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PubMed1994

Child abuse and neglect--recognition and reporting.

The dental profession has a legal, ethical and moral responsibility to report suspected cases of abuse and neglect. The risk to the child is significant. In non-fatal cases of abuse, 35 percent will be abused again within one year. To this end, dentists should discuss child abuse and neglect at staff meetings and establish office procedures if a case is identified. Encourage staff to discuss concerns they have regarding possible abuse they suspect in the office. Keep the child abuse hotline number or local agency responsible for receiving reports in the office rolodex. Abuse and neglect is a real problem in all neighborhoods and dentistry can make a difference.

Adolescent↗
PubMed1994

[Self-measurement of blood pressure in hypertensive subjects in Germany. Results of a questionnaire in Spring/early Summer 1993].

The 'cardiovascular hotline' in Heidelberg, established in April 1992, provides data concerning the self-measurement of blood pressure. For this purpose 277 hypertensives were asked from 15 April to 15 July 1993. 195 (70%) of those questioned (47% men, 53% women) practised home-recording, but only 17% on recommendation of their physician. Only 22% were introduced to the technique by experienced personnel; just 50% were adequately controlled. At least 35% of hypertensives used an oscillometric device and not more than 10% an auscultation device. 5 to 14% of the patients reported to have difficulties in handling their device. Approximately 60% of the patients practicing home-recording stated that this method enabled them to cope better with their disease. Compared with the 1987 pilot study in the Hamburg area, this percentage did not increase; however, it could be confirmed that only approximately 10% of the patients are unsuited for home-recording. 75% of the hypertensives measuring their own blood pressure documented their values, but in only 47% of all cases physicians drew conclusions from the data. 31% of the patients were unable to say whether their medication was adjusted on the basis of self-measured blood pressure values. In conclusion, many hypertensives practice self-measurement of blood pressure. Despite this fact, home-readings are not yet sufficiently accepted by physicians as a possible and desirable method to optimize high blood pressure treatment. This situation should be improved since compliance of physicians is the basis for a better education of hypertensive patients, thus optimizing patient compliance.

Adult↗
PubMed1993

Randomized telephone smoking-intervention trial initially directed at blue-collar workers.

Although smoking prevalence in the United States has declined markedly in recent years, prevalence among blue-collar workers remains high and few successful methods of reaching this group have been identified. The present study was designed to test the relative efficacy of two different approaches to telephone smoking-cessation counseling for blue-collar workers. Our study built on the experience of the National Cancer Institute's Cancer Information Service (CIS) and compared the past CIS smoking-cessation counseling procedure and a modified version of the present procedure. In our trial, callers to a special telephone hotline who asked for information on smoking cessation were randomly assigned to receive counseling under one of two protocols: 1) the past CIS procedure, in which general information was given and cessation materials were sent to the callers, and 2) a version of the present CIS stage-model procedure, adapted by us for use with blue-collar workers, in which callers were given counseling specific to their stage in the smoking-cessation process. The general-information group contained 185 subjects; the stage-model group contained 197. Despite extensive efforts in the present study, it was not possible to recruit the number of blue-collar workers planned for our statistical analysis. Consequently, of a total of 382 subjects recruited, 93 (24.3%) were blue-collar workers, 181 (47.4%) were white-collar workers, and 108 (28.3%) were retired persons who worked part time, student workers, or the unemployed. Our results show no statistically significant differences in either short-term or long-term nonsmoking rates between the general-information group and the stage-model group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The public health breast and cervical cancer program. Our role as physicians.

Through a federally funded breast and cervical cancer control program, women who have breast or cervical cancer should be identified at earlier stages of their disease. Working together, community physicians and local health departments can ensure that the highest quality breast and cervical cancer control services are available to all women in their communities. This public/private partnership will help ensure the survival of these crucial members of our families and communities--our mothers, grandmothers, wives, sisters, daughters, friends, and co-workers. For information about the location of participating local health departments, please call the Michigan Department of Public Health Mammogram Hotline at 1-800-922-MAMM (1-800-922-6266). For media materials or for more information about becoming involved as a provider of services for community breast and cervical cancer screening programs, call (517) 335-9161. All women are at risk of developing breast and cervical cancer. Please do what you can to encourage all women to obtain screening according to the schedule recommended by the American Cancer Society and the National Cancer Institute. And please cooperate with your local health department when your community initiates this program. References available upon request.

Adult↗
PubMed1993

Implementation of a hospital policy for health care workers exposed to hepatitis or the human immunodeficiency virus.

Implementation of a hospital policy for health care workers exposed to the human immunodeficiency virus (HIV) or hepatitis is discussed, using a model program established by San Francisco General Hospital (SFGH). Occupational Safety and Health Administration (OSHA) guidelines on blood-borne pathogens require a comprehensive program for management of occupationally exposed workers at all health care institutions. To meet the need of immediate assessment, SFGH has established a 24-hour hotline staffed by several clinicians. These clinicians provide risk assessment at the time of the call, and the 24-hour pharmacy service, using an anonymous system to protect the worker, can have zidovudine prophylaxis available within five minutes for workers potentially exposed to HIV. Hepatitis prophylaxis focuses on hepatitis B immunization and administration of hepatitis B immune globulin to workers who have been exposed. Ongoing medical management involves monitoring the adverse effects of zidovudine, ensuring that workers receive any workers' compensation benefits to which they are entitled, providing pretest and posttest counseling for exposed workers and their significant others and families, and supplying appropriate documentation. Confidentiality is essential for worker participation in the program. The costs of such a program are not insignificant but must be borne by the institution if it is to take care of its health care workers. Institutional policies and procedures must address all the components of postexposure management, as well as the issues related to HIV- and hepatitis B-infected health care workers. Sufficient staffing and funding, confidentiality, and prevention are the keys to a successful program.

Counseling↗
PubMed1996

Smoking policy and cessation in an inner-city hospital.

Hospital policies regarding cigarette smoking can affect the smoking habits of employees, patients, and visitors. Successful smoking policy development and impact have been reported in a number of hospitals. These reports have been from financially secure or university hospitals. This article reports on the policy experience at Interfaith Medical Center, a public hospital serving an economically disadvantaged black inner-city community. Policy implementation and smoking cessation efforts were directed by a broad-based hospital committee. An employee survey demonstrated support for a policy restricting but not banning smoking (89% of nonsmokers, and 80.2% of smokers). Among smoking employees, 87.6% wanted to quit. A policy restricting smoking to designated areas in the cafeteria and coffee shop was enacted. Health fairs and smokeout contests were enthusiastically received and resulted in short-term cessation verified by exhaled carbon monoxide levels. Assemblies where ex-smokers were given "Hall of Fame" certificates, "stop smoking" art contests, and a "stop smoking hotline" generated further cessation activity. The department of medicine, in cooperation with the National Heart, Lung, and Blood Institute's Smoking Education Program, set up a training program for residents on how to help patients quit. Overall, the smoking prevalence, attitudes, and enthusiasm to quit were similar to previous reports in financially secure hospitals. Unfortunately, lack of resources and staff turnover led to dissolution of the program. Institutional stability and a funding source are critical for the long-term success of hospital smoking cessation programs.

Adult↗
PubMed1996

Needs of family caregivers of patients receiving home hospice care for cancer.

PURPOSE/OBJECTIVES: To identify needs of family caregivers of home hospice patients with cancer. DESIGN: Exploratory, descriptive. SETTING: Six nonprofit homecare hospices in Canada. SAMPLE: Twenty Caucasian family caregivers of 20 patients with cancer enrolled in home hospice. METHODS: Subjects were recruited on admission to hospice and completed the Home Caregiver Need Survey in the home. MAIN RESEARCH VARIABLES: Family caregivers' assessment of their poorly satisfied informational, household, patient care, personal, spiritual, and psychological needs. FINDINGS: Family caregivers needed time for themselves away from the house and for their personal needs. They also lacked sufficient time to rest and did not experience adequate sleep. Caregivers needed to learn ways to help patients maintain some independence. A 24-hour hotline can be an important resource for caregivers. CONCLUSIONS: Family caregivers need social, volunteer, and professional support while caring for a family member at home so that their own physical and emotional health does not suffer. IMPLICATIONS FOR NURSING PRACTICE: To provide guidance and support to family caregivers, nurses should assess the needs of caregivers and tailor interventions to meet those needs. Nurses also should facilitate the development of a social, volunteer, and professional support network.

Adaptation, Psychological↗
PubMedDate not supplied

The STEPS Project: participatory action research to reduce falls in public places among seniors and persons with disabilities.

Through a process of participatory action research involving a telephone hotline, the STEPS project compiled data over a nine month period on the location and nature of 791 pedestrian slips, trips, falls and potential hazards in the Capital Regional District of British Columbia. Of the 533 people who reported a slip, trip or fall, the majority (80%) were female, and the average age was 65.27 years. Thirty-five percent (n = 186) had some type of physical disability and many (n = 106) reported using a mobility aide at the time of their accident. Most callers (75%) said they had suffered an injury, and of these 55% required medical attention. The most frequently reported fall locations were sidewalks and crosswalks. Major recommendations from the study include the need for municipal priority-setting for repairs with input from key user groups, including the elderly and people with disabilities.

Accident Prevention↗
PubMedDate not supplied

Toxic Pfiesteria and human health.

Toxic activity of a Pfiesteria-like organism occurred for much of 1997 in the waters of the lower Pocomoke River on Maryland's Eastern Shore. Maryland's experience with these toxic blooms of dinoflagellates, current knowledge of their potential human health effects, and the actions taken by state government agencies in response to a potential public health threat are reviewed. A medical diagnostic team commissioned by the Department of Health and Mental Hygiene evaluated a group of persons with intense exposures to lesioned fish or the waters from which they came and/or prominent symptoms following exposure to affected waters or lesioned fish. The principal findings of the team included consistent complaints of memory problems, acute burning of the skin following direct contact with water, and respiratory irritation. Findings on examination were limited to neurocognitive deficits in short-term memory and learning difficulties. Physicians and citizens are asked to continue to report, through their local health departments, illnesses thought to be related to exposure to lesioned fish or the waters from which they are taken. Persons with questions or wishing to report finding lesioned fish should call the state Pfiesteria hotline at 1-888-584-3110.

Animals↗
PubMed1997

The decline of youth suicidal behavior in an urban, multicultural public school system following the introduction of a suicide prevention and intervention program.

A 5-year longitudinal study of suicidal behavior of students attending Dade County Public Schools (DCPS) in Miami, Florida, between the 1989-1990 and 1993-1994 school years, is described. As the fourth largest public school system in the United States, DCPS is representative of an urban, multicultural community. The prevalence of suicidal behavior among DCPS students necessitated the development of a districtwide Suicide Prevention and School Crisis Management Program (SPSCMP), including the creation of the "Youth in Crisis Hotline." A review of eight national school districts' suicide prevention and intervention programs indicates similarities with the DCPS model. Statistical data compiled by the DCPS program are organized into annual, monthly, grade level, and school level classifications, and are analyzed to determine the degree and direction of self-destructive behavior among youth in a culturally and linguistically diverse school population following the introduction of a suicide prevention and intervention program. Evaluative data regarding the effectiveness of the program as well as implications for suicide prevention and intervention are discussed.

Adolescent↗
PubMed1998

Toxic-Pfiesteria--surveillance for human disease in Maryland.

The presence of toxic stages of the dinoflagellate Pfiesteria piscicida and other morphologically related organisms was documented in three estuarine waterways on the lower Eastern Shore of Maryland in 1997. The Maryland Department of Health and Mental Hygiene, working closely with the local health departments, established a surveillance system to collect reports of human illnesses. Maryland's experience has formed the base on which national surveillance criteria for Estuary Associated Syndrome have been developed and regional surveillance protocols have been built. The cooperation of practicing physicians is essential to continued surveillance efforts to further delineate the extent and nature of human health effects following exposures to waters where toxic forms of these dinoflagellates are active. Physicians wishing to report persons who may have Estuary Associated Syndrome should contact their local health department. Persons wanting information or wishing to report finding lesioned fish or a fish kill in progress should call the Maryland Pfiesteria Hotline at 1- 888-584-3110.

Animals↗
PubMed1993

Developing a comprehensive maltreatment intervention program.

The dental health care professional must understand that every individual cannot be saved from maltreatment, but the task is not futile. Suspicion must be investigated. The responsibility for investigating reports of suspected maltreatment lies at the state level. Every state has established a protective service reporting agency. Begin by determining the names and addresses of the protective agencies in your area and the procedure for reporting suspected cases of maltreatment. Determine the most effective and thorough means of gathering current and relevant information on the detection and proper evaluation of maltreatment. Consider the knowledge and training that dental personnel need to make an intervention program successful. Decide now dental staff should proceed and what timetable should be set for the implementation of an intervention. Dental health care providers must be a part of coordinated effort involving all groups concerned with the welfare of the aged and the young. Be proactive not reactive. Additional information may be obtained from the ADA's Council on Dental Practice at 1-800-621-8099, ext. 2895; the National Center on Child Abuse and Neglect, Department of Health & Human Services, P.O. Box 1182, Washington, D.C. 20013 (703) 821-2986; or the National Committee for the Prevention of Child Abuse 111 E. Wacker Drive, Suite 510, Chicago, IL 60601. Reporting agencies include: local department of public welfare; local police department; state departments of public welfare; state department of health & human services; national child abuse hotline, toll free (1-800-422-4453).

Adult↗
PubMed1994

AIDS hot lines and information agencies. The consistency of their information.

OBJECTIVES: To determine the consistency of responses given by acquired immunodeficiency syndrome (AIDS) hot lines and AIDS information agencies to a standard set of questions related to human immunodeficiency virus (HIV) infection and to investigate the training of workers in these telephone information agencies. DESIGN: A two-part questionnaire that addressed issues of HIV transmission and testing (part 1) and sexual behavior, diet, alcohol use, and partner notification (part 2). SETTING: Thirty-three AIDS telephone information agencies. PARTICIPANTS: Information specialists at these agencies were contacted on multiple occasions over a 1-year period. INTERVENTION: Initially, 48 calls were made to these agencies. Responses were recorded in the words of the information specialists, categorized, and assessed for consistency. Two additional surveys using the same questionnaire were also performed, examining the variability of responses within an individual agency and the variability of responses from six agencies, three with and three without formal training of their information specialists. RESULTS: The initial survey revealed inconsistencies and inaccuracies in responses from AIDS telephone information agencies particularly in the areas of HIV testing, risk factor assessment, safe-sex recommendations, and life-style changes for infected persons. The second survey revealed variability in responses from six information specialists within a single agency. The third survey revealed that, overall, agencies with and without formal training of workers were equally inconsistent in their responses. CONCLUSIONS: There are identifiable deficiencies in the quality and consistency of information given by some AIDS telephone information agencies. Training procedures of information specialists at these agencies are variable and may be inadequate.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Early effects of the healthy steps for young children program.

OBJECTIVE: The Healthy Steps for Young Children Program (HS) incorporates early child development specialists and enhanced developmental services into routine pediatric care. An evaluation of HS is being conducted at 6 randomization and 9 quasi-experimental sites. Services received, satisfaction with services, and parent practices were assessed when infants were aged 2 to 4 months. METHODS: Telephone interviews with mothers were conducted for 2631 intervention (response rate, 89%) and 2265 control (response rate, 87%) families. Analyses were conducted separately for randomization and quasi-experimental sites and adjusted for baseline differences between intervention and control groups. Hierarchical linear models assessed overall adjusted effects, while accounting for within-site correlation of outcomes. RESULTS: Intervention families were considerably more likely than controls to report receiving 4 or more developmental services and home visits and discussing 5 infant development topics. They also were more likely to be satisfied and less likely to be dissatisfied with care from their pediatric provider and were less likely to place babies in the prone sleep position or feed them water. The program did not affect breastfeeding continuation. Differences in the percentage of parents who showed picture books to their infants, fed them cereal, followed routines, and played with them daily were found only at the quasi-experimental sites and may reflect factors unrelated to HS. CONCLUSIONS: Intervention families received more developmental services during the first 2 to 4 months of their child's life and were happier with care received than were control families. Future surveys and medical record reviews will address whether these findings persist and translate into improved language development, better utilization of well-child care, and an effect on costs.

Adult↗
PubMed2005

An assessment of pediatric after-hours telephone care: a 1-year experience.

BACKGROUND: Pediatric after-hours telephone triage by call center nurses is an important part of pediatric health care provision. OBJECTIVES: To use a computerized database including the after-hours telephone calls for 90% of the pediatricians in Colorado to examine: (1) the epidemiology of after-hours calls during a 1-year period including the volume, seasonality, and timing of after-hours calls, the age of the patients, the presenting complaint, the triage dispositions, and mean rates of calls per pediatrician; (2) the process of care measures at the call center, including waiting times for nurse telephone call-backs, the length of triage calls, and how these factors varied by season; and (3) the frequency and content of calls requesting information but not requiring triage. DESIGN: Descriptive study. SETTING AND PARTICIPANTS: All telephone calls from the After-Hours Telephone Care Program, Denver, Colo, received between June 21, 1999, and June 20, 2000, were retrieved from a computerized database and categorized by age, season, triage disposition, and algorithm. MAIN OUTCOME MEASURES: The volume, seasonality, timing, age distribution, algorithms used, and triage dispositions of after-hours calls. The reasons for calls requesting information. RESULTS: During the 1-year period 141 922 calls were returned by the call center. Of the total calls, 88% were for a clinical illness; 5%, for information or advice; 5%, for calls in which the parent could not be recontacted; 1%, for duplicate calls, and 1%, for miscellaneous reasons. Listed in rank order for the year, the 10 most common algorithms used for illness calls were vomiting, colds, cough, earache, sore throat, fever, diarrhea, croup, head trauma, and eye infection. Of illness calls, 21% of callers were told to go in for urgent evaluation, 30% were told to contact their primary care physician either the next day or at a later time, 45% were given home care instructions, and 4% were referred to call the on-call physician. CONCLUSIONS: This study describes the epidemiology of after-hours telephone calls regarding children in 90% of the private practices in Colorado. Data provided are useful in guiding the planning of health care provision, providing staffing of after-hours facilities, and planning for the educational training of telephone care staff. They also highlight opportunities for patient education that might decrease unnecessary after-hours calls.

Adolescent↗