bluuebunny/crossref_metadata_2025 huggingface dataset:
The Adequacy of Pharmaceutical Treatment of Schizophrenia in Quebec Varies with Age, but is Not Influenced by Sex or Neighbourhood Deprivation
Authors: Brouwers Frederieke M , Courteau Josiane , Grégoire Jean-Pierre , Moisan Jocelyne , Lauzier Sophie , Lesage Alain , Fleury Marie-Josée , Vanasse Alain
Published: January 2017

Objective:

Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.

Methods:

We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004–2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.

Results:

Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).

Conclusions:

In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
Within-Hospital Readmission: An Indicator of Readmission after Discharge from Psychiatric Hospitalization
Authors: Vigod Simone N , Taylor Valerie H , Fung Kinwah , Kurdyak Paul A
Published: January 2017

Objective:

Readmission after psychiatric hospitalization is widely used as a quality of care indicator by government funding agencies, policy-makers, and hospitals deciding on clinical priorities. Readmission rates are calculated accurately to allow these varied groups to correctly translate the knowledge into appropriate, tangible outcomes. We aimed to assess how well hospital readmission rates, calculated using only readmissions to the discharging institution, can approximate actual readmission rates.

Method:

We used administrative data sources to identify patients with a mental health discharge in the province of Ontario (2008–2011). We identified mental health readmissions within 30 and 90 days of discharge occurring to the hospital from which the patient was discharged (within-hospital readmissions), and compared readmission rates using only within-hospital admissions with actual readmission rates.

Results:

The percentage of readmissions occurring to the discharging institution ranged from 39% to 89% (median 73%) and from 37% to 86% (median 70%) for 30- and 90-day readmissions, respectively. Using only within-hospital readmissions to rank hospitals by their readmission rates, only 56% of hospitals for 30-day readmissions and 50% for 90-day readmissions were ranked in the same quartile as when actual readmission rates were used.

Conclusions:

These findings highlight the importance of measuring psychiatric readmissions at the system level, particularly for hospitals with lower discharge volumes. As well, the high likelihood that multiple hospitals are involved in the hospital-based care of people who require readmission requires consideration at clinical and policy levels.
Posttraumatic Stress Disorder Post Iraq and Afghanistan: Prevalence among Military Subgroups
Authors: Hines Lindsey A , Sundin Josefin , Rona Roberto J , Wessely Simon , Fear Nicola T
Published: January 2017

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.
Repetitive Transcranial Magnetic Stimulation over the Dorsolateral Prefrontal Cortex for Treating Posttraumatic Stress Disorder: An Exploratory Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials
Authors: Berlim Marcelo T , Van den Eynde Frederique
Published: January 2017

Objective:

Repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) has yielded promising results as a treatment for posttraumatic stress disorder (PTSD). However, to date, no quantitative review of its clinical utility has been published.

Method:

We searched for randomized and sham-controlled trials from 1995 to March 2013 using MEDLINE, Embase, PsycINFO, CENTRAL, and SCOPUS. We then performed an exploratory random effects meta-analysis.

Results:

Studies on rTMS applied to the right DLPFC included 64 adults with PTSD. The pooled Hedges g effect size for pre and post changes in clinician-rated and self-reported PTSD symptoms were, respectively, 1.65 ( P < 0.001) and 1.91 ( P < 0.001), indicating significant and large-sized differences in outcome favouring active rTMS. Also, there were significant pre and post decreases with active rTMS in overall anxiety (Hedges g = 1.24; P = 0.02) and depressive (Hedges g = 0.85; P < 0.001) symptoms. Dropout rates at study end did not differ between active and sham rTMS groups. Regarding rTMS applied to the left DLPFC, there is only one study published to date (using a high frequency protocol), and its results showed that active rTMS seems to be superior overall to sham rTMS.

Conclusions:

Our exploratory meta-analysis shows that active rTMS applied to the DLPFC seems to be effective and acceptable for treating PTSD. However, the small number of subjects included in the analyses limits the generalizability of these findings. Future studies should include larger samples and deliver optimized stimulation parameters.
Descriptive Epidemiology of Major Depressive Disorder in Canada in 2012
Authors: Patten Scott B , Williams Jeanne V A , Lavorato Dina H , Wang Jian Li , McDonald Keltie , Bulloch Andrew G M
Published: January 2017

Objective:

The epidemiology of major depressive disorder (MDD) was first described in the Canadian national population in 2002. Updated information is now available from a 2012 survey: the Canadian Community Health Study—Mental Health (CCHS-MH).

Method:

The CCHS-MH employed an adaptation of the World Health Organization World Mental Health Composite International Diagnostic Interview and had a sample of n = 25 113. Demographic variables, treatment, comorbidities, suicidal ideation, and perceived stigma were assessed. The analysis estimated adjusted and unadjusted frequencies and prevalence ratios. All estimates incorporated analysis methods to account for complex survey design effects.

Results:

The past-year prevalence of MDD was 3.9% (95% CI 3.5% to 4.2%). Prevalence was higher in women and in younger age groups. Among respondents with past-year MDD, 63.1% had sought treatment and 33.1% were taking an antidepressant (AD); 4.8% had past-year alcohol abuse and 4.5% had alcohol dependence. Among respondents with past-year MDD, the prevalence of cannabis abuse was 2.5% and that of dependence was 2.9%. For drugs other than cannabis, the prevalence of abuse was 2.3% and dependence was 2.9%. Generalized anxiety disorder was present in 24.9%. Suicide attempts were reported by 6.6% of respondents with past-year MDD. Among respondents accessing treatment, 37.5% perceived that others held negative opinions about them or treated them unfairly because of their disorder.

Conclusions:

MDD is a common, burdensome, and stigmatized condition in Canada. Seeking help from professionals was reported at a higher frequency than in prior Canadian studies, but there has been no increase in AD use among Canadians with MDD.
The Heterogeneity of Memory Dysfunction in Schizophrenia
Authors: Stip Emmanuel , Lussier Isabelle
Published: January 2017

Objective:

To characterize the memory dysfunction of schizophrenic patients.

Method:

The components of the human memory system are described, and then a review of the various memory deficits identified among patients suffering from schizophrenia is presented. Finally, an overview of the latest developments in the comprehension of schizophrenia and a discussion on certain proposals advanced by various researchers in the field intended to shed light on the disorder is provided.

Results:

Schizophrenia appears to be an amalgamation of many different disorders. No single model for identifying the disorder has been able to encompass every aspect of schizophrenia.

Conclusion:

Future studies will need to consider new ways of selecting and grouping schizophrenic patients.
A Critical Review of Marital Therapy Outcome Research
Authors: Wesley Stephen , Waring Edward M
Published: January 2017

Objective:

This review critically examines conceptual and methodological issues of outcome research designed to evaluate the efficacy of marital therapy (MT). Behavioural marital therapy (BMT), cognitively orientated marital therapy (COMT), emotionally focused marital therapy (EFMT), and insight-oriented marital therapy (IOMT) have provided evidence for efficacy.

Method:

The initial literature search involved the use of the MEDLINE and Psychlit CD-ROM data bases. A secondary literature search based on citations in articles discovered in the initial search was also conducted. Three broad categories involving the delineation of the client sample, study design considerations, and determination of treatment effects were addressed to investigate the quality of evidence concerning the efficacy of MT.

Results:

None of the 4 approaches has proven superiority in efficacy, and the research does not provide evidence for the superiority of any one approach in distinct types of marital discord. There is some evidence to indicate that future outcome research should avoid the use of “waiting list control groups,” since their use appears to be neither ethical nor humane in marital discord research.

Conclusions:

The authors suggest that the concept of treatment efficiency may be more clinically relevant to outcome research. A gold standard for “efficiency” would suggest that a marital therapy approach should produce subjective and objective improvement in 50% of eligible couples, and this improvement should be maintained in half of these couples at the one-year follow-up assessment. This standard would be comparable to the data on the 4 effective approaches described in this review.
An Examination of the Relationship of Homelessness to Mental Disorder, Criminal Behaviour, and Health Care in a Pretrial Jail Population
Authors: Zapf Patricia A , Roesch Ronald , Hart Stephen D
Published: January 2017

Objective:

To examine the prevalence of homelessness and its relationship to mental disorder, criminal behaviour, and health care.

Method:

Interview and file data were collected for 790 male admissions to a large, pretrial jail facility over a 12-month period.

Results:

A significant relationship was found between homelessness and severe mental disorder as well as between homelessness and prior psychiatric history. There were no significant differences found between the homeless and the nonhomeless on the types of crimes for which they were incarcerated or on contact with health care services within the past year.

Conclusion:

The findings indicate the need for a link between the jail and community services for homeless individuals.
Psychiatric Manifestations of Multiple Sclerosis: A Review
Authors: Rodgers Jennifer , Bland Roger
Published: January 2017

Objective:

To report the occurrence, type, causes, and management of psychiatric manifestations in multiple sclerosis (MS).

Method:

Review of recent, relevant literature.

Results:

Psychiatric illness, especially depression, occurs much more frequently than expected inpatients with MS, is frequently unrecognized or ignored, and is treatable using standard methods, although patients with MS may be unusually sensitive to side effects of tricyclic antidepressants.

Conclusions:

Research is needed to better define the causes of psychiatric syndromes inpatients with MS. Those treating MS should increase their awareness of and sensitivity to the likelihood of psychiatric disorder in these patients.
Neonatal Insult to the Hippocampal Region and Schizophrenia: A Review and a Putative Animal Model
Authors: Beauregard Mario , Bachevalier Jocelyne
Published: January 2017

Objective:

To review the mounting evidence implicating early hippocampal dysfunction in the pathogenesis and the pathophysiology of schizophrenia. An account is made of recent neurodevelopmental hypotheses indicating how an early dysfunction of the hippocampal region disrupts maturational events in brain systems connected to that structure, thus inducing dysfunctional connectional development. Finally, an animal model is presented.

Method:

Socioemotional behaviour of monkeys (Macaca mulatta) with selective neonatal hippocampal lesions was assessed by analyzing their interactions with their age-matched controls at 2 months, 6 months, and 5 to 8 years of age and by comparing the social interactions at each age with those of normal controls paired together.

Results:

At 2 months of age, monkeys with neonatal hippocampal lesions presented minor disturbances in initiation of social interactions. These subtle changes of behaviour were less evident at 6 months, although by that age, the operated monkeys displayed more withdrawals in response to an increase in aggressive responses from their unoperated peers. In adulthood, the amount of time spent by the hippocampectomized monkeys in social contacts with their normal peers decreased markedly. In addition, operated monkeys exhibited more locomotor stereotypies than normal controls.

Conclusion:

These experimental findings indicate that the time-course and nature of the behavioural disturbances resulting from early trauma to the hippocampal region have some similarities with the clinical symptoms of schizophrenic patients and the typical time-course of the disease.
Psychotropic Medication and Insomnia Complaints in Two Epidemiological Studies
Authors: Ohayon Maurice M , Caulet Malijaï
Published: January 2017

Objective:

This study compared prescribed psychotropic medication patterns for reported sleep disorders in French and Quebec samples.

Method:

The first study was undertaken in France (N = 5622) and the second in the metropolitan area of Montreal (N = 1722). Lay interviewers used a specialized knowledge-based system for the purpose of evaluating sleep disorders by telephone.

Results:

Results showed similar prevalence of insomnia complaints in both samples (20.1% and 17.8%, respectively). A higher level of psychotropic consumption was found in France (11.7% [95% confidence interval (CI), 10.9 to 12.5]) compared with Quebec, however, where consumption was less than half the French rate (5.5% [95% CI, 4.4 to 6.6]). Both studies identified females and the elderly as the primary consumers of these drugs. For approximately two-thirds of both samples, sleep-promoting medications were prescribed for a year or longer, revealing a chronicity of the consumption. Approximately 4 out of 5 prescriptions for sleeping medications were ordered by general practitioners in both samples.

Conclusion:

These findings clearly show a higher prevalence of psychotropic drug use in the French compared with the Quebec population. The patterns of consumption and prescription, however, are quite similar in both studies.
Coping Resources, Loneliness, and Depressive Symptoms of Older Women With Chronic Illness
Authors: Warner Camille Beckette , Roberts Amy Restorick , Jeanblanc Alexandra Bohne , Adams Kathryn Betts
Published: January 2017

Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women ( N = 138) with at least one chronic illness ( M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.
Accessing Faith-Based Organizations Using Public Transportation: A Qualitative and GIS Study
Authors: Lewinson Terri , Maley Olivia , Esnard Ann-Margaret
Published: January 2017

Nondriving aging adults are at risk of experiencing mobility barriers that inhibit access to important community resources for managing health and wellbeing. This multimethod study explores bus transportation experiences of older adults who live in extended stay hotels and use faith-based organizations to access resources. Interviews from 17 nondriving older adults were analyzed for perspectives about using faith-based organizations and residents’ experiences navigating to faith-based organizations through available bus transportation in their communities. Residents described both favorable and unfavorable experiences when reaching out for help from faith-based organizations. Although they report reliance on faith-based organizations for a variety of resources, residents were challenged by an ineffective bus system that interfered with resource accessibility. Suggestions for improving bus transit systems and providing alternative, aging-friendly transportation options are discussed.
Scar Avoidance in Removal of Forehead Lipomata: An Endoscopic Approach
Authors: Salehi, BSc Parsa P. , Gilmore, MD Jim
Published: January 2017

Lipomas are among the most commonly presenting benign forehead masses. They commonly cause cosmetic concerns for patients. The purpose of this report is to introduce a novel endoscopic technique allowing for forehead soft tissue mass removal with superior cosmetic outcomes. We detail a case of a large 3.5-cm lateral forehead lipoma that was successfully removed endoscopically through a single incision via a subtemporoparietal approach. The lipoma presented is the largest documented case removed endoscopically using this approach. We introduce a novel technique using a single incision in the temporal area to remove a forehead mass via a dissection between the temporoparietal fascia and deep temporal fascia. Our broad literature search only found one other report of this approach used for forehead lipoma removal. Our report further validates this approach and highlights its efficacy in removing large masses. Patients with cosmetic concerns about having a facial scar, children, and those with predisposition for keloids or hyperpigmented/hypertrophic scars stand to benefit most from this procedure. When comparing the endoscopic approach with the commonplace open-incision approach, our approach shows superior cosmetic results, less risk of damage to important neurovascular structures, and, most importantly, higher patient satisfaction. Even when contrasting the technique outlined in this report versus other endoscopic approaches, our method produces enhanced results.
Vagus Nerve Stimulation in Intractable Epilepsy Associated With SCN1A Gene Abnormalities
Authors: Fulton Stephen P. , Van Poppel Kate , McGregor Amy L. , Mudigoudar Basanagoud , Wheless James W.
Published: January 2017

Mutations in the SCN1A gene cause a spectrum of epilepsy syndromes. There are 2 syndromes that are on the severe end of this spectrum. The classic severe form, Dravet syndrome, is an epileptic encephalopathy of childhood, causing cognitive decline as well as intractable seizures. Severe Myoclonic Epilepsy of Infancy–Borderline (SMEIB) is a term used to include cases with similar severities as those with Dravet syndrome, but lacking a single feature of classic severe myoclonic epilepsy of infancy. Vagus nerve stimulation is a nonpharmacologic treatment for intractable epilepsy. A retrospective review was conducted of patients with deleterious SCN1A mutations who had vagus nerve stimulation placement for treatment of their intractable epilepsy. These children had onset of their epilepsy between 3 and 29 months of age. Seizure control was assessed 6 months after implantation. Twenty patients are included in the study, with 12 implanted at our institution. Nine of the 12 patients implanted at our institution, who had confirmed pre- and post-implantation seizure assessments, showed improvement in seizure control, which was defined as >50% reduction in generalized tonic-clonic seizures, and 4 of those 12 reported improvement in cognitive or speech development. Seven of the 8 patients not implanted at our institution reported subjective benefit, with 4 relating “marked improvement” or seizure freedom. Vagus nerve stimulation appears to impart a benefit to children with deleterious SCN1A gene abnormalities associated with intractable epilepsy.
Synthesis and evaluation of pH-sensitive, self-assembled chitosan-based nanoparticles as efficient doxorubicin carriers
Authors: Raja Mazhar Ali , Arif Muhammad , Feng Chao , Zeenat Shah , Liu Chen-Guang
Published: January 2017

A novel pH-responsive polymer based on amphiphilic N-acetyl histidine and arginine-grafted chitosan was synthesized using N-acetyl histidine as hydrophobic segment and arginine as hydrophilic segment by 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide-mediated coupling reactions as anticancer drug delivery system for doxorubicin. The structure of the synthesized polymer was confirmed by Fourier transform infrared and 1H nuclear magnetic resonance analysis. Due to self-association behavior, N-acetyl histidine and arginine-grafted chitosan structured nanoparticles with in size range of 204 nm. N-acetyl histidine and arginine-grafted chitosan with different substitution degree of N-acetyl histidine were initially prepared and characterized. The critical micelle concentration decreased with increasing substitution degree of N-acetyl histidine. Furthermore, N-acetyl histidine and arginine-grafted chitosan nanoparticles exhibited an acidic pH-triggered aggregation and disassembling nature. The doxorubicin-encapsulated nanoparticles based on synthesized conjugate ( N-acetyl histidine and arginine-grafted chitosan/doxorubicin nanoparticles) showed a sustained drug release pattern, which could be hastened under acidic pH conditions but delayed with increasing substitution degree of N-acetyl histidine. Anticancer effects demonstrated that N-acetyl histidine and arginine-grafted chitosan/doxorubicin nanoparticles could suppress both sensitive and resistant human breast tumor cell line (MCF-7) efficiently in a dose- and time-dependent pattern. Confocal microscopy results evidenced increased cellular uptake and enhanced retention of the synthesized nanoparticles in drug-resistant cells demonstrating better efficacy of nanoparticles over native doxorubicin. These results suggest that N-acetyl histidine and arginine-grafted chitosan/doxorubicin nanoparticles might be promising carriers for delivery of hydrophobic drug doxorubicin against drug-resistant tumors.
Overcoming the problem of embedding change in educational organizations
Authors: Wood Phil
Published: January 2017

In this article, I begin by outlining some of the barriers which constrain sustainable organizational change in schools and universities. I then go on to introduce a theory which has already started to help explain complex change and innovation processes in health and care contexts, Normalization Process Theory. Finally, I consider what this theory might offer in practical terms to aid organizations and leaders in bringing about more sustainable and positive change in educational contexts.
Leadership and the Clinical Coordinator
Authors: Savitsky Maureen E.
Published: January 2017

Clinical coordinators are expected to provide leadership in a pharmacy department. Leadership involves influencing the activities or behaviors of another person. Leaders exhibit several characteristics, including an understanding of themselves, the ability to understand human nature, and the ability to adapt to rapid change. The key leadership skills are situational discretion, communications, motivation, decision-making, problem-solving, and conflict resolution. The situational and principle-centered leadership models provide useful tools for the development of leadership skills.
Documentation Processes Needed for Clinical Pharmaceutical Services
Authors: Swanson D. Sevrin
Published: January 2017

The practice of pharmacy in hospital settings has undergone a tremendous transformation in the last decade. With this change in practice came the need to overhaul the systems used for documenting the role of pharmacists. This documentation is essential if pharmacists are to justify continued and expanded clinical services. Though a consensus has not yet been reached which typifies the ideal documentation system, several elements are deemed necessary. The three pharmacy programs that have typically focused on reduction in costs and therefore offer an opportunity for expanded involvement by pharmacists are: closed formularies, the use of drug utilization evaluations, and educational cost containment reviews. The documentation of these programs poses one of the greatest challenge to pharmacy management teams.
A 12-Step Method for Developing New Pharmacy Programs
Authors: Eatherton-Coll Rena
Published: January 2017

Clinical pharmacy service managers are usually responsible for establishing new programs. Many different methods have been used successfully to implement new clinical pharmacy services. These methods vary greatly when services are forced into development during a crisis situation as opposed to having time to employ strategic planning. The 12-step method is ideal for pharmacy leaders who have time to plan the best process for service development. However, individual hospital demographics may dictate the most effective plan for new program development. Teaching versus community hospitals and for-profit versus not-for-profit hospitals have very diverse philosophies. Clinical coordinators must assume a selling role when writing program proposals. The future of pharmacy will depend on the ability of the pharmacy leaders to establish patient-focused services that are also cost-effective.
The Relative Accessibility for Health Districts to Regionally Supplied Specialist Services
Authors: Hindle Tony , Ngwube Clement
Published: January 2017

This paper describes a study carried out in the North Western Health Region of England where it is policy to provide access to regionally supplied specialist services on an equal basis to all component Health Districts. The results, however, suggest substantial differences in uptake depending on the proximity of the District of residence of the patient to the location of such specialist service. Throwing light on this phenomenon proved difficult because many important Regional services are hard to disentangle from the ‘normal’ District services with which they are organisationally linked. Also diagnostic classification schemes do not always provide a clear indication of those patients who require the super-specialist service.
Alternatives, Agendas and Outcomes: Budget Cutting in Health Care Organizations
Authors: Bigelow Barbara
Published: January 2017

The structural characteristics of health care organizations have received considerable attention since the early 1960s when Perrow (1961; 1965) and Gordon (1961; 1962) wrote about the relationships among the top management triangle. Despite dramatic changes in the industry since that time, the basic structure has changed little. Power is still more likely to be shared among administrators, medical staff and board members than concentrated in a managerial hierarchy (Morlock & Nathanson, 1983). Objectives held by each of these three groups still tend to be diverse and conflicting rather than congruent.

This combination of diverse goals and shared power suggests that decision making in these organizations may be more akin to the process observed in political and community settings than to the hierarchically determined process attributed to most types of organizations. That is, administrators in health care organizations may be constrained in their choice of actions by the preferences of other groups (Young & Saltman, 1985), and by the dominance of values that may act to the benefit of medical interests.
The Reproduction of Physician Autonomy in Ontario Medical Group Practice
Authors: Williams A. Paul , Burke Mike , Vayda Eugene
Published: January 2017

A belief exists about the advantages of group medical practice over solo practitioners. The paper through a survey of 105 group practices examines a number of organisational and operational factors. The results suggest that practices are not always organised in a way to maximise the benefits of group operation but are still characterised by an individualistic approach.
Contextual, experiential, and behavioral risk factors associated with HIV status: a descriptive analysis of transgender women residing in Atlanta, Georgia
Authors: Salazar Laura F , Crosby Richard A , Jones Jamal , Kota Krishna , Hill Brandon , Masyn Katherine E
Published: January 2017

This study assessed the prevalence of self-reported HIV infection among a community sample of transgender women and identified associated contextual, experiential, and behavioral factors. Ninety-two transgender women completed a self-administered interview. Recruitment occurred through an LGBT service organization, a transgender support group, transgender advocates, and informal communications. Eighty-two percent were African American/Black. Of 83 who knew their status, 60% reported being HIV infected. High rates of childhood sexual abuse (52%), rape (53%), intimate partner violence (56%), and incarceration (57%) were reported. Many did not have health insurance (53%), were not employed full-time nor in school (63%) and had been recently homeless (49%). HIV-infected transgender women as compared to HIV-uninfected transgender women were more likely to be African American/Black ( P = 0.04), and older than 34 years ( P = 0.01), unemployed/not in school ( P < 0.001). HIV-infected transgender women also experienced less trans-related discrimination ( P = 0.03), perceived less negative psychosocial impact due to trans status ( P = 0.04) and had greater happiness with their physical appearance ( P = 0.01). HIV-infected transgender women may experience relatively less trans-related stress compared to their HIV-uninfected counterparts. High rates of HIV, trauma, and social marginalization raise concerns for this population and warrant the development of structural and policy-informed interventions.
2017 European guideline for the management of chancroid
Authors: Lautenschlager Stephan , Kemp Michael , Christensen Jens Jørgen , Mayans Marti Vall , Moi Harald
Published: January 2017

Chancroid is a sexually acquired infection caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis, which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Nucleic acid amplification tests can demonstrate the bacterium in suspected cases. Antibiotics are usually effective in curing chancroid.
Implementation and outcomes of a new safeguarding pathway for vulnerable adults presenting to sexual health services
Authors: Mody Nisha , Kirby Catherine , Grech Patrice , Thompson Hermione , Turner Frances , Runacres Lorette , Hamlyn Elizabeth
Published: January 2017

Adult safeguarding is the process of protecting vulnerable adults from harm or exploitation. In 2014, our sexual health clinic implemented a new adult safeguarding pathway, including an adult safeguarding proforma, an electronic database and a monthly adult safeguarding meeting. We conducted a retrospective case note review of patients entered onto the safeguarding database and found that greater numbers of adults were identified as vulnerable following the introduction of this pathway. Many required referral for onward support, highlighting the importance of robust safeguarding procedures in a sexual health setting.
High HIV prevalence and associated risk factors among female sex workers in Rwanda
Authors: Mutagoma Mwumvaneza , Samuel Malamba S , Kayitesi Catherine , Gasasira Antoine R , Chitou Bassirou , Boer Kimberly , Hedt-Gauthier Bethany , Gupta Neil , Ntaganira Joseph , Nsanzimana Sabin
Published: January 2017

Human immunodeficiency virus (HIV) prevalence is often high among female sex workers (FSWs) in sub-Saharan Africa. Understanding the dynamics of HIV infection in this key population is critical to developing appropriate prevention strategies. We aimed to describe the prevalence and associated risk factors among a sample of FSWs in Rwanda from a survey conducted in 2010. A cross-sectional biological and behavioral survey was conducted among FSWs in Rwanda. Time–location sampling was used for participant recruitment from 4 to 18 February 2010. HIV testing was done using HIV rapid diagnostic tests (RDT) as per Rwandan national guidelines at the time of the survey. Elisa tests were simultaneously done on all samples tested HIV-positive on RDT. Proportions were used for sample description; multivariable logistic regression model was performed to analyze factors associated with HIV infection. Of 1338 women included in the study, 1112 consented to HIV testing, and the overall HIV prevalence was 51.0%. Sixty percent had been engaged in sex work for less than five years and 80% were street based. In multivariable logistic regression, HIV prevalence was higher in FSWs 25 years or older (adjusted odds ratio [aOR] = 1.83, 95% [confidence interval (CI): 1.42–2.37]), FSWs with consistent condom use in the last 30 days (aOR = 1.39, [95% CI: 1.05–1.82]), and FSWs experiencing at least one STI symptom in the last 12 months (aOR = 1.74 [95% CI: 1.34–2.26]). There was an inverse relationship between HIV prevalence and comprehensive HIV knowledge (aOR = 0.65, [95% CI: 0.48–0.88]). HIV prevalence was high among a sample of FSWs in Rwanda, and successful prevention strategies should focus on HIV education, treatment of sexually transmitted infections, and proper and consistent condom use using an outreach approach.
Tracing partners of patients with syphilis infection remains challenging: experience of Geneva Hospital
Authors: de Lorenzi Caroline , Gayet-Ageron Angèle , Girard-Strohbach Martine , Toutous-Trellu Laurence
Published: January 2017

Syphilis has been reinstated on the list of notifiable diseases in Switzerland since 2006 and the active management of sexual partners is encouraged to avoid reinfection. However, contact tracing has yielded unsatisfactory results and the incidence of syphilis remains important, especially in high-risk populations. The aim of this study was to compare the proportions of notified sexual partners of patients diagnosed with syphilis by the laboratories of Geneva University Hospitals (HUG) with those diagnosed in private laboratories (non-HUG) and to assess the risk factors for no notification to sexual partners. All syphilis cases notified to the Office of the Surgeon General in Geneva (Switzerland) between 1 January 2011 and 31 December 2013 were analysed. The proportions of partner notification (PN) between HUG and non-HUG laboratories were compared by Chi square test and the main risk factors for no notification to sexual partners were assessed by binomial log-linear regression. Among a total of 720 notifications reported, 244 cases were diagnosed with contagious syphilis stages and 263 with non-contagious stages (i.e. successfully treated patients with or late latent cases). Overall, PN was higher among contagious than non-contagious cases (58.4% versus 31.0%; p = 0.030) and it was significantly higher in the non-HUG compared to the HUG group (75.9% versus 50.0%, respectively; p < 0.001). Risk factors independently associated with no notification to sexual partners were the place of diagnosis (risk ratio [RR] 1.66; 95% confidence interval [CI] 1.21–2.27 for HUG versus non-HUG, respectively), age >45 years (RR 1.36; 95% CI: 1.05–1.76) and if the patient had received treatment for syphilis (RR 1.91; 95% CI: 1.38–2.66). Our results illustrate the difficulty of contact tracing in syphilis infection and the necessity to improve this crucial part of sexually transmitted infection management.
AIDS and the Adolescent
Authors: Graham C A
Published: January 2017

Recent findings on young people's response to HIV/AIDS and its perceived relevance to their sexual lives are reviewed. Research into adolescent sexual behaviour suggests a trend, over the last 2 decades, for an earlier age of first intercourse and a greater number of recent and lifetime sexual partners. Older cohorts of adolescents and those with either multiple partners or more ‘steady’ partners have been found to have lower rates of condom use. Data on the prevalence of specific sexual activities such as anal intercourse, while sparse, suggests a considerable number of young people engaging in behaviours carrying some risk of HIV infection. It is clear that sex education programmes which simply advocate ‘safer sex’ practices without addressing the interpersonal skills and emotional implications of negotiating such practices, and which do not provide a positive view of sexual health, are failing to influence adolescent behaviour. Recent research has highlighted a number of issues that need addressing if sex education and HIV/AIDS prevention campaigns are to be effective.
Cerebrospinal Fluid Proteins in Neurosyphilis and HIV Infection
Authors: Keir G
Published: January 2017

This paper briefly reviews the factors which influence the concentrations of proteins, particularly immunoglobulins, within the CSF and how antibodies which are locally synthesized within the central nervous system can be detected by the laboratory. The use of nitrocellulose immunoblotting for the identification of antibodies which are specific to Treponema pallidum and Human Immunodeficiency Virus Type-1 are discussed.
The Role of Early Colposcopy in the Management of Females with First Episode Anogenital Warts
Authors: Ward K A , Houston J R , Lowry B E , Maw R D , Dinsmore W W
Published: January 2017

212 females attending a genitourinary medicine (GUM) clinic with first episode anogenital warts were screened by cervical cytology and colposcopy/histology for the presence of cervical epithelial abnormalities in keeping with infection by the human papillomavirus (HPV infection) and/or cervical intraepithelial neoplasia (CIN).

The prevalence of cervical epithelial abnormalities detected by cervical cytology alone was 32%, rising to 56% after colposcopic examination. However, the majority of cervical lesions detected by colposcopy alone were of low grade (HPV infection and/or CIN I). Histologically confirmed high grade cervical lesions (CIN II or CIN III) were detected more frequently in those females in whom cervical cytological examination indicated dyskaryosis in keeping with any grade of CIN, compared to females without dyskaryotic changes on cervical smear ( P<0.05, chi-squared test with Yates' correction).

Early colposcopy is indicated for females with anogenital warts in the presence of a cervical smear showing dyskaryosis in keeping with any grade of CIN, because of the statistically significant increased risk of detecting a potentially progressive high grade cervical lesion. In females without dyskaryotic changes on cervical smear, the value of early colposcopy is uncertain and warrants larger more long-term trials.
The use of Intravenous Pentamidine as Prophylaxis against Pneumocystis Carinii Pneumonia in Patients with HIV Infection
Authors: Schroeder K E , Barton S E
Published: January 2017

The purpose of this study is to report on the use of monthly intravenous pentamidine as prophylaxis against Pneumocystis carinii pneumonia (PCP) within a central London HIV unit.

A retrospective case note analysis of HIV-seropositive individuals using intravenous pentamidine as PCP prophylaxis was carried out. Aspects examined included reasons for using the regimen, compliance, adverse reactions and episodes of PCP. Eight patients were studied. There was no prophylaxis failure in 5 patients. Three patients developed PCP whilst on the regimen, although their compliance was poor.

In patients who are intolerant of established prophylaxis regimens, intravenous pentamidine may be a useful alernative. It is well tolerated, although compliance is the main problem. Further prospective studies are indicated to assess its efficacy.
High Prevalence of Herpes Simplex Virus Type 1 in Female Anogenital Herpes Simplex in Newcastle upon Tyne 1983–92
Authors: Tayal S C , Pattman R S
Published: January 2017

This retrospective study was undertaken to evaluate the prevalence of the viral types and temporal epidemiology in patients with ano-genital herpes between 1983–92. One thousand one hundred and thirty-five patients with anogenital herpes were available for analysis. The annual incidence of anogenital herpes nearly tripled over the period of 7 years (1986–92) from 59 to 171 cases. The percentage of HSV-1 infection in female cases (63–79%) was much higher than in other reported studies and remained relatively constant over the study period.
Risk Behaviours for HIV Infection and Sexually Transmitted Diseases among Female Sex Workers from Copenhagen
Authors: Alary Michel , Worm Anne-Marie , Kvinesdal Birgit
Published: January 2017

In 1990–91, 237 female sex workers from Copenhagen were enrolled in a larger study performed in 9 European countries. None of 206 women accepting serological testing was HIV-infected despite the fact that 36 (17.5%) were injecting drug users (IDU). Whereas 95% of the women always used condoms with clients over the last 6 months, this proportion was 25% and 9% respectively for casual and regular non-paying partners ( P< 0.0001 for both comparisons). Those reporting at least one STD over the last year had more non-paying sexual partners than the others ( P< 0.01) and the frequency of STD was lower in women who always used condoms with non-paying partners (7% vs 31%, P=0.01). Women working on the street were more often IDU than others (78% vs 7%, P< 0.001). Independently of drug use, street prostitutes also tended to have more clients ( P=0.007) and more STD ( P=0.05).

The striking differences in condom use with clients as compared to non-paying partners and the association between STD and sexual behaviours with such partners but not with clients show that specific interventions should be designed to promote safer sex with non-paying partners.
A Large-Scale Test of the Goldilocks Hypothesis
Authors: Przybylski Andrew K. , Weinstein Netta
Published: January 2017

Although the time adolescents spend with digital technologies has sparked widespread concerns that their use might be negatively associated with mental well-being, these potential deleterious influences have not been rigorously studied. Using a preregistered plan for analyzing data collected from a representative sample of English adolescents ( n = 120,115), we obtained evidence that the links between digital-screen time and mental well-being are described by quadratic functions. Further, our results showed that these links vary as a function of when digital technologies are used (i.e., weekday vs. weekend), suggesting that a full understanding of the impact of these recreational activities will require examining their functionality among other daily pursuits. Overall, the evidence indicated that moderate use of digital technology is not intrinsically harmful and may be advantageous in a connected world. The findings inform recommendations for limiting adolescents’ technology use and provide a template for conducting rigorous investigations into the relations between digital technology and children’s and adolescents’ health.