Karin A. Mack

Pharmaceutical overdose deaths, United States, 2010.

risk reduction, be it cancer risk, cardiovascular risk, or progression of COPD. This potentially makes a negative outcome of screening counterproductive because it might be viewed as an incentive to continue smoking. However, smoking cessation remains difficult in any setting. Adherence is low and the outcome of screening has little longterm influence on smoking behavior. It recently has been shown that cardiovascular risk in smokers is increased, and this increase holds for any CAC score. Whereas the increased risk in smokers might suggest cardiovascular screening is not worthwhile in this population, the same study showed that mortality still increases substantially with higher CAC scores, even in smokers. These findings are corroborated by results from others, even in the setting of nongated chest CT scans used for cancer screening. Although the cardiovascular risk is increased on average, there is wide variation among smokers, which makes screening potentially useful to specifically detect those at high risk. Because smoking and CAC are independent risk factors, prediction will improve and not worsen when smoking and CAC and non-CAC are combined. Computed tomography technology currently used for lung cancer screening is limited by lack of electrocardiography gating. While this limitation reduces its value for excluding coronary calcium, the presence of larger amounts of calcium can be reliably detected, and the absolute risk of cardiovascular disease in individuals with high CAC scoring on screening scans is increased. Therefore, screening CT scans can readily establish increased risk. The real question is not whether to use the additional information provided by lung cancer screening but whether a highly positive result will be able to trigger treatment that can actually reduce this increased risk. For osteoporosis, quantitative CT of the lumbar spine had been superior to DEXA for measuring bone architecture and density. Technical and financial reasons have led to the widespread use of DEXA and to the decline of CT as an investigative tool. While osteoporosis assessment is generally performed on the lumbar spine, the thoracic spine is also affected and is readily assessable by chest CT. Direct implementation is hampered by the limited data available from most individuals, but it is not a reason why CT of the thoracic spine should not be able to detect osteopenia or osteoporosis. Although it is debated as to whether early diagnosis of COPD is useful, COPD and emphysema are independent predictors of lung cancer; therefore, detection may aid a more personalized and cost-effective lung cancer screening regimen. Independent of whether or not one supports CT-based lung cancer screening, extending this screening to other diseases that can be detected early by chest CT will provide valuable epidemiological data at least. At best, it may contribute to secondary prevention of some of the most debilitating diseases in the developed world.

Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000.

OBJECTIVE To examine trends in walking among adults in 31 states. METHODS Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4-5.2), from 26.2% (95% CI=25.1-25.3) in 1987 to 30.1% (95% CI=29.4-30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4-7.8), from 40.4% (95% CI=-39.4-41.1) to 46.9% (95% CI=46.2-47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2-14.2) in Hispanic women, 8.5% (95% CI=4.4-12.6) non-Hispanic black women, and 7.0% (95% CI=2.3-11.7) in non-Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for > or =30 minutes per session). CONCLUSIONS Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.

Self-Reported Falls and Fall-Related Injuries Among Persons Aged ≥ 65 Years–United States, 2006 ☆

PROBLEM In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.

AIDS and older americans at the end of the twentieth century

Summary: In the past 11 years, the cumulative number of AIDS cases reported to the Centers for Disease Control and Prevention in adults aged 50 years or older quintupled, from 16,288 in 1990 to 90,513 by the end of December 2001. This article provides an overview of AIDS cases through 2001, shows the growing totals of AIDS cases among persons aged 50 years or older, and describes and compares these cases with those among younger people. It also reviews work on perceptions of persons aged 50 years or older on their risk for contracting HIV and their preventive health practices. Most of the data for this article came from the CDC web site and the AIDS public use data set. Although the incidence of AIDS appears to be leveling off in the general population, the data show that older people as a group represent a substantial share of new cases. There are currently more than 60,000 persons estimated to be aged 50 years or older living with AIDS in the United States; more than 50,000 persons with AIDS in this age group have died since the epidemic began. In light of the new era of highly active antiretroviral therapy, it can be expected that the AIDS epidemic will continue to age in multifaceted ways.

Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012

INTRODUCTION Opioid analgesic prescriptions are driving trends in drug overdoses, but little is known about prescribing patterns among medical specialties. We conducted this study to examine the opioid-prescribing patterns of the medical specialties over time. METHODS IMS Healths National Prescription Audit (NPA) estimated the annual counts of pharmaceutical prescriptions dispensed in the U.S. during 2007-2012. We grouped NPA prescriber specialty data by practice type for ease of analysis, and measured the distribution of total prescriptions and opioid prescriptions by specialty. We calculated the percentage of all prescriptions dispensed that were opioids, and evaluated changes in that rate by specialty during 2007-2012. The analysis was conducted in 2013. RESULTS In 2012, U.S. pharmacies and long-term care facilities dispensed 4.2 billion prescriptions, 289 million (6.8%) of which were opioids. Primary care specialties accounted for nearly half of all dispensed opioid prescriptions. The rate of opioid prescribing was highest for specialists in pain medicine (48.6%); surgery (36.5%); and physical medicine/rehabilitation (35.5%). The rate of opioid prescribing rose during 2007-2010 but leveled thereafter as most specialties reduced opioid use. The greatest percentage increase in opioid-prescribing rates during 2007-2012 occurred among physical medicine/rehabilitation specialists (+12.0%). The largest percentage drops in opioid-prescribing rates occurred in emergency medicine (-8.9%) and dentistry (-5.7%). CONCLUSIONS The data indicate diverging trends in opioid prescribing among medical specialties in the U.S. during 2007-2012. Engaging the medical specialties individually is critical for continued improvement in the safe and effective treatment of pain.

Gender differences in seeking care for falls in the aged Medicare population.

BACKGROUND One third of adults aged ≥65 years fall annually, and women are more likely than men to be treated for fall injuries in hospitals and emergency departments. PURPOSE The aim of this study was to examine how men and women differed in seeking medical care for falls and in the information about falls they received from healthcare providers. METHODS This study, undertaken in 2010, analyzed population-based data from the 2005 Medicare Current Beneficiary Survey (MBCS), the most recent data available in 2010 from this survey. A sample of 12,052 community-dwelling Medicare beneficiaries aged ≥65 years was used to examine male-female differences among 2794 who reported falling in the previous year, sought medical care for falls and/or discussed fall prevention with a healthcare provider. Multivariable logistic regression analyses were conducted to determine the factors associated with falling for men and women. P-values ≤0.05 were considered significant. RESULTS Nationally, an estimated seven million Medicare beneficiaries (22%) fell in the previous year. Among those who fell, significantly more women than men talked with a healthcare provider about falls and also discussed fall prevention (31.2% [95% CI=28.8%, 33.6%] vs 24.3% [95% CI=21.6%, 27.0%]). For both genders, falls were most strongly associated with two or more limitations in activities of daily living and often feeling sad or depressed. CONCLUSIONS Women were significantly more likely than men to report falls, seek medical care, and/or discuss falls and fall prevention with a healthcare provider. Providers should consider asking all older patients about previous falls, especially older male patients who are least likely to seek medical attention or discuss falls with their doctors.

A population-based survey of chronic pain and its treatment with prescription drugs

&NA; Chronic pain is a common reason for medical visits, but prevalence estimates vary between studies and have rarely included drug treatment data. This study aimed to examine characteristics of chronic pain and its relation to demographic and health factors, and factors associated with treatment of pain with opioid analgesics. A chronic pain module was added to the 2007 Kansas Behavioral Risk Factor Surveillance System (response rate = 61%). Data on prevalence, duration, frequency, and severity of chronic pain, demographics, and health were collected from a representative sample of 4090 adults 18 years and older by telephone. Logistic regression was used to examine the association of both chronic pain and opioid use with demographic and health factors. Chronic pain was reported by 26.0% of the participants and was associated with activity limitations (adjusted odds ratio [AOR] = 3.6, 95% confidence interval [95% CI] 2.8–4.5), arthritis (AOR = 3.3, 95% CI 2.6–4.0), poor mental health (AOR = 2.0, 95% CI 1.4–2.8), poor overall health (AOR = 1.9; 95% CI 1.5–2.5), and obesity (AOR = 1.6; 95% CI 1.2–2.0). Of the 33.4% of people with pain who use prescription pain medication, 45.7% took opioids, including 36.7% of those with mild pain. Chronic pain affects a quarter of adults in Kansas and is associated with poor health. Opioid analgesics are the mainstay of prescribed pharmacotherapy in this group, even among those reporting mild pain. Chronic pain affects 26.0% of adults in the state of Kansas, USA. Overall, 45.7% of people who take prescription drugs for chronic pain reported taking opioid analgesics.

Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program

Tai chi--moving for better balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the re-aim framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings.

Middle-Aged and Older People with AIDS Trends in National Surveillance Rates, Transmission Routes, and Risk Factors

This article explores the stability and changes in national trends related to AIDS rates, transmission routes, and risk factors from the mid-1980s to 1997. The authors show that while the numbers of AIDS cases have grown dramatically for all age groups, the proportion of cases for persons age 50 and older (at diagnosis) has remained a fairly stable 10% of the total case load, resulting in more than 60,000 cases in 1997. Contrary to popular belief, the most prevalent transmission route for middle-aged and older people has always been through sexual contact. While middle-aged and older people may be at reduced risk compared to younger age groups, these data also reveal a disturbing trend. People age 50 and older continue to be less knowledgeable about AIDS risks, perceive themselves to be at lower risk, and, for those with known AIDS-related risks, have made fewer behavioral accommodations to avoid such risksas compared to younger people. With recent data indicating a faster rise in new AIDScases among the 50-plus population, middle-aged and older people can no longer beignored in AIDS prevention or treatment efforts.

Snakebite Injuries Treated in United States Emergency Departments, 2001–2004

Abstract Objective.—Venomous and nonvenomous snakes are found throughout most of the United States. While the literature on treatment is robust, there is not a current national epidemiologic profile of snakebite injuries in the United States. National estimates of such injuries treated in emergency departments (EDs) are presented along with characteristics of the affected population. Methods.—Data on snakebite injuries were abstracted from the National Electronic Injury Surveillance System–All Injury Program (2001–04). Variables included age, gender, body part affected, cause, disposition, and treatment date. When available, location, intentionality of the interaction, and snake species were coded based on narrative comments. Estimates were weighted and analyzed with SPSS Complex Samples. Results.—An estimated 9873 snakebites were treated in US EDs each year between 2001 and 2004. Males were more frequently seen in the ED for snakebites than were females (males: 72.0% [95% confidence interval (CI), 68.0–75.7]; females: 28.0% [95% CI, 24.3–32.0]). Approximately 32% of patients were known to be bitten by venomous species. Overall, more than one quarter of patients were hospitalized (27.9% [95% CI, 15.9–44.2]), although 58.9% of patients with known venomous bites were hospitalized (95% CI, 41.5–74.3). Conclusions.—While they are rare events, snakebites cause nearly 10 000 visits to EDs for treatment every year. Epidemiologic data regarding snakebites provide practicing physicians with an understanding of the population affected and can help guide public health practitioners in their prevention efforts.