Internet-based information on alcohol, tobacco, and other drugs: issues of ethics, quality, and accountability.

This article discusses ethical and quality issues involved in accessing and evaluating Internet-based information on alcohol, tobacco, and other drugs (ATODs). After a brief overview of the World Wide Web and its potential for increasing knowledge in the fields of ATOD prevention, treatment, research, and policy, we discuss potential threats that may compromise the quality and utilization of Web-based ATOD information. Consumers and authors of Web-based materials must critically assess and evaluate that information; the Information Quality Tool developed by the Health Summit Working Group is suggested as an analytic framework useful in evaluating ATOD information. The article concludes with observations about future issues regarding dissemination of ATOD information on the Internet.

Motivational interviewing: an effective brief intervention for alcohol and drug abuse patients.

Inadequate motivation is a crucial factor for the substance abuser's inability to change harmful behavior. Although not widely implemented in advanced nursing practice, the motivational interviewing strategies have great utility in interactions with substance abuse patients in primary care settings. This article provides implementation strategies for an effective independent nursing intervention that can be utilized to manage drug and alcohol abuse behaviors.

Organizing the community to target poor Latino children with asthma.

A community-university partnership to improve outcomes of care for poor Latino children (aged 6-14 years) with asthma in East Los Angeles was based on development of a community infrastructure. A family-centered educational program involved over 500 families. The Association of Latinos with Asthma and Allergy Symptoms (ALAAS) was formed. Parents report reductions in hospitalizations, emergency room, and acute care visits. Survival of the infrastructure following the end of grant funds is unlikely unless other resources offset the costs of volunteerism among poor families. Block grants to community agencies from established fund-raising groups might reduce dependency-producing practices currently employed to "help" the poor.

Drugs, poverty, pregnancy, and foster care in Los Angeles, California, 1989 to 1991.

To determine the characteristics and childbearing histories of women whose infants entered foster care in Los Angeles County, we examined the cases of 1,155 drug-using women whose infants were removed from them at birth and 236 non-drug-using women whose infants were also removed at birth by court order (July 1989 through March 1991). All of the women were indigent, and less than half had graduated from high school. The drug-using women frequently had criminal records, and more than a quarter were homeless. Many comparison women had mental health problems, and some (16.7%) were teenagers under court custody. Overall, 80% of all the children born to both groups of women were under court jurisdiction. Data obtained after study infants' births on 926 drug-using women observed for 18 months revealed that 22% had borne another infant who was placed in foster care; half of these infants had a positive drug immunoassay. Of the 185 non-drug-using women with 18-month follow-ups, 7.6% had borne another child who was in foster care. The magnitude of the repeated childbearing recorded among both groups of women in this study shows that preventive programs including family planning, mental health services, and drug prevention or rehabilitation programs have not reached this population.

Perceived need for treatment among pregnant and nonpregnant women arrestees.

Previous research has noted a high rate of drug use by women arrestees. Not only are women arrestees more likely to be found drug positive by urinalysis than are men arrestees, but in recent years, in part because of drug use, women have constituted the fastest growing population segment involved with the criminal justice system. One small but important subgroup of women arrestees are those who are pregnant and, thus, who particularly need intervention. This article utilizes Drug Use Forecasting (DUF) data from Los Angeles jails to examine whether or not pregnant drug-abusing women arrestees differ from nonpregnant drug-abusing women arrestees in terms of perceived need for treatment. Bivariate analyses and multivariate logistic regression show that pregnant drug-using women are not more likely than nonpregnant women to perceive a need for treatment. Although pregnancy status is not related to perceived need, a number of other factors are related, including being single, Euro-American ethnicity, using cocaine or opioids for more than three days in the past 30 days, being self-identified as currently drug dependent, having a substance abuse treatment history, and having lower legal incomes. Interventions with drug-using women arrestees should be made early in their drug use and criminal careers and should target both pregnant and nonpregnant women.

Prevalence of hepatitis B serologic markers in community hospital personnel.

The seroprevalence of hepatitis B markers among predominantly high-risk staff members and personnel of 31 community hospitals located throughout the United States was 8.4 per cent (greater than or equal to 5 per cent in 25 hospitals and greater than or equal to 10 per cent in 13 hospitals). Only two hospitals had seroprevalence rates less than or equal to 3 per cent. The institutional seroprevalence ranged from 0 per cent to 16.7 per cent, with a median of 8.2 per cent. Although there are limitations to this survey, the results suggest that the well established increased risk of contracting HBV infection among certain groups of health-care workers in urban teaching medical centers may also hold true for personnel in similar occupational and professional categories in community hospitals.

Major complications following tracheoesophageal puncture for voice rehabilitation.

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.