Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Harm Reduction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,117 records · Page 62Linked to original sources
PubMed2005

Optimization of an analytical procedure for the determination of banned azo dyes in leather.

The possibility of improving an existing method, based on supercritical-fluid extraction (SFE) and microwave-assisted extraction (MAE), for the determination of banned azo dyes in leather has been studied. Thus, optimization of experimental conditions in different steps (degreasing, reduction, and extraction) of the analytical procedure was performed. The influence of different variables (reaction time, temperature, and concentration of reducing agent) on the reduction process was evaluated by use of a factorial design. It was found that the concentration of the reducing agent and the interaction between time and temperature were the most influential variables. Consequently, by applying a higher temperature, the reaction time could be halved. The use of acidified water as extraction solvent in MAE was also investigated. Usually 1 mol L(-1) HCl was superior to methanol and buffer in terms of extraction efficiency. In conclusion, the present method gave significantly higher recoveries in comparison with the original method. All dyes were determined indirectly by measuring their corresponding harmful amines, formed after reduction by use of sodium dithionite.

Journal Article↗
PubMed1995

The efficacy of a nursing challenge to patients: testing a new intervention to decrease self-harm behaviour in severe personality disorder.

This paper describes the study of a new intervention, which was intended to increase therapeutic engagement with patients and to decrease self-harm behaviour. As a result of nursing observations in a unit that specialized in severe personality disorders, a psychodynamic perspective to treatment was introduced in the form of a nursing challenge. The intervention was evaluated in a new service for young adults at a psychiatric hospital in the south of England, as part of a clinical research apprenticeship. The care and treatment of persons with severe personality disorders present a major challenge to coherent and cohesive teamwork. A test and retrospective comparison study is described and its findings reported. Data from the study point to the need for more than a single challenge, to achieve a sustained reduction in self-harm, along with staff training to ensure working knowledge of a particular framework.

Adult↗
PubMed1999

Structured diagnostic assessment and depot fluphenazine treatment of multiple suicide attempters in the emergency department.

The aim of this study was to compare the efficacy of two doses of monthly intramuscular (i.m.) injections of fluphenazine decanoate in reducing self-harm behaviours in outpatients with histories of multiple suicide attempts. Fifty-eight patients who presented to a psychiatric emergency service after an attempted suicide and who had histories of multiple suicide attempts, were randomized to receive monthly i.m. injections of fluphenazine decanoate. Thirty patients received monthly 12.5 mg ('low' dose), and 28 patients received monthly 1.5 mg ('ultra low' dose) under double-blind conditions. DSM-III-R diagnoses were obtained on all patients using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P) and SCID for DSM-III-R Personality Disorders (SCID-II). Outcomes were assessed by the Parasuicide History Inventory and the Abnormal Involuntary Movement Scale, collected monthly for 6 months. Patients had an average of six current Axis I and 2.6 Axis II diagnoses, with borderline personality (85%) and alcohol dependence (58%) occurring most frequently in the sample. Both the low dose and ultra-low dose groups showed a marked reduction in self-harm behaviours. For 'serious' self-harm behaviours, there was a trend for a greater effect of the low dose over the ultra-low dose group, however, the differences did not reach statistical significance. A survival analysis indicated that the presence of 'acute' stressors at baseline and female sex were risk factors for continuing (post-randomization) 'serious' self-harm behaviours, while younger age and the absence of concurrent general medical conditions were risk factors for all self-harm behaviours.

Adult↗
PubMed2003

Ventilator-induced lung injury.

During mechanical ventilation, high end-inspiratory lung volume (whether it be because of large tidal volume (VT) and/or high levels of positive end-expiratory pressure) results in a permeability type pulmonary oedema, called ventilator-induced lung injury (VILI). Previous injury sensitises lung to mechanical ventilation. This experimental concept has recently received a resounding clinical illustration after a 22% reduction of mortality was observed in acute respiratory distress syndrome patients whose VT had been reduced. In addition, it has been suggested that repetitive opening and closing of distal units at low lung volume could induce lung injury but this notion has been challenged both conceptually and clinically after the negative results of the Acute Respiratory Distress Syndrome clinical Network Assessment of Low tidal Volume and Elevated end-expiratory volume to Obviate Lung Injury (ARDSNet ALVEOLI) study. Experimentally and clinically, involvement of inflammatory cytokines in VILI has not been unequivocally demonstrated. Cellular response to mechanical stretch has been increasingly investigated, both on the epithelial and the endothelial side. Lipid membrane trafficking has been thought to be a means by which cells respond to stress failure. Alterations in the respiratory system pressure/volume curve during ventilator-induced lung injury that include decrease in compliance and position of the upper inflection point are due to distal obstruction of airways that reduce aerated lung volume. Information from this curve could help avoid potentially harmful excessive tidal volume reduction.

Humans↗
PubMed2002

A calculus of unnecessary echoes: application of management principles to health care.

We studied the clinical utility of echocardiography in children and applied principles of business management to draw conclusions that are applicable to health care in general. A significant number (13% in this series) of expensive medical diagnostic tests could be avoided without harm to patients. Cost reduction in medicine is possible in many situations without compromising quality of care. Care pathways (i.e., practice guidelines or clinical algorithms) provide one useful modality. However, for the safety of patients, all cost reduction methods must start with practicing physicians (or involve them at conceptualization) and an escape clause must be available to the treating physician for the atypical patient. The analytic approach used--concurrent assessment of percentage cost, charge, and payor--is applicable to all components of the health care value chain. The use of "percentage of charges" as an indicator of collection effectiveness is unrealistic and should be changed to "percentage potential reimbursement" because health care is effectively a fixed-reimbursement industry rather than a system subject to standard microeconomic (supply and demand) forces. The current reimbursement structure provides conflicting incentives both to health care institutions and to providers, creating an insurmountable barrier to any effective incentive system. Colloquy between practicing physicians and experts in operations management will stimulate cost reduction and can optimize the delivery of health care.

Child↗
PubMed2004

Seasonal cardenolide production and Dop5betar gene expression in natural populations of Digitalis obscura.

Productivity variations and seasonal fluctuations of cardenolides have been studied in 10 natural populations of Digitalis obscura distributed in three bioclimatic belts. Main cardenolides in D. obscura plants are those of the series A and such predominance (ca. 80-85%) over the series B metabolites is independent of the population studied or the degree of maturity of the leaves. Primary glycosides represent ca. 50-60% of total cardenolides; this percentage did not vary among populations or with the leaf age but increased in summer and decreased in winter. A correlation analysis between plant biomass and cardenolide content showed a positive relationship of these parameters, which, according to the bioclimatic distribution of the populations, suggests that certain environmental conditions may cause marked decreases in plant biomass together with a reduction in productivity. Cardenolide contents changed in the timecourse of the four seasons as a multiple response to distinct plant and/or environmental factors. The lowest production was recorded in May, followed by a fast cardenolide accumulation in summer, a decreasing phase in autumn, and a stationary phase in winter. We also analysed the seasonal expression of the gene encoding the progesterone 5beta-reductase, enzyme producing the required 5beta-configured intermediaries of cardenolides. A fragment of the isolated partial genomic sequence was used as a probe for Northern analysis to study the seasonal gene expression in selected populations. The expression pattern showed increasing levels from February to July and a further reduction in autumn, although harmful climatic conditions seems to induce overexpression of this gene.

Base Sequence↗
PubMed2001

Opium past, opioid futures: imperialism, insurgency and pacification in a global commodity market.

This is a lightly edited version of Roger Lewis' notes for the speech he gave at the 11th International Conference on the Reduction of Drug Related Harm in Jersey in March 2000, shortly before his death. In this paper Roger Lewis argues for the need to take global and historical view of both drug markets and ways that nations try to control them. Drug markets have become globalised, influenced by changes in communication, finance, commodity and labour markets. Drug control activities are used to defend global strategic interests, amd foreign policy imperatives usually take precendence over drug policy.

Journal Article↗
PubMed2001

From reduced smoking to quitting: improvements in COPD symptoms and lung function: a case report.

This case report describes a smoker with chronic obstructive pulmonary disease (COPD) who had given up on trying to stop smoking because of many failed attempts. The patient, a 55-year-old woman, was, however, interested in reducing smoking and harm. During a long reduction phase, aided by nicotine replacement, the patient gained self-confidence, despite a depressive episode, and was finally able to quit smoking completely. Spirometry revealed several major improvements after reduction and abstinence.

Female↗
PubMed1990

Where there's smoke...carbon monoxide exposures in smoking and smoke-free workplaces.

Comparisons of expired air carbon monoxide levels in non-smoking staff in six licensed clubs (a smoking workplace) were made with those of non-smoking staff of a large public hospital (a smoke-free workplace). There was a significant difference between clubs and hospital in levels of CO at end of work. The average concentration of club workers was 8.7 ppm (Hospital, 5.3 ppm). Approximately one third of these non-smokers in licensed clubs exceeded 10 ppm putting them in the 'light smoker' category according to the manufacturer of the monitoring equipment. Club workers increased their CO level during work time by four times the increase of Hospital staff. This study suggests that there are significant gains to be made in reduction of intake of harmful passive-smoking products by removing tobacco smoke from workplaces.

Australia↗
PubMed2004

Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk?

AIMS: To assess the risk of further cases in educational settings in order to inform policy on managing cases and clusters of meningococcal disease. METHODS: Between 1 April 1995 and 31 March 2001, surveillance in preschool and school settings in England and Wales identified 114 clusters of meningococcal disease. Twenty clusters were reported in preschool settings, 43 in primary, 46 in secondary, and five in independent schools. Seventy three clusters (64%) consisted of two or more confirmed cases, of which 30 had two or more serogroup C cases. Following the introduction of the national meningococcal serogroup C vaccination programme in 1999, no serogroup C clusters were observed between April 2000 and March 2001. RESULTS: The relative risk of further cases in the four weeks after a single case compared with the background rate was raised in all settings, ranging from RR 27.6 (95% CI 15.2 to 39.9) in preschool settings to RR 3.6 (95% CI 2.5 to 4.6) in secondary schools. Absolute risk estimates ranged from 70/100 000 in preschool settings to 3.0/100 000 in secondary schools. The relative risk of clustering was similar for serogroup B and C strains. Most (68%) second cases occurred within seven days of the first case. CONCLUSIONS: Although there was a higher risk of further cases of meningococcal disease in schools and especially in preschool settings, it is not known whether widespread antibiotic use after single cases reduces risk of further cases and if there is a real risk of harm. Evidence of risk reduction is needed to inform public health policy.

Child↗
PubMed2006

WATCH IT: a community based programme for obese children and adolescents.

BACKGROUND: The WATCH IT programme was developed to address the needs of obese children from disadvantaged communities in Leeds and has been running since January 2004. Results of the pilot phase, prior to a randomised controlled trial, are presented. METHODS: A process evaluation to assess success of implementation was conducted in December 2004. User views (parent and child) were obtained by semi-structured interviews and focus groups. Change in BMI SD score was calculated for children attending between January 2004 and November 2005. RESULTS: A total of 94 children (49 girls, 45 boys), mean age (SD) 12.2 (2.0) years attended. They were moderately to severely obese (mean BMI SDS 3.09 (0.45), with low quality of life and self-image scores. There was a significant reduction in overweight at 6 months (DeltaBMI SD -0.07), especially for teenagers (DeltaBMI SD -0.13) and girls (DeltaBMI SD -0.07). The programme was successfully implemented. By December 2004 mean attendance was 2.1 (0.7) clinics per month, and sports sessions 3.3 (1.7) sessions per month. Fourteen children dropped out and non-attendance was low (only 7.5% sessions missed in 12 months). Qualitative research indicated significant appreciation of the service, with reported increase in self-confidence and friendships, and reduction in self-harm. CONCLUSION: WATCH IT offers a model for a community based service for obese children. The programme suggests that effective care can be delivered by health trainers supervised by health professionals, and so potentially provides a cost effective programme within children's communities. These findings are encouraging, and need to be substantiated by extension to other locations and evaluation by randomised controlled trial.

Adolescent↗
PubMed1999

Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of alcohol consumption on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: There are 2 main options for those at risk for hypertension: avert the condition by limiting alcohol consumption or by using other nonpharmacologic methods, or maintain or increase the risk of hypertension by making no change in alcohol consumption. The options for those who already have hypertension include decreasing alcohol consumption or using another nonpharmacologic method to reduce hypertension; commencing, continuing or intensifying antihypertensive medication; or taking no action and remaining at increased risk of cardiovascular disease. OUTCOMES: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the period 1966-1996 with the terms ethyl alcohol and hypertension. Other relevant evidence was obtained from the reference lists of articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design, and graded according to the level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: A reduction in alcohol consumption from more than 2 standard drinks per day reduces the blood pressure of both hypertensive and normotensive people. The lowest overall mortality rates in observational studies were associated with drinking habits that were within these guidelines. Side effects and costs were not measured in any of the studies. RECOMMENDATIONS: (1) It is recommended that health care professionals determine how much alcohol their patients consume. (2) To reduce blood pressure in the population at large, it is recommended that alcohol consumption be in accordance with Canadian low-risk drinking guidelines (i.e., healthy adults who choose to drink should limit alcohol consumption to 2 or fewer standard drinks per day, with consumption not exceeding 14 standard drinks per week for men and 9 standard drinks per week for women). (3) Hypertensive patients should also be advised to limit alcohol consumption to the levels set out in the Canadian low-risk drinking guidelines. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension and the previous recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control and the Canadian Hypertension Society. They have not been clinically tested. The low-risk drinking guidelines are those of the Addiction Research Foundation of Ontario and the Canadian Centre on Substance Abuse. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. The low-risk drinking guidelines have been endorsed by the College of Family Physicians of Canada and several provincial organizations.

Adult↗
PubMed2000

[Two years follow-up of a heroin users cohort treated with high dosage buprenorphine. Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice Subutex)].

BACKGROUND: Since February 1996, French GPs are allowed to prescribe high dosage buprenorphine for maintenance treatment of major opioid drug addiction. A prospective cohort of major opioid addicts was initiated in order to assess patient outcomes: follow-up, retention rate in treatment, drug use, intravenous injection and social situation evolution. METHODS: Each GP, known to be involved in drug user management, had to include the first 10 opioid drug addict patients to whom he prescribed high dosage buprenorphine, with a maximum inclusion period of 3 months. Patients were followed up for two years and a regular standardized information was collected (usual data on drug users and prescription modalities). RESULTS: Between May and July 1996, 919 patients (664 men and 255 women, mean age: 30 years) were included by 101 GPs. They had a long and serious history of drug addiction, important parallel consumption of cocaine, codeine and other illicit drugs and psychiatric problems (28% of definite problems and 45% of probable) and frequent hepatic conditions (hepatitis B: 23%, hepatitis C: 21%). Two years later, 55% of patients were still followed-up by the same GP and an additional 12% were followed by another GP or in a health care service (hospitalized or receiving methadone in a specialized centre). 13% were not followed, but GPs were able to describe their situation. 8% had been included by GPs who had dropped the study. Finally, 12% of patients were lost to follow-up. Among the 508 patients still followed-up by the same GP after 2 years, the substitution treatment rate was 84%. The dosage bracket had widened (inclusion: mean dosage=7.8 mg +/-4.5, minimum=0.8, maximum=28, median=8; after 2 years: mean=7.6 mg +/-5.4, minimum=0.4, maximum=28, median=8) and the duration of the prescription and dispensing had increased. Declaration of heroin intake in the previous month had fell from 40% to 11% and declaration of drug intake from 53% to 20%. Social situation had improved on average (housing conditions and work). There were 12 seroconversions for hepatitis B, 21 for hepatitis C and 4 for HIV. 14% of patients had declared intravenous injection of high dosage buprenorphine in the previous month. CONCLUSION: After two years of follow-up, 55% of patients were still followed-up by the same GP and an additional 12% was followed by another GP or in a health care service. Among patients still followed up by the same GP, a reduction of drug related harm (seroconversions for hepatitis B, hepatitis C and HIV) was observed.

Adult↗
PubMed1978

Identification and reduction of carcinogens in the respiratory environment.

Epidemiological studies have implicated three factors in the overall increase of lung cancer--tobacco, especially cigarette smoking, urban pollution and, to a lesser extent, certain industrial respiratory environments. Some data were discussed on carcinogenic industrial inhalants, and on the possible effect of urban pollution. The reduction of pollution and that of specific environmental agents is stressed. Laboratory studies on the identification of carcinogens in cigarette smoke and their reduction toward the "less harmful cigarette" represent a part of this aspect.

Air Pollution↗
PubMed1986

100 years of animal welfare regulation and of experiments with animals in Germany, effects and reasons.

The first regulations (1883) have been renewed twice (1933, 1972) and will soon be renewed once again (1986). They have always been influenced by two motivations: men's feeling of responsibility for animals on one hand and antiscientism or public suspicion against scientists on the other hand. The general rules concerning animal welfare (anaesthesia, reduction of number and harm, species selection etc.) have been constant for 100 years, but governmental control increases by the establishment of special licences (for each project, for the responsible scientist, for the location) by regular controls of the laboratories, by installing a permanent animal welfare officer in the institutions, by protocols, special taxes and increasing penalties. Out of different public ethical concepts about the use of animals, the law for the present agrees with those permitting to use animals for "reasonable purposes". But now the public opinion wants to change to "only for necessary" purposes; this especially concerns animal experiments causing severe pain. Philosophers and public have difficulties to find consentaneous reasons for the "necessity" of basic research. Each basic research in biology must be accepted as necessary because life is multifactorially organized and can be analyzed sufficiently only by random-like strategies to test not monocausally evidenthypotheses alone, but all reasonable possibilities.

Animal Welfare↗
PubMed1998

Prevention of exposure to mutagenic fumes produced by hot cooking oil in Taiwanese kitchens.

We evaluated the mutagens in fumes produced by heating three different cooking oils used in Taiwan to temperatures of 100 degrees C, 200 degrees C, and 300 degrees C, and constructed models to study the efficacy of fume extractors used commonly by Taiwanese women. Particulates of volatile emissions from lard (at 200 degrees C and 300 degrees C) and soybean oil (at 300 degrees C) were found to be mutagenic in the Salmonella/microsomal test with S9 mix, indicating that exposure of Taiwanese women to cooking oil fumes may be an important risk factor in the etiology of their lung cancer. Mutagenicity of lard and soybean oil fumes collected at 300 degrees C was obtained when a commonly used fume extractor was located at a usual distance of 70 cm above the oil surface, whereas the fume samples were not, or weakly, mutagenic in the Salmonella/ microsomal assay when the distance between fume extractor and oil surface was 60 cm or less. Reduction in mutagenicity was on average 1.2 +/- 0.5 revertants/cm (the percent reduction in mutagenicity was 46%), pointing to a possible cooking practice involving significant reductions in exposure to harmful oil fumes and, consequently, a decreased risk of lung cancer in Taiwanese housewives.

Cooking↗