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Biomedical subjects

S Rolnick

Publications and source records attributed to S Rolnick.

6 recordsLinked to original sources
PubMed1998

Lead levels in high-risk and low-risk young children in the Minneapolis-St Paul metropolitan area.

OBJECTIVES: To determine distribution of lead levels among children in a low-risk area; to validate a prescreening questionnaire; and to determine if universal lead screening is necessary in children in this area. DESIGN: Blood lead levels and questionnaires were obtained on eligible patients. Data were analyzed using stepwise regression analysis. SETTING: Community clinics and a health maintenance organization (HMO) in the Minneapolis-St Paul metropolitan area. PATIENTS: A total of 9603 children at well-child visits, age 6 months to 6 years at community clinics, and 6 months to 3 years at the HMO. OUTCOME MEASURES: Whole blood lead levels (WBLs) and questionnaires. RESULTS: The total sample rate of WBLs at >/=10 microg/dL was 12%, at >/=15 microg/dL was 31/2%, and at >/=20 microg/dL was 1.2%. At both 10 microg/dL and 15 microg/dL, the non-HMO group was at higher risk. For both groups, risk factors included living in the central cities, and living in housing built before 1950. For the non-HMO group a history of the child eating paint chips, or the child or a sibling having previous lead poisoning were also risk factors. CONCLUSIONS: Not all children need lead screening. Children living in the central cities, or with the risk factors of living in housing built before 1950 or a previous history of lead poisoning should be screened.

Child↗
PubMed1997

Telephone support as an adjunct to transdermal nicotine in smoking cessation.

OBJECTIVES: Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed care-based, single-session group orientation smoking cessation program with nicotine patch therapy. METHODS: The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. RESULTS: Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. CONCLUSIONS: Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session.

Administration, Cutaneous↗
PubMed1994

Decrease in the rate of ruptured ectopic pregnancies: a successful team approach.

Noting the increasing frequency of ectopic pregnancy and desiring to reduce both morbidity and mortality, OB/GYN physicians at a large midwestern HMO systematically monitored all ectopic pregnancies in their clinical practice as the first step in a quality improvement project. Data were collected on several components of care including access, risk assessment, diagnosis of ectopic pregnancy, and intervention. To ensure the system was able to coordinate new diagnostic and therapeutic modalities, several key initiatives were instituted to improve patient outcomes. These included application of comprehensive guidelines, increased ultrasound availability, and increased staff and patient awareness. Following the implementation of the initiatives, there was a decrease in rupture rates from 32% in 1988 to 5% in 1992. This paper discusses the development and integration of the initiatives into the staff model HMO.

Algorithms↗
PubMed1993

Effective and ineffective management behaviors of parents of infants and young children with asthma.

To define the specific objectives of a planned behavioral intervention directed toward parents of very young children with asthma, 574 detailed descriptions of ineffective and effective asthma management behaviors of parents of infants and young children (through 6 years of age) with asthma were collected via interviews with 117 physicians and other health professionals and 112 parents. Analysis of these data resulted in the identification of 130 ineffective and effective asthma management behaviors of parents that could be grouped in five major areas of responsibility: symptom intervention; symptom prevention; use of medical and educational resources; communication among caregivers; and child development and family relationships. This report presents the methodology of the study, describes the identified behaviors, and discusses implications of the results for the development of a behavioral intervention to improve asthma management by parents.

Adaptation, Psychological↗
PubMedDate not supplied

Pap smear screening in a health maintenance organization: 1986-1990.

BACKGROUND: To assess Pap smear utilization and compliance with screening recommendations, a study was conducted in a large midwestern HMO where cost is not a barrier to care. The purpose of the study was to examine rates of screening by age, identify the proportion of abnormal cytologic findings, and determine screening incidence for women with a diagnosis of cervical cancer. METHOD: Computerized records on screening frequency over a 5-year interval were examined for 23,649 consecutively enrolled women ages 18-70. In addition, medical records were examined for patients with a cervical cancer diagnosis (n = 32). RESULTS: Eighty-five percent of the women had at least one Pap smear within the 5-year duration. Nearly half (47%) obtained four to five tests, 30% obtained two or three tests, and 14% were screened only once during the 5 years. Percentages were similar across all age groups. Cytopathology reports indicated 95% of tests as normal, 4% as low-grade squamous intraepithelial lesions (SIL), <1% as high-grade squamous intraepithelial lesions, and 0.02% as suspected malignancy. Younger women were more likely to evidence SIL; older women were somewhat more likely to have carcinoma. For women with a cancer diagnosis, 63% had not been screened the previous year and 34% had no screening recorded for the prior 3 years. Twenty-two percent had no record of screening within the past 5 years compared with 8.5% of the total group. CONCLUSIONS: In HMOs with prepayment, one would hypothesize that patients would obtain more regular preventive screening of all types, yet women at highest risk seemed less likely to obtain Pap smear screening. This group is not fully understood and probably represents the best opportunity to reduce morbidity, mortality, and expense from preventable cervical neoplasias.

Adolescent↗