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Medical Sciences	85%

Selected Abstracts

The National Treatment Outcome Research Study (NTORS): 4,5 year follow-up results

ADDICTION, Issue 3 2003
Michael Gossop
ABSTRACT Aims ,The National Treatment Outcome Research Study (NTORS) is the first prospective national study of treatment outcome among drug misusers in the United Kingdom. NTORS investigates outcomes for drug misusers treated in existing services in residential and community settings. Design, setting and participants,The study used a longitudinal, prospective cohort design. Data were collected by structured interviews at intake to treatment, 1 year, 2 years and at 4,5 years. The sample comprised 418 patients from 54 agencies and four treatment modalities. Measurements, Measures were taken of illicit drug use, injecting and sharing injecting equipment, alcohol use, psychological health and crime. Findings, Rates of abstinence from illicit drugs increased after treatment among patients from both residential and community (methadone) programmes. Reductions were found for frequency of use of heroin, non-prescribed methadone, benzodiazepines, injecting and sharing of injecting equipment. For most variables, reductions were evident at 1 year with outcomes remaining at about the 1 year level or with further reductions. Crack cocaine and alcohol outcomes at 4,5 years were not significantly different from intake. Conclusions, Substantial reductions across a range of problem behaviours were found 4,5 years after patients were admitted to national treatment programmes delivered under day-to-day conditions. The less satisfactory outcomes for heavy drinking and use of crack cocaine suggest the need for services to be modified to tackle these problems more effectively. Despite differences between the United Kingdom and the United States in patient populations and in treatment programmes, there are many similarities between the two countries in outcomes from large-scale, multi-site studies. [source]

Improving clinical assessment: evaluating students' ability to identify and apply clinical criteria

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2010
C. Redwood
Abstract Aim:, There is ongoing concern by health educators over the inability of professionals to accurately self-assess their clinical behaviour and standards, resulting in doubts over a key expectation of effective self-regulation in the health professions. Participation by students in the assessment process has been shown to increase the understanding of assessment criteria in written assessment tasks. How this might transfer to the clinical setting is the focus of this study. This paper is part of an ongoing investigation of the impact on learning of a series of activities that provides students with opportunities to discuss and apply criteria and standards associated with self-assessment in clinical dentistry. Our aim was to evaluate whether participation in these assessment activities improved the ability of first-year dental students to recognise behaviours demonstrated by ,peers' in videos of clinical scenarios and to relate these to the assessment criteria. Materials and methods:, A series of three workshops in conjunction with weekly clinical assessment activities in Semesters 1 and 2 were use to support first-year students' learning of clinical assessment criteria. The design of the workshops was based on the principles of social constructivist theories of learning and the concept of tacit knowledge. Accordingly workshop activities were planned around videos that were specifically constructed to illustrate procedures and behaviours typical of those observed by staff and tutors in the first year of the dental course at The University of Adelaide, Australia. First-year students viewed the videos prior to and after the workshops and recorded observed behaviours that related to the assessment criteria that were used in their clinical practice course. Student learning outcomes were assessed 10,14 weeks after the initial workshop and again up to 42 weeks later. To check whether learning resulted from repeated viewing of the videos without formal discussion, a reference group of third-year students who did not attend the workshops also viewed the videos two times, separated by 12 weeks, and recorded observations in the same way. Results:, There was no consistent evidence that repeat viewing of the videos in isolation resulted in improved recognition of ,peer' behaviours by third-year dental students. Results for the first-year students indicated that the workshops and clinical assessment activities had a significantly positive effect on the ability of students to identify ,peer' behaviours related to the criteria used for clinical assessment. In particular, students' recognition in others of knowledge and professional behaviours improved significantly. This improvement was retained over the year and students were able to recognise these behaviours in other scenarios relevant to their year level. Conclusions:, This early exposure to the process of clinical assessment, coupled with ongoing self-assessment and tutor feedback throughout first year, improved the ability of first-year students to identify and apply some key assessment criteria to observed ,peer' behaviour, and this ability was retained over time. [source]

Child sun protection: Sun-related attitudes mediate the association between children's knowledge and behaviours

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2008
Caradee Wright
Aim: To describe and investigate the relationship among the sun-related knowledge, attitudes and behaviours of New Zealand primary schoolchildren and consider the roles of sex and school year level. Methods: A randomly selected, two-stage cluster sample of 488 children from 27 primary schools in five regions of New Zealand was surveyed regarding their sun-related knowledge, attitudes and behaviours. A scoring system was used to assign a knowledge, attitude and behaviour score to each child. Results: Although knowledge increased with school year level, there was a decline in sun protective attitudes and behaviours. There was little variation in knowledge, attitudes and behaviour between boys and girls, but sex,year level interactions were found for knowledge and behaviour. When considering children's knowledge, attitudes and behaviours simultaneously, knowledge was only significantly associated with behaviours when mediated by attitudes. Conclusions: When targeting child sun protection and skin cancer prevention programmes, a focus on attitudes towards sun exposure and a suntan may prove beneficial in influencing sun-related behaviours. [source]

Probability models for pine twisting rust (Melampsora pinitorqua) damage in Scots pine (Pinus sylvestris) stands in Finland

FOREST PATHOLOGY, Issue 1 2005
U. Mattila
Summary Factors affecting the probability that pine twisting rust (Melampsora pinitorqua) damage occur in a Scots pine (Pinus sylvestris) stand were analysed using the 7th Finnish National Forest Inventory data (NFI7) from southern Finland in 1977,1983. The inventory was based on systematic sampling. The NFI7 data was measured in clusters, each of which consisted of 21 sample plots. In addition to the stand and site characteristics measured for forest management planning purposes, the data included records of damage by pine twisting rust and occurrence of aspens (Populus tremula, the other host plant of the pathogen) in the stands. Two multilevel logit models were developed for predicting the overall probability of pine twisting rust damage and the probability of severe pine twisting rust damage. Site and stand characteristics were used as explanatory variables in the models. Residual variance in the models was studied on the inventory crew, cluster and year levels. The occurrence of aspens and site fertility were the most important factors increasing the probability that pine twisting rust damage will occur in a stand. The damage probability also decreased with increasing effective temperature sum calculated for the location. The overall damage probability was equally high on peatlands and on mineral soil if there were aspens in the stand. If, however, there were no aspens in the stand, the probability of damage was higher on mineral soils than on peatlands. In addition, the overall probability was lower in naturally regenerated stands than in planted or sown stands, and it decreased with increasing mean age of pines. In both models, the residual variance was significant on the both the inventory crew and the cluster levels. Résumé Les facteurs de probabilité d'occurrence d'un dégât de rouille courbeuse (Melampsora pinitorqua) dans un peuplement de Pin sylvestre (Pinus sylvestris) ont été analysés en utilisant les données du 7 Inventaire Forestier National de Finlande (NF17) pour la Finlande du Sud et la période 1977,1983. L'inventaire est basé sur un échantillonnage systématique. Les données de NF17 sont mesurées dans des groupes constitués de 21 placettes. En plus des caractéristiques de la station et du peuplement mesurées à des fins de gestion forestière, les données comprennent des notations de dégâts par la rouille courbeuse et de présence des trembles (hôte alternant de 1'agent pathogène) dans les peuplements. Des modèles logit multiniveaux ont été développés pour prédire la probabilité globale de dégât de rouille courbeuse et la probabilité de dégât sévère. Les caractéristiques de la station et du peuplement ont été utilisées comme variables explicatives dans les modèles. La variance résiduelle des modèles a étéétudiée au niveau de 1'observateur, du groupe de placettes et de 1'année. La présence de trembles et la fertilité de la station sont les facteurs les plus importants d'augmentation de la probabilité de dégât de rouille dans un peuplement. D'autre part, la probabilité de dégât décroît avec la somme des températures effectives calculée pour le site. La probabilité globale de dégât est aussi élevée sur sols de tourbières que sur sols minéraux dans le cas où des trembles sont présents dans le peuplement. En 1'absence de trembles dans le peuplement, la probabilité de dégât est plus importante sur sols minéraux qu'en tourbières. Enfin, la probabilité de dégât est plus faible dans les peuplements régénérés naturellement que dans les peuplements semés ou plantés, et elle décroít avec 1'âge moyen des pins. Pour les deux modèles, la variance résiduelle est significative au niveau observateur et groupe de parcelles. Zusammenfassung Faktoren, die die Wahrscheinlichkeit einer Schädigung durch den Kieferndrehrost (Melampsora pinitorqua) in Beständen von Pinus sylvestris beeinflussen, wurden anhand der Daten der 7. Finnischen Nationalen Forstinventur (NF17) aus den Jahren 1977,1983 in Südfinnland untersucht. Die Datenerhebung basierte auf einer systematischen Probenahme. Die NF17 Daten wurden in Clustern erhoben, jedes Cluster bestand aus 21 Probeflächen. Neben den Bestandes- und Standortsmerkmalen, die für die forstliche Planung erhoben wurden, wurden Angaben zum Befall (schwach, stark) mit Kieferndrehrost und zum Vorkommen von Zitter-Pappel (Populus tremula, alternativer Wirt des Pathogens) berücksichtigt. Es wurden zwei Multi Logit - Modelle entwickelt zur Vorhersage der Gesamtwahrscheinlichkeit einer Kieferndrehrost-Schädigung sowie der Wahrscheinlichkeit einer schweren Schädigung durch den Pilz. Die Standorts- und Bestandesmerkmale wurden als erklärende Variablen verwendet. In den Modellen wurde die Restvarianz bezüglich Inventur-Erhebungsgruppe, Cluster und Jahr geprüft. Das Vorkommen von Zitter-Pappel und die Bodenfertilität waren die wichtigsten Faktoren für eine zunehmende Wahrscheinlichkeit einer Kieferndrehrost-Schädigung auf Bestandesebene. Die Schadenswahrscheinlichkeit verringerte sich mit zunehmender Temperatursumme, die für den Standort berechnet wurde. Die Gesamtschadenswahrscheinlichkeit war auf Torf- und Mineralböden gleich hoch, sofern Zitter-Pappeln im Bestand vorkamen. Ohne Zitter-Pappeln war die Schadenswahrscheinlichkeit auf Mineralböden höher. Zudem war die Gesamtschadenswahrscheinlichkeit in natürlich regenerierten Beständen niedriger als in gepflanzten oder gesäten Beständen, und sie nahm mit zunehmendem Durchschnittsalter der Kiefern ab. In beiden Modellen war die Restvarianz auf der Ebene der Inventur-Erhebungsgruppe und der Probecluster signifikant. [source]

Preliminary study of stress in undergraduate nursing students in Singapore

ASIA-PACIFIC PSYCHIATRY, Issue 2 2009
Chi Ching Lim BScN
Abstract Introduction: Stress experienced by nursing students may adversely affect academic achievement, personal wellbeing and long-term professional capabilities. The current study is the first to report levels and sources of stress among Singaporean students undertaking a pre-registration baccalaureate nursing degree. Methods: An exploratory survey was conducted with students from all three year levels (n=112, 65% response rate) using the Stress in Nursing Students (SINS) scale. Use of this tool also enabled a regional comparison of results with published data from a nursing cohort in Hong Kong. Perceptions of support were measured using the Social Support Rating Scale (SSRS). It was hypothesized that students with higher levels of social support would report less stress. Results: In comparison to other year levels, Year 3 students reported higher levels of overall, clinical, and financial stress. There were statistical differences between Year 3 and Year 1 students in relation to clinical and financial stressors, but not with Year 2, nor were relationships found across year of study and confidence and education subscales. Level of stress was lower compared to Hong Kong nursing students. There were statistically significant differences on stress associated with clinical (P<0.01) and confidence (P<0.001) domains between datasets, but no differences on subscale scores for education and financial stressors. Social support was not statistically associated with stress. Discussion: Student stress increased throughout the program and was not mediated by social support. Awareness of types and progression of stress can inform professional development activities to bolster coping, and minimize adverse psychological, academic and professional consequences. [source]

Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009
Maureen Watson
Abstract Objective: To describe the process and challenges in the roll out of a large cervical cancer vaccination program to protect against human papilloma virus (HPV) infection. Methods: This article describes the process of planning and implementing a HPV vaccination program using the existing state-wide framework that supports vaccine delivery to all 219 high schools in South Australia. The decision was made to offer three doses of HPV vaccine to 50,191 female students in Years 8-12 during the 2007 school year. Results: By November 2007, despite many challenges, the school vaccination program had delivered 107,541 doses of HPV vaccine. Coverage of dose 1 was highest in Years 8 (83%) and 10 (70%), but was reduced for doses 2 and 3 in all year levels, with dose 3 coverage ranging from 55% (Year 11) to 77% (Year 8). Conclusions: The introduction of a large school-based vaccination program at short notice posed new challenges for the co-ordination and implementation. Not all schools supported the introduction of HPV vaccine, resulting in reduced access for some students. Negative media messages provided a strong platform for individuals who opposed vaccination. These factors may have contributed to the less-than-expected uptake of HPV vaccine. Implications: Historically, there has been high uptake of other vaccines given to adolescents. However, the introduction of HPV vaccine may have adversely affected the uptake of Hepatitis B vaccine, given concurrently in the school program. Further studies are needed to determine if this is likely to have a negative effect on the public perception of the value of vaccine programs in general. [source]