New Zealand community pharmacist attitudes toward opioid-dependent clients

Aim: To survey New Zealand community pharmacists to explore levels of training, attitudes towards providing services for drug users, and associations with current and past practice.

Methods: Postal survey of 898 randomly selected community pharmacists. Questions included demography, training and a 20-question attitude scale. Principle component analysis was conducted to identify the main attitude factors. Multiple linear regressions were used to model the effect of different independent variables on the factors.

Findings: Twenty-six percent of respondents had previously undertaken training about the management of opioid misuse. Four principal factors explained 57% of the variance within the attitude questions. These were attitudes towards: 'the general results of dispensing methadone to opioid misusers'; 'the effect of opioid-dependent clients on a pharmacy'; 'reducing harm associated with drug use'; and 'engaging with drug users'. Training (having it or wanting to have it) was positively associated with the four attitude factors.

Conclusions: The results of this study indicate that attitudes towards various aspects of service provision to drug misusers may not be as simple as previously perceived.     

Describing safe motherhood programs for priority setting: the case of Burkina Faso.

OBJECTIVE: This study was implemented to describe safe motherhood programs in Burkina Faso for planning and programming purposes. METHODS: Twenty safe motherhood programs were described from November 2003 through May 2004 using a structured questionnaire, interviews with safe motherhood program managers and document reviews. RESULTS: Only 2 of the 20 programs were designed to improve the availability of comprehensive emergency obstetric care, and only 2 comprehensively addressed all components of skilled attendance at delivery. Other gaps identified included poor availability of baseline data, few monitoring measures, and lack of planning for evaluation needs. National geographical coverage was also uneven. CONCLUSION: A systematic overview of safe motherhood programs in a country can help to set priorities and aid in decision making for the allocation of resources towards contextually relevant strategies to curtail maternal mortality and severe morbidity. Planning for program design and evaluation may also be aided by such a process.     

儿童哮喘系统管理68例报告

目的探讨应用全球哮喘防治创议（GINA）管理儿童哮喘的效果.方法对确诊为哮喘的68例管理组患儿实行专科病案管理、门诊治疗及定期防治知识学习班学习,以问卷调查、检测肺功能的最大呼气流速（PEF）评定疗效.结果管理组患儿在学习班前、后对10项知识问卷的认识差异有非常显著性意义（P＜0.01）;对吸药技术的掌握,经3～4次指导后正确使用率由11.00%上升至74.00%～94.00%;管理组在治疗后1个月和6个月时PEF＞80%的率与对照组间差异有显著性意义（P＜0.01）.结论有效的哮喘防治知识学习班是增加治疗依从性的必要形式,正确使用吸药装置、用峰流速仪监测PEF是保障疗效的重要环节.采用医院与家庭相结合的管理是长期控制儿童哮喘行之有效的模式.     

中医药重大科技项目计划制定:以"名老中医学术思想、经验传承研究"为例

在"十五"国家科技攻关计划"名老中医学术思想、经验传承研究"课题管理实践中引入项目管理知识体系指南(PMBOK)中的项同进度计划技术,在课题范围计划的基础上,根据中医药特色和课题特点探索制订了本课题的进度计划.该进度计划对做好课题顶层设计、保障研究工作顺利实施起到了重要支撑作用.     

Assessing the Health Attitudes, Beliefs, and Behaviors of African Americans Attending Church: A Comparison from Two Communities

Public health officials and researchers continue to be increasingly concerned about the health of populations of color, especially African Americans. A survey was administered in African American churches in two communities (Wichita, KS and Tuscaloosa, AL) to gather information concerning health behaviors and beliefs and to design interventions that might improve their health status. The study examined the homogeneity of attitudes, beliefs, and behaviors across these samples and to determine the readiness to change using the Transtheoritical Model. Individuals completed a 33-item survey: 6 demographic questions, 12 health behavior questions, 8 health belief questions, 3 church attendance questions, and 4 church-based health promotion program questions. The total sample consisted of 429 respondents. The results showed that 93% of respondents have had their blood pressure checked in the past 2 years. While only 44% indicated eating a high fiber diet during the week. Thirty percent of respondents indicated that their health was dependent on fate or destiny. The findings from this study confirm that among both samples that health attitudes, beliefs, and behaviors need to be changed to lower the risk of certain diseases and disorders. The findings also indicate that both samples have similar beliefs about health that may have important implications for disseminating information to the community. Innovative and culturally sensitive programs are needed in the African American community if disparities in health are to diminish.     

Effective psychosocial treatments for children: A selected review

A number of recent professional developments are having an increasing impact on the provision of social work mental health services to children. Among these developments are the emergence of practice guidelines by the federal government and the disciplines of psychology and psychology, the growing body of empirical research evidence documenting the efficacy of selected psychosocial interventions, and the impact of managed care programs. Citing the right of child clients to receive demonstrably effective social work treatments, the author reviews some disorders for which credible research evidence exists pertaining to how to alleviate them. The article suggests these developments possess the potential to positively impact the delivery of social work services to children, at some cost in terms of professional autonomy.     

Training health workers for primary care in a developing health service

To provide primary health care in a thinly populated mountainous country with few doctors presents great difficulties. The Royal Government of Bhutan decided to base their primary medical care service on appropriately trained medical auxilliaries. The training programme is described, and the problems of assessing the field activities discussed.     

NUTRITIONAL SIGNIFICANCE OF LACTOSE INTOLERANCE

Milk supplementation of school children showing a high prevalence of lactose intolerance as usually defined has no untoward nutritional effects.     

Antimicrobial drug prescribing for pneumonia in ambulatory care

To determine patterns and predictors of antimicrobial drug use for outpatients with community-acquired pneumonia, we examined office visit and pharmacy claims data of 4 large third-party payer organizations from 2000 to 2002. After patients with coexisting conditions were excluded, 4,538 patients were studied. Despite lack of coexisting conditions, fluoroquinolone use was commonly observed and increased significantly (p < 0.001) from 2000 to 2002 (24%-39%), while macrolide use decreased (55%-44%). Increased age correlated with increased fluoroquinolone use: 18-44 years (22%), 45-64 years (33%), and > or =65 years (40%) (p < 0.001). Increased use of fluoroquinolones occurred in healthy young and old patients alike, which suggests a lack of selectivity in reserving fluoroquinolones for higher risk patients. Clear and consistent guidelines are needed to address the role of fluoroquinolones in treatment of outpatient community-acquired pneumonia.     

Adherence to hepatitis B virus vaccination at syringe exchange sites

Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. ‘IDUs who use mobile health care services linked to a syring exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core antibodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, homeless, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR=1.06, 95% CI=1.04–1.07). injecting daily (OR=2.12,95% CI=1.36–6.73), and being homeless (OR=1.98,95% CI=1.14–12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.