Estudi preliminar per la creació d'una nova categoria d'impacte ambiental dins el marc de l'ACV: la dimensió natural del paisatge

L’Anàlisi de Cicle de Vida (ACV) és una eina emprada per gestionar els impactes ambientals i els recursos usats al llarg del cicle de vida d’un bé o servei. Existeixen reptes de futur en el desenvolupament de l’ACV, tals com la introducció de noves categories d’impacte ambiental, que permetin una anàlisi més específica dels impactes sobre determinats elements del medi, com ara el paisatge. En el present estudi s’analitza la dimensió natural del paisatge per tal de proposar la creació d’un índex de paisatge. Així doncs, s’han revisat les noves propostes de categories d’impacte en ACV que inclouen directament o indirecta el paisatge i s’ha analitzat una mostra de 33 estudis d’indicadors de paisatge. Aquesta cerca deriva en l’elecció de 6 indicadors: els usos del sòl, la diversitat paisatgística, la fragmentació, la connectivitat, la riquesa d’espècies i la densitat de carreteres. En la determinació dels seus respectius mètodes de càlcul s’ha detectat la importància de l’ús dels SIG, l’elecció d’una base de dades d’usos del sòl comuna (CORINE) i les interrelacions que existeixen entre indicadors. La proposta de l’índex hauria de poder ésser un punt de partida per a futurs estudis en aquest àmbit i derivar en una nova categoria d’impacte de paisatge, donat que caldrà estudiar alguns elements, com la interrelació entre indicadors.

Distintiu de garantia de qualitat ambiental per a equipaments culturals: aplicació pilot en biblioteques

El DGQA per a Equipaments Culturals és un distintiu per a la certificació ambiental de biblioteques i museus. L’objectiu del projecte és avaluar el distintiu mitjançant una aplicació pilot en 26 biblioteques de la província de Barcelona, i proposar millores tant per al distintiu com per a les biblioteques. També es pretén fer recerca sobre l’ecoetiquetatge de serveis, ja que és un àmbit poc desenvolupat, i sobre el sistema d’estudi, les biblioteques. Una anàlisi de les ecoetiquetes a nivell mundial, considerant 4 macroregions, ha permès caracteritzar les ecoetiquetes i determinar la situació actual dels serveis en l’ecoetiquetatge. Hi han variacions en el nombre de categories entre ecoetiquetes, i el percentatge de categories de serveis és, en general, reduït (8% de mitjana). Els subsectors serveis dominants són els d’Hosteleria, serveis de neteja i comerç. No hi ha cap experiència de certificació ambiental de serveis culturals, per tant, l’ecoetiquetatge de serveis culturals és un àmbit nou. El sistema d’estudi són 26 biblioteques de la província de Barcelona. L’aplicació del distintiu a aquestes s’ha dut a terme realitzant treball de camp a cadascuna per tal de determinar el seu estat ambiental. Posteriorment, s’han analitzat les dades per establir el grau de compliment de cadascuna. La majoria de les biblioteques (85%) compleixen més de la meitat dels criteris bàsics, i un 60% superen la puntuació mínima de compliment dels criteris opcionals. Els resultats obtinguts han permès avaluar la viabilitat de la implantació del distintiu, a través de l’anàlisi de cadascun dels seus criteris. Per tal de millorar les possibilitats d’èxit en la implantació del distintiu, s’han aportat un seguit de propostes a nivell individual i col·lectiu. S’ha realitzat una fitxa per a cadascuna de les 26 biblioteques, per tal d’orientar els gestors de les biblioteques en l’adopció de mesures per a l’acompliment dels criteris. També s’han inclòs propostes a l’avaluació dels criteris, dirigides als gestors del distintiu.

La perception de la productivité dans l'industrie hôtelière de luxe : le cas de la Suisse romande

La perception de la productivité SUMMARY The main objective of this thesis is the perception of the productivity in the luxury hospitality industry. Despite a lot of efforts which were already made in the field of the production of goods, this concept (productivity) still remains to be defined in the services sector, more still, in that of the luxury hospitality industry. Since the object of this study is the perception of productivity, we decided to analyze the elements considered to be relevant by the top management in this field. Then, it seemed important to evaluate these same elements for the categories of middle-management and by the in-line employees. As perception is not static, it is dependent in an indirect way on its improvement and however also with the means of improvement. The assumption of our work evokes the possible relationship between productivity and its perception (P), (Q) quality and profitability (R). On this basis we built the P-Q-R model: R=F(P,Q) Finally, our research on this model enabled us to establish a mathematical relation between the three predetermined elements: fR=fP+fQ+c That means that the function efficiency of a process of services -(fR) is the sum of its quality function (intrinsic and extrinsic)-(fP) and of its productivity function - fQ (and the constant of regression "c"). To increase the profitability of the most significant manner, it is necessary to increase at the same time the productivity and quality. On the other hand, according to this formula but also according to the perception of the managers, with a constant profitability, either the productivity decreases in favor of the increase in quality, or the reverse. If the dimensions of the model influence positively or negatively the production process of services, then those wí11 influence in same manner our model (P, Q, R). We advance a point of view saying that profitability depends on the labor productivity which follows same dynamics than the perception of the productivity. The identification of the labor productivity as an essential element of successful management of the hotel is fundamental. The question which always remains in suspense is however the relevance of the concept "labor productivity" for the luxury hospitality industry. It was not proven an obvious correlation between this notion and the one of profitability. We still remain at the stage of perception. It results that one interesting way of future research will be the study of this correlation. As in any kind of luxury industry, the real added value does not consist in the volume produced or in the speed with which the product/service is carried out but in the creativity involved in their results. Let us note that the field of luxury is extremely related to the emotions and to the experience provided to the customers. La perception de la productivité... RÉSUME L'objectif principal de cette thèse est la perception de la productivité dans l'hôtellerie de luxe. Malgré tous les efforts qui ont déjà été faits dans le domaine de la production de biens, ce concept (productivité) reste encore à définir dans le secteur des services, plus encore, dans celui de l'hôtellerie de luxe. Étant donné que l'objet de l'étude est la perception de la productivité, nous avons décidé d'analyser les éléments jugés pertinents par les cadres dirigeants dans ce domaine. Puis, il nous a semblé important d'évaluer ces mêmes éléments pour les catégories de cadres moyens et par les employés in-line. Comme la perception n'est pas statique, elle est liée d'une manière indirecte à son amélioration et cependant également aux moyens d'amélioration. L'hypothèse de notre travail évoque la possible relation entre la productivité et sa perception (P), la qualité (Q) et la rentabilité (R). Sur cette base nous avons construit le modèle P-Q-R de départ R=f(P,Q) Finalement, notre recherche sur ce modèle nous a permis d'établir une relation mathématique entre les trois construits prédéterminés: fR=fP+fQ+c Cela signifie que la fonction rentabilité d'un processus de services -(fR) est la somme de sa fonction qualité (intrinsèque et extrinsèque)-fP et de sa fonction productivité -fQ (plus la constante de régression « c ») Pour augmenter la rentabilité de la manière la plus significative, il faut augmenter en même temps la productivité et la qualité. En revanche, selon cette formule mais selon aussi la perception des managers, à une rentabilité constante, soit la productivité diminue en faveur de l'augmentation de la qualité, soit l'inverse. Si les dimensions du modèle influencent positivement ou négativement le processus de production de services, alors celles-ci vont influencer de la même manière les construits de notre modèle (P, Q, R). Nous avançons un point de vue disant que la rentabilité dépend de la productivité du travail qui suit la même dynamique que la perception de la productivité. L'identification de la productivité du travail comme élément essentiel de gestion réussie de l'hôtel s'avère fondamentale. La question qui reste toujours en suspens est pourtant la pertinence de la notion «productivité du travail » pour l'industrie hôtelière de luxe. Il n'a pas été prouvé une corrélation évidente entre cette notion et celle de la profitabilité. Nous restons donc ici encore au stade de perception. Il en résulte que l'une des voies les plus intéressantes de recherche future sera l'étude de cette corrélation. Comme dans toute industrie de luxe, la vraie valeur ajoutée ne consiste pas toujours dans le volume produit, ni dans la vitesse avec laquelle le produit/service est réalisé, mais parfois dans la créativité emmagasinée dans ces résultats. Notons que le domaine de luxe est extrêmement lié aux émotions et à l'expérience fournie aux clients.

Increased blood glucose variability during therapeutic hypothermia and neurological recovery after cardiac arrest

INTRODUCTION. Recent studies suggest that increased blood glucose variability (BGV) is associated with ICU mortality1. Hypothermia is known to induce insulin resistance, thus potentially increasing BGV. No studies however have examined the effect of therapeutic hypothermia (TH) on insulin requirements and BGV. OBJECTIVES. To examine the effect of TH on BGV and its relationship to outcome in patients with coma after cardiac arrest (CA). METHODS. We prospectively studied 132 consecutive comatose CA patients treated with TH (target core temp 33_C for 24 h, using surface cooling). All patients were treated with intravenous insulin (blood glucose target 6-8 mM), according to a written algorithm, with nurse-driven adjustment of insulin dose. For each patient, standard deviation of repeated blood glucose samples was used to calculate BGV. Two time-points, comparable in duration, were studied: TH (stable maintenance phase, i.e. 6-24 h, core temp ± 33_C) vs. Normothermia (NT, i.e. after rewarming, stable normothermic phase, core temp ± 37_C). Mortality and neurological recovery (Glasgow-Pittsburgh Cerebral Performance Categories, CPC, dichotomized as good = CPC 1-2 vs. poor = CPC 3-5) were assessed at hospital discharge. Statistical analysis was performed with ANOVA for repeated measures. RESULTS. Compared to NT, TH was associated with increased intravenous insulin dose (0.8 ± 1.1 vs. 1.6 ± 2 U/h, P\0.0001), higher mean (6.9 ± 1.3 vs. 7.7 ± 1.8 mM, P\0.0001) and maximum (9.1 ± 3.7 vs. 10.9 ± 3.6 mM, P\0.0001) blood glucose, and increased BGV (1.3 ± 1.2 vs. 1.7 ± 1.1 mM, P = 0.004). Increased BGV was strongly associated with mortality (2.5 ± 1.5 mM in non-survivors vs. 1.6 ± 1 mM in survivors, P\0.001) and worse outcome (2.3 ± 1.4 mM in patients with poor vs. 1.5 ± 0.8 mM in those with good neurological recovery, P\0.0001). CONCLUSIONS. Therapeutic hypothermia is associated with increased insulin requirements and higher blood glucose variability,which in turn correlateswithworse prognosis in patientswith post- CA coma. Strategies aimed to maintain stable glycemic profile and avoid blood glucose variability might contribute to optimize the management of TH and may translate into better outcome.

Absolute height-specific thresholds to identify elevated blood pressure in children.

OBJECTIVE: : Identification of children with elevated blood pressure (BP) is difficult because of the multiple sex, age, and height-specific thresholds to define elevated BP. We propose a simple set of absolute height-specific BP thresholds and evaluate their performance to identify children with elevated BP in two different populations. METHODS: : Using the 95th sex, age, and relative-height BP US thresholds to define elevated BP in children (standard criteria), we derived a set of (non sex- and non age-specific) absolute height-specific BP thresholds for 11 height categories by 10 cm increments. Using data from large school-based surveys conducted in Switzerland (N = 5207; 2621 boys, 2586 girls; age range: 10.1-14.9 years) and in the Seychelles (N = 25 759; 13 048 boys, 12 711 girls; age range: 4.4-18.8 years), we evaluated the performance of these height-specific thresholds to identify children with elevated BP. We also derived sex-specific absolute height-specific BP thresholds and compared their performance. RESULTS: : In the Swiss and the Seychelles surveys, the prevalence of elevated BP (standard criteria) was 11.4 and 9.1%, respectively. The height-specific thresholds to identify elevated BP had a sensitivity of 80 and 84%, a specificity of 99 and 99%, a positive predictive value of 92 and 91%, and a negative predictive value of 97 and 98%, respectively. Performance of sex-specific absolute height-specific BP thresholds was similar. CONCLUSION: : A simple table of height-specific BP thresholds allowed identifying children with elevated BP with high sensitivity and excellent specificity.

Allergie ou intolérance alimentaire [Food allergy or food intolerance?].

Adverse food reactions can be classified into two main categories depending on wether an immune mechanism is involved or not. The first category includes immune mediated reactions like IgE mediated food allergy, eosinophilic oesophagitis, food protein-induced enterocolitis syndrome and celiac disease. The second category implies non-immune mediated adverse food reactions, also called food intolerances. Intoxications, pharmacologic reactions, metabolic reactions, physiologic, psychologic or reactions with an unknown mechanism belong to this category. We present a classification of adverse food reactions based on the pathophysiologic mechanism that can be useful for both diagnostic approach and management.

Living with digestive stomas: strategies to cope with the new bodily reality.

OBJECTIVE the objective in this study was to describe the strategies developed by digestive stoma patients to cope with their situation. METHOD a qualitative and descriptive study was undertaken, involving 21 stoma patients living in the provinces of Málaga and Granada (Spain). The informants were selected in accordance with criteria of appropriateness and diversity, through intentional sampling. The data were collected by means of semistructured interviews. RESULTS the content analysis revealed three categories around which the distinct strategies were developed: Self-care, Adaptation to the bodily change and Self-help. CONCLUSION the strategies developed are focusing on achieving the effective management of the stoma and are closely linked with the achievement of autonomy. Discovering the strategies applied is fundamental for the nursing professionals to offer high-quality care, centered on people and their process.

Les poètes dans les inscriptions grecques de Rome : esquisse d'une approche socioculturelle

Cette étude basée sur le dépouillement des IGUR propose une approche socioculturelle des poètes grecs ou hellénophones qui ont séjourné à Rome à l'époque impériale, du Ier siècle après J.-C. à la fin du IVe siècle. Le nombre des inscriptions mentionnant des noms de poètes est relativement élevé (15). La première partie examine l'origine de ces artistes, le choix et le statut de la langue employée dans les inscriptions, les problèmes d'identité qui sont posés. La seconde partie étudie la considération et les possibilités de carrière que les poètes de langue grecque ont pu trouver à Rome ; elle distingue différentes catégories professionnelles et analyse les principales fonctions de ces poètes ainsi que leurs rapports avec le pouvoir impérial. Based on peruse of IGUR, this study offers a socio-cultural approach of Greek or Greek-speaking poets that stayed in Rome during Imperial times, from the first century AD to the end of the fourth century. Inscriptions relating poets names are relatively numerous (15). In the first part, we will discuss the artists' origin, the choice and status of the language used in the inscriptions, the problems of identities they raised. In the second part, we will discuss what kind of esteem and career opportunities Greek speaking poets could meet in Rome ; we would distinguish the different professional categories of those poets and analyse their main functions as well as their relationships with Imperial power.

COIM-BEST main contributions for a better joint response

El projecte COIM-BEST ha investigat com, per mitjà de la formació, es pot millorar la coordinació entre múltiples agències per fer front a les situacions crítiques que es produeixen en les grans emergències. Entre les conclusions de l’estudi COIM-BEST, que ja ha rebut bones valoracions per part de la comissió europea, es destaca la necessitat d’una bona coordinació entre els cossos i agents que participen en la gestió de les grans crisis, generar una confiança entre aquests actors, harmonitzar la formació i una bona articulació de les categories de comandament que es fan càrrec de la direcció de la gestió de l’emergència. El projecte COIM-BEST s'emmarca en el Programa per a la prevenció, preparació i gestió de les conseqüències del terrorisme i altres riscos relacionats amb la seguretat (CIPS) de la Direcció General de Justícia, Llibertat i Seguretat de la Comissió Europea i compta amb la col·laboració de l‘Institut de Seguretat Pública de Catalunya, la Fondazione per la Ricerca sulle Migrazione e Integrazione delle Tecnologie (FORMIT), el Global Law Enforcement Institute i la Universitat Politècnica de Catalunya

Do Swiss adolescents perceive the negative effects of their illegal substance use?

This study explores adolescents' perceptions of adverse consequences linked to their illegal psychoactive substance (IPS) use, as they are often thought to minimise them. From a Swiss nationally representative sample of 8740 adolescents aged 16 to 20 pursuing post-mandatory education, 2515 participants reported IPS use in the past month on a self-administered anonymous questionnaire. The percentages of participants reporting problems in four areas (individual, school, relationships and sexual) were assessed, depending on the type of IPS consumption over the last 30 days: occasional cannabis users: ≤2 times; regular cannabis users: ≥3 times; and poly-consumers: cannabis plus at least one other substance used. The percentages varied significantly across these three groups with 26.9% of occasional users, 53.8% of regular users, and 73.3% of poly-consumers reporting at least one problem. Compared to occasional cannabis users, poly-consumers were more likely to report problems in all four categories [relative risk ratio (RRR): 3.38 to 5.44], while regular cannabis users often reported only school and relationship problems [RRR: 2.43 to 3.23]. Thus, many adolescents seem to perceive the negative effects of their IPS use, with heavier consumption being associated with increasing problems. Physicians should feel confident questioning adolescents on the adverse consequences of their IPS consumption, as they are likely to be responsive on this issue.

Die Reichweite von Theorien als Indikator für ihre Umsetzbarkeit in der Praxis [The scope as an indicator of the applicability of nursing theories to practice]

In der Pflegewissenschaft geben der Einsatz von Theorien und der daraus folgende Gewinn immer wieder Anlass zu Diskussionen. Ein Hauptvorwurf ist, dass Pflegetheorien als sehr abstrakt und wenig praxisnah gelten. Jedoch gibt es wenige Indikatoren, um das Abstraktionsniveau von Theorien und die damit verbundene Reichweite zu bestimmen. Im vorliegenden Artikel werden Fragen basierend auf die Definitionen und Grundannahmen von Theorien erstellt. Damit werden anschließend drei ausgesuchte Theorien auf ihr Abstraktionsniveau und Reichweite untersucht. Es wurden 18 Fragen zu den drei Bereichen ,,Zweck der Theorie", ,,Aufgabe der Theorie" und ,,Beschreibung der Theorie" entwickelt. Diese 18 Fragen wurden auf die Theorie der Adaptation von Sister Callista Roy, die Theorie zur Unsicherheit von Merle M. Mishel und die Theorie der Omnipräsenz von Krebs von Maya Shaha angewendet. [The use of nursing theories and their associated benefits remain an area of repeated discussion in nursing. One of the main objections is that nursing theories are abstract and therefore cannot be easily applied to practice. However, only few indicators exist to help identify a theory's level of abstraction or its scope. In this article, questions based on definitions and assumptions of theories have been developed. These questions have then been applied to three selected theories to investigate their level of abstraction and scope. A total of 18 questions divided into three domains were developed. The three categories were: ,,the purpose of the theory", ,,the aim of the theory" and ,,the description of the theory". The theory of Adaptation by Sister Callista Roy, the Theory of Uncertainty by Merle M. Mishel and the Theory of the Omnipresence of Cancer by Maya Shaha were selected to be analysed following the three domains with the 18 questions.]

Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study.

BACKGROUND Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. METHODS The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. RESULTS The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models. CONCLUSIONS Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

Chlamydia control activities in Europe: cross-sectional survey.

BACKGROUND: Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. METHODS: The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. RESULTS: Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). CONCLUSION: A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programmes.

The potential of the European network of congenital anomaly registers (EUROCAT) for drug safety surveillance: a descriptive study.

BACKGROUND: European Surveillance of Congenital Anomalies (EUROCAT) is a network of population-based congenital anomaly registries in Europe surveying more than 1 million births per year, or 25% of the births in the European Union. This paper describes the potential of the EUROCAT collaboration for pharmacoepidemiology and drug safety surveillance. METHODS: The 34 full members and 6 associate members of the EUROCAT network were sent a questionnaire about their data sources on drug exposure and on drug coding. Available data on drug exposure during the first trimester available in the central EUROCAT database for the years 1996-2000 was summarised for 15 out of 25 responding full members. RESULTS: Of the 40 registries, 29 returned questionnaires (25 full and 4 associate members). Four of these registries do not collect data on maternal drug use. Of the full members, 15 registries use the EUROCAT drug code, 4 use the international ATC drug code, 3 registries use another coding system and 7 use a combination of these coding systems. Obstetric records are the most frequently used sources of drug information for the registries, followed by interviews with the mother. Only one registry uses pharmacy data. Percentages of cases with drug exposure (excluding vitamins/minerals) varied from 4.4% to 26.0% among different registries. The categories of drugs recorded varied widely between registries. CONCLUSIONS: Practices vary widely between registries regarding recording drug exposure information. EUROCAT has the potential to be an effective collaborative framework to contribute to post-marketing drug surveillance in relation to teratogenic effects, but work is needed to implement ATC drug coding more widely, and to diversify the sources of information used to determine drug exposure in each registry.

The association between alcohol screening scores and health status in male veterans.

OBJECTIVES: Alcohol use is associated with self-reported health status. However, little is known about the concurrent association between alcohol screening scores and patient perception of health. We evaluated this association in a sample of primarily older male veterans.METHODS: This secondary, cross-sectional analysis included male general medicine outpatients from 7 VA medical centers who returned mailed questionnaires. Screening scores from the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire were divided into 6 categories (0, 1­3, 4­5, 6­7, 8­9, and 10­12). Outcomes included scores on the 8 subscales and 2 component scores of the 36-item Short Form Health Survey (SF-36). Unadjusted and adjusted linear regression models were fit to characterize the association between AUDIT-C categories and SF-36 scores. Models were adjusted for demographic characteristics, smoking, and site?both alone and in combination with 14 self-reported comorbid conditions.RESULTS: Male respondents (n = 24,531; mean age = 63.6 years) represented 69% of those surveyed with the SF-36. After adjustment, a quadratic (inverted U-shaped) relationship was demonstrated between AUDIT-C categories and all SF-36 scores such that patients with AUDIT-C scores 4­5 or 6­7 reported the highest health status, and patients with AUDIT-C scores 0, 8­9, and =10 reported the lowest health status.CONCLUSIONS: Across all measures of health status, patients with the most severe alcohol misuse had significantly poorer health status than those who screened positive for alcohol misuse at mild or moderate levels of severity. The relatively good health status reported by patients with mild-moderate alcohol misuse might interfere with clinicians' acceptance and adoption of guidelines recommending that they counsel these patients about their drinking.