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Medical counterbioterrorism: The response to provide anthrax prophylaxis to New York City US postal service employees

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 441-446页

作者： Partridge, R Alexander, J Lawrence, T Suner, S Brown Univ Sch Med Rhode Isl Hosp Injury Prevent CtrDept Emergency Med Providence RI 02912 USA Maine Med Ctr Dept Emergency Med Portland ME 04102 USA Univ Vermont Coll Med Dept Surg Burlington VT USA Rhode Isl Dept Hlth Emergency Med Serv Children Providence RI 02908 USA Off Emergency Preparedness Dept Hlth & Human Serv Rockville MD USA

Study objective: We describe and analyze a recent rapid deployment of disaster medical assistance teams and other government agencies to provide medical screening and anthrax prophylaxis to New York City US Postal Service employees potentially exposed to letters contaminated with anthrax spores. Methods: A description of the response effort is presented. Data were collected on standardized forms and included the numbers of postal employees screened and offered antibiotic prophylaxis, as well as the numbers of patients seen per worker hour by various medical professionals. Results: One hundred members of 5 disaster medical assistance teams and other health professionals were deployed to New York City within 18 hours of activation. Over a 68-hour period, 7,076 patients were evaluated, representing all postal employees in the 6 major postal facilities in New York believed to be at risk for anthrax exposure. Of the total, 2,452 patients were seen during the first 24 hours, 3,875 during the second 24 hours, and the remaining 749 during the last 20 hours of operations. An average of 161 employees were screened per hour. The antibiotic most commonly dispensed was ciprofloxacin, followed by doxycycline and amoxicillin. Conclusion: The deployment of disaster medical assistance teams and other agencies to New York City to provide prophylaxis against inhalation anthrax to US Postal Service employees provides lessons for a rapid, efficient, and effective response to acts of bioterrorism. This deployment might also serve as a scaleable model for future events requiring medical prophylaxis.

关键词：炭疽/预防和控制抗菌药/治疗应用生物恐怖/预防和控制救灾计划/组织和管理效率组织预测卫生服务研究普查/组织和管理模型组织管理纽约市职业卫生服务/组织和管理病人依从/心理学病人依从/统计学和数值数据人员配备和时间安排/组织和管理邮政转诊和会诊/组织和管理回顾性研究危险因素时间因素工作负荷量人类

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Applying disease management strategies to Medicare

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MILBANK QUARTERLY 1999年第4期77卷 461-+页

作者： Tompkins, CP Bhalotra, S Trisolini, M Brandeis Univ Schneider Inst Hlth Policy Heller Grad Sch Waltham MA 02454 USA

Medicare coverage begins for many when they have already developed one or more chronic diseases, and it often pays for the latest and costliest phases. Population-based disease modeling, patient screening, and monitoring would be appropriate interventions for chronic renal disease. Patients who have not get advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and better preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated delivery systems, provider and patient education, and new information technologies. Medicare reflects the long-term public perspective, and thus should further this new direction by supporting education, reimbursing for prevention efforts and allied health services, encouraging efficiency, and monitoring cost and quality outcomes.

关键词：社区卫生计划/组织和管理费用控制疾病管理预测肾功能衰竭慢性/经济学肾功能衰竭慢性/治疗长期医疗/组织和管理普查/组织和管理 Medicare/组织和管理需求估价/组织和管理诊疗准则(主题) 一级预防/组织和管理质量保证卫生保健/组织和管理美国人类

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Mortality from breast cancer in Ireland prior to the introduction of population-based mammographic screening

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IRISH JOURNAL OF MEDICAL SCIENCE 1999年第2期168卷 87-92页

作者： Codd, MB Buttimer, J Comber, H Stack, J Gorey, TF Mater Misericordiae Hosp Dept Epidemiol Dublin 7 Ireland

Mammographic screening has been shown in international randomised controlled trials and case-control studies to be effective in reducing mortality from breast cancer. Ireland has a high mortality rate from breast cancer when compared with rates from other countries. Organised population-based mammographic screening for breast cancer is about to begin in Ireland. The purpose of this study was to examine current mortality from breast cancer, as well as trends in breast cancer mortality in Ireland since 1975, as a baseline against which future evaluations of the impact of screening can be carried out. Over the 23-yr period of review, mortality from breast cancer appears to have remained quite stable. Within the period, however, there is some variation in adjusted rates, most notably an increase to a peak in 1989, followed by a decrease between 1989 and 1997. Continued monitoring of recent trends is required, with in-depth analysis of possible explanations, such as changing breast cancer incidence rates, biological characteristics, therapeutic regimes and coding practices.

关键词：年龄分布乳腺肿瘤/诊断乳腺肿瘤/死亡率乳腺肿瘤/预防和控制死亡原因爱尔兰/流行病学线性模型乳房X线摄影术普查/方法普查/组织和管理肿瘤/死亡率人群监测登记危险因素存活率分析存活率青少年成年人老年人老年人 80以上女(雌)性人类中年人

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The impact of reminder letters on attendance for breast cancer screening

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IRISH JOURNAL OF MEDICAL SCIENCE 1999年第1期168卷 29-32页

作者： Hayes, C O'Herlihy, B Hynes, M Johnson, Z Dr Steevens Hosp Dept Publ Hlth Eastern Hlth Board Dublin 8 Ireland

Obejective - The aims of this investigation was to analyse the response to second and third postal invitations from a group of patients previously invited for mammographic screening and to identify any demographic differences between responders and non-responders Subjects - The subjects were females aged 50-64 yr resident in 6 adjacent District Electoral Divisions (DEDs) in North Dublin where screening had not been carried out prior to the study. Method - Non-responders to an invitation for screening were re-invited by computer-generated letter to attend for screening 6 weeks after issue of the first invitation and a final invitation was issued at 12 weeks. Data sources used for the project register were the Eastern Health Board General Medical Services data base (GMS), Voluntary Health Insurance Board (VHI) data and self-registration. Results - There were 1,310 females in the target age group who were eligible for screening. The response rate to the first invitation was 60.7 per cent. Issue of second invitation increased the rate by 17.9 per cent. A third invitation increased the response rate by a further 7.6 per cent, Those with private medical insurance were more likely to respond to the first and third invitations. The was no difference in response rate to the second invitation for those with and without private insurance. Women aged 55-64 were more likely to respond to first, second or third invitations than those aged less than 55 yr, Conclusions - Issue of second mailed invitations to women in the target age for mammography screening is cost-effective and should be incorporated into routine policy. Response to third invitations is not cost-effective.

关键词：乳腺肿瘤/预防和控制爱尔兰普查/方法普查/组织和管理病人依从/统计学和数值数据试点项目提醒者系统女(雌)性人类中年人

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Reaching Children of the Uninsured and Underinsured in Two Rural Wisconsin Counties: Findings from a Pilot Project

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The Journal of Rural Health 1993年第1期9卷 40-49页

作者： Clarridge, Brian R. Newman, Kathleen M. Center for Survey Research University of Massachusetts—Boston Boston Massachusetts 02125–3393 100 Morrissey Blvd. Healey Library 10th Floor United States

Abstract: Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties. The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：青少年成年人儿童儿童保健服务/组织和管理儿童保健服务/利用儿童学龄前费用分担/标准成本及成本分析/统计学和数值数据女(雌)性健康状况人类婴儿新生男(雄)性普查/组织和管理普查/利用 Medicaid/组织和管理 Medicaid/利用未参加医疗保险者试点项目方案评价/统计学和数值数据农村卫生美国威斯康星

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The Alaska Native women's wellness project

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Health Care for Woman International 1999年第5期20卷 487-492页

作者： Stillwater, Barbara Southcentral Foundation Anchorage AK United States Southcentral Foundation Anchorage AK 99508 4501 Diplomacy Drive United States

Alaska Native women have encountered many obstacles in the health care system which deter them from adhering to cancer screening recommendations. To improve access, it was necessary for us to listen to them and their attitudes about health care. As a result of this assessment, we changed our approach resulting in an overall increase in screening rates from 14% to 62%. A case example is presented to demonstrate barriers to cancer screening and our techniques for overcoming them.

关键词：阿拉斯加健康态度/人种学健康促进/组织和管理卫生服务易得程度/组织和管理印第安人北美洲/心理学普查/组织和管理肿瘤/预防和控制方案评价妇女卫生女(雌)性人类中年人

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A single issue program in an isolated area: mammography screening in Darwin, NT

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第4期23卷 357-361页

作者： McLean, MJ Condon, JR Hutt Hosp Lower Hutt New Zealand

Objective: A process evaluation of the Northern Territory (NT) mammography program, NT Breast Screen (NTBS), during its initial 18 months of operation. Methods: The study was undertaken in Darwin, NT, from December 1994 to May 1996. Clinical outcomes were obtained by reviewing computerised and manual program records to determine waiting times for results, recall rates and cancer detection rates. Client satisfaction was assessed by a questionnaire sent to all women with normal results over a 12-week period. General practitioner satisfaction was assessed by a questionnaire sent to all general practitioners in the region who had one or more clients who had attended the service. Results: During this time, 2,882 screening mammograms were performed;98 women were recalled for assessment (3.4%). Breast cancer was detected in 10 women (3.5 per 1000 women screened). The program was well accepted by clients and general practitioners. Performance criteria were not met for waiting times for results. Conclusions: NTBS faced challenges because of its smalt and dispersed population, a lack of local radiologists with mammographic experience and the conflict with other pressing health issues, particularly in Aboriginal health. Despite those challenges, the program functioned effectively during its initial 18 months. Implications: Mammography screening programs in isolated areas can function effectively. The constraints encountered by NTBS are likely to apply to similar programs. Issues identified requiring further research are the psychological consequences of long waiting times for results, and the prioritisation of mammography for Aboriginal women.

关键词：医务工作者的态度乳腺肿瘤/预防和控制乳房X线摄影术/心理学普查/组织和管理普查/心理学缺医地区北部地方大洋洲世系人群/心理学结果与过程评价(卫生保健) 病人满意度医师家庭/心理学方案评价问卷调查成年人老年人女(雌)性人类中年人

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Hemoccult screening, detecting the cancer nobody talks about

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Hospital Topics 1982年第1期60卷 29-30页

作者： Strahler, Tricia Cancer Research Center United States

Click to increase image sizeClick to decrease image size

关键词：结肠肿瘤/流行病学健康教育医院病床数 100至299张普查/组织和管理潜血俄亥俄直肠肿瘤/流行病学人类

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Developing a community based screening program: commitment to the underserved.

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Journal of the American Academy of Nurse Practitioners 1999年第6期11卷 249-252页

作者： Schulz, M. Cukr, P. Ludwick, R. Heart Group Inc. Ravenna OH United States

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A multi-disciplinary approach to the prevention of coronary heart disease

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Health Education Journal 1988年第4期47卷 164-166页

作者： Bennett, Paul Blackall, Mary Clapham, Michael Little, Shelley Player, David Coronary Prevention Project South Birmingham Health Authority United Kingdom

The South Birmingham Coronary Prevention Project is described, in which health checks by practice nurses in GPs' surgeries are combined with direct patient access to a secondary referral system. Where appropriate, health check attenders are offered the choice of either counselling by the practice nurse, direct referral to their GP, or direct referral to second ary intervention, including dietary advice for patients with high serum cholesterol, stress manage ment training for mild hypertension, and smoking cessation groups run by specialist workers. Further developments of the project may be toward increasing areas of nurses intervention, for example running lipid clinics, and combining with Look After Your Heart! in the workplace. Progress in each of these areas is described and discussed. © 1988, Sage Publications. All rights reserved.

关键词：冠心病/预防和控制英格兰家庭医学健康状况指标健康调查普查/组织和管理病人医疗小组危险因素人类

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