Public health reasoning: much more than deduction

The deductive paradigm has produced notable successes in epidemiology and public health. But while deductive logic has made a substantial contribution to the public health field, it must be recognized that there are also limits to that contribution. This report examines one such limit: the need for non-deductive models in public health reasoning. The findings of a study of public health reasoning in 879 members of the public are reported. Four non-deductive strategies were chosen for their capacity to bridge gaps in one’s knowledge. It emerged that subjects were adept at using these strategies in the absence of knowledge to arrive at judgements about public health problems. The implications of this finding for public health communication are discussed.     

Transitional Care Coordination in New York City Jails: Facilitating Linkages to Care for People with HIV Returning Home from Rikers Island

New York City (NYC) jails are the epicenter of an epidemic that overwhelmingly affects Black and Hispanic men and offer a significant opportunity for public health intervention. The NYC Department of Health and Mental Hygiene instituted population based approaches to identify the HIV-infected, initiate discharge planning at jail admission, and facilitate post-release linkages to primary care. Using a caring and supportive ‘warm transitions’ approach, transitional care services are integral to continuity of care. Since 2010, over three-quarters of known HIV-infected inmates admitted to jails received discharge plans; 74 % of those released were linked to primary care. The EnhanceLink initiative’s new Health Liaison, a lynchpin role, facilitated 250 court-led placements in medical alternatives to incarceration. Transitional care coordination programs are critical to facilitate continuity of care for people with chronic health conditions including the HIV-infected returning home from jail and for the public health of the communities to which they return.     

A Rapid Effect of Caffeinated Beverages on Two Choice Reaction Time Tasks

Abstract

Though consumers of tea and coffee can report feeling beneficial subjective effects of consumption virtually immediately, tests for objective effects of caffeine immediately post-consumption have been rare. Two experiments examined caffeine's ability to influence reaction time in choice reaction time tasks, using a dose of caffeine typical of a cup of tea or instant coffee, and testing at short post-consumption delays. Two groups of participants were given 60 mg of caffeine, after overnight abstinence, either in a hot tea drink, or a hot water drink. Two control groups also received hot tea or water, but without caffeine. In Experiment 1, participants were given a keypress task before the drink (baseline), immediately after the drink, and 40 min after the drink. In Experiment 2, a touch-screen test was given either 1, 14, or 27 min post consumption. Caffeine was found to reduce the effect of a distracter on reaction time in the keypress test and to reduce reaction time in a component of the touch-screen task; however, in neither experiment were these effects significantly modulated by post-consumption delay length. Thus, the speed of caffeine's action on psychomotor performance was shown to be on the order of minutes.     

Work-related stressors and occurrence of adverse events in an ED

ObjectiveThe purpose of this study was to investigate the relationship between 12 work-related stressors and the occurrence of adverse events in an emergency department (ED).MethodsNurses and physicians, working in an ED at a Danish regional hospital, filled out a questionnaire on occurrence and emotional impact of 12 work-related stressors after each shift during a 4-week period. The questionnaire also instructed the participants to describe any adverse events that they were involved in during the shift.ResultsTwo hundred fourteen adverse events were reported during the 979 studied shifts. During the same period, only 27 adverse events were reported to the mandatory national reporting system, and only 10 of these were duplicates. A high variability of stressors and emotional impact among the different groups of participants was found. Linear regression analysis showed an association between involvement in adverse events and the occurrence and emotional impact of stressors across groups, whereas no significant association was found for age, seniority, shift type, or length.ConclusionThe study showed an association between the occurrence and impact of 12 work-related stressors and involvement in adverse events across the groups of participants. Furthermore, the study showed that most adverse events were not reported to the mandatory national reporting system.     

Organizational defenses against the anxiety of terminal illness: A case study

Abstract

Working with the dying is a task which generates enormous anxiety in the caregiver as well as the entire organization which has taken on this assignment. This case study deals with a chronic care hospital and the organizational defense mechanisms observed by a consultant hired to do staff training and development. Further, there is a discussion of the training model devised to provide a facilitative means of tapping those defenses and working through the anxiety.