Public health, pandemic response, and the 2020 US election

From a health perspective, the upcoming US election could be the most consequential in our lifetimes. The USA has underperformed globally in its pandemic response but still has unparalleled resources and potential. There are, roughly, two choices for the 2020 candidates. Either they can deny the effect of the COVID-19 pandemic, and both the immediate failures and structural forces that let it play out so disastrously in the USA, or they can accept that we need change and articulate a real plan for it. The USA can achieve global health excellence, but leadership is needed to guide the country away from counterproductive assumptions of US exceptionalism, recognising with humility where we fall short and where we have much to learn from countries that fare better in health outcomes, both before and in COVID times. We need to start rebuilding with a solid framework, one capable of sheltering every American individual's health and one that will stand strong through the next global health crisis

Rural-Urban Disparities in Emergency Department Intimate Partner Violence Resources

Objective: Little is known about availability of resources for managing intimate partner violence (IPV) at rural hospitals. We assessed differences in availability of resources for IPV screening and management between rural and urban emergency departments (EDs) in Oregon. Methods: We conducted a standardized telephone interview of Oregon ED directors and nurse managers on six IPV-related resources: official screening policies, standardized screening tools, public displays regarding IPV, on-site advocacy, intervention checklists and regular clinician education. We used chi-square analysis to test differences in reported resource availability between urban and rural EDs. Results: Of 57 Oregon EDs, 55 (96%) completed the survey. A smaller proportion of rural EDs, compared to urban EDs, reported official screening policies (74% vs. 100%, p=0.01), standardized screening instruments (21% vs. 55%, p=0.01), clinician education (38% vs. 70%, p=0.02) or on-site violence advocacy (44% vs. 95%, p<0.001). Twenty-seven percent of rural EDs had none or one of the studied resources, 50% had two or three, and 24% had four or more (vs. 0%, 35%, and 65% in urban EDs, p=0.003). Small, remote rural hospitals had fewer resources than larger, less remote rural hospitals or urban hospitals. Conclusion: Rural EDs have fewer resources for addressing IPV. Further work is needed to identify specific barriers to obtaining resources for IPV management that can be used in all hospital settings. [West J Emerg Med. 2011;12(2):178-183.

The Association between Emergency Department Resources and Diagnosis of Intimate Partner Violence

Objective: There is little information about which intimate partner violence (IPV) policies and services assist in the identification of IPV in the emergency department (ED). The objective of this study was to examine the association between a variety of resources and documented IPV diagnoses. Methods: Using billing data assembled from 21 Oregon EDs from 2001 to 2005, we identified patients assigned a discharge diagnosis of IPV. We then surveyed ED directors and nurse managers to gain information about IPV-related policies and services offered by participating hospitals. We combined billing data, survey results and hospital-level variables. Multivariate analysis assessed the likelihood of receiving a diagnosis of IPV depending on the policies and services available. Results: In 754,597 adult female ED visits, IPV was diagnosed 1,929 times. Mandatory IPV screening and victim advocates were the most commonly available IPV resources. The diagnosis of IPV was independently associated with the use of a standardized intervention checklist (OR 1.71, 95% CI 1.04-2.82). Public displays regarding IPV were negatively associated with IPV diagnosis (OR 0.56, 95% CI 0.35-0.88). Conclusions: IPV remains a rare documented diagnosis. Most common hospital-level resources did not demonstrate an association with IPV diagnoses; however, a standardized intervention checklist may play a role in clinicians\u27 likelihood diagnosing IPV

Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers

BACKGROUND: The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. METHODS: ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling. RESULTS: Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p \u3c 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling. CONCLUSIONS: In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options

An Agenda for Increasing Grant Funding of Emergency Medicine Education Research

Funding is a perennial challenge for medical education researchers. Through a consensus process, the authors developed a multifaceted agenda for increasing funding of education research in emergency medicine ( EM ). Priority agenda items include developing resources to increase the competitiveness of medical education research faculty in grant applications, identifying means by which departments may bolster their faculty's grant writing success, taking long‐term steps to increase the number of grants available to education researchers in the field, and encouraging a shift in cultural attitudes toward education research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95395/1/acem12041.pd