Variability in childhood asthma and body mass index across Northern Plains American Indian communities.

OBJECTIVE: There are sparse data on the variability in childhood asthma across different Native American communities and the corresponding associations with known risk factors such as high body mass index and family history. The purpose of this study is to evaluate cross-sectional data on childhood asthma prevalence, body mass index, and other descriptive variables among Native Americans in five rural Northern Plains Indian reservation communities. METHODS: A school-based screening program was conducted on four Northern Plains Indian Reservations. The 1852 children (96% Native American, 4th through 12th grades) were screened for asthma status, body mass index (BMI), and family history. RESULTS: Approximately 9.5% of students reported current asthma. Current asthma varied significantly across the four reservation sites, ranging from 5.7% to 12.6%. Current asthma was also positively associated with BMI and family history of asthma. CONCLUSIONS: The intertribal differences in asthma prevalence noted here emphasize the need for further understanding the intertribal environmental, social, and behavioral factors that are associated with childhood asthma and obesity. Such knowledge can help inform disease prevention or disease management strategies that encompass the unique characteristics of tribal communities and culture.

Impediments to obtaining informed consent for clinical research in trauma patients.

BACKGROUND: Informed consent is required for, but a substantial barrier to, clinic research in trauma care. Exceptions have been established but remain controversial, and little objective data are available to illuminate this debate. METHODS: We prospectively assessed 2,011 consecutive patients admitted to the R Adams Cowley Shock Trauma Center of the University of Maryland Medical System for the potential to give consent for a hypothetical research trial within 1 hour of admission or whether consent could be obtained from a legally authorized representative (LAR) within 3 hours. These data were then linked with demographic, transport, physiologic, and injury data. RESULTS: Complete data were available for 1,734 patients: 982 (57%) appeared able to consent and 752 (43%) appeared unable to consent. Of the latter, LAR consent was potentially available for 404, leaving 348 (46%, 20% of all admissions) unconsentable. Those apparently able to consent were significantly less injured than those unable, but a third were subsequently found to have objective barriers to giving consent, and a further third had findings strongly suggestive of impairment. For those unable to consent, subsequent LAR consent was strongly associated with being a minor or being a woman. Lack of LAR consent was strongly associated with being the victim of intentional injury, with being an African-American male and-for European-American men only-with being transported greater distances. CONCLUSIONS: Severely injured trauma patients can seldom provide consent for research studies, and LARs are often unavailable. Further efforts to develop workable mechanisms for exception from informed consent are justified.

Thromboembolic complications associated with factor VIIa administration.

BACKGROUND: Factor VIIa (FVIIa) is given to promote hemostasis in coagulopathic trauma patients at high risk for death. FVIIa is associated with thromboembolic complications, but the incidence is not known, nor is which patients are at risk. We examined our experience with FVIIa to better understand this issue. METHODS: Medical records of patients who received FVIIa from 2001 to 2006 were reviewed for evidence of thromboembolic events, including ischemic cardiovascular accident, myocardial ischemia or infarct, mesenteric infarct, peripheral arterial thromboembolism, deep venous thrombosis, or pulmonary embolus. Indication for FVIIa dosing, timing of complication, and clinical outcome were recorded. Each event was assessed by a panel of experienced clinicians to determine the contribution of FVIIa to the event and to patient outcome. RESULTS: Two hundred eighty-five medical records were reviewed. Twenty-seven patients (9.4%) had thromboembolic complications after administration of FVIIa. Nine events were thought to be highly related to FVIIa, and 10 of 14 deaths were, in part, caused by the thrombotic complication. Eighteen of the events, including all cardiovascular accidents and most cases of mesenteric ischemia, were attributed to a combination of FVIIa and a definable, high-energy vascular injury. CONCLUSION: FVIIa is a potent procoagulant, with the potential for adverse thromboembolic events in susceptible patients. Our experience suggests that caution should be exercised in administration of FVIIa to patients with arterial injuries. Injured mesenteric and cerebral vessels may be especially susceptible to thrombosis.