Statin use and the risk of Alzheimer's disease: the MIRAGE study.

Background: The aim of this study was to examine the association between statin use before the onset of Alzheimer's disease (AD) symptoms and risk of having AD, and to explore the potential impact of APOE genotype and race on this association.

Methods: Data were collected through standardized, validated questionnaires from 895 subjects with probable or definite AD by research criteria, and 1,483 of their nondemented relatives in this family-based, case-control study of AD patients and their relatives enrolled at 15 research centers from 1996 through 2002. To minimize temporal and prescription biases, exposure to statin use within each family was ignored in the one year before the first appearance of AD symptoms in that family's affected member.

Prescribing hormone replacement therapy for menopausal symptoms.

This paper addresses the clinical presentation of menopause, pretreatment assessment for hormone replacement therapy, benefits and risks of this treatment, common hormone replacement regimens and their side effects, and patient management. The case-based discussion focuses on the clinical management of a patient who is considering hormone replacement therapy for menopausal symptoms.

Lack of a regular source of care among children using a public hospital emergency department.

Objectives: This study examined risk factors for not having a regular source of care among children presenting to an urban public hospital for nonappointment care. Lack of a regular source of care is associated with decreased use of appropriate health care services and preventive care among children.

Methods: A cross-sectional survey was conducted for all children less than 16 years of age attending an emergency department at an urban public hospital over a consecutive 7-day period.

Ambulatory health care use by patients in a public hospital emergency department.

Objective: To describe primary care clinic use and emergency department (ED) use for a cohort of public hospital patients seen in the ED, identify predictors of frequent ED use, and ascertain the clinical diagnoses of those with high rates of ED use.

Design: Cohort observational study.

Setting: A public hospital in Atlanta, Georgia.

Smoking cessation among inner-city African Americans using the nicotine transdermal patch.

Objective: To determine the efficacy of the transdermal nicotine patch for smoking cessation in inner-city African Americans.

Design: Double-blind, placebo-controlled, randomized trial.

Setting: Outpatient in an inner-city hospital.

Personal use of postmenopausal hormone replacement therapy by women physicians in the United States.

Background: Women physicians' use of postmenopausal hormone replacement therapy (HRT) is unknown.

Objective: To study use of HRT by women physicians in the United States.

Design: Stratified random-sample mail survey.

Cigarette smoking and severe uncontrolled hypertension in inner-city African Americans.

Purpose: Although over the past 2 decades great strides have been made in increasing the awareness, detection, and treatment of hypertension (HTN), actual control of blood pressure is far from optimal. We hypothesized that current cigarette smoking, by acting as a marker for poor health related behavioral patterns, would be significantly associated with uncontrolled blood pressure (BP).

Patients And Methods: Over a 3-month period in 1994, all patients who presented to a public hospital medical walk-in clinic were screened, and had their BP measured if they had been prescribed BP medication within 1 year and were aware of their diagnosis of HTN.

Use of postmenopausal hormone replacement therapy by African American women. The importance of physician discussion.

Background: Although nationally the use of hormone replacement therapy (HRT) has increased dramatically in the last decade, little is known about its use by disadvantaged, minority women or the role that physician discussion plays in determining its use.

Methods: In 1994, we surveyed a total of 328 predominantly indigent, African American women (refusals, 22) who attended public hospital medical continuity of care clinics staffed by internal medicine house officers.

Results: Of the 328 women who completed the survey, the mean age was 63 years, 302 women (92%) were African American, and 286 (87.

The cost-effectiveness of the nicotine transdermal patch for smoking cessation.

Background: Smoking is the single most preventable cause of premature mortality in the United States. In 13 double-blind, controlled trials, the nicotine transdermal patch has been demonstrated to be an effective aid to quitting smoking, even after 6 months of follow-up. Because physicians and payers may consider the cost of the patch to be prohibitive, we examine the cost-effectiveness of the nicotine patch as an adjunct to brief physician counseling during routine office visits.

Correlates of controlled hypertension in indigent, inner-city hypertensive patients.

Objective: To identify correlates of controlled hypertension in a largely minority population of treated hypertensive patients.

Design: Case-control study.

Setting: Urban, public hospital.

Changing physician prescribing behavior: a low-cost administrative policy that reduced the use of brand name nonsteroidal anti-inflammatory drugs.

Background: In the United States, expenditures for prescription drugs are rapidly rising. There is concern that physicians do not prescribe medications in the most cost-saving manner. The objective of this study was to determine if a low-cost administrative intervention would decrease the use of brand name nonsteroidal anti-inflammatory drugs (bnNSAIDs).

A randomized trial to improve follow-up care in severe uncontrolled hypertensives at an inner-city walk-in clinic.

A single-blinded, randomized trial was conducted to determine whether a mailed postcard improved follow-up in uncontrolled hypertensives. One hundred and seven patients with a systolic blood pressure (BP) of 180 or more or a diastolic blood pressure of 110 or more at an inner-city, hospital-based walk-in clinic were enrolled; mean age was 56 years, 95 percent were African American, 73 percent were female, and mean BP was 193/106. Patients were required to be aware of their diagnosis and to have been informed of their need for medication at least a month before the trial.

Breast and cervical cancer screening in an inner-city medical walk-in clinic: taking advantage of an often missed opportunity.

Background: Despite established evidence that screening for breast and cervical cancer reduces mortality in women, screening is underutilized, especially in poor, minority women. We hypothesized that a high percentage of women presenting for care to an inner-city medical walk-in clinic would report inadequate screening for breast and cervical cancer by current standards, accept same-day screening, and comply with recommended follow-up.

Methods: To determine how many women presenting to our medical Walk-In Clinic were inadequately screened for breast and cervical cancer and how many were willing to undergo same-day screening, we surveyed all women at this site over a three month period.

Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital.

Objective: To determine the correlation among obstacles to medical care, lack of a regular source of care, and delays in seeking care.

Design: Cross-sectional survey of patients presenting for ambulatory care during a 7-day period. Multiple logistic regression models were used to identify obstacles independently associated with outcome variables.

Prevalence of self-medication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases.

To ascertain the prevalence of self-medication with antimicrobial agents among patients attending a clinic for treatment of sexually transmitted diseases (STDs), we administered a questionnaire to and collected a urine specimen for antimicrobial testing from 551 patients before treatment. We defined self-medication as an antimicrobial agent taken on the patient's own initiative by self-report during the week before the visit to the clinic or a positive urine assay for antimicrobial agents at the time of the clinic visit. We tested urine for the presence of antimicrobial agents by a disk diffusion method using Sarcina lutea as the test organism.

Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men.

The ability of a urinary dipstick leukocyte esterase test (LET) to predict culture-verified asymptomatic urethral infections of Chlamydia trachomatis and Neisseria gonorrhoeae was determined in 1095 men (aged 18-39) who presented to an urban hospital for acute general medical care. Prevalence of chlamydial and gonococcal infections were 4% and 2.5% respectively; LET sensitivity was 41% and specificity was 91%.

High prevalence of recent cocaine use and the unreliability of patient self-report in an inner-city walk-in clinic.

Objective: To determine the prevalence of recent cocaine use and the reliability of patient self-reported cocaine use.

Design: A survey with blinded comparison to a criterion standard.

Setting: Walk-in clinic of a large public hospital in metropolitan Atlanta, Ga.