Medical economics of PM&R. V. Surviving the complexities of academic medical centers.

The mission statements of academic medical centers call on them to accomplish many goals. This often leads to conflicting choices when selecting activities and establishing policies. When individual faculty members are expected to divide work time to meet research, teaching and clinical needs, careful planning and disciplined decisions of action are necessary to avoid a sense of ambiguity and frustration.

Prevalence of acanthosis nigricans in an unselected population.

PURPOSE: The intent of this study was to determine, in an unselected population, the prevalence of the hyperinsulinemia-associated skin lesion, acanthosis nigricans. SUBJECTS AND METHODS: The posterior neck of every child in the sixth and eighth grades of the public schools of Galveston, Texas, was personally examined by the investigators during a state-mandated school health survey. A total of 1,412 children were examined. RESULTS: The data for each child examined included the absence or presence of acanthosis nigricans, height, weight, age, sex, and ethnic background. A subset of the children with the skin lesion also had fasting plasma insulin levels measured. Acanthosis nigricans was present in 7.1% of the 1,412 children examined. The skin lesion was equally distributed between boys and girls and was most common among children with severe obesity. The condition was present in two of 440 white non-Hispanics, 19 of 343 Hispanics, and 80 of 601 blacks examined. The fasting plasma insulin concentrations measured in some of these children and in previously evaluated subjects strongly correlate with the presence and severity of the acanthosis nigricans skin lesion. CONCLUSIONS: This skin lesion is much more common than previously believed and has a dramatic ethnic predisposition. We conclude that the high prevalence of this skin lesion further suggests that insulin resistance and hyperinsulinemia, with all of their serious medical implications, are also highly prevalent.

Food-borne disease in hospitals: prevention in a changing food service environment.

The results of an investigation into an outbreak of food-borne disease at a hospital in Los Angeles County are reported. The outbreak occurred at a luncheon buffet for nonpatient visitors attending an event at the hospital, which was catered by the hospital. The food source and etiologic agent(s) responsible for the outbreak were not identified by our investigation. However, several issues relating to the changing character of hospital food provision and their implications for prevention of food-borne disease in hospitals were conspicuous. Two trends apparent in hospital food service are toward increased use of foodstuffs prepared by wholesale food manufacturers and more frequent invitation to community groups to meet within hospital facilities and use hospital catering services. We found that (1) hospital kitchens in Los Angeles County are undersurveyed with respect to frequency of sanitary inspections; (2) hospitals have no mechanism whereby to assess the sanitary inspection record of wholesale food manufacturers from whom they purchase foodstuffs; and (3) crossover of food items prepared for nonpatient hospital visitors, including catered foods, to the inpatient menu occurs. The potential risks for a food-borne disease outbreak among compromised inpatients resulting from these factors are discussed, and measures to reduce such risk are proposed.

Compliance of insulin-dependent diabetics with a low-fat diet.

Compliance with medical therapy is widely researched yet unpredictable. When counseled by a dietitian to begin a low-fat (25%) diabetic diet, subjects significantly decreased fat intake but did not achieve the prescribed 25% fat level. The significantly lower fat intake after instruction identified the registered dietitian as an effective behavioral change agent. Six compliance predictors obtained at an initial interview accounted for 77% of the variance in compliance.

Enterotoxin production by atypical Staphylococcus aureus from poultry.

Phenotypically typical Staphylococcus aureus was isolated frequently from the necrotic bone and liver of poultry suffering from femoral head necrosis. Occasionally strains were isolated that differed from typical Staph. aureus in one or more of the major diagnostic tests, i.e. coagulase production, anaerobic fermentation of mannitol and production of a heat-stable deoxyribonuclease. Such atypical strains were also isolated from nasal swabs of healthy birds. Tests for enterotoxin production demonstrated that some atypical strains from both sick and healthy birds are capable of producing staphylococcal enterotoxins.