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Main Barriers (main + barrier)
Selected AbstractsDementia in primary care: the first survey of Irish general practitionersINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2006Suzanne Cahill Abstract Objective To investigate General Practitioners' (GPs) attitudes and practices in relation to screening, diagnosing, and disclosing a dementia diagnosis to patients. Design National postal survey. Participants A random sample of 600 GPs from a national database of 2400. Results Of the 600 GPs surveyed, 60% returned questionnaires of which 50% (300) were useable. GPs reported diagnosing on average four new cases of dementia annually. A multivariate analysis revealed that females diagnosed significantly fewer cases annually (t,=,5.532, df,=,289, p,<,0.001). A large majority of GPs reported performing thyroid function tests (77%), B12 (75%) and Folic acid tests (75%) to out rule reversible causes of cognitive impairment. The most reliable signs and symptoms of dementia identified were memory problems (58%). Main barriers to diagnosis were difficulty differentiating normal ageing from symptoms of dementia (31%), lack of confidence (30%) and the impact of the diagnosis on the patient (28%). GPs' age (,2,=,14.592, df,=,3, p,<,0.005) and gender (,2,=,11.436, df,=,3, p,<,0.01) were significantly associated with barriers to diagnosis. Only 19% claimed they often or always disclosed a diagnosis to a patient. Over one-third of GPs (38%) reported that the key factor influencing their disclosure patterns was their perceptions of the patient's level of comprehension. Most GPs (90%) had never undergone any dementia specific training and most (83%) expressed a desire for this. Conclusions GPs experience difficulty diagnosing and disclosing a diagnosis of dementia to patients. To improve dementia care in Ireland, there is an urgent need to develop an active and more systematic approach to GP training in dementia care. Copyright © 2006 John Wiley & Sons, Ltd. [source] Thrombolytic treatment for stroke in the Scandinavian countriesACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009K. Bruins Slot Objective,,, We wanted to describe the use of thrombolytic treatment for stroke in Scandinavia, to assess stroke doctors' opinions on this treatment, to identify barriers against treatment, and to suggest improvements to overcome these barriers. Methods,,, We sent questionnaires to 493 Scandinavian doctors, who were involved in acute stroke care. Results,,, We received 453 (92%) completed questionnaires. Overall, 1.9% (range per hospital 0,13.9%) of patients received thrombolytic treatment. A majority (94%) of the respondents was convinced of the beneficial effects of thrombolytic treatment and many (85%) felt that its risks were acceptable. Main barriers were: unawareness of stroke symptoms among patients (82%) and their failure to respond adequately (54%); ambulance services not triaging acute stroke as urgent (23%); and insufficient in-hospital routines (15%). The respondents suggested that the following measures should be prioritized to increase the treatment's use: educational programmes to improve public awareness on stroke and how to respond (96%); education of in-hospital (88%) and prehospital (76%) medical staff. Conclusions,,, A large majority of Scandinavian doctors regard thrombolytic treatment for stroke as beneficial, yet its implementation in clinical practice has so far been poor. Our survey identified important barriers and potential measures that could increase its future use. [source] Dentists' management of dental injuries and dental trauma in Australia: a reviewDENTAL TRAUMATOLOGY, Issue 3 2008Thai Yeng The levels of knowledge demonstrated by surveys of dentists were not high and dentists perceive inadequate financial remuneration as the main barrier to trauma management. With only a limited number of new dental traumatic injuries occurring annually, dentists may not be competent in providing appropriate care. The management of dental trauma and any hesitations that dentists might have in terms of knowledge and skills are important to investigate to formulate an approach to overcome their reluctance. There is a deficiency of literature on this subject. [source] Effect of lipid bilayer alteration on transdermal delivery of a high-molecular-weight and lipophilic drug: Studies with paclitaxelJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 9 2004Ramesh Panchagnula Abstract Skin forms an excellent barrier against drug permeation, due to the rigid lamellar structure of the stratum corneum (SC) lipids. Poor permeability of drugs can be enhanced through alteration in partition and diffusion coefficients, or concentration gradient of drug with an appropriate choice of solvent system, along with penetration enhancers. The aim of the current investigation was to assess applicability of lipid bilayer alteration by fatty acids and terpenes toward the permeation enhancement of a high-molecular-weight, lipophilic drug, paclitaxel (PCL) through rat skin. From among the fatty acids studied using ethanol/isopropyl myristate (1:1) vehicle, no significant enhancement in flux of PCL was observed (p,>,0.05). In the case of cis mono and polyunsaturated fatty acids lag time was found to be similar to control (p,>,0.05). This suggests that the permeation of a high-molecular-weight, lipophilic drug may not be enhanced by the alteration of the lipid bilayer, or the main barrier to permeation could lie in lower hydrophilic layers of skin. A significant increase in lag time was observed with trans unsaturated fatty acids unlike the cis isomers, and this was explained on the basis of conformation and preferential partitioning of fatty acids into skin. From among the terpenes, flux of PCL with cineole was significantly different from other studied terpenes and controls, and after treatment with menthol and menthone permeability was found to be reduced. Menthol and menthone cause loosening of the SC lipid bilayer due to breaking of hydrogen bonding between ceramides, resulting in penetration of water into the lipids of the SC lipid bilayer that leads to creation of new aqueous channels and is responsible for increased hydrophilicity of SC. This increased hydrophilicity of the SC bilayer might have resulted in unfavorable conditions for ethanol/isopropyl myristate (1:1) along with PCL to penetrate into skin, therefore permeability was reduced. The findings of this study suggest that the permeation of a high-molecular-weight and lipophilic drug cannot be enhanced through bilayer alteration by penetration enhancers, and alteration in partitioning of drug into skin could be a feasible mode to enhance the permeation of drug. © 2004 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 93:2177,2183, 2004 [source] The geographies of crisis: exploring accessibility to health care in CanadaTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 3 2002KATHLEEN WILSON There is increasing concern in Canada that the health care system is in a state of crisis. It is argued that reductions in federal government transfers to the provinces have resulted in a health care system characterized by under-funding in key areas and policy decisions based more on provincial fiscal concerns than the health needs of their constituents. Provincial governments have responded to reduced levels in federal funding by undertaking aggressive restructuring tactics such as the closure of hospitals and the deinsuring of medical services from provincial health plans. The end result of this restructuring, as argued by the media, consumer groups and indeed some health researchers, is a state of crisis' (i.e., lower levels of accessibility, long waiting lists, overcrowding in hospitals and increasing costs of medication). One crisis theme often mentioned is that fiscal decisions of various kinds are reducing economic and geographic accessibility, one of the five principles of the Canada Health Act (CHA) that defines the very essence of the Canadian health care system. Using data from the 1998-99 National Population Health Survey (NPHS), this paper explores the extent to which an accessibility crisis exists within the Canadian health care system by examining access to health care services and the barriers encountered in trying to access services in each of the ten provinces. The results show that approximately 6.0 percent of Canadians report access problems, with values ranging from 4.5 percent in Newfoundland to 8.3 percent in Manitoba. Regional variations in barriers to accessing care were also observed. In particular, geographic accessibility appears to be a main barrier to care in Atlantic Canada while economic accessibility emerges as a main barrier to care in Western Canada. We discuss these findings in the context of the current debates on the Canadian health care system ,crisis'. De plus en plus de Canadiens s'inquiétent que leur systéme de soins de santé soit en état de crise. On défend l'idée selon laquelle la réduction des paiements de transfert aux provinces par le gouvernement fédéral serait responsable de l'état d'un systeme de santé caractérisé par un sous-financement dans les domaines-clés et des décisions politiques de santé basées, non pas sur les besoins des membres de la société canadienne, mais sur la fiscalité provinciale. Les gouvernements provinciaux ont réagi à la réduction du financement fédéral par une tactique de restructuration agressive (fermeture d'hôpitaux et retrait de services médicaux des programmes d'assurance de santé provinciaux). Selon les médias, les groupes de consommateurs et même les chercheurs en soins de santé, cette restructuration a eu pour effet un système en état de ,crise' (diminution de l'aecès aux services, longues fetes d'attente, hôpitaux surchargés, augmentation des coûts des médicaments etc). Un des thèmes récurrent est celui des décisions flscales de toutes sortes qui entraînent une baisse de l'accessibilité financière et géographique. Cette accessibilité est pourtant un des cinq principes de la Loi canadienne sur la santé définissant l'essence même du système de santé au Canada. Utilisant les données tirèes de l'Enquête nationale sur la santé de la population, 1998-99 et examinant l'accès aux services de santé et les obstacles rencontrés dans les 10 provinces canadiennes, cet article évalue dans quelle mesure une crise d'accessibilité existe au sein du système de santé canadien. Les résultats démontrent qu'environ 6.0 pour cent des Canadiens ont rencontré des problèmes d'accessibilité, avec des variantes allant de 4.5 pour cent à Terre-Neuve jusqu'à 8.3 pour cent au Manitoba. On observe aussi des variantes régionales dans les obstacles rencontrés. L'accessibilité géographique en particulier semble un obstacle mqjeur dans les régions de l'Atlantique, alors que l'accessibilite financière semble être un obstacle majeur dans l'Ouest du Canada. Ces résultats sont présentés dans le contexte des débats actuels sur l'existence dune, ,crise' dans le système de santé au Canada. [source] The Risks of Everyday Life: Fat content of chips, quality of frying fat and deep-frying practices in New Zealand fast food outletsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2002Judith Morley-John Objectives:To collect baseline data on the fat content of hot chips, quality (degradation) of cooking fat, deep-frying practices and related attitudes in fast food outlets in New Zealand. To identify the key determinants of the fat content of chips and quality of cooking fat. Methods:A nationally representative sample of fast food outlets (n=150, response rate 80%) was surveyed between September 1998 and March 1999. Data collected included a questionnaire, observation of cooking practices and analysis of cooked chips and frying fat. Results:Only 8% of independent operators had formal training in deep frying practices compared with 93% of chain operators. There was a wide range of fat content of chips (5%-20%, mean 11.5%). The use of thinner chips, crinkle cut chips and lower fryer fat temperature were associated with higher chip fat content. Eighty-nine per cent of chain outlets used 6,10 mm chips compared with 83% of independent outlets that used chips ,12 mm. A wide range of frying temperatures was recorded (136,233°C) with 58% of outlets frying outside the reference range (175,190°C). As indices of fat degradation, fat acid and polar compound values above the recommended levels occurred in 54% and 5% of outlets respectively. Operators seemed willing to learn more about best practice techniques, with lack of knowledge being the main barrier to change. Conclusions and implications:Deep frying practices could be improved through operator training and certification options. Even a small decrease in the mean fat content of chips would reduce the obesogenic impact of this popular food. [source] Characterization of efflux proteins in human corneal epithelial cellsACTA OPHTHALMOLOGICA, Issue 2007KS VELLONEN Purpose: Corneal epithelium is the main barrier for absorption of drugs into intraocular tissues after topical administration and part of this barrier may be formed by efflux proteins which translocate molecules from the cell interior to the extracellular space. The aim of this study was to characterize the gene expression and the activity of the efflux transporters in the cell culture model of immortalized human corneal epithelial cells (HCE cells), in primary cell line (HCEpiC), and in the human corneal epithelium. Methods: The mRNA levels of MDR1, MRP1-MRP6, and BCRP were determined by the quantitative RT-PCR. Immunohistochemistry was used to study protein expression and localization of efflux transporters. Functionality of these proteins was assessed with calcein-AM efflux assay and by measuring the efflux of CDCF. Furthermore, bidirectional permeability of rhodamine 123 (Rh123) was studied. Results: The mRNA of MRP1 and MRP5 were detected in the human cornea and in both cell lines. These efflux proteins were found in the cell membranes of the human corneal epithelium. At mRNA level some efflux proteins were over-expressed in the HCE and the primary cell lines. Increased calcein retention and decreased CDCF efflux in the presence of inhibitors suggested efflux protein activity in both primary and HCE cells. Likewise, directionality in Rh123 permeability was diminished in the presence of verapamil in HCE model. Conclusions: Functionality of the efflux proteins was demonstrated in the human corneal epithelial cells. MRP1 and MRP5 proteins may have important protecting role in corneal surface by transporting molecules out from the epithelial cells. It seems that the efflux activity in the HCE model differs from that of the corneal epithelium in vivo [source] Postgraduate education for doctors in smoking cessationDRUG AND ALCOHOL REVIEW, Issue 5 2009NICHOLAS A. ZWAR Abstract Introduction and Aims. Smoking cessation advice from doctors helps improve quit rates but the opportunity to provide this advice is often missed. Postgraduate education is one strategy to improve the amount and quality of cessation support provided. This paper describes a sample of postgraduate education programs for doctors in smoking cessation and suggests future directions to improve reach and quality. Design and Methods. Survey of key informants identified through tobacco control listserves supplemented by a review of the published literature on education programs since 2000. Programs and publications from Europe were not included as these are covered in another paper in this Special Issue. Results. Responses were received from only 21 key informants from eight countries. Two further training programs were identified from the literature review. The following components were present in the majority of programs: 5 As (Ask, Advise, Assess, Assist and Arrange) approach (72%), stage of change (64%), motivational interviewing (72%), pharmacotherapies (84%). Reference to clinical practice guidelines was very common (84%). The most common model of delivery of training was face to face. Lack of interest from doctors and lack of funding were identified as the main barriers to uptake and sustainability of training programs. Discussion and Conclusions. Identifying programs proved difficult and only a limited number were identified by the methods used. There was a high level of consistency in program content and a strong link to clinical practice guidelines. Key informants identified limited reach into the medical profession as an important issue. New approaches are needed to expand the availability and uptake of postgraduate education in smoking cessation.[Zwar NA, Richmond RL, Davidson D, Hasan I. Postgraduate education for doctors in smoking cessation. Drug Alcohol Rev 2009;28:466,473] [source] Access to essential drugs in Guyana: a public health challenge,,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2010Enrique Seoane-Vazquez Abstract Guyana's pharmaceutical sector faces major challenges that limit access to essential drugs. This study analyzes Guyana's drug policy and regulation, public financing, and drug procurement and delivery. The study also identifies main barriers to drug access and proposes alternatives to strengthen the country's public health functions. Data were collected from the country's regulatory agencies, public procurement agency, pharmacies, wholesalers, and pharmaceutical companies. The information was supplemented with interviews with a convenient sample of Guyanese health authorities and stakeholders. Data were also compiled from scientific databases, and web pages of the country's Ministries of Health, Commerce and Finance, the Bureau of Statistics, and international organizations. Major barriers to drug access include: (1) lack of national drug policy and regulation, and limited role of the regulatory authority; (2) inefficient drug selection and irrational drug use; (3) insufficient financial resources and lack of drug pricing policy; (4) inefficient planning and managing public supply system; (5) deficient epidemiological and information systems; and (6) inadequate infrastructures and human resources shortage. Improving drug access in Guyana requires the strengthening of the country's public health functions and the implementation of a national drug policy and pricing policy, streamlining the drug financing, procurement, and planning and managing drug supply; and adequate infrastructures and human resources. Copyright © 2008 John Wiley & Sons, Ltd. [source] Alternatives to Public Provision: The Role of Legal Expenses Insurance in Broadening Access to Justice: The German ExperienceJOURNAL OF LAW AND SOCIETY, Issue 1 2003Matthias Kilian The literature suggests that the main barriers to justice range from a general lack of knowledge about legal rights, and the related prevalent use of technical language within justice systems (which has led to commentators describing law as a ,leviathan'), to a vague ,fear of the unknown'. In Germany the principal barrier is thought to be the problem of funding legal services. Empirical research indicates that the question of whether or not to consult a lawyer is primarily one of cost, although over one,third of potential clients have little idea about lawyers' fees. To find ways to surmount this barrier is therefore of paramount importance for a modern society. In broad terms, there are three potential attitudes to legal costs: reliance on one's own resources; hope for third party assistance (such as legal aid or pro bono); and insurance. This article concentrates on the last of these three options, comparing, in particular, the systems in Germany and England and Wales. [source] Understanding Barriers to Peace: Reflecting on Israeli,Palestinian Economic NegotiationsNEGOTIATION JOURNAL, Issue 3 2004Bari Bar-Zion Drawing on relevant negotiations literature, this article describes some of the main barriers in the negotiation process between Israel and the Palestinian Authority as experienced by the author between the years 1998,2000. The analysis of these barriers is viewed through a prism of one case study: the negotiations regarding the economic component of the Wye River Memorandum. By subjecting that two-year negotiation process to a reflective analysis, this article not only attempts to shed light on the case presented, but also to help identify a wider range of barriers and behaviors that characterize the ongoing negotiations between Israel and the Palestinian Authority. [source] Access and utilization of a new low-vision rehabilitation serviceCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2008Patricia M O'Connor PhD Abstract Background:, A new low-vision service linking a public hospital and a non-governmental organization was trialled in Melbourne, Australia. The factors associated with service use were investigated. Methods:, A survey was conducted with patients who used the service, those who accepted referrals but failed to attend and those who refused a referral. Hospital and non-governmental organization representatives were also interviewed. Results:, Ninety-eight eligible vision impaired people who were referred to the new service were recruited. Less than half (49%) followed through with their referral and attended the service. Proximity and convenience were listed as the main facilitators to service use while issues relating to transport, needing an accompanying person, lack of information about the service and poor health were the main barriers. More than a third of the non-compliant and referral refusers spoke a language other than English. Sixty-three per cent of all participants had not previously used low-vision services. Of the two main eye conditions, 81% of referred age-related macular degeneration participants (n = 26) attended the service, but only 32% of those with diabetic retinopathy (n = 31) did so. Conclusion:, As more than 60% of participants in each of the three groups had no prior use of low-vision services, clearly current models of care are not reaching many who could benefit from such services. This suggests that higher rates of referral are warranted. However, given that substantially more were referred than attended, referral alone is obviously not the answer. Access and attitudinal barriers also need to be addressed. [source] Unmet education and training needs in adolescent health of health professionals in a UK children's hospitalACTA PAEDIATRICA, Issue 6 2006Janet E. McDonagh Abstract Aim: To determine the perceived education and training needs in adolescent health of health professionals. Design: Cross-sectional survey Setting and subjects: Hospital staff in a UK children's hospital. Outcome measures: perceived barriers, confidence, knowledge, skill and prior teaching in key adolescent health subject areas. Results: The hospital survey was completed by 159/1400 professionals representing a completion rate of 11%. Doctors and staff from ,Professions allied to medicine' rated ,lack of training', ,lack of teaching materials' and ,lack of community resources' as the main barriers to providing developmentally appropriate care. Sixty per cent of hospital respondents had received no prior specific training in adolescent health. All but four topics were perceived to be of very high or high importance by the majority of respondents (54,90%). Low scores in perceived knowledge, confidence and/or skill were reported in nine key subject areas (including adolescent mental health and substance use). Differences between doctors and professions allied to medicine were observed in a minority of areas. Conclusion: Unmet education and training needs of a range of professionals working in a paediatric setting were identified in key areas of adolescent health and they provide useful directions for the development of future multidisciplinary training programmes. [source] | |||||||||||||