Drug-related problems and pharmacy interventions in community practice

DEFF Research Database (Denmark)

Westerlund, Tommy; Almarsdóttir, Anna Birna; Melander, Arne

1999-01-01

Objectives. (1) To document types and number of drug-related problems identified by community pharmacy personnel in Sweden; (2) to determine relationships among the types and number of problems identified and the gender, age and number of prescribed drugs in patients; and (3) to document the inte......Objectives. (1) To document types and number of drug-related problems identified by community pharmacy personnel in Sweden; (2) to determine relationships among the types and number of problems identified and the gender, age and number of prescribed drugs in patients; and (3) to document...... the interventions made by pharmacy personnel with patients and prescribers. Method. Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn nationwide in Sweden; 144 (63 per cent) of the employees fulfilling the inclusion criteria agreed to take part. The participants documented drug......-related problems, interventions and patient variables on a data collection form, and tallied the number of patients they served on another form. Setting. One hundred and sixteen community pharmacies and 12 outpatient hospital pharmacies. Key findings. One problem or more was identified among 2.5 per cent...

Problem Solving Strategies among Primary School Teachers

Science.gov (United States)

Yew, Wun Thiam; Lian, Lim Hooi; Meng, Chew Cheng

2017-01-01

The purpose of this article was to examine problem solving strategies among primary school teachers. The researchers employed survey research design to examine their problem solving strategies. The participants of this study consisted of 120 primary school teachers from a public university in Peninsula Malaysia who enrolled in a 4-year Graduating…

Problems Associated With Substandard And Counterfeit Drugs In ...

African Journals Online (AJOL)

Problems Associated With Substandard And Counterfeit Drugs In Developing Countries: A Review Article On Global Implications Of Counterfeit Drugs In The Era Of Anti-Retroviral (ARVS) Drugs In A Free Market Economy.

Subcutaneous drug infusions: a review of problems and solutions.

Science.gov (United States)

Mitten, T

2001-02-01

Subcutaneous drug infusion using a portable syringe driver has had a significant impact on patient comfort in palliative care. It permits the continuous delivery of a range of drug therapies, so bypassing problems of dysphagia, weakness and the inability of many patients in the terminal phase to take oral medication. The devices are not problem-free, however. Mechanical problems, reactions at the infusion site and difficulties with the mixing of drugs in the syringe are all widely recognized. This article reviews some general issues with the operation of portable syringe drivers, and discusses a range of potential problems and their solutions.

Drug-related problems among community-dwelling older adults in mainland China.

Science.gov (United States)

Yang, Jiadan; Meng, Long; Liu, Yu; Lv, Liping; Sun, Shusen; Long, Rui; Shan, Xuefeng; Song, Jie; Qiu, Feng

2018-04-01

Background Little is known about the extent of drug-related problems (DRPs) in community-dwelling older adult patients with chronic diseases in mainland China. Setting A medication therapy review service at a community health center in Chongqing, China. Objective To identify and categorize DRPs along with pharmacists' recommendations in addressing the DRPs identified. Method The study was conducted between May 2015 and July 2016. A total of 102 community-dwelling older adults were included. MTR was carried out by clinical pharmacists. DRPs and pharmacotherapy recommendations were recorded and analyzed. Main outcome measure The number of drug-related problems and main problem categories. Results The average age of patients was 69.4 years. Patients took an average of 6.3 medications. A total of 489 DRPs were identified (mean of 4.8 per patient). The most common category was under-treated (27.8%) followed by over- or under-dose (18.8%) and monitoring (17.8%). The number of medications taken was the significant associated factor for DRPs. Pharmacists made 526 recommendations to address the DRPs (mean of 1.1 recommendations per DRP). Primary care providers accepted 68.1% of these recommendations, and implemented 60.9% of them. Conclusion The prevalence of DRPs among studied patient population was high. Pharmacists may play a vital role in addressing the DRPs and optimize pharmacotherapy through MTR service located in community health centers.

KARAKTERISTIK DAN ANALISIS DRUG RELATED PROBLEMS (DRPs PASIEN PENDERITA TUBERKULOSIS DI PUSKESMAS TEMINDUNG SAMARINDA KALIMANTAN TIMUR

Directory of Open Access Journals (Sweden)

Nurul Fauziah

2014-12-01

Full Text Available A study concerning the characteristics and Analysis of Drug Related Problems (DRPs Patients with Tuberculosis Patients in Public Health Center (PHC Temindung, Samarinda in East Kalimantan. The study was conducted using a prospective approach to the study of data sources in the form of primary data and secondary data. The primary data source is data from interviews with patients and through the provision of questionnaires and secondary data in this research is a Tuberculosis patient medical record data. Data collection was performed by analyzing the accuracy of the DRPs categories of accuracy of drugs, side effects and patient non-compliance. As well as the data recorded in the form of research support patient characteristics are age, sex, and education. Data were analyzed descriptively. Data obtained from patients with male gender 63.6% and women 36.4. Patient with age 50 years 27.3% . Based on the patient's level of education, no school 9.1%, graduated from elementary school22.7%, graduated from high school18.2%, graduated from high school40.1%, scholar 9.1%. Incidence of DRPs on drugs interactions 507%. Tuberculosis patient compliance rate of 81.8% in PHC Temindung adherent patients and 18.2% of patients do not comply Keywords: Tuberculosis, Drug Related Problems (DRPs drugs interactions and patient compliance   ABSTRAK Telah  dilakukan penelitian tentang Karakteristik dan Analisis Drug Related Problems(DRPs Pasien Penderita Tuberkulosis di Puskesmas Temindung, Samarinda Kalimantan Timur. Penelitian ini dilakukan dengan menggunakan pendekatan prospektif dengan sumber data penelitian berupa data primer dan data sekunder. Sumber data primer  adalah data hasil wawancara dengan pasien dan melalui pemberian kuisioner sedangkan data sekunder dalam penelitian ini adalah data rekam medik pasien Tuberkulosis. Pengumpulan data dilakukan dengan menganalisis DRPs kategori interaksi obat dan ketidakpatuhan pasien. Serta dicatat data pendukung penelitian

Prescription drug abuse: problem, policies, and implications.

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Phillips, Janice

2013-01-01

This article provides an overview on prescription drug abuse and highlights a number of related legislative bills introduced during the 112th Congress in response to this growing epidemic. Prescription drug abuse has emerged as the nation's fastest growing drug problem. Although prescription drugs have been used effectively and appropriately for decades, deaths from prescription pain medicine in particular have reached epidemic proportions. Bills related to prescription drug abuse introduced during the 112th Congress focus on strengthening provider and consumer education, tracking and monitoring prescription drug abuse, improving data collection on drug overdose fatalities, combating fraud and abuse in Medicare and Medicaid programs, reclassifying drugs to make them more difficult to prescribe and obtain, and enforcing stricter penalties for individuals who operate scam pain clinics and sell pain pills illegitimately. This article underscores the importance of a multifaceted approach to combating prescription drug abuse and concludes with implications for nursing. Copyright © 2013. Published by Mosby, Inc.

Prevalence of problem alcohol use among patients attending primary care for methadone treatment

LENUS (Irish Health Repository)

Ryder, Niamh

2009-06-11

Abstract Background Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. Methods We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. Results We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. Conclusion Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make

Prevalence of problem alcohol use among patients attending primary care for methadone treatment.

LENUS (Irish Health Repository)

Ryder, Niamh

2012-02-01

BACKGROUND: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed to determine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. METHODS: We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test (\\'AUDIT\\'), with a score of >7 considered abnormal (ie \\'AUDIT positive cases\\') and socio-demographic, medical and substance use characteristics. RESULTS: We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight \\'AUDIT positive\\' cases were identified (prevalence of 35%, 95% CI = 28-41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. CONCLUSION: Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this

Drug related problems with Antiparkinsonian agents: consumer Internet reports versus published data.

Science.gov (United States)

Schröder, Sabrina; Zöllner, York Francis; Schaefer, Marion

2007-10-01

There is currently a lack of detailed information concerning drug related problems in the outpatient treatment of Parkinson's disease. Problems associated with drug treatment communicated anonymously in Parkinson's disease online forums were therefore retrospectively searched and documented for 1 year. Based on postings concerning 12 drugs for the treatment of Parkinson's disease, a total of 238 drug related problems were identified and categorised using the Problem Intervention Documentation (PI-Doc). Of these, 153 were adverse drug reactions. Adverse drug reactions associated with the skin were relatively common, but central effects such as cognitive or psychiatric changes, effects on the sleep/waking system and other problems like headache and dizziness accounted for the highest percentage of adverse events. A comparison with data from scientific literature revealed a number of differences. This means that an analysis of online forums detected a number of drug related problems that were otherwise largely invisible. These were mainly associated with the qualitative aspects of treatment such as medication handling, dosage and individual problems concerning adverse events. In addition, the described method of identifying and classifying drug related problems in Internet forums may also be seen as a contribution to the international discussion about consumer reports and pharmacovigilance. The information about adverse drug reactions given by Internet users can be seen as a valuable adjunct to clinical trial data and as being very timely with regard to the event itself. Online forums may be considered as a suitable source of observational information to complement data from randomised clinical trials.

Drug problems in contemporary China: a profile of Chinese drug users in a metropolitan area.

Science.gov (United States)

Huang, Kaicheng; Zhang, Lening; Liu, Jianhong

2011-03-01

Drug problems are reemerging in China since the nation implemented economic reform and an "open door" policy in the early 1980s. This is causing both national and international concern. However, knowledge and understanding of the Chinese drug problem is fairly limited because of the nation's unique social and political history. In response to this shortage of information, our study presents a profile of Chinese drug users. Data were collected from a survey of drug users attending mandatory treatment centres in a large city in 2009. We present a demographic profile of the drug users, describe their patterns of drug use, their access to drugs and their history of drug treatment. Chinese drug users, like those from the U.S., are likely to be unemployed and have a low level of education. However, they are more likely than those in the U.S. to use heroin, Bingdu (methamphetamine) and Maguo (a derivative of methamphetamine), and they pay less for their drugs. This profile of drug users is informative and valuable for drug prevention, intervention, and treatment in the Chinese setting because knowing and understanding the drug population is essential for effective control. Copyright © 2010 Elsevier B.V. All rights reserved.

Turkish Primary School Teachers' Opinions about Problem Posing

Science.gov (United States)

Kilic, Cigdem

2013-01-01

Problem posing is one of the most important topics in a mathematics education. Through problem posing, students gain mathematical abilities and concepts and teachers can evaluate their students and arrange adequate learning environments. The aim of the present study is to investigate Turkish primary school teachers' opinions about problem posing…

Pharmacist intervention in drug-related problems for patients with ...

African Journals Online (AJOL)

Trop J Pharm Res, October 2016; 15(10): 2275. Tropical Journal of ... medication errors in irrational drug use, while patient adherence ..... Drug-related problems identified from geriatric medication safety ... Ann. Pharmacother. 2005; 39:1423-.

A guided interview process to improve student pharmacists' identification of drug therapy problems.

Science.gov (United States)

Rovers, John; Miller, Michael J; Koenigsfeld, Carrie; Haack, Sally; Hegge, Karly; McCleeary, Erin

2011-02-10

To measure agreement between advanced pharmacy practice experience students using a guided interview process and experienced clinical pharmacists using standard practices to identify drug therapy problems. Student pharmacists enrolled in an advanced pharmacy practice experience (APPE) and clinical pharmacists conducted medication therapy management interviews to identify drug therapy problems in elderly patients recruited from the community. Student pharmacists used a guided interview tool, while clinical pharmacists' interviews were conducted using their usual and customary practices. Student pharmacists also were surveyed to determine their perceptions of the interview tool. Fair to moderate agreement was observed on student and clinical pharmacists' identification of 4 of 7 drug therapy problems. Of those, agreement was significantly higher than chance for 3 drug therapy problems (adverse drug reaction, dosage too high, and needs additional drug therapy) and not significant for 1 (unnecessary drug therapy). Students strongly agreed that the interview tool was useful but agreed less strongly on recommending its use in practice. The guided interview process served as a useful teaching aid to assist student pharmacists to identify drug therapy problems.

Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use?

Science.gov (United States)

Palfai, Tibor P; Cheng, Debbie M; Bernstein, Judith A; Palmisano, Joseph; Lloyd-Travaglini, Christine A; Goodness, Tracie; Saitz, Richard

2016-05-01

Although a number of brief intervention approaches for drug use are based on motivational interviewing (MI), relatively little is known about whether the quality of motivational interviewing skills is associated with intervention outcomes. The current study examined whether indices of motivational interviewing skill were associated with subsequent drug use outcomes following two different MI-based brief interventions delivered in primary care; a 15 min Brief Negotiated Interview (BNI) and a 45 min adaptation of motivational interviewing (MOTIV). Audio recordings from 351 participants in a randomized controlled trial for drug use in primary care were coded using the Motivational Interviewing Treatment Integrity Scale, (MITI Version 3.1.1). Separate negative binomial regression analyses, stratified by intervention condition, were used to examine the associations between six MITI skill variables and the number of days that the participant used his/her main drug 6 weeks after study entry. Only one of the MITI variables (% reflections to questions) was significantly associated with the frequency of drug use in the MOTIV condition and this was opposite to the hypothesized direction (global p=0.01, adjusted IRR 1.50, 95%CI: 1.03-2.20 for middle vs. lowest tertile [higher skill, more drug use]. None were significantly associated with drug use in the BNI condition. Secondary analyses similarly failed to find consistent predictors of better drug outcomes. Overall, this study provides little evidence to suggest that the level of MI intervention skills are linked with better drug use outcomes among people who use drugs and receive brief interventions in primary care. Findings should be considered in light of the fact that data from the study are from negative trial of SBI and was limited to primary care patients. Future work should consider alternative ways of examining these process variables (i.e., comparing thresholds of proficient versus non-proficient skills) or

Problem drug use the public health imperative: what some of the literature says.

Science.gov (United States)

Bevan, Gez

2009-12-16

With more than 200,000 problem drug users is contact with structured treatment services in England the public health imperative behind drug treatment is great. Problem drug use for many is a chronic and relapsing condition, where "cure" is often neither a reasonable or appropriate expectation and it can further be argued that in these circumstances problem drug use is no different from any number of chronic and enduring health conditions that are managed in the health care system and therefore should be conceptualised as such. A public health approach to drug treatment emphasises the need for drug users in or accessing treatment, to reduce their harmful drug use, reduce drug use related risks such as sepsis and overdose and stay alive for longer. However a public health perspective in relation to problem drug use isn't always either apparent or readily understood and to that end there is still a significant need to continue the arguments and debate that treatment and interventions for problem and dependent drug users need to extend beyond an individualistic approach. For the purposes of discussion in this article public and population health will be used interchangeably. A recognition and acceptance that a public and population health approach to the management of problem drug users is sound public health policy also then requires a long term commitment in terms of staffing and resources where service delivery mirrors that of chronic condition management.

PRIMARY IMMUNODEFICIENCY: STATUS OF A PROBLEM TODAY. RUSSIAN NETWORK OF JMF-CENTERS

Directory of Open Access Journals (Sweden)

E. A. Latysheva

2013-01-01

Full Text Available The problems of primary immunodeficiency in Russia and the ways of solving of them are discussed in the article. Primary immunodeficiency is a group of rare diseases, so awareness of this pathology in the medical community and among patients is very low. This leads to late diagnosis and inadequate treatment of patients with such conditions. The result of the late beginning of treatment is early development of disability, and the high mortality rate of patients, as well as the high costs of the treatment of complications of primary immunodeficiency and sick-leave certificates for the government. Today in time and adequate therapy allows patients not only to reach adulthood without signs of disability, and to lead an active way of life, but to have healthy children. Given the high cost of therapy in many countries, the issue of providing patients with life-saving drugs remains unresolved. The global practice is to involve social organizations and funds. One of the foundations supporting educational programs, development of laboratories and research in the field of primary immunodeficiency is the Foundation of the Jeffrey Modell. A network of centres for primary immunodeficiency supported by the Jeffrey Modell Foundation (JMF-centers has started its functioning over the territory of the Russian Federation since 2011 in order to improve diagnostics and treatment of patients with primary immunodeficiency. A brief description of activity of these centers is presented in the article.

[Variations in antihypertensive drug utilization among primary care areas in the autonomous region of Valencia (Spain)].

Science.gov (United States)

Sanfélix-Gimeno, Gabriel; Peiró, Salvador; Librero, Julián

2010-01-01

To estimate consumption of five subgroups of antihypertensive drugs by primary care areas and to analyze its variation. We performed an ecological, descriptive study of antihypertensive consumption in 239 primary care areas in the autonomous region of Valencia in 2005 followed by analysis of the variability observed. The 239 primary care areas were studied by descriptive analysis of dispensation [defined daily dose (DDD) per 1,000 inhabitants/day in pensioners (DDD/1000p/day) and in the active population (DDD/1000a/day)] and standardized consumption ratios. Small-area variation analysis was used to analyze the observed variability. Associations among dispensations of the distinct therapeutic subgroups were also analyzed. Overall antihypertensive use in the autonomous region of Valencia in 2005 was 235.6DDD/1000/day. This consumption was concentrated in pensioners (800DDD/1000p/day vs. 73DDD/1000a/day). Consumption of antihypertensive subgroups oscillated from 442DDD/1000p/day for drugs with action on the renin-angiotensin system to 32DDD/1000p/day for doxazosin. The active population showed similar patterns. Variation in consumption was moderate, with coefficients of variation from 0.20 to 0.40 (slightly greater for the active population). Associations among dispensations of the different therapeutic subgroups were strong. This study shows major variations in the overall consumption of antihypertensive drugs among primary care areas of the autonomous region of Valencia. These results suggest that variation may be associated with problems of underutilization in areas with lower consumption. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Pharmacist intervention in drug-related problems for patients with ...

African Journals Online (AJOL)

Purpose: To investigate the role of the community pharmacist in identifying, preventing and resolving drug related problems (DRPs) encountered by patients, with particular emphasis on cardiovascular drugs in community pharmacies in Northern Cyprus, Turkey. Methods: A prospective observational study for the ...

Faces of Change: Do I Have a Problem with Alcohol or Drugs?

Science.gov (United States)

... You Do About Drugs And Alcohol In Your Life? Know if there’s a problem: • Are drugs or alcohol affecting your work or health? • Do you feel like you need alcohol or drugs to get through the day? • Are your friends or family members telling you there’s a problem? ...

Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy.

Science.gov (United States)

Kelly, John F; Bergman, Brandon; Hoeppner, Bettina B; Vilsaint, Corrie; White, William L

2017-12-01

Alcohol and other drug (AOD) problems confer a global, prodigious burden of disease, disability, and premature mortality. Even so, little is known regarding how, and by what means, individuals successfully resolve AOD problems. Greater knowledge would inform policy and guide service provision. Probability-based survey of US adult population estimating: 1) AOD problem resolution prevalence; 2) lifetime use of "assisted" (i.e., treatment/medication, recovery services/mutual help) vs. "unassisted" resolution pathways; 3) correlates of assisted pathway use. Participants (response=63.4% of 39,809) responding "yes" to, "Did you use to have a problem with alcohol or drugs but no longer do?" assessed on substance use, clinical histories, problem resolution. Weighted prevalence of problem resolution was 9.1%, with 46% self-identifying as "in recovery"; 53.9% reported "assisted" pathway use. Most utilized support was mutual-help (45.1%,SE=1.6), followed by treatment (27.6%,SE=1.4), and emerging recovery support services (21.8%,SE=1.4), including recovery community centers (6.2%,SE=0.9). Strongest correlates of "assisted" pathway use were lifetime AOD diagnosis (AOR=10.8[7.42-15.74], model R2=0.13), drug court involvement (AOR=8.1[5.2-12.6], model R2=0.10), and, inversely, absence of lifetime psychiatric diagnosis (AOR=0.3[0.2-0.3], model R2=0.10). Compared to those with primary alcohol problems, those with primary cannabis problems were less likely (AOR=0.7[0.5-0.9]) and those with opioid problems were more likely (AOR=2.2[1.4-3.4]) to use assisted pathways. Indices related to severity were related to assisted pathways (R2<0.03). Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution. Copyright © 2017 Elsevier B.V. All rights reserved.

Analyzing Pre-Service Primary Teachers' Fraction Knowledge Structures through Problem Posing

Science.gov (United States)

Kilic, Cigdem

2015-01-01

In this study it was aimed to determine pre-service primary teachers' knowledge structures of fraction through problem posing activities. A total of 90 pre-service primary teachers participated in this study. A problem posing test consisting of two questions was used and the participants were asked to generate as many as problems based on the…

Characteristics of potential drug-related problems among oncology patients

NARCIS (Netherlands)

Bulsink, Arjan; Imholz, Alex L. T.; Brouwers, Jacobus R. B. J.; Jansman, Frank G. A.

Background Oncology patients are more at risk for drug related problems because of treatment with (combinations of) anticancer drugs, as they have a higher risk for organ failure or altered metabolism with progression of their disease. Objective The aim of this study was to characterize and to

Assessment of mitochondrial dysfunction-related, drug-induced hepatotoxicity in primary rat hepatocytes

International Nuclear Information System (INIS)

Liu, Cong; Sekine, Shuichi; Ito, Kousei

2016-01-01

Evidence that mitochondrial dysfunction plays a central role in drug-induced liver injury is rapidly accumulating. In contrast to physiological conditions, in which almost all adenosine triphosphate (ATP) in hepatocytes is generated in mitochondria via aerobic respiration, the high glucose content and limited oxygen supply of conventional culture systems force primary hepatocytes to generate most ATP via cytosolic glycolysis. Thus, such anaerobically poised cells are resistant to xenobiotics that impair mitochondrial function, and are not suitable to identify drugs with mitochondrial liabilities. In this study, primary rat hepatocytes were cultured in galactose-based medium, instead of the conventional glucose-based medium, and in hyperoxia to improve the reliance of energy generation on aerobic respiration. Activation of mitochondria was verified by diminished cellular lactate release and increased oxygen consumption. These conditions improved sensitivity to the mitochondrial complex I inhibitor rotenone. Since oxidative stress is also a general cause of mitochondrial impairment, cells were exposed to test compounds in the presence of transferrin to increase the generation of reactive oxygen species via increased uptake of iron. Finally, 14 compounds with reported mitochondrial liabilities were tested to validate this new drug-induced mitochondrial toxicity assay. Overall, the culture of primary rat hepatocytes in galactose, hyperoxia and transferrin is a useful model for the identification of mitochondrial dysfunction-related drug-induced hepatotoxicity. - Highlights: • Drug-induced mitochondrial toxicity was evaluated using primary rat hepatocytes. • Galactose and hyperoxia could activate OXPHOS in primary rat hepatocytes. • Cells with enhanced OXPHOS exhibit improved sensitivity to mitochondrial toxins. • Transferrin potentiate mitochondrial toxicity via increased ROS production.

Assessment of mitochondrial dysfunction-related, drug-induced hepatotoxicity in primary rat hepatocytes

Energy Technology Data Exchange (ETDEWEB)

Liu, Cong; Sekine, Shuichi, E-mail: ssekine@faculty.chiba-u.jp; Ito, Kousei

2016-07-01

Evidence that mitochondrial dysfunction plays a central role in drug-induced liver injury is rapidly accumulating. In contrast to physiological conditions, in which almost all adenosine triphosphate (ATP) in hepatocytes is generated in mitochondria via aerobic respiration, the high glucose content and limited oxygen supply of conventional culture systems force primary hepatocytes to generate most ATP via cytosolic glycolysis. Thus, such anaerobically poised cells are resistant to xenobiotics that impair mitochondrial function, and are not suitable to identify drugs with mitochondrial liabilities. In this study, primary rat hepatocytes were cultured in galactose-based medium, instead of the conventional glucose-based medium, and in hyperoxia to improve the reliance of energy generation on aerobic respiration. Activation of mitochondria was verified by diminished cellular lactate release and increased oxygen consumption. These conditions improved sensitivity to the mitochondrial complex I inhibitor rotenone. Since oxidative stress is also a general cause of mitochondrial impairment, cells were exposed to test compounds in the presence of transferrin to increase the generation of reactive oxygen species via increased uptake of iron. Finally, 14 compounds with reported mitochondrial liabilities were tested to validate this new drug-induced mitochondrial toxicity assay. Overall, the culture of primary rat hepatocytes in galactose, hyperoxia and transferrin is a useful model for the identification of mitochondrial dysfunction-related drug-induced hepatotoxicity. - Highlights: • Drug-induced mitochondrial toxicity was evaluated using primary rat hepatocytes. • Galactose and hyperoxia could activate OXPHOS in primary rat hepatocytes. • Cells with enhanced OXPHOS exhibit improved sensitivity to mitochondrial toxins. • Transferrin potentiate mitochondrial toxicity via increased ROS production.

Investigative Primary Science: A Problem-Based Learning Approach

Science.gov (United States)

Etherington, Matthew B.

2011-01-01

This study reports on the success of using a problem-based learning approach (PBL) as a pedagogical mode of learning open inquiry science within a traditional four-year undergraduate elementary teacher education program. In 2010, a problem-based learning approach to teaching primary science replaced the traditional content driven syllabus. During…

2010 drug packaging review: identifying problems to prevent errors.

Science.gov (United States)

2011-06-01

Prescrire's analyses showed that the quality of drug packaging in 2010 still left much to be desired. Potentially dangerous packaging remains a significant problem: unclear labelling is source of medication errors; dosing devices for some psychotropic drugs create a risk of overdose; child-proof caps are often lacking; and too many patient information leaflets are misleading or difficult to understand. Everything that is needed for safe drug packaging is available; it is now up to regulatory agencies and drug companies to act responsibly. In the meantime, health professionals can help their patients by learning to identify the pitfalls of drug packaging and providing safe information to help prevent medication errors.

Drug prescriptions in Danish out-of-hours primary care

DEFF Research Database (Denmark)

Christensen, Morten Bondo; Nørøxe, Karen Busk; Moth, Grete

2016-01-01

of prescriptions per 100 contacts. RESULTS: Of 644,777 contacts, 154,668 (24.0%) involved medication prescriptions; 21.9% of telephone consultations, 32.9% of clinic consultations and 14.3% of home visits. Around 53% of all drug prescriptions were made in telephone consultations. Anti-infective medications...... for systemic use accounted for 45.5% of all prescriptions and were the most frequently prescribed drug group for all contact types, although accounting for less than 1/3 of telephone prescriptions. Other frequently prescribed drugs were ophthalmological anti-infectives (10.5%), NSAIDs (6.4%), opioids (3......) primary care services cover more than 75% of all hours during a normal week, insight into the extent and type of OOH drug prescription is important. General practitioners (GPs) are responsible for more than 80% of all drug prescriptions in Denmark. Of all contacts 24.0% involved medication prescriptions...

Prisoners' views about the drugs problem in prisons, and the new Prison Service drug strategy.

Science.gov (United States)

Gore, S M; Bird, A G; Cassidy, J

1999-09-01

Three hundred and seventy-five out of 575 prisoners (222/299 drug users and 153/267 non-users) who responded to a self-completion health care questionnaire at two prisons in 1997 commented on drugs in prisons. One hundred and forty-eight out of 176 responses expressed negative opinions about mandatory drugs testing (MDT), and 107 said that MDT promoted switching to or increased use of heroin/hard drugs'. Sixty-two prisoners suggested that more help/counselling was needed for drug users, 52 segregation of drug users/drug-free wings, and 50 more security on visits/in corridors after medication. The new Prison Service drug strategy has revised random MDT. It targets those who supply drugs, and supports those who want to stop using drugs, and accords with prisoners' views about the heroin problem in prisons.

[Analysis of drug-related problems in a tertiary university hospital in Barcelona (Spain)].

Science.gov (United States)

Ferrández, Olivia; Casañ, Borja; Grau, Santiago; Louro, Javier; Salas, Esther; Castells, Xavier; Sala, Maria

2018-05-07

To describe drug-related problems identified in hospitalized patients and to assess physicians' acceptance rate of pharmacists' recommendations. Retrospective observational study that included all drug-related problems detected in hospitalized patients during 2014-2015. Statistical analysis included a descriptive analysis of the data and a multivariate logistic regression to evaluate the association between pharmacists' recommendation acceptance rate and the variable of interest. During the study period 4587 drug-related problems were identified in 44,870 hospitalized patients. Main drug-related problems were prescription errors due to incorrect use of the computerized physician order entry (18.1%), inappropriate drug-drug combination (13.3%) and dose adjustment by renal and/or hepatic function (11.5%). Acceptance rate of pharmacist therapy advice in evaluable cases was 81.0%. Medical versus surgical admitting department, specific types of intervention (addition of a new drug, drug discontinuation and correction of a prescription error) and oral communication of the recommendation were associated with a higher acceptance rate. The results of this study allow areas to be identified on which to implement optimization strategies. These include training courses for physicians on the computerized physician order entry, on drugs that need dose adjustment with renal impairment, and on relevant drug interactions. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Primary drug resistance in a region with high burden of tuberculosis. A critical problem.

Science.gov (United States)

Villa-Rosas, Cecilia; Laniado-Laborín, Rafael; Oceguera-Palao, Lorena

2015-01-01

To determine rates of drug resistance in new cases of pulmonary tuberculosis in a region with a high burden of the disease. New case suspects were referred for drug susceptibility testing. 28.9% of new cases were resistant to at least one first line drug; 3.9% had a multidrug-resistant strain, 15.6% a monoresistant strain and 9.4% a polyresistant strain. Our rate of drug resistant tuberculosis in new cases is very high; this has important clinical implications, since even monoresistance can have a negative impact on the outcome of new cases treated empirically with a six month regimen.

Drug utilization research in primary health care as exemplified by physicians' quality assessment groups.

Science.gov (United States)

von Ferber, L; Luciano, A; Köster, I; Krappweis, J

1992-11-01

Drugs in primary health care are often prescribed for nonrational reasons. Drug utilization research investigates the prescription of drugs with an eye to medical, social and economic causes and consequences of the prescribed drug's utilization. The results of this research show distinct differences in drug utilization in different age groups and between men and women. Indication and dosage appear irrational from a textbook point of view. This indicates nonpharmacological causes of drug utilization. To advice successfully changes for the better quality assessment groups of primary health care physicians get information about their established behavior by analysis of their prescriptions. The discussion and the comparisons in the group allow them to recognize their irrational prescribing and the social, psychological and economic reasons behind it. Guidelines for treatment are worked out which take into account the primary health care physician's situation. After a year with 6 meetings of the quality assessment groups the education process is evaluated by another drug utilization analysis on the basis of the physicians prescription. The evaluation shows a remarkable improvement of quality and cost effectiveness of the drug therapy of the participating physicians.

Child abuse, drug addiction and mental health problems of incarcerated women in Israel.

Science.gov (United States)

Chen, Gila; Gueta, Keren

2015-01-01

The mental health problems and pathways to drug addiction and crime among female inmates have long been of interest to researchers and practitioners. The purpose of the current study was to examine the possible association between multiple types of childhood abuse, mental health problems, and drug addiction and the incarceration of 50 Israeli women in prison. The findings indicated that female inmates come from risky families with a high prevalence of family mental health problems, parental drug addiction and crime, and sibling drug addiction and crime. Furthermore, they revealed that incarcerated women from risky families were victims of multiple types of childhood abuse and neglect by their parents, as well as their siblings. Overall, the results suggest that the adverse consequences of a family's mental health problems are much more dramatic than we assumed to date, and that women are more likely than men to be the victims of multiple types of childhood abuse and neglect, as well as suffering more severe psychiatric problems, depression, and drug addiction. The implications of these findings are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Problem Drug Use, Marijuana, and European Projects: How Epidemiology Helped Czech Policy Reformers

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Jan Morávek

2008-12-01

Full Text Available I examine the transfer of the Problem Drug Use (PDU concept into Czech scientific discourse through European institutions’ projects, and view PDU’s utilization by Czech researchers in relation to marijuana decriminalization efforts.PDU is defined as intravenous and/or long-term and regular use of opiates, cocaine, or amphetamines. Out of a vast array of illicit drug use patterns, this concept isolates a relatively small population with the riskiest use patterns to become the focus of public policies. A series of European Union and Council of Europe projects in 1990’s helped bring PDU into European research mainstream. The new common standard, promoted by the European Monitoring Centre for Drugs and Drug Addiction, was utilized by Czech authors in a 2001 policy analysis entitled “Impact Analysis Project of the New Drug Legislation in the Czech Republic” (PAD. PDU played a crucial role in PAD’s drug problem modeling, focusing on a “hard core” of opiate and methamphetamine users, while diverting attention from a large group of cannabis users.By using the new European methodological standard, PAD’s authors constructed marijuana as a non-problem. This helped drug policy reformers in the Czech Government legitimize their focus on “harder” drugs, and subsequently propose more lenient sanctions for the possession and cultivation of marijuana. I argue that continued ignorance of marijuana problems might jeopardize the tolerant expert-driven drug policy in the Czech Republic. Measurement of problem cannabis use should be introduced.

Primary drug resistance in a region with high burden of tuberculosis. A critical problem

Directory of Open Access Journals (Sweden)

Cecilia Villa-Rosas

2015-03-01

Full Text Available Objective. To determine rates of drug resistance in new cases of pulmonary tuberculosis in a region with a high burden of the disease. Materials and methods. New case suspects were referred for drug susceptibility testing. Results. 28.9% of new cases were resistant to at least one first line drug; 3.9% had a multidrug-resistant strain, 15.6% a monoresistant strain and 9.4% a polyresistant strain. Conclusion. Our rate of drug resistant tuberculosis in new cases is very high; this has important clinical implications, since even monoresistance can have a negative impact on the outcome of new cases treated empirically with a six month regimen.

Comparison of clinical features between primary and drug-induced sleep-related eating disorder

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Komada Y

2016-05-01

Full Text Available Yoko Komada,1 Yoshikazu Takaesu,2 Kentaro Matsui,3 Masaki Nakamura,3 Shingo Nishida,3 Meri Kanno,3,† Akira Usui,3 Yuichi Inoue1,3 1Department of Somnology, 2Department of Psychiatry, Tokyo Medical University, 3Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan †Meri Kanno passed away on March 1, 2016 Purpose: The aim of this study was to ascertain the clinical characteristics of drug-induced sleep-related eating disorder (SRED. Patients and methods: We retrospectively reviewed the medical records of 30 patients with primary SRED (without any comorbid sleep disorders and who were not taking any possible causative medications, and ten patients with drug-induced SRED (occurrence of SRED episodes after starting nightly medication of sedative drugs, which completely resolved after dose reduction or discontinuation of the sedatives. Results: All patients with drug-induced SRED took multiple types of sedatives, such as benzodiazepines or benzodiazepine receptor agonists. Clinical features of drug-induced SRED compared with primary SRED were as follows: higher mean age of onset (40 years old in drug-induced SRED vs 26 years old in primary SRED, significantly higher rate of patients who had total amnesia during most of their SRED episodes (75.0% vs 31.8%, significantly lower rate of comorbidity of night eating syndrome (0% vs 63.3%, and significantly lower rate of history of sleepwalking (10.0% vs 46.7%. Increased doses of benzodiazepine receptor agonists may be responsible for drug-induced SRED. Conclusion: The clinical features of drug-induced SRED were different from those of primary SRED, possibly reflecting differences in the underlying mechanisms between these two categories of SREDs. Keywords: nocturnal eating syndrome, night eating, eating disorder, hypnotics, amnesia, sleepwalking, benzodiazepine

Identification and management of physical health problems among an injecting drug using population

OpenAIRE

Patton, Robert

2013-01-01

Injecting drug use is highly prevalent in London and is associated with specific physical health problems. These problems are related to the toxicity of the substances, their mode of consumption and as a consequence of the drug taking lifestyle. Hepatitis B and C viral infections are common among drug users due to sharing of both needles and other drug taking paraphernalia. Hepatitis B infection can be prevented by immunisation. Hepatitis C infection can interact with alcohol consumption to a...

Helping someone with problem drug use: a delphi consensus study of consumers, carers, and clinicians

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Kelly Claire M

2011-01-01

Full Text Available Abstract Background Problem use of illicit drugs (i.e. drug abuse or dependence is associated with considerable health and social harms, highlighting the need for early intervention and engagement with health services. Family members, friends and colleagues play an important role in supporting and assisting individuals with problem drug use to seek professional help, however there are conflicting views about how and when such support should be offered. This paper reports on the development of mental health first aid guidelines for problem drug use in adults, to help inform community members on how to assist someone developing problem drug use or experiencing a drug-related crisis. Methods A systematic review of the scientific and lay literature was conducted to develop a 228-item survey containing potential first-aid strategies to help someone developing a drug problem or experiencing a drug-related crisis. Three panels of experts (29 consumers, 31 carers and 27 clinicians were recruited from Australia, Canada, New Zealand, the United Kingdom, and the United States. Panel members independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines. Results The overall response rate across three rounds was 80% (86% consumers, 81% carers, 74% clinicians. 140 first aid strategies were endorsed as essential or important by 80% or more of panel members. The endorsed strategies provide information and advice on what is problem drug use and its consequences, how to approach a person about their problem drug use, tips for effective communication, what to do if the person is unwilling to change their drug use, what to do if the person does (or does not want professional help, what are drug-affected states and how to deal with them, how to deal with adverse reactions leading to a medical emergency, and what to do if the person is aggressive. Conclusions The guidelines provide a consensus

Estimating incidence of problem drug use using the Horwitz-Thompson estimator - A new approach applied to people who inject drugs in Oslo 1985-2008.

Science.gov (United States)

Amundsen, Ellen J; Bretteville-Jensen, Anne L; Kraus, Ludwig

2016-01-01

The trend in the number of new problem drug users per year (incidence) is the most important measure for studying the diffusion of problem drug use. Due to sparse data sources and complicated statistical models, estimation of incidence of problem drug use is challenging. The aim of this study is to widen the palette of available methods and data types for estimating incidence of problem drug use over time, and for identifying the trends. This study presents a new method of incidence estimation, applied to people who inject drugs (PWID) in Oslo. The method took into account the transition between different phases of drug use progression - active use, temporary cessation, and permanent cessation. The Horwitz-Thompson estimator was applied. Data included 16 cross-sectional samples of problem drug users who reported their onset of injecting drug use. We explored variation in results for selected probable scenarios of parameter variation for disease progression, as well as the stability of the results based on fewer years of cross-sectional samples. The method yielded incidence estimates of problem drug use, over time. When applied to people in Oslo who inject drugs, we found a significant reduction of incidence of 63% from 1985 to 2008. This downward trend was also present when the estimates were based on fewer surveys (five) and in the results of sensitivity analysis for likely scenarios of disease progression. This new method, which incorporates temporarily inactive problem drug users, may become a useful tool for estimating the incidence of problem drug use over time. The method may be less data intensive than other methods based on first entry to treatment and may be generalized to other groups of substance users. Further studies on drug use progression would improve the validity of the results. Copyright © 2015 Elsevier B.V. All rights reserved.

Information and interaction : influencing drug prescribing in Swedish primary care

OpenAIRE

Stålsby Lundborg, Cecilia

1999-01-01

Aim The studies concern drug information and continuing education on drug treatment, focusing on doctors' prescribing in primary care in Sweden. The long-term aim has been to develop educational models accepted by the doctors, and to develop and apply means of evaluating the education. Methods Data have been collected from the study populations mainly through questionnaires and dispensed prescriptions, i.e., quantitative data. In addition, qualitative interview data w...

[Preventable drug-related morbidity: determining valid indicators for primary care in Portugal].

Science.gov (United States)

Guerreiro, Mara Pereira; Cantrill, Judith A; Martins, Ana Paula

2007-01-01

Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada. This study is part of a research programme; it aimed to determine a valid set of PDRM indicators for adult patients in primary care in Portugal. Face validity of 61 US and UK-derived indicators translated to Portuguese was preliminarily determined by means of a postal questionnaire using a purposive sample of four Portuguese pharmacists with different backgrounds. Preliminary content validity of indicators approved in the previous stage was determined by cross-checking each definition of PDRM with standard drug information sources in Portugal. Face and content validity of indicators yielded by preliminary work were then established by a 37 expert panel (20 community pharmacists and 17 general practitioners) using a two-round Delphi survey. Data were analysed using SPSS release 11.5. Nineteen indicators were ruled out in preliminary validation. Changes were made in the content of eight of the remaining 42 indicators; these were related to differences in the drugs being marketed and patterns of drug monitoring between countries. Thirty-five indicators were consensus approved as PDRM for adult patients in Portuguese primary care by the Delphi panel.

Drug problem in southeast and southwest Asia.

Science.gov (United States)

Kulsudjarit, Kongpetch

2004-10-01

In 2002, the drug problem in Southeast and Southwest Asia was serious, particularly in the production of opium and heroin in Afghanistan, Myanmar, and Laos, the three largest producers of illicit opium in the world. The increasing illicit manufacture of ATS, particularly methamphetamine, in Southeast Asia, mainly in China and Myanmar, was also a major concern. Some reports indicated that ephedrine, used for illicitly producing methamphetamine in Southeast Asia, is diverted and smuggled out of China and India, whereas caffeine, the adulterant used for producing methamphetamine tablets, is mainly smuggled into Myanmar through its border with Thailand. Seizure data showed a dramatic increase in trafficking in MDMA through Southeast Asia. In terms of the drug epidemic, in 2002, cannabis remained overall the main drug of abuse in all of the countries of Southeast and Southwest Asia. Opiates, mainly opium and heroin, were also the drugs of choice except in Thailand, where opiate abuse declined, but ATS was the main drug of abuse due to its low cost and availability. A significant increase in ATS abuse, amphetamine, methamphetamine, and MDMA among the youth who smoked, sniffed, and inhaled them was reported in Cambodia, China, Indonesia, Laos, Myanmar, the Philippines, and Thailand. Injecting drug use among opiate abusers has been identified as the prime cause of the rapid spread of HIV/AIDS in Southeast and Southwest Asia.

Prevalence of drug-related problems in self-medication in Danish community pharmacies

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Bente Frøkjær

2012-01-01

Full Text Available Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this. Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems. Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies. Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner. Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect

Prevalence of drug-related problems in self-medication in Danish community pharmacies

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Charlotte Rossing

2012-01-01

Full Text Available Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this.Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems.Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies.Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines.Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner.Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended

Is drug treatment for dementia followed up in primary care? A Swedish study of dementia clinics and referring primary care centres.

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Lars Sonde

Full Text Available PURPOSE: It is largely unknown how the medical treatment of patients diagnosed with dementia is followed up in primary care. Therefore, we studied patient medical records from two dementia clinics and from the referring primary care centres. METHODS: A retrospective study of 241 patients was conducted from April to October 2011 in north west Stockholm, Sweden. Over half (51.5% of the patients had Alzheimer's disease (AD, the remainder had mixed AD/vascular dementia (VaD. Eighty-four medical reports from primary care (35% of the study group were analysed at follow-up 18 months after diagnosis. RESULTS: All four dementia drugs available on the Swedish market (three cholinesterase inhibitors [donepezil, rivastigmine and galantamine] and memantine were prescribed at the two dementia clinics. The most commonly used dementia drug was galantamine. There were differences between the two dementia clinics in preference and combination of drugs and of treatment given to male and female patients. At follow-up, 84% were still on dementia medication. Drug use was followed up by the general practitioners (GPs in two-thirds of the cases. Eighteen per cent of the GPs' medical records made no reference to the patient's dementia or treatment even though dementia drugs were included in the list of medications prescribed. CONCLUSIONS: The results indicate that the Swedish guidelines for treatment of cognitive symptoms in AD are being followed in primary care. However, documentation of follow-up of drug treatment was sometimes insufficient, which calls for development of guidelines for complete medical records and medication lists.

Off-Label Drug Use in Pediatric Practice: Unsolved Problems

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A. R. Titova

2015-01-01

Full Text Available The widespread «off-label» drug use and the prescribing of unlicensed medicines in pediatric practice is a major health problem. The authors discuss actual regulatory and legal issues of «off-label» drug use in children in the US, Europe and Russia. The results of different population-based studies from many countries, showing the structure and frequency of «off-label» drug use in children, are summarized in this article. It is shown that such practice increases the risk of adverse drug reactions. The authors offer practical recommendations for a safer use of drugs in pediatric practice. The priority issue is conducting high quality clinical trials with the participation of children, improving national pharmacovigilance and the monitoring of off-label drug use, developing pediatric formularies, improving doctors’ knowledge and awareness of safety and efficacy of medicines in pediatric population.

Least bad solutions to the 'drugs problem'.

Science.gov (United States)

Mugford, S

1991-01-01

This paper examines the current difficulties being faced in Australia by policy-makers attempting to regulate the non-medical use of illegal drugs, and it is suggested that the difficulties centre upon two aspects. First, existing prohibitions are unsuccessful, with use levels rising and, in some arenas (e.g. cocaine use in the USA), quite out of control. On the other hand, a move towards decriminalization or legalization is difficult because past propaganda has been so vehement that a change now apparently risks sending the wrong messages to young people. This dilemma means that there is no solution, including inertia, which is risk-free, nor is there one free of difficulties. It is thus relevant to think in terms of 'least bad' rather than 'best' when formulating a system to face these problems. The exploration of what this least bad solution might be begins with the examination of the prominent myths (such as 'the drug-free society', 'the evil pusher', 'the user as victim' and 'the young person as cultural dope') that hinder our reasoning. Secondly, by suggesting that, in a climate of increasing crime related to drugs, inability of prohibitions to control that use and escalating health risks attendant on use (including the AIDS problem), the central policy thrust must be harm reduction and damage minimization rather than illusory goals such as widespread abstinence. The paper concludes with a discussion of some relevant evidence on alternative options.

A survey of drug abuse problems among students of selected ...

African Journals Online (AJOL)

The purpose of the study was to survey drug abuse problems among students of selected secondary schools in Ile-Ife in Osun State. Specifically, the study was to find out the reasons for drug abuse among students. The major instrument used to collect needed information was the questionnaire which was distributed to ...

Mental Adaptation Problems of Children in a Primary School

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Selma Dogan

2008-02-01

Full Text Available BACKGROUND: This study was carried out on explanatory purposes to determine psychological compliance state of the children between age group 6-14, receiving education in a primary school province and how common some psychological infancy problems are. METHODS: The samples of the research consist of mothers and teachers of 255 children between age group 6-14, receiving education in a primary school in Sivas province. “Personal Information Form” and “Psychological Compliance Measurement” were used in the collection of data. RESULTS: According to the evaluation of teachers it was found out that while %27.5 of the children has psychological compliance problems. According to the evaluation of mothers, it was obtained that only 24.7% of the children has psychological compliance problems. The average compliance points were found higher in boys than girls, in younger age group than older age group, in group having physical disorders than not having any physical disorders. In the research a meaningful difference was not found when the average psychological compliance points and other variables were compared. When infancy psychological compliance problems evaluated, in 2.3% of the children stammer, in 3.1% habit-spasm disorder, in 7% finger sucking, in 1.9% encopresis, in 9% enuresis, and in 19.6 educational failures were determined. When the state of being problematical in behaviors and neurotic compared with the gender, it was traced that behavioral problems were higher in boys (59.5% than girls (40.5% and the neurotic problems were higher in girls (56. 3% than boys (56.3%. CONCLUSION: Consequently, it was recognized that improvement of the services for the psychological care of the children in the society and primary schools is crucially needed. [TAF Prev Med Bull. 2008; 7(1: 47-52

Mental Adaptation Problems of Children in a Primary School

Directory of Open Access Journals (Sweden)

Selma Dogan

2008-02-01

Full Text Available BACKGROUND: This study was carried out on explanatory purposes to determine psychological compliance state of the children between age group 6-14, receiving education in a primary school province and how common some psychological infancy problems are. METHODS: The samples of the research consist of mothers and teachers of 255 children between age group 6-14, receiving education in a primary school in Sivas province. “Personal Information Form” and “Psychological Compliance Measurement” were used in the collection of data. RESULTS: According to the evaluation of teachers it was found out that while %27.5 of the children has psychological compliance problems. According to the evaluation of mothers, it was obtained that only 24.7% of the children has psychological compliance problems. The average compliance points were found higher in boys than girls, in younger age group than older age group, in group having physical disorders than not having any physical disorders. In the research a meaningful difference was not found when the average psychological compliance points and other variables were compared. When infancy psychological compliance problems evaluated, in 2.3% of the children stammer, in 3.1% habit-spasm disorder, in 7% finger sucking, in 1.9% encopresis, in 9% enuresis, and in 19.6 educational failures were determined. When the state of being problematical in behaviors and neurotic compared with the gender, it was traced that behavioral problems were higher in boys (59.5% than girls (40.5% and the neurotic problems were higher in girls (56. 3% than boys (56.3%. CONCLUSION: Consequently, it was recognized that improvement of the services for the psychological care of the children in the society and primary schools is crucially needed. [TAF Prev Med Bull 2008; 7(1.000: 47-52

Evaluation of drug therapy problems among renal patients receiving ...

African Journals Online (AJOL)

Adibe et al. Trop J Pharm Res, March 2017; 16(3): 697 .... suggestions to address medication problems, ..... Preventable drug-related hospital admissions. Ann. Pharmacother. 2002;. 36: .... geriatric hospitalized patients in yogyakarta hospitals,.

Factors influencing the detection rate of drug-related problems in community pharmacy

DEFF Research Database (Denmark)

Westerlund, T; Almarsdóttir, Anna Birna; Melander, A

1999-01-01

This study analyzes relationships between the number of drug-related problems detected in community pharmacy practice and the educational level and other characteristics of pharmacy personnel and their work sites. Random samples of pharmacists, prescriptionists and pharmacy technicians were drawn...... by each professional. The regression analysis showed the educational level of the professional to have a statistically significant effect on the detection rate, with pharmacists finding on average 2.5 more drug-related problems per 100 patients than prescriptionists and about 3.6 more than technicians....... The results of this study indicate the importance of education and training of pharmacy personnel in detection of drug-related problems. This findings speaks in favor of increasing the pharmacist to other personnel ratio, provided the higher costs will be offset by societal benefits....

Drug Therapy Problems in Patients on Antihypertensives and ...

African Journals Online (AJOL)

Drug therapy problems (DTPs), with the associated risks inherent in antihypertensive and antidiabetic therapy require utmost attention. This present study was aimed at assessing the DTPs observed in the management of hypertension and diabetes mellitus (DM) in two tertiary health facilities in Niger Delta region. In this ...

Academic Performance in Primary School Children With Common Emotional and Behavioral Problems.

Science.gov (United States)

Mundy, Lisa K; Canterford, Louise; Tucker, Dawn; Bayer, Jordana; Romaniuk, Helena; Sawyer, Susan; Lietz, Petra; Redmond, Gerry; Proimos, Jenny; Allen, Nicholas; Patton, George

2017-08-01

Many emotional and behavioral problems first emerge in primary school and are the forerunners of mental health problems occurring in adolescence. However, the extent that these problems may be associated with academic failure has been explored less. We aimed to quantify the association between emotional and behavioral problems with academic performance. A stratified random sample of 8- to 9-year-olds (N = 1239) were recruited from schools in Australia. Data linkage was performed with a national assessment of academic performance to assess reading and numeracy. Parent report assessed emotional and behavioral problems with students dichotomized into "borderline/abnormal" and "normal" categories. One in 5 grade 3 students fell in the "borderline/abnormal" category. Boys with total difficulties (β = -47.8, 95% CI: -62.8 to -32.8), conduct problems, and peer problems scored lower on reading. Numeracy scores were lower in boys with total difficulties (β = -37.7, 95% CI: -53.9 to -21.5) and emotional symptoms. Children with hyperactivity/inattention scored lower in numeracy. Girls with peer problems scored lower in numeracy. Boys with emotional and behavioral problems in mid-primary school were 12 months behind their peers. Children with emotional and behavioral problems are at high risk for academic failure, and this risk is evident in mid-primary school. © 2017, American School Health Association.

[Drug supplies in primary care units at the Ministry of Health in Mexico].

Science.gov (United States)

Gómez-Dantés, O; Garrido-Latorre, F; Tirado-Gómez, L L; Ramírez, D; Macías, C

2001-01-01

To identify the availability of some essential drugs (ED) at primary health care units of the Mexican Ministry of Health (SSA), using data from a research work conducted in 1996 and 1997. A random sample of the 18 sanitary jurisdictions of states participating in the Extension of Coverage Program (ECP) was drawn. All primary care units from selected jurisdictions were evaluated through an inspection visit, using a checklist that included 36 ED. In phase I of the analysis, the absolute number and proportion of units without a single item of any of the 36 drugs were calculated. In the units with available drugs, the median of the distribution was also calculated. In phase II, the medians according to the type of health unit and state was obtained. The statistic utilized for the comparison of the medians was the Scheffé test with one way variance analysis. In addition, the drugs were classified according to their therapeutic indication and the medians and proportion of available drugs were calculated. The differences in proportion were evaluated with the statistic chi 2. During the visits, on average, 18 of the 36 drugs included in the list of the study were found in the health units. The availability of antibiotics, antituberculosis drugs, and antimalarial drugs was particularly poor. In contrast, oral rehydration salts, family planning methods and vaccines were usually available. In general, the PAC3 states presented the best availability figures. The Ministry of Health of México will have to develop an enormous effort to overcome the obstacles related to the supply of essential drugs in primary health care units. Otherwise, all other efforts directed to meet the needs of the non-insured population will end up being useless, and enormous amounts of the already scarce resources of the health sector will be wasted since drugs are a vital component of the long chain of health care.

Failure of Chemotherapy in Hepatocellular Carcinoma Due to Impaired and Dysregulated Primary Liver Drug Metabolizing Enzymes and Drug Transport Proteins: What to Do?

Science.gov (United States)

Ul Islam, Salman; Ahmed, Muhammad Bilal; Shehzad, Adeeb; Ul-Islam, Mazhar; Lee, Young Sup

2018-05-28

Most of the drugs are metabolized in the liver by the action of drug metabolizing enzymes. In hepatocellular carcinoma (HCC), primary drug metabolizing enzymes are severely dysregulated, leading to failure of chemotherapy. Sorafenib is the only standard systemic drug available, but it still presents certain limitations, and much effort is required to understand who is responsive and who is refractory to the drug. Preventive and therapeutic approaches other than systemic chemotherapy include vaccination, chemoprevention, liver transplantation, surgical resection, and locoregional therapies. This review details the dysregulation of primary drug metabolizing enzymes and drug transport proteins of the liver in HCC and their influence on chemotherapeutic drugs. Furthermore, it emphasizes the adoption of safe alternative therapeutic strategies to chemotherapy. The future of HCC treatment should emphasize the understanding of resistance mechanisms and the finding of novel, safe, and efficacious therapeutic strategies, which will surely benefit patients affected by advanced HCC. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Screening for alcohol and drug use disorders among adults in primary care: a review

Directory of Open Access Journals (Sweden)

Pilowsky DJ

2012-04-01

Full Text Available Daniel J Pilowsky1, Li-Tzy Wu21Departments of Epidemiology and Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City, NY, 2Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USABackground: The Patient Protection and Affordable Care Act of 2010 supports integration of substance abuse interventions and treatments into the mainstream health care system. Thus, effective screening and intervention for substance use disorders in health care settings is a priority.Objective: This paper reviews the prevalence of alcohol and drug use disorders (abuse or dependence in primary care settings and emergency departments, as well as current screening tools and brief interventions.Methods: MEDLINE was searched using the following keywords: alcohol use, alcohol use disorder, drug use, drug use disorder, screening, primary care, and emergency departments. Using the related-articles link, additional articles were screened for inclusion. This review focuses on alcohol and drug use and related disorders among adults in primary care settings.Conclusion: Screening, brief intervention, and referral for treatment are feasible and effective in primary care settings, provided that funding for screening is available, along with brief interventions and treatment facilities to which patients can be referred and treated promptly.Keywords: brief intervention, emergency departments

Evolution of the concept of drug-related problems: outcomes as the focus / Evolución del concepto de problemas relacionados con medicamentos:resultados como el centro del nuevo paradigma

Directory of Open Access Journals (Sweden)

Fernandez-Llimos F

2005-12-01

Full Text Available Objective: To review the concept of drug-related problems and drug therapy problems, and its relationship with other concepts, like medication negative outcomes.Methods: Primary articles were identified through a MEDLINE search (1966 to September 2004; reference cites from the articles found provided additional resource material. Retrieved and selected papers were reviewed and relevant information was included.Results: the term drug-related problem has been widely used in literature, not always representing a simple concept. Process (causes and outcomes (effects had been mixed under different DRP definitions and classifications. Drug therapy problems, medicine-related problems and medication related problems are other terms used to define the same unclear concept. The idea of actual and potential problems was created to act on preventing the effect of these problems. This paper suggests the use of commonly accepted biomedical terms, and put these concepts into recognized models and paradigms (namely, SPO and ECHO. Also the name of medication negative clinical outcomes is proposed.Conclusions: Any medication negative clinical outcome can be assigned to a single definition and classification. A Systematic identification tool has been shown to be effective in detecting each and every one of the negative clinical outcomes in patient pharmacotherapy.

The analysis of Drug - Related Problems in patients with gastroesophageal reflux disease treated with proton-pump inhibitors

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Milutinović Jelena D.

2015-01-01

Full Text Available Introduction: Drug-related problems are frequent in almost all therapeutic areas. Aims: The aim of this paper was to detect drug - related problems in patients with gastroesophageal reflux and to analyze their possible association with the patient characteristics. Material and methods: The study was designed as descriptive, retrospective, crosssectional study aiming to determine the most common drug - related problems in patients with gastro-esophageal reflux disease treated with proton-pump inhibitors. The survey was conducted at the Department of Gastroenterology, Clinical Centre in Kragujevac. The study enrolled all patients treated from gastroesophageal reflux disease with proton pump inhibitors during the time period from 1.1.2014 until 1.1.2015. The study used descriptive statistics (percentage distribution, mean and standard deviation. The correlation between the number of adverse events and patient characteristics was also calculated. Results: The average age of the patients was 55.97±15.811 years, and 43 of the patients (60.6 % were male. The average hospitalization duration was 12.30±8.89 days. Based on the Pharmaceutical Care Network Europe classification, there were 182 Drug-Related Problems which was, on average, 2.56 problems per patient. Only 5 patients (7% did not report any problem while 11 patients (15.49% had over 10 possible drug-drug interactions. The most common problems which occurred were erroneous drug choice, inappropriate administration and possible interactions between medications. Conclusions: Based on the results of this study, one must pay attention to possible drug interactions and other problems which may occur with proton-pump inhibitors. Recognition of different sub-types of drug-related problems and of factors associated with drug related problems may reduce risk from adverse outcomes of gastro-esophageal reflux disease treatment with proton pump inhibitors.

Usage, Risk, and Benefit of Weight-Loss Drugs in Primary Care

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Tomas Forslund

2011-01-01

Conclusions. These results suggest that weight-loss drug treatment was often initiated upon patient request but was of limited clinical benefit as it was managed in a large portion of Swedish primary carecenters.

Cannabis Use and Drug Related Problems Among Adolescents in 27 European Countries: The Utility of the Prevention Paradox

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Romelsjö Anders

2014-10-01

Full Text Available AIMS – To study the prevalence of cannabis use and drug-related problems among European adolescents and the utility of the prevention paradox. METHODS – Survey data from the European School Survey Project on Alcohol and Other Drugs (ESPAD in 2007 in the 27 countries with information about drug use and drug-related problems was used. We analysed the proportion of all drug-related problems that occurred in a high risk group and among others who had used cannabis in the previous 12 months. The cut-off for the high risk group was chosen to include 10-15 % of the most frequent cannabis users. RESULTS – The high risk groups accounted for a substantial, but a minority, of drug-related problems among boys as well as girls. A minority of those who had used cannabis reported any drug-related problem. The proportion of adolescents with drug-related problems and the average number of problems increased with frequency of cannabis use. CONCLUSIONS – We find support for policy measures of more general character, supported by the prevention paradox. However, this does not exclude a policy supporting frequent drug users if they can be identified

Differential Effects of Parent and Grandparent Drug Use on Behavior Problems of Male and Female Children.

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Stein, Judith A.; And Others

1993-01-01

Grandparents' and mothers' drug use predicted hyperactivity, psychosomatic complaints, and social problems for boys, and acting-out behaviors for boys and girls. Maternal drug use predicted fearfulness, hyperactivity, and social problems for boys, and developmental problems for boys and girls. (BC)

Approaching the social control of drugs, I: Construction of the problem

OpenAIRE

Radulović Dragan

2008-01-01

The paper aims at outlining the social process whereby drug use has been defined as a major problem of contemporary society. The beginning of profane use of drugs is located in modern industrial society, while their global spread and the establishment of the prohibition system took place in the second half of 20th century. The generalized notion of drugs has dissolved into three different groups: some substances (coffee, tea, alcohol, tobacco) are socially accepted; others, like barbiturates ...

Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England.

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Davies-Kershaw, Hilary; Petersen, Irene; Nazareth, Irwin; Stevenson, Fiona

2018-04-01

Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. A semi-structured qualitative interview study of GPs working in general practices across England. Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. © British Journal of General Practice 2018.

College Students' Perceptions of Severity and Willingness to Seek Psychological Help For Drug and Alcohol Problems

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Lowinger, Robert Jay

2012-01-01

A sample of 201 college students were surveyed with respect to their perceptions of severity and willingness to seek psychological help for drug and alcohol problems. Results indicated that students perceive alcohol problems as significantly less serious than drug problems and are significantly less willing to seek help for alcohol problems. Males…

A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study

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Bauermeister, Jose A; Fessler, Kathryn; Delva, Jorge; Nelson, Annabelle; Nurenberg, Rachel; Mendoza Lua, Frania; Alers-Rojas, Francheska; Salas-Wright, Christopher P

2015-01-01

Background Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”). Methods A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician

A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study.

Science.gov (United States)

Cordova, David; Bauermeister, Jose A; Fessler, Kathryn; Delva, Jorge; Nelson, Annabelle; Nurenberg, Rachel; Mendoza Lua, Frania; Alers-Rojas, Francheska; Salas-Wright, Christopher P

2015-12-18

Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as "S4E"). A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication

Problems of culture of written expression in primary school

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Zlatić Marina V.

2014-01-01

Full Text Available This paper investigates the issue of the culture of written expression in primary school students. Starting from the fact that teaching practices increasingly points to the fact that knowledge of rules of writing in primary school students presents the weakest link in teaching Serbian language, we sought to describe the problem, point to the possible causes, propose measures and illustrate all this on concrete examples of students' essays. Our microinvestigation showed that primary school students display considerably poorer mastery of rules of writing than previously thought, to the extent that it presents a serious obstacle in language teaching as well as in other areas of educational process.

Problems of discipline in primary and secondary school: Teachers' opinions

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Savović Branka B.

2002-01-01

Full Text Available Investigations carried out in late 2001 in primary and secondary schools of Belgrade, Novi Sad and Niš comprised students, teachers and associates. The aim of investigations was to get insight into the state-of-the-arts problems and needs of our primary and secondary schools. The paper is a part of investigations, related to the results obtained for students' opinions of their interrelations with teachers as well as opinions of teachers themselves. The sample comprised 727 students of 4th grade of secondary vocational and high schools, 562 students of 8th grade of primary schools 168 secondary school and 107 primary school teachers. We investigated their interrelationships and within this framework the level of potential or current aggressive behavior. The majority of teachers (51% estimated student-teacher relationships mediocre - neither good nor bad. The most frequent problem in students' behavior is, according to the teachers instruction disturbance. One-quarter of teachers find that students offend them, ridicule them, or mock at them in front of others, and 5 per cent complain of physical injury intimidation on the part of students. When a problem comes up, 18 per cent of teachers talk with a student, and nearly 10 per cent of teachers give lower grades in their subject, so as to punish a student for undisciplined behaviors. In teachers' opinion, society, school the least, is to be blamed for the situation.

Drug trajectories among youth undergoing treatment: the influence of psychological problems and delinquency.

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Brunelle, Natacha; Bertrand, Karine; Beaudoin, Isabelle; Ledoux, Cinthia; Gendron, Annie; Arseneault, Catherine

2013-08-01

Previous research has documented associations of addiction with delinquency and psychological problems. However, few studies have evaluated their influence on adolescent's drug use trajectories. The current study aims to examine the influence of these factors on the recovery trajectories of 199 youths aged 15.6 years on average admitted to inpatient and outpatient addiction treatment centers, followed up three and six months later. Results indicate that youth who show higher severity of drug abuse exhibit greater improvement than youth with a lower severity of drug abuse at the onset of treatment. Although psychological problems were associated with baseline drug use, they did not influence drug use trajectory over time. Only delinquency influenced the recovery trajectories of these youth. Results suggest that a high level of delinquency can have a significant effect on the drug recovery process of adolescents and that interventions should attempt to reduce both drug use and delinquency. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

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Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

2013-05-01

In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

Undocumented Immigration, Drug Problems, and Driving Under the Influence in the United States, 1990-2014.

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Light, Michael T; Miller, Ty; Kelly, Brian C

2017-09-01

To examine the influence of undocumented immigration in the United States on 4 different metrics of drug and alcohol problems: drug arrests, drug overdose fatalities, driving under the influence (DUI) arrests, and DUI deaths. We combined newly developed state-level estimates of the undocumented population between 1990 and 2014 from the Center for Migration Studies with arrest data from the Federal Bureau of Investigation Uniform Crime Reports and fatality information from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention Underlying Cause of Death database. We used fixed-effects regression models to examine the longitudinal association between increased undocumented immigration and drug problems and drunk driving. Increased undocumented immigration was significantly associated with reductions in drug arrests, drug overdose deaths, and DUI arrests, net of other factors. There was no significant relationship between increased undocumented immigration and DUI deaths. This study provides evidence that undocumented immigration has not increased the prevalence of drug or alcohol problems, but may be associated with reductions in these public health concerns.

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

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Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

2016-04-01

Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

Worry and problem-solving skills and beliefs in primary school children

OpenAIRE

Parkinson, Monika; Creswell, Catharine

2011-01-01

Objective. To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children.\\ud Method. Children (8–11 years) were screened using the Penn State Worry Questionnaire for Children. High (N ¼ 27) and low (N ¼ 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to\\ud problems, planfulness, and effectiveness of solutions) and problem-solving beliefs(confidence and perceived ...

The comprehension of mathematic problems in primary school

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Karel Pérez Ariza

2015-05-01

Full Text Available The paper describes the result of the research project “A study of causes of difficulties in learning comprehension from an interdisciplinary perspective in Camagüey. The main objective of that study is to propose a methodology for the comprehension of mathematic problems in primary school. In designing the methodology, the characteristics of this text variety, basic principle of the theory of reading comprehension and problem solving were taking into account. In this research work several theoretical methods were used —analysis-synthesis, historical-logical, inductive-deductive— to elaborate the theoretical framework, while modeling and system approach in the methodology construction. Additionally, empirical methods were used in order to assess the knowledge about comprehension of mathematic problems; among them observation and analysis of the activity results.

The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

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Kimber Jo

2010-02-01

Full Text Available Abstract Background Injection drug use is an important public health problem. Epidemiological understanding of this problem is incomplete as longitudinal studies in the general population are difficult to undertake. In particular little is known about early life risk factors for later drug injection or about the life course of injection once established including the influence of medical and social interventions. Methods Individuals thought to be drug injectors were identified through a single primary medical care facility in Edinburgh between 1980 and 2006 and flagged with the General Registry Office. From October 2005 - October 2007, these cases were traced and invited to undergo interview assessment covering early life experience, substance use, health and social histories. Age and sex matched controls for confirmed cases (alive and dead were later recruited through the same health facility. Controls for living cases completed the same structured interview schedule. Data were also collected on cases and controls through linkage to routine primary care records, death registrations, hospital contact statistics and police and prison records. All interviews were conducted with the knowledge and permission of the current GP. Results The initial cohort size was 814. At start of follow up 227 had died. Of the remaining 587: 20 had no contact details and 5 had embarked from the UK; 40 declined participation; 38 did not respond to invitations; 14 were excluded by their GP on health or social grounds and 22 had their contact details withheld by administrative authorities. 448 were interviewed of whom 16 denied injection and were excluded. Of 191 dead cases with medical records 4 were excluded as their records contained no evidence of injection. 5 interviewed cases died before follow up was concluded though these individuals were counted as "live" cases. 1 control per case (dead and alive was recruited. Linkage to Scottish Morbidity Records data

Alcohol and other drug problems in Australia: the urgent need for nurse education.

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de Crespigny, C

1996-07-01

The economic, social and health costs associated with alcohol and other drug use, including medicines, impact on the Australian community profoundly. Many Australians use alcohol and other drugs (AODs) on a regular basis and a significant number experience problems at some time. There are about 25,000 drug-related deaths annually, the majority of which are related to alcohol and tobacco use. Many young people die or are injured as a direct result of alcohol intoxication, accidental overdose and related problems, and significant numbers of elderly people are hospitalised, permanently incapacitated or suffer avoidable trauma through adverse drug reactions and side-effects of medications. It is estimated that at least 25 per cent of acute hospital beds hold patients with alcohol-related problems directly associated with the medical diagnosis, and there are comparable numbers of people needing social and other forms of assistance at some time. Despite the preventative nature of many AOD problems and the call for harm reduction, timely intervention and support for the thousands of Australians attending hospitals, community health and mental health services, nurses are yet to effectively assist the community in preventing and responding to the range of AOD problems. Nursing policy, guidelines and clinical expertise are required to assist the community in addressing this issue. Undergraduate, postgraduate and continuing education have a vital role to play in providing the profession with the knowledge, skills and research base to meet this challenge.

Psychological and social problems in primary care patients - general practitioners' assessment and classification.

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Rosendal, Marianne; Vedsted, Peter; Christensen, Kaj Sparle; Moth, Grete

2013-03-01

To estimate the frequency of psychological and social classification codes employed by general practitioners (GPs) and to explore the extent to which GPs ascribed health problems to biomedical, psychological, or social factors. A cross-sectional survey based on questionnaire data from GPs. Setting. Danish primary care. 387 GPs and their face-to-face contacts with 5543 patients. GPs registered consecutive patients on registration forms including reason for encounter, diagnostic classification of main problem, and a GP assessment of biomedical, psychological, and social factors' influence on the contact. The GP-stated reasons for encounter largely overlapped with their classification of the managed problem. Using the International Classification of Primary Care (ICPC-2-R), GPs classified 600 (11%) patients with psychological problems and 30 (0.5%) with social problems. Both codes for problems/complaints and specific disorders were used as the GP's diagnostic classification of the main problem. Two problems (depression and acute stress reaction/adjustment disorder) accounted for 51% of all psychological classifications made. GPs generally emphasized biomedical aspects of the contacts. Psychological aspects were given greater importance in follow-up consultations than in first-episode consultations, whereas social factors were rarely seen as essential to the consultation. Psychological problems are frequently seen and managed in primary care and most are classified within a few diagnostic categories. Social matters are rarely considered or classified.

Exploring Primary Student’s Problem-Solving Ability by Doing Tasks Like PISA's Question

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Rita Novita

2012-07-01

Full Text Available Problem solving plays an important role in mathematics and should have a prominent role in the mathematics education. The term “problem solving” refers to mathematics tasks that have the potential to provide intellectual challenges for enhancing students’ mathematical understanding and development. In addition, the contextual problem that requires students to connect their mathematical knowledge in solving mathematical situational problem is believed to be an impact on the development students’ problem-solving ability. The tasks that have been developed by PISA meet both of these criteria. As stated by the NCTM, that problem-solving skill and ability should be developed to students when they were in primary school (K5-8, therefore, it is important to do an effort to guide students in developing problem-solving ability from primary school such as accustom students to do some mathematical solving-problem tasks. Thus, in this research we tried to investigate how to develop mathematical problem-solving tasks like PISA’s question that have potential effect toward students’ mathematical problem-solving abilities?. We used a  formative evaluation type of development research as an mean  to achieve this research goal. This type of research is conducted in two steps, namely preliminary stage and formative evaluation stage covering self evaluation, prototyping (expert reviews, one-to-one, and small group, and  field test. This research involve four primary schools in Palembang, there are SD Muhammadiyah 6 Palembang, MIN 1 & MIN 2 Palembang, and SDN 179 Palembang. The result of this research showed that the mathematical problem-solving tasks  that have been developed have potential effect in exploring mathematical problem-solving ability of the primary school students. It  is shown from their work in solving problem where all of the indicators of problem solving competency have emerged quite well category. In addition, based on interview

The assessment on impact of essential drugs policy on primary health care system in rural areas of Shandong Province policy and regulation division of the Health Department of Shandong Province.

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Li, Zhuge; Shu, Defeng; Xia, Mei; Gao, Dehai; Lu, Dan; Huang, Ning; Tian, Xiaoqing; An, Limei; Li, Shixue; Li, Sheng

2015-01-01

At present, China has achieved an initial establishment and gradual implementation of a framework for national essential drugs policy. With the further implementation of the national essential drugs policy, it is not clear how the policy works, whether it achieves the original intention of essential drugs policy, and what impact essential drugs policy exerts on the primary health care system. In view of it, we conducted a field research on sample areas of Shandong Province to understand the conditions of the implementation of the essential drugs policy in Shandong Province. From three perspectives of medical institutions, patients and medical staff, this thesis analyzes the impact of essential drugs policy on village-level and township-level health service system, summarizes the effectiveness of implementing essential drugs policy, discovers the problems of various aspects and conducts an in-depth analysis of the causes, and puts forward feasible suggestions to provide reference for improving the essential drugs policy. The assessment results show that the implementation of essential drugs policy in Shandong Province has played a positive role in promoting the sound development of the primary health care system, changed the situation of covering hospital expenses with medicine revenue in the past, contributed to the return of medical institutions to public welfare, and reduced the patient's economic burden of disease. But there emerge many problems as follows: impact on the doctor's diagnosis and treatment due to incompleteness of drug types, and distribution not in place, patient loss and operational difficulty of village clinic. Thus, this thesis makes recommendations of drugs catalog formulation, drug procurement, sales and use, and meanwhile points out that the supporting financial compensation policy and performance appraisal policy and other measures in place are a prerequisite for a positive role of essential drugs policy.

Pharmacists' Intervention to Reduce Drug Related Problems in HIV ...

African Journals Online (AJOL)

Despite advances in the use of highly active antiretroviral therapy (HAART) in the management of HIV/AIDS, drug-related problems (DRPs) still remain an issue, particularly in developing countries. This study evaluated the incidence of DRPs among HIV/AIDS patients in a HIV/AIDS care centre in southern Nigeria and the ...

Continuous admission to primary school and mental health problems

NARCIS (Netherlands)

S.A. Reijneveld (Sijmen); C.H. Wiefferink (Carin); E. Brugman (Emily); F.C. Verhulst (Frank); S.P. Verloove-Vanhorick; A.D.C. Paulussen (Aimée)

2006-01-01

textabstractBackground: Younger children in a school class have higher rates of mental health problems if admission to primary school occurs once a year. This study examines whether this relative age effect also occurs if children are admitted to school continuously throughout the year. Methods: We

Continuous admission to primary school and mental health problems

NARCIS (Netherlands)

Reijneveld, S.A.; Wiefferink, C.H.; Brugman, E.; Verhulst, F.C.; Verloove-Vanhorick, S.P.; Paulussen, T.G.W.

2006-01-01

Background: Younger children in a school class have higher rates of mental health problems if admission to primary school occurs once a year. This study examines whether this relative age effect also occurs if children are admitted to school continuously throughout the year. Methods: We assessed

Immigrants' use of primary health care services for mental health problems.

Science.gov (United States)

Straiton, Melanie; Reneflot, Anne; Diaz, Esperanza

2014-08-13

Equity in health care across all social groups is a major goal in health care policy. Immigrants may experience more mental health problems than natives, but we do not know the extent to which they seek help from primary health care services. This study aimed to determine a) the rate immigrants use primary health care services for mental health problems compared with Norwegians and b) the association between length of stay, reason for immigration and service use among immigrants. National register data covering all residents in Norway and all consultations with primary health care services were used. We conducted logistic regression analyses to compare Norwegians' with Polish, Swedish, German, Pakistani and Iraqi immigrants' odds of having had a consultation for a mental health problem (P-consultation). After accounting for background variables, all immigrants groups, except Iraqi men had lower odds of a P-consultation than their Norwegian counterparts. A shorter length of stay was associated with lower odds of a P-consultation. Service use varies by country of origin and patterns are different for men and women. There was some evidence of a possible 'healthy migrant worker' effect among the European groups. Together with previous research, our findings however, suggest that Iraqi women and Pakistanis in particular, may experience barriers in accessing care for mental health problems.

Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems.

Science.gov (United States)

Verissimo, Angie Denisse Otiniano; Grella, Christine E

2017-04-01

This study examines reasons why people do not seek help for alcohol or drug problems by gender and race/ethnicity using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey. Multivariate models were fit for 3 barriers to seeking help (structural, attitudinal, and readiness for change) for either alcohol or drug problems, controlling for socio-demographic characteristics and problem severity. Predicted probabilities were generated to evaluate gender differences by racial/ethnic subgroups. Over three quarters of the samples endorsed attitudinal barriers related to either alcohol or drug use. Generally, women were less likely to endorse attitudinal barriers for alcohol problems. African Americans and Latina/os were less likely than Whites to endorse attitudinal barriers for alcohol problems, Latina/os were less likely than Whites to endorse readiness for change barriers for alcohol and drug problems, however, African Americans were more likely to endorse structural barriers for alcohol problems. Comparisons within racial/ethnic subgroups by gender revealed more complex findings, although across all racial/ethnic groups women endorsed attitudinal barriers for alcohol problems more than men. Study findings suggest the need to tailor interventions to increase access to help for alcohol and drug problems that take into consideration both attitudinal and structural barriers and how these vary across groups. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of postoperative changes in antihypertensive drug consumption in patients with primary aldosteronism using the defined daily dose

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Takanobu Utsumi

2014-10-01

Conclusion: The defined daily dose is a useful tool for assessing total changes in the consumption of antihypertensive drugs in patients with primary aldosteronism. Using the defined daily dose, clinicians could explain in detail to patients with primary aldosteronism the predicted postoperative change in antihypertensive drug consumption.

49 CFR 40.203 - What problems cause a drug test to be cancelled unless they are corrected?

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false What problems cause a drug test to be cancelled unless they are corrected? 40.203 Section 40.203 Transportation Office of the Secretary of Transportation PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Problems in Drug Tests § 40.203...

An anticancer drug suppresses the primary nucleation reaction that initiates the production of the toxic Aβ42 aggregates linked with Alzheimer's disease.

Science.gov (United States)

Habchi, Johnny; Arosio, Paolo; Perni, Michele; Costa, Ana Rita; Yagi-Utsumi, Maho; Joshi, Priyanka; Chia, Sean; Cohen, Samuel I A; Müller, Martin B D; Linse, Sara; Nollen, Ellen A A; Dobson, Christopher M; Knowles, Tuomas P J; Vendruscolo, Michele

2016-02-01

The conversion of the β-amyloid (Aβ) peptide into pathogenic aggregates is linked to the onset and progression of Alzheimer's disease. Although this observation has prompted an extensive search for therapeutic agents to modulate the concentration of Aβ or inhibit its aggregation, all clinical trials with these objectives have so far failed, at least in part because of a lack of understanding of the molecular mechanisms underlying the process of aggregation and its inhibition. To address this problem, we describe a chemical kinetics approach for rational drug discovery, in which the effects of small molecules on the rates of specific microscopic steps in the self-assembly of Aβ42, the most aggregation-prone variant of Aβ, are analyzed quantitatively. By applying this approach, we report that bexarotene, an anticancer drug approved by the U.S. Food and Drug Administration, selectively targets the primary nucleation step in Aβ42 aggregation, delays the formation of toxic species in neuroblastoma cells, and completely suppresses Aβ42 deposition and its consequences in a Caenorhabditis elegans model of Aβ42-mediated toxicity. These results suggest that the prevention of the primary nucleation of Aβ42 by compounds such as bexarotene could potentially reduce the risk of onset of Alzheimer's disease and, more generally, that our strategy provides a general framework for the rational identification of a range of candidate drugs directed against neurodegenerative disorders.

Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway.

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Fog, Amura Francesca; Kvalvaag, Gunnar; Engedal, Knut; Straand, Jørund

2017-12-01

We describe the drug-related problems (DRPs) identified during medication reviews (MRs) and the changes in drug utilization after MRs at nursing homes in Oslo, Norway. We explored predictors for the observed changes. Observational before-after study. Forty-one nursing homes. MRs performed by multidisciplinary teams during November 2011 to February 2014. In all, 2465 long-term care patients. DRPs identified by explicit criteria (STOPP/START and NORGEP) and drug-drug interaction database; interventions to resolve DRPs; drug use changes after MR. A total of 6158 DRPs were identified, an average of 2.6 DRPs/patient, 2.0 for regular and 0.6 for pro re nata (prn) drugs. Of these patients, 17.3% had no DRPs. The remaining 82.7% of the patients had on average 3.0 DRPs/patient. Use of unnecessary drugs (43.5%), excess dosing (12.5%) and lack of monitoring of the drug use (11%) were the most frequent DRPs. Opioids and psychotropic drugs were involved in 34.4% of all DRPs. The mean number of drugs decreased after the MR from 6.8 to 6.3 for regular drugs and from 3.0 to 2.6 for prn drugs. Patients with DRPs experienced a decrease of 1.1 drugs after MR (0.5 for regular and 0.6 for prn drugs). The reduction was most pronounced for the regular use of antipsychotics, antidepressants, hypnotics/sedatives, diuretics, antithrombotic agents, antacid drugs; and for prn use of anxiolytics, opioids, hypnotics/sedatives, metoclopramide and NSAIDs. The medication review resulted in less drug use, especially opioids and psychotropic drugs.

Determining the Performances of Pre-Service Primary School Teachers in Problem Posing Situations

Science.gov (United States)

Kilic, Cigdem

2013-01-01

This study examined the problem posing strategies of pre-service primary school teachers in different problem posing situations (PPSs) and analysed the issues they encounter while posing problems. A problem posing task consisting of six PPSs (two free, two structured, and two semi-structured situations) was delivered to 40 participants.…

Drug Pollution - The Problem of Abuse | Bensusan | South African ...

African Journals Online (AJOL)

Some of the aetiological factors are given as well as an outline of the extent of drug abuse in many countries, age of addiction and also the role of the medical practitioner. The main problem facing the profession in South Africa, at this stage, is to educate the public in the dangers of dagga. Five principles are ...

Reasons behind Greek problem drug users’ decisions to quit using drugs and engage in treatment of their own volition: sense of self and the Greek filotimo.

Science.gov (United States)

Fotopoulou, Maria

2014-04-01

The aim of this study was to explore Greek problem drug users’ perceptions of the reasons that led them to quit using drugs and engage in treatment of their own volition. Qualitative semi-structured in-depth interviews. Two state drug agencies in Thessaloniki, Greece. A total of 40 adult problem drug-using men and women participated in the study. Participants were asked to reflect on their decisions to wean themselves from drugs and enter treatment. Findings Participants reported that their decisions centred on the re-conceptualization of the drug-using community and their membership in it, the desire to restore aspects of identities thatwere deemed to be spoiled, and finally memories of their drug-free selves. The importance of the distinctively Greek notion of filotimo in this discussion is highlighted. Primarily in relation to filotimo (a concept that represents a complex array of virtues that regulates behaviour towards one’s family), the desire to restore one’s spoiled identity plays a pivotal role in Greek problem drug users’ decisions to cease drug use and engage in treatment.

Parenting Stress and Emotional/Behavioral Problems in Adolescents with Primary Headache.

Science.gov (United States)

Operto, Francesca Felicia; Craig, Francesco; Peschechera, Antonia; Mazza, Roberta; Lecce, Paola Alessandra; Margari, Lucia

2017-01-01

Primary headache is a frequent and disabling disorder, common among children and adolescents, and it is a painful syndrome often accompanied by functional impairment and associated with emotional and behavior problems. The aim of this study was to investigate parenting stress and emotional/behavioral problems in adolescents affected by primary headache compared with healthy adolescents. The study population consisted of 35 adolescents and a control group of 23 healthy subjects. The assessment included the administration of clinical standardized scales such as Parent Stress Index-Short Form, Pediatric Migraine Disability Assessment Score Questionnaire, and Child Behavior Checklist (CBCL). Headache group and control group did not differ in terms of parenting stress ( p  = 0.29). On the contrary, headache group showed more internalizing problems ( p  = 0.023), affective problems ( p  = 0.01), anxious ( p  = 0.001), and somatic complaints ( p  headache group. The findings emphasize the need for expanded intervention in the clinical treatment of pediatric headache, a treatment that may also include the family members. Further research is needed.

Comparison of mathematical problem solving strategies of primary school pupils

OpenAIRE

Wasilewská, Eliška

2016-01-01

The aim of this dissertation is to describe the role of educational strategy especially in field of the teaching of mathematics and to compare the mathematical problem solving strategies of primary school pupils which are taught by using different educational strategies. In the theoretical part, the main focus is on divergent educational strategies and their characteristics, next on factors affected teaching/learning process and finally on solving the problems. The empirical part of the disse...

Program Administrator's Handbook. Strategies for Preventing Alcohol and Other Drug Problems. The College Series.

Science.gov (United States)

CSR, Inc., Washington, DC.

This handbook is for administrators of programs in higher education settings which deal with alcohol and other drug (AOD) related problems. Chapter 1, "Defining the Problem, Issues, and Trends" examines the problem from various perspectives and presents the latest statistics on the extent of AOD use on campuses, specific problems affecting…

Prenatal alcohol use: the role of lifetime problems with alcohol, drugs, depression, and violence.

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Flynn, Heather A; Chermack, Stephen T

2008-07-01

The purpose of this study was to examine a broader array of lifetime factors that theoretically may be associated with prenatal alcohol use than have previously been studied together, including family history of alcohol-use problems, history of physical or sexual abuse, lifetime major depressive disorder, alcohol-use disorder, illicit-drug-use problems, and partner violence. A total of 186 pregnant women, all of whom used alcohol in the year before pregnancy, were initially recruited in prenatal care settings. Women who reported no prenatal alcohol use (n = 96) were compared with women who drank 1-10 standard drinks during pregnancy (n = 75) and with women who drank more than 10 standard drinks during pregnancy (n = 13), considered to be a higher risk group, on the lifetime risk variables. Because of the public health implications, secondary analyses compared women who abstained during pregnancy with those who used any alcohol. Significant intercorrelations were found among most of the lifetime risk factors studied. Multivariate analyses showed that drug-use problems and partner violence were most strongly associated with prenatal alcohol use than any other variable studied. Consistent with a life span risk framework for alcohol-use problems, results of this study show that childhood abuse, familial alcoholism, lifetime major depressive disorder, and alcohol- and drug-use problems are interrelated. However, when considered together, only lifetime partner violence and drug use are significantly related to various levels of prenatal alcohol use. Identification, assessment, and intervention efforts should integrate these important factors.

Potential and problems in ultrasound-responsive drug delivery systems

Directory of Open Access Journals (Sweden)

Zhao YZ

2013-04-01

Full Text Available Ying-Zheng Zhao,1,3 Li-Na Du,2 Cui-Tao Lu,1 Yi-Guang Jin,2 Shu-Ping Ge3 1Wenzhou Medical College, Wenzhou City, Zhejiang Province, 2Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, People’s Republic of China; 3St Christopher’s Hospital for Children/Drexel University College of Medicine, Philadelphia, PA, USA Abstract: Ultrasound is an important local stimulus for triggering drug release at the target tissue. Ultrasound-responsive drug delivery systems (URDDS have become an important research focus in targeted therapy. URDDS include many different formulations, such as microbubbles, nanobubbles, nanodroplets, liposomes, emulsions, and micelles. Drugs that can be loaded into URDDS include small molecules, biomacromolecules, and inorganic substances. Fields of clinical application include anticancer therapy, treatment of ischemic myocardium, induction of an immune response, cartilage tissue engineering, transdermal drug delivery, treatment of Huntington’s disease, thrombolysis, and disruption of the blood–brain barrier. This review focuses on recent advances in URDDS, and discusses their formulations, clinical application, and problems, as well as a perspective on their potential use in the future. Keywords: ultrasound, targeted therapy, clinical application

Discussion in primary ecological environmental problems and relevant countermeasures in China

International Nuclear Information System (INIS)

An Yongfeng

2003-01-01

On the basis of sufficient statistical data, the primary ecological environmental problems, including water/soil loss and dissertation, water resource shortage and water pollution, deterioration of air quality and air pollution, despoilation of biodiversity, and environmental pollution, are listed in this paper. In addition, the causes of these problems are analyzed. Finally, relevant strategies and measures for environmental protection are brought forward. (authors)

Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait.

Science.gov (United States)

Bayoud, T; Waheedi, M; Lemay, J; Awad, A

2018-05-01

To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait. A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11. A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy. The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait. Copyright © 2018 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

Emerging drugs for primary progressive multiple sclerosis.

Science.gov (United States)

Narayan, Ram Narendra; Forsthuber, Thomas; Stüve, Olaf

2018-04-24

The identification of effective therapies for progressive forms of multiple sclerosis (MS) has remains a priority and challenge for the global MS community. Despite a few proposed mechanisms, a more complete understanding of the mechanisms involved in the pathogenesis of these MS phenotypes, animal models that incorporate these pathogenic characteristics, novel trial designs, drug repurposing strategies, and new models of collaboration between clinical and basic science personnel may be required in identifying effective therapies. Areas covered: Here, we review the current knowledge on putative pathogenic mechanisms in primary progressive MS (PPMS). Also, the rationale and outcomes of key phase II or III trial initiatives in PPMS are summarized. Future perspectives are outlined. Expert opinion: The recent approval of ocrelizumab is a major milestone forward in the therapy of PPMS. One reason for success of this drug is appropriate patient selection. The ultimate goal in PPMS therapy should be the reversal of disability, and the arrest of disease progression. Our current understanding of PPMS suggests that a combination of immune-modulatory, myelin-restorative, and neuro-regenerative therapies particularly early in the disease course would be a reasonable strategy. Finally, selection of appropriate patients, selection of appropriate outcomes and monitoring therapy is again crucial for success of therapeutic strategies.

[22q11.2 deletion: handicap-related problems and coping strategies of primary caregivers].

Science.gov (United States)

Briegel, Wolfgang; Schneider, Marco; Schwab, K Otfried

2009-11-01

To investigate handicap-related problems of children and adolescents with 22q11.2 deletion syndrome and their primary caregivers' coping strategies. Primary caregivers of 153 subjects aged 2-16 years were anonymously asked to fill out questionnaires, e.g., the Handicap Related Problems for Parents Inventory. Primary caregivers of 96 subjects (53 males, 43 females; mean age: 7;0 [2;1-16;11] years) sent back questionnaires. Patient's behaviour and discipline were the most important handicap-related problems. Significant correlations could be found between the patient's age and his/her relationship with the primary caregiver (rho=0.228; p=.029) and other family members (rho=0.293; p=.004). Compared to other parents of physically handicapped children or those with multiple handicaps, these parents did not experience increased stress. The more the coping strategies "self-fulfillment" and "intensification of partnership" were used, the lower parental stress was (p=.012, p=.025, respectively). "Focusing on the handicapped child" was positively correlated with high parental stress (p=.000). With regard to parental stress and coping strategies, primary caregivers of children and adolescents with 22q11.2 deletion do not significantly differ from other parents of physically handicapped children. As handicap-related family problems increase with the patient's age, a growing need for counseling, especially for aspects of parenting and discipline, and for treatment can be presumed.

Worry and problem-solving skills and beliefs in primary school children.

Science.gov (United States)

Parkinson, Monika; Creswell, Cathy

2011-03-01

To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children. Children (8-11 years) were screened using the Penn State Worry Questionnaire for Children. High (N= 27) and low (N= 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to problems, planfulness, and effectiveness of solutions) and problem-solving beliefs (confidence and perceived control). High and low worry groups differed significantly on measures of anxiety and problem-solving beliefs (confidence and control) but not on problem-solving skills. Consistent with findings with adults, worry in children was associated with cognitive distortions, not skills deficits. Interventions for worried children may benefit from a focus on increasing positive problem-solving beliefs. ©2010 The British Psychological Society.

Problem-Solving Treatment and Coping Styles in Primary Care for Minor Depression

Science.gov (United States)

Oxman, Thomas E.; Hegel, Mark T.; Hull, Jay G.; Dietrich, Allen J.

2008-01-01

Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care…

Is Team-Based Primary Care Associated with Less Access Problems and Self-Reported Unmet Need in Canada?

Science.gov (United States)

Zygmunt, Austin; Asada, Yukiko; Burge, Frederick

2017-10-01

As in many jurisdictions, the delivery of primary care in Canada is being transformed from solo practice to team-based care. In Canada, team-based primary care involves general practitioners working with nurses or other health care providers, and it is expected to improve equity in access to care. This study examined whether team-based care is associated with fewer access problems and less unmet need and whether socioeconomic gradients in access problems and unmet need are smaller in team-based care than in non-team-based care. Data came from the 2008 Canadian Survey of Experiences with Primary Health Care (sample size: 10,858). We measured primary care type as team-based or non-team-based and socioeconomic status by income and education. We created four access problem variables and four unmet need variables (overall and three specific components). For each, we ran separate logistic regression models to examine their associations with primary care type. We examined socioeconomic gradients in access problems and unmet need stratified by primary care type. Primary care type had no statistically significant, independent associations with access problems or unmet need. Among those with non-team-based care, a statistically significant education gradient for overall access problems existed, whereas among those with team-based care, no statistically significant socioeconomic gradients existed.

Perioperative drug management. Reduction of potential drug-related problems in patients undergoing orthopaedic surgery by perioperative participation of a hospital pharmacist

NARCIS (Netherlands)

Duyvendak, M.; Bosman, J.; Klopotowska, J.; Kuiper-Herder, A.J.; Van Roon, E.N.; Brouwers, J.R.B.J.

2007-01-01

Objective: Drug management in the perioperative period is complex. Only little is known about the effects of clinical pharmaceutical care in this setting. The aim of this study was to determine the effect of a clinical pharmacy-based intervention on the number of potential drug-related problems in

Perception of primary school teachers to school children's mental health problems in Southwest Ethiopia.

Science.gov (United States)

Kerebih, Habtamu; Abrha, Hailay; Frank, Reiner; Abera, Mubarek

2016-11-12

Teachers perception of child mental health problems and their attitude to school-based mental health services helps in designing early intervention strategies aimed at promoting the service. However, little is known in this regard among primary school teachers in Ethiopia. Therefore, this study assessed perceptions and attitude of primary school teachers to child mental health problem and school-based mental health programs in Jimma town, southwest Ethiopia in 2013. A cross-sectional study design was implemented among 568 primary school teachers in Jimma town, from 1 to 30 October 2013. Perceptions and attitude of teachers to children with mental health problems and school mental health related information were assessed using a structured self- administered questionnaire. About 40% of teachers recognized the list of psychopathology items presented to them as child mental health problems while 54.4% of them rated child mental health problem as severe. Externalizing behaviors were perceived as the most severe problems. Teaching experience and teaching in public schools were significantly associated with the perception of severe type of child mental health problems. About 95% of teachers acknowledged that school-based mental health programs are important but limited availability was reported. Despite the high problem severity ratings, teachers' perception of the psychopathology as a mental health problem in children was low. There was also a favorable attitude on the importance and the need of school-based child mental health programs. Thus, creating mental health awareness for teachers and establishing school mental health services to intervene in child mental health problem is crucial.

Causes of learning problems in primary school students

Directory of Open Access Journals (Sweden)

Mirkov Snežana I.

2003-01-01

Full Text Available Investigations were conducted on learning problems using the sample of eighth-grade students of primary school (N=335. The respondents opted for one or more than seven offered statements related to: insufficient previous knowledge, insufficient studying, teaching contents (extensive, difficult unintelligible, textbook and teacher’s method of presenting the contents. On the basis of the results obtained, one-third of students have problems in mastering teaching contents of foreign language, physics and chemistry, and about one-fourth in mastering those of history and mathematics. All the mentioned causes of problems are present in varying degrees in some school subjects. The causes of learning problems are markedly present in a larger number of school subjects and they are related to some characteristics of teaching contents. Respondents point out, to a large extent, that teaching contents of technical education are uninteresting. In addition, students’ responses indicate that it is necessary to improve the method for mastering the teaching contents in various school subjects i.e. methods applied in the teaching process. Subjective causes, as pointed out by students, are connected with some of the subjects they have characterized as the most difficult. Unintelligible textbook is stressed to the lowest extent as a cause of learning problems compared to other causes stated for the majority of school subjects.

Are therapeutic vaccines an answer to the global problem of drug and alcohol abuse?

Science.gov (United States)

Brashier, Dick B S; Sharma, Ashok Kumar; Akhoon, Neha

2016-01-01

Drug Abuse has become a major challenging problem for the society. It effects people of all countries economical strata's and all ages. According. Monetary loss all over the world regarding drug abuse is in million dollars, it not only has an impact on human productivity and healthcare cost but also on cost of crimes conducted by these drugs and alcohol abuse. Therapeutic vaccine has come as new approach to deal with this problem, after failures in search for a pharmaceutical agent to deal with drug of abuse and alcohol. Research in field of nicotine abuse has gone a way ahead with number of vaccines being tried clinically followed by cocaine, opioids, methamphetamine, phencyclidine and alcohol. All of them have a common mechanism of action by antibody production whereas alcohol acts by genetic intervention. None have being approved yet due to poor results in phase II trials, possibly due to not able to trigger an adequate immunological response. But still quest is on for cracking the ice by developing first successful vaccine against drug of abuse, that would follow for other drugs too. It would be great step in field of therapeutic vaccines for drug abuse after similar successful vaccines being approved for other diseases like cancer.

a survey on drug related problems in cervical cancer patients

African Journals Online (AJOL)

userpc

Cisplatin/5FU/paclitaxel. 6. 9.23. 6. Seizure. Cisplatin. 2. 3.08. 7. Loss of hair. Cisplatin/5FU/Paclitaxel. 3. 4.62. 8. Nephrotoxicity. Cisplatin. 3. 4.62. 9. Hypotension. Paclitaxel. 3. 4.62. TOTAL. 65. 100. Table 3: Relationship between cervical cancer patients' factors and DRPs. Patients Factor. Drug Related Problems (DRPs).

Correlation between patients' reasons for encounters/health problems and population density in Japan: a systematic review of observational studies coded by the International Classification of Health Problems in Primary Care (ICHPPC) and the International Classification of Primary care (ICPC).

Science.gov (United States)

Kaneko, Makoto; Ohta, Ryuichi; Nago, Naoki; Fukushi, Motoharu; Matsushima, Masato

2017-09-13

The Japanese health care system has yet to establish structured training for primary care physicians; therefore, physicians who received an internal medicine based training program continue to play a principal role in the primary care setting. To promote the development of a more efficient primary health care system, the assessment of its current status in regard to the spectrum of patients' reasons for encounters (RFEs) and health problems is an important step. Recognizing the proportions of patients' RFEs and health problems, which are not generally covered by an internist, can provide valuable information to promote the development of a primary care physician-centered system. We conducted a systematic review in which we searched six databases (PubMed, the Cochrane Library, Google Scholar, Ichushi-Web, JDreamIII and CiNii) for observational studies in Japan coded by International Classification of Health Problems in Primary Care (ICHPPC) and International Classification of Primary Care (ICPC) up to March 2015. We employed population density as index of accessibility. We calculated Spearman's rank correlation coefficient to examine the correlation between the proportion of "non-internal medicine-related" RFEs and health problems in each study area in consideration of the population density. We found 17 studies with diverse designs and settings. Among these studies, "non-internal medicine-related" RFEs, which was not thought to be covered by internists, ranged from about 4% to 40%. In addition, "non-internal medicine-related" health problems ranged from about 10% to 40%. However, no significant correlation was found between population density and the proportion of "non-internal medicine-related" RFEs and health problems. This is the first systematic review on RFEs and health problems coded by ICHPPC and ICPC undertaken to reveal the diversity of health problems in Japanese primary care. These results suggest that primary care physicians in some rural areas of Japan

Drug-resistant tuberculosis in Sindh

International Nuclear Information System (INIS)

Almani, S.A.; Memon, N.M.; Qureshi, A.F.

2002-01-01

Objective: To assess the prevalence of primary and secondary drug resistance amongst the clinical isolates of M.tuberculosis, to identify risk factors and how to overcome this problem. Design: A case series of 50 indoor patients with sputum smear-positive pulmonary tuberculosis. Place and duration of Study: Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro, Sindh, (Pakistan) from January 1999 to December 2000. Patients and methods: Four first line anti-tuberculous drugs rifampicine, ethambutol and streptomycin were tested for sensitivity pattern. Results: Twelve (26.66%) were sensitive to all four drugs, 12(26.66%) were resistant to one drug, 14 (31.11%) were resistant to two drugs, 2 (4.44%) were resistant to three drugs, and 5(11.11%) were resistant to all four drugs. Resistance to isoniazid was the most common in 27 cases (60%) with primary resistance in 6(13.33%) and secondary resistance in 21(46.66%), followed by resistance to streptomycin in 17 cases (37.77%) with primary resistance in 5(11.11%) and secondary resistance in 12 (26.66%). Resistance to ethambutol in 10 cases (22.22%) and rifampicine in 11 (24.44%) and all cases were secondary. Similarly multi-drugs resistance (MRD) TB was found in 11(24.44%) isolates. Conclusion: This study showed high prevalence of drug resistance among clinical isolates of M. tuberculosis. Their is a need to establish centers at number of places with adequate facilities for susceptibility testing so that the resistant pattern could be ascertained and treatment regimens tailored accordingly. (author)

Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

Science.gov (United States)

Shabila, Nazar P; Al-Tawil, Namir G; Al-Hadithi, Tariq S; Sondorp, Egbert; Vaughan, Kelsey

2012-09-27

As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers' perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq's Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and

The management of an adolescent with conduct problems in a primary care clinic - a case report.

Science.gov (United States)

Azimah, Mn; Khairani, O

2009-01-01

To describe the management of mild conduct problems in an adolescent at the primary care level. A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.

Antifibrinolytic drugs for treating primary postpartum haemorrhage.

Science.gov (United States)

Shakur, Haleema; Beaumont, Danielle; Pavord, Sue; Gayet-Ageron, Angele; Ker, Katharine; Mousa, Hatem A

2018-02-20

Postpartum haemorrhage (PPH) - heaving bleeding within the first 24 hours after giving birth - is one of the main causes of death of women after childbirth. Antifibrinolytics, primarily tranexamic acid (TXA), have been shown to reduce bleeding in surgery and safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events.An earlier Cochrane review on treatments for primary PPH covered all the various available treatments - that review has now been split by types of treatment. This new review concentrates only on the use of antifibrinolytic drugs for treating primary PPH. To determine the effectiveness and safety of antifibrinolytic drugs for treating primary PPH. We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (28 May 2017) and reference lists of retrieved studies. Randomised controlled trials (RCTs), including cluster-randomised trials of antifibrinolytic drugs (aprotinin, TXA, epsilon-aminocaproic acid (EACA) and aminomethylbenzoic acid, administered by whatever route) for primary PPH in women.Participants in the trials were women after birth following a pregnancy of at least 24 weeks' gestation with a diagnosis of PPH, regardless of mode of birth (vaginal or caesarean section) or other aspects of third stage management.We have not included quasi-randomised trials, or cross-over studies. Studies reported as abstracts have not been included if there was insufficient information to allow assessment of risk of bias.In this review we only identified studies looking at TXA. Two review authors independently extracted data from each study using an agreed form. We entered data into Review Manager software and checked for accuracy.For key review outcomes, we rated the quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach. Three trials (20,412 women) met our inclusion criteria. Two trials

Drug and alcohol abuse: The pattern and magnitude of the problem

Energy Technology Data Exchange (ETDEWEB)

Ajayi, P.A.

1996-12-31

In the last 12 months, many more cases of alcohol and drug (substance) abuse in the workplace were seen in the Escravos operations of Chevron Nigeria Limited than in previous years. This called the attention to the rising prevalence of drug and alcohol abuse in contradistinction to reports from similar organizations in other parts of the world. Chevron Nigeria has a written Drug and Alcohol Policy which has been dormant for some time because of the apparent rarity of the problem of substance abuse in the workplace. This Policy is being reviewed to broaden its scope and make it more effective. A total of 30 employees were tested for drugs and alcohol .6 exceeded the legal limits of Blood Alcohol Concentration (BAC) and 5 tested positive for drugs. Tests were mainly post-accident, reasonable cause and random. The common substances abused were alcohol, cannabis, cocaine and morphine in that order. The findings are compared with those of similar organizations in UK and USA. Efforts to control substance abuse in the workplace are being put into place.

Common skin problems in the community and primary care.

Science.gov (United States)

Armstrong, Kirsty

2014-10-01

Skin problems can be hard to diagnose, leaving clinicians frustrated and patients incorrectly treated, but rashes and lesions can be markers of systemic disease and infections. However, by using simple history-taking and mnemonics, safety and correct diagnoses can be achieved. This article will consider some common problems encountered in primary and community care, issues that need to be excluded, resources that will help with diagnosis and some management guidelines. This is not an exhaustive guide, and advice should be sought from learned colleagues in specific cases. Pressure area care and the use of compression bandaging will not be discussed unless it is of relevance to the subject of rashes and lesions.

[Alcohol and drugs in Central Europe--problems and possible solutions].

Science.gov (United States)

Nespor, K; Cs emy, L

1994-08-22

The high alcohol consumption and increasing abuse of other addictive inducing substances in Central Europe calls for broadley conceived preventive programmes and cheap and widely applicable therapeutic strategies (early treatment at the first contact level, self-help manuals, self-aid organizations). Social instability along with greater availability of alcohol and drugs create a dangerous combination. In addition to strategies of stress prevention at the societal level also strategy at the individual level is important (e.g. relaxation training, yoga, psychotherapy). It is also important to change the "image" of western society and commercial interests of those who make profits on alcohol and drugs should be under control and advertising should be greatly restricted if not prohibited. Prevention of problems caused by alcohol and drugs in particular in youths must be combined and really effective strategies should be used such as peer programmes. The authors mention also their own preventive programme FIT IN and print materials oriented specifically on certain population groups.

Peer substance use associated with the co-occurrence of borderline personality disorder features and drug use problems in college students.

Science.gov (United States)

Pizzarello, Scott; Taylor, Jeanette

2011-01-01

To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality. Participants were 2,202 undergraduates who attended a large southeastern university between 2003 and 2006. All subjects completed measures assessing the presence of BPD symptoms, drug use problems, general personality traits, and the proportion of their friends and partners who had used illicit drugs within the past 12 months. The illicit drug use patterns of one's friends and romantic partners was a significant contributor to the co-occurrence of BPD features and drug use problems even when controlling for levels of impulsivity and negative emotionality. These findings suggest possible additional avenues for treatment focusing on helping students with BPD and drug use problems modify their social group.

Recovery from Problem Drug Use: What Can We Learn from the Dociologist Erving Goffman?

Science.gov (United States)

Neale, Joanne; Nettleton, Sarah; Pickering, Lucy

2011-01-01

In this commentary, we critically review the contribution of the sociologist Erving Goffman (1922-1982) to understanding recovery from problem drug use. Previous research has indicated that drug users have a "spoiled identity" and must restore a "normal" or "unspoiled" identity in order to recover. This argument has been linked to Goffman's…

Strategies of Pre-Service Primary School Teachers for Solving Addition Problems with Negative Numbers

Science.gov (United States)

Almeida, Rut; Bruno, Alicia

2014-01-01

This paper analyses the strategies used by pre-service primary school teachers for solving simple addition problems involving negative numbers. The findings reveal six different strategies that depend on the difficulty of the problem and, in particular, on the unknown quantity. We note that students use negative numbers in those problems they find…

FAMILY HEALTH PROGRAM: CHALLENGES AND POTENTIALITIES REGARDING DRUGS USE

Directory of Open Access Journals (Sweden)

Marcelle Aparecida de Barros

2006-04-01

Full Text Available ABSTRACT: Epidemiological studies on drugs use point towards this phenomenon as a public health problem. Nowadays, the Family Health Program (FHP is presented by the Health Ministry as a model to restructure primary health care and aims to offer family-centered care, permeated by integrality, problem solving and community bonds. This article aims to discuss action possibilities of Family Health Care professionals involving drugs patients. It is evident that, as opposed to other actions already developed by FHP professionals in other health care areas, which has appeared clearly and objectively. This fact is observed in the daily activities of FHP professionals, which give little attention to drugs-related problems. However, research emphasizes that there exists a broad range of action possibilities for FHP professionals. Although other studies evidence this team’s fragilities in terms of care for drugs users, these can be overcome by investing in the training and valuation of these professionals. KEY WORDS: Family Health Program; Street drugs; Health Knowledge, Attitudes, Practice.

Prescription changes and drug costs at the interface between primary and specialist care

NARCIS (Netherlands)

Bijl, D; van Sonderen, E; Haaijer-Ruskamp, FM

Objective: To explore the relevance of prescription changes and related drug costs when patients are referred from primary to secondary care. Patients and methods: Secondary analysis of data derived from a study on the quality of referrals, which was performed in 1989-1990. New and non-acute

Producing the 'problem of drugs': A cross national-comparison of 'recovery' discourse in two Australian and British reports.

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Lancaster, Kari; Duke, Karen; Ritter, Alison

2015-07-01

The notion of 'recovery' as an overarching approach to drug policy remains controversial. This cross-national analysis considers how the problem of drugs was constructed and represented in two key reports on the place of 'recovery' in drug policy, critically examining how the problem of drugs (and the people who use them) are constituted in recovery discourse, and how these problematisations are shaped and disseminated. Bacchi's poststructuralist approach is applied to two documents (one in Britain and one in Australia) to analyse how the 'problem of drugs' and the people who use them are constituted: as problematic users, constraining alternative understandings of the shifting nature of drug use; as responsibilised individuals (in Britain) and as patients (in Australia); as worthy of citizenship in the context of treatment and recovery, silencing the assumption of unworthiness and the loss of rights for those who continue to use drugs in 'problematic' ways. The position of the organisations which produced the reports is considered, with the authority of both organisations resting on their status as independent, apolitical bodies providing 'evidence-based' advice. There is a need to carefully weigh up the desirable and undesirable political effects of these constructions. The meaning of 'recovery' and how it could be realised in policy and practice is still being negotiated. By comparatively analysing how the problem of drugs was produced in 'recovery' discourse in two jurisdictions, at two specific points in the policy debate, we are reminded that ways of thinking about 'problems' reflect specific contexts, and how we are invoked to think about policy responses will be dependent upon these conditions. As 'recovery' continues to evolve, opening up spaces to discuss its contested meanings and effects will be an ongoing endeavour. Copyright © 2015 Elsevier B.V. All rights reserved.

A typology and analysis of drug resistance strategies of rural Native Hawaiian youth.

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Okamoto, Scott K; Helm, Susana; Giroux, Danielle; Kaliades, Alexis; Kawano, Kaycee Nahe; Kulis, Stephen

2010-12-01

This study examines the drug resistance strategies described by Native Hawaiian youth residing in rural communities. Sixty-four youth from 7 middle and intermediate schools on the Island of Hawai'i participated in a series of gender-specific focus groups. Youth responded to 15 drug-related problem situations developed and validated from prior research. A total of 509 responses reflecting primary or secondary drug resistance strategies were identified by the youth, which were qualitatively collapsed into 16 different categories. Primary drug resistance strategies were those that participants listed as a single response, or the first part of a two-part response, while secondary drug resistance strategies were those that were used in tandem with primary drug resistance strategies. Over half of the responses reflecting primary drug resistance strategies fell into three different categories ("refuse," "explain," or "angry refusal"), whereas over half of the responses reflecting secondary drug resistance strategies represented one category ("explain"). Significant gender differences were found in the frequency of using different strategies as well as variations in the frequency of using different strategies based on the type of drug offerer (family versus friends/peers). Implications for prevention practice are discussed.

Problems Encountered by Primary School Teachers in the Teaching of Music

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Ilgım KILIÇ

2009-04-01

Full Text Available The aim of this research is to identify the problems encountered by primary school teachers and to makesuggestions to solve the problems. This is a descriptive study and also a case study. A questionnaire form wasused for data collection. The surveys were administered on the elementary education teachers working underAnkara Province Directorate of the Ministry of Education in 2006 – 2007 academic year. The data collectedwere analyzed using SPSS program and statistical analyses were carried out. It was concluded that theprimary school teachers’ music education was not sufficient and that they had encountered problems inimproving themselves with regard to music education. A number of suggestions were made in line with theresults obtained.

Current problems of teaching spelling in the first cycle of Primary Education

Directory of Open Access Journals (Sweden)

Martha Valcárcel González

2005-12-01

Full Text Available This article presents from the theoretical point of view the spelling problem as one of the main difficulties that there is in Primary Education and in which teachers intensively work searching for solutions.

The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care

DEFF Research Database (Denmark)

Larsen, Michael Due; Schou, Mette; Kristiansen, Anja Sparre

2014-01-01

decreased from 33.5 to 9.4 %, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4 % of esomeprazole use was initiated in the hospital, and this was 8.4 % for PPIs in general. After the change of hospital drug policy, this decreased to 6.5 % for esomeprazole and increased......AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing...... policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge...

[Ethical problems experienced by nurses in primary health care: integrative literature review].

Science.gov (United States)

Nora, Carlise Rigon Dalla; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida

2015-03-01

The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Problem solving styles among people who use alcohol and other drugs in South Africa.

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Sorsdahl, Katherine; Stein, Dan J; Carrara, Henri; Myers, Bronwyn

2014-01-01

The present study examines the relationship between problem-solving styles, socio-demographic variables and risk of alcohol and other drug (AOD)-related problems among a South African population. The Social Problem-Solving Inventory-Revised, Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were administered to a convenience sample of 1000 respondents. According to the ASSIST, 32% and 49% of respondents met criteria for moderate to high risk of alcohol use and illicit drug use respectively. After adjusting for the effects of other variables in the model, respondents who were of "Coloured" ancestry (PR=1.20, 95% CI 1.0-1.4), male (PR=1.19, 95% CI 1.04-1.37), older (PR=1.01, 95% CI 1.00-1.02), who adopted an avoidance style of coping with problems (PR=1.03, 95% CI 1.01-1.05) and who met criteria for depression (PR=1.42, 95% CI 1.12-1.79) were more likely to be classified as having risky AOD use. This suggests that interventions to improve problem solving and provide people with cognitive strategies to cope better with their problems may hold promise for reducing risky AOD use. © 2013.

Dynamic SIMS utilizing SF{sub 5}{sup +} polyatomic primary ion beams for drug delivery applications

Energy Technology Data Exchange (ETDEWEB)

Mahoney, Christine M.; Roberson, Sonya; Gillen, Greg

2004-06-15

The behavior of various biodegradable polymer films (e.g. polylactic acid, polyglycolic acid and polycaprolactone) as well as some model drugs (theophylline and 4-acetamidophenol) under dynamic SF{sub 5}{sup +} primary ion bombardment is explored. A series of polylactic acid films containing varying concentrations of 4-acetamidophenol are also analyzed under similar conditions. The resultant molecular depth profiles obtained from these polymer films doped with drug show very little degradation in molecular signal as a function of SF{sub 5}{sup +} primary ion dose, and it was found that the molecular ion signals of both polymer and drug remained constant for ion doses up to {approx}5x10{sup 15} ions/cm{sup 2}. In addition, the polymer film/Si interface was well defined which may imply that sputter-induced topography formation was not a significant limitation. These results suggest that the structure of the biodegradable polymers studied here which all have the common main chain structural unit, R-CO-O-R, allows for a greater ability to depth profile due to ease of bond cleavage. Most importantly, however, these results indicate that in these particular polymer systems, the distribution of the drug as a function of depth can be monitored.

THE MANAGEMENT OF AN ADOLESCENT WITH CONDUCT PROBLEMS IN A PRIMARY CARE CLINIC – A CASE REPORT

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KHAIRANI O

2009-01-01

Full Text Available Purpose: To describe the management of mild conduct problems in an adolescent at the primary care level. Case report: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. Conclusion: This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.

Problem Drug Use, Marijuana, and European Projects: How Epidemiology Helped Czech Policy Reformers

OpenAIRE

Jan Morávek

2008-01-01

I examine the transfer of the Problem Drug Use (PDU) concept into Czech scientific discourse through European institutions’ projects, and view PDU’s utilization by Czech researchers in relation to marijuana decriminalization efforts.PDU is defined as intravenous and/or long-term and regular use of opiates, cocaine, or amphetamines. Out of a vast array of illicit drug use patterns, this concept isolates a relatively small population with the riskiest use patterns to become the focus of public ...

[Effects of the new comprehensive system for designating illegal drug components on the abuse of designer drugs and future problems based on an online questionnaire].

Science.gov (United States)

Morino, Taichi; Okazaki, Mitsuhiro; Toda, Takaki; Yokoyama, Takashi

2015-12-01

Recently, the abuse of designer drugs has become a social problem. Designer drugs are created by modifying part of the chemical structure of drugs that have already been categorized as illegal, thereby creating a different chemical compound in order to evade Pharmaceutical Affairs Law regulations. The new comprehensive system for designating illegal drug components has been in effect since March 2013, and many designer drugs can now be regulated. We conducted an online questionnaire survey of people with a history of designer drug use to elucidate the effects of the new system on the abuse of designer drugs and to identify potential future problems. Over half the subjects obtained designer drugs only before the new system was implemented. Awareness of the system was significantly lower among subjects who obtained designer drugs for the first time after its introduction than those who obtained the drugs only before its implementation. Due to the new system, all methods of acquiring designer drugs saw decreases in activity. However, the ratio of the acquisition of designer drugs via the Internet increased. Since over 50% of the subjects never obtained designer drugs after the new system was introduced, goals that aimed to make drug procurement more difficult were achieved. However, awareness of the new system among subjects who obtained designer drugs after the new system was introduced was significantly low. Therefore, fostering greater public awareness of the new system is necessary. The results of the questionnaire also suggested that acquiring designer drugs through the Internet has hardly been affected by the new system. We strongly hope that there will be a greater push to restrict the sale of designer drugs on the Internet in the near future.

Science of the science, drug discovery and artificial neural networks.

Science.gov (United States)

Patel, Jigneshkumar

2013-03-01

Drug discovery process many times encounters complex problems, which may be difficult to solve by human intelligence. Artificial Neural Networks (ANNs) are one of the Artificial Intelligence (AI) technologies used for solving such complex problems. ANNs are widely used for primary virtual screening of compounds, quantitative structure activity relationship studies, receptor modeling, formulation development, pharmacokinetics and in all other processes involving complex mathematical modeling. Despite having such advanced technologies and enough understanding of biological systems, drug discovery is still a lengthy, expensive, difficult and inefficient process with low rate of new successful therapeutic discovery. In this paper, author has discussed the drug discovery science and ANN from very basic angle, which may be helpful to understand the application of ANN for drug discovery to improve efficiency.

A Study on Teaching Gases to Prospective Primary Science Teachers through Problem-Based Learning

Science.gov (United States)

Senocak, Erdal; Taskesenligil, Yavuz; Sozbilir, Mustafa

2007-01-01

The aim of this study was to compare the achievement of prospective primary science teachers in a problem-based curriculum with those in a conventional primary science teacher preparation program with regard to success in learning about gases and developing positive attitudes towards chemistry. The subjects of the study were 101 first year…

Primary Pre-Service Teachers' Understanding of Students' Internalising Problems of Mental Health and Wellbeing

Science.gov (United States)

Bryer, Fiona; Signorini, Jessica

2011-01-01

An emerging national agenda for the mental health and wellbeing of young Australians has fostered an expectation that primary teachers can recognise and respond to students with internalising problems. A mixed method survey of fourth-year preservice teachers revealed patchy personal and practicum exposure to internalising problems and scant…

Ethical problems experienced by nurses in primary health care: integrative literature review

Directory of Open Access Journals (Sweden)

Carlise Rigon Dalla Nora

Full Text Available The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Primary problems associated with the health and welfare of employees observed when implementing lean manufacturing projects.

Science.gov (United States)

Rampasso, Izabela Simon; Anholon, Rosley; Gonçalves Quelhas, Osvaldo Luiz; Filho, Walter Leal

2017-01-01

Lean philosophy is used by companies to increase productivity and reduce costs. Although uncontested benefits are created, it is necessary to highlight the problems related to employees' health and welfare caused by implementing lean manufacturing projects. The primary objective of this paper is to review the literature and identify the most relevant problems created by lean philosophy for employees. Research about the theme was performed on many international databases over three months, and an initial sample of 77 papers was found. Twenty-seven sources were utilized. We identified 22 categories of problems related to health and welfare of employees. The most cited problem was work intensification, mentioned by thirteen papers. Increased stress and increased responsibilities, demands and, consequently, pressure on the workers are among the primary problems observed in the research.

Continuity in Primary School Children's Eating Problems and the Influence of Parental Feeding Strategies

Science.gov (United States)

Matton, Annelies; Goossens, Lien; Braet, Caroline; Van Durme, Kim

2013-01-01

Eating problems are highly prevalent and seem to show continuity in children. Nevertheless, the effect of different maternal and paternal feeding practices on changes in these problems is not fully understood yet. This study examines short-term continuity in primary school children's overeating, loss of control (over eating), restraint and…

"Not just eliminating the mosquito but draining the swamp": A critical geopolitics of Turkish Monitoring Center for Drugs and Drug Addiction and Turkey's approach to illicit drugs.

Science.gov (United States)

Evered, Kyle T; Evered, Emine Ö

2016-07-01

In the 1970s, Turkey ceased to be a significant producer state of illicit drugs, but it continued to serve as a key route for the trade of drugs between East and West. Over the past decade, however, authorities identified two concerns beyond its continued transit state status. These reported problems entail both new modes of production and a rising incidence of drug abuse within the nation-state - particularly among its youth. Amid these developments, new law enforcement institutions emerged and acquired European sponsorship, leading to the establishment of TUBİM (the Turkish Monitoring Center for Drugs and Drug Addiction). Coordinating with and reporting to the European Union agency EMCDDA (the European Monitoring Center for Drugs and Drug Addiction), TUBİM's primary assigned duties entail the collection and analysis of data on drug abuse, trafficking, and prevention, the geographic identification of sites of concern (e.g. consumption, drug-related crimes, and peoples undergoing treatment), and the production of annual national reports. In this article, we examine the geopolitical origins of TUBİM as Turkey's central apparatus for confronting drug problems and its role as a vehicle for policy development, interpretation, and enforcement. In doing so, we emphasize the political and spatial dimensions inherent to the country's institutional and policy-driven approaches to contend with drug-related problems, and we assess how this line of attack reveals particular ambiguities in mission when evaluated from scales at world regional, national, and local levels. In sum, we assess how Turkey's new institutional and legislative landscapes condition the state's engagements with drug use, matters of user's health, and policy implementation at local scales and amid ongoing political developments. Copyright © 2016 Elsevier B.V. All rights reserved.

Optimal primary surgical management of infected pseudoaneurysm in intravenous drug abusers: ligation or reconstruction?

International Nuclear Information System (INIS)

Jamil, M.; Usman, R.; Afzal, M.; Malik, N.I.

2017-01-01

Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015. Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure. Results: All patients who underwent ligation and excision procedures did well initially. One (3.2%) patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five (16.1%) patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero. Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization.

Inappropriate prescribing and prescribing omissions among drug-related problems using STOPP-START criteria

NARCIS (Netherlands)

Verdoorn, M.A.; Kwint, H.-F.; Faber, A.; L. Bouvy, M.

2013-01-01

Background and objectives: Medication review has been suggested as a way to prevent drug related problems (DRPs). Screening tools have been formulated to identify potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) respectively called Screening Tool of Older

Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions

Science.gov (United States)

O’Brien, Doireann; Harvey, Kate; Howse, Jessica; Reardon, Tessa; Creswell, Cathy

2016-01-01

Background Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face. Aim To ascertain primary care practitioners’ perceptions of the barriers that prevent effective management of child and adolescent mental health problems. Design and setting A systematic review of qualitative and quantitative literature in a primary care setting. Method A database search of peer-reviewed articles using PsycINFO, MEDLINE®, Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers. Results A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions. Conclusion The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services. PMID:27621291

Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions.

Science.gov (United States)

O'Brien, Doireann; Harvey, Kate; Howse, Jessica; Reardon, Tessa; Creswell, Cathy

2016-10-01

Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face. To ascertain primary care practitioners' perceptions of the barriers that prevent effective management of child and adolescent mental health problems. A systematic review of qualitative and quantitative literature in a primary care setting. A database search of peer-reviewed articles using PsycINFO, MEDLINE(®), Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers. A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions. The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services. © British Journal of General Practice 2016.

Primary health care progress and problems.

Science.gov (United States)

Favin, M; Parlato, P; Kessler, S

1984-01-01

The 1st generation of primary health care efforts were assessed in order to temper future efforts with implementation realities. With support from the US Agency for International Development (USAID), the American Public Health Association (APHA) studied 52 primary health care (PHC) projects from 1980-82, documenting the numerous lessons learned. The contrast between the ideology of PHC and field realities provides valuable insights which must be fed back into 2nd generation projects. The projects were in 33 developing countries in Asia, Latin America, Africa, and the Near East. Approximately 1/3 were national level efforts; one-half, variously sized regional efforts; and the remainder, small scale pilot efforts. The sources of information were project documents and interviews with individuals who knew field activities firsthand. All the projects had as their primary goal provision of low-cost health services to previously unserved rural communities, using community personnel, and strengthening community institutions. Regarding overall assessment, while data continue to be limited on the impact of the approach on health status, there are some positive indications, especially for the projects of longer duration. For example, in Nepal and Thailand, there were modest improvements in health status of the target population in 2 project areas. A project in Kitui, Kenya reported reductions in infant mortality rates. A PHC program in Panama was responsible for decreases in the incidence of diarrhea, parasites, and typhoid. Many of the projects have been successful in setting up a PHC structure that extends coverage for health measures such as immunizations, family planning, and prenatal care. Many new facilities are in place. Skills of health workers have been upgraded, and new categories of paraprofessionals have been trained. Additionally, sizable numbers of community health workers have been trained and deployed. There is some evidence that in a few cases projects have

Digital Story-Based Problem Solving Applications: Preservice Primary Teachers' Experiences and Future Integration Plans

Science.gov (United States)

Kilic, Çigdem; Sancar-Tokmak, Hatice

2017-01-01

This case study investigates how preservice primary school teachers describe their experiences with digital story-based problem solving applications and their plans for the future integration of this technology into their teaching. Totally 113 preservice primary school teachers participated in the study. Data collection tools included a…

Primary health care physicians' treatment of psychosocial problems: implications for social work.

NARCIS (Netherlands)

Gross, R.; Rabinowitz, J.; Feldman, D.; Boerma, W.

1996-01-01

This study explores the extent to which primary care physicians serve as gatekeepers for the treatment of psychosocial problems and the extent to which they have contact with social workers. We also attempted to identify physician variables related to gatekeeping and amount of contact with social

EVALUASI DRUG RELATED PROBLEMS PADA PASIEN GERIATRI DENGAN HIPERTENSI DISERTAI VERTIGO DI RS PANTI RINI YOGYAKARTA AGUSTUS 2013

Directory of Open Access Journals (Sweden)

Kresensiana Yosriani

2016-04-01

Full Text Available Abstract : This study aimed to evaluate Drug Related Problems (DRPs among hypertensive geriatric patients with vertigo co morbid at Panti Rini Hospital Yogyakarta. This is a non-experimental research descriptive evaluative design using a retrospective medical record data. Collected data including patient's identity; initial, final, and complication diagnosis; cardiovascular system drugs and antivertigo, laboratory data. The inclusion criteria were ≥ 60 years with an initial diagnosis of hypertension with vertigo co morbid, used a diuretic drug, and had creatinine test result. Data were analyzed case by case using selected literatur. There were 20 cases found. Result of the study showed that 100% of patients used antihypertensive as the cardiovascular system drugs and 80% patients used antivertigo as nervous system drugs. There were 18 cases of DRPs found related to the use of antihypertensive and antivertigo. 1 case of dosage too low, 8 cases of adverse drug reaction, and 9 cases of dosege too high. Keywords : hypertension with vertigo co morbid, geriatrics, Drug Related Problems

Meta-analysis and time series modeling allow a systematic review of primary HIV-1 drug-resistant prevalence in Latin America and Caribbean.

Science.gov (United States)

Coelho, Antonio Victor Campos; De Moura, Ronald Rodrigues; Da Silva, Ronaldo Celerino; Kamada, Anselmo Jiro; Guimarães, Rafael Lima; Brandão, Lucas André Cavalcanti; Coelho, Hemílio Fernandes Campos; Crovella, Sergio

2015-01-01

Here we review the prevalence of HIV-1 primary drug resistance in Latin America and Caribbean using meta-analysis as well as time-series modeling. We also discuss whether there could be a drawback to HIV/AIDS programs due to drug resistance in Latin America and Caribbean in the next years. We observed that, although some studies report low or moderate primary drug resistance prevalence in Caribbean countries, this evidence needs to be updated. In other countries, such as Brazil and Argentina, the prevalence of drug resistance appears to be rising. Mutations conferring resistance against reverse transcriptase inhibitors were the most frequent in the analyzed populations (70% of all mutational events). HIV-1 subtype B was the most prevalent in Latin America and the Caribbean, although subtype C and B/F recombinants have significant contributions in Argentina and Brazil. Thus, we suggest that primary drug resistance in Latin America and the Caribbean could have been underestimated. Clinical monitoring should be improved to offer better therapy, reducing the risk for HIV-1 resistance emergence and spread, principally in vulnerable populations, such as men who have sex with men transmission group, sex workers and intravenous drug users.

Changes in psychiatric symptoms among persons with methamphetamine dependence predicts changes in severity of drug problems but not frequency of use.

Science.gov (United States)

Polcin, Douglas L; Korcha, Rachael; Bond, Jason; Galloway, Gantt; Nayak, Madhabika

2016-01-01

Few studies have examined how changes in psychiatric symptoms over time are associated with changes in drug use and severity of drug problems. No studies have examined these relationships among methamphetamine (MA)-dependent persons receiving motivational interviewing within the context of standard outpatient treatment. Two hundred seventeen individuals with MA dependence were randomly assigned to a standard single session of motivational interviewing (MI) or an intensive 9-session model of MI. Both groups received standard outpatient group treatment. The Addiction Severity Index (ASI) and timeline follow-back (TLFB) for MA use were administered at treatment entry and 2-, 4-, and 6-month follow-ups. Changes in ASI psychiatric severity between baseline and 2 months predicted changes in ASI drug severity during the same time period, but not changes on measures of MA use. Item analysis of the ASI drug scale showed that psychiatric severity predicted how troubled or bothered participants were by their drug us, how important they felt it was for them to get treatment, and the number of days they experienced drug problems. However, it did not predict the number days they used drugs in the past 30 days. These associations did not differ between study conditions, and they persisted when psychiatric severity and outcomes were compared across 4- and 6-month time periods. Results are among the first to track how changes in psychiatric severity over time are associated with changes in MA use and severity of drug problems. Treatment efforts targeting reduction of psychiatric symptoms among MA-dependent persons might be helpful in reducing the level of distress and problems associated with MA use but not how often it is used. There is a need for additional research describing the circumstances under which the experiences and perceptions of drug-related problems diverge from frequency of consumption.

Web-based cognitive behavioral relapse prevention program with tailored feedback for people with methamphetamine and other drug use problems: protocol for a multicenter randomized controlled trial in Japan.

Science.gov (United States)

Takano, Ayumi; Miyamoto, Yuki; Kawakami, Norito; Matsumoto, Toshihiko; Shinozaki, Tomohiro; Sugimoto, Takashi

2016-04-04

Despite the effectiveness of psychosocial programs for recovery from drug use problems, there have been challenges in implementation of treatment. Internet-based and computerized approaches have been known to be effective in treatment dissemination. The study purpose is to assess the effects of a web-based psychosocial relapse prevention program with a multicenter randomized controlled trial. Recruitment began in January 2015 for outpatient participants diagnosed with drug abuse or dependence who have used a primary abused drug in the past year at psychiatric hospitals and a clinic. Participants are randomized either to a web-based relapse prevention program or a self-monitoring group. The intervention is a web-based relapse prevention program named "e-SMARPP" that consists of six relapse prevention program modules with tailored feedback from health care professionals and 8 weeks of self-monitoring. The content is adapted from a face-to-face relapse prevention program which is based on cognitive behavioral therapy and motivational enhancement. The primary outcomes are relapse risk assessed by the Stimulant Relapse Risk Scale (baseline, 2-, 5- and 8-month) and the longest duration of consecutive abstinent days from primary abused drug during the intervention. Secondary outcomes will include motivation to change, self-efficacy for drug use and craving, abstinent days in the past 28 or 56 days, quality of life, sense of coherence, cost of substance use, medical cost, retention of treatment and use of self-help group. Completion, usability and satisfaction of the program will be also assessed to explore feasibility. This study protocol was approved by the Ethics Committee of The University of Tokyo and each recruiting hospital and clinic. To our knowledge, this study is the first clinical trial to assess the effects of a web-based therapeutic program for drug users in Japan. If successful, this program is a promising approach for drug user treatment in Japan, where the

Problem Space Matters: The Development of Creativity and Intelligence in Primary School Children

Science.gov (United States)

Welter, Marisete Maria; Jaarsveld, Saskia; Lachmann, Thomas

2017-01-01

Previous research showed that in primary school, children's intelligence develops continually, but creativity develops more irregularly. In this study, the development of intelligence, measured traditionally, i.e., operating within well-defined problem spaces (Standard Progressive Matrices) was compared with the development of intelligence…

Scientific Reasoning and Its Relationship with Problem Solving: The Case of Upper Primary Science Teachers

Science.gov (United States)

Alshamali, Mahmoud A.; Daher, Wajeeh M.

2016-01-01

This study aimed at identifying the levels of scientific reasoning of upper primary stage (grades 4-7) science teachers based on their use of a problem-solving strategy. The study sample (N = 138; 32 % male and 68 % female) was randomly selected using stratified sampling from an original population of 437 upper primary school teachers. The…

[Adverse reactions to drugs reported by the primary care physicians of Andalusia. Analysis of underreporting].

Science.gov (United States)

Torelló Iserte, J; Castillo Ferrando, J R; Laínez, M M; García Morillas, M; Arias González, A

1994-04-15

To discover the sort of adverse reactions to medication (ARM) notified by Primary Care doctors and identify the under-notification of those cases having special clinical-epidemiological interest. Retrospective study in which 2,597 ARM corresponding to 1,467 Yellow Cards (YC) were analysed. These were notified by Primary Care doctors to the Centro Andaluz de Farmacovigilancia (Andalusian Drug-watch centre) during the period from 1/6/90 to 31/12/92. To assess the seriousness of the ARM, their terminological classification and imputability, the criteria used in the WHO's international "Yellow Card" programme of spontaneous notification were followed. 77.2% of all notifications were from Primary Care, of which 7.4% were of special interest due to their serious or novel character. However an undernotification of serious and well-known ARM was detected, such as digestive haemorrhages (1.07/10(6) inhibitants per year), anaphylactic shock (0.34/10(6) inhab/year), agranulocytosis (0.23/10(6) inhab/year) and aplastic anaemia (0.05/10(6) inhab/year), among others. Most of the main under-notified ARM are generated in the community but treated in hospital Casualty departments. Therefore it would be useful to develop specific Drug-watch programmes in the hospitals themselves.

The concept and attitudes of primary health care workers towards ...

African Journals Online (AJOL)

Evil spirit possession and native charm/juju were incorrectly mentioned by half of the respondents as causes of mental illness while alcohol/drug abuse, emotional problems and marijuana smoking were correctly implicated by more than 70% of respondents. Although 90% of the primary health care workers preferred ...

Effectiveness of Problem-Solving Therapy for Older, Primary Care Patients with Depression: Results from the IMPACT Project

Science.gov (United States)

Arean, Patricia; Hegel, Mark; Vannoy, Steven; Fan, Ming-Yu; Unuzter, Jurgen

2008-01-01

Purpose: We compared a primary-care-based psychotherapy, that is, problem-solving therapy for primary care (PST-PC), to community-based psychotherapy in treating late-life major depression and dysthymia. Design and Methods: The data here are from the IMPACT study, which compared collaborative care within a primary care clinic to care as usual in…

Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

NARCIS (Netherlands)

Zaal, R.J.; Jansen, M.; Duisenberg-van Essenberg, M.; C.C., Tijssen; Roukema, J.A.; van den Bemt, P.M.

2013-01-01

Background Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective study.

Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts

NARCIS (Netherlands)

R.J. Zaal (Rianne); M.M.P.M. Jansen (Mark M. P.); M. Duisenberg-Van Essenberg (Marjolijn); C.C. Tijssen (Cees); J.A. Roukema; P.M.L.A. van den Bemt (Patricia)

2013-01-01

textabstractBackground Both clinical pharmacists and computerized physician order entry systems with clinical decision support (CPOE/CDSS) can reduce drug-related problems (DRPs). However, the contribution of a clinical pharmacist in addition to CPOE/CDSS has not been established in a prospective

Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support.

Science.gov (United States)

Kulesza, Magdalena; Watkins, Katherine E; Ober, Allison J; Osilla, Karen C; Ewing, Brett

2017-11-01

Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs). We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use. The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems. Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs. Copyright © 2017 Elsevier B.V. All rights reserved.

Admissions through the emergency department due to drug-related problems

International Nuclear Information System (INIS)

Yosef H Al-Olah; Khalifa M Al Thiab

2010-01-01

Hospital admissions due to drug-related problems (DRPs) have been studied internationally, but local data are limited. Therefore, we undertook a prospective, observational study of all admissions through the emergency department (ED) at a tertiary referral hospital in Saudi Arabia to determine the incidence of admissions through the ED due to DRPs, types of DRPs, length of stay (LOS) in the hospital after ED admissions due to DRPs, and assessment of preventability of admissions due to DRPs.All admissions through the ED over a period of 28 consecutive days were evaluated to determine if they were due to definite or possible DRPs. Data was collected on a daily basis for each admission over the previous 24 hours. Each incident was assessed by three investigators Of 557 patients admitted through the ED, 82 (14.7%) admissions were due to DRP (53 definite, 29 possible). The most common types of DRP were failure to receive medication in 25 cases (47.2%), an adverse drug reaction in 13 cases (24.5%), and drug overdose in 6 cases (11.3%). In the definite DRP group, 83.0% were definitely preventable, 3.8% were possibly preventable and 13.2% were definitely non-preventable.DRPs are a serious and costly issue facing health care professionals and health care systems. Most admissions due to DRPs are avoidable (Author).

Turkish Primary School Students' Strategies in Solving a Non-Routine Mathematical Problem and Some Implications for the Curriculum Design and Implementation

Science.gov (United States)

Erdogan, Abdulkadir

2015-01-01

Turkish primary mathematics curriculum emphasizes the role of problem solving for teaching mathematics and pays particular attention to problem solving strategies. Patterns as a subject and the use of patterns as a non-routine problem solving strategy are also emphasized in the curriculum. The primary purpose of this study was to determine how…

The role of the primary care provider in preventing and treating alcohol problems in adolescents

NARCIS (Netherlands)

Knight, [No Value

2001-01-01

Adolescents use alcohol more frequently and heavily than all other illicit drugs combined.(1) Given the myriad health, developmental, and social problems associated with alcohol use, it is not surprising that the American Medical Association's Guidelines for Adolescent Preventive Services recommends

ICT-Supported Problem-Based Learning: Possibilities of Applying Problem-Based Learning from Primary School to Higher Education

Directory of Open Access Journals (Sweden)

Czékmán Balázs

2016-06-01

Full Text Available Problem Based Learning was originally created for medical students to better diagnose new illnesses; this methodology can be used in almost all the fields of education. Teachers can teach by appealing to students’ natural instincts to create, and they can improve the students’ performance in different disciplines. So, we can say that it is an easy way of the acquisition and integration of new knowledge. While the content and structure of PBL courses may differ, the general goals and learning objectives tend to be similar. It begins with the assumption that learning is an active, integrated, and constructive process influenced by social and contextual factors. The task of our paper is to show how Problem-Based Learning can be used from primary to university level education in teaching different subjects.

Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence.

Science.gov (United States)

Staiger, Petra K; Richardson, Ben; Long, Caroline M; Carr, Victoria; Marlatt, G Alan

2013-07-01

Despite recognition of the harms related to alcohol misuse and its potential to interfere substantially with sustained recovery from drug dependency, research evaluating drug treatment outcomes has not addressed the issue comprehensively. It has been overlooked possibly because treatment research has been framed according to the primary drug of choice, rather than investigating the interactions between different combinations of drugs and/or alcohol use. This paper reports on a systematic review investigating whether concurrent alcohol use could impede recovery from illicit drug use in two potential ways: first, alcohol could become a substitute addiction and/or secondly, alcohol misuse post-treatment may place an individual at risk for relapse to their primary drug problem. A systematic search of four relevant databases was undertaken to identify peer-reviewed, quantitative drug treatment outcome studies that reported alcohol use pre-, post-treatment and follow-up. The search revealed 567 papers, of which 13 were assessed as fulfilling the key inclusion criteria.The review indicated inconsistent and therefore inconclusive support for the substitution hypothesis. However, the data revealed consistent support for the hypothesis that alcohol use increases relapse to drug use. (i) The potential negative impact of alcohol misuse on drug treatment outcomes remains under-researched and overlooked; (ii) alcohol consumption post-drug treatment may increase the likelihood that an individual will relapse to their primary drug; (ii) existing evidence regarding the substitution hypothesis is inconclusive, although there was an indication that a subgroup of participants will be vulnerable to alcohol becoming the primary addiction instead of drugs. We argue that future drug treatment outcome studies need to include detailed analysis of the influence of alcohol use pre- and post-drug treatment. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Solution of the ratchet-shakedown Bree problem with an extra orthogonal primary load

International Nuclear Information System (INIS)

Bradford, R.A.W.

2015-01-01

The complete shakedown and ratcheting solution is derived analytically for a flat plate subject to unequal biaxial primary membrane stresses and a cyclic secondary bending stress in one in-plane direction (x). The Tresca yield condition and elastic-perfectly plastic behaviour are assumed. It is shown that the results can be expressed in the form of a “universal” ratchet diagram applicable for all magnitudes of orthogonal load. For sufficiently large cyclic bending stresses, tensile ratcheting can occur in the x direction if the x direction primary membrane stress exceeds half that in the orthogonal direction. Conversely, for sufficiently large cyclic bending stresses ratcheting in the x direction will be compressive if the x direction primary membrane stress is less than half that in the orthogonal direction. When the x direction primary membrane stress is exactly half that in the orthogonal direction ratcheting cannot occur however large the cyclic secondary bending stress. - Highlights: • A complete shakedown and ratcheting solution is derived analytically. • The problem is Bree-like but with an extra orthogonal primary load. • The ratchet diagram can be expressed in a form applicable to any orthogonal load. • Tensile ratcheting can occur if the primary load exceeds half the orthogonal load. • Compressive ratcheting can occur for smaller primary loads

Primary School Text Comprehension Predicts Mathematical Word Problem-Solving Skills in Secondary School

Science.gov (United States)

Björn, Piia Maria; Aunola, Kaisa; Nurmi, Jari-Erik

2016-01-01

This longitudinal study aimed to investigate the extent to which primary school text comprehension predicts mathematical word problem-solving skills in secondary school among Finnish students. The participants were 224 fourth graders (9-10 years old at the baseline). The children's text-reading fluency, text comprehension and basic calculation…

Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California

Science.gov (United States)

Miller, Ted R.; Nygaard, Peter; Gaidus, Andrew; Grube, Joel W.; Ponicki, William R.; Lawrence, Bruce A.; Gruenewald, Paul J.

2017-01-01

Background Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California. Methods We used estimates of the incidence and prevalence of AOD use, abuse and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public-use survey data collected at state, county and city-levels over the years from 2009 to 2010. Results Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties. Conclusions AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need. PMID:28208210

Empathy and Critical Thinking: Primary Students Solving Local Environmental Problems through Outdoor Learning

Science.gov (United States)

Ampuero, David; Miranda, Christian E.; Delgado, Luisa E.; Goyen, Samantha; Weaver, Sean

2015-01-01

The present study explores the outcomes of teaching empathy and critical thinking to solve environmental problems. This investigation was done throughout the duration of an environmental education course within a primary school located in central Chile. A community-based research methodology was used to understand the formation of empathy and…

Surveillance of drug resistance for tuberculosis control: why and how?

Science.gov (United States)

Chaulet, P; Boulahbal, F; Grosset, J

1995-12-01

The resistance of Mycobacterium tuberculosis to antibiotics, which reflects the quality of the chemotherapy applied in the community, is one of the elements of epidemiological surveillance used in national tuberculosis programmes. Measurement of drug resistance poses problems for biologists in standardization of laboratory methods and quality control. The definition of rates of acquired and primary drug resistance also necessitates standardization in the methods used to collect information transmitted by clinicians. Finally, the significance of the rates calculated depends on the choice of the patients sample on which sensitivity tests have been performed. National surveys of drug resistance therefore require multidisciplinary participation in order to select the only useful indicators: rates of primary resistance and of acquired resistance. These indicators, gathered in representative groups of patients over a long period, are a measurement of the impact of modern chemotherapy regimens on bacterial ecology.

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil.

Science.gov (United States)

Ronzani, Telmo Mota; Higgins-Biddle, John; Furtado, Erikson F

2009-10-01

This study reports on the views of Primary Health Care (PHC) providers in Southeast Brazil on the use of alcohol and other drugs which reflect stigma, moralization, or negative judgment. Six hundred nine PHC professionals from the Brazilian states of São Paulo and Minas Gerais took part in the study. The majority (86.5%) of these professionals were female. Attitudes toward the use of alcohol and other drugs were evaluated in comparison to Hansen's disease, obesity, depression, schizophrenia, HIV/AIDS, and tobacco use. The use of tobacco, marijuana/cocaine, and alcohol were the most negatively judged behaviors (p health care workers demonstrated the severest judgment of alcohol use. In addition, marijuana/cocaine addicts and alcoholics suffered the highest rate of rejection by professionals. The hypothesis that the use of alcohol and other drugs is a behavior stigmatized by health professionals being confirmed, it is important to develop strategies for changing provider attitudes in order to provide a higher quality of service to these patients. This study is important as a first study among PHC professionals about social stigma of alcohol and other drugs users.

Admissions for drug-related problems at the Emergency Department of a University Hospital in the Kingdom of Saudi Arabia

Directory of Open Access Journals (Sweden)

Mastour S Alghamdy

2015-01-01

Full Text Available Background and Aim: Medication Errors can result in drug-related problems (DRPs. Insight into the frequency, type, and severity of DRPs could help reduce their incidence. The aim of the present study was to estimate the prevalence of admissions as a result of DRPs at the Emergency Department (ED of a university hospital in the Kingdom of Saudi Arabia. Materials and Methods: Files of suspected cases of DRPs reporting to ED in the year 2012 were scrutinized. Suspicion arose from the hospital record system based on Diagnosis Code Numbers (ICD-9-CM, Professional 2010 and from triggers, such as some drugs, laboratory tests, and signs and symptoms pointing to DRPs. Results: Of 5574 admissions, 253 (4.5% were DRPs and were categorized as: Overdose toxicity and side effects of drugs 50 (19.8%, drug-interactions 29 (11.5%, accidental and suicidal drug ingestions 26 (10.3%, drug abuse 18 (7.1%, drug allergy 10 (4%, super-infections 8 (3.2%, and noncompliance to treatment 112 (44.3%. About 70% of DRPs were preventable; 67 (26.5% required hospital admission for 7-102 days and 10 (4% died. Conclusions: Noncompliance to treatment, overdose toxicity, drug interactions, and drug abuse are important causes of hospital admissions as a result of DRPs. Awareness of prescribers to the problem and their education would help to prevent them and improve patient care.

Primary and secondary anti-tuberculosis drug resistance in Hitossa District of Arsi Zone, Oromia Regional State, Central Ethiopia

Directory of Open Access Journals (Sweden)

Shallo Daba Hamusse

2016-07-01

Full Text Available Abstract Background Multidrug-resistant tuberculosis (MDR-TB drugs which is resistant to the major first-line anti-TB drugs, Isoniazid and Rifampicin, has become a major global challenge in tuberculosis (TB control programme. However, its burden at community level is not well known. Thus, the aim of study was to assess the prevalence of primary and secondary resistance to any first line anti-TB drugs and MDR TB in Hitossa District of Oromia Regional State, Central Ethiopia. Methods Population based cross- sectional study was conducted on individuals aged ≥15 years. Those with symptoms suggestive of TB were interviewed and two sputum specimens were collected from each and examined using Lowenstein-Jensen (LJ culture medium. Further, the isolates were confirmed by the Ziehl-Neelsen microscopic examination method. Drug susceptibility test (DST was also conducted on LJ medium using a simplified indirect proportion method. The resistance strains were then determined by percentage of colonies that grew on the critical concentration of Isoniazid, Streptomycin, Rifampicin and Ethambutol. Results The overall resistance of all forms of TB to any first-line anti-TB drug was 21.7 %. Of the total new and previously treated culture positive TB cases, 15.3 and 48.8 % respectively were found to be a resistant to any of the first-line anti-TB drugs. Further, of all forms of TB, the overall resistance of MDR-TB was 4.7 %. However, of the total new TB cases, 2.4 % had primary while 14.3 % had secondary MDR-TB. Resistance to any of the first-line anti-TB drugs (adjusted odd ratio (AOR, 8.1; 95 % CI: 2.26–29.30 and MDR-TB (AOR, 7.1; 95 % CI: 2.6–43.8 was found to be linked with previous history of anti-TB treatment. Conclusions The study has identified a high rate of primary and secondary resistance to any of the first-line anti-TB drugs and MDR-TB in the study area. The resistance may have resulted from sub-optimal performance of directly observed

Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

Science.gov (United States)

Carrasco-Sanz, A; Leiva-Gea, I; Martin-Alvarez, L; Del Torso, S; van Esso, D; Hadjipanayis, A; Kadir, A; Ruiz-Canela, J; Perez-Gonzalez, O; Grossman, Z

2018-03-01

Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children. © 2017 John Wiley & Sons Ltd.

Common mental health problems in immigrants and refugees: general approach in primary care

Science.gov (United States)

Kirmayer, Laurence J.; Narasiah, Lavanya; Munoz, Marie; Rashid, Meb; Ryder, Andrew G.; Guzder, Jaswant; Hassan, Ghayda; Rousseau, Cécile; Pottie, Kevin

2011-01-01

Background: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. Methods: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. Results: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Interpretation: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally

Common mental health problems in immigrants and refugees: general approach in primary care.

Science.gov (United States)

Kirmayer, Laurence J; Narasiah, Lavanya; Munoz, Marie; Rashid, Meb; Ryder, Andrew G; Guzder, Jaswant; Hassan, Ghayda; Rousseau, Cécile; Pottie, Kevin

2011-09-06

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and

Using mHealth technologies to improve the identification of behavioral health problems in urban primary care settings

OpenAIRE

Staeheli, Martha; Aseltine, Robert H; Schilling, Elizabeth; Anderson, Daren; Gould, Bruce

2017-01-01

Introduction: Behavioral health disorders remain under recognized and under diagnosed among urban primary care patients. Screening patients for such problems is widely recommended, yet is challenging to do in a brief primary care encounter, particularly for this socially and medically complex patient population. Methods: In 2013, intervention patients at an urban Connecticut primary clinic were screened for post-traumatic stress disorder, depression, and risky drinking (n?=?146) using an elec...

Beating camp addiction: Drug use in the camps is a problem, but former addicts prove the habit can be broken.

Energy Technology Data Exchange (ETDEWEB)

Ball, C.

2004-12-06

Drug dependency among personnel in the oil industry, and the measures taken by industry trying to cope with it, are discussed. Because drug users are five times more likely to be in an accident, many companies have instituted regular drug testing programs. Such programs are considered to be particularly effective when combined with a program designed to educate personnel, but also managers and supervisors of the dangers of drug use and best practices to deal with them. It should be noted that firing an employee found to be using drugs is not a solution since drug dependency is considered to be a disability under the Human Rights Code, and employers are not allowed to discriminate against someone with a disability. The policy followed by most employers is immediate suspension upon discovery of drug use, followed by intensive supportive treatment, aimed at getting the individual to address his addiction, and putting him back to work as soon as it is deemed safe to do so. Wherever possible, voluntary admission of having a drug problem, and an enlightened, sincere effort to treat the problem as a disease in a non-judgmental way, is considered far superior to programs relying chiefly on drug testing.

Effects of problem-solving interventions on aggressive behaviours among primary school pupils in Ibadan, Nigeria.

Science.gov (United States)

Abdulmalik, Jibril; Ani, Cornelius; Ajuwon, Ademola J; Omigbodun, Olayinka

2016-01-01

Aggressive patterns of behavior often start early in childhood, and tend to remain stable into adulthood. The negative consequences include poor academic performance, disciplinary problems and encounters with the juvenile justice system. Early school intervention programs can alter this trajectory for aggressive children. However, there are no studies evaluating the feasibility of such interventions in Africa. This study therefore, assessed the effect of group-based problem-solving interventions on aggressive behaviors among primary school pupils in Ibadan, Nigeria. This was an intervention study with treatment and wait-list control groups. Two public primary schools in Ibadan Nigeria were randomly allocated to an intervention group and a waiting list control group. Teachers rated male Primary five pupils in the two schools on aggressive behaviors and the top 20 highest scorers in each school were selected. Pupils in the intervention school received 6 twice-weekly sessions of group-based intervention, which included problem-solving skills, calming techniques and attribution retraining. Outcome measures were; teacher rated aggressive behaviour (TRAB), self-rated aggression scale (SRAS), strengths and difficulties questionnaire (SDQ), attitude towards aggression questionnaire (ATAQ), and social cognition and attribution scale (SCAS). The participants were aged 12 years (SD = 1.2, range 9-14 years). Both groups had similar socio-demographic backgrounds and baseline measures of aggressive behaviors. Controlling for baseline scores, the intervention group had significantly lower scores on TRAB and SRAS 1-week post intervention with large Cohen's effect sizes of 1.2 and 0.9 respectively. The other outcome measures were not significantly different between the groups post-intervention. Group-based problem solving intervention for aggressive behaviors among primary school students showed significant reductions in both teachers' and students' rated aggressive behaviours

Long-term clinical outcome in STEMI patients treated with primary PCI and drug-eluting or bare-metal stents: insights from a high-volume single-center registry

DEFF Research Database (Denmark)

Pedersen, Sune; Galatius, Soren; Mogelvang, Rasmus

2011-01-01

Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial.......Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial....

Strontium ranelate is a drug to treat osteoarthrosis

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Oksana Anatolyevna Nikitinskaya

2013-01-01

Full Text Available To prevent disease progression in patients with osteoarthosis (OA remains a challenging problem. Despite the proposed drug, non-drug, and surgical treatments for OA, there is a clinical need for medications that have a structure-modifying effect and are able to delay or prevent cartilage degradation and to alleviate the clinical manifestations of the disease. A 3-year international randomized clinical trial has demonstrated strong evidence for the symptomand structure-modifying effect of strontium ranelate in female and male patients with clinical primary knee OA. The clinical use of the drug opens up new prospects for preventing the progression of the disease in patients with knee and hip OA.

[Moderation-integrated-balance presupposition of Chinese medicine compound and pharmacological problems in traditional Chinese drug research].

Science.gov (United States)

Zhao, Jun-Ning

2017-03-01

The moderation-integrated-balance presupposition (MIBP) of Chinese medicine compound was first proposed in this paper based on the review of function characteristics and action principles of Chinese medicine compound. Furthermore, the pharmacological problems of traditional Chinese drug research were discussed in details. The results were of important value in accelerating the transformation of traditional Chinese medicine compound, and constructing the new drug innovation and review system for traditional Chinese medicine. Copyright© by the Chinese Pharmaceutical Association.

The untreated dental caries in primary teeth: would it be problems?

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Udijanto Tedjosasongko

2016-06-01

Full Text Available Dental caries still remain as the most prevalent oral health disease in children. Many efforts have been done to prevent dental caries in children, but unfortunately there are dental practitioners who still have false mindset and prefer not to treat the dental caries case in primary teeth with the most common reasons are because it will be replaced with the permanent teeth. There are many negative effect will occur if the dental caries treatments in primary teeth are neglected.This topic would review the effects of untreated dental caries in children based on research reports.Severely decayed teeth have an important impact on children’s general health, nutrition, growth and body weight by causing discomfort, pain, sleeping problems, learning disorders and absence from school.  Untreated caries may affect seriously the quality of children’s life because of pain and discomfort, which could lead to acute and chronic infections, oral mucosal conditions and altered eating and sleeping habits. Furthermore, untreated caries in primary teeth can have a lasting detrimental impact on the permanent dentition by causing high caries risk or developmental defects of the permanent successor tooth. Moreover it has been reported that children at each higher level of caries had significantly lower height and weight outcomes than those with lower caries levels. The untreated dental caries in primary teeth would lead the children to poor growth and health which lowering the their quality of life.

Sleep problems and mental health in primary school new entrants: cross-sectional community-based study.

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Quach, Jon; Hiscock, Harriet; Wake, Melissa

2012-12-01

To determine at school entry (i) the prevalence and types of child sleep problems; (ii) sleep difficulties and hygiene practices associated with sleep problems; and (iii) their associations with child health-related quality of life, mental health and parent mental health. We conducted a cross-sectional community-based study at 22 primary schools in Melbourne, Australia. One thousand five hundred and twelve (70%) parents of children in the first 6 months of the child's first year of primary school took part. Parent report of child sleep problems (none, mild, and moderate/severe); sleep difficulties; pre-bedtime activities (television in bedroom, television or electronic games before bedtime, television or electronic games >2 h/day) and caffeine intake; child mental health (Strengths and Difficulties Questionnaire), health-related quality of life (Pediatric Quality of Life Inventory); and parent mental health (Depression Anxiety Stress Scale-21). 38.6% of children had a parent-reported sleep problem (27.9% mild, 10.8% moderate/severe). Sleep problems were characterised by problematic sleep difficulties but not poor sleep hygiene practices. Moderate/severe sleep problems were associated with poorer child mental health (mean difference -0.8; 95% confidence interval (CI) -1.1 to -0.5, P health-related quality of life (mean difference -9.9; 95% CI -11.9 to -7.9, P mental health (mean difference 9.8; 95% CI 7.7-11.9, P school entrants, sleep problems are common and associated with poorer child mental health, health-related quality of life and parent mental health. Future research needs to determine if systematically addressing sleep problems improves these outcomes. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Primary drug-resistant tuberculosis in Hanoi, Viet Nam: present status and risk factors.

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Nguyen Thi Le Hang

Full Text Available INTRODUCTION: Resistance of Mycobacterium tuberculosis (MTB to anti-tuberculosis (TB drugs presents a serious challenge to TB control worldwide. We investigated the status of drug resistance, including multidrug-resistant (MDR TB, and possible risk factors among newly diagnosed TB patients in Hanoi, the capital of Viet Nam. METHODS: Clinical and epidemiological information was collected from 506 newly diagnosed patients with sputum smear- and culture-positive TB, and 489 (96.6% MTB isolates were subjected to conventional drug susceptibility testing, spoligotyping, and 15-locus variable numbers of tandem repeats typing. Adjusted odds ratios (aORs were calculated to analyze the risk factors for primary drug resistance. RESULTS: Of 489 isolates, 298 (60.9% were sensitive to all drugs tested. Resistance to isoniazid, rifampicin, streptomycin, ethambutol, and MDR accounted for 28.2%, 4.9%, 28.2%, 2.9%, and 4.5%, respectively. Of 24 isolates with rifampicin resistance, 22 (91.7% were MDR and also resistant to streptomycin, except one case. Factors associated with isoniazid resistance included living in old urban areas, presence of the Beijing genotype, and clustered strains [aOR = 2.23, 95% confidence interval (CI 1.15-4.35; 1.91, 1.18-3.10; and 1.69, 1.06-2.69, respectively. The Beijing genotype was also associated with streptomycin resistance (aOR = 2.10, 95% CI 1.29-3.40. Human immunodeficiency virus (HIV coinfection was associated with rifampicin resistance and MDR (aOR = 5.42, 95% CI 2.07-14.14; 6.23, 2.34-16.58, respectively. CONCLUSION: Isoniazid and streptomycin resistance was observed in more than a quarter of TB patients without treatment history in Hanoi. Transmission of isoniazid-resistant TB among younger people should be carefully monitored in urban areas, where Beijing strains and HIV coinfection are prevalent. Choosing an optimal treatment regimen on the basis of the results of drug susceptibility tests and monitoring of treatment

The Impact of the National Essential Medicines Policy on Rational Drug Use in Primary Care Institutions in Jiangsu Province of China.

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Chao, Jianqian; Gu, Jiangyi; Zhang, Hua; Chen, Huanghui; Wu, Zhenchun

2018-01-01

Essential medicine policy is a successful global health policy to promote rational drug use. The aim of this study was to evaluate the impact of the National Essential Medicines Policy (NEMP) on the rational drug use in primary care institutions in Jiangsu Province of China. In this exploratory study, a multistage, stratified, random sampling was used to select 3400 prescriptions from 17 primary care institutions who implemented the NEMP before (Jan 2010) and after the implementation of the NEMP (Jan 2014). The analyses were performed in SPSS 18.0 and SPSS Clementine client. After the implementation of the NEMP, the percentage of prescribed EML (Essential Medicines List) drugs rose significantly, the average number of drugs per prescription and average cost per prescription were declined significantly, while the differences of the prescription proportion of antibiotics and injection were not statistically significant. BP (Back Propagation) neural network analysis showed that the average number of drugs per prescription, the number of using antibiotics and hormone, regional differences, size of institutions, sponsorship, financial income of institutions, doctor degree, outpatient and emergency visits person times were important factors affecting the prescription costs, among these the average number of drugs per prescription has the greatest effect. The NEMP can promote the rational use of drugs in some degree, but its role is limited. We should not focus only on the EML but also make comprehensive NEMP.

Drug adherence in treatment resistant and in controlled hypertension-Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

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Holmqvist, Lina; Boström, Kristina Bengtsson; Kahan, Thomas; Schiöler, Linus; Qvarnström, Miriam; Wettermark, Björn; Hjerpe, Per; Hasselström, Jan; Manhem, Karin

2018-03-01

To assess drug adherence in patients treated with ≥3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Patients with hypertension, without cardiovascular comorbidity, aged >30 years treated with ≥3 antihypertensive drug classes were followed for 2 years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level ≥ 80% were included. We found 5846 patients treated ≥3 antihypertensive drug classes, 3508 with TRH (blood pressure ≥ 140/90), and 2338 with controlled blood pressure (drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment. Copyright © 2018 John Wiley & Sons, Ltd.

Faculty Member's Handbook. Strategies for Preventing Alcohol and Other Drug Problems. The College Series.

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CSR, Inc., Washington, DC.

This handbook for higher education faculty is designed to inform them of the nature and extent of alcohol and other drug abuse on the nation's campuses and to enlist their involvement in responding to these problems. Based on the premise that each individual can make a difference, the faculty member is encouraged to help shape the campus…

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

Energy Technology Data Exchange (ETDEWEB)

Çildağ, Mehmet Burak, E-mail: mbcildag@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey); Çildağ, Songül, E-mail: songulcildag@yahoo.com [Adnan Menderes University, Department of Immunology and Allergy (Turkey); Köseoğlu, Ömer Faruk Kutsi, E-mail: kutsikoseoglu@yahoo.com [Adnan Menderes University, Department of Diagnostic and Interventional Radiology (Turkey)

2016-12-15

ObjectiveThe aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.Material-MethodThis retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectively independent factors affecting the primary patency and to compare the primary patency for the two balloon types.ResultsNLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).ConclusionIncreased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.

The Impact of Inattention and Emotional Problems on Cognitive Control in Primary School Children

DEFF Research Database (Denmark)

Sørensen, Lin; Plessen, Kerstin J; Lundervold, Astri J

2012-01-01

by the Behavior Rating Inventory of Executive Function (BRIEF) and performance-based tests (i.e.,Color Trail Test and Digit Span Test). Symptoms of inattention and emotional problems were measured with parent and teacher reports on Swanson Nolan and Pelham-IV questionnaire and Strengths and Difficulties......Objective: The present study investigated the predictive value of parent/teacher reports of inattention and emotional problems on cognitive control function in 241 children in primary school. Method: Cognitive control was measured by functions of set-shifting and working memory as assessed...

Drug safety and the impact of drug warnings

DEFF Research Database (Denmark)

Hostenkamp, G.; Fischer, K. E.; Borch-Johnsen, K.

2016-01-01

Objective To analyse the impact of drug safety warnings from the European Medicines Agency (EMA) on drug utilisation and their interaction with information released through national reimbursement bodies. Methods Insurance claims data on anti-diabetic drug prescriptions in primary care in Germany...

Workplace phobia, workplace problems, and work ability among primary care patients with chronic mental disorders.

Science.gov (United States)

Muschalla, Beate; Linden, Michael

2014-01-01

Work-related anxieties are frequent and have a negative effect on the occupational performance of patients and absence due to sickness. Most important is workplace phobia, that is, panic when approaching or even thinking of the workplace. This study is the first to estimate the prevalence of workplace phobia among primary care patients suffering from chronic mental disorders and to describe which illness-related or workplace-specific context factors are associated with workplace phobia. A convenience sample of 288 primary care patients with chronic mental disorders (70% women) seen by 40 primary care clinicians in Germany were assessed using a standardized diagnostic interview about mental disorders and workplace problems. Workplace phobia was assessed by the Workplace Phobia Scale and a structured Diagnostic and Statical Manual of Mental Disorders-based diagnostic interview. In addition, capacity and participation restrictions, illness severity, and sick leave were assessed. Workplace phobia was found in 10% of patients with chronic mental disorders, that is, approximately about 3% of all general practice patients. Patients with workplace phobia had longer durations of sick leave than patients without workplace phobia and were impaired to a higher degree in work-relevant capacities. They also had a higher degree of restrictions in participation in other areas of life. Workplace phobia seems to be a frequent problem in primary care. It may behoove primary care clinicians to consider workplace-related anxiety, including phobia, particularly when patients ask for a work excuse for nonspecific somatic complaints. © Copyright 2014 by the American Board of Family Medicine.

CYP51 is an essential drug target for the treatment of primary amoebic meningoencephalitis (PAM).

Science.gov (United States)

Debnath, Anjan; Calvet, Claudia M; Jennings, Gareth; Zhou, Wenxu; Aksenov, Alexander; Luth, Madeline R; Abagyan, Ruben; Nes, W David; McKerrow, James H; Podust, Larissa M

2017-12-01

Primary Amoebic Meningoencephalitis (PAM) is caused by Naegleria fowleri, a free-living amoeba that occasionally infects humans. While considered "rare" (but likely underreported) the high mortality rate and lack of established success in treatment makes PAM a particularly devastating infection. In the absence of economic inducements to invest in development of anti-PAM drugs by the pharmaceutical industry, anti-PAM drug discovery largely relies on drug 'repurposing'-a cost effective strategy to apply known drugs for treatment of rare or neglected diseases. Similar to fungi, N. fowleri has an essential requirement for ergosterol, a building block of plasma and cell membranes. Disruption of sterol biosynthesis by small-molecule inhibitors is a validated interventional strategy against fungal pathogens of medical and agricultural importance. The N. fowleri genome encodes the sterol 14-demethylase (CYP51) target sharing ~35% sequence identity to fungal orthologues. The similarity of targets raises the possibility of repurposing anti-mycotic drugs and optimization of their usage for the treatment of PAM. In this work, we (i) systematically assessed the impact of anti-fungal azole drugs, known as conazoles, on sterol biosynthesis and viability of cultured N. fowleri trophozotes, (ii) identified the endogenous CYP51 substrate by mass spectrometry analysis of N. fowleri lipids, and (iii) analyzed the interactions between the recombinant CYP51 target and conazoles by UV-vis spectroscopy and x-ray crystallography. Collectively, the target-based and parasite-based data obtained in these studies validated CYP51 as a potentially 'druggable' target in N. fowleri, and conazole drugs as the candidates for assessment in the animal model of PAM.

Knowledge of Male High School Students in Yazd and Rafsanjan (IRAN Regarding Illicit Drugs Use as a Social Problem: A comparative study

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Zahra Pourmovahed

2017-06-01

Conclusion: Illicit drugs consumption remains a serious problem among Iranian adolescents. There is the need to implement preventive measures and counselling approaches in schools. Regarding the role of an addict in the family, increasing the knowledge of people about the negative effects of drugs use (especially opiates might lead to the better prevention of this social problem and promotion of health.

IDENTIFIKASI DRUG RELATED PROBLEMs (DRPs PADA PASIEN PEDIATRI PNEUMONIA KOMUNITAS DI INSTALASI RAWAT INAP RSD MADANI PROVINSI SULAWESI TENGAH

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Putu Maharani Ajeng Astiti

2017-03-01

Full Text Available Drug Related Problems (DRPs are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs may occur in the treatment of various diseases such as community acquired pneumonia (CAP. This study aims to determine the percentage of DRPs in pediatric inpatients with CAP. This is a descriptive and observational study design with prospective data conducted in November 2015 until February 2016 at Madani Hospital, Central Sulawesi. The results obtained from 28 patients showed that incidences of DRPs categories of inappropriate drug is 1 event (1,7%, inappropriate drug combination 35 events (58,3%, drugs dose too low 18 events (30%, drugs dose too high  6 events (10%, and no indication for drug 0 event (0%.

Gender Comparisons Among Asian American and Pacific Islander Patients in Drug Dependency Treatment.

Science.gov (United States)

Han, Yun; Lin, Veronique; Wu, Fei; Hser, Yih-Ing

2016-05-11

Few studies have focused on Asian Americans and Pacific Islanders (AAPIs), despite indications of increasing substance abuse among AAPIs in recent years. This prospective longitudinal study examined gender differences among AAPIs in treatment. The study included 567 (177 women, 390 men) AAPI patients drawn from two prior studies, one with 32 community treatment programs in 13 California counties (CalTOP, 3, 9 months), and another project including 36 treatment sites in 5 California counties (TSI, 3, 12 months). Baseline and follow-up assessments utilized the Addiction Severity Index(ASI). A subset of patients was assessed at 3 and 9/12 months (n = 106). Significant gender-related differences were observed at baseline: fewer women than men were employed or never married. More women were living with someone having alcohol and drug problems. Methamphetamine was the primary drug for women and men, followed by alcohol and heroin. Compared to AAPI men, AAPI women reported greater problem severity in family/social relationships (0.18 vs. 0.11, p drug, and legal domains for both genders, and in mental health for men only. Compared to AAPI men, AAPI women demonstrated significantly greater improvements in drug problems (ΔASI = 0.07, p drug use problems for AAPI men.

The Usability and Acceptability of an Adolescent mHealth HIV/STI and Drug Abuse Preventive Intervention in Primary Care.

Science.gov (United States)

Cordova, David; Alers-Rojas, Francheska; Lua, Frania Mendoza; Bauermeister, Jose; Nurenberg, Rachel; Ovadje, Lauretta; Fessler, Kathryn; Delva, Jorge; Salas-Wright, Christopher P; Council, Youth Leadership

2018-01-01

Human Immunodeficiency Virus (HIV)/sexually transmitted infection (STI) risk behaviors among adolescents remain significant public health concerns. Shifts in policy and advances in technology provide opportunities for researchers and clinicians to deliver and evaluate mobile-health (mHealth) prevention programs in primary care, however, research is limited. This study assessed the usability and acceptability of Storytelling 4 Empowerment-a mHealth HIV/STI and drug abuse preventive intervention app-among adolescents in primary care. Informed by principles of community-based participatory research, we recruited a purposive sample of 30 adolescents from a youth-centered community health care clinic in Southeast Michigan. The study sample is primarily African American and female. Adolescents who participated in the Storytelling 4 Empowerment intervention assessed its usability and acceptability, and self-reported their HIV/STI risk behaviors. We used a multiple-methods approach. Adolescents reported high acceptability of the content, process, and format of Storytelling 4 Empowerment, as evidenced by qualitative data and mean scores from the Session Evaluation Form for the HIV/STI and Alcohol/Drug content, overall Storytelling 4 Empowerment intervention, and Client Satisfaction Questionnaire-8. Findings indicate that Storytelling 4 Empowerment is acceptable among adolescents in primary care. A next step is to examine the effect of Storytelling 4 Empowerment on adolescent sexual risk and drug use behaviors and HIV/STI testing.

The Relationship of Social Problem-Solving Skills and Dysfunctional Attitudes with Risk of Drug Abuse among Dormitory Students at Isfahan University of Medical Sciences.

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Nasrazadani, Ehteram; Maghsoudi, Jahangir; Mahrabi, Tayebeh

2017-01-01

Dormitory students encounter multiple social factors which cause pressure, such as new social relationships, fear of the future, and separation from family, which could cause serious problems such as tendency toward drug abuse. This research was conducted with the goal to determine social problem-solving skills, dysfunctional attitudes, and risk of drug abuse among dormitory students of Isfahan University of Medical Sciences, Iran. This was a descriptive-analytical, correlational, and cross-sectional research. The research sample consisted of 211 students living in dormitories. The participants were selected using randomized quota sampling method. The data collection tools included the Social Problem-Solving Inventory (SPSI), Dysfunctional Attitude Scale (DAS), and Identifying People at Risk of Addiction Questionnaire. The results indicated an inverse relationship between social problem-solving skills and risk of drug abuse ( P = 0.0002), a direct relationship between dysfunctional attitude and risk of drug abuse ( P = 0.030), and an inverse relationship between social problem-solving skills and dysfunctional attitude among students ( P = 0.0004). Social problem-solving skills have a correlation with dysfunctional attitudes. As a result, teaching these skills and the way to create efficient attitudes should be considered in dormitory students.

Recent bibliography on analytical and sampling problems of a PWR primary coolant

International Nuclear Information System (INIS)

Illy, H.

1980-07-01

An extensive bibliography on the problems of analysis and sampling of the primary cooling water of PWRs is presented. The aim was to collect the analytical methods for dissolved gases. The sampling and preparation are also taken into account. last 8-10 years is included. The bibliography is arranged into alphabetical order by topics. The most important topics are as follows: boric acid, gas analysis, hydrogen isotopes, iodine, noble gases, radiation monitoring, sampling and preparation, water chemistry. (R.J.)

Characterization of drug-related problems identified by clinical pharmacy staff at Danish hospitals

DEFF Research Database (Denmark)

Kjeldsen, Lene Juel; Birkholm, Trine; Fischer, Hanne

2014-01-01

Background In 2010, a database of drug related problems (DRPs) was implemented to assist clinical pharmacy staff in documenting clinical pharmacy activities locally. A study of quality, reliability and generalisability showed that national analyses of the data could be conducted. Analyses...... at the national level may help identify and prevent DRPs by performing national interventions. Objective The aim of the study was to explore the DRP characteristics as documented by clinical pharmacy staff at hospital pharmacies in the Danish DRP-database during a 3-year period. Setting Danish hospital pharmacies....... Method Data documented in the DRP-database during the initial 3 years after implementation were analyzed retrospectively. The DRP-database contains DRPs reported at hospitals by clinical pharmacy staff. The analyses focused on DRP categories, implementation rates and drugs associated with the DRPs. Main...

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.

Science.gov (United States)

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-09-01

The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

GEAR: A database of Genomic Elements Associated with drug Resistance

Science.gov (United States)

Wang, Yin-Ying; Chen, Wei-Hua; Xiao, Pei-Pei; Xie, Wen-Bin; Luo, Qibin; Bork, Peer; Zhao, Xing-Ming

2017-01-01

Drug resistance is becoming a serious problem that leads to the failure of standard treatments, which is generally developed because of genetic mutations of certain molecules. Here, we present GEAR (A database of Genomic Elements Associated with drug Resistance) that aims to provide comprehensive information about genomic elements (including genes, single-nucleotide polymorphisms and microRNAs) that are responsible for drug resistance. Right now, GEAR contains 1631 associations between 201 human drugs and 758 genes, 106 associations between 29 human drugs and 66 miRNAs, and 44 associations between 17 human drugs and 22 SNPs. These relationships are firstly extracted from primary literature with text mining and then manually curated. The drug resistome deposited in GEAR provides insights into the genetic factors underlying drug resistance. In addition, new indications and potential drug combinations can be identified based on the resistome. The GEAR database can be freely accessed through http://gear.comp-sysbio.org. PMID:28294141

Pervasive developmental disorder, behavior problems, and psychotropic drug use in children and adolescents with mental retardation

NARCIS (Netherlands)

de Bildt, Annelies; Mulder, Erik J.; Scheers, Tom; Minderaa, Ruud B.; Tobi, Hilde

2006-01-01

OBJECTIVE. This study investigated the interrelationship between psychopharmaco-therapy in general and the use of specific psychotropic drugs and pervasive developmental disorder and other behavior problems in children and adolescents with mental retardation. METHODS. A total of 862 participants 4

Pervasive developmental disorder, behavior problems, and psychotropic drug use in children and adolescents with mental retardation.

NARCIS (Netherlands)

Bildt, de A.; Mulder, E.J.; Scheers, T.; Minderaa, R.B.; Tobi, H.

2006-01-01

OBJECTIVE. This study investigated the interrelationship between psychopharmacotherapy in general and the use of specific psychotropic drugs and pervasive developmental disorder and other behavior problems in children and adolescents with mental retardation. METHODS. A total of 862 participants 4 to

MODELING OF TARGETED DRUG DELIVERY PART II. MULTIPLE DRUG ADMINISTRATION

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A. V. Zaborovskiy

2017-01-01

Full Text Available In oncology practice, despite significant advances in early cancer detection, surgery, radiotherapy, laser therapy, targeted therapy, etc., chemotherapy is unlikely to lose its relevance in the near future. In this context, the development of new antitumor agents is one of the most important problems of cancer research. In spite of the importance of searching for new compounds with antitumor activity, the possibilities of the “old” agents have not been fully exhausted. Targeted delivery of antitumor agents can give them a “second life”. When developing new targeted drugs and their further introduction into clinical practice, the change in their pharmacodynamics and pharmacokinetics plays a special role. The paper describes a pharmacokinetic model of the targeted drug delivery. The conditions under which it is meaningful to search for a delivery vehicle for the active substance were described. Primary screening of antitumor agents was undertaken to modify them for the targeted delivery based on underlying assumptions of the model.

Mathematical problem solving in primary school

NARCIS (Netherlands)

Kolovou, A.

2011-01-01

A student is engaged in (non-routine) problem solving when there is no clear pathway to the solution. In contrast to routine problems, non-routine ones cannot be solved through the direct application of a standard procedure. Consider the following problem: In a quiz you get two points for each

Using mHealth technologies to improve the identification of behavioral health problems in urban primary care settings.

Science.gov (United States)

Staeheli, Martha; Aseltine, Robert H; Schilling, Elizabeth; Anderson, Daren; Gould, Bruce

2017-01-01

Behavioral health disorders remain under recognized and under diagnosed among urban primary care patients. Screening patients for such problems is widely recommended, yet is challenging to do in a brief primary care encounter, particularly for this socially and medically complex patient population. In 2013, intervention patients at an urban Connecticut primary clinic were screened for post-traumatic stress disorder, depression, and risky drinking (n = 146) using an electronic tablet-based screening tool. Screening data were compared to electronic health record data from control patients (n = 129) to assess differences in the prevalence of behavioral health problems, rates of follow-up care, and the rate of newly identified cases in the intervention group. Results from logistic regressions indicated that both groups had similar rates of disorder at baseline. Patients in the intervention group were five times more likely to be identified with depression (p Post-traumatic stress disorder was virtually unrecognized among controls but was observed in 23% of the intervention group (p behavioral health problems identified in the intervention group were new cases. Follow-up rates were significantly higher in the intervention group relative to controls, but were low overall. This tablet-based electronic screening tool identified significantly higher rates of behavioral health disorders than have been previously reported for this patient population. Electronic risk screening using patient-reported outcome measures offers an efficient approach to improving the identification of behavioral health problems and improving rates of follow-up care.

THE MANAGEMENT OF AN ADOLESCENT WITH CONDUCT PROBLEMS IN A PRIMARY CARE CLINIC – A CASE REPORT

OpenAIRE

KHAIRANI O; AZIMAH MN

2009-01-01

Purpose: To describe the management of mild conduct problems in an adolescent at the primary care level. Case report: A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. Conclusion: This case report illustrates the opportunity for family physician...

CYP51 is an essential drug target for the treatment of primary amoebic meningoencephalitis (PAM.

Directory of Open Access Journals (Sweden)

Anjan Debnath

2017-12-01

Full Text Available Primary Amoebic Meningoencephalitis (PAM is caused by Naegleria fowleri, a free-living amoeba that occasionally infects humans. While considered "rare" (but likely underreported the high mortality rate and lack of established success in treatment makes PAM a particularly devastating infection. In the absence of economic inducements to invest in development of anti-PAM drugs by the pharmaceutical industry, anti-PAM drug discovery largely relies on drug 'repurposing'-a cost effective strategy to apply known drugs for treatment of rare or neglected diseases. Similar to fungi, N. fowleri has an essential requirement for ergosterol, a building block of plasma and cell membranes. Disruption of sterol biosynthesis by small-molecule inhibitors is a validated interventional strategy against fungal pathogens of medical and agricultural importance. The N. fowleri genome encodes the sterol 14-demethylase (CYP51 target sharing ~35% sequence identity to fungal orthologues. The similarity of targets raises the possibility of repurposing anti-mycotic drugs and optimization of their usage for the treatment of PAM. In this work, we (i systematically assessed the impact of anti-fungal azole drugs, known as conazoles, on sterol biosynthesis and viability of cultured N. fowleri trophozotes, (ii identified the endogenous CYP51 substrate by mass spectrometry analysis of N. fowleri lipids, and (iii analyzed the interactions between the recombinant CYP51 target and conazoles by UV-vis spectroscopy and x-ray crystallography. Collectively, the target-based and parasite-based data obtained in these studies validated CYP51 as a potentially 'druggable' target in N. fowleri, and conazole drugs as the candidates for assessment in the animal model of PAM.

Drug Abuse

Science.gov (United States)

... Cocaine Heroin Inhalants Marijuana Prescription drugs, including opioids Drug abuse also plays a role in many major social problems, such as drugged driving, violence, stress, and child abuse. Drug abuse can lead to ...

Drug Facts

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Full Text Available ... Use and Unborn Children Drug Use and Your Health Other Effects on the Body Drug Use Hurts Brains Drug Use and Mental Health Problems Often Happen Together The Link Between Drug ...

Privacy protection for patients with substance use problems

OpenAIRE

Hu, Lianne Lian; Sparenborg, Steven; Tai, Betty

2011-01-01

Lianne Lian Hu1, Steven Sparenborg2, Betty Tai21Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 2Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MDAbstract: Many Americans with substance use problems will have opportunities to receive coordinated health care through the integration of primary care and specialty care for substance use disorders under the Patient Protection...

Problems of Primary Education Today

Science.gov (United States)

Dubova, M. V.

2014-01-01

Primary education in Russia has failed to adapt to the needs of post-Soviet society, and is still based on rote learning and memorization instead of learning through discovery and learning to use and apply what is learned.

Impact of Age on Long-Term Outcome After Primary Angioplasty With Bare-Metal or Drug-Eluting Stent (From the DESERT Cooperation)

DEFF Research Database (Denmark)

De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian

2013-01-01

Despite mechanical reperfusion, elderly patients with ST-segment elevation myocardial infarction (STEMI) still experience unsatisfactory outcomes. Drug-eluting stents (DES) have significantly reduced target-vessel revascularization (TVR), but concerns have emerged about the higher risk of late st...... angioplasty and stent implantation included in the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation database. Age was significantly associated with female gender (p...

Perceived risk of mental health problems in primary care

Directory of Open Access Journals (Sweden)

Constança ePaúl

2015-11-01

Full Text Available In the face of limited resources and an ageing population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalisation, hospitalisation and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care. We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community (RISC to rank perceived risk of mental health concerns (including neurocognitive and mood disorders from 1 (mild to 3 (Severe. The mean age of the 4499 people assessed was 76.3 years (sd=7.3 and 2645 (58.8% were female. According to the primary care team 1616 (35.9% were perceived to have mental health concerns of whom 847 (52.4% were mild, 559 (34.6% were moderate and 210 (13% were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR=2.22, 95% CI 1.83-2.69 for institutionalisation; OR=1.66, 95% CI 1.41-1.94 for hospitalisation; OR=1.69, 95% CI 1.42-2.01 for death. These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

Predicting drug?drug interactions through drug structural similarities and interaction networks incorporating pharmacokinetics and pharmacodynamics knowledge

OpenAIRE

Takeda, Takako; Hao, Ming; Cheng, Tiejun; Bryant, Stephen H.; Wang, Yanli

2017-01-01

Drug?drug interactions (DDIs) may lead to adverse effects and potentially result in drug withdrawal from the market. Predicting DDIs during drug development would help reduce development costs and time by rigorous evaluation of drug candidates. The primary mechanisms of DDIs are based on pharmacokinetics (PK) and pharmacodynamics (PD). This study examines the effects of 2D structural similarities of drugs on DDI prediction through interaction networks including both PD and PK knowledge. Our a...

Influence of problem-based teaching and learning of grammar on pupils’ attainment in primary school

Directory of Open Access Journals (Sweden)

Jocić Zorica

2010-01-01

Full Text Available With the purpose of getting an insight into the effects of problem-based teaching and learning, an experiment was carried out by using the method of parallel groups on the sample of 204 pupils in the third and sixth grade of primary school. The results of final knowledge assessment showed that problem-based teaching and learning of grammar had positive influence on pupils' attainment comparing to the usual way of learning grammar. A significant improvement has been achieved in the field of reproductive and productive grammar knowledge on the whole sample of pupils as well as on the subsamples of pupils in the third and sixth grade. Because of the limited time left for this experimental programme, the reproductive knowledge of pupils was bigger than the productive knowledge. It has been noticed that regarding the successfulness of solving the grammatical problems, there was no difference between the pupils of younger and older primary school age, in the situation when these problems were decided on according to their age and intellectual abilities. All pupils had made an improvement, but they remained within the range of their marks in Serbian language. In addition to this, better progress was made by the pupils with better marks in Serbian language. Girls were more successful than boys, but the difference between boys and girls was smaller regarding the reproductive knowledge than the productive knowledge.

Inhibition of bile salt transport by drugs associated with liver injury in primary hepatocytes from human, monkey, dog, rat, and mouse.

Science.gov (United States)

Zhang, Jie; He, Kan; Cai, Lining; Chen, Yu-Chuan; Yang, Yifan; Shi, Qin; Woolf, Thomas F; Ge, Weigong; Guo, Lei; Borlak, Jürgen; Tong, Weida

2016-08-05

Interference of bile salt transport is one of the underlying mechanisms for drug-induced liver injury (DILI). We developed a novel bile salt transport activity assay involving in situ biosynthesis of bile salts from their precursors in primary human, monkey, dog, rat, and mouse hepatocytes in suspension as well as LC-MS/MS determination of extracellular bile salts transported out of hepatocytes. Glycine- and taurine-conjugated bile acids were rapidly formed in hepatocytes and effectively transported into the extracellular medium. The bile salt formation and transport activities were time‒ and bile-acid-concentration‒dependent in primary human hepatocytes. The transport activity was inhibited by the bile salt export pump (BSEP) inhibitors ketoconazole, saquinavir, cyclosporine, and troglitazone. The assay was used to test 86 drugs for their potential to inhibit bile salt transport activity in human hepatocytes, which included 35 drugs associated with severe DILI (sDILI) and 51 with non-severe DILI (non-sDILI). Approximately 60% of the sDILI drugs showed potent inhibition (with IC50 values monkey, dog, rat and mouse hepatocytes. Species differences in potency were observed with mouse being less sensitive than other species to inhibition of bile salt transport. In summary, a novel assay has been developed using hepatocytes in suspension from human and animal species that can be used to assess the potential for drugs and/or drug-derived metabolites to inhibit bile salt transport and/or formation activity. Drugs causing sDILI, except those by immune-mediated mechanism, are highly associated with potent inhibition of bile salt transport. Published by Elsevier Ireland Ltd.

Employee assistance program services for alcohol and other drug problems: implications for increased identification and engagement in treatment.

Science.gov (United States)

Jacobson, Jodi M; Sacco, Paul

2012-01-01

Fourteen million U.S. workers meet the diagnostic criteria for substance dependence, costing millions in lost productivity. Prior research suggests that employees who follow through with their Employee Assistance Program's (EAP) recommendations are more likely to participate and remain engaged in alcohol and other drug (AOD) treatment programs. This study identified rates of lifetime EAP service use for AOD problems and compared adults who reported using EAP services for AOD problems with those who used services other than EAP. Researchers analyzed a subset of participants from the National Epidemiologic Survey of Alcohol and Related Conditions who reported having received help for an AOD problem (NESARC, 2001-2002). Statistical analyses tested for differences in sociodemographic variables, lifetime mental health and substance abuse disorders, and health disability between EAP services users and users of other types of services. Among adults who sought services for AOD problems (n= 2,272), 7.58% (n= 166) reported using EAP services for these problems at some point during their lives. Major depressive disorder (lifetime), a drug use disorder (lifetime), and Black race/ethnicity were associated with a greater likelihood that someone would seek EAP services for help with their AOD problem. Results provide a foundation for researchers to understand who uses EAP services for AOD problems. Health and mental health professionals should increase their knowledge of EAP services to improve continuity of care for employees with AOD problems. EAPs are in a unique position to reach out to vulnerable employees in the workplace and engage them in treatment. Copyright © American Academy of Addiction Psychiatry.

Stability and periodicity in the Sitnikov three-body problem when primaries are oblate spheroids

Science.gov (United States)

Rahman, M. A.; Garain, D. N.; Hassan, M. R.

2015-05-01

This paper deals with the effect of oblateness of the primaries of equal masses on the series solutions of the Sitnikov problem of three bodies. Effects of oblateness have also been shown on the stability of libration points and Poincare surface of section. Here series solutions have been developed with the help of iteration process of Green's function and by the Lindstedt-Poincare method. Following Murray and Dermott (Solar System Dynamics, Cambridge University Press, Cambridge, 1999) we have checked the stability of the equilibrium points in the Sitnikov problem. Periodicity and quasi-periodicity have been examined by drawing the Poincare surfaces of section using the mathematical software.

Drugs and Mental Health Problems among the Roma: Protective Factors Promoted by the Iglesia Evangélica Filadelfia

Directory of Open Access Journals (Sweden)

Jelen Amador López

2018-02-01

Full Text Available Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF in promoting rehabilitation and prevention of these practices. Objective: In this article, authors analyze in which ways the IEF favors processes of drug rehabilitation and mental health recovery as well as the prevention of these problems among its Roma members. Methods: A communicative qualitative approach was developed. It was communicative because new knowledge was created by dialogically contrasting the existing state of the art with study participants. It was qualitative because everyday life stories were collected, gathering the experiences, perceptions and interpretations of Roma people who are actively involved in three different IEF churches based in Barcelona. Results: This article identifies these protective factors: anti-drug discourse, a supportive environment, new social relations, role model status, the promotion of interactions, the revaluation of oneself, spiritual activities and the improvement of the feeling of belonging and the creation of meaning. Conclusion: The present research contributes new evidence to the current understanding of the role played by the IEF in improving Roma health status and how the identified protective factors can contribute to rehabilitation and recovery from such problems in other contexts.

Drugs and Mental Health Problems among the Roma: Protective Factors Promoted by the Iglesia Evangélica Filadelfia.

Science.gov (United States)

López, Jelen Amador; García, Ramón Flecha; Martí, Teresa Sordé

2018-02-14

Background: High incidences of drug consumption and mental health problems are found among the Roma population in Spain, a reality that remains understudied. Past studies have indicated the positive role played by the Iglesia Evangélica Filadelfia (IEF) in promoting rehabilitation and prevention of these practices. Objective: In this article, authors analyze in which ways the IEF favors processes of drug rehabilitation and mental health recovery as well as the prevention of these problems among its Roma members. Methods: A communicative qualitative approach was developed. It was communicative because new knowledge was created by dialogically contrasting the existing state of the art with study participants. It was qualitative because everyday life stories were collected, gathering the experiences, perceptions and interpretations of Roma people who are actively involved in three different IEF churches based in Barcelona. Results: This article identifies these protective factors: anti-drug discourse, a supportive environment, new social relations, role model status, the promotion of interactions, the revaluation of oneself, spiritual activities and the improvement of the feeling of belonging and the creation of meaning. Conclusion: The present research contributes new evidence to the current understanding of the role played by the IEF in improving Roma health status and how the identified protective factors can contribute to rehabilitation and recovery from such problems in other contexts.

WHO/INRUD patient care and facility-specific drug use indicators at primary health care centres in Eastern province, Saudi Arabia.

Science.gov (United States)

El Mahalli, A A; Akl, O A M; Al-Dawood, S F; Al-Nehab, A A; Al-Kubaish, H A; Al-Saeed, S; Elkahky, A A A; Salem, A M A A

2012-11-01

This study aimed to measure the performance of primary health care centres in Eastern province, Saudi Arabia, using the WHO/International Network of Rational Use of Drugs patient care and facility-specific drug use indicators. In a cross-sectional study, 10 health centres were selected using systematic random sampling. A total of 300 patients were interviewed while visiting the centre from January to March 2011 and 10 pharmacists from the same centres were interviewed. Average consultation time was 7.3 min (optimal > or = 30 min), percentage of drugs adequately labelled was 10% (optimal 100%) and patient's knowledge of correct dosage was 79.3% (optimal 100%). The percentage of key drugs in stock was only 59.2% (optimal 100%). An overall index of rational facility-specific drug use was calculated and applied to rank the health centres for benchmarking.

Using the Van Hiele theory to analyze primary school teachers' written work on geometrical proof problems

Science.gov (United States)

Jupri, A.

2018-05-01

The lack of ability of primary school teachers in deductive thinking, such as doing geometrical proof, is an indispensable issue to be dealt with. In this paper, we report on results of a three-step of the field document study. The study was part of a pilot study for improving deductive thinking ability of primary school teachers. First, we designed geometrical proof problems adapted from literature. Second, we administered an individual written test involving nine master students of primary education program, in which they are having experiences as primary school mathematics teachers. Finally, we analyzed the written work from the view of the Van Hiele theory. The results revealed that even if about the half of the teachers show ability in doing formal proof, still the rest provides inappropriate proving. For further investigation, we wonder whether primary school teachers would show better deductive thinking if the teaching of geometry is designed in a systematic and appropriate manner according to the Van Hiele theory.

Drug Reactions

Science.gov (United States)

... problem is interactions, which may occur between Two drugs, such as aspirin and blood thinners Drugs and food, such as statins and grapefruit Drugs and supplements, such as ginkgo and blood thinners ...

The Andrews’ Principles of Risk, Need, and Responsivity as Applied in Drug Abuse Treatment Programs: Meta-Analysis of Crime and Drug Use Outcomes

Science.gov (United States)

Prendergast, Michael L.; Pearson, Frank S.; Podus, Deborah; Hamilton, Zachary K.; Greenwell, Lisa

2013-01-01

Objectives The purpose of the present meta-analysis was to answer the question: Can the Andrews principles of risk, needs, and responsivity, originally developed for programs that treat offenders, be extended to programs that treat drug abusers? Methods Drawing from a dataset that included 243 independent comparisons, we conducted random-effects meta-regression and ANOVA-analog meta-analyses to test the Andrews principles by averaging crime and drug use outcomes over a diverse set of programs for drug abuse problems. Results For crime outcomes, in the meta-regressions the point estimates for each of the principles were substantial, consistent with previous studies of the Andrews principles. There was also a substantial point estimate for programs exhibiting a greater number of the principles. However, almost all of the 95% confidence intervals included the zero point. For drug use outcomes, in the meta-regressions the point estimates for each of the principles was approximately zero; however, the point estimate for programs exhibiting a greater number of the principles was somewhat positive. All of the estimates for the drug use principles had confidence intervals that included the zero point. Conclusions This study supports previous findings from primary research studies targeting the Andrews principles that those principles are effective in reducing crime outcomes, here in meta-analytic research focused on drug treatment programs. By contrast, programs that follow the principles appear to have very little effect on drug use outcomes. Primary research studies that experimentally test the Andrews principles in drug treatment programs are recommended. PMID:24058325

Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?

Science.gov (United States)

Chan, Kitty S; Bird, Chloe E; Weiss, Robert; Duan, Naihua; Meredith, Lisa S; Sherbourne, Cathy D

2006-01-01

We sought to determine whether patient-provider gender concordance influences the detection and care of depression and comorbid anxiety and substance use in patients with major depression Cross-sectional analyses of baseline patient survey data linked with provider data were performed. Data based on routine primary care visits in clinics from a variety of health systems serving diverse patient populations across the United States. Participants all had major depression. Depression care was examined in the Quality Improvement for Depression (QID) Collaboration sample (n patients = 1,428, n providers = 389). In a subanalysis of data solely from 714 patients and 157 providers from Partners-In-Care, one of the projects participating in QID, we also examined detection of anxiety disorder and alcohol or drug problems. Rates of detection and care of mental health problems in primary care were low even among patients with major depression. Except for anxiety counseling in female patients, patient-provider gender concordance did not improve care as hypothesized. However, female providers were more likely to counsel on anxiety and less likely to counsel on alcohol or drug use than male providers. Female patients were less likely to be counseled on alcohol or drug use compared with male patients. Detection and care of mental health and substance use problems for patients with major depression is not influenced by patient-provider gender concordance. However, depressed female patients may have greater unmet needs for alcohol and drug use counseling than their male counterparts.

The making of a public health problem: multi-drug resistant tuberculosis in India.

Science.gov (United States)

Engel, Nora C

2013-07-01

This paper examines how actors construct the public problem of multi-drug resistant tuberculosis (MDR-TB) in India. MDR-TB has been framed by the World Health Organization as a pressing, global public health problem. The responses to MDR-TB are complicated as treatment takes longer and is more expensive than routine TB treatment. This is particularly problematic in countries, such as India, with high patient loads, a large and unregulated private sector, weak health systems and potentially high numbers of MDR-TB cases. This paper analyses how actors struggle for control over ownership, causal theories and political responsibility of the public problem of MDR-TB in India. It combines Gusfield's theory on the construction of public problems with insights from literature on the social construction of diseases and on medical social control. It highlights that there are flexible definitions of public problems, which are negotiated among actor groups and which shift over time. The Indian government has shifted its policy in recent years and acknowledged that MDR-TB needs to be dealt with within the TB programme. The study results reveal how the policy shift happened, why debates on the construction of MDR-TB as a public problem in India continue, and why actors with alternative theories than the government do not succeed in their lobbying efforts. Two main arguments are put forward. First, the construction of the public problem of MDR-TB in India is a social and political process. The need for representative data, international influence and politics define what is controllable. Second, the government seems to be anxious to control the definition of India's MDR-TB problem. This impedes an open, critical and transparent discussion on the definition of the public problem of MDR-TB, which is important in responding flexibly to emerging public health challenges.

IMPROVING ACCESS TO DRUGS

Directory of Open Access Journals (Sweden)

Max Joseph Herman

2012-11-01

Full Text Available Although essentially not all therapies need drug intervention, drugs is still an important components in health sector, either in preventive, curative, rehabilitative or promotion efforts. Hence the access to drugs is a main problem, either in international or national scale even to the smallest unit. The problem on access to drugs is very complicated and cannot be separated especially from pharmacy management problems; moreover in general from the overall lack of policy development and effective of health policy, and also the implementation process. With the policy development and effective health policy, rational drug uses, sufficient health service budget so a country can overcome the health problems. Besides infrastructures, regulations, distribution and cultural influences; the main obstacles for drug access is drugs affordability if the price of drugs is an important part and determined by many factors, especially the drug status whether is still patent orgenerics that significantly decrease cost of health cares and enhance the drugs affordability. The determination of essential drug prices in developing countries should based on equity principal so that poor people pay cheaper and could afford the essential drugs. WHO predicts two third of world population can not afford the essential drugs in which in developing countries, some are because of in efficient budget allocation in consequence of drug distribution management, including incorrect selection and allocation and also irrational uses. In part these could be overcome by enhancing performances on the allocation pharmacy needs, including the management of information system, inventory management, stock management and the distribution. Key words: access, drugs, essential drugs, generic drugs

Perceptions of substance use, treatment options and training needs among Iranian primary care physicians

Directory of Open Access Journals (Sweden)

Dolan Kate A

2005-06-01

Full Text Available Abstract In order to be optimally effective, continuing training programmes for health-care professionals need to be tailored so that they target specific knowledge deficits, both in terms of topic content and appropriate intervention strategies. A first step in designing tailored treatment programmes is to identify the characteristics of the relevant health-care professional group, their current levels of content and treatment knowledge, the estimated prevalence of drug and alcohol problems among their patients and their preferred options for receiving continuing education and training. This study reports the results of a survey of 53 primary care physicians working in Iran. The majority were male, had a mean age of 44 years and saw approximately 94 patients per week. In terms of their patients' drug use, primary care physicians thought most patients with a substance use problem were male, women were most likely to use tobacco (52%, opium (32% and marijuana/hashish and young people were most likely to use tobacco, alcohol, marijuana and heroin. Counselling and nicotine patches were the treatments most commonly provided. Although the majority (55% reported referring patients to other services, more than a third did not. Most primary care physicians reported being interested in attending further training on substance abuse issues. The implications of these data for ongoing education and training of primary care physicians in Iran are discussed.

Common primary headaches in pregnancy

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Anuradha Mitra

2015-01-01

Full Text Available Headache is a very common problem in pregnancy. Evaluation of a complaint of headache requires categorizing it as primary or secondary. Migrainous headaches are known to be influenced by fluctuation of estrogen levels with high levels improving it and low levels deteriorating the symptoms. Tension-type Headaches (TTHs are the most common and usually less severe types of headache with female to male ratio 3:1. Women known to have primary headache before conception who present with a headache that is different from their usual headache, or women not known to have primary headache before conception who present with new-onset of headache during pregnancy need neurologic assessments for potential secondary cause for their headache. In addition to proper history and physical examination, both non-contrast computed tomography (CT and Magnetic Resonance Imaging (MRI are considered safe to be performed in pregnant women when indicated. Treatment of abortive and prophylactic therapy should include non-pharmacologic tools, judicious use of drugs which are safe for mother and fetus.

Drug Facts

Medline Plus

Full Text Available ... Drug Use Hurts Brains Drug Use and Mental Health Problems Often Happen Together The Link Between Drug Use and HIV/AIDS Treatment & Recovery Why Does a Person Need Treatment? Does Drug Treatment Work? What Are the Treatment Options? What Is Recovery? ...

Recent bibliography on analytical and sampling problems of a PWR primary coolant Pt. 1

International Nuclear Information System (INIS)

Illy, H.

1981-12-01

The first bibliography on analytical and sampling problems of a PWR primary coolant (KFKI Report-1980-48) was published in 1980 and it covered the literature published in the previous 8-10 years. The present supplement reviews the subsequent literature up till December 1981. It also includes some references overlooked in the first volume. The serial numbers are continued from the first bibliography. (author)

Recent bibliography on analytical and sampling problems of a PWR primary coolant Suppl. 4

International Nuclear Information System (INIS)

Illy, H.

1986-09-01

The 4th supplement of a bibliographical series comprising the analytical and sampling problems of the primary coolant of PWR type reactors covers the literature from 1985 up to July 1986 (220 items). References are listed according to the following topics: boric acid; chloride, chlorine; general; hydrogen isotopes; iodine; iodide; noble gases; oxygen; other elements; radiation monitoring; reactor safety; sampling; water chemistry. (V.N.)

Discontinued drugs in 2012: cardiovascular drugs.

Science.gov (United States)

Zhao, Hong-Ping; Jiang, Hong-Min; Xiang, Bing-Ren

2013-11-01

The continued high rate of cardiovascular morbidity and mortality has attracted wide concern and great attention of pharmaceutical industry. In order to reduce the attrition of cardiovascular drug R&D, it might be helpful recapitulating previous failures and identifying the potential factors to success. This perspective mainly analyses the 30 cardiovascular drugs dropped from clinical development in 2012. Reasons causing the termination of the cardiovascular drugs in the past 5 years are also tabulated and analysed. The analysis shows that the attrition is highest in Phase II trials and financial and strategic factors and lack of clinical efficacy are the principal reasons for these disappointments. To solve the four problems (The 'better than the Beatles' problem, the 'cautious regulator' problem, the 'throw money at it' tendency and the 'basic researchbrute force' bias) is recommended as the main measure to increase the number and quality of approvable products.

Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Science.gov (United States)

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for ovarian cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters. The drug names link to NCI's Cancer Drug Information summaries.

RApid Primary care Initiation of Drug treatment for Transient Ischaemic Attack (RAPID−TIA): study protocol for a pilot randomised controlled trial

Science.gov (United States)

2013-01-01

Background People who have a transient ischaemic attack (TIA) or minor stroke are at high risk of a recurrent stroke, particularly in the first week after the event. Early initiation of secondary prevention drugs is associated with an 80% reduction in risk of stroke recurrence. This raises the question as to whether these drugs should be given before being seen by a specialist – that is, in primary care or in the emergency department. The aims of the RAPID-TIA pilot trial are to determine the feasibility of a randomised controlled trial, to analyse cost effectiveness and to ask: Should general practitioners and emergency doctors (primary care physicians) initiate secondary preventative measures in addition to aspirin in people they see with suspected TIA or minor stroke at the time of referral to a specialist? Methods/Design This is a pilot randomised controlled trial with a sub-study of accuracy of primary care physician diagnosis of TIA. In the pilot trial, we aim to recruit 100 patients from 30 general practices (including out-of-hours general practice centres) and 1 emergency department whom the primary care physician diagnoses with TIA or minor stroke and randomly assign them to usual care (that is, initiation of aspirin and referral to a TIA clinic) or usual care plus additional early initiation of secondary prevention drugs (a blood-pressure lowering protocol, simvastatin 40 mg and dipyridamole 200 mg m/r bd). The primary outcome of the main study will be the number of strokes at 90 days. The diagnostic accuracy sub-study will include these 100 patients and an additional 70 patients in whom the primary care physician thinks the diagnosis of TIA is possible, rather than probable. For the pilot trial, we will report recruitment rate, follow-up rate, a preliminary estimate of the primary event rate and occurrence of any adverse events. For the diagnostic study, we will calculate sensitivity and specificity of primary care physician diagnosis using the final

RApid Primary care Initiation of Drug treatment for Transient Ischaemic Attack (RAPID-TIA): study protocol for a pilot randomised controlled trial.

Science.gov (United States)

Edwards, Duncan; Fletcher, Kate; Deller, Rachel; McManus, Richard; Lasserson, Daniel; Giles, Matthew; Sims, Don; Norrie, John; McGuire, Graham; Cohn, Simon; Whittle, Fiona; Hobbs, Vikki; Weir, Christopher; Mant, Jonathan

2013-07-02

People who have a transient ischaemic attack (TIA) or minor stroke are at high risk of a recurrent stroke, particularly in the first week after the event. Early initiation of secondary prevention drugs is associated with an 80% reduction in risk of stroke recurrence. This raises the question as to whether these drugs should be given before being seen by a specialist--that is, in primary care or in the emergency department. The aims of the RAPID-TIA pilot trial are to determine the feasibility of a randomised controlled trial, to analyse cost effectiveness and to ask: Should general practitioners and emergency doctors (primary care physicians) initiate secondary preventative measures in addition to aspirin in people they see with suspected TIA or minor stroke at the time of referral to a specialist? This is a pilot randomised controlled trial with a sub-study of accuracy of primary care physician diagnosis of TIA. In the pilot trial, we aim to recruit 100 patients from 30 general practices (including out-of-hours general practice centres) and 1 emergency department whom the primary care physician diagnoses with TIA or minor stroke and randomly assign them to usual care (that is, initiation of aspirin and referral to a TIA clinic) or usual care plus additional early initiation of secondary prevention drugs (a blood-pressure lowering protocol, simvastatin 40 mg and dipyridamole 200 mg m/r bd). The primary outcome of the main study will be the number of strokes at 90 days. The diagnostic accuracy sub-study will include these 100 patients and an additional 70 patients in whom the primary care physician thinks the diagnosis of TIA is possible, rather than probable. For the pilot trial, we will report recruitment rate, follow-up rate, a preliminary estimate of the primary event rate and occurrence of any adverse events. For the diagnostic study, we will calculate sensitivity and specificity of primary care physician diagnosis using the final TIA clinic diagnosis as the

Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution.

Science.gov (United States)

Furberg, Curt D; Sealey, Jean E; Blumenfeld, Jon D

2017-09-01

About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy. A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels. Literature review. To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Problem of drug addiction in the youth in the Republic of North Ossetia-Alania of the RF North Caucasian Federal District

Directory of Open Access Journals (Sweden)

Hasan Vladimirovich Dzutsev

2015-03-01

Full Text Available This article is based on the large-scale survey “the problem of drug addiction among the youth in the Republic of North Ossetia-Alania of the RF North Caucasian Federal District”. In April-May North Ossetian Center of Social Research of the Institute of Socio-Political Research RAS together with North Ossetian State University after K.L. Khetagurov conducted a monitoring aimed at evaluating the drug abuse situation in the Republic of North Ossetia-Alania and identifying the causes of drug abuse among young citizens of the republic. It studied the system of beliefs, habits and aspirations of young people. The research focused on the sociological assessment of the drug abuse situation in the Republic of North Ossetia and it was based on the study of systems of beliefs, habits and preferences of the residents, as well as on the identification of the reasons for the spread of drug addiction among the population. The achievement of this goal required solution of the following tasks: • to evaluate beliefs, value systems, life plans, the state of health of the North Ossetia-Alania citizens, learn their opinion on the possibility of rational leisure time and recreation by means of monitoring; • to assess bad habits of the republic citizens, estimate the society’s relation to the problems of drug addiction and drug addicts, analyze the reasons for the emergence and existence of this phenomenon in the society; • to evaluate effectiveness of the measures to combat drug addiction; • to identify reasons for drug addiction, most frequently used types of drugs, the cost of a single dose, a market place and consumers’ access to drugs; • to assess practical activities aimed at improving the drug abuse situation in the republic. The sample size was 600 people

Higher-order thinking skill problem on data representation in primary school: A case study

Science.gov (United States)

Putri, R. I. I.; Zulkardi, Z.

2018-01-01

This article aimed at reporting research result on a case study of a lesson using a HOTS problem. The task was about data representation using baby growth context. The study used a design research method consisting of three stages: preparing for an experiment, experiment in the classroom (pilot and teaching), and retrospective analysis. Participants were sixth grade students who were learning data representations in a Primary School in Palembang Indonesia. A set of instructional activities were designed using Indonesian version of Realistic Mathematics Education (PMRI) approach. The result showed that students were able to solve the problem and present their solution in front of the classroom. The conclusion indicated that that HOTS problem using the growth of a child as the context could lead students to use their mathematical thinking. During the learning activities along with teacher orchestra’s guidance, and discussion, students were able to solve the problem using line graph although some of them used a bar graph. In the future, teachers are necessary to focus on the role of real-world figure in mathematics learning.

Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.

Science.gov (United States)

Gryczynski, Jan; McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha A; Svikis, Dace S; Cathers, Lauretta A; Sharma, Gaurav; King, Jacqueline; Jelstrom, Eve; Nordeck, Courtney D; Sharma, Anjalee; Mitchell, Shannon G; O'Grady, Kevin E; Schwartz, Robert P

2017-09-01

The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. To validate the TAPS-1 in primary care patients. Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). Two thousand adult patients at five primary care sites. DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as a biomarker of recent drug use. Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker. The TAPS-1 can identify unhealthy substance use in primary care patients with a high level of accuracy

Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review.

Science.gov (United States)

Giroux, Isabelle; Goulet, Annie; Mercier, Jonathan; Jacques, Christian; Bouchard, Stéphane

2017-01-01

Online interventions for gambling, alcohol, and illegal drug related problems have been developing at a fast pace over the past decade. Yet, little is known about the content and efficacy of interventions provided entirely online for reducing drug/alcohol use and gambling, or about the characteristics of those who use these interventions. This systematic review aims to describe the characteristics of online interventions, their efficacy, and the profile of their clientele. Documentation was mainly obtained through four scientific databases in psychology, technology, and medical research (PsychINFO, MedLine, Francis, and INSPEC) using three keywords (substances or gambling, intervention, Internet). Of the 4,708 documents initially identified, 18 studies meeting admissibility criteria were retained and analyzed after exclusion of duplicates and non-relevant documents. No study in the review related to problem gambling. The majority of interventions were based upon motivational or cognitive-behavioral theoretical approaches and called upon well-established therapeutic components in the field of addictions. The participants in these studies were generally adults between 30 and 46 years old with a high school education and presenting a high risk or problematic use. More than three quarters of the studies showed a short-term decrease in use that was maintained 6 months later, but only two studies included a 12 months follow-up. Online interventions seem promising and appear to meet the needs of participants who are in the workforce and seeking help for the first time. Long-term efficacy studies should nonetheless be conducted.

Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study.

Science.gov (United States)

Dijkstra, Nienke Elske; Sino, Carolina Geertruida Maria; Heerdink, Eibert Rob; Schuurmans, Marieke Joanna

2018-03-07

Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice-based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic

Drug Facts

Medline Plus

Full Text Available ... Other Effects on the Body Drug Use Hurts Brains Drug Use and Mental Health Problems Often Happen ... to prescription drugs. The addiction slowly took over his life. I need different people around me. To ...

Abuse of prescription drugs.

Science.gov (United States)

Wilford, B B

1990-01-01

An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disabled by personal problems with drugs or alcohol; dated in their knowledge of current pharmacology or therapeutics; or deceived by various patient-initiated fraudulent approaches. Even physicians who do not meet any of these descriptions must guard against contributing to prescription drug abuse through injudicious prescribing, inadequate safeguarding of prescription forms or drug supplies, or acquiescing to the demands or ruses used to obtain drugs for other than medical purposes. PMID:2349801

Drug Facts

Medline Plus

Full Text Available ... symptoms of someone with a drug use problem? How Does Drug Use Become an Addiction? What Makes Someone More Likely to Get Addicted to Drugs? Does Addiction Run in Families? Why Is It So Hard to ...

Study Drugs

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... to quit, they may have withdrawal symptoms like depression, thoughts of suicide, intense drug cravings, sleep problems, and fatigue. The health risks aren't the only downside to study drugs. Students caught with illegal prescription drugs may get suspended ...

Drug Pollution - The Problem of Abuse*

African Journals Online (AJOL)

at this stage, is to educate the public in the dangers of ... embroiled in a rebellion against 'The Establishment', where ... incidence of addicts, varying with the type of drug, to be .... behaviour disturbances. ... and personality disturbances.75.

Identification and management of prescription drug abuse in pregnancy.

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Worley, Julie

2014-01-01

Prescription drug abuse is a growing problem in the United States and many other countries. Estimates of prescription drug abuse rates during pregnancy range from 5% to 20%. The primary prescription drugs designated as controlled drugs with abuse potential in pregnancy are opiates prescribed for pain, benzodiazepines prescribed for anxiety, and stimulants prescribed for attention-deficit/hyperactivity disorder. Prescription drugs are obtained for abuse through diversion methods, such as purchasing them from others or by doctor shopping. The use of prescription drugs puts both the mother and the fetus at high risk during pregnancy. Identification of women who are abusing prescription drugs is important so that treatment can be ensured. It is crucial for healthcare professionals to use a multidisciplinary approach and be supportive and maintain a good rapport with pregnant women who abuse prescription drugs. Management includes inpatient hospitalization for detoxification and withdrawal symptoms, and in the case of opiate abuse, opiate maintenance is recommended for pregnant women for the duration of their pregnancy to reduce relapse rates and improve maternal and fetal outcomes. Other recommendations include referral for support groups and supportive housing.

Drug Facts

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Full Text Available ... Drug Use and Mental Health Problems Often Happen Together The Link Between Drug Use and HIV/AIDS Treatment & Recovery Why Does a Person Need Treatment? Does Drug Treatment Work? What Are the Treatment Options? What Is Recovery? ...

Differential effects of drugs targeting cancer stem cell (CSC and non-CSC populations on lung primary tumors and metastasis.

Directory of Open Access Journals (Sweden)

Leyre Larzabal

Full Text Available Cancer stem cells (CSCs are thought to be responsible for tumor initiation and recurrence after chemotherapy. Targeting CSCs and non-CSCs with specific compounds may be an effective approach to reduce lung cancer growth and metastasis. The aim of this study was to investigate the effect of salinomycin, a selective inhibitor of CSCs, with or without combination with paclitaxel, in a metastatic model. To evaluate the effect of these drugs in metastasis and tumor microenvironment we took advantage of the immunocompetent and highly metastatic LLC mouse model. Aldefluor assays were used to analyze the ALDH+/- populations in murine LLC and human H460 and H1299 lung cancer cells. Salinomycin reduced the proportion of ALDH+ CSCs in LLC cells, whereas paclitaxel increased such population. The same effect was observed for the H460 and H1299 cell lines. Salinomycin reduced the tumorsphere formation capacity of LLC by more than 7-fold, but paclitaxel showed no effect. In in vivo experiments, paclitaxel reduced primary tumor volume but increased the number of metastatic nodules (p<0.05, whereas salinomycin had no effect on primary tumors but reduced lung metastasis (p<0.05. Combination of both drugs did not improve the effect of single therapies. ALDH1A1, SOX2, CXCR4 and SDF-1 mRNA levels were higher in metastatic lesions than in primary tumors, and were significantly elevated in both locations by paclitaxel treatment. On the contrary, such levels were reduced (or in some cases did not change when mice were administered with salinomycin. The number of F4/80+ and CD11b+ cells was also reduced upon administration of both drugs, but particularly in metastasis. These results show that salinomycin targets ALDH+ lung CSCs, which has important therapeutic effects in vivo by reducing metastatic lesions. In contrast, paclitaxel (although reducing primary tumor growth promotes the selection of ALDH+ cells that likely modify the lung microenvironment to foster

Evaluation of the Risk of Drug Addiction with the Help of Fuzzy Sets

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L. Rakesh

2010-01-01

Full Text Available The primary focus of this paper is to present a general view of the current applications of fuzzy logic in medical analogy of consumption of drugs. The paper also deals with the origin, structure and composition of fuzzy sets. We particularly review the medical literature using fuzzy logic. Fuzzy set theory can be considered as a suitable formalism to deal with the imprecision intrinsic to many real world problems. Fuzzy set theory provides an appropriate framework for the representation of vague medical concepts and imprecise modes of reasoning. We present two concrete illustrations to investigate the impact of the risk related to drug addictions, like smoking and alcohol drinking and thereby highlighting the social problem related to health.

Effect of autogenic training on drug consumption in patients with primary headache: an 8-month follow-up study.

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Zsombok, Terezia; Juhasz, Gabriella; Budavari, Agota; Vitrai, Jozsef; Bagdy, Gyorgy

2003-03-01

To examine the effects of Schultz-type autogenic training on headache-related drug consumption and headache frequency in patients with migraine, tension-type, or mixed (migraine plus tension-type) headache over an 8-month period. Behavioral treatments often are used alone or adjunctively for different types of headache. There are, however, only a few studies that have compared the efficacy and durability of the same treatment in different types of primary headache, and the effects of treatment on headache-related drug consumption rarely have been assessed even in these studies. Twenty-five women with primary headache (11 with mixed headache, 8 with migraine, and 6 with tension-type headache) were evaluated via an open-label, self-controlled, 8-month, follow-up study design. After an initial 4 months of observation, patients began learning Schultz-type autogenic training as modified for patients with headache. They practiced autogenic training on a regular basis for 4 months. Based on data from headache diaries and daily medication records, headache frequencies and the amounts of analgesics, "migraine-specific" drugs (ergots and triptans), and anxiolytics taken by the patients were compared in the three subgroups over the 8-month period. Results.-From the first month of implementation of autogenic training, headache frequencies were significantly reduced in patients with tension-type and mixed headache. Significant reduction in frequency was achieved in patients with migraine only from the third month of autogenic training. Decreases in headache frequencies were accompanied by decreases in consumption of migraine drugs and analgesics resulting in significant correlations among these parameters. Reduction in consumption of anxiolytic drugs was more rapid and robust in patients with tension-type headache compared to patients with migraine, and this outcome failed to show any correlation with change in headache frequency. Schultz-type autogenic training is an effective

Barriers of Chinese primary care attenders to seeking help for psychological distress in Hong Kong.

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Sun, Kai Sing; Lam, Tai Pong; Lam, Kwok Fai; Lo, Tak Lam; Chao, David Vai Kiong; Lam, Edmund Wing Wo

2016-05-15

Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong. Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics. Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems. The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture. Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help. Copyright © 2016 Elsevier B.V. All rights reserved.

An assessment of factorial structure and health-related quality of life in problem drug users using the Short Form 36 Health Survey

NARCIS (Netherlands)

Buchholz, Angela; Krol, Anneke; Rist, Fred; Nieuwkerk, Pythia T.; Schippers, Gerard M.

2008-01-01

AIMS: To confirm the factorial structure of the Short Form 36 Health Survey (SF-36) in problem drug users and to compare their health-related quality of life (HRQOL) with general Dutch population norms. METHOD: Data of 394 participants from the Amsterdam Cohort Study among drug users, who had

Health problems among detainees in Switzerland: a study using the ICPC-2 classification

Directory of Open Access Journals (Sweden)

Bertrand Dominique

2011-04-01

Full Text Available Abstract Background Little is known about the health status of prisoners in Switzerland. The aim of this study was to provide a detailed description of the health problems presented by detainees in Switzerland's largest remand prison. Methods In this retrospective cross-sectional study we reviewed the health records of all detainees leaving Switzerland's largest remand prison in 2007. The health problems were coded using the International Classification for Primary Care (ICPC-2. Analyses were descriptive, stratified by gender. Results A total of 2195 health records were reviewed. Mean age was 29.5 years (SD 9.5; 95% were male; 87.8% were migrants. Mean length of stay was 80 days (SD 160. Illicit drug use (40.2% and mental health problems (32.6% were frequent, but most of these detainees (57.6% had more generic primary care problems, such as skin (27.0%, infectious diseases (23.5%, musculoskeletal (19.2%, injury related (18.3%, digestive (15.0% or respiratory problems (14.0%. Furthermore, 7.9% reported exposure to violence during arrest by the police. Conclusion Morbidity is high in this young, predominantly male population of detainees, in particular in relation to substance abuse. Other health problems more commonly seen in general practice are also frequent. These findings support the further development of coordinated primary care and mental health services within detention centers.

Online and Mobile Interventions for Problem Gambling, Alcohol, and Drugs: A Systematic Review

Directory of Open Access Journals (Sweden)

Isabelle Giroux

2017-06-01

Full Text Available Online interventions for gambling, alcohol, and illegal drug related problems have been developing at a fast pace over the past decade. Yet, little is known about the content and efficacy of interventions provided entirely online for reducing drug/alcohol use and gambling, or about the characteristics of those who use these interventions. This systematic review aims to describe the characteristics of online interventions, their efficacy, and the profile of their clientele. Documentation was mainly obtained through four scientific databases in psychology, technology, and medical research (PsychINFO, MedLine, Francis, and INSPEC using three keywords (substances or gambling, intervention, Internet. Of the 4,708 documents initially identified, 18 studies meeting admissibility criteria were retained and analyzed after exclusion of duplicates and non-relevant documents. No study in the review related to problem gambling. The majority of interventions were based upon motivational or cognitive-behavioral theoretical approaches and called upon well-established therapeutic components in the field of addictions. The participants in these studies were generally adults between 30 and 46 years old with a high school education and presenting a high risk or problematic use. More than three quarters of the studies showed a short-term decrease in use that was maintained 6 months later, but only two studies included a 12 months follow-up. Online interventions seem promising and appear to meet the needs of participants who are in the workforce and seeking help for the first time. Long-term efficacy studies should nonetheless be conducted.

PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

Science.gov (United States)

Guina, Jeffrey; Nahhas, Ramzi W.; Goldberg, Adam J.; Farnsworth, Seth

2016-01-01

Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs) are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472), we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis), as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses) in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs), DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs), most PTSSs (especially negative beliefs, recklessness, and avoidance), and interpersonal traumas (e.g., assaults and child abuse). Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment. PMID:27517964

PTSD Symptom Severities, Interpersonal Traumas, and Benzodiazepines Are Associated with Substance-Related Problems in Trauma Patients

Directory of Open Access Journals (Sweden)

Jeffrey Guina

2016-08-01

Full Text Available Background: Trauma is commonly associated with substance-related problems, yet associations between specific substances and specific posttraumatic stress disorder symptoms (PTSSs are understudied. We hypothesized that substance-related problems are associated with PTSS severities, interpersonal traumas, and benzodiazepine prescriptions. Methods: Using a cross-sectional survey methodology in a consecutive sample of adult outpatients with trauma histories (n = 472, we used logistic regression to examine substance-related problems in general (primary, confirmatory analysis, as well as alcohol, tobacco, and illicit drug problems specifically (secondary, exploratory analyses in relation to demographics, trauma type, PTSSs, and benzodiazepine prescriptions. Results: After adjusting for multiple testing, several factors were significantly associated with substance-related problems, particularly benzodiazepines (AOR = 2.78; 1.99 for alcohol, 2.42 for tobacco, 8.02 for illicit drugs, DSM-5 PTSD diagnosis (AOR = 1.92; 2.38 for alcohol, 2.00 for tobacco, 2.14 for illicit drugs, most PTSSs (especially negative beliefs, recklessness, and avoidance, and interpersonal traumas (e.g., assaults and child abuse. Conclusion: In this clinical sample, there were consistent and strong associations between several trauma-related variables and substance-related problems, consistent with our hypotheses. We discuss possible explanations and implications of these findings, which we hope will stimulate further research, and improve screening and treatment.

The Knowledge Level of Hypertension Patients for Drug Therapy in the Primary Health Care of Malang

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Hananditia R. Pramestutie

2016-04-01

Full Text Available Hypertension is a persistent blood pressure in which systolic pressure ≥140 mmHg and diastolic pressure ≥90 mmHg. The knowledge that should be owned by patients with hypertension is the meaning, causes, symptoms and treatment of hypertension. This knowledge is important to support the success of hypertension therapy. The aim of this research was to determine the knowledge level of hypertension patients about their drug therapy in the primary health care of Malang. This research used observational study methods. The selection of the patients and the primary health care was done using non-random sampling technique (purposive sampling. The subject who meet the inclusion criteria were involved. The result of this study revealed that the patients with hypertension who have a sufficient level of knowledge were 69 respondents (72,63%. Patients who have a good criteria were 26 respondents (27,3763%. There is no patient with low level of knowledge in this research. The conclusion from this study is most patients with hypertension in Primary Health Care Malang have enough knowledge about their treatment.

Prevention des Toxicomanies Aupres des Filles avec des Problemes de Comportement: Effets a Court Terme (Prevention of Drug Addiction in Girls with Behavior Problems: Short-Term Effects).

Science.gov (United States)

Vitaro, Frank; And Others

1992-01-01

This article, written in French, describes and evaluates the first phase of a program to prevent drug addiction among 110 fifth-grade girls with behavior problems in Montreal (Quebec, Canada). Evaluation of the instructional program showed positive results for student knowledge level, attitudes, and behaviors and supported program continuation…

Drug abuse first aid

Science.gov (United States)

... use of these drugs is a form of drug abuse. Medicines that are for treating a health problem ... about local resources. Alternative Names Overdose from drugs; Drug abuse first aid References Myck MB. Hallucinogens and drugs ...

Correlations of Symptoms of Dyslexia with Academic Achievement and Behavioral Problems in a Malaysian Primary School

Science.gov (United States)

Devaraj, Sheila; Rosian, Samsilah; Noah, Sidek Mohd; Mahyuddin, Rahil

2009-01-01

The purpose of this study is to determine whether there was any significant correlation between symptoms of dyslexia in Malaysian students and discipline problems. A total of 197 standard 3 and 4 students from a national primary school were involved in the study. Findings show that there was a significant negative correlation between academic…

Problems in the regulatory policy of the drug market

Science.gov (United States)

Miziara, Nathália Molleis; Coutinho, Diogo Rosenthal

2015-01-01

OBJECTIVE Analyze the implementation of drug price regulation policy by the Drug Market Regulation Chamber. METHODS This is an interview-based study, which was undertaken in 2012, using semi-structured questionnaires with social actors from the pharmaceutical market, the pharmaceuticals industry, consumers and the regulatory agency. In addition, drug prices were compiled based on surveys conducted in the state of Sao Paulo, at the point of sale, between February 2009 and May 2012. RESULTS The mean drug prices charged at the point of sale (pharmacies) were well below the maximum price to the consumer, compared with many drugs sold in Brazil. Between 2009 and 2012, 44 of the 129 prices, corresponding to 99 drugs listed in the database of compiled prices, showed a variation of more than 20.0% in the mean prices at the point of sale and the maximum price to the consumer. In addition, many laboratories have refused to apply the price adequacy coefficient in their sales to government agencies. CONCLUSIONS The regulation implemented by the pharmaceutical market regulator was unable to significantly control prices of marketed drugs, without succeeding to push them to levels lower than those determined by the pharmaceutical industry and failing, therefore, in its objective to promote pharmaceutical support for the public. It is necessary reconstruct the regulatory law to allow market prices to be reduced by the regulator as well as institutional strengthen this government body. PMID:26083945

Older depressed Latinos' experiences with primary care visits for personal, emotional and/or mental health problems: a qualitative analysis.

Science.gov (United States)

Izquierdo, Adriana; Sarkisian, Catherine; Ryan, Gery; Wells, Kenneth B; Miranda, Jeanne

2014-01-01

To describe salient experiences with a primary care visit (eg, the context leading up to the visit, the experience and/or outcomes of that visit) for emotional, personal and/or mental health problems older Latinos with a history of depression and recent depressive symptoms and/or antidepressant medication use reported 10 years after enrollment into a randomized controlled trial of quality-improvement for depression in primary care. Secondary analysis of existing qualitative data from the second stage of the continuation study of Partners in Care (PIC). Latino ethnicity, aged > or =50 years, recent depressive symptoms and/or antidepressant medication use, and a recent primary care visit for mental health problems. Of 280 second-stage participants, 47 were eligible. Both stages of the continuation study included participants from the PIC parent study control and 2 intervention groups, and all had a history of depression. Data analyzed by a multidisciplinary team using grounded theory methodology. Five themes were identified: beliefs about the nature of depression; prior experiences with mental health disorders/treatments; sociocultural context (eg, social relationships, caregiving, the media); clinic-related features (eg, accessibility of providers, staff continuity, amount of visit time); and provider attributes (eg, interpersonal skills, holistic care approach). Findings emphasize the importance of key features for shaping the context leading up to primary care visits for help-seeking for mental health problems, and the experience and/or outcomes of those visits, among older depressed Latinos at long-term follow-up, and may help tailor chronic depression care for the clinical management of this vulnerable population.

Drug nanocrystals for the formulation of poorly soluble drugs and its application as a potential drug delivery system

International Nuclear Information System (INIS)

Gao Lei; Zhang Dianrui; Chen Minghui

2008-01-01

Formulation of poorly soluble drugs is a general intractable problem in pharmaceutical field, especially those compounds poorly soluble in both aqueous and organic media. It is difficult to resolve this problem using conventional formulation approaches, so many drugs are abandoned early in discovery. Nanocrystals, a new carrier-free colloidal drug delivery system with a particle size ranging from 100 to 1000 nm, is thought as a viable drug delivery strategy to develop the poorly soluble drugs, because of their simplicity in preparation and general applicability. In this article, the product techniques of the nanocrystals were reviewed and compared, the special features of drug nanocrystals were discussed. The researches on the application of the drug nanocrystals to various administration routes were described in detail. In addition, as introduced later, the nanocrystals could be easily scaled up, which was the prerequisite to the development of a delivery system as a market product

Intervention on early-onset conduct problems as indicated prevention for substance use: A seven-year follow up.

Science.gov (United States)

Romero, Estrella; Rodríguez, Concepción; Villar, Paula; Gómez-Fraguela, X Antón

2017-06-28

The aim of this study is to evaluate the long-term effects of a manualised program which intervenes on children with early-onset conduct problems, their families and teachers. The program evaluation involved 14 primary schools which were randomly assigned to the intervention (45 participating families) and control (30 families) conditions during 2007-2008. After a screening process which identified children with significant conduct problems both at home with their family and at school, the program was implemented in eight schools. Seven years later, 58 families (37 from the intervention group and 21 from the control group), with characteristics equivalent to those of the study's entire initial group, were contacted again. With measures administered to the children and their parents, comparisons through multivariate analyses of variance between intervention and control groups supported the program's efficacy in reducing both conduct problems and relations with antisocial peers. Furthermore, the program fostered social and communication skills. As regards drug use, the intervention group showed less favourable attitudes towards drugs, lower intention of drug use, lower frequency of tobacco use and lower intensity of alcohol use. These results support the usefulness of multicomponent programs for conduct problems as a way to prevent, in the long term, unfavourable developmental trajectories, where drug use is a key element.

Engendering drug problems: Materialising gender in the DUDIT and other screening and diagnostic 'apparatuses'.

Science.gov (United States)

Dwyer, Robyn; Fraser, Suzanne

2017-06-01

It is widely accepted that alcohol and other drug consumption is profoundly gendered. Just where this gendering is occurring, however, remains the subject of debate. We contend that one important and overlooked site where the gendering of substance consumption and addiction is taking place is through AOD research itself: in particular, through the addiction screening and diagnostic tools designed to measure and track substance consumption and problems within populations. These tools establish key criteria and set numerical threshold scores for the identification of problems. In many of these tools, separate threshold scores for women and men are established or recommended. Drawing on Karen Barad's concept of post-humanist performativity, in this article we examine the ways in which gender itself is being materialised by these apparatuses of measurement. We focus primarily on the Drug Use Disorders Identification Test (DUDIT) tool as an exemplar of gendering processes that operate across addiction tools more broadly. We consider gendering processes operating through tools questions themselves and we also examine the quantification and legitimation processes used in establishing gender difference and the implications these have for women. We find tools rely on and reproduce narrow and marginalising assumptions about women as essentially fragile and vulnerable and simultaneously reinforce normative expectations that women sacrifice pleasure. The seemingly objective and neutral quantification processes operating in tools naturalise gender as they enact it. Copyright © 2017 Elsevier B.V. All rights reserved.

Feasibility of a self-administered survey to identify primary care patients at risk of medication-related problems

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Makowsky MJ

2014-02-01

Full Text Available Mark J Makowsky,1 Andrew J Cave,2 Scot H Simpson1 1Faculty of Pharmacy and Pharmaceutical Sciences, 2Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Background and objectives: Pharmacists working in primary care clinics are well positioned to help optimize medication management of community-dwelling patients who are at high risk of experiencing medication-related problems. However, it is often difficult to identify these patients. Our objective was to test the feasibility of a self-administered patient survey, to facilitate identification of patients at high risk of medication-related problems in a family medicine clinic. Methods: We conducted a cross-sectional, paper-based survey at the University of Alberta Hospital Family Medicine Clinic in Edmonton, Alberta, which serves approximately 7,000 patients, with 25,000 consultations per year. Adult patients attending the clinic were invited to complete a ten-item questionnaire, adapted from previously validated surveys, while waiting to be seen by the physician. Outcomes of interest included: time to complete the questionnaire, staff feedback regarding impact on workflow, and the proportion of patients who reported three or more risk factors for medication-related problems. Results: The questionnaire took less than 5 minutes to complete, according to the patient's report on the last page of the questionnaire. The median age (and interquartile range of respondents was 57 (45–69 years; 59% were women; 47% reported being in very good or excellent health; 43 respondents of 100 had three or more risk factors, and met the definition for being at high risk of a medication-related problem. Conclusions: Distribution of a self-administered questionnaire did not disrupt patients, or the clinic workflow, and identified an important proportion of patients at high risk of medication-related problems. Keywords: screening tool, pharmacists, primary

Prevalence and Risk Factors of Voice Problems Among Primary School Teachers in India.

Science.gov (United States)

Devadas, Usha; Bellur, Rajashekhar; Maruthy, Santosh

2017-01-01

Teachers are more prone to develop voice problems (VPs) when compared with other professional voice users. The aim of present study was to investigate the prevalence and risk factors of VPs among primary school teachers in India. Epidemiological cross-sectional survey. Self-reporting questionnaire data were collected from 1082 teachers. Out of 1082 teachers who participated in the present study, 188 teachers reported VPs that account for a prevalence rate of 17.4%. Tired voice after long hours of talking was the most frequently reported symptom, followed by sore/dry throat, strain in voice, neck muscle tension, and difficulty in projecting voice. The adjusted odds ratio values showed number of years of teaching, high background noise levels in the classroom, experiencing psychological stress while teaching classes, improper breath management (holding breath while speaking), poor focus of the tone (clenching jaw/teeth while speaking), upper respiratory tract infection, thyroid problems, and acid reflux as significant risk factors for the development of VPs in the current cohort of teachers. Current results suggest that teachers develop VPs due to multiple risk factors. These factors may be either biological, psychomotor, or environment-related factors. A holistic approach (which could include educating teachers about voice care during their training, and if they develop VP during their career, then managing the VP by taking into consideration different risk factors) addressing all these factors needs to be adopted to prevent VPs in primary school teachers. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A Multiple Indicators Multiple Causes (MIMIC) model of internal barriers to drug treatment in China.

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Qi, Chang; Kelly, Brian C; Liao, Yanhui; He, Haoyu; Luo, Tao; Deng, Huiqiong; Liu, Tieqiao; Hao, Wei; Wang, Jichuan

2015-03-01

Although evidence exists for distinct barriers to drug abuse treatment (BDATs), investigations of their inter-relationships and the effect of individual characteristics on the barrier factors have been sparse, especially in China. A Multiple Indicators Multiple Causes (MIMIC) model is applied for this target. A sample of 262 drug users were recruited from three drug rehabilitation centers in Hunan Province, China. We applied a MIMIC approach to investigate the effect of gender, age, marital status, education, primary substance use, duration of primary drug use, and drug treatment experience on the internal barrier factors: absence of problem (AP), negative social support (NSS), fear of treatment (FT), and privacy concerns (PC). Drug users of various characteristics were found to report different internal barrier factors. Younger participants were more likely to report NSS (-0.19, p=0.038) and PC (-0.31, p<0.001). Compared to other drug users, ice users were more likely to report AP (0.44, p<0.001) and NSS (0.25, p=0.010). Drug treatment experiences related to AP (0.20, p=0.012). In addition, differential item functioning (DIF) occurred in three items when participant from groups with different duration of drug use, ice use, or marital status. Individual characteristics had significant effects on internal barriers to drug treatment. On this basis, BDAT perceived by different individuals could be assessed before tactics were utilized to successfully remove perceived barriers to drug treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Federalizing Medical Campaigns against Alcoholism and Drug Abuse

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Metlay, Grischa

2013-01-01

Context The formation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Special Action Office for Drug Abuse Prevention (SAODAP) in the early 1970s dramatically expanded scientific and medical efforts to control alcoholism and drug abuse in the United States. Methods Drawing on a variety of primary, secondary, and archival sources, this article describes the creation and early years of these agencies. Findings I show that while the agencies appeared at roughly the same time, their creation involved separate sets of issues and actors. In addition, I show that SAODAP received more money and resources, even though advocates for alcoholics mobilized a stronger lobbying campaign. Conclusions Two factors explain this discrepancy in money and resources: (1) alcoholism was framed as a public health problem, whereas drug abuse was drawn into broader debates about crime and social decline; and (2) alcohol programs relied on congressional support, whereas drug programs found champions at high levels of the Nixon administration. These political and cultural factors help explain why current programs for illegal drugs receive more federal support, despite alcohol's greater public health burden. PMID:23488713

Federalizing medical campaigns against alcoholism and drug abuse.

Science.gov (United States)

Metlay, Grischa

2013-03-01

The formation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Special Action Office for Drug Abuse Prevention (SAODAP) in the early 1970s dramatically expanded scientific and medical efforts to control alcoholism and drug abuse in the United States. Drawing on a variety of primary, secondary, and archival sources, this article describes the creation and early years of these agencies. I show that while the agencies appeared at roughly the same time, their creation involved separate sets of issues and actors. In addition, I show that SAODAP received more money and resources, even though advocates for alcoholics mobilized a stronger lobbying campaign. Two factors explain this discrepancy in money and resources: (1) alcoholism was framed as a public health problem, whereas drug abuse was drawn into broader debates about crime and social decline; and (2) alcohol programs relied on congressional support, whereas drug programs found champions at high levels of the Nixon administration. These political and cultural factors help explain why current programs for illegal drugs receive more federal support, despite alcohol's greater public health burden. © 2013 Milbank Memorial Fund.

Vignette Research on Messy and Confusing Problems in Primary Mental Healthcare

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E. H. (Dineke Smit

2017-05-01

Full Text Available The average primary care psychologist feels an ever-widening gap between objective, measurable reality as described and the complex and dynamic reality they experience. To obtain a better understanding of this complex dynamic reality, we conducted an exploratory mixed-method study of primary care psychologists. We asked our participants to write vignettes about messy and confusing problems in the complex context of mental healthcare. We then examined the data in portions, exposed the patterns in the data, and subsequently analysed all in conjunction. The 113 vignettes showed experiences of psychologists dealing not only with the patient, but also with the family of the patient and/or employers, working together with other healthcare professionals, struggling with dilemmas and having mixed feelings. However, using the Cynafin Framework, 36% of the vignettes were still rated as simple. Was it because those vignettes contained fewer words (p = .006? Or because it is difficult to grasp complexity when cause and effect are intertwined with emotions, norms and values? In the discussion, we suggest examining a complex dynamic system in terms of both the consistency of its various elements and the dynamics of the system. We also discuss how to optimize the system’s adaptive self-organizing ability and how to challenge ourselves to invent negative feedback loops that can keep the complex system in equilibrium.

Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study.

Directory of Open Access Journals (Sweden)

Jianhua Wu

Full Text Available Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions.A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008 patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing.Of 365,718 patients with complete data, 13.8% (50,558 were prescribed lipid lowering drugs: 28.5% (21,101/74,137 of those eligible and 10.1% (29,457/291,581 of those ineligible. Only 41.7% (21,101/50,558 of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39; diabetes (OR 4.49; 95% CI 4.35-4.64; total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29; and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42. The predictors were similar in eligible and ineligible patients.Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

[Drug-Drug Interactions with Consideration of Pharmacogenetics].

Science.gov (United States)

Ozawa, Shogo

2018-01-01

　Elderly patients often suffer from a variety of diseases and therefore may be prescribed several kinds of drugs. Interactions between these drugs may cause problems in some patients. Guidelines for drug interactions were released on July 8, 2014 "Drug Interaction Guideline for Drug Development and Labeling Recommendations (Final Draft)". These guidelines include the theoretical basis for evaluating the mechanisms of drug interaction, the possible extent of drug interactions, and take into consideration special populations (e.g., infants, children, elderly patients, patients with hepatic or renal dysfunction, and subjects with minor deficient alleles for drug metabolizing enzymes and drug transporters). In this symposium article, I discuss this last special population: altered drug metabolism and drug interactions in subjects with minor alleles of genes encoding deficient drug metabolizing enzymes. I further discuss a drug label for eliglustat (Cerdelga) with instructions for patients with ultra-rapid, extensive, intermediate, and poor metabolizer phenotypes that arise from different CYP2D6 gene alleles.

Drug Control

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Leviton, Harvey S.

1975-01-01

This article attempts to assemble pertinent information about the drug problem, particularily marihuana. It also focuses on the need for an educational program for drug control with the public schools as the main arena. (Author/HMV)

[Drug interactions in chronic prescription].

Science.gov (United States)

Comet, D; Casajuana, J; Bordas, J M; Fuentes, M A; Arnáiz, J A; Núñez, B; Pou, R

1997-06-30

Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. An observational crossover study. Clutat Vella health district (City of Barcelona). Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.

Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.

Science.gov (United States)

McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha; Sharma, Gaurav; Cathers, Lauretta A; Svikis, Dace; Sleiter, Luke; Russell, Linnea; Nordeck, Courtney; Sharma, Anjalee; O'Grady, Kevin E; Bouk, Leah B; Cushing, Carol; King, Jacqueline; Wahle, Aimee; Schwartz, Robert P

2016-11-15

Substance use, a leading cause of illness and death, is underidentified in medical practice. The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients. Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693). 5 adult primary care clinics. 2000 adult patients consecutively recruited from clinic waiting areas. Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD). Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower. The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI. In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is

Diverging Conclusions from the Same Meta-Analysis in Drug Safety: Source of Data (Primary Versus Secondary) Takes a Toll.

Science.gov (United States)

Prada-Ramallal, Guillermo; Takkouche, Bahi; Figueiras, Adolfo

2017-04-01

Meta-analyses of observational studies represent an important tool for assessing efficacy and safety in the pharmacoepidemiologic field. The data from the individual studies are either primary (i.e., collected through interviews or self-administered questionnaires) or secondary (i.e., collected from databases that were established for other purposes). So far, the origin of the data (primary vs. secondary) has not been systematically assessed as a source of heterogeneity in pharmacoepidemiologic meta-analyses. The aim was to assess the impact of considering the source of exposure data as a criterion in sensitivity and subgroup analysis on the conclusions of drug safety meta-analyses. We selected meta-analyses published between 2013 and 2015 in which the intake of frequently used over-the-counter medicines was either the main exposure or a concomitant treatment and the outcome had short latency and induction periods. We stratified the results by origin of data (primary vs. secondary) and compared the new results to those presented originally in the meta-analyses. We used four meta-analyses that fulfilled our criteria of inclusion. The results were selective serotonin reuptake inhibitors and upper gastrointestinal bleeding: original estimate odds ratio (OR) = 1.71 [95% confidence interval (CI) 1.44-2.04], OR primary data = 1.19 (95% CI 0.90-1.58), OR secondary data = 1.81 (95% CI 1.50-2.17); proton pump inhibitors and cardiac events: original estimate hazard ratio (HR) = 1.35 (95% CI 1.18-1.54), HR primary data = 1.05 (95% CI 0.87-1.26), HR secondary data = 1.43 (95% CI 1.23-1.66); non-aspirin non-steroidal anti-inflammatory drugs and myocardial infarction: original estimate risk ratio (RR) = 1.08 (95% CI 0.95-1.22), RR primary data = 0.57 (95% CI 0.34-0.96), RR secondary data = 1.15 (95% CI 1.03-1.28); paracetamol during pregnancy and childhood asthma: original estimate OR = 1.32 (95% CI 1.14-1.52), OR primary data = 1.23 (95% CI 1.06-1.42), OR

The emergence of extensively drug-resistant tuberculosis: a global health crisis requiring new interventions: part I: the origins and nature of the problem.

Science.gov (United States)

Ellner, Jerrold J

2008-12-01

Surveillance studies and outbreak investigations indicate that an extensively drug-resistant (XDR) form of tuberculosis (TB) is increasing in prevalence worldwide. In outbreak settings among HIV-infected, there is a high-case fatality rate. Better outcomes occur in HIV-uninfected, particularly if drug susceptibility test (DST) results are available rapidly to allow tailoring of drug therapy. This review will be presented in two segments. The first characterizes the problem posed by XDR-TB, addressing the epidemiology and evolution of XDR-TB and treatment outcomes. The second reviews technologic advances that may contribute to the solution, new diagnostics, and advances in understanding drug resistance and in the development of new drugs.

Drug Facts

Medline Plus

Full Text Available ... Nicotine Facts Other Drugs of Abuse What is Addiction? What are some signs and symptoms of someone ... use problem? How Does Drug Use Become an Addiction? What Makes Someone More Likely to Get Addicted ...

Drug management in the elderly adult with chronic kidney disease: a review for the primary care physician.

Science.gov (United States)

Ponticelli, Claudio; Sala, Gabriele; Glassock, Richard J

2015-05-01

With advancing age, the functional reserve of many organs tends to decrease. In particular, the lean body mass, the levels of serum albumin, the blood flow to the liver, and the glomerular filtration rate are reduced in elderly individuals and can be further impaired by the concomitant presence of acute or chronic kidney disease. Moreover, patients with kidney disease are often affected by comorbid processes and are prescribed multiple medications. The aging process also modifies some drug interactions, including the affinity of some drugs for their receptor, the number of receptors, and the cell responses upon receptor activation. Therefore, older patients with kidney disease are particularly susceptible to the risks of adverse drug reactions. Planning a pharmacological regimen in such patients is confounded by the paucity of information available on the pharmacokinetic and pharmacodynamic profiles of a large number of drugs commonly used in this group of patients. Finally, many aged patients suffer from unintentional poor compliance. In this review, the problems physicians face in designing safe and effective medication management in elderly individuals are discussed, paying attention to those more frequently used, which may be potentially harmful in patients with kidney disease. The risks of overdosing and underdosing are outlined, and some recommendations to reduce the risk of adverse drug reactions are provided. A review of the literature covering the field of drug management in older patients with kidney disease was performed by selecting those articles published between January 1, 1990, and December 1, 2014, using PubMed as a search engine with the keywords elderly, kidney disease, drugs, drug interaction, and renal function. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

A Study on Teaching Gases to Prospective Primary Science Teachers Through Problem-Based Learning

Science.gov (United States)

Senocak, Erdal; Taskesenligil, Yavuz; Sozbilir, Mustafa

2007-07-01

The aim of this study was to compare the achievement of prospective primary science teachers in a problem-based curriculum with those in a conventional primary science teacher preparation program with regard to success in learning about gases and developing positive attitudes towards chemistry. The subjects of the study were 101 first year undergraduate students, who were in two different classes and who were taught by the same lecturer. One of the classes was randomly selected as the intervention group in which problem-based learning (PBL) was used, and the other as the control in which conventional teaching methods were used. The data were obtained through use of the gases diagnostic test (GDT), the chemistry attitude scale (CAS), and scales specific to students’ evaluation of PBL such as the peer evaluation scale (PES), self evaluation scale (SES), tutor’s performance evaluation scale (TPES) and students’ evaluation of PBL scale (SEPBLS). Data were analysed using SPSS 10.0 (Statistical Package for Social Sciences). In order to find out the effect of the intervention (PBL) on students’ learning of gases, independent sample t-tests and ANCOVA (analysis of co-variance) were used. The results obtained from the study showed that there was a statistically significant difference between the experimental and control groups in terms of students’ GDT total mean scores and, their attitude towards chemistry, as well as PBL has a significant effect on the development of students’ skills such as self-directed learning, cooperative learning and critical thinking.

Abuse of prescription drugs.

OpenAIRE

Wilford, B B

1990-01-01

An estimated 3% of the United States population deliberately misuse or abuse psychoactive medications, with severe consequences. According to the National Institute on Drug Abuse, more than half of patients who sought treatment or died of drug-related medical problems in 1989 were abusing prescription drugs. Physicians who contribute to this problem have been described by the American Medical Association as dishonest--willfully misprescribing for purposes of abuse, usually for profit; disable...

Primary prevention of adolescent pregnancy.

Science.gov (United States)

Schinke, S P; Blythe, B J; Gilchrist, L D; Burt, G A

1981-01-01

Teenage pregnancy is associated with many health, emotional and socioeconomic problems including higher rates of anemia, labor complications, mortality, legal and social struggles and hhigher divorce rates. Professional social workers need strategies to help teenagers avoid early, unwanted pregnancy. This paper offers promising experential and research backing for a primary prevention group work strategy for all adolescents. Social and health programs overlook educational, cognitive anc interpersonal factors biasing youths' ability to comprehend and regulate contraception. Primary prevention to assist adolescents in thinking analytically about their sexual behavior must stress problem solving and decision-making as well as facts about human reproduction and birth control. To implement decisions, youths also need interpersonal communication skills. Small groups are ideal for delivering cognitive-behavioral primary prevention. This approach is based on the premise that youths become pregnant not because of a lack of relevant information, but because they lack cognitive and behavioral skills necessary to use information. Group work involving role-playing helps develop communication skills. Results from 2 field studies describe short-term and longitudinal benefits of the prevention strategy. Professionals can reach significant numbers of youth in this way. By treating sexual issues and the risk of pregnancy as normal in adolescence, social workers can introduce information and pertinent skills to all teenagers. No one is singled out as deviant and the group format enables young people to discuss taboo topics, discovering what the norms are and gradually learning how to deal with peers, family members, techers and others. Adolescents in primary prevention groups gained knowledge, cognitive skills and communication acumen. Improved attitudes toward family planning, increased regular contraception and less unsafe sex resulted from this cognitive-behavioral approach

Predictivity of dog co-culture model, primary human hepatocytes and HepG2 cells for the detection of hepatotoxic drugs in humans

International Nuclear Information System (INIS)

Atienzar, Franck A.; Novik, Eric I.; Gerets, Helga H.; Parekh, Amit; Delatour, Claude; Cardenas, Alvaro; MacDonald, James; Yarmush, Martin L.; Dhalluin, Stéphane

2014-01-01

Drug Induced Liver Injury (DILI) is a major cause of attrition during early and late stage drug development. Consequently, there is a need to develop better in vitro primary hepatocyte models from different species for predicting hepatotoxicity in both animals and humans early in drug development. Dog is often chosen as the non-rodent species for toxicology studies. Unfortunately, dog in vitro models allowing long term cultures are not available. The objective of the present manuscript is to describe the development of a co-culture dog model for predicting hepatotoxic drugs in humans and to compare the predictivity of the canine model along with primary human hepatocytes and HepG2 cells. After rigorous optimization, the dog co-culture model displayed metabolic capacities that were maintained up to 2 weeks which indicates that such model could be also used for long term metabolism studies. Most of the human hepatotoxic drugs were detected with a sensitivity of approximately 80% (n = 40) for the three cellular models. Nevertheless, the specificity was low approximately 40% for the HepG2 cells and hepatocytes compared to 72.7% for the canine model (n = 11). Furthermore, the dog co-culture model showed a higher superiority for the classification of 5 pairs of close structural analogs with different DILI concerns in comparison to both human cellular models. Finally, the reproducibility of the canine system was also satisfactory with a coefficient of correlation of 75.2% (n = 14). Overall, the present manuscript indicates that the dog co-culture model may represent a relevant tool to perform chronic hepatotoxicity and metabolism studies. - Highlights: • Importance of species differences in drug development. • Relevance of dog co-culture model for metabolism and toxicology studies. • Hepatotoxicity: higher predictivity of dog co-culture vs HepG2 and human hepatocytes

Predictivity of dog co-culture model, primary human hepatocytes and HepG2 cells for the detection of hepatotoxic drugs in humans

Energy Technology Data Exchange (ETDEWEB)

Atienzar, Franck A., E-mail: franck.atienzar@ucb.com [UCB Pharma SA, Non-Clinical Development, Chemin du Foriest, 1420 Braine-l' Alleud (Belgium); Novik, Eric I. [H mu rel Corporation, 675 U.S. Highway 1, North Brunswick, NJ 08902 (United States); Gerets, Helga H. [UCB Pharma SA, Non-Clinical Development, Chemin du Foriest, 1420 Braine-l' Alleud (Belgium); Parekh, Amit [H mu rel Corporation, 675 U.S. Highway 1, North Brunswick, NJ 08902 (United States); Delatour, Claude; Cardenas, Alvaro [UCB Pharma SA, Non-Clinical Development, Chemin du Foriest, 1420 Braine-l' Alleud (Belgium); MacDonald, James [Chrysalis Pharma Consulting, LLC, 385 Route 24, Suite 1G, Chester, NJ 07930 (United States); Yarmush, Martin L. [Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854 (United States); Dhalluin, Stéphane [UCB Pharma SA, Non-Clinical Development, Chemin du Foriest, 1420 Braine-l' Alleud (Belgium)

2014-02-15

Drug Induced Liver Injury (DILI) is a major cause of attrition during early and late stage drug development. Consequently, there is a need to develop better in vitro primary hepatocyte models from different species for predicting hepatotoxicity in both animals and humans early in drug development. Dog is often chosen as the non-rodent species for toxicology studies. Unfortunately, dog in vitro models allowing long term cultures are not available. The objective of the present manuscript is to describe the development of a co-culture dog model for predicting hepatotoxic drugs in humans and to compare the predictivity of the canine model along with primary human hepatocytes and HepG2 cells. After rigorous optimization, the dog co-culture model displayed metabolic capacities that were maintained up to 2 weeks which indicates that such model could be also used for long term metabolism studies. Most of the human hepatotoxic drugs were detected with a sensitivity of approximately 80% (n = 40) for the three cellular models. Nevertheless, the specificity was low approximately 40% for the HepG2 cells and hepatocytes compared to 72.7% for the canine model (n = 11). Furthermore, the dog co-culture model showed a higher superiority for the classification of 5 pairs of close structural analogs with different DILI concerns in comparison to both human cellular models. Finally, the reproducibility of the canine system was also satisfactory with a coefficient of correlation of 75.2% (n = 14). Overall, the present manuscript indicates that the dog co-culture model may represent a relevant tool to perform chronic hepatotoxicity and metabolism studies. - Highlights: • Importance of species differences in drug development. • Relevance of dog co-culture model for metabolism and toxicology studies. • Hepatotoxicity: higher predictivity of dog co-culture vs HepG2 and human hepatocytes.

Recent bibliography on analytical and sampling problems of a PWR primary coolant Suppl. 3

International Nuclear Information System (INIS)

Illy, H.

1985-03-01

The present supplement to the bibliography on analytical and sampling problems of PWR primary coolant covers the literature published in 1984 and includes some references overlooked in the previous volumes dealing with the publications of the last 10 years. References are devided into topics characterized by the following headlines: boric acid; chloride; chlorine; carbon dioxide; general; gas analysis; hydrogen isotopes; iodine; iodide; nitrogen; noble gases and radium; ammonia; ammonium; oxygen; other elements; radiation monitoring; reactor safety; sampling; water chemistry. Under a given subject bibliographical information is listed in alphabetical order of the authors. (V.N.)

Open source biotechnology : A drug for developing countries' health problems?

NARCIS (Netherlands)

Schellekens, M.H.M.

2008-01-01

In developing countries, many people suffer from diseases for which there are no drugs or for which drugs exist that they cannot afford because they are too expensive. The advent of genomics has sparked the idea that new drugs can be more easily developed and that genomics thus could lessen the

The predictive power of family history measures of alcohol and drug problems and internalizing disorders in a college population.

Science.gov (United States)

Kendler, Kenneth S; Edwards, Alexis; Myers, John; Cho, Seung Bin; Adkins, Amy; Dick, Danielle

2015-07-01

A family history (FH) of psychiatric and substance use problems is a potent risk factor for common internalizing and externalizing disorders. In a large web-based assessment of mental health in college students, we developed a brief set of screening questions for a FH of alcohol problems (AP), drug problems (DP) and depression-anxiety in four classes of relatives (father, mother, aunts/uncles/grandparents, and siblings) as reported by the student. Positive reports of a history of AP, DP, and depression-anxiety were substantially correlated within relatives. These FH measures predicted in the student, in an expected pattern, dimensions of personality and impulsivity, alcohol consumption and problems, smoking and nicotine dependence, use of illicit drugs, and symptoms of depression and anxiety. Using the mean score from the four classes of relatives was more predictive than using a familial/sporadic dichotomy. Interactions were seen between the FH of AP, DP, and depression-anxiety and peer deviance in predicting symptoms of alcohol and tobacco dependence. As the students aged, the FH of AP became a stronger predictor of alcohol problems. While we cannot directly assess the validity of these FH reports, the pattern of findings suggest that our brief screening items were able to assess, with some accuracy, the FH of substance misuse and internalizing psychiatric disorders in relatives. If correct, these measures can play an important role in the creation of developmental etiologic models for substance and internalizing psychiatric disorders which constitute one of the central goals of the overall project. © 2015 Wiley Periodicals, Inc.

Not your problem? Exploring the relationship between problem formulation and social responsibility

Directory of Open Access Journals (Sweden)

Sveinung Jørgensen

2011-05-01

Full Text Available This article explores the relationship between organizationalproblem formulation and social responsibility. Thepurpose of the article is to illuminate how organizationalproblem formulations (1 determine the manner in whichthe organization attempts to solve the problem and (2involve the ascription of significance to a group of stakeholdersseen as relevant for the organization. This has implicationsfor the degree to which they assume responsibilityfor those stakeholders. We discuss three dimensions ofresponsible decision making – rationality in goal attainment,reverence for ethical norms, and respect for stakeholders.Thereby, we arrive at an understanding of how differentorganizations in the same sector conceive of, andattempt to solve fundamental problems in the sector, aswell as how their assumed responsibility is reflected therein.We present and discuss a case that discusses keysimilarities and differences between two organizations inthe drug sector – a pharmaceutical company that producesmedicine for the treatment of drug addiction and a foundationworking with drug rehabilitation. We illuminatehow the two organizations base their activities on divergentformulations of the drug problem and how this ismanifested in their approach to the problem. We argue that this ultimately translates into differences in the inclusion of various stakeholdersin their problem space, and thereby the degree to which they assumeresponsibility for key stakeholders. This contributes to the corporate socialresponsibility literature by providing an in depth account of how problem formulationsshape organizational activities and determine the practical inclusionof stakeholders’ interests in the decisions and activities of organizations.

Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia

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Faten N. AlZaben

2018-01-01

Full Text Available Objectives: To determine the prevalence of attention deficit hyperactivity disorder (ADHD, subtypes of ADHD, and psychiatric, academic, and behavioral comorbidity in public primary school students in Jeddah, Saudi Arabia. Methods: This is a cross-sectional study. A simple random sample of 6 primary government schools in Jeddah, Saudi Arabia, was identified (3 male, 3 female, and a random sample of classes in each of grades 1-6 were selected. Between July and November 2016, teachers in these classes were asked to complete the Vanderbilt ADHD scale on all students in their classes. Results: A total of 929 students were screened. The overall prevalence of ADHD was 5% (5.3% in girls, 4.7% in boys. The most prevalent subtype of ADHD was combined type (2.7%, followed by hyperactive type (1.2%, and inattentive type (1.1%. The highest prevalence of ADHD overall was in grade 3 (7.1% and the lowest prevalence in grade 6 (3.4%. Among students with ADHD, prevalence of comorbid psychiatric, academic, and behavioral problems was widespread (56.5% oppositional defiant disorder/conduct disorder, 54.4% impaired academic performance, 44.4% classroom behavioral problems, 41.3% depression/anxiety. Comorbid problems were especially prevalent in combined ADHD subtype and in boys. Conclusions: Attention deficit hyperactivity disorder is common in primary school children in Jeddah, and is associated with widespread psychiatric, academic, and behavioral problems, especially in boys. These findings have implications for the diagnosis and treatment of this serious neurobehavioral disorder.

Generic drugs: myths, facts, and limitations

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Antonio Marzo

2012-10-01

Full Text Available Bioequivalence (BE has always been an important pharmaceutical area, particularly (but not solely in Mediterranean region, where the use of generic drugs is a relatively recent development. The lack of new therapeutic molecules has concentrated primary research in the hands of a few large pharmaceutical companies. For smaller companies, this has created opportunities for the development of new formulations of existing drugs (orodispersible tablets that dissolve in the mouth, extended-release tablets, transdermal delivery systems, generic drugs. These applications take advantage of the Abridged New Drug Application (ANDA procedure, which exempts them from a series of expensive investigations and limits the requirement for clinical testing to bioequivalence trials. Since 1991, bioequivalence trials have been regulated by US Food and Drug Administration (FDA and European Medicines Agency (EMA guidelines that provide precise indications on the most specific procedures to be adopted. In spite of these guidelines, however, some aspects of the process have not been fully defined, the most important of which regards the management of endogenous substances. Additional problems are how to manage bioequivalence protocols with drugs that have long half-lives and those whose clearance is characterized by high intrinsic variability. The view that bioequivalence data would be more reliable if they were based on studies in target populations is a myth to be discredited. The present paper reviews issues relative to pharmacokinetics (PK, bioavailability (BA, and bioequivalence, also from an historical viewpoint, and includes a stimulating “questions and answers” section on some key aspects of the bioequivalence of generic drugs.

Drug Revolving Fund-Based

African Journals Online (AJOL)

Background: The Drug Revolving Fund (DRF) was instituted in 1996 in Oyo State to ensure sustainable drug availability at primary health care level with a seed stock of drugs supplied by the Petroleum Trust Fund. This was discontinued in 1999 and replaced in January 2000, with free health service, which involves ...

Cancer in silico drug discovery: a systems biology tool for identifying candidate drugs to target specific molecular tumor subtypes.

Science.gov (United States)

San Lucas, F Anthony; Fowler, Jerry; Chang, Kyle; Kopetz, Scott; Vilar, Eduardo; Scheet, Paul

2014-12-01

Large-scale cancer datasets such as The Cancer Genome Atlas (TCGA) allow researchers to profile tumors based on a wide range of clinical and molecular characteristics. Subsequently, TCGA-derived gene expression profiles can be analyzed with the Connectivity Map (CMap) to find candidate drugs to target tumors with specific clinical phenotypes or molecular characteristics. This represents a powerful computational approach for candidate drug identification, but due to the complexity of TCGA and technology differences between CMap and TCGA experiments, such analyses are challenging to conduct and reproduce. We present Cancer in silico Drug Discovery (CiDD; scheet.org/software), a computational drug discovery platform that addresses these challenges. CiDD integrates data from TCGA, CMap, and Cancer Cell Line Encyclopedia (CCLE) to perform computational drug discovery experiments, generating hypotheses for the following three general problems: (i) determining whether specific clinical phenotypes or molecular characteristics are associated with unique gene expression signatures; (ii) finding candidate drugs to repress these expression signatures; and (iii) identifying cell lines that resemble the tumors being studied for subsequent in vitro experiments. The primary input to CiDD is a clinical or molecular characteristic. The output is a biologically annotated list of candidate drugs and a list of cell lines for in vitro experimentation. We applied CiDD to identify candidate drugs to treat colorectal cancers harboring mutations in BRAF. CiDD identified EGFR and proteasome inhibitors, while proposing five cell lines for in vitro testing. CiDD facilitates phenotype-driven, systematic drug discovery based on clinical and molecular data from TCGA. ©2014 American Association for Cancer Research.

[Adolescent substance use and family problems].

Science.gov (United States)

Malbergier, André; Cardoso, Luciana Roberta Donola; Amaral, Ricardo Abrantes do

2012-04-01

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in São Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p illicit drugs had more family problems than those who did not consume any substance (p illicit drugs (p illicit drug use.

[Frequency of self-reported vocal problems and associated occupational factors in primary schoolteachers in Londrina, Paraná State, Brazil].

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Fillis, Michelle Moreira Abujamra; Andrade, Selma Maffei de; González, Alberto Durán; Melanda, Francine Nesello; Mesas, Arthur Eumann

2016-01-01

This study aimed to estimate the prevalence of self-reported vocal problems among primary schoolteachers and to identify associated occupational factors, using a cross-sectional design and face-to-face interviews with 967 teachers in 20 public schools in Londrina, Paraná State, Brazil. Prevalence of self-reported vocal problems was 25.7%. Adjusted analyses showed associations with characteristics of the employment relationship (workweek ≥ 40 hours and poor perception of salaries and health benefits), characteristics of the work environment (number of students per class and exposure to chalk dust and microorganisms), psychological factors (low job satisfaction, limited opportunities to express opinions, worse relationship with superiors, and poor balance between professional and personal life), and violence (insults and bullying). Vocal disorders affected one in four primary schoolteachers and were associated with various characteristics of the teaching profession (both structural and work-related).

RNA Disruption and Drug Response in Breast Cancer Primary Systemic Therapy.

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Pritzker, Kenneth; Pritzker, Laura; Generali, Daniele; Bottini, Alberto; Cappelletti, Maria Rosa; Guo, Baoqing; Parissenti, Amadeo; Trudeau, Maureen

2015-05-01

As there is now evidence that switching clinical nonresponders early in primary systemic therapy to alternate treatment regimens can enhance survival in some breast cancer patients, the need for a robust intermediate endpoint that can guide treatment response across all tumor subtypes is urgent. Recently, chemotherapy drugs have been shown to induce a decrease in RNA quality in tumor cells from breast cancer biopsies in some patients at midtherapy, and that this has been associated with subsequent achievement of pathological complete response (pCR). The decrease in RNA quality has been shown to be associated with RNA disruption; aberrant RNA bands visualized by RNA electrophoresis have been associated with subsequent tumor cell death. The objectives of these studies are to show that a new assay based on induction of RNA disruption in tumor cells by chemotherapy can stratify at midtherapy, pCR responders from non-pCR responders irrespective of clinical response and to present early evidence that clinically useful RNA disruption can be detected as early as 14 days after initiation of treatment. RNA disruption in tumor cells was quantified by analysis of the RNA electrophoresis banding pattern and expressed as an RNA disruption index (RDI). To develop the RNA disruption assay (RDA), RDI was correlated with clinical outcome (pCR) from the NCIC-CTG MA.22 breast cancer clinical trial (ClinicalTrials.gov NCT00066443). RDA Zones were established by stratifying patients using RDI values into Zone 1, Zone 2, and Zone 3. Zone 3 included seven out of eight pCR responders, whereas Zone 1 contained no pCR responders. An intermediate zone (Zone 2) was established which contained one pCR. Subsequently, to determine early drug response, RNA disruption was examined by RDI after 14 days exposure to trastuzumab, zoledronic acid, or letrozole + cyclophosphamide ± sorafenib therapy. In MA.22, RDA stratified 23 of 85 patients in Zone 1 as pCR nonresponders, 24 patients in Zone 2, an

Substance use among persons with homeless experience in primary care.

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Stringfellow, Erin J; Kim, Theresa W; Gordon, Adam J; Pollio, David E; Grucza, Richard A; Austin, Erika L; Johnson, N Kay; Kertesz, Stefan G

2016-01-01

Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.

Drugs and Young People

Science.gov (United States)

Drug abuse is a serious public health problem. It affects almost every community and family in some way. Drug abuse in children and teenagers may pose a ... of young people may be more susceptible to drug abuse and addiction than adult brains. Abused drugs ...

Adverse effects of the antimalaria drug, mefloquine: due to primary liver damage with secondary thyroid involvement?

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Herxheimer Andrew

2002-03-01

Full Text Available Abstract Background Mefloquine is a clinically important antimalaria drug, which is often not well tolerated. We critically reviewed 516 published case reports of mefloquine adverse effects, to clarify the phenomenology of the harms associated with mefloquine, and to make recommendations for safer prescribing. Presentation We postulate that many of the adverse effects of mefloquine are a post-hepatic syndrome caused by primary liver damage. In some users we believe that symptomatic thyroid disturbance occurs, either independently or as a secondary consequence of the hepatocellular injury. The mefloquine syndrome presents in a variety of ways including headache, gastrointestinal disturbances, nervousness, fatigue, disorders of sleep, mood, memory and concentration, and occasionally frank psychosis. Previous liver or thyroid disease, and concurrent insults to the liver (such as from alcohol, dehydration, an oral contraceptive pill, recreational drugs, and other liver-damaging drugs may be related to the development of severe or prolonged adverse reactions to mefloquine. Implications We believe that people with active liver or thyroid disease should not take mefloquine, whereas those with fully resolved neuropsychiatric illness may do so safely. Mefloquine users should avoid alcohol, recreational drugs, hormonal contraception and co-medications known to cause liver damage or thyroid damage. With these caveats, we believe that mefloquine may be safely prescribed in pregnancy, and also to occupational groups who carry out safety-critical tasks. Testing Mefloquine's adverse effects need to be investigated through a multicentre cohort study, with small controlled studies testing specific elements of the hypothesis.

Problem gambling and family violence: prevalence and patterns in treatment-seekers.

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Dowling, N A; Jackson, A C; Suomi, A; Lavis, T; Thomas, S A; Patford, J; Harvey, P; Battersby, M; Koziol-McLain, J; Abbott, M; Bellringer, M E

2014-12-01

The primary aim of this study was to explore the prevalence and patterns of family violence in treatment-seeking problem gamblers. Secondary aims were to identify the prevalence of problem gambling in a family violence victimisation treatment sample and to explore the relationship between problem gambling and family violence in other treatment-seeking samples. Clients from 15 Australian treatment services were systematically screened for problem gambling using the Brief Bio-Social Gambling Screen and for family violence using single victimisation and perpetration items adapted from the Hurt-Insulted-Threatened-Screamed (HITS): gambling services (n=463), family violence services (n=95), alcohol and drug services (n=47), mental health services (n=51), and financial counselling services (n=48). The prevalence of family violence in the gambling sample was 33.9% (11.0% victimisation only, 6.9% perpetration only, and 16.0% both victimisation and perpetration). Female gamblers were significantly more likely to report victimisation only (16.5% cf. 7.8%) and both victimisation and perpetration (21.2% cf. 13.0%) than male gamblers. There were no other demographic differences in family violence prevalence estimates. Gamblers most commonly endorsed their parents as both the perpetrators and victims of family violence, followed by current and former partners. The prevalence of problem gambling in the family violence sample was 2.2%. The alcohol and drug (84.0%) and mental health (61.6%) samples reported significantly higher rates of any family violence than the gambling sample, while the financial counselling sample (10.6%) reported significantly higher rates of problem gambling than the family violence sample. The findings of this study support substantial comorbidity between problem gambling and family violence, although this may be accounted for by a high comorbidity with alcohol and drug use problems and other psychiatric disorders. They highlight the need for routine

Prevalence and typology of potential drug interactions occurring in primary care patients.

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Lopez-Picazo, Julio J; Ruiz, Juan C; Sanchez, Jose F; Ariza, Angeles; Aguilera, Belen; Lazaro, Dolores; Sanz, Gonzalo R

2010-06-01

To investigate the prevalence and types of potential drug interactions in primary care patients to detect risky prescriptions as an essential condition to design intervention policies leading to an improvement in patient safety. Cross-sectional descriptive study. Two areas in Spain comprising 715,661 inhabitants. 430,525 subjects with electronic medical records and assigned to a family doctor regularly updating them. On a random day, 29.4% of the population was taking medication. Of these, 73.9% were at risk of suffering interactions, and these were found in 20.6% of them. The amount of interactions was higher among people with chronic conditions, the elderly, females and polymedicated patients. From the total of interactions, 55.1% belonged to the highest clinical relevance 'A' level, and 28.3% should have been avoided. The active ingredients primarily involved were hydrochlorothiazide and ibuprofen and, when focusing on those that should be avoided, omeprazole and acenocoumarol. The most frequent 'A' interaction that should be avoided was between non-conjugated excreted benzodiazepines and proton-pump inhibitors, followed by some NSAIDs and diuretics. 1 in 20 Spanish citizens is currently undergoing a potential drug interaction, including a high rate of clinically relevant ones that should be avoided. These results confirm the existence of a serious safety issue that should be approached and where all parties involved (physicians, health services, medical societies and patients) must do our bit to improve. Health services should foster the implementation of prescription alert systems linked with electronic medical records including clinical data.

Pharmaceutical drug detailing in primary care: extent and methods

DEFF Research Database (Denmark)

Schramm, Jesper

The dimension and methods of pharmaceutical marketing towards 47 danish general practitioners is described. Conclusions: Pharmaceutical drug detailing possesses a huge potential to influence the prescription pattern of GP's.......The dimension and methods of pharmaceutical marketing towards 47 danish general practitioners is described. Conclusions: Pharmaceutical drug detailing possesses a huge potential to influence the prescription pattern of GP's....

Drug-related problems in a sample of outpatients with chronic diseases: a cross-sectional study from Jordan

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Al-Azzam SI

2016-02-01

Full Text Available Sayer I Al-Azzam,1 Karem H Alzoubi,1 Salah AbuRuz,2 Qais Alefan1 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 2Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan Abstract: Optimization of drug therapy and preventing drug-related problems (DRPs are major factors to improve health care, reduce expenditure, and potentially save lives. This study aimed at describing the types, numbers, and frequencies of DRPs in the outpatient settings of a group of hospitals in Jordan. The study was set in the cardiology, endocrine, and respiratory outpatient clinics of five major hospitals in Jordan. Patients who visited the above clinics during the period from September 2012 to December 2013, were candidates for this study. Each included subject was fully assessed for DRPs by clinical pharmacists according to a specially designed and validated pharmaceutical care manual. The main outcome measures were the number and types of DRPs. Data were collected from 2,898 patients (mean age ± standard deviation: 56.59±13.5 years. The total number of identified DRPs was 32,348, with an average of 11.2 DRPs per patient. The most common DRPs were a need for additional or more frequent monitoring, a problem in patients’ adherence to self-care activities or nonpharmacological therapy, and that the patient was not given instruction in or did not understand nonpharmacological therapy or self-care advice. The numbers of DRPs per patient in our sample were associated with older age (>57 years, being unmarried, having an education level of high school or less, not having health insurance, and the presence of certain clinical conditions, including hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, cardiac catheterization, heart failure, and gout. In conclusion, implementation of clinical pharmacy services is a strategy to limit DRPs

Chemo-radioresistance of small cell lung cancer cell lines derived from untreated primary tumors obtained by diagnostic bronchofiberscopy

International Nuclear Information System (INIS)

Tanio, Yoshiro; Watanabe, Masatoshi; Inoue, Tamotsu

1990-01-01

New cell lines of small cell lung cancer (SCLC) were established from specimens of untreated primary tumors biopsied by diagnostic bronchofiberscopy. The advantage of this method was ease of obtaining specimens from lung tumors. Establishment of cell lines was successful with 4 of 13 specimens (30%). Clinical responses of the tumors showed considerable variation, but were well correlated with the in vitro sensitivity of the respective cell lines to chemotherapeutic drugs and irradiation. One of the cell lines was resistant to all drugs tested and irradiation, while another was sensitive to all of them. Although the acquired resistance of SCLC is the biggest problem in treatment, the natural resistance to therapy is another significant problem. Either acquired or natural, resistance mechanisms of SCLC may be elucidated by the use of such cell lines derived from untreated tumors. This method and these SCLC cell lines are expected to be useful for the serial study of biologic and genetic changes of untreated and pre-treated tumors, or primary and secondary tumors. (author)

Spatial Epidemiology of Alcohol- and Drug-Related Health Problems Among Northern Plains American Indians: Nebraska and South Dakota, 2007 to 2012.

Science.gov (United States)

Ponicki, William R; Henderson, Jeffrey A; Gaidus, Andrew; Gruenewald, Paul J; Lee, Juliet P; Moore, Roland S; Davids, Sharice; Tilsen, Nick

2018-03-01

Despite high abstinence rates, American Indians experience elevated rates of many alcohol and other drug problems. American Indians also predominantly reside in poor and rural areas, which may explain some observed health disparities. We investigated whether geographic areas including reservations or large American Indian populations exhibited greater incidence of alcohol- and drug-related hospitalizations. We obtained inpatient hospitalization records for 2 Northern Plain states (Nebraska and South Dakota) for the years 2007 to 2012. We constructed zip code counts for 10 categories of hospitalization with diagnoses or injury causation commonly associated with alcohol or drug use. We related these to community sociodemographic characteristics using Bayesian Poisson space-time regression models and examined associations with and without controls for whether each zip code was located within an American Indian reservation. Controlling for other demographic and economic characteristics, zip codes with greater percentage of American Indians exhibited greater incidence for all 10 substance abuse-related health outcomes (9 of 10 well supported); zip code areas within American Indian reservations had greater incidence of self-inflicted injury and drug dependence and abuse, and reduced incidence of alcohol cirrhosis and prescription opioid poisoning. However, the analyses generally demonstrated no well-supported differences in incidence associated with local residence percentages of American Indian versus African American. In our analyses, ethnicity or heredity alone did not account for alcohol- and drug-related hospitalizations among Native populations. Aspects of social, economic, and political dimensions of Native lives must be considered in the etiology of alcohol- and drug-related problems for rural-dwelling indigenous peoples. Copyright © 2018 by the Research Society on Alcoholism.

Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG.

Science.gov (United States)

Van Schayck, O C P; Williams, S; Barchilon, V; Baxter, N; Jawad, M; Katsaounou, P A; Kirenga, B J; Panaitescu, C; Tsiligianni, I G; Zwar, N; Ostrem, A

2017-06-09

Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it

BARRIERS TO THE UTILIZATION OF PRIMARY CARE SERVICES FOR MENTAL HEALTH PROLEMS

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KHAIRANI O

2010-01-01

Full Text Available Objective: To study the barriers toward the utilization of primary care services for mental health problems among adolescents in a secondary school in Hulu Langat, Selangor, Malaysia. Methods: This was a cross-sectional study conducted in July 2008 at a secondary school in Hulu Langat, Selangor. The respondents were selected using randomised cluster sampling among Form Four and Form Five students. Students were given self-administered questionnaire, consisting socio-demographic data and questions on their help-seeking barrier and behaviour. Help-seeking behaviour questions assess the use of medical facility and help-seeking sources. The formal help seeking sources include from teachers, counsellors and doctors. The informal help-seeking sources include from friends,parents and siblings. Results: A total of 175 students were included in the study. None of the students admitted of using the primary health care services for their mental health problems. Majority of the students were not aware of the services availability in the primary health care (97.1%. More than half of them thought the problems were due to their own mistakes (55.4% and the problems were not that serious (49.1%. With regard to perception of the primary health care services, (43.2% of the students were worried about confidentiality, half of them were concerned about other people’s perception especially from their family members(44.6% and friends (48.6%. Minority of them (10.8% thought that nobody can help them. Few of them thought smoking(3.4%, alcohol (3.4% and recreational drugs (1.1% can solve their emotional problems. Conclusion: One of the major barriers identified in the students’ failure to use the health care facilities was their unawarenessof the availability of the service for them in the community. Thus there is a need to promote and increase their awareness onthis issue.

Magnitude of the smoking problem, knowledge, attitude and practice, among family members of primary school students

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Babak Nakhostin-Roohi

2013-06-01

Full Text Available Background: smoking is a very important public health problem, urgently requiring immediate and effective measures due to its harmful effect on health. The purpose of this study was to collect baseline information about the magnitude of smoking problem, knowledge, attitude, and practice among family members of primary school students in the northwest region of Iran.Methods: of 55 680 primary school students (the 3th, 4th and 5th grades, 7.1% (n=3 954 were selected using randomized multi-stage cluster sampling. Data collection was conducted in April, May, and June 2011, by means of a self-administered two-page questionnaire.Results: a total of 3 954 students (57.6% boys and 42.3% girls with the mean age of 10.46±1.09 years were evaluated. According to our data, the prevalence of cigarette smoking among fathers was more than other family members (27.1% versus 17.8% whereas the prevalence of water pipe smoking among fathers and other family members was almost similar (9.2% and 9.7% respectively. None of the smoking type was prevalent among mothers (cigarette: 1% and water pipe: 1.1%. Considerable numbers of all students under study had been exposed to secondhand smoke at home (cigarette: 19.8% and water pipe: 7.7%.Conclusions: considering our findings, two procedures recommended to prevail the problem are to provide greater education about hazards of tobacco consumption among students and their family; and to legislate new laws by officials to ban tobacco use at home.

Rural attitudes, opinions, and drug use.

Science.gov (United States)

Logan, T K; Schenck, J E; Leukefeld, C G; Meyers, J; Allen, S

1999-01-01

There are two primary purposes of this paper. The first is to summarize the results of a survey conducted in a rural area of Kentucky on attitudes and behaviors regarding substance use. The second purpose is to examine differences in drug attitudes and behaviors for higher and lower density rural areas. Participants for this study were contacted by telephone in March 1996. The sample was generated by random digit dialing for eight county telephone exchanges. The sample included 334 respondents from the eight counties who were grouped into respondents from higher density areas (n = 132) and lower density areas (n = 202). Results indicated that respondents from both higher density and lower density areas were similar on drug use and attitudes. However, lower density areas reported their county as a worse place to live and less safe than respondents from higher density areas. Respondents from lower density areas were also more likely to report there was more alcohol/drug use and more alcohol bootlegging in the past year, and that bootlegging alcohol is a serious problem in their county. Future research could include the examination of heterogeneity of rural areas using different indices.

Dealing with Drug Problems: Preventing and Treating Drug Abuse

Science.gov (United States)

... Pittsburgh is looking at whether teaching healthy caregiving strategies to parents can help promote self-regulation skills in children and prevent substance abuse later on. Starting when children are two years old, Shaw’s study enrolls families at risk of substance use problems ...

Drug Facilitated Sexual Assault and That the Problems in Turkey

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Nabi Kantarcı

2012-10-01

Full Text Available The assailants of sexuel assault to serve this purpose to the victims of many different drug can use. These drugs can be applied together with alcohol, soft drinks, water and other drinks can be given together. Most of these drugs tasteless and odorless. In a few minutes after ingestion chemical effect of drugs can start. Victims the conscious reduction and limitation of the physical move occur. Drug drinking from the pass the time until impact memory loss can occur. For this purpose the main benzodiazepines (Diazepam, flunitrazepam, lorazepam, etc., hypnotics (Zopiclone, zolpidem, anesthetics (Gama-hydroxybutyrate, ketamine, amphetamines (Metylendioxymetamphetamine=ecstasy, opiats (Cocaine, cannabis=marihuana and alcohols such as ethanol substances used. However in study frequently encountered in the literature; cocaine, cannabis, metylendioxymetamphetamine, zolpidem, ketamine hydrochloride, zopiclone, gamma hydroxybutirate, diazepam, flunitrazepam and the effects of these substances after oral ingestion were evaluated and the approach to victims.

Compliance with national guidelines for the management of drug-drug interactions in Dutch community pharmacies.

NARCIS (Netherlands)

Buurma, H.; Schalekamp, T.; Egberts, A.C.G.; Smet, P.A.G.M. de

2007-01-01

BACKGROUND: Pharmacists contribute to the detection and prevention of drug therapy-related problems, including drug-drug interactions. Little is known about compliance with pharmacy practice guidelines for the management of drug-drug interaction alerts. OBJECTIVE: To measure the compliance of

Implementing primary health care: some problems of creating national programmes.

Science.gov (United States)

Vaughan, J P; Walt, G

1984-07-01

While there is a great deal of agreement about the principles underlying Primary Health Care (PHC), there exist many problems, political, planning and management, involved in putting the approach into effect. Some of these difficulties are discussed. It is clear that the PHC approach is essentially political; the way it is implemented in each country will reflect the political priorities and systems of that country. Moreover, ministries of health are not known for their strong position in the ministerial pecking order. Finance and planning ministeries would have to be won over to the importance of the concept of PHC to try to eexpand the health budget and to change the emphasis of existing resource allocation patterns. Costs incurred by a PHC approach ( e.g., expensive transport and communication systems), and resources needed to finance it may be available; however, they may not be channelled to the politically less articulate groups in rural areas. Political implications are not limited to national levels; considerable conflict may exist between different status groups and classes at the village level, thus sabotaging PHC plans. Professional politics will also be played at all levels. It is equally essential to recognize the historical context in which PHC is being introduced. Many countries have inherited colonial infrastructures. Changing the values, perceptions, expectations, administration and organization that accompany such systems is extremely hard, and to put PHC into effect demands radical changes. The planning difficulties which beset PHC are related to the still large private provision of social services like health, and to a flourishing traditional private sector in many developing countries. These may limit the implementation of a national health policy and PHC may thus result in a very patchy service throughout the country. The level of centralized planning will also affect resource allocation and therefore the policy, planning and implementation

The Drop-Out Problem in Primary Education: Towards Universalization of Primary Education in Asia and the Pacific--Some Case Studies: China, India, Peninsular Malaysia, Socialist Republic of Viet Nam, Sri Lanka, and Thailand.

Science.gov (United States)

United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and the Pacific.

The ways in which six developing countries in Asia are dealing with the problem of children dropping out of elementary school are discussed in these essays. One of the persistent problems that has deterred universalization of primary education is the early dropping out of children from schools. Case studies describing the magnitude and causes of…

Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

Science.gov (United States)

Straiton, Melanie L; Powell, Kathryn; Reneflot, Anne; Diaz, Esperanza

2016-01-01

Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings.

Science.gov (United States)

Chua, Siew Siang; Kok, Li Ching; Yusof, Faridah Aryani Md; Tang, Guang Hui; Lee, Shaun Wen Huey; Efendie, Benny; Paraidathathu, Thomas

2012-11-12

The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs) encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%), insufficient awareness and knowledge about disease condition and medication (20.4%), adverse drug reactions (15.6%), therapeutic failure (13.9%), drug-choice problems (9.5%) and dosing problems (3.4%). Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52%) were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2%) was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. This study demonstrates the importance of pharmacists working in

Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

Directory of Open Access Journals (Sweden)

Chua Siew

2012-11-01

Full Text Available Abstract Background The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. Methods This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Results Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%, insufficient awareness and knowledge about disease condition and medication (20.4%, adverse drug reactions (15.6%, therapeutic failure (13.9%, drug-choice problems (9.5% and dosing problems (3.4%. Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52% were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2% was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. Conclusions This study

A novel three-dimensional cell culture method enhances antiviral drug screening in primary human cells.

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Koban, Robert; Neumann, Markus; Daugs, Aila; Bloch, Oliver; Nitsche, Andreas; Langhammer, Stefan; Ellerbrok, Heinz

2018-02-01

Gefitinib is a specific inhibitor of the epidermal growth factor receptor (EGFR) and FDA approved for treatment of non-small cell lung cancer. In a previous study we could show the in vitro efficacy of gefitinib for treatment of poxvirus infections in monolayer (2D) cultivated cell lines. Permanent cell lines and 2D cultures, however, are known to be rather unphysiological; therefore it is difficult to predict whether determined effective concentrations or the drug efficacy per se are transferable to the in vivo situation. 3D cell cultures, which meanwhile are widely distributed across all fields of research, are a promising tool for more predictive in vitro investigations of antiviral compounds. In this study the spreading of cowpox virus and the antiviral efficacy of gefitinib were analyzed in primary human keratinocytes (NHEK) grown in a novel 3D extracellular matrix-based cell culture model and compared to the respective monolayer culture. 3D-cultivated NHEK grew in a polarized and thus a more physiological manner with altered morphology and close cell-cell contact. Infected cultures showed a strongly elevated sensitivity towards gefitinib. EGFR phosphorylation, cell proliferation, and virus replication were significantly reduced in 3D cultures at gefitinib concentrations which were at least 100-fold lower than those in monolayer cultures and well below the level of cytotoxicity. Our newly established 3D cell culture model with primary human cells is an easy-to-handle alternative to conventional monolayer cell cultures and previously described more complex 3D cell culture systems. It can easily be adapted to other cell types and a broad spectrum of viruses for antiviral drug screening and many other aspects of virus research under more in vivo-like conditions. In consequence, it may contribute to a more targeted realization of necessary in vivo experiments. Copyright © 2017 Elsevier B.V. All rights reserved.

EFFICACY AND SAFETY OF LIPID-LOWERING DRUGS IN PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASES IN THE ELDERLY

Directory of Open Access Journals (Sweden)

E. A. Ushkalova

2016-01-01

Full Text Available Effect of hyperlipidemia on morbidity and mortality in elderly patients is considered. Authors also cover issues of efficacy and safety of lipid-lowering therapy in primary and secondary prevention of cardiovascular diseases in patients ≥80 years of age who are the most quickly growing group of population and have the highest cardiovascular risk. They stress the need to take into account polymorbidity and polypharmacy that increase the risk of adverse reactions due to the use of both statins and their drug-drug interactions, which requires an assessment of risk/benefit ratio. In addition, there is a need for development of reliable prognostic tools to predict relevant outcomes (e.g., stroke, decrease in functionality/independence, quality of life reduction and rationales for lipid-lowering therapy in the elderly and also their adherence to treatment.

Approach to Classifying "Design" Drugs and New Potentially Dangerous Chemical Substances, with a Brief Review of the Problem

Science.gov (United States)

Asadullin, Azat R.; Galeeva, Elena Kh.; Achmetova, Elvina A.; Nikolaev, Ivan V.

2016-01-01

The urgency of this study has become vivid in the light of the growing problem of prevalence and use of new synthetic drug types. Lately there has been a tendency of expanding the range of psychologically active substances (PAS) used by addicts with the purpose of their illegal taking. The aim of this research is an attempt of systematizing and…

Illicit drugs policy through the lens of regulation.

Science.gov (United States)

Ritter, Alison

2010-07-01

The application of regulatory theory to the problem of illicit drugs has generally been thought about only in terms of 'command and control'. The international treaties governing global illicit drug control and the use of law enforcement to dissuade and punish offenders have been primary strategies. In this paper I explore the application of other aspects of regulatory theory to illicit drugs-primarily self-regulation and market regulation. There has been an overreliance on strategies from the top of the regulatory pyramid. Two other regulatory strategies--self-regulation and market regulation--can be applied to illicit drugs. Self-regulation, driven by the proactive support of consumer groups may reduce drug-related harms. Market strategies such as pill-testing can change consumer preferences and encourage alternate seller behaviour. Regulatory theory is also concerned with partnerships between the state and third parties: strategies in these areas include partnerships between police and pharmacies regarding sale of potential precursor chemicals. Regulatory theory and practice is a rich and well-developed field in the social sciences. I argue that governments should consider the full array of regulatory strategies. Using regulatory theory provides a rationale and justification to strategies that are currently at the whim of politics, such as funding for user groups. The greater application of regulatory approaches may produce more flexible and structured illicit drug policies. Copyright (c) 2009 Elsevier B.V. All rights reserved.

Self-Management for Primary School Students Demonstrating Problem Behavior in Regular Classrooms: Evidence Review of Single-Case Design Research

Science.gov (United States)

Busacca, Margherita L.; Anderson, Angelika; Moore, Dennis W.

2015-01-01

This review evaluates self-management literature targeting problem behaviors of primary school students in general education settings. Thirty-one single-case design studies met inclusion criteria, of which 16 demonstrated adequate methodological rigor, according to What Works Clearinghouse (WWC) design standards. Visual analysis and WWC…

Drug interactions in primary health care in the George subdistrict ...

African Journals Online (AJOL)

2012-02-15

Feb 15, 2012 ... Drug-drug interactions are a recognised cause of morbidity and mortality ..... or fatal if the interaction increases toxicity or reduces the intended effect of the ... antihypertensive effect of angiotensin-converting enzyme inhibitors ...

Work Process in Primary Health Care: action research with Community Health Workers.

Science.gov (United States)

Cordeiro, Luciana; Soares, Cassia Baldini

2015-11-01

The aim of this article was to describe and analyze the work of community health workers (CHW). The main objective of study was to analyze the development process of primary health care practices related to drug consumption. The study is based on the Marxist theoretical orientation and the action research methodology, which resulted in the performance of 15 emancipatory workshops. The category work process spawned the content analysis. It exposed the social abandonment of the environment in which the CHWs work is performed. The latter had an essential impact on the identification of the causes of drug-related problems. These findings made it possible to criticize the reiterative, stressful actions that are being undertaken there. Such an act resulted in raising of the awareness and creating the means for political action. The CHWs motivated themselves to recognize the object of the work process in primary health care, which they found to be the disease or addiction in the case of drug users. They have criticized this categorization as well as discussed the social division of work and the work itself whilst recognizing themselves as mere instruments in the work process. The latter has inspired the CHW to become subjects, or co-producers of transformations of social needs.

Health behaviours in a Canadian community college sample: prevalence of drug use and interrelationships among behaviours.

Science.gov (United States)

Mathieson, C M; Faris, P D; Stam, H J; Egger, L A

1992-01-01

This study investigated the prevalence of drug use among a Canadian college sample and the covariation of drug taking and other health-related behaviours. A representative sample of students at a community college in Alberta were interviewed using telephone surveys, mail-in questionnaires and face-to-face interviews. Data was collected on drug, alcohol and caffeine use, cigarette smoking, eating habits, sleep habits and exercise. While use of illicit drugs did not appear to be widespread, alcohol appeared to be a primary substance abuse problem for a minority of subjects. Factor analysis indicated that the various health habits did not form one dimension of health-related behaviours. Four separate factors emerged: abusive drinking, eating habits, a drug use factor (caffeine intake, smoking, cannabis and hallucinogen use), and exercise levels. Findings are discussed in terms of their implications for future research, treatment and intervention.

Quality of drug prescription in primary health care facilities in ...

African Journals Online (AJOL)

DR Marwa

north-western Tanzania. GIVENESS ... Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. .... Irrational use of drugs occurs in all countries and causes harm to people (El Mahalli 2012).

Unique properties of Drosophila spermatocyte primary cilia

Directory of Open Access Journals (Sweden)

Maria Giovanna Riparbelli

2013-09-01

The primary cilium is an essential organelle required for animal development and adult homeostasis that is found on most animal cells. The primary cilium contains a microtubule-based axoneme cytoskeleton that typically grows from the mother centriole in G0/G1 phase of the cell cycle as a membrane-bound compartment that protrudes from the cell surface. A unique system of bidirectional transport, intraflagellar transport (IFT, maintains the structure and function of cilia. While the axoneme is dynamic, growing and shrinking at its tip, at the same time it is very stable to the effects of microtubule-targeting drugs. The primary cilia found on Drosophila spermatocytes diverge from the general rules of primary cilium biology in several respects. Among these unique attributes, spermatocyte cilia assemble from all four centrioles in an IFT-independent manner in G2 phase, and persist continuously through two cell divisions. Here, we show that Drosophila spermatocyte primary cilia are extremely sensitive to microtubule-targeting drugs, unlike their mammalian counterparts. Spermatocyte cilia and their axonemes fail to assemble or be maintained upon nocodazole treatment, while centriole replication appears unperturbed. On the other hand, paclitaxel (Taxol, a microtubule-stabilizing drug, disrupted transition zone assembly and anchoring to the plasma membrane while causing spermatocyte primary cilia to grow extensively long during the assembly/elongation phase, but did not overtly affect the centrioles. However, once assembled to their mature length, spermatocyte cilia appeared unaffected by Taxol. The effects of these drugs on axoneme dynamics further demonstrate that spermatocyte primary cilia are endowed with unique assembly properties.

Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

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Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

2015-07-30

To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

Substandard/counterfeit antimicrobial drugs.

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Kelesidis, Theodoros; Falagas, Matthew E

2015-04-01

Substandard/counterfeit antimicrobial drugs are a growing global problem. The most common substandard/counterfeit antimicrobials include beta-lactams (among antibiotics) and chloroquine and artemisin derivatives (among antimalarials). The most common type of substandard/counterfeit antimicrobial drugs have a reduced amount of the active drug, and the majority of them are manufactured in Southeast Asia and Africa. Counterfeit antimicrobial drugs may cause increased mortality and morbidity and pose a danger to patients. Here we review the literature with regard to the issue of substandard/counterfeit antimicrobials and describe the prevalence of this problem, the different types of substandard/counterfeit antimicrobial drugs, and the consequences for the individuals and global public health. Local, national, and international initiatives are required to combat this very important public health issue. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Community "San Gregorio." A Christian Educative Response to the Problem of Drug Abuse in Youth Aged 12-18 Years.

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Lamus, Jose Antonio Lopez; Sarmiento, Albeiro Saldana

This pamphlet describes the "San Gregorio" pilot program in Latin America, the first of its type on the continent as a program specifically for adolescent drug addicts. The Christian educative program is designed for males 12-18 years of age, who are addicted to psycho-active substances and evidence serious behavioral problems. It is…

Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps.

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Kane, Jeremy C; Ventevogel, Peter; Spiegel, Paul; Bass, Judith K; van Ommeren, Mark; Tol, Wietse A

2014-11-24

Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees. Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage. Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits. Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and

A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial.

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Przytula, Kamila; Bailey, Stacy Cooper; Galanter, William L; Lambert, Bruce L; Shrestha, Neeha; Dickens, Carolyn; Falck, Suzanne; Wolf, Michael S

2015-01-27

The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is 'Tools for Optimizing Medication Safety.' Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the 'Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use'. The overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only). Through this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the

Corporal punishment and children's externalizing problems: a cross-sectional study of Tanzanian primary school aged children.

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Hecker, Tobias; Hermenau, Katharin; Isele, Dorothea; Elbert, Thomas

2014-05-01

The adverse effect of harsh corporal punishment on mental health and psychosocial functioning in children has been repeatedly suggested by studies in industrialized countries. Nevertheless, corporal punishment has remained common practice not only in many homes, but is also regularly practiced in schools, particularly in low-income countries, as a measure to maintain discipline. Proponents of corporal punishment have argued that the differences in culture and industrial development might also be reflected in a positive relationship between the use of corporal punishment and improving behavioral problems in low-income nations. In the present study we assessed the occurrence of corporal punishment at home and in school in Tanzanian primary school students. We also examined the association between corporal punishment and externalizing problems. The 409 children (52% boys) from grade 2 to 7 had a mean age of 10.49 (SD=1.89) years. Nearly all children had experienced corporal punishment at some point during their lifetime both in family and school contexts. Half of the respondents reported having experienced corporal punishment within the last year from a family member. A multiple sequential regression analysis revealed that corporal punishment by parents or by caregivers was positively related to children's externalizing problems. The present study provides evidence that Tanzanian children of primary school age are frequently exposed to extreme levels of corporal punishment, with detrimental consequences for externalizing behavior. Our findings emphasize the need to inform parents, teachers and governmental organizations, especially in low-income countries, about the adverse consequences of using corporal punishment be it at home or at school. Copyright © 2013 Elsevier Ltd. All rights reserved.

Synergistic drug-cytokine induction of hepatocellular death as an in vitro approach for the study of inflammation-associated idiosyncratic drug hepatotoxicity

International Nuclear Information System (INIS)

Cosgrove, Benjamin D.; King, Bracken M.; Hasan, Maya A.; Alexopoulos, Leonidas G.; Farazi, Paraskevi A.; Hendriks, Bart S.; Griffith, Linda G.; Sorger, Peter K.; Tidor, Bruce; Xu, Jinghai J.

2009-01-01

Idiosyncratic drug hepatotoxicity represents a major problem in drug development due to inadequacy of current preclinical screening assays, but recently established rodent models utilizing bacterial LPS co-administration to induce an inflammatory background have successfully reproduced idiosyncratic hepatotoxicity signatures for certain drugs. However, the low-throughput nature of these models renders them problematic for employment as preclinical screening assays. Here, we present an analogous, but high-throughput, in vitro approach in which drugs are administered to a variety of cell types (primary human and rat hepatocytes and the human HepG2 cell line) across a landscape of inflammatory contexts containing LPS and cytokines TNF, IFNγ, IL-1α, and IL-6. Using this assay, we observed drug-cytokine hepatotoxicity synergies for multiple idiosyncratic hepatotoxicants (ranitidine, trovafloxacin, nefazodone, nimesulide, clarithromycin, and telithromycin) but not for their corresponding non-toxic control compounds (famotidine, levofloxacin, buspirone, and aspirin). A larger compendium of drug-cytokine mix hepatotoxicity data demonstrated that hepatotoxicity synergies were largely potentiated by TNF, IL-1α, and LPS within the context of multi-cytokine mixes. Then, we screened 90 drugs for cytokine synergy in human hepatocytes and found that a significantly larger fraction of the idiosyncratic hepatotoxicants (19%) synergized with a single cytokine mix than did the non-hepatotoxic drugs (3%). Finally, we used an information theoretic approach to ascertain especially informative subsets of cytokine treatments for most highly effective construction of regression models for drug- and cytokine mix-induced hepatotoxicities across these cell systems. Our results suggest that this drug-cytokine co-treatment approach could provide a useful preclinical tool for investigating inflammation-associated idiosyncratic drug hepatotoxicity.

Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist.

Science.gov (United States)

Guignard, Bertrand; Bonnabry, Pascal; Perrier, Arnaud; Dayer, Pierre; Desmeules, Jules; Samer, Caroline Flora

2015-07-01

Patients admitted to general internal medicine wards might receive a large number of drugs and be at risk for drug-related problems (DRPs) associated with increased morbidity and mortality. This study aimed to detect suboptimal drug use in internal medicine by a pharmacotherapy evaluation, to suggest treatment optimizations and to assess the acceptance and satisfaction of the prescribers. This was a 6-month prospective study conducted in two internal medicine wards. Physician rounds were attended by a pharmacist and a pharmacologist. An assessment grid was used to detect the DRPs in electronic prescriptions 24h in advance. One of the following interventions was selected, depending on the relevance and complexity of the DRPs: no intervention, verbal advice of treatment optimization, or written consultation. The acceptance rate and satisfaction of prescribers were measured. In total, 145 patients were included, and 383 DRPs were identified (mean: 2.6 DRPs per patient). The most frequent DRPs were drug interactions (21%), untreated indications (18%), overdosages (16%) and drugs used without a valid indication (10%). The drugs or drug classes most frequently involved were tramadol, antidepressants, acenocoumarol, calcium-vitamin D, statins, aspirin, proton pump inhibitors and paracetamol. The following interventions were selected: no intervention (51%), verbal advice of treatment optimization (42%), and written consultation (7%). The acceptance rate of prescribers was 84% and their satisfaction was high. Pharmacotherapy expertise during medical rounds was useful and well accepted by prescribers. Because of the modest allocation of pharmacists and pharmacologists in Swiss hospitals, complementary strategies would be required. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Peer Substance Use Associated with the Co-Occurrence of Borderline Personality Disorder Features and Drug Use Problems in College Students

Science.gov (United States)

Pizzarello, Scott; Taylor, Jeanette

2011-01-01

Objective: To determine if the substance use patterns of one's close friends and romantic partners would be a significant contributor to the co-occurrence of borderline personality disorder (BPD) features and drug use problems above and beyond impulsivity and negative emotionality. Participants: Participants were 2,202 undergraduates who attended…

Influence of family history, irradiation and anti-cancer drug (mitomycin C) on the occurrence of multiple primary neoplasms in breast carcinoma patients

International Nuclear Information System (INIS)

Yoshimoto, Masataka; Sakamoto, Goi; Sugano, Haruo; Kasumi, Fujio; Fukami, Atsuo; Kuno, Keijiro.

1984-01-01

The influence of family history, irradiation and anti-cancer drug (Mitomycin C) on the occurrence of multiple primary neoplasms was analysed using the person-year method in 1359 Japanese breast carcinoma patients. There were 111 multiple primary neoplasms, including bilaterl breast cancer, in 109 patients; the incidence rate was 0.0072 per person-year. The incidence rate in patients with a family history of cancer was 1.29 times higher than in those without. In the bilateral breast cancer group there was about a 3 times higher frequency of family history of breast cancer. Irradiation therapy raised the occurrence of multiple primary neoplasms 1.28 fold, and Mitomycin C (40 mg) had no effect on the occurrence of neoplasms during a 10-year observation period. (author)

Treating depression with antidepressants: drug-placebo efficacy debates limit broader considerations.

Science.gov (United States)

Yapko, Michael D

2013-01-01

The core issue regarding antidepressants for many clinicians is whether they perform significantly better than placebos. However, this article suggests eight additional concerns beyond drug efficacy alone to consider regarding antidepressants including: (1) formulating only a one-dimensional, biological view of depression; (2) defining the client's role as passive in treatment; (3) economic corruption of the research and reporting; (4) false or misleading consumer advertising; (5) conflicting data that confuse practitioners and consumers alike; (6) over- and under-prescription of medications; (7) drug side-effects; and (8) harm to the environment. The enhanced effects of psychotherapy utilizing hypnosis offer a means of avoiding most, if not all, of the problems associated with the use of antidepressants as a primary form of treatment.

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review.

Science.gov (United States)

Savic, Michael; Best, David; Manning, Victoria; Lubman, Dan I

2017-04-07

There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians' primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening

Barriers for identification and treatment of problem drinkers in primary care.

Science.gov (United States)

Coloma-Carmona, Ainhoa; Carballo, José Luis; Tirado-González, Sonia

Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals' health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Drugs with anticholinergic side‑effects in primary care

African Journals Online (AJOL)

2014-05-31

May 31, 2014 ... retention or hesitancy, visual impairment, falls, confusion, drowsiness ... updated in 2012; as drugs, which may cause dementia and cognitive ... Two questions were asked to determine physicians' attention ... Even if selective.

Using vignettes to assess contributions to the work of addressing child mental health problems in primary care.

Science.gov (United States)

Wissow, Lawrence S; Zafar, Waleed; Fothergill, Kate; Ruble, Anne; Slade, Eric

2016-01-22

To further efforts to integrate mental health and primary care, this study develops a novel approach to quantifying the amount and sources of work involved in shifting care for common mental health problems to pediatric primary care providers. Email/web-based survey of a convenience sample (n = 58) of Maryland pediatricians (77% female, 58% at their site 10 or more years; 44% in private practice, 52 % urban, 48 % practicing with a co-located mental health provider). Participants were asked to review 11 vignettes, which described primary care management of child/youth mental health problems, and rate them on an integer-based ordinal scale for the overall amount of work involved compared to a 12th reference vignette describing an uncomplicated case of ADHD. Respondents were also asked to indicate factors (time, effort, stress) accounting for their ratings. Vignettes presented combinations of three diagnoses (ADHD, anxiety, and depression) and three factors (medical co-morbidity, psychiatric co-morbidity, and difficult families) reported to complicate mental health care. The reference case was pre-assigned a work value of 2. Estimates of the relationship of diagnosis and complicating factors with workload were obtained using linear regression, with random effects at the respondent level. The 58 pediatricians gave 593 vignette responses. Depression was associated with a 1.09 unit (about 50%) increase in work (95% CL .94, 1.25), while anxiety did not differ significantly from the reference case of uncomplicated ADHD (p = .28). Although all three complicating factors increased work ratings compared with the reference case, family complexity and psychiatric co-morbidity did so the most (.87 and 1.07 units, respectively, P work were physician time, physician mental effort, and stress; those least strongly associated were staff time, physician physical effort, and malpractice risk. Pediatricians working with co-located mental health providers gave higher work

Hypothesis: primary antiangiogenic method proposed to treat early stage breast cancer

International Nuclear Information System (INIS)

Retsky, Michael W; Hrushesky, William JM; Gukas, Isaac D

2009-01-01

Women with Down syndrome very rarely develop breast cancer even though they now live to an age when it normally occurs. This may be related to the fact that Down syndrome persons have an additional copy of chromosome 21 where the gene that codes for the antiangiogenic protein Endostatin is located. Can this information lead to a primary antiangiogenic therapy for early stage breast cancer that indefinitely prolongs remission? A key question that arises is when is the initial angiogenic switch thrown in micrometastases? We have conjectured that avascular micrometastases are dormant and relatively stable if undisturbed but that for some patients angiogenesis is precipitated by surgery. We also proposed that angiogenesis of micrometastases very rarely occurs before surgical removal of the primary tumor. If that is so, it seems possible that we could suggest a primary antiangiogenic therapy but the problem then arises that starting a therapy before surgery would interfere with wound healing. The therapy must be initiated at least one day prior to surgical removal of the primary tumor and kept at a Down syndrome level perhaps indefinitely. That means the drug must have virtually no toxicity and not interfere meaningfully with wound healing. This specifically excludes drugs that significantly inhibit the VEGF pathway since that is important for wound healing and because these agents have some toxicity. Endostatin is apparently non-toxic and does not significantly interfere with wound healing since Down syndrome patients have no abnormal wound healing problems. We propose a therapy for early stage breast cancer consisting of Endostatin at or above Down syndrome levels starting at least one day before surgery and continuing at that level. This should prevent micrometastatic angiogenesis resulting from surgery or at any time later. Adjuvant chemotherapy or hormone therapy should not be necessary. This can be continued indefinitely since there is no acquired resistance that

Methadone maintenance therapy as evidence based drug abuse ...

African Journals Online (AJOL)

Methadone maintenance therapy as evidence based drug abuse planning in ... drugs are being used as artificial problem-solvers such as frustrations, stress or ... Drug use is a problem to users when it begins to cause some damage to their ...

Bioprinted 3D Primary Liver Tissues Allow Assessment of Organ-Level Response to Clinical Drug Induced Toxicity In Vitro.

Directory of Open Access Journals (Sweden)

Deborah G Nguyen

Full Text Available Modeling clinically relevant tissue responses using cell models poses a significant challenge for drug development, in particular for drug induced liver injury (DILI. This is mainly because existing liver models lack longevity and tissue-level complexity which limits their utility in predictive toxicology. In this study, we established and characterized novel bioprinted human liver tissue mimetics comprised of patient-derived hepatocytes and non-parenchymal cells in a defined architecture. Scaffold-free assembly of different cell types in an in vivo-relevant architecture allowed for histologic analysis that revealed distinct intercellular hepatocyte junctions, CD31+ endothelial networks, and desmin positive, smooth muscle actin negative quiescent stellates. Unlike what was seen in 2D hepatocyte cultures, the tissues maintained levels of ATP, Albumin as well as expression and drug-induced enzyme activity of Cytochrome P450s over 4 weeks in culture. To assess the ability of the 3D liver cultures to model tissue-level DILI, dose responses of Trovafloxacin, a drug whose hepatotoxic potential could not be assessed by standard pre-clinical models, were compared to the structurally related non-toxic drug Levofloxacin. Trovafloxacin induced significant, dose-dependent toxicity at clinically relevant doses (≤ 4uM. Interestingly, Trovafloxacin toxicity was observed without lipopolysaccharide stimulation and in the absence of resident macrophages in contrast to earlier reports. Together, these results demonstrate that 3D bioprinted liver tissues can both effectively model DILI and distinguish between highly related compounds with differential profile. Thus, the combination of patient-derived primary cells with bioprinting technology here for the first time demonstrates superior performance in terms of mimicking human drug response in a known target organ at the tissue level.

Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment.

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Sandlund, Christina; Hetta, Jerker; Nilsson, Gunnar H; Ekstedt, Mirjam; Westman, Jeanette

2017-07-01

Insomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients. To evaluate the effects of a group treatment program for insomnia led by nurses in primary care. were the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use. A randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group. Routine primary health care; 7 primary care centers in Stockholm, Sweden. Patients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%. The intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1year. Mean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect

Introduction to the College on Problems of Drug Dependence special issue: contemporary advances in opioid neuropharmacology.

Science.gov (United States)

Walsh, Sharon L; Unterwald, Ellen M; Izenwasser, Sari

2010-05-01

Opioid receptors are critical therapeutic targets for medications development relevant to the treatment of drug dependence and pain. With recent advances in molecular neurobiology, it has become evident that the functional activity of opioid receptors, as ligand-regulated protein complexes, is modulated by multifarious intracellular and extracellular events, that there is genetic variation in coding for receptors, and that the activity of endogenous opioid systems may underlie actions common to other addictive disorders. This supplemental issue of Drug and Alcohol Dependence, arising from an invited symposium at the 71st Annual Meeting of the College on Problems of Drug Dependence, provides a series of contemporary reviews focused on recent advances in opioid neuropharmacology. Each speaker provides herein an invited comprehensive review of the state of knowledge on a specific topic in opioid neuropharmacology. Evans and colleagues describe the multi-faceted control of the opioid G-protein coupled receptor as a dynamic "sensor" complex and identify novel targets for drug development. von Zastrow focuses on opioid receptor-mediated events regulated by endocytosis and membrane trafficking through the endocytic pathway and differential responses to opioid agonists. Blendy and colleague provide a review of human association studies on the functional relevance of the mu opioid receptor variant, A118G, and presents data from the A112G knock-in model, an analogous mouse variant to A118G. Finally, Maldonado and colleagues provide a broader systems review from genetic, pharmacologic and behavioral studies implicating the endogenous opioid systems as a substrate for the mediation of substance use disorders spanning pharmacological classes.

Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP).

NARCIS (Netherlands)

Tak, E.C.P.M.; Hespen, A.T.H. van; Verhaak, P.F.M.; Eekhof, J.; Hopman-Rock, M.

2016-01-01

Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety,

Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP)

NARCIS (Netherlands)

Tak, E.C.P.M.; Hespen, A.T.H. van; Verhaal, P.F.M.; Eekhof, J.; Hopman-Rock, M.

2016-01-01

Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety,

Drug therapy in headache.

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Weatherall, Mark W

2015-06-01

All physicians will encounter patients with headaches. Primary headache disorders are common, and often disabling. This paper reviews the principles of drug therapy in headache in adults, focusing on the three commonest disorders presenting in both primary and secondary care: tension-type headache, migraine and cluster headache. The clinical evidence on the basis of which choices can be made between the currently available drug therapies for acute and preventive treatment of these disorders is presented, and information given on the options available for the emergency parenteral treatment of refractory migraine attacks and cluster headache. © Royal College of Physicians 2015. All rights reserved.

Links between Alcohol and Other Drug Problems and Maltreatment among Adolescent Girls: Perceived Discrimination, Ethnic Identity, and Ethnic Orientation as Moderators

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Gray, Calonie M. K.; Montgomery, Marilyn J.

2012-01-01

Objectives: This study examined the links between maltreatment, posttraumatic stress symptoms, ethnicity-specific factors (i.e., perceived discrimination, ethnic identity, and ethnic orientation), and alcohol and/or other drug (AOD) problems among adolescent girls. Methods: These relations were examined using archived data from a community sample…

The impact of drug policy liberalisation on willingness to seek help for problem drug use: A comparison of 20 countries.

Science.gov (United States)

Benfer, Isabella; Zahnow, Renee; Barratt, Monica J; Maier, Larissa; Winstock, Adam; Ferris, Jason

2018-06-01

While the impact of changing drug policies on rates of drug use has been investigated, research into how help-seeking behaviour changes as drug policies become more public-health focused is limited. This paper investigates reported changes in confidence to utilise drug services following hypothetical changes in national drug policy among a sample of individuals who report recent illicit drug use. We predict that liberalising national drug policy will increase the propensity for people who take illegal drugs to utilise health services. The data were drawn from a sample of self-reported responses to the 2014 Global Drug Survey. Respondents were asked if they would be more confident seeking help if each of the following policy changes were made in their country; a) drugs were legalised; b) penalties for possession of small amounts of drugs were reduced to a fine only; c) drugs were legally available through governments outlets. Multiple correspondence analysis and multinomial logistic regression with post-estimation linear hypothesis testing were conducted. Individuals residing in countries with relatively liberal drug policy regimes report their help-seeking behaviour is unlikely to change given the hypothetical policy amendments. Individuals from countries with prohibition-based drug policies reported a far greater propensity for changing their help-seeking behaviour in the event of hypothetical policy amendments, citing reduced fear of criminal sanctions as the major reason. Age and sex differences were also found. The current study demonstrates the capacity for national drug policy reform to influence drug use risk by facilitating or impeding health service engagement among individuals who use illicit substances. We suggest national drug policy requires careful consideration of both prevention goals and the needs of individuals already engaged in illicit substance use; more liberal drug policies may actually encourage the adoption of harm reduction strategies such

Drugs, money, and power: the Canadian drug shortage.

Science.gov (United States)

Kaposy, Chris

2014-03-01

This article describes the shortage of generic injectable medications in Canada that affected hospitals in 2012. It traces the events leading up to the drug shortage, the causes of the shortage, and the responses by health administrators, pharmacists, and ethicists. The article argues that generic drug shortages are an ethical problem because health care organizations and governments have an obligation to avoid exposing patients to resource scarcity. The article also discusses some options governments could pursue in order to secure the drug supply and thereby fulfill their ethical obligations.

Evaluation of drug interaction microcomputer software: Dambro's Drug Interactions.

Science.gov (United States)

Poirier, T I; Giudici, R A

1990-01-01

Dambro's Drug Interactions was evaluated using general and specific criteria. The installation process, ease of learning and use were rated excellent. The user documentation and quality of the technical support were good. The scope of coverage, clinical documentation, frequency of updates, and overall clinical performance were fair. The primary advantages of the program are the quick searching and detection of drug interactions, and the attempt to provide useful interaction data, i.e., significance and reference. The disadvantages are the lack of current drug interaction information, outdated references, lack of evaluative drug interaction information, and the inability to save or print patient profiles. The program is not a good value for the pharmacist but has limited use as a quick screening tool.

Perceived risk of mental health problems in primary care.

LENUS (Irish Health Repository)

2015-01-01

In the face of limited resources and an aging population with increasingly care needs, healthcare systems must identify community-dwelling older adults with mental health problems at higher risk of adverse outcomes such as institutionalization, hospitalization and death, in order to deliver timely and efficient care. The objectives of this study were to assess the prevalence of mental health concerns and the associated perceived risk of adverse outcomes in a large sample of older patients in primary care (PC). We trained general practitioners and nurses to use the Risk Instrument for Screening in the Community to rank perceived risk of mental health concerns (including neurocognitive and mood disorders) from 1 (mild) to 3 (severe). The mean age of the 4499 people assessed was 76.3 years (SD = 7.3) and 2645 (58.8%) were female. According to the PC team 1616 (35.9%) were perceived to have mental health concerns of whom 847 (52.4%) were mild, 559 (34.6%) were moderate and 210 (13%) were severe. Patients with mental health concerns had higher odds of perceived risk of adverse outcomes (OR = 2.22, 95% CI 1.83-2.69 for institutionalization; OR = 1.66, 95% CI 1.41-1.94 for hospitalization; OR = 1.69, 95% CI 1.42-2.01 for death). These results suggest a high prevalence of mental health concerns among older adults and supports the need for early identification of patients at high-risk of adverse healthcare outcomes.

Improving problem solving in primary school students: The effect of a training programme focusing on metacognition and working memory.

Science.gov (United States)

Cornoldi, Cesare; Carretti, Barbara; Drusi, Silvia; Tencati, Chiara

2015-09-01

Despite doubts voiced on their efficacy, a series of studies has been carried out on the capacity of training programmes to improve academic and reasoning skills by focusing on underlying cognitive abilities and working memory in particular. No systematic efforts have been made, however, to test training programmes that involve both general and specific underlying abilities. If effective, these programmes could help to increase students' motivation and competence. This study examined the feasibility of improving problem-solving skills in school children by means of a training programme that addresses general and specific abilities involved in problem solving, focusing on metacognition and working memory. The project involved a sample of 135 primary school children attending eight classes in the third, fourth, and fifth grades (age range 8-10 years). The classes were assigned to two groups, one attending the training programme in the first 3 months of the study (Training Group 1) and the other serving as a waiting-list control group (Training Group 2). In the second phase of the study, the role of the two groups was reversed, with Training Group 2 attending the training instead of Training Group 1. The training programme led to improvements in both metacognitive and working memory tasks, with positive-related effects on the ability to solve problems. The gains seen in Training Group 1 were also maintained at the second post-test (after 3 months). Specific activities focusing on metacognition and working memory may contribute to modifying arithmetical problem-solving performance in primary school children. © 2015 The British Psychological Society.

The recovery paradigm - a model of hope and change for alcohol and drug addiction.

Science.gov (United States)

Best, David W; Lubman, Dan I

2012-08-01

Alcohol and drug disorders remain major health and social problems in Australia, contributing enormously to the global burden of disease and the everyday practice of primary care. A recent growth in recovery research and recovery focused policies are starting to have an impact in Australia, with implications for how we attempt to resolve these problems. In this article we discuss recent international findings in recovery research, and explore their implications for primary care. Research indicates that over half of dependent substance users will eventually achieve stable recovery. Key predictors of recovery are active engagement in the community and immersion in peer support groups and activities. Recovery requires a twin track approach: enabling and supporting individual recovery journeys, while creating environmental conditions that enable and support a 'social contagion' of recovery, in which recovery is transmitted through supportive social networks and dedicated recovery groups, such as mutual aid.

[Are there any sex/gender differences in drug use and drug addiction?].

Science.gov (United States)

Mendrek, Adrianna

Drug use and drug addiction have been traditionally considered to be a male problem, however the gender gap has been decreasing over the past few decades. Thus, while the prevalence of alcohol, cannabis and nicotine dependence is still overall greater among men than among women, sex/gender differences in the abuse of stimulants and opiates seem to have disappeared. Moreover, women appear to be more prone to develop drug dependence, suffer more severe physical and psychological consequences of drug abuse, and have more difficulties quitting the habit. Numerous psychological, socio-cultural and biological factors have been implicated in these changing statistics. For example, while a large proportion of men initiate drug use to induce feelings of elation, energy or focus, women frequently start taking drugs to alleviate pre-existing mental health problems, including high levels of stress, feelings of alienation, depression, anxiety, or post-traumatic stress disorder. This maladaptive self-medication strategy often results in a faster transition to a habitual drug use and eventually a more severe dependence. In addition, the socio-cultural norms (particularly in the Western society) have changed dramatically over the past few decades. Thus, while there is still a more severe stigma and prejudice against women who use drugs (especially if they are pregnant of have children), overall there is much greater acceptance of women's drug use than it was several decades ago. Moreover, women have much greater access to various drugs of abuse than they used to have. Finally, over the past couple of decades new research started emerging pointing to some neurobiological factors that could also contribute to sex differences in drug addiction. Thus, there is now evidence that dopamine system, which for decades has been strongly implicated in drug reinforcement, is sexually dimorphic. The number of dopaminergic neurons, the density of the dopaminergic terminals, as well as

Drug-drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems.

Science.gov (United States)

Kumar, Santosh; Rao, P S S; Earla, Ravindra; Kumar, Anil

2015-03-01

Substance abuse is a common problem among HIV-infected individuals. Importantly, addictions as well as moderate use of alcohol, smoking, or other illicit drugs have been identified as major reasons for non-adherence to antiretroviral therapy (ART) among HIV patients. The literature also suggests a decrease in the response to ART among HIV patients who use these substances, leading to failure to achieve optimal virological response and increased disease progression. This review discusses the challenges with adherence to ART as well as observed drug interactions and known toxicities with major drugs of abuse, such as alcohol, smoking, methamphetamine, cocaine, marijuana, and opioids. The lack of adherence and drug interactions potentially lead to decreased efficacy of ART drugs and increased ART, and drugs of abuse-mediated toxicity. As CYP is the common pathway in metabolizing both ART and drugs of abuse, we discuss the possible involvement of CYP pathways in such drug interactions. We acknowledge that further studies focusing on common metabolic pathways involving CYP and advance research in this area would help to potentially develop novel/alternate interventions and drug dose/regimen adjustments to improve medication outcomes in HIV patients who consume drugs of abuse.

Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings.

Science.gov (United States)

van Engelenburg-van Lonkhuyzen, Marieke L; Bols, Esther M J; Benninga, Marc A; Verwijs, Wim A; de Bie, Rob A

2017-02-01

The aims of this study are to evaluate in a pragmatic cross-sectional study, the clinical characteristics of childhood bladder and/or bowel dysfunctions (CBBD) and locomotor problems in the primary through tertiary health care setting. It was hypothesized that problems would increase, going from primary to tertiary healthcare. Data were retrieved from patient-records of children (1-16 years) presenting with CBBD and visiting pelvic physiotherapists. Prevalence's of dysfunctions were compared between healthcare settings and gender using ANOVA and chi-square test. Agreement between physicians' diagnoses and parent-reported symptoms was evaluated (Cohen's Kappa). One thousand seventy hundred forty-eight children (mean age 7.7 years [SD 2.9], 48.9% boys) were included. Daytime urinary incontinence (P = 0.039) and enuresis (P physiotherapy are comparable in primary, secondary, and tertiary healthcare settings. • Concomitant CBBD appeared to be more prevalent than earlier reported. • Discrepancies exist between referring physicians' diagnoses and parent-reported symptoms.

Multi drug resistance tuberculosis: pattern seen in last 13 years

International Nuclear Information System (INIS)

Iqbal, R.; Shabbir, I.; Munir, K.; Tabassum, M.N.; Khan, S.U.; Khan, M.Z.U.

2011-01-01

Background: Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. Objectives: To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. Materials and Methods: The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines anti tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. Results: A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance was seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. Overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend of gradual increase of drug resistance. Conclusions Resistance to anti tuberculosis drugs is high. Policy message. TB Control Program should start 'DOTS Plus' schemes for which drug susceptibility testing facilities should be available for correctly managing the patients. (author)

Multi drug resistance tuberculosis: pattern seen in last 13 years

Energy Technology Data Exchange (ETDEWEB)

Iqbal, R; Shabbir, I; Munir, K [King Edward Medical University Hospital, Lahore (Pakistan). Dept. of Research Centre; Tabassum, M N; Khan, S U; Khan, M Z.U. [King Edward Medical University Hospital, Lahore (Pakistan). Dept. of Chest Medicine

2011-01-15

Background: Drug resistance in tuberculosis is a serious problem throughout the world especially, after the emergence of multi drug resistant TB strains. Objectives: To estimate drug resistance in TB patients and compare it with previous studies to see the changing trends. Materials and Methods: The PMRC Research Centre receives sputum samples from all the leading hospitals of Lahore. This retrospective analysis was done from 1996 to 2008 on the multi drug resistant TB strains that were seen during these years. Five first lines anti tuberculosis drugs were tested on Lowenstein Jensen medium using standard proportion method. Results: A total of 2661 confirmed isolates of Mycobacterium tuberculosis were seen over the past 13 years. Of the total, 2182 were pulmonary and 479 were extra pulmonary specimens. The patients comprised of those with and without history of previous treatment. These specimens were subjected to drug susceptibility testing. Almost half of the patient had some resistance; multiple drug resistance was seen in 12.3% and 23.0% cases without and with history of previous treatment respectively. Overall resistance to rifampicin was 26.4%, isoniazid 24.1% streptomycin 21.6% ethambutol 13.4% and pyrazinamide 28.4% respectively. Statistically significant difference was seen between primary and acquired resistance. When compared with the reports from previous studies from the same area, there was a trend of gradual increase of drug resistance. Conclusions Resistance to anti tuberculosis drugs is high. Policy message. TB Control Program should start 'DOTS Plus' schemes for which drug susceptibility testing facilities should be available for correctly managing the patients. (author)

Comparison of drug abuse in Germany and China.

Science.gov (United States)

Michels, Ingo Ilja; Fang, Yu-Xia; Zhao, Dong; Zhao, Li-Yan; Lu, Lin

2007-10-01

Drug abuse has a long, but also different history in Germany and China. The Opium War largely influenced the history of China in 19th century; however, China was once recognized as a drug-free nation for 3 decades from the 1950s to the 1980s. Drug abuse has spread quickly since re-emerging as a national problem in China in the late 1980s. The number of registered drug abusers increased from 70 000 in 1990 to more than 1 million by the end of 2005. In past decades, illicit drug trafficking and production have swept most provinces in China, and drug abuse has caused many problems for both abusers and the community. One major drug-related problem is the spread of HIV, which has caused major social and economic damage in China. Germany, the largest developed European country, also faces the drug and addiction problem. Germany has about 150 000 heroin addicts, for whom HIV/AIDS has become a serious threat since the mid 1980s. To control the drug problem, the German Government adopted the pAction Plan on Drugs and Addictionq in 2003; the China Central Government approved a similar regulation in the antidrug campaign in 2005. Germany has experience in reducing drug-related harm. The methadone maintenance treatment (MMT) program has run for more than 20 years and the public has become more tolerant of addicts. In 2003, China began the MMT program for controlling the spread of HIV/AIDS. It is necessary for China to learn from developed countries to acquire success in its antidrug campaign. In this review, we will go over the differences and similarities in drug abuse between Germany and China. The differences are related to history, population and economics, drug policy context, drug laws, HIV/hepatitis C virus infection, the MMT program and so on. These 2 nations have drug abuse problems with different histories and currently use different approaches to handle illicit drug marketing and use. The legal penalties for illicit drug offences reflect the social differences of

Drug Poisoning Deaths according to Ethnicity in Utah

Directory of Open Access Journals (Sweden)

Ray M. Merrill

2013-01-01

Full Text Available This study characterizes drug-related deaths according to ethnicity in Utah during 2005–2010, based on data from the Utah Violent Death Reporting System (UTVDRS. Hispanics made up 12.1% (12.5% male and 11.7% female of deaths. The most frequently identified drugs among decedents were opiates, then illicit drugs, benzodiazepines, over-the-counter medication, and antidepressants. Death rates for each drug were significantly greater in non-Hispanics than Hispanics. Most decedents used a combination of drugs. For each combination, rates were significantly greater for non-Hispanics than Hispanics, with an exception for opiates and illicit drugs combined, where there was no significant difference. Approximately 79% of non-Hispanics and 65% of Hispanics had one or more of the selected problems (e.g., mental, physical, or crisis related. Rates for each combination of problems were significantly greater in non-Hispanics, with the exception of crisis. Hispanics were less affected by the rise in prescription drug abuse. Hispanic decedents had a greater proportion of illegal drugs, consistent with it being more difficult to obtain prescription drugs. Hispanic decedents were less likely to have physical and mental health problems, which may be related to a smaller chance of diagnosis of such problems through the healthcare system.

In Connecticut: improving patient medication management in primary care.

Science.gov (United States)

Smith, Marie; Giuliano, Margherita R; Starkowski, Michael P

2011-04-01

Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medication management services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.

76 FR 59495 - Presidential Determination on Major Illicit Drug Transit or Major Illicit Drug Producing...

Science.gov (United States)

2011-09-26

... Belize are increasingly concerned about the presence of drug trafficking organizations, including Los... shows continued strengthening of illegal drug trafficking ties between South America and West Africa... dialogue with Canada to reduce the shared problem of illegal drug trafficking. The results of this...

[Cost]effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study)

NARCIS (Netherlands)

Hartholt, K.A.; van der Velde, N.; van Lieshout, E.M.M.; Polinder, S.; de Vries, O.J.; Boyé, N.D.A.; Kerver, A.J.H.; Ziere, G.; Bruijninckx, M.M.M.; de Vries, M.R.; Mattace-Raso, F.U.S.; Uitterlinden, A.G.; van Beeck, E.F.; Lips, P.T.A.M.; Patka, P.; van der Cammen, T.J.

2011-01-01

Background: Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of

Acute health problems due to recreational drug use in patients presenting to an urban emergency department in Switzerland.

Science.gov (United States)

Liakoni, Evangelia; Dolder, Patrick C; Rentsch, Katharina; Liechti, Matthias E

2015-01-01

To describe acute toxicity of recreational drugs including novel psychoactive substances. We included all cases presenting at the emergency department (ED) of the University Hospital of Basel, Switzerland, between October 2013 and September 2014 with acute toxicity due to self-reported recreational drug use or with symptoms/signs consistent with acute toxicity. Isolated ethanol intoxications were excluded. Intoxications were confirmed with immunoassays and liquid chromatography coupled with mass spectrometry (LC-MS/MS), which also detected novel psychoactive substances. Among the 47,767 attendances at the ED, 216 were directly related to acute toxicity of recreational drugs. The mean patient age was 31 years and 69% were male. Analytical drug confirmation was available in 180 cases. Most presentations were related to cocaine (36%), cannabis (31%), opioids (13%), 3,4-methylenedioxy-methamphetamine (MDMA, 9%), other amphetamines (7%), benzodiazepines (7%), and lysergic acid diethylamide (LSD, 5%). The substances most commonly detected analytically were cannabis (37%), cocaine (33%), opioids (29%), benzodiazepines (21%), and amphetamines including MDMA (13%). Notably, there were only two cases of novel psychoactive substances (2,5-dimethoxy-4-bromophenethylamine [2C-B] and pentylone). The most frequent symptoms were tachycardia (31%), anxiety (27%), nausea or vomiting (23%), and agitation (22%). Severe complications included myocardial infarction (2), psychosis (10), seizures (10), and 1 fatality. Most patients were discharged home (68%), 8% were admitted to intensive care and 9% were referred to psychiatric care. Medical problems related to illicit drugs mostly concerned cocaine and cannabis and mainly involved sympathomimetic toxicity and/or psychiatric disorders. ED presentations associated with novel psychoactive substances appeared to be relatively rare.

Dual diagnosis: co-existence of drug, alcohol and mental health problems.

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Manley, David

The Department of Health (DoH) published a set of good practice implementation guidelines on dual diagnosis in May 2002. This guidance suggests that in order to improve the prognosis for clients who have mental health problems and who drink or take drugs problematically, mental health and substance misuse services should adopt an integrated service model. There is a considerable amount of American-based research supporting this approach, but little evidence from the UK researchers demonstrating its application in the UK. This article offers an example of a service that has been developed in the city of Nottingham and argues that this client group will be served most effectively if mental health services support specialist dual-diagnosis resources. Integrated care pathways for this client group can be developed and led by specialist clinicians acting as consultants to mental health services (DoH, 2002a). This consultancy role within mental health services enhances the links needed between substance misuse and mental health services. As a result, specialist dual-diagnosis teams are best placed to increase positive prognoses for clients by ensuring evidence-based substance misuse skills are utilized and adapted by mental health teams to ensure fully integrated care coordination.

Prognosis and continuity of child mental health problems from preschool to primary school: results of a four-year longitudinal study.

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Beyer, Thomas; Postert, Christian; Müller, Jörg M; Furniss, Tilman

2012-08-01

In a four-year longitudinal study, changes in and continuity of behavioral and emotional problems were examined in 814 subjects from kindergarten to primary school. Mental health problems were assessed by means of the Child Behavior Checklist (CBCL). The distribution of the CBCL broadband groups revealed a high level of continuity of internalizing symptoms over the four-year period and a shift from externalizing symptoms at baseline towards a combination of internalizing and externalizing symptoms at follow-up. The presence of mental health problems at follow-up was correlated with gender (higher amongst boys), pre-existing mental health problems at baseline, and separation or divorce of the parents, but not with single-family status or the age and educational level of the mother. The increasing number of children with a combination of internalizing and externalizing symptoms demonstrates the increasing complexity of child mental health problems in the developmental span from preschool age to school age.

Non-steroidal Anti-inflammatory Drugs (NSAIDs) Use in Primary Health Care Centers in A'Seeb, Muscat: A Clinical Audit.

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Al-Shidhani, Asma; Al-Rawahi, Naama; Al-Rawahi, Abdulhakeem

2015-09-01

We sought to assess the trend of non-steroidal anti-inflammatory drug (NSAID) use in primary health care institutions located in A'Seeb, a province in the capital city of Oman, Muscat. Additionally, we evaluated the relationship between a physician's years of experience and the number of prescription issued, as well as the presence of risk factors and side effects in the patients who received these prescriptions. A clinical audit was conducted in four primary health care centers in the Muscat region over a one-week period in April 2014. The target population included patients aged 18 years or over who attended one of the four health centers and were prescribed NSAIDs. Overall, 272 patients were recruited by systematic random sampling. The data were collected by two methods: direct face-to-face interviews and evaluations of the patient's electronic medical file. The prescribing doctors were blind to the audit. The collected information included patients demographics, past and current medical history of related comorbidities, NSAID type, dose, duration and indications for use, concomitant warfarin or/and aspirin prescriptions, and co-prescription of gastroprotective agents. In total, 15% of patients received an NSAID prescription: females were issued more prescriptions than males. The percentage of patients who received an NSAID prescription across the health centers ranged from 9% to 24%. The main reason for prescribing NSAIDs was musculoskeletal problems. The most frequently prescribed NSAID was ibuprofen. Sixteen percent of patients who received an NSAID prescription had a risk factor related to its use. The mean and median duration of the NSAID prescriptions of all types were 5.6 and 5.0 days, respectively. Physicians with a greater number of years experience prescribed more NSAIDs. Our study showed that the number of prescriptions of NSAIDs among various institutes varied, which could reflect the level of awareness concerning NSAID risks among the prescribing

Calculation and Word Problem-Solving Skills in Primary Grades--Impact of Cognitive Abilities and Longitudinal Interrelations with Task-persistent Behaviour

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Jõgi, Anna-Liisa; Kikas, Eve

2016-01-01

Background: Primary school math skills form a basis for academic success down the road. Different math skills have different antecedents and there is a reason to believe that more complex math tasks require better self-regulation. Aims: The study aimed to investigate longitudinal interrelations of calculation and problem-solving skills, and…

Human Drug Discrimination: Elucidating the Neuropharmacology of Commonly Abused Illicit Drugs.

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Bolin, B Levi; Alcorn, Joseph L; Reynolds, Anna R; Lile, Joshua A; Stoops, William W; Rush, Craig R

2016-06-07

Drug-discrimination procedures empirically evaluate the control that internal drug states have over behavior. They provide a highly selective method to investigate the neuropharmacological underpinnings of the interoceptive effects of drugs in vivo. As a result, drug discrimination has been one of the most widely used assays in the field of behavioral pharmacology. Drug-discrimination procedures have been adapted for use with humans and are conceptually similar to preclinical drug-discrimination techniques in that a behavior is differentially reinforced contingent on the presence or absence of a specific interoceptive drug stimulus. This chapter provides a basic overview of human drug-discrimination procedures and reviews the extant literature concerning the use of these procedures to elucidate the underlying neuropharmacological mechanisms of commonly abused illicit drugs (i.e., stimulants, opioids, and cannabis) in humans. This chapter is not intended to review every available study that used drug-discrimination procedures in humans. Instead, when possible, exemplary studies that used a stimulant, opioid, or Δ 9 -tetrahydrocannabinol (the primary psychoactive constituent of cannabis) to assess the discriminative-stimulus effects of drugs in humans are reviewed for illustrative purposes. We conclude by commenting on the current state and future of human drug-discrimination research.

Topicality of the problem of combined course of multi-drug resistant pulmonary tuberculosis with diabetes mellitus

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O. M. Raznatovska

2017-08-01

Full Text Available According to the World Health Organization, today in the world among the infectious chronic diseases one of the leading places and causes of death is multi-drug resistant tuberculosis of the lungs, and chronic non-communicable diseases – diabetes mellitus. The situation is complicated by the fact that the number of patients with combined course of these two heavy separate illnesses that complicate each other increases. It is established that with increasing severity of diabetes mellitus, tuberculosis process in the lungs becomes more complicate and deteriorates, and vice versa, the specific process complicates the course of diabetes mellitus, contributing to the development of diabetic complications. Against this background, the effectiveness of treatment of patients suffering from multi-drug resistant tuberculosis of the lungs in our country remains very low, mainly due to the toxic adverse reactions to antimycobacterial drugs of the reserve line, and in the case of adding diabetes mellitus, it deteriorates even more. The aim of this study was to review the scientific literature to determine the relevance of the study of combined course of multi-drug resistant tuberculosis of the lungs with diabetes mellitus and perspectives of innovative methods of diagnosis of diabetes mellitus. Early diagnosis of pre-diabetes, and autoimmune diseases will allow the use of timely correction techniques that prevents the development of diabetes mellitus, depending on its type, and in the future the development of serious irreversible processes, allow timely applying appropriate methods of correction of the revealed violations. Results. Very little amount of work is dedicated to the problem of combined course of multi-drug resistant tuberculosis of the lungs with diabetes mellitus, regardless of its type, the theme is relevant for today, in Ukraine there are no data regarding its study. This combined course of very difficult in the treatment diseases requires

Analytical challenges in drug counterfeiting and falsification-The NMR approach.

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Holzgrabe, Ulrike; Malet-Martino, Myriam

2011-06-25

Counterfeiting of products is a global problem. As long as clothes, clocks, leather wear, etc. are faked there is no danger, but when it comes to drugs, counterfeiting can be life-threatening. In the last years sub-standard active pharmaceutical ingredients (APIs) were found more often even though the use of the quality-ensuring methods of international pharmacopoeias should have detected additional impurities and the low content of the API. Methods orthogonal to the separating methods used in the pharmacopoeias are necessary to find counterfeits. Beside Raman and NIR spectroscopies as well as powder X-ray analysis, NMR spectroscopy being a primary ratio method of measurement is highly suitable to identify and quantify a drug and its related substances as well as to recognize a drug of sub-standard quality. DOSY experiments are suitable to identify the ingredients of formulations and therefore to identify wrong and/or additional ingredients. This review gives an overview of the application of quantitative NMR spectroscopy and DOSY NMR in anticounterfeiting. Copyright © 2010 Elsevier B.V. All rights reserved.

[Representations of Care of Migrants from the former Soviet Union with Alcohol or Drug Problems in Germany].

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Röhnsch, Gundula; Flick, Uwe

2015-10-01

Which representations of care can be found in migrants with alcohol or drug problems from the former Soviet Union? How do they correspond with views in the care system? Episodic interviews with 46 migrants, expert interviews with 33 service providers; analysis with thematic coding. For migrants and experts holistic care is important, which include spiritual-religious components but are also control-oriented. The cultural specificity of migrants' care representations should be acknowledged by the health care system much more. © Georg Thieme Verlag KG Stuttgart · New York.

A Review of Economic Behaviour of Drug Consumers

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Shahrzad Borumand

2003-11-01

Full Text Available Illicit drug problem is one of the most worrying issues of the presenet century in all countries and anti-drug addiction programs are included in the agenda of all governments and international community. Drug abuse/addiction in Iran has been one of the most important social and economical problems for several years and the number and percentage of drug users/addicts are growing. Campaign against this phenomenon needs in-depth recognition of all aspects (economic, social and political of this problem. So, such programs will be successful in fighting against illicit drugs and drug addiction if they are developed and implemented through a realistic recognition. One can not hope the success of anti-drug programs if they are not planned on the basis of researches. Therefore, reviewing the economical aspect of illicit drugs via usrers’ viewpoints will help to undrestand illicit drug addiction phenomenon. In this article, the behaviour of drug usres is studied on the basis of micro-economic traditional assumptions. The relation between deman and prices of illicit drugs, the relation between tendency to drug consumption and the amount of drug consumption and the relaion between drug consumption and criminal acts are among the discussed issues of this article. Finally, a summary of the situation of illicit drug consumption is presented.