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PubMed1990

The effects of glucocorticoids on the availability of L-tryptophan and tyrosine in the plasma of depressed patients.

There is evidence that a functional deficit of serotonin/noradrenaline and/or of their precursors L-tryptophan (L-TRP)/tyrosine and disorders in the hypothalamic-pituitary-adrenal (HPA) axis are linked to the pathophysiology of severe depressions. Several reports suggest a reciprocal relationship between these neurotransmitters and HPA axis activity. In order to investigate the effect of glucocorticoid excess on the availability of L-TRP and tyrosine to the brain, we measured urinary cortisol (UC) excretion in 24-h urine, and the availability of both amino acids before and after treatment with 1 mg dexamethasone in 26 depressed patients. We found no relationship between UC excretion and the availability of either amino acid. Dexamethasone significantly suppressed the availability of L-TRP (P less than 10(-5] and of tyrosine (P = 0.005). Major depressed patients with melancholia exhibited a significantly lower availability of L-TRP than minor depressives (P = 0.007).

Amino Acids↗

PubMed1991

Effects of acidification on the availability of toxic metals and calcium to wild birds and mammals.

The effects of acidification on wildlife inhabiting aquatic or semi-aquatic environments are reviewed, with particular reference to the possibility for increased dietary exposure to Hg, Cd, Pb and/or Al, and decreased availability of essential dietary minerals such as Ca. It is concluded that: (1) piscivores risk increased exposure to dietary methyl-Hg in acidified habitats, and Hg concentrations in prey may reach levels known to cause reproductive impairment in birds and mammals; (2) piscivores do not risk increased exposure to dietary Cd, Pb or Al because these metals are either not increased in fish due to acidification, or increase are trivial from a toxicological perspective; (3) insectivores and omnivores may, under certain conditions, experience increased exposure to toxic metals in some acidified environments. Exposure levels are likely to be sufficiently low, however, that significant risks to health or reproduction are unlikely. More importantly, these wildlife species may experience a drastic decrease in the availability of dietary Ca due to the pH-related extinction of high-Ca aquatic invertebrate taxa (molluscs, crustaceans). Decreased availability of dietary Ca is known to adversely affect egg laying and eggshell integrity in birds, and the growth of hatchling birds and neonatal mammals. Acidification-related changes in the dietary availability of other essential elements, such as Mg, Se and P, have not been established and require further investigation; (4) herbivores may risk increased exposure to Al and Pb, and perhaps Cd, in acidified environments because certain macrophytes can accumulate high concentrations of these metals under acidic conditions. The relative importance of pH in determining the metal concentrations of major browse species, and the toxicological consequences for herbivores wildlife, is not well established and requires further study. A decreased availability of dietary Ca is also likely for herbivores inhabiting acidified environments.

Journal Article↗

PubMed1996

Chronic social stress produces reductions in available splenic type II corticosteroid receptor binding and plasma corticosteroid binding globulin levels.

Adult male and female rats were housed for 2 weeks in a Visible Burrow System resulting in the development of strong dominant-subordinate relationships among the male rats. Neuroendocrine measures indicated that the subordinate rats, and to a lesser extent dominant rats, experienced chronic HPA axis hyperstimulation during the 2 week experience. This paper focuses on the consequences of this chronic social stress on cytosolic type II corticosteroid receptor binding in the spleen. In the first study, rats were adrenalectomized 18 h prior to sacrifice in order to measure total cellular receptor protein levels in each animal. In spite of the severity of the social stress, there was no decrease in splenic type II corticosteroid receptor binding levels in these short-term adrenalectomized animals. In the second study, rats were left adrenal-intact. Corticosteroid receptor levels in these adrenal-intact animals reflect the level of receptors (available receptors) that were unoccupied by endogenous hormone at the time of sacrifice. Both subordinate and dominant rats had fewer available splenic type II receptors than control rats, suggesting that a greater proportion of receptors in subordinate and dominant rats were occupied and activated by endogenous hormone at the time of sacrifice than in control rats. The differences in available receptor levels were not a function of total plasma corticosterone levels at the time of sacrifice (mean corticosterone levels were the same for control and subordinate rats). Instead, the differences in available receptor levels may have been a function of plasma corticosteroid binding globulin (CBG) levels which regulate free corticosterone levels. There was a large reduction in plasma CBG levels of subordinate (-70%) and dominant (-40%) rats relative to control rats, and there was a significant correlation between plasma CBG level and available type II receptors in the spleen. These results suggest that a decrease in CBG levels as a result of chronic social stress led to greater access of free corticosterone hormone to type II receptors in the spleen than is typically present in rats under basal or acute stress conditions. This result illustrates one mechanism by which chronic stress may have a greater impact than acute stress on splenic immune function.

Animals↗

PubMed2005

Serotonin transporter availability in patients with schizophrenia: a positron emission tomography imaging study with [11C]DASB.

BACKGROUND: Postmortem studies have reported several alterations in serotonin transporter (SERT) binding parameters in patients with schizophrenia. The aim of this study was to compare SERT availability in vivo in patients with schizophrenia and matched control subjects. METHODS: Ten medication-free patients with schizophrenia and 10 healthy subjects underwent positron emission tomography (PET) scans for 90 min after 11C-3-amino-4-(2-dimethylaminomethylphenylthio)benzonitrile ([11C]DASB) injection. Metabolite-corrected arterial input function was measured. Regional distribution volumes (mL/g) were derived with a two tissue compartment kinetic model. Outcome measures for SERT availability included binding potential (BP) and the specific-to-nonspecific equilibrium partition coefficient (V3''). Ten brain regions with high density of SERT and where SERT availability can be reliably quantified with [11C]DASB were included in the analysis. RESULTS: No significant differences were observed in regional BP or V3'' between patients and control subjects. No significant relationships were observed between regional SERT availability and severity of positive, negative, and depressive symptoms. CONCLUSIONS: This study failed to detect alterations of SERT availability in patients with schizophrenia; however, this study does not rule out the possibility that schizophrenia might be associated with alterations of SERT density in the cortical regions, where the [11C]DASB-specific binding signal is too low for reliable quantification of SERT.

Adult↗

PubMed2006

A comparison of new drug availability in Canada and the United States and potential therapeutic implications of differences.

BACKGROUND: Claims are made that new valuable drugs are not available in Canada at the time that they are marketed in the United States. This study uses a convenience sample of new drugs marketed in the United States and determines how many of these products are initially unavailable in Canada and their therapeutic value. METHODS: Issues of the Canadian edition of The Medical Letter from May 12, 2003 to June 21, 2004 were hand searched for evaluations of new drugs and the following information was recorded: indication, availability in Canada and conclusions about therapeutic value. For drugs not available in Canada two clinical pharmacologists rated the therapeutic value of the products and the type of FDA review (standard or priority) was recorded. A database from the Therapeutic Products Directorate was searched to see if any of the drugs initially unavailable were subsequently marketed. RESULTS: Thirty-two of 37 drugs were not available in Canada. Between 9 and 11 of these products were rated as offering moderate to significant therapeutic gains. Twelve of the 32 drugs eventually were marketed in Canada. INTERPRETATION: Although the majority of new drugs marketed in the United States but not available in Canada do not offer any therapeutic advantage, between about a quarter and a third of may offer moderate to significant therapeutic gains. The reasons why these drugs are unavailable and how much their absence affects the treatment Canadians receive should be the subject of future research.

Canada↗

PubMed2005

Competitive foods available in Pennsylvania public high schools.

OBJECTIVE: This study examined the types and extent of competitive foods available in public high schools in Pennsylvania. DESIGN: We developed, pilot tested, and distributed surveys to school foodservice directors in a random sample of 271 high schools in Pennsylvania. SUBJECTS: Two hundred twenty-eight surveys were returned, for a response rate of 84%. Statistical analyses were performed: Descriptive statistics were used to examine the extent of competitive food sales in Pennsylvania public high schools. The survey data were analyzed using SPSS software version 11.5.1 (2002, SPSS base 11.0 for Windows, SPSS Inc, Chicago, IL). RESULTS: A la carte sales provide almost dollar 700/day to school foodservice programs, almost 85% of which receive no financial support from their school districts. The top-selling a la carte items are "hamburgers, pizza, and sandwiches." Ninety-four percent of respondents indicated that vending machines are accessible to students. The item most commonly offered in vending machines is bottled water (71.5%). While food items are less often available through school stores and club fund-raisers, candy is the item most commonly offered through these sources. CONCLUSIONS: Competitive foods are widely available in high schools. Although many of the items available are low in nutritional value, we found several of the top-selling a la carte options to be nutritious and bottled water the item most often identified as available through vending machines.

Adolescent↗

PubMed2006

Fruit, vegetable, and fat intake among non-Hispanic black and non-Hispanic white adolescents: associations with home availability and food consumption settings.

OBJECTIVE: This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents. PARTICIPANTS AND DESIGN: Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods. MAIN OUTCOMES: Correlates of fruit, vegetable, and fat consumption. STATISTICAL ANALYSIS: Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents. RESULTS: In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake. CONCLUSIONS: Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.

Adolescent↗

PubMed2006

Food store availability and neighborhood characteristics in the United States.

OBJECTIVE: This study provides a multivariate analysis of the availability of food store outlets in the US and associations with neighborhood characteristics on race, ethnicity and socioeconomic status (SES). METHOD: Commercial food store outlet data are linked across 28,050 zip codes to Census 2000 data. Multivariate regression analyses are used to examine associations between the availability of chain supermarkets, non-chain supermarkets, grocery stores and convenience stores and neighborhood characteristics on race, ethnicity and SES including additional controls for population size, urbanization and region. RESULTS: Low-income neighborhoods have fewer chain supermarkets with only 75% (p<0.01) of that available in middle-income neighborhoods. Even after controlling for income and other covariates, the availability of chain supermarkets in African American neighborhoods is only 52% (p<0.01) of that in White neighborhoods with even less relative availability in urban areas. Hispanic neighborhoods have only 32% (p<0.01) as many chain supermarkets compared to non-Hispanic neighborhoods. Non-chain supermarkets and grocery stores are more prevalent in low-income and minority neighborhoods. CONCLUSION: The study results highlight the importance of various potential public policy measures for improving access to supermarkets that may serve to reduce systematic local area barriers that are shown to exist by race, ethnicity and income.

Censuses↗

PubMed1984

Decreased response of plasma immunoreactive erythropoietin to "available oxygen" in anemia of prematurity.

Erythropoietin, hemoglobin, hematocrit, oxygen affinity (P50), and reticulocyte counts were measured weekly starting at 1 week of age in 10 very-low-birth-weight infants and on a single occasion in 15 healthy men. In the adults, "available oxygen" (derived from oxygen carrying capacity and P50) averaged 13.1 ml/dl blood and the mean erythropoietin level was 15.2 mU/ml. Erythropoietin levels in the infants were inversely related to concentration of hemoglobin, P50, and available oxygen. However, despite the much lower mean "available oxygen" of 9.3 ml/dl in the infants compared with that in adults (P less than 0.001), the mean erythropoietin value of 8.2 mU/ml in the infants was less than in adults (P less than 0.001). Furthermore, the erythropoietin response to decreased "available oxygen" was lowest in the least mature infants. VLBW infants often develop clinical evidence of hypoxia during the anemia of prematurity. The relatively low erythropoietin levels in relation to "available oxygen" are compatible with a decreased erythropoietin response to hypoxia compared with that in adults. Such a difference in response could be a contributing factor to the anemia of prematurity.

Adult↗

PubMedDate not supplied

The availability of potential hosts as a determinant of feeding behaviours and malaria transmission by African mosquito populations.

A simple model for the influence of host availability on vector bloodmeal choice is applied to estimate the relative availabilities of humans, cattle and other host populations to malaria vectors in African communities, using published human blood indices and ratios of cattle to humans. Cattle were bitten < 0.01, 0.021 +/- 0.11, 1.61 +/- 0.16 and 1.61 +/- 0.46 times as often as humans by Anopheles funestus, An. gambiae sensu stricto and An. arabiensis in Segera, Tanzania, and An. gambiae sensu lato in The Gambia, respectively. No significant feeding upon host species other than cattle or humans was detected. Even though An. gambiae s.l. in The Gambia were mostly An. gambiae s.s., they were 77 times more likely to choose cattle over humans than An. gambiae s.s. in Tanzania. The model accurately predicted cattle blood indices for the An. arabiensis population in Tanzania (predicted = 0.99 +/- 0.21 x observed + 0.00 +/- 0.10; r2 = 0.66). The potential effect of increased cattle abundance upon malaria transmission intensity was simulated using fitted relative availability parameters and assuming vector emergence rate, feeding cycle length and survivorship were unaffected. The model predicted that increased cattle populations would not affect malaria transmission in Tanzania but could drastically reduce transmission in The Gambia or where An. arabiensis is the dominant vector. We define the availability of a host as the rate at which a typical individual host-seeking vector encounters and feeds upon that host in a single feeding cycle. Mathematical models based on this definition also represent promising tools for quantifying the dependence of vector longevity, feeding cycle length and dispersal upon host availability.

Algorithms↗

PubMed2003

Smoked heroin in rhesus monkeys: effects of heroin extinction and fluid availability on measures of heroin seeking.

The purpose of the present study was to evaluate the reinforcing effects of smoked heroin in nonopioid-dependent nonhuman primates when an alternative reinforcer, sweetened fluid, was made available. Four adult male rhesus monkeys lived in three chambers, with heroin self-administration (0, 0.3, and 0.6 mg/kg) specific to one end of the chamber, oral sweetened fluid self-administration specific to the other end chamber, and no commodity available in the middle chamber. The length of time monkeys spent in the drug-associated chamber provided one measure of drug seeking (i.e., location preference). During self-administration sessions, a second-order schedule of reinforcement was used, with responding during the first component maintained by a brief presentation of the stimuli associated with reinforcement. Responding during the second component was maintained by a delivery of the reinforcer, and the associated stimuli. Responding during the first component provided a second measure of drug seeking. Monkeys also had choice trials each day, when they could choose to work for either commodity. Choice behavior provided a third measure of drug seeking. Each experimental day consisted of a smoking session (four smoking trials), a sweetened fluid session (four fluid trials), and a choice session (four choice trials). Monkeys typically completed all four smoking trials each day when either of the active heroin doses was available. They chose both heroin doses over fluid on 3.5 of the four choice trials, and they had a location preference for the heroin chamber. Under baseline conditions, the number of acquisition responses and the number of consumption responses (inhalations) were greater for the high dose of heroin compared to the low dose of heroin. Further, it took longer to extinguish the responding for the high dose of heroin compared to the low dose of heroin when a vehicle was substituted. During heroin extinction, acquisition responding for fluid increased, the number of fluid choices increased, and location preference shifted to the fluid chamber. These data suggest that in nondependent rhesus monkeys, measures of heroin seeking decreased when heroin was not available and seeking behavior shifted to the available alternative commodity.

Animals↗

PubMed1998

Irritation potential of a new topical tretinoin formulation and a commercially-available tretinoin formulation as measured by patch testing in human subjects.

BACKGROUND: A novel tretinoin preparation uses polyolprepolymer-2, a compound designed to reduce skin irritation by helping retain drugs on and in the surface layers of the skin. OBJECTIVE: We used patch testing to measure the effect of polyolprepolymer-2 on tretinoin-associated irritation. METHODS: Two patch test studies were conducted. The first assessed the effect of polyolprepolymer-2 by comparing commercially-available tretinoin formulations with respective polyolprepolymer-containing formulations of 0.025% tretinoin gel and 0.025%, 0.05%, and 0.1% tretinoin creams. The second assessed the effect of the polyolprepolymer-2 concentration on the potential decrease in irritation by comparing: (1) a commercially-available tretinoin cream with prototype tretinoin creams containing 20% polyolprepolymer-2 at three different concentrations of tretinoin (0.025%, 0.05%, and 0.1%); and (2) the effect of three different polyolprepolymer-2 concentrations (10%, 15%, and 20%) in prototype tretinoin creams on cumulative irritation. Patch agents were assigned to subjects according to a randomization schedule, and during a period of 5 days each subject received three 24-hour exposures to the test materials. Twenty-four hours elapsed between old patch removal and new patch application. RESULTS: In the first study, the tretinoin gel and cream containing polyolprepolymer-2 caused significantly less irritation than all equivalent formulations of the commercially-available tretinoin gel and creams except the 0.025% cream formulation. Irritation scores were not significantly different in terms of irritation in the 0.025% creams although scores did indicate a trend towards lower irritation with 0.025% tretinoin cream containing polyolprepolymer-2. In the second study, the tretinoin gel containing polyolprepolymer-2 and the three tretinoin prototype creams also containing polyolprepolymer-2 caused significantly less irritation than comparable concentrations of the commercially-available tretinoin. In addition, the 0.025% tretinoin gel formulation containing polyolprepolymer-2 was no more irritating than the commercially-available 0.025% tretinoin cream. CONCLUSION: Tretinoin formulations containing polyolprepolymer-2 are, in general, less irritating than the currently marketed tretinoin formulations.

Administration, Topical↗

PubMed2000

Genotype influences in vivo dopamine transporter availability in human striatum.

In vivo availability of striatal dopamine transporter (DAT) protein has been reported to be reduced among alcoholics, and allelic variation of the DAT gene (SLC6A3) has been associated with severity of alcohol withdrawal. We examined the VNTR polymorphism of the 3' untranslated region of SLC6A3 and DAT protein availability in 14 abstinent alcoholics and 11 control subjects. Single photon emission computed tomography (SPECT) and plasma levels of the radioligand [I-123]beta-CIT were used to quantify DAT protein availability. Individuals with the 9-repeat/10-repeat genotype had a mean 22% reduction of DAT protein availability in putamen compared with 10-repeat homozygous individuals (t = 2.14, df = 23, p < .05). Consistent with earlier studies, alcoholism, per se, was not significantly associated with either DAT availability or DAT genotype. These findings suggest that the VNTR polymorphism of the DAT gene effects translation of the DAT protein. This effect may explain a variety of clinical associations that have been reported with this polymorphism.

3' Untranslated Regions↗

PubMed1998

Effects of age, available response time and gender on ability to stop suddenly when walking.

Background: Injuries may occur during walking when a sudden stop to avoid a gait path obstacle is called for unexpectedly, but cannot be completed in the time available. Little is known about abilities, particularly those of older adults, to stop suddenly. Methods: Twenty young (mean age 23.4 years) and 20 older (72.6 years) healthy and physically active adults with equal numbers of females and males in each age group were studied. While walking straight ahead at approximately 1.3 m/s, they were cued by a light at one of five possible locations to stop as quickly as possible. Subjects were given available response times (ART), the times between the visual cue to stop and potential passage through a virtual wall that was outlined by the array of lights used to cue the subjects, ranging from 375 to 825 ms in 75-ms increments. The rate of success (RS) in completing the stops as prescribed was determined and the effects on RS of age, available response time and gender were examined. Regression analyses were used to interpolate the RS data. Results: At all ART, older female (OF) subjects had a significantly lower rate of success (RS) than either older male (OM) or young adult (YA) subjects. At an ART of 525 ms, for example, RS was 58% for YA and 51% for OM, but only 23% for OF. The regression analyses suggested that OM in the mean would have needed 10 ms longer and OF 70 ms longer than YA to achieve a 50% RS. No significant gender difference in RS were found among YA. Conclusions: The healthy and physically active older female subjects in this study needed longer available response times, and thus longer available stopping distances, than did the young adults or the older males to succeed as well in stopping suddenly while walking at their comfortable gait speed. Copyright 1998 Elsevier Science B.V.

Journal Article↗

PubMedDate not supplied

Availability of primary care providers and pharmacists in the United States.

OBJECTIVE: To determine the rural distribution of primary care providers (primary care physicians, physician assistants, nurse practitioners, and nurse midwives) and pharmacists. DESIGN: Five-digit ZIP code mapping to study the availability of primary care providers and pharmacists, alone and in combinations, in rural areas and ZIP code-based health professional shortage areas (HPSAs). National averages for annual physician visits for hypertension, asthma, and diabetes were used to estimate the sufficiency of the rural physician supply. SETTING: Rural areas of the United States. RESULTS: In rural areas, all providers were present in lower densities than national averages, particularly in HPSAs. The primary care physician supply was insufficient to meet national averages for office visits for hypertension, asthma, and diabetes. Among available providers, the most prevalent co-presence was primary care physician with pharmacist. HPSAs showed very low physician density (1 per 22,122), and the most prevalent providers were pharmacists. States varied widely in provider density. CONCLUSION: Despite longstanding efforts and the expansion of managed care, primary care providers remain in short supply in rural areas, especially ZIP code-based HPSAs. Making the best use of available providers should be encouraged. The continued shortfall of primary care providers in rural areas, particularly HPSAs, makes it logical to use other available providers and combinations to increase health care access. Pharmacists could increase care for patients with conditions treated with medications. Other available providers, based on skills and work site, could also offset shortages.

Asthma↗

PubMed1998

Availability of software services for a hospital information system.

Hospital information systems (HISs) are becoming more important and covering more parts in daily hospital operations as order-entry systems become popular and electronic charts are introduced. Thus, HISs today need to be able to provide necessary services for hospital operations for a 24-h day, 365 days a year. The provision of services discussed here does not simply mean the availability of computers, in which all that matters is that the computer is functioning. It means the provision of necessary information for hospital operations by the computer software, and we will call it the availability of software services. HISs these days are mostly client-server systems. To increase availability of software services in these systems, it is not enough to just use system structures that are highly reliable in existing host-centred systems. Four main components which support availability of software services are network systems, client computers, server computers, and application software. In this paper, we suggest how to structure these four components to provide the minimum requested software services even if a part of the system stops to function. The network system should be double-protected in stratus using Asynchronous Transfer Mode (ATM) as its base network. Client computers should be fat clients with as much application logic as possible, and reference information which do not require frequent updates (master files, for example) should be replicated in clients. It would be best if all server computers could be double-protected. However, if that is physically impossible, one database file should be made accessible by several server computers. Still, at least the basic patients' information and the latest clinical records should be double-protected physically. Application software should be tested carefully before introduction. Different versions of the application software should always be kept and managed in case the new version has problems. If a hospital information system is designed and developed with these points in mind, it's availability of software services should increase greatly.

Computer Communication Networks↗

PubMed2003

Trends in body size, diet and food availability in the Cook Islands in the second half of the 20th century.

The body size of adult Cook Islanders on Rarotonga for the years 1952, 1966 and 1996 has been increasing. The rate of increase in stature of women aged 20-39 years was 0.5cm per decade across the period 1952-1966, and 0.8cm per decade for the period 1966-1996. The rate of increase of weight in the 20-29 years age group was 0.6kg per decade in period 1, and 7.3kg per decade in period 2. In the age group 30-39 years, the rates were 3.2kg per decade and 5.1kg per decade respectively. Changing food availability for the period 1961-2000 is used to compare estimates of dietary energy availability with estimates of physiological energy requirements. There has been reduced availability of traditional staples, a likely reduction in consumption of fish, increased consumption of meat, and a decline in the availability of dietary fats and oils. Daily per capita energy intakes in 1952 and 1966 greatly exceed an hypothetical physiological maximum value for energy expenditure, suggesting a large positive energy balance in 1952 and an even greater one in 1966, both predisposing to weight gain. Although daily per capita energy availability in 1996 is similar to the hypothetical physiological maximum value for energy expenditure, it exceeds the measured level of energy expenditure at that time. It is speculated that excessive energy intake relative to requirement is more likely to predispose to positive energy balance and weight gain than decline in energy expenditure, although to a lower extent than in 1966 and 1952.

Adult↗

PubMed2005

Does availability of fetal firbonectin testing in the management of threatened preterm labour affect the utilization of hospital resources?

OBJECTIVES: To examine how the availability of fetal fibronectin testing affects the utilization of hospital resources. METHODS: A comparison of the rates, duration, and costs of hospitalization for a prospective cohort of women who presented with preterm labour after fetal fibronectin (Ffn) testing became available, and a historical baseline cohort who presented with preterm labour before fetal fibronectin testing was available. The study included singleton pregnancies presenting between 24 and 34 weeks' gestation with signs and symptoms of preterm labour. The women in each study cohort presented during a designated 20-week period. RESULTS: We examined the records of 116 subjects with comparable gestational age distributions in each 20-week period. During the study period when Ffn testing was available, 51 tests were performed. Four tests were invalid, and 12 subjects who were tested did not meeting the inclusion criteria. Admissions for preterm labour in the study period were significantly less than in the baseline cohort (12.1% vs. 24.1%, P = 0.03), with no difference in preterm births (8.6% vs. 7.8%). The mean length of stay per patient with preterm labour declined from 5.2 days to 0.6 days (P < 0.0001), and the mean cost per patient with preterm labour declined from $3666 to $581 (P < 0.0001). In the 20-week study period, there was a reduction in total length of hospital stay from 145 to 28 days, with an overall reduction in total cost from $102 660 to $26 169. CONCLUSION: The availability of Ffn testing was associated with a reduction in hospital admissions, length of hospital stay, and overall hospital costs in the management of threatened preterm labour.

Adult↗