Screening Adolescents for Health Risks Using Interactive Voice Response Technology

ABSTRACT

This report presents an evaluation of an interactive voice response telecommunications system developed for adolescent health risk screening. The technology provides a means to screen adolescents for general health risks and to score self-reported risk immediately. Adolescents listen to a series of prerecorded risk questions on standard touch-tone telephones and respond by pressing the appropriate keys on the keyboard. Health care workers are provided immediate feedback in the form of a summary fax report. The fax report indicates the adolescent's risk level and suggested interventions. This paper reports on an evaluation of this technology to collect self-reported risk data for 116 adolescents seen in an urban family practice center in Cleveland, Ohio. Clinical impressions of the new technology are reported for a pilot cohort of 22 physicians. The authors examine the process of using this technology to implement screening guidelines in various settings.     

Preenrollment Immunization Policies of American Colleges: An Assessment of the Need for Policy Implementation

Abstract

Alcohol abuse among college students is prevalent, yet few instruments with sound reliability and validity are available to assess these problems in this population. As part of a large, baseline assessment battery for a prospective study of offspring of alcoholics, the 27-item Young Adult Alcohol Problems Screening Test (YAAPST) was given to 490 freshmen at a large mid western university; approximately 9 months later, 482 subjects completed the scale again. In addition to asking about such traditional problems as experiencing blackouts and driving while intoxicated, the YAAPST included specific items relating to college experiences (eg, getting into sexual situations that were later regretted, missing classes, and receiving lower grades than usual). The YAAPST was designed to assess these drinking consequences over two different time frames, lifetime and past year, and also to indicate the frequency of occurrence during the past year. Results indicated that the YAAPST is a unidimensional scale with good psychometric properties (good internal consistency and test-retest reliability). Three different approaches were used to demonstrate the validity of the YAAPST. Findings supported criterion validity (with interview-based alcohol abuse/dependence diagnoses as the criterion), concurrent validity (comparing the YAAPST with other drinking measures), and construct validity (correlating the YAAPST with etiologically relevant personality, motivational, and peer influence variables). The YAAPST is a promising screening instrument for alcohol problems in college students. It has excellent psychometric properties and the potential to provide a range of useful information to the clinician or researcher.     

Repression and other Forms of Cognitive Evasiveness: Implications for Stress Symptoms in College Students

Abstract

Lazarus has proposed that palliative defenses against threat that interfere with direct efforts to alleviate the threat may prove maladaptive. Three evasive cognitive attributes that circumvent awareness of threat were studied to determine whether they related to the prevalence of stress symptoms in college students. Repression (selective forgetting of threatening material), awareness of the repressive defense, and internal scanning (breadth of association to cues) were considered. College students of both sexes who engaged in evasive cognitive activity reported more stress symptoms than those who did not, with a progressive increase in stress as increasingly homogeneous groups were considered. Students who defended themselves by repression experienced more stress than those who did not. Repressors who were the least aware of their use of this defense reported even more stress. Unconscious repressors who were the least reflective (narrow scanners) showed the highest frequency of stress symptoms.     

Nonspecific Urethritis: Its Current Status

Abstract

The etiology, epidemiology, clinical presentation, diagnosis, and treatment of nonspecific urethritis (N.S.U.) is discussed. Chlamydia seems to be responsible for approximately 40–50% of cases while the etiology of the remainder remains obscrue. There seems to be reasonably good evidence for venereal transmission as well as for treatment of the female partner whether symptomatic or asymptomatic.

Tetracyline given for 21 days or oxytetracycline given for four days seem to be the most effective first line treatment regimens at this time.

Complications which include prostatitis, epididymitis, urethral stricture, and Reiter's Syndrome, are discussed. It appears as though there is a reasonable possibility that Reiter's Syndrome is a separate entity (or immunological sequela) rather than a complication.     

Improving Intimate Partner Violence Services in Home Visiting: A Multisite Learning Collaborative Approach

Abstract

To improve intimate partner violence (IPV) service delivery, the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Initiative’s continuous quality improvement (CQI) team implemented a Breakthrough Series model Learning Collaborative with eight program sites. Using mixed-methods, we: examined post-Collaborative changes in Florida MIECHV home visitors’ knowledge, system awareness, and confidence; identified strategies to address challenges in supporting families with IPV; and assessed post-Collaborative program improvements. The Collaborative included three interactive 2-day sessions, six webinars, and testing strategies using the Model for Improvement (Plan-Do-Study-Act). Three online surveys assessed changes influencing IPV screening, referrals, and safety planning. Thematic content analysis of qualitative data revealed existing barriers and strategies to address challenges. Home visitors reported accurate knowledge (change: 2.3%-34.8%), confidence (change: 31.8%-37.9%), and system awareness (change: 22.7%-53.5%) for all items from baseline to final survey. There was also an increase in rates of IPV screening (change: 88.0%-91.0%) and referrals (change: 43.0%-100.0%). Strategies for addressing challenges in supporting families experiencing IPV were identified at the individual (self-care, continuous education); interpersonal (reflective supervision, trauma-informed approach); organizational (defining success, supportive agency/program, policies); and community (collaboration with IPV service providers) levels. Lessons learned from the MIECHV IPV Learning Collaborative informed future CQI projects.     

The social work services in screening process of compulsory treatment interventions in addicts in Iran: A content analysis study

Compulsory treatment has had a detrimental impact on drug abuse treatment policies and programs in Iran. Physicians are currently required to conduct initial treatment screening. Social workers are a part of the treatment team but have no authority to initiate a compulsory drug treatment plan. For this reason, the present article investigates social work service participation in the process of compulsory drug treatment. The study methodology is content analysis. Nine social workers participated in seven focus group discussions. Overall, 110 codes were extracted from the sessions and were categorized into five main themes: interview and initial assessment; referral; investigation of ineligibility criteria; report to judicial authority; and follow‐up and advocacy. The results of this research suggest amending executive bylaws based on a social work approach to the screening process for compulsory drug treatment.     

Cancer Screening Barriers for Community-based Older Hispanics and Caucasians

Despite advances in screening and early detection, ethnic minority populations, ages 65 and older, are less likely than Caucasians to participate in cancer screening services. Empirical research indicates that older ethnic minorities have cultural values that influence their behaviors. Addressing culturally relevant communication to better understand those values may increase participation in cancer screening. The study reported is a secondary analysis of qualitative data gathered from focus groups. Utilizing an interdisciplinary analytical lens, we compared older Hispanic and Caucasian's cultural values and their screening behaviors. Suggested psychosocial interventions are discussed to assist providers in their ongoing efforts to promote cancer screening.     

Proactive Screening for Health Needs in United Way's 2-1-1 Information and Referral Service

ABSTRACT

Cancer disproportionately affects the underserved. United Way 2-1-1 is an information and referral system that links underserved populations to community services. This study explores the feasibility of integrating proactive screening and referral to health services into 2-1-1. A cancer risk assessment was administered to callers (n = 297), measuring their need for 6 cancer control services. A subset of respondents was randomized to receive generic or tailored referrals to needed services. Nearly all participants (85%) needed at least one of the services. Those who received tailored referrals were more likely to make appointments. Future research will explore approaches to address and eliminate health disparities through 2-1-1.     

Do women of reproductive age presenting with pelvic floor dysfunction have undisclosed anal incontinence: A retrospective cohort study

BackgroundIndirect and direct trauma following vaginal birth can negatively impact on the pelvic floor function increasing the risk of anal incontinence. It is often difficult for women to openly disclose that they have anal incontinence and there are limited data collection tools available for the identification of these women in a clinical setting.AimThis study aims to describe the prevalence of undisclosed anal incontinence in antenatal and postnatal women with pelvic floor dysfunction.MethodsRetrospective cohort study of 230 antenatal and postnatal women referred to a Continence Nursing Service in a large tertiary hospital in South Australia, Australia, with pelvic floor dysfunction. A criteria list was utilised to access the primary reason for referral, anal incontinence assessments and attendance to an appointment.ResultsAnal incontinence was identified in 26% of women (n = 59). Anal incontinence was the primary reason for referral amongst 8 women, with the remaining 51 women identified as having anal incontinence following clinical screening via phone consultation. Eighty six percent of women stated they had not previously disclosed anal incontinence to health professionals. Overall, 71% of symptomatic women (n = 28 antenatal and n = 14 postnatal women) attended appointments to a service specialising in pelvic floor dysfunction.ConclusionWomen presenting with urinary incontinence or other markers of pelvic floor dysfunction should be actively screened for anal incontinence as the prevalence of this condition is high amongst childbearing women.     

Gay Abuse Screening Protocol (GASP):Screening for Abuse in Gay Male Relationships

ABSTRACT

Thirty-two male patients in gay relationships and eight family physicians were recruited from a family practice in order to determine comfort with an eight-question Gay Abuse Screening Protocol (GASP). The GASP was administered during a typical clinical encounter. After the encounter, physicians and patients each completed a 5-point Likert Scale questionnaire to assess their comfort levels with each of the 8 GASP questions (Likert Scale: 1?=?not at all comfortable to 5?=?very comfortable). The mean comfort score was high (Likert?>4) for both patients (4.16 ± 0.18) and physicians (4.71 ± 0.18). However, mean comfort scores were significantly lower for abused patients (3.26 ± 0.75) than nonabused patients (4.57 ± 0.26). Patients were comfortable (Likert?>3) with 76.2% of GASP items while physicians were comfortable with all GASP items.