Publications

OBJECTIVE

The aim of the study was to identify and quantify patient, physician, hospital, and system factors that are associated with a longer ED length of stay.

METHODS

Data were from the 2001-2003 National Hospital Ambulatory Medical Care Survey. The primary outcome was length of stay in minutes. Predictor variables were patient level (eg, age, triage score), physician level (eg, level of training), and hospital/system level (eg, geographic location, ownership).

RESULTS

Admitted patients' median length of stay was 255 minutes (interquartile range, 160-400); discharged patients stayed a median of 120 minutes (interquartile range, 70-199). Factors independently associated with longer ED stays for admitted patients were Hispanic ethnicity (+20 minutes), computed tomography scan or magnetic resonance imaging (+36 minutes), and hospital location in a metropolitan area (+32 minutes). Intensive care unit admissions had a shorter length of stay (-30 minutes).

CONCLUSION

Several factors are associated with significant increases in ED length of stay and may be important factors in strategies to reduce length of stay.

We used hospital discharge data to estimate incidence and distribution of coccidioidomycosis-associated hospitalizations in California. For 1997-2002, the average annual rate of hospitalization was 3.67 per 100,000 population. County of residence, older age, black race, male sex, HIV infection, and pregnancy were strongly associated with increased risk for hospitalization.

PURPOSE

Tobacco marketing campaigns target distinct psychographic segments of the population. We describe psychographic segments among Vietnamese-American youth and their relationship to smoking behavior.

METHODS

This was a cross-sectional survey of 411 Vietnamese-American young people (aged 14-24 years). Cluster analysis was performed to describe different population segments.

RESULTS

We identified four segments, categorized as follows: risk seekers, stressed pessimists, optimistic achievers, and sedentary well-behaved individuals. The risk seekers and stressed pessimists reported that they had tried smoking at some time (60% and 53%, respectively) in greater proportions than the other two segments (25% and 24%); and 20% of risk seekers and 22% of stressed pessimists were current smokers compared with 2% of the other clusters. In comparison to the other groups, the risk seekers more frequently went to bars and clubs, and their friends engaged in risky behavior. They agreed that secondhand smoke was dangerous, but accepted ventilation as an alternative to smoke-free policies more frequently than the other groups. The stressed pessimists had negative views of the future, did not value physical fitness, and doubted the dangers of secondhand smoke. Optimistic achievers were active in sports and student activities, were optimistic about future achievements, prioritized good nutrition, and supported smoke-free policies. The sedentary well-behaved group had well-behaved friends, did not value physical fitness, strongly opposed smoking, and supported smoke-free policies.

CONCLUSION

Different segments of the Vietnamese-American population have different attitudes and smoking risk, which may facilitate targeted tobacco control message development. Future research should address whether similar psychographic segments exist in other ethnic populations.

Tuberculosis kills nearly 2 million people annually, and current approaches to tuberculosis control are expensive, have limited efficacy, and are vulnerable to being overcome by extensively drug-resistant strains of Mycobacterium tuberculosis. Determination of the genome sequence of M. tuberculosis has revolutionized tuberculosis research, contributed to major advances in the understanding of the evolution and pathogenesis of M. tuberculosis, and facilitated development of new diagnostic tests with increased specificity for tuberculosis. In this review, we describe some of the major progress in tuberculosis research that has resulted from knowledge of the genome sequence and note some of the problems that remain unsolved.

BACKGROUND

HIV-associated adipose redistribution syndrome (HARS) is an HIV-associated disorder characterized by excess truncal fat, including visceral adipose tissue (VAT).

METHODS

From baseline to week 12 in this randomized, double-blind, placebo (PL)-controlled, multicenter trial investigating effects of recombinant human growth hormone (r-hGH; Serostim; EMD Serono Inc., Rockland, MA) in patients with HARS, 325 received induction (4 mg/d of r-hGH) or PL. At week 12, patients who initially received induction were rerandomized to 2 mg of r-hGH on alternate days (maintenance) or PL to week 36. Patients who initially received PL later received 4 mg/d of r-hGH. Change in VAT was the primary outcome. Key secondary outcomes included changes in non-high-density lipoprotein cholesterol (non-HDL-C) and limb fat.

RESULTS

At week 12, induction therapy resulted in decreased VAT (-32.6 vs. 0.5 cm2; P<0.001), limb fat (-0.4 vs. 0.2 kg; P<0.001), and non-HDL-C (-13.0 vs. -2.8 mg/dL; P=0.023) compared with PL. On r-hGH induction-maintenance (baseline to week 36), patients sustained losses in VAT and trunk fat but not losses of subcutaneous fat in the abdomen or limbs. Also, non-HDL-C remained significantly decreased on r-hGH but not on PL maintenance.

CONCLUSIONS

In patients with HARS, r-hGH induction-maintenance therapy produces greater relative losses of VAT and trunk fat than of subcutaneous fat and also has beneficial effects on the lipid profile.

Disruption of the permeability barrier stimulates a repair response that leads to the restoration of barrier function. Previous studies demonstrated that changes in ions, particularly calcium, and cytokines are positive signals, whereas serine protease activation of proteinase-activated receptor 2 is a negative signal regulating barrier recovery. Ikeyama and colleagues provide data that the nitric oxide signaling pathway also regulates barrier homeostasis.

OBJECTIVE

To determine the success of medical management of presumptive thoracolumbar disk herniation in dogs and the variables associated with treatment outcome.

STUDY DESIGN

Retrospective case series.

ANIMALS

Dogs (n=223) with presumptive thoracolumbar disk herniation.

METHODS

Medical records from 2 clinics were used to identify affected dogs, and owners were mailed a questionnaire about success of therapy, recurrence of clinical signs, and quality of life (QOL) as interpreted by the owner. Signalment, duration and degree of neurologic dysfunction, and medication administration were determined from medical records.

RESULTS

Eighty-three percent of dogs (185/223) were ambulatory at initial evaluation. Successful treatment was reported for 54.7% of dogs, with 30.9% having recurrence of clinical signs and 14.4% classified as therapeutic failures. From bivariable logistic regression, glucocorticoid administration was negatively associated with success (P=.008; odds ratio [OR]=.48) and QOL scores (P=.004; OR=.48). The duration of cage rest was not significantly associated with success or QOL. Nonambulatory dogs were more likely to have lower QOL scores (P=.01; OR=2.34).

CONCLUSIONS

Medical management can lead to an acceptable outcome in many dogs with presumptive thoracolumbar disk herniation. Cage rest duration does not seem to affect outcome and glucocorticoids may negatively impact success and QOL. The conclusions in this report should be interpreted cautiously because of the retrospective data collection and the use of client self-administered questionnaire follow-up.

CLINICAL RELEVANCE

These results provide an insight into the success of medical management for presumptive thoracolumbar disk herniation in dogs and may allow for refinement of treatment protocols.