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Study Objective:To use the clinical activities of an ambulance service as a tool to assess the residual and unmet medical need of a city in the aftermath of a major earthquake and to apply that assessment to the development of a training curriculum for the prehospital personnel.Methods:The researchers conducted structured interviews with health care workers at all levels of the emergency health care delivery system in Gyumrii, Armenia, and carried out a retrospective frequency analysis of 29,010 ambulance runs for an 11-month period from February through December 1992. Runs first were assigned into the broad categories of: 1) Adult Medical; 2) Pediatric Medical; or 3) Trauma, and then, according to diagnosis. The runs then were classified further as: 1) Primary Care; 2) Basic Life Support (BLS); or 3) Advanced Life Support (ALS).Results:Adult Medical calls represented 24,684 (85%), Pediatric Medical calls 459 (1.6%), and Trauma calls 3,867 (13%). Only 12% of all ambulance calls resulted in transport to a medical facility, although this percentage was higher in children. Thirty percent of Adult Medical patients were diagnosed by the emergency medical providers as having exclusively a psychiatric problem.Conclusion:In the late aftermath of a devastating earthquake, the ambulance service in Gyumrii, Armenia has been delivering a substantial proportion of non-emergency, primary care services. They have adopted this unconventional role to compensate for the deficit in health care facilities and personnel created by the disaster. The training program that the investigators developed reflected the actual work activities of the prehospital personnel demonstrated in their assessment.

Rats were trained, across 3 daily sessions, to avoid intense footshock in an automated one-way avoidance box. Subsequent to training and termination of footshock, groups of rats received different treatments, and all were tested for persistence of avoidance 3 days later. One group’s treatment was only handling, a no-treatment group. All other groups were given response prevention, i.e., 10 min on the previously shocking grid without the opportunity to avoid. Groups of rats experienced response prevention under the influence of saline or doses of drugs: meprobamate, meprobamate in conjunction with atropine, atropine alone, atropine methyl nitrate, physostigmine, ethanol, morphine sulfate, amphetamine, chlordiazepoxide, and chlorpromazine. Only atropine led to reliably less persisting avoidance than response prevention controls, whereas doses of chlordiazepoxide led to more persisting avoidance. These data provide little support for the idea that widely used “psychotropic” drugs are effective in aiding the reduction of anxiety-fear-avoidance when postdrug behavior is the criterion for a drug’s effectiveness.

Rats were fixed with chronically indwelling bipolar electrodes. After recovery from surgery they were trained to leverpress for intracranial stimulation (ICS). They pressed twice a day for three intensities of ICS for 5 min at each intensity. On each day for 10 days prior to tests with ICS, one group of rats was given THC (10 mg/kg, orally) and the other a placebo. The THC led to reduced pressing with initial doses but not with the later doses. Rats with electrode tips in the lateral hypothalamus near the entopeduncular nucleus of the internal capsule showed accelerated pressing toward the end of the 10 days of testing under THC.

Rats were fixed with a chronically indwelling electrode for intracranial stimulation (ICS) of the lateral hypothalamus. Subsequent to verification that rats would barpress for ICS, they were trained in an automated one-way avoidance chamber to avoid footshock by climbing to a ledge. After 50 daily training trials on 3 consecutive days, the footshock was terminated. One of three treatments was then programmed: (a) response prevention (retracting the ledge, forcing the rat to stay on the previously shocking grid), (b) periodic ICS during response prevention, or (c) ICS outside the chamber without response prevention. Three days later, persisting avoidance behavior in the rat was measured. It was concluded that ICS during response prevention was most effective in reducing persisting avoidance, followed by response prevention alone, and finally ICS outside the chamber.

Background Lack of knowledge regarding preventive health services for women might impede campaigns to expand these services in the emergency department setting. For 18–55-year-old English-speaking women visiting an urban emergency department, we aimed to: (1) Ascertain their knowledge regarding the applicability, purpose, and recommended intervals of three women's cancer screening and three contraceptive methods; and (2) Determine if patient age, race/ethnicity, medical insurance status, and current or recent usage of these methods are associated with greater or lesser knowledge about them. Methods Emergency department-based survey on recent or current usage and knowledge about Pap smears, breast self-examinations, mammograms, condoms, birth control, and emergency contraception. Analyses included calculation of summary statistics and creation of multivariable logistic regression models. Results Of 1,100 patients eligible for the study, 69.9% agreed to participate. Most of the participants were < age 35, white, single (never married and no partner), Catholic, and had private medical insurance. Participant's recent or current usage of a particular cancer screening or contraceptive method varied by type of method: Pap smear within the past year (69.1%), breast self-exam within the past month (45.5%), mammogram within the past year (65.7% for women age 45–55), condom usage during every episode of sexual intercourse (15.4%), current usage of birth control pills (17.8%), and ever use of emergency contraception (9.3%). The participants correctly answered 87.9% of all survey questions about condoms, 82.5% about birth control pills, 78.5% about breast self-exams, 52.9% about Pap smears, 35.4% about mammograms, and 25.0% about emergency contraception. In multivariable logistic regression models, survey participants who had private medical insurance and those who recently or currently used a given screening or contraceptive method had a greater odds of correctly answering all questions about each cancer screening or contraceptive method. Conclusion Although these female ED patients demonstrated strong knowledge on some women's cancer screening and contraceptive methods, there were several areas of knowledge deficit. Women without private medical insurance and those who have not used a particular cancer screening or contraceptive method demonstrated less knowledge. Reduced knowledge about women's cancer screening and contraceptive methods should be considered during clinical encounters and when instituting or evaluating emergency department-based initiatives that assess the need for these methods.

The Parents of Asthmatics Quit Smoking (PAQS) project contrasts two theory-based smoking cessation interventions for parents of children with asthma, and compares mechanisms of behavior change within and across theoretical perspectives. We hypothesize that enhancing the perception of risk to self and child will motivate smoking cessation more than standard approaches that emphasize building self-efficacy and coping skills for quitting in a population that is largely not motivated to quit smoking. Smokers (n = 288) and their asthmatic children who receive nurse-delivered in-home asthma education (as part of the insurance carrier's standard of care) are randomized into one of two treatment conditions: (1) the Behavioral Action Model (BAM), in which nurses emphasize goal setting and skill building to enhance self-efficacy to quit smoking, or 2) the Precaution Adoption Model (PAM), in which nurses tailor the intervention to the smoker's readiness to quit and incorporate biomarker feedback [i.e. level of carbon monoxide exposure to the smoker and level of environmental tobacco smoke (ETS) exposure to the child] in order to increase risk perception in smokers. In both conditions, smokers who are ready to quit receive the nicotine patch. Analyses will examine (1) quit rates, ETS level and motivation to quit as the primary dependent variables, (2) mediators of behavior change between and within conditions, and (3) relations between parent smoking outcomes and child asthma morbidity (i.e. ER visits and asthma symptoms) post-treatment. Results will help tailor interventions to this population, and identify mechanisms of behavior change that result in adaptive health outcomes for smokers and their children who have asthma.

Purpose To examine behavioral factors that lead patients to consider quitting smoking and features associated with readiness to quit among adults who are seeking treatment in the emergency department (ED) for respiratory symptoms. Methods A toal of 665 adult smokers seeking treatment in an ED for respiratory symptoms and respiratory illness answered survey questions during the ED visit. Results Patients self-reported "readiness to quit" was broadly distributed among this patient population. Patients with COPD, pneumonia or asthma perceived higher risks from smoking than other patients with respiratory complaints. Over half of all participants had scores indicative of depression. Regression analysis showed that prior efforts to quit, confidence, perceived importance of quitting and decisional balance were each significantly predictive of readiness to quit, accounting for 40% of the variance. Conclusions While many of these patients appear unaware of the connection between their symptoms and their smoking, patients with diagnosed chronic respiratory illness perceived higher risks from their smoking. In patients who do not perceive these risks, physician intervention may increase perceived risk from smoking and perceived importance of quitting. Interventions designed for the ED setting targeting this patient population should consider screening for depressive symptoms and, when appropriate, making referrals for further evaluation and/or treatment. Medications that can help alleviate depression and withdrawal symptoms while quitting smoking, such as bupropion, may be particularly useful for this subset of patients, as depression is a substantial barrier to quitting.