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We apply the theory of collateral consequences and a social stress process framework to school discipline to examine whether exclusionary school discipline policies are associated with the mental health and wellbeing of adolescents who have never been suspended or expelled and whether this association varies across race/ethnicity. Data are from 8,878 adolescents in the National Longitudinal Study of Adolescent to Adult Health. Hierarchical linear models examined associations between discipline policies and adolescent depressive symptoms and school-connectedness, and modification by race/ethnicity. Schools had high levels of exclusionary discipline for both violent and non-violent infractions. More exclusionary policies were associated with higher levels of depressive symptoms (b = 1.03, 95% CI: 0.15, 1.91, p < 0.05). Sense of school-connectedness was not associated with disciplinary policies. Neither association was modified by race/ethnicity.

A single-center randomized trial of overweight adults was conducted to assess adherence rates and the effectiveness of Atkins, Ornish, Weight Watchers, and Zone, four popular diets, for weight loss and cardiac risk factor reduction. The results indicated that each popular diet modestly reduced body weight and several cardiac risk factors at one year, and that the overall dietary adherence rates were low.

We apply the theory of collateral consequences and a social stress process framework to school discipline to examine whether exclusionary school discipline policies are associated with the mental health and wellbeing of adolescents who have never been suspended or expelled and whether this association varies across race/ethnicity. Data are from 8,878 adolescents in the National Longitudinal Study of Adolescent to Adult Health. Hierarchical linear models examined associations between discipline policies and adolescent depressive symptoms and school-connectedness, and modification by race/ethnicity. Schools had high levels of exclusionary discipline for both violent and non-violent infractions. More exclusionary policies were associated with higher levels of depressive symptoms (b = 1.03, 95% CI: 0.15, 1.91, p <.05). Sense of school-connectedness was not associated with disciplinary policies. Neither association was modified by race/ethnicity. [ABSTRACT FROM AUTHOR]

Myocardial perfusion imaging using SPECT scans and technetium can help emergency room doctors identify patients with chest pain who may be having a heart attack and those who are not. In a study of 2,475 patients, this technique reduced the number of hospital admissions among patients who were not actually having a heart attack. All of the patients in this study had chest pain but no ECG changes.

Research has been conducted on the relationship of viral loads, CD4 counts and highly active antiretroviral therapy use to health-related quality of life. Results demonstrate that the improvement of patients' CD4 counts improve health-related quality of life.

More research is needed to identify factors that can help emergency room doctors diagnose a heart attack. In a study of 10,689 people who went to an emergency room because they had chest pain, 2% of those who were having a heart attack were mistakenly discharged. Women under the age of 55, people of color, and people with a normal or near-normal electrocardiogram were most likely to be mistakenly discharged. Compared to heart attack patients who were hospitalized, patients mistakenly discharged were twice as likely to die.

Cellular telephones should not interfere with a cardiac pacemaker unless they are held close to the chest. Researchers performed 5,533 tests on 980 patients with pacemakers using five types of cellular phone. The patients were attached to an ECG machine to record any cardiac abnormalities. Only 6.6% of the tests resulted in any serious interference with the pacemaker. This only occurred when the phone was held over the pacemaker. When in the normal position at the ear, the phone caused no significant interference.

Clinical practice guidelines should be based on clinical data and should be tested in an appropriate population before they are published. The Agency for Health Care Policy and Research has published clinical practice guidelines to reduce hospitalization rates for unstable chest pain. Researchers used these guidelines to assign 457 patients presenting with chest pain to one of three categories: low-risk, intermediate risk and high risk. Only 6% were assigned to the low-risk group, indicating that the guideline probably will not reduce hospitalization rates significantly., Objective.--To determine the applicability to emergency department (ED) clinical practice of a nationally disseminated practice guideline on the disposition of patients with a diagnosis of unstable angina, and to determine the potential impact of the guideline on hospital admissions and demand for intensive care beds. Design.--Application of guideline criteria for ED disposition decisions to a validation sample derived from a prospective clinical trial. Setting.--Five hospitals, including 2 urban general teaching hospitals, 2 urban tertiary care university hospitals, and 1 suburban university-affiliated community hospital. Patients.--A consecutive sample of 457 patients who presented with symptoms suggestive of acute cardiac ischemia and who had "unstable angina" or "rule out unstable angina" diagnosed by ED physicians. Greater than 90% of eligible patients were enrolled in the clinical trial; follow-up data sufficient for assignment of a definitive diagnosis were obtained for 99% of subjects. Main Outcome Measures.--Acute myocardial infarction and unstable angina, based on blind review of initial and follow-up clinical data, including cardiac enzyme levels and electrocardiograms. After completion of the trial, without knowledge of final diagnosis or outcome, the investigators classified patients into risk groups specified by the unstable angina guideline. Results.--Of subjects with an ED diagnosis of unstable angina, only 6% (n=28) met the guideline&apos;s criteria corresponding to low risk for adverse events and were therefore suitable for discharge directly to home. Fifty-four percent (n=247) met the intermediate-risk criteria; 40% (n=182) met the high-risk criteria and were identified as requiring admission to an intensive care unit. Actual ED disposition differed from guideline recommendations in 2 major areas: only 4% (1/28) of low-risk patients were discharged to horne with outpatient follow-up, and only 40% (72/182) of high-risk patients were admitted to an intensive care unit. Conclusions.--Although the guideline was intended to reduce hospitalization by identifying a low-risk group, the small size of this group among ED patients suggests that little reduction in hospitalization can be expected. Indeed, the guideline may increase demand for the limited number of intensive care beds to accommodate patients with unstable angina considered high-risk but currently placed elsewhere. These results emphasize the need to use empiric data from target clinical settings to assess the likely actual impact of guidelines on clinical care prior to national dissemination. JAMA. 1996;276:1568-1574