Among patients who were overweight or obese, patient reports of being told by a physician that they were overweight were associated with more realistic perceptions of the patients' own weight, desire to lose weight, and recent attempts to lose weight.

PURPOSE Some studies suggest proprietary (for-profi t) hospitals are maximizing fi nancial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profi t environment. METHODSWe undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratifi ed by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status.RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a signifi cantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was signifi cantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P <.01). Among hospitalizations for ACSCs, inhospital mortality rate for individuals with either private insurance or Medicaid was not signifi cantly different from the mortality rate for those without insurance.CONCLUSIONS Patients without insurance have shorter lengths of stay for both ACSCs and non-ACSCs. Future research should examine whether patients without insurance are being discharged prematurely. INTRODUCTIONT he problem of health care access is one that continues to vex the United States. Recent estimates suggest that in 2009, 46 million US residents younger than 65 years (17.5%) were uninsured.1 Insurance is an indicator of access to care and is associated with getting timely care for conditions for which appropriate access can make a major difference. Past studies show that patients who do not have health insurance are less likely than those with health insurance to be seen by a physician in ambulatory care for acute conditions.2 Health care access, particularly in an ambulatory setting, for such conditions as pneumonia and asthma is important because lack of access leads to increased emergency department use, as well as what could be termed preventable hospitalizations. 490 INSUR A NCE A ND HOSPI TA L L ENG T H O F S TAYAlthough the recent passage of the Patient Protection and Affordable Care Act provides health insurance for many more Americans, it is unclear whether other factors affecting the cost of health insurance will actually increase the number of uninsured resulting from the increasing cost o...

Background: It is suggested that targeted screening for hemochromatosis and iron overload may be worthwhile. The aim of this study was to examine uric acid as a potential indicator of the presence of iron overload.Methods: We analyzed adults aged 20 and older in the National Health and Nutrition Examination Survey 1999 to 2002. We computed logistic regressions controlling for age, sex, race/ethnicity, liver or kidney condition, and alcohol use to see the relationship between combinations of uric acid and ferritin with the outcomes of elevated liver enzymes and proteinuria.Results: In unadjusted analyses, 20.7% of individuals with high uric acid had high ferritin levels versus 8.8% of individuals with low uric acid levels (P < .001). Individuals with both elevated uric acid and elevated ferritin levels had significantly higher liver enzymes than individuals with either elevated uric acid or ferritin. With low uric acid and low ferritin as the reference category, individuals with high uric acid and high ferritin were significantly more likely to also have proteinuria (odds ratio, 2.66; 95% CI, 1.82-3.91).Conclusions: Elevated levels of uric acid is associated with elevated ferritin levels and may serve as a risk stratification variable for presence of iron overload and hemochromatosis. (J Am Board Fam Med 2011;24:415-421.)

C. pneumoniae antibodies are related to progression of CAC, particularly in individuals with CAC present at baseline. This provides evidence that certain groups are at higher risk of atherosclerotic progression and may be useful for risk stratification and treatment.

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