Treatment satisfaction and efficacy of the rapid release formulation of sumatriptan 100 mg tablets utilising an early intervention paradigm in patients previously unsatisfied with sumatriptan.

AIMS: To evaluate treatment satisfaction, efficacy and functional ability of the rapid release formulation of sumatriptan 100 mg tablets (sumatriptan RT 100 mg) in an early intervention paradigm in patients who were dissatisfied with low-dose sumatriptan and not completely satisfied with their current migraine regimen. METHODS: Experienced migraineurs who reported a mild migraine pain phase, dissatisfaction with the previous sumatriptan treatment and some dissatisfaction with their current treatment regimen had no experience with sumatriptan at the 100 mg dose were enrolled in an open-label, single group study. Subjects were instructed to treat four migraine attacks within 30 min of the onset of mild pain. Treatment satisfaction was measured with the Patient Perception of Migraine Questionnaire Revised version (PPMQ-R) questionnaire. RESULTS: More than half of the subjects were either very satisfied or satisfied with the efficacy of early intervention sumatriptan RT 100 mg after each attack and at the follow-up study visit. The mean total PPMQ-R score was 75.2 out of 100. Between 63% and 73% of subjects were pain-free within 4 h of dosing. Between 79% and 90% of subjects reported an ability to function normally within 4 h of taking the study medication. CONCLUSION: Subjects who were previously unsatisfied with lower doses of sumatriptan and less than very satisfied with their current treatment regimen were more likely to be satisfied or very satisfied with sumatriptan RT 100 mg in an early intervention paradigm. Results were consistent across four migraine attacks and at a follow-up visit. The treatment satisfaction results corresponded with positive results on efficacy measures and a functional status measure.

Public health 101 for informaticians.

Abstract Public health is a complex discipline that has contributed substantially to improving the health of the population. Public health action involves a variety of interventions and methods, many of which are now taken for granted by the general public. The specific focus and nature of public health interventions continue to evolve, but the fundamental principles of public health remain stable. These principles include a focus on the health of the population rather than of individuals; an emphasis on disease prevention rather than treatment; a goal of intervention at all vulnerable points in the causal pathway of disease, injury, or disability; and operation in a governmental rather than a private context. Public health practice occurs at local, state, and federal levels and involves various professional disciplines. Public health principles and practice are illustrated by a case study example of neural tube defects and folic acid. The application of information science and technology in public health practice provides previously unfathomed opportunities to improve the health of the population. Clinical informaticians and others in the health care system are crucial partners in addressing the challenges and opportunities offered by public health informatics.

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.

Is suicide contagious? A study of the relation between exposure to the suicidal behavior of others and nearly lethal suicide attempts.

This study sought to determine the association between nearly lethal suicide attempts and exposure to the suicidal behavior of parents, relatives, friends, or acquaintances and to accounts of suicide in the media. The authors conducted a population-based case-control study in Houston, Texas, from November 1992 through July 1995. They interviewed 153 victims of attempted suicide aged 13--34 years who had been treated at emergency departments in Houston and a random sample of 513 control subjects. After controlling for potentially confounding variables, the authors found that exposure to the suicidal behavior of a parent (adjusted OR = 1.5; 95% CI: 0.6, 3.6; p = 0.42) or a nonparent relative (adjusted OR = 1.2; 95% CI: 0.7, 2.0; p = 0.55) was not significantly associated with nearly lethal suicide attempts. Both exposure to the suicidal behavior of a friend or acquaintance (adjusted OR = 0.6; 95% CI: 0.4, 1.0; p = 0.05) and exposure to accounts of suicidal behavior in the media (adjusted OR = 0.2; 95% CI: 0.1, 0.3; p = 0.00) were associated with a lower risk of nearly lethal suicide attempts. Exposure to accounts of suicidal behavior in the media and, to a lesser extent, exposure to the suicidal behavior of friends or acquaintances may be protective for nearly lethal suicide attempts, but further research is needed to better understand the mechanisms underlying these findings.

The influence of geographic mobility on nearly lethal suicide attempts.

Teenagers and young adults are very mobile and mobility has been identified as a potential risk factor for suicidal behavior. We conducted a population-based, case-control study of nearly lethal suicide attempts with 153 cases and 513 controls. Study participants were asked about changing residence over the past 12 months. Results indicate that moving in the past 12 months is positively associated with a nearly lethal suicide attempt (adjusted odds ratio of 2.1, with 95% confidence interval of 1.4-3.3), as are specific characteristics of the move (e.g., frequency, recency, distance, and difficulty staying in touch). These findings confirm and extend prior ecologic research by demonstrating a relationship, at the individual level, between the geographic mobility of adolescents and young adults and nearly lethal suicide attempts.

Characteristics of impulsive suicide attempts and attempters.

Suicide attempts often are impulsive, yet little is known about the characteristics of impulsive suicide. We examined impulsive suicide attempts within a population-based, case-control study of nearly lethal suicide attempts among people 13-34 years of age. Attempts were considered impulsive if the respondent reported spending less than 5 minutes between the decision to attempt suicide and the actual attempt. Among the 153 case-subjects, 24% attempted impulsively. Impulsive attempts were more likely among those who had been in a physical fight and less likely among those who were depressed. Relative to control subjects, male sex, fighting, and hopelessness distinguished impulsive cases but depression did not. Our findings suggest that inadequate control of aggressive impulses might be a greater indicator of risk for impulsive suicide attempts than depression.

Bioterrorism preparedness: planning for the future.

The release of nerve gas in a Tokyo subway and attempted releases of biological agents by the Aum Shinrikyo cult have demonstrated the willingness and ability of modern-day terrorists to use unconventional weapons. Unlike explosive weapons, the use of biologic weapons may only become apparent once people become ill. The detection and response to these man-made outbreaks will occur initially at the medical and public health levels. Therefore, the Centers for Disease Control and Prevention and its partners are strengthening their response, disease detection, diagnostic, and communication capabilities to better protect the nation's citizens against biological or chemical terrorism.

Public health informatics: improving and transforming public health in the information age.

Development of effective public health information systems requires understanding public health informatics (PHI), the systematic application of information and computer science and technology to public health practice, research, and learning. PHI is distinguished from other informatics specialties by its focus on prevention in populations, use of a wide range of interventions to achieve its goals, and the constraints of operating in a governmental context. The current need for PHI arises from dramatic improvements in information technology, new pressures on the public health system, and changes in medical care delivery. Application of PHI principles provides unprecedented opportunities to build healthier communities.

The Asian Pacific Economic Cooperation Emerging Infections Network.

ISSUE: The Asia Pacific Economic Cooperation (APEC) has undertaken an initiative in emerging infections. PROJECT: The APEC Emerging Infections Network project uses collaborative telecommunications tools such as e-mail and a World Wide Web site to bridge the broad geographic expanse and diversity of APEC. Scientists and policymakers share information to effectively combat emerging infectious disease (EID) through surveillance, prevention, research, and control measures. RESULTS: In the project's first year, site visits compiled information on Internet access in selected economies. Information sharing via electronic lists has been successful; feedback suggests that these strategies will become increasingly useful. The Emerging Infections Network (EINet) Web site includes project information, library access, surveillance data, prevention guidelines, and distance learning resources. A pilot effort to promote the secure electronic exchange of surveillance data demonstrated that informal communications may be both preferable and more feasible during the early stages of this project. LESSONS LEARNED: Human networking is as important as technology-based networking in addressing emerging infections. Internet technology in some APEC economies is barely adequate, but is becoming more reliable and accessible. Numerous member economies are eager to be included in project activities.

Identification of nearly fatal suicide attempts: Self-Inflicted Injury Severity Form.

The Self-Inflicted Injury Severity Form (SIISF) was developed as an epidemiological research tool for identifying individuals in hospital emergency departments who have life-threatening self-inflicted injuries. Data were collected from 715 patients with self-inflicted injuries in two large hospitals. In 295 of these cases, a second set of data was independently collected for assessment of interrater reliability. Validity was assessed by comparing the SIISF results with simultaneously collected Risk-Rescue Ratings. Assessment of interrater reliability found that only 2.4% of physicians disagreed on the suicide method used. The kappa statistic for method used was .94, indicating excellent agreement. The SIISF was found to distinguish between severe and less severe injuries. Thus, it appears to provide a simple method to distinguish patients who have life-threatening self-inflicted injuries.

Public health informatics: a CDC course for public health program managers.

Information science and technology are critical to the modern practice of public health. Yet today's public health professionals generally have no formal training in public health informatics--the application of information science and technology to public health practice and research. Responding to this need, the U.S. Centers for Disease Control and Prevention (CDC) recently developed, tested, and delivered a new training course in public health informatics. The course was designed for experienced public health program managers and included sessions on general informatics principles and concepts; key information systems issues and information technologies; and management issues as they relate to information technology projects. This course has been enthusiastically received both at the state and federal levels. We plan to develop an abbreviated version for health officers, administrators, and other public health executives.

CDC and ATSDR electronic information resources for health officers.

This article catalogs some of the Centers for Disease Control and Prevention's (CDC) more important information resource offerings, which make public health information accessible via computer and automated telephone systems and on electronic media (diskette and CD-ROM). We review mechanisms for (1) finding and retrieving CDC reports, (2) querying CDC's numeric data files, (3) transmitting surveillance and other data files to CDC, (4) exchanging electronic mail with CDC staff, and (5) disseminating state and local public health information and data by using CDC tools. Each resource is followed with a section on how to obtain access to these resources.

Beyond the Tower of Babel: a nomenclature for suicidology.

Suicidology finds itself confused and stagnated for lack of a standard nomenclature. This paper proposes a nomenclature for suicide-related behavior in the hope of improving the clarity and precision of communications, advancing suicidological research and knowledge, and improving the efficacy of clinical interventions.

The Kurt Cobain suicide crisis: perspectives from research, public health, and the news media.

The suicide of rock star Kurt Cobain in 1994 raised immediate concerns among suicidologists and the public at large about the potential for his death to spark copycat suicides, especially among vulnerable youth. The Seattle community, where Cobain lived and died, was especially affected by his sudden death. An overview of Cobain's life and death is presented and various crisis center and community-based interventions that occurred are discussed. Preliminary data collected from the Seattle Medical Examiner's Office and from the Seattle Crisis Center to assess the potential impact of Cobain's death on completed suicides and the incidence of suicide crisis calls are presented. The data obtained from the Seattle King County area suggest that the expected "Werther effect" apparently did not occur, but there was a significant increase in suicide crisis calls following his death. It is hypothesized that the lack of an apparent copycat effect in Seattle may be due to various aspects of the media coverage, the method used in Cobain's suicide, and the crisis center and community outreach interventions that occurred. The Cobain suicide and the role of media influence on copycat suicides are further discussed in commentaries from public health and news media perspectives.

CDC WONDER on the Web.

CDC WONDER, an information system developed at the Centers for Disease Control and Prevention (CDC), provides access to 26 text and numeric databases, and special facilities for surveillance, through an architecture developed for public health. We report extensions of the original architecture that allowed us to create a Web version (http:@wonder.cdc.gov).

CDC and ATSDR electronic information resources for health officers.

This article catalogues some of the Centers for Disease Control and Prevention's (CDC) more important information resource offerings, which make public health information accessible via computer and automated telephone systems and on electronic media (diskette and CD-ROM). We review mechanisms for: (1) finding and retrieving CDC reports, (2) querying CDC's numeric data files, (3) transmitting surveillance and other data files to CDC, (4) exchanging electronic mail with CDC staff, and (5) disseminating state and local public health information and data using CDC tools. Each resource is followed with a section on how to obtain access to these resources.

Reality discrimination, reality monitoring and disposition towards hallucination.

This investigation tested the hypotheses that individuals disposed towards hallucination are deficient in the meta-cognitive skills of reality discrimination and reality monitoring, and that there is a strong correlation between the measures of these skills. Normal subjects scoring high or low on a scale measuring predisposition towards hallucination were tested on an auditory signal detection task. High scorers on the scale were found to differ from low scorers on a measure of perceptual bias but not on a measure of sensitivity. The same groups of subjects were tested on a reality monitoring measure in which they were required to monitor two different types of word: words they were required to listen to, and words they were required to listen to on some trials and imagine on others. On a surprise frequency test it was found that high scorers did not differ from low scorers on their ability to accurately count the memories of words they had heard. It was also found that both high scorers and low scorers overestimated the number of times they had heard words when they had also been required to imagine these words on tests; however, high scorers made this error to a significantly greater extent. A strong correlation was found between reality discrimination and reality monitoring measures for high scorers, but no correlation was found for low scorers.