Journal of general internal medicine
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Hospital use near the end of life is often undesirable to patients, represents considerable Medicare cost, and varies widely across regions. ⋯ Functional decline is significantly associated with end-of-life hospital use among older adults. To improve care and reduce costs, health care programs and policies should address specific needs of patients with functional decline and disability.
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We know little about how much time low-income patients and physicians spend discussing pain during primary care visits. ⋯ Pain-related discussions comprise a substantial proportion of time during primary care visits. Future research should evaluate the relationship between time spent discussing pain and the quality of primary care pain management.
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Despite federal guidelines calling for the reduction of obesity and elimination of health disparities, black-white differences in obesity prevalence and in medical expenditures and utilization of health care services persist. ⋯ Black-white racial differences in total medical expenditures were observed in each body weight category and were significantly different in the obese I class, overweight, and healthy weight categories. Obese blacks also spent a smaller amount than obese whites--the insignificance might be due to the smaller sample size. These differences cannot be fully explained by socio-demographics, health conditions, or health beliefs. Black-white differences in medical expenditures may be largely due to relatively inexpensive types of care (office-based visits, outpatient care, medication) rather than more costly ones (inpatient care, ER).
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Histamine fish poisoning, also known as scombroid poisoning, is a histamine toxicity syndrome that results from eating specific types of spoiled fish. Although typically a benign syndrome, characterized by self-limited flushing, headache, and gastrointestinal symptoms, we describe a case unique in its severity and as a precipitant of an asthma exacerbation. ⋯ A diagnosis of histamine fish poisoning was made and the patient was treated supportively and discharged within 24 hours, but was readmitted within 3 hours due to an asthma exacerbation. Her course was complicated by recurrent admissions for asthma exacerbations.