Growth and determinants of access in patient e-mail and Internet use

OBJECTIVES: To measure the rate of access to and use of the Internet and e-mail, to determine sociodemographic predictors of access, and to measure the change in Internet and e-mail access over a 1-year interval. DESIGN: Survey study. Comparison of data with those from a similar survey from 1998. SETTING: Emergency department of a large urban pediatric teaching hospital. PARTICIPANTS: Primary caretakers of pediatric patients or the patients themselves if aged 16 years or older. MAIN OUTCOME MEASURES: Use of and access to the Internet or e-mail. RESULTS: We surveyed 214 individuals: 72.8% use or have access to the Internet, e-mail, or both, an increase from 52.2% in the 1998 survey (P<.001), and 48.5% regularly use the Internet or e-mail, compared with 43.1% in 1998 (P = .32). Outside the home, access is primarily at work (52.2%), schools (8.9%), public libraries (11.5%), and friends' and relatives' houses (16.7%). Internet use and access are linearly correlated with income (r = 0.43; P<.001). White patients are more likely to have access (odds ratio, 2.6; 95% confidence interval, 1.3-5.4; P<.001) than black or Asian patients, whereas those of Hispanic ethnicity are less likely to have access (odds ratio, 0.20; 95% confidence interval, 0.09-0.43; P<.001). However, after adjustment for race and Hispanic ethnicity, only income was a significant predictor of family access to the Internet and e-mail. CONCLUSIONS: During the past year, many patients have gained access to the Internet and e-mail, although rates of regular use have remained steady. This access is often from outside the home. Furthermore, access is directly related to income and is unevenly distributed across racial and ethnic groups.     

The use of helium-oxygen mixture in the ventilation study of children with chronic obstructive lung disease

OBJECTIVE: To study the distribution of Tc-99m DTPA radioaerosol when heliox or oxygen are used in the nebulization of children and adolescents with chronic obstructive pulmonary disease during pulmonary ventilation scintigraphy. MATERIAL AND METHODS: Clinical randomized and controlled trial. Patients with chronic obstructive pulmonary disease (5 to 18 years old) who required pulmonary scintigraphy between March 1996 and September 1998 were included. Obstruction of the lower airway was measured by spirometry. Patients were randomized into two groups according to the gas used for nebulization during scintigraphy: heliox (80% helium and 20% oxygen) or oxygen. Scintigraphy studies were expressed as slope of the cumulative pulmonary radioactivity uptake curve and as the maximal cumulative radioactivity in the lung. The mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was measured by laser diffraction. RESULTS: Ten patients were allocated in each group. There were no statistical differences (P>0.05) in terms of gender, main diagnosis, signs of malnutrition, mean values of weight, height, body area, or spirometry results. The mean slope in the heliox group (5,039-/+1,652) was significantly different (P=0.018) from the mean slope of the oxygen group (3,410-/+1,100). The mean slope of patients with severe airflow obstruction in the heliox group was statically different (P=0.017) from the mean slope of patients with airflow obstruction in the oxygen group. In both groups, patients without evidence of airflow obstruction were similar in terms of mean slopes (P=0.507) and mean cumulative radiation in the lung (P=0.507). The mean diameter of heliox-generated Tc-99m DTPA particles was 2.13 m (-/+0.62). This was statistically different (P=0.004) from the mean diameter of oxygen-generated particles (0.88-/+0.99 m). CONCLUSIONS: Nebulization with heliox was more efficacious than nebulization with oxygen for distribution and dispersion of Tc-99m DTPA radioaerosol in the lungs of children and adolescents with chronic obstructive pulmonary disease submitted to ventilation scintigraphy. The benefits of heliox over oxygen are more evident in the presence of lower airway obstruction. Without airway obstruction, we did not observe any difference in the distribution and dispersion of radioaerosol in the lungs. Although the mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was significantly different, the particles generated by both gases were still within the recommended range (between 1 and 5 m). Therefore, this difference does not account for the effects of heliox observed in this study.     

Evaluation of total energy balance and food habits of obese children

Total daily energy expenditure (TDEE) and time spent for activities of different intensities (heart rate monitoring method), as well as dietary and food habits (24-hour dietary recall) in two groups of 12-14 year-old boys, including 35 obese (weight 67.0 kg +/- 9.3, height 162 cm +/- 7.6) and 35 control group boys (weight 46.0 kg +/- 6.5, height 160 cm +/- 7.5) were estimated. Obese boys spent more time at rest and less time on physical activities than nonobese (p < 0.001). That resulted in differences of TDEE expressed per unit of body mass (p < 0.001). Time for sleeping and time in school was not statistically different in the two groups. The evaluation of nutritional habits indicated that the obese boys, when compared with controls, had higher energy intake and significantly higher percentage of fat energy in total energy intake, low intake of fruits and vegetables and irregular frequency of meals during the day. Diets of boys were not balanced with respect to calcium and phosphorus.     

Deep venous thrombosis of the arm: etiology, diagnosis and treatment

Thrombosis of the upper extremity is frequently (30-52%) related to the use of an indwelling venous catheter, but it can also occur in healthy individuals after exercise. In the past it was considered a relatively benign thrombotic event, which was treated conservatively, sometimes even without anticoagulant therapy. Recent studies have shown that complications of deep venous thrombosis of the upper extremity occur frequently: pulmonary embolism (8-36%), recurrence thrombosis after cessation of anticoagulant treatment (2-15%) and post-thrombotic syndrome (up to 50%). Therefore when thrombosis of the upper extremity is clinically suspected, it should be objectively diagnosed by compression echography followed if negative by phlebography, with anticoagulant treatment directly afterward, preferably with low-molecular heparin and then acenocoumarol or phenprocoumon.     

Hospital infections in general surgery wards

In 1997 the hospital infections programme was accepted by the National Association for Infectious Diseases (Polskie Towarzystwo Zakazeń Szpitalnych--PTZSz). About 100 hospitals from Poland participated in the surveillence system introducing nosocomial infection registration cards in their units. The results of the research were sent to the PTZSz. The results from general surgery departments in 1998 were analysed. This year 79 general surgery units took part in nosocomial infection programme of PTZSz, sending from 1 to 2259 questionnaires. The analysis included 48,964 nosocomial infection registration cards. Nosocomial infection developed in 1,031 cases in the general surgery departments what accounted for 2.11% of all treated patient in that period. Surgical site infections were the most often place of nosocomial infections (37.1%), next skin and soft tissue infections (20.1%), and finally respiratory tract infections (17.6%). The average duration of hospitalization in general surgery departments was 10.2 days. In case of nosocomial infection occurrence the time of treatment was extended three times. The most frequent aetiological pathogenes of nosocomial infections were as follows: Escherichia coli and Staphylococcus aureus.