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Capitol hill staff workers' experiences of bioterrorism: qualitative findings from focus groups.

Little systematic information is available on mental health issues related to bioterrorism. Five focus groups were conducted with Capitol Hill office staff (n = 28 total participants) to learn about their experience of the anthrax incident on October 15, 2001. More than 2,000 verbal passages were coded into categories and themes by using qualitative analysis software. Issues emerging from the discussions included difficulties utilizing customary social supports, concerns over potential long-term dangers created by efforts to eradicate the anthrax, and nonadherence to antianthrax medication regimens. Nonadherence to antibiotic prophylaxis is of immediate concern for response to future bioterrorist events as well as infectious disease epidemics. Other topics that warrant attention are social support and mental health interventions.

Administrative Personnel↗

Welfare reform and child care options for low-income families.

For the changes under welfare reform to positively affect children, the gains that mothers make from employment must lead to improvements in children's daily settings at home, in child care, at school, or in the community. This article focuses on the role child care can play in promoting the development of, and life opportunities for, low-income children. Key observations include: Total federal and state funding for child care for welfare and working poor families has increased dramatically since welfare reform, from $2.8 billion in 1995 to $8.0 billion in 2000. The majority of welfare mothers tend to rely on informal child care arrangements when first participating in welfare-to-work programs, but as they move off welfare and into more stable jobs, they are more likely to choose a center or a family child care home. Although children from poor households stand to benefit the most from high-quality care, they are less likely to be enrolled in high-quality programs than are children from affluent families, partly due to uneven access to high-quality options in their neighborhoods. Less than one-quarter of all eligible families use child care subsidies, and usage varies widely across states and local areas reflecting various barriers to access and scarcity of quality center-based care. The authors conclude that to achieve welfare reform's ultimate goal of breaking the cycle of intergenerational poverty and dependence on government benefits, welfare-to-work programs should promote learning and development among children in welfare and working poor families by increasing access to high-quality child care in low-income neighborhoods.

Child↗

The comparative retention of National Health Service Corps and other rural physicians. Results of a 9-year follow-up study.

OBJECTIVE: To contrast the retention of physicians serving National Health Service Corps (NHSC) Scholarship Program obligations in rural settings to that of non-NHSC physicians working in the same or similar practices, and to identify promising retention-enhancing strategies. DESIGN: Cohort study. PARTICIPANTS: Four hundred twelve primary care physicians initially identified during an earlier study as working in a national stratified random sample of 178 externally subsidized rural clinics in 1981. Thirty-six percent were serving obligations to the NHSC, nearly all through the NHSC's Scholarship Program. The NHSC and non-NHSC inception cohorts (those first coming to their 1981 [or "index"] practices from May 1979 through December 1981) were created from within the entire group for use in most analyses. INTERVENTION: In 1990, physicians were resurveyed to learn of their backgrounds, experiences in their index practices, and their subsequent career moves. RESULTS: By 1984 and in each year thereafter, fewer NHSC than non-NHSC physicians of the entire respondent cohort remained (1) in their index practices, (2) in their index communities, and (3) in practice in any rural county (P less than .001). In the inception cohort, fewer NHSC than non-NHSC physicians were retained within all three settings by the third year after their initial dates of employment (P less than or equal to .01). After 8 years of employment, group retention rates for NHSC and non-NHSC inception cohort physicians were 12% vs 39% in the index practice and 29% vs 52% in nonmetropolitan practice. Physicians in both NHSC and non-NHSC groups who left their index practices generally left rural practice altogether. CONCLUSIONS: When compared to non-NHSC physicians working in comparable rural settings, the retention of rural NHSC physicians is seen to be poor and only partially explained by fixed physician, practice, or community variables. Long-term retention of NHSC providers is now receiving much needed attention at the federal level.

Adult↗

Overcoming the barrier of lactose intolerance to reduce health disparities.

Federal health goals for the public have focused on reducing health disparities that exist between whites and various racial and ethnic groups. Many of the chronic diseases for which African Americans are at greater risk- hypertension, stroke, colon cancer, and obesity-may be exacerbated by a low intake of calcium and/or other dairy-related nutrients. For example, a low intake of dairy food nutrients, such as calcium, potassium, and magnesium, may contribute to the high risk of hypertension seen in African Americans. The Dietary Approaches to Stop Hypertension (DASH) study demonstrated that a low-fat diet rich in fruits and vegetables (8 to 10 servings) and low-fat dairy foods (3 servings) significantly reduced blood pressure-and was twice as effective in African-American participants. Calcium and dairy food consumption is particularly low among African-American, Hispanic, and Asian populations. Average intakes are near the threshold of 600 to 700 mg/day, below which bone loss and hypertension can result. Although lactose intolerance may be partly to blame for the low calcium intakes due to reduced dairy food consumption by minority populations, culturally determined food preferences and dietary practices learned early in life also play a role. The high incidence figures for primary lactose maldigestion among minority groups grossly overestimates the number who will experience intolerance symptoms after drinking a glass of milk with a meal. Randomized, double-blind, controlled clinical trials have demonstrated that by using a few simple dietary strategies, those who maldigest lactose (have low levels of the lactase enzyme) can easily tolerate a dairy-rich diet that meets calcium intake recommendations. Physicians and other health professionals can help their minority patients and the general public understand how to improve calcium nutrition by overcoming the surmountable barrier of lactose intolerance. At the same time they will be helping to reduce the incidence of calcium-related chronic diseases for which minority populations are at high risk.

Asian↗

Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network.

Few studies of community interventions examine independent effects of investments in: (1) capital (i.e., physical, human and social capital), and (2) management systems (e.g., monitoring and evaluation systems (M&E)) on maternal and child health behavior change. This paper does this in the context of an inter-organizational network. In Nicaragua, international non-governmental organizations (NGOs) and local NGOs formed the NicaSalud Federation. Using Lot Quality Assurance Sampling (LQAS), 14 member organizations took baselines measures of maternal safe motherhood and child health behavior indicators during November 1999 and August 2000, respectively, and final evaluation measures in December 2001. In April 2002, retrospective interviews were conducted with supervisors and managers in the 14 organizations to explore changes made to community health strategies, factors associated with the changes, and impacts they attributed to participating in NicaSalud. Physical capital (density of health huts), human capital (density and variety of paramedical personnel) and social capital (density of health committees) were associated with pregnant women attending antenatal care (ANC) 3+ times, and/or retaining ANC cards. The variety of paramedic personnel was also associated with women making post-partum visits to clinics. Physical capital (density of health huts) and social capital (density of health committees and mothers' clubs) were associated with child diarrhea case management indicators. One safe motherhood indicator (delivery of babies by a clinician) was not associated with intervention strategies. At the management level, NicaSalud's training of members to use LQAS for M&E was associated with the number of strategic and tactical changes they subsequently made to interventions (organizational learning). Organizational learning was related to changes in maternal and child health behaviors of the women (including changes in the proportion using post-partum care). As the latter result would not have occurred without NicaSalud, we conclude that this inter-organizational network provided added value by instigating organizational learning.

Female↗

Central collecting and evaluating of major accidents and near-miss-events in the Federal Republic of Germany--results, experiences, perspectives.

Lessons learnt from accidents are essential sources for updating state of the art requirements in process safety. To improve this input by a systematic way in the FRG, a central body for collecting and evaluating major accident (ZEMA) was established in 1993. ZEMA is part of the Federal Environmental Agency. All events which are to be notified due to the German Regulation on Major Accidents (Störfall-Verordnung) are centrally collected, analysed (deducing lessons learnt) and documented by ZEMA. The bureau is also responsible for the dissemination of the lessons learnt to all stake holders. This work is done in co-operation with the German Major-Accident Hazard Commission (Störfallkommission) and other international bodies like European MAHB. At the time being, over 375 events from 1980 to 2002 are registered in Germany. For each event, a separate data sheet is published in annual reports, first started in 1993. All information is also available at. A summary evaluation on the events from 1993 to 1999 is presented and some basic lessons learnt are shown. The results from root cause analysis underline the importance of maintenance, detailed knowledge of chemical properties, human factor issues and the role of safety organisation especially connected with subcontractors. The German notification system is described in detail and some experience with the system is reported. Keeping in mind that collecting reports from notified major accidents is only a small amount compared with all the events which might be interesting to learn from, the German Major-Accident Hazard Commission has established a separate body, the subcommittee "Incident Evaluation", which is in charge with collecting and evaluating of minor and near-miss events. Since 1994, a concept for the registration and evaluation of those non-notifiable events was developed. From 2000 on, the concept has been put into operation. Its main elements are; 1. reporting of the incident by the plant operator to an information collecting point of its trust, 2. passing the anonymous report to the "Incident Evaluation" subcommittee, 3. evaluation and classification whether the incident is safety relevant or not and, 4. publishing the relevant information to all interested stake holders, preparing of summary evaluation results in certain areas. Up to now, two brochures on "waste gas pipes" and "obstructions of pipes" were published.

Accidents↗

Chloramphenicol: what we have learned in the last decade.

Chloramphenicol is a unique antibiotic. The kinetics and efficacy of the oral and intravenous preparations are comparable. Chloramphenicol is usually bacteriostatic but is bactericidal against Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis, and chloramphenicol's clinical efficacy against these meningeal pathogens is well established. Chloramphenicol can be used to treat serious pediatric infections when Haemophilus influenzae is a likely pathogen, as well as typhoid fever, anaerobic infections, bacterial meningitis in patients allergic to penicillin, brain abscesses, and rickettsial infections. The use of chloramphenicol is limited because of its toxicity. Aplastic anemia is very rare but can occur after either oral or intravenous administration. The gray syndrome can be eliminated and marrow suppression minimized by using chloramphenicol at the recommended doses and monitoring levels. During the last decade the increased use of chloramphenicol has not resulted in increased resistance or in frequent reports of toxicity. Thus, chloramphenicol remains an important inpatient antibiotic that can be invaluable for treating certain life-threatening infections.

Adolescent↗

The resource utilization groups system of nursing home reimbursement policies: influences on occupational therapy practice.

OBJECTIVE: This study explored the effects of federal and state reimbursement mechanisms on occupational therapy practice in the nursing home setting, specifically, the selection and scheduling of patients for treatment programs, the content of the therapy provided, and the documentation requirements. METHOD: A questionnaire developed for the study was mailed to the chief occupational therapist in each of the 171 nursing homes located in New York city. Descriptive data on the research variables were collected from 83 respondents. RESULTS: Government regulation and reimbursement mechanisms specifically affected therapists' treatment decisions and patient programming and scheduling in the nursing home setting. Survey results described the clinical impact of the resource utilization groups (RUGs) data collection periods. Negative effects were seen in a substantial incidence of withholding therapies from patients and the decline in the use of some traditional occupational therapy treatments. Positive effects included an increase in staff and equipment and therapists' improved documentation skills. CONCLUSION: Occupational therapy practitioners in the nursing home setting need to find ways to live with the realities of government reimbursement without compromising professionalism or clinical judgment. Documentation is the key to assuring that patients receive the therapy they need. Therapists should be aware of the regulations, document accordingly, and review those cases that were denied reimbursement to learn of documentation errors.

Health Policy↗

[Psychological symptoms in school children. An epidemiologic study].

After a study of almost complete patient populations at selected child and adolescent psychiatric facilities as part of the federal government's "Modellprogramm Psychiatrie", two groups of children were investigated with the Child Behavior Checklist: a representative sample of 1969 school children between 6 and 17 years of age and 404 patients from child and adolescent psychiatric services. The presence of psychiatric problems was based on symptoms reported by the parents that experts rated as requiring treatment (at least two critical items). Of the 1969 school children, 253 (12.7%) required counseling or treatment, but only 64 (3.3%) were being treated for psychiatric problems or a developmental delay, half of them at non-psychiatric medical facilities. Symptoms prevalence correlated with age, social class, type of school and nationality.

Adolescent↗

[The graduate education project in the new federal German lands "Diabetics--Management in General Practice"].

Supported by the federal ministry of health, the Central Research Institute for Ambulatory Health Care in Germany organised postgraduate courses with the topic "How to take care of diabetic patients" in cooperation with the society of panel physicians. Contents and media of the postgraduate course were developed with the help of experts, a formative evaluation of the curriculum was carried out. In a consensus- and preparatory meeting, diabetologists discussed the medical objectives with experts and were trained under the guidance of educationalists (microteaching with video-monitoring aiming at improving teaching behaviour). Later on, 1315 physicians participated in 38 postgraduate courses. The experiences of this project can provide useful informations how to structure postgraduate medical education.

Diabetes Mellitus↗

Childhood injuries in Connecticut's Medicaid managed care program.

This study describes childhood injuries and injury-related care using encounter data from a Medicaid managed care program. Enrollment and encounter data for federal fiscal year 2000 were used to identify children who received treatment for an injury, to identify risk factors, and to describe injury-related care. Twenty percent of children were treated for an injury. Preschool-age children and adolescents, males, whites, and residents of nonurban areas were at greatest risk. Sixty percent of injured children received emergency care or were hospitalized. Length of hospital stay for treatment of injuries was 33 percent longer than admissions for other conditions. E-codes were rarely reported. One of five children in Connecticut's Medicaid managed care program was treated for an injury in a one-year period. Medicaid managed care data can be used to determine the percentage of children who experience injuries, to identify risk factors, and to describe injury-related care.

Adolescent↗

Chefs' attitudes toward healthful food preparation are more positive than their food science knowledge and practices.

OBJECTIVE: To determine if chefs' and student chefs' attitudes, knowledge, and practices regarding healthful food preparation are consistent with the Dietary Guidelines for Americans. DESIGN: An analytical survey questionnaire was distributed to 4 chef groups. Sections 1 and 2 of the survey measured chefs' food science knowledge (13 questions) and likelihood of using food preparation practices (15 questions) necessary to meet the 1990 Dietary Guidelines for Americans. Section 3 (22 questions) measured chefs' attitudes toward nutrition in general, toward the importance of healthful food preparation practices, and toward the US Dietary Guidelines. SAMPLE: Of 512 surveys distributed by mail, at culinary meetings, and in classes at 2 culinary schools, 447 (86%) were returned (158 from practicing chefs and 289 from student chefs). Practicing chefs included chef educators, foodservice chefs from a national corporation, and independent chef members of the American Culinary Federation of New York City. STATISTICAL ANALYSIS: Descriptive statistics included frequencies, means, and standard deviations of survey items and of individual survey sections. Reliability and validity were determined using alpha coefficients and principal components analysis. Analysis of variance was used to examine differences in practice, attitudes, and knowledge among chef groups. RESULTS: Both practicing chefs and student chefs answered more than 70% of the food science questions correctly; independent chefs scored significantly lower than educator and corporate chefs. More than two thirds of the chefs and student chefs correctly responded to questions about the nutrient composition of food and how cooking affects the nutrient content of food. All chef groups were confused about fat and cholesterol in food and in the body. Few healthful food preparation practices were likely to be used by any chef group more than two thirds of the time, although the subscale of the attitude toward the importance of these practices was very positive. The majority of practicing chefs thought that customers do not care about the US Dietary Guidelines and nutrition; student chefs thought that customers do care. Both groups strongly agreed that, as chefs, they are responsible for the nutritional content of the food they prepared. APPLICATION: Both chefs and student chefs are willing to learn about food science and recipe modification principles as they apply to healthful cooking practices. The opportunities are clear: Dietitians have the expertise to teach chefs healthful food preparation techniques, recipe modification, and food composition information.

Adolescent↗

Ngi and Internet2: accelerating the creation of tomorrow's internet.

Internet2 is a consortium of leading U.S. universities working in partnership with industry and the U.S. government's Next Generation Internet (NGI) initiative to develop a faster, more reliable Internet for research and education including enhanced, high-performance networking services and the advanced applications that are enabled by those services [1]. By facilitating and coordinating the development, deployment, operation, and technology transfer of advanced, network-based applications and network services, Internet2 and NGI are working together to fundamentally change the way scientists, engineers, clinicians, and others work together. [http://www.internet2.edu] The NGI Program has three tracks: research, network testbeds, and applications. The aim of the research track is to promote experimentation with the next generation of network technologies. The network testbed track aims to develop next generation network testbeds to connect universities and federal research institutions at speeds that are sufficient to demonstrate new technologies and support future research. The aim of the applications track is to demonstrate new applications, enabled by the NGI networks, to meet important national goals and missions [2]. [http://www.ngi.gov/] The Internet2/NGI backbone networks, Abilene and vBNS (very high performance Backbone Network Service), provide the basis of collaboration and development for a new breed of advanced medical applications. Academic medical centers leverage the resources available throughout the Internet2 high-performance networking community for high-capacity broadband and selectable quality of service to make effective use of national repositories. The Internet2 Health Sciences Initiative enables a new generation of emerging medical applications whose architecture and development have been restricted by or are beyond the constraints of traditional Internet environments. These initiatives facilitate a variety of activities to foster the development and deployment of emerging applications that meet the requirements of clinical practice, medical and related biological research, education, and medical awareness throughout the public sector. Medical applications that work with high performance networks and supercomputing capabilities offer exciting new solutions for the medical industry. Internet2 and NGI,strive to combine the expertise of their constituents to establish a distributed knowledge system for achieving innovation in research, teaching, learning, and clinical care.

Internet↗

Sequence-structure-function relationships of a tRNA (m7G46) methyltransferase studied by homology modeling and site-directed mutagenesis.

The Escherichia coli TrmB protein and its Saccharomyces cerevisiae ortholog Trm8p catalyze the S-adenosyl-L-methionine-dependent formation of 7-methylguanosine at position 46 (m7G46) in tRNA. To learn more about the sequence-structure-function relationships of these enzymes we carried out a thorough bioinformatics analysis of the tRNA:m7G methyltransferase (MTase) family to predict sequence regions and individual amino acid residues that may be important for the interactions between the MTase and the tRNA substrate, in particular the target guanosine 46. We used site-directed mutagenesis to construct a series of alanine substitutions and tested the activity of the mutants to elucidate the catalytic and tRNA-recognition mechanism of TrmB. The functional analysis of the mutants, together with the homology model of the TrmB structure and the results of the phylogenetic analysis, revealed the crucial residues for the formation of the substrate-binding site and the catalytic center in tRNA:m7G MTases.

Amino Acid Sequence↗

Clinical and quantitative assessment of headgear compliance: a pilot study.

INTRODUCTION: This study was undertaken to evaluate the compliance of patients using headgear with a timing device and to determine the efficiency of the electronic module timer as a patient motivator. METHODS: Twenty-one patients (average age, 14 years 10 months) were selected from the orthodontic clinic of Federal University of Paraná on the basis of headgear wear for anchorage. The patients were instructed to wear their headgear 14 hours a day for a given number of days. The headgears were equipped with recorders (Compliance Science System and Affirm smart headgear modules, Ortho Kinetics, Vista, Calif). The patients were not told about the recorders, but they were instructed to keep track of their wear times. At the end of the test period (T1), the patients' reported wear times were compared with readings from the electronic modules. The patients were assigned a second period of headgear wear (T2) and told that their use would be monitored electronically. Again, the wear times reported by the patients were compared with the values from the electronic modules. Total time, number of hours accumulated between sessions, and quality time (uninterrupted use of headgear) were assessed. RESULTS: Patients reported wearing their headgear an average of 13.6 hours per day; the electronic modules detected 5.6 hours per day in T1 and 6.7 hours per day in T2. Quality time was 1.8 hours per day in T1 and T2. The mean actual hours of daily wear relative to the provider's requirement was 56.7% in T1 and 62.7% in T2. Boys were more compliant than girls. After they learned of the electronic device, the girls' compliance improved. Younger patients were more compliant than older ones. The compliance rate of older patients improved slightly in T2. CONCLUSIONS: Patients tend to overreport their headgear wear times. The mean actual hours of daily wear relative to the providers' requirement was 56.7%. This increased to 62.7% when patients knew a recording device was being used. A monitoring system can provide feedback to the patient, facilitate parental involvement, and motivate patients to comply with headgear wear.

Adolescent↗

The provision of family planning services in the Caribbean.

This article examines the provision of family planning services in selected countries in the Caribbean. The potential impact of the funding shortfall resulting from the phasing out of funding by the International Planned Parenthood Federation (IPPF), and the strategies being adopted by the selected countries to cope with this, are considered. Stratified random sampling methods were employed to select eight Caribbean countries and a pre-designed questionnaire was administered to the agency responsible for family planning services in each country. The sample was stratified geographically to include countries from different parts of the Caribbean. The questionnaire was designed to collect information on the services provided, the name of the agency responsible for the provision of services and, where possible, the number of users of each type of service in 1998 and 1997. Vast disparities were found in the provision of family planning services in different Caribbean countries, in terms of the groups involved, the services available in each country, as well as methods of data collection and compilation. Anguilla and Bermuda were found to provide only limited family planning services, while Barbados, Jamaica and Grenada provide much more sophisticated services. A salient finding was the innovative approaches that various countries in the region have adopted to fund family planning programmes in anticipation of the phasing out of IPPF funding. The standpoint taken in the study is that countries such as Anguilla and Bermuda must strive to improve their provision of family planning services, and that they could learn from Barbados, Grenada and Jamaica, which provide much more comprehensive services. It is also concluded that, unless alternative funding sources are identified and accessed, the provision of family planning services in the Caribbean is likely to decline in the future.

Caribbean Region↗

Continuing education for maternal child health nurses: a means to improve the health care of mothers and children.

The University of Kentucky College of Nursing is in the 7th year of implementing a 7-year federally funded continuing education project. The major goal of MCH (maternal child health) Project 969, which is scheduled to terminate Sept. 30, 1984, is to develop and offer a series of quality continuing education courses for three distinct populations--practicing maternal child health nurses, State nurse consultants, and nurse supervisors at county or district levels. The purpose of these courses is to improve the practice of the participating nurses and thereby ultimately to improve the health status of mothers and children in Region IV of the Department of Health and Human Services. Evaluation of the project by its staff after its first 5 years showed that (a) it has provided a series of continuing education courses of high quality; (b) met its goals and objectives; (c) provided continuing education for practicing maternal child health nurses that has improved MCH nursing practice in Region IV; (d) provided continuing education for State nurse consultants that has enabled them to become more effective leaders in their respective States; (e) used previously untapped resources in Region IV to make the concept of regional continuing education in maternal child health nursing a reality; and (f) generated a networking system among State nurse consultants, nurse educators, and nurse leaders in other service-oriented Title V programs that has been most effective in meeting the learning needs of the three distinct populations it serves.

Child Health Services↗

Predicted mercury concentrations in hair from infant immunizations: cause for concern.

Mercury (Hg) is considered one of the worlds most toxic metals. Current thinking suggests that exposure to mercury occurs primarily from seafood contamination and rare catastrophic events. Recently, another common source of exposure has been identified. Thimerosal (TMS), a preservative found in many infant vaccines, contains 49.6% ethyl mercury (EtHg) by weight and typically contributes 25 microg of EtHg per dose of infant vaccine. As part of an ongoing review, the Food and Drug Administration (FDA) announced in 1999 that infants who received multiple TMS-preserved vaccines may have been exposed to cumulative Hg in excess of Federal safety guidelines. According to the centers for disease control (CDC) recommended immunization schedule, infants may have been exposed to 12.5 microg Hg at birth, 62.5 microg EtHg at 2 months, 50 microg EtHg at 4 months, 62.5 microg EtHg at 6 months, and 50 microg EtHg at approximately 18 months, for a total of 237.5 microg EtHg during the first 18 months of life, if all TMS-containing vaccines were administered. Neurobehavioral alterations, especially to the more susceptible fetus and infant, are known to occur after relatively low dose exposures to organic mercury compounds. In effort, to further elucidate the levels of ethyl mercury resulting from exposure to vaccinal TMS, we estimated hair Hg concentrations expected to result from the recommended CDC schedule utilizing a one compartment pharmacokinetic model. This model was developed to predict hair concentrations from acute exposure to methymercury (MeHg) in fish. Modeled hair Hg concentrations in infants exposed to vaccinal TMS are in excess of the Environmental Protection Agency (EPA) safety guidelines of 1 ppm for up to 365 days, with several peak concentrations within this period. More sensitive individuals and those with additional sources of exposure would have higher Hg concentrations. Given that exposure to low levels of mercury during critical stages of development has been associated with neurological disorders in children, including ADD, learning difficulties, and speech delays, the predicted hair Hg concentration resulting from childhood immunizations is cause for concern. Based on these findings, the impact which vaccinal mercury has had on the health of American children warrants further investigation.

Forecasting↗