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Selected AbstractsThe abuse potential of the synthetic cannabinoid nabiloneADDICTION, Issue 3 2010Mark A. Ware ABSTRACT Aim Nabilone is a synthetic cannabinoid prescription drug approved in Canada since 1981 to treat chemotherapy-induced nausea and vomiting. In recent years, off-label use of nabilone for chronic pain management has increased, and physicians have begun to express concerns about nabilone becoming a drug of abuse. This study evaluates the evidence for abuse of nabilone, which is currently ill-defined. Study design Scientific literature, popular press and internet databases were searched extensively for evidence of nabilone abuse. Focused interviews with medical professionals and law enforcement agencies across Canada were also conducted. Findings The scientific literature and popular press reviews found very little reference to nabilone abuse. Nabilone is perceived to produce more undesirable side effects, to have a longer onset of action and to be more expensive than smoked cannabis. The internet review revealed rare and isolated instances of recreational use of nabilone. The database review yielded little evidence of nabilone abuse, although nabilone seizures and thefts have occurred in Canada in the past few years, especially in Ontario. Most law enforcement officers reported no instances of nabilone abuse or diversion, and the drug has no known street value. Medical professionals reported that nabilone is not perceived to be a matter of concern with respect to its abuse potential. Conclusions Reports of nabilone abuse are extremely rare. However, follow-up of patients using nabilone for therapeutic purposes is prudent and should include assessment of tolerance and dependence. Prospective studies are also needed to definitively address the issue of nabilone abuse. [source] The harassment and stalking of plastic surgeons by their patients in AustralasiaANZ JOURNAL OF SURGERY, Issue 7-8 2009Stephen Allnutt Abstract Medical professionals come into direct contact with the public. The relationships are often personal. The aim of the survey is to examine the prevalence of harassment of plastic surgeons by their patients. Survey questionnaires were mailed to all plastic surgeons listed in the 1999 Australasian Society of Aesthetic Plastic Surgery List of Members. A very wide definition of harassment was then provided and information in regard to the nature of the harassment was obtained. This was a descriptive survey of plastic surgeons' experiences of harassment by patients in Australia and New Zealand. More than half of the plastic surgeons in Australia and New Zealand who responded to the questionnaire reported having been a victim of harassment at some point of their careers. One quarter had been harassed in the previous year. Over 20% of cases met the legal criteria for stalking. These estimates are in excess of those reported in the other studies of the general community. Harassment persisted in the majority of cases for at least a month and in a third of cases for up to 5 years. The recognition of psychiatric disorder, particularly personality dysfunction, prior to embarking on surgery may limit the likelihood of harassment by difficult patients. Formal teaching may be helpful to surgical registrars and consultants. Expert intervention could assist in reducing clinician anxiety. [source] When Will Older Patients Follow Doctors' Recommendations?JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 5 2008Interpersonal Treatment, Outcome Favorability, Perceived Age Differences Study participants were 104 older patients (M age = 76 years) who rated their last visit to a doctor. If they felt respectfully and honestly treated by the doctor, they were more willing to confide in a medical professional. If they received the information that they needed, they were more likely to follow the doctor's recommendations. However, if they perceived their doctor to be closer to them in age, respectful treatment was most closely related to compliance. If they perceived their doctor to be much younger than themselves, obtaining needed information was related most closely to compliance. The results illustrate the value of treating age as a salient social category that can shape older patients' reactions to their medical visits. [source] Factors that influence spontaneous reporting of adverse drug reactions: a model centralized in the medical professionalJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2004María T. Herdeiro BS Abstract Rationale, aims and objectives, The spontaneous reporting of adverse drug reactions (ADRs) through the yellow card and made concrete by the knowledge and attitudes of doctors, has been rousing a great deal of bibliographical interest in recent years. However, there does not seem to be any actual revision in the theme on which the theoretical models that explain the process of decision in reporting are proposed. In this work an explanatory model of the factors that condition reporting is proposed and a revision of the literature on the subject has also been carried out. Methods, The proposed model is centralized in the medical professional and it considers the habit of reporting as the result of the doctor's formation and his interaction with the environment. The combination of knowledge-attitudes-practices and the theory of the satisfaction of needs seemed very adequate for ADR systematization. Results and conclusions, The results also indicate that, to improve the participation of health professionals in surveillance systems through spontaneous reporting, it might be necessary to design combined strategies that modify both intrinsic (knowledge, attitudes) and extrinsic (relationship between health professionals and their patients, the national health system and pharmaceutical companies) factors. [source] Clinic in the Air?JOURNAL OF TRAVEL MEDICINE, Issue 6 2008A Retrospective Study of Medical Emergency Calls From A Major International Airline Background There is a high likelihood of a medical professional being onboard the aircraft at the time of emergency. Therefore, a health-care professional should be familiar with in-flight medical events and how to deal with them. Methods I present a 12-month retrospective study of medical distress calls from a major Asian international airline for which International SOS provided in-flight telemedical assistance. All the calls from the airplane to our center were analyzed from January 1, 2006, to January 1, 2007. The number of recommended diversions, availability of a medical professional, the range of medical problems, and used medications were considered. Results Overall, there were 191 in-flight air-to-ground consultations. Twenty-three (12.04%) calls were made for pediatric problems, with the youngest patient being 9 months old. Gastrointestinal complaints and simple faints comprised 50.2% of all calls. Most of the in-flight problems were successfully treated symptomatically with the initial recommendation to lie the patient down and administer oxygen. Metoclopramide, stemetil, loperamide, and buscopan were the most often administered drugs. A doctor was onboard in 45.5% of all calls. A recommendation to divert the aircraft was made in six (3.1%) cases. Conclusions Although developments in telemedical assistance and the content of a medical kit make the management of potential in-flight medical emergency much easier, they will never turn a commercial aircraft into a flying clinic. Preflight check-in screening by airlines and encouraging future air travelers with health concerns to seek medical help before flying should be recommended. [source] Quality of evidence for the present Swedish child health surveillance programmeACTA PAEDIATRICA, Issue 2000S Bremberg The present Swedish health surveillance programme includes 15 examinations by a nurse, 5 examinations by a physician, 7 assessments of development, 2 assessments of hearing and 1 assessment of visual acuity. The WHO criteria for evaluation of screening programmes can be applied to the Swedish health surveillance programme. These criteria state that the health problem must be important, that there should be an early phase during which the condition is only detectable by medical professionals and that treatment at an early phase should favourably affect the prognosis. The quality of evidence for fulfilment of these criteria has been graded I-III. Grade II-2 refers to evidence obtained from well-designed cohort or case-control analytical studies. The following disorders might be affected by health surveillance at child health centres: amblyopia, ADHD/DAMP, failure to thrive, cerebral palsy, congenital heart failure, congenital luxation of hip, hearing impairment (severe or moderate), mental retardation, retentio testis and hydrocephalus. None of these conditions fulfils the WHO criteria with quality of evidence grade II-2 or better. Thus, the evidence for the present Swedish health surveillance programme is problematic. [source] The abuse potential of the synthetic cannabinoid nabiloneADDICTION, Issue 3 2010Mark A. Ware ABSTRACT Aim Nabilone is a synthetic cannabinoid prescription drug approved in Canada since 1981 to treat chemotherapy-induced nausea and vomiting. In recent years, off-label use of nabilone for chronic pain management has increased, and physicians have begun to express concerns about nabilone becoming a drug of abuse. This study evaluates the evidence for abuse of nabilone, which is currently ill-defined. Study design Scientific literature, popular press and internet databases were searched extensively for evidence of nabilone abuse. Focused interviews with medical professionals and law enforcement agencies across Canada were also conducted. Findings The scientific literature and popular press reviews found very little reference to nabilone abuse. Nabilone is perceived to produce more undesirable side effects, to have a longer onset of action and to be more expensive than smoked cannabis. The internet review revealed rare and isolated instances of recreational use of nabilone. The database review yielded little evidence of nabilone abuse, although nabilone seizures and thefts have occurred in Canada in the past few years, especially in Ontario. Most law enforcement officers reported no instances of nabilone abuse or diversion, and the drug has no known street value. Medical professionals reported that nabilone is not perceived to be a matter of concern with respect to its abuse potential. Conclusions Reports of nabilone abuse are extremely rare. However, follow-up of patients using nabilone for therapeutic purposes is prudent and should include assessment of tolerance and dependence. Prospective studies are also needed to definitively address the issue of nabilone abuse. [source] The Meaning of Balanced Scorecards in the Health Care OrganisationFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 1 2001Lars-Göan Aidemark This study investigates the introduction of balanced scorecards in a health care organisation. It analyses a top-down control system, built on measurement, in a medical professional context, where attempts at implementing systematic performance auditing are expected to meet resistance. The study shows, however, that balanced scorecards, redesigned by medical professionals and used in a dialogue about service activities and finances, are regarded attractive successors to criticised financial control systems. In the light of the markets, hierarchies and clans perspective, developed by Ouchi, this popularity becomes comprehensible. Balanced scorecards are seen to reduce both the ambiguity of performance evaluation and the goal in-congruence between parties in the organisation. [source] Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of the literatureFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2007Anne Roussin Abstract Propofol (2,6-diisopropylphenol) is an intravenous short-acting anaesthetic widely used for inducing and maintaining anaesthesia. Propofol is also being increasingly used for sedation. Beside medical use, propofol is abused for recreational purpose, mostly in medical professionals who are not informed of the risk of dependence to this compound. The aim of this review was to provide an overview of molecular, animal and clinical pharmacological data of the literature evidencing the potential for abuse and dependence of propofol. [source] Building our global family , achieving treatment for allHAEMOPHILIA, Issue 2010M. W. SKINNER Summary., Building our global family by reaching out to women, children and youth and those in sub-Saharan Africa to achieve Treatment for All. The World Federation of Hemophilia (WFH) has committed to recognizing and incorporating the critical and important challenges that are faced by women with bleeding disorders within our global family. The next crucial steps include the development of outreach and registry programmes which can be adapted globally to accelerate the identification of such women, and to educate and guide them to the appropriate clinical care setting. Equally important, awareness must be raised within the broader medical community where women would typically first present with clinical symptoms. Family practitioners, nurse-midwives, obstetricians, gynaecologists and community health clinics will increasingly be strategic and central to WFH outreach efforts, in addition to serving as new care partners essential to the multidisciplinary model of care. Adapting and implementing the WFH development model regionally within Africa is proving to be a successful approach both for the introduction as well as the development of sustainable national care programmes for patients with bleeding disorders. The targeted development of solid national programmes such as in South Africa, Senegal and Kenya has expanded the training capacity of the WFH, as well as providing key regional examples. Local medical professionals are now responsible for providing the training in many regional programmes. Children with bleeding disorders in low-income countries are at great risk of dying young. WFH data demonstrate that among such patients, as the economic capacity of a country decreases so does the ratio of adults to children. The organization of care, training of a multi-disciplinary healthcare team, and education of patients and their families lead to improved mortality independent of economic capacity or increased clotting factor concentrate availability. Additionally, through enhanced youth education, awareness and engagement, we will assure continuity within WFH national member organizations, build greater unity within our global family and capture the innovation and creativity of their ideas to improve Treatment for All. [source] Provider networks and primary-care signups: do they restrict the use of medical services?HEALTH ECONOMICS, Issue 12 2009Partha Deb Abstract This article analyzes the effect of gatekeeper and network restrictions on use of health-care services using simulation-based estimation methods. Data from the Community Tracking Survey (1996,1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office-based visits to non-physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary-care provider have more visits to non-physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out-of-network services have more office-based and emergency room visits, but less surgeries and hospitalizations. Copyright © 2008 John Wiley & Sons, Ltd. [source] Internet-based information-seeking behaviour amongst doctors and nurses: a short review of the literatureHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 1 2010Paula Younger Background:, Reviews of how doctors and nurses search for online information are relatively rare, particularly where research examines how they decide whether to use Internet-based resources. Original research into their online searching behaviour is also rare, particularly in real world clinical settings. as is original research into their online searching behaviour. This review collates some of the existing evidence, from 1995 to 2009. Objectives:, To establish whether there are any significant differences in the ways and reasons why doctors and nurses seek out online information; to establish how nurses and doctors locate information online; to establish whether any conclusions can be drawn from the existing evidence that might assist health and medical libraries in supporting users. Methods:, An initial scoping literature search was carried out on PubMed and CINAHL to identify existing reviews of the subject area and relevant original research between 1995 and 2009. Following refinement, further searches were carried out on Embase (Ovid), LISA and LISTA. Following the initial scoping search, two journals were identified as particularly relevant for further table of contents searching. Articles were exclused where the main focus was on patients searching for information or where the focus was the evaluation of online-based educational software or tutorials. Articles were included if they were review or meta-analysis articles, where they reported original research, and where the primary focus of the online search was for participants' ongoing Continuing Professional Development (CPD). The relevant articles are outlined, with details of numbers of participants, response rates, and the user groups. Results:, There appear to be no significant differences between the reasons why doctors and nurses seek online Internet-based evidence, or the ways in which they locate that evidence. Reasons for searching for information online are broadly the same: primarily patient care and CPD (Continuing Professional Development). The perceived barriers to accessing online information are the same in both groups. There is a lack of awareness of the library as a potential online information enabler. Conclusions:, Libraries need to examine their policy and practice to ensure that they facilitate access to online evidence-based information, particularly where users are geographically remote or based in the community rather than in a hospital setting. Librarians also need to take into account the fact that medical professionals on duty may not be able to take advantage of the academic model of online information research. Further research is recommended into the difference between the idealised academic model of searching and real world practicalities; and how other user groups search, for example patients. [source] Credibility Assessments of Online Health Information: The Effects of Source Expertise and Knowledge of ContentJOURNAL OF COMPUTER-MEDIATED COMMUNICATION, Issue 4 2001Matthew S. Eastin Millions of Americans use the Internet as a resource for information, with a large proportion seeking health information. Research indicates that medical professionals do not author an extensive amount of health information available on the Internet. This creates a possibility for false information, thereby potentially leading ill people away from proper care. One way to begin addressing this problem is to assess perceptions of credibility about information found online. A between-groups, 2 (message type) × 3 (source type) factorial design was tested by manipulating source expertise (high, medium, low) and content knowledge (known and unknown). While findings did not indicate a significant interaction between source and content type, they did indicate an overall tendency to rate all information as relatively credible. In addition, results indicate that both knowledge of content and source expertise affect perceptions of online health information. [source] Irritable bowel syndrome in the 21st century: Perspectives from Asia or South-east AsiaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 1 2007Full-Young Chang Abstract Asian irritable bowel syndrome (IBS) studies not only confirm the truth of this functional disorder but also describe the current disease situation of this continent, with its variable socioeconomic backgrounds. Most Asian community IBS prevalence is within 5,10%, regardless of gender or ethnic character. As well as meeting the main Rome II criteria, Asian IBS subjects also have many minor symptoms. Thus this recommendation remains useful to diagnose Asian IBS. Also, female patients commonly express constipation-predominant (C-) symptoms. Extra-colonic symptoms are common in Asia, for example dyspepsia, insomnia and irritable urinary bladder. Asian IBS subjects do experience psychological disturbances including anxiety, depression, agoraphobia and neuroticism. Accordingly, their quality of life is poor and there is absenteeism leading to excessive physician visits. Abnormal gut motor and sensory functions have been indicated among the Asian IBS subjects. Now, there is evidence of altered colonic neuroimmune function leading to gut hypersensitivity and dysmotility. An Asia,Pacific trial also confirmed tegaserod efficacy on female C-IBS subjects. More than 90% of nurses have very limited IBS knowledge, and are unable even to explain it clearly. In conclusion, Western recommended criteria clearly diagnose Asian IBS and many factors are mutual leading to IBS. Current IBS treatments remain useful but additional reeducation for medical professionals appears to be needed. [source] Early Adolescents Perceptions of Health and Health Literacy,JOURNAL OF SCHOOL HEALTH, Issue 1 2007Stephen L. Brown PhD ABSTRACT Background:, Health illiteracy is a societal issue that, if addressed successfully, may help to reduce health disparities. It has been associated with increased rates of hospital admission, health care expenditures, and poor health outcomes. Because of this, much of the research in the United States has focused on adults in the health care system. This study investigated the effect of aspects of health literacy on the motivation to practice health-enhancing behaviors among early adolescents. Methods:, Measures were generally based on 3 National Health Education Standards for grades 5-8. Data were obtained from 1178 9- to 13-year-old students visiting 11 health education centers in 7 states. Students responded via individual electronic keypads. Results:, Multivariate logistic regression revealed that, in addition to age, difficulty understanding health information and belief that kids can do little to affect their future health, decreased the likelihood for interest in and desire to follow what they were taught about health. Further, low interest independently decreased motivation to follow what was taught. Girls were more likely to turn to school, parents, and medical personnel for health information. Older students were more likely to turn to school and to the Internet. Conclusions:, Programs and curricula should be designed to increase student interest in health issues and their self-efficacy in controlling their own health destinies. Educators should also teach students to more effectively use nonconventional health information sources such as the Internet, parents, and medical professionals. [source] Traditional Chinese herbal medicines for treatment of liver fibrosis and cancer: from laboratory discovery to clinical evaluationLIVER INTERNATIONAL, Issue 7 2007John M. Luk Abstract Liver disease afflicts over 10% of the world population. This includes chronic hepatitis, alcoholic steatosis, fibrosis, cirrhosis and hepatocellular carcinoma (HCC), which are the most health-threatening conditions drawing considerable attention from medical professionals and scientists. Patients with alcoholism or viral hepatitis are much more likely to have liver cell damage and cirrhosis, and some may eventually develop HCC, which is unfortunately, and very often, a fatal malignancy without cure. While liver surgery is not suitable in many of the HCC cases, patients are mostly given palliative support cares or transarterial chemoembolization or systemic chemotherapies. However, HCC is well known to be a highly chemoresistant tumour, and the response rate is <10,20%. To this end, alternative medicines are being actively sought from other sources with hopes to halt the disease's progression or even eliminate the tumours. Traditional Chinese herbal medicine has begun to gain popularity worldwide for promoting healthcare as well as disease prevention, and been used as conventional or complementary medicines for both treatable and incurable diseases in Asia and the West. In this article, we discuss the laboratory findings and clinical trial studies of Chinese herbal medicines (particularly small molecule compounds) for the treatment of liver disease ranging from fibrosis to liver cancer. [source] Redefining the role of medical professionals and medical education in IndiaMEDICAL EDUCATION, Issue 10 2007Venugopal Rao No abstract is available for this article. [source] Role of medical professionals and medical education in resource-limited settings like India: have we lost sight of the woods in the trees?MEDICAL EDUCATION, Issue 1 2007Gautam Ahluwalia No abstract is available for this article. [source] Triage screening for osteoporosis in dental clinics using panoramic radiographsORAL DISEASES, Issue 4 2010A Taguchi Oral Diseases (2010) 16, 316,327 Many patients with osteoporosis go undiagnosed because typically no symptoms are present before a fracture. Triage screening to refer patients to appropriate medical professionals for further investigation would be useful to address the increase in the incidence of osteoporotic fractures. Dental clinics may offer a new triage screening pathway because dentists frequently take radiographs of bones in the course of dental treatment. A major premise for such triage screening in dental clinics is that dentists can readily use a screening tool in their dental practice. For example, cortical width and shape of the mandible detected on panoramic radiographs may be appropriate indices for triaging individuals with osteoporosis. To date, several investigators have demonstrated significant associations between cortical indices on panoramic radiographs and bone mineral density of the skeleton generally, such as the spine and femur, biochemical markers of bone turnover and risk of osteoporotic fractures. Further, in two recent Japanese clinical trials, approximately 95% of women who were identified by trained dentists in their clinics using cortical shape findings did have osteopenia or osteoporosis. These findings support the possibility that dental clinics may offer a new triage platform to identify individuals with otherwise undetected osteoporosis. [source] DIADEM: implementation of a comprehensive disease management programme for type 2 diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2005Dr S Luzio PhD Clinical Trials Manager Abstract The purpose of the study was to evaluate the feasibility and acceptance of an IT-based diabetes disease management programme. The study was performed at two test sites in Aachen (Germany) and Cardiff (UK) including 166 and 137 patients respectively. The study focused on the technical feasibility of a web-based communication platform and its acceptance among medical professionals, the patient acceptance of entering self-measured data via phone and of service-centre support, the acceptance of implementing quality management measures, and the effects of all these measures on glycaemic control. The maximum programme duration was four months at Aachen and six months at Cardiff. The main outcomes were utilisation data, and satisfaction of both patients and physicians with the different components of DIADEM. HbA1c concentrations improved significantly from 7.1±1.0% to 6.8±1.1% in Aachen and from 7.7±1.0% to 7.1±1.1% in Cardiff (each p<0.001). The platform as a hosted ASP (application service provider) solution was accessible using a standard Internet enabled PC. Following training, a fast and efficient introduction of the software to professional users was obtained. Patient acceptance was very high both in terms of utilisation of the system (13 000 data entries performed during 6800 calls) and in terms of patient satisfaction assessed by a patient survey (93% very satisfied or satisfied). Patients strongly preferred a DTMF (dual tone multi-frequency) interface entering data by telephone key-pad rather than voice recognition. This study showed that an IT-based diabetes disease management service improved glycaemic control in patients with type 2 diabetes and could find acceptance by patients and professionals if convenient pathways for data entry and transmission are provided. Copyright © 2005 John Wiley & Sons, Ltd. [source] The effect of sharing health information on teachers' production of classroom accommodationsPSYCHOLOGY IN THE SCHOOLS, Issue 5 2006Melissa M. Cunningham Ninety elementary-school teachers read information about a hypothetical student experiencing school-related problems due to Type 1 diabetes mellitus (T1DM), generated classroom accommodations to assist the student, and rated their confidence in these accommodations. Each teacher was provided one of three levels of information about T1DM: (a) no disease information, (b) basic disease information, and (c) basic disease information + classroom implications. Providing teachers with more information about T1DM increased their ability to accommodate a student's learning needs. Similarly, a lower proportion of disease-specific accommodations were generated by teachers receiving no disease information (37%) than by teachers receiving basic disease information or basic disease information + classroom implications, and the later two groups were equivalent (47% for each). This study and future work concerning the effect of chronic illness on classroom performance and adjustment have implications for medical professionals, teachers, and school psychologists. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 553,564, 2006. [source] Doubles and Desire: Anatomies of masculinity in the later nineteenth centuryART HISTORY, Issue 5 2003Anthea Callen This article explores duality and splitting in representations of the male body, stressing as a crucial factor the issue of social class. Focusing on the ,golden age' of doubles in the 1880s and 1890s, my study crosses the boundaries between France and Britain, art and medicine, visual images and literature, to analyse François Sallé's monumental painting of male homosociality, The Anatomy Class at the Ecole des Beaux-Arts (1888); I suggest parallels with the male doubling identified in R.L. Stevenson's novella The Strange Case of Dr Jekyll and Mr Hyde (1886). Addressing representations of medical professionals, I position my material within nineteenth-century clinical discourse (Foucault), and propose readings that develop the medical gaze as an alternative visual economy to that of the modern Parisian flâneur. Linking anatomy and dissection to the performance of striptease, I argue that Sallé's painting represents a scene in which unsuppressed homoerotic pleasure allows the visibility of homosexual desire, and permeability of sexual categories. [source] Prevention of relapse and interventions for enhancing medication adherence in schizophrenia: An East Asian perspectiveASIA-PACIFIC PSYCHIATRY, Issue 2 2010Salleh Mohd Razali MPM FAMM Abstract Introduction: Studies investigating the efficacy of interventions for improving treatment non-adherence in schizophrenia have generated contrasting findings. The present review examined psychosocial interventions for improving medication adherence and prevention of relapse among patients with schizophrenia in developing countries in the Asia-Pacific. Methods: The relevant literature and systematic review were identified by computerized searches using keywords, and hand-searched for other selected articles. Results: The reasons for poor medication adherence were complex and heterogenous. Psychoeducation programs alone are ineffective in achieving good medication adherence because they do not lead to attitudinal and behavioral changes. The greatest improvement in adherence was seen with interventions employing a combination of educational, behavioral and cognitive strategies. Unfortunately, few relevant studies from this region were found. There were some interventions related to psychoeducation and compliance therapy (CT) that were successfully conducted by nurses. Patients in developing countries generally had better family support, but strong stigma towards mental illness and interference by traditional healers led to poor treatment adherence. Lack of facilities and shortage of medical professionals aggravated the situation. Discussion: Intervention to improve treatment adherence and prevention of relapse among patients with schizophrenia should be incorporated into existing psychiatric services. Adherence to treatment in patients with schizophrenia could be improved if continuously supported and monitored by caregivers and treating doctors, to facilitate a change in the patient's attitude. Paramedical personnel, such as psychiatric nurses, could be actively involved in intervention programs because of the shortage of medical professionals in this region. [source] Perceived adverse drug reactions among non-institutionalized children and adolescents in GermanyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2010Hildtraud Knopf WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Drug safety in paediatric medication is a public health concern. According to previous studies, the incidence of adverse drug reactions (ADRs) varies greatly from 0.7% to 2.7% among paediatric outpatients and from 2.6% to 18.1% among paediatric inpatients. Little has been reported on the risks of drug use in the general child population. WHAT THIS STUDY ADDS Our study showed that the prevalence of perceived ADRs in Germany was 0.9% among non-institutionalized children in general and 1.7% among children who had used at least one medicine within the 7 days before the medical interview. Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and for identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems. AIMS Little has been reported on the risks of drug use in the general child population. This study investigated perceived adverse drug reactions (ADRs) among non-institutionalized children in Germany. METHODS All medicines used in the last 7 days before the medical interview were recorded among the 17 450 children aged 0,17 years who participated in the 2003,06 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Perceived ADRs were reported by the children's parents and confirmed by trained medical professionals during the medical interview. RESULTS One hundred and fifty-seven medicines were involved in the occurrence of 198 perceived ADRs in 153 patients. This corresponded to 1.1% of total used drugs, 0.9% (95% confidence intervals 0.7, 1.1%) of all children, and 1.7% (1.4, 2.1%) of children treated with medications. About 40% of all perceived ADRs involved gastrointestinal disorders and 16% involved skin tissue disorders. Perceived ADRs were most frequently reported in relation to drugs acting on the nervous system (25.8%), followed by systemic anti-infectives (18.7%) and drugs acting on the respiratory system (16.2%). Risk factors for perceived ADRs included older age groups, polypharmacy (,2) and a poor health status. CONCLUSION Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems. [source] The psychological impact of genital anomalies on the parents of affected childrenACTA PAEDIATRICA, Issue 3 2007A Duguid Abstract Background: There is scarce information on how parents cope with children with genital anomalies. Participants & methods: Twenty-six parents of 25 children with a median age of 0.5 years (r, 5 days,10.8 years) were recruited through the Scottish Genital Anomaly Network and had a quantitative assessment of parenting stress and coping patterns; a qualitative assessment by a semi-structured interview was also performed in19 parents. Results: In five parents, the total stress score was above the 85th centile, denoting clinical levels of stress. Three parents showed reduced coping pattern scores for social support, self-esteem and psychological stability and three showed a reduction in utilization of communication with medical professionals. The scores did not correlate with each other or the extent of genital anomaly in the child. Semi-structured interview analysis revealed parents' need for more knowledge about the imminent surgery, post-operative care and their desire for written information that could complement the time-restricted contact with the clinical team. Conclusion: In the majority of cases, parents did not display abnormal levels of stress or coping on quantitative assessment. The semi-structured interview provided further information about the parents' level of coping and potential for stress and highlighted the need for more effective exchange of clinical information at a critical period of the parent,child relationship. [source] | ||||||||||||||||||||||||||||