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PubMed2001

Impact of a rural domestic violence prevention campaign.

Domestic violence is a prevalent health problem that in rural areas is further complicated by limited services, social isolation and the lack of privacy. Little is known about the impact of public health education on awareness, attitudes and behavior of the general public regarding domestic violence. This study sought to measure change in societal attitudes and behavioral intention in response to a seven-month public health education campaign targeting domestic violence in a rural county. From October 1998 to April 1999, the campaign used radio advertisements, posters, mailings to libraries and clergy, printed media articles, printed advertisements and health facility modifications. A random-digit-dialing telephone survey was used to evaluate attitudinal and behavioral changes in the intervention and comparison counties before and after the campaign. The response rates for the pre- (n =378) and postcampaign (n=633) surveys were 73 percent and 65 percent, respectively. Statistically significant increases in slogan and advertising recognition occurred in the intervention county (P=0.03), particularly among men recalling the campaign slogan (P=0.006). In a vignette regarding actions to be taken if the neighbor next door was abusing a partner, significant increases occurred in the intervention county in the percentage of respondents who thought that most people would talk to the victim (P=0.04), consult with friends (P=0.002) or talk to a doctor (P=0.004). Domestic violence agency hotline calls in the intervention county doubled following the campaign. Local public health education campaigns in a rural setting may be a valuable adjunct to national efforts, especially in reaching men.

Adolescent↗
PubMed2003

From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

Ambulatory Care↗
PubMed2004

Benefits of a prehospital stroke code system. Feasibility and efficacy in the first year of clinical practice in Barcelona, Spain.

BACKGROUND AND OBJECTIVES: Hospital admission delay is a main limiting factor for effective thrombolytic therapy in stroke patients. We developed a stroke code system for rapid request of emergency transportation to the hospital and a priority availability of the attending neurologist on the patient's arrival at the Emergency Department (ED). METHODS: Over a 1-year period, a 24-hour telephone hotline between the attending neurologist and the Barcelona public emergency coordination service was established. Priority 1 (P1) was defined as a patient with symptoms suggestive of acute stroke with onset of less than 3 h, in which case immediate transportation service and rapid ED reception was organized. Data from patients in the P1 group (n = 39) and patients without activation of the stroke code (P0) (n = 181) were compared. RESULTS: There were significant differences between P1 and P0 groups in mean time from ED arrival to request for neurologic assessment (4.4 +/- 19.5 vs. 194.7 +/- 244.9 min, p < 0.001), from arrival to neurologic examination (12.6 +/- 21.1 vs. 225.3 +/- 258.2 min, p < 0.005), and from arrival to performance of brain CT scan (35.5 +/- 34.9 vs.120.3 +/- 143.2 min, p < 0.001), and also in the number of patients treated with thrombolytic agents (19 vs. 4.5%, p < 0.003). There were no differences between groups in the time elapsed from stroke onset to ED arrival. CONCLUSIONS: Activation of the stroke code was effective in increasing the percentage of patients treated with thrombolytic drugs and also in shortening the delay from ED arrival until neurologic assessment and from ED arrival until brain CT.

Aged↗
PubMed1987

The role of drug information centers with consumers.

Heightened concern about drug abuse during the late 1960s prompted community leaders to request that the University of Cincinnati's Drug Information Center extend its services to the public. More than 500,000 inquiries have been handled by the Center since it first offered these services. The Center's "hotline" provides information, advice, counseling, and/or emergency treatment and referral information and is extensively involved in community outreach and prevention efforts. Providing reliable, authoritative, and beneficial information requires that all staff be professionally qualified and receive extensive training, pass specialized certification tests, follow structured policies and guidelines, and effectively use consultants. Impressions of the roles, impact, and need for such services in the 1980s are discussed.

Community Participation↗
PubMed2005

Jaundice as a presentation of heart failure.

On rare occasions the first manifestation of heart disease is jaundice, caused by passive congestion of the liver or acute ischaemic hepatitis. We looked for this presentation retrospectively in 661 patients referred over fifty-six months to a 'jaundice hotline' (rapid access) service. The protocol included a full clinical history, examination and abdominal ultrasound. Those with no evidence of biliary obstruction had a non-invasive liver screen for parenchymal liver disease and those with suspected heart disease had an electrocardiogram, chest X-ray and echocardiogram. 8 patients (1.2%), bilirubin 31-79 micromol/L, mean 46 micromol/L, had a primary cardiac cause for their jaundice. All had dyspnoea, an increased cardiothoracic ratio on chest X-ray and an abnormal electrocardiogram. The jugular venous pressure was raised in the 3 in whom it was recorded. In 6 patients the jaundice was attributed to hepatic congestion and in 2 to ischaemic hepatitis. All patients had severe cardiac dysfunction. Jaundice due to heart disease tends to be mild, and a key feature is breathlessness. The most common mechanism is hepatic venous congestion; ischaemic hepatitis is suggested by a high aminotransferase.

Aged↗
PubMed2000

A World Wide Web-based health resource. Survey of Missouri school nurses to determine priority health information resources for SchoolhealthLink.

Two hundred ninety-two school nurses in Missouri participated in a mailed survey to aid in the design of SchoolhealthLink, a World Wide Web (WWW)-based information service for Missouri school nurses and children. The nurses identified specific health information resources likely to benefit school nurses and school children and prioritized these resources. The school nurses assigned high priority to 11 types of health information resources: individualized health care plans, emergency care plans, communicable disease control plans, acute illness, injuries, communicable diseases, hotline numbers, medications in schools, immunization protocols and standards, community-based health care resources, and Department of Elementary and Secondary Education regulations that affect school nurse practice. The four most common health problems school nurses identified were asthma, attention deficit disorder, diabetes, and head lice. SchoolhealthLink will provide a one-stop WWW-based resource for school nurses and school children.

Adult↗
PubMed2002

Development of a "survival" guide for substance users in Harlem, New York City.

The community advisory board (CAB) of the Harlem Urban Research Center, which includes community service providers, Department of Health workers, and academics, identified substance users' health as an action priority. The CAB initiated the development of a wellness guide to provide informational support for substance users to improve access to community services. Focus groups of current and former users engaged substance users in the guide development process and determined the guide's content and "look." Focus group participants recommended calling this a "survival" guide. The guide will include three sections: (a) health information and how to navigate the system to obtain services, (b) a reference list of community services, and (c) relevant "hotline" numbers. The design will incorporate local street art. Substance users continue to shape the guide through ongoing art workshops. Dissemination and evaluation of the guide will continue to involve substance users, community service providers, and academics.

Community Health Services↗
PubMed1988

Format and quitting instructions as factors influencing the impact of a self-administered quit smoking program.

This article presents results from an experimental study designed to evaluate the effects of two features of self-help smoking cessation booklets, format (i.e., day-by-day plan for quitting versus a less structured menu format) and quitting instructions (i.e., "cold turkey" versus gradual reduction) on smoking cessation. Four separate self-help booklets were developed for comparison in this study. Each varied on a combination of the two study factors, but were similar in content, length, style, and readability. The four booklets provided similar advice on how to quit smoking, emphasizing behavioral self-management principles. In addition to the experimental booklets, a fifth control booklet provided general information about smoking and its adverse effects, but no specific advice on quitting. Study subjects included 1,534 adult cigarette smokers who called a stop smoking hotline in Buffalo, New York seeking information on how to quit. Subjects were followed up by phone one month and six months after enrollment to assess changes in smoking behavior. Overall, 18% of subjects reported of being off cigarettes for at least one week at the time of the six month follow-up interview. The format of the booklet and quitting instructions had no effect on smoking cessation rates. In addition, the four booklets emphasizing behavioral self-management skills were no more effective than the control booklet (6 month non-smoking prevalence rate: 17% versus 19%). It is recommended that future self-help quit smoking booklets include information aimed at motivating cessation and focus less attention on teaching strategies for quitting.

Adolescent↗
PubMed2005

Teaching about family violence: a proposed model curriculum.

BACKGROUND: Medical schools around the country have initiated ad hoc teaching around family violence issues, especially child abuse and intimate partner violence (IPV). However, these activities typically are not integrated with other aspects of the curriculum, or with each other. Consequently, students do not have the opportunity to learn the broader issues related to family violence prevention and intervention. DESCRIPTION: To address these concerns, students at the Southern Illinois University (SIU) School of Medicine participated in an elective to develop a model family violence curriculum encompassing child abuse, IPV, sexual assault, and elder abuse. The activities use standardized patients and resource people, including hotline and shelter staff, legal professionals, and law enforcement. EVALUATION: This article describes the family violence teaching activities at SIU preceding Curriculum 2000 and the proposed model curriculum including principles guiding the curriculum, the curriculum sequence, and descriptions of the proposed patient cases and related activities. CONCLUSIONS: Family violence teaching in medical schools is merely a first step. Continuing medical education in violence-related issues must also be available.

Curriculum↗
PubMed2005

An innovative Australian point-of-care model for urine albumin: creatinine ratio testing that supports diabetes management in indigenous medical services and has international application.

BACKGROUND: Type 2 diabetes is the leading cause of end-stage renal failure in Australia's indigenous people. The measurement of urine albumin:creatinine ratio (ACR) as a marker for early renal disease is an important component of the management of indigenous patients with diabetes. METHODS: An innovative national program (Quality Assurance for Aboriginal Medical Services [QAAMS]) for point-of-care (POC) urine ACR testing on the DCA 2000 analyser (Bayer Diagnostics) was established to monitor microalbuminuria in indigenous people with diabetes in 30 Aboriginal and Torres Strait Islander medical services across Australia. Aboriginal health workers perform the ACR test. The QAAMS model provides ongoing education and training, an annual workshop, monthly quality assurance testing and a telephone help hotline. Quality assurance testing is conducted using paired, linearly related samples with a wide range of ACR concentrations (1-25 mg/mmol). RESULTS: The average participation rate across four six-monthly QAAMS ACR testing cycles was 83%. In all, 94% of 1163 quality assurance tests performed were within the preset limits of acceptability. The median precision (coefficient of variation percent for ACR quality assurance testing averaged 5.4%, well within desirable performance specifications. Between-site accuracy was excellent. CONCLUSION: This unique POC model for supporting diabetes management is the first of its type to be developed for indigenous communities and has considerable potential to be adopted worldwide.

Albuminuria↗
PubMed2002

From asthma to AirBeat: community-driven monitoring of fine particles and black carbon in Roxbury, Massachusetts.

Asthma is an ongoing environmental justice concern in Roxbury, an urban neighborhood of Boston, Massachusetts. Residents, especially local youth, were the first to investigate the potential links between high asthma rates and air pollution, particularly from diesel buses and trucks. A youth-led march for clean air and community air monitoring projects drew governmental and media attention to these problems. In 1998, a collaboration of environmental justice, government, and research groups came together to develop a real-time air pollution monitoring system known as AirBeat. This community-based participatory research project was designed to answer community questions about whether there are pollution "hot spots" in Roxbury and the degree to which diesel emissions are contributing to health problems. AirBeat measures and reports levels of PM2.5 (particulate matter with a mass median aerodynamic diameter < or= to 2.5 microm), ozone, and black carbon on an hourly basis. These data are accessible via a website, telephone hotline, and a flag warning system. AirBeat is successful because community residents and organizations participate as equal partners with an equitable share of funding. The project also promotes a community sense of ownership and pride. Dozens of youth have developed leadership and scientific skills. The media have extensively covered the project as a community victory. The data support the claim that Dudley Square in Roxbury is a hot spot for air pollution. This information is now being used to advocate for alternative fuel transit buses and other clean air measures. Finally, this project has strengthened community partnerships with research and governmental institutions.

Air Pollutants↗
PubMed2002

Preventive agricultural medicine: a student's perspective of farmers' mental health.

As a medical student completing a required rural community medicine clerkship, I discovered my home community's concern for mental health of farmers. A local economic downturn affects everyone, but especially the farmers. One farmer had recently committed suicide. Leaning heavily on work presented at a Nebraska summit on the farm crisis and mental health and on the National Rural Health Association issue paper on rural mental health, I found farmer and rural mental health to be a widespread concern, exacerbated by a scarcity of rural mental health resources. In my recommendations for rural Alabama, I endorse recommendations of others, including strengthening the local family physician role as "front door" to the mental health system, outreach with such agents as extension personnel and ministers, and farm crisis hotlines.

Journal Article↗
PubMed1986

Managing organizational problems in alternative service organizations.

Alternative Service Organizations--hotlines, shelters, crisis centers, etc.--are a growing and essential part of the overall human service delivery system. These organizations face predictable problems which arise from their unique history, structure, and mission. Using a political economy perspective, the common issues and professionalization, funding, and formalization are discussed and procedures for effectively managing resulting problems are suggested.

Community Health Centers↗
PubMed2005

Sowing the seeds of hope: providing regional behavioral health supports to the agricultural population.

In 1999, project leaders from seven states (i.e., Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota, and Wisconsin) began to share ideas and resources for providing behavioral health assistance (i.e., mental health counseling and addictions services) to stressed farmers, ranchers, farm workers, and their families. The seven states are among those most impacted by the farm crisis of the 1980s and again by low commodity prices and disasters such as droughts and floods in the 1990s. Project leaders conferred in monthly telephone conference calls and by 2001 began meeting in semi-annual face-to-face meetings to formally agree on a mission, program components, and management structure. Administrative functions were transferred from the Wisconsin Office of Rural Health and Wisconsin Primary Healthcare Association, to AgriWellness, Inc., a regional nonprofit corporation founded to provide technical assistance, grant writing, training of service providers, and other administrative supports. The Sowing the Seeds of Hope program has become a model for the provision of behavioral health supports for the agricultural population, including development of farm stress telephone hotlines, provision of confidential and affordable outpatient mental health and substance abuse counseling, training of professional providers in agricultural behavioral health, training of indigenous farm and rural residents as outreach workers who can respond to disasters of all types, and weekend educational retreats for farm residents. The program has achieved economy of scale by sharing expertise across state boundaries and the formation of a regional administrative structure. Yet, many challenges exist, the greatest of which is obtaining ongoing permanent support for the increasing numbers of uninsured and underinsured people involved in agriculture.

Community Mental Health Services↗
PubMed2003

Recommendations for postexposure prophylaxis of operating room personnel and patients exposed to bloodborne diseases.

The purpose of this collective review is to discuss management of operating room personnel who have had occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus type I (HTLV-I). HBV postexposure prophylaxis includes starting hepatitis B vaccine series in any susceptible unvaccinated operating room personnel who sustain an exposure to blood or body fluid during surgery. Postexposure prophylaxis with hepatitis B immune globulin (HBIG) is an important consideration after determining the hepatitis B antigen status of the patient. Ideally, all operating room personnel should be vaccinated with hepatitis B vaccine before they pursue their career in surgery. Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) should not be used for postexposure prophylaxis of operating room personnel exposed to patients with HCV; rather, follow-up HCV testing should be initiated to determine if infection develops. Postexposure prophylaxis for HIV involves a basic four-week regimen of two drugs (zidovudine and lamivudine; lamivudine and stavudine; or didanosine and stavudine) for most exposures. An expanded regimen that includes a third drug must be considered for HIV exposures that pose an increased risk for transmission. When developing a postexposure prophylaxis regimen, it is helpful to contact the National Clinicians' Postexposure Prophylaxis Hotline (1-888-448-4911).

Blood-Borne Pathogens↗
PubMed2000

Thoughts on the condolence letter.

Genuine, specific, timely emotional support of caregivers at the time of euthanasia is an important part of the veterinary professional obligation. Such support helps ease client pain during the grieving process. However, caution and sensitivity are essential when assessing and responding to caregiver-companion animal relationships.(1) For example, some caregivers are highly bonded but conceal their emotions, so our perceptions and responses must be thoughtful and discerning. My veterinary technician and I are supportive of our clients during euthanasia. I later write the condolence letter according to our perceptions of that particular human-companion animal bond. The only exceptions to our attempt to be thoroughly supportive at the time of euthanasia are those instances when we perceive that there has been obvious and willful abuse or neglect. At such times, we try to maintain emotional neutrality. The condolence letter and its variations described here are intended to serve as a guide. We send the condolence letter to caregivers within 24 hours of euthanasia, and it is addressed to the entire family. In addition, a euthanasia packet is provided at the time of euthanasia. The packet includes 2 brochures on coping with the loss of a companion animal, (2,3) contact information for a pet loss support hotline and a pet loss support group, an essay and a poem about the death of a companion animal, and a how-to article on dealing with children and their emotions on the loss of a pet. (4) My veterinary technician almost always phones the caregiver 1 to 3 days after euthanasia of their companion animal. The timing of the call depends on the circumstances of death and our judgment as to the emotional needs of the caregiver and family. Where emotions around euthanasia and loss are especially deep, the follow-up call may be made as early as that night or the next morning, with a second call 2 to 3 days later. The nature of the conversation depends on the technician's perception of the caregiver's needs. A condolence letter should reflect the needs and values of the individual veterinarian. For example, McElyea includes a brief history or profile of the animal and a reminder that death was easy and without suffering. (5) Others may wish to send a separate condolence to a child who seems especially affected by the death and loss of their special friend. I hope this article will encourage colleagues to hand-write condolence letters that reflect positive personal thoughts and feelings about the patient, the client, and the circumstances of the loss.

Animals↗
PubMed1986

Cocaine users seen in medical practice.

Cocaine use and the public's awareness of cocaine abuse problems have escalated sharply in the past several years and yet little is known of the users direct contact with medical providers. A questionnaire was designed, mailed to 2,422 physicians in general and family practice, internal medicine, emergency medicine, and psychiatry. The results indicated that many more cocaine users were presently being seen than had been seen in the same month in the previous year. Most of the cocaine patients were seen by psychiatrists, and contrary to popular myth, only a small percentage had high incomes. Most were young male, polydrug users who had been using for more than several months. Few seemed to want treatment. The responding physicians who saw cocaine patients almost always commented on how they managed such patients. Physician involvement varied from almost none (drug use was seen as incidental) to brief advice, referral, or direct treatment. Physician's comments provide a mirror of problems and feelings surrounding this patient population. Contrasts and similarities with hotline data are discussed. The growth of physician recognition of this problem population clearly indicates a treatment need.

Adult↗
PubMed2004

Malaria-related deaths among U.S. travelers, 1963-2001.

Nearly 1500 malaria cases occur each year in the United States; approximately 60% are among U.S. travelers. Despite the availability of sophisticated medical care, malaria-related deaths continue to occur. The authors reviewed all 185 fatal cases between 1963 and 2001 that were reported to the National Malaria Surveillance System: 123 (66.5%) occurred among U.S. travelers, and of these, 114 (92.7%) were attributed to Plasmodium falciparum. Failure to take or adhere to recommended chemoprophylaxis, to promptly seek medical care for post-travel illness, and to promptly diagnose and treat suspected malaria all contributed to fatal outcomes. Health care providers need to take a travel history, obtain a blood film for suspected malaria, and use the 24-hour malaria management advice available through the Centers for Disease Control and Prevention (CDC) Malaria Hotline (770-488-7788) or the CDC Malaria Web site (http://www.cdc.gov/Malaria). Hospitals must maintain intravenous quinidine gluconate on formulary because it is the only drug available to treat severe malaria in the United States.

Antimalarials↗