Sunday, June 26 8: 30 Medicare Drug Coverage and Declining Disability Among the Elderly: Is There a Link? Michael Furukawa, Ph.D. Presented By: Michael Furukawa, Ph.D., Assistant Professor, School of Health Management and Policy, Arizona State University, P.O. Box 874506, Tempe, AZ 85287; Tel: 480 ; 9652363; Fax: 480 ; 965-6654; Email: Michael.Furukawa asu Research Objective: Over the past two decades, rates of disability have been declining among the elderly population in the U.S. One important contributor to the decline has been improved medical treatments, particularly the introduction of new pharmaceuticals to treat chronic diseases. While strong evidence suggests that insurance coverage increases utilization of medications by the elderly, little is known about the impact of prescription drug coverage on the level of functional disability. This study examines whether there is a link between drug coverage and transitions in the state of disability among elderly Medicare beneficiaries. Study Design: Data come from the Medicare Current Beneficiary Survey MCBS ; Cost and Use from 1994-1999. MCBS is a nationally-representative sample of 12, 000 Medicare beneficiaries and includes information on supplemental insurance and drug coverage as well as detailed measures of health status and functional disability. I estimate the effect of having drug coverage in year t 1 on the probability of being in one of six states of functional disability no disability; any physical limitation; any Instrumental Activities of Daily Living IADL 1 to 2 Activities of Daily Living ADL 3 or more ADLs; or death ; in year t. The probability of disability state is specified as an ordered probit with drug coverage as an endogenous treatment effect. I estimate a parametric two-step selection model and a non-parametric discrete factor model to address adverse selection and the endogeneity of drug coverage. Drug coverage effects are simulated to obtain changes in predicted probabilities for each disability state. Population Studied: The sample includes elderly age 65 or older ; , non-institutionalized Medicare beneficiaries who were continuously-enrolled in a single private supplemental plan employer, Medigap ; during year t 1. I compare persons with supplemental insurance with drug coverage to persons with supplemental insurance without drug coverage e.g., employer Rx vs. employer no Rx ; . Principal Findings: Preliminary results indicate that persons with drug coverage have lower probability of transition to greater states of disability in the following year. Notably, Medigap drug coverage reduces the probability of being in the 1 to 2 ADL state by 4.8 percent and reduces the probability of mortality by 1.8 percent. Simulations suggest that the drug coverage effects vary with the number of chronic conditions. Do you manufacture or supply any products on an `off' licence or Named Patient basis? If so please advise: a ; The nature of licence held granting permission b ; c ; Nature of products supplied off licence Estimated Annual Turnover: i ; Marketed ii ; d ; Manufactured. Market risks resulting from open derivative positions are estimated by a risk assessment system using a simulation of historical data and desmopressin. TEMPERATURES THAT ELICIT PEAK METABOLIC RATES: STATISTICAL DISTRIBUTIONS AND IMPLICATIONS. Richard W, HiIl, Patrick E. J, ederle * , md J3onald L. Beaver * . Michigan State University, East Lansing, MI 48824 Investigators typically employ a single ambient temperature to elicit coldinduced peak metabolic rates of recently captured mammals and birds. The temperature used in a particular study presumably was selected through exploratory tests, but data from such tests are usually not reported. Lack uf published data from exploratory tests precludes evaluation, and use of a single ambient temperature could fail to recognize important individual variation. Increased knowledge of the statistical distributions of temperatures that evoke peak metabolic rates is needed to place studies of peak rates on a firmer foundation. As part of a larger project, 146 deer mice Perumyscus manicrclntzrs ; and 158 black-capped chickadees Parus atticqillus ; caught in winter were tested at multiple ambient temperatures 5 C apart ; soon after capture to determine the particular temperature required to elicit peak metabolic rate in each individual. The helox method was used. In both species, the distribution of temperatures that elicited peak metabolic rates in various individuals was quasinormal. Most chickadees exhibited their peaks at 0, -5, -10, or -15 C; tie span of temperatures for mice was similarly wide but lower: -5, -10, -15, or -20 C. Members of both species were sufficiently variable that use of any single ambient temperature could cause substantial misestimation of peak metabolic rates of particular individuals. The population mean, however, could be estimated well enough for many purposes using only one or two test temperatures. The mean metabolic rate of all chickadees at -5 C, for example, was only 5% lower than the mean of their respective true peaks. Supported by U.S. Navy Submarine Communication Project Office, contracts N00039-84-C-0070 and NO0#9-88-C-0065. World Asthma Day - 2005 World Asthma Day is May 3, 2005. The theme this year is, Unmet Needs of Asthma. It was selected to call the attention of doctors and patients alike to the need for better asthma treatment and management. The Asthma Program distributed a packet of materials to assist local health departments and communities with raising asthma awareness. Some of the activities being planned include school walks, screenings, library events, and press releases. Please inform us as to what activities you conducted. Asthma Action Plans The revised Asthma Action Plans are currently being printed. Ten sample copies accompanied by a letter from the Commissioners of Public Health and Education encouraging the use of AAPs will be mailed to all pulmonologists and allergists, pediatricians, family practice physicians, community health centers, and school-based health centers in the state during the month of May. Copies of the AAP can be obtained upon request from DPH by calling 860-509-7751 or from the ALACT by calling 860-289-5401 and decadron, because stimate challenge.
SNF Report No. 13 03 Table 3.19 Unit cost estimates used in analyses by type of procedure. These studies no conclusive evidence is as yet available but more extensive work may provide us with the data needed. Cornel et al. therefore stress the importance of post-marketing surveillance studies that include prospective follow-up of a large number of pregnancies after ovulation induction to estimate the relative risk of neural tube defects.22 Adverse effects on the developing foetus associated with the use of ovulationstimulating drugs may not be limited to neural tube defects. An Australian group found an association with neuroectodermal turn our . They report on 2 neuroblastomas and 1 medulloblastoma in 3 children born after in vitro fertilization IW ; , all from the first cohort of 604 IW livebirths. The normal annual incidence rates in Australia are 1.0 and 0.4 per 100, 000children for neuroblastoma and medulloblastoma respectively. A further two patients were conceived after ovulation induction with clomiphene and artificial insemination. Any suspicion that drugs which stimulate ovulation and may be present in early pregnancy have teratogenic effects, creates an urgent need for thorough studies to describe and quantify these suspected risks. A possible obstacle to such studies could be concomitant drug use, in particular use of other ovulation-inducing drugs, since it is increasingly difficult to identify any causal relation with an individual drbg when increasing numbers of different drugs have been used. It is therefore important to investigate the intensity of co-medication in patients using ovulationstimulating drugs. Such studies also may indicate the degree of excessive prescription and therefore the unnecessary risks to which women and unborn children are exposed. We previously showed the reliability of drug utilization data that can be obtained from pharmacy records.24Especially when drug use has to be studied in a large population, pharmacy records offer the best tool to obtain optimal i n f this study we will report on the frequency and intensity of the use of clomiphene and of other ovulation-inducing drugs in a representative sample of a population of Dutch women in the child-bearing age group to better define the group that is at risk for the development of severe birth defects. METHODS Forty-two pharmacies in The Netherlands that were equipped with a computerized registration system Pharmacom ; were asked to cooperate in a search for patient exposure to ovulation-inducing drugs. All agreed to participate in the study, thus offering us an insight into the blinded pharmacy records of the patients registered at these pharmacies. The pharmacies were widely distributed over the country and included establishments from both urban and rural areas. The pharmacies covered a total population of approximately 524, 417 persons, which is approximately 3.4% of the entire Dutch population. The age distribution of the population under study was no different from the age distribution of the Dutch population as a whole.26 The population studied included approximately 83, 907 females 20-40 years of age and dexamethasone.

Medical officer Department of Preventive & Social Medicine Indira Gandhi Medical College Nagpur, . Address for correspondence : Dr. Uday W. Narlawar M.D PSM ; 46, Sai-Mansion, LIC Colony, RPTS Road Nagpur 440015 Maharastra state, India e-mail: Udayconl rediffmail.

A number of Group companies are currently involved in administrative proceedings, litigations and investigations arising out of the normal conduct of their business. These litigations include certain legal and product liability claims. Whilst provisions have been made for probable losses that Management deems to be reasonable or appropriate there are uncertainties connected with these estimates. Note 19 contains a more extensive discussion of these matters. In the opinion of Group Management, however, the outcome of these actions will not materially affect the Group's financial position but could be material to the results of operations in a given period and phenoxybenzamine. 2 0 2000 2001 2002 Source: IMS Health * Due to difference in definitions and statistical methodology, IMS estimates of sales growth may differ from values reported by the PMPRB. * Please refer to footnote 25.

Dr Peter Kreidl from the Epidemiological Observatory in Bolzano, South Tyrol, presented on the need for epidemiological studies as a basis for the evaluation of the impact of programmes, taking the example of diabetes in South Tyrol. The estimated number of diabetics in Italy is more than 1.7 million, and is likely to double by 2025. Diabetes is the most common cause of blindness in persons aged 2070 years, and is the third most common cause of chronic renal failure in Italy. It will increase the mortality due to cardiovascular complications by 30%, and the per capita cost of diabetics is three times the cost of others, with 60% of the cost due to hospital admissions because of complications. Two studies aimed to identify the size of the diabetes problem in South Tyrol and the areas where primary, secondary and tertiary preventive interventions might improve outcomes, reduce risk factors and improve quality of care. The ARGENTO study used standardized interviews and measures of blood pressure, weight, height and fasting blood glucose to levels to survey a cluster sample of 210 people in the region aged over 64. The QUADRI study used a standardized questionnaire to look at 200 randomly selected people aged 1864 years who do not pay fees for medical visits due to diabetes. The questions related to customer satisfaction, prevalence of risk factors and complications, information status, and behaviour. Results were as follows. The estimated prevalence in the region was 10% for females and 11% for males aged over 64 years. In addition, 5% of females and 5% of males showed blood glucose levels over 125 mg%. In total, among the QUADRI sample of diabetics aged 1864 years, 26% suffered complications, with retinopathy 16% ; and cardiac problems 11% ; the most common. Moreover, 61% were reported as having hypertension, but nearly a quarter reported receiving no treatment, and 45% reported as having hypercholesterolemia, of whom half said they had no treatment. Nearly half of the diabetics were overweight and 25% were obese. More than a third had an additional risk factor to their diabetes and nearly a third reported more than one. A third and phenytoin and stimate.

A systematic review by Canadian researchers of 22 studies including 3755 patients showed that errors in prescription medication histories at hospital admission were "disturbingly common and potentially harmful to patients." Such errors occurred in up to 67% of c ases in the studies, which were published between 1966 and April 2005 Between 27% and 54% of patients had at least one medication history error and 19-75% of the discrepancies were unintentional. In six of the studies n 588 patients ; the investigators estimated that 11-59% of the medication history errors were clinically important. The investigators searched Medline, Embase and CINAHL for the articles. They reviewed all published studies with quantitative results that compared prescription medication his tories obtained by physicians at the time of hospital admission with comprehensive medication histories. Three studies included errors in prescription and non-prescription drug history; one showed that 41% of the errors were clinically important. Another showed that 3% of the patients had drugs omitted from their drug history that were considered to be "life saving" and that 24% of the patients would have gained "significant benefit" from the omitted drugs. The third study found that 22% of the errors could have caused harm had the drug been continued in hospital and that 59% potentially could cause harm if continued beyond discharge. Prescription drugs most often involved in errors were cardiovascular agents for example, nitrates, digoxin, or blockers ; , sedatives benzodiazepines ; , and analgesics non-steroidal anti-inflammatory drugs and opioids ; . The study indicates a need for a systematic approach to ensuring that doctors take accurate drug histories at hospital admission and says that doctors may benefit from additional training. Pharmacists could be routinely involved in the task and patients and family members could help by bringing drug information to the hospital. Integrated community pharmacy databases accessible to hospital staff could also e nhance the accuracy of drug histories. MATERIALS AND METHODS Subjects. Patients must have fulfilled all the following eligibility criteria to be included in the study: 1 ; a documented hematologic malignancy; 2 ; recipient of a genotypically HLA-identical marrow transplantation; 3 ; age of 12 years of age or older; and 4 ; patients or legal guardians must sign the informed consent form approved by the Institutional Review Board. Patients were ineligible if they had one of the following exclusion criteria: 1 ; pregnant or unwilling to maintain an effective contraception during the study; 2 ; a previous marrow transplant; 3 ; serum creatinine 3.0 mg dL; 4 ; carriers of any of the human immunodeficiency viruses; and 5 ; use of a T-depleted marrow graft. In addition, patients must have met the criteria of patient selection according to the clinical protocols for marrow transplantation at the study sites. Study design. The primary endpoint of this study was the development of grade II-IV acute GVHD. The secondary end points were DFS and the incidence of chronic GVHD. We used the method of Makuch and Simon25 to calculate the sample size based on the primary end point--the development of moderate to severe grade II-IV ; acute GVHD, assuming that there was no difference in treatment efficacy between the two groups. An estimated sample size of 150 patients in each treatment arm was derived to ensure a probability of 80% that the upper 95% confidence limit for the true difference in efficacy did not exceed 0.15. Patients with hematologic malignancies who were candidates for BMT in each center were randomized in a 1: allocation ratio to receive tacrolimus or cyclosporine for GVHD prophylaxis. Patients were stratified according to age 40 v 40 years ; and whether they were a male recipient of a marrow graft from an alloimmunized female. The stage of underlying malignancy was categorized as `nonadvanced disease' if patients had chronic myeloid leukemia in chronic or accelerated phase, myelodysplasia, or if the disease was in remission; otherwise they were categorized as having `advanced disease.' This study was monitored by an independent Data Safety Monitoring Board DSMB ; . Results of interim analyses performed by the DSMB were blinded to the investigators and sponsor. The analysis for this report was based on the intent-to-treat principle. Treatment protocol. Preparative regimens were assigned according to the institutional protocols at the clinical sites. Supportive care such as protective isolation techniques, antimicrobial policy, and the use of intravenous IV ; immune globulin was standardized within each clinical site and was uniformly applied to the patients in both groups. All blood components were irradiated before administration. The day of transplantation was designated as day 0. Either tacrolimus or cyclosporine was initiated on day 1 of transplantation. The starting dose of tacrolimus 0.03 mg kg d ; or cyclosporine 3 mg kg d ; was administered by continuous IV infusion. The dose of cyclosporine or tacrolimus was calculated according to patient's lean body weight. The route of administration was converted from IV to oral at the ratio of 1: 4 when patients were able to tolerate oral intake. Dose modifications of tacrolimus and cyclosporine were dependent primarily on serum creatinine and the blood levels of tacrolimus or cyclosporine. A dose reduction of at least 25% was mandatory for patients with a creatinine elevated to greater than 2.0 times baseline and at least a 50% reduction for patients with a creatinine greater than 3 times baseline. Whole blood and valsartan.

Stimate drug A class action is maintainable under Rule 23 b ; 2 ; when "the party opposing the class has acted or refused to act on grounds generally applicable to the class, thereby making appropriate final injunctive relief or corresponding declaratory relief with respect to the class as a whole." Fed. R. Civ. P. 23 b ; Subsection b ; 2 ; class actions are "limited to those class actions seeking primarily injunctive or corresponding declaratory relief." 1 Newberg on Class Actions 4.11, at 4-39. Courts are divided over whether medical monitoring claims may be certified as a class action under Rule 23 b ; 2 ; See Wilson v. Brush Wellman, Inc., 2002 WL 31320323 Ohio App. 8 Dist. Oct. 17, 2002 Elliot v. Chicago Hous. Auth., No. 98 C 6308, 2000 WL 263730, at * 14 N.D. Ill. Feb. 28, 2000. Staging Staging evaluation of these patients includes a minimum database, as these dogs are older and may have concurrent organ impairment. Thoracic radiographs are also taken to screen for any distant metastasis. In reality, the presence of measurable metastasis at the time of diagnosis is rare, but it is estimated that 90-95% of dogs have micrometastasis at the time of diagnosis. Some authors advocate.performing a radionuclide bone scan or survey radiographs of bones to detect bone metastasis or synchronous primary lesions. In a Colorado State study, 6.4% of 171 dogs had bone metastasis at diagnosis detected by survey radiographs ; as compared to 4% with chest metastasis at diagnosis. Radionuclide scans may introduce the problem of false positive results, as any inflammatory lesion or injury degenerative joint disease or tooth root abscess, for example ; may "light up" on a bone scan. PROGNOSTIC FACTORS Prognostic factors include the age of the dog at diagnosis. younger dogs in one study. bone alkaline phosphatase osteosarcoma. Dogs. Hypercholesterolemic subjects. 2003 Elsevier Science Ltd. All rights reserved. 1226. Obesity: Selected medical issues - Mehler P.S., Lasater L. and Padilla R. [Dr. P.S. Mehler, Denver Health, 660 Bannock Street, Denver, CO 80204, United States] - EATING DISORD. 2003 11 4 ; - summ in ENGL The prevalence of obesity is rising at a very alarming rate in the United States. Estimates are that 27% of American adults are now considered obese, and another 52% are overweight. These individuals are at increased risk of premature mortality and the development of many comorbid illnesses. Numerous factors contribute to this epidemic. The medical treatment of obesity is difficult, but can be successful. Drug therapy and obesity surgery can be effective but more research is needed to improve all of the obesity treatments. 1227. Efficacy and safety of atorvastatin in patients with primary hypercholesterolemia: A multicenter brazilian national trial Port ; - ESTUDO MULTICENTRICO PARA AVALIAC AO DA SEGURANC A ~.

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