The effects of comorbidity and other factors on medical versus chiropractic care for back problems.

Study Design: This study is a cross-sectional analysis of adults in the United States who reported at least one back-related visit to a health care professional during a 2-week reference period.

Objectives: To estimate and compare the effects of comorbidity and other factors on self-reported use of medical and chiropractic care for back problems in the United States.

Summary Of Background Data: Although back pain is the second most frequent primary symptom reported by patients seeking medical care and the most frequent primary symptom among chiropractic patients, there is a dearth of research on the predictors of chiropractic and medical care among back pain patients.

A randomized trial of the impact of certified mail on response rate to a physician survey, and a cost-effectiveness analysis.

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive a final mailing either by U.

The African-American Health Project (AAHP): study overview and select findings on high risk behaviors and psychiatric disorders in African American men.

The AAHP investigated the neurobehavioral and psychosocial sequelae of HIV-1 and substance use in urban African American men. A community resident sample of 502 African American men stratified by HIV-1 serostatus, drug use and sexual orientation were recruited. A comprehensive battery of measures of neurobehavioral and health status, lifestyle and psychosocial characteristics were administered to all participants, and a stratified sub-sample of 120 participants were tested using state of the art brain imaging techniques to investigate differences in the functional and neurophysiologic effects of HIV-1 and substance use.

Correlates of back problems and back-related disability in the United States.

The purpose of this study is to identify correlates of back problems and back disability in the adult population of the United States. Cross-sectional analyses were performed using data from the 1989 National Health Interview Survey (NHIS). Weighted polytomous logistic regression modeling was performed to estimate odds ratios adjusted for the effects of covariates.

Behaviors as risk factors for rehospitalization: implications for predicting and preventing admissions among the seriously mentally ill.

This case-control study investigated the extent to which aberrant behaviors, in contrast to more traditional clinical factors (such as symptoms and alcohol abuse), place individuals with schizophrenia at increased risk for rehospitalization. One hundred and one recidivists (cases) were matched to 101 non-recidivists (controls) on gender, race, and time since index hospitalization. Key informants, usually family members, were interviewed to assess behaviors during a 2-week period.

Development of a health risk appraisal for the elderly (HRA-E).

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly.

Tuberculosis skin testing among homeless adults.

Objective: To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB.

Design: Cross-sectional study.

Setting: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.

Calmodulin antagonists decrease glucose 1,6-bisphosphate, fructose 1,6-bisphosphate, ATP and viability of melanoma cells.

Glycolysis is known to be the primary energy source in cancer cells. We investigated here the effect of four different calmodulin antagonists: thioridazine (10-[2-(1-methyl-2-piperidyl) ethyl]-2-methylthiophenothiazine), CGS 9343B (1,3-dihydro-1-[1-[(4-methyl-4H,6H-pyrrolo[1,2-a] [4,1]-benzoxazepin-4-yl)methyl]-4-piperidinyl]-2 H-benzimidazol-2-one (1:1) maleate), clotrimazole (1-(alpha-2-chlorotrityl)imidazole) and bifonazole (1-(alpha-biphenyl-4-ylbenzyl)imidazole), on the levels of glucose 1,6-bisphosphate and fructose 1,6-bisphosphate, the two stimulatory signal molecules of glycolysis, and on ATP content and cell viability in B16 melanoma cells. We found that all four substances significantly reduced the levels of glucose 1,6-bisphosphate, fructose 1,6-bisphosphate and ATP, in a dose- and time-dependent manner.

Handedness and the risk of tardive dyskinesia.

Previous results from five cross-sectional studies are conflicting about the relationship between hand preference and tardive dyskinesia (TD): two report a greater TD prevalence in left handers, and three report a greater prevalence in right handers. To help resolve these inconsistencies, the handedness-TD association was assessed in the Yale TD Study, a large prospective cohort investigation of outpatients maintained with neuroleptics. A consistent monotonic association was observed between the handedness score and TD incidence (p = 0.

Postdischarge geriatric assessment of hospitalized frail elderly patients.

Background: The diffusion of comprehensive geriatric assessment services has been rather limited in North America partly because of reimbursement and organizational constraints.

Objective: To evaluate the impact of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home.

Methods: Patients older than 65 years were selected who had either unstable medical problems, recent functional limitations, or potentially reversible geriatric clinical problems.

Identifying modifiable risk factors for rehospitalization: a case-control study of seriously mentally ill persons in Mississippi.

Objective: The authors sought to identify risk factors for rehospitalization in a seriously mentally ill population, focusing on factors that have the potential to be modified through community-based interventions.

Method: A case-control design was used in which 101 "case" subjects (recently readmitted psychiatric patients) and a comparison group of 101 subjects living in the community who had been previously hospitalized at the same time as the case subjects, but who in contrast had not been readmitted, were matched on gender, ethnicity, and length of time at risk for rehospitalization. The setting was the Mississippi public mental health system during the first 3 months of 1988, including Mississippi State Hospital and the 10 community mental health regions in its catchment area.

Estimating the occurrence of child maltreatment and risk-factor effects: benefits of a mixed-design strategy in epidemiologic research.

Despite the large volume of literature on child abuse and neglect generated over the past two decades, there has been relatively little comprehensive discussion of the limitations of different study designs for achieving major epidemiologic research goals. Although some improvements have been made in conventional research designs, there have been few efforts to develop new approaches. This article discusses the methodologic limitations of four observational study designs--ecologic, case-control, cross-sectional, and cohort--that dominate the child abuse and neglect literature; identifies key features of an "ideal" study of child maltreatment; and proposes a new mixed-design research strategy.

Health insurance and utilization in Pneumocystis carinii pneumonia.

To examine the relationship between health insurance status and health services utilization among HIV-infected patients with active Pneumocystis carinii pneumonia (PCP), the discharge and outpatient databases of a large California medical facility were reviewed. Four hundred fifty records met the inclusion criteria. Logistic regression indicated that those who had publicly funded insurance were about half as likely (95% CI 0.

Positive and negative symptom course in chronic community-based patients. A two-year prospective study.

Background: The long-term symptom profile of chronic out-patients was studied.

Method: 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over outpatient maintenance treatment.

Results: Overall and within groups, negative symptoms decreased and positive symptoms increased.

Occupational injury in female aerospace workers.

We conducted a population-based case-control study in women in high-risk manufacturing occupations to examine occupational injury and its association with possible risk factors inside and outside the work place. The primary hypothesis was that women with young children are at greater risk of occupational injury than are women without young children, owing to the responsibility and fatigue associated with raising young children. The odds of reported injury was 2.

Ecologic studies in epidemiology: concepts, principles, and methods.

An ecologic study focuses on the comparison of groups, rather than individuals; thus, individual-level data are missing on the joint distribution of variables within groups. Variables in an ecologic analysis may be aggregate measures, environmental measures, or global measures. The purpose of an ecologic analysis may be to make biologic inferences about effects on individual risks or to make ecologic inferences about effects on group rates.

Electroencephalographic coherence in acquired immune deficiency syndrome.

We studied a quantitative electroencephalographic (EEG) measure, coherence, in 28 patients with acquired immune deficiency syndrome (AIDS) and 56 uninfected volunteers. Compared with uninfected subjects, AIDS patients had increased coherence in the 6- to 10-Hz band. The largest increases in coherence were between frontal and occipital regions and between temporal and frontal regions.

Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992.

The study aims were (i) to describe secular trends in the utilization of antiretrovirals, antivirals, Pneumocystis carinii pneumonia (PCP) prophylaxis, and antifungal prophylaxis and (ii) to determine whether factors such as clinical status, health services utilization, insurance status, income, education and race were associated with access to therapy. Data on utilization of therapy, health services utilization, income and insurance status were collected semiannually from October 1990 through March 1992 from 1415 homosexual/bisexual HIV-1 seropositive men in the Multicenter AIDS Cohort Study (MACS). Prevalence of therapy use according to level of immunosuppression was determined at each study visit.

Predictors of treatment response in obsessive-compulsive disorder: multivariate analyses from a multicenter trial of clomipramine.

There have been many attempts to find predictors of the therapeutic response to the clomipramine treatment of obsessive-compulsive disorder. The majority of studies have failed to identify such predictors. Possible reasons for this failure include the small sample size of most studies, samples homogeneous with respect to the study factors of interest, and the use of statistical procedures that are insensitive to individual differences or that inadequately control for confounding.

[Chronic obstructive bronchopneumonia (COBP), a precancerous state through destabilization of body homeostasis and bioenergetics].

Out of a number of 2113 of COLD ambulatory cases followed-up over 20 years, 170 cases of death were registered. The causes were: heart in 54%, cancer in 42% among which 37% lung cancer, exceeding 8 times the mean figures on the whole country. These diseases: COLD, atherosclerosis inducing heart disease and lung cancer have common risk factors which unbalance respiratory homeostasis.

Impact of immunosuppression on health care use by men in the Multicenter AIDS Cohort Study (MACS).

The effects of human immunodeficiency virus type 1 (HIV-1) serostatus, AIDS, and level of immunosuppression on health service use were examined in the Multicenter AIDS Cohort Study. Data on self-reported hospitalizations, outpatient medical services (non-emergency room) and emergency room care during the preceding 6 months were collected for 3,447 homosexual/bisexual men returning for their 14th and/or 15th semiannual visits in Chicago, Baltimore, Los Angeles, and Pittsburgh. AIDS-free seropositive men with CD4+ cells < 200/microliters were more likely to be hospitalized [odds ratio (OR) = 2.