Rates of unemployment and penetrating trauma are correlated

BACKGROUND: Trauma surgeons have observed an increased rate of penetrating trauma during periods of increased unemployment. METHODS: During a 10-year period, the rate of unemployment in a metropolitan area was compared with the rate of intentional penetrating trauma at two Level I trauma centers. The total number of trauma cases was recorded. Assaults, derived from police records, were examined as an additional indicator of violent behavior. Pearson correlation coefficients were calculated to identify significant correlation between study variables. Stepwise maximum-likelihood estimation was used to derive a model predicting percent penetrating trauma. RESULTS: The rate of unemployment and percent penetrating trauma of individuals presenting to the emergency department were significantly correlated (P = 0.014). After stepwise estimation, a model was derived (r2 = 0.846, P = 0.014) that estimated percent penetrating trauma on the basis of percent unemployment and total number of trauma admissions. CONCLUSION: This long-term ecological study confirms that rates of penetrating trauma increase with increasing unemployment rates. This should inspire further research to identify areas of greatest need to improve delivery of resources and current public policy with the ultimate goal of decreasing the incidence of penetrating trauma.     

Salicylate enhances endotoxin-induced pro- and anti-inflammatory cytokine expression

Introduction: Salicylate is frequently given as an anti-inflammatory agent, and its effects are primarily due to cyclooxygenase inhibition and a resultant decrease in the synthesis of prostaglandins. However, salicylate also has effects beyond COX inhibition that may be pro-inflammatory. We have shown that salicylate enhances the expression of the pro-inflammatory enzyme iNOS in the gastric mucosa during endotoxemia. For this reason, this study examined the effects of salicylate on other pro-inflammatory and anti-inflammatory mediators in endotoxic rats. We hypothesized that salicylate would alter cytokine expression during endotoxemia. Methods: Rats were given intraperitoneal saline or salicylate (100 mg/kg). One hour later, rats were given intraperitoneal saline or LPS (20 mg/kg). Five hours later, serum was collected for determination of the pro-inflammatory cytokines IL-1α, IL-6 and IL-12 and the anti-inflammatory cytokine IL-10 by ELISA. Data are reported in mg/ml as means ± SEM (n = 5; ANOVA). Results: LPS significantly increased serum IL-1α, IL-6, IL-12 and IL-10 when compared to controls. Salicylate enhanced LPS-induced changes in IL-1α, IL-6, IL-12 and IL-10 protein. In the absence of LPS, salicylate had no effect on these cytokines. Conclusion: The data indicate that salicylate augments the effects of LPS on both pro- and anti-inflammatory cytokines. Whether this effect is due to inhibition of COX-1 or COX-2 or another mechanism remains to be determined. However, while salicylate may be anti-inflammatory in some tissues, caution should be exercised in its administration to septic patients given its potential for increasing expression of pro-inflammatory mediators that could have deleterious effects.

TABLE—ABSTRACT 21.

	IL-1α	IL-6	IL-12	IL-10
Saline/Sal	0.1 ± 0.09	1.9 ± 1.6	2.3 ± 0.1	0.03 ± 0.01
Saline/LPS	0.8 ± 0.2∗	46.6 ± 6.1∗	11.9 ± 1.4∗	1.2 ± 0.2∗
Salicylate/Sal	.01 ± .002	0.5 ± 0.2	1.6 ± 0.2	0.02 ± 0.01
Salicylate/LPS	2.8 ± 0.5∗∗	82.8 ± 5.9∗∗	17.3 ± 1.3∗∗	2.4 ± 0.3∗∗

∗

P < 0.05 vs. saline counterpart.

∗∗

P < 0.05 vs. Saline/LPS.

Full-size table

     

A survey of residents and faculty regarding work hour limitations in surgical training programs

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions. SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: All voluntarily participating surgical faculty and residents. MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment. METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis. RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery. CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.     

Dietary Patterns and 12-Year Risk of Frailty: Results From the Three-City Bordeaux Study

Objective

To analyze the association between dietary patterns and the 12-year risk of frailty and its components in community-dwelling elderly French adults.

Human fibroblast tissue factor is inhibited by lipoprotein-associated coagulation inhibitor and placental anticoagulant protein but not by apolipoprotein A-II

Studies of proteins that inhibit tissue factor activity have generally been conducted using either an extracted tissue homogenate ("thromboplastin") or tissue factor protein reconstituted into phospholipid vesicles rather than with tissue factor expressed in cell membranes (its physiological environment). In the present study, a human fibroblast cell strain was used to evaluate the effects of lipoprotein associated coagulation inhibitor (LACI), placental anticoagulant protein (PAP), and apolipoprotein A-II (apo A-II) on human tissue factor in cell membranes. LACI was tested from 7.8 to 500 pmol/L on fibroblasts cultured at cell densities ranging from 3,500 to 9,925 cells/well, and caused a progressive inhibition of tissue factor activity. PAP was tested from 3.9 nmol/L to 1 mumol/L at cell densities ranging from 4,500 to 15,400 cells/well and caused up to 83% inhibition of tissue factor activity. Inhibition by these proteins appeared to be influenced by cell density as well as whether the cells were intact or disrupted. Apo A-II, up to 1 mumol/L, did not inhibit the tissue factor activity of intact or disrupted fibroblasts at any cell density examined even though it did inhibit the activity of tissue factor in phospholipid vesicles. Of these inhibitors of tissue factor-dependent activation of factor X, LACI was the most effective in suppressing the generation of factor Xa activity. The effects obtained with apo A-II are clearly dependent on the nature of the tissue factor preparation with which it is tested. The disparity between the inhibitory effect of apo A-II on the activity of tissue factor reconstituted into lipid vesicles and the absence of effect on the activity of tissue factor remaining in cell membranes serves to reemphasize the necessity of reexamining results obtained with model systems using as nearly physiological reagents as possible.     

PCV16 Smoking Related Costs in the United States

Smoking is a high-risk behavior that affects the health and economic welfare of society. Thus, it is important to quantify the economic burden smoking places on social institutions in the United States.
OBJECTIVE: The purpose of this review paper is to analyze smoking cost studies and to provide estimates that represent the economic costs of smoking from different perspectives of society, and as a whole.
METHODS: Current Contents (1996–), Health Star (1970–), and Medline (1966–) databases were searched through the use of pertinent subject headings and key words: tobacco use, smoking, cost, and economics. The internet was utilized to identify potential sources of epidemiological and cost information on smoking. Recent cost-of-illness studies using different methodologies: human capital, incidence, and prevalence were chosen for review based on their relevance.
RESULTS: Preliminary results indicate that the published cost studies available underestimate the "true" costs of smoking. The most current articles approximate annual direct medical costs to health care payers of $50 billion (1993); inflating to 1997 equals $59 billion or $1,200 per smoker. Although the latest cost studies do not attempt to estimate indirect costs, past studies have found indirect costs to be 1.5–2 times the direct costs. Therefore, using direct and indirect costs we estimate total smoking costs to be $150 billion (1993); inflating to 1997 equals $176 billion or $3,500 per smoker.
CONCLUSION: Quantifying the cost of smoking is a difficult task due to tobacco use infiltrating many aspects of life and the dependency of cost on perspective. Cost-of-illness studies provide cost estimation data which can be useful in aiding decision-makers who are allocating health care resources.