Biomedical subjects
L Waller
Publications and source records attributed to L Waller.
Out-of-hospital violence injury surveillance: quality of data collection.
STUDY OBJECTIVE: The recognized need to improve data collection for violence prevention may be met, in part, by using out-of-hospital data for injury surveillance. The purpose of the Prehospital Violence Injury Surveillance project was to examine the extent to which paramedics can adequately collect information about injuries, particularly intentional injuries, at emergency scenes. METHODS: Paramedics in a large Midwestern metropolitan area were trained to assess violence-related events and collect relevant data using a modified ambulance run report form. Data collected from 8 violence-related training scenarios and from 13 ride-along observations were analyzed to estimate paramedic interrater reliability using the kappa statistic. Data from 7,363 run report forms, filed during a 3-month study period, were abstracted and analyzed for completeness and quality. RESULTS: Paramedics demonstrated fair to good, and sometimes excellent, interrater agreement when documenting the training scenarios. Paramedics revealed barriers to collecting violence-related out-of-hospital data. The paramedics and the observer disagreed in documenting 77% of the ride-along observations. Overall, 73% of abstracted run report forms showed documentation errors, with more than 99% of these reports containing errors of omission and 29% showing internal documentation inconsistencies. Despite the emphasis on violence-related data, documentation of domestic abuse screening was missing from more than 99% of run reports from female patients. CONCLUSION: Significant barriers to quality out-of-hospital data collection were identified during study implementation and in abstracted run reports. These barriers included the following: lack of organizational support; characteristics of the violence-related data elements; design of the ambulance run report form; and paramedic knowledge, attitudes, and behaviors regarding data collection.
The role of depression in the association between self-rated physical health and clinically defined illness.
We enrolled 543 elderly participants of a managed care organization in a cross-sectional study to test whether the association between self-rated physical health and clinically defined illness differs for persons who are not depressed compared with persons with minor or serious depression. Depression was measured with the Diagnostic Interview Schedule (DIS). Clinically defined illness was measured with the Chronic Disease Score (CDS), a pharmacy-based measure. Additional variables included age, sex, and self-reported pain and physical function. Self-rated physical health was associated with both minor and serious depression, independent of clinically defined illness; minor depression was no longer significant when self-reported pain and physical function were added to the model. A significant negative correlation between self-rated physical health and clinically defined illness was observed for minor and no depression, but no correlation was seen for serious depression. These results confirm the association between depression and self-rated physical health and emphasize that, for persons with serious depression, self-rated health provides a less accurate picture of clinically defined illness at both ends of the spectrum. Also, a diagnosis of minor depression should not forestall investigation of inconsistencies between patient report and clinical evidence.
Examining associations between childhood asthma and traffic flow using a geographic information system.
Using geographic information systems (GIS) and routinely collected data, we explored whether childhood residence near busy roads was associated with asthma in a low-income population in San Diego County, California. We examined the locations of residences of 5,996 children [less than/equal to] 14 years of age who were diagnosed with asthma in 1993 and compared them to a random control series of nonrespiratory diagnoses (n = 2,284). Locations of the children's residences were linked to traffic count data at streets within 550 ft. We also examined the number of medical care visits in 1993 for children with asthma to determine if the number of visits was related to traffic flow. Analysis of the distribution of cases and controls by quintiles and by the 90th, 95th, and 99th percentiles of traffic flow at the highest traffic street, nearest street, and total of all streets within a 550-ft buffer region did not show any significantly elevated odds ratios. However, among cases, those residing near high traffic flows (measured at the nearest street) were more likely than those residing near lower traffic flows to have two or more medical care visits for asthma than to have only one visit for asthma during the year. The results of this exploratory study suggest that higher traffic flows may be related to an increase in repeated medical visits for asthmatic children. Repeated exposure to particulate matter and other air pollutants from traffic exhaust may aggravate asthmatic symptoms in individuals already diagnosed with asthma.
Cigarette smoking is associated with abnormal involuntary movements in the general male population--a study of men born in 1933.
Abnormal involuntary movements, i.e., spontaneous and tardive dyskinesias, were studied in a random population sample of 559 men, aged 59 years, who were participating in an epidemiological study focused on cardiovascular health. The research diagnostic criteria for tardive dyskinesia were fulfilled by 8.2% (n = 46), discounting the fact that all had not been exposed to neuroleptics. The mean Abnormal Involuntary Movements Scale score in the dyskinetic group was 5.0 (SD = 1.8), indicating mild to moderate symptoms. Dyskinetic men had higher daily cigarette consumption and higher scores for parkinsonian symptoms. They also had higher frequencies of psychiatric morbidity, exposure to neuroleptics, and alcohol dependence than the men without dyskinesia. In a logistic regression model, exposure to neuroleptics (p < .05) and daily cigarette consumption (p < .0005) were independently associated with dyskinesia. The probability of dyskinesia in a person smoking 20 or more cigarettes per day was 19%, whereas the probability associated with exposure to neuroleptics was 30%.
The importance of osmolality in hydrophilic urethral catheters: a crossover study.
The longterm use of clean intermittent self catheterisation as an option for bladder management in the care of spinal cord injury patients has shown the possible risk of urethral trauma and chronic infections being developed over time. The basic properties of the catheters being used need to be evaluated. In this crossover study of 14 male spinal cord injury patients, two commercial hydrophilic catheters were compared, as to the maximum friction force during the removal of the catheters after bladder emptying. The friction force, measured by a dynamometer twice daily, showed significant lower values for LoFric (0.87/0.84 N) than for EsiCath/Conveen (1.38/1.27 N). Sticking to the urethral epithelium was reported three times (two patients) with the LoFric catheter, and 42 times (nine patients) with the EasiCath catheter. Osmolality of the outer layer of the catheters was measured using a freezing-point reduction technique. The greater than 10 times higher osmolality (approximately 900 mOsm/kg) of the Lofric catheter may explain the results.
Lower respiratory illness, recurrent wheezing, and day care attendance.
We prospectively assessed the relations between various characteristics of day care and lower respiratory illness (LRI) in a cohort of 1,268 Minnesotan children, born between October 1989 and January 1991 and followed to 2 yr of age. Information on LRI was abstracted from medical records and data on day care use, respiratory symptoms, and physician diagnosis of asthma were obtained from questionnaires. We identified a subgroup of 60 children with recurrent wheezing illnesses. The LRI rate ratio for day care attendance was 2.0 (95% confidence interval = 1.7, 2.2). Rate ratios were similar regardless of the day care setting, number of other children present, or the number of hours spent in day care. A parental history of asthma further increased the rate ratio for day care attendance. Day care attendance was associated with a threefold risk of having recurrent wheezing illnesses. We conclude that day care attendance is an important risk factor for LRI in young children, and for recurrent wheezing illnesses.
Essential fatty acids and abnormal involuntary movements in the general male population: a study of men born in 1933.
Spontaneous and tardive dyskinesias were studied in a random population sample of 446 men, aged 59 years. Dyskinesia, defined as an AIMS score of at least 2 in any body part, was seen in 15.1% (n = 74). Dyskinetic men had a higher cigarette consumption, and they had higher frequencies of psychiatric morbidity and exposure to neuroleptics. Dyskinesia was also associated with several abnormalities in EFA concentrations in plasma, but the most consistent finding was the low arachidonic acid levels in phospholipids, triglycerides and cholesterol esters. In a logistic regression model, cigarette consumption (P < 0.02), exposure to neuroleptics (P < 0.01), and low arachidonic acid levels in the phospholipid fraction (P < 0.0001) were independently associated with dyskinesia.
The indoor air and children's health study: methods and incidence rates.
The Indoor Air and Children's Health Study is a prospective cohort study of the relation between indoor air pollution and lower respiratory illness (LRI) during the first 2 years of life. Information on family and household characteristics was obtained from a health maintenance organization for 1,424 infants enrolled at birth. Data on LRI were abstracted from medical records. The incidence of all LRI was 48.4 per 100 child-years. Wheezing-associated respiratory illness (WARI)/asthma was the most common specific LRI, with an incidence of 11.5 per 100 child-years. Total LRI incidence was lowest during the first 6 months of life. Girls had lower incidence than boys [rate ratio (RR) = 0.8; 95% confidence interval (CI) = 0.7-0.8)]. With the exception of croup, all LRI were most common during February and March. These results are comparable with those of other prospective studies. Consistent with other studies, self-reported maternal smoking demonstrated an RR of 1.5 (95% CI = 1.2-1.8) for total LRI, but the association varied for specific LRIs from 2.3 (95% CI = 1.5-3.0) for WARI/asthma to 1.0 (95% CI = 0.7-1.6) for bronchitis.
Clean intermittent catheterization in spinal cord injury patients: long-term followup of a hydrophilic low friction technique.
Clean intermittent self-catheterization is an established option in bladder management of spinal cord injury patients. Several early and a small number of long-term studies have reported good preventive or therapeutic effects on hydronephrosis, vesicourethral reflux, urinary tract infection and incontinence. Most reports describe the use of small catheters and liberal use of jelly but urethral complications, such as strictures and false passages, seem to increase with the length of followup. All 30 spinal cord injury patients in this retrospective study had used disposable hydrophilic, low friction catheters from the early shock phase to a median of 7 years (range 5 to 9). There were 26 upper motor neuron and 4 lower motor neuron lesions. After tap water soaking, the surface layer of the catheter coating has a friction constant more than 10 times lower than that for a regular plastic catheter (Nélaton) with chlorhexidine jelly. There was no hydronephrosis, pyelonephritis or renal scarring. In 3 patients who had decreased the clean intermittent self-catheterization regimen, signs of upper tract dilatation developed but the excretory urogram returned to normal after correction of the regimen. Of 30 patients 12 (40%) maintained sterile urine, while 4 of the remaining 18 with bacteriuria had episodes of urinary sepsis and chronic infections. Two patients had epididymitis. Of 6 men with occasional insertion difficulties when the clean intermittent self-catheterization regimen started after the indwelling catheter had been removed 4 showed yielding signs of strictures during the subsequent clean intermittent self-catheterization regimen. In 1 patient 2 dilation attempts had failed but the patient can perform the clean intermittent self-catheterization regimen. One patient with Crohn's disease had advanced urethral changes in the acute phase but could perform clean intermittent self-catheterization with a small catheter. One patient has had recurrent modifications of the urethral wall but no development of a false passage. The study indicates that patients who use hydrophilic low friction low friction catheters do as well as or better than patients using conventional catheters. Above all, there is no increase in severe urethral complications with time after injury. Progression towards strictures after early urethral trauma seems to be preventable by the use of this catheter.
Pharmacists as HIV/AIDS information resources: survey of Alabama pharmacists.
Alabama pharmacists were surveyed by researchers from the University of Alabama at Birmingham's School of Public Health in collaboration with investigators at the Schools of Pharmacy at Auburn University and Stamford University as part of a statewide pharmacists' demonstration project to mobilize pharmacists and pharmacy locations as information resources for HIV/AIDS education and prevention. The objectives of the survey were to: (1) establish a baseline of knowledge and attitudes among Alabama pharmacists about HIV/AIDS; (2) to assess Alabama pharmacists' willingness to assume the role of HIV/AIDS information resources in their communities; and (3) to identify perceived barriers to assuming the role of information resources. The results of the survey were used in the development of an educational intervention program and will be used subsequently to assess the impact of the implementation of the Alabama demonstration project. Findings from this project will serve as a basis for development of a nationwide project as part of a collaborative agreement between the Centers for Disease Control and Prevention's National Partnership Program and the Foundation of Pharmacists and Corporate America for AIDS Education.
Secrets revealed: the limits of medical confidence.
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[The diabetes-nurse--a resource probably saving money and shortening the length of stay].
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[Group education in a diabetes school improves the metabolic control].
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New law for laboratory life.
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Metabolite kinetics: formation of acetaminophen from deuterated and nondeuterated phenacetin and acetanilide on acetaminophen sulfation kinetics in the perfused rat liver preparation.
The role of hepatic intrinsic clearance for metabolite formation from various precursors on subsequent metabolite elimination was was investigated in the once-through perfused rat liver preparation. Two pairs of acetaminophen precursors: [14C] phenacetin-d5 and [3H] phenacetin-do, [14C] acetanilide and [3H] phenacetin were delivered by constant flow (10 ml/min/liver) either by normal or retrograde perfusion to the rat liver preparations. The extents of acetaminophen sulfation were compared within the same preparation. The data showed that the higher the hepatocellular activity (intrinsic clearance) for acetaminophen formation, the greater the extent of subsequent acetaminophen sulfation. The findings were explained on the basis of blood transit time and metabolite "duration time." Because of blood having only a finite transit time in liver, the longer the drug requires for metabolite formation, the less time will remain for metabolite sulfation and the less will be the degree of subsequent sulfation. Conversely, when the drug forms the primary metabolite rapidly, a longer time will remain for the metabolite to be sulfated in liver to result in a greater degree of metabolite sulfation. Finally, the effects of hepatic intrinsic clearances for metabolite formation and zonal distribution of enzyme systems for metabolite formation and elimination in liver are discussed.
Effect of contraceptive pills on sexual activity in the luteal phase of the human menstrual cycle.
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