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1.  Effects on a Poison Center’s (PC) Triage and Follow-up After Implementing the No Ipecac Use Policy 
Journal of Medical Toxicology  2010;6(2):122-125.
For years, The American Academy of Pediatrics (AAP) had supported home use of syrup of Ipecac. However, due to mounting evidence that Ipecac use did not improve outcome nor reduce Emergency Department (ED) referrals, the AAP in November of 2003 issued a statement that Ipecac not be used for the home management of poison ingestion. To determine if the cessation of the use of Ipecac for home ingestions is associated with an increased number of follow-up calls, an increased time of observation at home and an increase in the number of ED referrals for care by poison center staff were administered. Fifty randomly selected pediatric (<6 years) cases that received Ipecac (“Ipecac” group) from January 1, 2003 to October 31, 2003 were selected for study. Up to two controls (“no Ipecac” group) were matched by age, amount ingested, and by toxin. Controls were selected from the 2004–2006 time period (Ipecac no longer in use). Fifty “Ipecac” cases and 84 “no Ipecac” controls were analyzed. The groups had no significant differences with respect to percent symptomatic, median time post-ingestion, mean age, and distribution of toxin categories (e.g., antidepressants, beta blockers, etc.). The “no Ipecac” group had nearly ten times the odds of ED referral compared to the “Ipecac” group, (OR = 9.9, 95%CI 3.3–32.2). The mean total hours of follow-up was not significantly different between the groups (diff = −1.1, t = −1.8, p = 0.07). The mean number of follow-up calls was significantly less in the “no Ipecac” group (diff = −1.4 calls, t = −6.8, p < 0.001). Toxicology consults were greater in the “no Ipecac” group (χ2 = 4.05, p = 0.04); however, consults were not associated with ED referral. For the time period from 2004 to 2006, the “no Ipecac” policy resulted in an increase in ED referrals at our center. While prior studies have shown that not using Ipecac did not affect clinical outcome, our research suggested that it may have initially influenced triaging outcome. Since the use of Ipecac by centers was once a commonly used home remedy for some ingestions (albeit without rigorously established efficacy), poison center personnel had to transition to the “no Ipecac” policy. Although our referrals increased during a transitional period of time, referral rates have since stabilized and returned to baseline.
doi:10.1007/s13181-010-0066-x
PMCID: PMC3550271  PMID: 20623216
Ipecac; Triage; Poison Center; Decontamination; Poisoning; Emergency Department; Pediatric; Overdose; Ingestion
2.  Sexual Orientation and Testing for Prostate and Colorectal Cancers among Men in California 
Medical care  2008;46(12):1240-1248.
Background
Previous quantitative studies have not compared the use of prostate and colorectal cancer testing between gay/bisexual and heterosexual men.
Methods
We analyzed cross-sectional data on 19,410 men in the California Health Interview Survey. The percentage of respondents age 50 and over who received prostate and colorectal cancer tests was calculated across subgroups defined by self-reported sexual orientation, race/ethnicity, and a combined variable on sexual orientation and race/ethnicity. Multivariate regression analysis was used to identify variables on respondent characteristics that were independently associated with testing.
Results
In bivariate analyses, the percentage of gay/bisexual men receiving colorectal cancer tests was 6%-10% greater than that of heterosexuals. There were no overall differences in prostate-specific antigen test use between gay/bisexual and heterosexual men; however, use of these tests by gay/bisexual African Americans was 12%–14% lower than that of heterosexual African Americans and 15%–28% lower than that of gay/bisexual Whites. In multivariate analyses, gay/bisexual men had greater odds of ever receiving colorectal cancer tests (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.06, 2.65), and lower odds of having an up-to-date prostate-specific antigen test than did heterosexuals (OR=0.61; CI=0.42, 0.89). However, interactions between sexual orientation and living situation showed that gay/bisexual men who lived alone had greater odds of receiving prostate-specific antigen tests than did other men (OR=1.93; CI=1.23, 3.03).
Conclusions
Sexual orientation is independently associated with cancer testing among men. Future work should investigate the differences in this association by race/ethnicity and living situation.
doi:10.1097/MLR.0b013e31817d697f
PMCID: PMC2659454  PMID: 19300314
Preventive services; prostate cancer; colorectal cancer; men; sexuality
3.  BRIEF REPORT: Influenza Vaccination and Health Care Workers in the United States 
OBJECTIVE
To determine influenza vaccination rates among U.S. health care workers (HCWs) by demographic and occupational categories.
DESIGN AND PARTICIPANTS
We analyzed data from the 2000 National Health Interview Survey (NHIS). Weighted multivariable analyses were used to evaluate the association between HCW occupation and other variables potentially related to receipt of influenza vaccination. HCWs were categorized based on standard occupational classifications as health-diagnosing professions, health-assessing professions, health aides, health technicians; or health administrators.
MAIN INDEPENDENT VARIABLES
Demographic characteristics and occupation category.
MAIN OUTCOME VARIABLES
Receipt of influenza vaccination within 12 months of survey.
ANALYSIS
Descriptive statistics and weighted multivariable logistic regression.
RESULTS
There were 1,651 HCWs in the final sample. The overall influenza vaccination rate for HCWs was 38%. After weighted multivariable analyses, HCWs who were under 50 (odds ratio [OR] 0.67%, 95% confidence interval [CI]: 0.50 to 0.89, compared with HCWs 50 to 64), black (OR 0.57 95% CI: 0.42, 0.78, compared with white HCWs), or were health aides (OR 0.73%, 95% CI: 0.51, 1.04, compared with health care administrators and administrative support staff) had lower odds of having been vaccinated against influenza.
CONCLUSIONS
The overall influenza vaccination rate among HCWs in the United States is low. Workers who are under 50, black, or health aides have the lowest rates of vaccinations. Interventions seeking to improve HCW vaccination rates may need to target these specific subgroups.
doi:10.1111/j.1525-1497.2006.00325.x
PMCID: PMC1484661  PMID: 16606378
Influenza vaccinations; health care workers; National Health Interview Survey; nosocomial infection; employee health
4.  A public health response to the methamphetamine epidemic: the implementation of contingency management to treat methamphetamine dependence 
BMC Public Health  2006;6:214.
Background
In response to increases in methamphatemine-associated sexually transmitted diseases, the San Francisco Department of Public Health implemented a contingency management (CM) field program called the Positive Reinforcement Opportunity Project (PROP).
Methods
Methamphetamine-using men who have sex with men (MSM) in San Francisco qualified for PROP following expressed interest in the program, provision of an observed urine sample that tested positive for methamphetamine metabolites and self-report of recent methamphetamine use. For 12 weeks, PROP participants provided observed urine samples on Mondays, Wednesdays and Fridays and received vouchers of increasing value for each consecutive sample that tested negative to metabolites of methamphetamine. Vouchers were exchanged for goods and services that promoted a healthy lifestyle. No cash was provided. Primary outcomes included acceptability (number of enrollments/time), impact (clinical response to treatment and cost-effectiveness as cost per patient treated).
Results
Enrollment in PROP was brisk indicating its acceptability. During the first 10 months of operation, 143 men sought treatment and of these 77.6% were HIV-infected. Of those screened, 111 began CM treatment and averaged 15 (42%) methamphetamine-free urine samples out of a possible 36 samples during the 12-week treatment period; 60% completed 4 weeks of treatment; 48% 8 weeks and 30% 12 weeks. Across all participants, an average of $159 (SD = $165) in vouchers or 35.1% of the maximum possible ($453) was provided for these participants. The average cost per participant of the 143 treated was $800.
Conclusion
Clinical responses to CM in PROP were similar to CM delivered in drug treatment programs, supporting the adaptability and effectiveness of CM to non-traditional drug treatment settings. Costs were reasonable and less than or comparable to other methamphetamine outpatient treatment programs. Further expansion of programs like PROP could address the increasing need for acceptable, feasible and cost-effective methamphetamine treatment in this group with exceptionally high rates of HIV-infection.
doi:10.1186/1471-2458-6-214
PMCID: PMC1559698  PMID: 16919170
5.  Does Racial Concordance Between HIV-positive Patients and Their Physicians Affect the Time to Receipt of Protease Inhibitors? 
Journal of General Internal Medicine  2004;19(11):1146-1153.
BACKGROUND
Compared to whites, African Americans have been found to have greater morbidity and mortality from HIV, partly due to their lower use of effective antiretroviral therapy. Why racial disparities in antiretroviral use exist is not completely understood. We examined whether racial concordance (patients and providers having the same race) affects the time of receipt of protease inhibitors.
METHODS
We analyzed data from a prospective, cohort study of a national probability sample of 1,241 adults receiving HIV care with linked data from 287 providers. We examined the association between patient-provider racial concordance and time from when the Food and Drug Administration approved the first protease inhibitor to the time when patients first received a protease inhibitor.
RESULTS
In our unadjusted model, white patients received protease inhibitors much earlier than African-American patients (median 277 days compared to 439 days; P < .0001). Adjusting for patient characteristics only, African-American patients with white providers received protease inhibitors significantly later than African-American patients with African-American providers (median 461 days vs. 342 days respectively; P < .001) and white patients with white providers (median 461 vs. 353 days respectively; P = .002). In this model, no difference was found between African-American patients with African-American providers and white patients with white providers (342 vs. 353 days respectively; P > .20). Adjusting for patients' trust in providers, as well as other patient and provider characteristics in subsequent models, did not account for these differences.
CONCLUSION
Patient-provider racial concordance was associated with time to receipt of protease inhibitor therapy for persons with HIV. Racial concordance should be addressed in programs, policies, and future racial and ethnic health disparity research.
doi:10.1111/j.1525-1497.2004.30443.x
PMCID: PMC1494794  PMID: 15566445
HIV; African Americans; quality of health care; physician-patient relations

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