Associations between IQ and alcohol consumption in a population of young males: a large database analysis.

PURPOSE: This study aimed at exploring the relationship between intelligence quotient (IQ) and alcohol consumption in a large sample of young males. This study explored whether IQ influences alcohol drinking and which pathways might be involved. We further hypothesized that IQ differences between lifetime abstainers and former drinkers exist, and that they primarily result from different group characteristics. METHOD: Within a psychiatric-epidemiological survey using a cross-sectional design IQ-tests were administered to approximately 50,000 Swiss conscripts at age of about 20 years. The sample was divided into four alcohol consumption categories (rare, occasional, moderate and daily drinking) and two non-drinker categories (former drinking and lifetime abstinence). Probabilities for different levels of consumption or former drinking against lifetime abstention in relation to IQ were estimated using multinomial logistic regression. Models were adjusted for education, disability pension, tobacco/cannabis use, migration, parental alcohol disorders, and mental health. RESULTS: After adjusting for confounders full-scale IQ displayed positive associations with being a rare (OR 1.13; CI 95 % 1.07-1.19), occasional (OR 1.41; CI 95 % 1.33-1.48), and moderate drinker (OR 1.53; CI 95 % 1.45-1.62), and negative associations with being a former drinker (OR 0.85; CI 95 % 0.79-0.93). Daily drinking was positively associated only with the performance subscale IQ (OR 1.12; CI 95 % 1.02-1.22). Confounders contributed significantly to the IQ-alcohol association and, therefore, highlight the distinction of non-drinkers into lifetime abstainers and former drinkers. CONCLUSIONS: Our data confirmed the positive link between IQ and moderate drinking. Lower IQ in non-drinkers, however, seems to be related to earlier consumption and the presence of other risk factors.

[Outpatient surgery in hospital. An instrument for resource optimization?]. / Ambulante Chirurgie am Krankenhaus. Ein Instrument zur Belegungssteuerung?

The societies of western countries are facing enormous economic and social challenges. Despite a declining population size the number of elderly patients is growing and will lead to an increase in cases of trauma in the near future. In addition, the health care system will have to be financed by a reduced labor force. To realize the ambitious political goal of providing comprehensive medical care an economization of hospital treatment must be achieved. The bottleneck within the surgical specialties in case of efficient scheduling will be the capacity utilization of the operating theatres. Additional separate outpatient operating theatres adjacent to hospitals could be an efficient instrument for using resources and economizing medical procedures. Considering the socio-demographic alterations of our society an adequate discussion regarding the general medical conditions is essential.

[The challenge of auditing by medical health insurance inspectors: development of individual case inspections according to 275ff SGB V]. / Herausforderung: MDK-Prüfung: Entwicklung der Einzelfallprüfungen gemäss 275ff SGB V.

BACKGROUND: The German DRG (diagnosis-related groups) system has changed since the inauguration in 2005, whereby written inquiries and on-site auditing have been carried out by the medical inspection service for health insurance companies (MDK). Modifications in the G-DRG system are reflected in changes in the MDK visitations. This article describes exactly how these examinations have changed over time. In order to achieve this all auditing reports were evaluated. RESULTS: In the beginning correct coding and documentation were the most interesting items for the health insurance fund inspectors. Nowadays, length of in-patient treatment and specific points relating to current changes in the G-DRG system are being questioned. All areas of the hospital have now been examined during this period. There was no change in the loss resulting from the regular examinations over the years. However, the effort and input of manpower are extremely high. CONCLUSIONS: To cope with the changes in the German DRG system hospitals have to be flexible. The experiences with the regular MDK visitations can positively influence hospital organizational structures.

[Cost analysis for ambulatory patients in internal medicine]. / Kostenanalyse ambulanter Patienten einer medizinischen Poliklinik.

We analyzed the diagnostical and therapeutical costs of 300 ambulatory patients over a two year period in a Swiss university policlinic of internal medicine. The calculations were based on the catalogue of hospital services (Spitalleistungskatalog) and the drugstore prices for pharmaceuticals (Apothekenpreise). The overall costs for the 300 patients were about 238,400 CHF. The refund by the health insurances represented 56% (excluding specific services such as radiological examinations). The main costs concerned analytical laboratory services (32%), physicians services (27%), technical services (26%), and pharmaceuticals (15%). Some analytical and technical services were prescribed unexpectedly frequently. Prevalent among the emitted pharmaceuticals were protone pump inhibitors, modern cardiovascular drugs and statins. Presumed reasons may be a minor cost awareness of the physicians and a trend towards modern but expensive therapies. An adequate cost awareness can only emerge from precise data of effective costs.

Patient radiation exposure in uterine artery embolization of leiomyomata: calculation of organ doses and effective dose.

The goal of this study was estimation of patient effective dose from uterine artery embolization of leiomyomata. Parameters and data relevant to patient dose were recorded for 33 consecutive procedures. Using Monte Carlo simulation of radiation transport, organ and effective doses were calculated in detail for a subset of five procedures, to estimate the effective dose for all procedures. Mean dose area product was 59.9, median 23.4, and range 8.8-317.5 Gycm(2). Mean absorbed ovarian dose was calculated as 51 mGy in the five procedures. Using the dose conversion factor estimated from the Monte Carlo simulation for all procedures a mean estimated effective dose of 34 mSv (median 13 mSv, range 5-182 mSv) results, with a tendency to lower values regarding the succession of the procedures. Patients' radiation exposure level is up to twice of that of an abdominal CT examination. Angiographic equipment related dose-reducing features and radiographic technique essentially influence organ doses and effective dose. Consistent application of dose-reducing techniques and awareness of radiation exposure justifies uterine artery embolization as a therapeutic option for the treatment of uterine fibroids.

Assessment of protein-tyrosine phosphatase 1B substrate specificity using "inverse alanine scanning".

An "inverse alanine scanning" peptide library approach has been developed to assess the substrate specificity of protein-tyrosine phosphatases (PTPases). In this method each Ala moiety in the parent peptide, Ac-AAAApYAAAA-NH(2), is separately and sequentially replaced by the 19 non-Ala amino acids to generate a library of 153 well defined peptides. The relatively small number of peptides allows the acquisition of explicit kinetic data for all library members, thereby furnishing information about the contribution of individual amino acids with respect to substrate properties. The approach was applied to protein-tyrosine phosphatase 1B (PTP1B) as a first example, and the highly potent peptide substrate Ac-ELEFpYMDYE-NH(2) (k(cat)/K(m) 2.2 +/- 0.05 x 10(7) M(-1) s(-1)) has been identified. More importantly, several heretofore unknown features of the substrate specificity of PTP1B were revealed. This includes the ability of PTP1B to accommodate acidic, aromatic, and hydrophobic residues at the -1 position, a strong nonpreference for Lys and Arg residues in any position, and the first evidence that residues well beyond the +1 position contribute to substrate efficacy.

Improved assessment of coronary stenosis severity using the relative flow velocity reserve.

BACKGROUND: Myocardial fractional flow reserve (FFR) is based on pressure measurements. We have now sought to establish a Doppler-based concept of relative flow velocity reserve (RFVR) for the functional assessment of stenosis severity in epicardial coronary arteries. A clear threshold value to discriminate the functional severity of a coronary stenosis does not exist for coronary flow velocity reserve (CVR) based on intracoronary Doppler measurements. In contrast, the concept of FFR, which is based on intracoronary pressure measurements, has been extensively validated. An FFR value below 0.75 reliably indicates a significant stenosis. METHODS AND RESULTS: RFVR is calculated as the ratio between distal CVR in the stenosed target vessel and distal CVR in a nonstenotic reference vessel. In 21 patients, RFVR was determined in 24 target vessels by use of intracoronary adenosine and correlated to the FFR, determined as the ratio of mean poststenotic to aortic pressures, in the target vessel. Stenosis severity was classified according to quantitative coronary angiography analysis. Reference diameter was 3.0+/-0.4 mm (mean+/-SD), and area stenosis was 74+/-15% (range, 40% to 95%). CVRs in the target and reference vessels were 2.1+/-0.5 and 2.6+/-0.7, respectively. FFR ranged from 0.49 to 0.99 (mean, 0.81+/-0.15) and RFVR from 0.53 to 1.0 (mean, 0.82+/-0.13). Poststenotic CVR did not correlate with either percent area stenosis (r=0.27, P=NS) or FFR (r=0.33, P=NS). In contrast, FFR as well as RFVR showed a curvilinear relation to percent area stenosis (r=0.89, P<0.0001 and r=0.79, P<0.0001, respectively). There was a close linear correlation between FFR and RFVR (r=0.91, P<0.0001). CONCLUSIONS: RFVR correlates closely to FFR and to percent area stenosis, whereas the correlation of CVR with FFR and percent area stenosis is rather poor. RFVR is a promising new concept for assessment of coronary stenosis severity and clinical decision making based on Doppler measurements.

An approach to idle fund babysitting.

Cash investing isn't just for large clinics. Smaller clinics can enhance profitability through a positive, well-informed approach to excess funds utilization. For some medical groups, a whole new mind-set is necessary--the need to "think yield." This means not only invest, but also not being satisfied with a modest return. Without risk, the clinic manager can significantly improve the clinic's bottom line. To paraphrase, an oft-used saying. "A day without interest income is like a day without sunshine."