Relevant Medical Conditions Research Articles

The effect of work location on urolithiasis in health care professionals

The objective of this study is to compare the prevalence and risks factors for urolithiasis among health care professionals who work in the operating room (OR) versus other locations. Electronic surveys, focusing on a history of urolithiasis, were sent to 3,921 randomly selected employees at our institution, 34% (1,340) of which worked in an OR. Additional information regarding potential risk factors such as quantity of daily fluid intake, stress level, activity level, body mass index, relevant medical conditions and family history of urolithiasis were obtained and analyzed. Of those surveyed, 46% (1,802/3,921) responded. The prevalence of urolithiasis for all responders was 10.9% (196/1,802). Those individuals working in an OR had a higher prevalence of stone disease compared to those who work elsewhere [14.6% (64/439) versus 9.7% (132/1,363); p=0.004]. Specifically, physicians that work in an OR had the highest prevalence of urolithiasis [17.4% (20/115) versus 9.7% (132/1,363); p=0.009). Additionally, physicians that work in an OR reported significantly less fluid intake (p=0.04) and higher stress levels (p<0.0001) compared to employees not working in an OR. On multivariate analysis, working in an OR remained associated with a significantly increased risk stone formation (HR 1.43; p=0.04). Our survey found that health care professionals working in an OR setting, and physicians in particular, are at higher risk of urolithiasis.

PSY2 - Thirty-day complications following bariatric surgery

In this study, we quantify common complications that happen within 30 days of bariatric surgery, determine if risk of complication depends on the type of bariatric procedure, and identify risk factors for each procedure type. Medical claims data were used to obtain information on 5,527 patients in the southeastern PA region who had one of three bariatric procedures between January 2009 and May 2012. Relevant pre-existing medical conditions and common complications within 30 days of surgery were identified by diagnosis and procedure codes from claims. Logistic regression models were used to determine significant predictors of having a complication, controlling for factors such as age, gender, illness burden, and facility effects. There were 5,527 surgeries, of which 60% were gastric bypass, 29% were adjustable band, and 11% were gastric sleeve procedures. The most common complications within 30 days of surgery were nausea and vomiting, anastomatic leakage, intestinal obstruction, dehydration, and vitamin deficiency. After controlling for factors such as age, gender, illness burden, and facility, patients undergoing gastric bypass or gastric sleeve had significantly greater odds of developing complications than patients who had the adjustable band. The strongest predictors for complications for gastric bypass were a history of COPD, hypertension, or deep venous thrombosis/ pulmonary embolism. For gastric sleeve, depression was a significant risk factor, and for the adjustable band, a history of COPD, deep venous thrombosis/pulmonary embolism, or type II diabetes were significant risk factors. The type of procedure (gastric bypass, gastric sleeve, or adjustable band) plays a significant role in the risk for complications within 30 days of bariatric surgery, with gastric bypass and gastric sleeve procedures having greater odds of complication than the adjustable band procedure. Certain pre-existing conditions such as COPD and deep venous thrombosis/pulmonary embolism also increase the odds for complications.

Ethnicity, body mass index and risk of pre‐eclampsia in a multiethnic New Zealand population

Pre-eclampsia rates are reported to vary by ethnicity; however, few studies include body mass index (BMI). Increasing BMI has a dose-dependent relationship with pre-eclampsia, and rates of overweight and obesity as well as ratios of body fat to muscle mass differ between ethnicities. We hypothesised that after adjusting for confounders, including ethnic-specific BMI, ethnicity would not be an independent risk factor for pre-eclampsia. To assess independent pre-eclampsia risk factors in a multiethnic New Zealand population. We performed a retrospective cohort analysis of prospectively recorded maternity data from 2006 to 2009 at National Women's Health, Auckland, New Zealand. After exclusion of infants with congenital anomalies and missing data, our final study population was 26 254 singleton pregnancies. Multivariable logistic regression analysis adjusted for ethnicity, BMI, maternal age, parity, smoking, social deprivation, diabetes, chronic hypertension and relevant pre-existing medical conditions was performed. Independent associations with pre-eclampsia were observed in Chinese (adjusted odds ratio (aOR) 0.56, [95% CI 0.41-0.76]) and Māori (aOR 1.51, [1.16-1.96]) compared with European women. Other independent risk factors for pre-eclampsia were overweight and obesity, nulliparity, type 1 diabetes, chronic hypertension and pre-existing medical conditions. Contrary to our hypothesis, we report an independent reduced risk of pre-eclampsia in Chinese and increased risk of pre-eclampsia in Māori women. Prospective studies are required to further explore these relationships. Other independent risk factors are consistent with international literature. Our findings may assist clinicians to stratify risk of pre-eclampsia in clinical practice.

Cardiometabolic risk factors in people with psychotic disorders: The second Australian national survey of psychosis

To determine the prevalence of cardiometabolic risk factors in Australian adults with a psychotic disorder. Data were collected during the interview phase of the second Australian survey of psychosis, a population-based survey of Australians aged 18 to 64 years with a psychotic disorder. Body mass index, waist circumference and blood pressure were measured. Participants were asked about diagnoses of relevant medical conditions, medications, smoking and physical activity. Fasting blood samples were analysed for glucose, high-density lipoprotein cholesterol, total cholesterol and triglycerides. The prevalence of metabolic syndrome was determined using the harmonized criteria developed by the International Diabetes Federation and other bodies. A total of 1087 men (60%) and 738 women (40%) participated. Their mean age was 38.36 (SD 11.16) years; 773 (42%) were aged 18-34 years and 1052 (58%) 35-64 years. Three-quarters were overweight or obese and 82% had abdominal obesity. Almost half were hypertensive. Two-thirds were current smokers and 81% had a lifetime history of smoking. Levels of physical activity were very low. About 30% reported a diagnosis of hypertension or high cholesterol, 20% knew they had diabetes or high blood sugar and 18% had cardiovascular disease. Half of those with self-reported hypertension were taking antihypertensive drugs, and about 40% with hypercholesterolemia or hyperglycaemia were receiving medication for these conditions. Seventy per cent (N = 1286) of participants provided fasting blood samples. Abnormal levels of high-density lipoprotein cholesterol and triglycerides were each found in almost half of participants and almost one-third had elevated fasting glucose. More than half of participants (54.8%) met criteria for metabolic syndrome. Australians living with psychosis have high rates of cardiometabolic risk factors. There are a number of obvious targets for prevention and treatment, including obesity (especially in women), smoking (more prevalent in men), hypertension, hyperlipidaemia and sedentary lifestyle.

Provider acceptance, safety, and effectiveness of a computer-based decision tool for colonoscopy preparation

Purpose To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. Methods We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. Results Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P < 0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P = 0.29), acceptable prep quality (62% vs. 56%; P = 0.22), colonoscopy duration (28 vs. 30 min; P = 0.17), patient satisfaction ( P = 0.38), or preparation tolerance ( P = 0.37). Conclusions An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. Limitations This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care.

Contemporary epidemiology of gout in the UK general population

IntroductionThe objective of this study was to investigate the contemporary incidence of gout, examine potential risk factors, and evaluate specific gout treatment patterns in the general population.MethodsUsing the health improvement network (THIN) UK primary care database, we estimated the incidence of gout based on 24,768 newly diagnosed gout patients among a cohort of 1,775,505 individuals aged 20 to 89 years between 2000 and 2007. We evaluated potential risk factors for incident gout in a nested case-control study with 50,000 controls frequency-matched by age, sex and calendar time. We calculated odds ratios (OR) by means of unconditional logistic regression adjusting for demographic variables, lifestyle variables, relevant medical conditions and drug exposures.ResultsThe incidence of gout per 1,000 person-years was 2.68 (4.42 in men and 1.32 in women) and increased with age. Conventional risk factors were significantly and strongly associated with the risk of gout, with multivariate ORs of 3.00 (95% confidence interval (CI)) for excessive alcohol intake (that is, more than 42 units per week), 2.34 (95% CI 2.22 to 2.47) for obesity (body mass index > = 30 kg/m2), 2.48 (95% CI 2.19 to 2.81) for chronic renal impairment, and 3.00 (95% CI 2.85 to 3.15) for current diuretic use. For other medical conditions the multivariate OR were 1.84 (95% CI 1.70 to 2.00) for heart failure, 1.45 (95% CI 1.18 to 1.79) for hypertriglyceridemia and 1.12 (95% CI 1.04 to 1.22) for psoriasis. Use of cyclosporine was associated with an OR of 3.72 (95% CI, 2.17 to 6.40). Among gout-specific therapies, allopurinol was the most frequently used with a one-year cumulative incidence of 28% in a cohort of incident gout diagnosed from 2000 to 2001. Use of gout-specific treatment has not changed over recent years except for an increase of colchicine.ConclusionsThe contemporary incidence of gout in UK remains substantial. In this general population cohort, associations with previously purported risk factors were evident including psoriasis, heart failure, hypertriglyceridemia, and cyclosporine therapy. Use of gout-specific treatment has remained relatively constant in recent years except for an increase of colchicine.

Medical Conditions Treated by Acupuncture: A Preliminary Review of Randomized Controlled Trials

Background: Physicians, patients, researchers, healthcare providers, and national health authorities have questioned which medical conditions can be treated by acupuncture. An increasing number of randomized controlled trials (RCTs) have involved acupuncture treatment. Objectives: To present a preliminary review of RCTs in PubMed and to summarize relevant medical conditions that can be treated by acupuncture. Design, Setting, and Subject: A PubMed search was performed to identify qualified RCTs from January 1978 to December 2007. Two reviewers independently extracted data for analysis. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was used for disease classifications. Main Outcome Measures: The total number of RCTs for every medical condition, RCTs for every major class, and the percentages of major class. Results: A total of 587 RCTs were identified; 130 medical conditions covered 16 major groups: diseases of the musculoskeletal system and connective tissue (21 conditions, 16.2% of the total number of conditions); diseases of the nervous system (17, 13.1%); diseases of the genitourinary system (14, 10.8%); mental and behavioral disorders (12, 9.2%); diseases of the digestive system (12, 9.2%); and injury, poisoning, and other consequences of external causes (12, 9.2%). Each of the remaining systems comprised less than 7%. Conclusions: Acupuncture has been tested in a wide range of diseases and disorders, with the most studies conducted in diseases of the musculoskeletal system and connective tissue, the nervous system, and the genitourinary system. Based on our analysis, painful conditions occupied a large proportion of acupuncture RCTs whereas little attention focused on diseases of the eye, skin, and infections.

The Impact of Co-Morbidities on Age-Related Differences in Mortality after Acute Traumatic Spinal Cord Injury

Despite the shift in demographics of spinal cord injury (SCI) due to an aging population, relatively little has been reported regarding the effect of age on outcomes after SCI. This study examines the potential confounding effect of co-morbidities on the age-related differences in the hospital mortality following acute traumatic SCI. All consecutive patients with SCI who were admitted to our spine center from 1996 to 2007 were included. Co-morbidities were classified using the Charlson Co-morbidity Index (CCI), Cumulative Illness Rating Scale, and the number of ICD-9 codes. Major potential confounders included age, gender, co-morbidity, and level and severity of SCI. There were 217 males and 80 females with ages from 15 to 96 years. Most patients had an incomplete cervical SCI following falls or motor vehicle accidents. The mean in-hospital mortality rate was 5.7%. Using univariate analyses, older age, relevant pre-existing medical conditions, and motor complete SCI were major risk factors for in-hospital death after acute SCI. Among the three co-morbidity assessments, the CCI was the most reliable co-morbidity index for prediction of hospital mortality in SCI patients after controlling for age in the Cox proportional hazard modeling. In addition, the CCI appears to be a major confounder, which accounts for the majority of age-related differences in mortality following SCI. Our findings have implications for future clinical trials of therapies for adult patients with acute SCI and for management strategies of elderly individuals with SCI.

On Health-enabling and Ambient-assistive Technologies

To provide an introductory overview on selected areas of health-enabling and ambient-assistive technologies and to suggest relevant fields for future research. Summarizing the state of the art for 1) ambient environments and 2) health-related sensor technologies, 3) presenting relevant medical conditions and their relation to health-enabling technologies, and 4) illustrating the application of those technologies for lifestyle management with examples for activity monitoring and prevention of overweight. The suggestions for future research are based on own research projects in this field. Health-enabling and ambient-assistive technologies are regarded to have the potential to significantly improve quality of life and efficiency of health care in aging societies. Research on health-enabling and ambient-assistive technologies is highly multidisciplinary. It still has, to a large extent, to be exploratory. An increasing amount of outcomes research through well-designed evaluation studies that explore technical solutions in a social context and in relation to individual needs will be crucial.

Experience of road and other trauma by the opiate dependent patient: a survey report

BackgroundTrauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions.MethodsA survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia.ResultsOf 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean ± S.D. 33.72 ± 8.14 vs. 44.24 ± 16.91 years, P < 0.0001) and had shorter driving histories (15.96 ± 8.50 vs. 25.54 ± 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38–13.63), duration of suspensions (1.71 ± 3.60 vs. 0.11 ± 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 ± 3.30 vs. 1.10 ± 1.32, P = 0.01), numbers of cars repaired (1.73 ± 3.59 vs. 1.08 ± 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13–3.25), running away after car crashes (O.R. = 26.37, CI 4.31–1077.48), other people hospitalized (O.R. = 2.00, C.I. 0.93–4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80–14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99–4.80) and road (O.R.= 2.73, C.I. 2.36–3.15) trauma.ConclusionThis study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.

Factors associated with nonmedical use of prescription opioids among heroin-abusing research volunteers.

This retrospective study examined factors associated with nonmedical opioid use among 208 heroin-abusing research volunteers in the metropolitan Detroit area. Drug and medical history data were obtained from structured questionnaires administered during screening for behavioral pharmacology research studies. Analyses included demographic data (gender and race), history of drug use (prescribed, nonmedical, and route of use), and potentially relevant medical conditions (e.g., pain). All volunteers (mean age=43 years) reported chronic heroin use (mean duration=21 years), with 66% currently injecting heroin. Two multiple logistic regression analyses were used to identify factors related to lifetime and current nonmedical opioid use (predicted variables). Odds ratios (ORs) from logistic regression--which predicted membership in lifetime heroin use only (n=52) versus heroin plus nonmedical opioid use (n=156) groups--indicated that nonmedical opioid use was significantly associated with legitimate prescription opioid use (OR=10.5), having ever sought treatment for heroin use (OR=4.21), and a history of lung problems (OR=3.66) and dental pain (OR=2.58). The finding of a significant positive association (R(2)=.83) between lifetime rates of medical and nonmedical use of specific opioids in this study is consistent with previous observations that prescription opioid use or availability is a prominent risk factor for nonmedical opioid use. A limitation of this study is that age-of-onset data were not originally collected; thus, the relative (predictive) order of pain conditions, medical use, and nonmedical use of opioids cannot be determined retrospectively.

Exploratory Polysomnographic Evaluation of Pregabalin on Sleep Disturbance in Patients with Epilepsy

To evaluate the effects of adjunctive pregabalin 300 mg/day versus placebo on polysomnographic (PSG) variables in patients with well controlled partial seizures and subjectively reported sleep disturbance. An exploratory, 4-week, double-blind, randomized study in patients with well controlled partial seizures on AED monotherapy and subjective sleep disturbance over the previous 6 months. Mean changes from baseline to endpoint in PSG and subjective sleep variables (MOS Sleep Scale, Groningen Sleep Questionnaire) in patients on adjunctive pregabalin 300 mg/day (n=8) were compared with patients on placebo (n=7). Baseline PSGs showed sleep fragmentation. Mean sleep efficiency improved significantly in both treatment groups in the mean baseline to endpoint change; there was no significant between-group difference. Pregabalin treatment was associated with a significant reduction in number of awakenings (p = 0.02), and improvement in wake time after sleep onset approached significance (p = 0.055), suggesting improvement in sleep continuity that was not observed in the placebo group. Pregabalin was also associated with significant improvements in the MOS sleep disturbance and sleep quantity subscales compared with placebo (p < or =0.03). There were no changes in self-reported seizure control. This exploratory pilot study suggests that pregabalin may improve sleep continuity in patients with clinically relevant sleep disturbance. The effect on disturbed sleep appears independent of seizure control. The effects of pregabalin on disturbed sleep and seizures and their interrelationships warrant further study.

American Academy of Neurology position statement on physician reporting of medical conditions that may affect driving competence

The American Academy of Neurology (AAN) represents over 20,000 neurologists and neuroscience professionals, many of whom have patients for whom driving is an uncertain privilege due to the progression of diseases that affect cognition, consciousness, vision, or motor skills. Physicians are expected to report a patient’s driving-related condition to driving authorities when it appears that the condition might pose a safety risk to the patient or others, especially when a patient is noncompliant with requests to be tested or stop driving. Making reporting a mandatory requirement, however, may have a strongly negative impact upon the patient–physician relationship, and may ultimately provide no greater safety benefits to the public or the patient, who may feel compelled to withhold important medical information. Poorly designed reporting laws may also expose physicians to undeserved liability for a patient’s driving outcomes, even when a physician has followed all applicable laws honestly and capably. For these reasons and more, the AAN has developed a new position statement to promote better policies for all parties involved in the discussion: patients, private citizens, and physicians alike. Driving laws for individuals with relevant medical conditions vary greatly from state to state. Current or would-be drivers with medical conditions of interest are expected to disclose their condition to the state Department of Motor Vehicles (DMV) and to obtain a physician’s note to confirm their fitness to drive. Many of these conditions (but not all) are neurologic in nature, such as dementia, epilepsy, and Parkinson disease. On a discretionary or mandatory basis, a physician may be obligated to report a patient to the DMV when that patient’s medical condition makes driving a hazardous proposition. According to the Epilepsy Foundation, six states currently have some form of mandatory-reporting law in place (California, Delaware, Nevada, New Jersey, Oregon, and Pennsylvania) for various medical …

Cerebral Perfusion Changes in Older Delirious Patients Using 99mTc HMPAO SPECT

Prior studies describe variable cerebral blood flow changes in delirium. This study aims to investigate cerebral blood flow changes in older hospitalized patients with delirium, the population in which most cases of delirium occur. Participants included hospitalized general medical patients aged 65 years and older with documented delirium and no relevant medical conditions or preexisting abnormalities on neuroimaging prospectively studied using 99mTc HMPAO single photon emission computed tomography (SPECT) scans obtained during and after resolution of delirium. Twenty-two patients enrolled in the study, of whom six completed both scans. All participants underwent neuropsychological assessment immediately prior to SPECT scanning. SPECT images were compared across all participants during delirium; for patients completing paired scans, within-patient comparisons were made. Visual assessment of SPECT scans revealed perfusion abnormalities in frontal (5 participants) or parietal regions (6 participants); scans were normal in 11 participants (50%). Region-of-interest analysis identified reduced blood flow (p <.01) in the left inferior frontal, right temporal, right occipital, and pontine regions. Analysis of paired scans revealed reversible abnormalities in three participants (p <.001), with decreased right parietal perfusion in two participants and increased left parietal perfusion in one participant. The results of this study of a small group of general medical patients are suggestive that frontal or parietal cerebral perfusion abnormalities occur in delirium, and these findings need to be confirmed by future, larger studies. These results may help to improve basic understanding of delirium pathophysiology, to identify long-term changes, and to evaluate response to treatment over time.

Use of Levetiracetam in Hospitalized Patients

The objective of the study was to analyze the short-term efficacy and safety of levetiracetam (LEV) to treat repetitive seizures in hospitalized patients. During admission to a tertiary hospital, we retrospectively identified patients with repetitive seizures who were treated for the first time with LEV during a hospital stay. LEV was considered effective if seizure cessation or >75% seizure reduction occurred in the 24 h after starting LEV (compared with the previous 48 h), requiring no further antiepileptic drug (AED) treatment. Thirty patients (12 men, 18 women) were included. Mean age was 59.7 years. Most frequent seizure type was focal motor in 12 (40%) of 30 patients. Most frequent etiology was stroke: nine (30%) of 30 patients. Relevant medical conditions included atrial fibrillation (three) and hepatic disease (three). Concomitant medications included oral anticoagulants (seven), corticosteroids (two), and chemotherapy (two). Four patients received LEV as the only AED. Six patients with focal SE and 20 (66.6%) patients with clusters of seizures but not in SE received LEV as add-on treatment after lack of response to first-line AEDs. Mean LEV dose during first day was 1,119 mg. Mean daily maintenance dose was 1,724 mg. LEV was effective in 24 (80%) patients, all four patients who received it as the only AED, four of six patients with focal SE, and 16 of 20 patients with clusters of seizures. Three (10%) elderly patients with seizures secondary to stroke and chronic obstructive pulmonary disease (COPD) reported moderate/severe somnolence and dizziness, leading to treatment discontinuation in one. On discharge, 20 (66.7%) patients continued on LEV, nine (30%) as the only AED. LEV is effective and safe to treat repetitive seizures in hospitalized patients, including patients in focal SE.

Traumatic Iris Loss In A Pseudophakic Patient

Traumatic Iris Loss In A Pseudophakic Patient

Incarceration and Veterans of the First Gulf War

This study investigated the prevalence of incarceration and the association with deployment among veterans of the first Persian Gulf War (GW). A structured telephone interview of military personnel from Iowa deployed to the Persian Gulf and a comparison sample of nondeployed military personnel was conducted. The interview consisted of validated questions, validated instruments, and investigator-derived questions to assess relevant medical and psychiatric conditions. A total of 4,886 subjects were randomly drawn from one of four study domains, i.e., GW regular military, GW National Guard/Reserve, non-GW regular military, or non-GW National Guard/Reserve. Symptoms of medical conditions, psychiatric disorders, and health care utilization were the main outcome measures. Nearly one-quarter (845 of 3,695 subjects, 22.9%) had been incarcerated at some point before the interview ("ever incarcerated"). Ever incarcerated veterans had a higher frequency of psychiatric and medical comorbidity and higher rates of health care utilization. Ever incarcerated status was associated with male gender, enlisted rank, lower educational levels, low levels of military preparedness, discharge from service, cigarette smoking, antisocial traits, court martial and/or other military discipline, having seen a mental health professional, and having used illegal drugs. GW veterans who participated in combat had a modestly higher risk for incarceration after the GW than did noncombatants (odds ratio, 1.6; 95% confidence interval, 1.0-2.5). Military recruits with a history of incarceration more often displayed problematic behaviors, more often developed psychiatric/medical conditions, and had high rates of health care utilization. A history of incarceration may be a behavioral marker for substance abuse, antisocial behavior, and mental illness. Importantly, GW deployment carried no increased risk of subsequent incarceration overall.

Childhood Abuse and Later Medical Disorders in Women

Background: There have been many studies documenting adverse psychiatric consequences for people who have experienced childhood and adult sexual and physical abuse. These include posttraumatic stress disorder, anxiety, depression, substance abuse, eating disorders and probably some personality disorders or trait abnormalities. Much less is known about the links between abuse and physical/psychosomatic conditions in adult life. Hints of causal links are evident in the literature discussing headache, lower back pain, pelvic pain and irritable bowel syndrome. These studies are not definitive as they use clinic-based samples. Methods: This study used interview data with a random community sample of New Zealand women, half of whom reported childhood sexual abuse and half who did not. Details about childhood physical abuse and adult abuse were also collected in a two-phase study. Results: Complex relationships were found, as abuses tended to co-occur. Seven of 18 potentially relevant medical conditions emerged as significantly increased in women with one or more types of abuse. These were chronic fatigue, bladder problems, headache including migraine, asthma, diabetes and heart problems. Several of these associations with abuse are previously unreported. Conclusions: In this random community sample, a number of chronic physical conditions were found more often in women who reported different types of sexual and physical abuse, both in childhood and in adult life. The causal relationships cannot be studied in a cross-sectional retrospective design, but immature coping strategies and increased rates of dissociation appeared important only in chronic fatigue and headache, suggesting that these are not part of the causal pathway between abuse experiences and the other later physical health problems. This finding and the low co-occurrence of the identified physical conditions suggest relative specificity rather than a general vulnerability to psychosomatic conditions in women who have suffered abuses. Each condition may require separate further study.

Association between renal insufficiency and malnutrition in older adults: Results from the NHANES III

The extent to which relevant confounding variables influence the recognized association between renal insufficiency and malnutrition is not known. This study examined whether renal insufficiency was associated with malnutrition, independent of relevant demographic, social, and medical conditions in noninstitutionalized adults 60 years of age and older. Participants (5248) in the United States Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994), a cross-sectional study, were examined in a multivariate logistic regression model. Participants were stratified into three groups of glomerular filtration rate (GFR) by serum creatinine. Dietary and nutritional factors were estimated from 24-hour dietary recall, biochemistry measurements, anthropometry, and bioelectrical impedance. Participants were malnourished if they demonstrated at least three of the following five criteria: (1) serum albumin < or =37 g/L, (2) male weight < or =63.9 kg, female weight < or =51.8 kg, (3) serum cholesterol <4.1 mmol/L, (4) energy intake <15 kcal/kg/day, and (5) protein intake <0.5 g/kg/day. A GFR <30 mL/min/1.73 m(2) was present in 2.3% of men and 2.6% of women; these participants demonstrated low energy and protein intake and higher serum markers of inflammation. Thirty-one percent of individuals with malnutrition demonstrated a GFR <60 mL/min/1.73 m(2). In multivariate analysis, a GFR <30 mL/min/1.73 m(2) was independently associated with malnutrition [odds ratio 3.6 (2.0 to 6.6)] after adjustment for relevant demographic, social and medical conditions. It is probable that renal insufficiency is an important independent risk factor for malnutrition in older adults. Malnutrition should be considered, prevented, and treated as possible in persons with clinically important renal insufficiency. These results should be confirmed in a prospective longitudinal cohort study.

Injuries. Thiazide diuretics and the risk of hip fracture among 70-79 year old women treated for hypertension

A possible protective effect of thiazide diuretics against the risk of hip fracture was investigated in a case-control study among 70-79 year old women who had been continuously treated with anti-hypertensive drugs for at least 5 years. In 1992, 2 independent national random samples of general practitioners and internists from West Germany identified 311 cases, who had suffered from their first hip fracture in 1991 or 1992 and 414 controls without any fracture of the hip. Besides relevant information about personal characteristics and medical conditions, the physicians provided detailed documentation of all drug prescriptions between 1986 and 1992 using patient records. Odds ratios (adjusted ORs) with 95% confidence intervals (95% Cl) for the association between hip fracture and prescription of thiazides were adjusted for putative confounders such as age, body mass index, smoking habits, alcohol consumption and relevant medical conditions. For prescriptions of any thiazide diuretics for at least 2 consecutive quarters during the period 1986-1990 the adjusted odds ratio was 0.93 (95% Cl: 0.65-1.34). The OR was lower for drugs containing pure thiazides (adjusted OR = 0.74, 95% Cl: 0.33-1.67), but the risk reduction was not statistically significant. For drugs containing thiazides in combination with other agents the adjusted OR was 0.97 (95% Cl: 0.66-1.42). There was no significant association between the duration or cumulative doses of thiazide prescriptions and the risk of hip fracture. In conclusion, these data provide only little evidence, if any, of a protective effect of thiazide diuretics against the risk of hip fracture among 70-79 year old women treated for hypertension.