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PubMed2001

Psychological distress and quality of life in drug-using and non-drug-using HIV-infected women.

BACKGROUND: Quantitative research on women infected with human immunodeficiency virus (HIV) has predominantly involved drug users. The present study assessed the psychosocial burden of HIV infection and identified some possible determinants in both drug-using and non-drug-using women. METHOD: Twenty-three hard-drug-using and 55 non-using HIV-positive women aged 18-64 years participated. Psychological distress (SCL-90, with eight scales and total score) and health-related quality of life (Rand SF-36, with eight scales and physical and psychosocial dimension) were measured. A cross-sectional comparison with reference groups (female general population, female psychiatric patients and HIV-positive homosexual men) was made. For analysis the t-test and multiple regression analysis were used. RESULTS: Compared to the general population, both HIV-positive groups had higher (i.e. unfavourable) SCL total scores (t = 8.33 and p < 0.001 and t = 4.97 and p < 0.001) and lower (i.e. unfavourable) Rand SF-36 scores (p < 0.001 on seven or more scales). Compared to psychiatric patients, drug users had similar (n.s.) and non-drug users had lower (t = -9.09 and p < 0.001) SCL scores. Both groups had lower SF-36 scores (p < 0.001 on seven or more scales). Compared to HIV-positive homosexuals, drug users had higher (t = 2.88 and p < 0.01) and non-drug users had similar SCL scores (n.s.). Psychosocial illness burden (SCL and Rand psychosocial dimension) was associated with low self-esteem, poverty, ethnic minority membership and illness stage (Rand only). Child care, drug use/prostitution and illness stage predicted high physical illness burden. CONCLUSION: Women with HIV/AIDS (acquired immune deficiency syndrome) experience considerable distress and poor quality of life, but drug users do more so than non-users. Drug- and gender-related lifestyles affect illness burden.

Adolescent↗
PubMed1992

Alcohol and drug abuse in Nepal.

Alcohol use has been in Nepal since time immemorial. Social tolerance to alcohol use is quite high and so far alcohol has not been taken seriously either by the Government or by any social organization. Production, sale, and consumption of alcohol is ever on the increase and it could be taken as the number one problem drug in the country. Cannabis and opium use has been in Nepal for centuries and in the past they did not pose much of a problem. Drug use began to be seen as a problem since only the mid-1960s and early-1970s with the influx of large numbers of hippies. Presently, the drug scene in Nepal is dominated by heroin and it has affected youths, mainly in the urban areas. A number of measures, both on supply reduction and demand reduction, have been taken by the Government together with non-Governmental organizations. However, the number of drug users is on the increase. Relapse rate following detoxification treatment is quite high. After-care and rehabilitative measures are lacking. Many drug users become involved in high-risk behaviours in spite of their knowledge of the dangers. Therefore, it calls for the change in our strategies which must be based on the thorough understanding of human nature and its behaviour.

Alcoholism↗
PubMed1984

Accidents associated with equipment.

Serious accidents in which the possibility of equipment-related hazards are raised have been reported to the Scientific and Technical Branch of the Department of Health and Social Security. The author has examined anonymous summaries of 23 such reports of events which occurred over a 5-year period. The principle cause of catastrophe in seventeen of the incidents was user error involving disconnexion or misconnexion. Faulty systems of equipment management combined in some cases with inadequate pre-anaesthetic checking of apparatus were responsible for the other instances. Appropriate systems of equipment management and checking together with meticulous basic clinical monitoring are recommended as the best safeguards in anaesthetic practice.

Anesthesia, General↗
PubMed1985

Possible adverse reactions to an enzyme-containing washing powder.

Following the launch of an enzyme (alcalase) containing washing powder, the manufacturers received numerous complaints from domestic users suggesting that it was responsible either for the precipitation of a rash or the exacerbation of a pre-existing rash. The 255 individuals living in London postal districts who complained to the manufacturers were contacted: 80 of them agreed to be investigated by patch and prick testing, and to a user test involving the double blind wearing of vests washed with the product. The results failed to substantiate that the enzyme containing washing powder was responsible for any dermatological problem.

Adolescent↗
PubMed1993

Biotechnology for developing countries. The case of the Central American isthmus.

Recent developments in the fields of chemistry, molecular biology, computer science, and communications promise to transform the way that many things will be done in the near future in diverse fields of scientific R&D. Fortunately for less developed countries (LDCs) some of the technologies involved are user friendly and safe, avoiding the need for radioactive precursors, large machines, or expensive reagents. For instance, tissue culture, polymerase chain reaction (PCR), dideoxi-sequencing, and recombinant DNA techniques have already invaded clinical laboratories, agricultural field stations, and natural history museums, even in some developing nations. Somatic cell culture for plant biotechnology and immunologic techniques for diagnosis have had wide applications for over a decade in all countries in the Central American Isthmus. More recently, recombinant DNA techniques, including PCR, have been introduced for diagnostic purposes and research at the two largest universities in Costa Rica and at other public institutions and are also used in Guatemala and Panama. Honduras and Nicaragua are only now acquiring these technologies for diagnostic purposes. Biotechnological applications in industry seem to be lagging behind, and presently no good links exist between research laboratories and industry for advanced applications. The application of biotechnologies in environmental problems is slowly underway, with molecular studies of natural wildlife populations and primary forest trees. A major effort is needed to create safe and effective ways of dealing with environmental degradation, wastes, and byproducts of tropical agriculture and industry. The creation of the National Biodiversity Institute (INBio) in Costa Rica to elaborate an inventory of flora and fauna and to prospect for useful substances provides a unique opportunity for biotechnological applications. In addition, government policies to promote biotechnological development are supported by CONICIT (National Research Council), the Ministry of Science and Technology, the newly established Costa Rican Academy of Science, and the national universities. Other countries in the region are beginning to take similar action. At the Cell and Molecular Biology Center (CIBCM) our strategy is to obtain the key components and infrastructure to handle nucleic acids and manage genetic information in databanks. Training has been an important priority during the last decade, with over 20 Central American students receiving graduate degrees in virology, molecular biology, genetics, and immunology, with support from German and Swedish governmental institutions. Diagnosis of viral diseases in cultivated plants and animals was done initially at CIBCM for research and later on a contractual basis for both the public and private agricultural sectors. DNA hybridization and PCR techniques are now replacing or being used concurrently with immunologic techniques.(ABSTRACT TRUNCATED AT 400 WORDS)

Agriculture↗
PubMedDate not supplied

Clinical practice guideline for managing acute urinary tract infections in adult females in Saudi Arabia.

The management of urinary tract infections at primary health clinics in Saudi Arabia varied widely and did not generally conform to modern recommendations. A clinical practice guideline was developed to standardize and modernize the approach in order to improve the quality of care and reduce costs. An algorithm was developed for the management of acute urinary tract infections in non-pregnant adult females. Guideline recommendations were generally well received, and acceptance was greater where users were involved in the initial stages of guideline development. The cost of managing urinary tract infections was reduced providing that reliance on dipstick analysis did not increase costs through increased misdiagnosis.

Acute Disease↗
PubMed2000

A standardised neurosurgical referral letter for the inter-hospital transfer of head injured patients.

OBJECTIVES: (1) To evaluate the use of a standardised neurosurgical referral letter in terms of compliance, completeness and clinical relevance. (2) To compare the clinical information provided on the standardised neurosurgical letter with that provided by referring hospitals that used alternative documentation. DESIGN: A six month prospective audit was conducted in south west Scotland. Consultant neurosurgeons were asked to weight key clinical variables on the neurosurgical referral letter (NRL). Postal surveys of 114 referring accident and emergency (A&E) staff and 18 neurosurgical receiving staff were undertaken to determine the clinical relevance of the NRL. Case notes were examined for the presence and level of completeness of the NRL. In the absence of the NRL, a form was completed retrospectively using data from the referring hospital's letter. This enabled comparison of the NRL with routine hospital letters in terms of the availability of key clinical information. RESULTS: 139 adult patients were identified as suitable for inclusion: 99 patients were transferred from 11 hospitals with access to the NRL. The compliance rate for use of the NRLwas 82%. Forty patients were transferred from nine hospitals that did not have access to the NRL. The completion rate of key variables on the NRL was higher than when an ordinary letter was sent: 87% compared with 38%. The NRL was considered useful by 67 of 71 (94%) A&E questionnaire respondents and by 14 of 15 neurosurgeons who responded. CONCLUSIONS: The widespread acceptance of the NRL and its ability to provide essential clinical information in a concise format not available in routine hospital letters indicates that national, standardised documentation can be implemented if users are involved in both its design and implementation.

Adult↗
PubMed1989

Use and abuse of volatile substances in industry.

1. Although there are trends towards the use of 'safer' or non-solvent materials, the overall consumption of solvents will probably not change very much over the next few years. Substitution of solvents by 'safer' materials is a complex and difficult process and the rate of change is correspondingly slow. 2. HSE exposure data show that generally industry controls most solvent use quite well. High personal exposures are not widespread and tend to occur in a fairly small number of premises involving 'end user' processes (mixing, spraying, etc). 3. Exposure in industry is generally to mixtures of solvents rather than single substances. The degree to which abuse is a contributory factor in exposure is uncertain, but there is probably greater opportunity for abuse to occur in 'end user' processes. 4. The experience of the author and colleagues in the HSE supports the evidence for the occurrence of volatile substance abuse (particularly of organic solvents) in industry but the extent of the practice is not known. 5. The proposed Control of Substances Hazardous to Health Regulations (COSHH) will bring greater emphasis on the assessment of risks to health in industry, which must include the potential for abuse, together with appropriate training and supervision.

Environmental Exposure↗
PubMed2005

What do we know about promoting mental health through schools?

There is a growing evidence base on what schools need to do to promote mental health effectively. There is strong evidence that they need first and foremost to use a whole school approach. This shapes the social contexts which promote mental health and which provide a backdrop of measures to prevent mental health disorders. In this context the targeting of those with particular needs and the work of the specialist services can be much more effective. Schools need to use positive models of mental health, which emphasise well being and competence not just illness--this will help overcome problems of stigma and denial and promote the idea of mental health as 'everyone's business'. The most effective programmes in schools which address mental health have the following characteristics: They provide a backdrop of universal provision to promote the mental health of all and then target those with special needs effectively. They are multi-dimensional and coherent. They create supportive climates that promote warmth, empathy, positive expectations and clear boundaries. They tackle mental health problems early when they first manifest themselves and then take a long term, developmental approach which does not expect immediate answers. They identify and target vulnerable and at risk groups and help people to acquire the skills and competences that underlie mental health. They involve end users and their families in ways that encourage a feeling of ownership and participation, and provide effective training for those who run the programmes, including helping them to promote their own mental health. Using these starting points, we need to develop a rigorous evidence-based approach on this issue. We also require the facilitation of the dissemination of such research findings while encouraging new and innovative approaches.

Health Promotion↗
PubMed2004

[Discovering pathways for health research in dealing with the social movement].

This article is about methodology for scientific research in health, where the researcher is an important part of the object of investigation. The implementation of a broad-based Health Reform in Brazil depends on the involvement of users. It is important to guarantee these social rights. Many experiences sharing this concern are going on in this country. Still, research on the relationship between institutional work in health and the Social Movement lacks a predefined methodology. Therefore, the main objectives of this study are the following: to contribute to the discussion of possible ways of approaching the mechanisms of relationships between health and users of health services, and to collaborate with the development of the citizenship process. This work was done through theoretical research on participatory methodology and "action-based research". The following aspects are particularly important: definition of the object of study, self-positioning by the researcher, subjective explanations, documentary surveys and interviews for case studies, and feedback to theory. Finally, the author concludes that this methodology allows for an understanding of some mechanisms that explain the relationship between macro- and micro-structural analyses. In addition, one also observes a maturation process in the research protagonists.

English Abstract↗
PubMed1996

Validity of self-reported drug use in high risk populations: a meta-analytical review.

Research involving drug users and treatment evaluations continue to rely extensively on self-reports of drug use. This paper presents a meta-analytical review of 24 studies published since 1985 that examined the validity of drug self-reports in high risk populations. Only studies employing a biological criterion of validity (e.g., urinalysis, hair analysis) are included. Coefficients of chance-corrected agreement between self-reports and the validity criteria are calculated from published data to facilitate cross-study comparisons. The median conditional kappa (kappa c) was .42, considerably below the level of kappa c = .80 that represents acceptable reporting accuracy. The magnitude of drug use underreporting documented in this review could seriously bias prevalence estimates and treatment outcome studies.

Alcoholism↗
PubMed1997

The nursing process--a method of collecting evidence?

This paper questions whether or not the nursing process can be a valid method of collecting evidence on which to base nursing care. The author asserts that it can, but only if the service user is involved in the entire process.

Data Collection↗
PubMed1992

Making the purchase decision: factors other than price.

Taking price out of the limelight and concentrating on customer relations, mutual respect, and build-in/buy-in; involving the user; developing communication and evaluation processes; and being process oriented to attain the results needed require commitment on the part of administration and materiel management. There must be a commitment of time to develop the process, commitment of resources to work through the process, and a commitment of support to enhance the process. With those three parameters in place, price will no longer be the only factor in the purchasing decision.

Communication↗
PubMedDate not supplied

Maximizing service delivery: one OR's experience.

Hospitals are being forced to make strategic downsizing decisions at a rapid rate. Surgical services are frequently targeted as much of the related activity is deemed to be controllable. However, strategies that only focus on bed and operating room reductions do not always achieve desired results. This article describes the experience of one community hospital in controlling surgical costs over a five-year period. The keys to its success include evaluating and monitoring the outcome of strategic decisions, identifying and integrating the systems that comprise the surgical process, and ensuring the involvement of users in developing and implementing change.

Appointments and Schedules↗
PubMed1997

ITHACA. Telematics for integrated client centred care.

ITHACA is a project supported by the healthcare telematics programme of the European commission's Fourth Framework Programme. The user organisations involved in ITHACA shared a philosophy of community based care that focuses on the client and development of the multi-disciplinary care team, involving a range of professionals delivering care to clients in their own homes or community facilities. The focus of ITHACA system is to support client case management which includes client assessment, care planning, delivery and evaluation of care outcomes. System analysis and design process identified that practices and procedures in health and social care are very similar throughout the diverse sites represented in ITHACA and they are represented in a generic model that describes the great majority of local health and social care requirements. The ITHACA demonstrator will consist of a client/patient centred community care information system, which is distributed across a number of community care centres within a given region and covers the homes of selected clients.

Aged↗
PubMed2001

A diffusion of innovations model of physician order entry.

OBJECTIVE: To interpret the results of a cross-site study of physician order entry (POE) in hospitals using a diffusion of innovations theory framework. METHODS: Qualitative study using observation, focus groups, and interviews. Data were analyzed by an interdisciplinary team of researchers using a grounded approach to identify themes. Themes were then interpreted using classical Diffusion of Innovations (DOI) theory as described by Rogers [1]. RESULTS: Four high level themes were identified: organizational issues; clinical and professional issues; technology implementation issues; and issues related to the organization of information and knowledge. Further analysis using the DOI framework indicated that POE is an especially complex information technology innovation when one considers communication, time, and social system issues in addition to attributes of the innovation itself. CONCLUSION: Implementation strategies for POE should be designed to account for its complex nature. The ideal would be a system that is both customizable and integrated with other parts of the information system, is implemented with maximum involvement of users and high levels of support, and is surrounded by an atmosphere of trust and collaboration.

Diffusion of Innovation↗
PubMed2002

On the value of architecture and facility management in health administration education.

This article discusses the role and function of architecture and facility management in health administration education vis-à-vis an interdisciplinary set of courses taught in a graduate-level health administration program. These courses provide the future health care executive with theory and applied knowledge on a variety of topics. These include the history of health care facilities, issues in facility planning and management, principles of patient and staff-focused design, campus master planning, participatory methods to involve end users in the design of their work, and care settings. Additional skills acquired include an introduction to contract negotiations, the reading of technical documents such as blueprints, the post-occupancy assessment of facilities-in-use, and familiarity with future trends. Students address the topic of managerial ethics in relation to the built environment in some detail as a vehicle to illustrate the nature of key fine-grain issues of importance to the health administration scholar and professional. The discussion concludes with the presentation of a model curriculum in this subject area.

Architecture↗