A cross-sectional study of public attitudes towards safer drug use practices in British Columbia,Canada

Background

Harm reduction programs are often vulnerable to political and vocal opposition despite documented evidence of their effectiveness and economic benefit. It is not well understood if opponents to harm reduction represent the general public’s attitudes.

Objective

To understand the attitudes of the people of British Columbia (BC) towards various harm reduction strategies and services, and factors associated with support for harm reduction.

Methods

A random-digit dialing telephone survey assessing attitudes towards various harm reduction strategies was administered to British Columbians in August 2011 (n?=?2000). We compared the level of support for general harm reduction by sex, age, education level, and area of residence (Health Authority region) (χ²). Multivariate logistic regression was used to assess odds of support for harm reduction.

Results

Overall support for general harm reduction among participants was 76%; needle distribution 72%; needle distribution in one’s local community 65%; and safer inhalation equipment distribution 52%. In the multivariate analysis, those with significantly lower odds of supporting harm reduction were male, older, had equal or less than high school education or completed a certificate/diploma program, and resided in the Fraser Health Authority region. The Health Authority region with a municipality that has introduced a bylaw prohibiting the implementation of harm reduction services was found to have 69% support for harm reduction. Another Health Authority region with a municipality that closed a long-standing needle distribution site was found to have over 78% support.

Conclusion

In contrast to some local policies, our results show the British Columbians surveyed in our study support harm reduction. It is unclear whether policy makers are swayed by a vocal minority or block harm reduction activities for other reasons. Tailoring messages towards segments of the public less likely to support harm reduction, as well civic policy-makers and the media, may help to reduce stigma and gain support for harm reduction services designed to protect and improve the health of the individual and the public.

     

Soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not improve muscle functional property restoration

Objectives

Effect of 3 different dairy protein sources on the recovery of muscle function after limb immobilization in old rats.

Design

Longitudinal animal study.

Setting

Institut National de la Recherche Agronomique (INRA). The study took part in a laboratory setting.

Intervention

Old rats were subjected to unilateral hindlimb immobilization for 8 days and then allowed to recover with 3 different dietary proteins: casein, soluble milk proteins or whey proteins for 49 days.

Measurements

Body weight, muscle mass, muscle fibre size, isometric, isokinetic torque, muscle fatigability and muscle oxidative status were measured before and at the end of the immobilization period and during the recovery period i.e 7, 21, 35 and 49 days post immobilization.

Results

In contrast to the casein diet, soluble milk proteins and whey proteins were efficient to favor muscle mass recovery after cast immobilization during aging. By contrast, none of the 3 diary proteins was able to improve muscle strength, power and fatigability showing a discrepancy between the recovery of muscle mass and function. However, the soluble milk proteins allowed a better oxidative capacity in skeletal muscle during the rehabilitation period.

Conclusion

Whey proteins and soluble milk proteins improve muscle mass recovery after immobilization-induced muscle atrophy in old rats but do not allow muscle functional property restoration.

     

Needle acquisition patterns,network risk and social capital among rural PWID in Puerto Rico

Background

People who inject drugs (PWID) take on significant risks of contracting blood-borne infection, including injecting with a large number of partners and acquiring needles from unsafe sources. When combined, risk of infection can be magnified.

Methods

Using a sample of PWID in rural Puerto Rico, we model the relationship between a subject’s number of injection partners and the likelihood of having used an unsafe source of injection syringes. Data collection with 315 current injectors identified six sources of needles.

Results

Of the six possible sources, only acquisition from a seller (paid or free), or using syringes found on the street, was significantly related to number of partners.

Conclusions

These results suggest that sources of syringes do serve to multiply risk of infection caused by multi-partner injection concurrency. They also suggest that prior research on distinct forms of social capital among PWID may need to be rethought.

     

Work-related self-assessed fatigue and recovery among nurses

Purpose

Adequate recovery opportunities are crucial for preventing long-term health effects of acute load reactions in response to stressful work. However, little is known about the time course of recovery from work during non-working days. Thus, the present study assessed recovery from two consecutive 12-hours day shifts during a period of three rest days among nurses.

Methods

In total, 48 nurses (89.6% females) working in three public Austrian nursing homes completed 5-day self-reporting diaries prior to a work phase consisting of two consecutive 12-hours day shifts followed by three consecutive rest days. Therefore, morning and evening fatigue, distress, vigor and sleep were self-assessed by standardized questionnaires. We analyzed the data using multivariate analysis of variance for repeated measures.

Results

Study participants experienced worse well-being and a greater decline in well-being on working days compared to rest days. Well-being increased from rest day 1 to rest day 2 in fatigue, vigor and distress. Rest day 2 to rest day 3 showed a further improvement in fatigue and vigor.

Conclusions

Understanding the concepts of allostatic load, need for recovery and fatigue is essential to develop personalized working schedules. The results suggest that at least three rest days are necessary for full recovery after two consecutive 12-hours day shifts. Thus, adequate time for recovery enables nurses to maintain caring attitudes with patients, thus contributing to patient safety.

     

Prioritizing health services research: an economic perspective

Introduction

Given limited resources policymakers need to decide about how much and in what areas of health services research (HSR) to invest. The purpose of this study is to provide guidance for priority setting of HSR projects based on economic theory.

Methods

The conceptual analysis starts from the premise that competition in health care is valuable—a position that seems to predominate among Western policymakers. The principle of competition rests on economic theory and, in particular, its branch of welfare economics.

Results

Based on economic theory, the role of HSR is to detect and alleviate information asymmetry, negative externalities, and harm caused by competition and inappropriate incentives for competition. A hierarchy of HSR projects is provided; following the ethical principle of harm (‘do not harm’), the detection and prevention of harm would receive highest priority among HSR projects.

Conclusions

Agreeing that competition is valuable in achieving efficiency and quality of care (and therefore agreeing to the assumptions of economic theory) implies accepting the role of HSR in detecting market failure and the HSR hierarchy as suggested. Disagreement would require an alternative coherent concept of improving efficiency and quality of care.

     

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment

Background

Most people prefer to “age in place” and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care.

Objective

To investigate preferences for home- and community-based long-term care services packages.

Design

Discrete choice experiment conducted in mailed survey.

Setting and participants

Randomly selected sample of the general population aged 45–64 years in Germany (n?=?1.209).

Main variables studied

Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2–4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment.

Results

Quality of care was the most important attribute to respondents and small teams of regular caregivers (1–2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98.

Conclusions

Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

     

Exploration of the administrative aspects of the delivery of home health care services: a qualitative study

Background

Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task.

Objectives

The purpose of this study was to explore the administrative aspects of the delivery of home health care services.

Methods

This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method.

Results

23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories.

Conclusion

Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

     

Suicide Prevention Among High School Students: Evaluation of a Nonrandomized Trial of a Multi-stage Suicide Screening Program

Background

Suicide is a leading cause of death among youth. Suicide screening programs aim to identify mental health issues and prevent death by suicide.

Objective

The present study evaluated outcomes of a multi-stage screening program implemented over 3 school years in a moderately-sized Midwestern high school.

Methods

One hundred ninety-three 9th-grade students were screened in the program. Students who screened positive were referred to mental health services and followed. Suicide-related thoughts and behaviors among 9th-grade students in the school with screening were compared to those of students in a similar school without screening.

Results

There was a significant increase in utilization of mental health services among students who screened positive and a decrease in rates of suicidal ideation and attempts among 9th-grade students at the school with screening.

Conclusions

This multi-stage screening program shows promise in addressing suicide-related behaviors in schools. Randomized trials are needed to confirm program efficacy.

     

Defining rehabilitation success in older adults with dementia–results from an inpatient geriatric rehabilitation unit

Objective

To quantify the magnitude of functional recovery in older adults with and without dementia admitted to an inpatient geriatric rehabilitation program by measuring change in measures of global physical function and physical therapy treatment outcomes.

Design

Retrospective cohort study.

Setting

Rehabilitation academic hospital.

Participants

Consecutive subjects, with (N=65, age 81.9±6.0 y) and without (N=157, age 82.8±7.2 y) a dementia diagnosis, had assessment data at admission and discharge from inpatient geriatric rehabilitation unit.

Interventions

Not applicable.

Measurements

The Functional Independence Measure (FIM) was used to estimate level of independence on activities of daily living. The Berg Balance Scale (BBS), Timed Up & Go Test (TUG) and 2 Minute Walk Test (2MWT) were used to estimate functional mobility and endurance. The FIM (total, motor subscale, cognitive subscale scores) were used to calculate rehabilitation efficacy and efficiency scores.

Results

After controlling for confounding, there was no group difference for gains on the BBS, TUG, 2MWT; there was no group difference on rehabilitation efficacy and efficiency values based on the FIM motor subscale. The magnitude of the rehabilitation gain using the total FIM score was statistically different between groups, people with dementia having smaller gains.

Conclusion

Older adults with a diagnosis of dementia are capable of making motor function recovery during inpatient sub-acute rehabilitation comparable to their peers without a dementia diagnosis. The metric used to evaluate functional recovery influences the determination of rehabilitation success between groups. Rehabilitation success should be defined among people with a dementia diagnosis by a change in the motor subscale of the FIM, rather than the total FIM score or the gain relative to the maximal FIM score.

     

One question might be capable of replacing the Shoulder Pain and Disability Index (SPADI) when measuring disability: a prospective cohort study

Questions

Is it possible to replace the Shoulder Pain and Disability Index (SPADI) with a single substitute question for people with shoulder pain, when measuring disability and how well does this substitute question perform as a predictor for recovery.

Design

A prospective cohort study.

Participants

A total of 356 patients with shoulder pain in primary care.

Analyses

Convergent, divergent, and “known” groups validity were assessed by using hypotheses testing. Responsiveness was assessed using the Receiver Operating Curve and hypothesis testing. In addition, we performed multivariate regression to assess if the substitute question showed similar properties as the SPADI and if it affected the model itself, using recovery as an outcome.

Results

The Spearman correlation coefficient between the total SPADI score and the substitute question was high, and moderate with the Shoulder Disability Questionnaire. The correlation between the substitute question and the EQ-5D-3L was low and the responsiveness was acceptable. The substitute question did not significantly contribute to both prognostic prediction models as opposed to the SPADI. Regardless all models showed poor to fair discrimination.

Conclusion

The single question is a reasonable substitute for the SPADI and can be used as a screening instrument for shoulder disability in primary clinical practice. It has slightly poorer predictive power and should therefore not be used for prognosis.

     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

     

Swallowing function and nutritional status in Japanese elderly people receiving home-care services: A 1-year longitudinal study

Objectives

Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care.

Design

Prospective observational cohort study with 1-year follow-up.

Setting

Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012.

Participants

One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving homecare services because of physical disabilities, without malnutrition.

Measurements

Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model.

Results

Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65–16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition.

Conclusion

Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.

     

The impact of rehabilitative interventions on quality of life: a qualitative evidence synthesis of personal experiences of individuals with amyotrophic lateral sclerosis

Background

The nature of amyotrophic lateral sclerosis (ALS) is progressive and degenerative, thus influencing individuals physically, emotionally, and socially. A broad review of qualitative studies that describe the personal experiences of people with ALS with physiotherapy, occupational therapy and speech and language pathology interventions, and how those affect QoL is warranted.

Purpose

This study synthesizes qualitative research regarding the potential that rehabilitation interventions have to maintain and/or improve QoL from the perspective of people with ALS.

Methods

The SPIDER search strategy was applied and five articles met inclusion criteria addressing the perceived impact of rehabilitation on QoL for individuals with ALS.

Results

Four themes emerged: the concept of control; adapting interventions to disease stage; struggles with interventions; and barriers between healthcare providers and patients.

Conclusions

Rehabilitation interventions were perceived to have potential to support QoL by people with ALS. Advantages and limitations of rehabilitation services within this population were identified.

     

Assessing pharmacy student experience with,knowledge of and attitudes towards harm reduction: illuminating barriers to pharmacist-led harm reduction

Background

As the burden from the opioid epidemic continues to increase in the state of Minnesota and across the nation, the University of Minnesota College of Pharmacy seeks to design an innovative, comprehensive harm reduction curriculum in order to better train student pharmacists to serve the varied needs of the greater community. This study examines incoming individuals’ baseline knowledge of and attitudes toward harm reduction in order to better inform curriculum planning and to ultimately produce pharmacists capable of impacting the devastating effects of the opioid crisis.

Methods

Incoming first-year pharmacy students took a survey focused on their knowledge of opioid overdose and the drug naloxone and also provided written reflections on their perceptions of harm reduction. Data was coded using consensual qualitative research (CQR) into appropriate domains.

Results

Pharmacy students beginning their professional education revealed a lack of knowledge of proper response to an overdose situation, with 18.56% unfamiliar with the opioid antagonist drug naloxone. Close to 10% (9.58%) of students expressed unwillingness to do anything other than call an ambulance during an overdose event, while 8.98% were either unsure or felt that they would not feel compelled to do something to help. Qualitative coding revealed many barriers to students’ becoming capable harm reductionists, including lack of knowledge of substance use, addiction, and harm reduction, in addition to the presence of bias and stigma.

Conclusion

In order to interrupt the cycle of misinformation and stigma within the larger community and the subgroup of medical providers, gaps in student knowledge must be addressed in meaningful, specific ways over the course of their pharmacy education. Evaluating baseline knowledge and beliefs informs the design of a flexible, action-oriented curriculum to produce well-trained pharmacists ready to engage in finding solutions to the opioid crisis.

     

Age and IQ Explained Working Memory Performance in a RCT with Fatty Fish in a Group of Forensic Inpatients

Objectives

To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.

Design

A randomized controlled trial.

Setting

A forensic facility.

Participants

Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.

Intervention

Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.

Measurement

Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.

Results

Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.

Conclusion

Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.

     

Perspectives on the causes of undernutrition of community-dwelling older adults: A qualitative study

Objectives

Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults.

Design

Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed.

Setting

Community-dwelling.

Participants

Older adults.

Measurements

A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition.

Results

33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food & appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization.

Conclusions

This study provides guidance to better understand the underlying causes of undernutrition from an older adult’s perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.