Vitamin D status, body composition, and fitness measures in college-aged students.

Low vitamin D, commonly assessed as serum 25-hydroxyvitamin D (25OHD), is associated with the development of many age-related chronic diseases. A positive relationship exists between elevated 25OHD and muscle synthesis, strength, power, and decreased body fat in elderly individuals. However, these findings have not been consistently reported in younger healthy populations. The purpose of this study was to investigate the relationship between 25OHD and measures of body size, composition, metabolism, and physical fitness in a young physically active population. Thirty-nine subjects (20 men, 19 women; aged 23 ± 0.7 years) reported 6 times for testing. Blood was collected to determine 25OHD. Primary outcomes included the following: body mass index (BMI) and percent body fat (dual x-ray absorptiometry); resting metabolic rate; maximal oxygen uptake (V[Combining Dot Above]O2max); power output (Wingate); and muscular strength (8 repetition maximum for bench press, upright row, and leg extension and flexion exercises). Our analysis included all participants, and subgroup analyses for individuals with suboptimal 25OHD concentration below 35 ng·mL ("low"; n = 20, 25.97 ± 1.97 ng·mL) or equal to and above 35 ng·mL ("high"; n = 19, 44.15 ± 2.17 ng·mL). Twenty subjects in this study had serum levels of 25OHD below 35 ng·mL. There was a significant positive relationship between V[Combining Dot Above]O2max and serum 25OHD and a negative relationship between BMI and serum 25OHD. These data suggest that vitamin D deficiency is prevalent even in a young physically active population in the southern United States and that there was a positive relationship between a measure of cardiovascular fitness and serum 25OHD, and a negative relationship between serum 25OHD and BMI.

The on-call crisis: a statewide assessment of the costs of providing on-call specialist coverage.

STUDY OBJECTIVE: A recent change in the delivery of emergency care is a growing reluctance of specialists to take call. The objective of this study is to survey Oregon hospitals about the prevalence and magnitude of stipends for taking emergency call and to assess the ways in which hospitals are limiting services. METHODS: This was a cross-sectional, standardized survey of chief executive officers from all hospitals with emergency departments in Oregon (N=56). This e-mail-based survey asked about payments made to specialists to take call and examined changes in hospitals' trauma designation and ability to provide continuous coverage for certain specialties. RESULTS: We received responses from 54 of 56 hospitals, representing a 96% response rate (100% of trauma centers). Twenty-three of 54 (43%) Oregon hospitals pay a stipend to at least 1 specialty, and 17 (31%) hospitals guarantee pay for uninsured patients treated on call. Stipends ranged from $300 per month to more than $3,000 per night, with a median stipend of $1,000 per night to take call. Trauma surgeons, neurosurgeons, and orthopedists were the specialists most likely to receive stipends. Seven of 54 (13%) hospitals have had their trauma designation affected by on-call issues. Twenty-six hospitals (48%) have lost the ability to provide continuous coverage for at least 1 specialty. CONCLUSION: Problems with on-call coverage are prevalent in Oregon and affect hospital financing and delivery of services. A continuation of the current situation could degrade the effectiveness of the trauma system and adversely affect the quality of emergency care.

The state of ED on-call coverage in California.

The ED provides initial treatment, but failure of specialists to respond unravels the safety net. To assess the scope of problems with on-call physicians in California. A mailed anonymous survey to all CAL/ACEP physician members (1876) asking patient, physician and ED demographics, specialist availability for consultation, insurance profile, and availability of follow-up care. 608/1876 physicians responded (32.4%), representing 320/353 California EDs (90.6%). The seven specialties in which the greatest proportion of EDs reported trouble with specialty response were: plastic surgery (37.5%), ENT (35.9%), dentistry (34.9%), psychiatry (26.0%), neurosurgery (22.9%), ophthalmology (18.4%) and orthopedics (18.0%). 71.6% of responder EDs reported that their medical staff rules required ED on-call coverage. However, the percentage of responders who stated that hospitals paid each specialty for call was low: neurosurgery (37.3%), orthopedics (34.4%), ENT (17.9%), plastic surgery (15.1%) and ophthalmology (13.1%). On-call problems were more acute at night (77.2%) or on weekends (72.4%). Patient insurance negatively affected (69.9%) willingness of on-call physicians to consult for at least a quarter of patients. Regarding follow-up, 91% reported some trouble, whereas 64% reported a problem at least half the time. Surgical sub-specialists are the most problematic on-call physicians. Insurance status has a major negative effect on ED and follow-up care. The on-call situation in California has reached crisis proportions.