Barriers to, and incentives for, the transfer of opioid-dependent people on methadone maintenance treatment from secondary care to primary health care

Aim. To explore barriers to, and incentives for, clients on methadone-maintenance treatment (MMT) in Auckland, New Zealand to transfer from secondary care to general practitioner (GP) care. Design. Surveys (with free text response sections) of MMT secondary care staff, stabilised clinic clients, authorised GPs and GP patients. Results. High response rates from secondary care staff (77%) and GPs (74%). Barriers to stable clients' transfer included financial cost and attitudes of secondary care staff and clients. Incentives for patient transfer included confidentiality, a holistic approach to their care, continuity of care, increased patient control, convenience and avoidance of contact with other opioid-dependent people. Distrust in the quality of care provided by authorised GPs was a major barrier for some secondary care staff and their clients, despite prerequisite training for authorisation. In contrast, patients rated primary better than secondary care with none stating a likelihood to return to the secondary service within 6 months. Conclusions. Progression from secondary to primary care should be incorporated in MMT planning from the outset, with secondary services staff reassured about the quality of primary care. An integrated transition period and exploration of funding options to assist transfer from largely publicly funded secondary to largely privately funded primary care are also recommended. [Sheridan J, Goodyear-Smith F, Butler R, Wheeler A, Gohns A. Barriers to, and incentives for, the transfer of opioid-dependent people on methadone maintenance treatment from secondary care to primary health care. Drug Alcohol Rev 2008;27:178-184]     

Severe Acute Illness in a Toddler Exposed to Multiple Agricultural Pesticides and an Insect Repellent

ABSTRACT

Acute severe pesticide-related illness among farm worker children is rarely reported. The authors report a toddler with acute onset of apnea, cyanosis, somnolence, hypotonia, tachycardia, and miosis who required hospitalization. Health care providers suspected pesticide poisoning, but were unable to determine the causal agent. Investigation by a public health program documented four pesticide exposures that occurred within one-half hour of acute illness. This case illustrates the importance of a thorough environmental/occupational exposure history and obtaining biological samples. It also documents the need to strengthen the Worker Protection Standard for agricultural workers and the importance of reporting and investigating pesticide-related illness.     

High dose rate brachytherapy source measurement intercomparison

This work presents a comparison of air kerma rate (AKR) measurements performed by multiple radiotherapy centres for a single HDR ¹⁹²Ir source. Two separate groups (consisting of 15 centres) performed AKR measurements at one of two host centres in Australia. Each group travelled to one of the host centres and measured the AKR of a single ¹⁹²Ir source using their own equipment and local protocols. Results were compared to the ¹⁹²Ir source calibration certificate provided by the manufacturer by means of a ratio of measured to certified AKR. The comparisons showed remarkably consistent results with the maximum deviation in measurement from the decay-corrected source certificate value being 1.1%. The maximum percentage difference between any two measurements was less than 2%. The comparisons demonstrated the consistency of well-chambers used for ¹⁹²Ir AKR measurements in Australia, despite the lack of a local calibration service, and served as a valuable focal point for the exchange of ideas and dosimetry methods.     

A six year longitudinal study of the occupational consequences of drinking over "safe limits" of alcohol.

Although much research has focused on the psychological, social, and economic consequences of heavy problem drinking, there has been far less attention paid to the consequences of "moderate" drinking. This study used a unique opportunity to carry out a six year follow up of a cohort of male and female white collar workers in whom there was baseline information on alcohol consumption and access to details on sickness absence, labour turnover, and promotion. It has provided evidence that even moderate alcohol consumption in the working population is associated with social costs for the employer and the employee, including substantial sickness absence, and lack of promotion in men, although the increase in labour turnover was not statistically significant. The longitudinal examination of consumption in this study suggests that early intervention in a drinking career may reduce alcohol consumption and consequently avoid years of morbidity and sickness absence, as well as having a favourable influence on performance and labour turnover.     

What can children learn from the menu at the child care center?

As a result of studies in Texas that indicated menus in child care centers may be depriving children of nutrients, a study was conducted to determine the prevalence of similar problems in 7 states. Menus for breakfast or morning snack, lunch, and afternoon snack for 10 consecutive program days were obtained from 171 child care centers. Results of nutrient analysis of the menus were compared against the Recommended Dietary Allowances (RDA) for children aged 1 to 3 and 4 to 6. Menus typically provided at least 100 percent of the RDA for protein and the vitamins A, ascorbic acid, B₁₂, and riboflavin. The menus offered an average of only 42 percent of the iron needed by both the younger and older children. In all 7 states the menus provided less than 56 percent of the kilocalories recommended and less than 64 percent of niacin for the 1 to 3 year olds. Mean value for kilocalories for the 3–5 year old averaged 40 percent of recommendation while niacin averaged 48 percent. These findings indicate that attention should be directed toward careful assessment of nutritional adequacy of meals and snacks actually served at child care centers, the children's nutritional intake at the center, and the nutritional content of meals and snacks eaten away from the center.Margaret E. Briley is Associate Professor of Graduate Nutrition at The University of Texas at Austin, Cynthia Roberts-Gray is Senior Scientist and Owner of The Resource Network in Austin, Texas, and Susanne Rowe is Research Associate in the Division of Graduate Nutrition at The University of Texas at Austin.This project was supported in part by a grant from the Texas Nutrition Education and Training Program, Texas Department of Human Services, Deborah Simpson, Coordinator. We appreciate the assistance of NET Program Coordinators and CACFP Coordinators in the seven states that participated in this study.     

Cytogenetic analysis of an exposed-referent study: perchloroethylene-exposed dry cleaners compared to unexposed laundry workers

Background  

Significant numbers of people are exposed to tetrachloroethylene (perchloroethylene, PCE) every year, including workers in the dry cleaning industry. Adverse health effects have been associated with PCE exposure. However, investigations of possible cumulative cytogenetic damage resulting from PCE exposure are lacking.     

甲型H1N1流感流行期间发热门诊的医院感染控制措施

目的总结甲型H1N1流感流行期间发热门诊的医院感染措施经验。方法调配人力资源,强化培训,使消毒隔离和个人防护措施落实到位。结果预检筛查发热患者2453例,确诊的甲型H1N1流感患者140例,占5.7%;与患者密切接触者和医务人员未发生感染,及时有效地阻止了疫情的扩散和蔓延。结论发热门诊的布局、管理体系和完善的工作流程,在应对突发公共卫生事件的救治中有重要意义。     

Effects of preventive cognitive self-instruction training on adolescent attitudes,experiences, and state anxiety

The effects of teacher-directed cognitive self-instruction (TI) were compared with an instructions-only component control condition (IO) in order to examine the former's efficacy as a primary prevention strategy. In a quasi-experimental design. two intact high school psychology classes were randomly assigned to either TI or IO. Each condition lasted for eight 45-minute class periods, and each group was given an in vivo homework assignment. Pretreatment equivalence and demand analyses yielded no evidence of differences. Results of a posttreatment measure of attitude toward treatments and a pre- and posttreatment measure of state anxiety suggested that trainerdirected cognitive self-instruction may be a promising primary prevention strategy.Stanley B. Baker is Associate Professor of Education at the Division of Counseling and Educational Psychology, Pennsylvania State University. James N. Butler is Psychology Teacher, Tyrone Area High School, Tyrone, PA.     

Cancer Outcomes Research in a Rural Area: A Multi-Institution Partnership Model

Whereas, most cancer research data come from high-profile academic centers, little is known about the outcomes of cancer care in rural communities. We summarize the experience of building a multi-institution partnership to develop a cancer outcomes research infrastructure in Southwest Georgia (SWGA), a primarily rural 33-county area with over 700,000 residents. The partnership includes eight institutions: the Emory University in Atlanta, the Centers for Disease Control and Prevention (CDC), the Georgia Comprehensive Center Registry (the Registry), the Southwest Georgia Cancer Coalition (the Coalition), and the four community cancer centers located within the SWGA region. The practical application of the partnership model, its organizational structure, and lessons learned are presented using two specific examples: a study evaluating treatment decisions and quality of life among prostate cancer patients, and a study of treatment discontinuation among prostate, breast, lung, and colorectal cancer patients. Our partnership model allowed us to (1) use the Coalition as a link between Atlanta-based researchers and local community; (2) collaborate with the area cancer centers on day-to-day study activities; (3) involve the Registry personnel and resources to identify eligible cancer cases and to perform data collection; and (4) raise community awareness and sense of study ownership through media announcements organized by the Coalition. All of the above activities were performed in consultation with the funding institution (CDC) and its project directors who oversee several other studies addressing similar research questions throughout the country. Our partnership model may provide a useful framework for cancer outcomes research projects in rural communities.     

Health researchers' attitudes towards public involvement in health research

Objective  To investigate health researchers' attitudes to involving the public in research.
Background  Public involvement in research is encouraged by the Department of Health in the UK. Despite this, the number of health researchers actively involving the public in research appears to be limited. There is little research specifically addressing the attitudes of health researchers towards involving the public: how they interpret the policy, what motivates and de-motivates them and what their experiences have been to date.
Design  A qualitative research design, using semi-structured telephone interviews.
Setting and participants  Fifteen purposively sampled UK-based University health researchers were the participants. Interviews were conducted over the telephone.
Findings  The participants suggested varying constructions of public involvement in research. Arguments based on moral and political principles and consequentialist arguments for involving the public in research were offered and most participants highlighted the potential benefits of involving the public. However, feelings of apprehension expressed by some participants imply that a number of researchers may still be uncomfortable with involving the public, as it presents a different way of working.