A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

INTRODUCTION: The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS: We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS: All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION: Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

Perspectives on Latino lay health promoter programs: Maryland, 2009.

OBJECTIVES: We examined common barriers and best practices in the design, implementation, monitoring, and evaluation of Latino lay health promoter programs. METHODS: Ten lay health promoter program coordinators serving Maryland Latinos were recruited in 2009 through snowball sampling for in-depth semistructured interviews with a bilingual and bicultural researcher. Program coordinators were asked about recruitment, selection, training, and supervision; key program elements; and evaluation. Analyses were conducted to identify common themes. RESULTS: Respondents had worked up to 13 years in programs focused on such areas as awareness of healthy lifestyles and reducing risk of illness. Coordinators looked for Latino leaders with team-building skills and a desire to help the community. Six programs compensated promoters with stipends; 4 paid an hourly wage. Promoters were usually trained in monthly meetings that actively engaged them. Most programs conducted site visits, practice sessions, and performance evaluations. CONCLUSIONS: Our findings indicate that successful health promoter programs require needs assessments, formation of a target population advisory board, identification of appropriate promoters, and a significant amount of training. These findings can be used to guide future programs in the identification, recruitment, and training of health promoters as well as in program monitoring.

Effect of less frequent bathing on premature infant skin.

OBJECTIVE: To evaluate the effect of less frequent bathing on skin flora of premature infants. DESIGN: Randomized clinical trial comparing the impact of every other day bathing to every 4th day bathing on skin flora type and colony count. SETTING: University of California, San Francisco, Medical Center Level IV neonatal intensive-care unit. PARTICIPANTS: Fifty-three premature infants less than 37 weeks gestational age, 14 days or older, and receiving a bath. INTERVENTION: Premature infants were randomized to either every other day bathing (control group, n = 28) or every 4th day bathing (intervention group, n = 25). MAIN OUTCOME MEASURE: Skin flora type and colony count obtained weekly. RESULTS: Repeated-measures ANOVA was used to test the main effect of group, time, and Group x Time interaction. These factors were not statistically significant; group F(1,21) = 1.842, p = .189; time F(3,63) = 1.359, p = .263; Group x Time interaction F(3,63) = 0.753, p = .525. None of the infants developed an infection as a result of participating in the study protocol. CONCLUSION: Every 4th day bathing of premature infants appears to be safe.

Integration and standardization within the Mayo Foundation Laboratories: the centralized laboratory purchasing group.

Integration and standardization of laboratories throughout a medical system can increase the efficiency and effectiveness of laboratory operations. This task is challenging in most health-care systems, as no central governance exists to compel laboratories to standardize and integrate. We describe the initial collaborative efforts to integrate and standardize the laboratories of the Mayo Foundation, which includes more than 60 laboratories of different sizes in diverse locations. The goals and objectives of the group formed to develop this initiative--the Centralized Laboratory Purchasing Group--its origin, and lessons learned are described. Similar initiatives by other academic medical centers and community health-care systems to integrate and standardize their laboratories are discussed. Successful standardization and integration increases the value of the laboratory to the larger health-care system by demonstrating accountability, efficiency, and effectiveness, and can result in considerable cost savings to the entire health-care system.

Nucleated red blood cell counts: not associated with brain injury or outcome.

The objective was to determine whether an elevated nucleated red blood cell count at birth after perinatal depression is associated with brain injury as measured by (1) proton magnetic resonance spectroscopy and (2) abnormal neurodevelopmental outcome at 30 months of age. The nucleated red blood cell counts from the first 24 hours of life were statistically analyzed in 33 term infants enrolled in a prospective study of the value of magnetic resonance imaging for the determination of neurodevelopmental outcome after perinatal depression. Nucleated red blood cell counts were elevated in 13/33 (39%). Abnormal outcome (19/33, 54%) was associated with Score for Neonatal Acute Physiology-Perinatal Extension (P = 0.04), decreased N-acetylaspartate to choline ratio in the basal ganglia (P = 0.009), and increased lactate to choline ratio in the basal ganglia (P = 0.02), but not with cord pH, Apgar score, or nucleated red blood cell value. In a logistic regression model, increasing nucleated red blood cell counts did not increase the odds of an abnormal outcome at 30 months of age (OR 1.02, P = 0.17). In a population of neonates with perinatal depression, the nucleated red blood cell count at birth does not correlate with magnetic resonance spectroscopy or 30-month neurodevelopmental outcome. The nucleated red blood cell count should not be used as a surrogate marker for subsequent brain injury.

Serial quantitative diffusion tensor MRI of the premature brain: development in newborns with and without injury.

PURPOSE: To determine the change over time of the apparent diffusion coefficient (ADC) and relative anisotropy of cerebral water in a cohort of premature newborns serially studied near birth and again near term. MATERIALS AND METHODS: Newborns were classified as normal (N = 11), minimal white matter injury (N = 7), or moderate white matter injury (N = 5). RESULTS: ADC decreased significantly with age in all brain regions in newborns classified as normal and those with minimal white matter injury. ADC increased with age or failed to decline in widespread areas of white matter in newborns with moderate white matter injury. Anisotropy increased with age in all white matter regions in newborns classified as normal. Anisotropy did not increase in frontal white matter in those with minimal white matter injury, and in widespread white matter areas in those with moderate white matter injury. CONCLUSION: This study demonstrates that serial diffusion tensor magnetic resonance imaging scans of premature newborns can detect differences in white matter maturation in infants with and without white matter injury.

Predictors of 30-month outcome after perinatal depression: role of proton MRS and socioeconomic factors.

The objective was to determine in infants with perinatal depression whether the relative concentrations of N-acetylaspartate and lactate in the neonatal period are associated with (1) neurodevelopmental outcome at 30 mo of age or (2) deterioration in outcome from age 12 to 30 mo; and to determine whether socioeconomic factors are associated with deterioration in outcome. Thirty-seven term neonates were prospectively studied with single-voxel proton magnetic resonance spectroscopy of the basal nuclei and intervascular boundary zones. Thirty-month outcomes were classified as normal [if Mental Development Index of the Bayley Scales of Infant Development (MDI) >85 and neuromotor scores (NMS) <3; n = 15], abnormal [if MDI or=3 at 12 and 30 mo; n = 11], or deteriorated [if normal at 12 mo and abnormal at 30 mo (MDI or=3); n = 11]. Thirty percent (11/37) of our cohort deteriorated between 12 and 30 mo. N-acetylaspartate/choline decreased across the groups ordered as normal, deteriorated, and abnormal [in basal nuclei (p