Wireless substitution: state-level estimates from the National Health Interview Survey, 2012.

OBJECTIVES: This report updates subnational estimates of the percentage of adults and children living in households that do not have a landline telephone but have at least one wireless telephone (i.e., wireless-only households). State-level estimates for 2012 are presented, along with estimates for selected U.S. counties and groups of counties, for other household telephone service use categories (e.g., those that had only landlines and those that had landlines yet received all or almost all calls on wireless telephones), and for one earlier 12-month period (July 2011-June 2012). METHODS: Small-area statistical modeling techniques were used to estimate the prevalence of adults and children living in households with various household telephone service types for 93 disjoint geographic areas that make up the United States. This modeling was based on 2007-2012 data from the National Health Interview Survey, 2006-2011 data from the American Community Survey, and auxiliary information on the number of listed telephone lines per capita in 2007-2012. RESULTS: The prevalence of wireless-only adults and children varied substantially across states. State-level estimates for 2012 ranged from 19.4% (New Jersey) to 52.3% (Idaho) of adults and from 20.6% (New Jersey) to 63.4% (Mississippi) of children.

Assessing non-response bias in pediatric palliative care research.

National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.

[Intensive care anaesthesia practice in the prison environment. Can a prisoner benefit from ambulatory anaesthesia]. / Pratique de l'anesthésie réanimation en milieu pénitentiaire. Un détenu peut-il bénéficier d'une anesthésie ambulatoire ?

Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France.

E-health: determinants, opportunities, challenges and the way forward for countries in the WHO African Region.

BACKGROUND: The implementation of the 58th World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO) African Region due to lack of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i) explore the key determinants of personal computers (PCs), telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii) to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. METHODS: The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP), the World Bank and the International Telecommunications Union (ITU) sources. RESULTS: There were a number of main findings: (i) the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test) positive effect on the number of PCs in a country; (ii) the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii) the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv) similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v) there were major inequalities in ICT connectivity between upper-middle, lower-middle and low income countries in the Region. By focusing on the adoption of specific technologies we attempted to interpret correlates in terms of relationships instead of absolute "causals". CONCLUSION: In order to improve access to health care, especially for the majority of Africans living in remote rural areas, there is need to boost the availability and utilization of e-health services. Thus, universal access to e-health ought to be a vision for all countries in the African Region. Each country ought to develop a road map in a strategic e-health plan that will, over time, enable its citizens to realize that vision.

Utilidad de la consulta telefónica en pediatría de atención primaria / Telephone consultation services in pediatric primary care

OBJETIVO. Hemos organizado una consulta telefónica de enfermería en atención primaria pediátrica que funciona como filtro y que con unos protocolos básicos intenta resolver el mayor número de dudas posibles. El objetivo de este trabajo es valorar la utilidad, seguridad y grado de aceptación de este servicio. Método. Entre los meses de febrero de 1999 y febrero de 2000, dos enfermeras pediátricas de la área básica de salud. de St. VicenÇ deis Horts han recogido las consultas telefónicas dirigidas a dos unidades de Pediatría. Durante una hora diaria al inicio del tiempo de consulta han intentado resolver las dudas formuladas por teléfono por la población asignada que es de 2.714 niños de 0 a 15 años. Han tenido acceso al pediatra cuando lo han creído conveniente. Hemos recogido el motivo de consulta, la edad del niño, si se resolvía la duda, si era necesario consultar con el pediatra y si se recomendaba visita. Resultados. Se analizan 1.461 llamadas recibidas en once meses. El 53.2 por ciento de las llamadas eran de tipo burocrático. De las 683 de tipo clínico el 66.3 por ciento fueron realizadas por cuidadores de niños menores de 4 años. Las consultas más frecuentes fueron sobre alimentación, fiebre, trastornos digestivos leves y vacunas. Sé resolvieron por teléfono el 89.2 por ciento de las llamadas, en un 20 por ciento de ellas previa consulta al pediatra. Conclusiones. Los cambios sociales y las nuevas situaciones laborales de los padres recomiendan ofrecer nuevos tipos de atención a los niños. La consulta telefónica realizada por una enfermera pediátrica bien entrenada y con unos protocolos básicos consensuados por el equipo ayuda a racionalizar el tiempo de consulta evitando interrupciones innecesarias. Las familias ahorran desplazamientos y visitas innecesarias. De las llamadas de tipo clínico el 89.2 por ciento se pueden resolver por teléfono recomendándose visita únicamente en el 10.8 por ciento (AU)

Validación de un protocolo telefónico para cardiopatía isquémica en emergencias sanitarias / Validation of a telephone questionannaire for Ischemic Cardiopathy in Emergency Healt Services

Fundamento: Ante la relevancia en la toma de decisiones en los centros de coordinación de una empresa de emergencias sanitarias, disponer de un instrumento (protocolo telefónico) científicamente validado permitiría una más adecuada asignación de recursos prioritarios, Unidad de Cuidados Intensivos, a estos pacientes demandantes de asistencia emergente. Esto es especialmente importante en los casos de cardiopatía isquémica, en los que una rápida actuación mejorará la supervivencia y calidad de vida posterior. El objetivo de este estudio ha sido la validación de un protocolo telefónico para cardiopatía isquémica en emergencias sanitarias. Material y métodos: Diseño: Estudio transversal de base extrahospitalaria. Ámbito de estudio: El estudio se ha realizado en cuatro provincias andaluzas (Almería, Cádiz, Granada y Jaén) de la Empresa Pública de Emergencias Sanitarias. Sujetos de estudio: La muestra objeto del estudio ha estado constituida por 736 pacientes con dolor torácico tomados de una muestra mayor constituida por 13.689 llamadas asistenciales a través de la línea 061. Instrumentalización: Se ha diseñado un cuestionario mediante un comité de 12 expertos. El cuestionario se le ha realizado a todas las llamadas asistenciales recibidas en los cuatro centros de coordinación que han participado en el estudio. Posteriormente mediante registros hospitalarios se ha realizado una identificación de casos diagnosticados de cardiopatía isquémica (Infarto agudo de miocardio y/o angina inestable). Se ha construido un modelo, mediante regresión logística, determinando su calibración (utilizando el test de Hosmer-Lemeshow) y su discriminación estudiando el área bajo la Curva ROC. Resultados: Se ha obtenido un protocolo final según modelo de regresión logística en el que se incluyen las siguientes seis variables: Presencia de antecedentes de cardiopatía isquémica, Edad mayor de 40 años, Dolor torácico irradiado a brazo izquierdo, Presencia de síntomas vegetativos entre un conjunto multisintomático, Disminución del dolor torácico tras la toma de nitritos y Sexo. El test de calibración presentó una 2 de 4,3613 con p=0,7374. Para la discriminación se ha calculado el área bajo la curva ROC (curva de rendimiento diagnóstico), obteniendo un área de 0,6904 y p<0,05.Conclusiones: El protocolo propuesto según modelo calibra y discrimina bien, selecciona adecuadamente a los pacientes con cardiopatía isquémica de aquellos que no la presenta (AU)