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At least 1,441 records · Page 80Linked to original sources
PubMed1997

Surveillance of sexual behaviour among homosexual men in a central London health authority.

OBJECTIVE: To establish a surveillance mechanism of high risk sexual behaviour among homosexual and bisexual men living, socialising and using services in a central London health authority. DESIGN: Baseline survey for a system of repeatable behavioural surveillance using a self-completed questionnaire delivered by healthcare providers. SETTING: Genitourinary medicine clinics, gay bars, clubs, community groups and a cruising ground in the defined geographical area of a central London health authority. PARTICIPANTS: Five hundred and fifty three homosexual and bisexual men. MAIN OUTCOME MEASURES: Self-reported behaviours including unprotected anal intercourse (UAI), HIV status of unprotected anal intercourse partners, uptake of HIV testing and use of condoms at first time of anal intercourse. RESULTS: Five hundred and sixty questionnaires were returned (response rate 76%) from 553 men. A third (35%) of men surveyed had had UAI in the previous year. Nearly a fifth (19%) of the sample had had UAI with one or more partners of a discordant or unknown HIV status. A total of 343 (63%) men had had an HIV test. The proportion of men using condoms on the occasion of first anal intercourse has risen from 6% before 1980 to 88% after 1993. CONCLUSIONS: We have demonstrated that a surveillance programme to monitor high risk sexual behaviour among homosexual men can be easily established. The results can be employed to assess progress towards risk reduction targets and also inform future policy development. Our baseline data demonstrate that a large proportion of homosexual men are continuing to engage in high risk sexual behaviour, although there is some evidence of improvement in condom use at first anal intercourse over time. There is a need for continuing health promotion with evaluation among homosexual men.

Adolescent↗
PubMed2002

'Getting checked and having the test': drug injectors' perceptions of HIV testing - findings from qualitative research conducted in England.

If HIV and AIDS policy initiatives are to be successful in tackling the spread of infection it is important to understand more about the ways in which people perceive HIV and AIDS. HIV testing is a policy initiative that will work when people take the test and make appropriate changes to their behaviour as a result. This paper is based on a study that used in-depth interviews and a vignette with drug injectors to explore drug injectors' perceptions of HIV risk outside and inside prison. HIV testing was an integral part of drug injectors' perceptions of risk. Three main themes emerged from the analysis of these data: first, reasons for not taking a test; second, reasons for taking a test; and third, the impact of testing upon subsequent behaviour. The paper ends with a summary and conclusions highlighting implications for future research and policy development.

Adolescent↗
PubMed2004

Comparisons of patients with comorbid psychiatric and substance use disorders: implications for treatment and service delivery.

OBJECTIVE: Individuals with co-occurring psychiatric and substance use disorders are treated in mental health and substance abuse treatment systems, yet research on comorbid disorders rarely includes comparisons across systems. Knowledge about patients who share the label "comorbid" but are found in different treatment sectors should illuminate service issues and inform policy development. Differences across systems should provide support for separate treatments; similarities should indicate the value of the integration of services. The hypothesis that there are meaningful clinical differences between patients with comorbid mental health disorders and patients in drug treatment was tested. METHOD: As part of a larger longitudinal study, 106 patients with comorbid illness from mental health (N=106) and drug treatment (N=120) settings were compared regarding diagnosis, drug use, and problem severity. Data were obtained by using the Diagnostic Interview Schedule for DSM-IV and the Addiction Severity Index. RESULTS: Few differences between groups emerged. There were no diagnostic differences except that schizophrenia spectrum disorders were more common among mental health (43%) than drug treatment (31%) patients. Although more drug abuse than mental health subjects reported drug use in the 30 days before treatment entry, the average number of days of drug use in this period was not different. CONCLUSIONS: These findings document the high prevalence of severe mental illness in drug treatment clients and of serious drug problems in mental health patients. Only minimal differences emerged between the groups and none that indicated need for specialized treatments in separate systems of care.

Comorbidity↗
PubMed1981

Pragmatic issues in design and implementation of a psychotherapy outcome study.

Studies of the outcome of psychotherapy are becoming an important part of health policy development, cost control, and program evaluation. The authors describe steps in the design and implementation of an outcome study, including the selection of measurement instruments, the role of human subject review boards, the cost of the study and the desirability of computerization, the time frame for collecting data, and methods of keeping track of the data. They emphasize the importance of staff cooperation and discuss ways it can be fostered. They also stress the need for periodic reviews and identify issues that should be addressed in such reviews to keep the study on course.

Data Collection↗
PubMed1988

Employee assistance programs: a primer for buyer and seller.

A growing number of firms in private industry now sponsor or contract with groups of mental health professionals to provide employee assistance programs (EAPs). Factors that have influenced the increasing demand for EAPs include corporations' humanitarian concern for employees with mental health problems, a desire to contain rising health costs and reduce corporate losses, and the need for effective supervisory systems for managing troubled employees. To assist corporate consumers in judging the quality of EAP services and to guide mental health practitioners who wish to enter the EAP field, criteria are provided for evaluating the following aspects of EAP programs: policy development, employee orientation, supervisor training, availability during nonbusiness hours, assessment and diagnostic services, crisis counseling, referral, quality assurance, program evaluation, and cost.

Crisis Intervention↗
PubMed2001

Accident or suicide? Predictors of Coroners' decisions in suicide and accident verdicts.

OBJECTIVE: To examine the factors used by Coroners to distinguish between suicide and accidental death among young men in Merseyside and Cheshire. DESIGN: Retrospective epidemiological survey of deaths due to external causes. Data sources included Coroner's Inquest, GP and hospital data. Logistic regression was carried out to determine the multiple effect of individual factors on defining Coroner's verdict. SETTING: Merseyside and Cheshire, United Kingdom. SUBJECTS: Males aged 15-39 years who died from unnatural causes during 1995 in Merseyside and Cheshire. MAIN OUTCOME MEASURE: Coroner's verdict. RESULTS: An active mode of death was by far the strongest predictor of a suicide as opposed to an accident verdict. Other significant differentiating factors included expressed intent, behavioural change, deliberate self-harm and psychiatric contact. CONCLUSION: The validity of using method of death as a predictor of intent is questionable. Evidence left by drug users who kill themselves may differ from that left by non-drug users and may need to be sought in less conventional ways. There may be a discrepancy between those factors deemed important by health professionals as indicators of suicide, such as deliberate self-harm, and those given most weight by the Coroner. It may be more pragmatic, in terms of public health policy development, to challenge the concept that self-destructive behaviour can be categorized as being either intentional or unintentional. There is some evidence suggesting that deaths due to suicide and accidents both result from elements of self-destructive behaviour and therefore, the practice of categorizing deaths as either suicides or accidents could be misleading.

Accidents↗
PubMed2006

Comparison of reports of randomized controlled trials and systematic reviews in surgical journals: literature review.

OBJECTIVES: Randomized controlled trials and systematic reviews of such trials are the gold standard for assessing the effectiveness of interventions. There have been concerns about the anecdotal evidence underpinning many of the interventions used and introduced into surgical care. The American College of Surgeons has prioritized the need for more trials and systematic reviews of trials. To investigate the assertion that the methodological quality of studies conducted in surgery is in general poor and to assess the possible impact of new policy developments in the US, we sought to compare the number and proportion of published randomized controlled trials and systematic reviews in the leading two US and UK general surgical journals. Two reviewers systematically and independently hand searched all issues of these journals over a 12-month period to identify randomised controlled trials and systematic reviews. DESIGN: Systematic searching and independent abstraction of data from all volumes of the top two general surgical journals published in the USA and the UK in 2004. SETTING: 519 original reports in UK journals and 616 original reports in USA journals. MAIN OUTCOME MEASURES: Number and proportion of randomized controlled trials and systematic reviews. RESULTS: Overall, the proportion of randomized controlled trials in all four journals was 5.6% (95% confidence interval [CI] 4.4-7.0) and 5.2% (95% CI 4.1-6.7) for systematic reviews. For journals published in the UK 29/519 (5.6%) of the publications were reports of randomized controlled trials, and for the USA journals this figure was 34/616 (5.5%); odds ratio [OR]=0.99, 95%CI 0.6-1.6; P=0.96. Systematic reviews were significantly more commonly reported in the UK journals: UK 37/519 (7.1%) versus USA 22/616 (3.6%); OR=0.48, 95%CI 0.3-0.8; P<0.01. CONCLUSIONS: The concerns expressed almost a decade ago remain valid: there are still very few reports of randomized controlled trials and systematic reviews published in leading USA and UK surgical journals, with relatively little difference between these countries in the proportion of reported studies employing these designs. The American College of Surgeons initiative has yet to make an impact.

Biomedical Research↗
PubMed1992

The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective.

Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful.

Community Participation↗
PubMedDate not supplied

Using a treatment-tradeoff method to elicit preferences for the treatment of locally advanced non-small-cell lung cancer.

The study was designed to evaluate a treatment-tradeoff method for its potential in helping lung cancer patients make treatment decisions. A treatment-tradeoff interview was conducted to determine how patients weighed potential survival benefits against the potential toxicities of different treatment options: 1) low-dose versus high-dose radiotherapy, and 2) high-dose radiotherapy versus combination chemo-radiotherapy. Fifty-six patients who had experienced cancer and 20 clinic staff participated; twenty of these participants repeated the interview in an assessment of response consistency. The treatment-tradeoff method proved feasible: all staff and 53 of the 56 patients were able to complete the process. A wide range of threshold scores across participants was observed for both tradeoffs. Sixty percent of the patients would accept the more toxic combination therapy over high-dose radiotherapy if the former offered a 10% absolute improvement in three-year survival. The method also proved reliable: test-retest correlations were high (tau ranged from 0.7 to 0.87 and r from 0.82 to 0.94) and test-retest mean score differences were low (1.3-4.2). The most clinically useful measure of consistency was a "preference consistency" index, which revealed that most patients declared the same treatment preference at test and retest. The authors conclude that, while there is great interindividual variability in willingness to accept aggressive treatments for lung cancer, patients' values can be consistently elicited with the tradeoff method. The method has potential for clinical application in decision making and for health-care policy development.

Aged↗
PubMedDate not supplied

Co-bedding versus single-bedding premature multiple-gestation infants in incubators.

OBJECTIVE: To compare the physiological stability and behavioral effects of co-bedding with those of single-bedding premature multiple-gestation infants in incubators as well as the psychological effects on their parents. DESIGN: Prospective, randomized, repeated measure. PARTICIPANTS: Convenience sample of 16 infants and 8 parents in the co-bedded group, and 21 infants and 11 parents in the control group. INTERVENTIONS: Infants in the study group were co-bedded in incubators. MAIN OUTCOME MEASURES: Baseline and posttesting for parental state anxiety, maternal attachment, and parental satisfaction measures; infant sleep-wake synchronicity; physiological measures; and stress cue measures during baseline and activity. MAIN RESULTS: Repeated measures 5 (time) x 2 (group) analysis of variance found significant differences in infant daily weight, feeding amount, and high-activity heart rate. There was no difference in parental state anxiety, maternal attachment, and parental satisfaction scores by group, except for higher baseline parental satisfaction scores in the co-bedded group. CONCLUSIONS: This research demonstrated the safety of co-bedding multiple-gestation infants in incubators but did not find any significant clinical improvement in infant or parental outcomes with co-bedding. Neonatal intensive-care unit providers should educate staff and parents about the potential benefits of co-bedding and consider developing policies and procedures for co-bedding in both incubators and cribs. Co-bedding of multiple-gestation infants may be provided as an adjunctive developmental care strategy if parents desire this intervention.

Female↗
PubMed1996

European drug information centers.

Drug information is a clinical specialty throughout the United States and Europe. This professional support service not only addresses drug information requests, but also provides pharmacy (drug) and therapeutics support, newsletter publication, fee-for-service consultation, education, drug policy development, and research. Although the primary services of drug information centers (DICs) in Europe are similar to those in the United States, substantial differences have been reported. Recent surveys have compared the locations, resources, staff, and services of the DICs throughout Europe. DICs in the United States and Europe play a pivotal role in the provision of pharmaceutical care to patients as well as providing support to hospital functions.

Drug Information Services↗
PubMed2003

The smallpox threat: the school nurse's role.

Today, with the threat of bioterrorism and war, there is a new dimension to the traditional role of the school nurse. The smallpox threat to public health will invoke the school nurse's role as an educator, liaison, and consultant in the community. This article discusses smallpox, the vaccination process, adverse effects, and postvaccination care. In addition to the role of educator, the school nurse has the role of a liaison between the school and the local health department. The school nurse also plays a vital role in school health policy development and implementation. Being prepared and educated makes our nation less vulnerable to these threats and will assist in keeping our children and communities safe.

Bioterrorism↗
PubMed1999

A state association surveys school nurses to identify current issues and role characteristics.

A state association of school nurses conducted a statewide survey, collaborating with university nursing faculty to secure necessary resources and research expertise. A questionnaire, including demographic, employment, and practice characteristics, was mailed to 340 school nurses in Michigan. The response rate was 49%. Findings demonstrated the complex, multiple roles and responsibilities of school nurses. Two strengths identified were memberships in professional organizations and employer support for continuing education. Issues identified included educational preparation below the recommended baccalaureate level, lack of differentiation in practice based on education, and certification through non-competency-based processes. Isolation and supervision/evaluation by non-nurses were pervasive themes. Findings are relevant for school nurses across the country. Results have been used both locally and at the state level in employer negotiations, with legislators for educational purposes, and in policy development. Strategies for addressing the identified issues are explored, including those facilitated through an association-university collaboration.

Adult↗
PubMed1997

Self-directed work teams: application to a drug information center.

OBJECTIVE: To describe the transition of a drug information center from a traditionally managed center to a self-directed work team responsible for service, education, research, and drug use policy development. SUMMARY: To adapt to economic, educational, and technologic changes, traditional management structures in healthcare organizations are being reassessed. In some instances, a team approach (using self-directed work teams [SDWTs]) is being implemented. SDWTs have the potential to provide a number of benefits to an organization, including reduced costs and greater employee motivation. The University of Illinois at Chicago Drug Information Center had functioned under a traditional management structure. For economic and professional reasons, the management structure of the center was changed to an SDWT, prompting a reevaluation of the mission and activities of the center. DISCUSSION: Although still in transition, the center's change to a team structure has proven to be positive. The nature of the SDWT requires greater involvement by team members in all aspects of the center's operation, adding to the experience of team members. The team structure also allows for greater freedom to pursue projects of personal interest to individual team members. A number of issues still need to be resolved, such as performance-based compensation and peer- and self-evaluations. CONCLUSIONS: SDWTs can provide many benefits. The successful implementation of an SDWT, however, has a number of requirements, the most important of which are a commitment from management and effective communication among team members and with management.

Drug Information Services↗
PubMed2006

Punitive action or gentle persuasion: exploring police officers' justifications for using dual arrest in domestic violence cases.

Mandatory and preferred arrest policies may be resulting in a backlash for victims who are arrested along with their batterers. Little prior research has explored why officers engage in dual arrests. The current study examines the rationales employed by officers to justify dual arrests in a preferred arrest jurisdiction. Content analysis of thought protocols of police officers (n=24) who reported they would arrest both parties was undertaken. Officers justified arrest of both parties, citing that such was required by law and the desire to force both parties to obtain counseling for their relationship. Implications for policy development are examined.

Adult↗
PubMed2006

A review of improved ethical practices in environmental and public health research: case examples from native communities.

This article presents a review of 14 case studies and articles of research ethics issues in the conduct of environmental and public health research with Native American and other indigenous populations. The purpose of this review is to highlight new practices in the ethical conduct of research with native community populations. The findings from this review can promote more dialogue and policy development on the issue of community protections in research. Formal guidelines exist in ethical codes for individual rights as human subjects, but there is a lack of development on community rights in the ethics of research. This review illustrates how community-based participatory research practices can provide working guidelines that can overcome past research harms. More important, the compilations of guidelines offer tested field methods for improving the ethical conduct of research with native community populations.

Community Participation↗
PubMedDate not supplied

An adaptation of Bigge's classification of learning theories to health education and an analysis of theory underlying recent health education programs.

This paper attempts to examine the practice of health education from the perspective of learning theory. Examples of recent health education programs are discussed in this context. It is suggested that, in general, health education and program rationales are firmly rooted in learning theory, but that goals, educational interventions, and evaluation methods are not always consistent with the learning theory apparently underlying the program. Furthermore, it is suggested that such inconsistencies are relevant to many controversial issues in health education and may have considerable impact on policy development.

Behavior Therapy↗
PubMed2004

Perceptions of well-being in sexual ill health: what role does age play?

This article explores the ways in which age can mediate the impact of sexual health problems on psychological well-being, and reports a qualitative interview study with 69 participants (aged 31-92). Data were analysed using 'Framework' and the following themes identified. Participants self-defined their sexual health problems, and these included tiredness, erectile dysfunction and menopause. Older participants reported more physical conditions of a long-term nature and younger participants experienced more shorter-term problems. The effect these had on the sufferer varied with regard to perceived aetiology and longevity of the problem, for instance older participants perceived some problems as age-related which buffered impact on well-being. The findings are discussed in relation to their implications for health care and policy development.

Adult↗