from the United States and the United Kingdom.

Comparative analysis of data from three large retrospective surveys in the United States and the United Kingdom reaffirms an increased incidence of spontaneous abortion among female physicians working in the operating room. The live-born children of female physicians exposed in the operating room also had substantially more congenital abnormalities. Male anesthetists, compared with nonanesthetist physicians, had an increased incidence of hepatic disease; there was also an increased frequency of congenital abnormality in their children. The incidence of spontaneous abortion in wives of male anesthetists and in the rate of cancer among exposed male anesthetists was similar to control. Despite differences in survey methods and analysis, there was remarkable agreement in conclusions to be drawn from the independent studies.