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PubMed2003

Mediators of effectiveness in dual-focus self-help groups.

Although research on the effectiveness of 12-step group participation has been increasing, there has been little examination of the processes by which such participation leads to positive outcomes. Two kinds of factors have been proposed as mediating between 12-step group affiliation and outcomes for members, common process factors that have been identified in a range of behavioral treatments and factors that are relatively unique to the 12-step model. The study tested the hypotheses that two common process factors (internal locus of control and sociability) and two unique factors (spirituality and installation of hope) mediate the effects of 12-step group affiliation on drug/alcohol abstinence and health promoting behavior. The study respondents were members of a dual focus 12-step-based fellowship, Double Trouble in Recovery (DTR), designed to address issues of both substance use and mental health. Members of 24 DTR groups in New York City were recruited and followed-up for 1 year. The degree of 12-step group affiliation during the study period was associated with more positive outcomes at follow-up. Internal locus of control and sociability mediated the effects of 12-step group affiliation on both outcomes, whereas spirituality and hope acted as mediators only for health promoting behavior. Understanding that the therapeutic factors inherent in 12-step are not mysterious, but appear to capitalize on well-documented social learning principles, may increase the acceptance of 12-step programs among addiction and mental health professionals.

Adult↗
PubMed2003

Use and assessment of complementary and alternative therapies by intravenous drug users.

Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies--religious healing, relaxation techniques, and meditation--were all from the mind-body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1-5), and CAM users were likely to use CAM for reasons related to their addiction.

Complementary Therapies↗
PubMed2002

Drug user treatment referrals and entry among participants of a needle exchange program.

OBJECTIVE: To compare characteristics of needle exchange program (NEP) participants who requested methadone treatment to those who did not, compare participants who subsequently enrolled into treatment to those who did not enroll, and suggest possible barriers to treatment among NEP participants. METHODS AND MATERIALS: Between 8/94 and 2/97, data pertaining to demographics and drug use were collected from Baltimore NEP participants upon registration. Participants were made aware that referrals to off-site methadone maintenance were available upon request. Odds ratios and multiple logistic regression models were used to compare those who requested treatment to those who did not and those who entered treatment to those who did not enter. RESULTS: Among 2659 NEP participants, 86% were African-American, 28% were female, 9% were employed, and the median age was 38 years. Requesting a drug user treatment referral was associated with female gender [Adjusted Odds Ratio (AOR) = 2.02], age > 38 years (AOR = 1.96), use of speedballs during the past 6 months (AOR = 3.38), and age > 20 years at time of first injection (AOR = 1.59). Among 139 individuals who requested treatment, males were twice as likely as females to enter treatment (OR = 2.45). In an open-ended survey, health insurance (p = .02) and not living with children (p = .01) were associated with drug user treatment entry. CONCLUSIONS: Even though female NEP participants were more likely to request methadone treatment, they were less likely than males to enter treatment. Although NEPs can be a bridge to drug user treatment, these data suggest that barriers to utilizing treatment referrals are important issues to resolve, especially for women who use community needle exchange programs.

Adolescent↗
PubMed1992

Applying a standard of care to the quality assessment of bacteremia.

OBJECTIVE: To identify an indicator of appropriate antibiotic use for bacteremia that is scientifically sound, that is noncontroversial, and that can be broadly applied as an index of the quality of care. DESIGN: Retrospective review of consecutive cases of significant documented bacteremias. SETTING: Suburban tertiary-care hospital. RESULTS: Two hundred ninety-one of 300 (97%) patients received appropriate antibiotics within 48 hours after the final antibiotic sensitivity report was placed on the hospital chart. Therapy was not appropriate in 6 patients with methicillin-resistant Staphylococcus aureus and in 3 patients with enterococcal bacteremia. INTERVENTIONS: Following this study, we instituted a program to prospectively monitor antibiotic use in bacteremias. During the most recent 1-year period, the infectious disease fellow or pharmacist called the attending physician to change antibiotics in 84 of 731 (11.5%) patients with bacteremia. The program was well-accepted by attending physicians. CONCLUSIONS: A scientifically sound, non-controversial standard of care was identified and used to evaluate the appropriateness of antibiotic use. When this standard was applied prospectively and incorporated into the hospital's routine operations, the quality of care was improved.

Anti-Bacterial Agents↗
PubMed2006

Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program.

This community-based, qualitative study conducted in rural Kisesa District, Tanzania, explores perceptions and experiences of barriers to accessing the national antiretroviral programme among self-identified HIV-positive persons. Part of wider operations research around local introduction of HIV therapy, the study involved consultation with villagers and documented early referrals' progress through clinical evaluation and, if eligible, further training and drug procurement. Data collection consisted of 16 participatory group discussions with community members and 18 in-depth interviews with treatment-seekers. Although participants welcomed antiretroviral therapy, they feared that transportation and supplementary food costs, the referral hospital's reputation for being unfriendly and confusing, and difficulties in sustaining long-term treatment would limit accessibility. Fear of stigma framed all concerns, posing challenges for contacting referrals who did not want their status disclosed or expressed reluctance to identify a "treatment buddy" as required by the programme. To mitigate logistical barriers, transportation costs were paid and hospital visits facilitated. Participants reported satisfaction with eligibility testing, finding the process easier than anticipated. Most were willing to join a support group and some changed attitudes toward disclosure. However, both experienced and anticipated discrimination continue to hinder widespread antiretroviral therapy (ART) uptake. While simple measures to reduce perceived barriers improved initial access to treatment and helped overcome anxiety among early referrals, pervasive stigma remains the most formidable barrier. Encouraging successful referrals to share their positive experiences and contribute to nascent community mobililzation could start to address this seemingly intractable problem.

Anti-HIV Agents↗
PubMed1992

Harnessing networked workstations as a powerful parallel computer: a general paradigm illustrated using three programs for genetic linkage analysis.

It is widely accepted that parallel computers, which have the ability to execute different parts of a program simultaneously, will offer dramatic speed-up for many time-consuming biological computations. The paper describes how the use of the machine-independent parallel programming language, Linda, allows parallel programs to run on an institution's network of workstations. In this way, an institution can harness existing hardware, which is often either idle or vastly underutilized, as a powerful 'parallel machine' with supercomputing capability. The paper illustrates this very general paradigm by describing the use of Linda to parallelize three widely used programs for genetic linkage analysis, a mathematical technique used in gene mapping. The paper then discusses a number of technical, administrative and social issues that arise when creating such a computational resource.

Algorithms↗
PubMed2007

Health care provision for illegal migrants: may health policy make a difference?

Illegal migrants in Europe are, generally, only entitled to emergency care and services for children and pregnant women. In 2002 legal changes in Spain made accessible medical cards and free medical care for illegal migrants in similar terms than the legal migrants or the Spanish population. We interviewed 380 migrants to assess whether there were differences on health services utilization by legal status. We did not find differences in the utilization of health services when ill between legal and illegal migrants. However, a significantly lower utilization of health services was associated with less education (RP = 0.4; 95% CI: 0.2-0.9).

Adolescent↗
PubMed2002

The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan.

The objective of this study was to assess the impact of National Health Insurance (NHI) on the utilization of neonatal care and childhood vaccination in Taiwan. Data are selected from two nationwide maternal and infant surveys undertaken in 1989 and 1996, which were funded by the Department of Health. The questionnaire was administered in all 23 administrative districts, including two metropolitan areas - the cities of Taipei and Kaohsiung. The first and second cohort consisted of 1641 and 3499 infants, respectively. This study used a bivariate probit estimation procedure to examine the factors that determine the probability of neonatal care use and vaccination by pooling the 2 years. Generally, the mothers who are older, more educated and more satisfied with birth delivery services were found to be more likely to use neonatal preventive care. The likelihood of receiving such care also tends to rise with advancing gestational age and higher probability of neonatal complication (icterus neonatorum) and being born in a hospital. The likelihood of care was also found to vary regionally with northern neonates having higher odds of receiving preventive care than non-northern neonates. In spite of having an insignificant impact on the use of care, NHI does lessen the inequality in use of these two services in various regions. However, regional variations in neonatal care use still exist. Residents of the southern area remain less likely to receive neonatal care than those of the northern area after NHI. This finding deserves serious consideration when attempting to design effective policies, such as expanding medical institutions in the aboriginal southern areas so as to increase the accessibility of such health care.

Child Health Services↗
PubMed1989

Primary prevention of cancer among children: changes in cigarette smoking and diet after six years of intervention.

A study of the effectiveness of an intervention program designed to favorably modify behaviors hypothesized to be related to the future development of cancer was initiated among 1,105 eligible children in 15 schools in the vicinity of New York City. Schools were assigned to either an intervention or a nonintervention group. Subjects in schools in the intervention group received each year, from fourth through ninth grade, a teacher-delivered curriculum focusing on diet and prevention of cigarette smoking. After 6 years of intervention, the rate of initiation of cigarette smoking was significantly lower among subjects in intervention schools than among those in nonintervention schools. There was a significant net decrease in reported intake of saturated fat and a significant net increase in reported intake of total carbohydrate among subjects in intervention schools compared to those in nonintervention schools. These findings, if replicated, suggest that such programs are feasible and acceptable and may have a favorable effect on diet and prevention of cigarette smoking in children.

Behavior Therapy↗
PubMed2005

"Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico.

Injection drug use is a growing problem on the US-Mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided in-depth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin ("carga", "chiva", "negra"), methamphetamine ("crico", "cri-cri"), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries ("yongos" or "picaderos") because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia ["cuete" (syringe), "cacharros" (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from "picaderos" (e.g., charging approximately 5 pesos or "10 drops" of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air "kills germs." This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.

Adolescent↗
PubMedDate not supplied

A statewide hepatitis B vaccination program for school children in Hawaii: vaccination series completion and participation rates over consecutive school years.

OBJECTIVE: The authors assessed a statewide school-based Hepatitis B (HepB) vaccination program for preadolescents in Hawaii over three consecutive school years. Factors assessed included number of schools and students participating and number of students receiving three doses of hepatitis B vaccine. METHODS: Records of the program, which targeted 4th and/or 5th graders in public and private schools, were reviewed for the period from 1996 to 1999. RESULTS: The proportion of participating schools increased from 76% of all schools in the state in School Year 1 to 94% in School Year 3. The proportion of children with completed consent forms who received three doses of HepB vaccine at school exceeded 80% throughout the project. In School Year 1, 10,003 (70%) of 14,333 children enrolled at participating schools received three vaccine doses in school; however, this proportion declined over subsequent school years to 51% (7,722/15,013) in School Year 2 and 24% (7,344/30,429) in School Year 3. A survey of 477 parents not consenting to school vaccination indicated that 84% of their children completed the vaccine series at a private provider office. CONCLUSION: Statewide school-based HepB vaccination campaigns for at-risk populations can result in a majority of children in targeted age groups receiving three doses of hepatitis B vaccine, though declining participation may be observed as uptake in the private sector increases.

Child↗
PubMed2004

Cardiac transplantation: the alternate list and expansion of the donor pool.

PURPOSE OF REVIEW: Advances in immunosuppression and surgical techniques have allowed cardiac transplantation to become a viable option and the treatment of choice for select patients with end-stage heart failure. The success of the procedure has, however, led to a discrepancy between the number of donors available and the number of patients awaiting cardiac transplantation. As wait times for heart transplant recipients increase, nonstandard donor hearts are increasingly being used for higher risk recipients and critically ill (Status I) patients. We review the development of two recipient lists as a way to provide cardiac transplantation as an option to recipients who would be otherwise ineligible, and determine its impact on expanding the donor pool. Other methods of expanding the donor pool are also reviewed. RECENT FINDINGS: The alternate list appears to be successful in offering transplantation to patients (mostly older patients) who would not normally be eligible for this life-saving procedure. The alternate list (by changing donor organ acceptance criteria) and ongoing programs to increase organ donation have helped to expand the donor pool. SUMMARY: The donor organ shortage will continue as an increasingly older population develops end-stage organ disease. Expanding the donor pool by a variety of methods will be essential to extend the lives of these patients.

Heart Failure↗
PubMed2000

The Mayo Clinic's Clinician-Educator Award: A program to encourage educational innovation and scholarship.

In 1998, the Board of Governors of the Mayo Clinic requested that the Education Committee design and implement a program to grant time and resources to clinical faculty to support the development of educational projects. The essence of the resulting Clinician-Educator Award Program is the concept of using funding to award time and resources for educational projects judged to be meritorious by an impartial, peer-review-based faculty mentoring process. The authors report early experiences with the program, which was enthusiastically accepted by faculty, to provide a model to help other academic health centers, especially those with salary-based faculty, to facilitate educational innovation and scholarship despite the growing constraints on academic clinicians' time and resources.

Academic Medical Centers↗
PubMed1995

Patterns of health services utilization and mammography use among women aged 50 to 59 years in the Québec Medicare system.

Many studies have identified physicians' recommendation as the single most important predictor of mammography use. Health services utilization is a complex phenomenon, and the contribution of the different dimensions of health services utilization on mammography use is underresearched. This study examines the specific contribution of health services utilization variables in a multivariate model of the recency of mammography use for women aged 50 to 59 years. Subjects were respondents of the 1987 Québec Health Survey. Survey data were then linked on an individual basis to the respondent's records of Medicare physicians' claims for health care services for the 3 years before the survey. This unique data set enabled the inclusion of sociodemographic variables, risk factors, health status, healthy lifestyles, and women's patterns of utilization of general and gynecologic health care services. Multivariate predictors of the recency of mammography are: having an education higher than high school, working outside home, not living in a remote area, suffering from benign breast disease, and not perceiving one's own health as good. The volume of general and gynecologic medical care is associated with the recency of mammography in independent logistic models that include women's predisposing, enabling, and need factors. This study shows that even in a universal third-party payer health care system, physicians are missing opportunities to promote breast cancer screening.

Female↗
PubMed1981

Increased incidence of IgM class smooth muscle antibody in patients after renal transplantation.

Autoantibodies were examined in 70 patients with renal failure, before acceptance on a hemodialysis program, during the program, and up to 3 months after renal transplantation. Smooth muscle antibody (SMA) in the IgM class was detected in 76% of the patients after transplantation compared with 14% before transplantation. This increase was significant at the 5% level. Furthermore, two groups of patients were distinguished on the basis of a 4-fold or greater increase or no demonstrable increase in the titer of IgM SMA after transplantation. Rejection episodes occurred more frequently amongst patients from this former group (67%) compared with the latter group (35%).

Adult↗
PubMed1986

Quantitative assessment of olfactory function in an industrial setting.

The University of Pennsylvania Smell Identification Test (UPSIT) was administered, on a volunteer basis, to workers frequenting the cafeteria of the corporate offices of a major chemical manufacturing company to (1) establish the level of acceptance of self-administered olfactory testing within such a setting, (2) determine the percentage of the sample that reported or evidenced marked olfactory impairment, and (3) develop guidelines for the use of the UPSIT as a corporate medical surveillance tool. The initial acceptance of the testing program was high. Thus, 640 of the cafeteria visitors agreed to take the test (total work force in building less than 1,000). However, only 52% of the tests handed out were completed by the employees and returned to the test examiners, possibly reflecting the informal atmosphere in which they were distributed. Of the group returning the tests, seven employees reported having smell problems due to allergies or sinus disease. However, all of these employees had normal UPSIT scores. Three subjects (1% of the sample) evidenced marked olfactory dysfunction. Of these three, only one was aware of the problem before testing. On average, the corporate subjects significantly outperformed matched control subjects obtained from previous administrations of the UPSIT at health fairs and other public events, although the difference was less than half a point (37.89 v 37.53; P less than .004). As in previous studies, the test scores of women were slightly, but significantly, higher than those of men (respective means = 37.98 v 37.80, P less than .04).

Adult↗
PubMed2006

A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG).

OBJECTIVE: This pilot study evaluated outcomes for a modified 12-session protocol of cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG) conducted between March 2004 and October 2005. CTG is an emerging condition characterized by a combination of posttraumatic stress and unresolved grief symptoms. This two-module treatment model consisting of sequential trauma- and grief-focused components was shortened from a previously presented 16-session protocol. METHOD: Thirty-nine children ages 6 to 17 years old with CTG and their parents received the modified 12-session protocol of CBT-CTG. CTG and posttraumatic stress disorder (PTSD) symptoms were assessed at pretreatment, after the trauma-focused module, and after the grief-focused module (at posttreatment). Child depression, anxiety, and behavioral symptoms, as well as parental depression and PTSD symptoms, were assessed at pre- and posttreatment. RESULTS: Children reported significant improvement in CTG, PTSD, depression, and anxiety, and parents reported significant improvement in children's PTSD, internalizing and total behavior problems, and their personal PTSD symptoms. Although PTSD significantly improved only during the trauma-focused module of treatment, CTG improved significantly during both trauma- and grief-focused modules of treatment. Child satisfaction and parent satisfaction for this treatment protocol were also high. CONCLUSIONS: These findings suggest that the shortened CBT-CTG protocol, which is similar in the number of sessions to what many community child bereavement programs offer, may be acceptable and efficacious for this population. The CBT-CTG model requires further evaluation in randomized, controlled treatment trials.

Adolescent↗
PubMed2004

Feasibility and short-term impact of linked education and urine screening interventions for Chlamydia and gonorrhea in male army recruits.

OBJECTIVE: The objective of this study was to assess the feasibility of an intervention for sexually transmitted diseases (STDs) and a screening program for Chlamydia trachomatis and Neisseria gonorrhoeae infections in male Army recruits. GOALS: The goals of this study were to identify and treat chlamydia and gonorrhea infections in recruits, assess their perceptions of risk, and increase their STD knowledge and behavioral intentions. STUDY DESIGN: Volunteers (n = 3911) entering basic training (July 1999-June 2000) at Fort Jackson, South Carolina, attended an educational intervention, completed pre- and post-questionnaires, and provided a urine specimen for chlamydia and gonorrhea screening by nucleic acid amplification testing. RESULTS: Chlamydia and gonorrhea prevalences were 4.7% and 0.4%, respectively. The mean STD knowledge score, intent to use condoms, and confidence in using condoms correctly increased (P <0.001). Participants reported increased risk perception and considered the educational program valuable (96.9%) and a learning experience (94.6%). CONCLUSIONS: A linked educational and screening program is feasible and acceptable in male Army recruits.

Adult↗