Impact of a community based fire prevention intervention on fire safety knowledge and behavior in elementary school children

The objective of this study was to determine the impact of a community based fire prevention intervention directed only to parents on the fire safety knowledge and behavior in elementary school children. This was a prospective, quasi-randomized controlled study in which third and fourth grade students from two elementary schools in an urban, poor, minority community completed knowledge/behavior surveys at baseline and following completion of the intervention. The intervention group received an in-home visit from fire department personnel who installed free lithium smoke detectors and provided a fire escape plan. After accounting for a small difference in baseline summary scores of knowledge and behavior between the control and intervention groups, this study found a modest improvement in fire safety behavior among children whose families received a fire prevention intervention reflecting a change in household fire safety practices. However, there was no significant change in fire safety knowledge.

The contribution of school meals to food consumption and nutrient intakes of young people aged 4–18 years in England

Objectives

To undertake secondary analyses of the 1997 National Diet and Nutrition Survey of Young People aged 4–18 years in order to describe the contribution of school meals to daily food and nutrient intakes; and to compare the findings from 1997 with data collected in English primary and secondary schools in 2004–2005.

Design

Cross-sectional analysis of 7-day weighed inventory food consumption data according to age, sex, household income, free school meals and breakfast consumption. Comparison of food consumption with the Balance of Good Health and of nutrient intake data with the Caroline Walker Trust (CWT) guidelines.

Setting

United Kingdom.

Subjects

One thousand four hundred and fifty-six UK schoolchildren aged 4–18 years, 7058 English primary-school pupils and 5695 English secondary-school pupils.

Results

Pupils' school meal choices in 1997 did not accord with the Balance of Good Health. Food choices in school were less healthy than choices outside school. School meals failed to make good the shortfalls in daily intakes of non-starch polysaccharides and zinc in primary-school pupils, and of calcium, iron, zinc, vitamin A and non-starch polysaccharides in secondary-school pupils, nor excess daily intakes of saturated fatty acids, non-milk extrinsic sugars and sodium at all ages. School meals typically failed to meet CWT guidelines. They were more likely to meet CWT guidelines when choice of foods was restricted.

Conclusions

School meals need substantial improvement to meet CWT guidelines for healthy eating. The introduction of food-based guidelines for school meals in England in 2001 did not improve the food choices in school meals.

Quality of psychosocial care in oncology: A national survey of oncologists

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Background: Little is known about the quantity and quality of psychosocial care being delivered by oncologists in the United States. This study surveyed oncologists about their management of psychosocial distress, using the National Comprehensive Cancer Network (NCCN) guidelines for psychosocial distress as a standard. Availability of mental health services and routine screening for distress were used as measures of quality care. Methods: A random sample of 1,000 oncologists in the United States belonging to ASCO were surveyed with an anonymous e-mail and mail-based questionnaire between 9/05 and 7/06. Initial univariate analyses were used to test differences in frequencies among groups using Chi-square for categorical variables, and t-tests and ANOVA for continuous variables. Variables that were associated with reported routine screening at the .05 significance level in the univariate analyses were entered into a logistic regression model to determine independent predictors of screening. Results: Forty-six percent (448/965) of oncologists responded. Almost two-thirds (63.6%, 285/448) practiced in community settings, 27.2% (122/448) at cancer centers, and 6.9% (31/448) in hospitals. Only half (50.3%, 95% CI 45.7–54.9%; 225/448) reported having any mental health services affiliated with their practice. Availability differed by practice setting, with cancer centers having the most and community having the least (P<.001). Only one-third (32.3%, 144/445) reported being at least somewhat familiar with the NCCN guidelines. Two-thirds (65.0%, 95% CI 60.6–69.4%; 290/446) reported routinely screening for distress, but only 14.3% (64/447) use a screening instrument. Availability of mental health services, knowledge of NCCN guidelines, experience, time, certainty about identifying distress and being female were independent predictors of reported screening. Conclusion: Only 36.4% (95% CI 34.1–38.7%; 162/445) reported both of our measures of quality care, available mental health services and routine screening for distress. While the majority report routinely screening for distress, only a small percentage follow NCCN guidelines by using a screening instrument, and only half report having mental health services available.

No significant financial relationships to disclose.

Statewide survey on the management of psychosocial distress by oncologists

8601

Background: Although the NCCN has published guidelines for the management of psychosocial distress, no data exists on how oncologists manage it in clinical practice. This study surveyed oncologists in Massachusetts on their estimated rates of distress in their patients, beliefs about distress, and practice patterns. Methods: All Massachusetts oncologists belonging to ASCO were e-mailed an electronic survey up to three times. Survey completion was anonymous and a small incentive was offered for participation. Descriptive statistics and cross-tabulations were compiled. Chi-squared analyses investigated differences in rates. Results: 393 e-mail addresses were identified. 338 surveys were delivered, but the e-mail survey could be blocked by SPAM filters. Ninety-nine responses were obtained yielding a response rate of 29%. Oncologists estimated that 77% (sd=23%) of their patients experience distress, but only 33% (sd=20%) have distress that warrants treatment. Emotional problems unrelated to illness, practical problems, and coping with illness were the three most frequently encountered forms of distress. Sixty-five percent of oncologists reported that they routinely screened for psychosocial distress, but only 3% use a screening instrument. Almost all reported that they would at least consider using a brief screening instrument (93%). Lack of time was identified as the main barrier to screening, but lack of knowledge about treatment of distress was the only variable that predicted lower rates of screening (p=.03). While reported rates of referrals to mental health professionals were high, the majority (85%) reported that they directly address the psychosocial distress in their practice and almost half reported that they initiate psychotropic medications (45%). Conclusions: The majority of oncologists report that they do some screening and management of psychosocial distress in their clinical practices. Although screening appears to mainly be done through the usual clinical encounter, research has shown that this method has a poor rate of detection for psychological disorders. Despite the fact that the NCCN recommends the use of screening instruments and most oncologists report interest in using them, oncologists rarely actually use such measures.

No significant financial relationships to disclose.

A comparison of 12- and 15-lead ECGS in ED chest pain patients: impact on diagnosis, therapy, and disposition

The objective of this study was to investigate the diagnostic and therapeutic impact of the 15-lead electrocardiogram (15ECG) on the emergency department (ED) management of chest pain (CP) patients. The design was prospective use of 15ECG with real-time physician survey and retrospective comparison to 12-lead ECG (12ECG). The study took place in a University hospital ED. Adult CP patients participated. During the 15ECG period (June 1996 to July 1996), 595 patients (92% of CP patients) had 15ECG analysis. Diagnoses of acute coronary ischemic syndromes (ACIS) were as follows: 13 acute myocardial infarction (AMI, 7 anterior [ANT], 5 inferior [INF], 1 lateral [LAT], 2 posterior [POST], 1 right ventricular [RV]) and 136 unstable angina (USA) with 47% exhibiting ECG abnormality; the 2 POST and 1 RV AMI occurred in the setting of coexisting INF AMI. The following management strategies were used: 6 fibrinolytic therapy (TT), 4 primary angioplasty (PTCA), 67 rule-out myocardial infarction (ROMI), and 144 admission to critical care unit (CCU). During the 12ECG period (June 1995 to July 1995), 599 patients were encountered. The diagnoses of ACIS were as follows: 11 AMI (5 ANT, 4 INF, 2 LAT) and 146 USA with 51% exhibiting ECG abnormality (P = NS for diagnostic comparisons to 15ECG). The following management strategies were used: 5 TT, 5 PTCA, 59 ROMI, and 137 admission to CCU (P = NS for all treatment comparisons to 15ECG). Of 15ECG cases 81% had completed real-time physician survey, showing that the diagnosis and management ACIS were not altered by the 15ECG; physicians felt, however, that the 15ECG provided a more complete anatomic picture of the ACIS. No false-positive cases of additional lead STE were noted in this investigation except in cases involving abnormal intraventricular conduction such as the bundle branch block scenario. The 15ECG provided a more complete description of myocardial injury without altering the ED diagnosis, ED-based therapy, or hospital disposition in adult CP patients. Further study is required to identify patient subset(s) which may benefit from the 15ECG.

Recurrent lambdoid synostosis within two families

We report on 2 families with multiple members who have proven or suspected lambdoid craniosynostosis. In one family the lambdoid suture was unilaterally involved in one sib, and bilaterally in the other. In the second family the propositus had unilateral lambdoid synostosis and his twin sisters each had bilateral lambdoid synostosis. Both families had another distant relative, a maternal grandmother in the first and paternal uncle in the second, who were also reported to have posterior plagiocephaly. We report these families as evidence for genetic transmission of a craniosynostotic trait which has only been rarely reported previously.