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Introduction: Altitude chamber exposures are used for training to allow aircrew to experience their hypoxia and pressure effect symptoms. Decompression illness (DCI) can occur subsequent to altitude chamber training or in operational aircraft when the cabin altitude is at least 18,000 feet. Definitive emergent treatment is hyperbaric oxygen (HBO2) to decrease bubble size, dissipate excess nitrogen, hyperoxygenate tissue and reduce inflammation. Case report: A 27-year-old female underwent altitude chamber training to 25,000 feet. She developed tingling in both legs and left arm, headache, dizziness, malaise, then difficulty talking. She underwent two HBO2 treatments. Over the next 12 months, she had paresthesia, decreased memory and cognitive function similar to symptoms seen following traumatic brain injury. She was referred 14 months after the event for evaluation. Using pre-deployment Automated Neuropsychological Assessment Metrics (ANAM) and serial tests over 58 HBO2 treatments, the patient demonstrated near-return to her pre-deployment test scores.. Discussion: The reason for HBO2 treatment was based on previous experience with chronic traumatic brain injury subjects where HBO2 improved outcome. The patient's chronic neurological symptoms mimicked chronic TBI. The patient was unique in that baseline cognitive tests existed that could be used to monitor her changes during the treatment series.
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Disfunción Cognitiva/terapia , Enfermedad de Descompresión/terapia , Oxigenoterapia Hiperbárica , Trastornos de la Memoria/terapia , Adulto , Altitud , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Enfermedad de Descompresión/etiología , Técnicas de Diagnóstico Neurológico , Femenino , Humanos , Oxigenoterapia Hiperbárica/estadística & datos numéricos , Trastornos de la Memoria/etiología , Personal Militar , Resultado del TratamientoRESUMEN
Purpose While Healthy Start has emphasized the need for multi-sectorial community engagement and collaboration since its inception, in 2014 Healthy Start adopted Collective Impact (CI) as a framework for reducing infant mortality. This paper describes the development of a peer-focused capacity-building strategy that introduced key elements of CI and preliminary findings of Healthy Start grantees' progress with using CI as an approach to collaboration. Description The Collective Impact Peer Learning Networks (CI-PLNs) consisted of eight 90-min virtual monthly meetings and one face-to-face session that reviewed CI pre-conditions and conditions. Evaluation sources included: a facilitated group discussion at the final CI-PLN exploring grantee CI and CAN accomplishments (n = 57); routine evaluations (n = 144 pre, 46 interim, and 40 post PLN) examining changes in knowledge and practices regarding CI; and post CI-PLN implementation, three in-depth interviews with grantees who volunteered to discuss their experience with CI and participation in the CI-PLN. Assessment CI-PLN participants reported increased knowledge and confidence in the application of CI. Several participants reported that the CI-PLN created a space for engaging in peer sharing challenges, successes, and best practices. Participants also reported a desire to continue implementing CI and furthering their learning. Conclusion The CI-PLNs met the initial goal of increasing Healthy Start grantees' understanding of CI and determining the initial focus of their efforts. By year five, the EPIC Center anticipates Healthy Start CANs will have a sustainable infrastructure in place that supports the established common agenda, shared measures, and ongoing and meaningful inclusion of community members.
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Creación de Capacidad , Educación en Salud/métodos , Mortalidad Infantil , Mentores , Evaluación de Programas y Proyectos de Salud/métodos , Participación de la Comunidad , Humanos , Lactante , Determinantes Sociales de la Salud , Estados UnidosRESUMEN
The Chronic Homelessness initiative has directed millions of federal dollars to services for single "unaccompanied homeless" individuals, specifically excluding women living with their children. Using a data set with a nationally representative sample of homeless adults, we calculated the prevalence rates and profiles of long-term homelessness in homeless women (n = 849). With the exception of the criterion of being a single "unaccompanied individual," many women, including women with children, met the criteria for chronic homelessness including having a disability of mental health or substance abuse problems. Our findings suggest that the federal definition of chronic homelessness needs to be revised.
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Salud de la Familia , Personas con Mala Vivienda/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Salud de la Mujer/legislación & jurisprudencia , Adolescente , Adulto , Niño , Protección a la Infancia/estadística & datos numéricos , Preescolar , Intervalos de Confianza , Femenino , Personas con Mala Vivienda/legislación & jurisprudencia , Jóvenes sin Hogar/legislación & jurisprudencia , Jóvenes sin Hogar/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Análisis Multivariante , Oportunidad Relativa , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services. METHODS: Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed. RESULTS: Homeless women with symptoms of mental illness showed higher rates of service use in behavioral, medical, and human domains, a finding that indicates that there are stronger service linkages for this group than for women without symptoms of mental illness. Predictors associated with service use differed by psychiatric symptoms among homeless women: predisposing and enabling factors influenced service use among homeless women without symptoms of mental illness, whereas need factors influenced service use among women with symptoms of mental illness. CONCLUSIONS: Mental illness symptoms may be a trigger for receiving an array of services for homeless women once they gain entrance into a service system. There was a negative association between symptoms of mental illness and use of behavioral health services among homeless mothers, which may be the result of the fear of child welfare service intervention and loss of child custody. This service distribution inequity among homeless women using mental health services deserves attention by policy makers, researchers, and providers.
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Servicios de Salud/estadística & datos numéricos , Personas con Mala Vivienda/psicología , Trastornos Mentales/epidemiología , Servicios de Salud Mental/estadística & datos numéricos , Asistencia Pública/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Niño , Comorbilidad , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Indicadores de Salud , Encuestas Epidemiológicas , Personas con Mala Vivienda/estadística & datos numéricos , Humanos , Funciones de Verosimilitud , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Madres/psicología , Madres/estadística & datos numéricos , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitación , Estados Unidos , Revisión de Utilización de Recursos/estadística & datos numéricos , Adulto JovenRESUMEN
Atrial septal defects are a frequent finding in young persons with strokes. New research now suggests migraines with aura may also be associated with these types of cardiac defects and that surgical treatment may result in a decrease or resolution of migraines. This case emphasizes the importance of a thorough evaluation of airmen with migraines, particularly migraines with aura.
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Medicina Aeroespacial , Defectos del Tabique Interatrial/complicaciones , Migraña con Aura/complicaciones , Accidente Cerebrovascular/complicaciones , Adulto , Defectos del Tabique Interatrial/cirugía , Humanos , Masculino , Migraña con Aura/prevención & control , Factores de Riesgo , Accidente Cerebrovascular/prevención & controlRESUMEN
Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that among homeless mothers (n = 588), those living without their children were more likely to: be older than 35 years, unmarried, have been incarcerated, have been homeless for at least 1 year, and to have used psychiatric medication. Many homeless mothers had histories of childhood trauma, but it was the accumulation of adulthood traumas that was associated with not living with one's children. Without mental health treatment, younger homeless mothers living with their children today may become the homeless mothers living without their children in the future.
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Personas con Mala Vivienda/psicología , Heridas y Lesiones/psicología , Adolescente , Adulto , Recolección de Datos , Femenino , Humanos , Entrevistas como Asunto , Persona de Mediana Edad , Características de la Residencia , Trastornos Relacionados con Sustancias , Estados UnidosRESUMEN
A new method for the positive identification of elemental sulfur in explosives and explosive residues is developed. Following a carbon disulfide wash of explosives or explosive residues, a sample of the extracted material is injected onto a gas chromatography (GC) column, then analyzed via mass-selective (MS) detection. A positive identification of elemental sulfur is based on both retention time and fragmentation pattern. The GC-MS method is demonstrated to be useful in detecting and positively identifying elemental sulfur from both burned and unburned explosive mixtures. With a detection limit of 2.5 ng (2.5 x 10(-9) grams) of elemental sulfur on the column, it is shown to be 400 times more sensitive than the presumptive chemical color test that is currently the method employed for detection of small amounts of sulfur.
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Although vaccination has been heralded as one of the 10 greatest public health achievements, how parents differ in their views about vaccination is not well understood. A deeper understanding of these attitudes and beliefs may improve the effectiveness of vaccine communications. In this mailed survey of U.S. parents in January 2001 (return response rate 49%), parental confidence in vaccination was very high, although there was significant variation among parents. Using multivariate analyses to group and profile parents, 90% of parents (n=1820) were classified into one of four distinct parent groups: (1) "Vaccine Believer" parents who were convinced of the benefit of vaccination; (2) "Cautious" parents noteworthy for a high emotional investment in their child; (3) "Relaxed" parents characterized by a less involved parenting style and some skepticism about vaccines; and (4) "Unconvinced" parents distinguished by their distrust of vaccinations and vaccination policy. These findings suggest that messages that are customized to parents' attitudes and beliefs may improve their understanding and acceptance of vaccination.