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PubMed2005

Charging up the public for automated external defibrillators.

Public training in the use of automated external defibrillators to treat out-of-hospital cardiac arrests has been receiving increased attention. The implementation of public access defibrillation programs has been the most significant intervention to improve survival in decades. Dramatic success came when we placed automated external defibrillators in the hands of the public to be utilized without an Emergency Medical Services response having to occur. The device is simple to operate -- sixth-grade children have demonstrated safe and effective operation. Training should be taken to its elemental level. Cardiopulmonary resuscitation training should not be forgotten; it too should be taken to its simplest form.

Cardiopulmonary Resuscitation↗
PubMed2004

Translational research in cancer complementary and alternative medicine: the National Cancer Institute's Best Case Series Program.

Public interest in CAM for cancer care likely will influence the need for continued scientific evaluation. The NCI BCS program evaluates case studies involving novel alternative therapies for cancer treatment. Through the NCI BCS program, meaningful data are generated that may lead to NCI-supported research projects, including prospective studies, clinical trials, and advances in scientific knowledge. Individuals interested in obtaining a submission packet for the NCI BCS program may access the official OCCAM Web site at http://www3.cancer.gov/occam/ or call 301-435-7980.

Complementary Therapies↗
PubMed1982

The social work advocacy role in discharge planning.

The social work role in discharge planning must include an advocacy function. This is important to facilitate discharge planning and can be carried out in three related areas: (1) political advocacy--to improve governmental programs, (2) resource development advocacy--to meet unmet needs; and (3) case advocacy--to ensure that programs are accessible and appropriate for eligible patients and families. This role is particularly suited for social workers because of their training and experience and should be included as part of their contribution to comprehensive health care.

Humans↗
PubMedDate not supplied

More pharmacists in high-risk neighborhoods of New York City support selling syringes to injection drug users.

OBJECTIVE: To document changes in pharmacists' opinions and practices from the time of passage to implementation of a law permitting selling syringes without a prescription (the Expanded Syringe Access Demonstration Program [ESAP]). DESIGN: Two cross-sectional randomized telephone surveys. SETTING: High-risk neighborhoods of New York City. SUBJECTS: Pharmacists. MAIN OUTCOME MEASURES: Support for selling syringes without a prescription to injection drug users (IDUs). RESULTS: We completed 130 surveys at baseline (BL) in August 2000, from neighborhoods with high numbers of injection-related acquired immunodeficiency syndrome (AIDS) cases and 231 surveys at law change (LC) in January 2001. To correct for differences in sampling, we limited the analysis to pharmacies in ZIP Codes represented in both samples and weighted results to adjust for the median income level of those postal codes. From BL (n = 83) to LC (n = 84), law awareness increased (43% to 90%, P < .001), as did personal support for selling syringes without a prescription to IDUs (36% to 63%, P < .001). From BL to LC, a larger proportion of supporters believed that selling syringes was an important part of human immunodeficiency virus (HIV) prevention and would help decrease HIV transmission, and a smaller proportion was concerned about customer discomfort and increased drug use. A total of 40% of respondents were ESAP registered at LC but registration was not associated with support for selling syringes to IDUs. CONCLUSIONS: Support for ESAP among pharmacists increased in high-risk neighborhoods as the program was implemented. The finding that some pharmacists were ESAP registered but did not support selling syringes to IDUs and others were supportive, but not ESAP registered, may have program implications.

Attitude of Health Personnel↗
PubMedDate not supplied

Legal syringe purchases by injection drug users, Brooklyn and Queens, New York City, 2000-2001.

OBJECTIVE: To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. DESIGN: Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. SETTING: Brooklyn and Queens, New York City. PARTIPANTS: IDUs. MAIN OUTCOME MEASURES: Attempts to purchase syringes from pharmacies and success in doing so. RESULTS: Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. CONCLUSIONS: The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.

Data Collection↗
PubMedDate not supplied

Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.

OBJECTIVE: To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. DESIGN: Pre-post comparison. SETTING: In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. MAIN OUTCOME MEASURES: Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. RESULTS: Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began. CONCLUSION: To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

Humans↗
PubMedDate not supplied

Pharmacy syringe sale practices during the first year of expanded syringe availability in New York City (2001-2002).

OBJECTIVE: [corrected] To assess the role that customer characteristics, including race, age, and gender and pharmacy characteristics, including type and location, play on actual syringe-selling practice by pharmacies registered to sell syringes under the New York State Expanded Syringe Access Demonstration Program (ESAP). DESIGN: 89 syringe-purchasing visits were made in randomly selected ESAP-registered pharmacies, stratified by chain and independent status. SETTING: Visits were conducted in 14 New York City neighborhoods. Three neighborhoods (two with high need for human immunodeficiency virus [HIV] prevention services and one with low need) were selected in each of New York City's five boroughs (except Staten Island, where only two neighborhoods were visited, as only one exists with high need for HIV prevention services). PARTICIPANTS: Visits were conducted by syringe-purchasing testers with different demographic characteristics, including age (< or = 25 and > 25), race/ethnicity (white, black, Latino), and gender (men, women). RESULTS: Testers were able to purchase syringes in 69% of visits. Tester race, age, and gender did not significantly affect sales of syringe-selling practices. Location of pharmacy was statistically significant, with only 33% of the registered pharmacies selling syringes in the Bronx, but 67% to 89% selling in other four boroughs. CONCLUSIONS: ESAP has been widely implemented among registered pharmacies in four of New York City's five boroughs. The program's effectiveness could be enhanced through pharmacy-based efforts focused broadly on the ESAP goal of preventing the transmission of HIV and other blood-borne infections among injection drug users.

HIV Infections↗
PubMed2006

Accessible support for family caregivers of seniors with chronic conditions: from isolation to inclusion.

Accessible support programs can improve health outcomes for family caregivers of older relatives with a chronic condition. Over the course of 6 months, 27 experienced family caregivers provided weekly support via the telephone to 66 individuals, either new family caregivers of seniors recently diagnosed with stroke or newly vulnerable family caregivers (i.e., facing increasing demands from the deterioration of their senior relative's condition) of seniors with Alzheimer's disease. Qualitative data documented the perceived impact of the intervention, including increased satisfaction with support, coping skills, caregiving competence and confidence, and decreased caregiver burden and loneliness. Caregivers identified varied support processes that overcame support deficits in their social networks. These processes can facilitate replication in future research and inform practice, programs, and policies.

Adaptation, Psychological↗
PubMed2001

Community socioeconomic status and children's dental health.

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.

Analysis of Variance↗
PubMed2001

A computerized system for remote monitoring of subterranean termites near structures.

Sensors comprising wooden stakes painted with conductive circuits of silver particle emulsion were inserted in Sentricon stations in soil near structures. Sensors were wired to a datalogger that was programmed to test for circuit breakage every 2 h and store the data in its memory. A host computer was programmed to access the datalogger through telephone communication lines for data download every 4 d. The computerized monitoring system was tested in three remote sites, and site visits were conducted monthly for 6 mo to examine system accuracy in detecting termite activity. The mean monthly accuracy for the system to correctly report the presence (true positive) or absence of termites (true negative) in the stations was 85%, but the accuracy at 6 mo after system installation ranged from 41 to 79%. Mean sensor longevity, defined as the time for a sensor circuit to break in the absence of termites, was approximately 4.4 mo.

Animals↗
PubMed1993

American adults' knowledge of HIV testing availability.

OBJECTIVES: Understanding client needs, knowledge, and preferences about services is necessary to ensure that human immunodeficiency virus (HIV) counseling and testing programs are accessible. This study addressed knowledge of HIV testing availability. METHODS: To study American adults' knowledge of HIV testing availability, we collected data during 1990 by random digit-dialing telephone surveys of adults residing in 44 states and the District of Columbia. RESULTS: Of the 81,557 persons who responded, almost two thirds identified medical doctors as a source of HIV testing. Fourteen percent identified public sites, and 12% said they didn't know where to go for HIV testing. Persons who were older, less educated, and had lower incomes were less likely to know where they could go for testing. Persons identifying public sites shared some characteristics with others who lacked adequate health care coverage. CONCLUSIONS: Physicians will be increasingly called upon to provide HIV counseling and testing to their patients. This may require additional training to provide effective, individualized, risk-reduction messages about sexual and drug use behaviors. Even when persons have adequate information about availability, sociodemographic characteristics are likely to influence preferences for HIV counseling and testing.

AIDS Serodiagnosis↗
PubMed1997

The federal government's use of Title VI and Medicare to racially integrate hospitals in the United States, 1963 through 1967.

Explicit discrimination against minorities existed in the 1960s in hospital patient admissions and physician and nurse staff appointments. With passage of the Civil Rights Act of 1964, along with Medicare legislation in 1965, civil rights advocates within the federal government had both a legislative mandate to guarantee equal access to programs funded by the federal government in Title VI and a federal program that affected every hospital in the country in Medicare. This study was conducted to determine the extent to which the Medicare hospital certification program was a major determinant in the racial integration of hospitals throughout the United States. In-depth interviews were conducted with individuals involved in hospital and health care policy in the 1950s and 1960s. Other primary resources include archival and personal manuscripts, government documents, newspapers, and periodicals.

Civil Rights↗
PubMed1988

Interventions among primary-care practitioners to improve care for preventable complications of diabetes.

The National Diabetes Advisory Board recommends that diabetes prevention and control programs focus on the preventable complications of diabetes, i.e., visual impairment, lower-extremity problems, renal problems, ketoacidosis, and adverse outcomes of pregnancy. The Florida Diabetes Control Program chose to focus its efforts on the first three of these complications at the federal- and state-funded primary-care programs in Florida because these programs had access to targeted, public-sector patients and because of fiscal restraints that make the care provider the logical source of entry to the health-care system. This study sought to document the current level of care for complications of diabetes in primary-care settings, provide state-of-the-art professional education along with patient education, and evaluate changes in practice habits. Three intervention and three control primary-care centers were selected. Medical records in each center were reviewed over a 2-yr period. At intervention sites, retinopathy referrals increased from 9 to 43% (P less than .001), urinalyses increased from 69 to 94% (P less than .001), and examinations of lower extremities increased from 66 to 94% (P less than .001). There were no such changes in the control sites. Hypertension was diagnosed in nearly two-thirds of patients, and a last blood pressure of greater than 140 mmHg systolic or greater than 90 mmHg diastolic was present in 64% of the intervention group at yr 1 and declined to 56% at yr 2 (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed2004

Teaching pharmacology to graduate nursing students: evaluation and comparison of Web-based and face-to-face methods.

As nursing schools develop Web-based courses to increase access to programs, evaluation of all aspects of these courses, from student learning to effectiveness of the course and instructor, becomes important. This article describes the evaluation of a 3-credit, semester-based, online graduate pharmacology course, and compares these student outcomes with those in the face-to-face course taught simultaneously. Eighteen students chose to participate in the Web-based course, and 52 chose to participate in the face-to-face course. The same instructor taught both courses, and the same examinations were administered. Students in the two courses were not different in age or in number of years of nursing practice prior to taking the course. There was no association between the course chosen and the type of basic nursing preparation or if the student had taken a pharmacology course in their basic nursing program. There were no significant differences between the mean examination scores of students enrolled in the two courses. Overall, students in the online course were positive about their experience. Student comments highlight the need to be aware of effectiveness of communication among faculty and students, the clarity of instructions, and the amount of information provided on course Web sites.

Adult↗
PubMed2001

Handwashing compliance: what works?

UNLABELLED: Health care personnel--particularly physicians--do a poor job of complying with national handwashing guidelines, yet handwashing is the cornerstone of infection control. New products designed to increase compliance are available, such as automated handwashing machines, but their clinical benefits have not been fully studied. The best solution for now may be to continue awareness campaigns and education programs, ensure access to sinks and appropriate antiseptic products, and promote the use of alcohol disinfectants when handwashing is not possible. KEY POINTS: Antiseptic products are now preferred over handwashing with plain soap, which does not reliably prevent transmission of bacteria. Because 100% compliance may not be realistic, interventions that improve compliance, such as the use of alcohol sanitizing products when handwashing is not possible, may be the best solution. A number of barriers deter compliance, including lack of access to handwashing stations and lack of time. Gloves are not a substitute for handwashing because they are not fully protective.

Automation↗
PubMed1999

[Clinico-statistical analysis of chronic cardiac failure].

AIM: To analyse epidemiologically chronic heart failure (CHF) according to 1996 records for patients admitted to therapeutic and cardiological departments of Moscow city hospital N 64. MATERIALS AND METHODS: An individual sheet has been developed for computer. The statistical processing has been conducted according to Access 97 program. It has covered 4019 case histories for 1996. 1232 patients were hospitalized for chronic cardiac failure this making 30.6% of all the hospitalizations. RESULTS: CHF was encounted in 60.9% of females and 39.1% of males. It was due to: ischemic heart disease (63.7%, with myocardial infarction in 73%), hypertension (17.5%), valvular disease (13.7%), dilated cardiomyopathy (3.7%), myocarditides and perocarditis (1.4%). Age groups 30-39 years, 40-49, 50-59, 60-69, 70-79, 80-89, 90-99 consisted of 0.6, 4, 11, 35.2, 31.4, 16.9, 0.6% of patients respectively. Females prevailed in the oldest age groups. The time from CHF diagnosis was 2, 3, 4, 5, 6, 7, 8, 9 and > 10 years in 26, 10.9, 4, 5.7, 0.9, 1.4, 1.7, 0.6 and 4% of patients, respectively. 72.9% of patients were admitted to hospital once a year. 19.7%, 5.2%, 0.9%, 0.6%, 0.9% of patients were hospitalized 2, 3, 4, 5 and more than 6 times, respectively. CHF was responsible for 50(27.8%) lethal outcomes of 180. Lethality resulted from cardiovascular insufficiency (50%), thromboembolism (30%), pneumonia (10%). CONCLUSION: CHF is a frequent cause of hospitalizations. Development of CHF, lethality, age groups distribution are closely associated with the patients' gender.

Adult↗
PubMed1997

Delivering mental health services in the inner city.

Inner-city clients pose challenges for home care providers in terms of access. When they are at risk for mental health problems, that adds another layer to the difficulty of access. One program in the South Bronx uses unique structure and staff to gain family acceptance for intervention.

Adolescent↗