Increase Treatment Rates Research Articles

Protection of Individual Ash Trees From Emerald Ash Borer (Coleoptera: Buprestidae) With Basal Soil Applications of Imidacloprid

We conducted field trials at five different locations over a period of 6 yr to investigate the efficacy of imidacloprid applied each spring as a basal soil drench for protection against emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae). Canopy thinning and emerald ash borer larval density were used to evaluate efficacy for 3-4 yr at each location while treatments continued. Test sites included small urban trees (5-15 cm diameter at breast height [dbh]), medium to large (15-65 cm dbh) trees at golf courses, and medium to large street trees. Annual basal drenches with imidacloprid gave complete protection of small ash trees for three years. At three sites where the size of trees ranged from 23 to 37 cm dbh, we successfully protected all ash trees beginning the test with <60% canopy thinning. Regression analysis of data from two sites reveals that tree size explains 46% of the variation in efficacy of imidacloprid drenches. The smallest trees (<30 cm dbh) remained in excellent condition for 3 yr, whereas most of the largest trees (>38 cm dbh) declined to a weakened state and undesirable appearance. The five-fold increase in trunk and branch surface area of ash trees as the tree dbh doubles may account for reduced efficacy on larger trees, and suggests a need to increase treatment rates for larger trees.

Effects of the Wars on Smoking Among Veterans

Effects of the Wars on Smoking Among Veterans

Determination of non-treatment with statins of high risk patients in the Netherlands

Objective:To determine in the Netherlands what proportions of high risk patients with established cardiovascular disease (CVD) or diabetes mellitus type 2 (DM2) who were not treated with statins on 1 January 2007 and which characteristics were associated with non-treatment.Methods:From the IPCI GP database patients were selected who were registered with a GP on 1 January 2007 who had a history of either CVD (CVD patients), DM2 (diabetics) or both (diabetics with CVD). The proportion of patients using statins around 1 January 2007 was determined. Associations of patient characteristics with non-treatment were quantified (CVD patients and diabetics only).Results:In all, 19 628 CVD patients, 5006 diabetics and 3767 diabetics with CVD were identified. Of these patients 71%, 54% and 45%, respectively did not use statins. These proportions were similar in the subgroups of patients with recent LDL-C measurements. Among these subgroups the vast majority of non-treated patients was eligible for statin treatment (LDL-C >2.5 mmol/l). The proportion of statin-treated patients was larger among diabetics than among CVD patients. Among CVD patients, female gender, age below 40 years, living in a deprived area, a history of CVD of less than 1 year and arrhythmia were significantly associated with non-treatment. Among diabetics, significant associations were: living in a deprived area and specialist visits in the previous year. In 2003, treatment rates among diabetics were lower, but among CVD patients they were similar. This suggests that the higher treatment rates among diabetics compared to CVD patients in 2007 may be the result of disease-management programmes introduced for diabetics in 2004.Conclusion:The majority of patients with established CVD or DM2 were not treated with statins on 1 January 2007. Eligibility for statin treatment may have been overestimated due to unavailability of cholesterol levels among many non-treated patients. Implementation of care programmes for CVD patients may increase treatment rates among eligible CVD patients.

Dialysis Delivery in Canada and the United States: A View From the Trenches

Although the general framework for health care delivery is vastly different in Canada and the United States, the framework for dialysis delivery is less divergent. However, the 2 systems have evolved very differently. Examined during the past 20 years, it is apparent that the dialysis system in the United States has undergone profound change, whereas the system in Canada is relatively stagnant. Most of the change in the United States has been positive, and this evolutionary change is expected to continue. In Canada, a system that historically has worked reasonably well is now showing severe signs of suboptimal performance that would be expected to get worse if no effort is made to improve it. This article, written from the perspective of 2 academic clinicians, tries to describe similarities and differences, identify strengths and weaknesses, and serve as a catalyst for discussions about improving both systems. Just as no dialysis treatment modality is perfect, the same can be said for dialysis delivery systems. Empirical methods to objectively evaluate the impact of change must be included in the design and implementation of new initiatives in the United States and Canada.

Screening for depression in the older long-term unemployed

Misdiagnosis and undertreatment of depression in older, long-term unemployed people may not only pose a serious medical problem, but may also be an obstacle for their vocational reintegration. Screening for depression could be a first step to increasing treatment rates within this high-risk group. Therefore, the WHO-5 Well-Being Index was tested for its validity in unemployment offices. Three hundred and sixty-five participants in a German programme for the vocational reintegration of long-term unemployed people were screened with the WHO-5 Well-Being Index. In 104 of these subjects, ICD-10 diagnoses were made using DIA-X Structured Clinical Interview. Using the DIA-X data as a gold standard, the WHO-5 Well-Being Index obtained satisfactory results for sensitivity (82.5%) and specificity (70.3%) as a screening tool for affective disorders when used with an adjusted cut-off-point of < or = 12. While none of the 18.5% male participants diagnosed with major depression received treatment, half of the 24% of female participants with major depression received treatment. Screening with the WHO-5 within unemployment offices is useful to detect people with depressive disorders. Many of them do not receive optimal treatment and can be motivated to seek professional help. Reducing depression by better treatment will also increase the chances of reemployment.

Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

ObjectiveReducing youth suicide and suicide attempts are national priorities. Suicidal youth emergency department (ED) patients are at high risk for repeat and fatal attempts, yet information is lacking to guide service delivery. In one of the largest clinical studies of youth ED patients presenting with suicidality, we examine ideators, single attempters, and repeat attempters with the aim of clarifying optimal strategies for ED management and risk assessment. MethodConsecutively admitted suicidal youths (10–18 years) from two EDs (N = 210) completed a questionnaire assessing sociodemographic, clinical, service use, and environmental stress variables. ResultsDespite differences in background characteristics, high levels of depression, externalizing behavior, posttraumatic stress symptoms, substance use, and thought problems were observed across sites. Suicide attempt risk, defined along a continuum ranging from ideation to single attempts to repeat attempts, was predicted by higher levels of clinical symptoms, service use, and environmental stress. Specific stresses associated with increased suicide attempt risk were romantic breakups, exposure to suicide/suicide attempts, and pregnancy in self or partner. Significant predictors of attempt risk in the male-only subgroup were depression, thought problems, previous ED visits, and romantic breakups. ConclusionsPediatric ED patients presenting with suicidal ideation, single attempts, and repeat attempts fall along a continuum of increasing risk. Suicide attempt risk in males is associated with high levels of depression, but not with increased treatment rates, suggesting undertreatment in males, a group with particularly high risk for death by suicide. Treatment barriers must be addressed to achieve our national goal of reducing suicide/suicide attempts in youths. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):958–966.

Multimodality Stroke Prevention

Prevention harbors the greatest potential for reducing the societal burden from stroke. As evidence accumulates on the multifactorial pathogenesis of vascular disease and the impact of novel combination therapies targeted at reducing recurrent vascular events, a new paradigm is emerging, which is that of multimodality vascular prevention. Knowledge of the evidence behind this strategy and the effective means for implementing it could be useful to the practicing neurologist taking care of stroke patients. Our review presents the evidence behind the broadening therapeutic options for recurrent vascular event prevention in ischemic stroke patients whose underlying stroke pathophysiologic mechanism is either presumed to be due to atherosclerosis or who have prior evidence of systemic atherosclerosis. We elaborate on conventional and novel vascular risk factors, as well as risk factor prediction models. Therapies discussed include antithrombotics, statins, antihypertensives, surgical/endovascular treatments, and lifestyle modification. Basis for evidence (or the lack thereof), national guideline recommendations, areas of controversy, and avenues of future focus for these treatments are also discussed in this paper. Furthermore, the knowledge-treatment gap as it pertains to optimal vascular risk-factor control and appropriate initiation and maintenance of evidence-based preventive therapies is explored, and an effective hospital-based intervention involving the in-hospital initiation of these treatments prior to discharge, that may help bridge this gap, is detailed. Neurologists should be aware that a timely, systematic, evidence-based multimodal preventive approach to atherothrombotic disease in stroke patients that transcends the continuum of care across points of service will likely increase treatment rates and improve clinical outcomes.

Audit of treatment and contact-tracing rates in immediate (presumptive) versus delayed (polymerase chain reaction) diagnosis of chlamydial infection

An audit of all cases of chlamydial infection diagnosed in men at the Edinburgh genitourinary (GU) medicine clinic over a six-month period from January 2003 is reported. In all, 189 men identified as requiring treatment for possible chlamydial infection on first attendance (because of contact with a partner with chlamydia or the diagnosis of non-gonococcal urethritis [NGU] on microscopy), who later proved chlamydia-positive by polymerase chain reaction (PCR), were compared with 83 men in whom infection was identified only on receipt of a PCR result. Treatment rates were 100% in the first group and 97.6% in the second group (chi(2) 0.046, P<0.05). In men presumptively diagnosed and treated, 88.6% of contacts identified were confirmed as traced, compared with 90% confirmed as traced in the group diagnosed by PCR alone. Our audit suggests that identifying men with chlamydial NGU by routine microscopy may carry a small but significant advantage in increasing treatment rates, but makes no difference to contact-tracing success rate.

Burden of musculoskeletal pain in Japan

Based on the prevalence of musculoskeletal pain in the context of interference with daily activities (IDA) and treatment for musculoskeletal disorders in the study population (n = 3188), we estimated the prevalence and years lived with disability (YLD) of musculoskeletal pain in Japan. The total of 42,287 thousand (41.2%) of Japanese adult people was estimated to suffer from musculoskeletal pain. Among them, 9127 thousand was estimated to interfere with daily activities due to the pain. Overall YLD for musculoskeletal pain in Japan were estimated at 1,297,843.7 (1263.6 per 100,000). The YLD for Pain without IDA were 33,159.3 (32.3 per 100,000) and the YLD for Pain with IDA were 1,264,684.4 (1231.3 per 100,000). One-way sensitivity analysis showed that the YLD of musculoskeletal pain might increase to 4,421,844.0 (4305.2 per 100,000) with the increased disability weight for Pain without IDA of 0.1, while they might inversely decrease to 1,018,875.0 (992.0 per 100,000) with the increased treatment rate in Pain with IDA of 100%. Musculoskeletal pain imposes a substantial burden on the Japanese adult population. To allow the population to keep their health-related quality of life, health professionals should pay more attention to musculoskeletal pain and make positive efforts to improve prevention and control of musculoskeletal pain.

Burden of musculoskeletal pain in Japan

Based on the prevalence of musculoskeletal pain in the context of interference with daily activities (IDA) and treatment for musculoskeletal disorders in the study population (n = 3188), we estimated the prevalence and years lived with disability (YLD) of musculoskeletal pain in Japan. The total of 42 287 thousand (41.2%) of Japanese adult people was estimated to suffer from musculoskeletal pain. Among them, 9127 thousand was estimated to interfere with daily activities due to the pain. Overall YLD for musculoskeletal pain in Japan were estimated at 1 297 843.7 (1263.6 per 100 000). The YLD for Pain without IDA were 33 159.3 (32.3 per 100 000) and the YLD for Pain with IDA were 1 264 684.4 (1231.3 per 100 000). One-way sensitivity analysis showed that the YLD of musculoskeletal pain might increase to 4 421 844.0 (4305.2 per 100 000) with the increased disability weight for Pain without IDA of 0.1, while they might inversely decrease to 1 018 875.0 (992.0 per 100 000) with the increased treatment rate in Pain with IDA of 100%. Musculoskeletal pain imposes a substantial burden on the Japanese adult population. To allow the population to keep their health-related quality of life, health professionals should pay more attention to musculoskeletal pain and make positive efforts to improve prevention and control of musculoskeletal pain.

In-hospital initiation of statin therapy in patients with acute coronary events.

After acute coronary events, patients remain at high risk for recurrent cardiovascular events and mortality. Despite the compelling scientific and clinical trial evidence that statin therapy reduces mortality in patients after acute coronary events, this life-saving therapy continues to be underutilized. It is now recognized that the setting in which statin therapy is initiated has a major impact on patient adherence. In-hospital initiation of statin therapy has been demonstrated to result in a markedly increased treatment rate, improved long-term patient compliance, more patients reaching low-density lipoprotein levels less than 100 mg/dL, and improved long-term clinical outcomes. As long-term risk reduction is seen with statin therapy irrespective of baseline low-density lipoprotein cholesterol, virtually all acute coronary event patients are candidates for statin treatment. In-hospital initiation of statin therapy may also reduce early clinical events in acute coronary syndrome patients, but further research is required before this is fully established. The adoption of in-hospital initiation of statin therapy as the standard of care for patients hospitalized with acute coronary events will dramatically improve treatment rates and thus substantially reduce the risk of future coronary events and prolong life in the large number of patients hospitalized each year.

Do lipoprotein subclass tests increase treatment rates in high-risk patients?

Do lipoprotein subclass tests increase treatment rates in high-risk patients?

Controlled Trials of CQI and Academic Detailing to Implement a Clinical Practice Guideline for Depression

The release of the Agency for Health Care Policy and Research (AHCPR)'s Guideline for the Detection and Treatment of Depression in Primary Care created an opportunity to evaluate under naturalistic conditions the effectiveness of two clinical practice guideline implementation methods: continuous quality improvement (CQI) and academic detailing. A study conducted in 1993-1994 at Kaiser Permanente Northwest Division, a large, not-for-profit prepaid group practice (group-model) HMO, tested the hypotheses that each method would increase the number of members receiving depression treatment and would relieve depressive symptoms. Two trials were conducted simultaneously among adult primary care physicians, physician assistants, and nurse practitioners, using the same guideline document, measurement methods, and one-year follow-up period. The academic detailing trial was randomized at the clinician level. CQI was assigned to one of the setting's two geographic areas. To account for intraclinician correlation, both trials were evaluated using generalized equations analysis. Most of the CQI team's recommendations were not implemented. Academic detailing increased treatment rates, but--in a cohort of patients with probable chronic depressive disorder--it failed to improve symptoms and reduced measures of overall functional status. New organizational structures may be necessary before CQI teams and academic detailing can substantially change complex processes such as the primary care of depression. New research and treatment guidelines are needed to improve the management of persons with chronic or recurring major depressive disorder.

Effect of neem on the growth and development of the obliquebanded leafroller, Choristoneura rosaceana

AbstractNeem, Azadirachta indica A. Juss. (Meliaceae), seed oil (NSO) added to meridic diet at concentrations as low as 0.016% reduced pupation and prevented adult eclosion of obliquebanded leafroller, Choristoneura rosaceana (Harris) (Lepidoptera: Tortricidae). At a rate of 0.0016%, NSO reduced the fitness of C. rosaceana, resulting in longer developmental times, lower adult eclosion rates, and reduced egg production compared with controls. The neem insecticide Margosan‐TM produced comparable results based on concentrations of the most biologically active constituent, azadirachtin. Pupation was completely inhibited at concentrations of 0.25% and 1.0% for larvae exposed at 5th or 6th instar, respectively; rates as low as 0.016% reduced pupal weights and adult eclosion rates. For larvae transferred to treated diet at 5th instar, physical abnormalities in the wings of adults occurred at a rate of 0.004% NSO and increased with increasing treatment rates. NSO at concentrations as high as 2.0% was not antifeedant to neonate larvae, based on 24 and 48 h choice test bioassays, when incorporated into a meridic diet.

Clinical evaluation of a latex agglutination test for streptococcal pharyngitis

The accuracy and clinical utility of a latex agglutination test were compared with anaerobic throat culture on selective media for detection of Group A streptococcal pharyngitis in an urban pediatric emergency department. Among 255 symptomatic cases prevalence of positive culture was 29% and antigen test sensitivity was 55%. Among 100 asymptomatic controls prevalence of positive culture was 20% and antigen test sensitivity was 20%. Controls with positive cultures and cases with false negative antigen tests had significantly fewer colonies on culture than cases with true positive antigen tests (P less than 0.01). Symptoms and clinical findings were not associated with antigen test result or number of colonies on culture. Eighty percent of patients with positive cultures received treatment when the antigen test was used as an adjunct to culture, compared with a 57% treatment rate among the subgroup in whom follow-up treatment was attempted based on positive culture results alone (P less than 0.05). We conclude that: (1) the antigen test had lower sensitivity in routine clinical use than previously reported; (2) the high rate of false negative tests may result, in part, from a high proportion of specimens with low colony counts; and (3) the availability of the antigen test as an adjunct to culture significantly increased treatment rates.

Radiation oncology in Australia: an increasing crisis.

ABSTRACTThe demands for radiotherapy services continue to increase relentlessly but the capacity to meet these demands is not available. In Australia only 36% of patients with invasive cancer are being treated with megavoltage radiotherapy beams whereas an increase of approximately 50% is necessary to reach a more appropriate level of 55%. A review of the number of radiation oncologists, radiographers and treatment machines shows that the shortage of staff and equipment are consistent with the low utilization of radiotherapy in Australia. Staff and equipment are fully occupied and lack the capacity to appreciably increase treatment rates. A 50% increase in the number Of radiation oncologists is required to reach the recommended number of 7 per million population for service commitments only. This increase is also necessary to adequately treat the additional 50% of patients who would benefit from appropriate modern radiotherapy. Similar increases in therapy radiographer staff numbers and treatment machines will also be required if these additional patients are to be treated. A greatly expanded training, recruitment and re‐equipment programme is urgently required.

Declining mortality from ischemic heart disease and changes in coronary risk factors in Japan, 1956-1980.

Mortality from ischemic heart disease has declined in Japan since 1970. This paper addresses the declining mortality from ischemic heart disease and the possible contributing factors for 1956-1980. Mortality figures were obtained from Vital Statistics reports by the Ministry of Health and Welfare in Japan. National trends in blood pressure levels, prevalence of hypertension, Keys' lipid factor phi instead of the serum cholesterol level, and body mass index were obtained from the National Nutrition Survey which is carried out annually from random samples in Japan. The smoking rate which was obtained from other national surveys was also reviewed for this purpose. The age-adjusted (30-69 years) mortality from ischemic heart disease declined by 24% and 37% for men and women, respectively, between 1968 and 1978. It seemed that the decline in blood pressure levels and in the prevalence of hypertension and the increasing treatment rate for cardiovascular disease might contribute to the declining mortality from ischemic heart disease. The decline in cigarette smoking may, in part, also play a role. On the other hand, the increase in intake of lipids which resulted in Keys' lipid factor phi was compatible with the increase in mortality from ischemic heart disease during 1956-1970. The experience in Japan shows that the treatment of hypertension or the lowering of blood pressure and the recommendation to stop smoking help to prevent ischemic heart disease.

Clinical performance and effect on treatment rates of latex agglutination testing for streptococcal pharyngitis in an emergency department.

Of 556 children with symptoms of streptococcal pharyngitis in a pediatric hospital emergency department, 38.8% had positive results on either a rapid latex agglutination test or throat culture for Group A Streptococcus. Twenty-six percent of patients with negative latex agglutination test results had growth on culture of a paired specimen. Under the best assumption rapid test sensitivity was 44.9%. The treatment rate (84%) for cases detected by the rapid test was markedly higher than the rate (44%) for cases detected only by culture (P less than 0.001), presumably because the rapid test result is available sooner. We conclude that: the rapid test had a lower sensitivity in routine use in our pediatric emergency department population than in previous reports from research settings; and using the rapid test in addition to culture can significantly increase treatment rates.