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Objectives. We assessed the health impact of a housing and case management program, the Chicago Housing for Health Partnership, for homeless people with HIV. Methods. HIV-positive homeless inpatients at a public hospital (n = 105) were randomized to usual care or permanent housing with intensive case management. The primary outcome was survival with intact immunity, defined as CD4 count ≥ 200 and viral load < 100 000. Secondary outcomes were viral loads, undetectable viral loads, and CD4 counts. Results. Outcomes were available for 94 of 105 enrollees (90%). Of 54 intervention participants, 35 (65%) reached permanent housing in program housing agencies. After 1 year, 55% of the intervention and 34% of the usual care groups were alive and had intact immunity (P = .04). Seventeen intervention (36%) and 9 usual care (19%) participants had undetectable viral loads (P = .051). Median viral loads were 0.89 log lower in the intervention group (P = .03). There were no statistical differences in CD4 counts. Conclusions. Homelessness is a strong predictor of poor health outcomes and complicates the medical management of HIV. This housing intervention improved the health of HIV-positive homeless people.

Many health care providers do not provide adequate language access services for their patients who are limited English-speaking because they view the costs of these services as prohibitive. However, little is known about the costs they might bear because of unaddressed language barriers or the costs of providing language access services. To investigate how language barriers and the provision of enhanced interpreter services impact the costs of a hospital stay. Prospective intervention study. Public hospital inpatient medicine service. Three hundred twenty-three adult inpatients: 124 Spanish-speakers whose physicians had access to the enhanced interpreter intervention, 99 Spanish-speakers whose physicians only had access to usual interpreter services, and 100 English-speakers matched to Spanish-speaking participants on age, gender, and admission firm. Patient satisfaction, hospital length of stay, number of inpatient consultations and radiology tests conducted in the hospital, adherence with follow-up appointments, use of emergency department (ED) services and hospitalizations in the 3 months after discharge, and the costs associated with provision of the intervention and any resulting change in health care utilization. The enhanced interpreter service intervention did not significantly impact any of the measured outcomes or their associated costs. The cost of the enhanced interpreter service was $234 per Spanish-speaking intervention patient and represented 1.5% of the average hospital cost. Having a Spanish-speaking attending physician significantly increased Spanish-speaking patient satisfaction with physician, overall hospital experience, and reduced ED visits, thereby reducing costs by $92 per Spanish-speaking patient over the study period. The enhanced interpreter service intervention did not significantly increase or decrease hospital costs. Physician-patient language concordance reduced return ED visit and costs. Health care providers need to examine all the cost implications of different language access services before they deem them too costly.

Purpose The aim of this study was to establish the concordance for quality of life (QOL), disability, and use of health service indicators between two modes of computerassisted interviews: audio-computer-assisted self-interview (A-CASI) and computer-assisted telephone interview (CATI). High concordance between these modes of data collection would allow comparisons and interchangeable use in cross-sectional or longitudinal assessments. Methods Adult English-speaking women (n = 126) were enrolled from women's health clinics at a public hospital.QOL using the short form 12 version 2, disability (days missed from work, inability to do household activities), and utilization of health services (number of emergency room visits and hospitalizations) were assessed first with A-CASI at the time of enrollment and again (n = 102) with CATI 1 week later. Participants assessed with both modes were 38 years old on average, predominantly African-American, 41% had a high school education or less, and 61% were uninsured. Lin's concordance correlation coefficient or Cohen's kappa was calculated to establish concordance between paired A-CASI and CATI assessments. Results Concordance between the two interview methods ranged from fair to substantial for the QOL components, (concordance correlation coefficient [CCC] of .76 and .87, respectively), the QOL subscales, and disability indices (CCC range; .53—. 91). For health services utilization, there was moderate concordance for emergency room visits (CCC = .70) but only slight concordance for the number of hospitalizations in the past year (CCC = .37). Conclusions Administering surveys through a telephone or self-administered computer-assisted interview resulted in moderate to substantial agreement for the short form QOL components and fair to substantial for the QOL subscales and disability measures. These findings suggest A-CASI and CATI can be used interchangeably for some QOL scales.

The value of azithromycin for treatment of acute bronchitis is unknown, even though this drug is commonly prescribed. We have investigated this question in a randomised, double-blind, controlled trial. Methods Adults diagnosed with acute bronchitis, without evidence of underlying lung disease, were randomly assigned azithromycin (n=112) or vitamin C (n=108) for 5 days (total dose for each 1·5 g). All individuals were also given liquid dextromethorphan and albuterol inhaler with a spacer. The primary outcome was improvement in health-related quality of life at 7 days; an important difference was defined as 0·5 or greater. Analysis was by intention to treat. The study was stopped by the data-monitoring and safety committee when 220 patients had been recruited. On day 7, the adjusted difference in health-related quality of life was small and not significant (difference 0·03 [95% CI -0·20 to 0·26], p=0·8). 86 (89%) of 97 patients in the azithromycin group and 82 (89%) of 92 in the vitamin C group had returned to their usual activities by day 7 (difference 0·5% [−10% to 9%], p>0·9). There were no differences in the frequency of adverse effects; three patients in the vitamin C group discontinued the study medicine because of perceived adverse effects, compared with none in the azithromycin group. Most patients (81%) reported benefit from the albuterol inhaler. Azithromycin is no better than low-dose vitamin C for acute bronchitis. Further studies are needed to identify the best treatment for this disorder.

Background: Community health workers (CHWs) are frontline public health workers who connect immigrant communities with health care services. Although CHW asthma interventions have been shown to improve some outcomes, their ability to change medication adherence remains unclear. Objective: Our goal was to determine if intensive asthma medication training resulted in objective improvements in asthma medication instruction abilities for immigrant Mexican CHWs. Methods: Eleven CHWs participated in a 15-hour training course conducted in only Spanish. The course covered asthma pathophysiology, reliever and controller medications, medication technique, and self-management skills. Before and after the training, CHWs completed a written asthma knowledge test and were tested on medication delivery technique using a demonstrator metered dose inhaler (MDI), spacer, and dry powder inhaler (DPI). After the training, CHWs performed a standardized role play to assess their ability to deliver medication instruction. At follow-up evaluations, the CHWs described benefits and weaknesses of the training. Results: Before the training, the median correct medication technique scores were: MDI = 25%, spacer = 0%, and DPI = 0%. After the training, the median scores were: MDI = 69%, spacer = 64%, and DPI = 67% ( p < .01). On the role plays, all CHWs were scored as \"Demonstrates adequate understanding of a complicated skill\" and four were \"Ready for the field on a clinical trial.\" The CHWs described specific application of training skills during the subsequent delivery of an asthma intervention. Conclusion: This training and follow-up evaluation provide objective evidence of improved asthma medication knowledge, delivery technique, and instruction abilities in immigrant Mexican CHWs. With proper training, CHWs can assist families to understand and correctly use complicated asthma medications.

To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings. Firm-based single-blinded controlled trial. Inpatient service at a university-affiliated public teaching hospital. Eighty Internal Medicine residents. The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, \"demonstration and practice\" (DP) (n=26) or (2) an innovative method, \"collaborative discovery\" (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE). All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings. Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.

OBJECTIVE: To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings. DESIGN: Firm‐based single‐blinded controlled trial. SETTING: Inpatient service at a university‐affiliated public teaching hospital. PARTICIPANTS: Eighty Internal Medicine residents. METHODS: The study assessed 2 intervention groups that received 3‐hour bedside teaching sessions during their 4‐week rotation using either: (1) a traditional teaching method, “demonstration and practice” (DP) (n=26) or (2) an innovative method, “collaborative discovery” (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE). RESULTS: All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings. CONCLUSIONS: Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching.

This study examined the proportion of women inmates who accepted HIV testing and the sociodemographic, criminal, and HIV-related risk characteristics associated with accepting such testing in a state prison offering voluntary HIV testing. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these inmates, 680 (84%) granted permission to access their medical records and had complete information on relevant characteristics. Seventy-one percent of the women inmates accepted HIV testing. In multivariate analysis, the exchange of sex for money or drugs and the conviction for a drug crime were significantly associated with accepting HIV testing. Injection drug use, drug-injecting sex partners, and a history of a sexually transmitted disease were not significantly associated with accepting HIV testing. A prison-based voluntary HIV testing program appears to be reaching a substantial proportion of women inmates potentially at risk for HIV, especially women inmates who exchanged sex for money or drugs.

: This study examined adolescents' perceptions concerning the presence of guns in their school and the adolescents' emotional and behavioral responses associated with these perceptions. Survey data from 376 African‐American sixth, seventh, and eighth grade students of a low‐income area of a North Carolina city were studied. Twenty‐eight percent of adolescents reported that other students brought guns to school. 36% felt afraid that someone would hurt or attack them while at school, 15% avoided school (or places in school) because of fear that a student would hurt or attack them, and 20% carried weapons to school for self‐protection. Logistic regression analyses found that, compared to their peers, adolescents who perceived that their school mates brought guns to school were almost twice as likely to experience fear while at school, were more than three times more likely to exhibit school avoidance behavior, and were more than twice as likely to bring a weapon to school themselves for self‐protection. Educators and school health professionals are urged to work together to address these problems concerning school safety. (J Sch Health, 1996;66(1):23–26)