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Biomedical subjects

Michael Goodman

Publications and source records attributed to Michael Goodman.

25 records · Page 2Linked to original sources
PubMed2003

Low frequency of treatment of osteoporosis among postmenopausal women following a fracture.

BACKGROUND: Osteoporosis is a major cause of morbidity. Treatment of osteoporosis reduces the risk of fracture, particularly for postmenopausal women with a history of fracture. METHODS: A retrospective study was conducted using the automated databases of 7 health maintenance organizations to evaluate the use of drugs recommended for secondary prevention of osteoporotic fracture. Women 60 years and older with an inpatient or outpatient diagnostic code for a fracture of the hip, vertebra, or wrist between October 1, 1994, and September 30, 1996, and at least 1 year of continuous enrollment with a drug benefit plan following the date of fracture, were identified. The frequency of use of medications for the treatment of osteoporosis (estrogen replacement therapy, bisphosphonates, and calcitonin) during the 1-year period following the date of the initial fracture was estimated overall and according to patient age, fracture site, and year of fracture. RESULTS: During the study period, 3492 women 60 years and older were diagnosed with a fracture of the hip, vertebra, or wrist, and met the inclusion criteria. Of these patients, 822 (24%) received a drug for osteoporosis treatment during the year following the fracture. The proportion of women receiving treatment for osteoporosis was approximately 2-fold higher among those with a fracture of the vertebra (44%) than among those with a fracture of the hip (21%) or wrist (23%) (P<.001). Of the 2605 women who had not been treated for osteoporosis in the 90 days before a fracture, 14% received treatment for osteoporosis in the year following a fracture. Increasing age was associated with a reduced likelihood of receiving osteoporosis treatment (P<.001). CONCLUSIONS: Most of the older women who had experienced a fracture of the hip, vertebra, or wrist did not receive drug treatment for osteoporosis within 1 year following the fracture. Interventions to improve the detection and treatment of osteoporosis in high-risk patients need to be developed.

Aged↗
PubMed2002

Cost effectiveness of influenza vaccination for healthy persons between ages 65 and 74 years.

Healthy persons between 65 and 74 years of age represent a large proportion of the population in this age group. Internationally, there is a substantial variation in whether these people are included among the recommendations for routine influenza vaccination. We therefore conducted this study, updating an earlier analysis, to assess the health and economic benefits of routine influenza vaccination of healthy persons between 65 and 74 years of age. The health benefits associated with vaccination were estimated using the administrative data bases of a large HMO in the Minneapolis, St. Paul, Minnesota area. Multivariate models were used to estimate reductions in hospitalization and death associated with vaccination. The economic analysis took the societal perspective and presented the results as net cost or saving per 10,000 persons vaccinated and per death prevented. Direct and indirect monetary costs were included in the models and were estimated from the published literature. Monte Carlo simulation was used to conduct probabilistic sensitivity analysis in order to derive probability intervals for each estimate of net costs or savings. Over the six consecutive study seasons, 1990-1991 to 1995-1996, vaccination of healthy elderly person was associated with a 36% reduction in hospitalization for pneumonia or influenza (95% CI, 2-39%), an 18% reduction in hospitalization for all respiratory conditions (95% CI, -6 to 37%) and a 40% reduction in death (95% CI, 14-38%). Vaccination was also associated with cost savings in all scenarios evaluated. The findings of this study again affirm the value of an age-based strategy for routine influenza vaccination of all elderly persons including healthy elderly persons between 65 and 74 years.

Aged↗
PubMed2002

Gastric and duodenal safety of daily alendronate.

BACKGROUND: Isolated case reports of gastric ulcers after alendronate sodium use raised concern about the gastroduodenal safety of daily alendronate. This study was conducted to estimate the excess risk of hospitalizations for gastric or duodenal perforations, ulcers, and bleeding associated with alendronate use. PARTICIPANTS AND METHODS: Study subjects were 6432 men and women, 35 years or older. The subjects were members of 8 health maintenance organizations who were dispensed alendronate from October 1995 through September 1997. There was also a group of 33 176 age-, sex-, and health maintenance organization-matched unexposed persons. Because of concerns that osteoporosis might confound the association between alendronate use and perforation, ulcer, or bleeding, a second comparison group of 9776 women, 60 years or older, who had osteoporotic fractures was assembled. Hospitalizations for gastroduodenal events were identified by discharge diagnosis codes in automated claims records, and confirmed by manual record review. RESULTS: Based on the 14 confirmed events in the alendronate group and 35 in the unexposed group, the crude incidence rate ratio of gastroduodenal perforation, ulcer, or bleeding for the alendronate cohort was 3.0. The incidence rate ratio was 1.8 (95% confidence interval, 0.8-3.9) after control for prior hospitalizations, comorbidity, and recent exposure to prescription nonsteroidal anti-inflammatory drugs and oral corticosteroids. The crude incidence ratio rate for the age, sex, and health maintenance organizations-restricted cohort of alendronate users relative to the fracture cohort was 1.1 and the adjusted incidence rate ratio was 1.1 (95% confidence interval, 0.6-2.2). CONCLUSIONS: Osteoporosis and related factors appear to play an important role in the relationship between alendronate use and confirmed gastroduodenal perforation, ulcer, or bleeding; a substantial fraction of the increased risk we observed for alendronate users in the unadjusted analysis was the result of confounding.

Adult↗
PubMed2002

Validation of diagnoses of peptic ulcers and bleeding from administrative databases: a multi-health maintenance organization study.

The automated health plan data and data from medical chart abstractions from eight large health maintenance organizations were used to evaluate the positive predictive values (PPVs) of the International Classification of Diseases, 9th revision (ICD-9) codes for cases of peptic ulcers and upper gastrointestinal bleeding. Overall, 207 of 884 cases of peptic ulcers and upper gastrointestinal bleeding (23%) were confirmed by surgery, endoscopy, X-ray, or autopsy. The PPVs were 66% for hospitalizations with codes for duodenal ulcer (ICD-9-CM 532), 61% for gastric/gastrojejunal ulcer (ICD-9-CM 531, 534), 1% for peptic ulcer (ICD-9-CM 533), and 9% for gastrointestinal hemorrhage (ICD-9-CM578). The overall and diagnostic category-specific PPVs were generally similar for the various HMOs. This study, using data from a large number of health plans located in different geographical regions, underscores the importance of evaluating the accuracy of the diagnoses from automated health plan databases.

Adult↗
PubMed2002

Evaluation of potential confounders in planning a study of occupational magnetic field exposure and female breast cancer.

We examined potential confounding factors that, if unaccounted for, could possibly produce a spurious association in a study of breast cancer among women occupationally exposed to magnetic fields. For each risk factor, we estimated strength of association, prevalence in the general population, and prevalence of the risk factor in the exposed group required to explain completely hypothetical odds ratios between occupational exposure to magnetic fields and breast cancer. We performed similar analyses for two, three, four, and five confounding factors acting simultaneously. Factors numerically capable of substantial confounding included obesity, continent of birth, family history of breast cancer in a first-degree relative, densities on the mammogram, benign proliferative breast disease, history of cancer in one breast, and consumption of at least two alcoholic drinks per day. Nevertheless, only continent of birth, history of cancer, obesity, and consumption of alcohol could potentially be related to occupation. Uncontrolled confounders, either alone or in combination, could possibly account for odds ratios in the 1.2-1.3 range but were very unlikely to produce an odds ratio of more than 1.5. A spurious negative association between magnetic fields and breast cancer could occur if the exposed group included a large number of immigrants from Asia and Africa.

Adult↗