Child health initiatives and journal narrow-mindedness.
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Adolescent↗
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Results for “Hotlines”
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On the threshold of disclosure. The effects of a mass media field experiment.
OBJECTIVE: To assess whether the number of disclosures of child abuse changed as a result of a prevention strategy on a national scale in a West-European country. The child abuse involved child sexual and physical abuse, both ongoing and past. METHODS: In order to assess possible intervention effects, changes in calling the Child Line were measured. For this, a 4 year longitudinal design, starting before the intervention and ending 2 and 1/2 years after it was used (N = 3,117 disclosures). In addition, data were collected from the Dutch Telecom and a newely developed Child Abuse Form (N = 1,227). Finally, two measures were introduced, the disclosure coefficient and the relative disclosure coefficient. RESULTS: Most calls were silent calls, a phenomenon that deserves more attention in disclosure research. Compared to pre-intervention data, the amount of disclosures almost tripled during the intervention and was even further enhanced in the post-intervention and follow-up. In nine out of 10 cases, ongoing abuse was disclosed. Marked differences between child physical abuse and child sexual abuse were observed. CONCLUSION: It is concluded that mass media communication, if well implemented, can positively influence the process of disclosure of ongoing child abuse.
Adolescent↗
Comparing professional and consumer drug information centers.
Providing drug information to consumers is an essential component of medical and pharmaceutical care. In recent years, profit-based consumer-oriented drug information centers (DICs) or drug hot lines have developed to fill this need. This study compared the services and information provided by DICs for consumers with those provided by DICs for health care professionals. The two consumer-oriented DICs provided-accurate and professional information, similar in content to that provided by the health care professional DICs. Although the data were too small for statistical analysis, it appears that the consumer-oriented DICs offer a valuable service.
Drug Information Services↗
Reflections on a pharmacy hot line.
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Drug Information Services↗
Seasonal variations in children's calls to a help-line: implications for preventive services.
BACKGROUND: To investigate seasonal variations in telephone calls to a help-line for children, and their correlation to changes in length of day, latitude and age. METHOD: 691,787 calls to the Red Cross Help-Line in Norway for children in the three-year period 1996-1998 were included. RESULTS: Monthly frequencies of calls deviated significantly from an expected even distribution (chi2=9446.34, df=11, P<0.0001). The frequency curve for calls peaked in April and October and had its lowest level in July and December. Variation was pronounced: the mean number of daily calls varied between 436 in July and 886 in April. There was a strong and positive correlation between the number of calls and the change in length of day across the year (r(s)=0.76, N=12, P<0.01). Increasing latitude correlated positively with the range of the monthly observed/expected ratios of calls (r(s)=0.79, N=7, P<0.05). The frequency of calls was largest among children 12 to 14 years of age. Age correlated negatively with the range of monthly observed/expected ratios of calls (r=-0.94, N=12, P<0.001). LIMITATIONS: Social and cultural factors could not be explored in the design used in the present study. CONCLUSIONS: The frequency of calls from children correlates positively with change in length of day (i.e., maximal in spring and fall), and the magnitude of the seasonal variation correlates positively with latitude and negatively with age. Knowledge of seasonal variation in requests for help may have value in planning services for children.
Adolescent↗
Willingness to pay for poison control centers.
We used the willingness-to-pay (WTP) method to value the benefits of poison control centers when direct access was blocked, comparing WTP among: (1) blocked callers (n = 396), (2) callers after access was restored (n = 418), and (3) the general population (n = 119). Mean monthly WTP was $6.70 (blocked callers), $6.11 (non-blocked callers), and $2.55 (general population). Blocked and non-blocked callers had a significantly higher WTP than general population respondents (p < 0.001). We conclude that the WTP method measured benefits that are difficult to quantify; however, WTP surveys need to be carefully conducted to minimize bias. We discuss how this approach could be useful for other health care services.
Cost-Benefit Analysis↗
Emergency department poison advice telephone calls.
STUDY OBJECTIVE: Requests for medical advice regarding treatment of poisonings are common in emergency departments. Although there are designated poison centers (PCs), most EDs are recognized by the community and medical staff as a poison information resource. The purpose of this study was to evaluate the accuracy and consistency of poison information given by ED personnel. DESIGN: A prospective, stratified-sample, telephone survey over a 6-month period of requests for medical advice about simulated poison ingestions. PARTICIPANTS: Fifty-two hospital EDs in urban and rural Illinois, all three PCs in Illinois, and three PCs from Indiana, Wisconsin, and Michigan. RESULTS: Hospital EDs responded correctly to only 100 of 156 calls (64.2%). PCs responded correctly to 17 of 18 calls (94.4%), whereas teaching hospitals responded correctly to 15 of 30 calls (50%, P = .002). ED night shift personnel were 5.5 times more likely to respond incorrectly than were personnel on other shifts (95% confidence interval, 2.72 to 11.12). Forty-eight percent of all calls to EDs resulted in advice to call the regional PC. CONCLUSION: Poison advice by ED personnel proved to be inaccurate and inconsistent. As a result, patients may be better served if advice calls are redirected to regional PCs.
Emergency Service, Hospital↗
Effect of visual cues, vital signs, and protocols on triage: a prospective randomized crossover trial.
STUDY OBJECTIVES: We sought to compare triage designations derived from in-person and telephone interviews and systematically examine the effect of visual cues, vital signs, and complaint-based protocols on the triage process. METHODS: We conducted a 2-phase, prospective, observational study employing a randomized, crossover design in a university teaching hospital emergency department. In both phases, every eligible patient underwent sequential in-person and telephone triage interviews conducted by certified ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetical triage designations and, after being told the patient's vital signs, again selected a designation. Phase 1 designations were based solely on nurses' clinical expertise. In phase 2, both nurses used complaint-based protocols. RESULTS: Agreement between telephone and in-person designations was poor (percent agreement, 43.1% to 48.8%; kappa,.19 to.26; taub,.34 to.45 for the 4 primary comparisons). Knowledge of vital signs and use of protocols did not improve agreement or increase identification of patients requiring admission to hospital. CONCLUSION: These data establish that telephone and in-person triage are not equivalent and suggest that visual cues may play an important role in the triage process. It is unclear whether telephone triage is an adequate method of assigning patients to an appropriate level of care.
Adolescent↗
A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study.
The Women's Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.
Adult↗
Who's your daddy?
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Emergency Medical Services↗
Do health care professionals report sudden cardiac arrest better than laymen?
OBJECTIVE: To compare the emergency calls made by health care providers and by laymen reporting a non-traumatic cardiac arrest, and to evaluate the handling of these calls by dispatchers. METHODS: The study was conducted prospectively over a 1-year period in 1996. The callers (N=328) where divided in to three groups based on profession: I, doctors and nurses (N=33); II, other health care providers (N=19); and III, laymen (N=276). Main outcome measures where the information given by the caller, use of the dispatching protocol, recognition of the cardiac arrest, and survival to hospital. RESULTS: Doctors and nurses told the dispatcher spontaneously what had happened in 67% of the calls when total strangers to the patient told it in 72%. Group I gave no information about the vital signs in 24% of the calls, group II in 0% and group III in 6%. Of the 52 phone calls made by groups I and II, in six cases the patient was not in cardiac arrest, in four the patient had already irreversible signs of death and in four only transportation to another hospital was requested for a patient in cardiac arrest. Of the professionals calling, 49 (94%) were on duty at the time of the call. The cardiac arrest was recognized by the dispatcher in group I in 70%, in group II in 74% and in group III in 73%. There where no statistical differences between the groups. CONCLUSIONS: Our data do suggest that health care professionals, excluding those in emergency medicine, are not better than laymen in evaluating an emergency situation correctly, and when the caller is a doctor or a nurse the dispatcher seems to trust the evaluation of the situation to be correct and rarely asks any clarifying questions about vital signs of the patient.
Emergencies↗
Knowledge of the national emergency telephone number and prevalence and characteristics of those trained in CPR in Queensland: baseline information for targeted training interventions.
Members of the community contribute to survival from out-of-hospital cardiac arrest by contacting emergency medical services and performing cardiopulmonary resuscitation (CPR) prior to the arrival of an ambulance. In Australia there is a paucity of information of the extent that community members know the emergency telephone number and are trained in CPR. A survey of Queensland adults (n=4490) was conducted to ascertain current knowledge and training levels and to target CPR training. Although most respondents (88.3%) could state the Australian emergency telephone number correctly, significant age differences were apparent (P<0.001). One in five respondents aged 60 years and older could not state the emergency number correctly. While just over half the respondents (53.9%) had completed some form of CPR training, only 12.1% had recent training. Older people were more likely to have never had CPR training than young adults. Additional demographic and socio-economic differences were found between those never trained in CPR and those who were. The results emphasise the need to increase CPR training in those aged 40 and over, particularly females, and to increase the awareness of the emergency telephone number amongst older people.
Adolescent↗
How helpful are drug abuse helplines?
Raters called a convenience sample of 30 helplines and claimed to be alcohol, cocaine, heroin, marijuana or tobacco dependent persons seeking treatment. Responses were categorized as helpful, neutral or unhelpful. The median Kappa for agreement between pairs of raters rating a single call was 0.91. Between 36 and 78% of the helplines gave inconsistent responses to two calls giving the same scenario. Across the 346 calls, 43, 40 and 40% of responses to alcohol, cocaine and heroin scenarios were helpful and 28 and 25% of responses to tobacco and marijuana calls were helpful. These preliminary results indicate that much of the time responses to calls to national helplines are not consistent and not helpful.
Hotlines↗
Assessment of a telephone helpline on infertility provided by a patient association.
An assessment was made of 161 telephone calls to volunteers of the Dutch association of infertility patients 'Freya'. The unpaid volunteers all had personal experience with infertility. The majority of callers were childless women. On average the callers had been experiencing infertility for 4 years and had already a considerate history of medical examinations. Calls were made throughout the day until late at evening. Most calls were focused at information gathering, especially about the real experience of treatment and the behaviour and quality of medical staff. Also, emotions regarding infertility were an important topic of the conversation. Sometimes informative questions were an introduction for bringing up emotional problems. The telephone helpline appears to be an easily accessible and empathic source of information and help for infertile persons.
Adult↗
Telephone counseling in psychosocial oncology: a report from the Cancer Information and Counseling Line.
Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N = 1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review.
Adult↗
Evaluation and impact of promotion of a cancer helpline to cancer patients through their specialists.
Four hundred and sixty four cancer patients attending their first outpatient consultation (96% of those eligible) were given a pamphlet promoting a cancer helpline by their participating specialist. Calls to the helpline during and six weeks following the study period were made relating to 4% (95% CI: 2.1%-5.6%) of patients or family members receiving the pamphlet. Whilst this response is small, the willingness of cancer specialists to distribute the pamphlet identifies them as a valuable channel for linking patients with complementary services.
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