Inter-organizational responses to AIDS: a case study of the Worcester AIDS Consortium

This case study focuses on development and community coordination of AIDS-related services and on coalition building. Its subject is the Worcester (Massachusetts) AIDS Consortium. The objectives are to: (1) describe the environmental conditions and pre-existing networks which facilitated the formation of the Worcester AIDS Consortium; (2) articulate processes which occurred during the formative, organizational and operational phases of the Worcester AIDS Consortium's development; (3) explore social and community goals and Consortium activities; and (4) document Consortium accomplishments. Data were collected through key informant interviews and review of archival materials. Information about the Worcester AIDS Consortium experience is compared with concepts and principles suggested by organizational theories and frameworks.     

Ambulance services. Digital dawn

Mersey Regional and Hereford and Worcester ambulance trusts are the only two in the country to have installed digital radio systems. Hereford and Worcester can now locate any of its 42 ambulances in real time, leading to dramatic reductions in response times. The system also allows for the transmission of clinical data while a casualty is in transit, supporting the development of paramedics' medical skills. The national rollout of digital radio has been repeatedly postponed; the current dealine for full intergration in England is 2007.     

Worcester Development Project: the closure and replacement of a mental hospital

The Worcester Development Project began in 1968 when the Department of Health and Social Security brought together the Worcester and Kidderminster Hospital Management Committee and the County Council in a co-ordinated joint planning venture. Powick Hospital was chosen as the location for testing the hypothesis that closing a mental hospital and replacing it with general hospital psychiatric units, supported by a variety of community facilities, would provide a more economical and better service. This paper describes the outcome of this unique opportunity to study the problems involved in closing a mental hospital and its replacement with other facilities.     

The association between state housing policy and lead poisoning in children.

OBJECTIVES: This study examined the effect of an active program of household lead paint hazard abatement, applied over 22 years, on childhood lead poisoning in Massachusetts. METHODS: A small areas analysis was used to compare screening blood lead levels of children in Worcester County, Mass (n = 27,590), with those in Providence County, RI (n = 19,071). Data were collapsed according to census tract. RESULTS: The percentage of children with lead poisoning (blood lead level > or = 20 micrograms/dL [Pe20]) was, on average, 3 times higher in Providence County census tracts (3.2% vs 0.9% in Worcester County census tracts, P < .0001), despite similar percentages of pre-1950s housing in both counties. The ratio of Pe20 in Providence vs Worcester County census tracts was 2.2 (95% confidence interval = 1.8, 2.7), after adjustment for differences in housing, sociodemographic, and screening characteristics. This estimate was robust to alternative regression methods and sensitivity analyses. CONCLUSIONS: Massachusetts policy, which requires lead paint abatement of children's homes and places liability for lead paint poisoning on property owners, may have substantially reduced childhood lead poisoning in that state.     

Homelessness in female-headed families: childhood and adult risk and protective factors.

OBJECTIVES: To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. METHODS: Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. RESULTS: Childhood predictors of family homelessness included foster care placement and respondent's mother's use of drugs. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. CONCLUSIONS: Factors that compromise an individual's economic and social resources are associated with greater risk of losing one's home.     

Needle plan defeated

The Worcester, MA, city council rejected a needle-exchange and drug treatment program proposed by a coalition of HIV prevention groups. The Harm and Risk Reduction Coalition plan was also opposed by the Christian Coalition of Massachusetts. One councilman voted against the plan because he said his constituents opposed it. This was the second defeat for needle-exchange programs in the town.     

The reappearance of a classical epidemic of infectious hepatitis in Worcester, Massachusetts

Worcester, MA, experienced an outbreak of hepatitis during 1969-1970, an expected event which had occurred previously at eight-year intervals since reporting of the disease began in 1950. Other Massachusetts communities of similar character and the nation did not experience an epidemic during that same period. An extensive epidemiologic study of the disease illustrated that the epidemic followed the classical pattern in which individuals 5-14 years old were most affected irrespective of sex. During the interepidemic years from 1968-1972 in Worcester, and in all years (1968-1972) in both New Bedford and Springfield, MA, those primarily affected were young adults 15-30 years old, with male cases predominating. Sociodemographic statistical analyses also indicated the classical pattern of the less affluent, less educated, and sometimes the more crowded populations being at greater risk of contracting the disease. This outbreak of hepatitis was comparable to another in Greenland two years later in which immunologic methods differentiated between type A and type B viral infections. The data from both studies support the conclusion that the type B virus, often associated with parenteral drug use, is the predominate infectious agent during the interepidemic (endemic) periods. The type A virus is most likely responsible for the periodic epidemics.     

Worcester Development Project: where do patients go when hospitals close?

The philosophy of Community Care has resulted in the closure of several mental hospitals in this country. The ethos of the Worcester Development Project saw the closure of St Wulstan's and Powick Hospitals, and their replacement by a community-based service. This paper briefly describes the outcome of a three-year retrospective study completed in 1988 following the closure of both hospitals. The findings provide a comparison of the two hospitals, including details of the destination of all the patients. It is suggested that the term 'hospital replacement' might be preferable to 'hospital closure.'     

Use of passive surveillance data to study temporal and spatial variation in the incidence of giardiasis and cryptosporidiosis

OBJECTIVE: The goal of this study was to evaluate temporal and spatial variations in the reporting of cases of giardiasis and cryptosporidiosis to a passive surveillance system, and to assess the relationship of those variations to source of drinking water, adjusting for socioeconomic variables. METHODS: The authors analyzed temporal and spatial patterns for 4,058 cases of giardiasis and 230 cases of cryptosporidiosis reported to the Massachusetts Department of Public Health for 1993-1996. They linked each reported case to a database containing information on source of residential water supply and socioeconomic characteristics and evaluated the association between these factors and reporting rates using regression techniques. RESULTS: Reports of giardiasis and cryptosporidiosis were highest for the mixed unfiltered drinking water supply category. Reports of giardiasis were associated with income levels. Increases in reporting for both giardiasis and cryptosporidiosis were seen in summer to early fall. During a suspected outbreak of cryptosporidiosis n the city of Worcester in 1995, a significant increase in reported cases was also observed in the Boston metropolitan area. Following the suspected outbreak, weekly giardiasis rates increased slightly in Worcester and the Boston metropolitan area, while reporting of cryptosporidiosis increased dramatically. CONCLUSIONS: Consistently collected passive surveillance data have the potential to provide valuable information on the temporal variation of disease incidence as well as geographic factors. However, passive surveillance data, particularly in the initial period of surveillance, may be highly sensitive to patterns of diagnosis and reporting and should be interpreted with caution.     

Legionnaires disease associated with potable water in a hotel--Ocean City, Maryland, October 2003-February 2004

During October 2003-February 2004, eight cases (seven confirmed cases and one possible) of Legionnaires disease (LD) were identified among guests at a hotel in Ocean City, Maryland. This report summarizes the subsequent investigation conducted by the Worcester County Health Department (WCHD), Maryland Department of Health and Mental Hygiene (DHMH), and CDC, which implicated the potable hot water system of the hotel as the most likely source of infection. The detection of this outbreak underscores the importance of enhanced, state-based surveillance for timely detection of travel-associated LD and implementation of control measures.     

A case-control analysis of exposure to traffic and acute myocardial infarction

BACKGROUND: Long-term exposure to particulate air pollution has been associated with an increased risk of dying from cardiopulmonary and ischemic heart disease, yet few studies have evaluated cardiovascular end points other than mortality. We investigated the relationship between long-term exposure to traffic and occurrence of acute myocardial infarction (AMI) in a case-control study. METHODS: A total of 5,049 confirmed cases of AMI were identified between 1995 and 2003 as part of the Worcester Heart Attack Study, a community-wide study examining changes over time in the incidence of AMI among greater Worcester, Massachusetts, residents. Population controls were selected from Massachusetts resident lists. We used cumulative traffic within 100 m of subjects' residence and distance from major roadway as proxies for exposure to traffic-related air pollution. We estimated the relationship between exposure to traffic and occurrence of AMI using logistic regression, and we adjusted for the following potential confounders: age, sex, section of the study area, point sources emissions of particulate matter with aerodynamic diameter < 2.5 microm, area socioeconomic characteristics, and percentage of open space. RESULTS: An increase in cumulative traffic near the home was associated with a 4% increase in the odds of AMI per interquartile range [95% confidence interval (CI), 2-7%], whereas living near a major roadway was associated with a 5% increase in the odds of AMI per kilometer (95% CI, 3-6%). CONCLUSIONS: These results provide support for an association between long-term exposure to traffic and the risk of AMI.     

Pharmacy: a unique opportunity to participate in education

Health education and health maintenance are part of the traditional role of the pharmacist, particularly for those engaged in general practice (retail) pharmacy, writes J. W. Barnett, APhO Hereford and Worcester AHA, in the last of our series. Pharmaceutical officers have many opportunities to exercise this professional role themselves either by direct contact with the public, or indirectly by helping and advising others. Although this generally involves educating the public on medicines, wider issues are also involved -- for example, fluoridation and the risk of poisoning from household chemicals.     

Studies on the 1967-8 foot-and-mouth disease epidemic: The relation of weather to the spread of disease

An analysis of the 1967-8 foot-and-mouth disease epidemic with reference to the initial spread, the origin of outbreaks more than 60 km. from the main epidemic area, the series of outbreaks near Worcester, a specific case history and the daily rate of spread of the epidemic, strongly suggests that the weather played a major part in the spread of disease. The two main factors involved in this type of spread are wind and precipitation. It is noted that after the epidemic had been checked, following anticyclonic weather, the association between the weather and the spread of disease was less apparent.     

A lipid trial tracking system.

A computerized tracking system was developed for the monitoring of recruitment and participant follow-up in the Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). In this study, over 8,000 subjects were screened, from which 1,278 were recruited over a two-year period. Subjects were randomized into three conditions (one is control, the other two with interventions) and followed for one year. Patient lipid profiles, dietary intakes, and psychosocial data were collected at baseline and after one year. The tracking system developed proved essential to the efficient management of WATCH and can be adapted for other research and nonresearch purposes.     

Demographic characteristics, risk behaviors, and HIV seroprevalence among intravenous drug users by site of contact: results from a community-wide HIV surveillance project.

We investigated differences in behaviors important for human immunodeficiency virus (HIV) transmission and HIV antibody status among 927 recent needle users enrolled in a multi-site HIV surveillance project in Worcester, Massachusetts. Subjects were enrolled at drug abuse treatment centers reported less risky injection practices unexplained by demographic variables. Risky sexual practices were in general reported more frequently by men at the jail than men at other sites. However, HIV status showed little relation to enrollment site. These results have implications both for targeting of acquired immunodeficiency syndrome (AIDS) prevention programs to needle users not in drug abuse treatment and for potential selection bias in studies of intravenous drug users.     

Five years' experience of combined impedance and audiometric screening at school entry

Many papers and pilot studies have considered whether school entry auditory screening should include testing with tympanometry. Some of these papers expressed concern that this type of screening would lead to an excessive number of failures and an overloading of ENT facilities. School children in the Worcester district have been screened at school entry using tympanometry, combined with pure tone audiometry, for the past five years. This paper describes how the combined screening programme was set up, and the advantages that have accrued. It also shows that combined testing has not significantly increased the number of children referred to ENT. The author suggests that this combined tympanometry and audiometric screening should become the accepted way to screen school entrants.     

Should clinical pastoral education and professional chaplaincy become more scientific? It's a matter of salt

I address the relationship of Clinical Pastoral Education (CPE) and professional chaplaincy to science by looking at the past in order to find meaning for the present. Specially, I explore the stories of Elwood Worcester, Anton Boisen and the beginnings of CPE. I conclude that these and other founding fathers believed that they were called to continue Christ's healing ministry and turned to science as means to do so although their relationship to science was often strained. Three issues emerge from the past that offer meaning for the present: the significance of a spiritual calling to do healing, the significance of science's "salt effect" as the means that makes a healing ministry possible, and the significance of faith as the identity around which a relationship with science is developed.     

Health Care of People at Work Agricultural Workers

Three per cent of the working population of Great Britain areemployed in agriculture. In spite of the reduction in theirnumbers in recent years it remains a substantial population—some 350 000 people. Medical supervision is notable chieflyby its absence, though the Agricultural Safety Inspectoratehas for years been engaged in improving standards of safetyin dealing with mechanical, toxic and infective hazards. Thisarticle discusses some of the hazards to which agriculturalworkers are exposed and suggests some health precautions thatmight be adopted to protect them.Requests for reprints shouldbe addressed to: Dr D. M. Smith, Health and Safety Executive,Government Buildings, Block ‘C’ Whittington Road,Worcester WR5 2LJ.     

Long-term Exposure to PM2.5 and Incidence of Acute Myocardial Infarction

Background: A number of studies have shown associations between chronic exposure to particulate air pollution and increased mortality, particularly from cardiovascular disease, but fewer studies have examined the association between long-term exposure to fine particulate air pollution and specific cardiovascular events, such as acute myocardial infarction (AMI).Objective: We examined how long-term exposure to area particulate matter affects the onset of AMI, and we distinguished between area and local pollutants.Methods: Building on the Worcester Heart Attack Study, an ongoing community-wide investigation examining changes over time in myocardial infarction incidence in greater Worcester, Massachusetts, we conducted a case–control study of 4,467 confirmed cases of AMI diagnosed between 1995 and 2003 and 9,072 matched controls selected from Massachusetts resident lists. We used a prediction model based on satellite aerosol optical depth (AOD) measurements to generate both exposure to particulate matter ≤ 2.5 μm in diameter (PM_2.5) at the area level (10 × 10 km) and the local level (100 m) based on local land use variables. We then examined the association between area and local particulate pollution and occurrence of AMI.Results: An interquartile range (IQR) increase in area PM_2.5 (0.59 μg/m³) was associated with a 16% increase in the odds of AMI (95% CI: 1.04, 1.29). An IQR increase in total PM_2.5 (area + local, 1.05 μg/m³) was weakly associated with a 4% increase in the odds of AMI (95% CI: 0.96, 1.11).Conclusions: Residential exposure to PM_2.5 may best be represented by a combination of area and local PM_2.5, and it is important to consider spatial gradients within a single metropolitan area when examining the relationship between particulate matter exposure and cardiovascular events.     

Harnessing the power of medical malpractice data to improve patient care

Intelligence gleaned from medical malpractice cases helps health care institutions analyze their litigation practices, trend financial outcomes, and even identify clinical services needing attention. But when examined more deeply, medical malpractice data can also be a powerful patient safety tool by revealing clinical patterns that contribute to medical errors and by enabling leadership to more accurately plan investments in patient safety and risk management. This case study describes how one organization, UMass Memorial Health Care in Worcester, Massachusetts, harnesses its deeply coded medical malpractice data and benchmarks its performance against national peers to catalyze clinical improvements. This strategy has proven successful in yielding positive change in such areas as emergency department ultrasound coverage, obstetrics communication, and airway management training. UMass Memorial's ability to embed claims data use into its culture and to share learning across clinical services offers lessons for health care organizations of any size.