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Objective: Studies of alcohol brief intervention for medical inpatients have mixed results. We explored potential moderators of the effectiveness of brief intervention for unhealthy alcohol use among medical inpatients. Method: This is a secondary analysis of a randomized controlled trial of brief motivational counseling among 341 urban-hospital medical inpatients (99 women) with unhealthy alcohol use. Self-reported main outcomes were receipt of alcohol treatment by 3 months in subjects with dependence and change in the mean number of drinks per day 3 and 12 months after enrollment in all subjects. Results: Among subjects with dependence, the effect of brief intervention on receipt of alcohol treatment differed significantly by gender and age (p = .02 for each interaction). In stratified analyses, brief intervention was associated with receipt of alcohol treatment in women (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI]: 1.2-12.7), and younger (, PROFESSIONAL ORGANIZATIONS RECOMMEND screening and brief intervention for all adults with unhealthy alcohol use (i.e., the spectrum from drinking risky amounts through dependence; Institute of Medicine, 1990; U.S. Preventive Services [...]

We examined the association between substance abuse treatment services and emergency department (ED) utilization among participants in the HIV-Alcohol Longitudinal Cohort study of HIV-infected persons with a history of alcohol problems. A standardized questionnaire was administered to 350 subjects inquiring about demographics, substance use, use of substance abuse treatment services, and ED attendance. We operationally defined substance abuse treatment services as: stable, unstable, or none. The outcome, ED attendance, defined as presenting to an ED without subsequent hospitalization, occurred in 101 (28.8%) subjects in the past 6 months. Stable substance abuse treatment was significantly associated with lower odds of ED attendance (adjusted odds ratio; 95% CI): (0.5; 0.3-0.9). The relationship between substance abuse treatment and HIV-infected individuals' use of health care services merits additional attention. Substance abuse treatment may present an opportunity to impact health care utilization patterns of HIV-infected persons with a history of alcohol problems. Keywords: Health services; Utilization; Substance use; Alcohol use; HIV disease/AIDS; Substance abuse treatment centers; Emergency department

Treating foot infections in diabetic patients with surgical debridement followed by oral antibiotic therapy appears to be as effective and less expensive than other treatments. Foot infections are a common complication of diabetes, and they can lead to osteomyelitis (bone inflammation) that may need to be treated with amputation. Surgical debridement involves cutting away infected tissue and cleaning a wound. Researchers used a computer model to analyze treatment strategies in relation to cost and quality-adjusted life expectancy. Treatment strategies included both short and long courses of antibiotics after debridement, diagnostic tests including imaging, laboratory tests and biopsy, and immediate amputation. Expensive and invasive tests did not appear to give any advantage in improved survival or quality of life. The best option in terms of cost-effectiveness was culturing the debrided tissue to identify the infecting organism and treating with an appropriate antibiotic for 10 weeks., Objective.--To examine the cost-effectiveness of approaches to the diagnosis and treatment of patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM) who have foot infections and suspected osteomyelitis. Design.--Decision and cost-effectiveness analyses were performed using a Markov model. We examined the prevalence of osteomyelitis, the major complications and efficacies of long-term antibiotic therapy and surgery, and the performance characteristics of four diagnostic tests (roentgenography, technetium Tc 99m bone scanning, indium In 111-labeled white blood cell scanning, and magnetic resonance imaging). Data were drawn from the English-language literature using MEDLINE searches and bibliographies from selected articles. Setting.--Primary care. Patients.--Patients with NIDDM who had foot infections and suspected osteomyelitis but no signs of systemic toxicity. Interventions--Following hospitalization for surgical debridement and intravenous antibiotic therapy: (1) treatment for presumed soft-tissue infection, (2) culture-guided empiric treatment for presumed osteomyelitis, (3) 71 combinations of diagnostic tests preceding antibiotic therapy for osteomyelitis, (4) 71 combinations of tests preceding amputation, and (5) immediate amputation. Main Outcome Measures.--Quality-adjusted life expectancy, average costs. Results.--Culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy has similar effectiveness to testing followed by a long course of antibiotic therapy if any test result is positive. However, empiric treatment is the least expensive strategy. Conclusions.--Noninvasive testing adds significant expense to the treatment of patients with NIDDM in whom pedal osteomyelitis is suspected, and such testing may result in little improvement in health outcomes. In patients without systemic toxicity, a 10-week course of culture-guided oral antibiotic therapy following surgical debridement may be as effective as and less costly than other approaches. (JAMA. 1995;273:712-720)

Aim: The Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to foetal and infant demise. This current report presents physiological data from full-term infants with no prenatal exposure to alcohol or maternal smoking.Methods: Data are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardised protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at one month of age.Results: Analyses revealed significant increases in heart rate and decreases in BP from the newborn to one-month time period as well as diminished heart rate responses to head-up tilt in one-month-old infants.Conclusion: The Safe Passage Study was successful in characterising physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS. [ABSTRACT FROM AUTHOR]