Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Data Sources”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed2006

Emergency contraception: knowledge and perceptions in a university population.

PURPOSE: The purpose of this study was to examine knowledge, attitudes, and behaviors regarding emergency contraception (EC) in university men and women aged 18-21. DATA SOURCES: Data sources included responses to a 25-item questionnaire and an 8-item demographic survey completed anonymously at a public site on campus. Ninety-seven university students participated in the study. Participants were asked to respond to questions relating to knowledge, attitudes, and behaviors regarding EC, perceived worthiness, objections, sources of information about EC, preferred birth-control method and usage, and perceptions of their personal risk of unintended pregnancy. CONCLUSIONS: Many respondents considered unintended pregnancy to be a major problem and considered EC a worthy option in the event of method failure or unprotected intercourse. While most participants were aware that there was a postcoital method of contraception, confusion existed between EC and RU-486 (the abortion pill). Almost half (49.5%) believed that EC was the same as RU-486. There was an association between advanced prescription for EC and its likelihood of use. Most women would be significantly more likely to use EC if they had a prescription on hand. Of the women who were less likely to choose EC, 100% indicated they would feel embarrassed or judged when asking for it. Only 34% of those women who have had a gynecological exam in the past 12 months had discussed EC with their provider. IMPLICATIONS FOR PRACTICE: Advanced practice nurses need to incorporate EC into preventive health counseling for both men and women. Providing women with an advanced prescription increases the likelihood that women will use EC.

Adolescent↗
PubMed2001

Birthweight distribution at Korle-Bu Teaching Hospital, Ghana.

OBJECTIVES: To determine the birthweight distribution of singleton births at the Korle-Bu Teaching Hospital and to determine if selected socio-demographic and reproductive characteristics that are known to be associated with birthweight would show the association in our setting. DESIGN: A non-randomised cross-sectional survey of all deliveries within the study period. SETTING: Korle-Bu Teaching Hospital, a tertiary institution, delivering about 11,000 women a year. STUDY POPULATION: From 1st November to 12th December 1994, 866 singleton normally formed livebirths and fresh stillbirths were sequentially enrolled. DATA SOURCES: Data sources were the antenatal and delivery records of the subjects and an interviewer-administered questionnaire. RESULTS: The mean birthweight for the total sample was 3070 g +/- 616 g. One hundred and fifteen (13.3%) babies were low birthweight. The mean birthweight for those with reliable dates and born at term was 3262 g +/- 488.8 g. Multiple logistic regression analysis showed lack of antenatal malaria chemoprophylaxis and a history of previous low birthweight to be significantly associated with low birthweight. CONCLUSION: Although the mean birthweight of Korle-Bu babies was lower than those of USA and UK babies, it was comparable with those from other developing countries. Antenatal malaria chemoprophylaxis is a practical intervention that can produce an increase in mean birthweight and reduce the risk of low birthweight in our population.

Birth Weight↗
PubMed2001

Enteric transmission of transfusion-transmitted virus.

OBJECTIVE: To detect the virus in the feces and sera of patients in an outbreak of enterically transmitted non-A, non-E hepatitis, and this review covers the epidemiologic features and experimental infection of this novel virus. DATA SOURCES: Data sources come from our own work on this subject, published and unpublished. STUDY SELECTION: Mainly our own work is included, and related literature is collected. RESULTS: In an outbreak of enterically transmitted non-A-E hepatitis among students, a total of 381 cases (60.7%) were documented. Viral fragments identical to transfusion transmitted virus (TTV) were detected in both serum and stool samples. Asymptomatic virus carriers among the staff had positive serum (32.1%) and feces (24.6%), clearly a potential source of infection. This viral infection prevalence in 2 remote villages in northern and southern China was 9.2% and 10.6%, respectively, suggesting that China is an endemic area. In this study, groups of 3 Rhesus monkeys were infected via oral or intravenous inoculation with patient feces. Two additional monkeys were infected by passage. The virus was detected in serum, peripheral blood mononuclear cell (PBMC), liver, spleen and small intestine, while the virus positive single strand, which might be a replicative intermediate, was only in liver, intestine and PBMC of all animals. CONCLUSIONS: This nonenveloped DNA virus might be transmitted both by blood and enteric routes. Considering its wide distribution and high prevalence, we suppose that nonparenteral transmission is more important.

Animals↗
PubMed1997

An empirical study of economies of scope in home healthcare.

OBJECTIVE: To apply the economic theory of economies of scope to the home healthcare industry. DATA SOURCES: Data on 488 observations obtained from the Cost Report (HCFA Form 1728-86) of all Connecticut state-licensed, Medicare-certified home health agencies. STUDY DESIGN: The Cost Report was the primary source of data for this study. Information on total cost, scope, and other related factors was collected. Logarithmic and nonlinear regression analyses were used to identify factors related to scope and also to test for economies of scope. DATA COLLECTION METHOD: Data collected were both cross-sectional and time series (from 1988-1992). Data accuracy was verified using description of frequencies, measures of central tendency and variation, and a calculation package so that a computer calculation on the data could be compared with the agency's calculation. PRINCIPAL FINDINGS: It was determined that initially as scope increases, costs go down, thus proving economies of scope. For larger values of scope, it was determined that costs go up, proving diseconomies of scope. CONCLUSIONS: Many of the home health agencies included in this study provide more services than is cost effective given the economic theory of economies of scope.

Connecticut↗
PubMed2005

Leukoplakia prevalence estimate lower than expected.

DATA SOURCES: Data were sourced using Medline and Embase. STUDY SELECTION: Initial selection criteria were that study samples should be representative of the underlying adult population and that the leukoplakia diagnostic criteria used by the examiners should have been widely accepted ones. Because most published studies did not comply with these requisites, modified criteria were as follows. First, the sample, even if not representative of the underlying study population, should not have been collected from surgical departments of dental hospitals or clinics, where leukoplakia is usually treated (these studies would overestimate the disease prevalence). Secondly, even if the examiners were not calibrated, the diagnostic criteria used should be consistent with the internationally accepted criteria and must have been reported in the text. Thirdly, to make statistical analysis possible even if leukoplakia prevalence was not reported as a proportion, the overall number of sampled subjects and the number with the condition must be easy to extrapolate with a high level of accuracy. DATA EXTRACTION AND SYNTHESIS: Data were pooled using inverse variance weighting and random-effect methods. A sensitivity analysis was performed. RESULTS: A total of 23 primary studies was included, giving point-prevalence estimates with the inverse variance method of 1.49% [95% confidence interval (CI), 1.42-1.56] and 2.60% (95% CI, 1.72-2.74) with the random-effects method. The high between-study heterogeneity and the sensitivity analyses suggested that the second estimate was more reliable. Leukoplakia was significantly more prevalent in males (prevalence ratio, 3.22), but no difference was found between geographical areas and between younger and older adults. Using these data, the crude annual oral cancer incidence rate attributable to leukoplakia would be between 6.2 and 29.1 cases per 100 000 people. CONCLUSIONS: The pooled leukoplakia prevalence estimate was lower than expected. The estimated oral cancer incidence rate due to leukoplakia malignant transformation was high, however, and suggested that the global number of oral cancer cases is probably under-reported, particularly in developing countries.

Comment↗
PubMed2005

Rugby injuries.

OBJECTIVES: The purpose of this chapter is to review critically the existing studies on the epidemiology of pediatric rugby injuries and discuss suggestions for injury prevention and further research. DATA SOURCES: Data were sourced from the sports medicine and science literature mainly since 1990, and from a prospective injury surveillance project in rugby undertaken by the University of New South Wales (UNSW) in Sydney during 2002. Literature searches were performed using Medline and SportsDiscus. MAIN RESULTS: Reported injury rates were between 7 and 18 injuries per 1,000 hours played, with the rate of injuries resulting in loss of playing or training time measured at 6.5-10.6 per 1,000 hours played. Injury rates increased with age and level of qualification. Head injury and concussion accounted for 10-40% of all injuries. In the UNSW study, concussion accounted for 25% of injuries resulting in loss of playing or training time in the under 13 year age group. Upper and lower extremity injuries were equally apportioned, with musculoskeletal injuries being the main type of injury. Fractures were observed in the upper extremity and ankle, and joint/ligament injuries affected the shoulder, knee and ankle. The tackle was associated with around 50% of all injuries. The scrum produced fewer injuries, but is historically associated with spinal cord injury. CONCLUSIONS: Rugby is a contact sport with injury risks related to physical contact, primarily in the tackle. Most injuries affect the musculoskeletal system, with the exception of concussion. Spinal cord injury is rare, but catastrophic. Research is required to understand better injury risks and to reduce the incidence of shoulder, knee and ankle joint injuries, concussion and spinal injury.

Adolescent↗
PubMed1996

Dose-response characteristics of cholesterol-lowering drug therapies: implications for treatment.

PURPOSE: To develop an optimal treatment strategy that reduces low-density lipoprotein (LDL) cholesterol levels and improves adherence to therapy by reviewing clinical trials that define the dose-response characteristics for 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), bile acid sequestrants, and niacin. DATA SOURCES: Data were obtained from a MEDLINE search of the English-language literature published from 1975 through November 1995 and from an extensive bibliography review. STUDY SELECTION: Controlled, clinical trials were reviewed if they evaluated 1) the effectiveness and toxicity of one LDL cholesterol-lowering agent (statins, bile acid sequestrants, or niacin, at two or more doses) or 2) monotherapy with two LDL cholesterol-lowering agents at defined doses used alone and in combination. Studies that had fewer than 10 patients in a treatment group or that selected patients on the basis of previous response to therapy were not included. DATA EXTRACTION: Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcomes. DATA SYNTHESIS: Dose-response relations for bile acid sequestrants and statins are nonlinear, and most of their LDL cholesterol-lowering effects can be obtained with lower doses. The few dose-response studies of niacin that have been done suggest that most of niacin's high-density lipoprotein cholesterol-increasing effect can also be achieved with relatively low doses, but higher doses are needed to substantially reduce LDL cholesterol levels. If bile acid sequestrants or niacin are added to statin therapy, the effect of combined therapy on LDL cholesterol levels is additive. CONCLUSION: The nonlinear dose-response relation of statins, bile acid sequestrants, and niacin and their additive LDL cholesterol-lowering effect when used together suggest a strategy for treating hypercholesterolemia that may optimize effectiveness while minimizing adverse effects and cost.

Anticholesteremic Agents↗
PubMed2004

Pharmacologic perspectives for once-daily antiretroviral therapy.

OBJECTIVE: To contrast available once-daily antiretroviral agents and combinations of these agents from a clinical pharmacologic viewpoint. DATA SOURCES: Data were extracted from publications and major HIV conference proceedings cited in MEDLINE (1966-March 2004) using the search terms antiretroviral therapy, combination therapy, once-daily therapy, and pharmacokinetics. Additional references were obtained from the bibliographies of these sources. STUDY SELECTION AND DATA EXTRACTION: Information pertaining to pharmacologic perspectives for once-daily antiretroviral agents was selected. DATA SYNTHESIS: Maximal and durable suppression of plasma HIV RNA, the principal goal of therapy, depends on the intrinsic antiviral activity of the antiretroviral regimen. A favorable tolerability/toxicity profile is also fundamentally important. All once-daily agents exhibit some pharmacologic limitations or lack adequate long-term follow-up. Of available agents, efavirenz has a long and distinguished efficacy record, with reasonable safety and moderate tolerability. Lamivudine, and newer agents such as atazanavir (or atazanavir/ritonavir), emtricitabine, fosamprenavir/ritonavir, and tenofovir, may offer pharmacologic advantages in the current state of once-daily therapy. Important considerations exist for coadministering once-daily agents including drug-drug interactions, drug-food incompatibilities, and synergistic toxicities. Few controlled studies have compared once-daily regimens with conventional regimens. CONCLUSIONS: Progress has been made toward once-daily therapy, but more clinical experience with available agents is needed, including comparative studies of entirely once-daily regimens versus conventional regimens. Limitations of currently available agents signify a need for improved antiretroviral utilization or new alternative agents.

Anti-HIV Agents↗
PubMed1996

Factors that enhance continued trauma center participation in trauma systems.

OBJECTIVES: To examine hospital, trauma system, and reimbursement factors that offset the financial burdens of trauma care delivery and to assess how proposed Medicaid and Medicare budget cuts may affect the ability of hospitals to alleviate financial pressures related to trauma care delivery. DESIGN AND SETTING: In-depth interviews and data collection for trauma centers in 12 metropolitan areas with populations of 1 million or more. PARTICIPANTS: Seventy trauma centers in these large urban communities that indicated a continuing commitment to providing trauma services for the foreseeable future. MAIN OUTCOME MEASURES: Hospital, trauma system, and reimbursement characteristics that distinguish hospitals that are better able to alleviate the financial burdens of indigent trauma care and a financial analysis that assesses payment adequacy for different payers and overall financial outcomes. DATA SOURCES: Data from a variety of sources were obtained to measure the factors that affect the operation and financing of trauma centers: published and unpublished hospital data from the American Hospital Association; trauma center level, length of operation, and the availability of alternative centers from a recently published study; Health Care Financing Administration data on Medicare and Medicaid program characteristics; automobile insurance requirements; and patient discharge data. Most data are reflective of 1992. RESULTS: Public hospitals, teaching hospitals, and institutions receiving supplemental indigent care payments appear to be best able to mitigate the financial burdens of uncompensated trauma care, especially those with moderate indigent care loads. A detailed financial analysis found that private hospitals with trauma centers were near break-even in 1992 for trauma care delivery and public hospitals experienced financial losses. Proposals to reduce Medicaid and Medicare would create substantial reductions in hospital payments for hospital-wide patient care and trauma patients specifically. CONCLUSION: Proposed Medicaid and Medicare payment cuts are likely to eliminate the delicate financial balance that many urban hospitals have achieved in providing trauma care. The erosion in funding from public programs may portend a new wave of trauma center closures as hospitals seek to deal with reduced reimbursement by eliminating unprofitable services.

Diagnosis-Related Groups↗
PubMed2005

Rural health alert: Helicobacter pylori in well water.

PURPOSE: This exploratory research project is an epidemiological study to determine in a specified population of farmworkers in Southeast Georgia the following: (a) the prevalence rate of gastritis, (b) related cofactors contributing to gastritis with or without a positive diagnosis of Helicobacter pylori (HP), (c) relationship of contaminated drinking water to gastritis, and (d) relative risk of acquiring gastritis from HP-contaminated drinking water. DATA SOURCES: Data were collected from five common water sources for 147 farmworkers in rural Southeast Georgia. Farmworkers were given a survey to identify cofactors related to HP gastritis. Water samples were taken from four common well water sources (experimental group) and one control well, analyzed for HP, and associated through nonparametric categorical data analysis to the survey items to discover possible relationships. CONCLUSIONS: Analysis of data using nonparametric regression showed a weak positive relationship (p= 0.07) between symptoms of gastritis and the HP-contaminated water. Risk analysis demonstrated that farmworkers who drank water contaminated with HP were 2.6 times more likely to have symptoms of gastritis. IMPLICATIONS FOR PRACTICE: This research established a positive relationship between well water contaminated with HP and signs and symptoms of gastritis. Nurse practitioners (NPs) working with populations who drink well water and have the signs and symptoms or positive diagnosis of HP should have a high degree of suspicion that the well water may be a source of HP infection. In addition to treating the patient for HP gastritis, NPs may utilize this research to plan other interventions that decrease the incidence of HP-related illnesses such as recommending well water treatment.

Adolescent↗
PubMed2005

Competition and health plan performance: evidence from health maintenance organization insurance markets.

OBJECTIVE: We sought to assess whether health maintenance organizations (HMOs) operating in competitive markets, or markets with substantial HMO penetration, perform better on the standardized Health Plan Employer Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey (CAHPS) measures. STUDY DESIGN: We performed a secondary analysis of nonexperimental, cross-sectional data. DATA SOURCES: Data were obtained from a variety of sources, including the National Committee for Quality Assurance (NCQA), Interstudy, the Area Resource File, the U.S. Office of Personnel Management, and the U.S. Department of Labor. METHODS: Multiple Indicator Multiple Cause models were used to simultaneously estimate 6 latent quality variables from 35 HEDIS and CAHPS measures and to relate these latent variables to HMO competition and HMO penetration while controlling for other health plan and market characteristics. PRINCIPAL FINDINGS: Greater competition, as measured by the Herfindahl index, was associated with inferior health plan performance on 3 of 6 quality dimensions. Plans in markets with greater HMO penetration perform better on HEDIS- but not CAHPS-based dimensions of performance. Plans that make their data available publicly perform significantly better on both the HEDIS and CAHPS domains, performing one third to three quarters of a standard deviation better than plans that don't make their results available publicly. CONCLUSIONS: Plans in more competitive markets in 1999 did not achieve better quality after controlling for other important covariates, although plans in markets with a high degree of HMO penetration are performing better on the HEDIS quality dimensions. Although our study design cannot determine causality, the results suggest reason to revisit the belief that competition among HMOs will inherently improve quality.

Catchment Area, Health↗
PubMed1991

Potential health effects of greenhouse effect and ozone layer depletion in Australia.

OBJECTIVE: To identify potential health effects of the greenhouse effect and ozone layer depletion in Australia. DATA SOURCES: Data were derived from a number of sources: (i) published articles accessed from relevant databases in the disciplines of health, public health and climatology over the past 20 years; (ii) published conference proceedings, review monographs and government reports covering the topic; (iii) a survey of experts in public health and climatology/geography (150 individuals were surveyed in the first phase with a 63% response rate); and (iv) a consensus conference in which 22 invited experts reviewed the results of the literature review and survey and a second conference in which 18 senior members of the health bureaucracy and public health profession considered the implications of the findings. STUDY SELECTION: Over 200 published articles or monographs were reviewed. Criteria for selection were whether the papers contributed information to the objectives of the review. DATA EXTRACTION: Because of the nature of the problem under investigation, predictions based on reasonable scientific assumptions were the major content of the review rather than conclusions based on scientific research. DATA SYNTHESIS: The major predicted health effects of long-term climatic change in Australia are skin and eye damage from increased ultraviolet radiation exposure, increased incidence of some respiratory diseases, vector-borne and water-borne diseases, and the social and physical effects of natural hazards and social and economic restructuring. The most vulnerable groups include the aged, the very young, the chronically ill, those living in poorly designed neighbourhoods and those working in outdoor occupations or heavy industry. CONCLUSIONS: The potential effects on health of long-term climatic change cover the broad spectrum of public health concerns. Detailed predictions of likely problems in specific geographic areas are not yet possible, but progressive development of such predictive capability is a high priority. Doctors will have an increasingly important role in monitoring local health status and participating in disease prevention and surveillance programmes.

Animals↗
PubMed2005

Systematic comparison of four sources of drug information regarding adjustment of dose for renal function.

OBJECTIVE: To compare advice on dosage adjustment for renal impairment provided by four commonly used secondary pharmacotherapeutic sources. DESIGN: Systematic comparison of the definitions of renal impairment, recommendations for dosage adjustment, and the evidence in support of these recommendations in four information sources. DATA SOURCES: British National Formulary, Martindale: the Complete Drug Reference, American Hospital Formulary System Drug Information, and Drug Prescribing in Renal Failure. REVIEW METHODS: Two reviewers independently extracted data on recommendations for dosage adjustment for impaired renal function of 100 drugs often used in our hospital. RESULTS: The four sources differed in their recommendations for adjustments of dosage and dosing interval. They vary in their definitions of renal impairment; some are qualitative and remain unclear. All sources provide only a general description; the methods on which the advice is based and references for original data are rarely presented. CONCLUSIONS: The remarkable variation in definitions and recommendations, along with scarce details of the methods used to reach this advice, makes the available sources of drug information ill suited for clinical use. The methods used to retrieve information and use data should be described and made available to the reader. Advice on drug prescription, dose and dosing interval, contraindications, and adverse effects should be evidence based.

Contraindications↗
PubMed1995

Longitudinal patterns of medical service use and costs among people with AIDS.

OBJECTIVE: This study examines the effect of race, HIV transmission group, and decedent status on the use and cost of inpatient and outpatient care among people with AIDS. DATA SOURCES: Data come from 914 people with AIDS who were receiving services in nine cities across the United States in 1990-1991 and who indicated that a hospital clinic was their usual source of care. Review of hospital medical and billing records provided data on use and costs of medical services over an 18-month period. Vital status was determined from hospital records and death certificates. STUDY DESIGN: Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data and working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal patterns of inpatient and outpatient use and costs. PRINCIPAL FINDINGS: Inpatient utilization and costs were higher for decedents than for nondecedents. However, differences between decedents and nondecedents varied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences were greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not display as strong a temporal trend. CONCLUSIONS: Much of the cost of treating HIV infection is concentrated in the period immediately preceding death. The intensity of service use in the terminal period should be considered when developing estimates of annual costs of care and when designing programs to provide community-based treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Inhaled respiratory medications and the use of chlorofluorocarbons (CFCs). Thoracic Society of Australia and New Zealand.

OBJECTIVE: To assess the use of chlorofluorocarbons (CFCs) in metered-dose aerosols against the background of community concerns regarding the adverse environmental effects of CFCs. DATA SOURCES: Data on the constituents of currently available metered-dose aerosols were supplied by the manufacturers, and details of chemistry and safety were obtained from monographs and papers published in the medical literature. STUDY SELECTION: Five papers, published in the early 1970s when metered-dose aerosols first became popular, were reviewed for safety data on CFCs. Several chapters in monographs were searched for data on the nature and function of CFCs in metered-dose aerosols, and five papers were the source of information on alternatives to CFCs as vehicles for the delivery of inhaled respiratory drugs. DATA SYNTHESIS: The medical use of CFCs accounts for only 1.5% of the total production in Australia, the majority being used for refrigeration, air-conditioning and other commercial or industrial purposes. The physicochemical properties of CFCs are such that they function as a suitable storage medium for active drugs within the canister and as an ideal vehicle for drug delivery. Approximately 20 s after inhalation of a clinically recommended dose of a bronchodilator metered-dose aerosol, CFCs are detectable in the blood, but the concentrations decline rapidly (half-life less than 40 s). Although CFCs have been shown to sensitise the myocardium to the arrhythmogenic effects of catecholamines in experimental animals, the requisite concentrations can only be achieved by patients if they inhale from a canister on every breath for approximately 20 successive breaths. CONCLUSIONS: CFCs used in metered-dose aerosols are an effective storage medium and a convenient vehicle for drug delivery. They are non-toxic--unless amounts far in excess of the clinically recommended doses are used, when arrhythmogenic effects may occur. The medical use of CFCs has minimal environmental impact compared with their industrial and commercial use. Dry powder delivery systems offer an alternative approach, and future research will yield nonozone-depleting CFCs suitable for replacing those in current metered-dose aerosols.

Administration, Inhalation↗
PubMed2000

Acromioclavicular joint injuries.

OBJECTIVE: To discuss the anatomy and biomechanics of the acromioclavicular (AC) joint, along with the clinical evaluation and treatment of an athlete with an AC joint injury. DATA SOURCES: I searched MEDLINE from 1970 through 1999 under the key words "acromioclavicular joint," "clavicle," "acromioclavicular separation," and "acromioclavicular dislocation." Knowledge base was an additional source. DATA SYNTHESIS: AC joint injury is common in athletes and a source of significant morbidity, particularly for athletes in overhead sports. Because this injury can masquerade as other shoulder conditions, the examiner must understand the anatomy and biomechanics of the shoulder in order to perform a systematic clinical evaluation and identify the injury. CONCLUSIONS/RECOMMENDATIONS: Careful attention to the clinical evaluation allows the clinician to categorize the athlete's AC joint injury and institute appropriate treatment in a timely fashion, thus permitting the athlete to return to sport as quickly and safely as possible.

Journal Article↗
PubMed2002

Primary care, self-rated health, and reductions in social disparities in health.

OBJECTIVE: To examine the extent to which good primary-care experience attenuates the adverse association of income inequality with self-reported health. DATA SOURCES: Data for the study were drawn from the Robert Wood Johnson Foundation sponsored 1996-1997 Community Tracking Study (CTS) Household Survey and state indicators of income inequality and primary care. STUDY DESIGN: Cross-sectional, mixed-level analysis on individuals with a primary-care physician as their usual source of care. The analyses were weighted to represent the civilian noninstitutionalized population of the continental United States. DATA COLLECTION/EXTRACTION METHODS: Principal component factor analysis was used to explore the stricture of the primary-care indicators and examine their construct validity. Income inequality for the state in which the community is located was measured by the Gini coefficient, calculated using income distribution data from the 1996 current population survey. Stratified analyses compared proportion of individuals reporting had health and feeling depressed with those with good and bad primary-care experiences for each of the four income-inequality strata. A set of logistic regressions were performed to examine the relation between primary-care experience, income inequality, and self-rated health. PRINCIPAL FINDINGS: Good primary-care experience, in particular enhanced accessibility and continuity, was associated with better self-reported health both generally and mentally. Good primary-care experience was able to reduce the adverse association of income inequality with general health although not with mental health, and was especially beneficial in areas with highest income inequality. Socioeconomic status attenuated, but did not eliminate, the effect of primary-care experience on health. In conclusion, good primary-care experience is associated not only with improved self-rated overall and mental health but also with reductions in disparities between more- and less-disadvantaged communities in ratings of overall health.

Adult↗
PubMed1995

The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'.

OBJECTIVE: In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making. DATA SOURCES: Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil. STUDY SELECTION: Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects. DATA EXTRACTION AND SYNTHESIS: Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome. CONCLUSION: Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.

Consciousness↗