Search

BackgroundHealth systems are increasingly implementing remote telephone and Internet refill systems to enhance patient access to medication refills. Remote refill systems may provide an effective approach for improving medication non-adherence, but more research is needed among patients with limited English proficiency with poor access to remote refill systems.ObjectiveTo compare the use of remote medication refill systems among limited-English-proficiency (LEP) and English-proficient (EP) patients with chronic conditions.MethodsCross-sectional survey in six languages/dialects (English, Cantonese, Mandarin, Korean, Vietnamese, and Spanish) of 509 adults with diabetes, hypertension, or hyperlipidemia. Primary study outcomes were self-reported use of 1) Internet refills, 2) telephone refills, and 3) any remote refill system. LEP was measured by patient self-identification of a primary language other than English and a claims record of use of an interpreter. Other measures were age, gender, education, years in the U.S., insurance, health status, chronic conditions, and number of prescribed medications. Analyses included multivariable logistic regression weighted for survey non-response.ResultsOverall, 33.1 % of patients refilled their medications by telephone and 31.6 % by Internet. Among LEP patients (n = 328), 31.5 % refilled by telephone and 21.2 % by Internet, compared with 36.7 % by telephone and 52.7 % by Internet among EP patients (n = 181). Internet refill by language groups were as follows: English (52.7 %), Cantonese (34.9 %), Mandarin (17.4 %), Korean (16.7 %), Vietnamese (24.4 %), and Spanish (12.6 %). Compared to EP patients, LEP patients had lower use of any remote refill system (adjusted odds ratio [AOR] 0.18; p

BackgroundThe US Preventive Services Taskforce (USPSTF) recommends routine lipid screening beginning age 35 for men [1]. For women age 20 and older, as well as men age 20-34, screening is recommended if cardiovascular risk factors are present. Prior research has focused on underutilization but not overuse of lipid testing. The objective is to document over- and under-use of lipid testing in an insured population of persons at low, moderate and high cardiovascular disease (CVD) risk for persons not already on statins.MethodsThe study is a retrospective cohort study that included all adults without prior CVD who were continuously enrolled in a large integrated healthcare system from 2005 to 2010. Measures included lipid test frequency extracted from administrative data and Framingham cardiovascular risk equations applied using electronic medical record data. Five year lipid testing patterns were examined by age, sex and CVD risk. Generalized linear models were used to estimate the relative risk for over testing associated with patient characteristics.ResultsAmong males and females for whom testing is not recommended, 35.8 % and 61.5 % received at least one lipid test in the prior 5 years and 8.4 % and 24.4 % had two or more. Over-testing was associated with age, race, comorbidity, primary care use and neighborhood income. Among individuals at moderate and high-risk (not already treated with statins) and for whom screening is recommended, between 21.4 % and 25.1 % of individuals received no screening in the prior 5 years.ConclusionsBased on USPSTF lipid screening recommendations, this study documents substantial over-testing among individuals with low CVD risk and under-testing among individuals with moderate to high-risk not already on statins. Opportunity exists to better focus lipid screening efforts appropriate to CVD risk.

The field of prevention and control of wildlife damage is changing and evolving along with clientele needs, pressures from user and non-user groups, and other factors. A theoretical overview of the field may offer an action model regarding changing trends and potential responses. I propose that three things happen every time a wildlife damage problem occurs: 1) A human activity, desire, or need is interfered with, 2) the experience footers an opinion about a wild animal usually negative, and 3) a decision is made to tolerate the situation or to control it. If control is selected, availability and effectiveness of prevention and control techniques become feedback mechanisms that may affect tolerance of damage; threshold levels at which control is initiated; and opinions about damage control, wild animals, and natural systems. Wildlife damage professionals might use these concepts in responding to enhance the public understanding and professional image of the wildlife damage field.

One technique for repelling or excluding birds is to stretch wires, monofilament lines, or nylon strings across sites needing protection. Wires or lines spaced at various intervals and in various configurations have successfully repelled birds such as ring-billed (Larus delawarensis) and/or herring (L. argentatus) gulls, and brant (Branta bernicla bernicla) from reservoirs, sanitary landfills, fish hatcheries, nesting areas, public places, or farm fields. Black thread has been suggested for repelling small birds such as sparrows (unspecified) from garden seedlings and bullfinches (unspecified) from fruit trees. Recent observations in New Mexico indicated that monofilament lines spaced at 30-cm (1-ft) intervals repelled house sparrows (Passer domesticus) and other birds from various feeding sites and barn swallows (Hirundo rustica) from nesting sites. Experiments in Nebraska have tested size (1.8-, 5.4-, and 9-kg test), color (clear and fluorescent golden), orientation (north-south, east-west, horizontal, vertical) and/or spacing (30 and 60 cm) of monofilament lines in a grape vineyard and at feeding stations. Results of food consumption and bird count data indicate that all treatments repelled house sparrows. Although the reasons lines repel certain birds is not fully understood, it appears that they have probable applications for excluding or repelling certain terrestrial as well as aquatic species.

Thirteen-lined ground squirrels (Spermophilus tridecemlineatus) and other small rodents damage corn (Zea mays) stands by digging and consuming planted seeds and young seedlings, particularly in reduced-tillage fields. The use of reduced-tillage systems such as ecofarming provides greater dryland crop yields, conserves moisture, reduces soil erosion, and provides suitable habitat for ground-nesting birds. The habitat available in these fields also allows various species of rodents to thrive. Reduced-tillage farming is expected to increase markedly in the years ahead; thus, rodent problems will increase as well. Seed repellents offer a promising and cost-effective method of controlling rodent damage to planted corn in some areas. This paper reviews repellents for this use and describes repellency studies currently in progress with the compounds methiocarb [3,5-dimethyl-4-(methylthio) phenol methylcarbamate] and thiram (tetramethylthiuram disulfide).

Conservation-tillage farming systems have changed agriculture and brought new challenges to the wildlife damage field. Associated minor problems may result from the presence of rattlesnakes (Crotalus viridis) or badgers (Taxidea taxus), but sprout-pulling damage by birds has not been reported. Rodents dig and consume newly planted corn. At least 14 small mammal species have been captured in no-tillage cornfields, some species throughout fields and others primarily at edges. Deer mice (Peromyscus maniculatus) generally have been the most abundant, comprising 71 to 93% of total captures. Small mammal populations in no-tillage fields are generally no higher than in conventionally tilled fields, but they may be more diverse, and possibly more stable. Rodent damage to newly-planted corn is variable among fields and years but is at times substantial, possibly resulting in annual losses of up to $16 million in Nebraska. Six rodent species have been implicated in the damage problem but the overall amount of damage caused by each species is unknown. Currently, there are no satisfactory control methods. A new zinc phosphide grain bait is being developed; other potential controls include cultural methods, alternate feeding, and repellents. Benefits of small mammals such as their consumption of crop-damaging cutworms should be considered in control decisions. Wildlife damage problems in conservation-tillage systems, particularly rodent problems, challenge further research to better quantify associated impacts and to develop appropriate control measures.