INTRODUCTION: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. MATERIALS AND METHODS: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. RESULTS: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner's choice of home-use and felt that their presence and support had been valuable. DISCUSSION: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions.
To document experience with directly observed chemoprophylaxis (DOPT) compared to self-administered isoniazid (INH) among aboriginal persons in British Columbia.
DOPT was compared to self-administered delivery (SAD) over a 3-year period. All aboriginal persons who received INH chemoprophylaxis in British Columbia between 1992 and 1994 were evaluated. Therapy completion rates and adverse outcomes associated with SAD were compared with DOPT. Treatment allocation was by patient choice.
Of 608 people who received INH prophylaxis, 443 received SAD (mean age 31.6 years) and 165 received DOPT (mean age 23.9 years). Two hundred and seventy (60.9%) SAD compared to 124 (75.2%) in the DOPT group completed 6 months of INH (P = 0.0011). The 12-month completion rates were 162/443 (36.6%) for the SAD group and 84/165 (50.9%) for the DOPT group (P = 0.0014). Adverse reactions requiring discontinuation of medication occurred in 13.5% of the patients on SAD and 9.7% of those receiving DOPT (P = 0.202). The most common reason cited for failure to complete therapy was non-cooperation in both groups. There were three deaths in the SAD group, one of which was due to suicide by self-ingestion of INH.
These data demonstrate that in aboriginal people compliance with preventive therapy can be improved by DOPT. Non random allocation to treatment groups might have influenced our findings, and further prospective randomized trials and cost-effectiveness analyses are required.
Adverse drug events (ADEs) are a frequent problem encountered in the elderly. The aim of this study was to elucidate the factors that influence ADEs in an elderly population with cognitive impairment.
242 patients were recruited from dementia clinics and assessed after 6 months for ADEs. The use of natural health products (NHPs) was also documented.
Backward logistic regression found that higher age (OR = 1.06; 95% CI 1.01-1.12), and greater cognitive impairment (OR = 0.94; 95% CI 0.90-0.98) were associated with an increased risk of developing an ADE while the use of NHPs (OR = 0.32; 95% CI 0.13-0.79) was associated with a decreased risk (chi(2) = 27.6, p
Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups.
To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation.
Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events.
A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients.
Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction.
After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits.
In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.
Notes
Comment In: JAMA. 2001 May 9;285(18):2328-911343477
Self-reported data are usually used for the evaluation of the effects of hormone therapy in population studies. We examined the agreement between self-reported hormone therapy use and nationwide prescription data from the Social Insurance Institution of Finland to evaluate the accuracy of self-reports.
The 10-year questionnaire of the population-based Kuopio Osteoporosis Study was sent in 1999 to 12,562 women aged 57 to 67 years; 11,377 women who completed questionnaires were eligible for analysis. We asked women whether they had been taking estrogen hormone therapy as a gel, plaster, or tablet for the treatment of climacteric symptoms or osteoporosis and if the answer was yes, to specify the brand and duration of treatment for each year from 1994 to 1999.
Among the 11,377 women, 3,105 (27.3%) reported the use of an estrogen-based preparation in 1996 to 1999, and 97.6% were confirmed by Social Insurance Institution of Finland to have been prescribed hormone therapy during that time. In these women the median duration of use was 32 months (range, 1-41), according to Social Insurance Institution of Finland data. An additional 1,738 women had been prescribed hormone therapy for short periods, but those women did not report it. The duration of self-reported hormone therapy use was compared to the duration of prescriptions. A difference of 3 months or less per year was observed in 63.4% to 77.0% of women during the years 1996-1998.
A postal inquiry is a reliable method of recording long-term hormone therapy use.
The Alaska Education and Research Towards Health (EARTH) Study assessed cancer risk among 3,821 Alaska Native people (AN). We present the prevalence of selected cancer risk factors and comparison with Healthy People 2010 goals. Participants completed extensive computer-assisted self-administered questionnaires on diet, physical activity, tobacco and alcohol use, cancer screening, family history of cancer, and environmental exposures. Measurement data were collected on blood pressure, height, weight, waist/hip circumference, fasting serum lipids, and glucose. Cancer risk factors are high for the Alaska EARTH study population. For all risk factors studied except for vegetable consumption, Alaska EARTH Study participants did not meet Healthy People 2010 goals. This study is unique in providing questionnaire and measurement data of cancer risk factors on a larger study sample than any previous study among AN living in Alaska. Data show that the prevalence of most cancer risk factors exceeded national recommendations. Given the disease disparities that exist for the AN population, these data provide important baseline data that can be used to target health interventions and reduce health disparities.
Significant advances have been achieved in prevention of haemophilic disability through prophylactic administration of concentrates and early administration of coagulation factors to control new bleeding episodes, but there is only limited experience with home treatment in haemophilia patients with inhibitors. A home treatment programme using recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) in early intervention against minor bleeds in patients with high responding inhibitors was initiated in Denmark in June 1994. Following careful education and instruction, 2-3 doses each giving 90-100 micrograms/kg bodyweight of rFVIIa were stored in each patient's home. At the onset of a new bleeding episode patients were instructed to inject 1 dose of rFVIIa, and to call the Haemophilia Centre to discuss further management of the episode. If the drug was not completely effective after 1-2 h, a second dose was injected after 3 h. Patients were further instructed to contact us the following day for final efficacy reporting. In total, 7 patients have been enrolled into the study, and to date 114 bleeding episodes have been managed at home with a mean of 2.1 doses per bleed. On 4 occasions, recurrence of bleeding was noted within 24 h. Hospital admission was required in 9 cases, because of a serious injury, insufficient compliance or, in 2 cases, because bleeding required prolonged treatment. Management of these bleeding episodes required a mean of 18 doses. We propose and discuss key criteria for selection of patients for a home treatment programme. The results of this study demonstrate that early intervention in the home setting with rFVIIa is safe and effective in the management of minor bleeding episodes in haemophilia patients with inhibitors.
