Disaster Training Needs and Expectations Among Turkish Emergency Medicine Physicians - A National Survey.

OBJECTIVES: Earthquakes, landslides, and floods are the most frequent natural disasters in Turkey. The country has also recently experienced an increased number of terrorist attacks. The purpose of this study is to understand the expectations and training of Turkish emergency medicine attending physicians in disaster medicine. METHODS: An online questionnaire was administered to the 937 members of the Emergency Medicine Association of Turkey, of which 191 completed the survey (20%). RESULTS: Most participants (68%) worked at a Training and Research Hospital (TRH) or a University Hospital (UH), and 69% had practiced as an attending for 5 years or less. Mass immigration, refugee problems, and war/terror attacks were considered to be the highest perceived risk topics. Most (95%) agreed that disaster medicine trainings should occur during residency training. Regular disaster drills and exercises and weekly or monthly trainings were the most preferred educational modalities. Most respondents (85%) were interested in advanced training in disaster medicine, and this was highest for those working less than 5 years as an attending. UH and TRH residency training programs were not considered in themselves to be sufficient for learning disaster medicine. CONCLUSIONS: Turkish emergency medicine residency training should include more disaster medicine education and training.

Improving Sun-Protective Behaviors and Self-Skin Examinations Among African Americans: A Randomized Controlled Trial.

BACKGROUND: Few studies describing sun-protective behaviors, knowledge, and self-efficacy in African Americans exist. Although educational programs targeting Caucasians and Hispanics have been successful in increasing melanoma awareness and knowledge, no such investigation has been applied to African Americans. OBJECTIVE: To evaluate the effectiveness of a brochure or video educational intervention on the sun-protective behaviors, knowledge, and self-efficacy regarding melanoma in African Americans. MATERIALS AND METHODS: A randomized controlled trial of a presurvey and postsurvey, in an academic outpatient dermatology clinic. Participants were self-identified African Americans, at least 18 years old, fluent, and literate in English. Patients randomized to the brochure-intervention group (n = 72) received a melanoma brochure from the National Cancer Institute. Patients randomized to the video-intervention group (n = 71) received the brochure and watched an online melanoma tutorial. RESULTS: Sun-protective behaviors, knowledge, and self-efficacy regarding melanoma all improved equally from pre-to posteducation, in both the brochure- and video-intervention groups. CONCLUSION: Melanoma educational interventions similar to those previously demonstrated to be successful in Caucasian and Hispanic populations are also effective among African Americans.

Low Other-Regard and Adolescent Addiction.

Although 12-step literature posits inconsiderate behaviors to characterize alcoholics and addicts, there is little data to support this association among adolescent populations. Using a matched-pair study design with 579 youth aged 14-18 (52% female, 30% minority), a significant, dose-response relationship was found between greater alcohol and drug use severity and increased likelihood of driving under the influence, having unprotected sex with and without a history of sexually transmitted incidence, and low volunteerism among boys. Findings suggest that alcohol and drug use severity is associated with poor awareness of the impact of behaviors on others.

Polypharmacy in the elderly.

OBJECTIVE: The objective was to assess the frequency of polypharmacy and potential complications among local seniors. METHODS: A cross-sectional convenience sample of 59 adults aged above 65 years was interviewed at Cuyahoga county (U.S. state of Ohio) senior programs. Polypharmacy was defined as more than five prescribed medications. Primary outcomes were frequent missed doses, one or more duplicate drug/s, and equal or more than one contraindicated drug combinations. FINDINGS: Among seniors with the mean age of 76.9 years (25.4% male), 40.6% used multiple pharmacies and 35.6% had polypharmacy. Of all seniors with polypharmacy, about 57% had contraindicated drug combinations. Polypharmacy was associated with duplication (P = 0.02), but not frequent missed doses (P = 0.20). CONCLUSION: As shown by this study, polypharmacy was associated with duplicated therapy and contraindicated drug combinations. Improved communications among seniors, physicians, and pharmacists is necessary to minimize adverse consequences of polypharmacy.

A qualitative examination of secondary prophylaxis in rheumatic heart disease: factors influencing adherence to secondary prophylaxis in Uganda.

BACKGROUND: Rheumatic heart disease (RHD) is the most common cause of heart disease among Ugandans age 15 to 49 years. Secondary prophylaxis with monthly injection of benzathine penicillin is effective in preventing recurrence of acute rheumatic fever and worsening of RHD, but adherence rates are poor in Uganda. OBJECTIVES: This study sought to identify health behaviors, attitudes, and health care system factors that influence adherence to RHD secondary prophylaxis. METHODS: We conducted 5 structured focus groups with 36 participants on monthly penicillin injections for RHD in Kamplala, Uganda. Transcripts were analyzed using qualitative description analysis and health behavior models. RESULTS: Most participants were female (64%), from an urban area (81%), and had family income less than US$1 daily (69%). Ages ranged from 14 to 58 years. Median prophylaxis duration was 1.42 years and 58% were adherent (≥80% of injections). Key facilitators include perceived worsening of disease with missing injections, personal motivation, a reminder system for injections, supportive family and friends, and a positive relationship with health care providers. Barriers to adherence include lack of resources for transportation and medications, fear of injection pain, poor patient-provider communication, and poor availability of clinics and providers able to give injections. CONCLUSIONS: We identified key facilitators and barriers to secondary prophylaxis for RHD from the patient perspective framed within the socioecological model. Our findings provide direction for intervention development to improve national RHD secondary prophylaxis.

Capacity building for evidence-based decision making in local health departments: scaling up an effective training approach.

BACKGROUND: There are few studies describing how to scale up effective capacity-building approaches for public health practitioners. This study tested local-level evidence-based decision making (EBDM) capacity-building efforts in four U.S. states (Michigan, North Carolina, Ohio, and Washington) with a quasi-experimental design. METHODS: Partners within the four states delivered a previously established Evidence-Based Public Health (EBPH) training curriculum to local health department (LHD) staff. They worked with the research team to modify the curriculum with local data and examples while remaining attentive to course fidelity. Pre- and post-assessments of course participants (n=82) and an external control group (n=214) measured importance, availability (i.e., how available a skill is when needed, either within the skillset of the respondent or among others in the agency), and gaps in ten EBDM competencies. Simple and multiple linear regression models assessed the differences between pre- and post-assessment scores. Course participants also assessed the impact of the course on their work. RESULTS: Course participants reported greater increases in the availability, and decreases in the gaps, in EBDM competencies at post-test, relative to the control group. In adjusted models, significant differences (p<0.05) were found in 'action planning,' 'evaluation design,' 'communicating research to policymakers,' 'quantifying issues (using descriptive epidemiology),' and 'economic evaluation.' Nearly 45% of participants indicated that EBDM increased within their agency since the training. Course benefits included becoming better leaders and making scientifically informed decisions. CONCLUSIONS: This study demonstrates the potential for improving EBDM capacity among LHD practitioners using a train-the-trainer approach involving diverse partners. This approach allowed for local tailoring of strategies and extended the reach of the EBPH course.

First time compliance inspections to evaluate an artificial trans fat ban in Nassau County.

BACKGROUND: In 2007, Nassau County, New York, restricted the use of artificial trans fats in food establishments licensed by the Nassau County Department of Health (NCDH). The regulation took effect April 1, 2008. OBJECTIVE: This study assesses first-time inspection compliance rates with the trans fat ban and examines barriers to enforcement. METHODS: A sample of food service establishments was inspected by an NCDH employee for labels documenting trans fat. Surveys that examined operator awareness and attitudes toward the ban were administered. A separate survey was conducted among the NCDH Office of Food Protection public health sanitarians to determine organizational barriers to enforcement. All inspections and surveys were conducted in Nassau County from June to September 2010. RESULTS: A total of 360 food service establishments were randomly selected for inspection; 328 completed the operator surveys. Compliance was 81%, even though 52% of operators were not aware of the ban. Of those who were aware, 57% heard about the regulation from the media, and almost all (92%) reported that compliance with the ban was easy. Of noncompliant respondents, 59% cited lack of knowledge regarding the ban as the primary reason for noncompliance. Of those who indicated they had received any customer feedback (9%), almost all reported the feedback to be positive. Knowledge of trans fats was not associated with compliance, but owners who were aware of the ban were more likely to be in compliance. Among the 23 participating sanitarians, 96% believed the ban was effective; language barriers were cited as the primary obstacle to enforcement. CONCLUSIONS: As assessed through surveys and inspections, the trans fat ban in Nassau County yielded relatively high compliance rates within 2 years and was accepted by sanitarians, establishment operators, and consumers.

Planning and incorporating public health preparedness into the medical curriculum.

As part of a 2010 conference entitled "Patients and Populations: Public Health in Medical Education," faculty from four U.S. medical schools (Case Western Reserve University, Harvard Medical School, the University of Colorado School of Medicine, and the University of Vermont College of Medicine), collaborated on a workshop to help other medical educators develop scenario-based learning experiences as practical, engaging, and effective mechanisms for teaching public health principles to medical school students. This paper describes and compares four different medical schools' experiences using a similar pandemic exercise scenario, discusses lessons learned, and suggests a curricular framework for medical schools adding such exercises to their population health curriculum. Different strategies to create realistic scenarios and engage students, including use of professionals and stakeholders from the community, are described.

Complexity of measuring "cigar use" in adolescents: results from a split sample experiment.

INTRODUCTION: Inclusion of brand-specific examples (BE) in health surveys assessing lifetime and current cigar use has been shown to impact response rates. A split sample experimental design was used to investigate whether these rates are consistent by race, gender, and geographic locale. METHODS: The 2009 Cuyahoga County Youth Risk Behavior Survey was conducted among 20 randomly selected high schools. Two versions of the survey were created; the first included items assessing lifetime and current cigar use with no brand-specific examples (NBE) while the second included BE in the items assessing cigar use. Both survey versions were distributed randomly within selected classrooms in participating schools. RESULTS: Within the City, both White and Black BE respondents reported higher lifetime cigar product use prevalence and current cigar product use compared to the NBE group; however, the difference was only significant among Black respondents (odds ratio [OR] = 1.45, 95% CI 1.02-2.06). In the Outer Ring, White BE respondents were significantly less likely to report lifetime cigar use (OR = 0.73, 95% CI: 0.54 - 0.98) and current cigar use (OR = 0.66, 95% CI: 0.44-0.99) when compared with White NBE respondents. CONCLUSIONS: Inclusion of BE in current measures of cigar product use may improve product use estimates in at-risk groups. However, better estimation of cigar product use may be accomplished by creating additional items to assess the use of subtypes of cigars.

Consumption of alcoholic beverages among pregnant urban Ugandan women.

The World Health Organization estimated alcohol consumption in Uganda to be one of the highest in the world. We examined alcohol consumption among Ugandan women prior to and after learning of pregnancy. We developed a screening algorithm using factors that predicted alcohol consumption in this study. In 2006, we surveyed 610 women attending antenatal care at the national referral hospital in Kampala, Uganda about consumption of traditional and commercial alcoholic beverages before and after learning of pregnancy. Predictors of alcohol consumption during pregnancy were examined and a practical screening algorithm was developed for use in antenatal clinics. One hundred eighty women (30%) drank alcohol at least monthly before learning of their pregnancy. Among these women, almost one-third reported usual consumption of at least one beverage type at quantities that equal binging levels for women. Overall, 151 women (25%) consumed alcohol after learning of pregnancy. Commercial beverages, particularly beer, were consumed more often than traditional drinks. A two-stage screening algorithm asking women about their religion, male partner or friends' drinking, and any lifetime drinking predicted self-reported consumption of alcohol during pregnancy with 97% sensitivity and 89% specificity. Alcohol consumption among pregnant Ugandan women attending antenatal care is high. A feasible screening algorithm can help providers target education and counseling to women who are likely drinking during pregnancy. Given the preference for commercial alcoholic beverages, it is recommended that labels be placed prominently on bottled alcoholic beverages warning of the adverse effects of consuming alcohol during pregnancy.

Pediatric specialists' beliefs about gastroesophageal reflux disease in premature infants.

BACKGROUND: Wide variation exists in the treatment of suspected gastroesophageal reflux disease (GERD) in premature infants; it is unknown to what degree diagnosis and treatment are affected by the treating physician's medical specialty or interpretation of the medical literature. METHODS: This study involved an online survey of board-certified neonatologists, pediatric pulmonologists, and pediatric gastroenterologists about their beliefs regarding the symptoms, diagnosis, and treatment of GERD in premature infants in the NICU on the basis of both clinical impression and interpretation of the literature. RESULTS: A total of 1021 neonatologists, 232 pediatric pulmonologists, and 222 pediatric gastroenterologists participated in the study (47.5% response rate). There was disagreement among specialists in nearly all aspects of the survey. Pulmonologists were most likely to report that respiratory symptoms are caused by GERD (P < .001). Neonatologists were least likely to report that a therapeutic trial of pharmacologic agents would be useful for diagnosing GERD (P < .001) or that lansoprazole, ranitidine, or cimetidine are safe or effective (P < .001). No pharmacologic therapy had >50% of respondents supporting its effectiveness. There was moderate correlation between physician belief based on the medical literature and belief based on clinical impression (Spearman rank correlation: 0.47-0.75). For therapies supported by multiple meta-analyses in infants versus therapies with few infant trials, physicians rated the evidence for effectiveness similarly. CONCLUSIONS: There is wide variation among pediatric specialists regarding beliefs about GERD in premature infants, as well as about the weight of evidence in the medical literature for this patient population. Physician beliefs do not seem to be driven by the degree of evidence in the neonatal literature. With no agreed-on standard of care in the setting of widespread use of antireflux medications, greater understanding is needed about the ways physicians form clinical impressions, access and process medical evidence, and apply it to patient care.

Measuring cigar use in adolescents: inclusion of a brand-specific item.

INTRODUCTION: This study examined whether the standard measure of cigar use in adolescents could be improved by the addition of a brand-specific example. METHODS: In 2002, prevalence of tobacco use was assessed in six midwestern U.S. high schools using the Youth Risk Behavior Survey. The survey was readministered to the same schools in 2004, with the brand name "Black and Milds" added to the item measuring cigar use. Changes in local prevalence rates were compared with national rates. RESULTS: Local rates of cigar and cigarette use in 2002 were consistent with national rates reported in 2003. In 2004, when the cigar item was modified to include a brand-specific example, the percentage of students reporting cigar use nearly doubled-from 12.9% to 20.7%. This difference was particularly notable among Black teens. During the same period, local rates of cigarette use remained constant, as did national rates of reported cigar and cigarette use. DISCUSSION: Results suggest that the current national survey item may not adequately measure cigar use. Accordingly, prevalence of cigar use among adolescents may be greatly underestimated, especially among Black youth.

Health risk behaviors in a unique population-first ring suburban adolescents.

This study aims to call attention to First Ring suburban communities as a unique and unrecognized population and to characterize health risk behaviors of adolescents within these communities. A risk behavior profile of the First Ring suburbs surrounding a large Midwestern city is presented and compared to the frequency of these behaviors in a national sample. In 2002, a representative sample of 3428 high school students from First Ring suburban communities in an urban county completed the Youth Risk Behavior Survey. A 20-item risk score composed of "current" risk behaviors was compiled in order to compare the relative number of risk behaviors exhibited by the First Ring schools to a 2001 national sample. Prevalence of individual behaviors was also determined and compared to data collected nationally. Prevalence was further subdivided by gender, race, and grade in order to explore risk groups within First Ring suburbs. Despite the perception that the "urbanization" of First Ring suburbs is synonymous with "urban" problems and risk behaviors, First Ring students reported significantly fewer current risk behaviors than did students nationally. Significant differences in behavior were found between First Ring and national gender and racial groups. Some patterns of behavior within gender and racial groups differed from national patterns. The commonly held presumption that First Ring suburbs are riskier for students due to increased urbanization of these communities appears unfounded. The contribution of these destructive misperceptions to social migration away from urban centers and the need for local data collection are discussed.

Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery.

BACKGROUND: Most research examining primary care office characteristics and preventive service delivery (PSD) has evaluated preventive service aids and equipment, while generally overlooking the complex interactions among multiple office systems where multiple factors influence the overall practice. We test a theoretical model of practice influences on PSD that accounts for Tools (preventive service aids/equipment), Teamwork (office organization), and Tenacity (prevention delivery attitudes). METHODS: Office characteristics and 4454 patient visits were observed for 138 family physicians in northeast Ohio. Utilizing U.S. Preventive Services Task Force recommendations, age- and gender-specific PSD summary scores were computed for each patient and then averaged per physician. Multivariate analysis of variance tested office characteristic associations with PSD scores. RESULTS: Tools were common, but most were not significantly associated with PSD scores. The Teamwork indicators of clear staff role expectations and shared vision among physician and staff existed, respectively, for 80 and 73% of physicians. A high average reported practice focus on prevention existed, despite low staff involvement in PSD (22.2%). Compared with Tools, more Teamwork and Tenacity characteristics were associated with the PSD scores. CONCLUSION: Teamwork and Tenacity appear to be more important than Tools in delivering preventive services in primary care practices.