Modeling of the Temporal Patterns of Fluoxetine Prescriptions and Suicide Rates in the United States

BACKGROUND: To study the potential association of antidepressant use and suicide at a population level, we analyzed the associations between suicide rates and dispensing of the prototypic SSRI antidepressant fluoxetine in the United States during the period 1960–2002. METHODS AND FINDINGS: Sources of data included Centers of Disease Control and US Census Bureau age-adjusted suicide rates since 1960 and numbers of fluoxetine sales in the US, since its introduction in 1988. We conducted statistical analysis of age-adjusted population data and prescription numbers. Suicide rates fluctuated between 12.2 and 13.7 per 100,000 for the entire population from the early 1960s until 1988. Since then, suicide rates have gradually declined, with the lowest value of 10.4 per 100,000 in 2000. This steady decline is significantly associated with increased numbers of fluoxetine prescriptions dispensed from 2,469,000 in 1988 to 33,320,000 in 2002 (r(s) = −0.92; p < 0.001). Mathematical modeling of what suicide rates would have been during the 1988–2002 period based on pre-1988 data indicates that since the introduction of fluoxetine in 1988 through 2002 there has been a cumulative decrease in expected suicide mortality of 33,600 individuals (posterior median, 95% Bayesian credible interval 22,400–45,000). CONCLUSIONS: The introduction of SSRIs in 1988 has been temporally associated with a substantial reduction in the number of suicides. This effect may have been more apparent in the female population, whom we postulate might have particularly benefited from SSRI treatment. While these types of data cannot lead to conclusions on causality, we suggest here that in the context of untreated depression being the major cause of suicide, antidepressant treatment could have had a contributory role in the reduction of suicide rates in the period 1988–2002

Single parenting: Interventions in the transitional stage

Following divorce or separation, many mother-headed families need to mourn losses, including reduced economic resources. They need to reestablish family rituals, confront such issues as time management and structural changes that can result in scapegoating or over-reliance on a parental child. Normalizing difficulties associated with parenting is important because single parents tend to internalize societal attribution of family difficulties to inadequate family structure rather than developmental stages, limited economic resources, and negative expectations about the capacity of women to head families.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44289/1/10591_2004_Article_BF00891869.pd

Diasporas and democratization in the post-communist world

If diaspora communities are socialized with democratic values in Western societies, they could be expected to be sympathetic to the democratization of their home countries. However, there is a high degree of variation in their behavior. Contrary to the predominant understanding in the literature that diasporas act in exclusively nationalist ways, this article argues that they do engage with the democratization of their home countries. Various challenges to the sovereignty of their homelands explain whether diasporas involve with procedural or liberal aspects of democratization. Drawing evidence from the activities of the Ukrainian, Serbian, Albanian and Armenian diasporas after the end of communism, I argue that unless diasporas are linked to home countries that enjoy both international legal and domestic sovereignty, they will involve only with procedural aspects of democratization. Diasporas filter international pressure to democratize post-communist societies by utilizing democratic procedures to advance unresolved nationalist goals

Accounting for the Change in Income Disparities between US Central Cities and their Suburbs from 1980 to 1990

Develops a method that uses cluster analysis to group central cities in the United States. Selection of the candidate cluster solutions; Median characteristics of the clusters; Stressed central cities; Healthy central cities

Planning for a statewide network of dementia assessment services: A survey of geriatric assessment services in Michigan

All 38 geriatric assessment service units identified in Michigan were surveyed and responded as a component of planning a statewide network of diagnostic and assessment services for patients with dementia. Most units were outpatient (71 percent), urban (71 percent), and hospital-based (82 percent). Some provided primarily geropsychiatric services (21 percent), while the rest provided general geriatric services. The staff included physicians (95 percent), nurses (100 percent), social workers (95 percent) and other professionals (SO percent) such as nutritionists, neuro psychologists or clinical pharmacists. Assessments performed by most units included physical (92 percent), psychosocial (95 percent), functional (95 percent), neurological (71 percent) mental (95 percent), and financial (89 percent). Patient referral sources were most frequently self/family, followed by physician, community agencies, and community mental health. Reasons for referral were most often confusion! memory loss, followed by behavior change, caregiver stress, depression, and evaluation for placement. Most patients seen were between 65 and 84 years of age (72 percent), lived within 25 miles of the unit (87 percent), and had dementia (62 percent). Urban sites assessed significantly more persons per month (19 percent) than non-urban sites (4 percent). Community-based services spent significantly more time per month on geriatric assessments (68 hours) than did hospital-based services (26 hours). These survey results will aid the development of a statewide network of dementia diagnostic and assessment services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67004/2/10.1177_153331759200700606.pd

Oral Health Knowledge and Sources of Information Among Elementary Schoolchildren

The dental health knowledge and sources of health information of 848 elementary schoolchildren (aged 9–12) in southwestern Michigan were assessed. Demographic parameters (education level, percent below poverty level, median income level) of the area were similar to state and national averages. The children were found to have some knowledge of caries and periodontal disease prevention, yet basic misconceptions were evident. More than one-third of the children thought that plaque should only be removed by a dentist. While 75 percent of the subjects knew that fluoride protected teeth from decay, only 4 percent of the children identified fluoridated water as the best source of this preventive agent. Knowledge of pit and fissure sealants was limited. Extent of correct dental knowledge was not related to age, sex, or mean DMFS scores. Children who answered the most questions correctly named parents and family as their source of information; dentist's office was the second most frequently mentioned source. Findings suggest a need to correct basic misinformation about dental health and to inform children about current efficacious preventive agents.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66129/1/j.1752-7325.1989.tb02019.x.pd

Variations in Health Insurance Coverage for Rural and Urban Nonelderly Adult Residents of Florida, Indiana, and Kansas

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72274/1/j.1748-0361.2006.00023.x.pd

Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic

Background. HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from.06 % in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country’s results by the country’s population. Methodology/Principal Findings. Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis. Conclusions/Significance. This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth

The public health benefits of insulation retrofits in existing housing in the United States

BACKGROUND: Methodological limitations make it difficult to quantify the public health benefits of energy efficiency programs. To address this issue, we developed a risk-based model to estimate the health benefits associated with marginal energy usage reductions and applied the model to a hypothetical case study of insulation retrofits in single-family homes in the United States. METHODS: We modeled energy savings with a regression model that extrapolated findings from an energy simulation program. Reductions of fine particulate matter (PM(2.5)) emissions and particle precursors (SO(2 )and NOx) were quantified using fuel-specific emission factors and marginal electricity analyses. Estimates of population exposure per unit emissions, varying by location and source type, were extrapolated from past dispersion model runs. Concentration-response functions for morbidity and mortality from PM(2.5 )were derived from the epidemiological literature, and economic values were assigned to health outcomes based on willingness to pay studies. RESULTS: In total, the insulation retrofits would save 800 TBTU (8 × 10(14 )British Thermal Units) per year across 46 million homes, resulting in 3,100 fewer tons of PM(2.5), 100,000 fewer tons of NOx, and 190,000 fewer tons of SO(2 )per year. These emission reductions are associated with outcomes including 240 fewer deaths, 6,500 fewer asthma attacks, and 110,000 fewer restricted activity days per year. At a state level, the health benefits per unit energy savings vary by an order of magnitude, illustrating that multiple factors (including population patterns and energy sources) influence health benefit estimates. The health benefits correspond to $1.3 billion per year in externalities averted, compared with$5.9 billion per year in economic savings. CONCLUSION: In spite of significant uncertainties related to the interpretation of PM(2.5 )health effects and other dimensions of the model, our analysis demonstrates that a risk-based methodology is viable for national-level energy efficiency programs