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PubMed1993

Early luteal phase treatment with mifepristone (RU 486) for fertility regulation.

Mifepristone (RU 486) is an antiprogestin which interacts with progesterone at the receptor level. Administration of mifepristone immediately after ovulation does not upset the menstrual cycle. However, the maturation and function of the endometrium is inhibited and uterine contractility is changed. To test if these effects are sufficient to prevent implantation, 21 women agreed to use one single treatment with 200 mg mifepristone on day luteinizing hormone (LH) + 2 monthly as their only contraceptive method. The women were treated for 1-12 months. The time of the LH peak was determined in the urine by the women themselves using a rapid LH test (Ovu-quick, Organon). The overall number of cycles studied was 169. In 12 cycles the women were unable to detect the LH peak. In these cycles no treatment was given and the women advised to use barrier methods during the time to menstruation. The remaining 157 cycles with a detectable LH peak were all ovulatory based on plasma progesterone measurement. One pregnancy occurred. On the basis of the time of the LH peak, it was retrospectively calculated that in 124 cycles at least one act of intercourse occurred during the period 3 days before to 1 day after ovulation. The probability of pregnancy in this period of the menstrual cycle is thus 0.008. The women did not complain of any treatment-related side-effects apart from slight bleeding for 2-3 days starting a few days after the day of treatment in 35% of the cycles.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

O/W emulsions compromise the stratum corneum barrier and improve drug penetration.

BACKGROUND: W/O emulsions improve the stratum corneum barrier, while microemulsions tend to compromise it. We, therefore, were interested to explore the effects of O/W emulsions on the stratum corneum barrier. METHODS: Aqueous Cream BP 2001, Clioquinol Cream BP 1999 without clioquinol, Nonionic Hydrophilic Cream DAB 2001 without glycerol, Hydrophilic Skin Emulsion Base NRF S. 25., point of time 2001, without glycerol, and Base Cream DAC were tested versus untreated controls in 29 healthy volunteers for 7 days. Outcome measures included transepidermal water loss (TEWL), skin redness (chromametry a*-value) and erythrocyte circulation in the subpapillary vessels (laser Doppler). Barrier compromise was subsequently explored by performing the hydrocortisone blanching test using Hydrocortisone Cream 0.5% NRF 11.36. (outcome measure: a*-value) in 15 subjects and the sodium lauryl sulfate (SLS) irritation test (outcome measures: TEWL, a*-value, laser Doppler) in 14 subjects. RESULTS: Pretreatment with the test emulsions produced increases in TEWL (statistically significant for all test emulsions), a*-value (statistically significant for Aqueous Cream BP 2001 and Base Cream DAC), and laser Doppler value (statistically significant for all emulsions except Base Cream DAC). Hydrocortisone penetration was statistically significantly increased with all test emulsions versus untreated contols. SLS irritation was mostly statistically significantly increased versus untreated controls when analyzing the study endpoint-baseline difference. CONCLUSIONS: O/W emulsions may compromise the stratum corneum barrier and improve drug penetration.

Adult↗
PubMed1993

Cancer screening and prevention in primary care. Obstacles for physicians.

BACKGROUND: Surveys have demonstrated that primary care physicians are aware of cancer screening and prevention guidelines. However, health primary care providers do not recommend these services for many patients. This introductory discussion describes a new area of clinical study: practice barriers. METHODS: Literature review and the author's synthesis are used to identify major types of obstacles impeding broad implementation of cancer screening and prevention. RESULTS: Practitioners and patients face three types of obstacles: provider-specific obstacles; patient-specific obstacles; and health care delivery system obstacles. Provider-specific obstacles include lack of time, distraction by other health issues, lack of expertise, lack of positive feedback, and disagreement with recommendations. Barriers that chiefly affect screening for the major cancer sites (breast, colon, and cervix) and obstacles affecting preventive counseling also are discussed. Several techniques to help providers overcome obstacles have proven successful in increasing preventive activities. CONCLUSIONS: Efforts to increase cancer screening and prevention must focus on helping providers identify and overcome barriers through acquisition of needed skills, refinement of office time management, implementation of effective reminder systems, and development of appropriate, innovative feedback and reward mechanisms.

Female↗
PubMed2004

[Experimental study on protecting intestinal barrier function of Huoxiang Zhengqi soft capsule].

OBJECTIVE: To study the effect of Huoxiang Zhengqi soft capsule on protecting intestinal barrier. METHOD: Lower limb ischemic reperfusion model was induced in Wistar rats. The Chinese medicine groups were administered orally with Huoxiang Zhengqi soft capsule before inoculation respectively. The small intestinal histopathology and ultrastructural of rats were observed with optical microscope and electronic microscope respectively. Mucus was observed under AB-PAS staining, mast cells were studied under toluidine blue staining, and serum NO was determined. RESULT: After Lower limb ischemic reperfusion, the intestinal barrier function was severely damaged. Huoxiang Zhengqi soft capsule could significantly reduce the levels of the serum NO (P < 0.01). CONCLUSION: Huoxiang Zhengqi soft capsule has apparent protective effect on the intestinal barrier function in lower limb ischemic reperfusion rats.

Animals↗
PubMedDate not supplied

Alternatives to vaginal intercourse practiced during the fertile time among calendar method users in Ireland.

A pilot study was conducted in Ireland to test the effectiveness of the calendar method of contraception. A conservative rule was used, requiring on average 16 days of abstinence per cycle. Among the 19 couples who entered into the study and were followed for up to seven cycles, there were no pregnancies. Since the length of abstinence was relatively long, we collected data to determine how couples expressed love and affection towards each other during those days when the woman was potentially fertile. We also collected data about barrier method use during the fertile time. We found that almost all couples gave each other hugs and kisses to show affection although couples were taught to abstain from vaginal intercourse during the fertile time. About one-third of the couples avoided genital contact, while about half reported using oral sex and/or frottage (body rubbing). Twice as many men reported using masturbation compared to women, although about half of the couples practiced mutual (partner) masturbation. In addition, about one-fifth of the couples used condoms during the fertile time in some cycles. These findings show that a variety of sexual expressions are used by couples when vaginal intercourse is to be avoided. Knowledge about these alternative sexual expressions may be important for couples who wish to engage in sexual activity and to avoid pregnancy.

Coitus↗
PubMed1995

Noninvasive measures of radiolabeled dextran transport in in situ rabbit lung.

UNLABELLED: Dextrans are nontoxic and can be obtained in a wide variety of molecular weights. The purpose of this study was to label 6-kDa and 40-kDa dextrans with gamma- (99mTc) and positron- (18F) emitting radioisotopes and monitor their transport across the pulmonary microvascular barrier. METHODS: External scan measurements for radiolabeled uncharged dextrans, albumin and red blood cells were obtained in eight blood-perfused in situ rabbit lung preparations. After 3 hr of external scanning, the lungs were removed for postmortem and extravascular distribution volume calculations. Extravascular distribution volumes were obtained in six additional rabbits following 4 hr of dextran perfusion to compare the effect of time. The normalized slope index (NSI), a measure of transvascular transport rate, was calculated for each diffusible tracer. RESULTS: The mean NSI for albumin (0.001676 +/- 0.000537 min-1) was significantly lower than NSI for the 40-kDa dextran (0.002303 +/- 0.0005426 min-1) as well as the 6-kDa dextran (0.004312 +/- 0.001134 min-1). The difference between the 6-kDa and the 40-kDa dextrans was also significant. After 4 hr of equilibration, distribution volumes were not significantly different than those obtained at 3 hr. CONCLUSION: Dextrans can be radiolabeled with gamma and positron emitters and small dextrans traverse the lung microvascular barrier more rapidly than albumin. Our results suggest that the use of small dextrans rather than albumin can reduce scan times in clinical applications and minimize motion artifact associated with the noninvasive gamma detection method.

Animals↗
PubMed2006

Willingness to offer chlamydia testing in general practice in New South Wales.

OBJECTIVES: To assess willingness of general practitioners (GPs) to offer chlamydia testing to patients, and to identify demographic and practice correlates associated with willingness to offer chlamydia testing. METHODS: A postal survey of practising GPs in New South Wales was undertaken in 2002 to assess management of STIs in general practice. A 15% (n = 1,020) stratified random sample, based on sex and area of practice, was selected. The overall response rate was 45.4% (n = 409). RESULTS: More than four out of five study participants reported that chlamydia testing should usually be offered to patients who had recently changed sexual partners or inconsistently used barrier methods such as condoms. While 76% of GPs would like to offer testing to young women, 65% were in favour of testing young men. Just over half (56%) felt that chlamydia testing should usually be offered to patients at the time of a Pap smear. Multivariate analyses revealed that female GPs were more likely to offer testing to young patients and to female patients at the time of a Pap smear. GPs who had postgraduate training in STls had double the odds of offering testing to young men and to female patients at the time of a Pap smear. CONCLUSIONS AND IMPLICATIONS: This paper reveals variations in GPs' willingness to offer chlamydia testing to patients. Special education programs highlighting the adverse health effects of chlamydial infection have the potential to improve GP involvement in chlamydia screening.

Adult↗
PubMed1985

Adolescent contraception: an update.

Increased adolescent sexual activity in the past decade has resulted in corresponding increases in pregnancy, childbirth, and abortion, as well as a changing spectrum of sexually transmitted diseases. Contraceptive use in this age group remains limited and is subject to developmental, peer, family, and cultural influences. The most appropriate contraceptive methods may differ among adolescents when compared with older parous women based upon such factors as efficacy, availability, cost, side effects, reversibility, and the need for preplanning. This review updates changes in patterns of contraceptive use among adolescents, presents recent data on both the benefits and the potential risks of the oral contraceptive pill, and addresses the risk of complications with the intrauterine device. The possible teratogenicity of spermicides, the risk of toxic shock syndrome with barrier methods of contraception, and controversy about the use of depot medroxyprogesterone acetate are explored. Newly introduced methods such as the triphasic pill, vaginal sponge, cervical cap, spermicidal condom, and a simplified approach to postcoital contraception are discussed. Finally, recent compliance studies conducted among adolescents are reviewed.

Adolescent↗
PubMed2005

Adhesive functions of both chains of VLA-integrins are not fully conserved across the human-porcine species barrier: implications for xenotransplantation.

BACKGROUND: A possible solution to the shortage of organs for transplantation would be the use of swine as source animals. As current immunosuppressive protocols cannot prevent rejection of these organs, super-selective immunosuppression or the induction of donor-specific central tolerance represent two promising approaches. Central tolerance induction involves bone marrow transplantation, and depends on intrathymic deletion of donor reactive host cells by donor antigen-presenting cells. In super-selective immunosuppression, the aim would be to block specific adhesive interactions on one species side only, leaving the other species side unaffected. As both processes depend on the interaction of adhesion molecules with their ligands, we investigated whether the beta1-integrins, which play roles in hematopoiesis as well as in rejection, can successfully interact across the swine-to-human species barrier. METHODS: We employed static cell-to-extracellular protein and cell-to-cell adhesion assays, using different cell types and monoclonal antibody as well as peptide-fragments to analyze conservation of cross-species adhesive interactions. RESULTS: We found that porcine and human cells interact differently with their cross-species ligands than their own and that the adhesive function of the beta1-chain does not seem to be fully conserved across the species barrier. CONCLUSIONS: Integrin functions are not fully conserved across the pig-to-human species barrier. While the development of multi-transgenic pigs, whose integrins interact with human ligands in a more ''human-like'' manner may be necessary to facilitate tolerance induction, these facts give rise to new possibilities concerning super-selective immunosuppression.

Animals↗
PubMed1989

Effects of smoking and oral contraception on plasma beta-carotene levels in healthy women.

Oral contraceptive use and smoking have been known to affect plasma vitamin levels. Total carotenoids have been studied with spectrophotometry, a relatively insensitive technique. In this study plasma concentrations of beta-carotene and retinol were measured in coded samples by sensitive high-pressure liquid chromatography in a cross-sectional study of 149 normal healthy women attending a family planning clinic. At the time of recruitment in the morning, a general health questionnaire was administered for patient age, methods of contraception, smoking habits, and food intake at breakfast. Of the 149 enrolled volunteers, 88 were oral contraceptive users and 61 were not users. Among users, 21 smoked cigarettes, and there were 18 smokers among nonusers. Oral contraceptive users had significantly lower plasma concentrations of beta-carotene (p less than 0.001) and higher retinol levels (p less than 0.0001). Plasma beta-carotene or retinol levels did not differ among users of intrauterine contraceptive devices or barrier methods of contraception. No association was noted between the plasma levels of these two micronutrients and age greater than or less than 30 years. Cigarette smoking alone was associated with significantly reduced plasma beta-carotene levels in nonusers (p less than 0.001). Combined cigarette smoking and oral contraceptive usage were associated with low plasma beta-carotene levels; the results appear to be additive. These findings suggest a possible synergistic effect on plasma beta-carotene levels from the use of both cigarette smoking and oral contraception.

Adolescent↗
PubMed2003

Stress-induced disruption of colonic epithelial barrier: role of interferon-gamma and myosin light chain kinase in mice.

BACKGROUND & AIMS: Stressful life events are supposed to be involved in various diseases such as inflammatory bowel diseases and irritable bowel syndrome. Impairment of the intestinal epithelial barrier function is a suspected consequence of stress, but the underlying mechanisms remain unclear. This study aimed to determine the mechanisms through which stress modulates the colonic epithelial barrier. METHODS: Cytokine messenger RNA (mRNA) expression was evaluated in murine colon, liver, and spleen by competitive reverse-transcription polymerase chain reaction after 1-4 days of daily 2-hour stress sessions. Colonic paracellular permeability was measured as the in vivo lumen-to-blood ratio of (51)Cr-ethylenediaminetetraacetic acid. The effect of a myosin light chain (MLC) kinase inhibitor (ML-7) was assessed on stress-induced interferon (IFN)-gamma mRNA expression and colonic epithelial barrier impairment, and MLC phosphorylation was determined by immunoblot. Finally, the incidence of repeated stress sessions on bacterial translocation was determined. RESULTS: Repeated stress induced an overexpression of colonic IFN-gamma. In the liver, higher levels of IFN-gamma, interleukin (IL)-4, and IL-10 mRNAs were detected and were associated with bacterial translocation, inflammation, and apoptosis. Stress increased colonic permeability of control mice, but not of SCID and IFN-gamma-deficient mice. ML-7 inhibited the stress-induced increased permeability, bacterial translocation, and cytokine overexpression in the liver and restored a normal histology. Larger amounts of phosphorylated MLC were detected in stressed animals. CONCLUSIONS: Repeated stress sessions drive organ-specific cytokine expression patterns and alter colonic mucosal barrier functions associated with bacterial translocation. This effect depends on the presence of CD4(+) T cells and requires IFN-gamma production and MLC phosphorylation.

3T3 Cells↗
PubMed2005

[MRI evidence of exogenous vascular endothelial growth factor-enhanced transport across inner ear barriers in guinea pigs].

OBJECTIVE: Increased vascular endothelial growth factor (VEGF) and VEGF receptor expression is the important biological response under shear stress, ischemia and hypoxia conditions. Mechanical vibration induced cochlea shear stress and trauma obviously upregulate VEGF and VEGF receptor 2 (VEGFR2) expression in the cochlea. To evaluate the possibility of VEGF varying the transport in blood-labyrinth barrier and blood-perilymphatic barrier. METHODS: Eleven guinea pigs, male and female, weighing from 300 g to 900 g were kept under general anaesthesia with xylazine (16 mg/kg) and ketamine (60 mg/kg) for both drug delivery and MRI measurement. VEGF (6 ears) and phosphate-buffered saline (PBS, 5 ears) were delivered to the inner ear via the round window membrane (soaked in gelfoam). The T1 contrast agent gadodiamide (Gd-DTPA-BMA) chelated bound paramagnetic gadolinium was used as the inner ear barrier transportation tracer. A Bruker Biospec Avance 47/40 experimental MRI system with a magnetic field strength of 4. 7 Tesla and a 40 cm bore was used for the 2-dimensional cochlea MRI evaluation. The Paravision software was used for image intensity measurement and the Adobe Photoshop 6.0 software was used for image presentation. RESULTS: VEGF induced significant Gd uptake in the scala tympani and scala vestibuli, but had little effect on the uptake of Gd in the scala media. CONCLUSIONS: VEGF significantly increased the transportation of blood-perilymphatic barrier and adapted the inner ear for compensation and repair.

Animals↗
PubMed2003

Tumor necrosis factor-alpha and interferon-gamma directly impair epithelial barrier function in cultured mouse cholangiocytes.

BACKGROUND/AIMS: In primary biliary cirrhosis (PBC), cytokines from CD4+ T lymphocytes were suggested to contribute to the intralobular bile duct damage together with cellular immunity by CD8+ T lymphocytes. Recently, we reported that immunolocalization of 7H6--a tight junction (TJ)-associated protein--was significantly diminished in cholangiocytes in the PBC liver. In this study, we examined the direct effects of several cytokines--tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-2 and 4 (IL-2 and 4)--on TJ in immortalized mouse cholangiocytes. Moreover, we examined the inhibitory effect of ursodeoxycholic acid (UDCA) on cytokine-induced changes in paracellular permeability. METHODS: Barrier function of TJ was evaluated by measuring transepithelial electrical resistance (TER) and 3H-inulin flux. We also performed immunostaining and immunoblotting for TJ-associated proteins--claudin-1 and -3, occludin, zonula occluden-1 (ZO-1) and 7H6. RESULTS: TNF-alpha and IFN-gamma, but neither IL-2 nor IL-4, significantly decreased TER (P < 0.005). 3H-inulin flux studies confirmed IFN-alpha-induced increases in paracellular permeability of cholangiocytes (P < 0.001). In immunostaining and immunoblotting studies, TJ-associated proteins were well preserved in TNF-alpha- or IFN-gamma-treated cells. Ursodeoxycholic acid has been found to have no inhibitory effect on increased paracellular permeability induced by TNF-alpha or IFN-gamma. CONCLUSION: These findings show that TNF-alpha and IFN-gamma disrupt barrier function of TJ in cholangiocytes without major structural changes to TJ and suggest that disruption of TJ function and subsequent leakage of the bile constituents may influence the aggravation of cholestasis in PBC.

Animals↗
PubMed2004

Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates.

OBJECTIVES: To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation. DESIGN: Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods. RESULTS: There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS. CONCLUSIONS: The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.

Adult↗
PubMed2006

Autogenous bone graft with or without a calcium sulfate barrier in the treatment of Class II furcation defects: a histologic and histometric study in dogs.

BACKGROUND: The purpose of this study was to histologically evaluate the healing of surgically created Class II furcation defects treated using an autogenous bone (AB) graft with or without a calcium sulfate (CS) barrier. METHODS: The second, third, and fourth mandibular premolars (P2, P3, and P4) of six mongrel dogs were used in this study. Class II furcation defects (5 mm in height x 2 mm in depth) were surgically created and immediately treated. Teeth were randomly divided into three groups: group C (control), in which the defect was filled with blood clot; group AB, in which the defect was filled with AB graft; and group AB/CS, in which the defect was filled with AB graft and covered by a CS barrier. Flaps were repositioned to cover all defects. The animals were euthanized 90 days post-surgery. Mesio-distal serial sections were obtained and stained with either hematoxylin and eosin or Masson's trichrome. Histometric, using image-analysis software, and histologic analyses were performed. Linear and area measurements of periodontal healing were evaluated and calculated as a percentage of the original defect. Percentage data were transformed into arccosine for statistical analysis (analysis of variance; P <0.05). RESULTS: Periodontal regeneration in the three groups was similar. Regeneration of bone and connective tissue in the furcation defects was incomplete in most of the specimens. Statistically significant differences were not found in any of the evaluated parameters among the groups. CONCLUSION: Periodontal healing was similar using surgical debridement alone, AB graft, or AB graft with a CS barrier in the treatment of Class II furcation defects.

Animals↗
PubMedDate not supplied

The immunization status and level of knowledge about hepatitis B virus infection among Nigerian surgeons.

Hepatitis B virus (HBV) infection is an occupational risk of surgeons especially in developing countries where asymptomatic carrier rate is about 15%. Despite better knowledge about mode of transmission and methods of prevention including use of active immunization, it still remains a threat. In this study, a questionnaire survey of Nigerian surgeons was conducted to ascertain their knowledge, and immunization status against HBV infection. Our study showed a 9.3% incidence of clinical HBV infection, poor perception of risk of infection, poor local availability of vaccines, and low uptake where same was available. Reasons cited for non-immunization are lack of awareness, cost, inertia and non-availability of vaccines. Only 10.2% of our respondents always used barrier methods, and 77.7% of our respondents do not check the immune status of their patients after sustaining an intraoperative sharp injury. The overall level of knowledge about HBV infection was deemed poor. We conclude with recommendations on how to improve knowledge about HBV infection and uptake of vaccines.

Adult↗
PubMed1997

Local spread of metastatic vertebral tumors. A histologic study.

STUDY DESIGN: Nineteen solitary metastatic vertebral tumors obtained by total en bloc spondylectomy were analyzed histologically. OBJECTIVES: To determine the mechanisms of local spread of vertebral tumors and identity barrier tissues to tumor progression in the vertebra. SUMMARY OF BACKGROUND DATA: Histologic studies of specimens resected at amputation or en bloc excision have determined the pattern of local spread of bone and soft tissue tumors in the extremities and identified barrier tissues to tumor spread. However, a similar assessment of vertebral malignancies is difficult. The development of total en bloc spondylectomy for primary vertebral malignancy and solitary has allowed the collection of tissue samples sufficient to analyze the pattern of local spread of tumors, using the concept of compartment and barrier. METHODS: Histologic sections of all vertebral elements were prepared from specimens collected after en bloc spondylectomy. Serial 5-mm sections in the sagittal plane were also prepared and examined. RESULTS: Analysis of tumor location showed that metastatic tumors reached the vertebral column by invading the bone marrow of the dorsal region of the vertebral body. The anterior longitudinal ligament, posterior longitudinal ligament, periosteum abutting the spinal canal, ligamentum flavum, periosteum of the lamina and spinous process, interspinous ligament, supraspinous ligament, cartilaginous endplate and the anulus fibrosus served as barriers to tumor progression. The posterior longitudinal ligament was the weakest barrier tissue and was gradually destroyed by the tumor at the point of perforating vessels. Even after destruction of the barrier tissue, tumor cells were covered with a thin, fibrous reactive membrane. Two pathways allowed tumor spread to the adjacent vertebrae: 1) from the edge of the vertebral body to the adjacent vertebral body beneath the longitudinal ligament, and 2) through the paravertebral muscles to the neighboring lamina. CONCLUSIONS: Each vertebra can be represented by a compartment surrounded by several barriers. The most common path for tumor spread is through the posterior longitudinal ligament to the epidural space.

Aged↗
PubMed2005

Are language barriers associated with serious medical events in hospitalized pediatric patients?

OBJECTIVE: Language barriers may lead to medical errors by impeding patient-provider communication. The objective of this study was to determine whether hospitalized pediatric patients whose families have language barriers are more likely to incur serious medical errors than patients whose families do not have language barriers. METHODS: A case-control study was conducted in a large, academic, regional children's hospital in the Pacific Northwest. Case patients (n = 97) included all hospitalizations of patients who were younger than 21 years and had a reported serious medical event from January 1, 1998, to December 31, 2003. Control patients (n = 475) were chosen from hospitalizations without a reported serious medical event and were matched with case patients on age, admitting service, admission to intensive care, and date of admission. The main exposure was a language barrier defined by self- or provider-reported need for an interpreter. Serious medical events were defined as events that led to unintended or potentially adverse outcomes identified by the hospital's quality improvement staff. RESULTS: Fourteen (14.4%) of the case patients and 53 (11.2%) of the control patients were assigned an interpreter during their hospitalization. Overall, we found no increased risk for serious medical events in patients and families who requested an interpreter compared with patients and families who did not request an interpreter (odds ratio: 1.36; 95% confidence interval: 0.73-2.55). Spanish-speaking patients who requested an interpreter comprised 11 (11.3%) of the case patients and 26 (5.5%) of the control patients. This subgroup had a twofold increased risk for serious medical events compared with patients who did not request an interpreter (odds ratio: 2.26; 95% confidence interval: 1.06-4.81). CONCLUSIONS: Spanish-speaking patients whose families have a language barrier seem to have a significantly increased risk for serious medical events during pediatric hospitalization compared with patients whose families do not have a language barrier.

Adolescent↗