To determine the direct and indirect costs associated with chronic prostatitis, The Chronic Prostatitis Collaborative Research Network used a questionnaire designed to capture health care utilization. Resource estimates were converted into direct and indirect unit costs. Chronic prostatitis is associated with substantial direct and indirect costs and lower quality-of-life scores, which predicted resource consumption.
Quality of care for patients with heart failure remains less than optimal. The reasons for this quality gap are complex and remain poorly understood. Using data from a Medicare quality improvement project, Havranek and colleagues demonstrated small area variation in heart failure care across the United States. Although regional difference in patient characteristics explained some of the variation in care, systematic differences in hospital and provider characteristics were significantly associated with quality of care after controlling for these patient characteristics.
Physical and mental illness have long been suggested as risk factors for suicide, particularly among older persons. However, only a few controlled studies exist exploring the relationship between illness and suicide, and most involve relatively few patients. Using a population-based approach, Juurlink and colleagues linked 9 years of provincial coroners' records with multiple health care databases in Ontario, Canada, to explore illness patterns among 1329 elderly persons who died of suicide. In addition to psychiatric illnesses, several common medical conditions were independently associated with an increased risk for suicide. A strong relationship between the number of illnesses and the risk of suicide was also evident. Importantly, most patients had contact with a physician in the days before committing suicide.
The study took place in a large family practice of 10 000 in Edinburgh, Scotland. Patients known to have ever injected drugs were recruited into a cohort study from 1980 until 2001. Causes of death were recorded from death certificates and supplemented when necessary with careful scrutiny of clinical notes. The principal cause of death in the early years was drug overdose, then human immunodeficiency virus/AIDS in later years, and toward the close of the study period hepatitis C emerged. Taken together, the deaths from all causes in the first period and the deaths from blood-borne viruses in the second period account for 74% of all deaths. This further supports the hypothesis that patterns of behavior, particularly damaging injecting drug use, have changed and that this change occurred some time in the mid-late 1980s. Clinical experience reinforces this message, since there have been no recent HIV seroconverters in the cohort. This study provides some of the most convincing evidence so far that harm minimization, in its broadest sense, is effective.
Herbal medicines have seen a tremendous surge in popular use over the past decade, in most cases without concomitant studies to prove their efficacy. In a randomized, double-blind, placebo-controlled clinical trial including 128 patients, Yale and Liu report finding no evidence that a standardized preparation of Echinacea purpurea lessened the severity or duration of cold symptoms compared with a lactose placebo.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2004;164(11):1165. doi:10.1001/archinte.164.11.1165