Publications
Department of Medicine faculty members published more than 3,000 peer-reviewed articles in 2022.
2008
INTRODUCTION
To determine the relationship between housing instability, economic standing, and access to health care and use of acute care services.
METHODS
We performed a meta-regression using four nationally representative surveys. The independent variable was an ordered measure of economic and housing instability: 1) the general population, 2) low-income population, 3) never homeless users-of-subsistence-services, 4) unstably housed, 5) formerly homeless, and 6) the actively homeless. Dependent variables were four measures of health care access and three measures of acute health care utilization.
RESULTS
Worsening housing instability and economic standing was associated with poorer access: being uninsured (5.4% per unit increase, 95% CI 1.7-9.2%, p=.011), postponing needed care (3.3%, 95% CI 1.9-4.7%, p=.001), postponing medications (6.1%, 95% CI 1.5-10.6%, p=.035), and with one measure of acute health care utilization: higher hospitalization rates (2.9%, 95% CI 1.2-4.6%, p=.008).
DISCUSSION
Economic and housing instability should be considered a graded risk factor for poor access to health care.
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BACKGROUND
Remote magnetic catheter navigation (RCN) is gaining acceptance in clinical cardiac electrophysiology, but details regarding how RCN affects procedure execution are not well characterized.
METHODS
From January 1, 2005, to November 30, 2007, 721 cases were retrospectively analyzed and compared. Of these, 127 used RCN and 594 used manual catheter navigation (MCN). Data including procedure time, fluoroscopy time, ablation catheter, procedural success, and complications were extracted from our procedure database and compared between RCN and MCN.
RESULTS
RCN use significantly decreased fluoroscopy time for atrial fibrillation (AF) ablation (-29 minutes, P < 0.001), atrioventricular nodal reentrant tachycardia ablation (-14 minutes, P < 0.001), and atrioventricular reentrant tachycardia ablation (-18 minutes, P = 0.045). While RCN significantly increased mean procedure time for AF (+36 minutes, P = 0.003) and atypical atrial flutter cases (+116 minutes, P = 0.016), RCN AF procedure time diminished with increasing number of cases performed. Two cases of tamponade occurred during AF ablation using MCN (2.2%, 2 of 91 cases). No tamponade occurred during all 75 AF ablations with RCN.
CONCLUSION
RCN can reduce fluoroscopy time and may reduce complications during catheter ablation. While it may increase total procedure duration, procedure times decrease with increasing operator experience. (PACE 2008; 31:1399-1404).
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OBJECTIVE
This experiment was designed to test if controlled exposure to particles and ozone would result in decreased heart rate variability (HRV).
METHODS
Five asthmatic adults were exposed for 4 hours to; filtered-air, carbon and ammonium nitrate particles, and particles and ozone. Twenty-minute electrocardiograms were obtained before and after each exposure.
RESULTS
Standard deviation of all normal-to-normal beat intervals (SDNN) decreased significantly across particles and ozone exposure compared with across filtered-air exposure (P = 0.01). Changes in SDNN-I (P = 0.04) and normalized low and high frequency (P = 0.02) were also seen across particles and ozone exposure; although these changes may best be characterized as trends given the small sample size. No significant changes in HRV were seen across the filtered-air or particles-only exposures.
CONCLUSIONS
The results of this study suggest that combined particle and ozone exposure may decrease HRV in asthmatics. Further investigation is needed to confirm this finding.
View on PubMed2008
OBJECTIVE
To determine sex, breed, and age distributions in a population of horses with cervical vertebral compressive myelopathy (CVCM), compared with contemporaneous control horses.
DESIGN
Retrospective case-control study.
ANIMALS
811 horses with CVCM and 805 control horses.
PROCEDURES
The Veterinary Medical Database was searched to identify horses with CVCM and contemporaneous control horses registered between July 1974 and August 2007. Admission date, admitting institution, sex, breed, age at the time of registration in the database, weight, and discharge status (alive, died, or euthanized) were recorded for each case and control horse.
RESULTS
On the basis of results of multivariable logistic regression analysis, geldings and sexually intact males had a significantly higher likelihood of having CVCM than females (odds ratio [OR], 2.0 [95% confidence interval, 1.5 to 2.6]; and OR, 2.4 [95% confidence interval, 1.8 to 3.2], respectively). Thoroughbreds, Tennessee Walking Horses, and Warm-bloods were overrepresented in the CVCM group, compared with Quarter Horses. Horses that ranged from < 6 months to < 7 years of age had significantly higher odds of having CVCM, compared with horses > or = 10 years of age.
CONCLUSIONS AND CLINICAL RELEVANCE
Sex, breed, and age predilections were detected in horses with CVCM. Improved understanding of these factors will aid clinical recognition of the disease in groups that may have a high prevalence of CVCM or were previously not recognized to be commonly affected. The results may also stimulate future investigations to further delineate etiopathogenesis, such as breed-related genetic causality.
View on PubMed2008
BACKGROUND
US national guidelines recommend assessing short-acting beta-agonist (SABA) medication use as a marker of asthma severity and control. However, the relationship between recent SABA use and asthma exacerbations is not currently known.
OBJECTIVE
To evaluate the proximal relationship between the type and frequency of SABA use and asthma-related outcomes.
METHODS
We evaluated SABA use among patients with asthma ages 5 to 56 years who were members of a large health maintenance organization in southeast Michigan. Frequency of use was estimated from pharmacy data assessing the timing and amount of SABA fills. Cox proportional hazards models were used to examine the prospective relationship between average daily SABA use for 3 months and outcomes associated with poor asthma control (ie, oral corticosteroids use, asthma-related emergency department visits, and asthma-related hospitalizations). We separately accounted for SABA metered-dose inhaler (MDI) and SABA nebulizer use.
RESULTS
Of the 2,056 patients who met study criteria, 1,569 (76.3%) had used a SABA medication in their baseline year. After adjusting for potential confounders, SABA nebulizer use was associated with asthma-related emergency department visits (adjusted hazard ratio [aHR], 6.32; 95% confidence interval [CI], 2.38 to 16.80) and asthma-related hospitalizations (aHR, 21.62; 95% CI, 3.17 to 147.57). In contrast, frequency of SABA MDI use was not associated with these outcomes.
CONCLUSIONS
Frequency of SABA use during a 3-month period was associated with poor asthma outcomes. The relationship with poor asthma outcomes was strongest for SABA nebulizer use, suggesting that the type of SABA used is also of prognostic importance.
View on PubMed2008
BACKGROUND
It is unknown whether health-related media stories reach diverse older adults and influence advance care planning (ACP).
OBJECTIVE
To determine exposure to media coverage of Terri Schiavo (TS) and its impact on ACP.
DESIGN AND PARTICIPANTS
Descriptive study of 117 English/Spanish-speakers, aged >or=50 years (mean 61 years) from a county hospital, interviewed six months after enrollment into an advance directive study.
MEASUREMENTS
We assessed whether participants had heard of TS and subject characteristics associated with exposure. We also asked whether, because of TS, subjects engaged in ACP.
MAIN RESULTS
Ninety-two percent reported hearing of TS. Participants with adequate literacy were more likely than those with limited literacy to report hearing of TS (100% vs. 79%, P < .001), as were participants with >or= a high school vs. < high school education (97% vs. 82%, P = .004), and English vs. Spanish-speakers (96% vs. 85%, P = .04). Because of TS, many reported clarifying their own goals of care (61%), talking to their family/friends about ACP (66%), and wanting to complete an advance directive (37%).
CONCLUSIONS
Most diverse older adults had heard of TS and reported that her story activated them to engage in ACP. Media stories may provide a powerful opportunity to engage patients in ACP and develop public health campaigns.
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Idiopathic pulmonary fibrosis (IPF) is a debilitating, fatal, chronic fibrosing lung disease with no known effective therapy. Endothelin-1 may underlie the pathogenesis of lung fibrosis, therefore it was hypothesized that the oral dual endothelin receptor antagonist bosentan may have efficacy for the treatment of IPF. The BUILD-1 study evaluated the efficacy, safety and tolerability of bosentan in patients with IPF. Bosentan was associated with a trend toward delayed time to disease progression or death and improvement in quality-of-life, both of which were more pronounced in patients with a biopsy-confirmed IPF diagnosis. These observations are being investigated in the ongoing BUILD-3 trial.
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2008
The skin serves the vital function of providing a barrier between the hostile external environment and the host. While the skin has many important barrier functions, the two that are absolutely essential for survival are the barrier to the movement of water and electrolytes (permeability barrier) and the barrier against invasive and toxic microorganisms (antimicrobial barrier). Lipids play an essential role in the formation and maintenance of both the permeability and antimicrobial barriers. A hydrophobic extracellular lipid matrix in the stratum corneum composed primarily of ceramides, cholesterol, and free fatty acids provides the barrier to the movement of water and electrolytes. A variety of lipids, such as fatty alcohols, monoglycerides, sphingolipids, phospholipids, and in particular free fatty acids, have antimicrobial activity and contribute to the antimicrobial barrier. In addition to these essential functions, we will also review the ability of skin surface cholesterol to reflect alterations in systemic lipid metabolism and the risk of atherosclerosis.
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