Measuring All-Cause Mortality With the Census Numident File

OBJECTIVES

To assess the quality of population-level US mortality data in the US Census Bureau Numerical Identification file (Numident) and describe the details of the mortality information as well as the novel person-level linkages available when using the Census Numident.

METHODS

We compared all-cause mortality in the Census Numident to published vital statistics from the Centers for Disease Control and Prevention. We provide detailed information on the linkage of the Census Numident to other Census Bureau survey, administrative, and economic data.

RESULTS

Death counts in the Census Numident are similar to those from published mortality vital statistics. Yearly comparisons show that the Census Numident captures more deaths since 1997, and coverage is slightly lower going back in time. Weekly estimates show similar trends from both data sets.

CONCLUSIONS

The Census Numident is a high-quality and timely source of data to study all-cause mortality. The Census Bureau makes available a vast and rich set of restricted-use, individual-level data linked to the Census Numident for researchers to use.

PUBLIC HEALTH IMPLICATIONS

The Census Numident linked to data available from the Census Bureau provides infrastructure for doing evidence-based public health policy research on mortality.

Using the Working Model of Adjustment to Chronic Illness to explain the burden of recurrent urinary tract infection: A survey-based study

Introduction

The treatment of recurrent urinary tract infection (RUTI) with antibiotics is causing concern as patients are often prescribed an inappropriate course of antibiotics, and the recurrence rate remains at 30–44% following treatment (1). Overprescription of antibiotics can also cause antimicrobial resistance. Given the current lack of adequate clinical guidelines for RUTI treatment, it is necessary for this population to adjust to living with a chronic condition, and research suggests that RUTI may be associated with poor mental health and a lower quality of life. Thus, there is a need for a more interdisciplinary approach to understanding RUTI, to inform additional treatment options.

Aim

The current study aimed to use the Working Model of Adjustment to Chronic Illness (WMACI) (see Figure 1) to explore the personal, physical and social burden of RUTI (2).

Methods

A cross-sectional survey was employed, which was informed by existing questionnaires and reviewed by experts including pain specialists (n = 6). 5,078 participants accessed liveutifree.com to seek information regarding their condition and completed the Live UTI Free survey. Participants provided information on their experiences with RUTI (recurrence rate, symptoms, pain intensity, triggers and comorbidity) and the associated burden. Binomial logistic regressions were conducted to assess the effect of RUTI characteristics on the likelihood of experiencing personal, physical and social burden.

Results

RUTI predicted greater likelihood of personal burden (enjoyment of life; enjoyment of favourite activities; mental health) (R² = 18.8 – 20.8, p = <.001), physical burden (sleep; activities of daily living; maintaining a healthy lifestyle; sexual behaviour) (R² = 21.1 – 35.9, p = <.001), and social burden (normal work; finances; relationships with friends and family; relationships with partners) (R² = 17.0 - 25.8, p = <.001), with the burden associated with sexual behaviour showing the largest amount of variance. Rate of recurrence, symptom burden, pain intensity, and having an additional diagnosis of Interstitial Cystitis (IC) were most predictive of participant burden.

Conclusion

RUTI was associated with all areas of burden. Some factors, including pain intensity and having an additional diagnosis of IC, affected a majority of areas. Predicted burden from having an additional diagnosis of IC may be a result of lack of clarity between the two diagnoses, which have shared symptom indicators and rely on urine culture testing, which has been demonstrated to be inaccurate. Misdiagnosis, or a dual diagnosis, may consequently contribute to burden. The WMACI was used to suggest how burden can lead to poor illness adjustment. Limitations of the study were that it did not explore the possibility of misdiagnosis and its impact, or investigate the effects of SES and country-level differences. However, the findings of the study have important clinical implications, as patients worldwide who are suffering with RUTI are required to manage significant burden that is associated with the condition, and this is an important issue which needs to be addressed in primary care settings. An interdisciplinary approach in primary care settings is recommended, which acknowledges the psychosocial burden that persists when treatment fails to resolve physical symptoms.

References

1. Gupta K, Trautner BW. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ (Online). 2013; 346: f3140.

2. Moss-Morris R. Adjusting to chronic illness: Time for a unified theory. British Journal of Health Psychology. 2013; 681–686.

Racial Disparities In Excess All-Cause Mortality During The Early COVID-19 Pandemic Varied Substantially Across States

The impact of the coronavirus disease 2019 (COVID-19) pandemic has been starkly unequal across race and ethnicity. We examined the geographic variation in excess all-cause mortality by race and ethnicity to better understand the impact of the pandemic. We used individual-level administrative data on the US population between January 2011 and April 2020 to estimate the geographic variation in excess all-cause mortality by race and Hispanic origin. All-cause mortality allows a better understanding of the overall impact of the pandemic than mortality attributable to COVID-19 directly. Nationwide, adjusted excess all-cause mortality during that period was 6.8 per 10,000 for Black people, 4.3 for Hispanic people, 2.7 for Asian people, and 1.5 for White people. Nationwide averages mask substantial geographic variation. For example, despite similar excess White mortality, Michigan and Louisiana had markedly different excess Black mortality, as did Pennsylvania compared with Rhode Island. Wisconsin experienced no significant White excess mortality but had significant Black excess mortality. Further work understanding the causes of geographic variation in racial and ethnic disparities-the relevant roles of social and environmental factors relative to comorbidities and of the direct and indirect health effects of the pandemic-is crucial for effective policy making.

CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease - A Call to Action

1. Non-melanoma skin cancer (NMSC) is by far the most common cancer diagnosed in westernized countries, and one of the few almost preventable cancers if detected and treated early as up to 90% of NMSC may be attributed to excessive exposure to ultraviolet radiation. 2. The incidence of NMSC is increasing: 2-3 million people are diagnosed worldwide annually, with an average yearly increase of 3-8% among white populations in Australia, Europe, the US and Canada over the last 30 years. 3. The link between solar ultraviolet (UV) radiation and certain forms of NMSC is clearly recognized. It is estimated that outdoor workers are exposed to an UV radiation dose 2-3 times higher than indoor workers, and there is a growing body of research linking UV radiation exposure in outdoor workers to NMSC: I. Occupationally UV-exposed workers are at least at a 43% higher risk of basal cell carcinoma (BCC) and almost doubled risk of squamous cell carcinoma (SCC) compared to the average population, with risk increasing with decreasing latitude. II. The risk for BCC, SCC and actinic keratosis (AK) among workers who have worked outdoors for more than 5 years is 3-fold higher than the risk among those with no years of working outdoors. 4. Primary prevention, early detection, treatment and regular follow-up of skin cancer (NMSC and melanoma) are shown to be beneficial from a health economic perspective. 5. Action is needed at international, European and national level to legislate for recognizing AK and NMSC as an occupational disease, which has the potential to improve access to compensation and drive preventative activities. 6. This report is a Call to Action for: I. The engagement of key stakeholders, including supranational institutions, national governments, trade organizations, employers, workers and patient organizations to drive change in prevention and protection of at-risk groups. II. Employers should be obliged to prevent outdoor worker's UV exposure from exceeding limit values, and to implement occupational skin cancer screening programmes among the at-risk workforce. III. Educational programmes for the outdoor workforce are needed to improve health literacy and drive behavioural change. IV. Nationally, steps to improve notifications and surveillance of skin cancers through both occupational services and public health programmes are required. V. Future research activities should focus on the precise definition of at-risk groups among outdoor workers through increased data gathering, including UV-dosimetry, and evaluation.

Is Mississippi's prescription-only precursor control law a prescription to decrease the production and raise the price of methamphetamine?

BACKGROUND

In 2010, Mississippi became the second state to require a prescription to purchase pseudoephedrine-based medications. Proponents of "prescription-only" laws argue that they are necessary to disrupt methamphetamine markets, but critics note the costs to legal consumers of cold medications may offset some of the laws' intended benefits.

OBJECTIVE

We evaluated the effect of prescription-only restrictions for methamphetamine precursors on state-level methamphetamine lab seizures and methamphetamine prices.

METHODS

We used a synthetic control approach to create a control state comparable to Mississippi and then used permutation testing to determine if the resulting difference was statistically significant.

RESULTS

We found that Mississippi's prescription-only law removed 2637 small methamphetamine labs in the two years after the law became effective, which represents a 77% reduction in small labs relative to the synthetic counterfactual. We found no evidence that the law impacted methamphetamine prices.

CONCLUSION

We conclude that while prescription-only laws can reduce the number of domestic small methamphetamine labs in operation, methamphetamine availability is unlikely to be materially impacted.

Willingness-to-accept pharmaceutical retail inconvenience: evidence from a contingent choice experiment

OBJECTIVES

Restrictions on retail purchases of pseudoephedrine are one regulatory approach to reduce the social costs of methamphetamine production and use, but may impose costs on legitimate users of nasal decongestants. This is the first study to evaluate the costs of restricting access to medications on consumer welfare. Our objective was to measure the inconvenience cost consumers place on restrictions for cold medication purchases including identification requirements, purchase limits, over-the-counter availability, prescription requirements, and the active ingredient.

METHODS

We conducted a contingent choice experiment with Amazon Mechanical Turk workers that presented participants with randomized, hypothetical product prices and combinations of restrictions that reflect the range of public policies. We used a conditional logit model to calculate willingness-to-accept each restriction.

RESULTS

Respondents' willingness-to-accept prescription requirements was $14.17 ($9.76-$18.58) and behind-the-counter restrictions was $9.68 ($7.03-$12.33) per box of pseudoephedrine product. Participants were willing to pay $4.09 ($1.66-$6.52) per box to purchase pseudoephedrine-based products over phenylephrine-based products.

CONCLUSIONS

Restricting access to medicines as a means of reducing the social costs of non-medical use can imply large inconvenience costs for legitimate consumers. These results are relevant to discussions of retail access restrictions on other medications.

Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance

Objective: To examine the effectiveness of whole body vibration (WBV) on tone, muscle force, sensation and functional performance in people with multiple sclerosis.

Design: A randomized cross-over pilot study.

Setting: Revive MS Support Therapy Centre. Glasgow, UK.

Subjects: Sixteen people with multiple sclerosis were randomly allocated to one of two groups.

Intervention: Group 1 received four weeks of whole body vibration plus exercise three times per week, two weeks of no intervention and then four weeks of exercise alone three times per week. Group 2 were given the two treatment interventions in the reverse order to group 1.

Main measures: Ten-metre walk, Timed Up and Go Test, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale (MSSS-88), lower limb muscle force, Nottingham Sensory Assessment and Multiple Sclerosis Impact Scale (MSIS-29) were used before and after intervention.

Results: The exercise programme had positive effects on muscle force and well-being, but there was insufficient evidence that the addition of whole body vibration provided any further benefit. The Modified Ashworth Scale was generally unaffected by either intervention, although, for each group, results from the MSSS-88 showed whole body vibration and exercises reduced muscle spasms (P = 0.02). Although results for the 10-m walk and Timed Up and Go Test improved, this did not reach statistical significance (P = 0.56; P = 0.70, respectively). For most subjects sensation was unaffected by whole body vibration.

Conclusion: Exercise may be beneficial to those with multiple sclerosis, but there is limited evidence that the addition of whole body vibration provides any additional improvements. Further larger scale studies into the effects of whole body vibration in people with multiple sclerosis are essential.

Normal anatomy and common labral lesions at MR arthrography of the shoulder

MR arthrography of the shoulder is the most accurate imaging modality in demonstrating abnormalities of the glenoid labrum and associated structures. Tears of the labrum, the capsule or the gleno-humeral ligaments can lead to pain, catching, popping or instability. The anatomy of this region is complex. We present the normal anatomy of the glenoid labrum, biceps anchor and gleno-humeral ligaments together with their normal variants and then describe common labral-ligamentous pathologies.

Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience

OBJECTIVE

To evaluate two separate MR sequences acquired in the axial oblique plane, parallel to the long axis of the scapholunate (SL) and lunotriquetral (LT) ligaments, to determine whether the addition of these sequences to the standard MR wrist examination improves visualization of the intrinsic ligaments, and the evaluation of their integrity. To our knowledge, this plane has not been described in the literature previously.

DESIGN AND PATIENTS

In total we evaluated 26 patients with chronic wrist pain or instability, referred for MR imaging following assessment by an orthopedic surgeon or physiatrist. All patients underwent initial conventional tri-compartment wrist arthrography, which served as the reference standard. This was immediately followed by MR arthrography, in the standard coronal and true axial planes, as well as in the axial oblique plane. The SL and LT ligaments were initially assessed for the presence or absence of tear, using the standard coronal and true axial sequences, and subsequently re-evaluated with the addition of the axial oblique planes.

RESULTS

A total of ten intrinsic ligament tears were identified with conventional arthrography: six SL and four LT tears. Five of the six SL tears were identified on the standard sequences. All six were diagnosed with the addition of the oblique sequences. There were three false-positive SL tears identified using standard MR imaging, and two false-positives with the addition of the oblique sequences. No LT tear was identified on standard sequences, whereas all four were confidently seen with the addition of oblique images. No false-positives of the LT ligament were recorded with either standard or axial oblique sequences.

CONCLUSION

The study suggests that the addition of axial oblique MR sequences helps identify tears to the intrinsic ligaments of the wrist, particularly the LT ligament. In addition, the axial oblique images assist in localization of the tear.

Ultrasound of intrinsic wrist ligament and triangular fibrocartilage injuries

OBJECTIVE

The objective of this study was to evaluate ultrasound as a diagnostic tool for investigating scapholunate and lunatotriquetral ligamentous and triangular fibrocartilage (TFC) tears. Ultrasound findings were compared to conventional arthrogram findings, as the reference gold standard.

DESIGN AND PATIENTS

In total 26 patients, 17 males and 9 females ranging in age from 17 to 35 (mean age, 34), were evaluated on referral for investigation of wrist pain. All patients were examined by high resolution ultrasound, using a 9-13 MHz transducer. All wrist ultrasound examinations were also compared to conventional tricompartmental arthrography, as the diagnostic gold standard reference.

RESULTS

All ten scapholunate tears confirmed on arthrography were detected on ultrasound. Two of 8 lunatotriquetral and 7 of 11 TFC tears were correctly diagnosed on ultrasound. Sensitivity of ultrasound diagnosis ranged from 25% for lunatotriquetral tears to 100% for scapholunate tears. No false positive results were recorded for any of the three examined structures.

CONCLUSION

The study results suggest that sonography is accurate for scapholunate tears, but is not accurate for evaluation of lunate-triquetral tears. It has intermediate accuracy for triangular fibrocartilage tears.

Ultrasound of the elbow

The elbow is an important synovial hinge joint of the upper extremity. This joint represents a common site of musculoskeletal symptomatology, affecting all age groups. The advantages of ultrasound imaging of the elbow include easy availability, multiplanar capability and the ability to assess structures dynamically. Patient symptomatology and site of maximal tenderness can be directly correlated with imaging findings. Comparison is easily made with the contralateral side. Particular strengths include the ability to assess para-articular structures, such as regional tendons and ligaments, in addition to assessment of joint effusions, loose bodies and regional bursae. With operator experience and excellent technique, ultrasound is a valuable imaging tool for assessment of disorders of the elbow joint.

Ultrasound of the knee

Ultrasound is emerging as a viable imaging modality in the diagnosis and assessment of the musculoskeletal system. Advantages of ultrasound include its easy availability and multiplanar capability, as well as economic advantages. Unlike magnetic resonance imaging, ultrasound demonstrates the fibrillar microanatomy of tendons, ligaments and muscles, enhancing its diagnostic capability. The ability to compress. dynamically assess structures and compare easily with the contralateral side is advantageous. The patient's exact point of clinical tenderness can be correlated with underlying anatomical structures and associated pathology. The main strength of knee ultrasound is the assessment of para-articular disease. The specific structures best suited for ultrasound assessment include tendons, muscles and ligaments, as well as periarticular soft tissue masses. Joint effusions, synovial thickening, bursal fluid collections, intra-articular loose bodies, ganglion cysts, ligament and tendons tears, tendonitis and occult fractures can be diagnosed. With experience, ultrasound is a time-efficient, economical imaging tool for assessment of the knee.

Imaging of chronic recurrent multifocal osteomyelitis

The disease of CRMO is a "great clinical and radiologic mimic. There are no specific clinical or laboratory findings and no pathognomonic imaging or pathologic features have been described. Because the disease is not well known by clinician, radiologist, and pathologist alike, it is likely to be more common than the literature implies. It has been suggested that the diagnosis of CRMO requires an interdisciplinary team approach dependent on the cooperation of the pediatrician, orthopedic surgeon, pathologist, and microbiologist. We strongly advocate the addition of the radiologist to this list. We believe that it is the informed radiologist who frequently suggests the correct diagnosis.

Neuritis of the lateral femoral cutaneous nerve in leprosy

Neuritis of the lateral femoral cutaneous nerve (meralgia paresthetica) is observed more frequently in leprosy than in nonleprosy patients, and its symptoms can easily be confused with those suggesting, e.g., ischialgia. The diagnosis can be confirmed by a diagnostic block with a local anesthetic solution. Analgesics, antiinflammatory drugs, bed rest and, in severe cases, therapeutic blocks were successfully applied in the treatment of the neuritis, and no surgical intervention was needed. Three leprosy patients with severe meralgia paresthetica are presented.