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[Evaluation of the Heidelberg cancer information service by the consumer].
The Cancer Information Service (KID) was established 1986 as a model project of the BMJFFG in the German Cancer Research Center. Its task is to provide the general public with quickly accessible information about cancer research, cancer prevention, cancer diagnosis, cancer treatment and cancer after-care by phone. Aim of this study was to collect data by a questionnaire given to a sample of 444 callers to describe the characteristics of the callers, their motivation to use the service, the contents of the inquiries and their judgement of effectivity of the work of the service. It was found that nearly 80% of the callers were patients and their relatives, predominantly in the period after the primary treatment. Their questions concerned the field of medical treatment. Their motivation to use the service was not lack of information, but to reinforce the knowledge they already had. The callers fundamentally appreciated the institution of an information service and 62% were satisfied with the actual work of the KID.
Study of the work of a community medical emergency service with psychosomatic and psychiatric patients.
The study aims to: (a) assess the incidence of functional/psychosomatic (FP) and psychiatric (P) calls to the Community Emergency Medical Service (during the night, week-ends, public holidays, when the primary care physicians are not on duty) and to determine the type of response provided; (b) highlight the diagnostic, relational, therapy and assistance problems involved in an approach to these patients at an emergency call level by a young, nonspecialist physician. The study data show that the quantitative importance of FP and P patients, as noted in the literature, is equally valid for emergency. But the study also highlights the numerous difficulties these patients cause to nonspecialist physicians. Liaison psychiatrist activity should find excellent growth potential in this new direction.
Telephone helpline unit in Athens: differences between women and men suicidal callers.
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Dispatcher-assisted cardiopulmonary resuscitation. Validation of efficacy.
Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p less than 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)
Influence of comorbidity on the outcome of patients treated for out-of-hospital ventricular fibrillation.
BACKGROUND: A number of factors have previously been shown to be predictive of survival from out-of-hospital ventricular fibrillation. These include witnessed collapse, prompt initiation of cardiopulmonary resuscitation, early application of defibrillation, and younger age. Arrests occurring away from home are also associated with improved survival. Additionally, hospital mortality after successful resuscitation has been related to a history of congestive heart failure as well as to some of the factors noted above. An association of prearrest comorbidity with outcome has not been systematically evaluated. METHODS AND RESULTS: We define here a comorbidity index, which is constructed from histories of chronic conditions as well as a number of recent symptoms in 282 victims of out-of-hospital VF. This indicator of comorbidity is strongly associated with outcome (P = .004). However, when analyzing a comprehensive set of predictors of survival after out-of-hospital ventricular fibrillation, including the index of comorbidity, we could identify overall only about one fourth of the variation that one might hope to account for. CONCLUSIONS: Comorbidity appears to be an important (but usually overlooked) predictor of survival from out-of-hospital ventricular fibrillation. However, most of the statistical variability in predicting survival remains unexplained when we consider comorbidity in conjunction with previously identified predictors of survival.
Urgent therapy for acute stroke. Effects of a stroke trial on untreated patients.
BACKGROUND AND PURPOSE: As part of the recruitment efforts for the National Institutes of Health Tissue Plasminogen Activator Pilot Study, public education and awareness campaigns were conducted to encourage early hospital arrival. We evaluated the change in arrival times during the course of the study for all stroke patients, including those who were not entered into study. METHODS: Data were gathered on all patients presenting within 24 hours of stroke onset to all of the study hospitals. Coincident with the start of the study, educational and promotional programs, which stressed signs and symptoms of stroke and the need to call 911, were presented to physicians, paramedical personnel, and the public. The study was divided into four quartiles to analyze differences in time to hospital arrival and use of 911. RESULTS: Of 2099 patients screened, time data were available on 1116. During the course of the study, the mean time from symptom onset to hospital arrival declined significantly (3.2 hours versus 1.5 hours). Patients arrived for treatment sooner at community hospitals than at university/teaching hospitals. The use of 911 increased from 39% in the first quartile of the study to 60% in the fourth quartile. This was a consistent finding in all study sites. Increased use of 911 was seen almost exclusively in patients with nonhemorrhagic stroke. CONCLUSIONS: Times from stroke onset to hospital arrival decreased significantly during the course of the National Institutes of Health Tissue Plasminogen Activator Pilot Study. Significantly increased use of 911 was the likely major explanation for the shortened arrival times. The decrease in arrival times may be a consequence of the public and professional education programs conducted at all study sites.
Lower suicide rates associated with a Tele-Help/Tele-Check service for the elderly at home.
OBJECTIVE: The authors' goal was to determine the impact on suicidal behavior of Tele-Help/Tele-Check, a telephone service designed to provide elderly people with home assistance. Tele-Help is an alarm system that the client can activate to call for help; in Tele-Check the client is contacted about twice a week for assessment of needs and for emotional support. METHOD: The authors determined the number of suicides among 12,135 elderly subjects who were connected to the Tele-Help/Tele-Check service in the Veneto region of Italy from Jan. 1, 1988, to Dec. 31, 1991, and compared it with the suicide rate for the general population in the Veneto region. RESULTS: Only one death by suicide was found in the elderly subjects connected to Tele-Help/Tele-Check, compared with the expected number of 7.44 for the general population (standardized mortality ratio = 13.44%). CONCLUSIONS: Since many of the traditional risk factors for suicide were concentrated in the elderly subjects studied, the Tele-Help/Tele-Check service appears to provide support of great interest for the prevention of suicide in the elderly.
New perspectives in mental health services in Shanghai.
This article reports developments in mental health services in Shanghai during the past several years, including family education and involvement, new forms of community services, psychological consultation programs, hot line services and crisis intervention, dealing with psychological problems in general hospitals, and nursing care for elderly patients with dementia. The authors reevaluate and outline the new perspectives in mental health services in Shanghai.
Gender-related differences in the characteristics of problem gamblers using a gambling helpline.
OBJECTIVE: The characteristics of male and female gamblers utilizing a gambling helpline were examined to identify gender-related differences. METHOD: The authors performed logistic regression analyses on data obtained in 1998-1999 from callers to a gambling helpline serving southern New England. RESULTS: Of the 562 phone calls used in the analyses, 349 (62.1%) were from male callers and 213 (37.9%) from female callers. Gender-related differences were observed in reported patterns of gambling, gambling-related problems, borrowing and indebtedness, legal problems, suicidality, and treatment for mental health and gambling problems. Male gamblers were more likely than female gamblers to report problems with strategic or "face-to-face" forms of gambling, e.g., blackjack or poker. Female gamblers were more likely to report problems with nonstrategic, less interpersonally interactive forms of gambling, e.g., slot machines or bingo. Female gamblers were more likely to report receiving nongambling-related mental health treatment. Male gamblers were more likely to report a drug problem or an arrest related to gambling. High rates of debt and psychiatric symptoms related to gambling, including anxiety and depression, were observed in both groups. CONCLUSIONS: Individuals with gambling disorders have gender-related differences in underlying motivations to gamble and in problems generated by excessive gambling. Different strategies may be necessary to maximize treatment efficacy for men and for women with gambling problems.
A peer-based assistance program for officers with the New York City Police Department: report of the effects of Sept. 11, 2001.
Few data on stress symptoms related to the World Trade Center disaster in law enforcement personnel have been reported. Most New York City Police Department (NYPD) officers had significant exposure to the events of Sept. 11, 2001. Approximately 5,000 officers responded within the first 2 days, and more than 25,000 officers worked at ground zero, the morgues, or the Staten Island landfill. Because the police are the first line of defense against terrorist attacks, it is imperative that they maintain optimal health and functioning. Concern for the long-term effects from traumatic exposure is warranted. In partnership with Project Liberty, peer officers and clinicians from the Police Organization Providing Peer Assistance performed outreach, support work, and screening for stress symptoms related to the disaster in the NYPD from December 2002 until December 2003. Psychological issues in law enforcement personnel, a description of the outreach program, and data from these screenings are presented.
Assessment of police calls for suicidal behavior in a concentrated urban setting.
As a result of deinstitutionalization over the past half-century, police have become frontline mental health care workers. This study assessed five-year patterns of police calls for suicidal behavior in Toronto, Canada. Police responded to an average of 1,422 calls for suicidal behavior per year, 15 percent of which involved completed suicides (24 percent of male callers and 8 percent of female callers). Calls for suicidal behavior increased by 4 percent among males and 17 percent among females over the study period. The rate of completed suicides decreased by 22 percent among males and 31 percent among females. Compared with women, men were more likely to die from physical (as opposed to chemical) methods (22 percent and 43 percent, respectively). The study results highlight the importance of understanding changes in patterns and types of suicidal behavior to police training and preparedness.
Developing local resources to enrich the practice of rural community psychology.
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Combining telephone peer counseling and professional services for clients in intensive psychiatric rehabilitation.
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Accuracy and response time when clerks are used for telephone triage.
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Consumer marketing of infant formula.
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The intelligibility of synthesized speech in data inquiry systems.
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Community psychiatry in Hong Kong.
Community psychiatry is well developed in many western countries. However, this psychiatric subspecialty has only recently been officially recognized and established in Hong Kong. This article describes the development and current scope of services. It illustrates how local psychiatrists have met the challenge of adopting a western service model to suit the local Chinese population, with its different socio-cultural value system.