Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “OUTPATIENT SERVICE”

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 1,117 records · Page 62Linked to original sources
PubMed2002

Isolated hallucinosis in Alzheimer's disease is associated with African-American race.

OBJECTIVES: The aim of this investigation was to study the relationship between isolated hallucinosis and race in Alzheimer's disease. METHODS: This was a cross-sectional, case control study carried out at the Neuropsychiatry Service, outpatient clinic at the Johns Hopkins School of Medicine, USA. The participants were 237 community-residing patients with probable Alzheimer's disease according to NINCDS/ADRDA criteria were included in the study. 9 patients with isolated hallucinosis were compared to a control group of 228 patients who had neither delusions nor hallucinations. Patients with only delusions or both delusions and hallucinations were excluded based on prior research. Patients were assessed clinically for the presence of hallucinations using the DSM-IV glossary definitions. They were also rated on standardized measures of cognitive impairment, depression, functional impairment, and general health. RESULTS: There was a significant association between hallucinations and race in patients with Alzheimer's disease. Before adjustment for other variables, the African-American race conferred a 5.5-fold (95% CI = 1.4-21.6; p = 0.02) increased risk for isolated hallucinosis. After adjustment for multiple other variables, this risk increased further to 27.2-fold (95% CI = 1.6-457.3; p = 0.02). CONCLUSIONS: African-American patients with Alzheimer's disease are more likely to have isolated hallucinations than Caucasian patients even after statistical adjustment for multiple confounding variables, which might distort this association. This finding has implications for our understanding of the etio-pathogenesis of hallucinations in Alzheimer's disease and for meeting health service needs of African-American patients.

Black or African American↗
PubMed2005

Bacteriological urinalysis in patients after renal transplantation.

The study consisted of microbiological urinalysis performed in 269 patients after renal transplantation who remained under medical care at the Outpatient Service of the Transplantation Institute in Warsaw. The patients enrolled into the study had undergone renal transplantation 6 to 72 months before urine samples were collected. 304 urinalysis were performed. In the group of 269 patients, 42 individuals had bacteria in their urine what was confirmed in 47 urine cultures. Cases of bacteriuria were divided into 5 groups: 5 cases of symptomatic urinary tract infection (5 individuals--2% of all studied patients), 27 cases of asymptomatic bacteriuria in 22 individuals (8% of all studied patients), 5 cases of insignificant bacteriuria in 5 patients (2%), 10 cases of involuntary urine contamination in 10 cases (4%). Eventually, urinary tract infection (UTI) was established in 27 patients (5 cases of symptomatic UTI and 22 cases of asymptomatic UTI) what makes out for 10% of all studied patients. In cases where urinalysis showed significant bacteriuria, following pathogens were detected in urine cultures: Escherichia coli: 22 strains, Enterococcus faecalis--4 strains, Enterobacter cloacae--2 strains and 1 strains of Ralstonia picketii, Streptococcus uberis, Pseudomonas aeruginosa and Proteus mirabilis. Over 90% of Gram-negative bacteria were susceptible to ceftriaxone and ceftazidime, as well as to amikacin and aztreonam which are the drugs usually administered intravenously in hospitalized patients. The only drug of similar efficacy, which could be administered orally in outpatients was fosfomycin.

Adult↗
PubMed2005

Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach.

OBJECTIVE: To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. DESIGN: Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. RESULTS: The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. CONCLUSION: The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.

Activities of Daily Living↗
PubMed2003

Inter--rater and test--retest reliability of the Japanese version of the subjective deficit syndrome scale.

The subjective deficit syndrome scale (SDSS) was established in 1990 by Jaeger et al. to assess systematically subjective experiences of schizophrenic patients. It was translated into Japanese in 1999 by this paper's second author (T.I.). In this study, the inter-rater reliability of this Japanese version (SDSS-J) was examined. The subjects studied were 13 schizophrenic patients (male 6, female 7; respective average ages at study entry and disease onset: 41 and 25 years), who were being followed up at the outpatients' service of the Department of Neuropsychiatry, Hyogo College of Medicine. Four psychiatrists attended together, the systematic interview with each subject to rate the SDSS-J and independently rated 19 items. The severity scales of the items assessed by these raters ranged from 0 to 4 for 12 items and from 0 to 3 for 7. The ANOVA ICC inter-rater reliability values for the 19 individual items ranged from 0.67 to 0.96. The ANOVA ICC test-retest reliability values achieved by two raters were also high overall, ranging from 0.72 to 1.00, except for one item (item 13) assessed by one rater. Our results suggest that the SDSS-J is a potentially useful rating scale for evaluating subjective experiences of schizophrenic subjects.

Adolescent↗
PubMed1987

Actual versus reported benzodiazepine usage by medical outpatients.

Benzodiazepines are widely prescribed, and in 1979 almost 10% of the adult population was taking them. Prior studies of outpatient usage of benzodiazepines have relied on survey or prescription data, which may be confounded by noncompliance. To determine the actual use of benzodiazepines, plasma benzodiazepine concentrations were measured in 225 consecutive outpatients from a university cardiology outpatient service. Self reports indicated that the great majority of the patients (191) were taking at least one medicine, and 70 reported being on a psychotropic drug. Seventy-seven patients reported taking benzodiazepines, the majority being on bromazepam (20), diazepam (26) or oxazepam (19). In 25 of those 77 patients, the reported drug could not be detected in plasma. Conversely, in 10 of the 225 patients, benzodiazepines which were not reported were detected (diazepam or flurazepam). Of those taking benzodiazepines, many had a low concentration, suggesting intermittent rather than regular use. Thus, many patients for whom benzodiazepines are prescribed take them irregularly, and a small group uses them without reporting their prescription. These findings have implications for the clinical presentation of illness and for the possibility of drug interactions.

Adolescent↗
PubMed1977

Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance.

The purpose of this study was to investigate the effectiveness, dynamics, and consequences of a health education intervention designed to increase patient question asking during the patient's medical visit. Data were collected at a Baltimore family and community health center which provides outpatient services to a low income, predominantly black and female population. The majority of the study participants were, in addition, elderly and chronically ill. A total of 294 patients and 3 providers took part in the study. The study design included random assignment of patients to experimental and placebo groups with two non-equivalent (non-randomized) control groups. Findings included: (1) The experimental group patients asked more direct questions and fewer indirect questions than did placebo group patients. (2) The experimental group patient-provider interaction was characterized by negative affect, anxiety, and anger, while the placebo group patient-provider interaction was characterized as mutually sympathetic. (3) The experimental group patients were less satisfied with care received in the clinic on the day of their visit than were placebo patients. (4) The experimental group patients demonstrated higher appointment-keeping ratios (an average number of appointments kept divided by an average number of appointments made) during a four-month prospective monitoring period.

Consumer Behavior↗
PubMed1987

Comparison of use of outpatient mental health services in an HMO and fee-for-service plans. Sensitivity to definition of a visit.

Whereas previous authors have used a variety of strategies to identify use of mental health services, the sensitivity of estimates to the definition of a visit has been little studied. The authors examined the sensitivity of estimates of use of outpatient mental health services in both HMO and fee-for-service plans to the method of identifying outpatient mental health visits. The HMO and fee-for-service plans had identical benefits (i.e., free care). Data were from the Rand Health Insurance Study. Mental health visits were identified using two definitions: presence of a mental health diagnosis or procedure; and presence of a mental health procedure, diagnosis, or prescription for psychotropic medication in the absence of physical disorders requiring such medications. The major policy conclusions about lower levels of use in the HMO compared to fee-for-service plans were insensitive to the definition of a visit. Nevertheless, estimates of use of general medical providers were higher when psychotropic medications were included in the definition of a mental health visit; this sensitivity to definition was significantly greater for fee-for-service than HMO participants (P less than 0.05). Further, conclusions about the comparability of enrollment mental health status of patients treated by general medical providers in HMO and fee-for-service plans were somewhat sensitive to the definition of a visit.

Data Collection↗
PubMed2001

Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study.

BACKGROUND: Deinstitutionalisation has led to persons with serious mental illness spending most of their time outside psychiatric institutions. Not much is known about their social life. The paper presents the results of structured interviews with non-institutionalised persons with schizophrenia about treatment, care and social network. The network data are analysed from three perspectives: finding predictors of the number and of the quality of social contacts, and establishing the respective variables that characterise persons with high, and those with low, scores on both the quantity and quality dimensions of social integration. METHODS: Random samples of persons with schizophrenia receiving outpatient services in ten psychiatric centres in the four Nordic countries were interviewed. The following instruments were used: Interview Schedule for Social Interaction (ISSI), Camberwell Assessment of Needs, Lancashire Quality of Life Profile, General Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS), in addition to a checklist covering the utilisation of different services. The ISSI provided the main data for this paper. A restricted number of possible predictors were used in General Linear Model (GLM) factorial analysis and discriminant analysis. RESULTS: A total of 418 persons took part in the study. The overall participation rate was 55%. Social integration in terms of number of contacts was related to a high GAF score, few BPRS negative and hostility symptoms, having contact with user organisations and living in urban (in contrast to rural) areas. Availability of emotional relations was predicted by female sex, low scores on the BPRS hostility dimension, high GAF score, having contact with one's family more than once a month, and living in urban areas. Work, adequate leisure activities and GAF score discriminated between the best and worst integrated groups. CONCLUSIONS: Living in urban areas, being female, having a high GAF score and low scores on hostility predicted better integration in terms of number of contacts and emotional relations.

Adult↗
PubMed1996

Costs of HIV+/AIDS at CD4+ counts disease stages based on treatment protocols.

We report treatment protocols for HIV+/AIDS patients by CD4+ counts (T-lymphocyte cells/mm3: > or = 500, 499-200, 199-50, and < 50) as a tool to provide better definition and to project annual costs (total charges for services) and lifetimes costs for HIV+/AIDS. The treatment protocols, derived from the literature and an HIV+/AIDS Physician Panel, defined the resource use associated with antiretroviral therapy and opportunistic disease prophylaxis and treatment. Resource use costs were derived from the published literature, insurance database, Medicare fee schedules, surveys, and the Physician Panel. At CD4+ counts, the rates of opportunistic diseases were derived from the Physician Panel experience; the mean occupancy times were derived from the literature. The sensitivity analysis indicated stability of the lifetime costs to variation in mean occupancy times, rates of opportunistic diseases, rates of adverse events (AE), and costs. The total annual costs (1995 dollars) of HIV+/AIDS patients ranged from $1,934 (> or = 500), $6,015 (200-499), and $9,031 (50-199), to $25,239 ( < 50). The annual costs of opportunistic diseases are esophageal candidiasis (EC) ($2,194), tuberculosis (TB) ($2,924), cryptococcal meningitis (CM) ($17,264), toxoplasmosis ($17,631), Mycobacterium avium complex (MAC) (+20,153), Non-Hodgkin's lymphoma (NHL) ($22,329), wasting syndrome ($26,676), central nervous system (CNS) lymphoma ($27,333), Pneumocystis carinii pneumonia (PCP) [mild ($3,545), moderate ($4,889), and severe ($32,609)], Kaposi' sarcoma (KS) [mild/moderate ($5,902), and severe ($10,744)], and cytomegalovirus (CMV) retinitis ($100,337). The projected lifetime costs of HIV+/AIDS are $94,726 (annual costs $7,645). Our lower lifetime costs as compared with recent estimates may be due to including resources only for HIV+/AIDS-related treatment and not for non-HIV+/AIDS conditions, as well as reduced resource use resulting from more efficient diagnostic and therapeutic techniques and earlier prophylaxis provided by experienced HIV+/AIDS physicians. Nonetheless, our estimates are consistent with decreasing costs of HIV+/AIDS due to a reduction in the average length of stay and frequency of hospitalizations as well as to replacement of inpatient care by outpatient services.

AIDS-Related Opportunistic Infections↗
PubMed2006

Vitamin D status and its relation to age and body mass index.

BACKGROUND/AIMS: While numerous studies have examined 25(OH)-vitamin D(3) (25-D) concentrations and their relation to parathyroid hormone (PTH) levels there is only limited information on the interrelation between 25-D, 1,25(OH)(2)-vitamin D(3) (1,25-D) and PTH. It was the aim of this study to assess the vitamin D endocrine system and its relation to age and body mass index (BMI). METHODS: This cross-sectional study comprised a convenience sample of 483 adults which attended the endocrinology outpatient service of a university hospital in the years 2002-2004. RESULTS: The mean concentrations of 25-D, 1,25-D, calcium and PTH were 21.0 +/- 10.6 ng/ml, 47.9 +/- 21.7 pg/ml, 9.48 +/- 0.48 mg/dl and 51.0 +/- 27.2 pg/ml, respectively. 25-D was related (p < 0.01) to BMI, age, PTH and 1,25-D. After correction for 25-D, we found no relation between BMI and 1,25-D. PTH was related (p < 0.01) to serum calcium, BMI, age and 1,25-D (p = 0015). There was a seasonal variation in both, 25-D and 1,25-D serum concentrations: 25-D levels were lowest in January and increased until July while the nadir and zenith of 1,25-D were found in April and October, respectively. CONCLUSION: Since BMI was negatively related to 25-D the prevalence of 25-D deficiency (<8.8 ng/ml) increased from 8.8% in subjects with BMI <30 kg/m(2) to 15.0% in subjects with BMI >30 kg/m(2). BMI, age and season should be taken into account when assessing a patients vitamin D status and more aggressive vitamin D supplementation should be considered for obese subjects.

Adult↗
PubMed2000

Dietary intake, serum lipids, insulin resistance and body composition in the era of highly active antiretroviral therapy 'Diet FRS Study'.

OBJECTIVES: To investigate (i) differences in dietary fat and energy intake between those reporting and those not reporting fat redistribution syndrome (FRS), and (ii) the relationship between dietary fat, total energy intake, serum biochemistry and the clinical characteristics of the syndrome. DESIGN: A cross-sectional study. SETTING: Outpatient service of a tertiary referral hospital, Sydney, Australia. PATIENTS AND METHODS: Dietary intake, serum lipids and insulin resistance and body composition (fat-free mass, fat mass, waist-to-hip ratio; WHR) were determined in 100 HIV-positive patients whose FRS status was classified on the basis of self-report of body composition changes, verified by clinical examination. RESULTS: There was no significant difference in total or saturated dietary fat intake when grouped by FRS status. There was no significant correlation between dietary saturated or total fat intake and the serum or body composition parameters measured. Total energy intake was higher in those patients reporting FRS (14575 versus 12283 kJ, P = 0.037) after adjustment for age, smoking and exercise status. CONCLUSION: There appears to be no relationship between either dietary saturated or total fat intake and the serum or body composition parameters characteristic of FRS; however, the total energy intake was significantly higher in those with FRS. The nature of the relationship between total energy intake and FRS (cause or effect) warrants further investigation.

Adipose Tissue↗
PubMed1999

Prevalence of primary hyperparathyroidism in 13387 patients with thyroid diseases, newly diagnosed by screening of serum calcium.

Primary Hyperparathyroidism (PHP) often goes unrecognised. Evidence of the influence of thyroid diseases on parathyroid activity exists. In order to determine the prevalence of primary hyperparathyroidism (PHP) in patients with thyroid diseases, a series of patients referred to an outpatient department for patients with thyroid diseases were examined for additional PHP. In addition to screening for thyroid diseases, serum calcium concentration (S-Ca) was measured in a series of persons who came to our outpatients' service for patients with thyroid diseases during the period 1992 to 1998. 13387 persons, median age 48 y, m = 2367, f = 11020, among them 9017 patients with thyroid diseases and 4370 persons without thyroid dysfunction, were studied. In patients with S-Ca outside the normal range, further diagnostic tests relating to PHP were performed. 106/13387 persons showed S-Ca > or = 2.6 mmol/L, in 31 cases due to PHP. In comparison to persons without thyroid diseases, the occurrence of PHP was significantly higher in patients with thyroid diseases (4/4370 = 0.09% vs. 26/9017 = 0.29%). Furthermore, 2 patients with normal S-Ca were diagnosed as having PHP in addition to another endocrine disease (acromegaly, multiple endocrine neoplasia type IIa, resp.). 31 of the 54 persons with S-Ca > 2.6mmol/L and who showed no other reasons for hypercalcaemia were found to be in a hyperthyroid state. The prevalence of PHP was significantly higher in patients with euthyroid goitre (p < 0.05) and in patients with thyroid carcinoma (p = 0.01) as compared to other persons with thyroid diseases. The groups of patients did not differ with regard to age. However, patients without thyroid diseases were significantly younger (median age 38y). Above the age of 50, the prevalence of PHP became higher in patients with euthyroid goitre or thyroid carcinoma than in those with a healthy thyroid gland. In contrast, in persons of under 50 y, there was no difference between these groups. The percentage of males with PHP was higher than in the total population studied (30% vs. 21.5%). In conclusion, a high occurence of PHP could be demonstrated in patients with thyroid diseases (0.29%) as compared to persons without thyroid dysfunction (0.09%), the highest prevalence being in patients with thyroid carcinoma. A clinically not relevant influence of thyroid function on S-Ca was seen in some patients with hyperthyroidism. Determination of S-Ca is recommended for each patient referred to a thyroid outpatients' department because of the high number of PHP cases in this context.

Adolescent↗
PubMed2002

Clinical and economic outcomes associated with olanzapine for the treatment of psychotic symptoms in a county mental health population.

BACKGROUND: The comparatively high acquisition costs of the newer antipsychotic medications have caused the mental health community to look closely at their potential benefits. OBJECTIVE: The purpose of this study was to perform a naturalistic analysis of changes in mental health service utilization, economic costs, and clinical outcomes after the initiation of olanzapine therapy for psychotic symptoms in an indigent patient population from a large county-operated mental health care system. METHODS: This was a prospective, uncontrolled investigation using a mirror-image cohort design. All captured costs from patients who began olanzapine therapy between November 1, 1996, and April 30, 1998, were analyzed in an intent-to-treat fashion to compare resource utilization in the 12 months immediately before and after the intervention. Clinical function was assessed at baseline and 6 months using the Positive and Negative Syndrome Scale (PANSS). In a subgroup analysis, the baseline characteristics of patients who completed 12 months of olanzapine treatment were compared with those of patients who (1) changed medication or (2) changed pay or source or were lost to follow-up. RESULTS: One hundred eighty-nine patients were started on olanzapine treatment during the 18-month study entry phase. Patients were primarily male (63.5%) and had a mean age of 35.9 years. Most (66.3%) had a formal diagnosis of thought disorder. Fifty-six patients received olanzapine for 12 consecutive months, and 22 were switched to other psychotropic medications. Of the remaining 111 patients, 70 changed payors (ie, qualified for Medicaid), and 41 were lost to follow-up. In the subgroup analysis, patients who completed 12 months of treatment (ie, responders) had significantly lower mean PANSS total scores at baseline compared with those who changed payors or were lost to follow-up (P = 0.047), and were significantly more likely to have a formal diagnosis of thought disorder (P = 0.039). Responders demonstrated a significant reduction in PANSS total and negative subscale scores at 6-month follow-up (both measures, P < 0.001). In the intent-to-treat analysis of resource utilization in all patients with complete data sets (n = 78), hospitalization costs and crisis costs decreased significantly during the 12-month follow-up period (P = 0.003 and P = 0.009, respectively), and both outpatient and medication costs increased significantly (P = 0.035 and P < 0.001, respectively). Overall, the change in total annual resource utilization during the 12 months after initiation of olanzapine was not statistically significant (mean decrease per patient, $1,991; 95% CI, -$5,258 to $1,122). CONCLUSIONS: Initiation of olanzapine therapy was associated with favorable clinical outcomes in this population, particularly in patients with a formal diagnosis of thought disorder. Overall, there was a cost shift away from hospital and crisis costs toward medication and outpatient services costs. The decline in total resource utilization was not statistically significant, although it may be of practical importance.

Adult↗
PubMedDate not supplied

Recruitment and retention topics for a changing environment in medical imaging.

Imaging directors are fighting just to keep the vacuum of a four percent unemployment market and a hungry computer industry from rapidly depleting their technical staff. Many factors have contributed to the current nationwide shortage of radiologic technologists. One is the closure of many hospital and community college-based programs of radiologic technology in the late 1980s and 1990s. The closures were a direct result of problems encountered by new technologists coming into a saturated workforce in the mid 1980s and early 1990s. The exodus of so many potential workers from the profession coincided with the changing perception students had of health careers versus computer technology and other careers. At the same time, the increasing importance of preventive care and diagnostic procedures almost tripled exam volumes. To cope with the increased demand for imaging services, outpatient diagnostic centers popped up. Increased numbers of exams and facilities meant an increased demand for qualified technologists, especially multicompetent technologists. Managed care and capitation demanded that we keep costs down as much as possible. Full-time employees were laid off and found good work at good pay and extraordinary benefits in other industries. New modalities have stretched a thinning labor force even tighter. MRI, PET and others continue to increase the demand for highly trained technologists. Levels of stress at work continue to rise, adding to the exodus of technologists to other careers. In this environment, staffing needs assessment is crucial. Some of the scheduling strategies you can use are: creative use of staff and referring physician preferences, flexible staffing tools and understanding the effect of the capacity of your imaging systems. The tight labor market affects all levels of hiring. But, as urgent as the need to fill openings is, don't make a quick decision to hire. You will live with the consequences. There is no stronger disincentive to your good employees than having to work with "problem children" or failing to discipline those who are not producing. Image and perceptions can have a significant effect on recruiting. How does the public perceive your organization? How does the technical community perceive your department? The current shortage of radiologic technologists and tight labor market require administrators to use all avenues toward improving their departments, retaining valuable employees and offering the most attractive salary and benefit packages to qualified applicants.

Health Services Needs and Demand↗
PubMedDate not supplied

Mexican American clients' perceptions of services in an outpatient mental health facility in a border city.

This descriptive-exploratory pilot study analyzed the perceptions of services in an outpatient mental health facility located in a border city in southwest Texas among Mexican American clientele with chronic mental illness. Face-to-face interviews using structured questionnaires were conducted with high functioning mentally ill clients. The questionnaire, with both English and Spanish versions, consisted of items on sociodemographics, support networks, illness experiences, reasons for seeking health services, reactions to being visited in the home setting for follow-up care, receiving care from a mental health professional with a similar cultural background, satisfactions, problems encountered in the mental health delivery system, and suggestions for improving health services. Data from 56 respondents yielded generally highly favorable and positive ratings of services received in the facility. Overall, these baseline data present challenges and implications for delivering culturally competent mental health care to Mexican American clients with chronic mental illness.

Adult↗
PubMed1998

Microscopic morphology of different types of urticaria.

OBJECTIVE: To identify possible special histopathologic features of different types of urticaria. DESIGN: Hematoxylin-eosin- and toluidine blue-stained sections from biopsy specimens of all patients with urticaria seen from 1990 to 1993. SETTING: Inpatient and outpatient services of the Virchow Klinikum, Humboldt University, Berlin, Germany. PARTICIPANTS: We studied spontaneous or induced wheals of 108 patients with acute, chronic, and physical urticaria who consented to an additional biopsy from uninvolved skin. The controls were 10 normal volunteers with wheals that tested positive on a prick test and who had contralateral normal skin. MAIN OUTCOME MEASURE: Mast cell numbers in both lesional and nonlesional skin in the upper and lower dermis of biopsy specimens from patients and controls. RESULTS: Blind evaluations of microscopic sections showed dermal edema and dilated lymphatic and vascular (P < .001 for all, Fisher exact test) capillaries almost exclusively in involved skin. The same held for inflammatory infiltrates, with significantly increased numbers of neutrophils and eosinophils in specimens from patients with acute urticaria and those with delayed pressure urticaria (P < .01 for each). Mast cell numbers were higher in the upper (P < .01) and lower dermis (P < .05) of lesional and uninvolved skin of all patients with urticaria, with a further increase (P < .01) in patients with disease of more than 10 weeks' duration. Edema and vascular changes were most prominent in the skin of patients with cold urticaria (P < .005) and mononuclear infiltrates were more pronounced in those with cold urticaria, chronic urticaria, and prick test-positive wheals (P < .05 for each) and in the lower dermis of patients with delayed pressure urticaria (P < .001). CONCLUSIONS: In all types of urticaria, mechanisms must be operative that cause an increase of cutaneous mast cells. Distinctive pathological features can be identified in different types of urticaria, although these are not diagnostic.

Acute Disease↗
PubMed1999

Association of early-stage psoriasis with smoking and male alcohol consumption: evidence from an Italian case-control study.

OBJECTIVE: To analyze the association of psoriasis with smoking habits and alcohol consumption before first diagnosis by a dermatologist. DESIGN: A multicenter case-control study. Interviews were conducted by trained medical investigators using a structured questionnaire. SETTING: Outpatient services of 10 general and 10 teaching hospitals in northern and southern Italy. SUBJECTS: Patients with a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no longer than 2 years after the reported disease onset. Patients with new diagnoses of skin diseases other than psoriasis were selected as control subjects. A total of 404 case patients (median age, 35 years) and 616 controls (median age, 36 years) were included in the analysis. RESULTS: The risk for psoriasis was higher in ex-smokers and in current smokers than in patients who never smoked. The relation with smoking was stronger and more consistent among women than men. In men, a significant association was restricted to the ex-smoker status. Smoking was strongly associated with pustular lesions (29 patients) with an adjusted odds ratio of 10.5 (95% confidence interval, 3.3-33.5) for those smoking more than 15 cigarettes per day. No significant overall association with alcohol consumption was documented after controlling for smoking habits. However, the risk seemed to vary according to sex, with a moderate association being documented in men. CONCLUSIONS: Cigarette smoking and, in men, alcohol consumption are associated with psoriasis. There is a strong association between smoking and pustular lesions.

Adult↗