Low cost, manual drug use review of Medicaid recipients to screen prescriber and pharmacist performance.

A manual drug use review (DUR) methodology to screen outpatient prescribing which would meet the needs of large third-party programs that cannot afford elaborate computerized DUR was developed and pilot tested. A Medicaid drugs data base was used for the pilot test. A probability sample of 100 recipients over a three-month period was selected for the DUR. The drugs for each recipient, listed by their generic composition and amount, were recorded. Then a priori, explicit, screening criteria were developed for these generics. These criteria delineated drugs of choice, daily dose and refill patterns and, as appropriate, therapy length, drug holidays, and disease-drug and drug-drug interactions. Only 11% of recipients had prescribing patterns which passed all the screens. The most frequent screening failure was due to the prescribing of a drug which was not a drug of choice. In nearly all of the cases which failed the other screens, an alert pharmacist with patient records should have noticed these problems. An analysis showed that the initial start-up cost for the manual DUR was estimated at $1053 (not including personnel fringe benefits); for subsequent quarterly review, the cost was estimated to be about $530. The project showed that manual DUR can effectively and efficiently screen prescribing in a large third-party program.     

Self-harm and bulimia nervosa: a complex connection

There is some evidence to suggest that eating disordered individuals are unusually likely to engage in self-harm behavior. However, the nature of the relationship among self-harm, bulimia nervosa, and related constructs such as borderline personality disorder and multi- impulsive bulimia nervosa remains unclear. This article briefly addresses the nature of this relationship and discusses two possible mechanisms for self-harm behavior in bulimia nervosa. Additionally, a protocol for managing such behavior in the treatment of eating disordered individuals is presented.     

Predictors of infection with Trichomonas vaginalis: a prospective study of low income African-American adolescent females

OBJECTIVES: To identify psychosocial predictors of Trichomonas vaginalis infection among low income African-American adolescent females living in a high risk urban area of the United States. METHODS: Baseline plus 6 and 12 month follow up data collected as part of an HIV prevention intervention trial were utilised. The baseline sample consisted of 522 African-American females, 14-18 years of age. Recruitment sites were located in low income neighbourhoods of Birmingham, Alabama, characterised by high rates of unemployment, substance abuse, violence, teenage pregnancy, and sexually transmitted infections. Self administered vaginal swab specimens were cultured for T vaginalis. Baseline measures collected as part of a self administered survey and face to face interviews were used to predict subsequent infection with T vaginalis at any of the three assessment periods conducted over the span of 1 year. RESULTS: At baseline, 12.9% were diagnosed with T vaginalis. At the 6 and 12 month follow ups, T vaginalis was diagnosed in 8.9% and 10.2%, respectively. The strongest multivariate predictor of T vaginalis infection was biologically confirmed marijuana use; those using marijuana were more than six times as likely to test positive for T vaginalis (adjusted odds ratio (AOR) = 6.2, p = 0.0003). Other multivariate predictors were reporting that typical sex partners were at least 5 years older (AOR = 2.6; p = 0.005), reporting sex with non-steady partners (AOR = 1.9; p = 0.02), and history of delinquency (AOR = 1.3; p = 0.02). The odds of testing positive increased by 31% for every one unit increase on a six item scale measure of delinquency. CONCLUSIONS: Infection with T vaginalis was common and significant multivariate predictors comprised a constellation of problem behaviours, each of which are potentially amenable to behavioural intervention.     

Photoreduction of the chloropropionic acid of carfentrazone-ethyl in sodium sulfide [corrected

The purpose of this study was to determine whether the conversion of carfentrazone-chloropropionic acid to carfentrazone-propionic acid in sunlit rice paddies is attributed to photoreduction. Model solutions (Na2S with quinoids) irradiated by laboratory ultraviolet light dechlorinated carfentrazone-chloropropionic acid (1.6-28.4% yield of carfentrazone-propionic acid), though Na2S alone was also reactive. Minor conversion (0-2.5%) occurred in the dark, along with dehydrochlorination to carfentrazone-cinnamic acid. Carfentrazone-propionic acid formed proportionally to the Na2S concentration (0-50.7% at 1.3-91 mM), whereas acidic pH inhibited reactivity. Photoreduction with Na2S was verified with 2-chloropropionic acid conversion to propionic acid (53.5%) and by minor 4-chlorophenoxyacetic acid dechlorination. Dissolved Na2S was the primary photoreductant, whereas reduced quinones degraded carfentrazone-chloropropionic acid by an alternate reaction. A survey of ambient rice field conditions indicates that carfentrazone-chloropropionic acid photoreduction is not directly attributed to H2S/HS- in this environment, though reduced quinones may be involved to an unknown extent.