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Biomedical subjects

P S Millard

Publications and source records attributed to P S Millard.

At least 19 recordsLinked to original sources
PubMed1999

A deviation bar chart for detecting dengue outbreaks in Puerto Rico.

OBJECTIVES: A Centers for Disease Control and Prevention deviation bar chart (Statistical Software for Public Health Surveillance) and laboratory-based surveillance data were evaluated for their utility in detecting dengue outbreaks in Puerto Rico. METHODS: A significant increase in dengue incidence was defined as an excess of suspected cases of more than 2 SDs beyond the mean for all 4-week periods from April through June (the period of lowest seasonal incidence), 1989 through 1993. An outbreak was defined as a cumulative annual rate of reported dengue greater than 3 per 1000 population. RESULTS: Retrospective application of the system to 1994 data showed agreement with previous analyses. In 1995 and 1996, 36.4% and 27.3%, respectively, of municipalities with a significant increase in reports for 2 or more consecutive weeks before the first week of September had an outbreak, compared with 9.0% (in 1995, P = .042) and 6.0% (in 1996, P = .054) of towns without a significant increase. The system showed sensitivity near 40%, specificity near 89%, and accuracy in classifying municipalities near 84%. CONCLUSIONS: This method provides a statistically based, visually striking, specific, and timely signal for dengue control efforts.

Data Interpretation, Statistical↗
PubMed1998

Screening calcaneal ultrasound and risk factors for osteoporosis among lesbians and heterosexual women.

We compared calcaneal ultrasound measurements (speed of sound [SOS], broadband ultrasound attenuation [BUA], and stiffness index [SI]) of lesbian and heterosexual women to examine the medical and lifestyle risk factors for osteoporosis in each group. This was an exploratory, community-based, cross-sectional study. Subjects were mailed food frequency, health, and physical activity questionnaires. Weight, height, and calcaneal ultrasound measurements were taken at one office visit. In communities in southern and eastern Maine, 71 lesbians and 77 heterosexual women between the ages of 30 and 50 with regular menses and in good general health were the subjects. Statistical analysis used t-tests and chi-square tests to evaluate differences between study groups. Linear regression models were used to evaluate risk factors for low calcaneal ultrasound measurements. There were no differences between the lesbian and heterosexual women in age, body mass index (BMI), exercise, calcium intake, alcohol use, or calcaneal ultrasound measurements. There was a positive association between BUA and both BMI and alcohol consumption (p < 0.01). Antidepressant use significantly reduced SOS and SI (p < 0.05). There were no differences in calcaneal ultrasound measurements between lesbian and heterosexual women. BMI was strongly and positively associated with BUA. Antidepressant use in both populations was associated with a significant reduction in calcaneal bone mass. Studies are needed to define the relationship of depression and its treatment to bone mineral density and the future risk of osteoporosis.

Adult↗
PubMed1997

Osteoporotic vertebral fractures in postmenopausal women.

Back pain is a common symptom in postmenopausal women. As in younger age groups, most cases of back pain in postmenopausal women do not represent serious disease and resolve spontaneously within four weeks. However, acute back pain in postmenopausal women may be caused by vertebral fracture, and "red flags" in the history and physical examination can help clinicians decide on the appropriate work-up. When findings suggest vertebral fracture, anteroposterior and lateral radiographs of the thoracolumbar spine should be obtained. The diagnosis of existing vertebral fractures is critical because the probability of sustaining new spine and hip fractures is increased in women with one vertebral fracture, and the presence of multiple fractures puts the patient at risk for chronic debilitation. Acute fractures should be treated supportively, and a further work-up should be performed to assess the degree of osteoporosis and to exclude secondary causes. Evaluation of bone mineral density is a helpful guide to further management. Treatment may include calcium and vitamin D, hormone replacement therapy, bisphosphonates and/or calcitonin.

Bone Density↗
PubMed1996

Isoniazid-related fatal hepatitis.

To describe the clinical and demographic characteristics of fatal hepatitis due to single-drug isoniazid preventive therapy for tuberculosis, we did a survey of cases from state health departments, published case reports, and reports to the Centers for Disease Control and Prevention from 1970 to 1992. Of 108 reported cases, some clinical information was available for 76. A medical review panel judged 39 of these deaths as probably due to isoniazid hepatitis and 23 deaths as possibly due to isoniazid hepatitis. Of the 62 probable and possible cases combined, 50 (81%) were female, 49 (79%) were non-Hispanic black or Hispanic, and 19 (31%) were younger than 35 years. The median duration of isoniazid preventive therapy before symptom onset was 16 weeks. Of the 60 cases with symptom information, 54 (90%) presented with jaundice. Of the 62 cases, 26 (42%) were monitored monthly in accordance with current recommendations, and 6 of the patients were younger than 35 years. We estimate that the rate of fatal isoniazid hepatitis among patients in the public sector was no greater than 4.2 per 100,000 persons beginning therapy and no greater than 7 per 100,000 persons completing therapy. Adherence to isoniazid preventive therapy guidelines apparently reduces, but does not eliminate, the risk of fatal hepatitis. Careful patient selection, education, and monitoring are critical for minimizing that risk.

Adolescent↗
PubMed1994

Rurality and tuberculosis incidence trends in North and South Carolina, 1980 to 1992.

U.S. tuberculosis incidence rates increased steadily from 1985 through the end of 1992. Many factors have been implicated as contributors to the reversal in the historic decline of tuberculosis: the HIV epidemic, poverty and homelessness, immigration from less developed countries, and a deteriorating public health infrastructure. The purposes of this study were to demonstrate the extent of geographic variation in tuberculosis incidence rate trends in North and South Carolina and to quantify the association between aggregate-level characteristics of state economic areas and incidence rate trends. Data were obtained from the U.S. 1980 and 1990 decennial census and from the North and South Carolina health departments. In North Carolina, tuberculosis trends declined rapidly in the early 1980s, but declined much less rapidly from 1986 to 1992. In South Carolina, tuberculosis trends were nearly static during the early 1980s, but declined rapidly from 1986 to 1992. Rural and high-poverty state economic areas in South Carolina experienced especially favorable changes in tuberculosis incidence trends. South Carolina has a unique tuberculosis control program that makes widespread use of enablers, incentives, and directly observed therapy. This study demonstrates the distinct tuberculosis incidence trends that existed in two contiguous states and suggests that approaches to tuberculosis control that improve access to care may be effective in improving tuberculosis incidence trends, particularly in poor and rural areas. Strengthening tuberculosis programs may be an important strategy for controlling the current resurgence of tuberculosis in the United States.

Cohort Studies↗
PubMed1994

Premature graying of hair is a risk marker for osteopenia.

Premature graying of hair is associated with several endocrine disorders, vitiligo, and the aging process. Although the pathophysiology of melanin depletion in hair follicles is unknown, genetic factors regulate the expression of this trait. As acquisition of bone mass is also genetically determined, we performed an exploratory case control study of the association between premature graying of hair and osteopenia (lumbar bone density t score, below -1.0). Subjects were recruited from a single metabolic bone clinic. Premature graying of hair in 36 men and women with osteopenia (cases) was compared to that in 27 men and women without osteopenia (controls). Subjects with premature graying but no other identifiable risk factor were 4.4 times as likely to have osteopenia as subjects without premature graying (P = 0.02). Subjects with osteopenia and premature graying in their teens and twenties had a stronger family history of osteoporosis than those who had osteopenia and graying later in their thirties (P = 0.06), but bone density and other characteristics were not different. The association between premature graying and low bone mass could be related to genes that control peak bone mass or factors that regulate bone turnover. Premature graying of hair may be an important risk marker for osteopenia.

Adult↗
PubMed1993

Primary care physicians' views on access and health care reform: the situation in North Carolina.

BACKGROUND: This cross-sectional study assessed physicians' satisfaction with the current insurance-based reimbursement system and preferences for the two most frequently discussed health care reform proposals, and estimated the association between demographic and practice characteristics and attitudes toward health policy issues and reform plans. METHODS: A random sample of 300 physicians was drawn from state licensure files of general practitioners, family physicians, and pediatricians practicing in North Carolina. All sample physicians were sent a schematic outline of the two major health reform alternatives and a 1-page self-administered questionnaire to determine their attitudes toward the current health care system and their preferences for health reform alternatives. RESULTS: Sixty-nine percent of physicians responded to the survey. The responses indicated dissatisfaction with the current system and strong beliefs that access to care is inadequate in this diverse state with a large poor and rural population. Nearly one third of the physicians reported having insufficient information to choose between plans. Among physicians expressing a preference, 37% preferred managed competition, 38% preferred continuing the current system, and 25% preferred a single-payer system. CONCLUSIONS: A uniform opinion about health care policy is a thing of the past for American medicine. Because terms used in the health reform debate (especially "managed competition") are ambiguous and set in the context of an increasingly diverse medical profession, no single direction of health reform (much less a specific plan) secures widespread understanding or support from a large proportion of physicians. None of the plans will please all of the doctors all of the time.

Adult↗