Digital Commons Network^™

Outcomes Of Care By Hospitalists, General Internists, And Family Physicians, Peter K. Lindenauer, Michael B. Rothberg, Penelope Susan Pekow, Christopher Kenwood, Evan M. Benjamin, Andrew D. Auerbach

Penelope Susan Pekow

Background: The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.

Methods: We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used …

Outcomes Of Care By Hospitalists, General Internists, And Family Physicians, Peter K. Lindenauer, Michael B. Rothberg, Penelope Susan Pekow, Christopher Kenwood, Evan M. Benjamin, Andrew D. Auerbach

Peter Lindenauer MD

Background: The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.

Methods: We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used …

Synergistic Induction Of Ahr Regulated Genes In Developmental Toxicity From Co-Exposure To Two Model Pahs In Zebrafish, Alicia R. Timme-Laragy, Crystal J. Cockman, Cole W. Matson, Richard T. Di Giulio

Alicia R. Timme-Laragy

Polycyclic aromatic hydrocarbons (PAHs) are pollutants created by the incomplete combustion of carbon, and are increasing in the environment largely due to the burning of fossil fuels. PAHs occur as complex mixtures, and some combinations have been shown to cause synergistic developmental toxicity in fish embryos, characterized by pericardial edema and craniofacial malformations. Previous studies have indicated that in the zebrafish model, this toxicity is mediated by the aryl hydrocarbon receptor 2 (AHR2), and enhanced by inhibition of CYP1A activity. In this study, we further examined this interaction of the model PAH and AHR agonist β-naphthoflavone (BNF) with and without …

Ethnicity And Mental Health Treatment Utilization By Patients With Personality Disorders, Donna S. Bender, Andrew E. Skodol, Ingrid R. Dyck, John C. Markowitz, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Anthony Pinto, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson, Maria T. Daversa, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic …

Correction: Using Participatory Design To Develop (Public) Health Decision Support Systems Through Gis, S. Michelle Driedger, Anita Kothari, Jason Morrison, Michael Sawada, Eric J. Crighton, Ian D. Graham

Anita Kothari

Background: Organizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for nonspecialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool.

Methods: A case study …

Obesity And Diabetes In Vulnerable Populations: Reflection On Proximal And Distal Causes, Lucy M. Candib

Lucy M. Candib

Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting …

Biological Variability Dominates And Influences Analytical Variance In Hplc-Ecd Studies Of The Human Plasma Metabolome, Yevgeniya I. Shurubor, Wayne R. Matson, Walter C. Willett, Susan E. Hankinson, Bruce S. Kristal

Susan E. Hankinson

Background Biomarker-based assessments of biological samples are widespread in clinical, pre-clinical, and epidemiological investigations. We previously developed serum metabolomic profiles assessed by HPLC-separations coupled with coulometric array detection that can accurately identify ad libitum fed and caloric-restricted rats. These profiles are being adapted for human epidemiology studies, given the importance of energy balance in human disease. Methods Human plasma samples were biochemically analyzed using HPLC separations coupled with coulometric electrode array detection. Results We identified these markers/metabolites in human plasma, and then used them to determine which human samples represent blinded duplicates with 100% accuracy (N = 30 of 30). …

Managing A Widespread E-Procurement Implementation In Public Healthcare, Tommaso Federici, Andrea Resca

Federici Tommaso

In large parts of Europe, the development of healthcare is subject to contrasting forces. On the one hand, there has been an explosion in spending and, at the same time, governments are faced with strict budget constraints. On the other hand, public healthcare is under pressure to be innovative, technologically advanced and to provide increasingly better quality of services. In this context, eprocurement can be seen as an instrument to offer a solution to the first issue of this dilemma. However, e-procurement initiatives in such domain have not been widely deployed, and most of them have not fully delivered the …

Smoking Cessation In Later Life: An Evaluation Of The Impact Of Smoking Cessation Training On The Knowledge, Attitudes And Practice Of Members Of The Primary Care Team Who Work With Older People, Susan M. Kerr, Rosemary Whyte, Hazel Watson, Debbie Tolson, Angus Mcfadyen K

Dr. Susan Kerr

1. Introduction

Smokers aged 65 years and older are a vulnerable group who are likely to have conditions that are caused or complicated by smoking. Older smokers are also likely to die prematurely, losing on average 16 years from their projected life expectancy.

In recent years a growing body of research has demonstrated that older smokers can derive significant health benefits from stopping smoking in later life, despite having smoked for many years. The benefits of cessation are almost immediate for conditions such as heart disease and stroke. Stopping smoking also reduces the risk of developing cancer and stabilises existing …

The Epidemiology And Economics Of Chronic Obstructive Pulmonary Disease, David M. Mannino, S. Braman

David M. Mannino

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease responsible for a large human and economic burden around the world. Cigarette smoking is the main risk factor for COPD in the developed world, although other important risk factors include occupational exposures, air pollution, airway hyperresponsiveness, asthma, and genetic predisposition. In most of the world, COPD prevalence and mortality continue to rise in response to increases in smoking, particularly by women and adolescents. COPD is also an important cause of disability, and is linked to comorbid diseases, such as depression and cardiovascular disease, which adds to the large economic …

Effects Of Smoke-Free Laws On Indoor Air Pollution, Chizimuzo T.C. Okoli, Ellen J. Hahn, Kiyoung Lee

Chizimuzo T.C. Okoli

Purpose:

To assess the impact of smoke-free laws on indoor air quality by monitoring particulate matter smaller than 2.5μm (PM 2.5) under both smoking and nonsmoking conditions in Kentucky, USA

Background:

• In April 2004, Lexington, Kentucky implemented the first comprehensive smoke-free ordinance in the state

• Tobacco smoke substantially contributes to indoor particle concentration in hospitality venues and can be greatly reduced by smoke-free laws.

Methods:

• Descriptive, prospective study of hospitality venues in Lexington (n = 10) and Louisville (n = 10)

• Pre-law in Lexington: Friday and Saturday, September 2003, 7:30 PM-12:30 AM

• Post-law and in …

Public Health Citation Patterns: An Analysis Of The American Journal Of Public Health, 2003-2005, Melissa L. Rethlefsen, Lisa C. Wallis

Lisa C. Wallis, MSPH, MS

Tgfb1 And Tgfbr1 Polymorphisms And Breast Cancer Risk In The Nurses' Health Study, David G. Cox, Kathryn Penney, Qun Guo, Susan E. Hankinson, David J. Hunter

Susan E. Hankinson

Background Transforming growth factor beta 1 (TGFB1) forms a signaling complex with transforming growth factor beta receptors 1 and 2 and has been described as both a tumor suppressor and tumor promoter. Single nucleotide polymorphisms in TGFB1 and a microsatellite in TGFBR1 have been investigated for association with risk of breast cancer, with conflicting results. Methods We examined polymorphisms in the promoter region of the TGFB1 gene as well as the TGFBR1*6A microsatellite in the Nurses' Health Study cohort. Results No overall associations between the L10P polymorphism of TGFB1 or the TGFBR1 microsatellite were detected. However, we observed an inverse …

Alien Crustacean Decapods From The Aegean Coast Of Turkey, M. Baki Yokes, S. Ünsal Karhan, Erdogan Okus, Ahsen Yüksek, Asli Aslan, I. Noyan Yilmaz, Nazli Demirel, Volkan Demir, Bella S. Galil

Asli Aslan

Thirty of the 33 alien decapod crustacean species that have been reported off the Turkish Mediterranean coast are believed to have invaded the region via the Suez Canal, but only three of the species have been recorded along the Turkish Aegean coast. The marine biota of Gökova Bay, Datça Peninsula and Gulf of Fethiye, on the southern Aegean coast of Turkey, was studied by diving between 2002 and 2006. Of the eight Erythrean alien decapod species collected there, five constitute new records for the Aegean Sea and three are newly recorded from the Turkish coast of the Aegean Sea.

Modelling The Impact And Cost-Effectiveness Of The Hiv Intervention Programme Amongst Commercial Sex Workers In Ahmedabad, Gujarat, India, Isaac Chun-Hai Fung, Lorna Guinness, Peter Vickerman, Charlotte Watts, Gangadhar Vannela, Jagdish Vadhvana, Anna M. Foss, Laxman Malodia, Meena Gandhi, Gaurang Jani

Isaac Chun-Hai Fung

Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme.
Methods: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW …

More Than Meets The Eye: The Import Of Retail Cigarette Merchandising, Richard W. Pollay

Richard W. Pollay

No abstract provided.

Drug Utilization And Cost In A Medicaid Population: A Simulation Study Of Community Vs. Mail Order Pharmacy, Rosa Rodriguez-Monguio, Satish Valluri, Enrique Seoane-Vazquez, Sheryl Szeinbach

Rosa Rodriguez-Monguio

Background Outpatient drugs are dispensed through both community and mail order pharmacies. There is no empirical evidence that substitution of community pharmacy with mail order reduces overall drug expenditures. The need for evaluating the potential effects on utilization and costs of the possible extension of mail order services in Medicaid provides the rationale for conducting this study. This study compares drug utilization and drug product cost in community vs. mail order pharmacy dispensing services in a Medicaid population. Methods This study is a retrospective cohort study comparing utilization and cost patterns in community vs. mail order pharmacy. A simulation model …

A Study Of Secondary Organic Aerosol Formation In The Anthropogenic-Influenced Southeastern United States, Rodney Weber, Amy Sullivan, Richard Peltier, Armistead Russell, Bo Yan, Mei Zheng, Joost De Gouw, Carsten Warneke, Charles Brock, John Holloway, Elliot Atlas, Eric Edgerton

Richard E. Peltier

The formation of secondary organic aerosol (SOA) in an anthropogenic-influenced region in the southeastern United States is investigated by a comparison with urban plumes in the northeast. The analysis is based on measurements of fine-particle organic compounds soluble in water (WSOC) as a measure of secondary organic aerosol. Aircraft measurements over a large area of northern Georgia, including the Atlanta metropolitan region, and in plumes from New York City and surrounding urban regions in the northeast show that fine-particle WSOC are spatially correlated with vehicle emission tracers (e.g., CO), yet the measurements indicate that vehicles do not directly emit significant …

Copd And Lung Cancer Have Come A Long Way...Baby, David M. Mannino

David M. Mannino

Comment on

The growing burden of chronic obstructive pulmonary disease and lung cancer in women: examining sex differences in cigarette smoke metabolism.

http://www.atsjournals.org/doi/pdf/10.1164/rccm.200704-590ED

Comparison Of Alternative Models For Personality Disorders, Leslie C. Morey, Christopher J. Hopwood, John G. Gunderson, Andrew E. Skodol, M. Tracie Shea, Shirley Yen, Robert L. Stout, Mary C. Zanarini, Carlos M. Grilo, Charles A. Sanislow, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

BACKGROUND: The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed.

METHOD: Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample.

RESULTS: All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets …

Positive Childhood Experiences: Resilience And Recovery From Personality Disorder In Early Adulthood, Andrew E. Skodol, Donna S. Bender, Maria E. Pagano, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Carlos M. Grilo, Maria T. Daversa, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

OBJECTIVE: Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder.

METHOD: Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from …

Psychosocial Impairment And Treatment Utilization By Patients With Borderline Personality Disorder, Other Personality Disorders, Mood And Anxiety Disorders, And A Healthy Comparison Group, Emily B. Ansell, Charles A. Sanislow, Thomas H. Mcglashan, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

This study compared psychosocial functioning and treatment utilization in 130 participants who were diagnosed with a borderline personality disorder (BPD), a non-BPD personality disorder (OPD), a mood and/or anxiety disorder (MAD), or had no current psychiatric diagnosis and served as a healthy comparison group. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) diagnoses, psychosocial functioning, and treatment utilization were determined by using well-established semistructured research interviews conducted by trained doctoral-level clinicians. Analysis of variance revealed the most severe deficits in functioning characterized the BPD group across areas of global functioning with more moderate impairments in functioning occurring in OPD …

Longitudinal Diagnostic Efficiency Of Dsm-Iv Criteria For Borderline Personality Disorder: A 2-Year Prospective Study, Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, Donna S. Bender, Shirley Yen, M. Tracie Shea, Leslie C. Morey, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for borderline personality disorder (BPD). METHODS: At baseline, we used semistructured diagnostic interviews to determine criteria and diagnoses; blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (specifically, conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, with the independent BPD diagnosis at follow-up used as the standard. RESULTS: Longitudinal diagnostic efficiencies for the BPD criteria varied, with the criteria of suicidality or self-injury and unstable relationships demonstrating the most predictive utility. CONCLUSIONS: BPD criteria differ in their predictive …

Natural Course Of Bulimia Nervosa And Of Eating Disorder Not Otherwise Specified: 5-Year Prospective Study Of Remissions, Relapses, And The Effects Of Personality Disorder Psychopathology, Carlos M. Grilo, Maria E. Pagano, Andrew E. Skodol, Charles A. Sanislow, Thomas H. Mcglashan, John G. Gunderson, Robert L. Stout

Charles A. Sanislow, Ph.D.

OBJECTIVE: To examine prospectively the natural course of bulimia nervosa and eating disorder not otherwise specified (EDNOS) and to test for the effects of personality disorder psychopathology on remission and relapse.

METHOD: Subjects were 92 female patients with current bulimia nervosa (N = 23) or EDNOS (N = 69) at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study. Axis I psychiatric disorders (including eating disorders) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Version, and personality disorders were assessed with the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). The course of eating disorders was assessed …

Risk Factors Of Gastrointestinal Nematode Parasite Infections In Small Ruminants Kept In Smallholder Mixed Farms In Kenya., Agricola Odoi, J M. Gathuma, C K. Gachuiri, A Omore

Agricola Odoi

BACKGROUND: Helminth infections in small ruminants are serious problems in the developing world, particularly where nutrition and sanitation are poor. This study investigated the burden and risk factors of gastrointestinal nematode parasite infections in sheep and goats kept in smallholder mixed farms in the Kenyan Central Highlands. Three hundred and seven small ruminants were sampled from 66 smallholder mixed farms in agro-ecological zones 1 (humid) and 3 (semi-humid) in the Kenyan Central highlands. The farms were visited once a month for eight months during which a health and production survey questionnaire was administered. Fecal samples were collected at each visit …

Physician Colorectal Cancer Screening Recommendations: An Explanation Based On Informed Decision-Making, Yelena N. Tarasenko, Sarah B. Wackerbarth, Jennifer M. Joyce, Steven A. Haist

Yelena N. Tarasenko

Objective: The purpose of this research was to examine the content of physicians’ colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients.

Methods: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation.

Results: Almost all of the physicians (98.5%) addressed the “nature of decision” element. A majority of physicians discussed “uncertainties …

Perinatal Bisphenol A Exposure Increases Estrogen Sensitivity Of The Mammary Gland In Diverse Mouse Strains, Perinaaz R. Wadia, Laura Vandenberg, Cheryl M. Schaeberle, Beverly S. Rubin, Carlos Sonnenschein, Ana M. Soto

Laura Vandenberg

BACKGROUND: Studies of low-dose effects of xenoestrogens have yielded conflicting results that may be attributed to differences in estrogen sensitivity between the rodent strains examined. Perinatal exposure of CD-1 mice to low doses of the xenoestrogen bisphenol A (BPA) alters peripubertal mammary gland development. Future studies to assess the role of estrogen receptors as mediators of BPA action require estrogen receptor knock-out mice that were generated on a C57Bl6 background. The sensitivity of the C57Bl6 strain to estradiol and BPA is unknown. OBJECTIVES: In the present study we examined whether the mammary glands of CD-1 and C57Bl6 mice exhibited similar …

No Evidence For Acid-Catalyzed Secondary Organic Aerosol Formation In Power Plant Plumes Over Metropolitan Atlanta, Georgia, Richard E. Peltier, A. P. Sullivan, R. J. Weber, A. G. Wollny, J. S. Holloway, C. A. Brock, J. A. De Gouw, E. L. Atlas

Richard E. Peltier

Aircraft-based measurements of the water-soluble fraction of fine PM organic carbon (WSOC) and inorganic salt composition in the Atlanta, GA region were conducted in the summer of 2004. Five notable plumes of SO2, apparently from coal-fired power plants, were intercepted, and had NH4 +/SO42 molar ratios ranging from approximately 0.8 to 1.4 compared to molar ratios near 2 outside of the plumes. Sulfate aerosol concentrations increased from a regional background of 5–8 mg m 3 to as high as 19.5 mg m 3 within these plumes. No increase in WSOC concentrations was observed in plumes compared to out-of plumes within …

Avoiding Bias In The Annualized Rate Of Changed Of Fev1, David M. Mannino, Matthew M. Reichert, Kourtney J. Davis

David M. Mannino

No abstract provided.

Adrb2 Arg16gly Polymorphism, Lung Function, And Mortality: Results From The Atherosclerosis Risk In Community Study, Jill M. Ferdinands, David M. Mannino, Marta L. Gwinn, Molly S. Bray

David M. Mannino

Background

Growing evidence suggests that the Arg16Arg genotype of the beta-2 adrenergic receptor gene may be associated with adverse effects of beta-agonist therapy. We sought to examine the association of beta-agonist use and the Arg16Gly polymorphism with lung function and mortality among participants in the Atherosclerosis Risk in Communities study.

Methodology and Principal Findings

We genotyped study participants and analyzed the association of the Arg16Gly polymorphism and beta-agonist use with lung function at baseline and clinical examination three years later and with all-cause mortality during 10 years of follow-up. Lung function was characterized by percent-predicted forced expiratory volume in 1 …