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 Ser...
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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.
Objectives: (1) To document rates and patterns of adherence from enrollment until week 24 of an AIDS clinical trial;(2) to examine the association of adherence to clinical end-points including plasma HIV-1 RNA level a...
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Objectives: (1) To document rates and patterns of adherence from enrollment until week 24 of an AIDS clinical trial;(2) to examine the association of adherence to clinical end-points including plasma HIV-1 RNA level and CD4 cell count;and (3) to identify predictors of adherence from clinical, behavioural, psychosocial and demographic factors. Design: Sub-study of a multicentre, randomised, open-label, comparison-control led trial;21 collaborating units of the Adult AIDS Clinical Trials Group. Observational, prospective analysis. Methods: Ninety-three subjects with baseline plasma HIV-1 RNA levels >500 copies/ml, who completed clinical assessment, plasma HIV-1 RNA titres and CD4 cell counts at study entry, weeks 2, 4 and every 4 weeks thereafter until week 24. All patients were anti retroviral-experienced but were naive to non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Self-reported adherence to antiretroviral therapies prescribed as part of the trial was assessed every 4 weeks from trial, week 4 until week 24. Results: Average adherence was high, with 63%, of subjects reporting >95% adherence across the trial. However, there was a significant decline in adherence over time on trial. After controlling for potential confounding variables, patients who were less than 95% adherent to medications were 3.5-times more likely to have treatment failure (HIV-1 RNA >50 copies/ml) than subjects with adherence rates of 95-100%. The strongest predictor of adherence was adverse clinical events (for example, dermatological, gastrointestinal symptoms): patients with adverse events were 12.8-times less likely to have 95-100% adherence. Other clinical, demographic, psychosocial and behavioural factors were also significant predictors of adherence. Conclusions: Adherence influences virological outcome even in AIDS clinical trials where overall adherence rates are high and should therefore be monitored in future trials. Intervention may be warranted to enhance
Objective: To assess adherence to antiretroviral therapy with the use of Medicaid pharmacy claims data for human immunodeficiency virus (HIV)-infected pregnant women and to identify associated maternal and health care...
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Objective: To assess adherence to antiretroviral therapy with the use of Medicaid pharmacy claims data for human immunodeficiency virus (HIV)-infected pregnant women and to identify associated maternal and health care factors. Methods: We retrospectively studied a cohort of 2714 HIV-infected women in New York State who delivered live infants from 1993-96;Among 682 women prescribed antiretroviral therapy in the last two trimesters, we studied 549 who started therapy more than 2 months before delivery. Adherence was defined as adequate if the supplied drug covered at least 80% of the days from the first prescription in the last two trimesters until delivery. Multivariable analyses were used to examine associations between maternal and health care factors and adherence. Results: Only 34.2% of 549 subjects had at least 80% adherence based on pharmacy data, a rate that remained stable over time. The adjusted odds ratios (ORs) of adherence for black (OR 0.47, 95% confidence interval [CI] 0.30, 0.75) and Hispanic (OR 0.49, 95% CI 0.29, 0.82) women were nearly 50% lower than for white women. The OR of adherence was 0.32 (95% CI 0.12, 0.90) for teenagers compared with women aged 25-29 years and 0.56 (95% CI 0.34, 0.92) for women in New York City versus those residing elsewhere. Women on antiretroviral therapy before pregnancy were more likely to adhere (OR 1.55, 95% CI 1.02, 2.35). Conclusion: Teenagers, women of minority groups, and women living in New York City had greater risks of poor antiretroviral adherence, whereas women already prescribed antiretrovirals before pregnancy had better adherence. Our conservative pharmacy data-based measure showed that most HIV -infected women adhered poorly and adherence did not improve over the 4-year study. (C) 2000 by The American College of Obstetricians and Gynecologists.
The aim of the study was to compare the management of suicide attempts by patients in Sweden and Italy with a view to providing a perspective on differences in treatment. Two consecutive samples of suicide attempters ...
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The aim of the study was to compare the management of suicide attempts by patients in Sweden and Italy with a view to providing a perspective on differences in treatment. Two consecutive samples of suicide attempters from Huddinge (n=97) and Padua (n=100) were studied in trans of sociodemographic characteristics previous care, referral, medical and psychiatric care, hospitalization, aftercare and short-term compliance. In Italian somatic management of acute suicidal crises, there are more physicians specializing in anesthesia or internal medicine working in ambulances and emergency wards, and there is a heavier emphasis on somatic care. Swedish management procedures seem to entail more medical examinations and biohumoral tests. Moreover, the procedures at the Swedish hospital give priority to early psychiatric intervention, and admission to psychiatric inpatient care is more frequent. However, it is not normal practice in emergency psychiatric care at either of the centers for specialists to serve in the immediate liaison consultation. There are differences in assessment and treatment between the two countries that may provide a perspective on their procedures, implying that current procedures for managing patients belonging to groups identified as "high-risk" in terms of suicide may be modified. (C) 2000 Elsevier Science Inc.
The purpose of this study is to develop and evaluate a theoretically appropriate measure for adherence to a self-care fitness walking routine. Self-care activities are very different from prescribed therapeutic regime...
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The purpose of this study is to develop and evaluate a theoretically appropriate measure for adherence to a self-care fitness walking routine. Self-care activities are very different from prescribed therapeutic regimens. One important difference is the determination of the activity prescription or behavioral standard. When the activity is classified as self-care, the behavioral standard is determined by the individual. When the activity is a prescribed therapeutic regimen, it is determined by the health care provider. Adherence to health related activities is usually calculated by comparing actual behaviors with an expert determined standard. When this technique is used to measure adherence to a self-care regimen, the theoretical assumption that self-care activities are self-prescribed has been ignored. In this study, adherence to the self-care activity fitness walking is calculated by comparing actual recorded fitness walking behaviors with the walker's own fitness walking intention.
Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relapse. A number of sociodemographic variables, and illness, attitudinal and treatment variables, have been demonstrated to ...
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Objectives. Non-compliance with neuroleptic medication in schizophrenia is a major cause of relapse. A number of sociodemographic variables, and illness, attitudinal and treatment variables, have been demonstrated to be associated with non-compliance. The present study examined a range of these variables and their predictive value in determining past and current compliance. Methods. Thirty-nine patients suffering from schizophrenia and three patients suffering from schizoaffective disorder completed a series of questionnaires assessing psychological reactance, insight, subjective response to medication, perceived threat to freedom of choice, and degree of current and past compliance. Logistic regression analyses were performed to determine which factors best predicted past and current compliance. Results. Psychological reactance and age were found to be the best predictors of past compliance, with an interaction between reactance and perceived threat to freedom of choice posed by treatment provision also making a significant contribution. Past compliance behaviour and subjective response to medication predicted current compliance most significantly. Conclusions. Reactance is an important predictor of compliance history especially when patients perceive treatment to be a threat to freedom of choice. Subjective response to neuroleptics is most important in predicting current compliance. Implications for intervention are discussed.
作者：
Dunn, GUniv Manchester
Sch Epidemiol & Hlth Sci Biostat Grp Hlth Care Trials Unit Manchester M13 9PT Lancs England
This paper explores the implications of measurement error in the analysis of compliance-response relationships in data from randomized trials. Given that compliance measures are rarely, if ever, error-free indicators ...
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This paper explores the implications of measurement error in the analysis of compliance-response relationships in data from randomized trials. Given that compliance measures are rarely, if ever, error-free indicators of exposure it is argued that both the designs for the collection of compliance data and the statistical models for their resulting analysis should be changed to take the possibility of measurement error into account. An analysis which ignores measurement error in the compliance measurements will provide biased estimates of compliance-response relationships. Provided that one has two or more indicators of compliance for each subject, more appropriate models can be fitted using covariance structure modelling software. If one wishes to explore interactions from repeated measures data on both compliance and response then it is also important that one recognizes that the response measures are also error-prone and that they too are dealt with appropriately. Copyright (C) 1999 John Whey & Sons, Ltd.
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 dif...
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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.
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