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PubMed2006

Telephone counselling for smoking cessation.

BACKGROUND: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES: To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS: Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. MAIN RESULTS: Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. AUTHORS' CONCLUSIONS: Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.

Counseling↗

PubMedDate not supplied

The effects and use of maintenance newsletters in a smoking cessation intervention.

This article evaluates the effects and use of adjuncts to a televised smoking cessation program, based on the American Lung Association's "Freedom From Smoking in 20 Days." Subjects were randomized to maintenance and control conditions. The maintenance condition received newsletters with information and support addressing different stages in the cessation process and information about a telephone hotline. The maintenance condition did not increase cessation at any wave of interviewing, assessed by multiple point or point prevalence of abstinence. Those abstinent at 6 months and those who had made an attempt to stop smoking by that time were more likely to have used the newsletters and were more likely to have used the sections relevant to their cessation stage. Rates of use of the telephone hotline were low. The newsletters appear to be useful to smokers who are predisposed to use written materials.

Adolescent↗

PubMed2005

Brief cognitive-behavioral phone-based intervention targeting anxiety about the threat of attack: a pilot study.

A brief, cognitive-behavioral, phone-based intervention was employed with an Israeli sample experiencing anticipatory anxiety about potential war-related attacks. In this quasi-experimental controlled pilot study, the cognitive-behavioral therapy intervention (diaphragmatic breathing and a modified cognitive-restructuring technique) was compared with the standard hotline care administered when worried citizens called a mental health emergency hotline in Israel. Individuals (n=32) were administered anxiety and worry measures pre-intervention, post-intervention, and three days post-intervention. The results indicated that anxiety levels decreased for the experimental and control group immediately post-intervention; however, three days later, the levels of anxiety in the CBT group continued to decline, while anxiety levels in the control group reached pre-intervention levels on two of the three outcome measures. These results suggest that CBT can be effectively delivered by paraprofessionals over the phone, which is cost-effective and efficient. Limitations are considered, and implications for treating individuals coping with the threat of terrorism are discussed.

Analysis of Variance↗

PubMed2002

Calls for help after September 11: a community mental health hot line.

Although unprepared for a disaster of the magnitude of September 11th, New York City's mental health system responded immediately. Within weeks, Project Liberty, a recovery program funded by the Federal Emergency Management Agency (FEMA), was in operation. The program provides free education, outreach, and crisis counseling services for those affected by the disaster and its aftermath. LifeNet, a 24-hour, 7-day-a-week mental health information and referral hotline, is a key component of Project Liberty. In this article, we describe the operation of LifeNet and examine the volume of calls to the hotline during the 6 months following the terrorist attacks on the World Trade Center. We describe the demographics of the callers and the kinds of disaster-related mental health problems that callers presented. The data indicate a clear pattern of increasing calls from October through March for all demographic subgroups except seniors. Callers complaining of symptoms of posttraumatic stress and symptoms of anxiety, panic, and phobia increased over time. Bereavement-related calls increased as well. The number of callers who reported symptoms of depression and substance abuse/dependence did not show as clear-cut an increase over time. We looked at the volume of LifeNet calls in relation to the Project Liberty media campaign and suggest that the campaign has had a positive effect on call volume and that its impact is likely to continue over time.

Community Mental Health Services↗

PubMed2006

Health services utilization in Jerusalem under terrorism.

OBJECTIVE: The authors explored the effects of an escalation of terrorism on the help-seeking behavior of the general population in Jerusalem, a city that offers an adequate supply of medical and psychiatric services. METHOD: Time-series analyses were applied to examine the utilization of health services (primary medical care and ambulance calls) and mental health services (clinics, hospitals, and telephone hotlines) by Jerusalem residents before and during part of the current intifada. The authors assessed seasonality, general linear trends (from factors such as health education and increased access), short-term intifada impact (reflecting reactions that peaked at the third month and ended 1 year thereafter), and long-term impact (starting at the intifada outbreak and reflecting a more stable population behavior). RESULTS: Adult psychiatric outpatient visits did not change except for the elderly in ongoing care who had both short- and long-term increases. The proportion of recorded ICD-10 diagnoses reflecting intifada-related reactions remained generally stable. Short-term effects included an increase in psychiatric readmissions. First contacts to substance abuse clinics remained unchanged. While long-term effects included a decrease in new psychiatric hospitalizations, the rate of monthly general practitioner visitors and the number of monthly ambulance and hotline calls increased. CONCLUSIONS: Except for the elderly and previously hospitalized persons, Jerusalem residents did not increase their use of psychiatric services but did increase their use of some other health services. These results suggest that this terrorism-affected population did not perceive their mental and social suffering as requiring specialized intervention.

Adult↗

PubMed2004

A statewide evaluation of services provided to rape survivors.

This article presents the descriptive results of a statewide evaluation of hotline, advocacy, and counseling services provided to sexual assault victims in Illinois. Collaborative efforts of a multidisciplinary research team and sexual assault service providers resulted in victim-sensitive evaluation measures and data that reflect, for the first time, the collective impact of services on rape victims across the state of Illinois. Results of the evaluation suggest that, overall, services provided to rape victims provided support, increased information and knowledge, and helped victims to understand options and make decisions. The evaluation approach is notable for its collaborative nature and its sensitivity to rape victims during help-seeking and delivery; however, due to the high levels of distress common among rape survivors, some evaluation methods may not be appropriate for crisis intervention services such as hotline or advocacy. Implications for future evaluation research and policy are noted.

Adolescent↗

PubMed2002

Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?

This paper evaluates the effectiveness of a bar-based, peer-led community-level intervention to promote sexual health amongst gay men. The intervention consisted of peer education within bars, gay specific genitourinary medicine (GUM) services and a free-phone hotline. Data were collected at baseline (1996) and at follow-up (1999) in gay bars in Glasgow (intervention city) and Edinburgh (control city). During the intervention peer educators interacted with 1484 men and new clients increased at the gay specific GUM service. However, the hotline was under-utilized and abused. The outcome measures were: reported hepatitis B vaccination; HIV testing; unprotected anal intercourse (UAI) with casual partners; negotiated safety; and amongst men reporting UAI with a regular partner, the proportion who knew their own and their partner's HIV status. Significant differences in sexual health behaviours were observed across locations and across time, but the only significant intervention effects were amongst men who had direct contact with the intervention, with higher uptake of hepatitis B vaccination and HIV testing. The intervention did not produce community-wide changes in sexual health behaviours. These results question the replication and transferability of peer-led, community-level sexual health promotion for gay men outwith the USA and across time.

Adolescent↗

PubMed1993

A stop-smoking telephone help line that nobody called.

The purpose of this study was to evaluate the reach of a smoker's hotline that provided a variety of services to over 2100 health maintenance organization members. Formative evaluation procedures identified topics of concern, and repeated promotions advertised the service via multiple channels. Excluding a special giveaway promotion, an average of less than three calls per month were made during the 33 months of operation. To be cost-effective, smoker's hotlines should be offered to large populations and should be consistently and intensively publicized.

Hotlines↗

PubMedDate not supplied

Developing an educational workshop on teen depression and suicide: a proactive community intervention.

Eight years into the YES emergency services collaboration, a comprehensive Youth Emergency Services model has emerged, one that incorporates a proactive approach to clinical and prevention strategies. In addition to direct service provision, these strategies include: (1) workshop training of school and community professionals so that they can identify young persons at highest risk for suicidal thoughts, threats, and attempts; (2) prevention education for both adolescents and parents about suicide, risk factors, and interventions; (3) a partnership with the local hotline to facilitate community screening and referral to appropriate crisis services for families and youths; (4) collaboration with a large primary care provider network to streamline the after-hours crisis referral process, using the hotline; and (5) the use of a website to inform individuals about services and resources. It is proposed that this is a contemporary model that can meet the present primary and secondary intervention needs for children, adolescents, and their families.

Adolescent↗

PubMed1993

Adjustment problems among Soviet immigrants at risk, Part 2: Emotional distress among elderly Soviet immigrants during the Gulf War.

The nature and components of emotional distress under the threefold stress--old age, immigration and war--were studied in a group of 170 elderly Soviet immigrants in two settings--a mental health hotline for Soviet immigrants and an outreach project to immigrants deemed at risk. Most of the subjects reported distress during and following the war. Outreach subjects reported lower levels of distress determined by emotional factors and were much more concerned with objective problems related to immigration. In contrast, the predominant determinants of the hotline subjects' distress were emotional reactions related to the war. Among the emotional reactions, anxiety reactions were the most common symptom among women, while depressive reactions were more characteristic of men. Identified risk factors for emotional distress in men included prior experience with acute stress (Chernobyl accident) and living within an extended family. Academic education was identified as a resilience factor for women. No factors were identified that related to emotional distress combined with active help seeking behavior. This finding is particularly important in the context of primary and secondary prevention with Soviet immigrants.

Adjustment Disorders↗

PubMed1996

Utility of emergency, telephone-based national surveillance for Hantavirus pulmonary syndrome. Hantavirus Task Force.

On May 27, 1993, in response to the outbreak investigation of newly recognized Hantavirus pulmonary syndrome (HPS) in the Four Corners states (New Mexico, Arizona, Utah, and Colorado), the Centers for Disease Control and Prevention established a national surveillance case definition for severe, unexplained respiratory disease to determine the extent of HPS throughout the United States. A toll-free telephone hotline number was instituted to provide updated information about unexplained respiratory illness and to serve as a passive mechanism for reporting suspected cases. Clinical information was obtained from callers reporting suspected cases, and diagnostic specimens and medical record reviews were requested from health care providers. From June 3 through December 31, 1993, the hotline received 21,443 telephone inquiries; callers identified 280 suspected cases living outside the Four Corners states with at least one specimen available for diagnostic testing. By December 31, 1993, 21 confirmed cases (age range, 14 to 58 years) residing in 11 states outside the Four Corners region had been identified. This passive surveillance system was successful in rapidly identifying the widespread sporadic geographic distribution for HPS cases throughout the United States and could serve as a model for similar emergencies. Expanding and coordinating surveillance systems for the early detection, tracking, and evaluation of emerging infections is a critical component of disease prevention.

Disease Outbreaks↗

PubMed1998

Pfiesteria in Maryland: preliminary epidemiologic findings.

In the fall of 1996, fish kills in Maryland rivers were attributed to the dinoflagellate, Pfiesteria piscicida. After a group of researchers established a potential link between exposure to Pfiesteria and an illness causing memory problems, state health authorities closed a portion of the Pocomoke River. To determine the extent of illness, the range of symptoms, potential risk factors for disease, and to provide information to concerned citizens, a toll-free hotline was created. All symptomatic persons who called the toll-free number were administered a standardized questionnaire. Persons who had been exposed to Pfiesteria or Pfiesteria-laden waters were more likely to have respiratory, neurologic, dermatologic, and gastrointestinal problems than those persons without exposure. Among the persons calling the hotline, many had extensive neuropsychologic testing. Of the neuropsychologic test battery, low scores on the Rey Auditory Verbal Learning Test (RAVLT), a standardized measure of learning and memory, best characterized illness related to Pfiesteria exposure. Patients with low RAVLT scores were more likely to have neurologic symptoms and skin lesions than control subjects. Low RAVLT scores were associated with fishing (OR, 9.00, 95% CI, 106, 409.87), catching fish with lesions (OR, 6.17, 95% CI 1.27, 32.10), and handling fish with lesions (OR, 5.34, 95% CI, 1.05, 29.92), but not with consumption of seafood. While preliminary, these results do suggest that some risk factors for Pfiesteria-related illness may be easy to modify and used to prevent unnecessary human exposure.

Adult↗

PubMed1996

[The comparative effectiveness of different infusion and blood warming methods].

UNLABELLED: Heat loses during surgery occur mainly to the environment and due to infusions and irrigations. Infusions given at room temperature account for a great deal of the total heat deficit during major operations, e.g., the infusion of 53 ml/kg 20 degrees C fluid leads to a loss of 1 degree C in mean body temperature. Hence, heating i.v. fluids will add to the effect of other measures aimed at reducing heat loss to the environment. We investigated the efficacy of different warming methods for i.v. fluids in an experimental model by measuring the temperature at the end of the delivery line. METHODS: The following in-line warmers were studied: Hotline HL-90 and System H-250/heat exchanger D-50 (Level 1 Technologies, Marshfield, USA), Astotherm IFT 260 (Stihler Elektronic GmbH, Stuttgart, Germany), RSLB 30 H Gamida (Productions Hospitalieres Francaises, Eaubonne, France), Bair Hugger 241/Modell 500 Prototype (Augustine Medical, Eden Prairie, USA). They were compared with pre-warming infusions (39 degrees C) only using the Clinitherm S (Labor Technik Barkey GmbH, Bielefeld, Germany) and pre-warming with "active insulation" of the delivery line using the Autotherm/Autoline system (Labor Technik Barkey GmbH, Bielefeld, Germany). We investigated the influence of four variables on the efficacy of warming: (1) flow rate (50-15,000 ml/h); (2) ambient temperature (20 degrees C and 25 degrees C); (3) infusion bag temperature (6 degrees C, 20 degrees C, and 39 degrees C); and (4) length of infusion system downstream from the heat exchanger. Fluid temperatures were measured using thermistors of 1 mm diameter (Modell YSI 520, Yellow Springs Instruments Co., Yellow Springs, USA) incorporated into 3-way stopcocks. Temperatures were recorded using Hellige temperature monitors (Hellige GmbH, Freiburg im Breisgau, Germany) and the signals were collected at 10 Hz through an AD converter and averaged over 1 min. Flows were calculated by timed collection into calibrated cylinders; 10 to 12 different flow rates were taken to define one temperature/ flow plot. Effective warming was defined as a temperature > 33 degrees C at the end of the infusion line. RESULTS: At high flow rates (> 2,500 ml/h) using 20 degrees C fluids at 20 degrees C ambient temperature, the H-250/D-50 system gave the highest temperatures throughout the range and showed effective warming from 1,300 ml/h on over the entire range tested (35 degrees C at 17,000 ml/h) compared to the RSLB 30 H Gamida system (3,000-18,000 ml/h) (Fig. 2). This difference in performance was almost abolished with fluids at 6 degrees C (Fig. 4). Similar efficacy could be reached by using prewarmed infusions that gave effective warming at > 2,000 ml/h and reached 39 degrees C at 13,000 ml/h. Prewarmed infusions could be used effectively down to > 80 ml/h applying "active insulation" (Autotherm/Autoline) to the whole infusion system. The Hotline HL-90 (50-4, 700 ml/h) appeared to be the most effective in-line warmer in the low (< 250 ml/h) and middle (250-2,500 ml/h) flow range, followed by the Astotherm IFT 260 (400-4,000 ml/h), but only if used with a length of 40 cm down-stream from the heat exchanger (Fig. 1). Increasing this distance to 145 cm markedly reduced its efficacy below the range of 2,000 ml/min (1,200- 3,000 ml/h) (Fig. 5). The Bair Hugger 241 Prototype showed a narrow effective range (700-1,300 ml/h) that could be extended beyond 1,300 ml/h by the use of prewarmed infusions (Figs. 1 and 3). The performance for 6 degrees C solutions and ambient temperatures of 25 degrees C are given in Fig. 4 and Table 1. CONCLUSIONS: The importance of infusion warming increases with the amount of fluid given.(ABSTRACT TRUNCATED)

Blood Physiological Phenomena↗

PubMed2004

Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto.

BACKGROUND: Toronto was the site of North America's largest outbreak of the severe acute respiratory syndrome (SARS). An understanding of the patterns of transmission and the effects on public health in relation to control measures that were taken will help health officials prepare for any future outbreaks. METHODS: We analyzed SARS case, quarantine, and hotline records in relation to control measures. The two phases of the outbreak were compared. RESULTS: Toronto Public Health investigated 2132 potential cases of SARS, identified 23,103 contacts of SARS patients as requiring quarantine, and logged 316,615 calls on its SARS hotline. In Toronto, 225 residents met the case definition of SARS, and all but 3 travel-related cases were linked to the index patient, from Hong Kong. SARS spread to 11 (58 percent) of Toronto's acute care hospitals. Unrecognized SARS among in-patients with underlying illness caused a resurgence, or a second phase, of the outbreak, which was finally controlled through active surveillance of hospitalized patients. In response to the control measures of Toronto Public Health, the number of persons who were exposed to SARS in nonhospital and nonhousehold settings dropped from 20 (13 percent) before the control measures were instituted (phase 1) to 0 afterward (phase 2). The number of patients who were exposed while in a hospital ward rose from 25 (17 percent) in phase 1 to 68 (88 percent) in phase 2, and the number exposed while in the intensive care unit dropped from 13 (9 percent) in phase 1 to 0 in phase 2. Community spread (the length of the chains of transmission outside of hospital settings) was significantly reduced in phase 2 of the outbreak (P<0.001). CONCLUSIONS: The transmission of SARS in Toronto was limited primarily to hospitals and to households that had had contact with patients. For every case of SARS, health authorities should expect to quarantine up to 100 contacts of the patients and to investigate 8 possible cases. During an outbreak, active in-hospital surveillance for SARS-like illnesses and heightened infection-control measures are essential.

Communicable Disease Control↗

PubMed2002

Rapid public health interventions in response to an outbreak of syphilis in Los Angeles.

BACKGROUND: Despite national ambitions to eliminate syphilis, occasional outbreaks continue to occur in many areas of the United States. GOAL: The goal of the study was to describe and evaluate the public health interventions in response to an outbreak of syphilis in Los Angeles County among men who have sex with men. STUDY DESIGN: Reported cases of primary, secondary, and early latent syphilis that occurred during an outbreak period from December 1999 to September 2000 were included in the study. The outbreak components of provider awareness, active surveillance, community-based organization recruitment, media campaign, community-outreach education and screening, and a correctional facility intervention were described. Screening results were reviewed, sexually transmitted disease (STD) hotline calls were counted, and a street-intercept survey was conducted. RESULTS: A multifaceted outbreak response was initiated in March 2000. Of the 89 outbreak cases identified, 40% were detected by HIV/AIDS early intervention providers and 26% by private clinicians or health maintenance organizations. Other case identification sources included public STD clinics (10%), STD program case-management contacts (7%), mobile van screening (7%), and correctional facility screening (10%). Screening at high-risk venues detected a syphilis prevalence of <1% and an HIV prevalence of 6%. Weekly calls to the STD hotline increased 600% during the outbreak, and 80% of surveyed individuals cited the media as the source of their awareness of syphilis. CONCLUSIONS: A multifaceted outbreak response was launched to react to an outbreak of syphilis among men who have sex with men. Prompt provider awareness and a preexisting network of HIV/AIDS providers aided case detection. Although the effectiveness of the response could not be scientifically determined, the diverse components of the response were associated with a faster decline in the outbreak than would have been expected. After 3 months, 89 cases had been identified. Outbreak preparedness should include a focus on communities of men who have sex with men, because the reintroduction of syphilis in this population may threaten national efforts toward syphilis elimination.

Adult↗

PubMed2006

Universal perinatal depression screening in an Academic Medical Center.

OBJECTIVE: To develop a department-based program to identify and treat women at risk for perinatal depression. METHODS: Private and employed physician groups were engaged to conduct antepartum maternal depression screening using the Edinburgh Postnatal Depression Scale. A comprehensive program was established to ensure that patients identified as being at risk would receive appropriate care. The program 1) developed a network of existing community mental health providers to accommodate screen-positive referrals, 2) created a 24/7 hotline staffed by mental health workers to respond to urgent/emergent patient needs, 3) provided nursing and physician education via a comprehensive curriculum on perinatal depression, and 4) facilitated outpatient depression screening that included a centralized scoring and referral system. RESULTS: A total of 4,322 women completed 4,558 screens during the initial 24 months (June 2003-May 2005). Although initial uptake of the screening program was gradual, all 20 departmental obstetric practices were screening their patients at the end of the first year. Depression screening was accomplished between 28-32 weeks of gestation, and postpartum screening (during the 6-week postpartum visit) was subsequently added. Overall, 11.1% of women screened positive in the antenatal period, and 7.3% screened positive in the postnatal period. Three hundred three women were referred for evaluation and care. CONCLUSION: Department-based, perinatal depression screening was feasible when individual physician practices were not required to develop the infrastructure necessary to respond to at-risk patients. We believe that the provision of clinical safety nets (mental health provider network and the hotline) were essential to the universal acceptance of this program by practitioners. LEVEL OF EVIDENCE: III.

Adult↗

PubMed2000

Georgia's breastfeeding promotion program for low-income women.

OBJECTIVE: Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS: Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS: PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.

Breast Feeding↗

PubMed1999

Occupational exposures to body fluids among medical students. A seven-year longitudinal study.

BACKGROUND: Medical students may be at high risk for occupational exposures to blood. OBJECTIVE: To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN: Review of all exposures reported by medical students at the University of California, San Francisco, School of Medicine. SETTING: Teaching hospitals affiliated with the University of California, San Francisco. PARTICIPANTS: Third- and fourth-year medical students from the classes of 1990 through 1996 at the University of California, San Francisco, School of Medicine. INTERVENTIONS: A needlestick hotline service was instituted at teaching hospitals affiliated with the University of California, San Francisco, and a required course was created to train students in universal precautions and clinical skills before the beginning of the third-year clerkship. MEASUREMENTS: Reports of exposures made to the needlestick hotline service, including type of exposure, training site, clerkship, and time of year. RESULTS: 119 of 1022 medical students sustained 129 exposures. Of these exposures, 82% occurred on four services: obstetrics-gynecology, surgery, medicine, and emergency medicine. The probability of exposure was not related to graduation year, clerkship location, previous clerkship experience, or training site. Surveys of two graduating classes at the beginning and end of the study showed that the percentage of exposures reported increased from 45% to 65% over the 7-year study period. Thus, the reported injury rates represent minimum estimates of actual occurrences. Human immunodeficiency virus infection and hepatitis were not reported, although follow-up was limited. CONCLUSIONS: Instruction in universal precautions and clinical procedures is not sufficient to prevent exposures to blood during medical training. Medical schools must assume greater responsibility for ensuring that students are proficient in the safe conduct of clinical procedures and must develop systems that protect students so that they can report and learn from their mistakes.

Blood↗