Life with and without disease: women experience more of both.

This paper examines gender differences in life with and without six major diseases, including both mortal and morbid conditions. Disease prevalence and health behavior data are from the 1993-1995 National Health Interview Surveys for the United States. Vital registration data are the source of mortality rates used in computing life expectancy. The Sullivan method is used to estimate life lived with and without disease and risky behavior for men and women at various ages. Women live more years with each of the diseases examined, and, for arthritis, the extended years with disease are greatest. Women also live more years than men free of each of these diseases with the exception of arthritis. Gender differences in life without two health-risk behaviors are also discussed. Men spend more years of their lives overweight and have fewer years during which they see a doctor.

Pharmacokinetic/pharmacodynamic predictors of time to clinical resolution in patients with acute bacterial exacerbations of chronic bronchitis treated with a fluoroquinolone.

Forty nine subjects with acute bacterial exacerbations of chronic bronchitis (ABECB) treated with grepafloxacin were evaluated for parameters predictive of clinical outcome. Signs and symptoms associated with ABECB were serially collected and evaluated for changes. Coughs per day, sputum volume and the percentage of sputum neutrophils were associated with clinical outcome. A by groups analysis, based on clinical success was performed using Cox regression analysis to determine factors associated with time to clinical success and time to reduction in sputum volume, coughs per day and sputum neutrophil percent. Factors evaluated included AUIC (AUC/MIC), isolate species, years and type of underlying lung disease, alcohol use, smoking history and number of ABECB within the previous 12 months. AUIC<276 (mg h/l)/mg/l (P<0.03) and or the presence of mild bronchiectasis (P<0.01) were associated with longer time to clinical success. In addition a relationship was found between AUIC>212 (mg h/l)/mg/l (P<0.01) and AUIC>576 (mg h/l)/mg/l (P<0.02) and decreasing days to sputum volume reduction and coughs per day, respectively. A diagnosis of mild bronchiectasis prolonged the time to reduce coughs per day (P<0.03) and neutrophil percentage (P<0.01). Patients with mild bronchiectasis were found to have an increase in the time to clinical success, coughs per day improvement and sputum neutrophil percent improvement. AUIC is an important PK/PD parameter predictive of successful outcome in ABECB, even in subjects with mild bronchiectasis. Grepafloxicin has been withdrawn from sale since these studies were carried out. This work is published to illustrate the relationship between pharmacodynamics and clinical efficacy and the use of AUIC as a valuable predictive parameter for fluoroquinolones.

A randomized study of ciprofloxacin versus ceftriaxone in the treatment of nursing home-acquired lower respiratory tract infections.

OBJECTIVE: To compare the efficacy and safety of ciprofloxacin and ceftriaxone in patients with nursing home-acquired lower respiratory tract infections requiring initial hospitalization. DESIGN: Prospective, randomized trial. SETTING: Extended care nursing homes affiliated with a teaching hospital. PATIENTS: Fifty patients aged 60 years or older with normal or mildly impaired renal function admitted to the hospital for treatment of lower respiratory tract infections. INTERVENTIONS: Twenty-four patients received initial therapy with intravenous ciprofloxacin, 200 mg every 12 hours (19 patients) or 400 mg every 12 hours (5 patients) during the acute phase followed by 750 mg orally every 12 hours during the convalescence phase. Twenty-six patients received initial therapy with intravenous ceftriaxone, 2 g every 24 hours during the acute phase followed by 1 g administered intramuscularly every 24 hours during the convalescent phase. The total duration of therapy was 14 days. MAIN OUTCOME MEASUREMENTS: Successful outcome was defined as resolution or marked improvement in clinical signs and symptoms of lower respiratory tract infection upon completion of the treatment course. RESULTS: Twelve (50%) of the ciprofloxacin-treated and 14 (54%) of ceftriaxone-treated patients had successful outcomes. Recurrent oropharyngeal aspiration was the reason for treatment failure in most patients refractory to either antibiotic. Mortality during therapy was 8% in each group. From 21 satisfactory sputum specimens collected, S. pneumoniae was the most common isolate, followed by H. influenzae and other Gram-negative bacteria. Ciprofloxacin therapy was well tolerated; ceftriaxone therapy was discontinued in two patients (8%) due to adverse reactions (intramuscular pain and drug fever). CONCLUSIONS: Sequential intravenous/oral ciprofloxacin appears to be as safe and effective as sequential intravenous/intramuscular ceftriaxone. The optimal dosage of intravenous ciprofloxacin in this patient population appears to be 400 mg every 12 hours; however, additional clinical and pharmacokinetic studies with this regimen are warranted.

Epidemiological survey of oil distribution centres in Britain.

A mortality study of workers employed for at least one year between 1 January 1950 and 31 December 1975 at oil distribution centres from three oil companies in Britain has been carried out. Ninety nine per cent of the population were successfully traced to determine their vital status at 31 December 1975. The mortality observed in the study population was compared with that which would be expected from the mortality rates for all the male population of England and Wales. The overall mortality observed was considerably lower than expected on this basis as was the mortality from stroke, hypertensive disease, bronchitis, and pneumonia. The observed number of deaths from all neoplasms was also much less than expected as were the observed deaths from lung cancer. The observed deaths from ischaemic heart disease approximately equalled those expected overall and in each of the companies, however, and there was no evidence of a "healthy worker effect" for this disease group. The ratio of observed over expected deaths from ischaemic heart disease tended to decrease with increasing age at death, and for most of the job groups overall, the observed and expected deaths were about the same. Raised mortality patterns from ischaemic heart disease were found in several subgroups of the population of one company. Mortality from myelofibrosis and diseases of the lymphatic and haematopoietic tissue was slightly raised overall. Only myelofibrosis showed an overall excess but raised mortality was found in subgroups of the population defined by company, job, and length of service in several of the other neoplasms making up this disease group. The numbers of deaths from these causes were all small, making it difficult to exclude chance effects. Further work would be required to ascertain whether these results are due to an occupational factor and if so to identify the physical or chemical nature of the risk.

Epidemiological survey of maintenance workers in London Transport Executive bus garages and Chiswick Works.

A mortality study of maintenance men employed for at least one year between 1 January 1967 and 31 December 1975 at 71 London Transport bus garages and Chiswick Works has been carried out. Over 97% of the population were successfully traced to determine their vital status at 31 December 1975. The mortality observed in the study population was compared with that which would be expected from the mortality rates for the all male population of England and Wales. The mortality of the study population from all causes was much lower than expected on this basis, as was the mortality from cerebrovascular disease, ischaemic heart disease, and bronchitis. Mortality from all neoplasms was slightly less than expected overall and especially in the younger age groups. The observed deaths from cancer of the lung were approximately the same as those expected on the basis of national rates. Nevertheless, a deficit of observed deaths from lung cancer was obtained after adjusting for the higher mortality from this disease in Greater London. Raised mortality was found in subgroups of the population for several malignant disease groups but these were almost all based on small numbers of deaths, making it difficult to exclude chance effects. Both the number of men and deaths in the study were limited and the follow up time was also short. Considerable extension of the study to include more men and increase the follow up time would be required for any definite mortality patterns to emerge.