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PubMed2004

[Receptiveness and links to clients in a Family Health Program team].

This study analyzes the work by a Family Health Program (FHP) team, identifying the potential for developing receptiveness by the team and fostering links between the health professionals and clients. This was a case study with a qualitative approach. The data were collected through free observation, a semi-structured interview, and documents. A dialectic approach was used to analyze the material. A relationship was observed between the organization of the work process and the achievement of receptiveness and links to clients. There are gaps in receptiveness to health services clients, especially in the openness to demand, accountability for the population's health problems, and encouragement for client autonomy. Production of links is related to the development of clinical activities. According to FHP team members, health services clients are viewed alternately as subjects and objects. The principles and guidelines of the Unified National Health System (SUS) do not represent a project as conceived by the health professionals. The study concludes by proposing greater nursing staff involvement in clinical activities and receptiveness to users of the program.

Community Health Services↗
PubMed2006

[Building bridges between research and policy to extend social protection in health in Latin America and the Caribbean: a strategy for cooperation].

The Pan American Health Organization (PAHO) and International Development Research Centre (IDRC) have promoted a joint initiative to design, implement, and evaluate innovative strategies for the Extension of Social Protection in Health (SPH) in Latin America and the Caribbean (LAC), involving active partnership between researchers and research users. This initiative was based on a previous review of research on health sector reforms and the recommendations of the workshop on "Health Sector Reforms in the Americas: Strengthening the Links between Research and Policy" (Montreal, Canada, 2001). In its first phase, the initiative supported the development of proposals aiming to extend SPH, elaborated jointly by researchers and decision-makers. In the second phase, the implementation of five of these proposals was supported in order to promote the development of new SPH strategies and new stakeholder interaction models. In this edition of the journal, the process of linking researchers and decision-makers will be analyzed in the context of the five projects supported by this initiative.

Biomedical Research↗
PubMed1998

The use of alcohol by Miami's adolescent public school students 1992: peers, risk-taking, and availability as central forces.

This analysis examines the use of alcohol by 535 adolescents in Dade County Public Schools during 1992. Statistically significant factors which tend to increase the probability of alcohol use by adolescents include: the fact that their friends drink, their awareness of the risks associated with the use of alcohol, and their ease in obtaining alcohol. Hence, the typical adolescent who uses alcohol seems to be a risk-taker, who may enjoy the dangers involved with alcohol use; friends are also users of alcohol. Not significantly related to alcohol use are a number of other variables, including family-related variables (whether adolescents live with their mothers, fathers, or alone; and whether someone in the family has a problem with drugs or alcohol). Similarly, early cigarette smoking did not serve as a gateway to later alcohol use. Religion, gender, race, academic performance, and extracurricular school activities (athletics, music, school clubs, and other activities) were all unrelated to the use of alcohol by adolescents. Although the typical adolescent who consumed alcohol was older (in grades 9 through 12), this was not a significant variable.

Adolescent↗
PubMed1998

The effect of entering drug treatment on involvement in HIV-related risk behaviors.

The research described here is based on a sample of 8,241 out-of-drug-treatment users of injected drugs and/or crack, aged 18 or older, recruited from 22 sites across the United States and Puerto Rico. The study divided respondents into three groups-(a) cocaine or crack users who did not also use heroin or speedball (cocaine-only users), (b) heroin injectors who did not also use cocaine or crack or speedball (heroin injectors), and (c) users of cocaine or crack and injected heroin or speedball (dual users)--and compared the efficacy of entering drug treatment for these groups' involvement in HIV-related risk behaviors. The study found that entry into treatment corresponded to greater reductions in substance abusers' frequency of drug use and involvement in risky injection practices compared to those observed in people who did not enter treatment between their baseline and 6-month follow-up interviews. Entry into drug treatment was also associated with reductions in the practice of risky sexual behaviors, but these reductions were less substantial and less consistent than those noted for drug use and injection risk behaviors.

Cocaine-Related Disorders↗
PubMed1991

Biomechanics and the wheelchair.

Wheelchair biomechanics involves the study of how a wheelchair user imparts power to the wheels to achieve mobility. Because a wheelchair can coast, power input need not be continuous, but each power strike can be followed by a period of recovery, with the stroking frequency depending on user preferences and the coasting characteristics of the wheelchair. The latter is described in terms of rolling resistance, wind resistance and the slope of the surface. From these three factors the power required to propel the wheelchair is determined, and must be matched by the power output of the user. The efficiency of propulsion is the ratio of this power output to the metabolic cost and is typically in the order of 5% in normal use. The features required in a wheelchair depend upon user characteristics and intended activities. The ideal wheelchair for an individual will have the features that closely match these characteristics and activities. Thus prescription is not just choosing a wheelchair, but choosing the components of the wheelchair that best serve the intended purpose. In this paper, each component is examined for available options and how these options effect the performance of the wheelchair for the individual. The components include wheels, tyres, castors, frames, bearings, materials, construction details, seats, backrests, armrests, foot and legrests, headrests, wheel locks, running brakes, handrims, levers, accessories, adjustments and detachable parts. Each component is considered in relation to performance characteristics including rolling resistance, versatility, weight, comfort, stability, maneouvrability, transfer, stowage, durability and maintenance. Where they exist, wheelchair standards are referred to as a source of information regarding these characteristics.

Biomechanical Phenomena↗
PubMed1992

Colonization of the uterus by the oral protozoan Entamoeba gingivalis.

Pap smears occasionally reveal protozoa of the genus Entamoeba in the uterus of intrauterine device (IUD) users, but definitive identification of the species involved has not been possible. Using riboprinting, a technique that compares ribosomal RNA gene sequences, we present evidence that the organism is Entamoeba gingivalis, an inhabitant of the mouth. Colonization most likely occurs via orogenital contact and requires the presence of an IUD and a concomitant bacterial infection.

Actinomycosis↗
PubMed1998

Mental health. Home alone.

Carers of people diagnosed with schizophrenia want more support and greater involvement in the care of the service user. Access to 24-hour support is highly rated. Almost half the carers in this study received no support from anyone--professional or otherwise.

Caregivers↗
PubMed2001

[Study on sexual and drug use behaviors of high risk among sex workers in entertainment in establishments in Shanghai].

OBJECTIVE: To understand the types of entertainment establishments involved in commercial sex and Acquired immunodeficiency syndrome (AIDS) related risk behaviors among sex workers. METHODS: One district in Shanghai was selected. All entertainment establishments in the district were mapped. In-depth interview was carried out to collect information about demographic, sexual, drug use, measures of self-protection, condom use, history with sexually transmitted disease (STD) and health care seeking behaviors. RESULTS: Sixty-three sex workers were recruited from 38 places, of which, 38 from beauty parlors, 13 from pubs/bars and sauna settings, 10 from KTV and 2 freelance. The average age was 25 (17-45) years old. 73% were not permanent residents. Thirty-seven had reportedly engaged in commercial sex activities. Some reportedly had sex even during menstruation and involved in-group sex. Five drug users and 3 of them reported injecting and sharing needles. Ten of them knew that other sex workers had used drugs. Sixteen (25%) reportedly using condoms but only 4 for disease prevention. Another 2 reported consistent condom use with clients but never used with boyfriends or steady partners. Twenty-two (35%) reported suffering from STDs at least once. Twenty-six (41%) reported seeking care when having diseases, with 38% going to public clinics, 27% to pharmacy and 35% to private clinics. CONCLUSION: AIDS related sexual and drug injecting high-risk behaviors were common among sex workers in Shanghai. Specific and effective interventions, particularly the implementation of 100% condom use program at all entertainment establishments are called with much urgency.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The adverse effects of kava.

In Fiji, kava is also known as yaqona or grog. A convenient sample of 300 kava drinkers in Nadi, Lautoka, Ba and Sigatoka were studied to see whether local people in Fiji experienced side effects of kava use. Because males usually consume kava in Fiji, we approached specific groups of people and asked them to participate in the survey. To evaluate the side effects of kava consumption, we interviewed housewives of male kava drinkers regarding specific effects of kava. We interviewed these housewives during kava drinking sessions since they were usually not taking part in the kava drinking. We also interviewed employers of these kava drinkers and the market vendors in Nadi Town since they were closely involved with kava drinkers. Wives of kava users felt deprived of basic family needs due to the amount of money spent on kava. In Urban schools, 64% males and 46.2% had tried kava. The present study aims to assess the prevalence of side effects of kava usage among a community sample of kava drinkers in Fiji and to compare the result with some of the side effects provided by other studies. The questionnaire also asked how much kava was consumed and the reasons. Since kava use is very much part of our everyday culture and existence, convincing people to change their behavior and kava consumption is a major tasks. I hope that this study would emphasize the need at a national level to educate people on the harmful effects of kava and the need for the health ministry to view very heavy kava intake as contributing to morbidity in Fiji.

Data Collection↗
PubMed2004

Russian Federation: penalties eased for possession of illegal drugs.

In November 2003, after long deliberations, the Russian Parliament passed a bill amending the national Criminal Code to differentiate between the liability for possession of illegal drugs for drug users and for drug traffickers. The reforms involved redefining the terms "large" and "extra-large" with respect to the quantities for possession and trafficking of illegal substances. (There is no criminal liability for possession of less than a large amount.) On 16 December 2003, the new bill was enacted into law.

Crime↗
PubMed2005

Peritoneal dialysis training: a multisensory approach.

Undertaking peritoneal dialysis (PD) therapy poses a challenge to all patients with renal failure. The potentially high risk of infection makes it essential that patients undertaking PD have adequate training and ongoing support. Over recent years, increasing numbers of elderly patients, patients with significant learning disabilities, and patients with marked comorbidities have been accepted onto renal replacement therapy programs. For those undertaking PD in particular, this has posed new educational challenges. The Community Dialysis Team recognized an area of weakness in their current training program for these patient groups. The degree of literacy skills as well as the volume of written material and the amount of medical terminology used did not result in a user-friendly training program. A collaborative approach involving various members of the multidisciplinary team designed an appropriate training program for patients with learning disabilities. The new program included (1) a photographic bag-exchange procedure; (2) the provision of simple, step-by-step instructions on audiotape; (3) a new assessment sheet where words were replaced with symbols; (4) a redesigned daily record sheet (used to monitor clinical parameters); and (5) a simple contact card. The quality of the new training program was assessed by a small pilot study evaluation. The reduction of training times and the satisfactory peritonitis rates suggest that the new multisensory training program could be successfully implemented. The use of pictorial aids and more symbols, with less focus on the written word, made PD training a viable option for many individuals, including elderly patients and those with learning disabilities. The increased use of pictorial aids and symbols may also be helpful in training patients where there is a language barrier as well as the pediatric population.

Comorbidity↗
PubMed2005

The ownership elephant: ownership and community-governance in primary care.

Ownership of primary care is an often neglected but important health systems design parameter. The New Zealand Primary Health Care Strategy has established Primary Health Organisations (PHOs) as non-profit umbrella organisations, however in most instances their constituent general practices are for-profit small businesses. This viewpoint paper aims to: (a) define ownership and community participation; (b) summarise some of the evidence from the NatMedCa study pertaining to ownership-related differences; and (c) discuss the policy implications of different ownership forms in primary care, and the implications of merging different ownership forms under the umbrella of PHOs. Ownership confers governance responsibility (ultimate control) for an organisation, and accountability for its actions. Community governance involves vesting overall control of resources in users and the community, rather than with health service managers or health professionals. Results from three studies using the NatMedCa survey indicate that community-governed non-profits in New Zealand differ in a number of respects from their for-profit counterparts. As non-profit and for-profit ownership forms have different social roles, and as meaningful community participation in governance is determined in large part by ownership structures, there is a need for ownership frameworks to be used more widely in health policy making. Because of the ownership boundary that exists between non-profit community-governed PHOs and their constituent for-profit general practices PHOs may have little real ability to effectively govern their practices.

Community-Institutional Relations↗
PubMedDate not supplied

[Factors effecting recurrence of duodenal ulcers after highly selective vagotomy].

Recurrence of duodenal ulcer was diagnosed in 15 patients who underwent highly selective vagotomy before 6-13 years, i.e. in 12.2%. Factors possibly contributing to such a recurrence were analysed. Patients with ulcer recurrence were: 1) non-qualified workers, 2) tobacco smokers, 3) heavy drinkers, 4) users of ulcerogenic medicines, and 5) were involved into conflict situations.

Adult↗
PubMed2005

Measuring clinicians' expectations prior to EHR implementation.

To measure user expectations and knowledge of the issues involved in the transition from a paper-based system to an EHR, we created an on-line questionnaire, and invited physicians from several specialties at Beth Israel Medical Center (BIMC) to respond to it. As expected, most participants had positive expectations for the EHR and its features, but respondents were more skeptical of electronic clinical decision support systems (CDSS) than we had expected. The responses of this "EHR-naïve" group of physicians underscore the importance of managing expectations with the implementation of the EHR and of the delicate balance involved in preserving physician independence when proposing a clinical decision support system.

Attitude of Health Personnel↗
PubMed1980

The Singapore heroin control programme.

In 1975 Singapore experienced a sudden heroin epidemic, and within two years an estimated 3 per cent of the males, 15-24, were involved. In 1977 the Government responded with an all-out enforcement strategy aimed at rapid containment. Demand reduction involved the large scale arrest of suspected users, and the immediate commitment of those with positive urines to Drug Rehabilitation Centres. The primary rehabilitation emphasis is on instilling discipline, social responsibility and sound work habits. Releases are placed on two years of compulsory supervision with a 5-day cycle for reporting and urine specimens. Sixty-three per cent show no detected drug use within the first year of supervision. Supply reduction efforts are equally strong and, while these were not immediately successful in limiting availability, heroin is currently very scarce and expensive. While there is some evidence of the substitution of cannabis, psychotropic drugs and alcohol, the number of new heroin cases is minimal. Overall, the epidemic appears to have been controlled.

Drug and Narcotic Control↗
PubMed1996

[Peripheral nerve and spinal cord complication in intravenous heroin addiction].

The neurological complications observed in 6 HIV negative intravenous drug users are reported. Four developed acute neuromuscular involvement in a lumbosacral or brachial distribution with rhabdomyolysis, myoglobinuria, hypovolemia, renal and hepatic failure in the 3 most severely affected patients. Despite evidence of immunologic abnormalities and especially presence of anti-heroin antibodies, we feel that causative mechanisms include mixed compression and ischemia with an underlying toxic myopathy, resulting in segmental myopathy with secondary compression of peripheral nerves. Two patients developed myelopathy with acute or chronic onset. The mechanisms were vascular with spinal cord infarction in the acute form and probably infectious with secondary compressive arachnoiditis in the chronic form. In these 2 patients with myelopathy, outcome was poor.

Acute Disease↗