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PubMed1993

Writing for publication: overcoming common obstacles.

This article presents the results of a survey of recent authors in the International Journal of Group Psychotherapy who were asked to identify (a) the three most difficult obstacles they encountered when publishing their first article, (b) three types of resources that were most helpful when preparing their manuscript for publication, and (c) advice they would offer to authors who are planning their first paper for submission to a mental health journal. Common problems in manuscripts submitted for editorial review are also highlighted, based on an analysis of 150 letters mailed to authors whose papers were rejected or accepted pending revision. The goal of the present article is to provide guidelines for how to publish successfully.

Authorship↗

PubMed1989

Prevention in practice: obstacles and opportunities.

General Practitioners are excellently placed within the community to provide health education and advice in relation to HIV infection and AIDS. This paper will report on some of the findings from the first national study of HIV infection and general practice in England and Wales. The findings cast light on the preparedness of practitioners to undertake health education on HIV infection. Findings that relate to the extent of contact that practitioners have with people with HIV infection, people with AIDS and people with worries about HIV infection or AIDS will be discussed in the light of opportunities that are created for HIV-related health education and prevention. Findings that relate to practitioners' opinions about providing health education and counselling, about working with people who are gay, bisexual and injecting drugs, and about confidentiality and consent, will be discussed in the light of obstacles that exist to the effective provision of HIV-related health education and prevention. The paper will conclude by discussing the implications of these findings for primary health care responses to HIV infection in Britain.

Attitude of Health Personnel↗

PubMed2004

Women on sickness absence--views of possibilities and obstacles for returning to work. A focus group study.

PURPOSE: The aim was to learn how women on sickness absence due to work related strain perceive and describe their possibilities and obstacles for returning to work. METHOD: The focus group method was used. Five groups were conducted and each group met at one occasion. Twenty women participated in total. RESULTS: Three different themes were found. In 'The process of losing control' the participants describe the process from controlling every day living, to total loss of control of private and working life. The second theme, 'Not finding alternatives', deals with the difficulties of finding an alternative way back to work. 'Mastering life as a whole' contains strategies for regaining control over daily activities and life as a whole. The results show that personal as well as environmental factors have an impact for returning to work. CONCLUSIONS: In this study we have received an understanding of the complex situation of being on sickness absence due to work related strain. We have learned the importance of recognizing the context of the individual and understanding the interplay between the person and the environment. As professionals in rehabilitation we can use this knowledge to create a rehabilitation programme supporting people back to work.

Absenteeism↗

PubMed2005

Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multinational, multi-disciplinary expert groups.

Experts from eight European countries (Belgium, France, The Netherlands, Ireland, Italy, Portugal, Spain and the United Kingdom) and the disciplines of clinical psychology, general practice, geriatric medicine, old age psychiatry, medical sociology, nursing and voluntary body organisation met in 2003 to explore obstacles to recognition of and response to dementia in general practice within Europe. A modified focus group methodology was used in this exploratory process. Groups were conducted over a two-day period, with five sessions lasting 1-1.5 hours each. An adapted nominal group method was used to record themes arising from the group discussion, and these themes were used in a grounded theory approach to generate explanations for delayed recognition of and response to dementia. The overarching theme that arose from the focus groups was movement, which had three different expressions. These were: population movement and its consequences for localities, services and professional experience; the journey of the person with dementia along the disease process; and the referral pathway to access services and support. Change is the core issue in dementia care, with multiple pathways of change that need to be understood at clinical and organisational levels. Practitioners and people with dementia are engaged in managing emotional, social and physical risks, making explicit risk management a potentially important component of dementia care. The boundary between generalist and specialist services is a particular problem, with great potential for dysfunctionality. Stigma and ageism are variably distributed phenomena both within and between countries.

Aged↗

PubMed2005

Obstacles to condom use among secondary school students in Maputo city, Mozambique.

This study explores how urban youth in Mozambique perceive their sexual behaviour and identifies the factors that hinder them from having safer sex in the context of HIV/AIDS, with special emphasis on the condom use. Data was collected form high school students in Maputo, Mozambique. Using a combination of focus group discussions, interviews and informal conversations, it was possible to identify that one major obstacle to the use of condoms was young people's belief that they did not have to use condoms in steady relationships built on love and trust. Trust and love provide a sense of immunity to infection. Such a perception is reinforced, it is argued, by previous HIV/AIDS campaigns in Mozambique that have advocated the use of condoms only with 'occasional sexual partners'. Students' understandings of pleasure, lack of accurate information, lack of sex education at home and at school, and gender inequalities further contribute to making condom use a difficult issue. There should be a change in focus in condom campaigns. Efforts should also be made to encourage young people to 'emotionally invest' in their health by using condoms.

Adolescent↗

PubMed2003

Obstacles to the development of prevention and public health policies in Argentina.

The spread of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic and its impact in the injection drug user population occurred while the social assistance of the State diminished and poverty increased within the Argentinean population. Five main obstacles have been identified for the development of HIV infection/AIDS prevention policies for injection drug users: the scarce development of research and its poor impact in the definition of governmental policies, the characteristics of the legal framework regarding illegal drug use, the orientation of the health and social care services directed to drug users, deficiencies in the training of technicians and professionals related to these issues, and problems in assigning existing resources. International agencies play a very important role in this context. The project "Prevention of HIV Infection in Injection Drug Users in the Southern Cone," financially supported by the Joint United Nations Programme on HIV/AIDS and the United Nations Office on Drugs and Crime, is presented as an example.

Argentina↗

PubMed2003

Drug use, harm reduction, and health policies in Argentina: obstacles and new perspectives.

High human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) incidence among injection drug users (IDUs) shows the failure of traditional health policies. The preference of IDUs for injected cocaine exposes them to high risks for contracting HIV because of the frequency of drug use. The correlation of poverty with the selling of drugs, especially the so-called "drugs of poverty"--freebase cocaine and crack--is a consequence of prohibitions against drug use and of urban unemployment. In Argentina, "zero-tolerance" approaches and punishment for personal drug use tend to exclude IDUs from the country's health care system. A historical perspective is presented regarding approaches to the prevention of HIV/AIDS and harm reduction in Latin America and Argentina, where, despite isolated efforts, IDUs had no free access to sterile needles until the end of the 1990s. We present the impact of programs and campaigns of the Argentinean Harm Reduction Association, showing how and why, even with obstacles, harm reduction is possible and necessary.

Anti-HIV Agents↗

PubMed2001

HIV type 1 genetic diversity is a major obstacle for antiretroviral drug resistance hybridization-based assays.

Human immunodeficiency virus type 1 (HIV-1) is characterized by high genetic diversity. Current antiretroviral (ARV) drug resistance genotyping assays have been designed on the basis of the most prevalent sequence patterns circulating in the United States and Europe, which belong to the B subtype. However, little is known about their performance on non-B subtype samples. In Argentina, circulating forms have been characterized as subtypes B, C, F, and B/F recombinant forms. Our aim was to analyze the association between the genetic diversity of HIV-1 forms circulating in Argentina and the lack of reactivity at codon 74 in an ARV drug resistance hybridization-based assay. Samples taken from 93 HIV-1-infected individuals of Buenos Aires, Argentina were studied. The reverse transcriptase (RT) region of HIV-1 was genotypically assessed by a line probe assay (INNO-LiPA HIV-1 RT; Innogenetics, Ghent, Belgium) and automatic sequencing (TruGene and OpenGene; Visible Genetics, Toronto, Canada). Phylogenetic and intersubtype recombination analyses were carried out, showing that 52 of 93 (55.9%) samples belonged to subtype B, whereas 41 of 93 (44.1%) showed a (5') F1/B (3') subtype recombinant genomic structure. For codon 74 in the LiPA test, 4 of 52 (7.7%) B-subtype samples were nonreactive, whereas 27 of 41 (65.9 %) F1/B recombinant samples showed a nonreacting result, indicating a significant difference in the subtype distribution of the nonreacting samples. The presence of a synonymous polymorphism at codon 72 of RT (AGA --> AGG) associated with the lack of reaction at codon 74 in LiPA, was more prevalent in F1/B subtype recombinant samples (p < 0.001). The present data indicate that HIV-1 genetic diversity is a major obstacle for ARV drug resistance hybridization-based assays.

Base Sequence↗

PubMed2002

Overcoming obstacles to the success of protease inhibitors in highly active antiretroviral therapy regimens.

Success with current protease inhibitors (PIs) is limited by substantial variability in pharmacokinetics, onset of adverse metabolic effects that include sustained lipid elevations and insulin resistance, and increased risk of lipodystrophy. Additionally, poor adherence to the often complex regimens can lead to emergence of PI-resistant human immunodeficiency virus (HIV) variants and treatment failure. Boosting blood levels of current PIs through coadministration of ritonavir can improve the pharmacokinetic characteristics of these agents, increasing the chances of success, but often at the price of additional adverse effects. New PIs in development have the potential to overcome at least some of these obstacles. Tipranavir, mozenavir, and atazanavir have favorable and unique resistance profiles, making them potentially effective in new treatment strategies in both PI-naïve and PI-experienced patients. Atazanavir does not cause the lipid elevations seen with current PIs, and it may improve adherence through once-daily dosing.

Antiretroviral Therapy, Highly Active↗

PubMedDate not supplied

Epidemiologic designs for the study of acquired immunodeficiency disease: options and obstacles.

Epidemiologic methods are designed to identify risk factors involved in production of a particular disease, even when the specific etiologic agent is unknown. However, a major problem currently presenting obstacles to research on the acquired immunodeficiency syndrome (AIDS) relates to classification; approaches are described that will permit reclassification when better laboratory techniques are developed or when more information is available from studies on natural history. Further descriptive studies will be valuable in the determination of whether extension of disease has occurred to new population groups or geographic areas. Case control studies can provide information on changes of known risk factors or can confirm and help to specify those factors already recognized. Because of the dynamic nature of AIDS and the probable existence of multiple risk factors, prospective cohort studies will be of greatest value, although they will take longer to complete. As understanding of the etiologic factors improves, preventive measures will become more efficient.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Obstacles to shared care for patients with dementia: a qualitative study.

BACKGROUND: All Primary Care Trusts in England were meant to have shared care protocols for antidementia medication use in place by 1 April 2004. Shared care of medical treatment in dementia depends upon early diagnosis, but under-recognition of and under-response to dementia appear widespread in general practice. AIM: To investigate the perceptions of specialists and generalists about the potential for shared care of people with dementia. DESIGN OF STUDY: Qualitative study with semistructured interviews. SETTING: Three inner-city and two rural areas. METHODS: Semistructured interviews were arranged at the participants' convenience and were tape-recorded and transcribed. Thematic analysis of the anonymized transcripts was undertaken and a case and cross-case analysis was performed. RESULTS: Thirty-nine GPs and 30 specialists were interviewed. Broad themes were reduced to following four key categories which appear to be layered over each other: therapeutic nihilism; risk reduction or avoidance; concerns about competency; and resources for shared care. CONCLUSION: Roles for primary and secondary care professionals are inappropriately distributed and require clearer definition. Resistance to shared care mostly comes from within general practice and reflects concerns about staffing, time constraints, lack of experience and confidence in making and disclosing a diagnosis. Developers of shared care protocols must dissect layered obstacles, addressing the issues of therapeutic nihilism, risk management and clinical competence.

Adult↗

PubMed1998

Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway.

BACKGROUND: Older adults commonly experience falls because of balance and mobility problems. Better assessment methods are needed to understand and correct balance and mobility disorders. METHODS: We used a low technology, functional obstacle course (FOC) to measure balance and mobility in 352 community-dwelling elderly participants. To establish concurrent validity of the FOC, we compared performance on the FOC with two established measures of balance and mobility: performance on the Tinetti Index (TI) and postural sway area measured on a force platform. RESULTS: Bivariate correlation analyses revealed significant inverse correlations between FOC completion time, the TI balance and gait subscores, and the TI total score (r = -.73 to -.78). The FOC quality scores and TI balance and subscores gait and TI total scores (r = .76 to .82) were significantly positively correlated. FOC time had significant, but small, positive correlations with sway area with eyes open (r = .18) and closed (r = .17) and nonsignificant correlation with sway area with visual feedback. FOC quality also had significant, but smaller, inverse correlations with sway area with eyes open (r = -.024) and closed (r = -.015), and nonsignificant correlation with sway area with visual feedback. Regression analysis showed that TI gait and balance measures accounted for most of the variance found in FOC performance. CONCLUSIONS: Our findings support the position that the FOC and the TI measure dynamic balance, whereas postural sway measures a different aspect of balance. Advantages of the FOC include the evaluation of environmentally influenced falls and balance problems.

Accidental Falls↗

PubMed2006

Facilitators and obstacles to sperm banking in young men receiving gonadotoxic chemotherapy for cancer: the perspective of survivors and health care professionals.

BACKGROUND: Testicular cancer and Hodgkin's disease are among the most common malignancies to affect young men of reproductive age. Although both are associated with high rates of infertility, sperm banking (SB) remains underutilized by both diagnostic groups. Reasons for this remain elusive. METHODS: This study used a qualitative design. In-depth interviews were conducted with 20 cancer survivors and 18 health care professionals (HCPs) to examine their perspectives on factors that facilitate or hinder SB. Interview data were analysed using a mixed approach and a three-step process of data reduction, data display and conclusion drawing and verification. RESULTS: Eight factors were identified as having an impact on SB, and findings suggest that effective promotion of SB involves adequate communication around the severity and personal risk for infertility, assessing the importance of patients place on having children, emphasizing the benefits of SB and addressing possible obstacles such as cost, misperceptions or cultural and other factors. In addition, the communicator should be perceived as appealing. CONCLUSIONS: These results are conceptually consistent with both the Health Belief Model and the Elaboration Likelihood Model of health promotion and are useful in informing HCPs on how to better promote SB.

Adult↗

PubMed1983

Conceptual obstacles in computerized medical diagnosis.

Despite extensive research and a multitude of computer systems, there is no viable computerized system that is even remotely capable of approaching the skill of an expert human physician. Minor obstacles in the design of a practical system include imprecise medical terminology, the use of nonindependent clinical parameters, incorrect or inaccurate information supplied to the computer, and static representation of a patient's medical history. Major problems that go beyond computer manipulation of data include the requirement for a massive data base, representation of medical knowledge in general rather than specific terms, and physician fallibility in the design of a computer system.

Diagnosis, Computer-Assisted↗

PubMed1991

Obstacles to clinical research and new drug development in schizophrenia.

Enormous opportunities currently exist to develop and test new treatments for schizophrenia. Treatment research not only holds promise for alleviating the suffering and disability associated with this illness, but also in providing clues to etiology and ultimately prevention. At the same time as there are increasing opportunities for treatment development, there are also increasing challenges and obstacles to the conduct of needed research. A variety of different issues need to be addressed in facilitating appropriate research including treatment settings, reimbursement for costs of care, legal and ethical issues affecting patient participation, stable funding, and the development of clinical investigators. Adequate attention to these problems in strategic planning can help to ensure that emerging opportunities are neither wasted nor delayed.

Antipsychotic Agents↗

PubMed2006

The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles.

Many types of family interventions have been found to be effective in reducing exacerbations in schizophrenia; some also improve consumer social functioning and reduce family burden. Regardless of their origins, these interventions share a number of common features, such as showing empathy for all participants, providing knowledge about the illness, assuming a nonpathologizing stance, and teaching communication and problem-solving skills. Importantly, these family interventions have many characteristics that are consistent with the growing recovery movement in mental health in that they are community-based, emphasize achieving personally relevant goals, work on instilling hope, and focus on improving natural supports. Nevertheless, these interventions are generally reflective of older models of serious and persisting psychiatric illnesses that are grounded in a "patient being treated for a chronic illness" rather than a "consumer assuming as much responsibility as possible for his/her recovery" stance. These interventions could be made more consistent with recovery principles by (1) expanding the definition of family to include marital, parenting, and sibling relationships, (2) identifying better ways to match consumers with treatments, (3) broadening the research focus to include systems change that promotes making family members a part of the treatment team (with the consumer's consent), and (4) overcoming implementation obstacles that preclude access to effective family interventions for most consumers and their relatives.

Community Mental Health Services↗

PubMed2001

Effect of a changing health care environment on social work leaders: obstacles and opportunities in hospital social work.

The health care system is undergoing dramatic change in auspice, structure, and services delivery in response to an emphasis on market-driven, cost-containment strategies. Consequently, many hospital social work directors either have lost some of their administrative responsibilities or have expanded their span of control beyond social work services. This article examines the responses of social work administrators to the breadth of changes occurring throughout their hospitals; the major accomplishments of social work services within their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. As a result of examining the relationship between their actual and anticipated behavior and changes in the hospital and external environment, the authors found that social work leaders in hospitals understand the complexities and challenges of the world around them. Overall, they have exhibited commitment, competence, and confidence in shaping organizational change.

Hospital Administrators↗

PubMed1998

Clinical recognition of adverse drug reactions: obstacles and opportunities for the nursing profession.

Knowing that adverse drug reactions (ADRs) can occur is only part of the challenge facing nurses today. Clinical recognition of ADRs when they occur is an equally challenging component of pharmacotherapeutics. By understanding the obstacles to their clinical recognition, nurses can design strategies that will engender renewed enthusiasm and vigilance for these complications of drug therapy. These strategies will afford the nursing profession with enhanced opportunities to assume a leadership role in the recognition and intervention of ADRs.

Adverse Drug Reaction Reporting Systems↗