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Objective: Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services., Methods: Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year., Results: Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time., Conclusions: Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource., Competing Interests: Dr. Gould has received research support from Vibrant Emotional Health and the National Suicide Prevention Lifeline. Dr. Gould has also received funding to conduct research evaluations of the National Suicide Prevention Lifeline. Dr. Keyes has been financially compensated as an expert witness in litigation. Dr. Shaman has received research funding from Pfizer, Salesforce, and Regeneron and has also been a consultant for BNI. Dr. Shaman and Columbia University declare partial ownership of SK Analytics. The other authors report no financial relationships with commercial interests.

Objectives: During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators in order to monitor both the epidemic growth and potential public health consequences of preventative measures such as lockdown. We assessed whether the automatic classification of the content of calls to emergency medical communication centers could provide relevant and responsive indicators., Methods: We retrieved all 796,209 free-text call reports from the emergency medical communication center of the Gironde department, France, between 2018 and 2020. We trained a natural language processing neural network model with a mixed unsupervised/supervised method to classify all reasons for calls in 2020. Validation and parameter adjustment were performed using a sample of 39,907 manually-coded free-text reports., Results: The number of daily calls for flu-like symptoms began to increase from February 21, 2020 and reached an unprecedented level by February 28, 2020 and peaked on March 14, 2020, 3 days before lockdown. It was strongly correlated with daily emergency room admissions, with a delay of 14 days. Calls for chest pain and stress and anxiety, peaked 12 days later. Calls for malaises with loss of consciousness, non-voluntary injuries and alcohol intoxications sharply decreased, starting one month before lockdown. No noticeable trends in relation to lockdown was found for other groups of reasons including gastroenteritis and abdominal pain, stroke, suicide and self-harm, pregnancy and delivery problems., Discussion: The first wave of the COVID-19 crisis came along with increased levels of stress and anxiety but no increase in alcohol intoxication and violence. As expected, call related to road traffic crashes sharply decreased. The sharp decrease in the number of calls for malaise was more surprising., Conclusion: The content of calls to emergency medical communication centers is an efficient epidemiological surveillance data source that provides insights into the societal upheavals induced by a health crisis. The use of an automatic classification system using artificial intelligence makes it possible to free itself from the context that could influence a human coder, especially in a crisis situation. The COVID-19 crisis and/or lockdown induced deep modifications in the population health profile.

The aim of this article was to conduct a rapid critical review of the literature about the relationship between violence against women (VAW) and the current COVID-19 pandemic. After the screening process, a total of 42 articles were considered. Our review confirmed that the "stay at home" policies to contrast the pandemic have increased the problem of VAW, creating a "shadow pandemic within the pandemic", as it was called by the United Nations. However, rigorous studies estimating the relationship between VAW and COVID-19 pandemic are scarce; most of the articles are commentaries, letters, editorials, and most of the published data derives from social media, internet, anecdotal evidence and helplines reports. Health care systems should promote further investigations into the relation between VAW and COVID-19, to identify creative solutions to provide clinical care and forensic services for victims of VAW., Competing Interests: Declaration of Competing Interest Authors have no conflict of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background and Objective: Patient medicines helpline services (PMHS) are available from some National Health Service Trusts in the UK to support patients following their discharge from hospital. The aim of this systematic review was to examine the available evidence regarding the characteristics of enquirers and enquiries to PMHS, in order to develop recommendations for service improvement., Methods: Searches were conducted using Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science, on 4 June 2019. Forward and backward citation searches were conducted, and grey literature was searched. Studies were included if they reported any characteristics of enquirers who use PMHS, and/or enquiries received. Study quality was assessed using the Axis tool. A narrative synthesis was conducted, and where appropriate, weighted means (WMs) were calculated. Where possible, outcomes were compared with Hospital Episode Statistics (HES) data for England, to establish whether the profile of helpline users may differ to that of hospital patients., Results: Nineteen studies were included (~4362 enquiries). Risk of bias from assessed studies was 71%. Enquirers were predominantly female (WM=53%; HES mean=57%), elderly (WM=69 years; HES mean=53 years) and enquired regarding themselves (WM=72%). Out of inpatient and outpatient enquirers, 50% were inpatients and 50% were outpatients (WM). Six of 15 studies reported adverse effects as the main enquiry reason. Two of four studies reported antimicrobial drugs as the main enquiry drug class. From two studies, the main clinical origin of enquiries were general surgery and cardiology. Across six studies, 27% (WM) of enquiries concerned medicines-related errors., Conclusions: Our findings show that PMHS are often used by elderly patients, which is important since this group may be particularly vulnerable to experiencing medicines-related issues following hospital discharge. Over a quarter of enquiries to PMHS may concern medicines-related errors, suggesting that addressing such errors is an important function of this service. However, our study findings may be limited by a high risk of bias within included studies. Further research could provide a more detailed profile of helpline users (eg, ethnicity, average number of medicines consumed), and we encourage helpline providers to use their enquiry data to conduct local projects to improve hospital services (eg, reducing errors)., Prospero Registration Number: CRD42018116276., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Households are increasingly stockpiling and producing hand sanitizer amid the coronavirus disease 2019 (COVID-19) pandemic, which can pose an increased risk for unintentional toxicity among children. Despite guidelines for hand sanitizer production published by the World Health Organization, many turn to streaming media for instruction., Objective: The purpose of this investigation was to evaluate hand sanitizer formulations and safety precautions discussed in popular do-it-yourself (DIY) YouTube videos, and to assess the frequency of calls to poison control centers for pediatric hand sanitizer exposure before and after the arrival of COVID-19 in the United States., Methods: The first 100 videos on YouTube with the most views using the search term "DIY hand sanitizer" were evaluated for accuracy compared with the World Health Organization local hand sanitizer production guidelines. The incidence of pediatric hand sanitizer exposure reported to participating U.S. poison control centers from January 2018 through May 2020 was reviewed from the American Association of Poison Control Centers National Poison Data System. The average number of calls between January 2020 and May 2020 was compared, and the average number of calls in March 2020 was compared with March 2019 and March 2018., Results: Of the YouTube videos that met inclusion criteria, 27% discussed the use of at least 96% ethanol or 99.8% isopropyl alcohol, 4.1% incorporated 3% hydrogen peroxide, 82% used glycerol or an alternative humectant, and 4.1% specified the need for distilled or previously boiled water. Most of the videos failed to describe labeling storage containers, 69% of videos encouraged the use of oils or perfumes to enhance hand sanitizer scent, and 2% of videos promoted the use of coloring agents to be more attractive for use among children specifically. There was a significantly increased average number of daily calls to poison control centers regarding unsafe pediatric hand sanitizer exposure since the first confirmed COVID-19 patient in the United States. There was a significantly increased average number of daily calls in March 2020 compared with the previous 2 years., Conclusions: YouTube may not be an accurate source for effective hand sanitizer concoction. Health care providers and parents should be aware of the increased surge in hand sanitizer exposure among children and should take proper precautionary measures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Thirty-day all-cause readmissions are high after aortic valve replacement (AVR). We aimed to assess the effectiveness of a structured telephone follow-up (TFU) and a 24/7 hotline on reducing 30-day all-cause readmission (30-DACR) after AVR, on reducing symptoms of anxiety and depression and on improving perceived health state., Methods: A prospective randomized controlled trial was conducted. Patients (n = 288) were randomly allocated to either post-discharge usual care or to care that provided TFU and access to a 24/7 hotline after AVR. Ancillary endpoints were time-to-event (readmission), proportion of avoidable versus unavoidable readmissions after AVR, and predictors of 30-DACR after AVR., Results: 30-DACR was 22.3%. The structured TFU and 24/7 hotline intervention failed to reduce 30-DACR rates after AVR (P = 0.274). Symptoms of anxiety were significantly reduced 30 days after surgery (P = 0.031), an effect that did not persist one year after surgery (P = 0.108). Most readmissions occurred before 15 days post-discharge, and 75% of them were deemed to be unavoidable. Pleural drainage before hospital discharge (P = 0.027) and symptoms of anxiety before surgery (P = 0.003) were predictors of 30-DACR after AVR., Conclusion: The TFU and 24/7 hotline had no effect on reducing 30-DACR after AVR. However, we did measure reduced symptoms of anxiety the first month after AVR. Anxiety reduction appeared to be an important target for intervention, because we found it to be a risk factor for readmission. Future research should focus on the effectiveness of interventions to prevent avoidable unplanned readmissions., Trial Registration: ClinicalTrial.gov, NCT02522663., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Telephone nurses give advice and support and make assessments based on verbal communication only. Web-based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses' use of decision support systems is needed to develop both telephone nursing and decision support systems., (© 2019 John Wiley & Sons Australia, Ltd.)

Background: Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory., Research Objective: The aim was to explore the meaning of responsibility as it appeared in patients' or caregivers' experiences of calling an oncological emergency telephone., Design, Participants and Context: Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed., Ethical Considerations: The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act., Findings: Two main themes emerged: (1) to act responsibly as a patient or caregiver was to 'be watchful and alert', 'report symptoms the right way' and 'do crosschecking' and (2) to deal with the burden of responsibility was to 'feel safe when dealing with the burden of responsibility' and 'be relieved from the burden of responsibility'., Discussion: Too much responsibility and a potential imbalance between healthcare professionals' expectations and callers' knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care., Conclusion: The meaning of responsibility appeared in the participants' capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.

Competing Interests: Competing interests: None declared.

Background: Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India., Objective: This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India., Methods: We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed., Results: The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents' mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline., Conclusions: A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India., (©Sangita Kulathinal, Bijoy Joseph, Minna Säävälä. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 09.08.2019.)

Purpose: To summarize the reach, services offered, and cessation outcomes of the New York Quitline and compare with other state quitlines., Design: Descriptive study., Setting: Forty-five US states., Participants: State-sponsored tobacco cessation quitlines in 45 US states that provided complete data to the Centers for Disease Control and Prevention's National Quitline Data Warehouse (NQDW) for 24 quarters over 6 years (2010-Q1 through 2015-Q4)., Intervention: Telephone quitlines that offer tobacco use cessation services, including counseling, self-help materials, and nicotine replacement therapy (NRT), to smokers at no cost to them., Measures: Percentage of adult tobacco users in the state who received counseling and/or free NRT from state quitlines (reach), services offered by state quitlines, and cessation outcomes among quitline clients 7 months after using quitline services., Analysis: Reach, services offered, and cessation outcomes for the New York Quitline were compared with similar measures for the other 44 state quitlines with complete NQDW data for all quarters from 2010 through 2015., Results: New York's average annual quitline reach from 2010 through 2015 was 3.0% per year compared to 1.1% per year for the other 44 states examined., Conclusion: Although the New York Quitline was open fewer hours per week and offered fewer counseling sessions and a smaller amount of free NRT than most of the other 44 state quitlines, the New York Quitline had similar quit rates to most of those state quitlines.

Background: The use of information technology (IT) in health care has continuously increased. This includes software solutions for digitalisation, data storage and innovative approaches in diagnostics. The facilitation of the access to specific information, even by the patient, has changed daily clinical work. Patients inform themselves about symptoms, diagnostic methods and treatment options. This urge for information and the wish for the best treatment is summarised in the expression "patient empowerment". In some countries, the gap between do-it-yourself diagnosis and telemedicine via the telephone has already been closed. A sophisticated telemedical hotline may help to improve consultation and treatment of patients living in remote regions or rural communities. Traumatology telemedicine may also be used in trauma environments, such as disasters or mass casualties. Therefore, the purpose of this study was to assess the demand for e-health solutions among patients seeking the help of the emergency department in a trauma hospital., Methods: A total of 255 patients (age range 18 - 75 years) were included in the study and were surveyed with the use of a questionnaire. As regards personal data, the questionnaire asked the patient about their Internet habits and about interesting topics they had researched in the world wide web. However, the questionnaire was specifically designed to ask for potential benefits and the patient's expectations for e-health solutions. Expected weaknesses and procedures for telemedical services were also included in a subsection., Results: 43.5% of the patient cohort were woman and 56.5% men. The average distance to the hospital was 39.86 km. 223 patients were insured by the governmental health service providers and 32 had private insurance coverage. Aside from online shopping and online banking, the search for health topics was most frequent. The greatest fear was the lack of personal contact to the doctor (71.2%). Patients were also concerned about the safety of individual health data in privately run databanks (54.3%). On the other hand, patients were neutral towards the web-based scheduling of medical appointments. Automatic reminders for such appointments were desired via e-mail (68.8%) or SMS (66.5%)., Conclusion: Patients are demanding mobile solutions for scheduling medical appointments, including reminders of these. Patients are keen to be involved in the communications and would like to receive overall information about their health status. Online chats or video calls with physicians are not their first choice but might be a possibility until personal presentation., Competing Interests: M. Holderried, M. Schlipf, A. Höper und U. Stöckle geben an, dass kein Interessenkonflikt besteht. T. M. Kraus und R. Meier sind Mitglieder des medizinischen Beirats der Teleclinic GmbH., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: State quitlines provide free telephone-based cessation services and are available in all states. However, quitlines presently reach 1% of US cigarette smokers. We assessed variations in quitline reach by race/ethnicity across 45 US states included in the National Quitline Data Warehouse, a repository on non-identifiable data reported by state quitlines., Methods: During 2011 to 2013, we analyzed 1 220 171 records from the National Quitline Data Warehouse. Annual quitline reach was defined as the proportion of cigarette smokers and smokeless tobacco users who utilized quitline services during each year, and was calculated by dividing the number of state-specific quitline registrants in each year by the number of adult cigarette smokers and smokeless tobacco users in the state., Results: Average annual reach ranged from: 0.08% (Tennessee) to 3.42% (Hawaii) among non-Hispanic whites; 0.17% (Tennessee) to 3.85% (Delaware) among non-Hispanic blacks; 0.27% (Nevada) to 9.98% (Delaware) among non-Hispanic American Indians/Alaska Native; 0.03% (Alabama) to 2.43% (Hawaii) among non-Hispanic Asian/Pacific Islanders; and from 0.08% (Tennessee) to 3.18% (Maine) among Hispanics. Average annual reach was highest among non-Hispanic American Indians/Alaska Native in 27 states, non-Hispanic blacks in 14 states, and non-Hispanic whites in four states., Conclusions: Quitlines appear to be reaching minority populations; however, overall reach remains low and variations in quitline reach exist by race/ethnicity. Opportunities exist to increase the utilization of quitlines and other effective cessation treatments among racial/ethnic minority populations., Implications: Some studies have assessed quitline reach across demographic groups in individual states; however, no studies have provided multistate data about quitline reach across race/ethnic groups. Ongoing monitoring of the use of state quitlines can help guide targeted outreach to particular race/ethnic groups with the goal of increasing the overall proportion and number of tobacco users that use quitlines. These efforts should be complemented by comprehensive tobacco control initiatives that increase cessation including mass media campaigns, smoke-free policies, increased tobacco prices, expansion of health insurance coverage, and health systems change., (Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence-informed protocols for symptom management., Aim: To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone-based symptom support to cancer patients., Methods: A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases., Results: At baseline, >85% nurses rated protocols positively but barriers were identified (64-80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self-management. Twenty-two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support., Linking Evidence to Action: Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses' use of evidence-informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses' confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally., (© 2016 The Authors. Worldviews on Evidence Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.)

Introduction: The public health consequences of the legalization of marijuana, whether for medical or recreational purposes, are little understood. Despite this, numerous states are considering medical or recreational legalization. In the context of abrupt changes in marijuana policy in 2009 in Colorado, the authors sought to investigate corresponding changes in marijuana-related public health indicators., Methods: This observational, ecologic study used an interrupted time-series analysis to identify changes in public health indicators potentially related to broad policy changes that occurred in 2009. This was records-based research from the state of Colorado and Denver metropolitan area. Data were collected to examine frequency and trends of marijuana-related outcomes in hospital discharges and poison center calls between time periods before and after 2009 and adjusted for population. Analyses were conducted in 2014., Results: Hospital discharges coded as marijuana-dependent increased 1% per month (95% CI=0.8, 1.1, p<0.001) from 2007 to 2013. A change in trend was detected in poison center calls mentioning marijuana (p<0.01). After 2009, poison center calls increased 0.8% per month (95% CI=0.2, 1.4, p<0.01). Poison center calls also increased 56% (95% CI=49%, 63%, p<0.001) in the period following the policy change. Further, there was one hospital discharge coded as dependent for every 3,159 (95% CI=2465, 3853, p<0.001) medical marijuana registrant applications., Conclusions: The abrupt nature of these changes suggests public health effects related to broad policy changes associated with marijuana. This report may be used to assist in policy decisions regarding the short-term public health effects of marijuana legalization., (Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Tobacco cessation quitlines are generally effective in assisting smokers who want to quit. However, up to half of quitline callers report a history of mental health conditions and/or recent emotional challenges (MH+), and there has been little study of cessation outcomes for this population. Moreover, evidence suggests that callers who expect their MH+ to interfere with quit attempts have less success with quitting. This study compares rates of quitting among MH+ callers and callers with no mental health conditions or recent emotional challenges (MH-). It also compares rates of quitting between those who felt that mental health issues would interfere with their quit attempt (MHIQ+) and those who did not (MHIQ-)., Methods: National Jewish Health collected telephone data from 6 state quitlines. Participants received up to 5 coaching sessions and up to 8 weeks of nicotine replacement therapy. Smoking status was assessed during 3-month and 6-month post-intervention calls in a subset of participants (n = 4,960) for whom follow-up interviews were completed., Results: Participation in follow-up interviews was not significantly different between callers with MH+ and those without MH- (p = .13). However, at follow-up MH+ participants were less likely to report a successful quit compared with MH- (3-month: 31% vs. 43%; 6-month: 33% vs. 43%; both p < .001). Among MH+ participants, those reporting MHIQ+ were significantly less likely to quit compared with those who were MHIQ- (3-month: 24% vs. 34%; 6-month: 26% vs. 35%; both p ≤ .001)., Conclusions: These findings highlight the importance of evaluating both the mental health status of individuals seeking support for smoking cessation as well as the individuals' expectations for success, because they may need more tailored intervention to ensure the potential for better compared with outcomes., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The purpose of this article is to examine the Institute of Medicine's recommendations, the National Prevention Council Action Plan, the medical home model, and the nursing standards that drive quality for telephone nursing triage., Findings: These guidelines require reconceptualizing nursing roles, a commitment to lifelong learning, continued competence, and transformational leadership as demonstrated in a best practice case study., Conclusion: Given the changing climate of the healthcare system, telephone nurses are capable of improving healthcare delivery in the twenty-first century., (© 2014 Wiley Periodicals, Inc.)

Background: Telephone counselling services are increasingly utilised by consumers to obtain contemporary and confidential information about perinatal drug and toxin exposure. The use of such services in regard to psychotropic agents is unknown., Aim: To determine the frequency and types of calls to a New South Wales (NSW)-based telephone counselling service regarding perinatal psychotropic agent exposure between 2000 and 2011., Methods: Retrospective analyses of MotherSafe call data between two epochs: I (2000-2005, n = 46,277) and II (2006-2011, n = 118,587), total 164,864 calls., Results: 25,698 (15.6%) calls were made about psychotropic agents: 16,218 (9.8%) about antidepressants, 3,145 calls (1.9%) about mood stabilisers/antiepileptic agents, 2,878 (1.7%) about benzodiazepines and 3,457 (2.1%) about antipsychotic drugs. Calls regarding psychotropic agents doubled in epoch II (18,231 vs 7,467, epoch I) but decreased as a proportion of total calls (I: 16.1% vs II: 15.4%, P < 0.001). Selective serotonin inhibitors (SSRIs) were the most common drugs of concern (>44% of total psychotropic calls). The proportion of calls regarding particular agents changed significantly between epochs, for example paroxetine (epoch I: 14.8% vs epoch II: 6.7% of all antidepressant calls, P < 0.001) and quetiapine (epoch 1: 10.6% vs epoch II: 34.7% of all antipsychotic calls (P < 0.001). Calls from rural areas of NSW increased from 22.6 to 24.7% (P < 0.001)., Conclusion: Consumer demand for information about the use of psychotropic agents for women of child-bearing age has increased considerably over the last decade, particularly in rural areas of Australia. This indicates a need to review current existing services, particularly for rural consumers., (© 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Mass media campaigns and telephone quitlines are effective in increasing cessation rates among cigarette smokers. During March 19-June 10, 2012, CDC aired Tips from Former Smokers (TIPS), the first federally funded, nationwide, paid-media tobacco education campaign in the United States. The TIPS campaign featured former smokers talking about their experiences living with diseases caused by smoking. The campaign was primarily intended to encourage adult smokers aged 18-54 years to quit by making them aware of the health damage caused by smoking and letting them know that they could call the telephone quitline portal 1-800-QUIT-NOW or visit the National Cancer Institute (NCI) smoking cessation website (http://www.smokefree.gov) if they needed free help to quit. The campaign included advertising on national and local cable television, local radio, online media, and billboards, and in movie theaters, transit venues, and print media. To determine the effects of the TIPS campaign on weekly quitline call volume and weekly unique visitors to the cessation website, CDC analyzed call and visitor data immediately before, during, and immediately after the campaign period and compared them with data from the corresponding weeks in 2011. This report summarizes the results of that analysis, which found that the number of weekly calls to the quitline from the 50 states, the District of Columbia, Guam, and Puerto Rico increased 132% (207,519 additional calls) during the TIPS campaign, and the number of unique visitors to the cessation website increased 428% (510,571 additional unique visitors). These results indicate that many smokers are interested in quitting and learning more about cessation assistance, and will respond to motivational messages that include an offer of help.

Mental health telephone help-lines usually play a significant role in mental health services system. Their importance is substantiated during periods of financial crisis, where the mental health of the population is gravely inflicted. Media reports have documented a large increase in calls made to mental health telephone help-lines around the world as a corollary to the global economic crisis; however, a systematic investigation of this observation is still lacking. In this context, the present study endeavours to fill this gap in the literature, while it adds strength to the handful of studies which have empirically supported the impact of the financial crisis on mental health in Greece. Data were extracted from information gleaned during the calls made to the Depression Telephone Helpline of the Greek University Mental Health Research Institute. The information entailed the reason for calling, the socio-demographic and clinical profile of the person with mental health problems, his/her previous and current contacts with mental health professionals and the treatment he/she might be receiving. The results showed a steep increase in calls with direct or indirect reference to the economic crisis during the first half of 2010 and onwards. The callers who referred to the economic crisis manifested depressive symptomatology of clinical significance to a greater degree than callers who made no such reference. The latter exhibited increased levels of distress and agitation as well as drug/alcohol misuse. Concomitantly, a higher frequency of depressive symptomatology was discerned among the unemployed, whereas employed people were found to experience anxiety symptoms to a higher degree. The impact of the financial crisis on the mental health of the Greek population has been considerable, underscoring in this way the importance of mental health help-lines as emotional buffers and as guides for timely and appropriate service use in response to the emerging mental health problems.

QuitWorks is a Massachusetts referral program that links health care organizations, providers, and patients to the state's tobacco cessation quitline and provides feedback reporting. Designed collaboratively with all major Massachusetts health plans, QuitWorks was launched in April 2002. In 2010, approximately 340 institutions and practices used QuitWorks. Between April 2002 and March 2011, approximately 3,000 unique providers referred patients and 32,967 tobacco users received referrals. An analysis of QuitWorks data showed 3 phases in referrals between April 2002 and March 2011: referrals increased from April 2002 through November 2005, plateaued during December 2005 through January 2009, then substantially increased during February 2009 through March 2011. Factors responsible include partnerships with stakeholders, periodic program promotions, hospital activities in response to Joint Commission tobacco use measures, service evolutions, provision of nicotine replacement therapy for referred patients, and electronic referral options. QuitWorks' history demonstrates that tobacco cessation referral programs can be successfully sustained over time; reach substantial numbers of tobacco users, benefit providers and health care organizations; and contribute to sustainable systems-level changes in health care.

Objective: To understand the relative effectiveness of television advertisements that differ in their thematic focus and portrayals of negative emotions and/or graphic images in promoting calls to a smokers' quitline., Methods: Regression analysis is used to explain variation in quarterly media market-level per smoker calls to the New York State Smokers' Quitline from 2001 to 2009. The primary independent variable is quarterly market-level delivery of television advertisements measured by target audience rating points (TARPs). Advertisements were characterised by their overall objective--promoting cessation, highlighting the dangers of secondhand smoke (SHS) or other--and by their portrayals of strong negative emotions and graphic images., Results: Per smoker call volume is positively correlated with total TARPs (p<0.001), and cessation advertisements are more effective than SHS advertisements in promoting quitline call volume. Advertisements with graphic images only or neither strong negative emotions nor graphic images are associated with higher call volume with similar effect sizes. Call volume was not significantly associated with the number of TARPs for advertisements with strong negative emotions only (p=0.71) or with both graphic images and strong emotions (p=0.09)., Conclusions: Exposure to television advertisements is strongly associated with quitline call volume, and both cessation and SHS advertisements can be effective. The use of strong negative emotions in advertisements may be effective in promoting smoking cessation in the population but does not appear to influence quitline call volume. Further research is needed to understand the role of negative emotions in promoting calls to quitlines and cessation more broadly among the majority of smokers who do not call quitlines.

High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers' Quitline (free telephone based service). Smokers were exposed to either gain-framed (n=810) or standard-care (n=1222) counseling and printed materials. Those smoking 10 or more cigarettes per day and medically eligible were also offered a free 2-week supply of nicotine patches, gum, or lozenge. Smokers were contacted for follow-up interviews at 3 months by an independent survey group. There was no interaction of nicotine dependence scores and message condition on the likelihood of achieving 7-day point prevalence smoking abstinence at the 3-month follow-up contact. Among continuing smokers at the 3-month follow-up, smokers who reported higher nicotine dependence scores were more likely to report smoking more cigarettes per day and this effect was greater in response to standard-care messages than gain-framed messages. Smokers with higher dependence scores who received standard-care messages also were less likely to report use of nicotine medications compared with less dependent smokers, while there was no difference in those who received gain-framed messages. These findings lend support to prior research demonstrating nicotine dependence heterogeneity in response to message framing interventions and suggest that gain-framed messages may result in less variable smoking outcomes than standard-care messages., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

The Motherisk Alcohol and Substance Use Helpline at The Hospital for Sick Children in Toronto, Canada, is a unique telephone service providing evidence-based information on the negative effects associated with alcohol and substance use in pregnancy and lactation. We describe the characteristics of the service, the demographics of the callers, and the inquiries made during its first ten years of service. Since its inception in November 1998 until November 2008, almost 20,000 calls had been received with 60% of calls initiated by pregnant and breastfeeding women, the remainder from various health care providers. Most women exposed to alcohol and substances were of Caucasian descent (80%), employed (65%), and married (46%) with some level of post-secondary education (52%). The demographics of the callers deviate from the well-documented cohort of women at risk of engaging in alcohol and substance use in pregnancy and lactation, confirming that a selective group of women is more likely to use the services offered by the Motherisk program. Thus, further efforts are required to reach out to the subgroup of women at high risk of continuing their harmful behaviors during pregnancy and lactation.

Background: Despite recent advances in the management of patients with chronic obstructive pulmonary disease (COPD), interventions to reduce hospitalization have had only modest success. The aim of this study was to report the outcomes of a novel, nurse-led 24-h telephone support line (hotline) for patients with COPD., Methods: Observational study of patients' use of hotline between September 2002 and November 2004. All patients with COPD referred to a Respiratory Ambulatory Care programme over this period (n = 458) were given access to the hotline. The number and time of calls to the hotline, outcomes of hotline calls and safety of hotline, were assessed. The characteristics of hotline callers and non-callers were compared using an unpaired Student's t-test for normally distributed variables, a chi(2) test for categorical variables and a Mann-Whitney test for non-normally distributed variables., Results: Over the period studied, 675 calls were made to the hotline by 118 patients and 56% of calls were made after hours. For 78 calls (12%), advice and interventions given by hotline staff averted potential 000 calls by patients/carers. Specific advice about interventions for acute exacerbations of COPD (AECOPD) was given in a further 117 calls (17%). Callers had more severe COPD than non-callers (worse lung function, lower exercise capacity and higher prescription of home oxygen, all P < 0.05). No adverse events related to use of the hotline were documented., Conclusion: A nurse-led 24-h hotline for patients with COPD is safe, is used by patients and carers and, when used, reduces hospital presentations with AECOPD.

Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption.

Purpose: Recent data demonstrate that the mortality rate from carbon monoxide poisoning has declined over the past 2 decades. It is not known whether this decrease in mortality is reflective of the total burden of carbon monoxide poisoning. This study sought to examine trends in other potential indicators of the incidence of carbon monoxide poisoning in the United States., Basic Procedures: Published data from US poison control centers (PCCs) were used to calculate annual rates of calls regarding carbon monoxide exposures. Data on numbers of carbon monoxide-poisoned patients treated with hyperbaric oxygen (HBO) were used to calculate annual treatment rates. Trends in rates of carbon monoxide-related mortality, calls to PCCs, and HBO treatment were then compared., Main Findings: Contrary to the decline in carbon monoxide-related mortality from 1968 to 1998, rates of calls to PCCs significantly increased over the same period. Neither rates of PCC calls nor HBO treatment changed significantly from 1992 to 2002. The latter 2 measures were strongly correlated., Principal Conclusions: Although deaths from carbon monoxide poisoning have clearly decreased in the United States, other indicators of the incidence of the condition suggest that the total burden (fatal and nonfatal) may not have significantly changed. Efforts to prevent carbon monoxide poisoning should not be relaxed.

This article examines the impact of the launch of NHS Direct which was part of the Government's vision for a modern and dependable NHS. In particular, the challenges for nursing practice are detailed within a healthcare strategy which seeks to provide fast access primary health care to the whole population. The strengths and weaknesses of NHS Direct are discussed and its interface with other agencies explored. As NHS Direct will cover the whole of England by October 2000, the evidence to underpin its effectiveness must be considered in the light of media criticisms which indicate that the quality of advice given to callers is sometimes less than optimum.

The overall volume and complexity of calls in this review reflects the pace and stresses of most current health care settings in Alberta. This synopsis only highlights some areas of concern and does not encompass the nature of every call. The consulting services are available to all registered nurses and all Albertans- and it is clear from this review that callers are contacting the AARN in record numbers with a wide range of practice questions and concerns.

Despite aggressive efforts to recruit into treatment cocaine users 21 years and younger, we obtained only 12 such clients over a period of 9 months, while recruiting 122 adult cocaine clients during a comparable time frame. An examination of admissions data for the city, state, and nation indicated that our experience was typical. However, data from the most recent national household survey indicate that, to the extent need for treatment is determined by frequency of cocaine use, we should anticipate a much greater proportion of admissions to treatment to come from persons 21 years of age and younger. Yet, there appears to be an under-recruitment of youth into treatment, particularly evidenced by low rates of self-referral for juvenile as compared to older treatment admissions. Younger cocaine users may be less severely impaired and/or dependent, or may be more reluctant to use the treatment resources available. Whatever the barriers are to getting help, it becomes the special task of agencies and individuals in the community to help assure that younger cocaine users will obtain the assistance they need. Four community resources are seen as particularly relevant: family, schools, the medical community, and public agencies in the areas of health, social services, and criminal justice. The capacity of each to take action and possible impediments to that action are discussed.