Archives of Internal Medicine

doi: 10.1001/archinte.1997.00440340014001pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Dinneen, Sean F.;Gerstein, Hertzel C.

doi: 10.1001/archinte.1997.00440340025002pmid: N/A

Abstract Objectives: To critically analyze the literature linking microalbuminuria with total and cardiovascular mortality and cardiovascular morbidity in non—insulin— dependent diabetes mellitus (NIDDM) and to quantify the risk. Methods: A combination of retrieval techniques (MEDLINE, SCISEARCH, and handsearching published bibliographies) was used to find all relevant articles based on title and abstract and "Methods" sections. Unpublished data on albumin excretion rate were sought from large NIDDM cohort studies. Results: A total of 264 citations were retrieved, of which 11 cohort studies were selected for inclusion in the overview, representing a total of 2138 patients followed up for a mean of 6.4 years. Patient age was similar across cohorts. Duration of NIDDM ranged from newly diagnosed to 13 years. The prevalence of microalbuminuria ranged from 20% to 36% in the 8 cohorts that excluded patients with clinical proteinuria. All studies reported either a trend or a significant association between microalbuminuria and total mortality or cardiovascular morbidity or mortality; the overall odds ratio for death was 2.4 (95% confidence interval, 1.8-3.1) and for cardiovascular morbidity or mortality, 2.0 (95% confidence interval, 1.4-2.7). We found no evidence of reporting bias. Conclusion: Microalbuminuria is a strong predictor of total and cardiovascular mortality and cardiovascular morbidity in patients with NIDDM.Arch Intern Med. 1997;157:1413-1418 References 1. Mogensen CE, Chachati A, Christensen CK, et al. Microalbuminuria: an early marker of renal involvement in diabetes . Uremia Invest. 1985-1986; 9:85-95. 2. Mogensen CE, Damsgaard EM, Froland A, Nielsen S, de Fine Olivarius N, Schmitz A. Microalbuminuria in non-insulin dependent diabetes . Clin Nephrol. 1992;38:528-538. 3. Alzaid AA. Microalbuminuria in patients with NIDDM: an overview . Diabetes Care. 1996;19:79-89.Crossref 4. Bennett PH, Haffner S, Kasiske BL, et al. Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation . Am J Kidney Dis. 1995;25:107-112.Crossref 5. Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes . N Engl J Med. 1984;310:356-360.Crossref 6. Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ. Microalbuminuria predicts mortality in non-insulin-dependent diabetes . Diabet Med. 1984;1:17-19.Crossref 7. Jensen T, Borch-Johnsen K, Kofoed-Enevoldsen A, Deckert T. Coronary heart disease in young type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors . Diabetologia. 1987;30:144-148.Crossref 8. Yudkin JS, Forrest RD, Jackson CA. Microalbuminuria as predictor of vascular disease in nondiabetic subjects . Lancet. 1988;2:530-533.Crossref 9. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage: the Steno hypothesis . Diabetologia. 1989;32:219-226.Crossref 10. Deckert T, Kofoed-Enevoldsen A, Norgaard K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen T. Microalbuminuria: implications for micro and macrovascular disease . Diabetes Care. 1992;15:1181-1191.Crossref 11. Gilbert RE, Cooper ME, McNally PC, O'Brien RC, Toft J, Jerums G. Microalbuminuria: prognostic and therapeutic implications in diabetes mellitus . Diabet Med. 1994;11:636-645.Crossref 12. Breslow NE, Day NE. Statistical methods in cancer research: the analysis of case-control studies . IARC Sci Publ. 1980;1:122-159. 13. Schmitz A, Vaeth M. Microalbuminuria: a major risk factor in non-insulin-dependent diabetes: a 10-year follow-up study of 503 patients . Diabet Med. 1988;5:126-134.Crossref 14. Patrick AW, Leslie PJ, Clarke BF, Frier BM. The natural history and associations of microalbuminuria in type 2 diabetes during the first year after diagnosis . Diabet Med. 1990;7:902-908.Crossref 15. Stiegler H, Standl E, Schulz K, Roth R, Lehmacher W. Morbidity, mortality, and albuminuria in type 2 diabetic patients: a three-year prospective study of a random cohort in general practice . Diabet Med. 1992;9:646-653.Crossref 16. Mattock MB, Morrish NJ, Viberti GC, Keen H, FitzGerald AP, Jackson G. Prospective study of microalbuminuria as predictor of mortality i n NIDDM. Diabetes. 1992;41:736-741.Crossref 17. Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Eight to nine year mortality in known non-insulin dependent diabetics and controls . KidneyInt. 1992;41:731-735. 18. Stehouwer CDA, Nauta JJP, Zeldenrust GC, Hackeng WHL, Donker AJM, Den Ottolander GJH. Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus . Lancet. 1990;340:319-323.Crossref 19. Niskanen L, Voutilanen R, Terasvirta M, et al. A prospective study of clinical and metabolic associates of proteinuria in patients with type 2 diabetes mellitus . Diabet Med. 1993;10:543-549.Crossref 20. Standl E, Stiegler H. Microalbuminuria in a random cohort of recently diagnosed type 2 (non-insulin-dependent) diabetic patients living in the greater Munich area . Diabetologia. 1993;36:1017-1020.Crossref 21. Damsgaard EM, Froland A, Jorgensen OD, Mogensen CE. Prognostic value of urinary albumin excretion rate and other risk factors in elderly diabetic patients and non-diabetic control subjects surviving the first 5 years after assessment . Diabetologia. 1993;36:1030-1036.Crossref 22. Uusitupa MIJ, Niskanen LK, Siitonen O, Voutilainen E, Pyorala K. Ten-year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in type 2 (non-insulin-dependent) diabetic and non-diabetic subjects . Diabetologia. 1993;36:1175-1184.Crossref 23. Neil A, Hawkins M, Potok M, Thorogood M, Cohen D, Mann J. A prospective population-based study of microalbuminuria as a predictor of mortality i n NIDDM. Diabet Care. 1993;16:996-1003.Crossref 24. Macleod JM, Lutale J, Marshall SM. Albumin excretion and vascular deaths in NIDDM . Diabetologia. 1995;38:610-616.Crossref 25. Beatty OL, Ritchie CM, Bell PM, Hadden DR, Kennedy L, Atkinson AB. Microalbuminuria as identified by a spot morning urine specimen in non-insulin-treated diabetes: an eight-year follow-up study . Diabet Med. 1995;12:261-266.Crossref 26. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Mortality from coronary heart disease and stroke in relation to degree of glycemia: the Whitehall Study . BMJ. 1983;287:867-870.Crossref 27. Nosadini R, Solini A, Velussi M, et al. Impaired insulin-induced glucose uptake by extrahepatic tissue is hallmark of NIDDM patients who have or will develop hypertension and microalbuminuria . Diabetes. 1994;43:491-499.Crossref 28. Niskanen L, Laakso M. Insulin resistance is related to microalbuminuria in patients with type 2 (non-insulin-dependent) diabetes mellitus . Metabolism. 1993;42:1541-1545.Crossref 29. Viberti G, Mogensen CE, Groop LC, Pauls JF. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria . JAMA. 1994; 271:275-279.Crossref 30. Lewis EJ, Hunsicker LG, Bain RP, Rohde RP. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy: the Collaborative Study Group . N Engl J Med. 1993;329:1456-1462.Crossref 31. Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M. Long-term stabilizing effect of angiotensinconverting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type 2 diabetic patients . Ann Intern Med. 1994;118:577-581.Crossref 32. The HOPE Study Investigators. The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large simple randomized controlled trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events . Can J Cardiol. 1996;12:127-137. 33. Hypertension in Diabetes Study Group. Hypertension in Diabetes Study III: prospective study of therapy of hypertension in type 2 diabetic patients: efficacy of ACE inhibition and β-blockade . Diabet Med. 1994;11:773-782.Crossref

Joshi, Nirmal;Miller, Debra Q.

doi: 10.1001/archinte.1997.00440340035003pmid: N/A

Abstract Although several new antibiotics have recently become available, in several clinical instances conventional antibiotics may be equally efficacious at a considerably lower cost. In today's era of cost containment, it is particularly relevant to revisit older, inexpensive antibiotics to reexplore their role in the face of the emergence of resistant microorganisms and competition from newer agents. Doxycycline is one such antibiotic. It is an inexpensive, broad-spectrum antimicrobial agent that remains the drug of first choice for several infections. In addition, it can be used for a variety of other indications. Adverse effects are infrequent and relatively minor. While interactions occur with several medications, none of these interactions has significant adverse consequences. Arch Intern Med. 1997;157:1421-1428 References 1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States . JAMA. 1995;273:241-242.Crossref 2. Joshi N, Milfred D. The use and misuse of new antibiotics: a perspective . Arch Intern Med. 1995; 155:569-577.Crossref 3. Duggar BM. Aureomycin: product of continuing search for new antibiotic . Ann N Y Acad Sci. 1948;51:177.Crossref 4. Finland M. Twenty-fifth anniversary of the discovery of Aureomycin: the place of the tetracyclines in antimicrobial therapy . Clin Pharmacol Ther. 1974;15:3-8. 5. Jones M, Comer JB, Cunha BA. Tetracyclines . In: Ristuccia AM, Cunha BA, eds. Antimicrobial Therapy . New York, NY: Raven Press; 1948:219-234. 6. Barza M, Brown RB, Shanks C, Gamble C, Weinstein L. Relation between lipophilicity and pharmacological behavior of minocycline, doxycycline, tetracycline, and oxytetracycline in dogs . Antimicrob Agents Chemother. 1975;8:713-720.Crossref 7. Barza M, Schiefe RT. Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, I: tetracyclines . Am J Hosp Pharm. 1977; 34:49-57. 8. Connamacher RH, Mandel HG. Binding of tetracycline to the 30 S ribosomes and to polyuridylic acid . Biochem Biophys Res Commun. 1965;20:98.Crossref 9. Maxwell IH. Studies of the binding of tetracycline to ribosomes in-vitro . Mol Pharmacol. 1968; 4:25-37. 10. Suarez G, Nathans D. Inhibition of aminoacyl-tRNA binding to ribosomes by tetracycline . Biochem Biophys Res Commun. 1965;18:743.Crossref 11. Day LE. Tetracycline inhibition of cell-free protein synthesis, II: effect of the binding of tetracycline to the components of the system . J Bacteriol. 1966;92:197-203. 12. Pato ML. Tetracycline inhibits propagation of deoxyribonucleic acid replication and alters membrane properties . Antimicrob Agents Chemother. 1977;11:318-323.Crossref 13. Kucers A, Bennett NM. The Use of Antibiotics. 4th ed. Philadelphia, Pa: JB Lippincott; 1987: 979-1044. 14. Benveniste R, Davies J. Mechanisms of antibiotic resistance in bacteria . Annu Rev Biochem. 1973;42:471-506.Crossref 15. Bread NS Jr, Armentrout SA, Weisberger AS. Inhibition of mammalian protein synthesis by antibiotics . Pharmacol Rev. 1969;21:213-245. 16. Korkelia J. Antianabolic effect of tetracyclines . Lancet. 1971;1:974-975.Crossref 17. Saivin S, Houin G. Clinical pharmacokinetics of doxycycline and minocycline . Clin Pharmacokinet. 1988;15:355-366.Crossref 18. Davis CM, Vandersarl JV, Kraus EW. Tetracycline inequivalence: the importance of 96-hour testing . Am J Med Sci. 1973;265:69-74.Crossref 19. Meyer MC, Dann RE, Whyatt PL, Slywka GW. The bioavailability of sixteen tetracycline products . J Pharmacokinet Biopharm. 1974;2:287-297.Crossref 20. Saux MC, Mosser J, Pontagnier H, Leng B. Pharmacokinetics of doxycycline pylophosphate (PPD), hydrochloride (CHD) and base (DB) . Eur J Drug Metab Pharmacokinet. 1981;6:3-10.Crossref 21. Schreiner A, Digranes A. Pharmacokinetics of lime-cycline and doxycycline in serum and suction blister fluid . Chemotherapy. 1985;31:261-265.Crossref 22. Malmborg AS. Bioavailability of doxycycline monohydrate: a comparison with equivalent doses of doxycycline hydrochloride . Chemotherapy. 1984;30:76-80.Crossref 23. Musher DM, Minuth JN, Thorsteinsson SB, Holmes T. Effectiveness of achievable urinary concentrations of tetracyclines against 'tetracycline resistant' pathogenic bacteria . J Infect Dis. 1975;131( (suppl) ):S40-S44.Crossref 24. MacColloch CD, Richardson RA, Allwood GK. The penetration of doxycycline, oxytetracycline and minocycline into sputum . N Z Med J. 1974;80:300-302. 25. Brihmer C, Brundin J. Levels of ampicillin and doxycycline in human oviduct mucosa and serum . Acta Obstet Gynecol Scand. 1983;62:231-234.Crossref 26. Brihmer C, Brundin J. Doxycycline in human oviduct mucosa and plasma 24-30 hours after an oral dose of 100 mg . Acta Obstet Gynecol Scand. 1985;64:529-530.Crossref 27. Whelton A, Blanco LJ, Carter CG, et al. Therapeutic implications of doxycycline and cephalothin concentrations in female genital tract . Obstet Gynecol. 1980;55:28-32.Crossref 28. Blanchard P, Rudhardt M, Fabre J. Behaviour of doxycycline in the tissues . Chemotherapy. 1975; 21:8-18.Crossref 29. Yim C, Flynn NN, Fitzgerald TF. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis . Antimicrob Agents Chemother. 1985;28:347-348.Crossref 30. Andersson H, Alestig K. The penetration of doxycycline into CSF . Scand J Infect Dis Suppl. 1976; 9:17-19. 31. MacDonald H, Kelly RG, Allen AS, et al. Pharmacokinetic studies on minocycline in man . Clin Pharmacol Ther. 1973;14:852-861. 32. Houin G, Brunner F, Nebout T, et al. The effects of chronic renal insufficiency on the pharmacokinetics of doxycycline in man . Br J Clin Pharmacol. 1983;16:245-252.Crossref 33. Whelton A, Schach von Wittenau M, Twomey TM, Walker WG, Bianchine JR. Doxycycline pharmacokinetics in the absence of renal function . Kidney Int. 1974;5:365-371.Crossref 34. Letteri JM, Miraflor F, Tablante V, Siddiqi S. Doxycycline (Vibramycin) in chronic renal failure . Nephron. 1973;11:318-324.Crossref 35. Neu HC. A symposium on the tetracyclines: a major appraisal . Bull N Y Acad Med. 1978;54:141-155. 36. Vilde JL, Dournon E, Rajagopalan P. Inhibition of Legionella pneumophila multiplication within human macrophages by antimicrobial agents . Antimicrob Agents Chemother. 1986;30:743-748.Crossref 37. Havlichek D, Saravolatz L, Pohlod D. Effect of quinolones and other antimicrobial agents on cell-associated Legionella pneumophila . Antimicrob Agents Chemother. 1987;31:1529-1534.Crossref 38. Hammerschlag M. Antimicrobial susceptibility and therapy of infections caused by Chlamydia pneumoniae . Antimicrob Agents Chemother. 1994;38:1873-1878.Crossref 39. Bowie WR, Wang S, Alexander ER, et al. Etiology of nongonococcal urethritis . J Clin Invest. 1977;59:735-742.Crossref 40. Drugs for sexually transmitted diseases . Med Lett Drugs Ther. 1994;36:1-6. 41. Egerman RS. The tetracyclines . Obstet Gynecol Clin North Am. 1992;19:551-561. 42. Wolner-Hanssen P, Paavonen J, Kiviat N, Young M, Eschenbach DA, Holmes KK. Outpatient treatment of pelvic inflammatory disease with cefoxitin and doxycycline . Obstet Gynecol. 1988; 71:595-600. 43. Centers for Disease Control and Prevention. 1993 Sexually transmitted diseases treatment guidelines . MMWR Morb Mortal Wkly Rep. 1993;42:1-102. 44. Black RE. Epidemiology of travelers'diarrhea and relative importance of various pathogens . Rev Infect Dis. 1990;12( (suppl) ):S73-S79.Crossref 45. Alam AN, Alam NH, Ahmed T, et al. Randomised double-blind trial of single-dose doxycycline for treating cholera in adults . BMJ. 1990; 300:1619-1621.Crossref 46. Prevention and treatment of cholera . Med Lett Drugs Ther. 1991;33:107-108. 47. Rahaman MM, Majid MA, Alam AKM, Islam MR. Effects of doxycycline in actively purging cholera patients: a double-blind clinical trial . Antimicrob Agents Chemother. 1976;10:610-612.Crossref 48. Massarotti EM, Luger SW, Rahn DW, et al. Treatment of early Lyme disease . Am J Med. 1992; 92:396-403.Crossref 49. Nowakowski J, Nadelman RB, Forseter G, McKenna D, Wormser GP. Doxycycline versus tetracycline therapy for Lyme disease associated with erythema migrans . J Am AcadDermatol. 1995;32:223-227.Crossref 50. Bella F, Font B, Uriz S, et al. Randomized trial of doxycycline versus josamycin for Mediterranean spotted fever . Antimicrob Agents Chemother. 1990;34:937-938.Crossref 51. Raoult D. Treatment of Q fever . Antimicrob Agents Chemother. 1993;37:1733-1736.Crossref 52. Brown GW, Saunders JP, Singh S, Huxsoll DL, Shirai A. Single dose doxycycline therapy for scrub typhus . Trans R Soc Trop Med Hyg. 1978; 72:412-416.Crossref 53. Krause DW, Perine PL, McDade JE, Awoke S. Treatment of louse-borne typhus fever with chloramphenicol, tetracycline, or doxycycline . EastAfr Med J. 1975;52:421-427. 54. Wallace RJ, Wiss K. Susceptibility of Mycobacterium marinum to tetracyclines and aminoglycosides . Antimicrob Agents Chemother. 1981; 20:610-612.Crossref 55. Kim R. Tetracycline therapy for atypical mycobacterial granuloma . Arch Dermatol. 1974;110:299.Crossref 56. Robin RB, Beatty RF, Dunn S, et al. Mycobacterium chelonei keratitis after radial keratotomy . Am J Ophthalmol. 1986;102:72-79. 57. McClain JB, Ballov WR, Harrison SM, Steinweg DL. Doxycycline therapy for leptospirosis . Ann Intern Med. 1984;100:696-698.Crossref 58. Takafuji ET, Kirkpatrick JW, Miller RN, et al. An efficacy trial of doxycycline chemoprophylaxis against leptospirosis . N Engl J Med. 1984;310:497-500.Crossref 59. Acocella G, Bertrand A, Beytout J, et al. Comparison of three different regimens in the treatment of acute brucellosis: a multicenter multinational study . J Antimicrob Chemother. 1989; 23:433-439.Crossref 60. Farrell ID, Hinchliffe PM, Robertson L. Sensitivity of Brucella spp to tetracycline and its analogues . J Clin Pathol. 1976;29:1097-1100.Crossref 61. Cisneros JM, Viciana P, Colmenero J, Pachon J, Martinez C, Alarcon A. Multicenter prospective study of treatment of Brucella melitensis brucellosis with doxycycline for 6 weeks plus streptomycin for 2 weeks . Antimicrob Agents Chemother. 1990;34:881-883.Crossref 62. Mansson T. Treatment of malignant pleural effusion with doxycycline . Scand J Infect Dis. 1988; 53:29-34. 63. Seaton KG, Patz EF Jr, Goodman PC. Palliative treatment of malignant pleural effusions: value of small-bore catheter thoracostomy and doxycycline sclerotherapy . AJR Am J Roentgenol. 1995;164:589-591.Crossref 64. Harrison PV. A comparison of doxycycline and minocycline in the treatment of acne vulgaris . Clin Exp Dermatol. 1988;13:242-244.Crossref 65. Plewig G, Petrozzi JW, Berendes V. Double-blind study of doxycycline in acne vulgaris . Arch Dermatol. 1970;101:435-438.Crossref 66. Levallois P, Rioux JE. Prophylactic antibiotic for suction curettage abortion: results of a clinical controlled trial . Am J Obstet Gynecol. 1988;158:100-105.Crossref 67. Darj E, Stralin EB, Nilsson S. The prophylactic effect of doxycycline on postoperative infection rate after first-trimester abortion . Obstet Gynecol. 1987;70:755-758. 68. Simelaro JP, Ghen M, Ginsberg P. Evaluation of doxycycline in the treatment of acute sinusitis and bronchopulmonary disease . Curr Ther Res Clin Exp. 1980;27:769-773. 69. Jacobs P, Robinson R. Experiences with doxycycline in the management of acute respiratory tract infections . S Afr Med J. 1969;43:206-210. 70. Rogerson R. Doxycycline, a once-daily antibiotic in the treatment of chest infections in general practice . Br J ClinPract. 1971;25:175-176. 71. Maesen FPV, Davies BI, van Noord JA. Doxycycline in respiratory infections: a reassessment after 17 years . J Antimicrob Chemother. 1986; 18:531-536.Crossref 72. Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease . Ann Intern Med. 1987;106:196-204.Crossref 73. Lyons HA, Thomas JS, Heurich AE, Shepherd DA, Wetmore SD. Efficacy of doxycycline in acute infections of the lower respiratory tract . Curr Ther Res Clin Exp. 1976;19:24-31. 74. Williams DN, Lockey JE, Boxmeyer M, et al. Treatment of urinary infections with doxycycline. In: Finegold SM, ed. Doxycycline: Recent Investigation and Clinical Experience . Amsterdam, the Netherlands: Excerpta Medica; 1977:51. 75. Peterman TA, Zaidi AA, Lieb S, Wioten JE. Incubating syphilis in patients treated for gonorrhea: a comparison of treatment regimens . J InfectDis. 1994;170:689-692.Crossref 76. Centers for Disease Control and Prevention. Epididymitis.MMWR Morb Mortal Wkly Rep. 1993; 42:81-83. 77. Tornquist A, Edelund G, Forsgren A, Leandoer L, Olson S, Ursing G. Single-dose doxycycline prophylaxis and preoperative bacteriological culture in elective colorectal surgery . Br J Surg. 1981;68:565-568.Crossref 78. Hojer H, Wetterfors J. Systemic prophylaxis with doxycycline in surgery of the colon and rectum . Ann Surg. 1978;187:362-368.Crossref 79. Walder M, Leandoer L, Tornquist A, Forsgren A. Long-term effects on bacterial sensitivity patterns of preoperative antibiotic prophylaxis in colorectal surgery . Scand J Infect Dis. 1988;53 ( (suppl) ):59-64. 80. Pang LW, Boudereau EF, Limsomwong N, Singharaj P. Doxycycline prophylaxis for falciparum malaria . Lancet. 1987;1:1161-1164.Crossref 81. McCulloch CAG, Birek P, Overall C, et al. Randomized, controlled trial of doxycycline in prevention of recurrent periodontitis in high-risk patients: antimicrobial activity and collagenase inhibition . J Clin Periodontol. 1990;17:616-622.Crossref 82. Nicolson GL, Rosenberg-Nicolson NL. Doxycycline treatment and Desert Storm . JAMA. 1995; 273:618-619.Crossref 83. Joshi RK, Atukorala DN, Abanmi A, Khamis OA, Haleem A. Successful treatment of Sweet's syndrome with doxycycline . Br J Dermatol. 1993; 128:584-586.Crossref 84. Viswalingham ND, Darougar S, Yearsley P. Oral doxycycline in the treatment of adult chlamydial ophthalmia . Br J Ophthalmol. 1986;70:301-304.Crossref 85. Toth A, Lesser ML, Naus G, Brooks C, Adams D. Effect of doxycycline on pre-menstrual syndrome: a double-blind, randomized clinical trial . J Int Med Res. 1988;16:270-279. 86. Frucht-Pery J, Chayet AS, Feldman ST, Lin S, Brown SI. The effect of doxycycline on ocular rosacea . Am J Ophthalmol. 1989;107:434-435. 87. Smit JM, Ost MM, Groen AK, et al. A placebo-controlled study on the efficacy of aspirin and doxycycline in preventing clogging of biliary endoprostheses . Gastrointest Endosc. 1989;35:485-489.Crossref 88. Bowie WR. Urethritis in males . In: Holmes KK, Mardh P-H, Sparling PF, Weiser PJ, eds. Sexually Transmitted Diseases. 2nd ed. New York, NY: McGraw-Hill Book Co; 1989:627-639. 89. Drugs for sexually transmitted diseases . Med Lett Drugs Ther. 1995;37:117-121. 90. Centers for Disease Control and Prevention. Pelvic inflammatory disease . MMWR Morb Mortal Wkly Rep. 1993;42:75-81. 91. Solhaug JH, Bergman L, Kylberg F. A randomized evaluation of single-dose chemoprophylaxis in elective colorectal surgery: a comparison between metronidazole and doxycycline . Ann Clin Res. 1983;15:15-20. 92. Johnson JR, Stamm WE. Diagnosis and treatment of acute urinary tract infections . Infect Dis Clin North Am. 1987;1:773-791. 93. Rosenstock J, Smith LP, Gurney M, et al. Comparison of single-dose tetracycline hydrochloride to conventional therapy of urinary tract infection . Antimicrob Agents Chemother. 1985; 27:652-654.Crossref 94. Brickfield FX, Carter WH, Johnson RE. Erythromycin in the treatment of acute bronchitis in a community practice . J Fam Pract. 1986;23:119-122. 95. Stott NCH, West RR. Randomised control trial of antibiotics in patients with cough and purulent sputum . BMJ. 1976;2:556-559.Crossref 96. Orr PH, Scherer K, MacDonald A, Moffatt MEK. Randomized placebo-controlled trials of antibiotics for acute bronchitis: a critical review of the literature . J Fam Pract. 1993;36:507-512. 97. Pines A. Trimethoprim-sulfamethoxizole in the treatment and prevention of purulent exacerbations of chronic bronchitis . J Infect Dis. 1973; 128( (suppl) ):706-709.Crossref 98. Ball P. Epidemiology and treatment of chronic bronchitis and its exacerbations . Chest. 1995; 108( (suppl) ):43S-52S.Crossref 99. Chodosh S, Tuck J, Pizzuto D. Comparative trials of doxycycline versus amoxicillin, cephalexin and enoxacin in bacterial infections in chronic bronchitis and asthma . Scand J Infect Dis. 1988;53( (suppl) ):22-28. 100. Bille J, Moser F, Francioli P. Etiology of community-acquired pneumonia . Eur J Clin Microbiol Infect Dis. 1986;5:389-390. 101. Pomila PV, Brown RB. Outpatient treatment of community-acquired pneumonia in adults . Arch Intern Med. 1994;154:1793-1802.Crossref 102. Berntsson E, Lagergard T, Strannegard O, Trollfors B. Etiology of community-acquired pneumonia in outpatients . Eur J Clin Microbiol Infect Dis. 1986;5:446-447. 103. Erard P, Moser F, Wenger A, et al. Prospective study on community-acquired pneumonia diagnosed and followed up by private practitioners. In: Program and abstracts of the International Conference on Antimicrobial Agents and Chemotherapy; September 29-October 2 , 1991; Chicago, Ill. Abstract 56. 104. American Thoracic Society Statement. Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity and initial antimicrobial therapy . Am Rev Respir Dis. 1993;148:1418-1426.Crossref 105. Shea KW, Cunha BA, Ueno Y, Abumustafa F, Qadri SM. Doxycycline activity against Streptococcus pneumoniae . Chest. 1995;108:1775-1776.Crossref 106. Twartz JC, Shirai A, Selvarajv G, Saunders JP, Huxsoll JP, Groves MG. Doxycycline prophylaxis for human scrub typhus . J Infect Dis. 1982; 146:811-818.Crossref 107. Gudiol F, Pallares R, Caratulla J, et al. Randomized double-blind evaluation of ciprofloxacin and doxycycline for Mediterranean spotted fever . Antimicrob Agents Chemother. 1989;33:987-988.Crossref 108. Levy PY, Drancourt M, Etienne J, et al. Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis . Antimicrob Agents Chemother. 1991;35:533-537.Crossref 109. Ljungberg B, Christensson B, Grubb R. Failure of doxycycline treatment in aquarium-associated Mycobacterium marinum infections . Scand J Infect Dis. 1987;19:539-543.Crossref 110. Dalovisio JR, Pankey GA, Wallace RJ, Jones DB. Clinical usefulness of amikacin and doxycycline in the treatment of infection due to Mycobacterium fortuitum and Mycobacterium chelonei . Rev Infect Dis. 1981;3:1068-1074.Crossref 111. Kitamura S, Sugiyama Y, Izumi T, et al. Intrapleural doxycycline for control of malignant pleural effusion . Curr Ther Res Clin Exp. 1981;4:515-521. 112. Dembry LM, Uzokwe K, Zervos MJ. Control of endemic glycopeptide-resistant enterococci . Infect Control Hosp Epidemiol. 1996;17:286-292.Crossref 113. Montecalvo MA, Horowitz H, Carbonaro C, et al. Effect of rovobrocin containing antibiotic regimens on infection and colonization with vancomycin- and ampicillin-resistant Enterococcus faecium (VAREF) . In: Program and abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 4-7, 1994; Orlando, Fla. Abstract J153. 114. Lo S-C, Shih JW, Newton PB, et al. Virus-like infectious agent (VLIA) is a novel pathogenic mycoplasma: Mycoplasma incognitus . Am J Trop Med Hyg. 1989;41:586-600. 115. Hinton NA. The effect of oral tetracycline HCI and doxycycline on the intestinal flora . Curr Ther Res Clin Exp. 1970;12:341-352. 116. Clendinnen IJ. Doxycycline in the treatment of chronic lung infections . Med J Aust. 1974;1:9-11. 117. Lanza FL. Esophageal ulceration produced by doxycycline . Curr Ther Res Clin Exp. 1988;44:475-484. 118. Schneider R. Doxycycline esophageal ulcers . Am J Dig Dis. 1977;22:805-807.Crossref 119. Shiff AD. Doxycycline-induced esophageal ulcers in physicians . JAMA. 1986;256:1893.Crossref 120. Doxycycline and renal failure . Med Lett Drugs Ther. 1972;14:3-4. 121. Orr LH, Rudisill E, Brodkin R, Hamilton RW. Exacerbation of renal failure: association with doxycycline . Arch Intern Med. 1978;138:793-794.Crossref 122. Shwachman H, Fekete E, Kulczycki LL, Foley GE. The effect of long-term antibiotic therapy in patients with cystic fibrosis of the pancreas . Antibiot Annu. 1958;59:692. 123. Wallman IS, Hilton HB. Teeth pigmentation by tetracycline . Lancet. 1962;1:827.Crossref 124. Porter PJ, Sweeney EA, Golan H, Kass EH. Controlled study of the effect of prenatal tetracycline on primary dentition . Antimicrob Agents Chemother. 1965;5:668-671. 125. Cohlan SQ, Bevelander G, Tiamsic T. Growth inhibition of prematures receiving tetracyclines . AJDC. 1963;105:453. 126. Edwards R. Doxycycline and photosensitivity . N Z Med J. 1987;100:640. 127. Council on Drugs. Evaluation of a new antibacterial agent: doxycycline monohydrate and doxycycline hyclate (Vibramycin) . JAMA. 1969;209:549-550.Crossref 128. Frank SB, Choen HJ, Minken W. Photo-onycholysis due to tetracycline hydrochloride and doxycycline . Arch Dermatol. 1971;103:520-521.Crossref 129. Ramelli G. Photo-onycholysis following doxycycline hyclate . Cutis. 1972;10:155-156. 130. Curley RK, Verbov JL. Stevens-Johnson syndrome due to tetracyclines: a case report (doxycycline) and review of the literature . Clin Exp Dermatol. 1987;12:124-125.Crossref 131. Trueb RM, Burg G. Acute generalized exanthematous pustulosis due to doxycycline . Dermatology. 1993;186:75-78.Crossref 132. Neuvonen PJ. Interactions with absorption of tetracyclines . Drugs. 1976;11:45-54.Crossref 133. VenhoVMK, Salonen RO, Mattila MJ. Modification of the pharmacokinetics of doxycycline in man by ferrous sulfate or tissues . Chemotherapy. 1975;21:8-18.Crossref 134. Jonkman JHG, Van Der Boon WJV, Schoenmaker R, Holtkamp A, Hempenius J. No influence of doxycycline on theophylline pharmacokinetics . Ther Drug Monit. 1985;7:92-94.Crossref 135. Caraco Y, Rubinow A. Enhanced anticoagulant effect of coumarin derivatives induced by doxycycline coadministration . Ann Pharmacother. 1992;26:1084-1085. 136. Mattila MJ, Laisi U, Linnoila M, Salonen R. Effect of alcoholic beverages on the pharmacokinetics of doxycycline in man . Acta Pharmacol Toxicol (Copenh). 1982;50:370-373.Crossref 137. Nguyen VX, Nix DE, Gillikin S, et al. Effect of oral antacid administration on the pharmacokinetics of intravenous doxycycline . Antimicrob Agents Chemother. 1989;33:434-436.Crossref 138. Ericsson CD, Feldman S, Pickering LK, et al. Influence of subsalicylate bismuth on absorption of doxycycline . JAMA. 1982;247:2266-2267.Crossref 139. Neely JL, Abate M, Swinker M, et al. The effect of doxycycline on serum levels of ethinyl estradiol, norethindrone and endogenous progesterone . Obstet Gynecol. 1991;77:416-420.

Wong, Linda L.;McFall, Paul;Wong, Livingston M. F.

doi: 10.1001/archinte.1997.00440340047004pmid: N/A

Abstract Background: The high cost of liver transplantation is well known. The cost of dying of complications of end-stage liver disease (ESLD) without transplant, however, has not been well documented. Methods: For a 5-year period (1991-1995), in 153 patients, mean inpatient hospital charges and length of stay were analyzed in 6 groups of patients: (1) patients admitted with the primary diagnosis of esophageal varices, (1a) the subset of group 1 patients who died on this admission, (2) patients admitted to the liver team who died of complications from ESLD, (3) patients who underwent transjugular intrahepatic portosystemic shunts, (4) patients who underwent surgical shunt for bleeding varices, and (5) patients who underwent liver transplantation. Results: One hundred twenty-nine patients with esophageal varices were hospitalized 13.7 days with a mean charge of $30 980 for each of 202 admissions. Of these, 38 died after 24 days with a mean charge of $67 091. Seven patients admitted to the liver team died of complications of ESLD at $110 576 per admission. Transjugular intrahepatic portosystemic shunt was performed in 17 patients with a mean charge of $43 209. Six patients underwent surgical shunt for $53 994. Mean charge for 7 liver transplantations was $222 968. During the study period, 36.7% of all charges were for patients who died. Conclusions: It is difficult to estimate the total cost of ESLD; however, in evaluating inpatient costs, we see that it is expensive and significant amounts are spent on patients who die. Further study is necessary to determine which factors can optimize the cost of ESLD.Arch Intern Med. 1997;157:1429-1432 References 1. Evans R. Cost-effectiveness analysis of transplantation . Surg Clin North Am. 1980; 66:603-615. 2. Evans R, Manninen DL, Dong FB. An economic analysis of liver transplantation . Gastroenterol Clin North Am. 1993;22:451-473. 3. Evans R. Organ transplantation costs, insurance coverage and reimbursements . Clin Transpl. 1990:343-355. 4. Kilpe VE, Krakauer H, Wren RE. An analysis of liver transplant experience from 37 liver transplant centers as reported to Medicare . Transplantation. 1993;56:554-561.Crossref 5. Muto P, Freeman RB, Haug CE, Lu A, Rohrer RJ. Liver transplant candidate stratification systems . Transplantation. 1994;57:306-308.Crossref 6. O'Donnell TF, Gembarowic RM, Callow AD, et al. The economic impact of acute variceal bleeding, cost-effectiveness implications for medical and surgical therapy . Surgery. 1980;88:693-701. 7. Busuttil R, Klintmalm GB. Transplantation of the Liver . Philadelphia, Pa: WB Saunders Co; 1996:77-78.

Gelber, Allan C.;Klag, Michael J.;Mead, Lucy A.;Thomas, John;Thomas, D. Johniene;Pearson, Thomas A.;Hochberg, Marc C.

doi: 10.1001/archinte.1997.00440340060005pmid: N/A

Abstract Background: Patients with gout are encountered frequently in clinical practice. Previous studies have suggested that hyperuricemia and gout may represent risk factors for coronary heart disease (CHD), the most common cause of death in American men. Methods: Prospectively collected data from 2 longitudinal cohort studies of former medical students—371 black men in the Meharry Cohort Study and 1181 white men in the Johns Hopkins Precursors Study—were analyzed. The development of gout and of CHD was determined by physician self-report, and validated by using published criteria. The risk for CHD associated with gout was evaluated using Cox proportional hazards analysis. Results: During a median follow-up of 30 years, there were 38 gout cases and 44 CHD events among the Meharry men, and 68 gout cases and 138 CHD events among the Hopkins men. Prior gout was not associated with an increased risk for incident CHD (relative risk=1.20; 95% confidence interval, 0.37-3.92) among the Meharry men or among the Hopkins men (relative risk=0.66; 95% confidence interval, 0.24-1.79). Multivariate analysis adjusted for known CHD risk factors did not alter these findings. Conclusion: These results, in black and white male physicians, do not suggest a role in men for targeting gout identification in the primary prevention of CHD.Arch Intern Med. 1997;157:1436-1440 References 1. Gertler MM, Garn SM, Levine SA. Serum uric acid in relation to age and physique in health and in coronary heart disease . Ann Intern Med. 1951;34:1421-1431.Crossref 2. Klein R, Klein BE, Cornoni JC, Maready J, Cassel JC, Tyroler HA. Serum uric acid: its relationship to coronary heart disease risk factors and cardiovascular disease, Evans County , Georgia. Arch Intern Med. 1973;132:401-410.Crossref 3. Yano K, Rhoads GG, Kagan A. Epidemiology of serum uric acid among 8000 Japanese-American men i n Hawaii. J Chronic Dis. 1977;30:171-184.Crossref 4. Goldbourt U, Medalie JH, Herman JB, Neufeld HN. Serum uric acid: correlation with biochemical, anthropometric, clinical and behavioral parameters in 10,000 Israeli men . J Chronic Dis. 1980;33:435-443.Crossref 5. Brand FN, McGee DL, Kannel WB, Stokes J, Castelli WP. Hyperuricemia as a risk factor of coronary heart disease: the Framingham Study . Am J Epidemiol. 1985; 121:11-18. 6. Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I Epidemiology Follow-up Study . Am J Epidemiol. 1995;141:637-644. 7. Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases . Oxford, England: Oxford University Press; 1993:289-314. 8. Thomas CB. Observations on some possible precursors of essential hypertension and coronary artery disease . Bull Johns Hopkins Hosp. 1951;89:419-441. 9. Thomas J, Semenya KA, Neser WB, Thomas DJ, Green DR, Gillum RF. Risk factors and the incidence of hypertension in black physicians: the Meharry Cohort Study . Am Heart J. 1988;110:637-645.Crossref 10. Roubenoff R, Klag MJ, Mead LA, Liang K, Seidler AJ, Hochberg MC. Incidence and risk factors for gout in white men . JAMA. 1991;266:3004-3007.Crossref 11. Hochberg MC, Thomas J, Thomas DJ, Mead L, Levine DM, Klag MJ. Racial differences in the incidence of gout: the role of hypertension . Arthritis Rheum. 1995; 38:628-632.Crossref 12. Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu T. Preliminary criteria for the classification of the acute arthritis of primary gout . Arthritis Rheum. 1977;20:895-900.Crossref 13. Lipid Research Clinics Program. The Lipid Research Clinics Coronary Primary Prevention Trial results, I: reduction in incidence of coronary heart disease . JAMA. 1984;251:351-364.Crossref 14. International Classification of Diseases, Ninth Revision, Clinical Modification. Washington, DC: Public Health Service, US Dept of Health and Human Services; 1980:1. 15. Cox DR. Regression models and life-tables . J R Stat Soc. 1972;34:187-202. 16. Abbott RD, Brand FN, Kannel WB, Castelli WP. Gout and coronary heart disease: the Framingham Study . J Clin Epidemiol. 1988;41:237-242.Crossref 17. Fessel WJ. High uric acid as an indicator of cardiovascular disease: independence from obesity . Am J Med. 1980;68:401.Crossref 18. Ginsberg MH, Kozin F, O'Malley M, McCarthy DJ. Release of platelet constituents by monosodium urate crystals . J Clin Invest. 1977;60:999-1007.Crossref 19. Mustard JF, Murphy EA, Ogryzlo MA, Smythe HA. Blood coagulation and platelet economy in subjects with primary gout . Can Med Assoc J. 1963;89:1207-1211. 20. Newland H. Hyperuricemia in coronary, cerebral, and peripheral arterial disease: an explanation . Med Hypotheses. 1975;1:152-155.Crossref 21. Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST. Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity-insulin resistance syndrome . Am J Epidemiol. 1995;142:288-294. 22. Messerli FH, Frohlich ED, Dreslinski GR, Suarez DH, Aristimuno GG. Serum uric acid in essential hypertension: an indicator of renal vascular involvement . Ann Intern Med. 1980;93:817-821.Crossref 23. Klag MJ, Ford DE, Mead LA, et al. Serum cholesterol in young men and subsequent cardiovascular disease . N Engl J Med. 1993;328:313-318.Crossref

Randall, Daniel C.;Jones, David L.

doi: 10.1001/archinte.1997.00440340069006pmid: N/A

Abstract Background: Consensus recommendations call for the elimination of lactate dehydrogenase (LDH) tests from routine rule out myocardial infarction (ROMI) protocols. Methods: We conducted a utilization review project in which we evaluated the institutional impact of removing LDH and LDH isoenzyme tests from our hospital diagnostic panel. We then conducted a scripted telephone survey of 100 US hospitals to assess the generalizability of this project. Results: All our cardiology staff members supported this intervention. Lactate dehydrogenase isoenzyme test results did not add clinically useful data for any of 200 consecutive patients discharged with a diagnosis of acute myocardial infarction, and selective use of LDH isoenzyme testing in cases where it was clinically believed to be indicated cut costs 99% during the year after our intervention. Furthermore, our telephone survey demonstrated that 66% of US hospitals polled continue to test for LDH isoenzymes in every patient with possible myocardial infarction. Conclusions: Our results corroborate prior recommendations for the removal of LDH testing from the routine ROMI protocol. Such an intervention may be accomplished easily, with excellent staff acceptance and considerable savings. Most US hospitals continue to include LDH testing in their ROMI panels despite national guidelines recommending otherwise.Arch Intern Med. 1997;157:1441-1444 References 1. Martin AR. Common and correctable errors in diagnostic test ordering . West J Med. 1982;136:456-461. 2. Apple FS. Acute myocardial infarction and coronary reperfusion: serum cardiac markers for the 1990s . Am J Clin Pathol. 1992;97:217-226. 3. Puleo PR, Meyer D, Wathen C, et al. Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction . N Engl J Med. 1994;331:561-566.Crossref 4. Wong SS. Strategic utilization of cardiac markers for the diagnosis of acute myocardial infarction . Ann Clin Lab Sci. 1996;26:301-312. 5. Galbraith LV, Leung FY, Jablonsky G, Henderson AR. Time-related changes in the diagnostic utility of total lactate dehydrogenase, lactate dehydrogenase isoenzyme-1, and two lactate dehydrogenase isoenzyme-1 ratios in serum after myocardial infarction . Clin Chem. 1990;35:1317-1322. 6. Lee TH, Goldman L. Serum enzyme assays in the diagnosis of acute myocardial infarction: recommendations based on a quantitative analysis . Ann Intern Med. 1986;105:221-233.Crossref 7. Fisher ML, Kelemen MH, Collins DC, et al. Routine serum enzyme tests in the diagnosis of acute myocardial infarction: cost effectiveness . Arch Intern Med. 1983;143:1541-1543.Crossref 8. Lee TH, Goldman L. Serum enzyme assays in the diagnosis of acute myocardial infarction: recommendations based on a quantitative analysis . In: Sox HC, ed. Common Diagnostic Tests: Use and Interpretation . 2nd ed. Philadelphia, Pa: American College of Physicians; 1990:67-78. 9. Gunnar RM, Passamani ER, Bourdillon PD, et al. Guidelines for the early management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to Develop Guidelines for the Early Management of Patients With Acute Myocardial Infarction) . J Am Coll Cardiol. 1990;16:249-292.Crossref 10. American Hospital Association Guide to the Health Care Field . Chicago, Ill: American Hospital Association; 1994:A19-A502. 11. Reis GJ, Kaufman HW, Horowitz GL, Pasternak RC. Usefulness of lactate dehydrogenase and lactate dehydrogenase isoenzymes for diagnosis of acute myocardial infarction . Am J Cardiol. 1988;61:754-758.Crossref 12. Wong ET. Cost-effective use of laboratory tests: a joint responsibility of clinicians and laboratorians . Clin Lab Med. 1985;5:665-672. 13. Lewandrowski K, Bailey E, Dhanak E, Laposata M, Flood J. Mandatory laboratory consultation: how one hospital's program reduced overuse of cardiac tests . Lab Med. 1994;25:460-463. 14. Foreback CC. Biochemical diagnosis of myocardial infarction . Henry Ford Hosp Med J. 1991;39:159-164. 15. Ravel R. Clinical Laboratory Medicine: Clinical Application of Laboratory Data. 6th ed. St Louis, Mo: Mosby—Year Book Inc; 1995:331-342.

doi: 10.1001/archinte.1997.00440340072007pmid: N/A

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In the article titled "What Is the Role of Timing in the Surgical and Rehabilitative Care of Community-Dwelling Older Persons With Acute Hip Fracture," published in the March 10 issue (Arch Intern Med. 1997;157: 513-520), the third sentence of the "Results" subheading of the abstract section on page 513 should have read, "Patients who ambulated earlier had shorter lengths of stay...."

Saitz, Richard;Ghali, William A.;Moskowitz, Mark A.

doi: 10.1001/archinte.1997.00440340078008pmid: N/A

Abstract Background: There is controversy regarding the role of alcoholism as a prognostic factor in hospitalized patients with pneumonia. Objective: To assess the impact of alcohol abuse on hospitalization charges, length of hospital stay, intensive care unit use, and in-hospital mortality. Methods: We studied a cohort of all adults hospitalized in 1992 in Massachusetts with a principal diagnosis of pneumonia, and all Massachusetts residents hospitalized for pneumonia in 6 bordering states. Results: For the 23 198 pneumonia cases the mean total hospitalization charges were $9925, mean length of hospital stay was 9.6 days, 12% of the cases had intensive care unit stays, and 10% of the cases died during the hospitalization. In bivariate analyses, pneumonia cases with alcoholrelated diagnoses had higher charges (mean, $11 232 vs $9877, P=.07), had shorter length of hospital stay (9.2 vs 9.6 days, P=.02), were more likely to experience an intensive care unit stay (19% vs 12%, P<.001), and had lower in-hospital mortality (6.0% vs 10.2%, P<.001). Multivariable analyses adjusting for comorbidity, pneumonia etiology, and demographics revealed that for pneumonia cases with alcohol-related diagnoses, risk-adjusted hospital charges were $1293 higher (adjusted mean, $11 179 vs $9888, P<.001), length of hospital stay was 0.6 days longer (10.1 vs 9.5 days, P=.001), intensive care unit use was higher (18% vs 12%; adjusted odds ratio, 1.63; 95% confidence interval, 1.33-1.98), and mortality was no different (10% with or without an alcohol-related diagnosis). Conclusions: Having an alcohol-related diagnosis is associated with more use of intensive care, longer inpatient stays, and higher hospital charges. To understand resource utilization in cases of pneumonia, alcohol abuse is a comorbid factor that must be considered.Arch Intern Med. 1997;157:1446-1452 References 1. Garibaldi RA. Epidemiology of community-acquired respiratory tract infections in adults: incidence, etiology, and impact . Am J Med. 1985;78( (suppl 6B) ):32-37.Crossref 2. Health Care Investment Analysts and Ernst and Young. Comparative Clinical and Financial Standards: The Medicare DRG Handbook . Baltimore, Md: Health Care Investment Analysts Inc; 1991. 3. Daley J, Jencks S, Draper D, Lenhart G, Thomas N, Walker J. Predicting hospital-associated mortality for Medicare patients: a method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure . JAMA. 1988; 260:3617-3624.Crossref 4. Centers for Disease Control and Prevention. Mortality patterns: United States, 1993 . MMWR Morb Mortal Wkly Rep. 1996;45:161-164. 5. Dixon RE. Economic costs of respiratory tract infections in the United States . Am J Med. 1985;78( (suppl 6B) ):45-51.Crossref 6. The Secretary of Health and Human Services . Eighth Special Report to the US Congress on Alcohol and Health . Alexandria, Va: US Dept of Health and Human Services; 1993. 7. Rice DP, Kelman S, Miller LS, Dunmeyer S. Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985. San Francisco: Institute for Health and Aging, University of California; 1990. 8. Capps JA, Coleman GH. Influence of alcohol on prognosis of pneumonia i n Cook County Hospital. JAMA. 1923;80:750-752. 9. MacFarlane JT, Finch RG, Ward MJ, Macrae AD. Hospital study of adult community-acquired pneumonia . Lancet. 1982;2:255-258.Crossref 10. Torres A, Serra-Batlles J, Ferrer A, et al. Severe community-acquired pneumonia: epidemiology and prognostic factors . Am Rev Respir Dis. 1991;144:312-318.Crossref 11. Fang G-D, Fine M, Orloff J, et al. New and emerging etiologies for community-acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases . Medicine. 1990;69:307-316. 12. Pickrell KL. The effect of alcoholic intoxication and ether anesthesia on resistance to pneumococcal infection . Johns Hopkins Bull. 1938;63:238-260. 13. Guarneri JJ, Laurenzi GA. Effect of alcohol on the mobilization of alveolar macrophages . J Lab Clin Med. 1968;72:40-51. 14. Berkowitz H, Reichel J, Shim C. The effect of ethanol on the cough reflex . Clin Sci Mol Med. 1973;45:527-531. 15. Glassman AB, Bennett CE, Randall CL. Effects of ethyl alcohol on human peripheral lymphocytes . Arch Pathol Lab Med. 1985;109:540-542. 16. Nair MP, Kronfol ZA, Schwartz SA. Effects of alcohol and nicotine on cytotoxic functions of human lymphocytes . Clin Immunol Immunopathol. 1990;54:395-409.Crossref 17. Mili F, Flanders WD, Boring JR, Annest JL, DeStefano F. The associations of alcohol drinking and drinking cessation to measures of the immune system in middle-aged men . Alcohol Clin Exp Res. 1992;16:688-694.Crossref 18. Chomet B, Gach BM. Lobar pneumonia and alcoholism: an analysis of thirty-seven cases . Am J Med Sci. 1967;253:300-304.Crossref 19. Winterbauer RH, Bedon GA, Ball WC. Recurrent pneumonia: predisposing illness and clinical patterns in 158 patients . Ann Intern Med. 1969;70:689-700.Crossref 20. Adams HG, Jordan C. Infections in the alcoholic . Med Clin North Am. 1984;68:179-200. 21. Niquille M, Koehn V, Magnenat P, Paccaud F, Yersin B. Utilization of hospital resources by alcoholic and nonalcoholic patients: a prospective study . J Gen Intern Med. 1991;6:216-222.Crossref 22. Zook CJ, Moore FD. High-cost users of medical care . N Engl J Med. 1980;302:996-1002.Crossref 23. Roghmann KJ, Roberts JS, Smith TS, Wells SM, Wersinger RP. Alcoholics' versus nonalcoholics' use of services of a health maintenance organization . J Stud Alcohol. 1981;42:312-322. 24. Forsythe AB, Griffiths B, Reiff S. Comparison of medical services by alcoholics and non-alcoholics . Am J Public Health. 1982;72:600-602.Crossref 25. Putnam SL. Alcoholism, morbidity and care-seeking: the inpatient and ambulatory service utilization and associated illness experience of alcoholics and matched controls in a health maintenance organization . Med Care. 1982;20:97-121.Crossref 26. Pankrantz L, Jackson J. Habitually wandering patients . N Engl J Med. 1994;331:1752-1755.Crossref 27. Fernandez-Sola J, Junque A, Estruch R, Monforte R, Torres A, Urbano-Marquez A. High alcohol intake as a risk and prognostic factor for community-acquired pneumonia . Arch Intern Med. 1995;155:1649-1654.Crossref 28. Pachon J, Prados MD, Capote F, Cuello JA, Garnacho J, Verano A. Severe community-acquired pneumonia . Am Rev Respir Dis. 1990;142:369-373.Crossref 29. Ortqvist A, Hedlund J, Grillner L, et al. Aetiology, outcome, and prognostic factors in community-acquired pneumonia requiring hospitalization . Eur Respir J. 1990;3:1105-1113. 30. Farr BM, Sloman AJ, Fisch MJ. Predicting death in patients hospitalized for community-acquired pneumonia . Ann Intern Med. 1991;115:428-436.Crossref 31. Research Committee of the British Thoracic Society and the Public Health Laboratory Service. Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome . Q J Med. 1987;62:195-220. 32. Tilghman RC, Finland M. Clinical significance of bacteremia in pneumococcic pneumonia . Arch Intern Med. 1937;59:609-619.Crossref 33. Austrian R, Gold J. Pneumococcal bacteremia with special reference to bacteremic pneumococcal pneumonia . Ann Intern Med. 1964;60:759-776.Crossref 34. Fine MJ, Smith DN, Singer DE. Hospitalization decision in patients with community-acquired pneumonia: a prospective cohort study . Am J Med. 1990;89:713-721.Crossref 35. Black ER, Mushlin AI, Griner PF, Suchman AL, James RL Jr, Schoch DR. Predicting the need for hospitalization of ambulatory patients with pneumonia . J Gen Intern Med. 1991;6:394-400.Crossref 36. Fine MJ, Singer DE, Hanusa BH, Lave JR, Kapoor WN. Validation of a prognostic index using the MedisGroups comparative hospital database . Am J Med. 1993; 94:153-159.Crossref 37. Fine MJ, Singer DE, Phelps AL, Hanusa BH, Kapoor WN. Differences in length of stay in patients with community-acquired pneumonia: a prospective four-hospital study . Med Care. 1993;31:371-380.Crossref 38. Fine MJ, Hanusa BH, Lave JR, et al. Comparison of a disease-specific and a generic severity of illness measure for patients with community-acquired pneumonia . J Gen Intern Med. 1995;10:359-368.Crossref 39. Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community-acquired pneumonia: a meta-analysis . JAMA. 1996;275:134-141.Crossref 40. Fine MJ, Orloff JJ, Arisum D, et al. Prognosis of patients hospitalized with community acquired pneumonia . Am J Med. 1990;88:5-1N—5-8N.Crossref 41. Densen PM, Fielding JE, Getson J, Stone EM. The collection of data on hospital patients: the Massachusetts Health Data Consortium Approach , N Engl J Med. 1980;302:171-173.Crossref 42. Practice Management Information Corp. ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification , Fourth Edition. Los Angeles, Calif: Practice Management Information Corp; 1995. 43. Adams WL, Yuan Z, Barboriak JJ, Rimm AA. Alcohol-related hospitalizations of elderly people: prevalence and geographic variation in the United States . JAMA. 1993;270:1222-1225.Crossref 44. Dufour MC, Fe Caces M. Epidemiology of the medical consequences of alcohol . Alcohol Health Res World. 1993;17:265-271. 45. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases . J Clin Epidemiol. 1992;45:613-619.Crossref 46. Krumpe PE, Cummiskey JM, Lillington GA. Alcohol and the respiratory tract . Med Clin North Am. 1984;68:201-219. 47. Ballard HS. Hematological complications of alcoholism . Alcohol Clin Exp Res. 1989;13:706-720.Crossref 48. Moss M, Bucher B, Moore FA, Moore EE, Parsons PE. The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults . JAMA. 1996;275:50-54.Crossref 49. Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J. Interpreting hospital mortality data: the role of clinical risk adjustment . JAMA. 1988;260:3611-3616.Crossref 50. Iezzoni LI. Using administrative diagnostic data to assess the quality of hospital care: pitfalls and potential of ICD-9-CM . Int J Tech Assess Health Care. 1990;6:272-281.Crossref 51. Romano PS, Mark DH. Bias in the coding of hospital discharge data and its implications for quality assessment . Med Care. 1994;32:81-90.Crossref 52. Whittle J, Fine MJ, Joyce DZ, et al. Community acquired pneumonia: can it be defined with claims data? J Gen Intern Med. 1996;11( (suppl) ):93. Abstract.

Metlay, Joshua P.;Schulz, Richard;Li, Yi-Hwei;Singer, Daniel E.;Marrie, Thomas J.;Coley, Christopher M.;Hough, Linda J.;Obrosky, D. Scott;Kapoor, Wishwa N.;Fine, Michael J.

doi: 10.1001/archinte.1997.00440340089009pmid:

O&apos;Malley, Ann S.;Mandelblatt, Jeanne;Gold, Karen;Cagney, Kathleen A.;Kerner, Jon

doi: 10.1001/archinte.1997.00440340102010pmid: N/A

Abstract Objective: To examine how continuity of care affects the use of breast and cervical cancer screening in a multiethnic population. Methods: All data came from a structured telephone survey of a population-based quota sample designed to determine the cancer prevention needs of multiethnic blacks and Hispanics in New York, NY, in 1992. The study included 1420 women of 7 racial/ethnic groups: US-born blacks, English-speaking Caribbean-born blacks, Haitian blacks, and Puerto Rican, Dominican, Colombian, and Ecuadorian Hispanics. The main outcome measures were ever and recently having had a Papanicolaou smear, clinical breast examination (CBE), or mammogram. Results: Among respondents who qualified for the survey on the basis of age and ethnicity, the refusal rate for completing the interview was 2.1%. Compared with women without a usual site of care, those with a usual site, but no regular clinician, were 1.56, 2.45 (P≤.01), and 2.32 (P≤.05) times as likely ever to have received a Papanicolaou smear, CBE, or mammogram, respectively, and 1.84, 1.92 (P≤.05), and 1.75 times as likely to have received a recent Papanicolaou smear, CBE, or mammogram, respectively. Compared with women without a usual site of care, women with a regular clinician at that usual site of care were 2.63 (P≤.01), 2.83 (P≤.01), and 2.30 (P≤.05) times as likely ever to have received a Papanicolaou smear, CBE, or mammogram, and were 2.00 (P≤.05), 2.65 (P≤.01), and 1.40 times as likely to have recently received a Papanicolaou smear, CBE, or mammogram, respectively (adjusted odds ratios). For uninsured women, presence of a usual site of care was associated with increases in recent use of cancer screening for all screening tests. Conclusions: There is a linear trend in increasing breast and cervical cancer screening rates when one goes from having no usual source of care, to having a usual source, and to having a regular clinician at that usual source. Emphasis on continuity of care, especially on usual source of care, may help to bridge the gap in access to cancer prevention services faced by minority women.Arch Intern Med. 1997;157:1462-1470 References 1. Cancer Statistics Review 1973-1987: SEER Program . Bethesda, Md: US Dept of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 1990. National Institutes of Health publication 90-2789. 2. Freeman HP, Wasfie TJ. Cancer of the breast in poor black women . Cancer. 1989; 63:2562-2569.Crossref 3. Axtell LM, Myers M. Contrasts in survival of black and white cancer patients: 1960-1973 . J Natl Cancer Inst. 1978;60:1209-1215. 4. Bassett T, Krieger N. Social class and black-white differences in breast cancer survival . Am J Public Health. 1986;76:1400-1403.Crossref 5. Dayal HH, Power RN, Chiu C. Race and social-economic status in survival from breast cancer . J Chronic Dis. 1970;23:105-116.Crossref 6. Baquet CR. Cancer prevention and control in the black population: epidemiology and aging implications . In: Jackson JS, ed. The Black American Elderly: Research on Physical and Psychosocial Health . New York, NY: Springer Publishing Corp; 1988:50-68. 7. National Cancer Institute. Cancer Among Blacks and Other Minorities: Statistical Profiles . Bethesda, Md: US Dept of Health and Human Services, National Cancer Institute; 1986. NIH publication 86-2785. 8. National Cancer Institute. Cancer Statistics Review 1973-1986: Including a Report on the Status of Cancer Control . Bethesda, Md: US Dept of Health and Human Services, National Cancer Institute; 1989. NIH publication 89-2789. 9. Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer . JAMA. 1994;272:947-954.Crossref 10. Becker TM, Wheeler CM, Key CR, Samet JM. Cervical cancer incidence and mortality in New Mexico's Hispanic, American Indians, and non-Hispanic whites . West J Med. 1992;156:376-379. 11. Polednak AP. Estimating cervical cancer incidence in the Hispanic population of Connecticut by use of surnames . Cancer. 1993;71:3560-3564.Crossref 12. Peters RK, Thomas D, Hagan DO, et al. Risk factors for invasive cervical cancers among Latinas and non-Latinas i n Los Angeles County. J Natl Cancer Inst. 1986;77:1063-1077. 13. Centers for Disease Control and Prevention. Black-white differences in cervical cancer mortality—United States, 1980-1987 . MMWR Morb Mortal Wkly Rep. 1990;39:245-248. 14. International Agency for Research on Cancer, Working Group on Evaluation of Cervical Cancer Screening Programs. Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies . BMJ. 1986;293:659-664.Crossref 15. Shapiro S, Venet W, Strax P, Venet L. Periodic Screening for Breast Cancer: The Health Insurance Plan Project and Its Sequelae, 1963-1986 . Baltimore, Md: Johns Hopkins University Press; 1988. 16. Collette HJA, Day NE, Romback JJ, et al. Evaluation of screening for breast cancer in a non-randomized study (the DOM project) by means of a case-control study . Lancet. 1984;1:1224-1226.Crossref 17. O'Malley MD, Fletcher SW, Morrison B. Does screening for breast cancer save lives? effectiveness of treatment after breast cancer detection following screening by clinical breast examination, mammography, and breast self-examination . In: Lawrence RS, Goldbloom R, eds. Preventing Disease . New York, NY: Springer-Verlag NY Inc; 1989:251-264. 18. US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996. 19. National Cancer Institute. Intervention Research in Hispanic Populations . Bethesda, Md: Division of Cancer Prevention and Control, National Cancer Institute; 1989. RFA No. 89-CA-15. 20. Mandelblatt J, Andrews H, Kerner J, Zauber A, Burnett W. Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class and hospital type . Am J Public Health. 1991;81:646-649.Crossref 21. Bain RP, Greenberg RS, Whitaker JP. Racial differences in survival of women with breast cancer . J Chronic Dis. 1986;39:631-642.Crossref 22. McWhorter WP, Mayer WJ. Black/white differences in type of initial breast cancer treatment and implications for survival . Am J Public Health. 1987;77:1515-1517.Crossref 23. Natarajan N, Nemoto T, Mettlin C, Murphy GP. Race-related differences in breast cancer patients: results of the 1982 National Survey of Breast Cancer by the American College of Surgeons . Cancer. 1985;56:1704-1709.Crossref 24. Polednak AP. Breast cancer in black and white women in New York State: case distribution and incidence rates by clinical stage at diagnosis . Cancer. 1986; 58:807-815.Crossref 25. Satarino WA, Belle SH, Swanson GM. The severity of breast cancer at diagnosis: a comparison of age and extent of disease in black and white women . Am J Public Health. 1986;76:779-782.Crossref 26. Vernon SW, Tilley BC, Neale AV, Steinfeldt L. Ethnicity, survival, and delay in seeking treatment for symptoms of breast cancer . Cancer. 1985;55:1563-1571.Crossref 27. Nemoto T, Vana J, Bedwani RN, Baker HW, McGregor FH, Murphy GP. Management and survival of female breast cancer: results of a national survey by the American College of Surgeons . Cancer. 1980;45:2917-2924.Crossref 28. Richardson JL, Marks G, Solis JM, Collins LM, Birba L, Hisserich JC. Frequency and adequacy of breast cancer screening among elderly Hispanic women . Prev Med. 1987;16:761-774.Crossref 29. Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J. Impact of access and social context on breast cancer stage at diagnosis . J Health Care Poor Underserved. 1995;6:342-348.Crossref 30. Richardson JL, Langholz B, Bernstein C, Burciaga C, Danley K, Ross RK. Stage and delay in breast cancer diagnosis by race, socioeconomic status, age and year . Br J Cancer. 1992;65:922-926.Crossref 31. Celentano DD, Klassen AC, Weisman CS, Rosenhein NB. Duration of relative protection of screening for cervical cancer . Prev Med. 1989;18:411-422.Crossref 32. Mandelblatt J, Gopaul I, Wistreich M. Gynecological care of elderly women: another look at Papanicolaou smear testing . JAMA. 1986;256:367-371.Crossref 33. Stenkvist B, Bergstrom R, Ekiung G, et al. Papanicolaou smear screening and cervical cancer: what can you expect? JAMA. 1984;252:1423-1426. 34. LaVecchia C, Franseschi S, DeCarli A, et al. 'Pap' smears and the risk of cervical neoplasia: quantitative estimates from a case-control study . Lancet. 1984; 2:779-782. 35. Clarke EA, Anderson TW. Does screening by 'Pap' smears help prevent cervical cancer? a case-control study . Lancet. 1979;2:1-4.Crossref 36. Fruchter RG, Boyce J, Hunt M. Missed opportunities for early diagnosis of cancer of the cervix . Am J Public Health. 1980;70:418-420.Crossref 37. Calle EE, Flanders D, Thun M, Martin LM. Demographic predictors of mammography and Pap smear screening by US women . Am J Public Health. 1993; 83:53-60.Crossref 38. Fox SA, Murata PJ, Stein JA. The impact of physician compliance on screening mammography for older women . Arch Intern Med. 1991;151:50-56.Crossref 39. Caplan LS, Wells BL, Haynes S. Breast cancer screening among older racial/ ethnic minorities and whites: barriers to early detection . J Gerontol. 1992;47 (special issue):101-110. 40. Mandelblatt J, Traxler M, Lakin P, Kanetsky P, Kao R, Harlem Study Team. Mammography and Papanicolaou smear use by elderly poor black women . J Am Geriatr Soc. 1992;40:1001-1007. 41. NCI Breast Cancer Screening Consortium. Screening mammography: a missed clinical opportunity? results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies . JAMA. 1990;264:54-58.Crossref 42. Potvin L, Camirand J, Beland F. Patterns of health services utilization and mammography use among women aged 50 to 59 years in the Quebec Medicare system . Med Care. 1995;33:515-530.Crossref 43. Lillie-Blanton M, Alfaro-Correa A. In the Nation's Interest: Equity in Access to Health Care. Washington, DC: Joint Center for Political and Economic Studies; 1995:1-44. 44. Fujii SM. Minority group elderly: demographic characteristics and implications for public policy . Annu Rev Gerontol Geriatr. 1980;1:261-284. 45. Cuellar JB. Aging and Health: Hispanic American Elders . Stanford, Calif: Stanford Geriatric Education Center; 1990. SGEC Working Paper Series, No 6: Ethnogeriatric Reviews. 46. Starfield B. Primary Care: Concept , Evaluation and Policy. New York, NY: Oxford University Press; 1992. 47. Fletcher RH, O'Malley MS, Earp JA, et al. Patients' priorities for medical care . Med Care. 1983;21:234-242.Crossref 48. Breslau N. Continuity re-examined: differential impacts on satisfaction with medical care for disabled and normal children . Med Care. 1982;20:347-360.Crossref 49. Hjortdahl P, Laerum E. Continuity of care in general practice: effect on patient satisfaction . BMJ. 1992;304:1287-1290.Crossref 50. Soh G. Patient satisfaction with physician care . Hawaii Med J. 1991;50:149-152. 51. Weiss GL, Ramsey CA. Regular source of primary medical care and patient satisfaction . ORB Qual Rev Bull. 1989;15:180-184. 52. Mechanic D, Weiss N, Cleary PD. The growth of HMOs: issues of enrollment and disenrollment . Med Care. 1983;21:338-347.Crossref 53. Kibbe DC, Bentz E, McLaughiin CP. Continuous quality improvement for continuity of care . J Fam Pract. 1992;36:304-308. 54. Barr DA. The effects of organizational structure on primary care outcomes under managed care . Ann Intern Med. 1995;122:353-359.Crossref 55. Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on outcomes of chronic disease . Med Care. 1989;27:5110-5127. 56. Starfield B. Primary Care: Concept , Evaluation and Policy. New York, NY: Oxford University Press; 1992. 57. Committee on the Future of Primary Care, Division of Health Care Services, Institute of Medicine; Donaldson M, Yordy KI, Vanselow N, eds. Defining Primary Care: An Interim Report . Washington, DC: National Academy Press; 1994. 58. Institute of Medicine. A Manpower Policy for Primary Health Care . Washington, DC: National Academy of Sciences; 1978. IOM publication 78-02. 59. US Dept of Commerce. Census Statistics, 1985: Statistical Abstract of the United States , 105th Edition. Washington, DC: US Dept of Commerce; 1985. 60. Kovar MG, Poe GS. The National Health Interview Survey: design, 1973-84, and procedures, 1975-83 . Vital Health Stat 11985; No. (18) . 61. Dusenbury L, Kerner JF. Smoking among New York City Hispanics. Read before the Annual Meeting of the American Public Health Association; October 1987; New Orleans, La. 62. Delgado JL, Johnson CL, Roy I, Trevino FM. Hispanic Health and Nutrition Examination Survey: methodological considerations . Am J Public Health. 1990; 80:S6-S10.Crossref 63. Solis JM, Marks G, Garcia M, Shelton D. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES1982-4 . Am J Public Health. 1990;80:S11-S19.Crossref 64. Marin G, Vanoss Marin B, Perez-Stable EJ. Feasibility of a telephone survey to study a minority community: Hispanics in San Francisco . Am J Public Health. 1990;80:323-326.Crossref 65. Perez-Stable EJ, Sabogal F, Otero-Sabogal R, et al. Misconceptions about cancer among Latinos and Anglos . JAMA. 1992;268:3219-3223.Crossref 66. Perez-Stable EJ, Otero-Sabogal R, Sabogal F, et al. Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan . Arch Intern Med. 1994;154:1073-1081.Crossref 67. Response Analysis Corp. Cancer Control Needs in Multiethnic Communities, Methodology Report—Telephone Phase: Conducted for Memorial Sloan-Kettering Cancer Control Unit . Princeton, NJ: Response Analysis Corp; November 1992. 68. American Cancer Society. Update January 1992: the American Cancer Society Guidelines for the Cancer-Related Checkup . CA Cancer J Clin. 1992;42:44-45.Crossref 69. Hu DJ, Covell RM. Health care usage by Hispanic outpatients as a function of primary language . West J Med. 1986;144:490-493. 70. Wilcox LS, Mosher WD. Factors associated with obtaining health screening among women of reproductive age . Public Health Rep. 1993;108:76-85. 71. Wells KB, Golding JM, Hough RL, Bumam MA, Kamo M. Acculturation and the probability of use of health services by Mexican Americans . Health Serv Res. 1989;24:237-257. 72. Pousada L. Hispanic-American elders: implications for health-care providers . Ethnogeriatrics. 1995;11:39-52. 73. Breen N, Kessler L. Trends in cancer screening—United States, 1987 and 1992 . MMWR Morb Mortal Wkly Rep. 1996;45:57-61. 74. Aldrich JH, Nelson FD. Linear Probability , Logit, and Probit Models. Newbury Park, Calif: Sage Publications; 1984. Sage University Paper Series on Quantitative Applications in the Social Sciences, 07-045. 75. Council of American Survey Research Organizations (CASRO). Cancer Control Needs in Multiethnic Communities , Methodology Report—Telephone Phase. Princeton, NJ: Response Analysis Corp; 1992. 76. SAS Institute Inc. SAS/STAT User's Guide, Version 6 , Fourth Edition, Volume 2. Cary, NC: SAS Institute Inc; 1989. 77. O'Malley AS, Forrest CB. Continuity of care and children's use of ambulatory services in community health clinics . J Community Health. 1996;21:159-173.Crossref 78. Anderson LM, May DS. Has the use of cervical, breast and colorectal cancer screening increased in the United States? Am J Public Health. 1995;85:840-842.Crossref 79. Hiatt RA, Pasick RJ. Unsolved problems in early breast cancer detection: focus on the underserved . Breast Cancer Res Treat. 1996;40:37-51.Crossref 80. Munoz E. Care for the Hispanic poor: a growing segment of American society . JAMA. 1988;260:2711-2712.Crossref 81. Hopper SV. The influence of ethnicity on the health of older women . Clin Geriatr Med. 1993;9:231-259. 82. Allegria D, Guerr E, Martinez C, et al. El hospital invisible: a study of curanderismo . Arch Gen Psychiatry. 1977;34:1354-1357.Crossref 83. Andersen RM, Lewis SZ, Giachello AO, et al. Access to medical care among the Hispanic population of the southwestern United States . J Health Soc Behav. 1981;22:78-79.Crossref 84. Anda RF, Sienko DG, Remington RL, et al. Screening mammography for women 50 years of age and older: practices and trends, 1987 . Am J Prev Med . 1990; 6:123. 85. Coll PP, O'Connor OJ, Crabtree BF, et al. Effects of age, education and physician advice on utilization of screening mammography . J Am Geriatr Soc. 1989; 37:957. 86. Haiart DC, McKenzie L, Henderson J, et al. Mobile breast screening: factors affecting uptake, efforts to increase response and acceptability . Public Health. 1990;104:239.Crossref 87. Rimer B, Engstrom PF, Keintz MK, Meiers RE, Rosan J. Barriers and facilitators to compliance with routine mammographic screening . Prog Clin Biol Res. 1989;293:125-133. 88. Champion VL. Compliance with guidelines for mammography screening . Cancer Detect Prev. 1992;16:253. 89. Zapka JG, Hosmer D, Costanza ME, et al. Changes in mammography use: economic need and service factors . Am J Public Health. 1992;82:1345.Crossref 90. Gordon NP, Hiatt RA, Lampert DI. Concordance of self-reported data and medical record audit for six cancer screening procedures . J Natl Cancer Inst. 1993; 85:566-570.Crossref 91. Walter SD, Clarke EA, Hatcher J, Stiff LW. A comparison of physician and patient self-reports of Pap smear histories . J Clin Epidemiol. 1988;41:401-410.Crossref 92. Sawyer JA, Earp JA, Fletcher RH, Daye FF, Wynn TM. Accuracy of women's self-report of their last Pap smear . Am J Public Health. 1989;79:1036-1037.Crossref 93. Bowman JA, Redman S, Dickinson JA, Gibbard R, Sanson-Fisher RW. The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research . Health Serv Res. 1991;26:97-107. 94. McKenna MT, Speers M, Mallin K, Wamecke R. Agreement between patient self-reports and medical records for Pap smear histories . Am J Prev Med. 1992;8:287-291. 95. Michielutte R, Dignan MB, Wells HB, et al. Errors in reporting cervical screening among public health clinic patients . J Clin Epidemiol. 1991;44:403-408.Crossref 96. Hiatt RA, Perez-Stable EJ, Quesenberry C Jr, Sabogal F, Otero-Sabogal R, McPhee SJ. Agreement between self-reported early cancer prevention practices and medical audits among Hispanic compared with non-Hispanic white health plan members in northern California . Prev Med. 1995;24:278-285.Crossref 97. Johnson CS, Archer J, Campos-Outcalt D. Accuracy of Pap smear and mammogram self-reports in a southwestern Native American tribe . Am J Prev Med. 1995;11:360-363. 98. Suarez L, Goldman DA, Weiss NS. Validity of Pap smear and mammogram self-reports in a low-income Hispanic population . Am J Prev Med. 1995;11:94-98. 99. 1994 Current Population Survey . Washington, DC: US Bureau of the Census; 1995. 100. Lambrew JM, DeFriese GH, Carey TS, et al. The effects of having a regular doctor on access to primary care . Med Care. 1996;34:138-151.Crossref 101. Burns RB, McCarthy EP, Freund KM, et al. Black women receive less mammography even with similar use of primary care . Ann Intern Med. 1996;125:173-182.Crossref