Characteristics and experiences of past participants in the Texas Peer Assistance Program for Nurses

There are nearly 200,000 licensed practicing nurses in the state of Texas, representing one-tenth of the nations' workforce. The prevalence of substance abuse among nurses is estimated to range between six and 20 percent in this professional group.^ Since March 1987, the Texas Peer Assistance Program for Nurses (TPAPN) has offered intervention, education, support and monitoring to nurses in Texas whose practice has become impaired due to substance abuse and/or mental illness. Since then approximately 44 percent of nurses who voluntarily signed participation agreements successfully completed the program; fifty-six percent have not. One determinant of completion for those nurses identified as chemically dependent is abstinence from mood altering substances. Other helping professions report higher rates of abstinence two years following treatment.^ The purpose of this study was to investigate the relationship between relapse, demographics, treatment variables, work setting, "stress" indicators and support factors for nurses who participated in TPAPN. A questionnaire was mailed to 1000 randomly selected nurses who had signed agreements since 1987 and were no longer active in the program. More than 41% of the questionnaires were returned undeliverable.^ Recipients of the questionnaire were known only to TPAPN, never to the investigator. All information was received anonymously except when the participant chose to sign the questionnaire. A cover letter explaining the study and inviting participation was enclosed. Completion and return of the questionnaire was considered consent to participate.^ Findings demonstrated a significant relationship between relapse and opiates as the drug of choice for past participants in the Texas Peer Assistance Program for Nurses. Significant associations were found among factors such as control at work, support, physical complaints, job security, self-esteem and employment in this sample. Respondents shared copious written comments about their experiences in TPAPN. These data were analyzed using qualitative methods and compared with similar studies of recovering nurses. Further research with nurses whose practice has been affected by abuse of chemical and mental illness is warranted. ^

Podcasting and the use of portable music/video players at the School of Nursing

Introduction As students become more connected with the internet and other current technologies, the school of nursing has continued to investigate more innovative, meaningful, and effective uses of technology. One particular technology whose use has increased is the portable music/video player. Like the cell phone, mp3 players and iPods have become a standard accessory for students. To capitalize on this popular technology the School has started several pilot projects involving podcasting under graduate and graduate nursing classes and has also been involved in one research project using video iPods. [See PDF for complete abstract]

History of Medicine Schedule and Abstracts 2009-2010

From Genes to Genome: An historical perspective (David Wheeler) Ignaz Semmelweis: Medical Prophet Without Honor (Ronald L. Young) Why Lewis Thomas, MD is Not a Bore: The Life of a Biology Watcher (Steven Greenberg) Doctors from Hell: The Horrific Account of Nazi Experiments on Humans (Vivien Spitz) Illuminating Autism: Passing the Torch from the Twentieth Century (Student Essay Contest Winners) (Lynn Yudofsky) Healing Beyond Hippocrates: The Temples of Asclepius and Public Health Care in Ancient Greece (Andrew Baldwin) Iron Wills and Iron Lungs: The Polio Years in Texas (Heather Green Wooten) William Osler and the Inspirational Uses of History (Michael Bliss) Working Too Hard and Achieving Too Much: The Cost of Being Harvey Cushing (Michael Bliss) Medicine in Ancient Egypt (Gene Boisaubin) The History of Diabetes (Jeff Unger)

A study of the impact of cigarette advertising on adolescent susceptibility to smoking among 5th-, 8th-, and 12th-grade students in Hempstead and Hitchcock Independent School Districts

This study assessed the impact of cigarette advertising on adolescent susceptibility to smoking in the Hempstead and Hitchcock Independent School Districts. A convenience sample of 217 youths, 10-19 years of age was recruited in the study. Students completed both a paper-and-pencil and a computer-aided questionnaire in April 1996. Adolescents were defined as susceptible to smoking if they could not definitely rule out the possibility of future smoking. For the analysis, an index was devised: a 5-point index of an individual's receptivity to cigarette advertising. The index is determined by the number of positive responses to five survey items (recognizing cigarette brand logos, recognizing cigarette advertisement's pictures, recognizing cigarette brand slogans, evaluating adolescent attitudes toward cigarette advertising, and the degree to which adolescents were exposed to cigarette advertisements). Using logistic regression, we assessed the independent importance of the index in predicting susceptibility to smoking and ever smoking after adjusting for sociodemographic variables, perceived school performance and family composition. Of students surveyed, 54.4% of students appeared to have started the smoking uptake process as measured by susceptibility to smoking. Camel was recognized by the majority of students (88%), followed by Marlboro (41.5%) and Newport (40.1%). The pattern for recognition of the cigarette advertisements was the same as the pattern of market for cigarette. Advertisement featuring the cartoon character Joe Camel was significantly more appealing to adolescents than were advertisements with human models, with animal models, and with text only (p $<$ 0.001). Text only advertisement was significantly less appealing than other types of advertisements. The cigarette advertisement with White models (Marlboro) had significantly higher appeal to White students than to African-American students (p $<$ 0.001). The cigarette advertisement featuring African-American models (Virginia Slims) was significantly more appealing to African-American students than other ethnic groups (p $<$ 0.001). Receptivity to cigarette advertising was to be an important concurrent predictor of past smoking experience and intention to smoke in the future. Adolescents who scored in the fourth quartile of the Index of Receptivity to Cigarette Advertising were 7.54 (95% confidence interval (CI) = 1.92-29.56) times as likely to be susceptible to smoking, and were 4.56 (95% CI = 1.55-13.38) times as likely to have tried smoking, as those who scored in the first quartile of the Index. The findings confirmed the hypothesis that cigarette advertising may be a strong current influence in encouraging adolescents to initiate the smoking uptake process than sociodemographic variables, perceived school performance and family composition. ^

Prenatal care: A survey of African American women in Houston

The focus of the study was to identify variables that African American women who delivered at a teaching hospital in Houston, Harris County, Texas, between January 12, 1998 and April 24, 1998 perceived to prevent them from receiving adequate prenatal care. The research was based on Aday and Andersen's Framework for the Study of Access to Medical Care. A self-administered questionnaire, using realized and potential access indicators, was developed and administered to 161 African American patients at the study hospital. ^ The objectives of the study were (1) to describe the demographic characteristics of African American women who delivered at a large urban teaching hospital between January 12, 1998 and April 24, 1998; and to determine the relationships between (2) predisposing factors such as age, race, educational level, marital status, family structure, social support and attitude toward prenatal care and prenatal care utilization; (3) enabling factors such as income, employment, insurance status, transportation, appointment, and regular source of care; (4) need factors such as perceived health status, number of past pregnancies, pregnancy occurrence; and (5) the relative importance of predisposing, enabling and need factors as predictors of utilization of prenatal care. The indicators of prenatal care utilization examined included the trimester in which the women initiated prenatal care, number of visits, and numbers and types of services received during pregnancy. Barriers cited included low income and inadequate insurance coverage, problems of transportation and child care, unawareness of pregnancy, delays in the scheduling of appointments, and having too many other problems. ^ The results of the study have implications for well-defined public health promotion campaigns, social support system enhancement, and appointment scheduling reform with an emphasis on prenatal care. ^

An ethnographic study of home remedy use for African-American children

Background and significance. The use of herbs and other remedies by adult and elderly African-Americans has been documented. However, little is understood regarding the use of herbs for African-American children. The purpose of this study was to document and describe the historical and present day uses of herbal and other remedies, specifically for the health and illness of African-American children. This information will provide health care providers with a better understanding of their African-American patients. This information may also contribute to the emerging appreciation of indigenous uses of phytotherapeutics. ^ Methods. A focused ethnographic approach was used to describe the cultural context, including the beliefs, values, customs, and behaviors of a particular culture. The use of intensive fieldwork, including participant observation, audiotaped formal interviews, photographs, and specimen collection of plants helped to describe herb use in this population. Information on the growing, harvesting, preparation, and storage of these plant remedies, as well as the amount and dosage of these compounds was collected in a typology. Detailed information was gathered to discern how, when, and under what conditions these remedies were used and their expected results. Further data collection focused on the history of herbal use, and explanations for how and why informants thought the herbs work. ^ Setting and participants. The setting for this study was in East Texas and field work extended over the period of one year. Thirty African-Americans, age 38 to 98, were interviewed for the study. The African-American population in this area has been relatively stable, with roots dating back prior to the reconstruction period, which allowed excellent historical information. Informants were chosen by a nominated sampling technique starting with two key informants knowledgeable about the use of home remedies for children. ^ Findings. The findings of this study suggest that African-American children in East Texas have a long history of receiving herbs and home remedies for health promotion and illness. Data further suggests that there is a strong connection between spirituality and the health beliefs and practices of this community. This spiritual component underlies the accuracy of oral recall for remedies that have been used over many generations and the use of natural folk remedies. A typology of the herbal remedies was developed with folk and Latin name, herb place of origin, known scientific properties, and informant folk usage and dosage information. ^

The seroprevalence of Rocky Mountain spotted fever in shelter dogs in Harris County

Rocky Mountain spotted fever (RMSF) is a tick-borne illness caused by the bacteria Rickettsia rickettsii, with infections occurring in humans and dogs. The prominent tick vector of RMSF, Dermacantor variabilis, and another potential vector, Rhipacephalus sanguineus, are prevalent in Texas. The goal of this study was to determine the prevalence of past infections by testing for IgG antibodies to R. rickettsii in dogs in an animal shelter in Harris County using an immunofluorescence assay (IFA) test. We found that 12.6% (24) of 191 dogs tested had a positive IFA test at 1:64 serum dilution, indicating infection at some time in the past. We also sampled the ticks present on dogs in the animal shelter to understand the prevalence of potential vector species. Of a total of 58 ticks, 86% were D. variabilis and the remaining 14% were R. sanguineus. The results of this study demonstrate that RMSF has the potential to be, and may already be, endemic to the Harris County area. Public health actions such as heightened surveillance and education that RMSF is present would be appropriate in the Harris County area.^

Process evaluation of the Texas occupational safety & health surveillance system

Introduction: The Texas Occupational Safety & Health Surveillance System (TOSHSS) was created to collect, analyze and interpret occupational injury and illness data in order to decrease the impact of occupational injuries within the state of Texas. This process evaluation was performed midway through the 4-year grant to assess the efficiency and effectiveness of the surveillance system’s planning and implementation activities1. ^ Methods: Two evaluation guidelines published by the Centers for Disease Control and Prevention (CDC) were used as the theoretical models for this process evaluation. The Framework for Program Evaluation in Public Health was used to examine the planning and design of TOSHSS using logic models. The Framework for Evaluating Public Health Surveillance Systems was used to examine the implementation of approximately 60 surveillance activities, including uses of the data obtained from the surveillance system. ^ Results/Discussion: TOSHSS planning activities omitted the creation of a scientific advisory committee and specific activities designed to maintain contacts with stakeholders; and proposed activities should be reassessed and aligned with ongoing performance measurement criteria, including the role of collaborators in helping the surveillance system achieve each proposed activity. TOSHSS implementation activities are substantially meeting expectations and received an overall score of 61% for all activities being performed. TOSHSS is considered a surveillance system that is simple, flexible, acceptable, fairly stable, timely, moderately useful, with good data quality and a PVP of 86%. ^ Conclusions: Through the third year of TOSHSS implementation, the surveillance system is has made a considerable contribution to the collection of occupational injury and illness information within the state of Texas. Implementation of the nine recommendations provided under this process evaluation is expected to increase the overall usefulness of the surveillance system and assist TDSHS in reducing occupational fatalities, injuries, and diseases within the state of Texas. ^ 1 Disclaimer: The Texas Occupational Safety and Health Surveillance System is supported by Grant/Cooperative Agreement Number (U60 OH008473-01A1). The content of the current evaluation are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.^

Development of a conceptual model for mass gatherings

In making the arrangements for the visit of Pope John Paul II to San Antonio, Texas, in September, 1987, it was discovered that no comprehensive documents or guidelines are available in the public sector for planning such an event. It was not clear which, if any, laws applied. The literature describes rock concerts, papal masses, and civil disorders. These events are held in stadia, and in the open. There was little agreement on what services, if any, were needed to protect the public's health and the environment; or if needed, how services should be provided, or by whom.^ A literature review and bibliography are given to provide greater understanding of the variety of mass gatherings and the many factors that impinge on temporary groups while away from their homes. Descriptions of past mass gatherings in terms of personnel ratios are provided. This study develops a conceptual model which delineates some of the known parameters necessary for successfully conducting a mass gathering. A study of one such site is given.^ Provisions for public wellness and freedom from disease at a mass gathering include adequate water (fluids), food, sanitary facilities, security, transportation, and medical services. The determination of adequacy of these provisions is discussed. Methods of determining the use of provided facilities are given. ^

Understanding and Characterizing Shared Decision-Making and Behavioral Intent in Medical Uncertainty

Applying Theoretical Constructs to Address Medical Uncertainty Situations involving medical reasoning usually include some level of medical uncertainty. Despite the identification of shared decision-making (SDM) as an effective technique, it has been observed that the likelihood of physicians and patients engaging in shared decision making is lower in those situations where it is most needed; specifically in circumstances of medical uncertainty. Having identified shared decision making as an effective, yet often a neglected approach to resolving a lack of information exchange in situations involving medical uncertainty, the next step is to determine the way(s) in which SDM can be integrated and the supplemental processes that may facilitate its integration. SDM involves unique types of communication and relationships between patients and physicians. Therefore, it is necessary to further understand and incorporate human behavioral elements - in particular, behavioral intent - in order to successfully identify and realize the potential benefits of SDM. This paper discusses the background and potential interaction between the theories of shared decision-making, medical uncertainty, and behavioral intent. Identifying Shared Decision-Making Elements in Medical Encounters Dealing with Uncertainty A recent summary of the state of medical knowledge in the U.S. reported that nearly half (47%) of all treatments were of unknown effectiveness, and an additional 7% involved an uncertain tradeoff between benefits and harms. Shared decision-making (SDM) was identified as an effective technique for managing uncertainty when two or more parties were involved. In order to understand which of the elements of SDM are used most frequently and effectively, it is necessary to identify these key elements, and understand how these elements related to each other and the SDM process. The elements identified through the course of the present research were selected from basic principles of the SDM model and the “Data, Information, Knowledge, Wisdom” (DIKW) Hierarchy. The goal of this ethnographic research was to identify which common elements of shared decision-making patients are most often observed applying in the medical encounter. The results of the present study facilitated the understanding of which elements patients were more likely to exhibit during a primary care medical encounter, as well as determining variables of interest leading to more successful shared decision-making practices between patients and their physicians. Understanding Behavioral Intent to Participate in Shared Decision-Making in Medically Uncertain Situations Objective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent of men between the ages of 45-70 with regard to participating in shared decision-making in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information which may facilitate greater understanding, efficiency and effectiveness of doctor-patient consultations.Design: Qualitative Study using deductive content analysisSetting: Individual semi-structure patient interviews were conducted until data saturation was reached. Researchers read the transcripts and developed a list of codes.Subjects: 25 subjects drawn from the Philadelphia community.Measurements: Qualitative indicators were developed to measure respondents’ experiences and beliefs related to behavioral intent to participate in shared decision-making during medical uncertainty. Subjects were also asked to complete the Krantz Health Opinion Survey as a method of triangulation.Results: Several factors were repeatedly described by respondents as being essential to participate in shared decision-making in medical uncertainty. These factors included past experience with medical uncertainty, an individual’s personality, and the relationship between the patient and his physician.Conclusions: The findings of this study led to the development of a category framework that helped understand an individual’s needs and motivational factors in their intent to participate in shared decision-making. The three main categories include 1) an individual’s representation of medically uncertainty, 2) how the individual copes with medical uncertainty, and 3) the individual’s behavioral intent to seek information and participate in shared decision-making during times of medically uncertain situations.