RESUMEN
Environmental tobacco smoke (ETS) is a significant component of indoor air pollution yet the acute upper respiratory response has not been well studied. The goal of this study was to determine the response of healthy subjects to moderate levels of sidestream tobacco smoke (SS). Twenty-three subjects were challenged on 2 separate days to clean air or SS (2 h, 15 ppm carbon monoxide, at rest). Subjects completed symptom questionnaires, posterior rhinomanometry, and body plethysmography. Average total and differential cell counts and albumin concentration were determined on nasal lavage samples. The urinary cotinine: creatinine ratio was used as a biomarker of exposure. Following SS exposure, irritant and rhinitis symptoms increased, nasal resistance rose from 4.9+/-0.4 to 6.3+/-0.6 cm H2O/L/s and specific airway conductance decreased from 0.14+/-0.01 to 0.13+/-0.01 cm H2O(-1) s(-1). Total cell counts, neutrophils, and albumin were unchanged. An increased nasal congestive response did not correlate with an increased cotinine: creatinine ratio. A history of ETS rhinitis did not predict an increased group response to smoke, but individuals with the largest physiologic and inflammatory response were historically ETS sensitive. In summary, healthy normal subjects demonstrate nasal congestion with exposure to moderate levels of SS without evidence of increased nasal vascular permeability.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Cavidad Nasal/fisiopatología , Líquido del Lavado Nasal/citología , Contaminación por Humo de Tabaco/efectos adversos , Adolescente , Adulto , Contaminación del Aire Interior/análisis , Resistencia de las Vías Respiratorias , Albúminas/análisis , Biomarcadores/orina , Monóxido de Carbono/análisis , Recuento de Células , Cotinina/orina , Creatinina/orina , Femenino , Humanos , Masculino , Líquido del Lavado Nasal/química , Neutrófilos , Rinitis/etiología , Encuestas y CuestionariosRESUMEN
When testing for stochastic order in ordered 2 x J contingency tables, it is common to select the cutoff required to declare significance so as to ensure that the size of the test is exactly alpha conditionally on the margins. It is valid, however, to use the margins to select not only the cutoff but also the form of the test. Linear rank tests, which are locally most powerful and frequently used in practice, suffer from the drawback that they may have power as low as zero to detect some alternatives of interest when the margins satisfy certain conditions. The Smirnov and convex hull tests are shown, through exact conditional power calculations and simulations, to avoid this drawback. The convex hull test is also admissible and palindromic invariant and minimizes the required significance level to have limiting power of one as the alternative moves away from the null in any direction.
Asunto(s)
Biometría/métodos , Antineoplásicos/uso terapéutico , Humanos , Funciones de Verosimilitud , Neoplasias/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Procesos Estocásticos , Resultado del TratamientoRESUMEN
Objective measures of upper respiratory function are needed to understand the effects of inhaled toxicants on the nasal passages. Acoustic rhinometry (AR) is a simple new technique that determines nasal volume by measuring the cross-sectional area of the upper airway as a function of the distance along the nasal passage. This study compares acoustic rhinometry with the more traditional posterior rhinomanometry (NAR) and correlates these objective measures with the symptom of nasal congestion. Healthy young adults (n = 29) were studied on 4 days, each separated by at least 1 wk, in a climate-controlled environmental chamber for 6 h, with exposure to clean air or sidestream tobacco smoke (SS) (2 h, 1, 5, and 15 ppm CO). The coefficient of variation for single measurements was 8-15% (AR) and 4% (NAR); for across-day measurements it was 15-25% (AR) and 13-15% (NAR); and for between days it was 19-27% AR and 17-21% (NAR). These coefficients were similar in subjects with a history of environmental tobacco smoke sensitivity (ETS-S) and those with no history of ETS sensitivity (ETS-NS). At baseline, the perception of unilateral nasal congestion was significantly correlated with unilateral nasal dimensions or nasal resistance; the symptom of baseline bilateral nasal congestion (estimated for both nasal passages simultaneously) correlated less well with objective measures of nasal patency. Under challenge conditions (SS at 1-15 ppm CO), there were typically significant correlations between changes in unilateral congestion and both unilateral rhinomanometry and acoustic rhinometry, but correlations of bilateral congestion and measurable dimensions were much lower. ETS-S and ETS-NS subjects differed in correlations between bilateral subjective and objective measures: ETS-S subjects showed significant correlation between baseline congestion and NAR; in contrast, ETS-NS subjects showed significant correlation between baseline congestion and acoustic rhinometry. These results indicate that NAR and AR are complementary tests for use in inhalation challenge studies and have different correlations with nasal congestion under baseline and challenge conditions.
Asunto(s)
Acústica/instrumentación , Nariz/efectos de los fármacos , Otolaringología/instrumentación , Ventilación Pulmonar/fisiología , Sonido , Adulto , Cámaras de Exposición Atmosférica , Relación Dosis-Respuesta a Droga , Estudios de Evaluación como Asunto , Humanos , Mucosa Nasal/efectos de los fármacos , Mucosa Nasal/fisiopatología , Otolaringología/métodos , Ventilación Pulmonar/efectos de los fármacos , Reproducibilidad de los Resultados , Rinitis/inducido químicamente , Rinitis/fisiopatología , Lesión por Inhalación de HumoRESUMEN
Little information exists on the utility of transcranial Doppler sonography (TCD) in detecting anterior (ACA) and posterior cerebral artery (PCA) vasospasm following subarachnoid hemorrhage. During the period at risk for vasospasm, 53 patients with subarachnoid hemorrhage who had technically adequate TCD performed within 24 hours of cerebral angiography, allowing evaluation of 87 ACAs and 84 PCAs, were studied. ACA and PCA vasospasm were defined by mean blood flow velocities of at least 120 cm/sec and at least 90 cm/sec, respectively. For detection of ACA vasospasm, sensitivity was 18% and specificity was 65%. For PCA vasospasm, sensitivity was 48% and specificity was 69%. False-positive findings for occlusion accounted for 12 (92%) of 13 ACA of false-positive results and 7 (37%) of 19 PCA false-positive results, and were most often due to anatomical factors and operator error or inexperience. After exclusion of both true-positive and false-positive findings for occlusion and changes in the diagnostic criterion to at least 130 cm/sec for ACA vasospasm and at least 110 cm/sec for PCA vasospasm, specificity improved for both types of vasospasms (100 and 93%, respectively). However, the sensitivity of TCD to detect ACA and PCA vasospasm is limited by a variety of anatomical, technical, and other factors. It is concluded that TCD is highly specific in detecting both ACA and PCA vasospasm on arteries that can be insonated.
Asunto(s)
Arterias Cerebrales/diagnóstico por imagen , Ataque Isquémico Transitorio/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal , Adulto , Anciano , Arteria Basilar/diagnóstico por imagen , Velocidad del Flujo Sanguíneo , Angiografía Cerebral , Circulación Cerebrovascular , Estudios de Cohortes , Reacciones Falso Positivas , Femenino , Humanos , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Hemorragia Subaracnoidea/complicaciones , Arteria Vertebral/diagnóstico por imagenRESUMEN
This study determined exposure-response relationships to side-stream tobacco smoke (2 hrs; 0, 1, 5, and 15 ppm CO) in 29 healthy nonsmoking young adults. Sixteen subjects had no history of environmental tobacco smoke rhinitis (ETS-NS) while 13 subjects had a history of ETS rhinitis (ETS-S). Eye irritation and odor perception showed a statistically significant exposure response in both groups; headache was significant in ETS-S and nose irritation was significant in ETS-NS subjects. Significant postexposure (P1) symptoms were first reported at 1 ppm CO among both groups, but in 3/9 symptoms were significantly greater at this exposure level in ETS-S subjects. Nasal congestion, rhinorrhea, and cough increased significantly at 15 ppm CO only. In ETS-S subjects, nasal volume decreased and nasal resistance increased in an exposure-response fashion. ETS-NS subjects had a qualitatively different shape to the exposure-response curve; significant dimensional reductions in mid- and posterior nasal volume occurred with exposure at 1 ppm CO but not at 5 ppm CO and reductions in posterior nasal volume occurred at 15 ppm CO exposure. These studies indicate subjective and objective response relationships with exposure to sidestream tobacco smoke at concentrations from 1 to 15 ppm CO. Some differences are noted among the two subject groups in the magnitude of some symptoms at the lowest exposure level and in the qualitative shape of the acoustic rhinometry and nasal resistance exposure-response curves.
Asunto(s)
Sistema Respiratorio/fisiopatología , Fumar , Contaminación por Humo de Tabaco/efectos adversos , Adulto , Cámaras de Exposición Atmosférica , Femenino , Humanos , Masculino , Manometría , Obstrucción Nasal/etiología , Enfermedades Nasales/inducido químicamente , Estudios Prospectivos , Valores de Referencia , Proyectos de Investigación , Sistema Respiratorio/efectos de los fármacos , Encuestas y CuestionariosRESUMEN
Little is known about the accuracy of transcranial Doppler (TCD) sonography in detecting intracranial internal carotid artery (IICA) and middle cerebral artery (MCA) vasospasm. TCD was performed in 49 patients with subarachnoid hemorrhage to evaluate 90 IICAs and 87 MCAs during the vasospasm period. When a mean velocity of at least 90 cm/sec was used to indicate IICA vasospasm, there were 11 positive, 42 negative, 4 false-positive, and 33 false-negative results. Sensitivity was 25% and specificity was 93%. When a mean velocity of at least 120 cm/sec was used to indicate MCA vasospasm, there were 15 positive, 45 negative, 3 false-positive, and 24 false-negative results (15 operator errors). Sensitivity was 38.5% and specificity was 93.7%. When the diagnostic criterion was changed to at least 130 cm/sec, specificities were 100% (IICA) and 96% (MCA) and positive predictive values were 100% (IICA) and 87% (MCA). The authors conclude that TCD accurately detects IICA and MCA vasospasm when flow velocities are at least 130 cm/sec. However, its sensitivity may be underestimated and the importance of operator error, overestimated.
Asunto(s)
Arteria Carótida Interna/diagnóstico por imagen , Arterias Cerebrales/diagnóstico por imagen , Espasmo/diagnóstico por imagen , Hemorragia Subaracnoidea/complicaciones , Adulto , Anciano , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Espasmo/etiología , Ultrasonografía Doppler TranscranealRESUMEN
BACKGROUND AND PURPOSE: Transcranial Doppler sonography is of established value in the detection and monitoring of middle cerebral artery vasospasm. Little information exists on the utility of transcranial Doppler for detection of posterior circulation vasospasm. METHODS: Cerebral angiography and conventional hand-held transcranial Doppler sonography were compared to determine sensitivity and specificity of transcranial Doppler for detection of vertebral and basilar artery vasospasm. RESULTS: Of 59 consecutive subarachnoid hemorrhage patients with transcranial Doppler angiogram correlations, 42 underwent posterior circulation angiography to evaluate 64 vertebral arteries and 42 basilar arteries during the period of risk for vasospasm and had technically adequate transcranial Doppler examinations within 24 hours of the angiogram. A mean flow velocity of 60 cm/s and above was indicative of both vertebral and basilar artery vasospasm. For the vertebral artery, there were 7 true-positive test results, 42 true-negatives, 6 false-positives (unknown cause in 3, increased collateral flow in 1, adjacent vessel vasospasm in 1, hyperperfusion in 1), and 9 false-negatives (anatomic in 7, operator error in 2). Sensitivity was 44% and specificity was 87.5%. For the basilar artery, there were 10 true-positives, 23 true-negatives, 6 false-positives (unknown cause in 4, hyperemia/hyperperfusion in 1, increased collateral flow in 1), and 3 false-negatives (operator error in 2, tortuous vessel course in 1). Sensitivity was 76.9% and specificity was 79.3%. When the diagnostic criterion was changed to > or = 80 cm/s (vertebral artery) and > or = 95 cm/s (basilar artery), all false-positive results were eliminated (specificity and positive predictive value, 100%). CONCLUSIONS: Our data suggest that transcranial Doppler has good specificity for the detection of vertebral artery vasospasm and good sensitivity and specificity for the detection of basilar artery vasospasm. Transcranial Doppler is highly specific (100%) for vertebral and basilar artery vasospasm when flow velocities are > or = 80 and > or = 95 cm/s, respectively.
Asunto(s)
Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/etiología , Hemorragia Subaracnoidea/complicaciones , Ultrasonografía Doppler Transcraneal , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/etiología , Adulto , Anciano , Velocidad del Flujo Sanguíneo , Angiografía Cerebral , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Ataque Isquémico Transitorio/diagnóstico , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Insuficiencia Vertebrobasilar/diagnósticoRESUMEN
This study defines what degree of respiratory rate (RR) elevation can be attributed to fever using a double blind randomized pre- and post-acetaminophen comparison of vital signs of febrile children presenting to an outpatient clinic. Inclusion criteria were aged between 6 weeks and 24 months, fever between 38.5 and 40.1 degrees C, no serious illness such as sepsis, and no recent receipt of antipyretics or antibiotics. RRs counted over 1 min and rectal temperatures were recorded by a trained observer before, and 1 and 1.5 hours (hr) after receipt of 10-15 mg/kg/dose of either acetaminophen (A) or placebo (P). Randomization produced groups A (n = 54), and P (n = 50) with similar mean age (12.3 vs 12.8 mo.), gender distribution (57 vs 54% female), baseline temperature (39.1 vs 39.1 degrees C), baseline RR (44 vs 45), and hours of fever prior to visit (42 vs 37 hr). The most common diagnoses were otitis media (49%), viral syndrome (18%), upper respiratory infection (16%) or gastroenteritis (7%). The mean temperature decrement of group A was 0.4 degrees C at 1 hr and 0.9 degrees C at 1.5 hr compared to slight increases in fever of 0.3 degrees C at 1 hr and 1.5 hr in group P. Significant decreases in RR occurred in group A compared to group P at 1 hr (7.0 vs 1.9, p = 0.009) and 1.5 hr (10.8 vs 4.0, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Fiebre/fisiopatología , Respiración , Acetaminofén/uso terapéutico , Preescolar , Método Doble Ciego , Femenino , Fiebre/tratamiento farmacológico , Humanos , Lactante , MasculinoRESUMEN
OBJECTIVE: To examine the efficacy of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis. DESIGN: Randomized, double-blind, placebo-controlled outpatient clinical trial utilizing four study groups: neubulized albuterol, nebulized saline, oral albuterol, and oral placebo. SETTING: Pediatric emergency department and outpatient clinic at University of Maryland in Baltimore. PATIENTS: Eighty-eight infants (median age 5.5 months) being treated for their first episode of wheezing were randomly assigned to nebulized albuterol (n = 22), nebulized saline (n = 23), oral albuterol (n = 19), oral placebo (n = 24). INTERVENTIONS: The nebulized groups received two nebulizations 30 minutes apart, whereas the oral groups received one oral dose. MAIN OUTCOME MEASURES: Respiratory and heart rates, clinical score, oxygen saturation (Spo2), and the infant's state, ie, asleep, awake, or feeding, were recorded at baseline and at 30 and 60 minutes after treatment. RESULTS: Randomization produced equivalent groups in terms of demographics and baseline measures. There were no statistically significant differences in any outcomes among the four treatments, except for oral albuterol, which produced an increase in heart rate (15 beats per minute, P = .005). No differences in the need for additional treatment or hospitalization were observed. Change in the state of the infant during the trial had significant effects on respiratory rate and clinical score. CONCLUSIONS: Albuterol is as effective as oral placebo in the management of bronchiolitis. Past studies supporting the use of albuterol did not control for effects of change in state of the infant and did not use a truly inactive placebo group. This study underscores the importance of these design components in measuring the efficacy of albuterol in infants.
Asunto(s)
Albuterol/uso terapéutico , Bronquiolitis/tratamiento farmacológico , Administración por Inhalación , Administración Oral , Aerosoles , Albuterol/administración & dosificación , Análisis de Varianza , Bronquiolitis/epidemiología , Método Doble Ciego , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Lactante , Masculino , Respiración/efectos de los fármacosRESUMEN
To determine how hypoxia may alter determinants of pulmonary transvascular fluid flux, adult male ferrets were exposed to either room air (C) or hypoxia (H; FIO2 = 0.12) for 24 h. After anesthesia and ventilation with C or H, the mean pulmonary artery pressures were 18.4 +/- 2.2 (SEM) and 27.3 +/- 2.9 mm Hg, respectively (p < 0.025). The right lung was then removed for gravimetric analysis of lung water and the left lung was blood-perfused (approximately 142 ml/kg/min) and continuously weighed for 15 min at left atrial pressures of 20, 25, and 30 mm Hg. Filtration coefficient (Kf) was estimated from the slopes of the relationships of rate of weight gain versus change in vascular pressure over the last 5 min of each interval. Extravascular lung water/blood-free dry lung weight for C and H were 2.95 +/- 0.06 (SEM) and 3.53 +/- 0.09 ml/g, respectively (p < 0.01). Kf for C and H were 0.0645 +/- 0.0190 (SEM) and 0.0662 +/- 0.0085 ml/min/mm Hg/100 g, respectively (NS). In a second group of experiments, in which lungs were removed from ferrets after 24 h exposures to C or H, protein reflection coefficients (sigma) were estimated by comparing the increases in perfusate hematocrit and protein concentrations during edema formation. Reflection coefficients for albumin were 0.64 +/- 0.03 (SEM) and 0.39 +/- 0.07 with C and H, respectively (p < 0.01). The sigma values for IgG and IgM were not affected.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Agua Pulmonar Extravascular/fisiología , Hipoxia/fisiopatología , Enfermedad Aguda , Animales , Presión Sanguínea , Hurones , Hipoxia/inmunología , Hipoxia/patología , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Pulmón/patología , Masculino , Tamaño de los Órganos , Arteria Pulmonar/fisiopatologíaRESUMEN
In isolated perfused organs, vascular protein reflection coefficients (sigma) can be calculated from the changes in hematocrit and perfusate protein concentration (CP) that occur during edema formation. This technique requires the assumption that transvascular protein flux by diffusion is negligible. To assess diffusion-induced errors in calculations of sigma, we derived an expression for CP that includes determinants of diffusive protein flux: protein permeability-surface area product (PS), transvascular fluid flux (J), true sigma, and transvascular protein concentration. We used this expression to obtain values of CP under various experimental conditions and then calculated values of sigma (measured sigma) for those conditions. Diffusion causes measured sigma to be lower than true sigma. The diffusion-induced error is larger and potentially substantial when J/PS is low and when true sigma is high. Diffusion-induced error is also larger when the amount of edema formation is greater. In recent isolated canine lung experiments where J/PS was approximately 2.7, diffusion-induced errors in measured sigma for albumin would have been approximately 0.06 (at true sigma = 0.5) and approximately 0.18 (at true sigma = 0.9). When J/PS was higher, the potential for diffusion-induced errors was much smaller. We conclude that diffusion causes underestimation of true sigma and that the error in measured sigma may be substantial when J/PS is < 5 and when true sigma is > 0.5.
Asunto(s)
Difusión , Proteínas/análisis , Animales , Vasos Sanguíneos/metabolismo , Permeabilidad Capilar , Perros , Edema/metabolismo , Filtración , Hematócrito , Albúmina Sérica/análisisRESUMEN
OBJECTIVE: To determine quantitative measles, mumps, and rubella serum antibody levels as a function of time since vaccination in a sample of vaccinated Baltimore children. DESIGN: Cross-sectional serologic survey. SETTING: Pediatric outpatient departments at the University of Maryland Medical Center, Baltimore. PARTICIPANTS: One hundred seventy children, ranging in age from 1.5 through 16 years, who had measles, mumps, and rubella vaccination between ages 12 and 18 months. RESULTS: Serum antibody levels to measles and rubella declined with increasing time since vaccination. However, no such decline in antibody levels to mumps was observed. Children who were vaccinated between ages 12 and 14 months did not have lower antibody levels than children who were vaccinated at age 15 months or older. CONCLUSIONS: In areas free from natural disease, antibody levels resultant from measles, mumps, and rubella vaccine are likely to decline with advancing age. Revaccination with measles, mumps, and rubella vaccine may boost falling antibody titers.
Asunto(s)
Anticuerpos Antivirales/sangre , Vacuna Antisarampión/inmunología , Vacuna contra la Parotiditis/inmunología , Vacuna contra la Rubéola/inmunología , Adolescente , Factores de Edad , Baltimore , Niño , Preescolar , Estudios Transversales , Combinación de Medicamentos , Humanos , Lactante , Virus del Sarampión/inmunología , Vacuna contra el Sarampión-Parotiditis-Rubéola , Virus de la Parotiditis/inmunología , Virus de la Rubéola/inmunologíaRESUMEN
OBJECTIVES: Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. METHODS: Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. RESULTS: Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have a diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonproprietary ownership of the nursing home, and aggressive behavior point to general physician care. CONCLUSIONS: Our findings indicate significant neglect of the mental health needs of older nursing home residents and underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act.
Asunto(s)
Accesibilidad a los Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Casas de Salud , Anciano , Humanos , Trastornos Mentales/epidemiologíaRESUMEN
In isolated perfused organs, the protein reflection coefficient (sigma) can be estimated by comparing increases in hematocrit (Hct) and protein concentration (CP) during transvascular fluid filtration. In this study, we developed an equation for sigma to examine the potential influences of perfusate leak, evaporation, and hemolysis-induced changes in red blood cell volume and perfusate water. We also performed experiments in isolated ferret lungs to quantitate the magnitude of these potential sources of error and the effects of free hemoglobin on measurements of CP. These studies demonstrated that 1) perfusate leak does not cause an error because its effects on changes in Hct and CP counteract each other; 2) evaporation causes an overestimation of sigma, but in our experiments this effect was small; 3) hemolysis-induced changes in red blood cell and perfusate water volumes may cause an over- or underestimation of sigma, but these effects are small; 4) overestimations of CP due to increasing free perfusate hemoglobin concentration can cause substantial overestimations of sigma; and 5) values of sigma calculated from previous equations and from our equation were virtually identical, suggesting that the assumptions necessary for the previous equations were not significant sources of error. In agreement with previous workers, we conclude that the most important potential source of error is hemolysis-induced increases in free perfusate hemoglobin.
Asunto(s)
Permeabilidad Capilar/fisiología , Proteínas/metabolismo , Animales , Dióxido de Carbono/sangre , Hurones , Filtración , Hematócrito , Hemólisis/fisiología , Hipoxia/fisiopatología , Técnicas In Vitro , Pulmón/fisiología , Perfusión , Proteínas/análisis , Respiración/fisiología , Albúmina Sérica/metabolismo , Volumen de Ventilación Pulmonar/fisiologíaRESUMEN
A retrospective study was undertaken of trauma patients over 55 years of age who were admitted to a rehabilitation hospital during an 18-month period. Significant risk factors for poorer in-hospital improvement in functional independent measures were male sex, having an offspring listed as next of kin, pre-injury diabetes mellitus and/or dementia, and number of co-morbidities. Being married was found to be protective.
Asunto(s)
Actividades Cotidianas , Hospitalización , Traumatismo Múltiple/rehabilitación , Anciano , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Maryland , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Centros de Rehabilitación , Tasa de SupervivenciaRESUMEN
In Maryland a six-month fiscal incentive to promote nursing homes' acceptance of chronic patients discharged from state psychiatric hospitals was evaluated after one year. During the fiscal year of the incentive program, such placements (N = 182) increased an average of 38 percent from previous years. Of 163 patients whose placements were evaluated, 22 were returned to the state hospital during the six-month period that the incentive was in place. Ten of the 22 were returned within 30 days of placement. Contrary to expectation, the return rate did not rise after the incentive was discontinued; four patients were returned during the second six months of the study period. Most returns during the first six months were due to patients' physical and verbal threats. The results supported the use of short-term fiscal incentives and emphasized the importance of intensive supportive interventions with chronic mentally ill patients early in the nursing home placement.
Asunto(s)
Desinstitucionalización/economía , Hospitales Psiquiátricos/economía , Hospitales Provinciales/economía , Trastornos Mentales/economía , Casas de Salud/economía , Reembolso de Incentivo/economía , Anciano , Enfermedad Crónica , Control de Costos/tendencias , Desinstitucionalización/estadística & datos numéricos , Estudios de Evaluación como Asunto , Femenino , Recursos en Salud/economía , Necesidades y Demandas de Servicios de Salud/economía , Hospitales Psiquiátricos/estadística & datos numéricos , Hospitales Provinciales/estadística & datos numéricos , Humanos , Masculino , Maryland , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Casas de Salud/estadística & datos numéricos , Planes Estatales de Salud/economía , Estados UnidosRESUMEN
Mean birth weights were evaluated in infants with D-transposition of the great arteries, tetralogy of Fallot, endocardial cushion defect, hypoplastic left heart syndrome, pulmonary stenosis, aortic stenosis, coarctation of the aorta, ventricular septal defect, and atrial septal defect in a population-based case-control study of congenital cardiovascular malformations in residents of Maryland, Washington, D.C., and northern Virginia (1981-1987). Study subjects were liveborn singletons without extracardiac anomalies. After adjustment for potentially confounding maternal, gestational, and infant factors, significant birth weight deficits were found for infants with tetralogy of Fallot, endocardial cushion defect, hypoplastic left heart syndrome, pulmonary stenosis, coarctation of the aorta, ventricular septal defect, and atrial septal defect. After adjustment, infants with these malformations (except coarctation of the aorta and atrial septal defect) were also significantly more likely than were controls to have low birth weight for gestational age. These findings strengthen previous evidence that certain cardiovascular malformations and low birth weight may be causally related.
Asunto(s)
Retardo del Crecimiento Fetal/etiología , Cardiopatías Congénitas/etiología , Recién Nacido de Bajo Peso , Estudios de Casos y Controles , District of Columbia/epidemiología , Defectos de la Almohadilla Endocárdica/epidemiología , Defectos de la Almohadilla Endocárdica/etiología , Cardiopatías Congénitas/epidemiología , Humanos , Recién Nacido , Maryland/epidemiología , Oportunidad Relativa , Tetralogía de Fallot/epidemiología , Tetralogía de Fallot/etiología , Transposición de los Grandes Vasos/epidemiología , Transposición de los Grandes Vasos/etiología , Virginia/epidemiologíaRESUMEN
Results of a controlled experiment are often adjusted for covariates found by a preliminary test to differ significantly between the treatment and control groups. The resulting test's true significance level is lower than the nominal level. Greater power can be achieved by always adjusting for a covariate that is highly correlated with the response regardless of its distribution between groups.
Asunto(s)
Análisis de Varianza , Ensayos Clínicos como Asunto , Factores de Confusión Epidemiológicos , Interpretación Estadística de Datos , HumanosRESUMEN
Controlled experiments can be used to study the effects on health of behaviors that cannot be perfectly controlled. A simple statistical technique allows causal effects to be distinguished from selection effects. The technique is applied to measure the effect of maternal smoking on birth weight.