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Biomedical subjects

G Tomson

Publications and source records attributed to G Tomson.

At least 37 records · Page 2Linked to original sources
PubMed2000

Knowing when but not how!--mothers' perceptions and use of antibiotics in a rural area of Viet Nam.

Given the world-wide focus on how to rationally use antibiotics, national drug policy programmes have been developed in many countries in order to minimize the environmental antibiotic pressure and thereby hopefully limit increasing bacterial resistance. This study investigated perceptions of antibiotics in a health system with weak drug regulation. The study was conducted in two rural communes in Viet Nam, with a drug market characterized by the increased accessibility and consumption of pharmaceuticals. The study focused on rural mothers' perceptions and use of antibiotics in the treatment of acute respiratory infections (ARI) in children 5 years and under. A combination of qualitative and quantitative methods were used including key informant interviews, focus group discussions, and interviews with mothers and drug vendors. The study demonstrated that using a combination of qualitative and quantitative methods gives a better understanding of the prevailing perceptions and use of antibiotics in communities. The results showed that the mothers recognized well the signs of severe ARI and that antibiotics were reserved for more severe illness episodes, where penicillin V and ampicillin were first drugs of choice. However, the mothers' perceptions and use of antibiotics reflects indigenization of antibiotics into traditional Vietnamese thinking and medical practice. This resulted in self-medication and a respect for antibiotics from the mothers' point of view. A first step towards the rational use of antibiotics is already taken where mothers, as the health decision-maker, know when to initiate antibiotic treatment and try to limit unnecessary use of antibiotics. The next step is to develop a well-functioning health education programme in order to promote the correct use of antibiotics for a successful clinical outcome. This requires acknowledgement of the mothers' culture based behaviour.

Acute Disease↗
PubMed2000

Pharmaceutical sector in transition--a cross sectional study in Vietnam.

Increasing efforts are being made to improve pharmaceutical sector performance in low- and middle-income countries. An essential tool for such work is an objective and standard method of assessment which can be used to promote evidenced based National Drug Policy development and implementation. The average drug expenditure per capita has steadily increased in Vietnam and at the time of this study a National Drug Policy was being developed. This study assessed the Vietnamese pharmaceutical sector 1991-1994, focusing on the standard of the drug quality control system, availability of drugs and rational use of essential drugs in the private and public sectors by means of standardised indicators. The results from this study show that the quality control system is impaired and does not have capacity to quality control all drugs on the market. The availability of essential drugs is good whereas essential drugs are poorly prescribed, injections common and there is a high average number of drugs per prescription, both in the public and private sectors. Violations are common and enforcement of regulations weak. On top of this there is an active commercial advertising and marketing of drugs. These findings identify priorities for action to improve the present situation where the development and implementation of the Vietnamese National Drug Policy will be of major importance.

Cross-Sectional Studies↗
PubMed1999

"Doi moi" and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam.

Vietnam, a developing country, has had comparatively good health and human survival at low cost. The economic reform changed the health care system, and private pharmacies during the last 5 years have taken over a majority of the drug distribution. Problems include weaknesses in drug regulation and reported increases in antibiotic resistance. This case study, a purposive sample of two private pharmacies in Hanoi, explored management, including dispensing, inventory and financing, using the concept of triangulation. Observations and interviews of customers were complemented by stock inventory and interviews of the pharmacy staff. Drugs were classified according to the ATC code and the essential drug list of Vietnam. Pretested protocols were used. In all 1833 encounters were studied during the 2 weeks, out of which 286 were children. Less than 1% of customers came with prescriptions and 94.9% decided by themselves which drugs to buy. Antibiotics represented 17%, of which 90% were broad spectrum. Ampicillin dominated, both in children and adults. Some 50% of the antibiotics were given for 2.5 days or less. Less than 50% of the drugs were essential drugs (ED) on dispensing and even less on inventory. Antibiotics and vitamins were the most commonly sold drugs and, overall, brand names dominated. Little if any drug information was observed. Antibiotics were said to represent the most profitable drugs, according to the pharmacy staff. More than 20% of all products were combination drugs, including irrational and popular products with antibiotics and corticosteroids and combinations of aspirin, phenacetin and caffeine. This study shows an unexpectedly high proportion of customers, being "Tu Lam Bac Sy" (their own doctors), deciding themselves which drugs to buy. Although the "Doi moi" renovation has led to much improved drug availability, at least in urban setting, our case study highlights major problems in need of urgent actions. In particular the prevailing practices regarding antibiotics and combination drugs need to be seriously scrutinized and drug regulatory mechanisms should be enforced.

Adolescent↗
PubMed1999

Influencing prescribing for urinary tract infection and asthma in primary care in Sweden: a randomized controlled trial of an interactive educational intervention.

Our aim was to evaluate effects on prescribing for urinary tract infection (UTI) and asthma, of an education with messages based on national guidelines, aimed at improving prescribing in primary care in Sweden. The study is part of the European Drug Education Project. A randomized controlled trial, with groups of general practitioners (GPs) allocated to education on UTI (18 groups, 104 GPs) or asthma (18 groups, 100 GPs), the two parallel intervention arms being controls for each other. Feedback was provided on the GP's judgments of simulated cases and prescribing. Prescribing indicators were developed and measured before and after the intervention. Analysis was performed by multi-level technique. Prescribing of first choice UTI drugs increased in the intervention arm from 52% to 70% and remained constant in the control arm (P < 0.001). The proportion of patients receiving an inhaled corticosteroid increased insignificantly in both study arms. The educational model can be used to improve prescribing. Further studies are needed to define when the model is effective.

Adult↗
PubMed1999

Combining feedback from simulated cases and prescribing. Design and implementation of an educational intervention in primary care in Sweden.

OBJECTIVES: To develop and evaluate a new model of continuing medical education (CME) for general practitioners (GPs). The study is part of the joint European Drug Education Project (DEP). This paper presents the Swedish part regarding the design of the evaluation study, the educational methodology, and the participants' evaluation. METHODS: An educational model was developed. Two peer group discussions (facilitated by a GP/pharmacist team), including individual feedback on the GPs' judgments of written simulated cases and prescribing, were main components. The model was tested in a parallel randomized controlled study including 36 GP groups, allocated to education on asthma or urinary tract infections. Background and outcome data were knowledge and attitudes (K/A) assessed by a questionnaire and prescribing practices for actual and written simulated cases. The GPs' evaluation of the model was captured through a questionnaire. RESULTS: All 36 groups completed the program. The mean participation rate in the group discussions was 75%. The response rates were 82-98% regarding outcome data K/A questionnaire and written cases), and 80% regarding the evaluation questionnaire. Prescribing data were captured for 99% of the GPs. Both group discussions were considered important by 84-89%. Eighty-seven percent wished to take part in similar CME activities for other conditions. About 80% reported that their purpose in participating had been fulfilled. CONCLUSIONS: It was feasible to evaluate the developed educational model by using a two-armed parallel study design. The model was well received by the participants.

Adolescent↗
PubMed1998

Tet offensive: winning hearts and minds for prevention. Discourse and ideology in Vietnam's "Health" Newspaper.

A quantitative content (CA) and qualitative discourse analysis (DA) was made of all 67 articles in the February 1995 ("Tet") issue of Suc Khoe ("Health"), a bi-weekly newspaper issued by Ministry of Health, Hanoi, Vietnam. The aim was to uncover discursive strategies used in the construction of health-related meaning during a period of rapid economic transition and latent ideological struggle in Vietnam. The DA was based on the work of i.a. Foucault, Fairclough, Thompson, and Fowler. The CA showed a strong domination of Western sources. There were four themes: prevention, cure, the Tet festival, and crime and punishment. In the two first, health-related groups, prevention (n = 31) dominated over cure (n = 22), modern (n = 19) over traditional (n = 13) medicine, and overall, the theme of continuity (prevention and crime/punishment) over change (cure and Tet), reflecting Vietnam's programmatic pluralism in the health field and its ideological struggle against outside influences. The DA revealed three mixed but unintegrated discourses in the material; "popular" (simplistic, authoritarian, and sentimentalizing), "expert" (technical, egalitarian, and uncritical), and "nationalist" (administrative, impersonal and propagandistic). Prevention was mainly expressed via the popular discourse, whereas cure was represented, prospectively, by the expert discourse, and retrospectively, by the nationalist discourse. This combined order of discourse functions, we suggest, as a disciplinary "Discourses of Order". A proposed integrative CA/DA model relates content themes and discursive foci to the classical rhetorical dichotomy hope/fear. We see "Health" as struggling to uphold traditional besieged values under the new economic policies by using preventive propaganda in both medical and political terms. These findings are compared with expressed editorial policy statements.

Health Education↗
PubMed1997

Chloroquine blood concentrations and malaria prophylaxis in Tanzanian women during the second and third trimesters of pregnancy.

OBJECTIVE: Routine malaria prophylaxis with chloroquine (CQ) is recommended to pregnant semi-immune women in several countries in Africa. The dosage is empirically based. We investigated whether blood CQ concentrations and apparent oral blood clearance (CL/F) change during the course of pregnancy. We also studied whether malaria parasites could be detected together with low CQ blood levels. METHODS: Forty nine semi-immune Tanzanian women were recruited in the 16th week of pregnancy. They were given 310 mg oral CQ base once per week as prophylaxis during the whole pregnancy. Capillary blood samples were taken for analysis of CQ before treatment and at weeks 26 and 36. Blood samples were dried on filter paper and analysed by HPLC. Blood was also drawn to detect occurrence of malaria parasites. RESULTS: A total of 25 women fulfilled the sampling schedule. CL/F increased significantly from 160 ml.min-1 at week 26 to 180 ml.min-1 at week 36. In 7 of 25 women, CL/F increased > 20%. Trough blood CQ concentrations, determined on four occasions at week 26 and at week 36 varied between 200 and 900 nmol.l-1. No statistically significant differences between occasions were seen. Malaria parasites were seen in two individuals early in pregnancy. CONCLUSION: Blood CQ CL/F showed a small increase during the course of pregnancy. The estimated mean blood CL/F values of 160 and 180 ml.min-1 (week 26 and 36, respectively) were higher than the mean CL/F of 125 ml.min-1 in non-pregnant individuals, published previously. Efficacy of higher dosages of CQ in malaria prophylaxis in pregnant women could, therefore, be evaluated in controlled trials in high-risk malaria areas.

Adult↗
PubMed1997

Asthma education for Swedish primary care physicians--a study on the effects of "academic detailing" on practice and patient knowledge.

OBJECTIVE: To assess the effect of an intervention on general practitioners' (GPs) knowledge about the diagnosis and treatment of asthma, including the prescribing of anti-asthmatic drugs, and asthmatic patients' knowledge about their disease. METHODS: The study took place in the south-west region of Stockholm County. In the area where the intervention took place (area 1), 44 GPs at 21 health centres were visited by a clinical pharmacologist and a pharmacist presenting oral and written information. The basic messages were: (1) the central role of inhaled glucocorticoids; (2) the use of peak expiratory flow (PEF) meters; and (3) the use of reversibility tests. In the control area (area 2), there were 19 GPs at nine health centres. The GPs knowledge about the intervention message was evaluated by a questionnaire pre- and post-intervention. The ratios of prescribed inhaled be beta-adrenoceptor agonists to inhaled glucocorticoids were determined. At the 26 local pharmacies, all asthmatic patients who presented a prescription for anti-asthmatic drugs, issued at the 30 health centres, were given a questionnaire before and after the intervention regarding their knowledge of asthma and its treatment. RESULTS: GPs in area 1 showed significantly more knowledge about item numbers 2 and 3 in the above-described intervention message than did the GPs in the control area 2. The data on prescriptions showed lower ratios of beta-adrenoceptor agonists to glucocorticoids in area 1 than in area 2. The difference, however, between area 1 and area 2 was not significant. After the GP intervention, the patients' knowledge about asthma had increased in area 1, as assessed by the questionnaire filled in by the patients. However, there was no significant difference from that in area 2. CONCLUSIONS: The study shows differences between the intervention and control areas regarding the knowledge and practice of GPs after the intervention. We found changes in knowledge, attitudes and actual practice, the latter being measured by the prescriptions.

Asthma↗
PubMed1997

North-South health research collaboration: challenges in institutional interaction.

North-South health development cooperation often includes research financed largely by external donors. The cooperation varies between projects and programmes with regard to subject area, mix of disciplines involved, research methods, training components and project management arrangements. A variety of problems is encountered, but they are rarely described and discussed in published project reports. We authors conducted a study of a small number of European health researchers collaborating with researchers from the Third World. We focused upon projects involving both biomedical and social science researchers, and apart from a literature review three methods were applied: self-administered questionnaires to European researchers, semistructured interviews with five IHCAR researchers, and written summaries by the three authors, each on one recent or ongoing collaborative project of their choice. Most collaborative projects were initiated from the North and are monodisciplinary or partly interdisciplinary in the sense that researchers did independent data collection preceded by joint planning and followed by joint analysis and write-up. There may be disagreements concerning remuneration such as allowances in relation to fieldwork and training. Socio-cultural misunderstanding and conflict was reportedly rare, and no serious problems were reported regarding authorship and publishing. It is concluded that collaborative research is a complex and poorly understood process with considerable potential and worth pursuing despite the problems. Difficulties related to logistics and finance are easily and freely discussed, while there is little evidence that transdisciplinary research is conducted or even discussed. We recommend that published and unpublished reports on collaborative research projects include more detailed accounts of the North-South collaborative arrangements and their management, ethical and financial aspects.

Cooperative Behavior↗
PubMed1997

Ally, advocate, analyst, agenda-setter? Positions and perceptions of Swedish medical journalists.

Medical journalists in the mass media play a key role in health information dissemination and risk/benefit education. Public education on the rational use of various health technologies, e.g. pharmaceuticals, is increasingly important as part of ongoing global health sector reforms. In a survey of 110 Swedish medical journalists (55% response rate) about medicinal drugs, risk perceptions and professional concerns, fact-giving, stimulating, and critical functions were rated as the most important journalist role attributes, followed by advocacy of patient interests and of public health goals. Major perceived problems were self-imposed professional demands, job stress, knowledge and time constraints, and selection and contextualization of news material. In terms of medicinal drugs, attitudes were strongly in favor of a unique drug information role for the media and critical of physician prescribing and information-giving. Views on the appropriateness of specific ethical rules or guidelines for medical journalists were sharply divided. The results offer some promise for increased alliance-building between public health and the mass media.

Attitude to Health↗
PubMed1997

Pharmaceutical regulation in context: the case of Lao People's Democratic Republic.

An explosive development of private pharmacies in the Lao People's Democratic Republic (Lao P.D.R.) has led to 80% of pharmaceuticals being provided by the private sector. In order to achieve the goal of access to good quality health care for all citizens, the Lao government is making an effort to regulate the private pharmaceutical sector using the emerging legal system of laws, decrees, and regulations. The aim of this paper is to describe and analyze the system of drug regulation in Lao P.D.R. in relation to the public social goals. Relevant official documents at the central, provincial and district levels have been reviewed, interviews were held with 30 key informants and 15 pharmacies were surveyed. The public social goals have been expressed in terms of equity and quality of care. However, total drug expenditure may be as low as US$1 per person per year which is far below any minimum standard and does not make it possible to achieve reasonable access to drugs for all. The regulatory system has so far been focused on entry into the pharmaceutical retail market and dealing with basic issues of product quality and conditions of sale. An enforcement system including sanctions is being developed; other policy instruments such as information and economic means are hardly being used at all. The government presently faces a trade-off between quality of pharmaceutical services and geographical equity of access. The study shows that regulation is strongly influenced by the general socioeconomic context.

Developing Countries↗
PubMed1996

Acute respiratory infections--mothers' perceptions of etiology and treatment in south-western Nigeria.

The focus of this research was on what mothers do when their children suffer from ARI at household level in rural settlements in Oyo State, Nigeria. A total of 419 mothers were interviewed. The study has combined three research methods, namely semi-structured questionnaire, in-depth interview and focus group discussion to get an insight into their perceptions in relation to cause and treatment of the disease. Most mothers regard ARI episodes as ordinary coughs and colds. They strongly believe that these are mostly caused by exposure to cold and perceive coldness of the body as a causal 'agent', whereas none of them mention viral or bacterial agents. The reported dominating practice of mothers was either the use of irritants to get rid of the cause of the disease ('coldness') through vomiting, by forcing the child to swallow bitter remedies such as cow urine, or to use a remedy with warming and soothing properties.'Robb', a methyl salicylate--probably the most popular Nigerian ointment-appeared to be the drug of choice to 'warm the chest, both from outside and inside', either applied topically or dissolved in hot water to drink. The paper emphasizes the importance of behavioural and social science type studies to get closer to community perceptions of disease etiology and practices as a prerequisite for contextualized health education. The use of inappropriate administration of remedies should be discouraged. Marketing of medicinal drug products for inappropriate indications also needs to be controlled.

Attitude to Health↗
PubMed1995

Effects of "group detailing" on the prescribing of lipid-lowering drugs: a randomized controlled trial in Swedish primary care.

The objective was to study the effect of "academic group detailing" on the prescribing of lipid-lowering drugs in Swedish primary care. A randomized controlled trial was conducted, randomization being by group. Groups of doctors at 134 community health centres were randomly allocated to an intervention and a control group. The 67 intervention health centres were offered four sessions, conducted by a pharmacist, with group information on guidelines for the management of hyperlipidaemia. The number of prescriptions of lipid-lowering drugs per month increased in the intervention health centres and the increase was statistically different from the corresponding change in the control health centres among women in the age group 30-65 years (p = 0.03). The prescription of first-line lipid-lowering drugs increased by 20% in the intervention health centres (p = 0.03). "Academic group detailing" by pharmacists to primary care doctors can be an effective method for influencing prescribing practices.

Adult↗
PubMed1994

General practitioners for rational use of drugs. Examples from Sweden.

In the south west region of Stockholm a group of 125 general practitioners (GPs) at 27 health centres asked about the extent to which the drug formulary of the University Hospital was useful in their practices. To answer this question, the GPs asked their local pharmacies for prescribing data. When presented this started a process towards rational prescribing from within the group of GPs, including repeated prescribing surveys, starting with health centres as the unit of analysis and proceeding to individual prescribing analyses on request by the GPs. As the prescribing data revealed major differences between health centres, the GPs arranged two workshops on drug use in primary health care. They developed a list of 167 recommended drugs based on drug statistics and morbidity in general practice. Signs of increased cost cautiousness could be shown. There was a clear trend towards both smaller volumes and cost per prescription item for the health centres in the study area. Compared to the national prescribing pattern, prescribing practice in the study area represented a 20 per cent lower drug cost. Although the GPs decided on a drug list separate from that of the hospital, collaboration between the Drug and Therapeutic Committee at the hospital and the GPs increased as a result of their increased engagement in drug management, thereby also bridging the gap between primary health care and clinical pharmacology.

Drug Prescriptions↗
PubMed1992

Drug utilization at primary health care level in southern India.

Primary health centres provide health care to the majority of the population in developing countries. A drug utilization study was conducted for 1 y at two primary health centres in Pondicherry, India. Information on complaints, diagnosis and drugs prescribed was collected. From the 2953 prescriptions studied, it was found that on an average each patient received 2.71 drugs. Vitamins, antibiotics, analgesics and antihistamines were the most commonly used, accounting for more than 80% of the drugs prescribed. The antimicrobials which constituted one fourth of the drug consumption, comprised sulphonamides, tetracycline and cotrimoxazole. About half of the patients received injections, particularly of the vitamin B Complex and antibiotics. The results will be used to plan intervention strategies for the promotion of rational drug use.

Adult↗
PubMed1992

Medicines and culture--a double perspective on drug utilization in a developing country.

A double perspective, one medical-pharmacological and one social-anthropological, is used to understand the logic of drug utilization among practitioners and outpatients at a health unit in Sri Lanka. Both negative and positive aspects of local prescribing practices are highlighted. Western pharmaceuticals are integrated into therapeutic choices for outpatients in Sri Lanka by means of the Ayurvedic theory of balance and practitioners' and patients' behaviour in consultations results in their expectations being met, even if they do not use the same set of health ideas and interpretations of health intervention. The healing power ascribed to Western pharmaceuticals is described and their possible risks discussed from both a biomedical and an anthropological point of view.

Adult↗