Evaluation of a workplace brief intervention for excessive alcohol consumption: the workscreen project

BACKGROUND: The workplace provides a useful setting for early identification and intervention with individuals who have unhealthy lifestyles. The objective was to evaluate the effects of a workplace-based lifestyle intervention (Workscreen) to reduce excessive drinking. METHOD: There were eight Australia Post networks randomly allocated to experimental and control conditions, comprising 67 worksites and 1206 employees. The experimental condition involved a broad spectrum lifestyle campaign, incorporating support from management, employee awareness of health, and brief interventions for high-risk behaviors, including excessive alcohol use. Focus groups identified relevant cultural factors. Changes in workplace culture and employee behavior were assessed 10 months after baseline. Males and females were analyzed separately. RESULTS: Over half of APOST employees participated at each screening point. In the experimental condition 61% of employees overall and 58% of those identified as excessive drinkers in Phase 1 responded to the lifestyle campaign by attending health assessments. Analyses focusing on the organization as a whole did not reveal significant reductions in excessive alcohol consumption among men or women. However, a significant reduction in number of drinks was observed in the experimental condition among women for whom completion of baseline and follow-up could be confirmed (P < 0.001). CONCLUSIONS: The present study indicates that a workplace-based lifestyle campaign can assist self-selected employees in reducing their alcohol consumption. There was a moderately high level of participation among those identified as drinking excessively, which supports our approach of embedding a low-intensity alcohol program within the context of a broader health promotion campaign.     

Cost-effectiveness analysis of a family physician delivered smoking cessation program

OBJECTIVES: The objectives were to present a cost-effectiveness analysis of a smoking cessation program delivered by physicians and compare results to other smoking cessation interventions. METHODS: Retrospective effectiveness figures from a previous evaluation of the smoking cessation program were supplemented with estimates based on researched assumptions. Net abstinence rates were determined for smokers, depending on their stage of readiness to quit, that is, "prepared," "contemplative," and "precontemplative," leading to an assessment of the number of smokers achieving abstinence as a result of the Smokescreen intervention. Costs were calculated from the perspectives of smokers, family physicians, organizers, trainers, and all parties combined. Assumptions were varied with a sensitivity analysis. RESULTS: Baseline costs per additional abstainer were $183 based on physicians' intervention costs at 1995 prices. This is the figure most comparable to previously conducted economic evaluations of smoking cessation interventions. Sensitivity analysis varying the perspective and under optimistic and pessimistic assumptions about effectiveness produced a wide variety of estimates. The decision to include or exclude training costs had a particularly important bearing on the estimates. However, under reasonable assumptions the cost per additional quitter compares favorably to smoking and other medical and health care interventions worldwide. CONCLUSIONS: The program appears cost-effective when compared to other smoking cessation and health promotion interventions and illustrates the potential for retrospective cost-effectiveness analysis of interventions.     

Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trial

OBJECTIVES: This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness. METHODS: Street-dwelling persons with severe mental illness were randomly assigned to the experimental program (called Choices) or to standard treatment in New York City. We assessed study participants at baseline and at 6-month intervals over 24 months, using measures of service use, quality of life, health, mental health, and social psychological status. The average deviation from baseline summary statistic was employed to assess change. RESULTS: Compared with persons in standard treatment (n = 77), members of the experimental group (n = 91) were more likely to attend a day program (53% vs 27%), had less difficulty in meeting their basic needs, spent less time on the streets (55% vs 28% reduction), and spent more time in community housing (21% vs 9% increase). They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms. CONCLUSIONS: With an appropriate service model, it is possible to engage disaffiliated populations, expand their use of human services, and improve their housing conditions, quality of life, and mental health status.     

Role of cystourethrography in the preoperative evaluation of stress urinary incontinence in women

Thirty-two women with stress urinary incontinence and 27 control continent patients with pelvic relaxation underwent a detailed clinical and urodynamic evaluation of the lower urinary tract. All patients underwent a standard chain urethrocystographic evaluation to detect anatomic pathology of the lower urinary tract. Urethrocystographic study included an evaluation of the posterior and anterior urethral angle, funneling of the proximal urethra on straining, the position of the urethrovesical junction and flattening of the bladder base. No differences were seen in the incidence of radiographic findings in women with pelvic relaxation with or without stress urinary incontinence. All five cystographic criteria were similar in the continent and stress incontinence patients. Static urethrocystography cannot differentiate women with and without stress urinary incontinence from among those with pelvic relaxation and thus should not be relied upon in the evaluation of women with urinary incontinence.     

Perinatal lead and cadmium burden in a British urban population.

Concentrations of the potential pollutants, lead and cadmium, were studied in the perinatal period in a British urban population. Blood lead and cadmium concentrations and iron status were measured in 28 mother and infant pairs at delivery and at five days postpartum in the mother; breast milk collected at five days postpartum under controlled conditions was analysed for lead and cadmium. Placental transfer of both metals was noted; concentrations of lead in breast milk (mean concentration 0.01 mmol/l (2 micrograms/l) were less than in two brands of commercial prepacked formulas, and the concentration of cadmium in breast milk and prepacked formulas (mean 3.6 nmol/l (0.4 microgram/l] were similar. The risk of excess lead or cadmium intake from breast milk is small.     

Assessment of diaphragm function after stellate ganglion block using magnetic stimulation

Stellate ganglion block is a procedure frequently used for the management of patients with chronic sympathetically mediated pain affecting the arm, neck or head. We studied the effect of stellate ganglion block on ipsilateral phrenic nerve function, and hence diaphragmatic strength, in 11 adult patients with chronic sympathetically mediated pain. Pre- and post-block forced vital capacity (FVC) measurements were recorded using a pneumotachograph and a Magstim nerve stimulator was used to generate pre- and post-block twitch mouth pressures (P(TWM)). This device can be used to stimulate the phrenic nerves and hence the diaphragm. The resulting change in airway pressure was measured at the mouth and has previously been shown to reflect diaphragm strength. There was no statistically significant difference in FVC or P(TWM) pre- or post stellate ganglion block. In conclusion, a stellate ganglion block has no adverse effect on ipsilateral phrenic nerve function or diaphragm strength in healthy adult patients.     

Effects of meniscal and articular surface status on knee stability,function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study

BACKGROUND: Concomitant injuries to secondary structures have been proposed as a major cause of failure of anterior cruciate ligament reconstruction. PURPOSE: Our purpose was to determine the relationship between meniscal status at the time of anterior cruciate ligament reconstruction and ultimate long-term function and stability. STUDY DESIGN: Prospective cohort study. METHODS: We prospectively studied 63 patients for an average of 10.4 years after arthroscopically assisted bone-patellar tendon-bone anterior cruciate reconstruction. All surgeries were performed between 1988 and 1991; concomitant meniscal surgery was performed if necessary. Subjects were divided into subgroups relative to the integrity of their menisci at the end of the reconstruction procedure (intact meniscus, partial meniscectomy, complete meniscectomy). RESULTS: Patients who had undergone any degree of meniscal resection reported significantly more subjective complaints and activity limitations than those with intact menisci. Subjective International Knee Documentation Committee and Lysholm scores were lower in the meniscectomy subgroups than in the meniscus-intact group. Objective testing revealed a significantly lower ability to perform the single-legged hop in the meniscectomy subgroups. Ligament stability based on instrumented laxity measurements was not significantly different between the subgroups. Radiographic abnormalities were also more common in the subgroups that had undergone meniscectomy. CONCLUSIONS: The menisci should be repaired if at all possible, especially in the setting of anterior cruciate ligament reconstruction, for optimal functional outcome and patient satisfaction.     

Constraints on the Use of Animal Source Foods for Young Children in Ghana: A Participatory Rapid Appraisal Approach

Micronutrient deficiencies limit child health and development. Although animal source foods (ASF) provide highly bioavailable micronutrients, Ghanaian preschoolers consume little. Participatory rapid appraisal methods identified constraints to the availability, accessibility, and utilization of ASF. Stakeholders working with or living in six communities in three agro-ecological zones reported constraints including low income, lack of access to technology and markets, inequitable household food allocation, inadequate knowledge, and beliefs. The least expensive ASF was fish, which was easy to preserve and consumed by all communities. Since ASF was primarily purchased, interventions that increase income may be most successful in improving Ghanaian children's diets.     

Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study.

AIMS: To study the frequency and associations of early postpartum discharge and infant readmission to hospital. METHODS: Infants readmitted to hospital during the first 28 days of life in 1998 in the Northern Region of the UK were studied. RESULTS: A total of 4743 of 11,338 (42%) babies were discharged on or before the first postnatal day. Rates of early discharge varied significantly between hospitals. Infants <2500 g at birth (adjusted odds ratio (AOR) 0.44, 95% CI 0.29 to 0.66), infants 35-37 weeks gestation at birth (AOR 0.65, 95% CI 0.49 to 0.86), and firstborn infants (AOR 0.09, 95% CI 0.08 to 0.10) were less likely to be discharged early. Women from more deprived areas were more likely to be discharged early (AOR 1.37, 95% CI 1.12 to 1.67). A total of 907 of 32,015 (2.8%) babies liveborn in the region were readmitted to hospital during 1998. Readmission rates varied significantly by hospital of birth but not by timing of discharge. Babies <2500 g at birth (AOR 1.95, 95% CI 1.16 to 3.28) and babies born at 35-37 weeks gestation (AOR 1.72, 95% CI 1.15 to 2.57) were more likely to be readmitted. Breast fed babies were less likely to be readmitted (AOR 0.69, 95% CI 0.53 to 0.90). Infants initially discharged early were not more likely to be readmitted. CONCLUSIONS: Early discharge occurred variably in the Northern Region in 1998. It is not associated with readmission to hospital. Breast feeding is associated with lower rates of readmission to hospital.