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Assessing the capacity of health departments to engage in community-based participatory public health.

OBJECTIVES: We created indicators of local public health agency capacity to engage in community-based participatory public health. METHODS: We sent a survey of 27 items reflecting aspects of community-based participatory public health to 429 employees in 4 local health departments. Two thirds (n = 282) responded. We performed a factor analysis to identify components of community-based participatory practice. RESULTS: We identified 4 factors: (1) the agency's and (2) the individual employee's skills in working with community groups and minority populations, (3) the extent and frequency of agency networking, and (4) community participation in health department planning. CONCLUSIONS: Our findings suggest that it is possible to measure the competencies needed by health department staff to engage in community-based participatory public health.

Community Participation↗

Food-service establishment wastewater characterization.

Food-service establishments that use on-site wastewater treatment systems are experiencing pretreatment system and/or drain field hydraulic and/or organic overloading. This study included characterization of four wastewater parameters (five-day biochemical oxygen demand [BOD5]; total suspended solids [TSS]; food, oil, and grease [FOG]; and flow) from 28 restaurants located in Texas during June, July, and August 2002. The field sampling methodology included taking a grab sample from each restaurant for 6 consecutive days at approximately the same time each day, followed by a 2-week break, and then sampling again for another 6 consecutive days, for a total of 12 samples per restaurant and 336 total observations. The analysis indicates higher organic (BOD5) and hydraulic values for restaurants than those typically found in the literature. The design values for this study for BOD5, TSS, FOG, and flow were 1523, 664, and 197 mg/L, and 96 L/day-seat respectively, which captured over 80% of the data collected.

Food Services↗

Is primary care physician supply correlated with health outcomes?

Assessment of the relation between life indicators and health outcomes is a complex problem. The authors' analysis uses descriptive canonical correlation, and their solution suggests that socioeconomic factors play a major role in health outcomes. The supply of primary care physicians has a lesser but still important role: canonical correlation suggests no apparent role in enhancing health outcomes among the elderly but a larger role in improving health among the young. The authors' analysis does support the notion that specialist physician supply has no correlation with a wide range of health outcomes.

Adult↗

ADL: an integrated database for filing and study of malignant lymphoma patients.

The filing of clinical data must comply with purposes of logical organization for comparisons and evaluations. ADL (Archives of Data on Lymphomas) is an application program of dBASE III plus (Ashton-Tate) for personal computers, especially suitable for filing and studying patients afflicted with malignant lymphoma. It is subdivided into four data files: general data (private data, stage, therapy); disease data (sites of disease by tests and body area); immunological data (lymphocyte subpopulations, globulin and immunoglobulin dosage, delayed hypersensitivity skin tests); lost patients (register of patients not seen for at least 1 year). It has many utilities (descriptive statistics, clinical report, export service). Congruence checks and verification of names and dates input are included. This program stands as a valuable alternative to more traditional filing systems.

Archives↗

Vital statistics and reasons for disposal of United States and Canadian artificial insemination dairy sires.

Vital statistics were evaluated for artificial insemination sires leaving service during 1939 through 1974. Data consisted of 11,704 sires of six breeds. The major cause for leaving service was reproductive failure at a frequency of 32.5%; next ranked was undesirable characteristics of offspring with a frequency of 20.7%. Overall culling rate for low yields of daughters was 14.8%, but after 1965 this cause accounted for about 30%. Mean life span was 3.4 yr with small differences among years. Breed differences were detected for service life and causes for leaving service. Modifications of classic life table techniques are needed to reflect entry of sires into service at various ages and evaluation of vital statistics subsequent to 1974.

Age Factors↗

Psychiatric nurses' attitudes toward and involvement in nursing research.

1. The three major blocks to clinical nursing research are lack of time, knowledge, and administrative support. 2. Positive attitudes toward nursing research were found to be related to nurses' advanced levels of education. 3. Two strategies to foster the development of research skills are inservice education classes and individualized guided learning experiences. 4. Two essential resources for staff who are expected to engage in clinical research activities are statistical consultation and clerical services.

Adult↗

The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments.

OBJECTIVE: To examine the relationship between hospital and emergency department (ED) occupancy, as indicators of hospital overcrowding, and mortality after emergency admission. DESIGN: Retrospective analysis of 62 495 probabilistically linked emergency hospital admissions and death records. SETTING: Three tertiary metropolitan hospitals between July 2000 and June 2003. PARTICIPANTS: All patients 18 years or older whose first ED attendance resulted in hospital admission during the study period. MAIN OUTCOME MEASURES: Deaths on days 2, 7 and 30 were evaluated against an Overcrowding Hazard Scale based on hospital and ED occupancy, after adjusting for age, diagnosis, referral source, urgency and mode of transport to hospital. RESULTS: There was a linear relationship between the Overcrowding Hazard Scale and deaths on Day 7 (r=0.98; 95% CI, 0.79-1.00). An Overcrowding Hazard Scale>2 was associated with an increased Day 2, Day 7 and Day 30 hazard ratio for death of 1.3 (95% CI, 1.1-1.6), 1.3 (95% CI, 1.2-1.5) and 1.2 (95% CI, 1.1-1.3), respectively. Deaths at 30 days associated with an Overcrowding Hazard Scale>2 compared with one of <3 were undifferentiated with respect to age, diagnosis, urgency, transport mode, referral source or hospital length of stay, but had longer ED durations of stay (risk ratio per hour of ED stay, 1.1; 95% CI, 1.1-1.1; P<0.001) and longer physician waiting times (risk ratio per hour of ED wait, 1.2; 95% CI, 1.1-1.3; P=0.01). CONCLUSIONS: Hospital and ED overcrowding is associated with increased mortality. The Overcrowding Hazard Scale may be used to assess the hazard associated with hospital and ED overcrowding. Reducing overcrowding may improve outcomes for patients requiring emergency hospital admission.

Adolescent↗

Ultrasonography in patients without trauma in the emergency department: impact on discharge diagnosis.

OBJECTIVE: The aim of this study was to examine to what extent findings on ultrasonography performed in the emergency department (ED) after hours confirm or alter the referral diagnosis in patients without trauma as reflected in the discharge diagnosis. METHODS: In this prospective study, data from 136 ultrasonographic examinations performed in patients without trauma after hours in the ED during January and February 2002 were evaluated against the suspected preimaging diagnosis of the referring ED physician and the actual discharge diagnosis from the ED or after hospitalization. The rate of preimaging and postimaging concordance was statistically analyzed and compared by calculation of confidence intervals and by the McNemar test. RESULTS: Normal ultrasonographic findings were documented in 54 patients (40%), and pathologic findings were documented in 82 (60%). Thirty-four (25%) of the 136 examinations were concordant with the initial referring physician's diagnosis. Of the 102 studies that were not concordant with the initial referral suspected diagnoses, that is, being either a study with normal findings or offering an alternative diagnosis, 81 (79.4%) were concordant with the discharge diagnosis. CONCLUSIONS: After-hours ultrasonographic findings in patients without trauma seen in the ED seem to have a high impact on the discharge diagnosis and are concordant with it in more than 80% of cases.

Adult↗

Segmenting the antihistamine market: an investigation of consumer preferences.

The authors combine conjoint analysis and contingent valuation into a single model to estimate the value of product attributes for antihistamine drugs. One hundred forty-three allergic rhinitis suffers were examined. The results show evidence of validity in the data. Cluster analysis reveals five segments of patients with various patterns of preference for product attributes.

Cluster Analysis↗

A multifacet typology of patient satisfaction with a hospital stay.

The author views patient satisfaction after a hospital visit as a combination of several different and distinct evaluations. Patients are posited to form satisfaction judgments concurrently for each of the individual "objects" (e.g., physician, insurance provider) comprising the health care system. With patient data from four geographic areas, the author examines this multifacet view empirically and uses it to derive a typology of patient satisfaction. The study results suggest two broad groups of patients, the "satisfieds" and the "dissatisfieds." Finally, the author delineates the behavioral and demographic characteristics that discriminate between the two groups. Implications for health care researchers, practitioners, and public policy officials are presented.

Consumer Behavior↗

Projected cost savings associated with cefmetazole: a new cephamycin for the hospitalized patient.

In this article, a cost-minimization model was used to make an economic comparison between cefmetazole and cefoxitin--two drugs with comparable in vitro spectra of activity, clinical efficacy, and safety profiles. Drug acquisition costs were estimated from published information and labor and material costs were calculated based on actual costs at Presbyterian Hospital of Dallas. Costs of the agents were calculated based on the dosage and administration schedules typically used in published clinical trials of cefmetazole and cefoxitin and on the typical dosing patterns of cefoxitin used at Presbyterian Hospital. Results of the cost analysis revealed that an annual savings of $36,015 to $59,143 could be realized at Presbyterian Hospital if cefmetazole were used in place of cefoxitin for surgical prophylaxis. Furthermore, use of cefmetazole in place of cefoxitin for wound treatment would yield annual savings of $33,242.

Accounting↗

The development of a medication reminder card for elderly persons.

This paper describes the development and testing of a medication reminder card specifically designed for elderly persons on complex drug regimens. The need for such a system was confirmed by a survey of approximately 100 Canadian hospital pharmacy departments where no system provided at discharge by respondents met with our criteria for the "ideal" card. The new medication reminder card was tested in 29 ambulatory and 16 institutionalized elderly persons. Over 75 percent of patients continued to use the card two weeks post enrollment and a majority of ambulatory elderly were still using the card at six weeks. In addition to organizing medications and providing a reminder for patients to take drugs, the card facilitated communication with the pharmacist (a mean of 20 minutes) and with other health care professionals. Patients found the card easy to read and the system easy to understand. Despite time constraints, eight of nine participating community pharmacists indicated they would continue to use the system for select patients. A major obstacle to the use of the card was patient reluctance, for a variety of reasons. Although the card will require further modification in design, it provides a useful alternative as a compliance aid for ambulatory and hospitalized patients on chronic, complex drug regimens.

Aged↗