The role of drug users’ advocacy group in changing the dynamics of life in the Downtown Eastside of Vancouver,Canada

The Downtown Eastside (DTES) of Vancouver, Canada, has been the epicentre of HIV and drug overdose related to injection drug users (IDUs) since the mid 1990s. In response to growing government inaction, a drug user-run organization known as Vancouver Area Network of Drug User (VANDU) was formed. This study was conducted to capture the genesis and influence of VANDU over the past 14 years in shaping the neighbourhood. Semi-structured qualitative interviews were conducted with purposively chosen sample of 11 VANDU board members and those attending the services. Interviews were transcribed verbatim and analysed thematically using NVivo 9 software. Participants’ narratives indicate that VANDU has been instrumental in improving conditions of the DTES, altering the risky injection behaviour of its members. Moreover, VANDU has given a voice to the most marginalized members of society who otherwise would not be represented. Findings from this study highlight the important role that a drug user organization can play in creating new physical and conceptual space.     

Community Stakeholders’ Perceptions of the Role of Family in HIV Prevention in Iringa,Tanzania

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.     

Hospices in partnership? Public health,end of life,and the responsibility of hospices

Public health approaches to palliative care must appreciate that health professionals are part of communities, and the importance of partnerships should not be ignored – despite the inherent challenges. The true partners in a public health approach towards the end of life are of course, dying people, their families and friends, and members of the communities within which they are living and dying. However, we ignore important partnerships with nurses, doctors, and other healthcare professionals at our peril. This paper situates hospices within the broader community and uses vignette's to highlight approaches to community engagement and the challenges of partnership.     

The use of opioids in the treatment of osteoarthritis: When,why, and how?

As life expectancy increases every decade, the incidence and prevalence of osteoarthritis (OA) also will increase. Despite progress in our knowledge of the pathophysiology of OA, the management of OA-mediated pain continues to challenge physicians. Concern regarding the cardiovascular effects of cyclooxygenase-2 inhibitors and the gastrointestinal and renal side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in general has limited the use of these medications in the management of chronic non-cancer pain. Appropriately dosed and monitored use of opioids for OA pain, when more conservative methods have failed, has potentially fewer life-threatening complications associated with it than the more commonly and often less successfully employed pharmacotherapeutic approaches to care. When used as part of a multimodal approach to pain control, opioids are a safe and effective treatment for joint pain, including that of OA. Patients for whom NSAIDs are contraindicated, or for whom combined acetaminophen, tramadol, and NSAID therapy is ineffective, may be started on low-dose opioids and titrated as needed and tolerated. Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.     

Quality of the Live Birth Information System in the state of Paraná, from 2000 to 2005

This study analyzed the quality of the Live Birth Information System in the State of (SINAC) Paraná, Brazil, from 2000 to 2005, through the percentage of undeclared variables, using a database provided by the State Health Department. Quality was analyzed using the following scale: excellent, undeclared percentage<1%; good between 1% and 2.99%; regular between 3% and 6.99%; and poor>7%. The quality in completing the SINAC in Paraná was excellent, especially as of year 2003. The mothers' occupation, classified as regular and poor, was the variable with the lowest quality in all Regional Health Departments. Live births, stillbirths, and race/color varied between poor and excellent quality. There is a need to improve the quality of the variables marital status and stillbirths in all Regional Health Departments. The excellence of the SINAC demonstrated its potential as a source of health information in Paraná.     

Loss of weight and loss of appetite in advanced cancer: a problem for the patient,the carer,or the health professional?

This paper aims to examine the loss of weight and loss of appetite as 'problems' experienced by patients with advanced cancer and those that care for them. It reports the results of a systematic search of the literature and presents the findings as a narrative review. Research to date has focused upon charting the prevalence and incidence of these symptoms, but little empirical work has been conducted to investigate how patients and carers experience these problems. There is some evidence to suggest that anorexia may be more distressing for those caring for the patient than the person suffering from the symptom itself. Understanding the reason for this anguish requires an appreciation of the meaning of food refusal and constitutes the first step towards informing the development of effective interventions. Such exploratory work is mandatory if health professionals wish to move beyond speculation and deliver interventions that provide meaningful benefits for the cancer patient and their family.     

Art therapist’s perceptions of the role of the art medium in the treatment of bereaved clients in art therapy

The exploratory study’s aim was to examine how art therapists perceive the role of the art medium in the treatment of bereaved clients. Eight Israeli art therapists reflected on this topic through drawings and interviews. Qualitative analysis identified three major roles, specifically art as: (1) a space for the client’s grief work; (2) a communication channel that impacts the art therapist’s experience and therapeutic relationship; and (3) a shared space where client and therapist create a new narrative. The discussion deals with the findings and their clinical implications, identifying the central therapeutic processes involved in art therapy with bereaved clients.     

Are the contents of treatment outcomes in fibromyalgia trials represented in the International Classification Of Functioning, Disability, and Health?

OBJECTIVES: To identify the concepts contained in treatment outcomes of randomized controlled trials (RCTs) for interventions in patients with fibromyalgia (FM) using the International Classification of Functioning, Disability, and Health (ICF) as external reference. METHODS: RCTs between 1992 and 2001 were located in MEDLINE and selected according to predefined eligibility criteria. The outcome measures were extracted and the concepts within the outcome measures were identified and linked to the ICF using a content-analytical approach. RESULTS: Forty-two trials on FM were included. Twenty-seven different questionnaires were extracted. Of all, 79.2% (N=236) of the clinical and physiologic outcomes could be linked to 31 different ICF categories and 84.7% (N=964) of the concepts contained in the health-status questionnaire to 113 ICF categories. CONCLUSIONS: The ICF provides a useful external reference to identify the concepts contained in outcome measures used in RCTs in FM.     

Cumulative abuse: do things add up? An evaluation of the conceptualization, operationalization, and methodological approaches in the study of the phenomenon of cumulative abuse

For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.     

Sounds of the future? Ultrasonography in the field

During the past two decades, the development and maturation of ultrasonography as a diagnostic tool has revolutionized the practice of radiology, cardiology, obstetrics and surgery. In fact, few areas of medicine have not been affected by this technology. Unlike the still-frame images of standard X-rays and computerized axial tomography (CAT) scans, ultrasound technology displays an ongoing cross-sectional image of an anatomic area in "real time," which can then be stored and played back on videotape. This ability to quickly assess function, as well as anatomy, has become invaluable in the management of critically ill patients.     

Prediction of success in the first-year exam in the study of medicine – a prospective survey

OBJECTIVE: To identify predictors of students' success in the first-year exam in a new curriculum in the study of medicine in Vienna. DESIGN: We tested 11 topics (including socio-demographic variables, family background, school performance, economic situation, living conditions, social integration and health, learning capacity, study motivation and ability to cope with stress) for their relevance in terms of study success in a prospective study of an unselected student sample. Data were collected from questionnaires filled in by 674 first-year students (50.8% of the total number of 1327 new students) who enrolled in the academic year 2002/03. MAIN OUTCOME: Comparison of students who passed the first-year exam with students who failed identified four predictors: male sex, German mother tongue, performance in secondary school and learning capacity. CONCLUSIONS: The new curriculum exerted subliminal selectivity; the predictive powers of school marks and subjective learning capacity were confirmed; the influence of a student's sex should be investigated further; the influence of mother tongue requires modification of pre-study courses for foreign students.     

Prevalence and determinants of exclusive breastfeeding in the city of Serrana, São Paulo, Brazil

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.