The impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States: a pilot study.

OBJECTIVES: Studies on colorectal cancer screening among specific Asian American groups are limited despite the fact that Asians are comprised of culturally distinct subgroups. The purpose of this study was to investigate the impact of cultural characteristics on colorectal cancer screening adherence among Filipinos in the United States. METHODS: One hundred and seventeen Filipino men and women aged 50 years or older participated in the cross-section research design. Lifetime proportion of immigration, language preference and cultural beliefs of personal control regarding health outcomes measured cultural characteristics. Demographic and healthcare variables were also measured to describe the study sample. Participant recruitment employed culturally responsive sampling methods. RESULTS: There was no significant association between language preference and screening. Likewise, perceived personal internal control of health outcome was not related to screening. However, personal external control revealed a marginally significant association. The percent of lifetime residence in the United States was significantly greater among those who were adherent to screening than those who were not adherent. After adjusting for demographic and healthcare variables, the relationship between length of immigration and screening adherence was no longer significant. Finally, age and doctor's recommendation showed significant impact on colorectal cancer screening adherence. DISCUSSION: This pilot study adds to the knowledge regarding cultural factors associated with colorectal cancer screening behaviors among Filipino Americans. Future research is needed to confirm findings that will be useful in developing culturally appropriate strategies to increase screening adherence.

Disaster Olympix: a unique nursing emergency preparedness exercise.

Despite increased disaster preparedness training and funding, healthcare organizations remain ill-prepared. Nontraditional approaches should be a focus of disaster training. We conducted a novel pediatric disaster exercise at a children's hospital. We designed 6 specific exercises comprising Disaster Olympix and piloted a Web-based evaluation survey of the exercise. The mean score of the participants' perception of their Disaster Olympix performance was 3.8/5. The mean score of the perception of the utility of Disaster Olympix was 4.3/5. Novel training approaches can be valuable to staff. Nonpediatric hospitals can readily adapt this approach to prepare for pediatric victims.

Willingness to respond in a disaster: a pediatric nurse practitioner national survey.

OBJECTIVE: The objective of this study was to examine factors associated with pediatric nurse practitioners (PNPs) reporting to work in the event of a disaster. METHODS: An anonymous national survey of PNPs was conducted. Several domains were explored, including demographics, personal preparedness plans, disaster training, prior disaster experience, and likelihood of responding in the event of a disaster. A logistic regression analysis was conducted to determine which factors were associated with the respondent's likelihood of responding in the event of a disaster. RESULTS: Factors associated with increased likelihood of responding included gender (being a male PNP), military experience, and disaster training. The most significant factor associated with an increased likelihood of responding to work during a disaster was having a specified role in the workplace disaster plan. PNPs with a specified role were three times more likely to respond than were those without a specified role. CONCLUSIONS: PNPs are health care workers with advanced skill sets. This untapped resource is available to provide care for a vulnerable population: our children. Disaster planners should explore the possibility of utilizing these highly skilled health care workers in their disaster plans.

Violation of school behavioral policies and its relationship with overall crime.

PURPOSE: Schools enact behavioral policies (e.g., dress codes, truancy policies) to enhance social control and create safe environments. Following the Theory of Social Disorganization, we hypothesize that poor social control measured by violations of behavioral policies is associated with greater rates of school crime. METHODS: We collected incidence of behavioral policy violations and crime from security reports maintained by a South Los Angeles school district of 19,365 students during two school years (2003-2005). Weekly counts of policy violations and crime were modeled by use of the Generalized Linear Models fit using Generalized Estimating Equations based on an autoregressive correlation structure. RESULTS: Greater rates of school policy violations were associated with greater rates of school crime. The strongest association was between substance use violations and crime (high school: rate ratio [RR], 3.4, 95% confidence limit [CL], 2.6-4.6, middle school: RR, 3.8, CL, 2.6-5.4, elementary schools: RR, 2.4, 95% CL, 1.6-3.6). A one-unit increase in the weekly truancy rate per 1000 students was associated with a sixfold increase in the crime rate at the middle school and a 10% increase at the high school but had no apparent association with crime in elementary schools. A one-unit increase in the weekly dress code violation rate was linked to a 20% increase in crime at the high school. CONCLUSIONS: Collective adherence to school behavioral policies may increase social control and reduce disorganization, which may in turn contribute to a positive safety culture and reduced violence at school. Interventions to increase adherence to school policies are needed particularly during early adolescent school years.

Examining depressive symptoms and use of counseling in the past year among Filipino and non-Hispanic white adolescents in California.

OBJECTIVE: We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California. METHODS: This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed. RESULTS: Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score > or = 7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes > or = 300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004-0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00-15.89). CONCLUSION: Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

Pediatric disaster preparedness of a hospital network in a large metropolitan region.

OBJECTIVES: We describe pediatric-related emergency experiences and responses, disaster preparation and planning, emergency plan execution and evaluation, and hospital pediatric capabilities and vulnerabilities among a disaster response network in a large urban county in the West Coast of the United States. METHODS: Using semistructured key informant interviews, the authors conducted qualitative research between March and April 2008. Eleven hospitals and a representative from the community clinic association agreed to participate (86 percent response rate) and a total of 22 key informant interviews were completed. Data were analyzed using ATLAS.ti.v.5.0, a qualitative analytical software program. RESULTS: Although hospitals have infrastructure to respond in the event of a large-scale disaster, well-established disaster preparedness plans have not fully accounted for the needs of children. The general hospitals do not anticipate a surge of pediatric victims in the event of a disaster, and they expect that children will be transported to a children's hospital as their conditions become stable. CONCLUSIONS: Even hospitals with well-established disaster preparedness plans have not fully accounted for the needs of children during a disaster. Improved communication between disaster network hospitals is necessary as incorrect information still persists.

Disaster preparedness among medical students: a survey assessment.

OBJECTIVE: To describe the level of preparedness in performing medical procedures of medical students at one allopathic medical school and to determine the level of willingness to perform these procedures in the event of a disaster. DESIGN: Cross-sectional survey. SETTING: US allopathic medical school associated with a county hospital. PARTICIPANTS: All third- and fourth-year medical students (344) in the 2007-2008 academic year were invited to participate. One hundred ninety-five students participated in this study (response rate = 57.6 percent). MAIN OUTCOME MEASURES: Information on demographic characteristics, personal disaster experience, personal disaster preparedness, and overall preparedness level and willingness to perform various medical procedures was collected. Multiple regression analysis was used to identify the factors predicting procedural willingness during a disaster. RESULTS: Demographics and personal disaster preparedness were not statistically significant between third-year medical students (M3) and fourth-year medical students (M4). Although procedural preparedness was significantly higher in M4 than M3, willingness to perform these procedures in a disaster was not different. Fourth-year students, first receivers (students' anticipated field is in emergency medicine or surgery), not having had a personal disaster experience, and increased procedural preparedness independently impact procedural willingness in a disaster However, when controlled for the covariate effects in the regression model, only first receivers, no past personal disaster experience, and increased procedural preparedness predicted willingness to perform medical procedures during a disaster. CONCLUSIONS: Third- and fourth-year students possess skills that may prove useful in a disaster response. Further investigations are necessary to determine how medical students may be utilized during these events.

Emergency drills and exercises in healthcare organizations: assessment of pediatric population involvement using after-action reports.

BACKGROUND: Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare organizations to demonstrate disaster preparedness through the use of disaster exercises, the evaluation of pediatric preparations is often lacking. Our investigation identified, described, and assessed pediatric victim involvement in healthcare organizations' disaster drills and exercises using data from after-action reports. METHODS: Following the IRB approval, the authors reviewed the after-action reports generated by healthcare organizations after a disaster drill and exercise, as a self-assessed reporting tool for JCAHO regulations. Forty-nine of these reports that were voluntarily supplied to the emergency medical services agency were collected. The authors analyzed the data using quantitative and qualitative analytic approaches. RESULTS: Only nine reports suggested pediatric involvement. Hospitals with large bed capacity (M = 465.6) tended to include children in exercises compared with smaller facilities (M = 350.8). Qualitative content analysis revealed themes such as lack of parent-child identification and family reunification systems, ineffective communication strategies, lack of pediatric resources and specific training, and unfamiliarity with altering standards of pediatric care during a disaster. CONCLUSIONS: Although many organizations are performing disaster exercises, most are not including pediatric concerns. Further work is needed to understand the basis for this gap in emergency preparedness. Overall, pediatric emergency planning should be a high priority for this vulnerable population.