CiteULike: randyt's library [58 articles]

Decisions to adopt new technologies at the hospital level: insights from Israeli medical centers.

D Greenberg — 2008-07-25T19:31:40-00:00

International journal of technology assessment in health care, Vol. 21, No. 2. (2005), pp. 219-227.

OBJECTIVES: New medical technologies have been identified as the leading cause of increasing health-care expenditures. Adoption of a new technology is one of the most important decisions in medical centers. The objectives of this study were to map and describe the function of hospital decision-makers within the area of new technology assessment and adoption, and to examine relevant considerations, sources of information, and decision-making processes in the adoption of a new technology. METHODS: A questionnaire was mailed to hospital executives and referred to (i) the considerations for and against adoption of a new technology, (ii) the decision-making process, (iii) information sources used in the decision-making process. RESULTS: The most frequent criteria favoring adoption included increased cost-effectiveness, increased efficacy, and decrease in complication rates. An increase in complication rates or side effects and decreased efficacy were the top ranked criteria against adoption. The final decision-making responsibility varied among technologies; the medical director frequently made the final decision when a new device was involved, but this responsibility decreased when a new drug or a new procedure was considered, Participation in scientific meetings, opinions of local experts, medical journals, and Food and Drug Administration clearance documents were the most important information sources used in the decision-making process. However, these were not necessarily the optimal sources of information. Significant barriers in adoption decision-making are lack of timely data regarding the safety of the new technology, its cost-effectiveness, and efficacy. CONCLUSION: To improve the adoption decisions, hospitals must develop criteria upon which the decision-making will be based.

Understanding the implementation of complex interventions in health care: the normalization process model

Carl May — 2007-09-20T20:06:49-00:00

BMC Health Services Research, Vol. 7 (19 September 2007), 148.

A rational model for assessing and evaluating complex interventions in health care

Carl May — 2006-07-08T05:02:11-00:00

BMC Health Services Research, Vol. 6 (07 July 2006), 86.

How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.

A Laupacis — 2008-07-18T23:26:13-00:00

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Vol. 146, No. 4. (15 February 1992), pp. 473-481.

Because economic evaluations of health care services are being published with increasing frequency it is important to (a) evaluate them rigorously and (b) compare the net benefit of the application of one technology with that of others. Four "levels of evidence" that rate economic evaluations on the basis of their methodologic rigour are proposed. They are based on the quality of the methods used to estimate clinical effectiveness, quality of life and costs. With the use of the magnitude of the incremental net benefit of a technology, therapies can also be classified into five "grades of recommendation." A grade A technology is both more effective and cheaper than the existing one, whereas a grade E technology is less or equally effective and more costly. Those of grades B through D are more effective and more costly. A grade B technology costs less than $20,000 per quality-adjusted life-year (QALY), a grade C one $20,000 to $100,000/QALY and a grade D one more than $100,000/QALY. Many issues other than cost effectiveness, such as ethical and political considerations, affect the implementation of a new technology. However, it is hoped that these guidelines will provide a framework with which to interpret economic evaluations and to identify additional information that will be useful in making sound decisions on the adoption and utilization of health care services.

Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem.

A Gafni — 2008-07-18T20:33:29-00:00

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Vol. 148, No. 6. (15 March 1993), pp. 913-917.

The guidelines proposed by Laupacis and associates do not stem from economic theory and are a prescription for uncontrolled growth in health care expenditure. In particular, cost-effectiveness ratios provide information relevant to allocation decisions only in very special circumstances that do not usually apply in practice. When two interventions are compared a positive cost-effectiveness ratio (the common case) can tell us, at best, what additional costs will be incurred to generate the additional outcomes. From an economic perspective the information required to determine the attractiveness of a new technology is different: the source of the additional resource requirements must be identified and the opportunity cost of their redeployment estimated. Because the cost-effectiveness ratio (cost/-QALY) is sensitive to the method chosen to calculate QALYs, guidelines that do not specify (or justify) the appropriate method for calculating outcomes are unlikely to produce comparable results (or common yardsticks). In a health care system such as Canada's in which there is always pressure to introduce more effective technology, even if it is more costly, there is a risk of using such noncomparable data to justify adoption of particular technologies. The method of technology evaluation proposed by us is consistent with the stated goal of maximizing the community's health-related well-being for a given level of resources allocated to health care and ensures that new technologies are adopted only if this adoption represents an improvement in resource allocation.

Community and Culture

Beti Thompson — 2008-06-02T00:55:16-00:00

(15 May 2008)

Culturally Competent Care of Patients with Acute Chest Pain

Mary Sobralske — 2008-06-02T00:33:46-00:00

Journal of the American Academy of Nurse Practitioners, Vol. 17, No. 9. (2005), pp. 342-349.

Purpose To inform nurse practitioners (NPs) about the influence of culture on patients' responses to pain using the example of acute chest pain. Data sources Selected clinical and research articles on pain and culture and the authors' clinical experiences providing care across a variety of cultures. Conclusions There is very little written and even fewer studies on the connection of culture and the response to acute chest pain. This topic needs more attention by nurse researchers. Implications for practice If NPs are not aware that some patients may not demonstrate behavior typically expected in acute myocardial infarction, they may miss the diagnosis and fail to treat or refer these patients for immediate treatment.

Community-based HIV prevention research among substance-using women in survival sex work: The Maka Project Partnership

Kate Shannon — 2007-12-09T22:46:09-00:00

Harm Reduction Journal, Vol. 4 (08 December 2007), 20.

Development and evaluation of a cultural competency training curriculum

David Thom — 2006-07-28T01:48:40-00:00

BMC Medical Education, Vol. 6 (26 July 2006), 38.

Use of a Writing Elective to Teach Cultural Competency and Professionalism

Joanne Wilkinson — 2008-05-30T22:13:19-00:00

Family Medicine, Vol. 38, No. 10. (November 2006), pp. 702-704.

Cultural competence in mental health care: a review of model evaluations.

Kamaldeep Bhui — 2007-02-01T19:09:03-00:00

BMC Health Services Research, Vol. 7 (31 January 2007), 15.

Disaster preparedness training for tribal leaders

Wayne Peate — 2008-01-16T11:16:08-00:00

Journal of Occupational Medicine and Toxicology, Vol. 3 (15 January 2008), 2.

Strategies for Incorporating Cultural Competence Into Childbirth Education Curriculum

Margaret Greene — 2007-05-11T17:01:51-00:00

Journal of Perinatal Education, Vol. 16, No. 2. (2007), pp. 33-37.

Drug Use and the Risk of Major Depressive Disorder, Alcohol Dependence, and Substance Use Disorders

David Brook — 2008-05-18T18:42:36-00:00

Archives of General Psychiatry, Vol. 59 (2002), pp. 1039-1044.

Theory at a glance: A guide to health promotion practice

Barbara Rimer — 2008-05-17T01:23:37-00:00

(2005)

The Role of Interpretation Processes and Parental Discussion in the Media's Effects on Adolescents' Use of Alcohol

Weintraub — 2008-05-16T00:47:55-00:00

Pediatrics, Vol. 105, No. 2. (February 2000), pp. 343-349.

Alcohol and adolescents: study to implement municipal policies

Denise Vieira — 2008-05-16T00:35:42-00:00

Revista de Saúde Pública, Vol. 41, No. 3. (June 2007)

Screening, early identification, and office-based intervention with children and youth living in substance-abusing families.

MJ Werner — 2008-05-14T20:15:01-00:00

Pediatrics, Vol. 103, No. 5 Pt 2. (May 1999), pp. 1099-1112.

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, associated health problems or concerns in children of substance-abusing parents, and to be able to assist these children and families in seeking treatment and promoting health. Health care providers can have a tremendous influence on families of substance-abusing parents because of their understanding of family dynamics and their close long-standing relationship with the family. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, and recurring episodes of apparent accidental trauma, and in the setting of recurrent or multiple vague somatic complaints by the child or adolescent. In many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening effort. Combining the principles of anticipatory guidance, screening, and early identification, with the acknowledgment that families should be included in the process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childhood, and adolescence. Health care providers need to be trained in the identification and management of children and youth exposed to parental addiction. Such training must begin during undergraduate education in the health professions and be reinforced by role-modeling among health professions faculty as well as practicing providers.

Getting the mix right: family, community and social policy interventions to improve outcomes for young people at risk of substance misuse

Graham Vimpani — 2008-05-14T20:10:59-00:00

Drug and Alcohol Review, Vol. 24, No. 2. (2005), pp. 111-125.

Societal responses to the existence of substance misuse fluctuate between harm minimisation and prohibition. Both approaches are predominantly downstream reactions to substance misuse that focus on the supply of harmful substances and the containment of misuse through treatment, rehabilitation or punishment. Until recently, little attention has been paid to the upstream individual, family, relationship, community or societal antecedents of substance misuse (which often overlap with those for other adverse life outcomes, such as unemployment, antisocial personality disorder and mental health problems) that have operated during earlier life. A growing body of evidence highlights the overlapping biological and experiential antecedents for substance abuse and other poor outcomes as well as the trajectory-changing protective factors that can prevent risks being translated into destiny. Risk minimisation and protection enhancement embedded in family and social systems are the essential building blocks of a set of early intervention strategies that begin antenatally and continue through the developing years of childhood, adolescence and young adult life, that have been shown to be effective in improving many outcomes in development, health and well-being. Much remains to be done to enable the promise of effective universal and targeted early intervention to be translated into policies, programs and practices that could be life-changing for citizens bogged in the mire of substance misuse and their children. Realistic, timely investment, influenced by the best scientific evidence indicating what works, for whom, under what circumstances, an increased degree of collaboration within and between governments and their agencies to enable whole of government responses in partnership with community-based initiatives are essential along with investments in multidisciplinary program evaluation research that will enable evidence-informed policy decisions to be tailored to the needs of individual countries. <span>[Vimpani G. Getting the mix right: family, community and social policy interventions to improve outcomes for young people at risk of substance misuse. </span> Drug Alcohol Rev <span>2005;24:111&hairsp;&hairsp;125]</span>

Alcohol use beliefs and behaviors among high school students.

L Feldman — 2008-05-14T19:52:36-00:00

The Journal of adolescent health : official publication of the Society for Adolescent Medicine, Vol. 24, No. 1. (January 1999), pp. 48-58.

PURPOSE: To identify specific alcohol use beliefs and behaviors among local high school students; to determine whether relationships exist between alcohol use and various sociodemographic and lifestyle behaviors; and to assist in the development and implementation of alcohol abuse prevention programs. METHODS: This cross-sectional study involved the completion of a questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three Canadian urban schools. Data analyzed here are part of a larger lifestyle survey. RESULTS: A total of 24% of students reported never having tasted alcohol, 22% have tasted alcohol but do not currently drink, 39% are current moderate drinkers, 11% are current heavy drinkers (five or more drinks on one occasion at least once a month), and 5% did not answer. Reasons stated most often for not drinking were "bad for health" and "upbringing," while reasons stated most often for drinking were "enjoy it" and "to get in a party mood." Student drinking patterns were significantly related to gender, ethnicity, grade, and the reported drinking habits of parents and friends. Older male adolescents who describe their ethnicity as Canadian are at higher risk for heavy drinking than students who are younger or female, or identify their ethnicity as European or Asian. Current heavy drinkers are at higher risk than other students for engaging in other high-risk behaviors such as drinking and driving, being a passenger in a car when the driver is intoxicated, and daily smoking. CONCLUSIONS: Heavy alcohol use in adolescents remains an important community health concern. Older self-described Canadian and Canadian-born male adolescents are at higher risk for heavy drinking. Current and heavy drinking rises significantly between Grades 9 and 12. Students who drink heavily are more likely to drink and drive, to smoke daily, and to have friends and parents who drink alcohol.

Health-compromising behaviors: why do adolescents smoke or drink?: identifying underlying risk and protective factors.

E Simantov — 2008-05-14T19:49:28-00:00

Archives of pediatrics & adolescent medicine, Vol. 154, No. 10. (October 2000), pp. 1025-1033.

OBJECTIVES: To better understand the motivation for adolescent smoking and drinking and to identify the underlying risk and protective factors associated with these behaviors among adolescents. DESIGN: Cross-sectional, school-based survey of students in grades 5 through 12. PARTICIPANTS: A nationally representative sample of 2574 boys and 2939 girls in grades 7 through 12 from 297 public, private, and parochial schools across the United States who participated in The Commonwealth Fund Survey of the Health of Adolescent Girls and Boys in 1997. MAIN OUTCOME MEASURES: Sex-specific adjusted relative risks (RRs) and 95% confidence intervals (CIs) comparing self-reported regular smokers and regular drinkers by risk and protective factors with adolescents reporting none of these behaviors. RESULTS: Adolescent boys and girls were equally likely to be regular smokers (11.2%). The prevalence rate of regular drinking was only slightly higher for boys (22.4%) than it was for girls (19.3%). The rates of both health-risk behaviors were significantly higher for those reporting risk factors, and the strengths of associations varied by sex. Sex differences also emerged in motivation for engaging in these behaviors. When we adjusted for demographic characteristics, exposure to childhood abuse (RR, 4.1; 95% CI, 2.4-7.0) and stressful life events (RR, 2.4; 95% CI, 1.1-5.4) were strongly associated with increased risk for boys' regular smoking. Similar associations were found for regular drinking. For girls, a history of abuse (RR, 1.8; 95% CI, 1.1-2.8), violence within the family (RR, 2.2; 95% CI, 1.6-3.2), depressive symptoms (RR, 1.6; 95% CI, 1.0-2.4), and stressful life events (RR, 3.1; 95% CI, 1.8-5.6) were significantly associated with increased risk for regular smoking. Similar associations were again found for regular drinking. Parental support was protective against both health-risk behaviors for both sexes. Participation in extracurricular activities was associated with lower risk for regular smoking for boys (RR, 0.4; 95% CI, 0.2-0.7) and for girls (RR, 0.3; 95% CI, 0.2-0.5); however, there was no significant association between drinking behavior and participation in activities. CONCLUSIONS: The increased risk for regular smoking and regular drinking among adolescents with a history of abuse, family violence, depressive symptoms, and stressful life events suggests that routine screening for abuse, violence, and other family experiences should be an essential component of adolescent health care visits. Effective prevention programs to reduce smoking and drinking among adolescents should recognize that health-risk behaviors may be associated with other negative life experiences and that the strength of these associations differs by sex.

ALCOHOL CONSUMPTION PATTERNS AMONG YOUNG PEOPLE FROM RURAL AREAS OF LUBLIN PROVINCE

Makara-Studzińska Marta — 2008-05-14T19:37:06-00:00

Annals of Agricultural and Environmental Medicine, Vol. 14, No. 1. (2007), pp. 45-49.

Adolescents' health and health behaviour as predictors of injury death - A prospective cohort follow-up of 652,530 person-years

Ville Mattila — 2008-03-18T05:47:06-00:00

BMC Public Health, Vol. 8 (17 March 2008), 90.

Paternal alcoholism and youth substance abuse: the indirect effects of negative affect, conduct problems, and risk taking.

CM Ohannessian — 2008-05-14T19:16:10-00:00

The Journal of adolescent health : official publication of the Society for Adolescent Medicine, Vol. 42, No. 2. (February 2008), pp. 198-200.

This longitudinal study followed 200 adolescents into early adulthood to explore the potential mediating roles that hostility, sadness, conduct problems, and risk-taking play in the relationship between paternal alcoholism and substance abuse. Results indicated that paternal alcoholism predicted hostility; in turn, hostility predicted risk taking, which predicted substance abuse.

Predictors of Initiation of Alcohol Use Among US Adolescents

Laurie Fisher — 2008-05-14T19:09:25-00:00

Archives of Pediatrics & Adolescent Medicine, Vol. 161, No. 10. (2007), pp. 959-966.

Objective To identify precursors of adolescent alcohol initiation and binge drinking. Design Prospective cohort study. Setting Self-report questionnaires. Participants A total of 5511 Growing Up Today Study participants aged 11 to 18 years in 1998. Main Exposures Individual, family, and social factors. Main Outcome Measures First whole drink of alcohol and binge drinking. Results Between 1998 and 1999, 611 girls (19%) and 384 boys (17%) initiated alcohol use. Older age, later maturational stage, smoking, adults drinking in the home, underage sibling drinking, peer drinking, possession of or willingness to use alcohol promotional items, and positive attitudes toward alcohol were associated with an increased likelihood of alcohol initiation. Girls who ate family dinner at home every day were less likely to initiate alcohol use than girls who ate family dinner only on some days or never (odds ratio, 0.66; 95% confidence interval, 0.50-0.87). Girls with higher social self-esteem and boys with higher athletic self-esteem were more likely to initiate alcohol use than those with lower self-esteem. Among teens who initiated alcohol use, 149 girls (24%) and 112 boys (29%) further engaged in binge drinking. Among girls, positive attitudes toward alcohol, underage sibling drinking, and possession of or willingness to use alcohol promotional items were associated with binge drinking; among boys, positive attitudes toward alcohol and older age were associated with binge drinking. Conclusions Eating family dinner at home every day may delay alcohol uptake among some adolescents. Alcohol promotional items appear to encourage underage alcohol initiation and binge drinking; this may warrant marketing restrictions on the alcohol industry.

Prevention of melatonin suppression by nocturnal lighting: relevance to cancer

Leonida Kayumov — 2008-05-11T19:52:27-00:00

European Journal of Cancer Prevention, Vol. 16, No. 4. (August 2007), pp. 357-362.

Melatonin in pathogenesis and therapy of cancer

T Ravindra — 2008-05-11T19:13:59-00:00

Indian Journal of Medical Sciences, Vol. 60, No. 12. (2006), pp. 523-535.

Rotating Night Shifts and Risk of Breast Cancer in Women Participating in the Nurses' Health Study

Eva Schernhammer — 2008-05-11T19:07:57-00:00

Journal of the National Cancer Institute, Vol. 93, No. 20. (17 October 2001), pp. 1563-1568.

Night-Shift Work and Risk of Colorectal Cancer in the Nurses’ Health Study

Eva Schernhammer — 2008-05-11T19:03:58-00:00

Journal of the National Cancer Institute, Vol. 95, No. 11. (4 June 2003), pp. 825-828.

Epidemiology of Urinary Melatonin in Women and Its Relation to Other Hormones and Night Work

Eva Schernhammer — 2008-05-11T19:01:07-00:00

Cancer Epidemiology Biomarkers and Prevention, Vol. 13 (June 2004), pp. 936-943.

Urinary Melatonin Levels and Breast Cancer Risk

Eva Schernhammer — 2008-05-11T18:58:00-00:00

Journal of the National Cancer Institute, Vol. 97, No. 14. (20 July 2005), pp. 1084-1087.

Circadian Disruption, Shift Work and the Risk of Cancer: A Summary of the Evidence and Studies in Seattle

Scott Davis — 2006-04-12T04:08:22-00:00

Cancer Causes and Control, Vol. 17, No. 4. (May 2006), pp. 539-545.

Shift work, light at night, and breast cancer on Long Island, New York.

ES O'Leary — 2008-05-10T02:03:21-00:00

American Journal of Epidemiology, Vol. 164, No. 4. (15 August 2006), pp. 358-366.

Melatonin, environmental light, and breast cancer

V Srinivasan — 2008-05-10T01:58:41-00:00

Breast Cancer Research and Treatment, Vol. 108, No. 3. (20 April 2008), pp. 339-350.

Abstract Although many factors have been suggested as causes for breast cancer, the increased incidence of the disease seen in women working in night shifts led to the hypothesis that the suppression of melatonin by light or melatonin deficiency plays a major role in cancer development. Studies on the 7,12-dimethylbenz[a]anthracene and N-methyl-N-nitrosourea experimental models of human breast cancer indicate that melatonin is effective in reducing cancer development. In vitro studies in MCF-7 human breast cancer cell line have shown that melatonin exerts its anticarcinogenic actions through a variety of mechanisms, and that it is most effective in estrogen receptor (ER) α-positive breast cancer cells. Melatonin suppresses ER gene, modulates several estrogen dependent regulatory proteins and pro-oncogenes, inhibits cell proliferation, and impairs the metastatic capacity of MCF-7 human breast cancer cells. The anticarcinogenic action on MCF-7 cells has been demonstrated at the physiological concentrations of melatonin attained at night, suggesting thereby that melatonin acts like an endogenous antiestrogen. Melatonin also decreases the formation of estrogens from androgens via aromatase inhibition. Circulating melatonin levels are abnormally low in ER-positive breast cancer patients thereby supporting the melatonin hypothesis for breast cancer in shift working women. It has been postulated that enhanced endogenous melatonin secretion is responsible for the beneficial effects of meditation as a form of psychosocial intervention that helps breast cancer patients.

Cholinesterase measurements with an automated kit.

GH Oliveira — 2008-04-24T01:05:15-00:00

American journal of industrial medicine, Vol. Suppl 2 (August 2002), pp. 49-53.

BACKGROUND: The Test-mate kit determines acetylcholinesterase (AChE, EC 3.1.1.7) and hemoglobin content of a drop of blood, displaying enzyme activities normalized to 25 degrees C. Previous models produced inconsistent results at different temperatures. This report focuses on the current model, ChE 400, and two instruments of a previous OP model. METHODS: AChE activities were determined by the Ellman assay, using the three kits and a 96-well microplate reader. Temperatures ranged from 10 to 37 degrees C. Fetal bovine serum was the source of AChE. RESULTS: Normalized activities decreased below 20 degrees C in the ChE model and below 25 degrees C in the OP models. Activities of the same serum sample differed between the three Test-mate kits, ranging from 1.03 to 1.49 micromoles/min/ml. Percent errors were greater than with the microplate reader at all temperatures. CONCLUSIONS: Neither we nor the manufacturer recommend the current Test-mate model for fieldwork. Nevertheless, there have been field measurements with Test-Mate kits, and we recommend that an enzyme activity standard be run in parallel with their use.

Field verification of Test-mate ChE

Patterson Taylor — 2008-04-24T01:03:13-00:00

Military Medicine, Vol. 168, No. 4. (April 2003)

Organophosphate toxicity and occupational exposure

R Kamanyire — 2008-04-24T00:07:32-00:00

Occupational Medicine, Vol. 54 (2004), pp. 69-75.

Cholinesterase measurements with an automated kit

Georgino — 2008-04-23T17:59:23-00:00

American Journal of Industrial Medicine, Vol. 42, No. S2. (9 August 2002), pp. 49-53.

Repeatability and validity of a field kit for estimation of cholinesterase in whole blood.

L London — 2008-04-23T17:54:57-00:00

Occupational and environmental medicine, Vol. 52, No. 1. (January 1995), pp. 57-64.

OBJECTIVES--To evaluate a spectrophotometric field kit (Test-Mate-OP) for repeatability and validity in comparison with reference laboratory methods and to model its anticipated sensitivity and specificity based on these findings. METHODS--76 farm workers between the age of 20 and 55, of whom 30 were pesticide applicators exposed to a range of organophosphates in the preceding 10 days, had blood taken for plasma cholinesterase (PCE) and erythrocyte cholinesterase (ECE) measurement by field kit or laboratory methods. Paired blinded duplicate samples were taken from subgroups in the sample to assess repeatability of laboratory and field kit methods. Field kits were also used to test venous blood in one subgroup. The variance obtained for the field kit tests was then applied to two hypothetical scenarios that used published action guidelines to model the kit's sensitivity and specificity. RESULTS--Repeatability for PCE was much poorer and for ECE slightly poorer than that of laboratory measures. A substantial upward bias for field kit ECE relative to laboratory measurements was found. Sensitivity of the kit to a 40% drop in PCE was 67%, whereas that for ECE was 89%. Specificity of the kit with no change in mean of the population was 100% for ECE and 91% for PCE. CONCLUSION--Field kit ECE estimation seems to be sufficiently repeatable for surveillance activities, whereas PCE does not. Repeatability of both tests seems to be too low for use in epidemiological dose-response investigations. Further research is indicated to characterise the upward bias in ECE estimation on the kit.

The inverse care law today

Graham Watt — 2008-04-22T23:06:29-00:00

The Lancet, Vol. 360, No. 9328. (20 July 2002), pp. 252-254.

Screening for insecticide overexposure under field conditions: a reevaluation of the tintometric cholinesterase kit.

R McConnell — 2008-04-22T17:12:33-00:00

American journal of public health, Vol. 84, No. 3. (March 1994), pp. 479-481.

A semiquantitative tintometric field kit has been used in the developing world for almost 30 years to measure whole blood cholinesterase levels in persons exposed to organophosphate pesticides. The validity of this screening kit was evaluated among 79 workers heavily exposed to organophosphates by comparison with a reference assay for erythrocyte cholinesterase. Overall correlation between the two methods was good. However, either sensitivity or specificity of the tintometric kit was less than 75% for each of the three tintometric categories commonly used to define the limit of normal. Because baseline erythrocyte cholinesterase levels were not available for this population, the true sensitivity and specificity of the tintometric assay may be even lower.

Pesticide exposures, cholinesterase depression, and symptoms among North Carolina migrant farmworkers.

S Ciesielski — 2008-04-22T17:10:35-00:00

American journal of public health, Vol. 84, No. 3. (March 1994), pp. 446-451.

OBJECTIVES. We conducted a clinic-based study of erythrocyte cholinesterase levels, pesticide exposures, and health effects among farmworkers and nonfarmworkers to determine risks for exposure and associated morbidity. METHODS. Two hundred two farmworkers and 42 nonfarmworkers were recruited sequentially at two community health centers. Erythrocyte cholinesterase levels were measured colorimetrically. Questionnaires obtained data on demographics, occupational history, exposures, and symptoms. RESULTS. Cholinesterase levels were significantly lower among farmworkers (30.28 U/g hemoglobin) than among nonfarmworkers (32.3 U/g hemoglobin). Twelve percent of farmworkers, but no nonfarmworkers, had very low levels. Farmworkers applying pesticides also had lower cholinesterase levels. One half of farmworkers reported being sprayed by pesticides and working in fields with an obvious chemical smell. Of reported symptoms, only diarrhea was associated with cholinesterase levels. Reported exposures, however, were strongly associated with symptoms. CONCLUSIONS. Farmworkers reported many pesticide exposures that violate state and federal regulations. Farmworkers had cholinesterase levels significantly lower than those of nonfarmworkers, although only spraying pesticides was associated with very low levels.

Designing an AIDS information campaign to reach intravenous drug users and sex partners.

RM Perloff — 2008-04-21T19:24:41-00:00

Public health reports (Washington, D.C. : 1974), Vol. 106, No. 4. (g 1991), pp. 460-463.

Intravenous drug users are currently the second largest group to have developed the acquired immunodeficiency syndrome in the United States and Europe. Clearly, health communication plays an important role in the development of AIDS prevention programs directed at IV drug users. However, few public information campaigns have been developed to reach IV drug users or their sexual partners. In a recent campaign directed at these groups, the selection of messages to be used was based both on theory and on research into multi-media public information campaigns. The attempt was made to communicate basic facts about AIDS etiology and prevention. This included information that needle sharing and unprotected sex could spread the human immunodeficiency virus (HIV) that causes AIDS, while bleaching needles and using condoms properly could reduce the risk of infection. A step-by-step diagram on how to bleach needles was provided. Posters, pamphlets, billboards, and out-reach workers were used to spread the word in inner-city neighbors, and coverage of the campaign was sought in the news media. Strategies incorporating practical and theory-based suggestions for future campaigns on IV drug use and AIDS are discussed.

The association between HIV media campaigns and number of patients coming forward for HIV antibody testing.

JD Ross — 2008-04-21T19:20:13-00:00

Genitourinary medicine, Vol. 69, No. 3. (June 1993), pp. 193-195.

AIM--To assess the relationship between national and local media campaigns with respect to the number of patients requesting HIV antibody tests as a surrogate marker of the effectiveness of different campaign strategies. METHODS--Analysis by month of the numbers of HIV tests performed in the regional genitourinary (GUM) clinic for Lothian over a 5 year period and in the whole of Lothian Region, Scotland over a 3 year period. Changes in testing rates were monitored with respect to media campaigns over the same time period. RESULTS--Television based media campaigns produced the greatest increase in testing rates (average 46% increase over 2 months) compared with newspapers and poster campaigns (average 6% increase over 2 months). Regional HIV testing rates correlated significantly with GUM clinic testing rates. No increase in positive HIV tests was seen following media campaigns. CONCLUSIONS--Using HIV testing rates as a surrogate marker, television based media campaigns appear to be the most effective way of increasing awareness of HIV. The effect of media campaigns is short-lived indicating a need for constant reminder of the dangers of HIV infection. The increase in HIV testing occurs largely in the "worried well" with few additional HIV positive patients being identified.

Urban African-American males' perceptions of condom use, gender and power, and HIV/STD prevention program.

SB Kennedy — 2008-04-21T18:59:19-00:00

Journal of the National Medical Association, Vol. 99, No. 12. (December 2007), pp. 1395-1401.

The overall goal of the research project was to develop, administer and assess a brief male-focused condom promotion program for inner-city young adult African-American males. To achieve that goal, we conducted a formative study consisting of both quantitative and qualitative research methods. For the qualitative component, which was guided by the relevant tenets of the social cognitive theory and the stages of change model, a series of focus group discussions was conducted among the target population based upon a thematic topic guide that covered three broad areas: young men's perceptions of condom use relative to pregnancy and HIV/sexually transmitted disease (STD) prevention, gender-based issues surrounding condom use, and potential guidelines for the development of customized condom promotion programs. Those focus group discussions were audiotaped and the transcribed data summarized and analyzed based on those thematic topics. The findings revealed that respondents were more likely to assume that they know the risk behaviors of their sexual partners, more likely to consider pregnancy as a socially desirable outcome, more likely to control condom use within relationship dynamics and sexual contexts, and also more likely to provide suggestions on suitable components for program development. The implications and limitations of those findings from this qualitative component of the project are herein described, including potential recommendations for program development.

Black-white disparities in HIV/AIDS: the role of drug policy and the corrections system.

KM Blankenship — 2008-04-21T00:03:00-00:00

Journal of health care for the poor and underserved, Vol. 16, No. 4 Suppl B. (November 2005), pp. 140-156.

African Americans in the United States are disproportionately affected by HIV/AIDS. We focus in this paper on the structural and contextual sources of HIV/AIDS risk, and suggest that among the most important of these sources are drug policy and the corrections system. In particular, high rates of exposure to the corrections system (including incarceration, probation, and parole) spurred in large part by federal and state governments' self-styled war on drugs in the United States, have disproportionately affected African Americans. We review a wide range of research literature to suggest how exposure to the corrections system may affect the HIV/AIDS related risks of drug users in general, and the disproportionate HIV risk faced by African Americans in particular. We then discuss the implications of the information reviewed for structural interventions to address African American HIV-related risk. Future research must further our understanding of the relations among drug policy, corrections, and race-based disparities in HIV/AIDS.

Racial Differences in the Use of Drug Therapy for HIV Disease in an Urban Community

Richard Moore — 2008-04-18T19:14:30-00:00

New England Journal of Medicine, Vol. 330, No. 11. (17 March 1994), pp. 763-768.

Race, gender, drug use, and participation in AIDS clinical trials. Lessons from a municipal hospital cohort.

VE Stone — 2008-04-18T19:11:28-00:00

Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine, Vol. 12, No. 3. (March 1997), pp. 150-157.

OBJECTIVES: To determine whether participation rates of women, persons of color, and injection drug users in AIDS clinical trials are similar to those of other HIV/AIDS patients, and to examine whether differences in patients' knowledge of clinical trails or reasons for not participating explain differences in participation rates by gender, race, or drug use. DESIGN: Cross-sectional survey of patients with HIV disease. SETTING: Ambulatory practice of a municipal teaching hospital. PATIENTS: Two hundred sixty patients receiving primary care for HIV disease. MEASUREMENTS AND MAIN RESULTS: Overall, 22.3% of patients had participated in a clinical trail. Women, patients of color, and drug users were significantly less likely to have ever participated in an AIDS clinical trial (p < .05). Multiple logistic regression confirmed being a person of color (odds ratio [OR] 2.14; 95% confidence interval [CI] 1.12-4.08) and injection drug use (OR 2.09; 95% CI 1.08-4.04) as significant predictors of nonparticipation in AIDS clinical trials (p < .05). Patients of color and women reported less knowledge of clinical trials, and were less likely to have been told about clinical trials for which they were eligible (p < .05). Patients of color were half as likely as whites to cite ineligibility as their reason for not participating (10.4% vs 22.4%). and more likely to hold unfavorable opinions of clinical research (50.7% vs. 40.5%). Reasons for nonparticipation did not differ by gender. CONCLUSIONS: Even when AIDS clinical trials are available on-site, persons of color, women, and drug users are less likely to participate. Educational efforts for patients and providers are needed to remedy continuing disparities in participation by race, gender, and risk factor group in AIDS clinical trials.

Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need.

H Amaro — 2008-04-18T19:08:54-00:00

Public health reports (Washington, D.C. : 1974), Vol. 116, No. 5. (t 2001), pp. 434-448.

In 1998, community leaders prompted members of the Black and Hispanic Congressional Caucuses to urge President Clinton to declare HIV/AIDS a crisis in the African American and Latino communities; their advocacy resulted in the formation of the Minority AIDS Initiative. As part of this initiative, the Center for Substance Abuse Prevention (CSAP) of the Substance Abuse and Mental Health Services Agency funded the Substance Abuse and HIV Prevention Youth and Women of Color Initiative (CSAP Initiative). The CSAP Initiative is the first major federal effort to develop community-based integrated HIV and substance abuse prevention approaches targeting racial/ethnic populations that have been disproportionately impacted by HIV/AIDS. This article describes the current state of HIV prevention research involving racial/ethnic minority populations and the current status of the CSAP Initiative. The data collected through the CSAP Initiative, implemented by 47 community organizations, will help to fill the existing knowledge gap about how to best prevent HIV in these communities. This data collection effort is an unparalleled opportunity to learn about risk and protective factors, including contextual factors, that are critical to the prevention of HIV/AIDS in African American, Latino, and other racial/ethnic minority communities but that are often not investigated.

Responding to racial and ethnic disparities in use of HIV drugs: analysis of state policies.

SF Morin — 2008-04-18T19:07:03-00:00

Public health reports (Washington, D.C. : 1974), Vol. 117, No. 3. (n 2002)

OBJECTIVES: The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients. METHODS: State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities. RESULTS: Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns. CONCLUSIONS: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.