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The effectiveness results demonstrated that 8% capsaicin and topical lidocaine patches had significantly higher effectiveness rates than the oral agents used to treat PHN. In addition, this cost-effectiveness analysis found that the 8% capsaicin patch was similar to topical lidocaine patch and within an accepted cost per QALY gained threshold compared to the oral products.

Few studies have examined the extent to which treatment of patients with neuropathic pain in the community is consistent with evidence-based treatment recommendations. U.S. health care claims were used to identify patients who received a diagnosis of postherpetic neuralgia (PHN). The initial pharmacologic treatments and changes to these treatment regimens were categorized according to the International Association for the Study of Pain Neuropathic Pain Special Interest Group recommendations for first-, second-, and third-line treatment of neuropathic pain. The results indicated that the treatment of PHN was only partially consistent with these treatment recommendations. Of the patients diagnosed with PHN who were not already on a specified treatment, 70% began treatment with either a first-, second-, or third-line treatment or a not-recommended treatment, and 30% did not begin treatment with any of these medications. Only one-quarter of patients began treatment with a first-line medication, the same percentage that began treatment with either a third-line medication or a not-recommended treatment. There was a wide range of initial treatment durations, but the means and medians suggest that patients and clinicians often decide to change the initial treatment within 2 months, either by discontinuing it, replacing it with a new medication, or adding a new medication. Although there were generally shorter treatment durations with opioid analgesics and tramadol, these medications were more frequently used in beginning treatment than the other treatments. The results suggest that a considerable number of patients with PHN in the community are not receiving evidence-based treatment.

The results contribute to and expand current knowledge of the excess healthcare usage and costs of two prevalent peripheral neuropathic pain conditions and can be used in future studies of the cost-effectiveness of treatment and preventive interventions.

OBJECTIVE:To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. DESIGN:Cross-sectional study. SETTING: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.PARTICIPANTS: A representative sample of 260 homeless adults. MEASUREMENTS AND MAIN RESULTS:Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. nderstanding the epidemiology of tuberculosis (TB) among the homeless, as well as other high-risk populations, is critical. Despite relatively recent predictions that TB could be eradicated in the United States by the year 2010, 1-3 we have been confronted by a sharp rise in active TB (10% increase between 1985 and 1994) 4 and an increase in multidrug-resistant TB since 1985 when reported cases of TB reached their lowest levels since national reporting began in 1953. [4][5][6][7] This increase in active TB has also led to increased numbers of individuals with newly acquired asymptomatic TB infection resulting from contact with persons with active contagious disease. Such individuals are at increased risk of developing active disease: the 1-year risk of becoming an active case is 3% within 1 year of infection and 0.5% in each subsequent year after 2 years of infection. 8 A multiplicity of factors, including the HIV/AIDS epidemic, increasing poverty and homelessness in America's cities, illicit drug use, budgetary constraints on local health departments, immigration from high-prevalence nations, and high rates of noncompliance among TB patients, have contributed to the resurgence of TB. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Previous research on homeless adults demonstrated their elevated risk of asymptomatic TB infection, active disease, and multidrug-resistant TB. [23][24][25][26][27][28] Further, reports have cited outbreaks of TB in emergency shelters for the homeless in Boston and Ohio,29,30 as well as in a neighborhood bar frequented by a homeless person with active disease. 31 Why is the risk of TB increased among homeless persons? Among the homeless, men outnumber women approximately four to one and ethnic and racial minority groups, especially African Americans, are overrepresented. [32][33][34] A disproportionate number of individuals with serious mental health problems (including previous psychiatric hospitalization), or a history of substance dependence, have been found among the homeless, and a significant number of homeless persons have dual diagnoses of mental illness and substance dependence. [35][36][37][38] Further, homeless persons have gr...

OBJECTIVE:To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. DESIGN:Cross-sectional study. SETTING: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.PARTICIPANTS: A representative sample of 260 homeless adults. MEASUREMENTS AND MAIN RESULTS:Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. nderstanding the epidemiology of tuberculosis (TB) among the homeless, as well as other high-risk populations, is critical. Despite relatively recent predictions that TB could be eradicated in the United States by the year 2010, 1-3 we have been confronted by a sharp rise in active TB (10% increase between 1985 and 1994) 4 and an increase in multidrug-resistant TB since 1985 when reported cases of TB reached their lowest levels since national reporting began in 1953. [4][5][6][7] This increase in active TB has also led to increased numbers of individuals with newly acquired asymptomatic TB infection resulting from contact with persons with active contagious disease. Such individuals are at increased risk of developing active disease: the 1-year risk of becoming an active case is 3% within 1 year of infection and 0.5% in each subsequent year after 2 years of infection. 8 A multiplicity of factors, including the HIV/AIDS epidemic, increasing poverty and homelessness in America's cities, illicit drug use, budgetary constraints on local health departments, immigration from high-prevalence nations, and high rates of noncompliance among TB patients, have contributed to the resurgence of TB. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Previous research on homeless adults demonstrated their elevated risk of asymptomatic TB infection, active disease, and multidrug-resistant TB. [23][24][25][26][27][28] Further, reports have cited outbreaks of TB in emergency shelters for the homeless in Boston and Ohio,29,30 as well as in a neighborhood bar frequented by a homeless person with active disease. 31 Why is the risk of TB increased among homeless persons? Among the homeless, men outnumber women approximately four to one and ethnic and racial minority groups, especially African Americans, are overrepresented. [32][33][34] A disproportionate number of individuals with serious mental health problems (including previous psychiatric hospitalization), or a history of substance dependence, have been found among the homeless, and a significant number of homeless persons have dual diagnoses of mental illness and substance dependence. [35][36][37][38] Further, homeless persons have gr...

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