PURPOSE: Echinacea is one of the most popular dietary supplements with over $10 million in annual sales in the U.S. However, since dietary supplements are not regulated by the FDA in the same manner as other over-the-counter products, there is concern as to whether contents are consistent with the labeling. Three species of Echinacea are sold commercially, augustifolia (EA), pallida (EPA), and purpurea(EPU). Each species has a different biochemical footprint, analogous to different contents. Clinical trials have reported decreases in cold symptoms using EPU, decreases in cold symptoms and duration using EPA, and no effect on cold symptoms using EA. It follows that labeling of species content on Echinacea supplements is important consumer information. We hypothesized that species content in Echinacea preparations may not be consistent with labeling. METHODS: Ten single-herb liquid-only preparations of Echinacea from 5 Denver area stores were purchased and sent to a blinded independent laboratory. The preparations were analyzed by thin layer chromatography (TLC) for fingerprints unique to each species of Echinacea. Of the 10 samples sent, 3 were not analyzed due to difficulties with glycerol in the preparation. RESULTS: The following RESULTS: Of the 182 persons interviewed, 120 (66%) eventually enrolled into the program. Enrollees in the work component were middle aged (mean age = 39), minority race (92%), and male sex (64%) and abusing primarily alcohol (31%), crack/cocaine (21%), heroin (5%) alone or poly-substance abuse (44%). They lived in emergency shelters (23%), doubled-up (49%), and bridge-housing (25%) arrangements. Self identified co-morbid medical and psychiatric illness were common and a third were on at least one prescribed medication. Fifty-seven (48% of enrolled) completed the work component of the program. Of these, 95% were subsequently employed at completion of the work component. During the work component, clients were abstinent (40%), improved their housing status (47%), attended medical appointments (87%), reported career skill improvement (69%), and arrest free (84%). Six months after the completion of the program, over 33% continued to be employed full-time, 39% had further improved their housing, and 36% remained abstinent of substance use. A vast majority reported having medical (90%) and psychiatric (93%) service needs met. CONCLUSION: A work stabilization program, supported by a collaborative network of community and academic partners, decreased substance use, criminal behavior, and health care utilization for a drug and alcohol abusing homeless population. Community and academic partnerships can be a powerful impetus to promote health and social improvement for this distressed population. The majority of depressed patients initially present in primary care with physical symptoms rather than psychological complaints. We examined the outcome of physical symptoms with antidepressant treatment of depression during a 9-month period. METHODS: This clinical trial enrolled 573 depressed patients cared for by 40 physicians in two primary care research networks. Patients were randomized to receive one of three selective serotonin reuptake inhibitor (SSRI) antidepressants: paroxetine, fluoxetine, or sertraline. Data was collected from participants via computer-administered telephone interviews both at baseline and after 1, 3, 6, and 9 months of treatment. This data included validated measures for depression, anxiety, and 14 common physical symptoms (SCL-20 and PRIME-MD), healthrelated quality of life (SF-36), work functioning (Work Limitation Questionnaire), and Medical Outcomes Study measures for social functioning, positive well-being, sleep, concentration, and sexual functioning. The prevalence of each physical symptom was assessed at baseline and all follow-up intervals and symptom severity graded from 0 (none)to 2 (bothered a lot). Stepwise linear regression models were used to determine the independent effects of physical symptoms and depression on HRQoL and other domains at baseline and over 9 months of treatment. All models were adjusted for demographics and anxiety scores. RESULTS: Most of the individual symptoms had a baseline prevalence in depressed patients of 50% or greater. Moreover, the prevalence of symptoms that were graded as``bothered a lot'' exceeded 10% for 11 of the 14 symptoms. Physical symptom prevalence and severity dropped substantially during the first 4 weeks of antidepressant therapy with minimal improvement thereafter. While also showing the greatest improvement during the first month, depression and all other outcomes continued to improve over the 9-month trial. Physical symptoms had the strongest association with physical functioning (11% ± 20% of the variance), pain (23%), and overall health perceptions (19%), whereas depression had the greatest association with mental (32% ± 49%), social (11% ± 36%), and work functioning (9% ± 37%). CONCLUSION: Many physical symptoms are present in at least half of depressed patients presenting in primary care. The predominant benefits of antidepressant therapy occur during the first 4 weeks of treatment for physical symptoms, while depression and other HRQoL domains continue to improve for some months thereafter. Physical symptoms and depression have diffential effects on HRQoL domains. METHODS: We surveyed a stratified random probability sample representative of managed care members aged 45 and older in 2 health plan locations (n=2168). Respondents reporting doctor-diagnosed arthritis or chronic joint symptoms (pain, stiffness or swelling of a joint within the past year that is present on at least half the days of a typical month) were considered to have arthritis. Weighted descriptive analyses were conducted to estimate the age-and gender-specific arthritis prevalence, and to describe the impact of arthritis (i.e., health status, activity limitations). We also describe treatments respondents reported using for arthritis and the type of physician who provided the arthritis diagnoses. RESULTS: The prevalence of arthritis ranged from 32.0% for the 45 ± 54 age group to 36.8% for the !75 age group. Women were more likely to report arthritis than men (38.3% vs. 29.9%). Compared to those without arthritis, respondents with arthritis were more than twice as likely to report fair or poor health (24.9% vs. 11.1%). Of those with arthritis, 39.9% indicated activity limitations related to their joint symptoms. Respondents reported using prescription medicines (43.9%), over-the-counter pain medications (57.2%), complementary therapies (i.e., herbs, glucosamine) (32.8%), physical or occupational therapy (20.2%), and exercise (i.e., walking, swimming) (70.5%) to treat their arthritis symptoms. Just over half of those reporting physician-diagnosed arthritis received their diagnosis from a primary care physician. CONCLUSION: One-third of these managed care members have self-reported arthritis and 40% report arthritis-related activity limitations. The prevalence and impact of arthritis on health-related quality of life suggest an opportunity to explore interventions, including education on self-help activities, that may complement care provided by clinicians. None have explored these issues in a multi-culturally diverse population of young women. The purpose of this exploratory study was to assess knowledge, beliefs and behaviors about osteoporosis prevention in this target population. METHODS: We performed a cross-sectional study of multi-culturally diverse college women attending classes over a two week period in 2000. In this convenient sample (N=50), we collected data using a survey instrument of 20 questions designed to measure knowledge, beliefs and behaviors about osteoporosis prevention. Incorporating the selfreported data, we characterized the respondents by demographic information, medical conditions and family history; calculated Body Mass Index, general consumption of calcium, their level of alcohol and nicotine use and degree of physical activity; and tabulated à`B elief-about-Disease'' Score to capture their perception of osteoporosis in relation to other medical conditions. RESULTS: Nearly a third of the respondents were non-White and 14% were of Asian origin. Respondents were able to identify the risk factors of low calcium intake(96%), lack of exercise(86%), and menstrual irregularities(68%). However, other risk factors such as White race(20%), Asian race(21%), and excessive exercise (42%)were less likely to be identified. Ten percent had a medical condition putting them at risk. There was no relationship between correctly identifying lack of exercise and low calcium intake as risk factors and getting adequate osteoprotective exercise ( > 360 minutes/month)(p = 0.53) and dietary calcium( > 1200mg/daily) (p = 0.85). Osteoporosis (3.31) (on Likert scale from 1 ± 5, 1 indicates not at all; 5, extremely)was believed to be significantly less serious than heart disease(3.60) * , breast cancer(3.66) * , AIDS(3.79) * , and Alzheimer's disease(3.54) * ( * =p < 0.05). There were no associations between ethnicity and respondents' responses, knowledge and beliefs. CONCLUSIONS: Many college women, regardless of race, lacked knowledge about the relationship between osteoporosis and low calcium intake, use of tobacco, alcohol, physical inactivity, and excessive exercise. Increasing levels of osteoporosis knowledge was not associated with young women's beliefs and behavior.Our data suggest a need to educate young women. Comprehensive osteoporosis educational programs during college should be evaluated as an intervention to improve osteoporosis prevention. Recently published studies suggest that automated external defibrillators (AEDs) on commercial aircraft may save the lives of passengers who have out-of-hospital cardiac arrest (OHCA). However, AED equipment and training costs are high, while cardiac arrests onboard aircraft remain rare. We conducted a cost-effectiveness analysis to explore the economic and health impact of AED deployment in the U.S. passenger air fleet. METHODS: We developed a decision analytic model using a societal perspective for costs and benefits. Estimates of the incidence of OHCA onboard aircraft, effectiveness of AEDs in resuscitation, subsequent hospital survival rate, and annual mortality after surviving OHCA were derived from the medical literature. Equipment, maintenance, and flight attendant training costs were obtained from AED manufacturers, the Federal Aviation Administration, and the Air Transportation Association. Hospitalization and downstream medical costs were abstracted from published cost analyses. Published estimates of healthrelated utility after cardiac arrest were used to express effectiveness in terms of qualityadjusted life years (QALYs) gained. We compared four strategies: 1) AEDs on all aircraft with basic life support (BLS) training for flight attendants; 2) AEDs on wide-body aircraft only; 3) AEDs on no aircraft±but attendants trained in BLS; and 4) no aircraft AEDs and no BLS training. RESULTS: Placing AEDs on all passenger aircraft with concurrent BLS training would cost $49,800 per QALY gained compared to no AEDs and no BLS training. BLS training without AEDs was dominated by a combination of strategies #1 and #4. Deploying AEDs exclusively on wide-body aircraft would be cost-effective only if total training costs could be limited to less than 49% of the cost of training all attendants. Sensitivity analyses indicated that the ability of AEDs to improve survival was the most important influence on cost-effectiveness. AEDs must demonstrate an incremental survival rate of at least 14% to have a cost-effectiveness ratio less than $50,000/QALY. A Monte Carlo analysis, which varied all assumptions simultaneously, indicated that the cost/QALY value for strategy #1 would be less than $50,000 at a probability of 34%, while the probability of the cost-effectiveness being greater than $100,000/QALY was only 0.1%. CONCLUSION: The use of AEDs on passenger aircraft is similar in cost-effectiveness to many widely accepted medical interventions and health policy regulations. Sensitivity analysis suggests this result is robust, even when underlying assumptions are varied widely. This study implies that requiring the placement of AEDs on U.S. commercial aircraft would be a cost-effective use of resources. PURPOSE: Pressures to shorten length of stay increase the chance that patients (Pts) may be discharged`sicker and quicker.' Pts hospitalized with hip fracture are very frail and maybe at particularly high risk. We sought to measure prevalence of active clinical issues (ACIs)on discharge (DC) in Pts hospitalized with hip fracture and their associated clinical and functional outcomes. METHODS: Information on vital signs, eating status, mentation, mobility, incontinence, and wound status, and other active problems on DC, and in the 24 and 48 hours prior to DC was collected on 559 Pts hospitalized with hip fracture as part of a 4 hospital prospective cohort study. Deaths, readmission, and functional mobility within 60 days of DC were ascertained by telephone interviews and querying the NY State hospitalization database. Mobility was measured with the validated Functional Independence Measure-Locomotion scale (FIM). Logistic and linear regression assessed associations between the number of ACIs on DC and post-DC outcomes. ACIs on DC were defined as any of the following in the 24 hrs prior to DC (Temp > 100, 100 > HR > 60, SBP < 90, DBP < 60, RR > 24, O2 sat < 90%, altered mentation, inability to eat, incontinence, and not mobilized beyond a chair (all different from baseline), and other active medical problems [dyspnea, chest pain, arrhythmias, CHF, or wound infection]). We used a validated risk adjustment model to control for covariates known to influence clinical and functional hip fracture outcomes. RESULTS: Pts mean age was 81 yrs, 82% were female, 22% had dementia, and 12% came from a nursing home. The mean length of stay was 8.56.2 days. Overall, 74% of Pts had!1 ACI on DC (29% had 1, 28% had 2, and 17% had!3 ACIs), most commonly not mobilized beyond a chair (37%), new urinary incontinence (34%), Temp > 100 (11%), abnormal mentation (5%), DBP < 60 (5%), and new bowel incontinence (3%). Within 60 days of DC, 3.8% of Pts died, 18.8% were readmitted, and 20.2% died or were readmitted (major events). The mean FIM locomotion score at Day 60 was 6.1 4.0 (scale from 2 ± 14; higher is better). The greater the number of ACIs on discharge, the higher the risk of post-DC death, readmission, and major events and worse functional mobility [FIM score] (p < .001 for all). The odds of major events increased 40% for every additional ACI on DC (OR=1.4; 95% CI 1.1 ± 1.8). The number of ACIs on DC remained a significant predictor of all post-DC outcomes even after controlling for age, sex, comorbidities, initial APACHE score, and pre-fracture nursing home residence, dementia, home health assistance, and FIM score. Similar results were obtained for outcomes at 30 and 90 days as well as for analyses that considered only the last set of vital signs along with the other ACIs or ACIs in the 48 hours prior to DC. CONCLUSION: The greater the number of ACIs on DC, the worse the post-DC clinical and functional outcomes even after controlling for other important prognostic factors. Clinicians should factor this information into deciding appropriateness for DC and the type and intensity of post-DC care and medical observation. PURPOSE: Elevated HDL is considered a negative risk factor for ischemic heart disease and HDL level > 75mg/dl has been found to be associated with the``longevity syndrome''. We wanted to study people with extreme HDL elevation as no studies have been done to evaluate them before. METHODS: We identified all persons presented to our hospital with HDL level > 95mg/dl in the last 2 years. All subjects were contacted by phone. RESULTS: 102 subjects were contacted (83 females and 19 males). The majority were African Americans (52 subjects) (13 males and 39 females). The mean age was 59.3 + 1.5 years. The mean cholesterol was 234 + 5 mg/dl with a mean HDL of 108 + 2 mg/dl, triglyceride of 85 + 4 mg/dl, and LDL of 112 + 5 mg/dl. The total cholesterol to HDL ratio was 2.4 + 0.2. Mean Body Mass Index (BMI) was 25.8 + 0.6 kg/m2. (table) Only 15% were younger than 50 years old. We found an unusually high prevalence of hypertension in our subjects (53%) especially in the African American population (71%). Seven patients have coronary artery disease (CAD) but all had other cardiac risk factors. CONCLUSION: Our study showed a predominance of African Americans and postmenopausal females. This population had normal TG, LDL, and BMI, and a high prevalence of hypertension and smoking. Half exercised or reported following a special diet. Although elevated HDL is associated with longevity syndrome, it may not be protective against CAD in people with multiple other risk factors. were advised not to have or were not offered AVR by a cardiologist or cardiothoracic surgeon, and 2 declined further evaluation for AVR. For the remaining patients a decision was made to proceed with AVR or no decision had been documented by 60 days. At the time of the chart review (2 ± 4 years after echocardiogram), 37 patients (39%) had AVR and 13 (14%) had palliative aortic valvuloplasty. Compared with patients who did not have AVR, patients who had AVR were younger (78 vs 84, p < .0001), more likely to be male (46% vs 26%, p=.05), had fewer comorbid illnesses (mean number comorbidities 1.1 vs 1.7, p=.04), and were less likely to need assistance with ADLs (mean number of ADL dependencies 1.1 vs 1.7, p=.04). In a multivariable logistic regression model including age, sex, number of comorbid illnesses, and ADL dependency, these differences persisted, but only the effect of age was statistically significant at p < 0.05. Of the 33 patients who had AVR at one of the study hospitals, 19 also had coronary artery bypass surgery, 2 also had mitral valve repair or replacement, 2 died postoperatively, and 1 suffered a stroke. CONCLUSION: In this cohort of elderly patients with severe, symptomatic AS, the majority did not have AVR surgery. Patients who were younger and who had better baseline health status were more likely to have AVR. Few patients who were selected for AVR died postoperatively or suffered a major surgical complication. PURPOSE: African American women experience higher breast cancer mortality than Caucasian women despite increasing rates of screening mammography. One postulated factor in these worse outcomes is a lower rate of follow-up for diagnostic testing once a breast abnormality is detected. We examined factors associated with inadequate follow-up in a referral group of predominantly low-income minority women. METHODS: The study population consisted of women referred to a Breast Center at an urban medical center from January to June 2000. Demographic information was collected via medical charts, registration files completed at the time of appointment scheduling, and consultation/referral forms. Adequate follow-up was defined as patient arrival to the scheduled Breast Center appointment and inadequate follow-up was defined as failure to arrive on the designated appointment day. We analyzed factors associated with inadequate follow-up such as patient age, race, median household income by zip code, referral source, and insurance type. Maintenance dose was defined as being greater than one month out from initiation of warfarin therapy with at least two consecutive measurements one week apart within the target range. Potential predictor variables included: age, sex, weight, race, indication for anticoagulation, individual medications and total number of medications. A combined approach using recursive partitioning and multivariate logistic regression was used to develop and evaluate potential prediction rules. Two different rules were tested: one looking at low maintenance requirements (less than or equal to 3 mg per day), the other looking at high maintenance requirements (greater than or equal to 7 mg per day). RESULTS: 131 patients meeting entry criteria were identified with an average age of 68 years (range 27 to 93 years), 52% male sex, 70% Caucasian race, 75% anticoagulated for either atrial fibrillation (38%) or deep venous thrombosis/pulmonary embolus (37%), average weight of 184 pounds (range 100 to 350 pounds) and average number of chronic medications (in addition to warfarin) of 6 (range 0 ± 29). The simultaneous presence of 3 of the following variables predicted low maintenance requirements with 80% specificity (95% CI 73 ± 87%), 67% sensitivity (95% CI 59 ± 75%) and a positive predicted value of 92% (95% CI 87 ± 97%): age greater than 50, weight less than 200 pounds and being on 5 or more chronic medications. Although there were factors (age less than 50 years, and weight greater than 200 pounds) that on univariate analysis were associated with high maintenance requirements, a statistically meaningful rule could not be developed. CONCLUSION: A prediction rule that identifies those with the lowest warfarin maintenance requirements has been developed which could potentially aid in determining how to initiate warfarin therapy. This rule needs to be validated and refined using different patient populations. PURPOSE: Our objectives were three-fold: To conduct a pilot study of risk factors and screening behaviors relevant to breast and cervical cancer in rural lesbian women, to assess women's willingness to participate in a study of these factors, and to assess the feasibility of contacting women through regional lesbian organizations. METHODS: Using a brief self-administered questionnaire, we obtained information concerning major risk factors and screening behaviors relevant to breast and cervical cancer. The questionnaire, targeted to rural lesbian who were at least 40 years of age, was distributed at lesbian community events in rural New Hampshire and Vermont between June and August 1997. A separate survey, assessing willingness to participate in a future study, was distributed (between October and December 1998) by regional lesbian organizations to their membership. RESULTS: The first questionnaire was completed by 105 women. Of these, 82% reported at least one physician visit during the previous year. With regard to breast cancer risk factors and screening, 66% were nulliparous, 66% had at least one clinical breast exam during the previous year, 43% had had a mammogram, and 40% conducted breast self-exams. With regard to cervical cancer risk factors and screening, 80% had a history of heterosexual activity, and 62% had undergone a Pap smear during the previous year. Over the past 3 years, 21% had an abnormal pap smear. The later survey assessing willingness to participate in breast and cervical cancer research was mailed to 250 women; 47 surveys were undeliverable due to unknown address. Of the remaining 203 (62%), 108 women (53%) expressed willingness to participate. CONCLUSION: This pilot study suggests that breast cancer risk may be higher among lesbian women than non-lesbian women, and that lesbian women are at risk of cervical cancer despite of their current sexual practices. Our preliminary data also suggest that rural lesbian women are medically underserved with regard to breast and cervical cancer screening. The mailed survey also supports the feasibility of recruiting large numbers of rural lesbian women for health research.