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PubMed2005

[Health warnings on cigarette packets. An overview].

The implementation of health warnings leads to continuous dissemination of the latest scientific findings on the health consequences of smoking. In combination with other recognized effective tobacco control measures, a lower consumption and an increased quit-rate are thus to be stimulated. The effectiveness of health warnings depends on their content as well as on their design and size. Thus, large warnings are by far better than smaller warnings. The same applies for warnings that are placed on the front of cigarette packets. Warnings that incorporate pictures are considerably more effective than warnings based solely on text. The combination of pictures and text format is most effective. International experience shows that the dissemination of Quitline phone numbers in combination with health warnings on every packet clearly improves the effectiveness and broad reach of smoking cessation advice via Quitlines. The implementation of pictorial health warnings combined with the imprint of the phone number of the Quitline of the Federal Center for Heath Education is highly recommended in Germany.

Consumer Product Safety↗
PubMed2004

The themes expressed in suicide calls to a telephone help line.

BACKGROUND: Little is known about the suicidal ideation of callers to telephone help lines even though these services are in the front line of suicide prevention efforts. Where thematic data are collected by telephone counseling agencies, it is rarely clear how the categories were constructed and the measurement properties of the instruments are rarely reported. METHODS: The call sheets kept by counselors on 409 suicide calls were content-analyzed, resulting in a reliable checklist comprising nine major themes. The prevalence of these themes within the sample was then determined and age and gender differences in the themes expressed by first-time callers (n = 189) were examined using logistic regression analysis. RESULTS: Almost equal numbers of male and female calls were received and the nine themes were mentioned a total of 981 times. Among first-time callers, males under 35 years were around 75% more likely to refer to relationship breakdown in their calls than were same-age females. Male callers were also around twice as likely to refer to material hardship. Females were four times more likely to refer to being the victim of abuse and nearly 60% more likely to refer to interpersonal and family problems. CONCLUSION: The vast majority of suicide callers expressed dissatisfaction with the quality of their intimate relationships, which suggests that the promotion of intimacy and coping strategies for relationship breakdown are central to the primary prevention of suicide.

Adolescent↗
PubMed2001

Effect of the 1998 Soccer World Cup tournament on rescue requests.

OBJECTIVES: We studied whether the Soccer World Cup Tournament in 1998 had an impact on the number of distress calls received by an emergency service. METHODS: Time series analysis was used retrospectively to study the relative frequency of telephone calls to a French emergency dispatching center during the period of the World Cup. RESULTS: Between 1 May 1997 and 15 August 1998 a total of 109,139 calls were recorded. During the period of the World Cup (10 June-12 July 1998) there was an overall decrease in rescue requests, distress calls, treatments in a mobile intensive care unit, and ambulance runs. There was no significant decrease during the French team matches except that between France and Italy. DISCUSSION: Rescue requests vary with the occurrence of public events. The decline which we discovered affected not the period of specific matches but the duration of the entire tournament. These results raise the question of the specificity of distress calls to an emergency dispatching center that receives not only medical requests but also general questions concerning illnesses.

Emergency Service, Hospital↗
PubMed2003

The anti-doping hot-line, a means to capture the abuse of doping agents in the Swedish society and a new service function in clinical pharmacology.

With the support of the Swedish National Institute of Health a national information service was started in 1993 aiming to capture the abuse of doping agents in the general public. It was organized as a telephone service, called the Anti-Doping Hot-Line, from our department and managed by trained nurses co-operating with clinical pharmacologists. Important information collected about all callers (anonymous) was: date of call, its origin, category of caller, doping experience and main question being asked. Abusers were asked about their age, sex, affiliation, abused drug(s), duration of abuse, habit of administration and adverse reactions (ADRs). Between October 1993 and December 2000 25,835 calls were received with a peak during spring and autumn. Most calls (12,400) came from non-abusers, 60% being males. Callers connected with gyms represented the largest group (30%). Most calls about specific drugs concerned anabolic androgenic steroids (AAS). Other drugs or products included ephedrine, clenbuterol and creatine. The most commonly abused anabolic steroids were testosterone, nandrolone-decanoate, methandienone and stanozolol. The ten most commonly reported ADRs of AAS were aggressiveness (835), depression (829), acne (770), gynecomastia (637), anxiousness (637), potency problems (413), testicular atrophy (404), sleep disorders (328), fluid retention (318) and mood disturbances (302). Female side effects included menstruation disturbances, hair growth in the face, lower voice and enlarged clitoris. During the period 1996-200, totally 4339 persons reported about 10,800 side effects. This figure should be compared with the very low number of ADRs (27) reported by prescribers to the Swedish ADR committee during the same period. Abuse of doping agents appears to be a new public health problem that needs detection, medical care and prevention.

Adolescent↗
PubMed2005

[Domestic elder abuse and neglect--conclusions from the evaluation of a model project].

The main task of a federally funded model project in the German city of Hannover was to develop approaches for prevention and intervention in the field of domestic elder abuse. Over a three year period (1998-2001), different approaches--like a telephone helpline for senior citizens, and social workers operating as counsellors for elderly people and their relatives--were tested at a local level. The paper presents results from the evaluation of the project and draws conclusions for future prevention and intervention in the field. The authors argue that the explicit use of the conceptual framework of "violence"/"abuse" creates potentials for scandalizing the issue and is therefore supportive for media appearance, whereas it can impede the approach to the main target groups (elderly people and their relatives) and reduce accessibility of counselling services for potential clients. In the light of evaluation results the focus of the project ("domestic elder abuse" or "violence against elderly people in close relationships") was too narrow for a local project. Counselling services were used in a relatively small number of cases; analyses of cases show that incidents of domestic elder abuse are often embedded in complex problem constellations. Cases brought to the attention of the model project were multifaceted and not limited to incidents of neglect and abuse of elderly care recipients caused by caregiver overload. Cases of intimate violence in partnerships and of intergenerational violence without any of the participants being dependent on care show the need to develop a broader concept of domestic elder abuse. Integration of the concepts of domestic violence, violence against women, elder abuse/neglect and abuse/neglect in caregiving relationships is necessary on a conceptual level as well as on the level of interagency cooperation of institutions dealing with cases of "elder abuse".

Aged↗
PubMed2005

After-hours paediatric telephone triage and advice: the Neuchâtel experience.

UNLABELLED: Delivery of paediatric primary care by call centres has emerged as a satisfactory system. It has been reported in the literature in the United States and Australia. European public-funded paediatric emergency departments (ED) have little epidemiological data to rely on to match the demand in care. Since 1996, we have run a free nurse-led after-hours paediatric telephone triage and advice (TTA) system. To determine whether other Swiss public paediatric departments practiced formal TTA, we conducted a nation-wide postal survey. To delineate who used our call centre and for what reasons, we embarked on a retrospective study of all the 1997/2000 calls. Most of the units run a TTA (27/35) but few specifically train their staff (14/27). A 43% increase in call numbers was seen between 1997 (3242) and 2000 (4628). During week-days, most of the calls were between 6 and 11 pm and at weekends, a mid morning activity peak was seen. Some 75% of calls were for children aged 5 years or less. Fever, earache and cough accounted for 42% of the main complaints. Of all calls, 27% were dealt by nurses' advice only. About 15% of the calls were transferred to the on-call resident. About 50% led to a same day ED appointment. CONCLUSION: Nurse-led paediatric telephone triage and advice is common in Switzerland where training seems to be irregular. Our data can help units to better plan an eventual paediatric telephone triage and advice service.

After-Hours Care↗
PubMed1999

Quantity and quality of information desired by Portuguese cancer patients.

Disclosure of the diagnosis of cancer to the patients affected has always been a controversial issue in the doctor-patient relationship. Undoubtedly this is so not only because of differences between countries and cultures, but also because there have been changes of opinion over the years. The aim of this study was to evaluate the quality and quantity of information desired by Portuguese cancer patients, and how and from whom they want to hear this information. Our sample comprised a total of 193 cancer patients, 87 men and 106 women. We found that 68.9% knew what their diagnosis was. In our sample, 74% wanted "as much information as possible, good or bad"; 85% said they wanted to know if their disease was cancer; 95% wanted to know the best or worst likely outcome of their disease; and 96.4% wanted to know the chances of getting cured. Most patients said they would prefer to be informed by physicians (92.7%) and have access to a telephone help-line, books and television. In conclusion, most patients wanted to know as much as possible about their illness and treatment, and the majority preferred to be involved in treatment decisions.

Adult↗
PubMed2005

A profile of mental health crisis response in a rural setting.

Systems of crisis intervention are frequently difficult to operationalize; they are often described as crisis components rather than systems, fail to differentiate levels of crisis acuity, provide very limited fundamental utilization data, and are almost exclusively implemented in urban areas. A system of rural crisis intervention differentiating levels of acuity and fundamental utilization information was profiled. Implications for clinicians and administrators are presented. This system of crisis intervention was highly effective in reducing inpatient utilization with the help of crisis residential beds and partial hospitalization. Mobile response was infrequently used in this setting. Age and gender were important variables in mental health emergency situations. Use of acute crisis level services was rarely more than once. More systematic descriptions of crisis systems of care were encouraged.

Adult↗
PubMed2005

Characteristics of gambling helpline callers with self-reported gambling and alcohol use problems.

The characteristics of problem gamblers calling the Connecticut Council on Problem Gambling (CCPG) gambling helpline during the years 2000-2001 (n = 960) were examined based on the presence or absence of self-reported alcohol use problems. A relatively low proportion of callers reported a problem with alcohol use (173/960 or 18.0%), and of those acknowledging an alcohol use problem, the majority reported a past rather than current problem (143/173 or 82.7%). A logistic regression analysis found that, as compared with problem gamblers denying any alcohol use problems, those reporting past or current alcohol use problems were more likely to be male and more frequently acknowledged problems with more forms of gambling, suicide attempts related to gambling, arrests secondary to gambling, daily tobacco use, drug use problems, prior substance abuse treatment, and family histories positive for alcohol and drug use problems. The findings highlight the strong relationship between alcohol use problems and other substance use problems, and suggest that problem gamblers with as compared with those without alcohol use problems demonstrate greater problems in multiple areas (arrest, attempted suicide) linked by impaired impulse control.

Adult↗
PubMed2006

Characteristics of older adult problem gamblers calling a gambling helpline.

BACKGROUND: Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems. DESIGN AND METHODS: Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline. RESULTS: Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling. CONCLUSIONS: Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.

Adult↗
PubMed2005

TPMG Northern California appointments and advice call center.

Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

Adolescent↗
PubMed2005

Web and computer telephone-based diabetes education: lessons learnt from the development and use of a call center.

Diabetes is a chronic disease that causes a great deal of morbidity and mortality and poor quality of life for millions of people. Continuing care and patient education help maintain a good control of the disease and prevent complications. Since current available resources are limited to providing such an education during clinic or physician visits only, alternative ways to educate people about diabetes need to be identified. In this article we discuss the implementation of an automated diabetes education call center, we define the evaluation procedures we adopted, we summarize general guidelines for the implementation of the entire system based on our experience, and we present preliminary results about the use of the call center. We believe our system is providing "active health" since we deliver educational messages to patients at regular intervals and at the time of their choice without waiting for their actions.

Diabetes Mellitus↗
PubMed2002

Enhancing support via interactive technologies.

Despite some improvements in diabetes treatment processes, outcomes for many patients remain inadequate. Interactive health technologies (IHTs) can address many of the challenges that diabetes patients and their health systems face, and research on IHT applications for diabetes care are intensifying. This article describes recent evidence regarding the feasibility and impact of 1) clinic-based CD-ROM systems supporting behavior change; 2) automated telephone diabetes management allowing for ongoing monitoring and patient education between face-to-face clinical encounters; and 3) Web-based systems focusing on a range of diabetes management goals such as enhanced emotional support for patients and improved clinician adherence to treatment guidelines. Studies in each of these areas have been somewhat encouraging. However, intervention effects have been moderate, and researchers face significant challenges in designing and implementing definitive studies.

CD-ROM↗
PubMed1994

A weight reduction intervention that optimizes use of practitioner's time, lowers glucose level, and raises HDL cholesterol level in older adults.

OBJECTIVE: The effects of a cognitive-behavioral weight control intervention were compared in two independent-living, older adult (mean age = 70.5 years) communities. DESIGN: The research design compared the experimental community (n = 163), which received the intervention, with the control community (n = 162). SUBJECTS: Overweight individuals (> 4.5 kg of age-adjusted weight according to height-weight tables) were recruited from both communities. INTERVENTION: Components of the Dietary Intervention: Evaluation of Technology (DIET) program included a video-tape, a workbook, computerized tracking of participants, a telephone hot line, educational group discussions, and individual consultation. OUTCOME MEASURES: Changes in body weight, body mass index, and lipid and glucose measures were selected to evaluate the effectiveness of the intervention. STATISTICAL ANALYSIS: One-way analysis of variance by group was done to compare changes in continuous variables between the intervention and control communities. RESULTS: Baseline body mass index and weight were 30.8 and 79.5 kg, respectively, in the experimental community and 28.8 and 75.8 kg, respectively, in the control community. Mean weight change in the experimental community was -3.2 kg after 40 weeks of intervention, compared with no weight change in the control community (P < .0001). Mean plasma glucose level decreased -0.3 mmol/L and mean high-density lipoprotein cholesterol level increased 0.15 mmol/L in the experimental community, compared with no change in lipid parameter and a +0.3 mmol increase in glucose level in the control community (P < .0001). APPLICATIONS: Our findings suggest that an intervention that optimizes use of the practitioner's time can achieve a moderate weight loss and metabolic improvement in a community of older adults.

Aged↗
PubMed1996

The Latin American trial of psychosocial support during pregnancy: effects on mother's wellbeing and satisfaction. Latin American Network For Perinatal and Reproductive Research (LANPER).

A randomized controlled trial including 2235 women at high risk of low birthweight was conducted in four Latin American institutions. The objective of this trial was to evaluate a psychosocial support intervention during pregnancy aimed at improving perinatal health and mothers' psychosocial conditions. The core of the intervention was four to six home visits where emotional support, counseling and strengthening of the woman's social network was provided. Outcomes were measured at 36 weeks of pregnancy, post-partum and 40 days after delivery. The intervention was not successful in either altering women's perception of social support and satisfaction with the reproductive experience, as well as maternal and newborn's health care. It is concluded that although high levels of psychosocial distress during pregnancy may play an independent role in determining adverse pregnancy outcomes, this adverse effect does not appear to be ameliorated by psychosocial interventions conducted only during pregnancy, particularly those of a magnitude that can be realistically implemented (in content and frequency) at public care services in most developing countries.

Adolescent↗
PubMed1990

Urgent care center pediatric telephone advice.

Pediatric telephone advice is sought frequently by members of the community. This study was undertaken to evaluate the quality and accuracy of pediatric telephone advice given by free-standing urgent care centers. One hundred such facilities were telephoned and advice was requested by a research assistant. A case was presented that could have represented a pediatric medical emergency. Overall only 17 centers gave adequate advice. The data suggest that under some circumstances free-standing urgent care center pediatric telephone advice may be inaccurate and inappropriate. Workable policies and protocols for pediatric telephone advice should be instituted by these facilities.

Algorithms↗
PubMed1990

Meeting information needs of significant others: use of the Cancer Information Service.

Although significant others (spouses, relatives and friends) of cancer patients play an important role in providing support and assistance to the patient, their need for information regarding the disease is frequently overlooked by the health care system. This analysis examines information needs of (1) diagnosed cancer patients, (2) significant others of diagnosed cancer patients and (3) the general public, as reflected in their calls to the Cancer Information Service (CIS), a national toll-free telephone inquiry service. Major focus is on the types of cancer-related subjects significant others inquire about, as well as how they first found out about the CIS. Results indicate that significant others are similar to diagnosed cancer patients in their need for additional information on specific cancer sites, treatment, and referrals for second opinions, but differ in their request for information on counseling services and clinical trials. Additionally, significant others and cancer patients are similar in how they find out about the CIS. In contrast, significant others differ from the general public in their information requirements, as well as in their source of referral to the CIS. While the CIS appears to be a channel of communication capable of addressing the dynamic information needs of significant others, further research concerning the effectiveness of the CIS and other channels of cancer information in satisfying the information requirements of significant others is recommended.

Adult↗
PubMed1996

The Dutch cancer information helpline: experience and impact.

A study was performed to evaluate the experience and impact of the Dutch national cancer information helpline. During a period of 4 weeks all callers from the target groups general public, cancer patients and friends/relatives of patients were asked to fill in a structured postal questionnaire (response 73%; N = 532). Different characteristics of the helpline were evaluated: the overall quality of the information given, the communication skills of the educators and the telephone as a channel for getting information concerning cancer. Also, several outcomes were measured: the overall satisfaction with the helpline, the impact on anxiety and the impact on meeting expectations. Most of the callers evaluated the different characteristics of the helpline very positively. Most callers were positive concerning the outcomes of the helpline. However, different target groups showed different predictors of these outcomes. The general public were mostly interested in general information, while relatives/friends and patients also seemed much in need of communicational feedback and reassurance. To maintain the high quality of the helpline it is of great importance to keep the line's expertise at a constant high level. This can be realized by training educators to attune more to the specific needs and questions of the different target groups and to try to get the 'real' questions to the surface.

Adult↗