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Biomedical subjects

T A Hodgson

Publications and source records attributed to T A Hodgson.

At least 37 records · Page 2Linked to original sources
PubMed2002

Patient-centred outcome measures in oral medicine: are they valid and reliable?

The present study evaluates the performance of patient-centred outcome measures in the oral medicine setting in patients with oral lichen planus. The study included 48 patients with a histologically confirmed diagnosis of oral lichen planus who completed a questionnaire incorporating two patient-centred outcome measures: the 16-item UK Oral Health Related Quality Of Life Measure (OHQOL-UK) and 14-item Oral Health Impact Profile (OHIP-14). They subsequently underwent an oral examination and rated the pain they experienced on a visual analogue scale (VAS). The impact of oral health on their life quality was considerable with physical, social and psychological consequences. Both OHQOL-UK (P<0.01) and OHIP-14 scores (P<0.01) were associated with clinical findings; demonstrating criterion validity. Patient rating of pain experienced (on a VAS) correlated with OHQOL-UK scores (P<0.01) and OHIP-14 (P<0.01); demonstrating construct validity. The mean inter-item correlation for OHQOL-UK was 0.93 and was 0.90 for OHIP-14; demonstrating high internal consistency reliability. Our results suggest both OHQOL-UK and OHIP-14, patient-centred outcome measures perform well in patients with oral lichen planus, demonstrating validity and reliability. This implies patient-centred outcome measures may be utilized in both oral medicine and oral and maxillofacial surgery to assess patient needs and opinions.

Adult↗
PubMed2002

Management of recalcitrant ulcerative oral lichen planus with topical tacrolimus.

OBJECTIVE: Our purpose was to investigate the efficacy and safety of 0.1% topical tacrolimus in erosive or ulcerative oral lichen planus. METHODS: This was an open-label, noncomparative study conducted in an outpatient oral medicine unit in London, United Kingdom. The study covered an 8-week period with a 22-week follow-up after cessation of therapy. Nineteen patients, aged 28 to 87 years with biopsy-proven oral lichen planus refractory to, or dependent on, systemic immunosuppressive agents, were enrolled. Seventeen patients (89%) completed the study. Application of 0.1% tacrolimus was administered to all symptomatic oral mucosal lesions. Clinical review took place 1, 3, 5, 7, and 8 weeks after commencing therapy. Alleviation of symptoms was evaluated by using a visual analogue scale as well as the McGill Pain and Oral Health Impact profile questionnaires. The extent of the oral mucosal erosion or ulceration was directly measured by the same clinician at all visits. Safety assessments included monitoring of adverse events, complete blood cell count, renal and hepatic clinical chemistry, and tacrolimus blood concentrations. RESULTS: Tacrolimus caused a statistically significant improvement in symptoms within 1 week of commencement of therapy. A mean decrease of 73.3% occurred in the area of ulceration over the 8-week study period. Local irritation (in 6 subjects, 35%) was the most commonly reported adverse effect. Laboratory values showed no significant changes with time. Therapeutic levels of tacrolimus were demonstrated in 8 subjects but were unrelated to the extent of oral mucosal involvement. Thirteen of 17 patients suffered a relapse of oral lichen planus within 2 to 15 weeks of cessation of tacrolimus therapy. CONCLUSION: Topical tacrolimus is effective therapy for erosive or ulcerative oral lichen planus.

Administration, Cutaneous↗
PubMed2002

Fluticasone propionate spray and betamethasone sodium phosphate mouthrinse: a randomized crossover study for the treatment of symptomatic oral lichen planus.

BACKGROUND: Symptomatic oral lichen planus (OLP) has been palliated with a wide spectrum of topical and systemic therapies. Although the majority of management strategies include corticosteroids, few have been evaluated in randomized controlled trials. OBJECTIVE: We investigated the acceptability and efficacy of topical fluticasone propionate spray (FP) and betamethasone sodium phosphate mouthrinse (BSP) upon the signs and symptoms of OLP, assessing patient quality of life changes as a consequence of these therapies. METHODS: We implemented a randomized, crossover study in which each drug was administered for a period of 6 weeks with an intervening washout period of 2 weeks at an outpatient oral medicine unit in London, United Kingdom. We treated 48 patients with biopsy-proven symptomatic OLP, and 44 patients (92%) completed the study. The dosage was 50 microg two dose unit sprays and BSP 500 microg, each 4 times daily. Symptomatic improvement was evaluated by means of a visual analogue scale (VAS), the McGill pain score, the Oral Health Impact Profile (OHIP), and Oral Health Quality of Life (OHQoL) questionnaires. The total surface area of the lesions, including all white, erythematous, and ulcerative lesions was measured at each visit. The efficacy, ease of application, and adverse effects associated with each medication were recorded. RESULTS: Both FP and BSP mouthwash caused both a statistically significant reduction in painful symptoms as measured by the VAS and improvement in quality of life as measured by the OHIP and OHoQL indices. There was no significant difference between the two corticosteroids in their efficacy in reducing painful symptoms (measured by the VAS) or in their effect on patient quality of life. Both FP and BSP significantly reduced the surface area of oral lesions. However, FP was statistically significantly better than BSP in reducing lesion surface area. There was no statistically significant difference between the patient-assessed effects of the 2 therapies. CONCLUSIONS: FP and BSP are both effective in the short-term clinical management of symptomatic OLP. FP is more acceptable to patients than BSP because of the convenience of the spray form.

Administration, Topical↗
PubMed2001

Medical care expenditures for hypertension, its complications, and its comorbidities.

OBJECTIVES: Medical expenditures attributed to hypertension were estimated, including expenditures for cardiovascular complications, other conditions for which hypertensives are at higher risk, and comorbidities (secondary diagnoses) that raise the cost of medical care. This article presents total, per capita, and per condition US expenditures in 1998 according to sex, age, and type of health service. METHODS: A variety of national data sources were used to disaggregate national health expenditures in 1998 by diagnosis. Expenditures for cardiovascular complications and other conditions for which hypertensives had higher rates of utilization were determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities were estimated by regression analyses. RESULTS: In 1998, $108.8 billion in health care spending was attributed to hypertension, 12.6% of total national spending that could be allocated to diagnoses, including $22.8 billion for hypertension, $29.7 billion for cardiovascular complications, and $56.4 billion for other diagnoses. Per capita expenditures increased with age from $249 for those younger than 65 years to $3,007 for those 85 years and older. The average amount spent per hypertensive condition was $3,787. Expenditures were generally higher for females. CONCLUSIONS: The economic burden of hypertension is large, but health services directly related to hypertension account for only a fraction of attributed expenditures. Comprehensive accounting of expenditures more accurately assesses the cost of hypertension and potential savings from prevention and treatment. Alteration of lifestyles and medical intervention provide opportunities to reduce national health expenditures.

Adult↗
PubMed2000

Primary syphilis remains a cause of oral ulceration.

After many years the incidence of infective syphilis (infection with Treponema pallidum) is increasing in the United Kingdom. This may reflect changes in sexual attitudes and behaviour, altering trends in HIV disease, and increased foreign travel. Oral disease as a consequence of primary syphilis is rare. The present report details two patients presenting to an oral medicine clinic in London, within a 6-month period in 1999, with oral ulceration as their only clinical manifestation of undiagnosed primary syphilis. The oral aspects of early syphilis and the need for dentists to be aware of changing epidemiological trends in relevant infectious diseases are highlighted.

Adult↗
PubMed1999

Medical care expenditures for diabetes, its chronic complications, and its comorbidities.

BACKGROUND: Medical expenditures for diabetes are estimated, including expenditures for chronic complications of diabetes, unrelated conditions for which diabetics are at higher risk, and various comorbidities that raise the cost of medical care. METHODS: A variety of national data sources are used to disaggregate the Health Care Financing Administration's national health expenditures in 1995 by sex, age, and diagnosis. Expenditures for chronic complications and other unrelated conditions for which diabetics have higher rates of utilization are determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities are estimated by regression analyses. Sensitivity analysis is used to calculate a range of estimated expenditures. RESULTS: Total expenditures attributed to diabetes are $47.9 billion in 1995, including $18.8 billion for first listed diabetes, $18.7 billion for chronic complications, $8.5 billion for unrelated conditions, and $1.9 billion for comorbidities. The range of total expenditures is $34.3 to $63.7 billion. CONCLUSIONS: Comprehensive accounting of expenditures more accurately assesses the economic burden of diabetes and potential savings from prevention, especially of chronic complications. This analysis is illustrative for other chronic illnesses.

Adult↗
PubMed1999

Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures.

OBJECTIVES: Circulatory system diseases are a significant burden in terms of morbidity, mortality, and use of health care services. This article presents total, per capita, and per condition US medical care expenditures in 1995 for circulatory diseases according to sex, age, and type of health service. METHODS: Total personal health care expenditures estimated by the Health Care Financing Administration for each type of health care service are separated into components to estimate patient expenditures by age, sex, primary medical diagnosis, and health care service for all diseases of the circulatory system, heart disease, coronary heart disease, congestive heart failure, hypertensive disease, and cerebrovascular disease. RESULTS: Expenditures for circulatory diseases totaled $127.8 billion in 1995 (17% of all personal health care expenditures), $486 per capita, and $1,636 per condition. Approximately one half of expenditures was for hospital care and 20% was for nursing home care. Heart disease accounted for 60% of circulatory expenditures. Expenditures increased with age and reached 35% of expenditures among persons aged 85 years and older, which was almost $7,000 per capita. These relationships vary somewhat according to the specific circulatory disease, type of health care, and age. CONCLUSIONS: Expenditures increase with age and circulatory diseases can be expected to command an increasing share of national health expenditures as the number and proportion of the population that is elderly grows. The alteration of lifestyles and medical interventions provide many opportunities to prevent circulatory diseases and to reduce national health expenditures.

Age Distribution↗
PubMed1999

Medical costs of smoking in the United States: estimates, their validity, and their implications.

OBJECTIVE: To compare estimates of the medical costs of smoking in the United States and to consider their relevance to assessing the costs of smoking in developing countries and the net economic burden of smoking. DATA SOURCES: A Medline search through early 1999 using keywords "smoking" and "cost", with review of article reference lists. STUDY SELECTION: Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population. DATA EXTRACTION: Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings. DATA SYNTHESIS: With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. The exception, a recent study, found much larger attributable expenditures. The lower estimates may reflect the limitation of analysis to costs associated with the principal smoking-related diseases. The higher estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range. CONCLUSIONS: The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing the magnitude of their current cost-of-smoking burden and their future burdens, with differences in tobacco use histories and the availability of chronic disease treatment affecting country-specific estimates. The debate over the use of gross or net medical cost estimates is likely to intensify with the proliferation of lawsuits against the tobacco industry to recover expenditures on tobacco-produced disease.

Developing Countries↗
PubMed1999

Medical expenditures for major diseases, 1995.

This article distributes the Health Care Financing Administration's (HCFA) estimates of 1995 personal health care expenditures (PHCE) according to sex, age, and diagnosis for each type of health care service. Aggregate and per capita expenditures are reported for 18 broad categories of disease classified according to the International Classification of Diseases (ICD-9-CM). Special emphasis is given to expenditures for persons age 65 or over, the segment of the population with the highest expenditures. These results show how the relative importance of medical conditions and type of health services differs between the sexes and changes with increasing age.

Adolescent↗
PubMed1997

HIV-associated oral lesions: prevalence in Zambia.

OBJECTIVES: To describe the prevalence of HIV-associated oral lesions in known HIV+ subjects in Zambia and assess the predictive value of these lesions to identify individuals with CD4 cell counts less than 200 x 10(6) L-1. SETTING: St Francis Hospital, situated in the rural Katete District, Eastern Province, Zambia. SUBJECTS: 107 newly diagnosed heterosexual HIV positive individuals included 42% males and 58% females (mean age 34.5, range 16-62). METHODS: Following a medical history and detailed oral examination, blood and whole saliva were collected in each subject. RESULTS: A total of 47.7% from this sample had an AIDS diagnosis. The mean CD4 count was 252.2 cells mm-3 (s.d. +/- 160.5, range 44-810); 40.2% of the study group demonstrated oral lesions associated with HIV seropositivity. Candidiasis was most commonly seen (25% prevalence). In this population erythematous candidiasis was the only oral lesion significantly associated with CD4 counts of less than 200 x 10(6) L-1 (P < 0.05, Two-tailed Fisher's Exact Test). CONCLUSION: In resource poor countries a thorough oral examination may suggest HIV infection and predict disease progression. Health care professional education regarding the orofacial manifestations of HIV infection needs urgent reinforcement in these areas.

AIDS-Related Opportunistic Infections↗
PubMed1994

Costs of illness in cost-effectiveness analysis. A review of the methodology.

Costs of illness are an important input in cost-effectiveness analysis (CEA). Reviews of the literature have found that many CEAs are of low technical quality and fail to take account of costs of illness appropriately. The costs of illness and disease averted by an intervention, indirect costs, and medical care costs in added years of life are topics that present methodological issues and are not handled consistently in CEAs. Costs of illness and disease averted may be estimated by prevalence- or incidence-based methods; the correct conceptual paradigm depends on the nature of the disease. Incidence costs may be estimated by modelling the disease process, or directly from prevalence costs, the choice being determined by the extent and quality of data available. Regardless of the method, in forward-looking CEAs potential technological change must be taken into account so that incidence-based lifetime costs estimated from current treatment practices will not be biased. Whether to include indirect costs is an important issue, because indirect costs may be large and have a significant impact on the cost-effectiveness ratio. In the pure CEA model, indirect costs are excluded on ethical grounds and to prevent incursion of elements of cost-benefit analysis into CEA. The modified CEA model accepts enhanced productivity as an economic benefit made possible by, but distinct from, the health effect of an intervention. Indirect costs are included when appropriate, depending on the perspective of the analysis, the measure of effectiveness, and who bears the costs. When medical care extends life, expenditures will be incurred in the added years for illness and disease unrelated to the intervention. As with indirect costs, the pure CEA considers unrelated 'downstream' costs an indirect consequence of the health benefit of the intervention and excludes them from CEAs with the societal perspective. The modified CEA treats unrelated downstream costs as an economic effect of the change in health due to the intervention and includes them in order to have a more complete accounting of the cost of the intervention.

Cost of Illness↗
PubMed1993

Skin testing after anaphylactoid reactions to dental local anesthetics. A comparison with controls.

Reactions to scratch and intradermal challenge with a variety of local anesthetics were examined in 90 patients and compared with 45 controls. The frequency of a positive scratch test was 13 of 90 in the patient group and 12 of 45 in the control group. Thus scratch testing did not appear to discriminate between test and control groups. Significantly greater numbers of patients (22 of 90) gave a positive intradermal response than controls (4 of 45) (chi-squared test p < 0.05). Nine patients showed reactions to more than one agent. The majority of reactions in both patients and controls were in atopic subjects (chi-squared test p < 0.05). In 87 of the 90 patients with suspected anaphylactoid reactions to local anesthetic agents, negative skin reactions to at least one of the agents allowed intrabuccal challenge and subsequent recommendation of an agent for future use. Skin testing, though not providing formal proof of allergy, provides a useful test to indicate local anesthetics that may be used for future procedures.

Adolescent↗
PubMed1992

An economic evaluation of asthma in the United States.

BACKGROUND: Asthma is a common chronic illness. Recently, increases in morbidity and mortality due to this disease have been reported. We studied the distribution of health care resources used for asthma in order to lay the groundwork for further policy decisions aimed at reducing the economic burden of this disorder. METHODS: Estimates of direct medical expenditures and indirect costs (in 1985 dollars) were derived from data available from the National Center for Health Statistics. These cost estimates were projected to 1990 dollars. RESULTS: The cost of illness related to asthma in 1990 was estimated to be $6.2 billion. Inpatient hospital services represented the largest single direct medical expenditure for this chronic condition, approaching $1.6 billion. The value of reduced productivity due to loss of school days represented the largest single indirect cost, approaching $1 billion in 1990. Although asthma is often considered to be a mild chronic illness treatable with ambulatory care, we found that 43 percent of its economic impact was associated with emergency room use, hospitalization, and death. Nearly two thirds of the visits for ambulatory care were to physicians in three primary care specialties--pediatrics, family medicine or general practice, and internal medicine. CONCLUSIONS: Potential reductions in the costs related to asthma in the United States may be identified through a closer examination of the effectiveness of care associated with each category of cost. Future health policy efforts to improve the effectiveness of primary care interventions for asthma in the ambulatory setting may reduce the costs of this common illness.

Absenteeism↗
PubMed1992

Cigarette smoking and lifetime medical expenditures.

The cumulative impact of excess medical care required by smokers at all ages while alive outweighs shorter life expectancy, and smokers incur higher expenditures for medical care over their lifetimes than never-smokers. This accords with the findings by Manning et al. (1989) of positive lifetime medical care costs per pack of cigarettes, but disagrees with the results found by Leu and Schaub (1983, 1985) for Swiss males. The contradictory conclusions of the analyses are undoubtedly due to a large difference in the amount of medical care used by smokers relative to neversmokers in the United States and Swiss data. Excess expenditures increase with the amount smoked among males and females so that lifetime medical costs of male heavy smokers are 47 percent higher than for neversmokers when discounted at 3 percent. Each year more than one million young people start to smoke and add an extra $9 to $10 billion (in 1990 dollars discounted at 3 percent) to the nation's health care bill over their lifetimes. Given the smoking behavior, medical care utilization and costs of care, and population size embedded in the data used in this analysis, I have concluded that in the first five years from baseline the population of smokers aged 25 and over incurs excess medical expenditures totaling $187 billion, which is $2,324 per smoker. The excess cost of medical care associated with cigarette smoking is 18 percent of expenditures for hospital care, physicians' services, and nursing-home care required by all persons (smokers and neversmokers) aged 25 and over. In the absence of large and rapid changes in the values of the underlying parameters, $187 billion, 18 percent of medical expenditures, can be taken as the premium currently being paid every five years to provide medical care for the excess disease suffered by smokers. Even without the addition of any new smokers, the present value of the bill that will be incurred for excess medical care required by the current population of smokers over their remaining lifetimes is high. The civilian noninstitutionalized population of cigarette smokers in 1985 who are age 25 and older is expected to incur over its remaining lifetime excess medical expenditures of $501 billion, or $6,239 per smoker. It is possible that future changes beyond recent historical trends in the habits of those who currently smoke, such as reductions in the amount smoked, higher rates of quitting, whether occurring fortuitously or brought about by design, may result in lower costs of smoking than estimated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗