Posttreatment follow-up, aftercare, and worksite reentry of the recovering alcoholic employee

A review of literature on the effects of aftercare in the treatment of alcoholism reveals mixed results, with some studies showing positive effects and some showing no effects. However, few studies controlled for bias in the process of selection into aftercare, and many of the studies reveal significant difficulties in engaging patients into aftercare. The relapse prevention model is reviewed as a potentially powerful tool for use in aftercare. The literature on worksite reentry of alcoholics shows a generally positive correlation between employment and recovery, but does not produce unambiguous findings regarding the direction of the relationship. A nontraditional, proactive approach to aftercare is proposed, based on studies of other types of health problems that show improved results with this approach. It is argued that the worksite is the most appropriate place to locate aftercare services for employed alcoholics, particularly worksites with employee assistance programs. However, further research is needed to guide the development of these services.

Diagnosis of the rare solid and papillary epithelial neoplasm of the pancreas by fine needle aspiration cytology. Light and electron microscopic study of a case

A case of the rare solid and cystic papillary tumor of the pancreas in a young woman is described. The diagnosis was made by fine needle aspiration cytology, with electron microscopic examination of the needle washings. The preoperative cytologic diagnosis enabled appropriate surgical treatment to be planned and carried out without undue delay. It is important to distinguish this rare tumor from other pancreatic tumors with similar cytohistologic features since, if diagnosed correctly and managed surgically, this neoplasm is associated with a good prognosis.

Cost-effectiveness of work-site blood pressure control programs

The cost-effectiveness of work-site hypertension programs was examined at three manufacturing plants. A fourth plant was used as a control site to estimate expected levels of hypertension control from screening without further intervention. The annual cost per hypertensive employee of the three intervention programs was $26.26 for semiannual follow-up, $35 for full follow-up, and $96.19 for on-site treatment. Each intervention resulted in an additional 1% of hypertensive employees maintained under control, per dollar spent annually, with the highest cost per unit of effectiveness being incurred for free on-site treatment. Cost-effectiveness may vary considerably, however, depending on the additional costs a company may incur as a result of program adoption.

Hypertension control at the work site. Comparison of screening and referral alone, referral and follow-up, and on-site treatment

Four methods for improving hypertension control among employees were tested in one manufacturing plant each: screening and referral to a physician but no other intervention; referral to a physician and semiannual follow-up; referral to a physician and more frequent follow-up as needed; and on-site treatment or care by a family physician. All methods significantly increased the proportion of subjects under treatment, but only the three programs offering follow-up or treatment significantly improved the adequacy of control. At the end of the three years of the project, 56 to 62 per cent of the hypertensive employees in these three programs had blood-pressure readings below 140/90 mm Hg, and 86 to 90 per cent had readings below 160/95. In contrast, among employees who received no intervention after screening, only 21 per cent had readings below 140/90 mm Hg at the end of the study, and only 47 per cent had readings below 160/95. Employees selecting on-site treatment had the highest level of blood-pressure control, but this finding appeared to be due to self-selection of previously untreated patients into on-site treatment and to exclusion of employees with other medical problems. We conclude that work-site hypertension programs can produce substantial improvements in blood-pressure control if they include systematic, routine follow-up that provides employees with information about their condition and offers support for maintenance of therapy.

A hospital-based screening, referral, and follow-up program for high blood pressure

A hypertension program staffed largely by volunteer nurses in a hospital outpatient department is described. A three-year evaluation shows 19% of 4,282 clients screened as having high readings, 86% of those referred saw a physician for high blood pressure, 92% of those who saw a physician began treatment for high blood pressure and 50% of those under treatment were showing successful control or progress toward successful control.