Varieties of health services utilization by underserved Mexican American women

Varieties of health services utilization by medically underserved patients were examined in 250 Mexican American women attending a primary care clinic in San Diego, California. Less than half (48.4 percent) of these medically underserved women had obtained clinical preventive services conforming to recommended guidelines, 34.4 percent reported having obtained an annual physical examination in the past year, and 66.0 percent reported visiting a doctor only when they were sick. Lack of any form of health insurance, including Medi-Cal, was associated with underutilization of primary care services to a greater degree than the other variables examined. However, other factors such as full-time employment, low education, dissatisfaction with primary care delivery, and cultural preference for traditional ethnomedical alternative forms of health care, constitute important barriers to utilization of primary care services. Efforts to provide health care to the medically underserved must take these barriers into consideration if they are to be successful.     

Suppression of alcohol delirium tremens by baclofen administration: a case report

Delirium tremens (DT) is a clinical condition that appears in some patients affected by severe alcohol withdrawal syndrome (AWS). DT represents a serious complication, being characterized by elevated morbidity and mortality. Benzodiazepines are presently the drug of choice; however their use is related to several side effects. Baclofen is a stereoselective gamma-aminobutyric acid (GABAB) receptor agonist. Recent studies show that baclofen is able to suppress alcohol withdrawal symptoms. At present there are no data on the effects of baclofen administration in AWS complicated by DT. Here, we report a case of DT successfully treated with baclofen. This result indicates that the efficacy of baclofen in the treatment of DT should be examined in future clinical trials.     

Nutritional Status and Body Fluid Distribution in Chronic Alcoholics Compared With Controls

BACKGROUND: At present few data are available on the total body water (TBW) content and in particular on the distribution of water in the intra- and extracellular compartments (ICW and ECW) of alcoholics. The aim of this study was to evaluate TBW, ICW, and ECW in chronic alcoholic patients. METHODS: Thirty-six alcoholics meeting DSM-III-R criteria for diagnosis (20 men, 16 women; body mass index [BMI] 22.3+/-2.57 kg/m2) were enrolled. Fifty-four healthy social drinkers (31 men, 23 women; BMI 23.7+/-1.68 kg/m2) matched for age and height were used as controls. Systolic and diastolic blood pressure was measured for all cases. All patients were assessed using specific anthropometric measurements. The waist-to-hip ratio (WHR) was used as an indicator of body fat distribution. TBW was measured by isotopic dilution by giving 100 microCi of tritiated water. ICW and ECW were assessed by multifrequence bioelectric impedance analysis (BIA). Basal metabolic rate (BMR) was measured by indirect calorimetry. RESULTS: Body weight was lower in the alcoholics than in the controls (61.9+/-5.5 kg vs. 65.8+/-5.2 kg;p < 0.01), essentially due to a reduction in fat mass. Significantly higher WHR values were found in both male (p < 0.001) and female (p < 0.001) alcoholics than in healthy subjects. A higher ECW/TBW ratio was found in the alcoholics compared with the controls, both as a whole (0.53+/-0.04 vs. 0.41+/-0.03; p < 0.0001) and separated by gender (p < 0.001). CONCLUSIONS: The increased ECW could derive from an increase in cellular permeability related to endothelial damage linked to the vasoconstriction present in the alcoholics and/or to a direct toxic effect of ethanol on cellular membranes. In addition, because the high ECW volumes correlated positively with WHR in the alcoholics, a potential association of these two factors in determining an increased risk of liver disease, hypertension, and cardiovascular disease may exist. Finally, the lower TBW characteristic of women may be one of the reasons for the observed greater rate of toxic effects of ethanol that occur in women.     

Endothelin‐1 effects on spontaneous oscillations in choroidal arterioles

Acta Ophthalmol. 2010: 88: 742–747

Abstract.

Purpose: This study characterizes the effects of endothelin‐1 (ET‐1) on the perfusion pressure of the choroidal vasculature using in situ perfused isolated rabbit eyes. Methods: Rabbit external ophthalmic arteries (n = 12) in a head‐mounted preparation were cannulated and perfused with warmed tyrode. The three‐way polypropylene catheter was further connected to a pressure transducer and the effect of intraluminal pressure as a measure of total vascular resistance was assessed. Response curves to intra‐arterial injections of ET‐1 (group A; n = 6) and to an intravitreal injection followed by an intra‐arterial injection of ET‐1 (group B; n = 6) were obtained. Data were studied using paired t‐test and fast Fourier transform. Results: Before any drugs were administered, spontaneous oscillations were observed in the 12 rabbit models. In group A, ET‐1 induced a short and weak vasodilating effect followed by a strong and long‐lasting vasoconstrictor tone. Vasomotion became more evident, showing a higher frequency and shorter amplitude of oscillations. In group, B the intravitreal injection produced no significant changes in registered pressure or vasomotion characteristics. The intra‐arterial injection produced effects similar to those observed in group A. Conclusion: Our study has three main findings: (i) the choroidal vasculature demonstrated spontaneous oscillations in perfusion pressure in basal conditions in all rabbit eye models; (ii) ET‐1 applied intra‐arterially induced a short drop in perfusion pressure followed by a long withstanding contraction; and (iii) intra‐arterial ET‐1 modulated the frequency and amplitude of the spontaneous oscillations, causing a faster rate of pulsatility.     

Epidemiology and outcomes of peritonitis in children on peritoneal dialysis in Australasia

Peritonitis is a common complication and major cause of morbidity in children on peritoneal dialysis. In this retrospective longitudinal study, we analysed data retrieved from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) on 167 patients aged less than 18 years of age who were treated with peritoneal dialysis during the period from October 2003 to December 2007. During this period there were 100 episodes of peritonitis in 57 patients (0.71 episodes/patient-year), with Gram-positive organisms most commonly isolated (44%). Peritonitis occurred frequently in the first 6 months after starting dialysis, with survival analysis showing peritonitis-free survival rates of 72%, 56% and 36% at 6 months, 1 year and 2 years respectively. Age was a weak predictor of peritonitis on univariate analysis, but previous peritonitis was the only significant predictor in a multivariate Cox proportional hazards model (adjusted hazard ratio 2.02; 95% CI: 1.20 to 3.40, p = 0.008). Peritonitis episodes infrequently resulted in relapse (5%), recurrence (7%) or the need for either temporary or permanent haemodialysis (5% and 7% respectively) and there were no patient deaths directly attributable to peritonitis. Compared with single organism peritonitis, polymicrobial peritonitis was not associated with any statistically significant differences in outcome. Further prospective studies are required to determine the most appropriate prophylactic measures and antibiotic regimens for use in pediatric patients.     

Epidemiology of autism spectrum disorder in Portugal: prevalence, clinical characterization, and medical conditions

The objective of this study was to estimate the prevalence of autistic spectrum disorder (ASD) and identify its clinical characterization, and medical conditions in a paediatric population in Portugal. A school survey was conducted in elementary schools, targeting 332 808 school-aged children in the mainland and 10 910 in the Azores islands. Referred children were directly assessed using the Diagnostic and Statistical Manual of Mental Disorders (4th edn), the Autism Diagnostic Interview–Revised, and the Childhood Autism Rating Scale. Clinical history and a laboratory investigation was performed. In parallel, a systematic multi-source search of children known to have autism was carried out in a restricted region. The global prevalence of ASD per 10 000 was 9.2 in mainland, and 15.6 in the Azores, with intriguing regional differences. A diversity of associated medical conditions was documented in 20%, with an unexpectedly high rate of mitochondrial respiratory chain disorders.