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PubMed2005

The qualifications of pain physicians in Ohio.

Pain physicians in Ohio come from many medical backgrounds and use different medical boards to claim board certification in the field of pain medicine. Our goal was to explore the number, demographics, and qualifications of pain physicians in Ohio. The names of Ohio physicians designating themselves as pain physicians were collected from the State Medical Board of Ohio and the American Medical Association. The directories of the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine, the American Academy of Pain Management, and the American Board of Medical Acupuncture were referenced for certification in pain medicine, pain management, or medical acupuncture. The requirements for these credentials vary widely, yet they have all been used to claim "board certification." Board certification in medicine implies recognition by an ABMS member board as having completed the required training, met the standards, and then passed an examination that validates qualifications, and knowledge in a specific medical field. In 2002, there were 335 Ohio physicians designating themselves as pain physicians. Two-hundred-eighteen (65%) had at least one pain board certification. Ninety-six (29%) of the Ohio pain physicians were certified in pain medicine by the American Board of Anesthesiology, the American Board of Physical Medicine and Rehabilitation, or the American Board of Psychiatry and Neurology, which are all member boards of the ABMS. One-hundred-seventeen (35%) of the self-declared Ohio pain physicians held no pain-related board certification. Anesthesiologists comprise the majority of all pain physicians and are the majority in all four pain boards.

Certification↗
PubMed1990

OHIO-1 beta-lactamase is part of the SHV-1 family.

The OHIO-1 beta-lactamase gene was subcloned in a 1.16-kilobase TaqI fragment in the 2.4-kilobase chimeric plasmid pSK04. After directional subcloning into M13, the DNA sequence of this fragment was determined. The results showed an open reading frame of 858 base pairs (bp) encoding a protein of 286 amino acids. The structural gene showed 95, 87, and 60% DNA sequence identity with SHV-1, LEN-1, and TEM-1, respectively, and 93, 85, and 62% predicted amino acid sequence identity, respectively. The 87 bp upstream of the OHIO-1 structural gene had 96% identity with the upstream flanking sequence of SHV-1, including the -35 and -10 consensus sequences and the putative ribosomal binding site. A 223-bp DNA probe derived from a PstI-HaeII fragment in the C-terminal sequence of OHIO-1 had predicted 96, 88, and 61% sequence identity with SHV-1, LEN-1, and TEM-1, respectively. This probe hybridized to SHV-1 and poorly to LEN-1, but not to TEM-1 or a variety of other plasmid-mediated beta-lactamase genes, under stringent conditions. Screening of plasmid DNA derived from 40 ampicillin-resistant clinical isolates by Southern hybridization with the 223-bp probe uncovered no strains encoding OHIO-1. Isoelectric focusing of the same collection did identify two strains producing enzymes resembling SHV-1, however. We have also performed a kinetic comparison of OHIO-1, SHV-1, and TEM-1. OHIO-1 and SHV-1 were indistinguishable from each other but could be distinguished from TEM-1. These data clearly place OHIO-1 within the SHV-1 family of beta-lactamases.

Amino Acid Sequence↗
PubMed1984

Interview: John C. Cuddy on the Ohio health care system.

Prior to his appointment as Director of the Ohio Department of Public Welfare, John C. Cuddy served as deputy secretary of the Pennsylvania Department of Public Welfare, as associate director of the National Regulatory Research Institute at Ohio State University, and as assistant director of the Utilities Division of the Public Utilities Commission of Ohio. As a consultant to welfare agencies in New York and Chicago, he assisted with the development of social welfare statistical reporting systems. He holds a bachelor's degree in economics from Ohio State University and a master's degree in Business Administration from Columbia University. In this interview, Mr. Cuddy discusses the present state of the health care system in Ohio, the reasons for the tremendous increase in health care costs, and the Department of Welfare's plans to attempt to make the Ohio system more cost-efficient.

Medicaid↗
PubMedDate not supplied

Statewide survey of risk factor prevalence: the Ohio experience.

In 1982, a statewide survey was conducted to determine the prevalence of health risk factors among Ohio's population. The survey was mandated by a health education-risk reduction grant to the Ohio Department of Health. The background, development, and validation of the survey instrument are described. The four goals of "Health Ohio"--the collection of descriptive statistics on selected risk factors for adult Ohioans, the compilation of baseline data, the development of a standard methodology for a prevalence survey, and the reporting of these findings for potential users of the data--were achieved. The population sample consisted of 607 Ohioans aged 18 and older who were polled by telephone. Subjects were selected through a modified random digit dialing technique. As a result of this technique and the designation of a specific household respondent, demographic characteristics of the sample matched those of the State's population in the 1980 census. Among the implications of the survey findings were the needs to (a) remove economic barriers that apparently impede the installation of residential smoke detectors, (b) initiate health education at an earlier age to counter cigarette smoking trends, and (c) encourage adult self-determination in reducing health risk. The February 1982 "Health Ohio" data describing the need for intervention to reduce health risk factors have become the basis for health education-risk reduction efforts of the Ohio Department of Health. In addition, "Health Ohio" has spawned two local prevalence surveys in the State; these resulted in more precise local data on the prevalence of health risk factors. Other multiplier effects of health education-risk reduction projects should be documented for future reference.

Adolescent↗
PubMed2002

Modeling possible cooling-water intake system impacts on Ohio River fish populations.

To assess the possible impacts caused by cooling-water intake system entrainment and impingement losses, populations of six target fish species near power plants on the Ohio River were modeled. A Leslie matrix model was constructed to allow an evaluation of bluegill, freshwater drum, emerald shiner, gizzard shad, sauger, and white bass populations within five river pools. Site-specific information on fish abundance and length-frequency distribution was obtained from long-term Ohio River Ecological Research Program and Ohio River Sanitation Commission (ORSANCO) electrofishing monitoring programs. Entrainment and impingement data were obtained from 316(b) demonstrations previously completed at eight Ohio River power plants. The model was first run under a scenario representative of current conditions, which included fish losses due to entrainment and impingement. The model was then rerun with these losses added back into the populations, representative of what would happen if all entrainment and impingement losses were eliminated. The model was run to represent a 50-year time period, which is a typical life span for an Ohio River coal-fired power plant. Percent changes between populations modeled with and without entrainment and impingement losses in each pool were compared to the mean interannual coefficient of variation (CV), a measure of normal fish population variability. In 6 of the 22 scenarios of fish species and river pools that were evaluated (6 species x 5 river pools, minus 8 species/river pool combinations that could not be evaluated due to insufficient fish data), the projected fish population change was greater than the expected variability of the existing fish population, indicating a possible adverse environmental impact. Given the number of other variables affecting fish populations and the conservative modeling approach, which assumed 100% mortality for all entrained fish and eggs, it was concluded that the likelihood of impact was by no means assured, even in these six cases. It was concluded that in most cases, current entrainment and impingement losses at six Ohio River power plants have little or no effect at the population level.

Animals↗
PubMed2005

The Professor of Public Psychiatry Model in Ohio: the impact on training, program innovation, and the quality of mental health care.

The Ohio Department of Mental Health and five of Ohio's University-based Departments of Psychiatry have developed strong working partnerships that have improved the quality of psychiatric residency education and Ohio's mental health services. Strategies integral to Ohio's Public Psychiatry Model include identifying a strong champion, integrating expert consultation, and developing consensus expectations using a small amount of catalytic funding. Successful outcomes include the establishment of public psychiatry leadership roles in Ohio's community and academic settings; positive community-focused residency training experiences; revised curricula; and spin-off opportunities, such as "Coordinating Centers of Excellence" to accelerate adoption of evidence-based practices in community settings.

Community Mental Health Services↗
PubMed1996

An Ohio telemedicine system for prison inmates: a case report.

BACKGROUND: A project was established by The Ohio State University Medical Center (OSUMC) and the Ohio Department of Rehabilitation and Corrections (ODRC) to investigate the use of telemedicine in providing health care to Ohio's prison inmates. OBJECTIVES: To determine the effects of telemedicine on continuity of inmate care, the sense of isolation experienced by health care providers at remote institutions, the security risks incurred when transporting inmates to outside facilities, and the overall cost of care. In tracing the initial adoption and implementation of the project, the authors describe health care in Ohio's prisons and the unique nature of providing that care. METHODS: The project was conducted over a 1-year period, from November 1994 through December 1995, using a variety of methods: direct observation of inmate consultations; participation in task force meetings; unstructured interviews with physicians, prison administrators, ancillary health care personnel, and security guards; and initial collection of survey data. RESULTS: Telemedicine enables Ohio's inmates to receive health care in a more timely fashion than before. Physicians and inmates were generally satisfied, and the costs of providing inmate medical care were reduced by lessening or eliminating the need for additional security guards, vans, chase vehicles, and travel time for physicians. CONCLUSIONS: Some initial hurdles in using the system, such as scheduling and triage, are being overcome as new methods are devised, and additional incentives for specialty physicians to use the system are being investigated. The OSUMC/ODRC project suggests that the advantages of using telemedicine in prison settings are immense, and the ODRC plans to expand the network to include two more remote sites early in 1996.

Delivery of Health Care↗
PubMedDate not supplied

Breastfeeding care in Ohio hospitals: a gap between research and practice.

OBJECTIVE: To assess current breastfeeding care in Ohio hospitals and compare that care to research-based principles. DESIGN: Survey. SETTING: Ohio hospitals that provide maternity care. PARTICIPANTS: All 141 Ohio hospitals that provide maternity care were invited to participate. One-hundred sixteen (83%) hospitals returned usable surveys completed by obstetric nurse managers. MAIN OUTCOME MEASURE: A 38-item questionnaire provided data on hospital demographics and information regarding the care of breastfeeding mother-infant dyads. RESULTS: Research-based practices common in Ohio's hospitals include demand feeding, breastfeeding education, and breastfeeding as the initial neonatal feeding. Common non-research-based practices include supplemental fluid administration, postpartum nipple treatments, mandatory initial nursery stays, limited sucking time, restricted maternal-infant contact, distribution of formula packs, minimal follow-up care, and the suspension of breastfeeding for hyperbilirubinemia. CONCLUSIONS: Despite positive changes in perinatal care, a number of non-research-based practices persist in Ohio hospitals for the care of the breastfeeding mother-infant dyad.

Aftercare↗
PubMed2005

Predictive spatial dynamics and strategic planning for raccoon rabies emergence in Ohio.

Rabies is an important public health concern in North America because of recent epidemics of a rabies virus variant associated with raccoons. The costs associated with surveillance, diagnostic testing, and post-exposure treatment of humans exposed to rabies have fostered coordinated efforts to control rabies spread by distributing an oral rabies vaccine to wild raccoons. Authorities have tried to contain westward expansion of the epidemic front of raccoon-associated rabies via a vaccine corridor established in counties of eastern Ohio, western Pennsylvania, and West Virginia. Although sporadic cases of rabies have been identified in Ohio since oral rabies vaccine distribution in 1998, the first evidence of a significant breach in this vaccine corridor was not detected until 2004 in Lake County, Ohio. Herein, we forecast the spatial spread of rabies in Ohio from this breach using a stochastic spatial model that was first developed for exploratory data analysis in Connecticut and next used to successfully hind-cast wave-front dynamics of rabies spread across New York. The projections, based on expansion from the Lake County breach, are strongly affected by the spread of rabies by rare, but unpredictable long-distance translocation of rabid raccoons; rabies may traverse central Ohio at a rate 2.5-fold greater than previously analyzed wildlife epidemics. Using prior estimates of the impact of local heterogeneities on wave-front propagation and of the time lag between surveillance-based detection of an initial rabies case to full-blown epidemic, specific regions within the state are identified for vaccine delivery and expanded surveillance effort.

Animals↗
PubMed1991

[Comparison between Kanagawa Prefecture and Ohio state of factors related to health behavior among older adults].

Factors related to health behavior of older adults in Japan and the United States were compared. A total of 900 persons from three age groups (45 to 59, 60 to 74 and 75 and over) were interviewed in three communities (major metropolitan, midsized city, and small town), in both Kanagawa Prefecture and Ohio State. To determine the reliability of the results, in addition to analysis for all subjects, each of communities were analyzed separately. Health behaviors were divided into 2 separate levels: 1) preventive health behaviors and 2) coping behaviors for symptoms which may be signs of a serious illness. The latter behaviors were classified into three types: 1) seeing a physician, 2) changing lifestyle and 3) taking OTC drugs. The following results were obtained: 1) In both Kanagawa Prefecture and Ohio State, good preventive health behaviors were unrelated to coping behaviors associated with potentially serious illness. Interviewees who used OTC drugs when experiencing a potentially serious illness had a low tendency toward seeing a physician. In Kanagawa Prefecture, individuals who saw a physician showed a strong tendency toward changing their lifestyle, for symptoms which were potential signs of a serious illness. 2) There were some differences in factors related to preventive health behaviors between Kanagawa Prefecture and Ohio State. In Kanagawa Prefecture, there were sex differences, with males exhibiting preventive health behaviors. In Ohio State, good preventive health behaviors were few among interviewees who were black. 3) There was little difference between Kanagawa and Ohio State as far as the tendency toward seeing a physician when experiencing potentially serious illness. In both places, interviewees with good self-rated health status and having strong self-treatment attitudes showed a lower tendency to see a physician when experiencing symptoms which were potential signs of a serious illness.

Age Factors↗
PubMed1989

Human immunodeficiency virus seropositivity in intravenous drug users in Ohio.

A seroprevalence survey of 508 intravenous (IV) drug users enrolled in methadone treatment programs in Ohio for evidence of infection with the human immunodeficiency virus (HIV) demonstrated a positivity prevalence of 1.4%. This seropositivity prevalence is low compared with 10% to 72% positive from surveys conducted in the IV drug-using populations of New York, New Jersey, Detroit and San Francisco. Although needle sharing was common (71% since 1983), the number of sharing partners was usually limited and regular. A potential for cross-infection from urban centers with higher seropositivity prevalence was indicated by patterns of travel and needle sharing while traveling to higher risk metropolitan centers such as New York. Hispanics appeared to be at greater risk for HIV infection (OR 17.7, 95% CI 2.4-133.0), as were male IV drug users with gay/bisexual lifestyles (OR 14.1, 95% CI 1.3-153.0). HIV positive individuals were identified in Cleveland (1.6%), Dayton (3.1%), and Columbus (0.8%), but not in the four other Ohio metropolitan areas participating in the survey. Study participants indicated that knowledge of AIDS had changed their IV drug-using habits with 60% reporting that fear of AIDS had caused them to give up IV drugs or needle sharing. Sampling from methadone clinics may underestimate the HIV seropositivity in Ohio's IV drug-using community; however, it appears that relatively few IV drug users in Ohio are currently infected with HIV. The low prevalence of HIV infection in the Ohio IV drug-using community provides the opportunity to intervene in limiting the spread of the virus by educating individuals to reduce or eliminate risk factors for the transmission of the disease.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Surgical practice and perceived training needs of selected Ohio family physicians.

This study was performed to determine, relative to Ohio, what percentage of family physicians are actively involved in providing surgical care, what types of surgical care are provided, and what variations exist in opinions and practices regarding surgery related to previous training and practice location. Data were collected from active members of the Ohio Academy of Family Physicians; usable returns were secured from 76 percent of the members. Several conclusions were made. Overwhelming percentages of family physicians in Ohio are actively involved in providing surgical care. A considerably greater percentage of family physicians are actively involved in performing minor surgery compared with major surgery, although they perform a wide range of minor and major surgical procedures at relatively high frequencies. Over the years, however, there has been a decrease in performance of major surgery on the part of family physicians in Ohio. Issues related to surgery in family practice are more positively influenced by being in a rural practice rather than an urban or suburban practice, having had more surgical training, and having had family practice residency training. Family physicians in Ohio definitely think that surgical training should be included in family practice training programs, and they think that the surgical training should be balanced between a curriculum standardized for all residents and one individualized to the anticipated future practices of the residents.

Attitude of Health Personnel↗
PubMedDate not supplied

An analysis of dental hygienist remuneration. Part III. From the results of the Ohio Dentist and Dental Hygiene Surveys.

The Division of Dental Hygiene of Ohio State University, working under a grant from the Ohio Dental Association, completed research defining the practice of dental hygiene in Ohio utilizing data gathered in the summer of 1991. This portion of the research focuses on the salaries and benefits earned by practicing Ohio dental hygienists. It also presents the salary and benefit levels which Ohio dentists believe to be reasonable for dental hygienist employees. The largest number of dental hygienists work 27 hours per week and are paid a straight salary averaging $15.86 per hour. The largest number of dentists believe that experienced, full-time dental hygienists should receive higher salaries and more benefits than part-time hygienists. They feel that $16-$21 per hour is a reasonable salary, and they most often provide reduced dental fees as a benefit.

Data Collection↗
PubMed1989

Biochemical, immunological and physicochemical comparisons between OHIO-1 and four SHV-type beta-lactamases.

The biochemical, immunological and physicochemical properties of the beta-lactamase OHIO-1 were compared to those of four beta-lactamases commonly found in Klebsiella pneumoniae: SHV-1, SHV-3 and the beta-lactamases of strains GN 11-03 and GN 422. The substrate profile of SHV-1, OHIO-1 and of the beta-lactamases GN 11-03 and GN 422 were similar, while that of SHV-3 appeared comparable to that of the extended spectrum SHV-2. Moreover, anti-TEM-1 serum inactivated OHIO-1 as well as SHV-1 and the beta-lactamases of strains GN 11-03 and GN 422. Analysis of the electrophoretic mobilities, isoelectric points and titration curves demonstrated that OHIO-1 and the 4 other beta-lactamases examined were closely related variants. From these findings it appears that OHIO-1 could be classified among the SHV-type beta-lactamases.

Electrophoresis↗
PubMed1999

OHIO-1 beta-lactamase mutants: the Arg244Ser mutant and resistance to beta-lactams and beta-lactamase inhibitors.

Mutations at residue 244 (Ambler numbering system) in the class A TEM beta-lactamase confer resistance to inactivation by beta-lactamase inhibitors and result in diminished turnover of beta-lactam substrates. The Arg244Ser mutant of the OHIO-1 beta-lactamase, an SHV family enzyme, demonstrates variable susceptibilities to beta-lactamase inhibitors and has significantly reduced catalytic efficiency. The minimum inhibitory concentrations (MICs) for Escherichia coli DH5alpha expressing the Arg244Ser beta-lactamase were reduced when compared to the strain bearing the OHIO-1 beta-lactamase: ampicillin, 512 vs. 8192 micrograms ml-1; cephaloridine, 4 vs. 32 micrograms ml-1, respectively. The MICs for the beta-lactam beta-lactamase inhibitor combinations demonstrated resistance only to ampicillin-clavulanate, 16/8 vs. 8/4 micrograms ml-1 respectively. In contrast, there was increased susceptibility to ampicillin-sulbactam, ampicillin-tazobactam, and piperacillin-tazobactam. When compared to the OHIO-1 beta-lactamase homogenous preparations of the Arg244Ser beta-lactamase enzyme demonstrated increased Km and decreased kcat values for benzylpenicillin (Km=17 vs. 50 microM, kcat=345 vs. 234 s-1) and cephaloridine (Km=97 vs. 202 microM, kcat=1023 vs. 202 s-1). Although the Ki and IC50 values were increased for each inhibitor when compared to OHIO-1 beta-lactamase, the turnover numbers (tn) required for inactivation were increased only for clavulanate. For the Arg244Ser mutant enzyme of OHIO-1, the increased Ki, decreased tn for the sulfones, and different partition ratio (kcat/kinact) support the notion that not all class A enzymes are inactivated in the same manner, and that certain class A beta-lactamase enzymes may react differently with identical substitutions in structurally conserved amino acids. The resistance phenotype of a specific mutations can vary depending on the enzyme.

Drug Resistance↗
PubMed1998

Kinetic analysis of an inhibitor-resistant variant of the OHIO-1 beta-lactamase, an SHV-family class A enzyme.

The Met69-->Ile mutant of the OHIO-1 beta-lactamase, an SHV-family enzyme, is resistant to inactivation by beta-lactamase inhibitors. Analysis of purified Met69-->Ile enzyme reveals that its isoelectric point (pI 7.0) and CD spectrum are identical with those of the OHIO-1 enzyme. Levels of beta-lactamase expression in Escherichia coli as determined by immunoblotting are similar for OHIO-1 and Met69-->Ile beta-lactamase. The kinetic constants of the Met69-->Ile enzyme compared with OHIO-1 are smaller for benzylpenicillin (Km = 6 microM compared with 17 microM; kcat = 234 s-1 compared with 345 s-1 respectively) and carbenicillin (Km = 3 microM compared with 17 microM; kcat = 131 s-1 compared with 320 s-1 respectively). For the cephalosporins cephaloridine and 7-(thienyl- 2-acetamido)-3-[2-(4-N,N- dimethylaminophenylazo)pyridinium-methyl]-3-cephem-4-carboxylic acid (PADAC), a similar pattern is also seen (Km=38 microM compared with 96 microM and 6 microM compared with 75 microM respectively; kcat = 235 s-1 compared with 1023 s-1 and 9 s-1 compared with 50 s-1 respectively). Consistent with minimum inhibitory concentrations that show resistance to beta-lactam beta-lactamase inhibitors, the apparent Ki values, turnover numbers and partition ratios (kcat/kinact) for the mechanism-based inactivators clavulanate, sulbactam and tazobactam are increased. The inactivation rate constants (kinact) are decreased. The difference in activation energy, a measurement of altered affinity for the wild-type and mutant enzymes leading to acylation of the active site, reveals small energy differences of less than 8.4 kJ/mol. In total, these results suggest that the Met-->Ile substitution at position 69 in the OHIO-1 beta-lactamase alters the active site, primarily affecting the interactions with beta-lactamase inhibitors.

Anti-Bacterial Agents↗
PubMed1998

[Investigation of a water-borne Salmonella ohio outbreak].

BACKGROUND: The genus Salmonella is one of the main causes of foodborne and waterborne illness worldwide. It is a major public health concern almost entirely due to S. enteritidis. However, outbreaks caused by Salmonella ohio are rare. We have not found any reference about salmonellosis by S. ohio whose origin was water of a drinking fountain. METHODS: An epidemiological survey was carried out to investigate the origin of the outbreak, and information was sought on personal details, symptoms, contact with others who had ill as well as a history of eating. Fecal specimens and water samples were cultured for bacterial pathogens including Salmonella. Salmonella isolates obtained were characterized by stereotyping. RESULTS: A total of 101 persons were exposed. 87 of these were interviewed, but only 59 of these were affected (attack rate: 67.8%), including 56 children and 3 adults. Syndrome was not severe, in general, persisting for a period of 2 days, in average. S. ohio was isolated from the water and from 2 of the 13 stool specimens analysed. CONCLUSIONS: The outbreak was caused by consumption of water from a drinking fountain which was contaminated by S. ohio. This fountain had not a chlorination system. An outbreak due to S. ohio whose origin is the consumption of water from a drinking fountain is described for the first time in this paper. It can be concluded the importance of keeping a good epidemiological control system to investigate and prevent outbreaks. The control of drinking fountains is also important, to prevent its contamination.

Adult↗
PubMed2003

Predictors of warfarin use among Ohio medicaid patients with new-onset nonvalvular atrial fibrillation.

BACKGROUND: Despite demonstrated efficacy in stroke prevention, warfarin is underused in patients with atrial fibrillation (AF). Reasons for warfarin nonuse are unclear. METHODS: We conducted a retrospective cohort analysis using Ohio Medicaid administrative billing data to ascertain determinants of warfarin use for patients with new-onset nonvalvular AF. The database included data from all institutions, providers, and pharmacies providing services to Ohio Medicaid enrollees. Subjects included all 11699 continuously enrolled fee-for-service recipients of Ohio Medicaid with a new diagnosis of nonvalvular AF between January 1, 1998, and December 31, 2000. We determined incipient warfarin use and presence of risk factors for stroke and hemorrhage by searching claims records for corresponding International Classification of Diseases, Ninth Revision, Clinical Modification codes and National Drug Codes. Univariate and multivariable analyses were performed to examine the association of risk factors with warfarin use. RESULTS: Only 9.7% of all patients and 11.9% of those without apparent contraindications filled prescriptions for warfarin from 7 days preceding to 30 days after the development of AF. Hypertension and congestive heart failure independently predicted increased warfarin use. Older age (>or=85 years), younger age (<55 years), prior intracranial hemorrhage, prior gastrointestinal hemorrhage, predisposition to falls, alcohol or other drug abuse, renal impairment, and conditions perceived as barriers to compliance predicted decreased warfarin use. CONCLUSIONS: Few in this cohort of Ohio Medicaid patients with incident AF filled prescriptions for warfarin within 30 days of the diagnosis. Several factors, including alcohol or other drug abuse or dependence, psychiatric disease, homelessness or inadequate housing, and lack of a caregiver, were highly prevalent and seemed to bias against warfarin prescribing.

Adult↗