Determinants of in-hospital death after acute spinal cord injury: a population-based study.

OBJECTIVES: First, to evaluate the influence of comorbid diseases and concomitant injuries on the risk of in-hospital death after traumatic spinal cord injury (TSCI). Second, to identify the risk characteristics of TSCI patients with likelihood of death. STUDY DESIGN: Population-based retrospective cohort study. SETTING: Sixty-two acute care hospitals in South Carolina, USA. METHODS: Records of 3389 TSCI patients hospitalized with acute TSCI were evaluated. Days elapsing from the date of injury to date of death established the survival time (T). Cox regression examined risk of in-hospital death as a function of counts of comorbid conditions and injuries along with their joint effects controlling for other covariates. RESULTS: Counts of comorbid conditions and injuries showed dose-dependent risk of death while in-hospital independent of demographical and clinical covariates. Hazard ratios (HR) for counts 3+, 2 and 1 comorbid conditions were 2.19 (P<0.001), 1.73 (P=0.005) and 1.20 (P=0.322), respectively. For counts of 4+, 3 and 2 other injuries were 1.85 (P<0.001), 1.81 (P<0.001) and 1.46 (P=0.022), respectively. The joint effect of the two was transadditive with statistically significant HR ranging from 1.72-3.14. CONCLUSION: Counts of comorbid conditions and injured body regions strongly indicate risk of in-hospital death after TSCI and their joint effects elicited dose-dependent gradient independent of demographical and clinical covariates. Assessing risk of in-hospital death based on joint use of counts of comorbid diseases and injuries is highly informative to target TSCI patients at high risk of dying.

Microscopic-observation drug susceptibility assay provides rapid and reliable identification of MDR-TB.

BACKGROUND: Liquid culture systems are more rapid and sensitive for both the detection and drug susceptibility testing (DST) of Mycobacterium tuberculosis. SETTING: St Peter's TB Specialised Hospital and public health laboratory, Addis Ababa. OBJECTIVE: To compare the microscopic-observation drug susceptibility (MODS) assay with the BACTEC-MGIT 960 system for isoniazid and rifampicin DST (i.e., multidrug-resistant tuberculosis [MDR-TB] identification) of M. tuberculosis. DESIGN: The evaluation was based on 58 smear- and culture-positive sputum samples from patients diagnosed in Addis Ababa, Ethiopia. BACTEC-MGIT was used as the reference standard. RESULTS: For the detection of MDR-TB, MODS has a sensitivity, specificity and accuracy rate of respectively 95%, 100% and 98.3% (kappa 0.981, concordance 98.3%). Concurrent culture detection and DST results are obtained in a median of 9 days with MODS, while indirect DST results with BACTEC-MGIT are obtained in a median of 8 days (this does not include time to primary isolate). CONCLUSION: MODS is an accurate, rapid and relatively inexpensive method for the identification of MDR-TB.

Self-report of delivery of clinical preventive services by U.S. physicians. Comparing specialty, gender, age, setting of practice, and area of practice.

OBJECTIVES: To summarize national survey results for key clinical preventive services provided by primary care physicians, characterize the results by demographic and practice attributes of the respondents, and compare the results to those obtained in other studies. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 3881 clinicians who provided primary care at least 50% of their time, randomly sampled from the professional associations representing family practitioners, pediatricians, internists, and OB-GYNs. MEASURES: The Primary Care Providers Survey instrument of 1992, administered through the Office of Disease Prevention and Health Promotion, designed to assess the provision of clinical preventive services by primary caregivers. MAIN RESULTS: Few of the physicians surveyed reported providing most indicated clinical preventive services more than 80% of the time. For the purposes of this paper, > 80% provision of preventive services is considered adequate. Female physicians reported providing more preventive services involving exercise, diet, alcohol/drugs, seatbelts, sexual activity, family planning, immunizations, and screening procedures. Physicians aged < 50 reported providing more preventive services involving smoking, alcohol/drugs, seatbelts, sexual activity, and family planning. Older physicians generally reported more delivery of vaccines and screening procedures. Practitioners from big metropolitan areas reported more preventive services involving alcohol/drugs and family planning while respondents in rural areas reported less immunizations and screening procedures. When analyzed by specialty, physicians reporting the most preventive care varied by type of preventive care. CONCLUSIONS: Small differences in the self-report of provision of clinical preventive services between specialties and demographic subgroups did exist. At the time of this survey, however, no group of primary care physicians reported providing clinical preventive services to their patients at adequate levels.

Association between exercise and HIV disease progression in a cohort of homosexual men.

PURPOSE: To study the relationship between exercise and human immunodeficiency virus (HIV) disease progression. METHODS: 415 individuals (156 HIV positive, 259 HIV negative), from a cohort study of 851 homosexual men from New York City, 1985-1991. By 1991, 68 of the 156 persons developed Acquired Immune Deficiency Syndrome (AIDS) and 49 died with AIDS. Exercise was defined as self-report of exercising 3-4 times/week or daily at entry; less was considered nonexercise. CD4 lymphocyte decline was constructed for each subject by modeling log CD4 count against time in days. The association between exercise and progression to AIDS and death with AIDS, adjusting for baseline CD4 count, was determined using Cox model. Linear regression was used to model CD4 decline with exercise for HIV positive and HIV negative groups separately, adjusting for initial CD4 count. RESULTS: Having exercised was associated with slower progression to AIDS at 1 year (HR = 0.68, 90% confidence interval (CI): 0.4-1.17); hazard ratios (HR) at 2, 3, and 4 years were 0.96, 1.18, and 1.36, respectively. Having exercised was also associated with slower progression to death with AIDS at 1 year (HR = 0.37, 90% CI: 0.14-0.94) with hazard ratios at 2, 3, and 4 years of 0.68, 0.98, and 1.27, respectively, suggesting a protective effect close to the time exercise was assessed, but an increased risk after 2 years. Exercising 3-4 times/week had a more protective effect than daily exercise. Exercisers in the HIV positive group showed an increase in CD4 count during a year by a factor of 1.07. CONCLUSION: Moderate physical activity may slow HIV disease progression.

Patient and physician satisfaction with an outpatient care visit.

BACKGROUND: The purpose of this study was to identify factors contributing to patient and physician satisfaction during outpatient care visits, and to determine the degree to which physician and patient satisfaction are related. METHODS: The sample (N = 250) was drawn from the outpatient practice of the University of South Carolina Department of Family and Preventive Medicine. Opinions were obtained by self-administered written questionnaires for physicians and by interviews with patients conducted by second-year medical students. RESULTS: Most encounters (88%) were satisfying for the physician. Resident physicians reported greater satisfaction than did faculty. Physicians were most satisfied with encounters in which they believed they had adequate time, were competent to address patient problems, and communicated successfully with the patient. Patient satisfaction was high (78% highly satisfied). Patients were more likely to be fully satisfied if they believed themselves to be in good health, did not wait long, and had health insurance. Unperceived patient dissatisfaction was associated with waiting time and a belief that the physician did not pay attention. No relationship was found between patient satisfaction and physician satisfaction. CONCLUSIONS: The majority of patient care encounters were satisfying for both participants. The pervasive effect of waiting time on patient satisfaction emphasizes the need for careful scheduling. Lower satisfaction among faculty physicians should be explored to identify possible interventions to prevent physician burnout. Pressures from managed care organizations may decrease physician satisfaction if these take the form of reducing the time available for each patient or restricting physicians' ability to seek subspecialist consultation.

International Conference on Population and Development, Cairo 5-13 September 1994 -- IAC presence.

PIP: During the International Conference on Population and Development (ICPD) in Cairo in September 1994, the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) exhibited posters, leaflets, brochures, T-shirts, and handkerchiefs, and distributed 2000 leaflets on IAC programs. On September 7, IAC staff showed videos on female genital mutilation (FGM) in Ethiopia and Uganda in the NGO Forum; this was followed by discussions with the 100 attending participants. On the same day, the IAC president made a statement in the Plenary Hall of the ICPD concerning the discrimination and gender bias faced by African women due to certain traditions and value systems. She proposed adopting legislation to raise the age of marriage; intensification of public education and information; mobilization of the media; and organization of educational programs for health workers, traditional birth attendants (TBAs), and policymakers. A special session on harmful traditional practices in Egypt was presented on September 12. The IAC executive secretary strongly opposed the medicalization of FGM.^ieng

A preliminary anthropometric study (body weight, body height, body-mass index) of Ethiopian schoolchildren and college students.

Body weight and height have been recorded in 261 schoolchildren and 283 college students from Gondar, North-western Ethiopia. The body-mass index has been calculated for different age-groups in males and females to provide reference data for the evaluation of the nutritional status.

Rituals of childbirth in the Tigrigna of Ethiopia (Axum area).

PIP: This essay describes the rituals of childbirth in the Tigrigna traditions of Ethiopia, starting with the onset of labor up until circumcision of the baby at day 12. If labor lasts for more than 1 day, shots are fired from the woman's room to induce birth by shock. After the cutting of the unbilical cord, the cord from the mother is tied to her leg to prevent the cord and placenta from slipping back into the uterus. The midwife massages the woman's abdomen with butter to accelerate delivery of the placenta; if it does not have a smooth surface, it is considered incomplete and the midwife presses a water jar down on the abdomen until all the remains are discharged. The baby is expected to sneeze as soon as it is born; if it does not, a thread is used to tickle the nostrils. Childbirth is associated with uncleanliness; those present cannot enter a church for 20 days if the baby is a boy and 40 days if it is a girl. On the 7th day the woman makes either a spear and shield (for a boy) or a sieve (for a girl) and is offered fasting food containing no meat or dairy products. Then the women present close the door and dance and sing songs to make the new mother laugh and forget labor pains. On the 12th day the child is circumcised, and garlic and rice are sprinkled on the blood which is then mixed with kohl and used as a wound dressing.^ieng