Greater Number Of Days Research Articles

Different Components of Opioid-Substitution Treatment Predict Outcomes of Patients With and Without a Parent With Substance-Use Problems*

The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems. This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined. Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use. The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.

Physical health consequences of intimate partner violence in Spanish women

Intimate partner violence (IPV) against women can result in serious health problems. The objectives of this study are to analyse the association between the different types of IPV and women's physical health, and to examine whether this association varies depending on the intensity, duration and timing of the violence. A sample of 1402 randomly selected women attending 23 family practices in Spain responded to an anonymous self-reported questionnaire. Measures considered were exposure to physical, sexual and psychological IPV; intensity, duration and timing of such violence; chronic physical disease; number of lifetime surgical operations and number of days spent in bed in the last three months. Descriptive, bivariate and multivariate analyses were conducted. Lifetime IPV prevalence was 32%. Higher prevalence of chronic disease was observed in abused women than in never abused women, as well as greater number of days spent in bed. Women who reported having experienced the three types of IPV were more likely to suffer a chronic disease (OR = 2.03; 95% CI = 1.18-3.51) and to spend more days in bed (t = 2.35; P = 0.019) than those never abused. Women abused in the past but not in the present presented a higher probability of having a chronic disease than never abused women, and women who had been abused both in the past and in the present had a higher probability of spending more days in bed. IPV can negatively affect physical health of the victims. It is therefore necessary to detect cases of IPV at a primary health care level.

Kinetic Therapy Beds Are Associated with More Complications in Patients with Thoracolumbar Spinal Column Injuries

Traumatic spine injuries are an important cause of morbidity and mortality. Kinetic therapy (KT) beds were designed to minimize skin breakdown and enhance clearance of pulmonary secretions by rotating the patient from side to side. However, little evidence exists to suggest that fewer complications occur in patients with thoracolumbar spine injuries (TLSIs) treated preoperatively with a KT bed. We investigated the effect of KT bed use on infectious complications and respiratory failure in patients requiring surgery for TLSIs. We queried the trauma registry of a Level 1 trauma center for patients who had surgery for a TLSI from January 1, 1994, through June 30, 2001, and performed a retrospective medical record review. Patients were divided into two groups according to whether they were treated with a KT bed preoperatively. Patient data included age, injury severity score (ISS), admission Glasgow Coma Scale score (GCS), time to surgery, narcotics administered in total and during the first 24 h after injury, the lowest recorded systolic blood pressure, and acute resuscitation volume requirement. Outcome data included infectious complications, neurologic deficits, respiratory failure, hospital length of stay (LOS), and number of days of ventilator support. Infectious complications included pneumonia, urinary tract infections, and surgical site infections. Patients treated with a KT bed and patients treated with a conventional bed were similar in age, ISS, admission GCS, time to surgery, total narcotics administered, lowest recorded systolic blood pressure, and resuscitation requirement during the first 24 h. However, patients with neurologic deficits were more frequently treated with a KT bed. Infectious complications were more common in patients receiving KT bed therapy than among those on conventional beds. The incidence of respiratory failure, the number of days of ventilator support, and hospital LOS also were significantly higher in patients treated with KT beds. The variables most predictive of infectious complications were the number of days of ventilator support, the amount of fluid administered during the first 24 h, and KT bed therapy (r2 = 0.459). Patients with TLSIs treated with a KT bed had a higher incidence of infectious complications and respiratory failure and more days of ventilator support than patients treated with a conventional bed despite similar ISS and time to surgical repair. The longer hospital LOS in patients treated with a KT bed may be secondary to the higher incidence of infectious complications and respiratory failure and the greater number of days of ventilator support.

Health-Related Quality of Life in Pediatric Patients with Irritable Bowel Syndrome:

The primary aim of the study was to investigate the generic health-related quality of life (HRQOL) of pediatric patients meeting Rome II criteria for irritable bowel syndrome (IBS) in comparison to healthy children. The secondary aim was to compare pediatric patients with IBS to pediatric patients with Rome II criteria diagnosed functional abdominal pain (FAP) and patients with diagnosed organic gastrointestinal (GI) disorders. The study also investigated the associations between GI symptoms with generic HRQOL and evaluated group differences in school days missed and days sick in bed and needing care. HRQOL was measured with the PedsQLtrade mark 4.0 Generic Core Scales (Physical, Emotional, Social, and School Functioning). The PedsQLtrade mark was administered in outpatient pediatric gastroenterology clinics in California, Texas, and New Jersey. A total of 287 families (280 child self-report, 286 parent proxy-report) with children diagnosed with IBS (n = 123), FAP (n = 82), or organic GI disorders (n = 82) participated. Pediatric patients with IBS demonstrated significantly lower Physical, Emotional, Social, and School Functioning in comparison to healthy children, and comparable HRQOL to patients with FAP and organic GI diagnoses. GI symptoms were significantly associated with generic HRQOL. Patients with IBS demonstrated a significantly greater number of days missed from school, days sick in bed/too ill to play, and days needing someone to care for them than healthy children, but significantly fewer days than patients with FAP and organic GI disorders. Pediatric patients with IBS demonstrated impaired HRQOL in dimensions measuring Physical, Emotional, Social, and School Functioning. These findings suggest the need for targeted interventions to address these dimensions of impaired HRQOL.

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Facilitation of Seedling Microsites by Rhododendron Caucasicum Extends the Betula Litwinowii Alpine Treeline, Caucasus Mountains, Republic of Georgia

ABSTRACTIn the Central Greater Caucasus Mountains, Georgia, Betula litwinowii (birch) occurs on north-facing slopes of east-west ridgelines that extend upward to high mountain peaks, forms the alpine timberline at higher elevation, and reaches its highest treeline limit only when associated with the broadleaf evergreen shrub, Rhododendron caucasicum. This association might generate an ecological facilitation of either temperatures or sky exposure, both of which have been related to the altitudes at which timberlines/treelines occur. At the lowest site (2072 m) the greatest abundance of birch seedlings (up to 2.3 seedlings/m2) occurred at shaded microsites beneath the B. litwinowii overstory and along shaded north-facing walls of polyhedral soil depressions just beyond this treeline. These seedling microsites also had substantially colder air and soil temperature regimes than more sun-exposed microsites. Similarly, at the highest elevation site (2512 m) the second greatest seedling abundance (0.73 seedlings/m2) occurred in the shaded understory beneath R. caucasicum. Moreover, these microsites had the coldest minimum air and soil temperatures (−1.3°C at 5 cm depths), along with the greatest number of days (40) with minimum soil temperatures <5°C recorded for the measurement period (11 July to 25 October 2003). In addition to the lowest number of seedlings, the more sun-exposed microsites at all sites also had the greatest percent (28–32%) of red leaves per plant, indicative of high concentrations of photoprotective anthocyanins. Thus, reduced sky exposure, and not cold temperature effects, was associated with greater seedling abundance and fewer red leaves per seedling, despite colder temperature regimes. Thus, facilitation of B. litwinowii seedling establishment by the R. caucasicum overstory appeared to extend the maximum altitude of the Betula treeline via reductions in sunlight exposure, despite lower temperatures.

Nosocomial Antibiotic-Associated Diarrhea Associated with Enterotoxin-Producing Strains of Methicillin-Resistant Staphylococcus Aureus

The aim of this study is to present new evidence that enterotoxin-producing strains of methicillin-resistant Staphylococcus aureus may cause nosocomial antibiotic-associated diarrhea. We conducted a prospective study that utilized standard methods to exclude other bacterial, parasitic, and viral pathogens as causes of nosocomial diarrhea in patients with heavy growth of methicillin-resistant S. aureus in their stool. Staphylococcal enterotoxin assays were performed on S. aureus strains recovered from patients' stools and on stool specimens from affected patients. Retrospective cohort studies compared the severity of diarrhea in patients with methicillin-resistant S. aureus-associated diarrhea with that of patients whose stool did not contain the organism and with patients colonized or infected with enterotoxin-negative methicillin-resistant S. aureus strains. During an 18-month period, 11 patients had nosocomial antibiotic-associated diarrhea associated with enterotoxin-producing strains of methicillin-resistant S. aureus. Other common bacterial, parasitic, and viral pathogens were excluded. S. aureus strains from the 11 patients produced staphylococcal enterotoxin A, A and B, or D. Eighty-nine percent of patients had the same enterotoxin(s) in stool specimens as produced by the strain recovered from their stool. Case patients had a greater number of days of diarrhea than patients without methicillin-resistant S. aureus in their stool (p < 0.001), or randomly selected patients colonized or infected with enterotoxin-negative methicillin-resistant S. aureus (p < 0.001). Our findings provide evidence that enterotoxin-producing strains of methicillin-resistant S. aureus may cause nosocomial antibiotic-associated diarrhea. Greater recognition of this disease should result in more rapid and appropriate treatment of affected patients.

Evaluation of Depressive Symptoms and Sleep Alterations in College Students

Increasing evidence suggests that sleep alterations could favor subsequent depression development. In order to identify the simultaneous occurrence of these parameters in young people, in this work we evaluated the prevalence of depressive symptoms, sleep habits, and possible sleep disturbances in college students. Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), and a Sleep Habits Questionnaire were applied to students registered at the Autonomous University of Yucatan, Merida (mean age 20.2 +/- 2.6 years). The final sample was composed of 340 (53%) women and 298 (47%) men. Reliability of the BDI and ESS was assessed by Cronbach's alpha method. Taking 10 as ESS cut-off point, it was found that 31.6% of the students had a high level of sleepiness. Students with depressive symptoms had a greater number of days with somnolence during class (p <0.05) and perceived that this affected their academic performance at a higher level (p <0.001) than the students without symptoms. In comparison to subjects without depressive symptoms, students with those symptoms rated their sleep quality as poor (p <0.001), perceived a greater latency to initiate sleep after going to bed (p <0.03), and experienced a greater number of awakenings (p <0.04). We found diverse sleep alterations in a large proportion of the studied subjects, which were more severe in those who showed depressive symptoms. Educating students for appropriate sleep hygiene and encouraging them to seek professional advice to treat sleep disturbances may be useful to prevent depression.

Effects of Absorbable Suture Strand Diameter on Retention of External Radio Transmitters by Juvenile Lake Sturgeon

Abstract We evaluated the effects of four absorbable suture strand diameters (numbers 3/0, 0, 1, and 2 [from smallest to largest diameter]) on the short-term retention of externally attached dummy radio transmitters by juvenile lake sturgeon Acipenser fulvescens (fork-length range, 257–293 mm; wet-weight range, 100–132 g). Four lake sturgeon were contained in each of 10 aquaria, and one fish in each tank was assigned to each of the four suture treatment groups. Transmitter retention was positively related to suture strand diameter, the mean retention duration for number 2 sutures being nearly twice as long (21 d) as that of number 3/0 sutures (11.8 d). The smallest suture (number 3/0) also exhibited the fewest number of days to transmitter loss (25% loss, 9 d; 50% loss, 11 d; and 75% loss, 14 d). In contrast, the largest suture (number 2) had the greatest number of days to transmitter loss (25% loss, 16 d; 50% loss, 21 d; and 75% loss, 26 d). Based on the diameter of sutures examined in this study, we rec...

Endometrial cancer risk with medroxyprogesterone appears to decrease with a greater number of days used per month

Endometrial cancer risk with medroxyprogesterone appears to decrease with a greater number of days used per month

Primary Pulmonary Sporotrichosis: A Case Report

To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded. A total of 156 adults (67 women and 89 men; mean [+/- SD] age, 48 +/- 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 +/- 7.5) with severe ARDS (ie, mean Pao(2)/fraction of inspired oxygen [Fio(2)] ratio, 91 +/- 48 mm Hg; mean oxygenation index [OI], 31 +/- 14) who had received CV for a duration of 5.6 +/- 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. Pao(2)/Fio(2) ratios and OI ([Fio(2) x mean airway pressure x 100]/Pao(2)) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 +/- 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV. HFOV has beneficial effects on Pao(2)/Fio(2) ratios and OI, and may be an effective rescue therapy for adults with severe oxygenation failure. The early institution of HFOV may be advantageous.

The association between smoking during pregnancy and hospital inpatient costs in childhood

Although the health sequelae of smoking during pregnancy are well documented, relatively little is known about its long-term economic implications. The objective of this study was to analyse individual-level data on maternal smoking behaviour and sociodemographic, perinatal and resource utilisation variables in order to estimate the association between smoking during pregnancy and hospital inpatient service utilisation and costs through the first 5 years of the infant's life. Data from the Oxford Record Linkage Study, a collection of birth registrations, death certificates and statistical abstracts of hospital inpatient and day case admissions formed the basis of the investigation. The study population comprised all infants born to women who both lived and delivered in Oxfordshire or West Berkshire during the period 1 January 1980–31 December 1989 (n=119,028). The cost of each hospital admission, including the initial birth admission, was estimated by multiplying the length of stay by the per diem cost of the respective specialty (£ 1998–1999 sterling). The effect of maternal smoking behaviour on cumulative 5-year hospital inpatient service utilisation and costs was analysed in a series of multivariate analyses, taking account of confounding clinical and sociodemographic factors. Infants born to women who reported smoking during pregnancy were hospitalised for a significantly greater number of days than infants born to women who had either never smoked or had smoked in the past (P<0.0001). Over the first 5 years of life, the adjusted mean cost difference was estimated at £462 (95%CI: £353–£571) when infants born to women who smoked at least 20 cigarettes per day were compared to infants of non-smoking mothers, and £307 (95%CI: £221–£394) when infants born to women who smoked 10–19 cigarettes per day were compared to infants of non-smoking mothers (P<0.0001). The results of this study should add an economic dimension to the importance of providing smoking cessation services for pregnant women.

High-Frequency Oscillatory Ventilation in Adults: The Toronto Experience

<h3>Study objectives:</h3> To review the clinical experience with high-frequency oscillatory ventilation (HFOV) in three medical-surgical ICUs in Toronto, ON, Canada, and to describe patient characteristics, HFOV strategies, and outcomes. <h3>Design and patients:</h3> Retrospective chart review of all patients treated with HFOV at three academic university-affiliated ICUs since 1998. The data extracted included patient demographics, etiology of respiratory failure, ventilator settings, and gas exchange and cardiovascular data from baseline to 72 h of treatment, as well as at the transition from HFOV to conventional ventilation (CV). Heart rate and BP were recorded at regular intervals in all patients, and hemodynamic data were recorded in 32 patients who had pulmonary artery catheters in place. Cointerventions and ICU mortality were also recorded. <h3>Measurements and results:</h3> A total of 156 adults (67 women and 89 men; mean [± SD] age, 48 ± 18 years; mean acute physiology and chronic health evaluation [APACHE] II score, 23.8 ± 7.5) with severe ARDS (<i>ie</i>, mean Pao₂/fraction of inspired oxygen [Fio₂] ratio, 91 ± 48 mm Hg; mean oxygenation index [OI], 31 ± 14) who had received CV for a duration of 5.6 ± 7.6 days underwent 171 trials of HFOV. HFOV was discontinued within 4 h in 19 patients (12%) because of difficulties with oxygenation, ventilation, or hemodynamics. Pao₂/Fio₂ ratios and OI ([Fio₂ × mean airway pressure × 100]/Pao₂) improved significantly with the application of HFOV, and this benefit persisted for the 72-h study duration. Significant changes in hemodynamics following HFOV initiation included an increase in central venous pressure and a reduction in cardiac output (throughout the 72 h), and an increase in pulmonary artery occlusion pressure (at 3 and 6 h). Patients were treated with HFOV for 5.1 ± 6.3 days. The 30-day mortality rate was 61.7%. Pneumothorax occurred in 21.8% of patients, 43.6% of patients were treated with inhaled nitric oxide, and 37.2% of patients were treated with steroids. Independent predictors of mortality on multivariate analysis were older age, higher APACHE II score, lower pH at the initiation of HFOV, and a greater number of days receiving CV prior to HFOV. <h3>Conclusions:</h3> HFOV has beneficial effects on Pao₂/Fio₂ ratios and OI, and may be an effective rescue therapy for adults with severe oxygenation failure. The early institution of HFOV may be advantageous.

A prospective assessment investigating the relationship between work productivity and impairment with premenstrual syndrome.

Our objective was to assess life domain and work-related impairment in patients experiencing premenstrual syndrome (PMS). A sample of women, 18 to 45 years of age, completed the Daily Rating of Severity of Problems Form to record daily symptoms for two consecutive menstrual cycles. In the workplace, women with PMS reported higher absenteeism rates (2.5 days vs. 1.3 days; P = 0.006) and more workdays with 50% or less of typical productivity per month (7.2 days vs. 4.2 days; P < 0.0001). Women with PMS in one of two menstrual cycles reported a greater number of days with impairment in routine work, school, and household activities in comparison with women without PMS. Results indicate that PMS leads to substantial im in normal daily activities and occupational productivity and significantly increased work absenteeism.

Within-person variation in serum lipids: implications for clinical trials.

Little is known about the degree to which behavioural, biological, and genetic traits contribute to within-person variation in serum cholesterol. Materials and Methods The authors studied within-person variation in serum total and high density lipoprotein (HDL) cholesterol in 458 participants of 27 dietary intervention studies in Wageningen, The Netherlands, from 1976 to 1995. For a median of 4 days between blood draws, the geometric mean of the within-person standard deviation was 0.13 mmol/l ( approximately 5 mg/dl, coefficient of variation = 3.0%) for total cholesterol and 0.04 mmol/l ( approximately 1.5 mg/dl, coefficient of variation = 3.0%) for HDL cholesterol. In mixed-model linear regressions using within-person variance as the dependent variable and including lipid concentration and covariates listed below, within-person variance of both total cholesterol and HDL cholesterol was higher for greater number of days between blood draws and for self-selected diet rather than investigator-controlled diet. Within-person variance of total cholesterol only was higher for non-standardized versus standardized phlebotomy protocol and for female sex. The authors found evidence that the APOA4 -347 (12/22 genotype) and MTP -493 (11 genotype) polymorphisms may increase the within-person variation in total cholesterol. Under certain study design (self-selected diet, use of non-standardized phlebotomy protocol) or participant characteristics (female, certain polymorphisms) within-person lipid variance is increased and required sample size will be greater. These findings may have important implications for the time and cost of such interventions.

Morbid obesity is not a contraindication to kidney transplantation

Background Concern that morbidly obese (body mass index [BMI] 35) kidney transplant recipients have worse outcomes than non-morbidly obese recipients leads many transplant centers to deny them the benefit of kidney transplantation. These concerns are supported by guidelines recently published by the American Society of Transplantation. However, successfully transplanted morbidly obese persons have a survival advantage over those that remain on dialysis. It is our practice to evaluate morbidly obese transplant candidates for transplantation under the same criteria used for nonobese candidates. This report reviews our experience with morbidly obese kidney transplant recipients having a three year follow-up. Methods Outcomes for 23 morbidly obese (BMI 35, range 37 to 56) kidney transplant recipients transplanted between January 1995 and February 2000 were compared with 224 nonobese (BMI 25) kidney recipients transplanted during the same period. Results Patient and graft survivals were similar between both groups. Although 3-year graft survival for morbidly obese recipients of cadaver organs was 75% compared with 90% for the nonobese group, this finding was not statistically significant, and 3-year graft survival was 100% for morbidly obese recipients of living donor organs compared with 91% for nonobese recipients. Morbidly obese recipients had significantly longer hospital stays, higher readmission rates, and a higher wound infection rate than nonobese recipients. Conclusions We found that morbidly obese persons have 3-year graft and patient survivals similar to nonobese persons. Although they also have greater complications and greater numbers of days in the hospital, we believe these reasons are not sufficient to deny morbidly obese persons the survival and quality-of-life advantages of kidney transplantation.

Smoking status and substance abuse severity in a residential treatment sample

Treatment seeking substance abusers were classified as current smokers or non-smokers to identify differences between groups on psychiatric and substance use severity variables. The Addiction Severity Index (fifth edition; ASI) was administered to 313 substance abusers seeking treatment in a private, residential addictions treatment program. Since current smokers were younger and less educated than non-smokers, these variables were entered as covariates in all analyses. As measured by the ASI, current smokers experienced a significantly greater number of days with drug problems in the last 30 days and were seen as being in significantly more need of drug treatment and alcohol treatment by ASI interviewers. These findings indicate that smoking status may be a marker for greater substance use severity, although the fact that participants were not randomly assigned to groups precludes making causal interpretations of these data. Areas of future research are suggested including examining the potential mediating role of third variables such as personality and temperament.

The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury.

The purpose of this study was to determine the incidence of acute lung injury (ALI) in trauma patients with severe traumatic brain injury (TBI), to evaluate the impact of ALI on mortality and neurologic outcome after severe traumatic brain injury (TBI), and to identify whether the development of ALI correlates with the severity of TBI. Clinical data were collected prospectively over a 4-year period in a Level I trauma center. Patients included in the study met the following criteria: mechanical ventilation > 24 hours, head Abbreviated Injury Scale score >or= 3, no other body region Abbreviated Injury Scale score >or= 3, and age between 18 and 54 years. ALI was defined using international consensus criteria. Glasgow Outcome Scale scores were assessed at 3 and 12 months. Bivariate comparisons were made between ALI and non-ALI groups. Multivariate analysis with stepwise logistical regression was used to assess independent factors on mortality. The patient's admission head computed tomographic (CT) scan was graded using the Marshall system, and the presence and size of specific intracranial abnormality was noted. Glasgow Coma Scale (GCS) score, Marshall CT scan score, and intracranial abnormality were correlated with the development of ALI. One hundred thirty-seven patients with isolated head trauma were enrolled in the study over a 4-year period. Thirty-one percent of patients with severe TBI developed ALI. Head trauma patients with ALI had a significantly higher ISS, a greater number of days on the ventilator, and a worse neurologic outcome for those who survived their hospitalization. Mortality was 38% in the ALI group and 15% in the non-ALI group (p = 0.004). Only 3 of 16 (19%) of the deaths within the ALI group were directly related to ALI. By multivariate analysis, only the presence of ALI, older age, and lower initial GCS score were associated with higher mortality. There was no association between ISS, the presence of arterial hypotension (arterial systolic pressure < 90 mm Hg) at admission to the hospital, or the amount of blood transfused and mortality. No correlation was found between the severity of head injury (GCS score, Marshall score, or intracranial abnormality) and development of ALI. The development of ALI is a critical independent factor affecting mortality in patients suffering traumatic brain injury and is associated with a worse long-term neurologic outcome in survivors. The risk of developing ALI is not associated with specific anatomic lesions diagnosed by cranial CT scanning.

The impact of psychological distress on absence from work.

The aims of this study were to examine the impact of psychological distress on absence from work; to compare psychological distress and job satisfaction as predictors of absence; and to compare the relative effects of 2 components of psychological distress, depression and anxiety, on absence. Organizational records of absence over a 3-year period were obtained for 323 health service staff in the United Kingdom, who also completed self-report measures of psychological distress and job satisfaction at the beginning of the study and 2 years later. Psychological distress, particularly depression, was found to predict absence, with higher levels of distress predicting a greater number of days and number of times absent. Job satisfaction and psychological distress independently predicted levels of absence. The psychological distress-absence relationship was not moderated by demographic variables.

Depressive symptoms and readiness to quit smoking among cigarette smokers in outpatient alcohol treatment.

The authors examined whether length of alcohol abstinence and depressive symptoms were related to motivational readiness to consider smoking cessation among patients in alcohol treatment. Participants were adults (N = 253) enrolled in a smoking cessation trial. Controlling for gender, depressive symptoms, and nicotine dependence, hierarchical regression analysis of readiness scores revealed a significant interaction of days since last drink and depressive symptoms. It was found that a greater number of days since last drink was associated with greater readiness, but only among patients with low scores on the Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). The findings suggest that alcoholic smokers with low depressive symptoms are more receptive to quitting smoking after sustained alcohol abstinence.