Violent video game effects on children and adolescents. A review of the literature.

Studies of violent video games on children and adolescents were reviewed to: 1) determine the multiple effects; 2) to offer critical observations about common strengths and weaknesses in the literature; 3) to provide a broader perspective to understand the research on the effects of video games. The review includes general theoretical and methodological considerations of media violence, and description of the general aggression model (GAM). The literature was evaluated in relation to the GAM. Published literature, including meta-analyses, are reviewed, as well as relevant unpublished material, such as conference papers and dissertations. Overall, the evidence supports hypotheses that violent video game play is related to aggressive affect, physiological arousal, aggressive cognitions, and aggressive behaviours. The effects of video game play on school performance are also evaluated, and the review concludes with a dimensional approach to video game effects. The dimensional approach evaluates video game effects in terms of amount, content, form, and mechanics, and appears to have many advantages for understanding and predicting the multiple types of effects demonstrated in the literature.

Parents rate the ratings: a test of the validity of the American movie, television, and video game ratings.

BACKGROUND: Numerous studies have documented the potential effects on young audiences of violent content in media products, including movies, television programs, and computer and video games. Similar studies have evaluated the effects associated with sexual content and messages. Cumulatively, these effects represent a significant public health risk for increased aggressive and violent behavior, spread of sexually transmitted diseases, and pediatric pregnancy. In partial response to these risks and to public and legislative pressure, the movie, television, and gaming industries have implemented ratings systems intended to provide information about the content and appropriate audiences for different films, shows, and games. METHODS: We conducted a panel study to test the validity of the current movie, television, and video game rating systems. Participants used the KidScore media evaluation tool, which evaluates films, television shows, and video and computer games on 10 aspects, including the appropriateness of the media product for children on the basis of age. RESULTS: Results revealed that when an entertainment industry rates a product as inappropriate for children, parent raters agree that it is inappropriate for children. However, parent raters disagree with industry usage of many of the ratings designating material suitable for children of different ages. Products rated as appropriate for adolescents are of the greatest concern. The level of disagreement varies from industry to industry and even from rating to rating. CONCLUSIONS: Analysis indicates that the amount of violent content and portrayals of violence are the primary markers for disagreement between parent raters and industry ratings. Short-term and long-term recommendations are suggested.

Urinary histamine metabolite elevations during experimental influenza infection.

BACKGROUND: Although histamine is hypothesized to mediate symptoms induced by viral upper respiratory infections, elevations of this mediator have not been observed in nasal lavage fluids recovered from patients with viral upper respiratory infections. OBJECTIVE: The purpose of this study was to use a novel method to determine whether histamine is released during experimental influenza A infection. METHODS: Healthy adults (n = 15) were cloistered and inoculated intranasally with influenza A virus, and monitored for infection and illness. Daily morning void urines were collected and assayed for histamine and its metabolites by gas chromatography-mass spectrometry. Total histamine was calculated for each urine specimen by summing the assayed values of histamine and its metabolites. RESULTS: All subjects were infected and developed illness. ANOVA documented a significant effect of study day (viral infection) on urinary levels of total histamine (P < 0.02). Pairwise analysis showed a significant elevation 2 days after inoculation. CONCLUSIONS: These results provide the first direct evidence that histamine is released in vivo during infection with a virus that causes cold/flu symptoms.

A validity test of movie, television, and video-game ratings.

CONTEXT: Numerous studies have documented the potential effects on young audiences of violent content in media products, including movies, television programs, and computer and video games. Similar studies have evaluated the effects associated with sexual content and messages. Cumulatively, these effects represent a significant public health risk for increased aggressive and violent behavior, spread of sexually transmitted diseases, and pediatric pregnancy. In partial response to these risks and to public and legislative pressure, the movie, television, and gaming industries have implemented ratings systems intended to provide information about the content and appropriate audiences for different films, shows, and games. OBJECTIVE: To test the validity of the current movie-, television-, and video game-rating systems. DESIGN: Panel study. MEASURE: Participants used the KidScore media evaluation tool, which evaluates films, television shows, and video games on 10 aspects, including the appropriateness of the media product for children based on age. RESULTS: When an entertainment industry rates a product as inappropriate for children, parent raters agree that it is inappropriate for children. However, parent raters disagree with industry usage of many of the ratings designating material suitable for children of different ages. Products rated as appropriate for adolescents are of the greatest concern. The level of disagreement varies from industry to industry and even from rating to rating. Analysis indicates that the amount of violent content and portrayals of violence are the primary markers for disagreement between parent raters and industry ratings. CONCLUSIONS: As 1 part of a solution to the complex public health problems posed by violent and sexually explicit media products, ratings can have value if used with caution. Parents and caregivers relying on the ratings systems to guide their children's use of media products should continue to monitor content independently. Industry ratings systems should be revised with input from the medical and scientific communities to improve their reliability and validity. A single ratings system, applied universally across industries, would greatly simplify the efforts of parents and caregivers to use the system as well as the efforts of outside parties to monitor the use and validity of the system.

Effect of intranasal challenge with interleukin-6 on upper airway symptomatology and physiology in allergic and nonallergic patients.

BACKGROUND: Interleukin-6 (IL-6) is a potent regulator of airway inflammation and an important component of biologic homeostasis. Previously, a temporal relationship between the local elaboration of IL-6 and the development of upper airway symptoms and pathophysiologic findings was reported for patients experimentally infected with influenza A virus or rhinovirus. OBJECTIVE: The objective of this study was to determine the provocative effects of direct, intranasal administration of IL-6 on those symptoms, signs, and pathophysiologic findings that accompany viral upper respiratory infection. METHODS: In this double-blind, placebo-controlled, crossover trial, 10 symptomatic allergic, 10 asymptomatic allergic, and 10 nonallergic adult patients were pretreated with intranasal histamine and, after 15 minutes, were challenged with repeated doses of placebo (saline) or with increasing doses (0, 0.01, 0.1, and 1 microg/mL) of recombinant IL-6 at 20-minute intervals, during randomized paired sessions. Symptom scores, sneeze and cough counts, nasal secretion weights, nasal conductance (rhinomanometry), middle ear pressure (tympanometry), Eustachian tube function (sonotubometry), and pulmonary function (spirometry) were evaluated before and after the histamine challenge, after each dose of IL-6 or placebo, and then at 90 minutes and 2, 3, 4, 6, and 24 hours. RESULTS: At the doses used, intranasal challenge with IL-6 was well tolerated. At the 90-minute postchallenge endpoint, a significant effect of challenge substance and group assignment was documented for nasal secretion weight. Paired comparisons showed that the effect was greater for the allergic patients when compared with the nonallergic patients. There were no differences between placebo and IL-6 challenge for any of the other measured parameters. CONCLUSIONS: These results show that local IL-6 at relatively low doses can provoke increased nasal secretions in patients with allergic rhinitis.

Viral rhinitis.

Viral rhinitis is a common, morbid, and costly malady, often complicated by otitis media, sinusitis, and asthma. Current therapies are relatively ineffective and aimed at reducing symptoms rather than moderating underlying mechanisms. Nasal elevations of proinflammatory cytokines track symptom expression during viral rhinitis, and it is hypothesized that these chemicals orchestrate a common response to infection with many different viruses that cause rhinitis. Also, recent evidence supports a role for neurogenic inflammation in the development of complications. Future studies should dissect the role of proinflammatory cytokines and neuropeptides in the expression of symptoms, signs, pathophysiologies, and complications of viral rhinitis.

Effect of experimental influenza A infection on systemic immune and inflammatory parameters in allergic and nonallergic adult subjects.

BACKGROUND: The economic impact and medical complication rate of viral upper respiratory infections are well documented, but many of the physiologic, inflammatory, and immune responses to respiratory viruses have only recently been investigated. A previous study demonstrated differential systemic immune and inflammatory responses in allergic rhinitis (AR) and nonallergic rhinitis (NAR) subjects during experimental infection with rhinovirus-39. OBJECTIVE: The purpose of this study was to compare selected systemic immune and inflammatory responses to experimental influenza A virus (FLU) challenge in seronegative AR and NAR subjects. METHODS: Peripheral blood was obtained at baseline (study day 0) and 3, 6, 18, and 31 days after intranasal FLU challenge and assayed for leukocyte histamine release, serum immunoglobulins, and plasma histamine. RESULTS: All subjects were infected, as manifested by viral shedding in nasal secretions and/or seroconversion. FLU infection induced decreases in spontaneous leukocyte histamine release and increases in anti-immunoglobulin E-induced leukocyte histamine release, which were evident at least 1 month after infection, but caused no significant changes in serum immunoglobulins or plasma histamine. There were no differences between AR and NAR subjects for any of the study parameters. CONCLUSIONS: The results show that intranasal challenge with FLU induces changes in leukocyte histamine release, but not other systemic immune and inflammatory responses.

Evidence for cytokine mediation of disease expression in adults experimentally infected with influenza A virus.

The roles of interleukin (IL)-6 and IL-8 in mediating the symptoms and signs of influenza A infection were examined. Adults were intranasally inoculated with a rimantadine-sensitive strain of influenza A HlNl virus and treated with rimantadine or placebo. Viral shedding, secretion weights, symptom scores, and concentrations of IL-6 and IL-8 in nasal lavage fluids were compared between treatment groups. Viral shedding was associated with increases in local and systemic symptoms, in expelled secretion weights, and in levels of IL-6 and IL-8. Compared with placebo, rimantadine treatment reduced viral shedding, systemic symptoms, and levels of IL-8. Days of viral shedding and IL-6 but not IL-8 concentrations were significantly correlated with the other measures of symptoms and signs. These data support a causal relationship between viral replication, cytokine production, and symptom expression, and they suggest that IL-6 may have a role in mediating symptom and sign expression during influenza A infection.

Diminished IL-10 production in subjects with allergy after infection with influenza A virus.

BACKGROUND: Recent studies have documented a link between respiratory viral infections and the expression of asthma and other allergic disorders. Results from other studies have suggested that diminished production of IL-10, an anti-inflammatory cytokine, may contribute to the pathophysiologic features of these diseases. OBJECTIVE: The objective of this study was to determine whether diminished IL-10 production and TH2 cytokine skewing occur in allergic, as compared with nonallergic, subjects after experimental infection with the influenza A virus. METHODS: PBMCs were isolated from 11 subjects with allergy and 14 subjects with no allergy before and after influenza A infection and stimulated with either mitogen (PHA) or antigen (influenza A). Supernatants were assayed for IL-10, IL-4, and IFN-gamma by ELISA. RESULTS: PBMC IL-10 production was significantly diminished in subjects with allergy, as compared with subjects with no allergy, after experimental infection with influenza A virus. However, significant TH2 skewing and enhanced airway symptoms were not observed in these same subjects. CONCLUSIONS: These data provide further support that subjects with allergy have an intrinsic inability to upregulate IL-10 production in response to inflammatory stimuli and extend this observation to include respiratory viral infections. Future studies in this area could lead to a better understanding of the pathogenesis of asthma and other allergic disorders

Inhibition of peripheral blood mononuclear cell proliferation by cardiac glycosides.

INTRODUCTION: Prior studies have shown that ouabain, a cardiac glycoside that inhibits the sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme, downregulates phytohemagglutinin (PHA)-induced peripheral blood mononuclear cell (PBMNC) proliferation. OBJECTIVE: This study examined and compared the effects of both ouabain and digoxin, a cardiac glycoside used therapeutically in humans, on PBMNC proliferation. METHODS: Peripheral blood mononuclear cells were isolated from healthy human subjects, incubated for 72 hours with and without PHA (2%) in the presence and absence of ouabain (10(-12) M to 10(-4) M) or digoxin (10(-9) M to 10(-6) M), and pulsed with 3H thymidine. RESULTS: For PHA-stimulated PBMNCs in the ouabain-treated group (n = 10 subjects), the mean (+/-STD) % uptake (% 3H thymidine uptake in absence of ouabain) was 80.5 +/- 6.0 at 10(-12) M ouabain, 73.1 +/- 8.4 at 10(-10) M, 47.89 +/- 13.1 at 10(-8) M, 6.9 +/- 3.2 at 10(-6) M, and 3.4 +/- 1.6 at 10(-4) M. For PHA-stimulated cells in the digoxin-treated group (n = 9 subjects), the mean (+/-STD) % uptake (% 3H thymidine uptake in absence of digoxin) was 89.8 +/- 9.8 at 10(-9) M digoxin, 92.6 +/- 8.2 at 10(-8) M, 54.3 +/- 19.8 at 10(-7) M, and 1.0 +/- 2.4 at 10(-6) M. Repeated measures ANOVA demonstrated a significant effect of concentration of both glycosides on PBMNC proliferation (P < .01). The inhibitory effect was reversible, but was largely abbrogated if ouabain was added after 48 hours of incubation with PHA. Further, the inhibitory effect extended to PBMNCs stimulated with recall antigen (tetanus) and to fractionated PBMNCs (CD4+, CD8+ and CD19+) stimulated with mitogens. Additionally, dose-response inhibitory effects of glycosides on PBMNC Na+,K+ ATPase enzyme activity and interleukin-2 (IL-2) secretion by PHA-stimulated PBMNC were also noted. Neither glycoside had an effect on spontaneous PBMNC proliferation (no PHA) or trypan blue exclusion. CONCLUSIONS: These studies demonstrate that both cardiac glycosides inhibited PHA-induced PBMNC proliferation, possibly via Na+,K+ ATPase inhibition, but not via cell toxicity. The concentration range over which inhibition was observed was similar for both glycosides. The results raise the possibility that therapeutic or toxic doses of digoxin could have an effect on cell-mediated immunity in vivo.

The relationship between airway hyperreactivity (AHR) and sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme inhibition.

Previous studies have documented the presence of a sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme inhibitor on platelet membranes and in the plasma of patients with allergy, many of whom historically had airway hyperreactivity (AHR). The purpose of this study was to investigate the relationship between methacholine AHR and Na+,K+ ATPase enzyme inhibition. In the first experiment, 47 adult subjects (13 allergic, 5 potentially allergic, 12 asthmatic, and 17 control subjects) were tested for platelet membrane Na+,K+ ATPase inhibition and AHR. Area under the methacholine dose-response curve (AUC) was expressed as percent baseline FEV1 x log concentration of methacholine (log [mg/ml]) and plotted as a function of the difference in postfreezing and prefreezing platelet membrane Na+,K+ ATPase activities (reflective of membrane-bound inhibitor), which was expressed as nanomoles per microgram of protein per minute (nmol/microg protein/min). A significant (r = -0.44, p < 0.005) negative correlation between the two was detected, such that high levels of AHR (low AUC) were associated with high levels of membrane-bound inhibitor. To test for a causal relationship between the two, the ability of a Na+,K+ ATPase inhibitor to directly influence the level of AHR was determined in a second experiment. Eight allergic and 10 control subjects were administered AHR tests on 2 different days, immediately after inhalation of either nebulized ouabain (1 mg) or placebo in a double-blind fashion. Ouabain versus placebo inhalation decreased the PC20 in four of the patients with allergy. Additionally, ouabain increased methacholine AHR in patients with allergy, as manifested by a lower AUC in seven of the eight patients. In contrast, the mean AUC for the ouabain versus placebo prechallenges did not change significantly in the control group. Finally, a positive correlation was demonstrated between the levels of platelet membrane Na+,K+ ATPase inhibition and bronchial responsiveness to ouabain (r = 0.49, p < 0.05). These results provide both correlative and mechanistic evidence for a causal relationship between Na+,K+ ATPase enzyme inhibition and AHR.

Inhibition of the sodium, potassium adenosine triphosphatase enzyme in peripheral blood mononuclear cells of subjects with allergic rhinitis.

BACKGROUND: Previous investigations have documented that a sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme inhibitor is bound to the platelet membrane, displaced from the platelet membrane by freezing, and present in the plasma of subjects with allergic rhinitis. Others have shown that stimulation of Na+,K+ ATPase is an important early event in mitogen-induced activation of peripheral blood mononuclear cells. OBJECTIVE: The purpose of this study was to determine whether the Na+,K+ ATPase enzyme inhibition observed in the platelets of subjects with allergic rhinitis also extends to peripheral blood mononuclear cells. METHODS: Na+,K+ ATPase activity of a particulate fraction of sonicated peripheral blood mononuclear cells was determined by spectrophotometry in asymptomatic adults with and without allergic rhinitis. RESULTS: The mean Na+,K+ ATPase activity of peripheral blood mononuclear cells expressed as nanomoles per microgram protein per minute (nM/ microgram protein/ min) +/-1 standard deviation of the subjects with allergic rhinitis (n = 14) was 1.04 +/- 1.01, while that of the control subjects (n = 12) was 3.57 +/- 1.60 (P < or = .001). In contrast, when the peripheral blood mononuclear cell membranes were frozen and then thawed prior to assay, the mean Na+,K+ ATPase activity for the subjects with allergic rhinitis (n = 24) was 5.33 +/- 2.62, while that of the control subjects (n = 23) was 1.12 +/- 1.24 (P < or = .001). Samples from a subset of subjects (n = 5) were assayed for both pre-freezing and post-freezing Na+,K+ ATPase activity. The freezing process was associated with a striking increase in Na+,K+ ATPase levels of subjects with allergic rhinitis (4.42 +/- 2.06) but a decrease in those of the control subjects (-3.89 +/- 0.95; P < or = .001). CONCLUSIONS: These data demonstrate that peripheral blood mononuclear cells from subjects with allergic rhinitis, like platelets, possess a membrane-bound Na+,K+ ATPase inhibitor that is displaced from the membrane by freezing. In vivo Na+,K+ ATPase inhibition could have significant effects on the activation and function of peripheral blood mononuclear cells in subjects with allergic rhinitis.

A role for the sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme in degranulation of rat basophilic leukaemia cells.

BACKGROUND: A circulating inhibitor of the sodium, potassium adenosine triphosphatase (Na+,K+ ATPase) enzyme has been described in allergic subjects. Recent studies have suggested that the Na+,K+ ATPase, enzyme may be involved in the signal transduction pathways of various cell types and that inhibition of its activity can modulate histamine release from basophils and mast cells. OBJECTIVE: The purpose of this study was to determine if modulation of Na+,K+ ATPase activity alters degranulation in the 2H3 subline of rat basophilic leukaemia cells (RBL-2H3), a mucosal mast cell model bearing high-affinity Fc receptors for IgE. METHODS: Degranulation was measured by the release of both exogenous serotonin and endogenous histamine. Na+,K+ ATPase activity was assessed by ouabain-sensitive [86rubidium] uptake ([86Rb] uptake) and ex situ enzyme activity. RESULTS: Ouabain-sensitive [86Rb] uptake and degranulation increased in parallel and in a dose-response fashion with increasing Fc receptor cross-linking. Additionally, incubation with ouabain, a known inhibitor of Na+,K+ ATPase activity, decreased both anti-IgE and calcium ionophore-induced degranulation, but increased spontaneous degranulation, each in a dose-response manner. Moreover, the effect of ouabain on degranulation was reversed by rinsing and mimicked by other known inhibitors of Na+,K+ ATPase activity. Finally, in the absence of anti-IgE or calcium ionophore, stimulation of ouabain-sensitive [86Rb] uptake by the sodium (Na+) ionophore monensin was associated with a corresponding dose-response increase in ouabain-sensitive degranulation. These experiments demonstrate that ouabain-sensitive [86Rb] uptake increases following IgE receptor cross-linking in RBL-2H3, and that factors which modulate Na+,K+ ATPase activity in these cells may also regulate degranulation. CONCLUSION: The results of this study suggest an important role for Na+,K+ ATPase activation in the signal transduction pathway of stimulated RBL-2H3.

Modulation of histamine release by sodium, potassium adenosine triphosphatase inhibition.

BACKGROUND: Previous studies have shown that a sodium, potassium adenosine triphosphatase inhibitor is present in the plasma of allergic subjects in whom enhanced histamine releasability has also been reported. PURPOSE: The purpose of this study was to determine the effect of in vitro sodium, potassium adenosine triphosphatase inhibition on whole blood histamine release. METHODS: Samples obtained from 12 patients with allergic rhinitis and 12 nonallergic subjects were incubated in duplicate for 30 minutes with anti-IgE antibody (100 micrograms/mL) or control buffer following a 0-, 10-, 20-, 30-, 60-, 120- and 180-minute preincubation with ouabain (3.0 mM) or diluent. Cell supernatants were assayed for histamine by radioimmunoassay and results were expressed as a percentage of total histamine release. RESULTS: Mean (+/- 1 SEM) anti-IgE induced release, in the presence and absence of ouabain, respectively, for allergic subjects was 27.5 +/- 5.5 and 21.0 +/- 4.5 (ten minutes, P < 0.05), 30.3 +/- 6.0 and 22.4 +/- 4.8 (20 minutes, P < .025), 28.9 +/- 5.2 and 23.5 +/- 4.1 (30 minutes), 33.8 +/- 7.1 and 26.7 +/- 5.4 (60 minutes, P < .05), 43.2 +/- 7.5 and 24.3 +/- 4.6 (120 minutes, P < .001), and 34.5 +/- 5.0 and 29.8 +/- 5.4% (180 minutes). Spontaneous histamine release in allergic subjects was also significantly increased by ouabain. Mean (+/- SEM) spontaneous release, in the presence and absence of ouabain, respectively, for allergic subjects was 2.0 +/- 0.5 and 0.9 +/- 0.2 (60 minutes, P < .025), 2.8 +/- 0.5 and 1.9 +/- 0.4 (120 minutes, P < .05), and 5.4 +/- 1.5 and 3.9 +/- 0.8% (180 minutes, P < .005). Ouabain did not significantly alter histamine release in non-allergic subjects. CONCLUSIONS: These data show that ouabain induced a significant increase in both spontaneous and induced histamine release in allergic subjects. In vivo, sodium, potassium adenosine triphosphatase inhibition may have an effect on histamine release in allergic subjects.

In vitro modulation of platelet sodium, potassium adenosine triphosphatase enzyme activity by antiallergy drugs.

Previous studies have documented decreased levels of platelet sodium, potassium adenosine triphosphatase (Na+, K+ ATPase) enzyme activity in allergic subjects. The purpose of this study was to determine the effect of several drugs used to treat allergy and asthma on platelet Na+,K+ ATPase activity. Platelets from five allergic and five nonallergic subjects were incubated at 37 degrees C for 30 minutes with cortisol (1.0 to 3.6 micrograms/ml), theophylline (10 to 40 micrograms/ml), cromolyn (0.5 to 2.0 micrograms/ml), albuterol (3 to 24 ng/ml), chlorpheniramine (2.5 to 20 micrograms/ml), or diluent. The platelets were then rinsed, sonicated, serially centrifuged, and assayed for Na+,K+ ATPase activity nmol/min x micrograms protein by spectrophotometry. Mean activity (+/- 1 SEM) for the diluent incubation was 5.55 +/- 1.27 nmol/min x micrograms protein and 0.91 +/- 0.32 nmol/min x micrograms protein for the nonallergic and allergic subjects, respectively. The enzyme activity of allergic platelets (same units as above) increased after incubation with the following drugs: cortisol, 6.07 +/- 1.75 (p < 0.025) at 1.0 micrograms/ml, 7.55 +/- 1.36 (p < 0.005) at 1.4 micrograms/ml, and 5.95 +/- 0.91 (p < 0.025) at 1.8 micrograms/ml; cromolyn, 5.79 +/- 1.68 (p < 0.050) at 1.0 micrograms/ml; and albuterol, 4.43 +/- 1.61 (p < 0.05) at 12 ng/ml. Theophylline and chlorpheniramine did not have a similar effect on Na+,K+ ATPase activity. These data show that some of the drugs commonly used to treat allergic patients, especially anti-inflammatory agents, can increase the depressed platelet levels of Na+,K+ ATPase activity observed in allergic subjects. Modulation of Na+,K+ ATPase is a possible mechanism of action for these drugs in vivo.

Wilderness injuries and illnesses.

STUDY OBJECTIVE: To determine injury and illness patterns and occurrence rates during wilderness recreation. DESIGN: Prospective injury and illness surveillance study. SETTING: Wilderness areas throughout the Western hemisphere. TYPE OF PARTICIPANTS: All students and instructors on National Outdoor Leadership School courses over a five-year period. MAIN RESULTS: A single fatality occurred, resulting in a death rate of 0.28 per 100,000 person-days of exposure. Injuries occurred at a rate of 2.3 per 1,000 person-days of exposure. Sprains and strains and soft tissue injuries accounted for 80% of the injuries. The illness rate was 1.5 per 1,000 person-days of exposure. Sixty percent of illnesses were due to nonspecific viral illnesses or diarrhea; hygiene appeared to have a significant impact on the incidence of these illnesses. Thirty-nine percent of the injuries and illnesses required evacuation (1.5 per 1,000 person-days of exposure). CONCLUSION: The injury and illness patterns indicate that wilderness medical efforts should concentrate on wilderness hygiene and management of musculoskeletal injuries and soft tissue wounds. The data also indicate that wilderness activities can be conducted relatively safely, but the decision to participate should be individualized, with an understanding of risks versus benefits.

Treatment of mild exacerbations of recurrent alcoholic pancreatitis in an emergency department observation unit.

Patients with mild exacerbations of recurrent alcoholic pancreatitis are occasionally treated in the emergency department observation unit with parenteral hydration and analgesia in hopes of avoiding hospitalization. To determine whether such treatment is efficacious and cost-effective, we reviewed 27 consecutive admissions to the emergency department observation unit for exacerbation of previously documented recurrent alcoholic pancreatitis. For comparison, we studied 27 randomly selected, matched patients admitted directly to the hospital. Of the 27 admitted to the observation unit, 14 (52%) improved sufficiently for discharge in less than 24 hours (group A; mean duration of observation, 14.4 hours); the other 13 (48%) required continued hospitalization (group B; average length of stay, 7.5 days). The group admitted directly to the hospital (group C) had a mean stay of 5.8 days (difference not significant). Of a variety of parameters compared, only serum amylase values differed significantly between the three groups. A serum amylase cutoff of 300 U/dl would have correctly identified all patients in group A (sensitivity 100%), though with a relatively low specificity (60%). We conclude that there may be a subset of patients with mild exacerbation of recurrent alcoholic pancreatitis, identifiable by a low serum amylase level, who would benefit from a trial of management in an emergency department observation unit.