Comparing performance among male and female candidates in sex-specific clinical knowledge in the MRCGP

Background

Patients often seek doctors of the same sex, particularly for sex-specific complaints and also because of a perception that doctors have greater knowledge of complaints relating to their own sex. Few studies have investigated differences in knowledge by sex of candidate on sex-specific questions in medical examinations.

Aim

The aim was to compare the performance of males and females in sex-specific questions in a 200-item computer-based applied knowledge test for licensing UK GPs.

Design and setting

A cross-sectional design using routinely collected performance and demographic data from the first three versions of the Applied Knowledge Test, MRCGP, UK.

Method

Questions were classified as female specific, male specific, or sex neutral. The performance of males and females was analysed using multiple analysis of covariance after adjusting for sex-neutral score and demographic confounders.

Results

Data were included from 3627 candidates. After adjusting for sex-neutral score, age, time since qualification, year of speciality training, ethnicity, and country of primary medical qualification, there were differences in performance in sex-specific questions. Males performed worse than females on female-specific questions (–4.2%, 95% confidence interval [CI] = –5.7 to –2.6) but did not perform significantly better than females on male-specific questions (0.3%, 95% CI = –2.6 to 3.2%.

Conclusion

There was evidence of better performance by females in female-specific questions but this was small relative to the size of the test. Differential performance of males and females in sex-specific questions in a licensing examination may have implications for vocational and post-qualification general practice training.     

Evaluating the clinical teaching of medical imaging students at Curtin University of Technology, Australia

Purpose:

To ascertain the effectiveness of the clinical, tutorial-based component of teaching and the clinical assessment method in the Bachelor of Medical Imaging Science at Curtin University of Technology (CUT), Perth, Western Australia.

Materials and Methods:

In mid-2006, second- and third-year students enrolled in CUT’s Medical Imaging Science degree were asked to complete a questionnaire assessing the Objective Structured Clinical Examination (OSCE) evaluation program and clinical teaching. Thirty-three of 57 students answered questions about demographics and their opinions of the laboratory sessions, clinical placements and the OSCEs.

Results:

Seventy-six per cent of students were satisfied with their laboratory sessions and clinical placements. Sixty-four percent of respondents indicated that the OSCE was not an objective evaluation, but 82% of students felt the OSCE was an effective test of their radiography skills and knowledge, and believed that they were able to evaluate and care for a patient during the OSCE.

Conclusion:

Overall, the surveyed students believed that the practical skills explored in laboratory sessions helped improve clinical training outcomes; however, only 33% of the students were satisfied that the OSCE was an appropriate assessment of their clinical training in hospitals.     

Performance and views of examiners in the Applied Knowledge Test for the nMRCGP licensing examination

Background

A new computer-based Applied Knowledge Test (AKT) has been developed for the licensing examination for general practice administered by the Royal College of General Practitioners.

Aim

The aim of this evaluation was to assess the acceptability, feasibility, and validity of the test as well as its transfer to a computerised format at local test centres.

Design of study

Computer-based test and postal questionnaire.

Participants and setting

Panel of examiners, Membership of the Royal College of General Practitioners (MRCGP) examination, UK.

Method

Self-administered postal questionnaires were sent to examiners not involved with the development of the test after completing it. Their performance scores were compared with those of candidates.

Results

The majority of participants (80.9%) were satisfied with the new computer-based test. Responses relating to content and attitudes to the test were also positive overall, but some problems with content were highlighted. Fewer examiners (61.9%) were positive about the physical comfort of the test centre, including seating, heating, and lighting. Examiners had significantly higher scores (mean 83.3%, range 69 to 93%, 95% confidence interval [CI] = 81.9 to 84.7%) than ‘real’ candidates (mean 75.0%, range 45 to 94%, 95% CI = 74.6 to 75.5%), who subsequently took an identical test.

Conclusion

The new computer-based licensing test (the AKT) was found to be acceptable to the majority of examiners. The pass–fail standard, determined by routine methods including an Angoff procedure, was supported by the higher success rate of examiners compared with candidates. The use of selected groups to assess high-stakes (licensing) examinations can be useful for assessing test validity.     

Developing a curriculum statement based on clinical practice: genetics in primary care

Background

Advances in medical genetics are increasingly being incorporated into clinical management outside specialist genetic services. This study was therefore undertaken to develop learning outcomes in genetics for general practice specialty training, using methods to ensure the knowledge, skills, and attitudes relevant to genetics in primary care were identified.

Aim

To identify key knowledge, skills, and attitudes in genetics and to synthesise these into learning outcomes to assist training in genetics for primary care.

Design of study

Delphi survey and review by expert group.

Setting

Primary care practices and Regional Genetics Centre in the West Midlands region of the UK.

Method

A modified Delphi survey involved GP trainers, programme directors, and geneticists (n = 60). The results, along with results from a survey of GP registrars, were reviewed by an expert group, which included GPs, geneticists, and educationalists.

Results

Core genetics topics for GPs were identified, prioritised, and developed into competency statements in the style of the curriculum structure of the Royal College of General Practitioners.

Conclusion

The development of the GP curriculum statement Genetics in Primary Care was based on a study of educational needs, incorporating the views of practitioners (GP trainers, programme directors, and registrars) and specialists (clinical geneticists). This inclusive approach has enabled the identification of learning outcomes which directly reflect clinical practice.     

Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice

Background

Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing.

Aim

To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing.

Design and setting

A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group.

Method

Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on prescribing. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis.

Results

Registrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor.

Conclusion

Understanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future.     

National collegiate athletic association division and primary job title of athletic trainers and their job satisfaction or intention to leave athletic training

Context:

Membership in the National Athletic Trainers'' Association (NATA) has declined in recent years, generating much debate about professional commitment.

Objective:

To compare the contributing factors of job satisfaction and intention to leave athletic training of certified athletic trainers (ATs) employed in National Collegiate Athletic Association (NCAA) institutions.

Design:

Cross-sectional study.

Setting:

A link to a Web-based questionnaire containing the Spector Job Satisfaction Survey (JSS) and an original Intention to Leave Survey (ITLS) was distributed by e-mail to 1003 certified members of the National Athletic Trainers'' Association.

Patients or Other Participants:

A total of 191 certified members of the NATA employed in a college or university setting in a primarily clinical capacity; representing all NCAA divisions; and having the job title of head athletic trainer, associate/assistant athletic trainer, or graduate assistant/intern athletic trainer.

Main Outcome Measure(s):

We used separate 3 × 3 factorial analyses of variance to compare the mean scores of each JSS subscale and of the ITLS with NCAA division and job title. A stepwise multiple regression was used to determine the strength of the relationships between the JSS subscales and the ITLS.

Results:

We found differences for job title in the subscales of Fringe Benefits (F_2,182 = 7.82, P = .001) and Operating Conditions (F_2,182 = 12.01, P < .001). The JSS subscale Nature of Work was the greatest indicator of intention to leave (β = −0.45).

Conclusions:

We found a strong negative correlation between various facets of job satisfaction and intention to leave athletic training. The NCAA division seemed to have no effect on an individual''s job satisfaction or intention to leave the profession. In addition, only Fringe Benefits and Operating Conditions seemed to be affected by job title. The ATs had similar levels of job satisfaction regardless of NCAA division, and their job titles were not a major factor in job satisfaction.     

Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs

Background

Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice.

Aim

To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice.

Design and setting

An appropriateness ratings evaluation in UK general practice.

Method

Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method.

Results

Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other.

Conclusion

NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography.     

Recently Certified Athletic Trainers' Undergraduate Educational Preparation in Psychosocial Intervention and Referral

Context:

“Psychosocial Intervention and Referral” is one of the 12 content areas established by the National Athletic Trainers'' Association Education Council and is required to be taught in athletic training education programs (ATEPs). The perceived preparation of athletic trainers (ATs) in this content area has not been evaluated.

Objective:

To explore the preparation level of recently certified ATs within the content area of “Psychosocial Intervention and Referral.”

Design:

Qualitative design involving semistructured, in-depth, focus group interviews.

Setting:

Interviews were conducted at 2 National Collegiate Athletic Association Division I institutions in 2 regions of the United States.

Patients or Other Participants:

A total of 11 recently certified ATs who met predetermined criteria were recruited. The ATs represented a range of undergraduate ATEPs and current employment settings.

Data Collection and Analysis:

Focus group interviews were transcribed verbatim and analyzed deductively. Peer debriefing and member checks were used to ensure trustworthiness.

Results:

The ATEPs are doing an adequate job of preparing ATs for many common communication and interpersonal issues, but ATs report being underprepared to deal with athlete-related issues in the areas of motivation and adherence, counseling and social support, mental skills training, and psychosocial referral.

Conclusions:

Limitations of undergraduate ATEPs regarding preparation of athletic training students within the “Psychosocial Intervention and Referral” content area were identified, with the goal of improving athletic training education. The more we know about the issues that entry-level ATs face, the more effectively we can structure athletic training education.     

A Comparison of Whole-Body Vibration and Resistance Training on Total Work in the Rotator Cuff

Context:

Whole-body vibration machines are a relatively new technology being implemented in the athletic setting. Numerous authors have examined the proposed physiologic mechanisms of vibration therapy and performance outcomes. Changes have mainly been observed in the lower extremity after individual exercises, with minimal attention to the upper extremity and resistance training programs.

Objective:

To examine the effects of a novel vibration intervention directed at the upper extremity as a precursor to a supervised, multijoint dynamic resistance training program.

Design:

Randomized controlled trial.

Setting:

National Collegiate Athletic Association Division IA institution.

Patients or Other Participants:

Thirteen female student-athletes were divided into the following 2 treatment groups: (1) whole-body vibration and resistance training or (2) resistance training only.

Intervention(s):

Participants in the vibration and resistance training group used an experimental vibration protocol of 2 × 60 seconds at 4 mm and 50 Hz, in a modified push-up position, 3 times per week for 10 weeks, just before their supervised resistance training session.

Main Outcome Measure(s):

Isokinetic total work measurements of the rotator cuff were collected at baseline and at week 5 and week 10.

Results:

No differences were found between the treatment groups (P > .05). However, rotator cuff output across time increased in both groups (P < .05).

Conclusions:

Although findings did not differ between the groups, the use of whole-body vibration as a precursor to multijoint exercises warrants further investigation because of the current lack of literature on the topic. Our results indicate that indirectly strengthening the rotator cuff using a multijoint dynamic resistance training program is possible.     

Two Modes of Weight Training Programs and Patellar Stabilization

Context:

Underconditioned patellar stabilizing muscles could be a predisposing factor for patellar instability.

Objective:

To examine the effect of 2 modes of weight training on the size of the vastus medialis obliquus (VMO), the resting position and passive mobility of the patella, and the strength of the knee extensor muscles.

Design:

Prospective intervention, repeated measures in 3 groups.

Setting:

Orthopaedic and sports sciences research laboratory.

Patients or Other Participants:

48 healthy adults free from back and lower extremity injuries.

Intervention(s):

Participants were randomly assigned to muscle hypertrophy training, muscle strength training, or the control group. Those in the training groups pursued training 3 times per week for 8 weeks.

Main Outcome Measure(s):

Magnetic resonance imaging and ultrasound cross-sectional area of the VMO, patellar tilt angle on magnetic resonance imaging, instrumented passive patellar mobility, and isometric knee extension torque of the dominant leg.

Results:

Participants in both training groups had comparable gains in VMO size, passive patellar stability, and knee extension force, all of which were greater than for the control group (P < .05).

Conclusions:

Both short-term muscle hypertrophy and strength training programs can reinforce the patellar stabilizers in previously untrained volunteers.     

Partograph utilization and associated factors among obstetric care providers in North Shoa Zone,Central Ethiopia: a cross sectional study

Background

Globally, prolonged and obstructed labor contributed to 8% of maternal deaths which can be reduced by proper utilization of partograph during labor.

Methods

An Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care providers. A pre-tested and structured questionnaire was used to collect data. Data was entered to EpiInfo version 3.5.1 statistical package and exported to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables.

Results

Out of 403 obstetric care providers, 40.2% utilized partograph during labor.Those who were midwives by profession were about 8 times more likely to have a consistent utilization of the partograph than general practitioners (AOR=8. 13, 95% CI: 2.67, 24.78). Similarly, getting on job training (AOR=2. 86, 95% CI: 1.69, 4.86), being knowledgeable on partograph (AOR=3. 79, 95% CI: 2.05, 7.03) and having favorable attitude towards partograph (AOR=2. 35, 95% CI: 1.14, 4.87) were positively associated with partograph utilization.

Conclusion

Partograph utilization in labor monitoring was found to be low. Being a midwife by profession, on job training, knowledge and attitude of obstetric care providers were factors affecting partograph utilization. Providing on job training for providers would improve partograph utilization.     

Balance Training for Neuromuscular Control and Performance Enhancement: A Systematic Review

Objective:

As a result of inconsistencies in reported findings, controversy exists regarding the effectiveness of balance training for improving functional performance and neuromuscular control. Thus, its practical benefit in athletic training remains inconclusive. Our objective was to evaluate the effectiveness of training interventions in enhancing neuromuscular control and functional performance.

Data Sources:

Two independent reviewers performed a literature search in Cochrane Bone, Joint and Muscle Trauma Group Register and Cochrane Controlled Trials Register, MEDLINE, EMBASE, PEDro (Physiotherapy Evidence Database), and SCOPUS.

Study Selection:

Randomized controlled trials and controlled trials without randomization with healthy and physically active participants aged up to 40 years old were considered for inclusion. Outcomes of interest were postural control, muscle strength, agility, jump performance, sprint performance, muscle reflex activity, rate of force development, reaction time, and electromyography.

Data Extraction:

Data of interest were methodologic assessment, training intervention, outcome, timing of the outcome assessment, and results. Standardized mean differences and 95% confidence intervals were calculated when data were sufficient.

Data Synthesis:

In total, 20 randomized clinical trials met the inclusion criteria. Balance training was effective in improving postural sway and functional balance when compared with untrained control participants. Larger effect sizes were shown for training programs of longer duration. Although controversial findings were reported for jumping performance, agility, and neuromuscular control, there are indications for the effectiveness of balance training in these outcomes. When compared with plyometric or strength training, conflicting results or no effects of balance training were reported for strength improvements and changes in sprint performance.

Conclusions:

We conclude that balance training can be effective for postural and neuromuscular control improvements. However, as a result of the low methodologic quality and training differences, further research is strongly recommended.     

Half-marathon and full-marathon runners' hydration practices and perceptions

Context:

The behaviors and beliefs of recreational runners with regard to hydration maintenance are not well elucidated.

Objective:

To examine which beverages runners choose to drink and why, negative performance and health experiences related to dehydration, and methods used to assess hydration status.

Design:

Cross-sectional study.

Setting:

Marathon registration site.

Patients or Other Participants:

Men (n = 146) and women (n = 130) (age = 38.3 ± 11.3 years) registered for the 2010 Little Rock Half-Marathon or Full Marathon.

Intervention(s):

A 23-item questionnaire was administered to runners when they picked up their race timing chips.

Main Outcome Measure(s):

Runners were separated into tertiles (Low, Mod, High) based on z scores derived from training volume, expected performance, and running experience. We used a 100-mm visual analog scale with anchors of 0 (never) and 100 (always). Total sample responses and comparisons between tertile groups for questionnaire items are presented.

Results:

The High group (58±31) reported greater consumption of sport beverages in exercise environments than the Low (42 ± 35 mm) and Mod (39 ± 32 mm) groups (P < .05) and perceived sport beverages to be superior to water in meeting hydration needs (P < .05) and improving performance during runs greater than 1 hour (P < .05). Seventy percent of runners experienced 1 or more incidents in which they believed dehydration resulted in a major performance decrement, and 45% perceived dehydration to have resulted in adverse health effects. Twenty percent of runners reported monitoring their hydration status. Urine color was the method most often reported (7%), whereas only 2% reported measuring changes in body weight.

Conclusions:

Greater attention should be paid to informing runners of valid techniques to monitor hydration status and developing an appropriate individualized hydration strategy.     

Scapular-muscle performance: two training programs in adolescent swimmers

Context:

Swimming requires well-balanced scapular-muscle performance. An additional strength-training program for the shoulders is pursued by swimmers, but whether these muscle-training programs need to be generic or specific for endurance or strength is unknown.

Objective:

To evaluate isokinetic scapular-muscle performance in a population of adolescent swimmers and to compare the results of training programs designed for strength or muscle endurance.

Design:

Controlled laboratory study.

Setting:

University human research laboratory.

Patients or Other Participants:

Eighteen adolescent swimmers.

Intervention(s):

Each participant pursued a 12-week scapular-training program designed to improve either muscle strength or muscle endurance.

Main Outcome Measure(s):

Bilateral peak force, fatigue index, and protraction/retraction strength ratios before and after the scapular-training program.

Results:

Scapular protraction/retraction ratios were slightly higher than 1 (dominant side  =  1.08, nondominant side  =  1.25, P  =  .006). Side-to-side differences in retraction strength were apparent both before and after the training program (P  =  .03 and P  = .05, respectively). After the training program, maximal protraction (P < .05) and retraction (P < .01) strength improved on the nondominant side. Peak force and fatigue index were not different between the training groups. The fatigue indexes for protraction on both sides (P < .05) and retraction on the nondominant side (P  =  .009) were higher after the training program.

Conclusions:

We describe the scapular-muscle characteristics of a group of adolescent swimmers. Both muscle-strength and muscle-endurance programs improved absolute muscle strength. Neither of the strength programs had a positive effect on scapular-muscle endurance. Our results may be valuable for coaches and physiotherapists when they are designing exercise programs for swimmers.     

The UK pay-for-performance programme in primary care: estimation of population mortality reduction

Background

General practices in the UK contract with the government to receive additional payments for high-quality primary care. Little is known about the resulting impact on population health.

Aim

To estimate the potential reduction in population mortality from implementation of the pay-for-performance contract in England.

Design of study

Cross-sectional and modelling study.

Setting

Primary care in England.

Method

Twenty-five clinical quality indicators in the contract had controlled trial evidence of mortality benefit. This was combined with condition prevalence, and the differences in performance before and after contract implementation, to estimate the potential mortality reduction per indicator. Improvement was adjusted for pre-existing trends where data were available.

Results

The 2004 contract potentially reduced mortality by 11 lives per 100 000 people (lower–upper estimates 7–16) over 1 year, as performance improved from baseline to the target for full incentive payment. If all eligible patients were treated, over and above the target, 56 (29–81) lives per 100 000 might have been saved. For the 2006 contract, mortality reduction was effectively zero, because new baseline performance for a typical practice had already exceeded the target performance for full payment.

Conclusion

The contract may have delivered substantial health gain, but potential health gain was limited by performance targets for full payment being set lower than typical baseline performance. Information on both baseline performance and population health gain should inform decisions about future selection of indicators for pay-for-performance schemes, and the level of performance at which full payment is triggered.     

Prediction of large esophageal varices in cirrhotic patients using classification and regression tree analysis

OBJECTIVES:

Recent guidelines recommend that all cirrhotic patients should undergo endoscopic screening for esophageal varices. That identifying cirrhotic patients with esophageal varices by noninvasive predictors would allow for the restriction of the performance of endoscopy to patients with a high risk of having varices. This study aimed to develop a decision model based on classification and regression tree analysis for the prediction of large esophageal varices in cirrhotic patients.

METHODS:

309 cirrhotic patients (training sample, 187 patients; test sample 122 patients) were included. Within the training sample, the classification and regression tree analysis was used to identify predictors and prediction model of large esophageal varices. The prediction model was then further evaluated in the test sample and different Child‐Pugh classes.

RESULTS:

The prevalence of large esophageal varices in cirrhotic patients was 50.8%. A tree model that was consisted of spleen width, portal vein diameter and prothrombin time was developed by classification and regression tree analysis achieved a diagnostic accuracy of 84% for prediction of large esophageal varices. When reconstructed into two groups, the rate of varices was 83.2% for high‐risk group and 15.2% for low‐risk group. Accuracy of the tree model was maintained in the test sample and different Child‐Pugh classes.

CONCLUSIONS:

A decision tree model that consists of spleen width, portal vein diameter and prothrombin time may be useful for prediction of large esophageal varices in cirrhotic patients.     

Performance of small general practices under the UK's Quality and Outcomes Framework

Background

Small general practices are often perceived to provide worse care than larger practices.

Aim

To describe the comparative performance of small practices on the UK''s pay-for-performance scheme, the Quality and Outcomes Framework.

Design of study

Longitudinal analysis (2004–2005 to 2006–2007) of quality scores for 48 clinical activities.

Setting

Family practices in England (n = 7502).

Method

Comparison of performance of practices by list size, in terms of points scored in the pay-for-performance scheme, reported achievement rates, and population achievement rates (which allow for patients excluded from the scheme).

Results

In the first year of the pay-for-performance scheme, the smallest practices (those with fewer than 2000 patients) had the lowest median reported achievement rates, achieving the clinical targets for 83.8% of eligible patients. Performance generally improved for practices of all sizes over time, but the smallest practices improved at the fastest rate, and by year 3 had the highest median reported achievement rates (91.5%). This improvement was not achieved by additional exception reporting. There was more variation in performance among small practices than larger ones: practices with fewer than 3000 patients (20.1% of all practices in year 3), represented 46.7% of the highest-achieving 5% of practices and 45.1% of the lowest-achieving 5% of practices.

Conclusion

Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices.     

Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata,India

Background

In India, substance abuse has infiltrated all socio-cultural and economic strata causing loss of productivity. Prevention of relapse is crucial for its control.

Objectives

To find out the pattern of substance use, relapse rate, its association with various socio-demographic factors and treatment related issues.

Methods

An observational study with cross-sectional design during April 2009-March 2010 at a de addiction centre was conducted among consecutive 284 clients admitted with relapse. They were detoxified earlier in the same centre. Data were collected by interviewing clients with schedule and clinical examination.

Results

Brown sugar (an adulterated form of Heroin) was primary drug of abuse in urban area contrary to alcohol in rural area. Commonest age of initiation was between 15–20 years. Polydrug abusers (59.1%) were common. Only 31.3% of the relapse cases took regular follow up. Common psychiatric illnesses were anxiety (44.7%) and depression (30.6%). Peer pressure (77.8%) was commonest cause of relapse. Significantly higher relapse episodes were present with increasing age, Muslim religion, ever marriage, poor literacy, current unemployment, living in nuclear rather than joint family, early age of initiation, longer duration of abuse and no follow up.

Conclusion

Regular follow up with family, peer and social support are essential along with vocational rehabilitation to prevent relapse.