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PubMed2004

What does it mean to involve consumers successfully in NHS research? A consensus study.

OBJECTIVE: To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. DESIGN: Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. SETTING AND PARTICIPANTS: Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. MAIN OUTCOME MEASURES: Consensus on principles and indicators of successful consumer involvement in NHS research. RESULTS: Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. CONCLUSIONS: Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice.

Community Participation↗
PubMed1991

Grassroots strategies for promoting maternal and infant health.

For the past four years, grassroots organizing efforts in Rhode Island have been directed toward improving maternal and infant health. Coalitions of consumer organizations, health care providers, and activists have achieved important legislative initiatives, such as health insurance for uninsured pregnant women and promotion of midwifery services. This article examines the processes involved in organizing for improved maternal and infant health care, the dynamics involved in achieving a particular outcome, and the ways in which grassroots mobilization can affect public policy and contribute toward improved maternal and infant health.

Adult↗
PubMedDate not supplied

Peroxide detoxification by brain cells.

Peroxides are generated continuously in cells that consume oxygen. Among the different peroxides, hydrogen peroxide is the molecule that is formed in highest quantities. In addition, organic hydroperoxides are synthesized as products of cellular metabolism. Generation and disposal of peroxides is a very important process in the human brain, because cells of this organ consume 20% of the oxygen used by the body. To prevent cellular accumulation of peroxides and damage generated by peroxide-derived radicals, brain cells contain efficient antioxidative defense mechanisms that dispose of peroxides and protect against oxidative damage. Cultured brain cells have been used frequently to investigate peroxide metabolism of neural cells. Efficient disposal of exogenous hydrogen peroxide was found for cultured astrocytes, oligodendrocytes, microglial cells, and neurons. Comparison of specific peroxide clearance rates revealed that cultured oligodendrocytes dispose of the peroxide quicker than the other neural cell cultures. Both catalase and the glutathione system contribute to the clearance of hydrogen peroxide by brain cells. For efficient glutathione-dependent reduction of peroxides, neural cells contain glutathione in high concentration and have substantial activity of glutathione peroxidase, glutathione reductase, and enzymes that supply the NADPH required for the glutathione reductase reaction. This article gives an overview on the mechanisms involved in peroxide detoxification in brain cells and on the capacity of the different types of neural cells to dispose of peroxides.

Animals↗
PubMed2004

A consumer involvement model for health technology assessment in Canada.

Similar to other health policy initiatives, there is a growing movement to involve consumers in decisions affecting their treatment options. Access to treatments can be impacted by decisions made during a health technology assessment (HTA), i.e., the rigorous assessment of medical interventions such as drugs, vaccines, devices, materials, medical and surgical procedures and systems. The purpose of this paper was to empirically assess the interest and potential mechanisms for consumer involvement in HTA by identifying what health consumer organizations consider meaningful involvement, examining current practices internationally and developing a model for involvement based on identified priorities and needs. Canadian health consumer groups representing the largest disease or illness conditions reported a desire for involvement in HTA and provided feedback on mechanisms for facilitating their involvement.

Biomedical Technology↗
PubMed2004

How is patient-centred care understood by the clinical, managerial and lay stakeholders responsible for promoting this agenda?

AIMS AND OBJECTIVES: This study explores how the term patient-centred care is understood, particularly by those who are involved in translating the concept from a theoretical idea into a practical application. It examines the ways in which intermediate level stakeholders such as health service managers, educationalists, professional leaders and officers of patient bodies understand and promote patient-centred care among health professionals actually delivering patient care. DESIGN: Qualitative interview study. SETTING AND PARTICIPANTS: Interviewees were drawn from groups and organizations from four categories: health agencies and regulatory bodies, Royal Colleges and other professional bodies, educational institutions, patient and user groups and consumer organizations. MAIN VARIABLES STUDIED: The meanings and understandings of patient-centred care, commitment to implementing patient-centred care and barriers and opportunities to implementation. RESULTS AND CONCLUSIONS: Patient-centred care covers a range of activities from patient involvement in individual care to public involvement in health policy decisions. Current Department of Health policy has made patient-centred care a priority, but has not clarified exactly what it means. Thus, health professionals, educationalists, managers and patient representatives have all developed different meanings of patient-centred care to reflect their own particular backgrounds and roles. The individual aspects of patient-centred care have been neglected in policy terms and important research findings have not been incorporated into policies to change the attitudes and behaviours of health professionals. Developing a shared understanding of patient-centred care which encompasses all its components is an important role for the new Commission for Patient and Public Involvement.

Administrative Personnel↗
PubMedDate not supplied

[Gastrointestinal bacteriology of the earthworm Eisenia foetida grown in composted broiler litter].

The high animal concentration in intensive production brings about problems due to the volume of excreta and environmental pollution with the consequent risk for animal and human health. Therefore, previous to the application of any strategy of organic wastes recycling it is necessary to know possible sanitary risks. Farm organic wastes can be recycled through the intensive breeding of earthworms from species Eisenia foetida (Annelida, Oligochaeta) which can break down the consumed organic substance into humus. E. foetida is able to accelerate biodegrading wastes decomposition. It has been selected for recycling because its self productivity, its capacity to live in high concentrations, its feeding habits as well as its resistance to stress. The aim of this work is to study the microbial flora potentially pathogenic and their survival in the intestinal tract in sexually mature earthworms cultivated in composted broiler litter. Total coliforms, faecal coliforms, Salmonella, Pseudomonas and other enteric bacteria were sought in accordance with the recommended methodology. In E. foetida no positive results were obtained in the MPN/g (most probable number) of total coliforms, faecal coliforms, Salmonella, Pseudomonas and other Enterobacteriaceae family bacteria. These results suggest an antimicrobial response upon Gram negative bacteria from the gizzard and through the intestinal tract.

Animal Husbandry↗
PubMed1970

Comparative utilization of paraffins by a Trichosporon species.

Utilization of normal and isoparaffins, separately and in mixtures, by a Trichosporon sp. was investigated. From a mixture of normal paraffins and isoparaffins, the organism consumed straight-chain paraffins, leaving the branched paraffins relatively unchanged. When offered separately, the highest utilization of n-alkanes by the organism was obtained in the range of undecane to octadecane; n-pentadecane was poorly utilized. From a mixture of n-alkanes, the rate of consumption of shorter-chain alkanes, n-decane to n-dodecane, was found to be relatively faster and more uniform than that of longer-chain alkanes.

Alkanes↗
PubMedDate not supplied

Evaluating organic compound migration in poly(ethylene terephthalate): a simple test with implications for polymer recycling.

The safety of recycled plastics for food contact use is largely dictated by the ability of post-consumer organic contaminants to absorb into recycled materials and later diffuse from containers made from recycled plastics into the food supply. Diffusion and solubility data for organic contaminants in poly(ethylene terephthalate) (PET) are scarce. An approach for determining permeability constants, diffusion coefficients and solubility constants of slowly migrating contaminants in PET is described. Compounds (neat or in admixture) were heat-sealed in packets made from thin (0.00127 cm) PET films. Packets were placed in containers with GC sampling closures. Headspace (volatile compounds) or an external liquid medium (non-volatile compounds) was analysed for emergence of the compound. Diffusion coefficients were determined from non-steady state diffusion equations, permeability constants were determined from steady state permeation, and solubility constants were calculated from diffusion and permeability values. Diffusion coefficients (25 degrees C) ranged from 10(-9) to < 10(-16) cm2/s. The diffusion coefficient of benzene increased dramatically with concentration. Compounds with high permeation increased the transport rate of slower permeating volatiles.

Conservation of Natural Resources↗
PubMed2001

Patient safety: a call to action: a consensus statement from the National Quality Forum.

OBJECTIVE: The Institute of Medicine (IOM) and the Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry have both recently highlighted healthcare errors as a serious public health problem. An in-depth review of the issue was conducted by the National Quality Forum (NQF) in preparation for work the federal government has asked the NQF to do. PARTICIPANTS: The membership of the NQF includes a wide array of public and private health agencies, healthcare provider organizations, consumer groups, healthcare purchasers, and research and quality improvement organizations. EVIDENCE: Published literature, including more than 350 journal articles and over 30 books and monographs, were reviewed, and input was solicited from individuals and organizations known to be knowledgeable on the topic, including the Harvard University Executive Session on Medical Error, the VA National Patient Safety Center, the Joint Commission on Accreditation of Healthcare Organizations, the National Patient Safety Foundation, and the IOM. The principal observations and findings were collated; 10 high-priority strategic areas needing action were identified; and specific recommendations for each area were crafted. CONSENSUS PROCESS: A draft statement was prepared and submitted to the NQF membership and Directors, as well as to external reviewers. The statement was revised following subsequent rounds of review and comment, after which it was approved by the NQF Board of Directors. CONCLUSIONS: There is an urgent need to reduce healthcare errors; however, numerous barriers impede progress in this regard, including widespread misunderstanding about why healthcare errors occur, the prevailing culture of "name and blame" surrounding these events, lack of user-friendly error-reporting mechanisms, and fear of litigation if errors are acknowledged and reported. To eliminate these barriers, and to begin to reduce healthcare errors, the NQF recommends that concerted action be taken in the 10 strategic areas identified here.

Medical Errors↗
PubMed1996

What determines trust in information about food-related risks? Underlying psychological constructs.

Trust in risk information about food related-hazards may be an important determinant of public reactions to risk information. One of the central questions addressed by the risk communication literature is why some individuals and organizations are trusted as sources of risk information and others are not. Industry and government often lack public trust, whereas other sources (for example, consumer organizations, the quality media, medical doctors) are highly trusted. Problematically, previous surveys and questionnaire studies have utilized questions generated by the investigators themselves to assess public perceptions of trust in different sources. Furthermore, no account of the hazard domain was made. In the first study reported here, semistructured interviewing was used to elicit underpinning constructs determining trust and distrust in different sources providing food-related risk information (n = 35). In the second study, the repertory grid method was used to elicit the terminology that respondents use to distinguish between different potential food-related information sources (n = 35), the data being submitted to generalised Procrustes analysis. The results of the two studies were combined and validated in survey research (n = 888) where factor analysis indicated that knowledge in itself does not lead to trust, but that trusted sources are seen to be characterised by multiple positive attributes. Contrary to previous research, complete freedom does not lead to trust-rather sources which possess moderate accountability are seen to be the most trusted.

Adult↗
PubMed1996

CEC-CED Joint Knowledge and Skills statement for all becoming teachers of students who are deaf or hard of hearing. Joint Standards Committee of the National Council on Education of the Deaf and the Council for Exceptional Children.

In 1992, the National Council on Education of the Deaf (CED) and the Council for Exceptional Children (CEC) began a collaborative process in which new standards were jointly developed and approved by a representation of members from all organizations engaged in the preparation of teachers and in the delivery of services to deaf and hard of hearing learners, including educational, professional/administrative and consumer organizations. A Joint Standards Committee was appointed, and in 1992 enunciated mutually acceptable standards for the preparation of teachers of students who are deaf and hard of hearing. Fundamental to the entire standards development process was respect for the continuum of educational options available for children who are deaf and hard of hearing. The intent of this committee was to provide standards which were credible for all university and college teacher preparation programs and which could serve as a foundation for the development and maintenance of strong and viable programs according to the specific stated philosophy and practice of each. Information regarding the new standards and University/College Program Evaluation can be obtained from: Dr. Harold Johnson, Program Evaluation Chair, Kent State University, Room 405 White Hall, Kent, Ohio 44242.

Deafness↗
PubMed1998

[Stress and anticortisols--17-ketosteroid sulfate conjugate as a biomarker in tissue repair and recovery].

We attempted to determine compounds in human urine which, differing from cortisol (17-OHCS), show high values in healthy individuals, decrease with failing health, clearly decline with advancing disease and finally reach very low values in severe disease. We have eventually established that 17-ketosteroid sulfate conjugates (17-KS-S) are the compounds we were searching for. Hans Selye regarded stress as the rate of wear and tear and 17-OHCS as its indicator, but we considered that, differing from inanimate objects, living organisms consume energy to cope with stress and "repair" "wear and tear" of the tissue and "recover" its function. This concept led us to determine the organism's requirement for two mechanisms: "Wear and tear" which could be represented by the secretion of 17-OHCS (Selye), and "repair and recovery", which could be determined by the amounts of 17-KS-S derived from dehydroepiandrosterone (DHEA)-sulfate, a product of the adrenal cortex, which enhances neuronal survival, longterm memory, maintains the function of peripheral tissues, and stimulates immune system (17-KS mainly consists of 17-KS-S and 17-KS glucuronides 17-KS-G, the latter derived from cortisol, DHEA and testosterone). We hold that stress response is a series of biological process, beginning from CRH.ACTH and catecholamines, cortisol (17-OHCS), followed by insulin, acting as an anabolic agent and finally DHEA (17-KS-S) leads the tissues to repair by utilizing produced energy. Balanced changes of hormones, such as 17-KS-S, 17-OHCS, cortisol, catecholamines and insulin are seen in healthy individuals under healthy lifestyles and disruption of the balance brings apparent reduction in 17-KS-S. From this standpoint, we wish to develop research in interrelations between biologically antagonistic 17-KS-S and 17-OHCS, focusing particularly at 17-KS-S, which represents a contact point for mind and body, the healthy state of which is kept by appropriate sleeping and exercise programs on the basis of adequate food intake. The above three factors, 17-KS-S, 17-OHCS, and 17-KS-G, are expressed in creatinine ratio (mg/g creatinine).

17-Hydroxycorticosteroids↗
PubMed1998

[17-KS sulfate as a biomarker in health and disease].

We attempted to determine compounds in human urine which, differing from 17-OHCS, show high values in healthy individuals, decrease with failing health, clearly decline with advancing disease and finally reach very low values in severe disease. We have initially established that 17-ketosteroid sulfates (17-KS-S) are the compound we were searching for. Hans Selye regarded stress as the rate of wear and tear and 17-OHCS as its indicator, but we considered that, differing from inanimate objects, living organisms consume energy to cope with stress and "repair" "wear and tear" of the tissue "and recover" its function. This concept led us to determine the organism's requirements for two mechanisms: "Wear and tear" which could be represented by the secretion of 17-OHCS (Selye), and "repair and recovery", which could be determined by the amounts of 17-KS-S (Nishikaze) derived from dehydroepiandrosterone sulfate (DHEA-S), a product of the adrenal cortex, which enhances neuronal survival, long-term memory, maintains the function of peripheral tissues (skin, bone-muscle, gastro-intestinal and vascular system etc.), increases lipid metabolism, protein anabolism (antiobesity, antiatherosclerosis etc.) and stimulates the immune system. We hold that the stress response is a series of biological processes, beginning with CRH.ACTH and Catecholamines, Cortisol (17-OHCS), followed by Insulin, acting as an anabolic agent and finally DHEA-S (17-KS-S) induces tissue repair utilizing the energy produced. Low levels of urinary 17-KS-S are observed not only in cases of low cortisol or catecholamines secretion, but also when these are elevated. Normalization of these levels is followed by an increase in 17-KS-S excretion. Balanced changes of hormones, such as 17-KS-S, 17-OHCS, Cortisol, Catecholamines and Insulin are seen in a normal organism under healthy lifestyles and disruption of the balance induces an apparent reduction in 17-KS-S. From this perspective, we hope to research the interrelations between biologically antagonistic 17-KS-S and 17-OHCS as well as other agents, focusing particularly on 17-KS-S, which represents a contact point for mind and body, which is kept in healthy balance by appropriate sleeping and exercise programs along with adequate food intake.

17-Ketosteroids↗
PubMed2006

Comparative renal anatomy of exotic species.

All living organisms consume nutrients that are required for the production of both tissue and energy. The waste products of this process include nitrogenous materials and inorganic salts. They are removed from the body by excretory organs, which in vertebrate shave developed into kidneys and into salt glands in some birds and reptiles. Many invertebrates use a series of excretory organs called nephridia to perform the same function. Even though they perform similar functions, there is no evolutionary connection between invertebrate nephridia and vertebrate kidneys. Both evolved independently.

Amphibians↗
PubMed2005

Advocacy for mental health: roles for consumer and family organizations and governments.

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

Consumer Organizations↗
PubMed2005

Safety of ingredients used in cosmetics.

The Cosmetic Ingredient Review (CIR) program was established in 1976 by the Cosmetics, Toiletry, and Fragrance Association, with the support of the Food and Drug Administration (FDA) and the Consumer Federation of America (CFA). CIR performs independent, expert reviews to determine if ingredients used in cosmetics are safe. CIR staff prepares summaries of available data and the CIR Expert Panel reviews the data in open, public meetings. If more data are needed, requests are made. Unpublished studies may be provided, but become public and available for review once summarized in CIR safety assessments. Tentative conclusions are supported with a rationale and public comment is sought. Taking any input into consideration, a final safety assessment monograph is issued. These monographs are submitted for publication in the peer-reviewed International Journal of Toxicology . To date, 1194 individual cosmetic ingredients have been addressed. Of these, 683 were found to be safe in cosmetics in the present practices of use and concentration. With qualifications, another 388 have been found safe for use in cosmetics; specific qualifications for each are given. Nine ingredients have been deemed unsafe for use in cosmetics and the safety issue has been described. The available data were found insufficient to support the safety of 114 ingredients; the needed data are listed. Hair dyes represent an important product category reviewed by CIR. In considering hair dyes, the CIR Expert Panel reviews experimental and clinical data specific to the particular chemical structure of each hair dye and reviews epidemiologic studies that address hair dye use that are less specific. Recently the CIR Expert Panel concluded that the available epidemiologic studies are insufficient to conclude there is a causal relationship between hair dye use and cancer and other end points. It is inevitable that new information will become available concerning ingredients for which safety assessments were completed in the early days of the program. To consider new data, the CIR Expert Panel has instituted a re-review program. Sodium lauryl sulfate (SLS), formaldehyde, and parabens are discussed as examples. Safety assessments currently underway are listed, along with high-priority ingredients from which new work will be chosen. Although supported by the cosmetics industry, the CIR program has remained independent in its decision making, based on its open, public process; the integrity of the expert panel members; the participation of the FDA and the CFA; and the cooperation of the cosmetics industry.

Beauty Culture↗
PubMed1986

Industry, doctors and bureaucracy.

The central actors on the health arena are industry, doctors and bureaucracy. Whilst general trends towards industrialization, professionalization and bureaucratization are not limited to the health field, developments there have been extremely rapid and show unique features. The three actors often cooperate in harmony despite different goals. On the other hand, bureaucracy is often unable to reach its goals because of resistance from the other two actors. Conflicts, however, occur and are intensive in many third world countries. In industrial countries, too, trade interest in pharmaceuticals may over-ride public health considerations. Conflicts concerning individual drugs have received much publicity. In general, doctors as an organized profession tend to protest against bureaucracy but not against industry. In recent years it has become more and more apparent that health issues cannot be treated as the internal affairs of the actors. New actors have entered the arena. Patients' and consumers' organizations, small groups of doctors and new bodies such as Health Action International have changed the scene. Acting together with fundamental societal changes, this adds a new dimension to the debate and raises the question of including a social element in doctors' ethics. Medical research will also be more directed towards the health care system and become closer to the traditional problems of social science. Social scientists will therefore have contributions to make - studying how the relations between the actors influence the health care system and public health, for instance.

Delivery of Health Care↗