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PubMedDate not supplied

The criminal histories of male non-medical opiate users in the United Kingdom.

Although there is general agreement that there is some association between non-medical opiate use and criminality the nature, extent and significance of the association remains controversial. The most plausible explanation for an association is that crime becomes an economic necessity for the opiate user where there is, as in most countries, a legislative prohibition on licit supplies of the drugs. In the United Kingdom, however, opiate users may be prescribed the drugs and may also qualify for social security benefits. The criminal histories of three series of United Kingdom male non-medical opiate users are described. A somewhat higher proportion of the series had criminal convictions before any admitted drug misuse when compared with that expected from a general population sample. When age and the number of convictions before identification as opiate users were taken into account, there was no consistent evidence that they were more likely than expected to be convicted of further offences during the two-year period following identification. When the proportion found to have been convicted during this period was greater than expectation, it was due to the proportion convicted exclusively of drug offences. The criminal histories showed a decrease in the number of convictions for theft and other offences and an increase in the number of convictions for, and the number of users convicted of, drug offences during the stages of the drug using history, most particularly during the two years following identification as opiate users. The majority of the drug offences during this period involved opiates when most of the users were, or had been, in receipt of prescriptions for these drugs. It was concluded that the pattern of criminality of male non-medical opiate users was related both to the type of national drug control legislation and to their individual criminal histories.

Adolescent↗

PubMed2000

Application and maintenance habits do make a difference in adhesion of Alora transdermal systems.

OBJECTIVES: To explore and evaluate Alora placebo patch application and maintenance habits of women in order to identify the factors that influence adhesion success. METHODS: This single-center, open-label, placebo, randomized, multiple-application, parallel-group study involved 99 healthy naïve users of transdermal patches. Participants applied and wore an Alora placebo patch for ten consecutive applications of approximately 3.5 days each and evaluated adhesion of the patches twice-daily. Three subgroups comprising participants achieving low, moderate or high adhesion success took part in focus groups to discuss their wear habits, practices and attitudes regarding transdermal patches. RESULTS: There was a significant behavioral component involved in patch adhesion. The habits, practices and attitudes of high achievers were clearly different from the other two subgroups. The three most important issues identified to improve adhesion were: mastering the removal of the patch liner, identifying the best site of application, and developing and implementing techniques to maintain patch adhesion. The Alora placebo patch was well tolerated throughout the study. CONCLUSION: The data showed that there is a learning curve involved in achieving maximal adhesion with a transdermal patch. During the study, a novel patch application method ('press, fold and slide') was demonstrated for the participants. This method was very well received by all participants and was more easily executed than the previous method. An adaptation of this method was incorporated into the Alora patient information leaflet, together with several other changes to help improve adhesion success.

Adhesiveness↗

PubMed2002

Evidence-based medicine and radiology: how to build a guideline. An attempt in minor head injury.

PURPOSE: To evaluate the use of Evidence-based Medicine (EBM) to build radiological Guidelines, with the aim to have a better compliance by users. It has been decided to work on minor head injury, where we have found, in our institution, a wide and unjustified use of conventional skull x-ray. MATERIAL AND METHODS: A Workgroup, that reunites the main figures that enter in the management of the patient with minor head injury, has been created within our Hospital. The bibliography relative to the problem has been selected, employing criteria that held account of the methodological correctness, and in particular the existing Guidelines have been carefully analysed. It is therefore proceeded drawing up a Guideline that adhered to the principles of the EBM, adapting it to the hospital environment. Subsequently it has been passed to the phase of its implementation, with reunions in small groups of the involved professional figures, the distribution of informative material and the use of poster that reassumed the diagnostic flow-chart. Moreover a survey of the relative data to the number of skull x-ray and brain TC, executed in the patients with head trauma, has been completed. RESULTS: The analysis of the data relative to the variation of the number of demands for skull Rx after introduction of the Guideline has demonstrated a great reduction (-83,8%), with little variation of the number of brain TC (+17,0%); such reduction has naturally implicated an important reduction of costs (-25,2%) and of the x-ray dose to population, measured to the crystalline (34,5%) and to thyroid (-71,0%). CONCLUSIONS: The employ of the EBM in the Guideline creation, beyond representing the more correct methodology, concurs to obtain a greater adhesion from the users involved in management of the patient; in particular this happens if the Guideline is a product of a vast contribution and if it is supported from all additional procedures that can be useful for its implementation.

Costs and Cost Analysis↗

PubMed2002

Development and implementation of computerized clinical guidelines: barriers and solutions.

Research indicates that computerized decision support systems (CDSSs) can improve clinical performance and patient outcomes, and yet CDSSs are not in widespread use. Physician guidelines, in general, face barriers in implementation. Guidelines in a computerized format can overcome some of the barriers to conventional text-form guidelines; however, computerized programs have novel aspects that have to be considered, aspects such as technical problems/support and user interface issues that can act as barriers. Though the literature points out that human, organizational, and technical issues can act as barriers in the implementation of CDSSs, studies clearly indicate that there are methods that can overcome these barriers and improve CDSS acceptance and use. These methods come from lessons learned from a variety of CDSS implementation ventures. Notably, most of the methods that improve acceptance and use of a CDSS require feedback and involvement of end-users. Measuring and addressing physician or user attitudes toward the computerized support system has been shown to be important in the successful implementation of a CDSS. This article discusses: 1) the barriers of implementation of guidelines in general and of CDSSs; 2) the importance of the physician's role in development, implementation, and adherence; 3) methods that can improve CDSS acceptance and use; and 4) the types of tools needed to obtain end-user feedback.

Attitude of Health Personnel↗

PubMed1998

An association between the regular use of 3,4 methylenedioxy-methamphetamine (ecstasy) and excessive wear of the teeth.

AIMS: This study was established to determine if users of ecstasy had greater tooth wear than a comparison group of non-users. DESIGN: The study involved a direct comparison between two groups of young people gathered by a peer information network and divided by the response to the question "Do you take ecstasy?" SETTING: The information network was established at the Maryland Centre in Liverpool (UK). Besides offering advice on drug and sex-related problems this centre distributes free condoms and is therefore visited by many young people who would not consider themselves to have these problems. PARTICIPANTS: There were 30 users and 28 non-users with no significant difference in the gender ratio. Age was not recorded to maintain absolute confidentiality, but all the participants appeared to be of student age. MEASUREMENTS: Tooth wear was measured using the index of Smith & Knight. The social and drug-taking profile of the two groups was ascertained by questionnaire. FINDINGS: It was found that the mean (+/- STD) tooth wear score for the back teeth was 0.96 +/- 0.16 in the users compared with 0.12 +/- 0.08 for the comparison group. These values were significantly different (p < 0.001). The values for the front teeth were not significantly different. Many users were aware of clenching their teeth 12 or even 24 hours after taking the drug. CONCLUSION: Taking ecstasy results in an increased likelihood of tooth wear on the back teeth. This is likely to result from clenching the teeth in the acidic environment caused by carbonated (fizzy) drinks.

Drinking↗

PubMed2002

The computerized patient record: balancing effort and benefit.

PROMISE AND REALITY: this review addresses two questions. First, why is the introduction of the computerized patient record (CPR) so slow, while its potential for improved quality of care and reduction of cost is well recognized? Second, what, in this respect, is the role of record architecture and standardization? BARRIERS: the impediments for CPR adoption are put in a larger context by addressing the relationship among effort, benefit, and the parties involved. An important financial impediment is insufficient return of investment. Other hurdles related to the use of CPRs are lack of integration and flexibility, which cause clinicians to experience insufficient reward to motivate them for data entry and changes in working style. Effort and benefit have to be balanced for each party involved. REQUIREMENTS FOR IMPROVEMENT: lack of standardization impedes exchange and sharing of medical data, and new developments cause fear of applications to become outdated. Flexibility in content and use, integration, and adaptability to change, are key requirements for CPR systems. These requirements can most effectively be met through an architecture that separates content and structure, such that the road to standardization is not paved with frequent expensive adaptations. STRATEGIES FOR IMPLEMENTATION: successful implementation and acceptance require reliable evaluation of applications by independent professional groups. Users need to be involved in setting priorities and planning for actual implementation.

Cost Control↗

PubMed1988

Social and psychological factors underlying inhalant abuse.

There are three distinct types of inhalant users: young inhalant users, adolescent polydrug users, and inhalant-dependent adults. Young inhalant users have a modal age of 12 to 13. They use inhalants and may also use alcohol and marijuana. They are likely to have more emotional problems than nondrug users or young marijuana users. These problems, particularly when they involve feelings of anger and alienation, increase the chances that they will identify with other youth who have similar feelings. When this happens, young people form peer clusters; they find a best friend or form a small gang that has a high potential for getting involved with drugs. Most of these peer clusters use inhalants only a few times a month, although some may become obsessed with inhalant use to the exclusion of nearly all other activities. The data showing that young inhalant users have more emotional problems than either nondrug users or young marijuana users suggest that treatment should involve therapy as well as drug avoidance approaches. Every youth caught using inhalants, however, should not automatically be sent for therapy. Sometimes a youth caught using a drug is not really drug involved and overreaction can be damaging. In addition, the emotional problems of all young inhalant users are not identical. A higher average level of emotional problems only means that some of the young inhalant users have those problems, not all of them. Older adolescents, including those who used inhalants earlier, are not likely to use inhalants. Since young inhalant users seem to be troubled youth, have shown an early penchant for drug use, and have drug-using associates, it seem unlikely that they quit using drugs. They probably move on to other drugs, leaving inhalants behind. The older adolescents who do use inhalants are adolescent polydrug users, with a modal age of around 15 to 16. They take many different drugs, and some of them use inhalants as well. The adolescents who use inhalants are probably using a wider range of drugs than other adolescents and are probably getting high more often. Furthermore, they are likely to be more deviant and may be involved in more aggression and more crime. Inhalant-dependent adults usually have a long history of alcohol and other drug involvement. At some point, inhalants have become their preferred drug. By that time, they are usually in their midtwenties to early thirties. They have serious problems.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Inhalation↗

PubMed1995

Road traffic accidents in Kenya: an epidemiological appraisal.

A descriptive analysis of road traffic accident (RTA) and injury data in Kenya was done using routine accident reports, official statistical abstracts, published and unpublished surveys. The characteristics of injury-producing accidents examined included trends, distribution patterns, risk factors, types of vehicles involved, and road-users injured or killed. The numbers killed increased by 578%, while non-fatal casualties rose by 506% between 1962 and 1992. Fatality rate per 10,000 vehicles increased from 50.7 to 64.2, while fatality per 100,000 population ranged between 7.3 and 8.6. 66% of the accidents occurred during daytime. 60% of the reported RTAs occurred on rural roads and had a higher case fatality rate (CFR) of 16% compared to those occurring in urban areas (11%). Human factors were responsible for 85% of all causes. Vehicle-pedestrian collisions were most severe and had the highest CFR of 24%, while only 12% of injuries resulting from vehicle-vehicle accidents were fatal. Utility vehicles, 'matatus' and buses were involved in 62% of the injury producing accidents. Of all traffic fatalities reported, pedestrians comprised 42%, passengers 38%, drivers 12%, and cyclists 8%. The high pedestrian and passenger deaths imply the need to investigate the underlying risk factors, operational and policy issues involved in the transport system, and to develop and implement appropriate responsive road safety interventions.

Accidents, Traffic↗

PubMed1991

Risk factors for shooting gallery use and cessation among intravenous drug users.

BACKGROUND: Shooting galleries, locations where intravenous drug users (IVDUs) can rent or borrow needles and syringes, are a high-risk environment for HIV-1 transmission. This study investigates risk factors for lifetime attendance at shooting galleries and differentiates characteristics of those who continue to frequent shooting galleries and those who have stopped. METHODS: We interviewed 2615 active IVDUs in Baltimore in 1988 and 1989 and determined patterns of IV drug use, sociodemographics, and HIV-1 serostatus as related to persistence vs cessation of shooting gallery use. RESULTS: Over half (52%) of active IVDUs reported ever using a shooting gallery, with 33% reporting use within the prior 3 months. In multivariate analysis, lifetime shooting gallery use was associated with male gender, homosexuality/bisexuality, low socioeconomic status, Black race, and heavier drug involvement. Persistent shooting gallery users were more frequently male, homosexual/bisexual, homeless, less educated, and started IV drug use more recently compared with those who ceased going to shooting galleries. CONCLUSIONS: Shooting gallery attendance may be pragmatic from a sociological and economic perspective, but it carries with it a heightened risk of acquiring HIV-1 infection.

Adult↗

PubMed2003

User-centered development of a Web-based preschool vision screening tool.

Although amblyopia is most successfully treated when detected in early childhood, many preschool-aged children are not being screened. This project explored the delivery of Web-based vision screenings, integrated with patient education, to parents and children, aged 3 to 6 years. Through a user-centered design methodology involving requirements gathering, iterative prototype development, and usability testing, a highly usable screening Website was created. Interviewing and testing parents and children in the home were essential in gathering accurate data about environments where the tool would actually be used. Frequent iterations of designing, testing, and modifying the tool were useful in identifying and correcting usability problems. Usability goals were set early in the project, and in the final phase a satisfaction questionnaire was administered to participants. Twenty-one out of 22 final usability objectives were achieved and the feasibility of Web-based vision screening was demonstrated.

Amblyopia↗

PubMed2005

HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy.

BACKGROUND: A decrease in the rate of human immunodeficiency virus (HIV) infection-related wasting has been reported in the era of highly active antiretroviral therapy (HAART). We investigated this concern in a hard-to-reach population of HIV-infected drug users in Miami, Florida. METHODS: After informed consent was obtained, 119 HIV-infected drug users were administered questionnaires involving demographic, medical history, and food-security information. Blood samples were drawn for immunological and viral studies. HIV-related wasting over a period of > or =6 months was defined as a body mass index of <18.5 kg/m2, unintentional weight loss of > or =10% over 6 months, or a weight of <90% of the ideal body weight. RESULTS: The prevalence of HIV-related wasting was 17.6%. A significantly higher proportion of those who experienced wasting (81%) reported that there were periods during the previous month when they went for > or =1 day without eating (i.e., food insecurity), compared with those who did not experience wasting (57%). Although a greater percentage of patients who experienced wasting were receiving HAART, their HIV RNA levels were more than twice as high (mean+/-standard deviation [SD], 166,689+/-238,002 copies/mL; median log HIV RNA level +/- SD, 10.2+/-2.7 log10 copies/mL) as those for the group that did not experience wasting (mean+/-SD, 72,156 +/- 149,080; median log HIV RNA level+/-SD, 9.2+/-2.3 log10 copies/mL). Participants who experienced wasting were more likely to be heavy alcohol drinkers and users of cocaine. In multivariate analysis that included age, sex, food security, alcohol use, cocaine use, viral load, and receipt of antiretroviral therapy, the only significant predictors of wasting were > or =1 day without eating during the previous month (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.18-3.26; P=.01) and viral load (OR, 1.64; 95% CI, 1.00-2.69; P=.05). CONCLUSIONS: HIV-related wasting continues to be common among HIV-infected drug users, even among HAART recipients. Food insecurity and viral load were the only independent predictors of wasting. The social and economic conditions affecting the lifestyle of HIV-infected drug users constitute a challenge for prevention and treatment of wasting.

Anti-HIV Agents↗

PubMed2004

[Development of a secure and cost-effective infrastructure for the access of arbitrary web-based image distribution systems].

PURPOSE: To build an infrastructure that enables radiologists on-call and external users a teleradiological access to the HTML-based image distribution system inside the hospital via internet. In addition, no investment costs should arise on the user side and the image data should be sent renamed using cryptographic techniques. MATERIALS AND METHODS: A pure HTML-based system manages the image distribution inside the hospital, with an open source project extending this system through a secure gateway outside the firewall of the hospital. The gateway handles the communication between the external users and the HTML server within the network of the hospital. A second firewall is installed between the gateway and the external users and builds up a virtual private network (VPN). A connection between the gateway and the external user is only acknowledged if the computers involved authenticate each other via certificates and the external users authenticate via a multi-stage password system. All data are transferred encrypted. External users get only access to images that have been renamed to a pseudonym by means of automated processing before. RESULTS: With an ADSL internet access, external users achieve an image load frequency of 0.4 CT images per second. More than 90 % of the delay during image transfer results from security checks within the firewalls. Data passing the gateway induce no measurable delay. CONCLUSION: Project goals were realized by means of an infrastructure that works vendor independently with any HTML-based image distribution systems. The requirements of data security were realized using state-of-the-art web techniques. Adequate access and transfer speed lead to a widespread acceptance of the system on the part of external users.

Education, Continuing↗

PubMed1992

I.v. versus non-i.v. drug use and selected patient variables related to AIDS risk behaviors.

A sample of 206 drug users volunteered for a survey questionnaire of AIDS-related risk behaviors. The Risk Behavior Inventory (RBI) was used to elicit self-report information on risk behaviors including drug use, needle use, and sexual practices. Non-IV cocaine users reported less risk behaviors than patients involved in IV drug use. Nevertheless, non-IV users remained substantially at risk for HIV exposure because of sexual practices and sexual interaction with IV drug users. Multiple regression analysis indicated that method of drug administration (IV vs non-IV) was the major contributor of accountable variance in risk behaviors, while other patient variables, such as age, gender, educational level, employment, and marital status, did not contribute significantly to the explained variance.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Oral contraceptive use and the prognosis of breast cancer.

In 471 breast cancer patients the influence of a positive history of oral contraceptive (OC) use on survival was investigated. 297 (63%) patients used OCs during any period of their life and 92 (20%) used them still at the time of diagnosis. Sixty months after diagnosis OC users had a significantly increased overall survival (p = 0.037). Survival rates amounted to 79.5% and 70.3% for OC users and non-users, respectively. The effect persisted after adjustment for other prognostic factors and was mainly attributed to women who had taken OCs four years or longer (p = 0.025). Comparing the survival after a 56 months median follow-up dependent on duration of OC use (never, 1-48 months, > or = 49 months) in subgroups of prognostic factors, the most significant influence on survival was observed among long-term users with tumors more than 2 cm in diameter (p = 0.005), with axillary node-positive tumors (1-3 nodes, p = 0.055/ > or = 4 nodes, p = 0.019), and with tumors of low estrogen receptor (p = 0.015) or progesterone receptor content (p = 0.04). The difference in survival between OC users and non-users cannot be explained by the distribution of prognostic factors investigated (histological type, histological grade, tumor size, lymph node involvement, hormonal receptor content). OC users had an even higher percentage of poorly differentiated tumors (p = 0.003). These results suggest an effect of OC use on tumor biology during the preclinical phase of the disease.

Adult↗

PubMed1999

Informal care and the empowerment of minority communities: comparisons between the USA and the UK.

This paper examines informal care and the empowerment of minority communities with respect to health care and health promotion in the USA and the UK based upon work prepared for the workshop, 'Involving Black and Minority Ethnic Users in Delivery of Services and Empowering Communities' presented during the bi-national 1997 USA, UK. Conference, 'Health Gain for Black and Minority Ethnic Communities' and the information gained from that Conference. 'Informal care' is operationally defined as 'the practice of alleviating distressful physiological and psychological dysfunctions through all others (e.g. traditional healers, family members, self, etc.) using measures that do not require a physician's prescription or intervention (e.g. lifestyle modifications) typically outside of formal, institutionally based care mechanisms (e.g. homes and communities). Informal care is a significant force in health maintenance, health promotion, and disease prevention. In the USA, at least one-third of the population is estimated to engage in unconventional medical practices, and perhaps, one-half of racial/ethnic populations use informal care. An enormous potential exists to better utilize informal care because informal care is culturally more compatible, relatively low cost, and flexible. The policy of the Indian Health Service in accepting the use of traditional medicine was cited. The US Congress recognized the potential of alternative medicine by establishing such an Office within the National Institutes of Health. 'Empowerment of racial/ethnic minority communities is the right for minority populations to determine their own destinies. In the USA, racial/ethnic minority populations are Blacks, Hispanics, Asians or Pacific Islanders, and American Indian/Alaska Native. These classifications are based upon self-report; in the UK, the black and minority classifications are based upon countries of birth rather than self-reported racial/ethnic identities. Empowerment of these communities is important both demographically and historically. In demographic terms, racial/ethnic minority populations are increasing at higher rates than the majority population in the USA and hence, the health status of minorities will become the health status of the nation in the next half century. Historically, racial/ethnic minorities have not been empowered. As a consequence of the 1985 Secretary's Task Force Report on Black and Minority Health Federal measures to address disparities in the health status of minorities were initiated. In March 1994, the UK Government initiated the Ethnic Health Unit within the National Health Service. These measures are not mature enough to evaluate their impact. However, progress in implementing measures to empower minorities in the UK have begun and are illustrated by the work reported by Dr Pui-Ling Li, the UK counterpart to the workshop, 'Involving Black and Minority Ethnic Users in Delivery of Services and Empowering Communities'. Recommendations are made to increase use of informal care and the empowerment for racial/ethnic minority communities and to build upon the works in progress in both the USA and the UK.

Complementary Therapies↗

PubMed1993

Barriers to general practitioners caring for patients with HIV/AIDS.

This paper describes some of the barriers to caring for people with HIV and AIDS by general practitioners. It is based on a review of the literature and on interviews with individuals. The first section examines the reasons given by interviewees for their involvement in HIV and AIDS care. The next section discusses the relationship between primary and secondary care services in the care of patients with HIV and AIDS. One of the factors previously underexplored seems to be that of who 'owns' the patients. The final section looks at GPs' involvement in services for intravenous drug users with HIV and AIDS. It is concluded that there are still considerable barriers to GPs' involvement with patients with HIV and AIDS, in particular with drug users who have HIV or AIDS. It is likely that needs for continuing training in this area are not being met.

Acquired Immunodeficiency Syndrome↗

PubMed2000

A comprehensive package of support to facilitate the treatment of problem drug users in primary care: an evaluation of the training component.

Since the early 1980s, government policy documents and specialist reports have encouraged the involvement of general practitioners (GPs) in the treatment of problem drug users. In spite of such policy initiatives, their involvement has been patchy and slow. In response to this apparent reluctance, the London Boroughs of Brent and Harrow established the substance misuse management project (SMP) to support and train GPs in the management of substance misuse. The SMP is a GP-led project that provides ongoing support, shared-care protocol, primary care team training, treatment audits and financial reimbursements. In 1996, the SMP worked with GPs who were not currently involved in treating problem drug users, and those who were providing only minimal interventions. This paper evaluates the training and support given to these GPs and examines changes in their practice. A pre- and post-test survey was undertaken of GP knowledge, attitudes and levels of activity. A structured questionnaire was administered to all GPs before training (n=40) and re-administered between 6 and 9 months following training. SMP audit data were also reviewed to validate any reported changes in practice. All GPs initially reported insufficient knowledge to manage problem drug users. One-fifth were unaware they could prescribe methadone, and nearly half believed drug problems should be treated by specialist services. Post-training, the GPs had increased their levels of treatment activity and reported greater confidence and willingness to treat. This study demonstrates the potential to involve GPs in the treatment of problem drug users. The training was part of a package that included ongoing support sessions, team training, audits of treatment and financial reimbursements. It is proposed that, whilst training is a necessary condition, a more comprehensive package of support is needed to facilitate the treatment of problem drug users in primary care.

Journal Article↗

PubMed2003

Sustainable land use requires attention to ecological signals.

This case study details the difficulties of landscape management, highlighting the challenges inherent in managing natural resources when multiple agencies are involved, when the land users have no incentive for conservation, and when government agencies have too few resources for effective management. Pumping of groundwater from the aquifer of La Costa de Hermosillo in the state of Sonora, Mexico, began in 1945 and developed so quickly that by the late 1950s salinity intrusion from the Gulf of California was occurring in the wells. In the 1970s, the irrigatable land in La Costa peaked at 132,516 ha and the extracted volume of water from the aquifer peaked at around 1.14 billion cubic meters annually. By the 1980s, 105 wells of the total of 498 were contaminated with seawater and, therefore, identified for closure. At present La Costa de Hermosillo still represents 15% of the total harvested land, 16% of the total annual production, and 23% of the gross agricultural production of the state of Sonora. However, there are approximately 80,000 ha of abandoned fields due to salt water intension, lack of water and/or lack of credit available to individual farmers. This unstable situation resulted from the interplay of water management policies and practices, and farm-land policies and practices. While government agencies have been able to enforce better water use for agricultural production, there remains a significant area that requires restoration from its degraded state. For this piece of the ecosystem management puzzle, government agencies have thus far been unable to affect a solution.

Agriculture↗