The effect of linking community health centers to a state-level smoker's quitline on rates of cessation assistance

<p>Abstract</p> <p>Background</p> <p>Smoking cessation quitlines are an effective yet largely untapped resource for clinician referrals. The aim of this study was to assess the effect of a fax referral system that links community health centers (CHCs) with the New York State Quitline on rates of provider cessation assistance.</p> <p>Methods</p> <p>This study was conducted in four CHCs using a quasi experimental study design. Two comparison sites offered usual care (expanded vital sign chart stamp that prompted providers to ask about tobacco use, advice smokers to quit, assess readiness, and offer assistance (4As)) and two intervention sites received the chart stamp plus an office-based fax referral link to the New York State Quitline. The fax referral system links patients to a free proactive telephone counseling service. Provider adherence to the 4 As was assessed with 263 pre and 165 post cross sectional patient exit interviews at all four sites.</p> <p>Results</p> <p>Adherence to the 4As increased significantly over time in the intervention sites with no change from baseline in the comparison sites. Intervention sites were 2.4 (p < .008) times more likely to provide referrals to the state Quitline over time than the comparison sites and 1.8 (p < .001) times more likely to offer medication counseling and/or a prescription.</p> <p>Conclusions</p> <p>Referral links between CHCs and state level telephone quitlines may facilitate the provision of cessation assistance by offering clinicians a practical method for referring smokers to this effective service. Further studies are needed to confirm the efficacy of fax referral systems and to identify implementation strategies that work to facilitate the utilization of these systems across a wide range of clinical settings.</p

Data Linkage: A powerful research tool with potential problems

Background: Policy makers, clinicians and researchers are demonstrating increasing interest in using data linked from multiple sources to support measurement of clinical performance and patient health outcomes. However, the utility of data linkage may be compromised by sub-optimal or incomplete linkage, leading to systematic bias. In this study, we synthesize the evidence identifying participant or population characteristics that can influence the validity and completeness of data linkage and may be associated with systematic bias in reported outcomes

A exposição ao chumbo como fator de risco para alterações no desenvolvimento da linguagem Lead exposure as a risk factor for alterations in language development

OBJETIVO: Verificar a ocorrência de alterações no desenvolvimento, em particular, o desenvolvimento da linguagem, em crianças com histórico de exposição ao metal chumbo, e a existência ou não de correlação entre índice de contaminação e desenvolvimento de linguagem. MÉTODOS: Cinqüenta e oito crianças entre 12 e 36 meses foram submetidas à triagem fonoaudiológica; destas, 15 compareceram para avaliação específica por meio da Escala de Desenvolvimento Comportamental de Gesell e Amatruda por terem falhado na triagem. A correlação entre índice de chumbo e o grau de defasagem na linguagem foi verificada. RESULTADOS: Seis crianças apresentaram defasagem na área da linguagem da Escala, sendo que, uma delas apresentou defasagem em todos os campos. CONCLUSÃO: Não foi encontrada correlação negativa significante entre a concentração de chumbo e o grau de defasagem no desenvolvimento de linguagem dos indivíduos participantes, entretanto, o estudo sugere que a contaminação pelo chumbo tornou-se fator de risco para alterações no desenvolvimento da linguagem destas crianças. Dessa forma, mais estudos são necessários para verificar o grau de prejuízo que este metal pode ocasionar às pessoas, principalmente quando estão em desenvolvimento.<br>PURPOSE: To verify the occurrence of alterations in the development, in particular language development, in children with history of metal lead exposure, and whether there is a correlation between index of contamination and language development. METHODS: Fifty eight children with ages between 12 and 36 months were submitted to speech-language pathology screening; 15 of these children failed the screening, and were referred to specific evaluation using the Behavioral Development Scale by Gesell and Amatruda (Escala de Desenvolvimento Comportamental de Gesell e Amatruda). The correlation between lead index and the degree of language deficits was verified. RESULTS: Six children presented deficits in the scale's language items; one of them had deficits in all items. CONCLUSION: No significant correlation was found between lead concentration and the degree of the language deficits of the subjects, however, the study suggests that lead contamination became a risk factor for deficits in language development. Therefore, further studies are necessary to verify the damages that this metal can cause in people exposed to it, especially when they are in development