JAMA : the journal of the American Medical Association
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To develop and validate a simple prognostic scoring system to identify patients in nontraumatic coma at high risk for poor outcomes using data available early in the hospital course. ⋯ Five readily available clinical variables identify a large subgroup of patients in nontraumatic coma at high risk for poor outcomes. This risk stratification approach offers physicians, patients, and patients' families information that may prove useful in patient care decisions and resource allocation.
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To test the hypothesis that insulin resistance precedes impaired insulin secretion in individuals genetically predisposed to non-insulin-dependent diabetes mellitus (NIDDM). ⋯ In this study population, heterogeneous defects in insulin secretion were demonstrated, while defects in insulin sensitivity were not evident. We therefore conclude that since the earliest defects identified in a group genetically at high risk to develop NIDDM are those related to insulin secretion, defects in insulin secretion rather than insulin sensitivity are likely the major genetic factor predisposing to development of NIDDM.
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A study of 222 intraracial domestic homicides in Atlanta, Ga, found that when black and white populations were unstratified, the relative risk of homicide in black populations was 5.8 (95% confidence interval [CI], 4.3 to 8.0); when black and white populations were stratified by rates of household crowding, the relative risk of homicide in black populations was no longer significantly elevated (relative risk [RR], 1.2; 95% CI, 0.7 to 2.0). The current study sought to replicate, or not replicate, these findings in New Orleans, La. ⋯ The findings of the Atlanta homicide study are replicated in the current study of homicide in New Orleans. In both cities, sixfold differences in black and white rates of intraracial domestic homicide are entirely accounted for by differences in socioeconomic status between the respective black and white populations. There are no significant residual differences requiring cultural explanations.
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To quantify the actual cost of inpatient medical care for firearm-related injuries at a university trauma center. ⋯ Treatment of firearm-related injuries produces net income for this university trauma center by virtue of the cost shifting built into its pricing structure. If data from this institution are extrapolated to the nation, then the actual cost of providing medical care for firearm-related injuries in the United States in 1995 is projected to be $4.0 billion. The majority of this cost will be paid indirectly by private health insurance.
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To describe the magnitude and characteristics of nonfatal firearm-related injuries treated in hospital emergency departments in the United States and to compare nonfatal injury rates with firearm-related fatality rates. ⋯ Nonfatal firearm-related injuries contribute substantially to the overall public health burden of firearm-related injuries. NEISS can be useful to monitor the number of nonfatal firearm-related injuries in the United States. A national surveillance system is needed to provide uniform data on firearm-related injury morbidity and mortality for use in research and prevention efforts.