JAMA : the journal of the American Medical Association
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Cisapride, a gastrointestinal tract promotility agent, can cause life-threatening cardiac arrhythmias in patients susceptible either because of concurrent use of medications that interfere with cisapride metabolism or prolong the QT interval or because of the presence of other diseases that predispose to such arrhythmias. In June 1998, the US Food and Drug Administration (FDA) determined that use of cisapride was contraindicated in such patients and informed practitioners through additions to the boxed warning in the label and a "Dear Health Care Professional" letter sent by the drug's manufacturer. ⋯ The FDA's 1998 regulatory action regarding cisapride use had no material effect on contraindicated cisapride use. More effective ways to communicate new information about drug safety are needed.
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A relative paucity of data exist on the possible health effects of using cellular telephones. ⋯ Our data suggest that use of handheld cellular telephones is not associated with risk of brain cancer, but further studies are needed to account for longer induction periods, especially for slow-growing tumors with neuronal features.
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Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources. ⋯ Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.
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Immigration is a major force sustaining the incidence of tuberculosis (TB) in the United States. ⋯ The number of TB cases among foreign-born persons increased 2.6%, from 7402 in 1993 to 7591 in 1998, and the proportion of US cases that were foreign-born increased from 29.8% to 41.6%. During 1993-1998, the TB case rate was 32.9 per 100000 population in foreign-born persons compared with 5.8 per 100000 in US-born persons. Six states reported 73.4% of foreign-born cases (California, New York, Texas, Florida, New Jersey, and Illinois). Approximately two thirds of these cases were originally from Mexico, the Philippines, Vietnam, India, China, Haiti, and South Korea. Among those for whom date of US entry was known, 51.5% arrived 5 years or less prior to the diagnosis of TB. Most were male and aged 25 to 44 years. During 1993-1996, the proportion receiving some portion of treatment under directly observed therapy increased from 27.3% to 59.1% and approximately 70% completed therapy in 12 months. The rate of primary resistance to isoniazid was 11.6% and to both isoniazid and rifampin was 1.7%. Conclusions As the United States moves toward the goal of TB elimination, success will depend increasingly on reducing the impact of TB in foreign-born persons. Continued efforts to tailor local TB control strategies to the foreign-born community and commitment to the global TB battle are essential.