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Poor Compliance (poor + compliance)

Distribution by Scientific Domains

Medical Sciences	92%
2 Other Domains	8%

Distribution within Medical Sciences

Cardiovascular Disease	7%
18 Other Subdomains	79%

Selected Abstracts

The Impact of Race on the Acute Management of Chest Pain

ACADEMIC EMERGENCY MEDICINE, Issue 11 2003
Arvind Venkat MD
Abstract Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non,ST-elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non-ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non-ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non-ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non-ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation. [source]

Poor radiotherapy compliance predicts persistent regional disease in advanced head/neck cancer,

THE LARYNGOSCOPE, Issue 3 2009
Urjeet A. Patel MD
Abstract Objective: To determine if poor compliance to chemoradiation results in an increased rate of persistent neck disease. Study Design: Retrospective, cohort study in an urban, tertiary-care medical center. Methods: The study included patients with N+ stage III/IV squamous cell carcinoma of the upper aerodigestive tract treated with curative-intent chemoradiation, who underwent subsequent planned neck dissection. Main outcome measure was persistent regional disease evidenced by identifiable carcinoma in neck dissection specimens. Variables including age, gender, race, primary site, initial T, N staging, imaging results, and treatment compliance were assessed and correlated to positive neck dissection pathology. Results: Of 40 patients, 18 (45%) had persistent carcinoma in neck dissection specimens while 22 (55%) demonstrated complete response in the neck. There were 14 patients (35%) who were poorly compliant to radiotherapy (,14 days treatment interruption) and the remaining 26 patients (65%) were considered compliant (<14 missed days). Only 23% of compliant patients had positive pathology while 79% of noncompliant patients had positive pathology (hazard ratio: 9.9). Noncompliance was the only variable that had a statistically significant correlation to positive pathology results (P = .002). Multivariate logistic regression showed all other variables to be insignificant in predicting pathology. Conclusions: This study found that poorly compliant patients are at significantly higher risk of persistent neck disease. Poor compliance may help identify patients who will most benefit from neck dissection after chemoradiation. This variable was more predictive than pretreatment variables and posttreatment CT scan. Further studies investigating patterns of failure after chemoradiotherapy in the poorly compliant patient population are warranted. Laryngoscope, 2009 [source]

Current Lifestyle of Young Adults After Liver Transplantation During Childhood

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010
J. P. Dommergues
The authors studied the psychosocial adjustment of pediatric liver transplant (LT) recipients reaching adulthood. The study comprised phone interviews of 116 volunteers aged 17,33 years. Results were compared to those for healthy peers and 65 patients who were eligible for inclusion but did not participate. Participants' median age at LT was 6 years and the median period since LT was 15 years. Of the 116 participants, 76% considered their quality of life as good or very good. Seventy-five patients (65%) were attending schools, 27 of whom were 2 years or more below the age-appropriate level. Of the remaining 41 patients, 26 had a job and 15 were unemployed. Poor compliance with medications was reported by 52 patients (45%). Alcohol consumption was lower than in the reference population (p < 0.001). Anxiety, loneliness and negative thoughts were expressed by 53, 84 and 47% of the participants, respectively. Thirteen patients (11%) were being cared for by psychologists or psychiatrists. The 65 nonparticipants had greater psychological problems than the participants, and a lower educational level. In conclusion, after LT in early life, most patients displayed psychological vulnerability during early adulthood. The educational level of patients was lower than that of theirs peers. [source]

The case for long-acting antipsychotic agents in the post-CATIE era

ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2007
H. A. Nasrallah
Objective:, Long-acting antipsychotic agents were developed to promote treatment compliance in patients requiring maintenance treatment for schizophrenia. Method:, An analysis of the impact of non-compliance on treatment outcomes in schizophrenia and the advantages and disadvantages of long-acting antipsychotics. Results:, Partial or total non-compliance with oral antipsychotics remains widespread and is associated with significant increases in the risk of relapse, rehospitalization, progressive brain tissue loss and further functional deterioration. Long-acting agents have the potential to address issues of all-cause discontinuation and poor compliance. The development of the first long-acting atypical antipsychotic, which appears to be effective and well tolerated, should further improve the long-term management of schizophrenia. Conclusion:, Long-acting agents represent a valuable tool for the management of schizophrenia and merit wider use, especially in light of emerging literature regarding the neuroprotective advantages of atypical antipsychotics over conventional agents in terms of regenerating brain tissue during maintenance therapy. [source]

Postprandial hyperglycaemia in type 2 diabetes: pathophysiological aspects, teleological notions and flags for clinical practice

DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S2 2004
Eleni I. Boutati
Abstract Type 2 diabetes subjects carry an excess risk for micro- and macrovascular disease and a higher cardiovascular morbidity and mortality rate. The beneficial impact of tight glycaemic control,evidenced by the integrated marker of fasting glucose and postprandial glucose values, the HbA1c,for the prevention of microvascular complications is definitely confirmed. Over the past few years, several studies have identified postprandial hyperglycaemia as a better predictor of cardiovascular or even of all-cause mortality, as well as an independent risk factor for atherosclerosis. The continuous glucose monitoring could offer a rationale means for the detection of postprandial hyperglycaemia and ultimately for its effective management. Advances in technology keep a promise for a reliable, convenient and closer to the idea of the artificial endocrine pancreas glucose sensor. Subcutaneous glucose levels charted by one of the new sensors were found to be well correlated with venous glucose measurements. Intervention for a healthy lifestyle is frequently hampered by patients' poor compliance. The availability of diverse antidiabetic agents provides options for targeting the glycaemic goal and a choice more fitted to the particularized pathophysiology of each individual subject. Drugs targeting postprandial glycaemia may prove to represent the ,sine qua non' for the ,return' of postprandial glucose values at a ,non-deleterious' threshold, either as monotherapy for the early stages of the disease or as combination therapy later in the progression of diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Bacterial endocarditis in a child with haemophilia B: risks of central venous catheters

HAEMOPHILIA, Issue 5 2001
D. K. Hothi
The use of central venous catheters may be complicated by thrombosis and infection. We report a case of a needle-phobic 5-year-old boy with factor IX deficiency, in whom a portacath was inserted owing to poor compliance with prophylactic treatment. Within a week, he developed a Staphylococcus aureus line infection that was treated with a 2-week course of intravenous antibiotics. One month later he presented with nonspecific symptoms and blood cultures again grew S. aureus. An echocardiogram revealed a large vegetation adherent to the tricuspid valve, confirming the diagnosis of bacterial endocarditis. His clinical course was further complicated by the development of pulmonary emboli. Medical treatment with intravenous antibiotics led to a successful resolution of the endocarditis and pulmonary emboli with a favourable long-term outcome. [source]

A Community-Based Study of Helicobacter pylori Therapy Using the Strategy of Test, Treat, Retest, and Re-treat Initial Treatment Failures

HELICOBACTER, Issue 5 2006
Yi-Chia Lee
Abstract Background:, Although eradication of Helicobacter pylori infection can decrease the risk of gastric cancer, the optimal regimen for treating the general population remains unclear. We report the eradication rate (intention-to-treat and per protocol) of a community-based H. pylori therapy using the strategy of test, treat, retest, and re-treat initial treatment failures. Materials and methods:, In 2004, a total of 2658 residents were recruited for 13C-urea breath testing. Participants with positive results for infection received a standard 7-day triple therapy (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and clarithromycin 500 mg twice daily), and a 10-day re-treatment (esomeprazole 40 mg once daily, amoxicillin 1 g twice daily, and levofloxacin 500 mg once daily) if the follow-up tests remained positive. Both H. pylori status and side-effects were assessed 6 weeks after treatment. Results:, Among 886 valid reporters, eradication rates with initial therapy were 86.9% (95% confidence interval [CI]: 84.7,89.1%) and 88.7% (95%CI: 86.5,90.9%) by intention-to-treat and per protocol analysis, respectively. Re-treatment eradicated infection in 91.4% (95%CI: 86,96.8%) of 105 nonresponders. Adequate compliance was achieved in 798 (90.1%) of 886 subjects receiving the initial treatment and in all 105 re-treated subjects. Mild side-effects occurred in 24% of subjects. Overall intention-to-treat and per protocol eradication rates were 97.7% (95%CI: 96.7,98.7%) and 98.8% (95%CI: 98.5,99.3%), respectively, which were only affected by poor compliance (odds ratio, 3.3; 95%CI, 1.99,5.48; p < .0001). Conclusions:, A comprehensive plan using drugs in which the resistance rate is low in a population combined with the strategy of test, treat, retest, and re-treat of needed can result in virtual eradication of H. pylori from a population. This provides a model for planning country- or region-wide eradication programs. [source]

Structured treatment interruption in patients with alveolar echinococcosis

HEPATOLOGY, Issue 2 2004
Stefan Reuter
In human alveolar echinococcosis (AE), benzimidazoles are given throughout life because they are only parasitostatic. It has been a longstanding goal to limit treatment, and recent reports suggest that, in selected cases, benzimidazoles may be parasitocidal. Previously, we showed that positron ,emission tomography (PET) using [18F]fluoro-deoxyglucose discriminates active from inactive lesions in AE. We have now performed a 3-year prospective study in 23 patients and conducted a structured treatment interruption in those without signs of PET activity. Disease progression was further assessed by ultrasound, computerized tomography, laboratory parameters, and clinical examination. We found PET-negative lesions in 15 of 23 patients and benzimidazoles were discontinued in these patients. After 18 months, patients were reevaluated, and, of the 15 initially PET-negative patients, 8 showed either new activity on PET (n = 6) or signs of clinical progression (n = 2). Reinitiation of benzimidazoles halted parasite growth again. No further progression was detected after 36 months. PET had a sensitivity of 91% for the detection of active lesions. In conclusion, despite successful suppression of metabolic activity, in most cases benzimidazoles do not kill the parasite. PET is a reliable tool for assessing metabolic activity and for timely detection of relapses. Neither duration of treatment, kind of treatment, lesion size, calcifications, or regressive changes reliably indicate parasite death. We discourage the discontinuation of benzimidazoles in inoperable AE even after many years of treatment. However, patients with a poor compliance of benzimidazole intake or patients suffering from side effects to benzimidazoles might be assessed for PET negativity. If permanent discontinuation of benzimidazoles is attempted, the course of disease should be followed by PET. (HEPATOLOGY 2004;39:509,517.) [source]

The development and pilot evaluation of a nutrition education intervention programme for pregnant teenage women (food for life)

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 2 2003
W. L. Wrieden
Abstract Background A healthy diet in pregnancy is important for both maternal and infant health but this may be difficult to achieve particularly for groups such as teenage pregnant women, many of whom are from disadvantaged backgrounds. To our knowledge this is the first report of a practical nutrition education programme for this group in the UK. Method An intervention was designed incorporating seven informal food preparation sessions, which allowed opportunities for discussion of nutritional, and other topics (e.g. food safety and well-being in pregnancy). Midwives in a community centre setting led the sessions. The acceptability of the package to participants and midwives was recorded and pre- and post-intervention data collected on sociodemographic details, dietary intake (using an eating-habits questionnaire and a 24-h dietary recall) and cooking skills. Results The midwives found the package easy to follow and use. The 16 (of the 120 invited) women who attended found the courses helpful but objective evaluation of dietary intake was not possible because of poor compliance. Conclusions The nutrition education programme was favourably received by midwives and the women who participated. However recruitment was problematic and alternative methods of delivering and evaluating such a package should be investigated. [source]

Recent developments in the management of postmenopausal osteoporosis with bisphosphonates: enhanced efficacy by enhanced compliance

JOURNAL OF INTERNAL MEDICINE, Issue 4 2008
S. Boonen
Abstract. Bisphosphonates are the current mainstay of treatment for postmenopausal osteoporosis. Although daily oral dosing is effective, it is associated with poor compliance, partly because of the pre and postdose fasting and posture requirements. This negatively impacts treatment outcomes, leading to a reduced clinical benefit. Improved, yet still suboptimal adherence has been noticed with less frequent bisphosphonate dosing e.g. once-weekly and once-monthly oral regimens. The recently approved quarterly intravenous (i.v.) injection regimen of ibandronate and yearly i.v. infusion of zoledronic acid are attractive options in the management of postmenopausal osteoporosis. These regimens may assure quarterly and year long compliance. [source]

Relative in vitro efficacy of the phosphate binders lanthanum carbonate and sevelamer hydrochloride

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 10 2007
Valerie Autissier
Abstract The high tablet burden and poor compliance associated with phosphate-binding drugs has led to a search for more potent agents. In vitro -binding studies were performed on the recently introduced binder, lanthanum carbonate (LC; Fosrenol®), to compare its phosphate-binding affinity with sevelamer hydrochloride (SH; RenagelÔ). Langmuir equilibrium binding affinities (K1) for LC and SH were established using different phosphorus (5,100 mM) and binder (134,670 mg per 50 mL) concentrations at pH 3,7, with or without salts of bile acids present (30 mM). At all pH levels, LC had a higher binding affinity for phosphate than SH. For LC, K1 was 6.1,±,1.0 mM,1 and was independent of pH. For SH, K1 was pH dependent, being 1.5,±,0.8 mM,1 at pH 5,7 and 0.025,±,0.002 mM,1 at pH 3, that is, >200 times lower than for LC. In the presence of 30 mM bile salts, SH lost 50% of its phosphate, whereas no displacement of phosphate occurred for LC. These findings indicate that LC binds phosphate more effectively than SH across the pH range encountered in the gastrointestinal tract, and has a lower propensity for bound phosphate to be displaced by competing anions in the intestine. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 96: 2818,2827, 2007 [source]

Decreasing incidence of hepatocellular carcinoma among children following universal hepatitis B immunization

LIVER INTERNATIONAL, Issue 5 2003
Mei-Hwei Chang
Abstract: Hepatocellular carcinoma (HCC) is one of the 10 most common malignant tumors worldwide. Chronic infection with hepatitis B or C virus is closely related to hepatocarcinogenesis. The outcome of current therapies for HCC is not satisfactory. Prevention is the best way to control HCC. Among the various strategies of HCC prevention, immunization against hepatitis B virus infection is the most effective. Universal hepatitis B immunization has proved to be effective in reducing the incidence of HCC to 1/4,1/3 of that in children born before the hepatitis B vaccination era in Taiwan. The problems we face in achieving global control of hepatitis-related HCC include: (1) no effective vaccine for the prevention of hepatitis C and its related HCC; (2) no immunization program for hepatitis B in areas with inadequate resources; (3) poor compliance to the immunization program as a result of ignorance, anxiety, or poverty; and (4) vaccine failure. Integration of the hepatitis B vaccination program into the expanded program of immunization for all infants throughout the world will be most urgent and important for HCC control. The reduction of the incidence of HCC will be seen in adults 30,40 years of age after the launch of the universal hepatitis B vaccination program. This concept of cancer vaccine can be applied to other infectious agents and their related cancers. [source]

Cause of death in Wilson disease

MOVEMENT DISORDERS, Issue 15 2007
John M. Walshe MD
Abstract Before 1948, all patients with Wilson disease died shortly after diagnosis. In 1948, BAL (dimercaprol) was introduced as a possible effective treatment, to be followed by penicillamine (1955), zinc salts (1961), trientine (1969), liver transplantation (1982), and tetrathiomolybdate (1984). Despite this wide range of therapeutic options, patients still die. This article examines the cause of death in 67 patients (33 men, 34 women) out of a series of 300 seen between 1948 and 2000. Patients were classified according to their presentation as neurological, 32 patients, hepatic 11, mixed hepatic/neurological 10, hemolytic, 6, and "sibling biopsy " 8. Diagnostic failure was the principal cause of death but there were multiple other causes of which the principal was poor compliance and the development of malignant disease after 10 years of follow-up. The development of new symptoms should alert the physician to the possibility of a new pathology. © 2007 Movement Disorder Society [source]

Leg clubs: A new approach to patient-centred leg ulcer management

NURSING & HEALTH SCIENCES, Issue 3 2000
DNCERT, DipHE, Ellie Lindsay BSC(HONS)
Abstract Loneliness is a significant health-care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self-esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non-medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ,club' concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non-compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long-standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ,well leg' checks and ongoing health education has dramatically reduced the incidence of recurrence. [source]

Weight gain profiles of new anti-psychotics: public health consequences

OBESITY REVIEWS, Issue 3 2003
S. Tardieu
Summary Anti-psychotic medications are an important therapeutic option for many individuals with schizophrenia. Recently, a growing interest has been observed on weight gain, which is now a well-known adverse effect of many anti-psychotics. As obesity is frequently a comorbid condition with schizophrenia, patients with schizophrenia are inherently at increased risk of developing obesity-related conditions such as cardiovascular disease and type 2 diabetes. The consequences of excessive weight gain (obesity) associated with anti-psychotic drugs are likely to include adverse effects on health, social burden and poor compliance or even discontinuation of therapy by the patients. In this article, we focus on different aspects of weight gain induced by anti-psychotics. This review comprises the following sections: (i) the pharmacological basis of anti-psychotic-induced weight gain and metabolic effects with a review of all anti-psychotics that can be used in patients with schizophrenia; (ii) the clinical impact of the body weight gain (morbidity, psychatric consequences, mortality); (iii) the management of obesity (identification of risk factors including pharmacogenetics, diet, behavioural therapies, pharmacological approach). An understanding of these aspects is important for those who prescribe anti-psychotics in order to provide the patient the best therapeutic management. [source]

Chronic open angle glaucoma: patient awareness of the nature of the disease, topical medication, compliance and the prevalence of systemic symptoms

OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2004
Sunil Deokule
Abstract Purpose:, To study the awareness of the nature of the disease, compliance with treatment, and prevalence of systemic symptoms in a group of patients with chronic open angle glaucoma (COAG). Method:, A structured questionnaire was designed and given to 260 consecutive COAG patients attending a general ophthalmology clinic. Questions related to the increased risk of COAG amongst family members, screening of family members, nature of field defects, variation in IOP, topical treatment and availability of a free eye test for a COAG patient in the UK were asked. Compliance and systemic symptoms were also assessed. Results:, Forty-one per cent (107 of 260) of patients in the study group were aware of the increased risk of COAG in family members and 45.5% (118 of 260) of patient's family members had undergone screening for COAG. Seventy-three per cent (191 of 260) of the patients were aware of their own and their family members' entitlement to a free eye test. Seventy-seven per cent of patients claimed full compliance. Thirty per cent of patients were noted to have systemic symptoms. Conclusions:, The awareness of the nature of COAG in this population was low and incidence of perceived drug related systemic symptoms very high. Both of these may contribute to poor compliance. [source]

The Effectiveness of Transtelephonic Monitoring of Pacemaker Function in Pediatric Patients

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2007
SCOTT A. FOX M.B.B.S.
Background:To determine the sensitivity and specificity, rate of compliance, and predictors of failure of telephone transmission of pacemaker function in a pediatric population. Methods:A total of 2,638 pacemaker transmission records were reviewed retrospectively. Standard calculations of sensitivity, specificity, and positive and negative predictive values were performed. Longitudinal data analysis was used to detect factors influencing the effectiveness of transtelephonic monitoring. The proportion of missed transmissions was calculated, thus enabling assessment of compliance. Logistic regression was performed to determine predictors of poor compliance. Results:Telephone transmission of pacemaker function, as a diagnostic tool, had a sensitivity of 94.8%, specificity of 99.2%, positive predictive value of 82.1%, and negative predictive value of 99.9%. Longitudinal analysis failed to show any significant predictors of transmission failure. Compliance with a prescribed transmission reached 84.5% in our patient population. Logistic regression analysis failed to identify any predictors of noncompliance. Conclusion:Values for sensitivity and specificity indicate that telephone transmission is a useful diagnostic tool for assessing pacemaker function at a distance. Negative predictive value is 99.9%, indicating that normal telephone transmissions are very reassuring of normal pacemaker function. Telephone transmission is equally successful in all age groups, genders, distances from a tertiary referral center, underlying diagnoses, pacing modes, and pacemaker models. Compliance with telephone transmission follow-up was higher in our population than in previous studies. [source]

Successful Treatment of Pediatric Psoriasis with Indigo naturalis Composite Ointment

PEDIATRIC DERMATOLOGY, Issue 5 2006
Yin-Ku Lin M.D.
Many modes of therapy are currently in use but the disease is often resistant to treatment owing to the unacceptable toxicity that leads to poor compliance. Therefore, to develop an alternative treatment is indispensable. Traditional Chinese medicine has been documented for over 1000 years to provide various effective treatments for inflammatory skin diseases. Herein, we report an 8-year-old boy with recalcitrant pediatric psoriasis who, after multiple treatment failures with conventional antipsoriatic medications, showed remarkable clinical improvement with 8 weeks of topical treatment with Indigo naturalis composite ointment. Remission has lasted for over 2 years until now. Our patient's response suggests that topical Indigo naturalis composite ointment may provide a safe and effective alternative treatment for pediatric psoriasis. [source]

The Pennsylvania certified safety committee program: An evaluation of participation and effects on work injury rates

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 8 2010
Hangsheng Liu PhD
Abstract Background Since 1994, Pennsylvania, like several other states, has provided a 5% discount on workers' compensation insurance premiums for firms with a certified joint labor management safety committee. This study explored the factors affecting program participation and evaluated the effect of this program on work injuries. Methods Using Pennsylvania unemployment insurance data (1996,2006), workers' compensation data (1998,2005), and the safety committee audit data (1999,2007), we conducted propensity score matching and regression analysis on the program's impact on injury rates. Results Larger firms, firms with higher injury rates, firms in high risk industries, and firms without labor unions were more likely to join the safety committee program and less likely to drop out of the program. The injury rates of participants did not decline more than the rates for non-participants; however, rates at participant firms with good compliance dropped more than the rates at participant firms with poor compliance. Conclusions Firm size and prior injury rates are key predictors of program participation. Firms that complied with the requirement to train their safety committee members did experience reductions in injuries, but non-compliance with that and other requirements was so widespread that no overall impact of the program could be detected. Am. J. Ind. Med. 53:780,791, 2010. © 2010 Wiley-Liss, Inc. [source]

Diabetes mellitus in Sudan: the size of the problem and the possibilities of efficient care

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 9 2001
Awad Mohamed Ahmed MBBS MD Consultant Physician Assistant Professor of Medicine
Abstract Sudan has, for a long time, suffered economic collapse, drought and civil war. Diabetes mellitus is currently emerging as an important health problem, especially in urban areas. The actual prevalence of diabetes is unknown although one small study showed a prevalence of 3.4%. Diabetes is the commonest cause of hospital admission and morbidity due to a non-communicable disease (7 and 10% respectively). The problems of diabetes care in Sudan include the lack of efficient diabetes care centres, lack of specially trained personnel, the high cost of anti-diabetic treatments, poor compliance with therapy or diet, ignorance and wrong beliefs, food and dietary factors and gender-related problems. The goal of efficient diabetes care can be achieved through implementing a national diabetes programme. This programme should be responsible for personnel training, establishing model care centres, patients' education, availability and affordability of insulin, scientific and clinical research and primary prevention. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Behavioral Medicine Strategies for Heart Disease Prevention: The Example of Smoking Cessation

PREVENTIVE CARDIOLOGY, Issue 1 2000
Barrie J Guise PhD
Health related behavior change is one of the most important challenges in the prevention of cardiovascular disease. Lifestyle patterns, such as high fat diet, lack of exercise, persistent smoking, and poor compliance with prescribed medications present the core of this challenge. Conventional wisdom and considerable scientific evidence establish that the barriers to health related behavior change are many and varied. However, much is also known about methods of improving behavioral outcomes. Behavioral medicine strategies incorporate fundamental principles of behavior change together with biomedical and interpersonal approaches to facilitate successful cardiac risk factor modification. Physicians have the most potent opportunity to assist patients with health behavior change. Unfortunately, physicians are least familiar with behavior change technology and the contemporary physician-patient relationship lacks the partnership needed to succeed in these difficult areas. The good news is that medical education has begun to incorporate training in behavior change and interpersonal effectiveness. A description of the behavioral medicine approach to smoking cessation provides an excellent model for a thoughtful and practical approach to heart disease prevention in every day practice. [source]

Counting on codes: An examination of transnational codes as a regulatory governance mechanism for nanotechnologies

REGULATION & GOVERNANCE, Issue 2 2009
Diana M. Bowman
Abstract This article examines the rise of nanotechnology-specific codes of conduct (nano-codes) as a private governance mechanism to manage potential risks and promote the technology. It examines their effectiveness as well as their legitimacy as regulatory instruments in the public domain. The study first maps the rise of voluntary nano-codes and the roles played by different actors. Focusing on five specific nano-codes, the article then discusses their adequacy in terms of scientific uncertainty, gaps in existing regulatory regimes, and broader societal concerns. It concludes that these voluntary nano-codes have weaknesses including a lack of explicit standards on which to base independent monitoring, as well as no sanctions for poor compliance. At the same time it also highlights the potential power of these governance mechanisms under conditions of uncertainty and co-regulation with government. It is likely that nano-codes will become the "first cut" of a new governance regime for nanotechnologies. [source]

Yoga in Female Sexual Functions

THE JOURNAL OF SEXUAL MEDICINE, Issue 2pt2 2010
Vikas Dhikav MD
ABSTRACT Introduction., Yoga is a popular form of complementary and alternative therapy. It is practiced both in developing and developed countries. Female sexual dysfunctions are common and do not always get adequate clinical attention. Pharmacotherapies for treating female sexual dysfunctions are available but suffer from drawbacks such as poor compliance, low efficacy, and side effects. Many patients and yoga protagonists claim that it is useful in improving sexual functions and treating sexual disorders. Aim., To establish the effect yoga can have on female sexual functions. Methods., We recruited 40 females (age range 22,55 years, average age 34.7 ± 8.49 years) who were enrolled in a yoga camp and were given a standardized questionnaire named Female Sexual Function Index (FSFI) before and after the 12 weeks session of yoga. Main Outcome Measures., FSFI scores. Results., It was found that after the completion of yoga sessions; the sexual functions scores were significantly improved (P < 0.0001). The improvement occurred in all six domains of FSFI (i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain). The improvement was more in older women (age > 45 years) compared with younger women (age < 45 years). Conclusions., Yoga appears to be an effective method of improving all domains of sexual functions in women as studied by FSFI. Dhikav V, Karmarkar G, Gupta R, Verma M, Gupta R, Gupta S, and Anand KS. Yoga in female sexual functions. J Sex Med 2010;7:964,970. [source]

Poor radiotherapy compliance predicts persistent regional disease in advanced head/neck cancer,

Cystometric evaluation of reconstructed classical bladder exstrophy

BJU INTERNATIONAL, Issue 4 2001
S. Dave
Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Patients and methods Thirty-one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto-urethrography, ultrasonography and artificial slow-filling cystometry. Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty-one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end-fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end-fill pressure of < 40 cmH2O. Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end-fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment. [source]

Emergency Medicine Clerkship Encounter and Procedure Logging Using Handheld Computers

ACADEMIC EMERGENCY MEDICINE, Issue 8 2007
CCFP(EM), Rick Penciner MD
BackgroundTracking medical student clinical encounters is now an accreditation requirement of medical schools. The use of handheld computers for electronic logging is emerging as a strategy to achieve this. ObjectivesTo evaluate the technical feasibility and student satisfaction of a novel electronic logging and feedback program using handheld computers in the emergency department. MethodsThis was a survey study of fourth-year medical student satisfaction with the use of their handheld computers for electronic logging of patient encounters and procedures. The authors also included an analysis of this technology. ResultsForty-six students participated in this pilot project, logging a total of 2,930 encounters. Students used the logs an average of 7.6 shifts per rotation, logging an average of 8.3 patients per shift. Twenty-nine students (63%) responded to the survey. Students generally found it easy to complete each encounter (69%) and easy to synchronize their handheld computer with the central server (83%). However, half the students (49%) never viewed the feedback Web site and most (79%) never reviewed their logs with their preceptors. Overall, only 17% found the logging program beneficial as a learning tool. ConclusionsElectronic logging by medical students during their emergency medicine clerkship has many potential benefits as a method to document clinical encounters and procedures performed. However, this study demonstrated poor compliance and dissatisfaction with the process. In order for electronic logging using handheld computers to be a beneficial educational tool for both learners and educators, obstacles to effective implementation need to be addressed. [source]