CONCLUSION: These data suggest that alcohol may reduce the risks of total and cardiovascular mortality in men with a history of stroke. More data are needed to confirm or refute these results. PURPOSE: Historically, it has been suggested that the symptoms associated with benign prostatic hyperplasia can be aggravated by infrequent sex. We evaluated this by assessing the cross-sectional association between frequency of ejaculation and lower urinary tract symptom severity and general self-perceived health among participants in the Olmsted County Study of Urinary Symptoms and Health Status among Men. METHODS: In 1989 and 1990, 2,115 Caucasian men between the ages of 40 and 79 years were recruited from a random sample of Olmsted County residents (55% response rate). These men completed a self-administered questionnaire that assessed lower urinary tract symptom severity with questions similar to those in the American Urological Association Symptom Index (AUASI) and completed a similar questionnaire biennially thereafter through 1998. In 1994, a question was added to assess the frequency of ejaculation during the previous month. This was answered by 81 percent of participants in that round. RESULTS: Overall, men who reported ejaculating at least once a week were less likely to have moderate-severe (AUASI > 7) symptoms than men reporting no ejaculations (Odds ratio=0.62, 95% Confidence Interval=0.51, 0.75). There was a similar association with health-related quality of life (Poor-good vs. very good-excellent, OR=0.45, 95% CI=0.37, 0.60). The association with symptom severity did not exist within age decade, however. The odds ratios for ejaculating at least once a week were 0.93, 0.79, 1.21 and 1.12 for men in their forties, fifties, sixties and seventies, respectively. Thus, after adjusting for age, the odds ratio was 0.95 (0.75, 1.21). The odds ratio for health-related quality of life, however, remained virtually unchanged (OR=0.47, 95% CI=0.37, 0.60). CONCLUSION: While there has been speculation about the adverse effects of abstinence on prostate health, these cross-sectional data suggest that frequency of ejaculation has no effect on lower urinary tract symptoms; the apparent protective association appears to be an artifact caused by the confounding effects of age. This is not the case, however, for the cross-sectional association with quality of life. PURPOSE: Re-hospitalization after in-patient treatment for community-acquired pneumonia (CAP) is common. The aims of this study were to examine reasons and identify predictors of rehospitalization (rehosp). METHODS: This analysis was performed as part of the randomized, controlled trial,`D issemination of Guidelines for Pneumonia Length of Stay,'' implemented in 7 hospitals in Pennsylvania from February 1998 to March 1999. The trial assessed the effect of a guideline intervention to reduce the length of stay (LOS) for patients hospitalized with CAP. Inclusion criteria included a clinical diagnosis of pneumonia and a chest radiograph with a new pulmonary infiltrate. Severity of illness was quantified using the Pneumonia Severity Index (PSI), a predictor of 30-day mortality in patients with CAP. For this study, 2 physicians independently reviewed the records of patients re-hospitalized within 30 days and afterwards reached a consensus on reasons for rehosp. Demographic, clinical, laboratory, and radiological data were used to identify reasons for rehosp. Categorical and continuous variables were assessed using the Chi-square test and the Student's t-test, respectively. Any variable significant at the p < 0.05 level was entered into a multiple logistic regression model. RESULTS: Of the 608 patients (283 in the intervention arm and 325 in the control arm), 69 patients (11%) were re-hospitalized within 30 days. There was no significant difference in readmission rates between the 2 groups. The mean time to rehosp was 8.49 (+/À 0.96) days. The reasons for rehosp were CAP-related (n=14), combination of CAP and comorbid condition (n=3), or comorbid condition alone (n=52). The kappa statistic, assessing inter-rater reliability, was 0.784. The major comorbid conditions requiring rehosp were cardiovascular (n=19), neurologic (n=6), pulmonary (n=6), gastrointestinal (n=5), genitourinary (n=5), and others (n=11). Significant predictors of rehosp included age (p < 0.001), unemployment status (p = 0.04), congestive heart failure (p < 0.001), coronary heart disease (CAD) (p < 0.001), ventricular arrhythmias (p = 0.014), chronic obstructive pulmonary disease (COPD) (p < 0.001), chronic oxygen treatment (p = 0.001), and PSI (p = 0.05). Significant predictors in the multiple logistic regression model included CAD (odds ratio 3.2 with a 95% confidence interval of 1.8 ± 5.5), COPD (2.5, 1.5 ± 4.2), and unemployment status (2.4, 1.1 ± 5.3). CONCLUSION: This study describes the incidence and reasons for re-hospitalization in patients with CAP and identifies subsets of patients that could be targeted for interventions to decrease re-admissions after CAP. The value of hospice lies in its ability to provide continuous quality care until the time of death. However, some patients are discharged from hospice, usually because they no longer meet hospice criteria or choose more aggressive care. We sought to determine differences between patients who are discharged vs. those who die in the hospice setting. METHODS: We identified 48 patients who were discharged from a local hospice organization between the years 1996 and 2000. We then selected 47 control cases, matched on primary diagnosis and month of admission, who died while in the same hospice organization. Data were collected on these patients through restrospective chart review. RESULTS: Of the 95 patients, 66% were female, 87% were Caucasian, 37% were married and 74% had Medicare as the primary payor source. The mean age of admission was 70 years, mean length of stay 50 days, and mean Karnofsky status on admission 30%. The most common primary diagnosis was cancer (38%), followed by neurologic disease (14%) and dementia (14%). At the time of admission, 43% received care at home, 40% in assisted living or a nursing home (AL/NH), and 17% in the hospice facility. At the time of discharge/death, 33% were at home, 41% in AL/NH, and 26% in the hospice facility. The reason for discharge was stabilization of condition in 54%, revocation of hospice benefit in order to pursure more aggressive treatment in 13%, and transfer to different hospice in 11%. Discharge disposition was to a different hospice in 11%, to AL/NH in 48%, and to home in 23%. The discharged patients vs. deaths did not differ in age, sex, race, payor source, site of hospice care, admission weight, level of cognition, severity of pain, level of mobility at admission, number of ADL's performed at admission, or Karnofsky status at admission. Having a primary caregiver was also not significant. Compared to patients who died, those discharged had a longer length of stay (mean 62 and 38 days, p=0.05), were less likely to be married (25% and 50%), and less likely to be bedbound at discharge (23% and 76%, p = 0.000). CONCLUSION: Patients discharged alive from hospice, compared to case controls matched on diagnosis and date of admission who died in hospice, had similar demographics and level of functioning at the time of admission. The presence of a primary caregiver did not alter outcome and being married was associated with death. We speculate that hospice provides additional social contact or improved medical care that prolongs the life of some patients. PURPOSE: Recognizing patients' expectations is considered as an important objective for primary care physicians. However, few studies have investigated the influence on such matter of race and/or ethnicity, specially among immigrants. The aim of the study was to investigate whether patients' expectations among immigrants and natives are different and if physicians can perceive them. METHODS: The design is a two month pre-consultation patient survey and post-consultation physician survey (matched pairs) in an academic primary care center. Subjects were natives (Swiss French-speaking people) and immigrants (ex-Yougoslav, European, French-speaking African and other) consulting without appointment. The main outcome measures were patients' expectations (14-item questionnaire: receiving a prescription, a sickness certification, reassurance, seeing a specialist, etc...), patients' perception of their health status, physicians' perception of their patients' expectations (14-item questionnaire) and agreement between patient and physician. Questionnaires were available in 3 languages (French, Serbo-Croat and Albanian). RESULTS: 343 patient and 333 physician questionnaires were analyzed. Patients were separated into 5 groups: Swiss (n=167), European (n=50), Ex-Yugoslav (n=37), African (n=62) and other (n=27). Immigrants (n=176) do not consult more quickly than native patients and initiate a treatment at home as often (n=ns). However, more immigrants perceive their health as bad (22.7% vs 5.4% p < 0.01) and ask their doctor for reassurance (84.3% vs 62.7% p < 0.01). More Ex-Yugoslav patients expect to be referred to specialists (60% vs 30% p < 0.01) and more African patients wish to receive medication than Swiss patients (83% vs 59% p < 0.01). These results are confirmed by a stepwise logistic regression including independent variables such as age, sex, civil status and education. Finally, we found a poor agreement between patients' expectations and their perception by physicians, regardless of patients' origin (k < 0.36) CONCLUSION: Our study suggests that patients' expectations may differ according to their origin and that physicians certainly have a poor perception of their patients' expectations in an outpatient emergency setting, regardless of patients' origin. However, further investigation is needed to analyze whether the physicians' lack of knowledge of their patients' expectations influences the latter's satisfaction and the quality of medical care. shown that vaginal administration of hormones decreases UTI risk in post-menopausal women with recurrent UTIs, but evidence supporting a similar effect of oral hormones is mixed. We assessed the effects of oral hormone treatment in a randomized trial and evaluated potential risk factors for UTI frequency among post-menopausal women. METHODS: 2,763 postmenopausal women were enrolled in the Heart and Estrogen/progestin Replacement Study (HERS), a randomized, double-blinded, controlled trial to evaluate hormone treatment for the prevention of coronary heart disease events in women with established coronary heart disease. Participants were randomly assigned to daily 0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate or placebo and followed for a mean of 4.1 years. We analyzed results for 1,318 women randomized to hormone therapy and 1,336 women randomized to placebo who had complete data. Participant demographic information, reproductive history, sexual activity, vaginal symptoms, urinary incontinence symptoms, overall health status and chronic medical illnesses including diabetes were assessed at baseline and each annual visit. Number of UTIs diagnosed by a physician in the previous year was assessed by self-report at each annual visit. A proportional-odds model for repeated ordinal measures was used to test the treatment effect at all annual visits together, and risk factors for UTI were assessed using generalized estimating equation logistic models. RESULTS: UTI frequency tended to be a little higher in the group randomized to hormone treatment, although the difference was not statistically significant [Odds Ratio (OR) 1.2; 95% confidence interval 1.0 ± 1.4]. Among the 116 women who reported multiple UTIs in the previous year at baseline, there was no difference in the odds of UTI for the oral hormone vs. placebo group [OR 1.1 (0.7 ± 1.9)]. The average incidence of UTI at each annual visit was 12.3%. Among women with at least one UTI during a reporting period, 32.2% had two or more UTIs in the previous year. In multivariate analysis, risk factors significantly associated with UTI included diabetes requiring medications [OR 1.6 (1.3 ± 2.0)], urinary urge incontinence symptoms [OR 1.5 (1.3 ± 1.7)], frequent vaginal itching or dryness [OR 1.4 (1.1 ± 1.7)], history of child-birth [OR 1.4 (1.0 ± 1.9)], and self-reported poor health [OR 1.4 (1.2 ± 1.6)]. UTI in the previous year was strongly associated with incident UTI [single UTI: OR 6.9 (5.8 ± 8.1); multiple UTI: OR 18.2 (14.0 ± 23.5)]. After controlling for diabetes status, fasting blood glucose level was not associated with risk of UTI. Sexual intercourse was not a risk factor for UTI. CONCLUSION: Oral hormone therapy did not reduce the frequency of urinary tract infections. Potentially modifiable risk factors to decrease risk of urinary tract infection in postmenopausal women are different from those for younger women, and include diabetes, vaginal symptoms, and urge incontinence. PURPOSE: Thyroid dysfunction increases with age, is more common among women, and among whites is associated with lipid changes. There is limited information on racial differences in thyroid dysfunction and the association with cholesterol abnormalities. METHODS: Health ABC is a cohort of well-functioning whites and blacks, ages 70 ± 79, recruited for a population-based study in 1997. We analyzed thyrotropin (TSH) and serum cholesterol test results for 2,742 participants performed at the second annual visit. Free thyroxine (FT4) levels were performed on those with abnormal TSH results. Medical history and physical measurements were gathered at baseline and the second annual visit. The relationship between TSH and total cholesterol was analyzed with multivariable linear regression adjusting for multiple covariates. RESULTS: 267 (9.7%) participants were taking thyroid hormone medication and 223 (83.5%) of these men and women were biochemically euthyroid. Among those not taking thyroid hormone, 2,364 (95.5%) participants were euthyroid. Subclinical hypothyroidism was the most prevalent disorder among all race/gender groups; white women had a significantly higher prevalence of subclinical hypothyroidism than black women (4.5% vs. 1.6%, p = 0.004). Mean cholesterols were highest for those who were biochemically hypothyroid and lowest among those who were hyperthyroid. After adjustment for age, gender, race, body-mass index, smoking, alcohol use, diabetes, hormone-replacement therapy and thyroid hormone use, a TSH > 7.0 ulU/ml was associated with a 18 mg/dl increase in cholesterol and a TSH < 0.1 ulU/ml, with a 21 mg/dl decrease and did not differ between black and white participants. CONCLUSION: Healthy community-dwelling elderly blacks have a lower prevalence of thyroid dysfunction compared to whites. The association between increased TSH and increased cholesterol is similar in blacks and whites. PURPOSE: Atrial Fibrillation (AF) is the most common sustained arrhythmia, and is the cause of significant morbidity. Risk factors which increase the incidence of AF are: increasing age, ischemic heart disease, valvular heart disease, cardiomyopathy, congestive heart failure and chronic lung disease. AF may also occur in a normal heart. Ibutilide, a class III antiarrhythmic agent, has emerged as an effective intravenous agent for treatment of AF to normal sinus rhythm (NSR). However it is associated with a 4% chance of ventricular arrhythmias. In addition, Ibutilide remains a very expensive medication often requiring a second dose. Oral Propafenone, a class IC agent, has been shown to be an effective treatment for recent-onset AF in patients without structural heart disease. It is an inexpensive medication usually administered as an oral medication in the dose range of 150 to 300 mg. Recently it was shown that a single dose of 600 mg of Propafenone, was successful compared to control, in converting recent-onset AF to NSR. Although the effectiveness of both oral Propafenone and Ibutilide, individually, in converting recent-onset AF to NSR has been well established, the comparative studies of these agents are lacking. The aim of this study is to evaluate in a randomized fashion the efficacy of Intravenous Ibutilide versus a single 600 mg dose of oral Propafenone in treatment of recent-onset AF. METHODS: All eligible patients with recent-onset AF/atrial Flutter (AFL) were identified and placed in the telemetry unit. Recent-onset AF was defined as arrhythmia lasting less than two weeks duration. The onset of AF was established based on symptoms such as palpitation, dizziness, chest pain or electrocardiogram (ECG) finding. If timing of onset of AF/AFL was unclear or greater than 48 hours, before attempting cardioversion, patients underwent a transesophageal echocardiogram (TEE). All patients were started on heparin and their prothrombin time (PTT) was maintained at 1.5 ± 2.0 times control. If patients had a rapid ventricular rate of greater than 100 bpm, AV nodal blocking agents were used to control the ventricular response. Exclusion criteria included: age less than 18 year old; hemodynamically unstable patient; previous myocardial infarction; known coronary artery disease; unstable angina; NYHA functional class greater than 1 heart failure; ventricular rate less than 60 bpm; hypokalemia (less than 3.5 mEq/L); hyperkalemia (greater than 5.5 mEq/L); untreated thyroid disease; recent GI bleeding; history of adverse drug reaction; contraindication to heparin; second or third degree atrioventricular block; bifascicular block; Complete bundle branch block; sick sinus syndrome; other antiarrhythmic therapy used within 8 hours prior to the enrollment in this study. Patients were monitored, TSH was checked and all electrolytes including potassium and magnesium were supplemented prior to drug administration. After it was determined that AF/AFL has been stable with a documented duration of greater or equal to one hour, eligible patients were randomly assigned to receive a single 600 mg dose of oral Propafenone or an intravenous infusion of 1 mg of Ibutilide over 10 minutes. A second infusion of Ibutilide was given 10 minutes after completion of the first infusion if conversion did not occur. Serial ECG's were performed following drug administration. A 12-lead ECG was performed immediately upon cardioversion to NSR. Cardioversion was identified as a stable sinus rhythm lasting for at least one hour. In case of persistent AF/AFL, patients underwent electrical cardioversion after the 24-hour observation period. RESULTS: We identified a total of 100 patients with recent-onset AF/AFL. Of the 100 patients 37 were eligible for enrollment in this study. 19 patients (51%) converted to NSR spontaneously. 18 patients were randomized to either receive Propafenone(8) or Ibutilide(10). 6 of 8 patients converted to NSR following Propafenone(75% conversion rate) with a mean time to conversion of 4.5 hours. 7 of 10 patients converted to NSR following Ibutilide (70% conversion rate). No significant difference in conversion rate between drug arms. All patients except for one required two doses of Ibutilide for conversion. Mean time for conversion to NSR with Ibutilide was 2 hours. No significant ventricular tachyarrhythmias were noted. CONCLUSION: Propafenone is a safe, inexpensive and well-tolerated agent for the acute conversion of recent-onset AF/AFL to NSR, with the same efficacy as Ibutilide. In select patients(e.g. patients with no structural heart disease) Propafenone may be safe to use as an outpatient basis.