Biomedical subjects

R Sturm

Publications and source records attributed to R Sturm.

115 records · Page 7Linked to original sources

PubMed1975

Neuropsychological effects of chronic asymptomatic increased lead absorption. A controlled study.

Twenty-seven asymptomatic children with confirmed chronic increased lead absorption were compared with 27 matched control children for evidence of neuropsychological impairment. Evaluation of each child included a complete history, physical examination, quantitative neurological tests, and comprehensive psychological tests. There was significantly increased incidence of hyperactive behavior in the subjects with increased lead levels, but there was no significant difference in any of the quantitative test results. Uncontrolled variables, especially lead absorption in infancy and adverse environmental pressures other than lead, still leave questions about the relationship between chronic lead exposure and behavior of intelligence.

Chelating Agents↗

PubMedDate not supplied

Three-month comparison of bimatoprost and latanoprost in patients with glaucoma and ocular hypertension.

A multicenter, randomized, investigator-masked, parallel-group trial compared bimatoprost and latanoprost for efficacy and safety in patients with glaucoma or ocular hypertension. Patients received bimatoprost 0.03% (n = 119) or latanoprost 0.005% (n = 113) once daily in the evening for 3 months. Visits were at prestudy, baseline (day 0), week 1, and months 1, 2, and 3. Primary outcome measures were mean IOP and the percentage of patients achieving IOP of 17 mm Hg or lower at 8:00 AM. Secondary outcome measures were diurnal IOP measurements (8:00 AM, 12 noon, 4:00 PM, 8:00 PM) at month 3 and safety measures including adverse events. Mean IOP was lower with bimatoprost than with latanoprost at all time points during the 3-month follow-up, although the between-group difference was not always statistically significant. At month 3 at 12 noon, mean IOP was as much as 1.0 mm Hg lower with bimatoprost (P = .021). Target pressures of < or = 17 mm Hg were reached more often with bimatoprost than with latanoprost at 8:00 AM (53% vs 43%; P = .029). Over all diurnal measurements at month 3, low target pressures of < or = 13, < or = 14, and < or = 15 mm Hg were achieved significantly more often with bimatoprost (P < or = .006). Both drugs were safe and well tolerated. Conjunctival hyperemia was more common with bimatoprost, while headache was more frequent with latanoprost. Bimatoprost provided lower mean pressures than latanoprost at every time point throughout the study and was statistically superior in achieving low target pressures. More patients reached low target pressures with bimatoprost.

Amides↗

PubMedDate not supplied

Effectiveness research and implications for study design: sample size and statistical power.

Most clinical trials have started to incorporate more broadly defined outcome measures, such as health-related quality of life, to complement clinical status measures as well as direct costs and cost-effectiveness analyses. Contrasting a broad range of outcome and cost measures, we analyze the implications for sample sizes and study design using data from prior mental health and primary care studies that span a wide range of practice settings, patient populations, and geographic areas. While meaningful clinical symptomatic differences are often detectable with sample sizes of well under 100 per cell, detecting even large changes in health-related quality of life generally requires several hundred observations per cell. Reasonable precision in cost estimates usually requires sample sizes in the thousands. Very few clinical trials or observational effectiveness studies that incorporate quality of life or cost measures have such sample sizes, resulting in many (unreported) null findings and, due to publication biases favoring significant results, scientific publications that exaggerate true effects. It raises issues for the general direction of clinical trials and effectiveness studies, as well as for how cost and health-related quality of life results based on small studies should be dealt with in publications.

Clinical Trials as Topic↗

PubMedDate not supplied

Costs and use of mental health services before and after managed care.

This paper tracks access, utilization, and costs of mental health care for a private employer over nine years during which mental health benefits were carved out of the medical plan and managed care was introduced. Prior to the carve-out, mental health costs increased by around 30 percent annually; in the first year after the change, costs dropped by more than 40 percent; in the six follow-up years, costs continued to decline slowly. This cost reduction was not attributable to decreased initial access, as the number of persons using any mental health care increased following the change. Instead, the cost reduction was the result of (1) fewer outpatient sessions per user, (2) reduced probability of an inpatient admission, (3) reduced length-of-stay for an inpatient episode, and (4) substantially lower costs per unit of service.

Cost Control↗

PubMedDate not supplied

State mental health parity laws: cause or consequence of differences in use?

A new wave of state and federal legislation affecting mental health insurance was passed during the 1990s. Although patient advocacy groups have hailed the passage of numerous parity laws, it is unclear whether this activity represents a major improvement in insurance benefits or significantly increases access to mental health care. We investigated this issue with data from two new national studies sponsored by the Robert Wood Johnson Foundation. We found that states with below-average utilization were more likely to enact state legislation, but utilization in those states continues to lag behind the rest of the nation.

Health Care Rationing↗

PubMedDate not supplied

Toward full mental health parity and beyond.

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001. This paper examines what the MHPA accomplished and steps toward more comprehensive parity. We explain the strategic and self-reinforcing link of parity with managed behavioral health care and conclude that the current path will be difficult to reverse. The paper ends with a discussion of what might be behind the claims that full parity in mental health benefits is insufficient to achieve true equity and whether additional steps beyond full parity appear realistic or even desirable.

Civil Rights↗

PubMedDate not supplied

State legislation and the use of complementary and alternative medicine.

There are increasing attempts at the federal and state levels to change regulations for complementary and alternative medicine (CAM). We use data from a new survey of about 10,000 individuals to examine CAM use and insurance coverage and their relationship to state regulations. We find that insurance mandates to cover CAM providers are significantly associated with increased coverage of CAM, but not with increased use of CAM providers. Liberalization of physician licensure to practice CAM is associated with significantly increased CAM use, as are practice laws authorizing nonphysician CAM providers. In states with multiple CAM practice laws, insurance coverage for CAM visits among users is significantly lower than in states without CAM practice laws.

Adult↗