Passive surveillance for Kawasaki disease in San Diego County

BACKGROUND: Kawasaki disease (KD) is the most common cause of acquired heart disease in children in the United States. Epidemiologic surveillance is conducted to monitor baseline incidence of the disease and to identify epidemics. The aim of this study was to evaluate a passive surveillance system for reporting cases of KD in San Diego County to the local, state and national health authorities. METHODS: We performed a retrospective review of a 2-year period to identify the number of patients who met criteria of the Centers for Disease Control and Prevention for diagnosis of KD and who were successfully reported to the county, state and national databases. RESULTS: The total number of KD patients for 1994 and 1995 was determined by retrospective review of medical record discharge diagnosis codes. Of the 28 San Diego County residents diagnosed with KD in 1994, 24 (86%) met CDC criteria and 15 (63%) of these eligible patients were reported to the county and state health authorities. Of the 41 residents in 1995, 34 (83%) met CDC criteria and 22 (65%) were reported to the above agencies. No patient in either 1994 or 1995 was reported by local or state health authorities to the CDC. CONCLUSION: Passive surveillance for KD in San Diego County resulted in the reporting of approximately two-thirds of the eligible patients at the county and state levels but completely failed to report any documented cases to the CDC. Implementation of a sentinel hospital reporting system should be considered as a preferred alternative to national passive surveillance in the effort to track total numbers of patients and to follow disease trends over time.     

Conceptions of prenatal care among Somali women in San Diego

Studies have shown that culturally sensitive prenatal care improves access to and utilization of that care. Focus groups were used to explore the beliefs and attitudes toward prenatal care among Somali women in San Diego, particularly in regard to their perinatal experiences following immigration. The women were very well informed about healthy prenatal practices, including nutrition and exercise, and very compliant in following such practices, having found ways and means to accommodate these practices into their new American lifestyle. The women were generally pleased with the care that they have received in San Diego and tolerant of most diagnostic and therapeutic interventions. The women preferred to be seen by a female doctor/health care practitioner who is informed about the female circumcision practiced in Somalia and who is conservative in the decision to perform cesarean section deliveries.     

Diabetes education infrastructure and capacity in hospitals and home health agencies in Maryland and Pennsylvania

Sex-peptide (SP), which is secreted by the accessory gland of Drosophila males, is transferred to the female during copulation, thereby reducing her sexual appetite (receptivity to males) and stimulating ovulation/oviposition. SP is known to be taken up into the hemolymph of mated females, but it is not clear whether there are two separate target tissues, for behavioral changes and ovulation or only one target for both responses. We have employed the GAL4-UAS system to express SP transgene constructs, both in different tissues and in different cellular components of virgin females. A cytoplasmic form of SP lacking a signal sequence did not evoke any responses, even when expressed ubiquitously. In contrast, a membrane-bound form of SP induced typical post-mating behavior, indicating that SP must be outside the cell in order to exert its biological effects. A total of 204 randomly selected P[GAL4] enhancer-trap lines were screened for their ability to induce SP responses in combination with the membrane-bound SP expressed under GAL4 control. Thirty-three lines were associated with both behavioral change and stimulated ovulation. No line was associated with only one of the two responses, implying that the SP target(s) mediating the two responses are either identical, very closely located, or present in two distinct tissues with a common set of genetic determinants. Western blot analysis of head, thorax, and abdominal extracts revealed that the biological activity was correlated with expression in the head fraction.     

引人注目的MIM材料与生产工艺进展

2015年5月17-20日,在美国加州圣地亚哥市举行的POWDERMET2015会议与展会览上,MIM材料与生产工艺最引人们注目,来自世界各地的MIM生产厂家,产业支持者及研究人员共享了他们最近的研究与开发成果。在Dr.David Whittaker的这篇报告中,述评了来自日本,印度,德国,英国及美国的论文。这些论文反映了MIM生产在增强与产业在增长的许多关键领域。     

Disaster preparedness: institutional capacity building in the Americas

Latin American and Caribbean countries are prone to natural, technological and "complex" disasters. This vulnerability to catastrophic events led the region to undertake the long journey away from an ad hoc response towards institutional preparedness and, more recently, to disaster prevention and mitigation. This article attempts to outline the definitions and basic principles of institutional emergency preparedness, including reliance on the more effective use of existing resources, rather than establishment of special stockpiles and equipment; the critical importance of general participation and awareness; and the interrelationship of the health sector with others and the potential for leadership. How to assess the level of preparedness is discussed. Stress is placed on the fact that preparedness is traditionally confused with the existence of a written disaster plan. Preparedness should be seen as a never-ending, complex process that can only be assessed through an in-depth review of coordination, planning, training and logistic elements. There is also a fundamental distinction between preparedness, i.e., "getting ready to respond" and disaster prevention/mitigation, which aims to reduce the health impact. The latter calls for the collaboration of engineers, architects, planners and economists with the health sector. It is illustrated by the regional initiative in the Americas to reduce the physical vulnerability of hospitals to earthquakes and hurricanes. In spite of the encouraging achievements, much remains to be done. Weak areas include preparedness for technological disasters, and a true inter-country preventive approach to common disasters across borders. Electronic communications through the Internet will also help to suppress borders and boundaries, contributing to a truly collective approach to emergency preparedness and disaster relief coordination.     

The home as a framework for health care

A 6-month-old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment for bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.     

Evaluation of the Biocriteria of Streams in the San Diego Hydrologic Region

In this study, bioassessment data collected between 1998 and 2005 were synthesized and analyzed for streams and rivers throughout the San Diego Hydrologic Region to provide a spatial and temporal context for the results of several monitoring projects conducted between 1998 and 2005 and to ascertain the applicability of the Southern California benthic macroinvertebrate index of biological integrity (SoCal B-IBI) to the region’s streams. The water quality of the sites studied in the region, as reflected by temporal and spatial analyses of SoCal B-IBI scores, was found to be quite poor. When streams were analyzed individually most showed stable scores over the time frame of the study with some showing better scores in the fall. Spatially, scores were found to be better farther away from the coast in the upstream reaches of the watersheds. This study further explored the applicability of the SoCal B-IBI to a focused geographic region by demonstrating the necessity of each component metric to the assignment of biological condition. Although all component metric scores were deemed to be necessary, the percent intolerant individuals score had a more significant effect in driving impairment. The analysis of the component metrics of the SoCal B-IBI provides useful insights to the changes in scores among and between the sampled sites in the region’s watersheds. Based on this study, natural resource management agencies responsible for managing water quality should incorporate regular measures of biological integrity into their water quality programs to ascertain regional and temporal trends.     

How access to long-term care affects home health transfers

This study examines the determinants of home health use after hospitalization for acute illness for eleven diagnosis-related groups (DRGs) in 1985, drawing on data from four primary sources: Medicare hospital bills, Medicare home health bills, the Medicare and Medicaid Automated Certification System files, and the American Hospital Association Survey. Separate Tobit models are estimated for each DRG. The analysis shows that transfers to home health care are heavily influenced by the hospital's long-term care arrangement and by conditions in local nursing home and home health care markets. Especially important is whether a hospital has its own long-term care unit, swing beds, or both, and whether nursing home beds are available in the local area. Patients discharged from hospitals are more likely to use home health care in areas with a low supply of nursing home beds and low Medicaid reimbursement levels for skilled nursing facilities. The results of this study have implications for proposals to extend Medicare's Prospective Payment System for hospital services to include postacute care. Proponents of a "bundled payment" that encompasses both acute and postacute services argue that the current system leads to inefficiencies and inequities. This analysis points to systematic relationships between home health and nursing home services, which should be factored into the development of a bundled payment policy.     

A model for improving medication use in home health care patients

OBJECTIVES: (1) To develop a model for the identification and resolution of problems associated with suboptimal medication use in elderly patients receiving home health care; (2) To select the most important identifiable problems and develop structured procedures for their resolution. DESIGN: Expert panel review, problem selection, and development of a problem resolution model and guidelines. SETTING: Home health care. PARTICIPANTS: A panel with expertise in home health nursing, pharmacy, clinical pharmacology, gerontology, pharmacoepidemiology, and health services research. INTERVENTIONS: A list of potential problems associated with the most frequently used classes of drugs was compiled for review by the panel. Problems that were controversial or that could not be identified in the home care setting were excluded. Panel members individually ranked the remainder. Detailed procedures for identification and resolution of the 15 top-ranking problems were developed. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Potential medication problems were defined by both drug use and symptoms or clinical signs associated with specific adverse effects, to ensure that clinically relevant problems would be identified. The model developed for problem assessment and resolution was centered on the drug utilization review (DUR) coordinator and the attending home health nurse. Following guidelines developed by the panel, the DUR coordinator advises the home health nurse about identified problems and how to resolve them. One of these practitioners, usually the nurse, then contacts the attending physician to explain their concerns, offer potential solutions, and request instructions. CONCLUSION: A potentially useful model for the identification and resolution of medication problems in the home health care setting was developed. This model is currently being evaluated in a randomized controlled trial.     

A baseline assessment of cigarette sales to minors in San Diego, California

A community-wide survey of 302 parents of 2-year-old children and 90 private medical practitioners in a large midwestern city revealed low immunization rates (31%) and differences in parent and provider perceptions of barriers to preschool immunizations. Parents most frequently identified barriers of system factors such as cost, lack of insurance coverage, and long office waits. System barriers were reported across differing sources of immunizations (private physician as well as public clinics) and were pervasive across income groups. Providers were more likely to report barriers of parental difficulties with forgetting immunizations or not knowing when the immunizations were due. Even though providers identified parental shortcomings with scheduling as problematic, only one fifth employed tracking and reminder systems. Implications of findings for modifications of the delivery of immunization services and for parent education are discussed.     

Cash planning in community mental health agencies

Community mental health agencies often receive funds from a number of different sources with varying restrictions. Cash planning can help them manage these funds properly and avoid serious problems. The use of a projected cash flow statement may even help produce additional income for them.     

Explication of the construct of shared care and the prevention of pressure ulcers in home health care

A new procedure specific for the determination of the analytical form of the model weighting function of a complex multicomponent pharmacokinetic system with or without a shunt and time delays is described. The procedure is based on the theory of linear dynamic systems and on a circulatory pharmacokinetic model of the living body. The model transfer function of the system under study was obtained by the frequency response method in the form of the ratio of two frequency dependent polynomials. Subsequently, the technique of the partial fraction inversion was employed to determine the analytical form of the model weighting function. Two examples from bioavailability studies in pharmacokinetics are given. The first example presents two estimates of the model weighting function of a pharmacokinetic system obtained by the new procedure and by a polyexponential deconvolution method. To compare these results, two models of the measured system output were determined using the two estimates of the model weighting function, the actual system input and a convolution method. The model weighting function obtained by the new procedure yielded a better model approximation of the output data than that obtained by the polyexponential deconvolution method. The second example, using the new procedure, presents the determination of the model weighting function of such a system that the deconvolution methods, commonly used in pharmacokinetics, cannot be applied to.     

Health patterns of cardiac surgery clients using home health care nursing services

The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.     

Firearm ownership and safety practices: a random-digit dial survey of San Diego

A random-digit dialing procedure was used to identify correlates of gun ownership and storage for a defined population. Of subjects contacted, 525 (64.7%) completed the survey. Subjects were generally representative of the population with slight underrepresentation of minority groups (16% were non-Caucasian). Of respondents, 129 (25.2%) reported owning a gun. Of these, 72.6% owned a handgun, 55% kept firearms for protection, 27.7% kept gun(s) loaded and ready to shoot, 66.4% kept gun(s) locked, and 46.2% carried gun(s) in the car some of the time. The strongest correlates of ownership were formal training (odds ratio [OR] = 3.52; 95% confidence intervals [CI] = 2.18, 5.67) and having been shot at (OR = 2.15; 95% CI = .97, 4.75). The strongest correlates of loaded gun status were children in the home (OR = 6.46; 95% CI = 1.18, 35.42), formal training (OR = 4.65; 95% CI = 1.04, 20.77), and keeping a gun for protection (OR = 8.82; 95% CI = .87, 89.83). Having been shot at was negatively correlated with keeping one's gun(s) locked (OR = .26; 95% CI = .07, 1.01). The strongest correlates of keeping a gun in the car were handgun ownership (OR = 11.44; 95% CI = 1.02, 128.65), keeping one's gun(s) loaded (OR = 3.79; 95% CI = 1.00, 14.43), and formal training (OR = 3.34; 95% CI = .82, 13.65). The data suggest that leaving firearms loaded and unlocked is common. Results may provide guidance in the design of interventions to decrease firearm-related morbidity and mortality.     

Case managed mental health care in the San Antonio catchment area: the crisis-intervention unit

Through the use of government nursing case management, this crisis-focused inpatient psychiatric program provided cost-effective and therapeutically directed services to Civilian Health and Medical Program for the Uniformed Services (CHAMPUS)-eligible beneficiaries in the San Antonio catchment area. Using managed care principles and a continuum-based case management model, these services were provided in local contracted civilian facilities. This acute care mental health program directly saved Brooke Army Medical Center 1.1 million mental health dollars and saved 7.7 million CHAMPUS dollars in total cost avoidance. Program costs were minimal, resulting in a 557% return on investment. A joint Army/Air Force endeavor, the program was originally administered by the Coordinated Care Division, Brooke Army Medical Center as a CHAMPUS recapture initiative. Currently under TRICARE management, the program continues intact as a managed care mental health service alternative.