A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project

OBJECTIVES: We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. METHODS: Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. RESULTS: Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. CONCLUSIONS: This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.     

A group intervention to reduce smoking in individuals with psychiatric disorder: brief report of a pilot study

Objectives: To evaluate a group intervention to help individuals with psychiatric disorder stop smoking.
Method: A waitlist-treatment crossover design. Outcome measures included smoking cessation, motivation to stop, the Fagerstrom Test for Nicotine Dependence (FTND), urinary cotinine and psychiatric symptoms on the General Health Questionnaire.
Results: 38 subjects participated, of whom 19 completed the waitlist and intervention phases. There were no significant differences between subjects and dropouts. During the waitlist period there were no significant changes in tobacco use. At the end of the intervention, almost a quarter had stopped smoking, ( z = -2.24, p =0.02). Subjects also showed significant improvements on state of change, FTND score and urinary cotinine levels. These improvements were maintained at three-month follow-up (n=10). Psychiatric morbidity showed no change.
Conclusions: It is possible to reduce smoking in individuals with psychiatric disorder.
Implications: Larger randomised controlled trials are indicated to determine the relative contributions of nicotine replacement, bupropion and group interventions to smoking cessation in this population.     

A group intervention to reduce smoking in individuals with psychiatric disorder: brief report of a pilot study

OBJECTIVES: To evaluate a group intervention to help individuals with psychiatric disorder stop smoking. METHOD: A waitlist-treatment crossover design. Outcome measures included smoking cessation, motivation to stop, the Fagerstrom Test for Nicotine Dependence (FTND), urinary cotinine and psychiatric symptoms on the General Health Questionnaire. RESULTS: 38 subjects participated, of whom 19 completed the waitlist and intervention phases. There were no significant differences between subjects and dropouts. During the waitlist period there were no significant changes in tobacco use. At the end of the intervention, almost a quarter had stopped smoking, (z = -2.24, p = 0.02). Subjects also showed significant improvements on state of change, FTND score and urinary cotinine levels. These improvements were maintained at three-month follow-up (n = 10). Psychiatric morbidity showed no change. CONCLUSIONS: It is possible to reduce smoking in individuals with psychiatric disorder. IMPLICATIONS: Larger randomised controlled trials are indicated to determine the relative contributions of nicotine replacement, bupropion and group interventions to smoking cessation in this population.     

A retrospective analysis of boarding times for adolescents in psychiatric crisis

ABSTRACT

The boarding of children and adolescents with identified psychiatric conditions at medical facilities has numerous negative effects on the patients and the systems that treat them. Efforts to minimize boarding times serves to increase patients’ access to appropriate levels of care, redirect medical resources to patients who need them most, and reduce safety risks to people and property. This study explores the role Clinical Social Workers can play in facilitation of care and highlights the advantages of a coordinated data collection process facilitated by the effective use of the Electronic Medical Record. A retrospective chart analysis of 100 patients admitted to the Emergency department at a pediatric hospital in Central Florida was conducted for patients seen between 1 January 2015 and 30 June 2016. The data suggest key correlates that may impact the boarding times of pediatric patients presenting in a psychiatric crisis and the average duration of boarding time in hours (M = 5.11, SD = 2.07) was found to be significantly lower than prior published studies in the adult and pediatric literature. Discussion of these data implications on behavioral health practice is discussed.     

Medicare Part A utilization and expenditures for psychiatric services: 1995

This study provides an overview of Medicare's current coverage and payment policies regarding hospitalization for psychiatric disorders, and presents new information on demographic, diagnostic, utilization, and expenditure characteristics associated with inpatient psychiatric care among 1995 Medicare beneficiaries. Results suggest that utilization and expenditure patterns for Medicare beneficiaries hospitalized for psychiatric illness in 1995 differ across demographic (e.g., age, sex, race) and diagnostic categories. The implications of these findings for current management of the Medicare program as well as the evolution of Medicare managed care systems for behavioral health services are discussed.     

A brief smoking cessation intervention for Chinese and Korean American smokers

OBJECTIVE: This study evaluated changes in smoking-related beliefs and behavior following a brief, culturally adapted smoking cessation intervention for Chinese and Korean smokers. METHOD: From May 2002 to March 2003, 66 smokers residing in or around southeastern Pennsylvania were randomly assigned to a theory-based smoking cessation intervention or general health counseling. Participants completed assessments of perceived risks of smoking, pros and cons of quitting, quitting self-efficacy, and distress at baseline and follow-up time points. Sessions were conducted in the participant's native language (Korean, Cantonese, or Mandarin). Both groups received nicotine replacement therapy. RESULTS: Overall, 38% of participants reported quitting smoking at 3-month follow-up. Quit rates were higher (52.6% among Chinese, 60.0% among Korean) in the intervention condition compared to the control condition (23.5% among Chinese, 40.0% among Korean) at 1-month, but not 3-month, follow-up. There was a main effect of treatment condition for self-efficacy with intervention participants reporting significantly higher levels of self-efficacy compared to control participants. Further, a treatment x time interaction was observed for cons of quitting, reflecting fewer cons in the intervention group than the control group at 1-month and 3-month follow-up. CONCLUSION: A culturally adapted intervention for Chinese and Korean Americans can be effective in changing specific smoking-related cognitions and behavior. This study represents a promising first step toward advancing our understanding of the associations between smoking-related cognitions and behavior among Asian American smokers.     

Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes

BACKGROUND: Adolescent mothers may be at increased risk of irreversible bone loss during pregnancy and lactation, particularly when calcium intake is low. OBJECTIVE: Longitudinal changes in bone mass from lactation to postweaning were evaluated in 10 adolescent mothers aged 15-18 y who habitually consumed <500 mg Ca/d. DESIGN: Total-body bone mineral content (TBBMC), total-body bone mineral density (TBBMD), and lumbar spine bone mineral density (LSBMD) were measured at lactation (6-24 wk postpartum) and after weaning (12-30 mo postpartum). Serum hormones (intact parathyroid hormone, estradiol, and prolactin), serum calcium, and markers of bone turnover [urinary N-telopeptide cross-linking region of type I collagen (NTx) and plasma activity of bone alkaline phosphatase] were measured at lactation. RESULTS: TBBMC, total calcium content, TBBMD, and LSBMD increased from lactation to postweaning (P < 0.01). TBBMD and LSBMD were, respectively, 3.6% and 9.7% lower than predicted at lactation and 0.3% and 4.8% lower than predicted in the postweaning period. The increase in age-matched TBBMD adequacy was correlated with the time after resumption of menses (r = 0.86, P < 0.01). Calcium accretion from lactation to postweaning correlated negatively with estradiol (r = -0.86) and prolactin (r = -0.69) and positively with intact parathyroid hormone (r = 0.72) and NTx (r = 0.84) measured at lactation (P < 0.05). CONCLUSIONS: It appears that adolescent mothers with habitually low calcium intakes recover from lactation-associated bone loss after weaning. The rate of bone accretion, however, may not be sufficient to attain peak bone mass at maturity. Hormones regulating bone turnover during lactation may influence bone recovery in adolescent mothers.     

A brief smoking cessation intervention for women in low-income planned parenthood clinics

OBJECTIVES: The purpose of this study was to evaluate a brief smoking cessation intervention for women 15 to 35 years of age attending Planned Parenthood clinics. METHODS: Female smokers (n = 1154) were randomly assigned either to advice only or to a brief intervention that involved a 9-minute video, 12 to 15 minutes of behavioral counseling, clinician advice to quit, and follow-up telephone calls. RESULTS: Seventy-six percent of those eligible participated. Results revealed a clear, short-term intervention effect at the 6-week follow-up (7-day self-reported abstinence: 10.2% vs 6.9% for advice only, P < .05) and a more ambiguous effect at 6 months (30-day biochemically validated abstinence: 6.4% vs 3.8%, NS). CONCLUSIONS: This brief, clinic-based intervention appears to be effective in reaching and enhancing cessation among female smokers, a traditionally underserved population.     

A brief telephone intervention targeting treatment engagement from a substance abuse program wait list

This study compares three brief participant-initiated telephone interventions aimed at enhancing treatment engagement of individuals on a substance abuse treatment wait list. Policies requiring that wait list members call at least every other week in order to remain eligible for treatment remained in place for the standard and enhanced conditions but not for the voluntary condition. The standard condition was a minimal intervention, providing information on the program. The enhanced condition focused on client motivation for treatment and recovery. If individuals in the voluntary condition called, they were provided information about current wait list number and approximate remaining wait time. The rate of treatment engagement was the same among treatment conditions. The best predictor of engagement was the number of calls placed to the program while waiting. Treatment condition was a positive predictor of call frequency; presence of a comorbid psychiatric diagnosis was a negative predictor. The article also discusses future directions.     

Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment?

Background  

Patients with psychiatric problems often seek help and assistance in hospital emergency departments. An important task of emergency room staff is to decide whether such patients need to be admitted or whether they can be treated on an outpatient basis.     

Factors that help injecting drug users to access and benefit from services: A qualitative study

Background  

International research shows that injecting drug users (IDUs) can encounter many barriers when they try to access drug treatment and other services. However, the existing literature is mostly quantitative and does not consider the kinds of factors that injectors themselves identify as enabling them to access and benefit from services. Responding to this gap in knowledge, our paper explores IDUs' own suggestions for improving service engagement and their reports of other factors enabling them to seek help.     

A threshold concentration of anti-merozoite antibodies is required for protection from clinical episodes of malaria

Antibodies to selected Plasmodium falciparum merozoite antigens are often reported to be associated with protection from malaria in one epidemiological cohort, but not in another. Here, we sought to understand this paradox by exploring the hypothesis that a threshold concentration of antibodies is necessary for protection. We analyzed data from two independent cohorts along the Kenyan coast, one in which antibodies to AMA1, MSP-2 and MSP-3 were associated with protection from malaria (Chonyi) and another in which this association was not observed (Junju). We used a malaria reference reagent to standardize antibody measurements across both cohorts, and applied statistical methods to derive the threshold concentration of antibodies against each antigen that best correlated with a reduced risk of malaria (the protective threshold), in the Chonyi cohort. We then tested whether antibodies in Junju reached the protective threshold concentrations observed in the Chonyi cohort. Except for children under 3 years, the age-matched proportions of children achieving protective threshold concentrations of antibodies against AMA1 and MSP-2 were significantly lower in Junju compared to Chonyi (Fishers exact test, P < 0.01). For MSP-3, this difference was significant only among 4–5 year olds. We conclude that although antibodies are commonly detected in malaria endemic populations, they may be present in concentrations that are insufficient for protection. Our results have implications for the analysis and interpretation of similar data from immuno-epidemiological studies.     

A suspicion of AIDS is sufficient to trigger exams for food handlers

The Michigan Supreme Court has ruled that food handlers suspected of having AIDS can be required by their employers to undergo testing for opportunistic infections. Such employers are obligated by the Public Health Code and by other food-safety regulations to exclude employees who may transmit opportunistic diseases such as salmonella and tuberculosis. The ruling applies only to the food services industry. Employees may not be tested specifically for HIV, and may not be fired if they have AIDS but are free from other diseases. This ruling came as a result of a suit filed by Dorene Sanchez against the Paradise Family Restaurant. Based on rumors that Sanchez had AIDS, the restaurant owner asked Sanchez to be tested and to not return to work without a doctor's note certifying that she was healthy. Sanchez's test was negative, and she sued claiming discrimination under the Michigan Handicappers' Civil Rights Act.     

A call for help. Collaboration with community officials is key

The U.S. government's war on terrorism is a battle with an unseen enemy that uses tactics that are just as elusive. Although such conventional terrorists' assault methods as bombs and other explosives are a major concern, the threat of a biological, chemical or nuclear attack is particularly troubling to the government and those who would have to deal with the aftermath of such an attack.