Relationship between dietary and biochemical measures of nutritional status in HANES I data.

Data from the first National Health and Nutrition Examination Survey were examined for individual 24-h dietary intakes of protein, vitamin A, thiamin, riboflavin, and iron, and for laboratory indices of the same nutrients in blood and urine. Mean intake values were close to or above reference standards for all nutrients except iron. Substandard laboratory values were recorded for: serum albumin and vitamin A--less than 3% of subjects; urinary thiamin/creatinine excretion--3 and 8% of white and Black subjects, respectively; Hb, hematocrit, and percentage transferrin saturation--5 to 15% of whites and 18 to 27% of Black subjects; serum iron--less than 6% of subjects. Individual dietary recall data were of limited value in predicting the laboratory indices; regression analyses indicated that sociodemographic variables may be of greater predictive value.

Late outcomes of open heart surgery in patients 70 years or older.

BACKGROUND: The purpose of this study is to examine the long-term survival and quality of life, including the influence of comorbidities, in patients 70 years of age and over after open heart surgery. METHODS: This was a retrospective study of 401 consecutive patients, who were 70 years of age or older at the time of surgery. Survival and quality of life of these patients were measured at 6- to 8-year follow-up. RESULTS: The 5-year survival rate was 85%, and was comparable with the age- and gender-matched West Virginia population. Survival declined with increasing preexisting comorbidities. Of the 176 respondents completing the quality of life (SF-36) survey, most scores were similar to or substantially better than the US population normative scores for individuals 70 years of age or older. CONCLUSIONS: Survival rates vary by presence or absence of specific comorbid conditions. Quality of life in the appropriately selected elderly after open heart surgery appears to be similar to the US population normative scores.

Injuries to volunteer fire fighters in West Virginia.

The distribution and characteristics of workplace injuries for West Virginia volunteer fire fighters (VFFs) are described using 1992 workers' compensation data. Most of the injuries occurred in VFFs who were less than 30 years of age (62%). The most common type of injuries were those in the category of lacerations and contusions (28.9%), with a notable percentage of injuries due to smoke inhalation and respiratory problems (13.7%). The proportional rates related to falls in VFFs were almost twice the national figures for the same year (39.3% versus 22.3%). County population density was found to be directly associated with injury rates, even when adjusted for number of responses. Claims statistics mirror a similar geographical trend in overall workers' compensation claims for all injuries in West Virginia. The results of this study provide a foundation for additional follow-up studies in order to develop improved occupational safety policies and target educational programs aimed at the prevention of injuries in volunteer fire fighters. Several findings have already resulted in programmatic recommendations.

Medical school affiliations with Department of Veterans Affairs medical centers: attitudes of medical center leadership.

Affiliations between Department of Veterans Affairs [VA] medical centers and colleges of medicine are important to both parties. Recently, the values and costs of these relations have come under increasing scrutiny. In this study, the authors attempted to determine the attitudes of local VA medical center leadership members toward these affiliations. A mail survey of directors, associate directors, and chiefs of staff of VA medical centers was undertaken. Respondents were asked to score their agreement or disagreement with each of eight statements defining various features and values of VA-medical school affiliations. Scores were reported on a Likert scale of 1 (strongly agree) to 7 (strongly disagree). Strongly positive general attitudes toward VA-university affiliations were found from the results. Mean scores averaged 2.02. However, responses to statements identifying specific concerns with these affiliations (eg, diversion of resources away from VA toward university goals and the lower status of VA-based faculty) were less positive. More positive general attitudes and less negativity about specific concerns were expressed by chiefs of staff than by medical center directors or associate medical center directors and by leaders of highly affiliated medical centers than by leaders of other types of centers. Therefore, local VA medical center leaders have very positive general attitudes toward university affiliations. However, specific problem areas do exist. These issues and attitudes are important for leaders of both the VA health-care system and academic medical centers to consider when developing and implementing local and national policies.

Synthesis of a new class of 1,4-dihydropyridines having a hydroxamic ester group in position 3 with a potential calcium antagonistic activity.

The synthesis of new 1,4-dihydropyridines having a hydroxamic acid or hydroxamic ester group in position 3 is described. Pharmacological evaluation included calcium antagonistic activity in the guinea pig Taenia coli test and acute toxicity. The compounds had not a calcium antagonistic activity, if compared with other well known DHP utilized as standard, so the pharmacological tests were not furtherly studied.

Reading versus comprehension: implications for patient education and consent in an outpatient oncology clinic.

Written educational materials and consent forms are often given to patients with little regard for their ability to read them. Nationwide sampling and data from the 1990 census suggest that 10% of U.S. adults are functionally illiterate. In this study, 100 adult patients (64 female, 36 male) seen consecutively in an oncology clinic were tested for reading vocabulary (RD-VOCAB) and reading comprehension (RD-COMP) using the Woodcock-Johnson Psychoeducational Battery. The mean grade levels of education (last grade completed), reading vocabulary, and reading comprehension of all participants were 12.5, 11.3, and 10.5, respectively. The discrepancy between the grade level of education and RD-COMP varied by age, the largest discrepancies being found in the 30-39 (three grades) and 60-69 (2 1/2 grades) age groups. After controlling for educational level, it was found that the mean grade level of RD-COMP was statistically lower than educational level. Statistically assuming all subjects to have completed high school, the mean levels of RD-COMP ranged from ninth grade in the 30-39 age group to twelfth grade in the 40-49 age group. This study underscores the fact that the health professional cannot assume that a patient who has completed a certain grade level in school can read at the corresponding level. Consent forms and other health education materials should be written at least three grade levels lower than the average educational level of the target population.

Attitudes of local VA leadership toward the VA health care system.

A nationwide survey of directors, associate directors, and chiefs of staff of Department of Veterans Affairs (VA) Medical Centers was conducted to (1) determine the attitudes of these local health care executives toward the public's perception of the VA health care system, their own job satisfaction, and the level of job support they receive; and (2) assess how these attitudes relate to the stated intention of the local leadership to leave the VA health care system before retirement. A total of 268 responses were analyzed. Significant differences between local executive positions were identified, including a less favorable perception of the public's attitude toward the VA system and less satisfaction with the VA system by chiefs of staff; and less general job satisfaction and satisfaction with the local VA facility by associate directors. Variables related to public perception, job satisfaction, and job support were significant predictors of plans for each group to leave the VA; 34 to 49 percent of the variance in a multiple linear regression model could be explained by these factors.