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Biomedical subjects

Nat M J Wright

Publications and source records attributed to Nat M J Wright.

7 recordsLinked to original sources
PubMed2005

Exploring risk perception and behaviour of homeless injecting drug users diagnosed with hepatitis C.

Injecting drug users (IDUs) are at the greatest risk of hepatitis C infection by using any item of injecting equipment that has come into contact with contaminated blood. Alongside this, homeless IDUs have been identified as being at increased risk of harm in their illicit drug taking behaviour. This study interviewed 17 hepatitis C positive homeless IDUs about their injecting practices. In-depth interviews explored the impact of a positive hepatitis C diagnosis on their injecting and identified their risk behaviours and perceptions. The interviews were tape-recorded, transcribed and analysed using the framework approach. Homeless IDUs engaged in both high risk and unhygienic injecting practices, such as using drugs outside and in public places, sharing injecting equipment and re-using cleaned needles. Excessive needle reuse whilst in prison was also identified. However, the findings were not universally bleak as a positive diagnosis of hepatitis C did lead to some behaviour change towards safer injecting and some adopted other lifestyle and behaviour changes. It was, however, common for homeless people to devolve responsibility for preventing hepatitis C transmission to their peers, especially when injecting with others. Knowledge regarding possible transmission through injecting paraphernalia appeared to make users more careful to reduce it through these routes. Placing a continuous emphasis on health promotion is therefore important in educating IDUs about the hepatitis C transmission risks associated with injecting drug use. Information regarding safer and hygienic use, including accurate information regarding the most effective methods to clean used equipment, must be re-enforced by people working with homeless injecting drug users.

Blood-Borne Pathogens↗
PubMed2004

The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) project: an open-label pragmatic randomised control trial comparing the efficacy of differing therapeutic agents for primary care detoxification from either street heroin or methadone [ISRCTN07752728].

BACKGROUND: Heroin is a synthetic opioid with an extensive illicit market leading to large numbers of people becoming addicted. Heroin users often present to community treatment services requesting detoxification and in the UK various agents are used to control symptoms of withdrawal. Dissatisfaction with methadone detoxification 8 has lead to the use of clonidine, lofexidine, buprenorphine and dihydrocodeine; however, there remains limited evaluative research. In Leeds, a city of 700,000 people in the North of England, dihydrocodeine is the detoxification agent of choice. Sublingual buprenorphine, however, is being introduced. The comparative value of these two drugs for helping people successfully and comfortably withdraw from heroin has never been compared in a randomised trial. Additionally, there is a paucity of research evaluating interventions among drug users in the primary care setting. This study seeks to address this by randomising drug users presenting in primary care to receive either dihydrocodeine or buprenorphine. METHODS/DESIGN: The Leeds Evaluation of Efficacy of Detoxification Study (LEEDS) project is a pragmatic randomised trial which will compare the open use of buprenorphine with dihydrocodeine for illicit opiate detoxification, in the UK primary care setting. The LEEDS project will involve consenting adults and will be run in specialist general practice surgeries throughout Leeds. The primary outcome will be the results of a urine opiate screening at the end of the detoxification regimen. Adverse effects and limited data to three and six months will be acquired.

Adolescent↗
PubMed2004

Abusive behaviour experienced by primary care receptionists: a cross-sectional survey.

BACKGROUND: Receptionists act as gatekeepers to GPs, and thus are often placed in situations of conflict. However, there is a lack of research in this area. OBJECTIVE: The purpose of this study was to identify the incidence and associations of verbal and physical abuse against primary care receptionists, both pre- and post-'zero tolerance'. METHODS: A postal questionnaire was designed, piloted and sent to all reception staff in 50 randomly selected general practices in Leeds. The primary purpose was to identify any verbal or physical abuse experienced in the 12 months prior to the survey and assess the association between abuse experienced and deprivation. RESULTS: Seventy percent of receptionists completed and returned the questionnaire. Over two-thirds of receptionists had experienced verbal abuse in the last year. During the same time period, 60% reported telephone abuse and 55% reported face to face abuse. The incidence of abuse was higher in the year prior to the study than in the preceding period. Practice deprivation was identified as a significant factor for verbal abuse (P = 0.003). CONCLUSION: Verbal abuse against receptionists is significantly associated with the level of deprivation of the practice area. There is no evidence that 'zero tolerance' led to a reduction in abuse experienced by primary care receptionists. All primary care receptionists should receive adequate training on managing abuse.

Adult↗
PubMed2004

Impact of the CSM advice on thioridazine on general practitioner prescribing behaviour in Leeds: time series analysis.

In December 2000, the Committee for Safety of Medicines (CSM) advised that thioridazine may prolong QT intervals risking arrhythmias. We investigated the impact on general practitioner prescribing of thioridazine using a time series analysis. Numbers of items and costs of antipsychotics and benzodiazepines prescribed in Leeds from May 1999 until April 2002 were collated. Post-advice, thioridazine prescriptions dropped by 810 items per month (95% confidence interval = 420 to 1200, P < 0.001) but others increased slightly in response. Costs mimicked these changes. Fresh criteria are proposed for appraising the quality of evidence needed to inform future urgent facsimile transmissions.

Antipsychotic Agents↗
PubMed2003

Associations between migrancy, health and homelessness: a cross-sectional study.

There is limited awareness of the link between differing health problems and migrancy of homeless people. The present cross-sectional study sought to quantify the extent of migrancy of homeless people from their place of birth (PLOB) and evaluate whether a history of problematic drug use, alcohol misuse or enduring mental health problems were associated with migrancy from their PLOB. The work was conducted at an inner-city health centre for the homeless in the north of England. Place of birth was created as an entry on the computerised registration records. The PLOB was collected and recorded for each homeless person registering with the service over the study period. Information was also extracted regarding diagnoses of problematic illicit drug use, problematic alcohol use and enduring mental health problems for each homeless person. The study identified statistically significant differences for the migration of homeless people from their PLOB for age, problematic drug use and problematic alcohol use. Problematic alcohol use is independently associated with an increased likelihood of migration from the PLOB. Conversely, a history of illicit drug use is associated with a reduced possibility of migration from the PLOB when accessing primary healthcare services. There was no significant difference for migration from the PLOB for mental health. Not all homeless people migrate from their PLOB and health problems of drug use, mental health or alcohol use are independently associated with different patterns of migration. Understanding the migrancy of homeless people is important when planning and targeting appropriate health and social services to address their varying health, social and psychological needs.

Adolescent↗