Percepciones sobre salud (física, mental y bucal) en un grupo de mujeres en situación de prostitución en la ciudad de Medellín / Perceptions about health (physical, mental and oral) in a group of women in situation of prostitution in the city of Medellin

Introducción: las mujeres y las personas trans que han ejercido el trabajo sexual se encuentran vulneradas puesto que son víctimas de discriminación por su condición laboral, por su género y por los riesgos que acarrea esta labor, y esto impacta en su situación de salud. Este estudio tuvo como objetivo conocer las percepciones sobre salud (física, mental y bucal) en cuatro mujeres que ejercen la prostitución en Medellín, a partir de sus experiencias de vida y aquellas relacionadas con su contexto social. Métodos: se realizó una investigación cualitativa con enfoque etnográfico para analizar las situaciones mencionadas de acuerdo con el objetivo general. Se contó con la participación de cuatro mujeres: dos de nacionalidad venezolana y dos de nacionalidad colombiana; se llevaron a cabo entrevistas semiestructuradas. Se realizó análisis de contenido cualitativo, lo cual permitió la generación de cuatro categorías (salud mental, salud bucal, salud general y calidad de vida). Resultados: sus discursos permitieron elucidar la conexión entre las condiciones de vida y la situación de salud. La falta de oportunidades laborales, un proceso migratorio de profundos cambios económicos y sociales, y una Colombia con inequidades y barreras de acceso a servicios de salud y sociales, son procesos determinantes de orden general, particular y singular de las precarias condiciones de salud bucal y general. Conclusiones: la población participante se encuentra en situación de vulnerabilidad social y de salud, lo cual evidencia la necesidad de políticas públicas y estrategias basadas en la realidad social que contribuyan a generar equidad en salud.

Introduction: women and trans people who have engaged in sex work are triply vulnerable since they are victims of discrimination due to their employment status, their gender, and the risks that this work entails, this impacts their health situation. This study aimed to know the perceptions about health (physical, mental, and oral) of four women who work in prostitution in Medellin, based on their life experiences and those related to their social context. Methods: qualitative research with an ethnographic approach was conducted to analyze the situations mentioned. Four women participated, two Venezuelans and two Colombians, and semi-structured interviews were conducted. Qualitative content analysis was performed, which allowed the generation of four categories (mental health, oral health, general health, and quality of life). Results: her discourses made it possible to elucidate the connection between the living conditions and the health situation. Lack of job opportunities, a migratory process of profound economic and social changes, and a Colombia with inequities and barriers to access to health and social services are determining processes of a general and singular order of the precarious conditions of oral health and general. Conclusions: the participating population is in a situation of social and health vulnerability, which shows the need for public policies and strategies based on the social reality that contribute to generating equity in health.

Satisfacción en los servicios de salud sexual y reproductiva: perspectiva de jóvenes. Medellín-Colombia / Satisfaction in Sexual and Reproductive Health Services: Youth Perspective. Medellín-Colombia / Satisfação nos serviços de saúde sexual e reprodutiva: perspectiva de jovens. Medellín-Colômbia

Resumen Objetivo: comprender la satisfacción en jóvenes de Medellín, Colombia, frente a los servicios de salud sexual y reproductiva ofertados en la Ciudad durante el período 2014-2015. Metodología: estudio cualitativo que utilizó la teoría fundada como método y el interaccionismo simbólico como perspectiva teórica. Para la recolección de información se realizaron nueve entrevistas en profundidad y un grupo focal con jóvenes entre 14 y 25 años, usuarios de los servicios de salud para jóvenes en la ciudad de Medellín. Resultados: la manera de ofrecer la atención y las características actitudinales del prestador del servicio son vitales para el logro de la satisfacción y la adhesión al servicio de asesoría en salud sexual y reproductiva. La escucha activa, el respeto, la construcción de confianza y la información diversa y sin tabúes, son fundamentales para responder a las necesidades de la población joven y generar un vínculo joven-prestador. Conclusión: para los jóvenes, la satisfacción y la adherencia a los servicios de salud están íntimamente ligados a la construcción de un vínculo de confianza con el servicio y con el prestador del servicio a partir de compartir y conversar lo que se vive, se piensa y se siente cotidianamente, promoviendo conciencia de autocuidado, actitudes críticas y reflexivas frente a la toma de decisiones.

Abstract Objective: To understand the satisfaction level of young people from Medellin, Colombia, about the sexual and reproductive health services offered in the City during the 2014-2015 period. Methodology: qualitative study that used grounded theory as a method and symbolic interactionism as a theoretical perspective. The collection of information was carried out by applying nine in-depth interviews and one focus group with young people between 14 and 25 years old, users of health services for young people in the city of Medellin. Results: The way of offering care and the attitudinal characteristics of the service provider are vital for achieving satisfaction and adherence to the sexual and reproductive health advisory service. Active listening, respect, trust building and diverse taboofree information is essential to respond to the needs of the young population and generate a young-provider bond. Conclusion: for young people, satisfaction and adherence to health services are intimately linked to building a bond of trust with the service and with the service provider based on sharing and talking about what is experienced, what is thought and what is felt on a daily basis, promoting awareness of self-care, critical and thoughtful attitudes towards decision-making.

Resumo Objetivo: compreender a satisfação em jovens de Medellín, Colômbia, frente aos serviços de saúde sexual e reprodutiva ofertados na Cidade durante o período 2014-2015. Metodologia: estudo qualitativo que utilizou a teoria fundada como método e o interaccionismo simbólico como perspectiva teórica. Para a colheita de informação foram feitas nove entrevistas em profundidade e um grupo focal com jovens entre 14 e 25 anos, usuários dos serviços de saúde para jovens na cidade de Medellín. Resultados: a maneira de oferecer a atenção e as características atitudinais do prestador do serviço são vitais para o logro da satisfação a adesão ao serviço de assessoria em saúde sexual e reprodutiva. A escuta ativa, o respeito, a construção de confiança e a informação diversa e sem tabus, são fundamentais para responder às necessidades da população jovem e gerar um vínculo jovem-prestador. Conclusão: para os jovens, a satisfação e a aderência aos serviços de saúde estão intimamente ligados à construção de um vínculo de confiança com o serviço e com o prestador do serviço a partir de compartir e conversar o que se vive, se pensa e se sente cotidianamente, promovendo consciência de autocuidado, atitudes críticas e reflexivas frente à toma de decisões.

Experience on how to implement a preanalytical and POCT unit in Madrid's IFEMA field hospital during this unprecedented COVID-19 emergency.

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.

Comparative study of pencil-and-paper and electronic formats of GHQ-12, WHO-5 and PHQ-9 questionnaires. / Estudio comparativo de los formatos en lápiz y papel y electrónicos de los cuestionarios GHQ-12, WHO-5 y PHQ-9.

INTRODUCTION: The increase in telemedicine in the mental health field has led to psychometric instruments changing from paper-and-pencil administration to an electronic format. A study is performed to determine if both formats are equivalent for well-known questionnaires such as GHQ-12, WHO-5, and PHQ-9. MATERIAL AND METHODS: Forty-seven volunteers completed GHQ-12, WHO-5 and PHQ-9 questionnaires in paper-and-pencil format, and in the following 24h they completed their electronic versions via the web site www.memind.net. An electronic-Likert format was used by 24 participants, and 23 used an electronic-slider format. Internal consistency was measured by α-Cronbach index and omega coefficient, and test-retest was measured by the intraclass correlation coefficient (ICC). Agreement between individual items was compared using Weighted Kappa coefficients, and dimensional structure between formats using the Comparative Fit Index (CFI). RESULTS: Internal consistency was higher than 0.8 for GHQ-12 and WHO-5. The ICC ranged between 0.655 for PHQ-9 paper-and-pencil/electronic-slider and 0.901 for GHQ-12 paper-and-pencil/electronic- slider. Agreement for individual items in paper-and-pencil and electronic-Likert versions was variable, ranging from low agreement in PHQ-1 (weighted κ=0.143; P=.384) to high agreement in PHQ-5 (weighted κ=0.769; P=.000). The CFI results showed an adequate equivalence between formats. CONCLUSIONS: Except for the PHQ-9 electronic-Likert, questionnaires keep their structure in electronic formats. Discrepancies were found in items agreement. This study supports previous works indicating that the change from paper-and-pencil to electronic formats is not an immediate process, and needs a proper adaptation.

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

CONTEXT: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. OBJECTIVE: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. DESIGN: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. SETTING: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. PARTICIPANTS: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. INTERVENTION: The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. MAIN OUTCOME MEASURES: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. RESULTS: For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. CONCLUSION: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

Instrumento para la evaluación curricular de la función de administración en la Carrera de Medicina / A tool for curricular evaluation of the management function of Medicine career

Introducción: La formación actual de médicos en Cuba responde a las necesidades de salud de la población de nuestro país y de otros lugares del mundo. El Área de Docencia e Investigación del Ministerio de Salud Pública creó un grupo de investigación, el cual diseñó el proyecto Efectividad del Currículo de Medicina. Uno de los cortes de valoración del currículo evalúa la correspondencia entre el modelo del profesional declarado para las cinco funciones descritas en el currículo y el profesional en formación. Una de las cinco funciones que se describe es la función de administración. Objetivo: Diseñar un instrumento para evaluar la correspondencia entre la función de administración modelada en el currículo de la Carrera de Medicina y los resultados que muestran los profesionales en formación. Material y métodos: Se realizó una investigación de desarrollo tecnológico en tres etapas: primera: diseño del instrumento evaluativo; segunda: aplicación de la encuesta y ejecución del ejercicio teórico-práctico; tercera: valoración del instrumento. Resultados: El instrumento diseñado demostró que con el actual currículo la función de administración se cumple en 77.07 por ciento. La totalidad de los profesores y la mayor parte de los estudiantes se proyectaron correctamente, al focalizar sus opiniones en los aspectos requeridos para la validación. Conclusiones: El instrumento diseñado permitió evaluar la correspondencia entre la función de administración modelada en el currículo de la Carrera de Medicina y los resultados que muestran los profesionales en formación. Las acciones de validación aplicadas apoyan la validez del instrumento en cuanto a su contenido y operatividad en la práctica(AU)

Introduction: Current medical training in Cuba responds to the health needs of the population of our country and others worldwide. The Teaching and Research Department belonging to the Ministry of Public Health created a research group, which designed the project Medicine Curriculum Effectiveness. One of the partial curriculum assessments evaluates the correspondence between the professional model declared for the five functions described in the curriculum and professional training. One of the five functions described in the model is the management function. Objective: To design a tool to assess the correspondence between the management function declared and modeled in the curriculum and the actual results showed by professionalist on training. Material and Methods: An investigation of technological development was performed in three stages: First: design an assessment instrument; Second: implementation of the survey and of theoretical - practical exercise; Third: valuation of the instrument. Results: The designed instrument demonstrated that, with the current educational curriculum, management function is fulfilled in a 77.07 percent. All the teachers and mostly of students disclosed correctly, focusing their opinions on the required aspects for validation. Conclusions: Was designed a tool for assessing the correspondence between the management function declared and modeled in the curriculum and the actual results showed by the training professionalist. The applied validation actions support the instrument's tenability in terms of their operativeness and content(AU)

Efectividad del currículo de la carrera de Medicina. Diseño y validación de instrumentos para valorar la función de investigación / Curriculum effectiveness of the medical career. Design and validation of tools to assess the role of research

Introducción: la formación actual de médicos en Cuba responde a las necesidades de salud de la población del nuestro país y de otros lugares necesitados del mundo. El Área de Docencia e Investigación del Ministerio de Salud Pública creó un grupo de investigación, el cual diseñó el proyecto Efectividad del Currículo de Medicina. Uno de los cortes de valoración del currículo evalúa la correspondencia entre el modelo del profesional declarado para las cinco funciones descritas en el currículo y el profesional en formación. Una de las cinco funciones que se describe en el modelo es la función de investigación. Objetivo: diseñar un instrumento para evaluar la correspondencia entre el modelo del profesional declarado para la función de investigación en el currículo y el profesional en formación. Material y métodos: se realizó una investigación de desarrollo tecnológico en tres etapas: primera: diseño del instrumento evaluativo; segunda: ejecución de los ejercicios teóricos y prácticos; tercera: valoración del instrumento. Resultados: mediante el instrumento diseñado se demostró que con el actual currículo la función de investigación se cumple en 80.8%. La totalidad de los profesores y la mayor parte de los estudiantes se proyectaron correctamente, al focalizar sus opiniones en los aspectos requeridos para la validación. Conclusiones: se diseñó un instrumento que permite evaluar la correspondencia entre el modelo del profesional declarado para la función de investigación en el currículo y el profesional en formación. Las acciones de validación aplicadas apoyan la validez del instrumento en cuanto a su contenido y operatividad en la práctica.

Introduction: current medical training in Cuba responds to the health needs of the population of our country and others in need around the world. The Department of Teaching and Research of the Ministry of Health created a research group, which designed the project Curriculum Effectiveness of Medicine. One of the cuts curriculum assessments evaluates the correspondence between the professional model declared for the five functions described in the curriculum and professional training. One of the five functions described in the model is the role of research. Objective: to design an instrument to assess the correspondence between the professional models for the function declared in curriculum research and professional training. Material and methods: a technological development research was conducted in three stages: first: design of the assessment instrument; second: implementation of the theoretical and practical exercises; Third, assessment of instrument. Results: using the designed instrument showed that the current curriculum with the research function is fulfilled by 80.8%. All the teachers and most students are projected correctly, to focus their views on the aspects required for validation. Conclusions: a tool for assessing the correspondence between the professional models for the function declared in curriculum research and professional training is designed. Shares applied validation support the validity of the instrument in terms of content and functionality in practice.

Valoración de las actividades de orientación de contenido de la disciplina Morfofisiología Humana / Assessment of the content orientation activities of Human Morphophysioloogy discipline

Se realizó una investigación descriptiva, de corte transversal, en cuatro policlínicos facultades del Polo de Formación de Jagüey Grande con el objetivo de valorar la preparación y desarrollo de las actividades de orientación de contenidos, de la disciplina Morfofisiología Humana como una novedosa forma organizativa dentro del proceso docente-educativo del Nuevo Programa de Formación de Médicos Latinoamericanos. Se les aplicó el instrumento a 308 estudiantes y 68 profesores, los que constituyeron la muestra dentro del universo del total de profesores y estudiantes de los centros antes mencionados. Esto permitió concluir que aunque en términos generales el balance es positivo, se deben mejorar algunos aspectos, tales como la preparación previa de los estudiantes, la orientación por parte de los profesores de algunos aspectos metodológicos en la realización de la actividad, y la gestión de los profesores y de los estudiantes en su desarrollo de valores

A cross-sectional descriptive research study was conducted in four polyclinics which serve as medical faculties in the Formation Pole of Jaguey Grande municipality. The objective was to assess the preparation and development of content orientation activities in Human Morphophysiology as a novel organizational form within the educational and teaching process of the New Formation Program of Latin-American Physicians. This instrument was administered to 308 students and 68 professors, who made up the sample from the total universe of professors and students of the above-mentioned centers. This allowed arriving at the conclusion that although the overall balance was positive, some aspects such as previous preparation of students, the instructions on some methodological aspects to carry out the activity, and the work of both professors and students to develop values for these activities must be improved

Valoración de la utilización de los medios de enseñanza-aprendizaje en las actividades de orientación de contenido / Assessment of the use of teaching-learning aids in content guiding activities

Se realizó una investigación descriptiva, de corte transversal, en 4 policlínicos facultades del Polo de Formación de Jagüey Grande con el objetivo de valorar la preparación y utilización de los medios de enseñanza-aprendizaje en las actividades de orientación de contenidos de la disciplina Morfofisiología Humana, como una novedosa forma organizativa dentro del proceso docente-educativo del Nuevo Programa de Formación de Médicos Latinoamericanos. Se les aplicó el instrumento a 308 estudiantes y 68 profesores, los que constituyeron la muestra dentro del universo del total de profesores y estudiantes de los centros antes mencionados. Se caracterizó la utilización de los medios auxiliares de enseñanza-aprendizaje, en particular, de los videos didácticos, se demostró su importancia y eficacia en el proceso para el que fueron concebidos, por lo cual deben tenerse en cuenta algunos aspectos perfectibles, en aras de elevar la calidad y lograr un mayor desarrollo de este importante medio de enseñanza.

A cross-sectional descriptive research study was made in 4 teaching polyclinics located in the Medical Formation Complex of Jaguey Grande, with the objective of assessing the preparation and use of teaching-learning aids in the content guiding activities of the subject Human Morphophysiology, as a novel organizational form within the teaching-education process of the New Program of Latin American Medical Formation. The instrument was applied to 308 students and 68 professors, who were the sample taken from the universe of students and professors of the above-mentioned institutions. The use of teaching-learning aids, particularly didactic videos, was characterized. Their importance and efficacy in the process were proved, therefore, some aspects that are to be improved must be taken into account, with a view to increasing quality and to developing even more this important teaching means.

Inter y transdisciplinariedad de las ciencias básicas en el nuevo modelo de formación de enfermeros / Inter and transdisciplinarity in the basic science in the new model of nursing education

Se describió las principales transformaciones curriculares que caracterizan el nuevo modelo de formación de enfermeros en Cuba , particularmente, la flexibilización del modelo flexneriano de organización de las ciencias básicas biomédicas y su impacto en la transformación del currículo hacia un modelo más coherente con las bases ideológicas de equidad y justicia social de la universidad cubana. Ante la necesidad de modificar la composición disciplinar del primer año de la carrera, dentro de un nuevo modelo curricular (NMF) que integra la formación técnica y la profesional universitaria, se desarrolló un trabajo de equipo multi e interdisciplinario para la identificación de contenidos pertinentes, partiendo de aquellos que tradicionalmente han sido abordados en esta carrera por varias asignaturas de las ciencias básicas biomédicas; también se trabajó en la identificación de esencialidades y en la organización y estructuración de esos contenidos de acuerdo con los requerimientos del NMF y las relaciones de precedencia con la disciplina Enfermería. Se logró una redistribución de las ciencias básicas biomédicas a lo largo de la carrera con un enfoque inter y transdisciplinar al que se le ha reconocido un impacto favorable en el éxito académico y la permanencia de los estudiantes del primer año de la carrera. Esto ha favorecido su rápida inserción laboral como enfermeros básicos, con repercusión favorable en el estado socioeconómico de los estudiantes y en la cobertura de los servicios. Su correcta aplicación, desarrollo y evaluación mediante el trabajo metodológico de los profesores propiciará su perfeccionamiento, en función de una creciente pertinencia y calidad en la formación de enfermeros(AU)

It described major curricular changes that characterize the new model of nursing education in Cuba, particularly the flexible organizational model Flexnerian basic biomedical Science and its impact on the transformation of the curriculum towards a model more consistent with the ideological foundations of equity and social justice Cuban University. Given the need to modify the disciplinary composition of the first year of the race, within a new curriculum model ( MFM) that integrates technical and vocational training collage, a study was developed multi and interdisciplinary team to identify relevant content bossed on those who have traditionally been addressed in this race for several subjects of biomedical science, also worked on the identification of the essential and in the organization and structuring of the content in accordance with the requirements of the MFN and precedence relations Nursing discipline. It was possible a redistribution of biomedical sciences over the race with and inter and transdisciplinary approach that has been recognized has having a favorable impact on academic success and retention of students in the first year of the race. This has led to its rapid job placement as basic nursing with positive impact on students' socioeconomic status and coverage of services. Its correct implementation, development and evaluation by the methodological work of the teachers will encourage their development, according to a growing relevance and quality in nursing education(AU)

Principios estratégicos de la educación en Ciencias de la salud en Cuba (I): la equidad / Strategic principles of Health Sciences education in Cuba (I): the equality

La formación de profesionales de la salud tiene actualmente en el mundo un marcado enfoque elitista, con diversos grados de inequidad que no favorecen la solución de los crecientes problemas de salud, principalmente en los países con menor desarrollo o francamente pobres. En Cuba se ha desarrollado a partir del triunfo de la Revolución, un proceso de formación de profesionales de la salud con amplias posibilidades de ingreso y con currículos que priorizan los estudios desde la atención primaria y el desarrollo de competencias profesionales, mediante la educación en el trabajo desde el inicio de cada carrera. Más recientemente, se ha incorporado el concepto de la Universalización que constituye la expresión más elevada de equidad con el que la Revolución aborda los problemas de la educación en salud y de la educación universitaria en general. Se presentan ejemplos y cifras que muestran lo anterior en forma concreta

The training of health professionals nowadays has worldwide a marked elitist approach with different grades of inequality that are disadvantageous for solution of increasing problems of health, mainly in those countries with less development or frankly poor. In Cuba, from the triumph of Revolution, has been developed a training process of health professionals with great possibilities of incorporation and with curricula priorizing studies from the primary care and the development of professional competences, through work education from the onset of each career. More recently, the concept of universality has been incorporated, which means the higher expression of fairness used by Revolution to approach the problems of health education and university education in general. There are examples and figures showing the above mentioned in a specific way

An evaluation of the asthma intervention of the New York State Healthy Neighborhoods Program.

BACKGROUND: The Healthy Neighborhoods Programs (HNP) are funded by the Federal Preventive Health and Health Services block grants and administered by the New State Department of Health (NYSDOH). Eight county and local health departments are funded for 3 years for a total of $1.25 million per year to target households at risk for environmental health and safety hazards. The HNP asthma intervention uses home visits to identify asthmatics, assess asthma morbidity and management, and identify environmental asthma triggers. Outreach workers provide education about asthma, referrals, and controls for asthma triggers. The purpose of this evaluation was to assess the impact of the HNP asthma intervention for the 1997-1999 funding cycle and for the first year of the 2000-2002 funding cycle. Because of changes in reporting requirements across the funding cycles, the findings for 1997-1999 and 2000 were analyzed separately. METHODS: We analyzed one final outcome measure, the rate of self-reported hospitalizations (admissions and emergency room visits), and three intermediate outcome measures (the percent of homes with cockroaches, the percent of asthmatics with a written management plan, and the percent of asthmatics using a peak flow meter). We also estimated the net savings resulting from a reduction in hospital admissions due to asthma. RESULTS: For the 1997-1999 funding cycle, the average hospitalization rate was 86 hospitalizations per 100 asthmatics per year at the intervention visit (i.e., the baseline rate) and 44.5 at the 1-year follow-up, a decrease of 48%. This was a larger decrease than the 24% average annual decrease in the baseline rates during the 3 years. In 2000, there were 96 hospitalizations per 100 asthmatics per year at the intervention visit and 25 at the one-year follow-up, a decrease of 74%. In 2000 there were about 110 fewer hospital admissions thought to be due to the net effects of the HNP intervention, resulting in an estimated gross savings of $905,300 (110 x $8,230). After subtracting the estimated cost of the asthma intervention ($624,683), the net savings were $280,617. CONCLUSION: New York's HNP seems to be succeeding in reducing asthma morbidity as measured by the hospitalization rates among asthmatics who have received the intervention. The HNP was successful in decreasing cockroach infestation in HNP homes. A standardized evaluation methodology and instrument are necessary to conduct a more rigorous evaluation of the HNP.

Maternal blood lead concentration, diet during pregnancy, and anthropometry predict neonatal blood lead in a socioeconomically disadvantaged population.

To determine the influences of maternal diet and nutrition during pregnancy on the blood lead level of neonates, we conducted a study of mother-infant pairs from lower socioeconomic circumstances living in Albany County, New York. Maternal blood lead (MBPb), anthropometry, and diet were assessed in each trimester. Neonates' blood lead (NBPb) levels were low (geometric mean = 1.58 micro g/dL), and none had elevated blood lead. More than 50% of the mothers had intakes below the recommended dietary allowances for zinc, calcium, iron, vitamin D, and kilocalories. As expected, MBPb was strongly and positively related to NBPb. Among the anthropometric measures of maternal nutritional status, variables measuring gain in weight and arm circumference were negatively related to NBPb. In multivariable models reflecting different analytic strageties and including MBPb, anthropometry, and sociodemographic characteristics, dietary intakes of iron and vitamin D were negatively related to NBPb. The effect of zinc varied substantially depending on model covariates. Effects of dietary constituents are difficult to distinguish, given the intercorrelated nature of nutrients in the diet. Nevertheless, the influences of maternal anthropometric variables, iron, and vitamin D on neonatal lead levels are clear in our analyses.