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PubMed2006

Counterfeit and substandard antimalarial drugs in Cambodia.

Counterfeit and substandard antimalarial drugs can cause death and contribute to the growing malaria drug resistance problem, particularly in Southeast Asia. Since 2003 in Cambodia the quality of antimalarial drugs both in the public and private health sector is regularly monitored in sentinel sites. We surveyed 34% of all 498 known facilities and drug outlets in four provinces. We collected 451 drug samples; 79% of these were not registered at the Cambodia Department of Drugs and Food (DDF). Twenty-seven percent of the samples failed the thin layer chromatography and disintegration tests; all of them were unregistered products. Immediate action against counterfeit drugs was taken by the National Malaria Control Program (NMCP) and the DDF. They communicated with the Provincial Health Department about the presence of counterfeit antimalarial drugs through alert letters, a manual, annual malaria conferencing and other training occasions. Television campaigns to alert the population about counterfeit drugs were conducted. Moreover, the NMCP has been promoting the use of good quality antimalarial drugs of a blister co-packaged combination of artesunate and mefloquine in public and private sectors. Appropriate strategies need to be developed and implemented by relevant government agencies and stakeholders to strengthen drug quality assurance and control systems in the country.

Antimalarials↗
PubMed2006

Perceived barriers to implementation of a successful sharps safety program.

IN RESPONSE TO INCREASING needle sticks and sharps injuries at a large, urban trauma center in the northeastern United States, a nurse educator assembled a focus group of OR staff members to determine what they perceived to be barriers to successful implementation of a sharps safety program. THE FOCUS GROUP IDENTIFIED inadequate communication, powerlessness, resistance to change, intimidation, inconsistencies in practice, negative attitudes, inexperienced staff members, and time constraints as barriers to a successful change implementation. USING THIS INFORMATION, the nurse educator identified strategies to implement a practice change to decrease the rate of needle sticks and sharps injuries.

Focus Groups↗
PubMed1982

Newborn screening for hemoglobinopathies in New York State: experience of physicians and parents of affected children.

Responses of physicians and parents to New York State-mandated newborn screening for sickle cell disease were solicited and evaluated. The index group comprised 25 infants born in western upstate New York. Each was found to have either sickle cell disease, hemoglobin SC disease, sickle beta-thalassemia, or hemoglobin C disease. In nondirective interviews the following factors were assessed: clinical course, the physician's policies of disease treatment and family counseling, the parents' reactions to the diagnosis and their level of understanding and compliance with medical recommendations, and the physicians' and parents' views on newborn screening. Newborn screening for sickle hemoglobin makes early prophylaxis and prompt treatment possible. Some morbidity may have been averted, judging from parental understanding of medical needs. Parents and physicians agreed that newborn screening for hemoglobinopathies is a valuable public health program. Suggestions for improving the New York state program included a need to increase communication among the screening laboratory, the hospital, and the physician; encouraging physicians to educate parents more fully, provide genetic counseling, and test parents and siblings of the identified neonate; and, most important, provide a well-delineated mechanism for follow-up of every infant with a potentially symptomatic hemoglobinopathy.

Age Factors↗
PubMed2001

Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis.

Few studies have examined sexual risk behaviors among drug users in the context of their primary sexual relationships. The aim of this study is to examine characteristics of sexual partners associated with inconsistent condom use among a sample of 703 cocaine and opiate users from Baltimore, MD who participated in a network oriented intervention study of human immunodeficiency syndrome (HIV) risk behaviors among drug users. The current study examines relationship characteristics between drug users and their sexual partners (n=1003). Some of the study participants had more than one sexual partner, accounting for the greater number of sexual pairs than study participants. Study participants reported using multiple drugs (56% injected, 48% sniffed heroin, and 48% smoked crack) and that 70% of their sexual partners also used heroin and/or cocaine. Forty percent reported consistent condom use in the past 3 months. In multiple logistic regression, characteristics associated with consistent condom use were, the drug user being HIV infected; not living with their sexual partners; and not being financially interdependent. Previous research has demonstrated lower rates of condom use with main compared with casual and exchange partners. Primary sexual partners provide a sense of stability and introducing condoms may not be desirable or realistic. HIV prevention programs that target drug users should focus on the benefits, such as trust and a sense of security, and risks of not using condoms in primary relationships. Programs should also focus on enhancing communication and negotiation skills through targeting individuals as well as couples.

Adolescent↗
PubMed1991

Ethics committees.

Three kinds of ethics committees should be distinguished, the mandatory local hospital or clinic-based committee, the statutory national committee set up to issue licences, or survey issues highlighted by local committees, or in the national press, reporting to Parliament, and publishing annual reports; and the committee established either temporarily or on a permanent basis to examine outstanding and general problems in the morals of medical practice and research, and to advise Ministers as to possible changes in the law. At all levels, such committees will be concerned with moral problems, and can never, therefore, be expected to come up with uniquely 'correct' solutions. Nevertheless they are essential both to reassure the public and to give guidance to the medical profession, both in clinical practice and research. Such committees should, at all levels, have a non-medical chairman, and a high proportion of 'lay' members. They must have regard to common moral sentiments, and to what will be morally acceptable in the country as a whole (though they can never hope for total agreement with their conclusions). Their recommendations, being in the sphere of public rather than private morality will be as far as possible the outcome of consensus, without which legislation is not possible.

Advisory Committees↗
PubMed2000

Interventions to facilitate communication in autism.

The purpose of this article is to discuss research opportunities arising from the current literature in the area of communication. Six general themes are discussed, including (a) increasing spontaneity, initiations, and the variety of functions of language verbal and nonverbal children with autism exhibit; (b) assessing and teaching precursors relating to positive outcome; (c) the importance of family involvement in intervention programs; (d) best practices for implementation of communicative interventions; (e) the interrelationship between language and other behavioral symptoms of autism; and (f) the social and pragmatic use of language. These areas are discussed in terms of improving assessment and intervention practices to produce greater long-term communicative outcomes for individuals with autism.

Autistic Disorder↗
PubMed2002

Clinical networks for nursing research.

As a central feature of national research and development strategies, clinical effectiveness emphasizes the importance of rigorous experimental research in nursing. It is naïve to assume that over-worked practitioners, with little research training and supervision, can undertake this type of research. Traditional approaches to research support rely on the practitioner registering for a higher degree and academic supervision. This assumes that the responsibility for research lies with practice, with higher education adopting a reactive stance in supporting research and development in nursing. The literature demonstrates a growing number of innovative models for facilitating nursing research. These, however, tend to focus on single appointments with limited and predefined access to clinical areas and patient populations. This article details a new initiative from the Clinical Nursing Practice Research Unit (CNPRU) that aims to support programmatic research in nursing practice through Clinical Networks for Nursing Research. Our research strategy is to contribute to the development of nursing science by facilitating effective collaboration between clinicians and higher education in core clinical specialties, including stroke rehabilitation, diabetes, mental health and community nursing. Each researcher has developed networks with a number of clinical areas, locally, regionally or nationally, through seminars, conferences or newsletters, to link practitioners and generate answerable research questions. Network communications also rely heavily on the establishment of interactive websites. This strategy has resulted in a number of collaborative, evaluative studies including clinical trials in rehabilitation, diabetic nursing and primary care.

Clinical Nursing Research↗
PubMedDate not supplied

TB-HIV Registry Matching in Missouri, 1987-1999.

Mycobacterium tuberculosis (MTB) is an important problem for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. This study investigated whether all cases of MTB reported to the HIV/AIDS Registry (HARS) in Missouri were also reported to the Tuberculosis Information Management System (TIMS) to determine the sensitivity of TIMS and the predictive value of HARS. We found 262 total MTB cases registered in HARS. Of these, 145 (55%) were included in the TIMS. Thirty-eight of the remaining 117 were caused by mycobacteria other than TB leaving 79 for investigation. Chart review of the 79 revealed 16 cases of MTB. Sensitivities and predictive values were calculated first including unknown/unreported group as being MTB-positive and the second including this group as being MTB-negative. Sensitivities for TIMS were 83 and 90%, respectively, and predictive values for HARS were 68 and 63%, respectively. The fact that there were at least 16 unreported cases of MTB has significant public health implications for TB control in Missouri. Public health nursing could work with HARS surveillance staff to help improve the accuracy of case finding and reporting. By whatever means necessary, communications between the TB and HIV programs within the Missouri Department of Health should be enhanced.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

A real-time video pattern generator for use in ophthalmology.

An automated real-time microcomputer-based video pattern generator for use in optometry and ophthalmology is presented. The system can generate various vision pattern tests including a static and dynamic random dot stereogram that can be used to test depth perception. The patterns are generated in real time, which provides the ability to generate programmable images with objects that can move at different speeds. This feature is very useful in testing depth perception among infants and non-communicative people by correlating the movement of the eye with the movement of the object. The system also can generate other patterns such as checkerboards, vertical and horizontal bars, and provide the ability to sweep the size of the checkers and bars. These patterns are also useful for testing visual acuity. The system hardware is based on the TMS34010 graphics processor and hardware circuits and is connected to a host computer through a RS-232C serial communication port. Both control and application programs are written in assembly language. The system is fast, versatile and flexible with affordable cost.

Computer Graphics↗
PubMed1991

Communicating the risk from radon.

A prominent television station developed a special series of newscasts and public service announcements about radon. This was combined with their advertising of the availability of reduced-price radon test kits in a local supermarket chain. The large number of test kits sold was a success from a marketing perspective, but not from a public health perspective--especially because of the very small share of high readings that were mitigated. In contrast, a study of housing sales showed a much higher testing rate and corresponding mitigation when risk communication accompanied the housing transaction, rather than being directed toward the general public. This paper examines the relative effectiveness of these alternative approaches to radon risk communication, emphasizing the implications for developing and implementing radon programs.

Communication↗
PubMedDate not supplied

Spatio-temporal organization of the mitochondrial phase of apoptosis.

Signaling cascades often utilize highly ordered interactions between intracellular organelles to propagate a particular signal throughout the cell. In many apoptotic paradigms, the stress signal is delivered to the mitochondria, and mitochondria release to the cytosol several apoptotic factors, which in turn, trigger execution of the program of cell suicide. Although intermitochondrial communication has been shown to give rise to regenerative phenomena such as Ca2+ release waves and depolarization waves, it has not been elucidated whether mitochondria interact with each other during apoptosis and whether the postmitochondrial phase of apoptosis displays a coordinated response throughout the cell. The objective of this review is to draw attention to recent observations that shed some light onto the subcellular spatio-temporal organization of the apoptotic machinery.

Animals↗
PubMed2001

Community involvement at what cost?--local appraisal of a pan-European nutrition promotion programme in low-income neighbourhoods.

In the UK, government has committed itself to improving health and reducing inequalities in health. For the first time, issues such as food poverty will be addressed by tackling the causes of poverty and wider determinants of ill health. The time has never been better, therefore, for health and local authorities to work collaboratively to promote and improve health. Community involvement is also paramount to sustainable programmes. However, such a dramatic shift in policy and greater emphasis on public health requires health professionals themselves to adopt a different approach. The World Health Organization (WHO) recommends a health promotion approach as a framework for action. But despite the existence of this framework there is little evidence that a wider understanding of health promotion and the necessary practical experience has been achieved. This has weakened the potential impact of health promotion and has possibly encouraged inappropriate use of health promotion principles in practice. The European Food and Shopping Research Project (SUPER project) was established under the WHO European network of Healthy Cities to help local projects implement the principles of health promotion (WHO, 1986). This paper describes the SUPER project and its implementation in Liverpool (1989-1997), where levels of unemployment, deprivation and ill health are amongst the highest in the UK. Participation in SUPER is appraised to identify the various benefits and obstacles involved and to identify links with progress at the local level. This appraisal is discussed and the use, and potential misuse, of participatory appraisal techniques to elicit information and mobilize communities is examined.

Community Health Planning↗