Tesi sul tema "Drug safe use"

Problem: Nurses are potentially exposed to hazardous drugs (HDs) in their practice. HD exposure is associated with adverse outcomes (reproductive problems, learning disabilities in offspring of nurses exposed during pregnancy, and cancer occurrence). Safe handling precautions (safety equipment and personal protective equipment, [PPE]) minimize exposure to HDs and decrease the potential for adverse outcomes. Despite existing OSHA recommendations, adherence to precautions is below recommendations. The purpose of this study was to examine relationships among factors affecting nurses’ use of HD safe handling precautions, to identify factors that promote or interfere with HD precaution use, and to determine nurse managers’ perspectives on use of safe handling precautions. This study used a conceptual model which proposes that both individual and organizational factors influence precaution use. Methods: A cross-sectional, correlational design was used. Nurses (N = 165; 46% response rate) from oncology centers across the US who reported handling chemotherapy completed a mailed survey. Instruments measured HD precaution use, knowledge, self efficacy, barriers, perceived risk, conflict of interest, interpersonal influences and workplace safety climate. Hierarchical regression was used. Twenty managers of nurses handling chemotherapy were interviewed. Results: Nurses were experienced in oncology (M = 15.8 ± 7.6) yrs, well-educated (62.5% ≥BSN), certified in oncology nursing (85%), worked in outpatient settings (69%), and on average treated 6.8 ± 5.2 patients per day. Chemotherapy exposure knowledge was high (M = 10.9, ± 1, 0-12 scale); as was self efficacy for using PPE (M = 20.8 ± 3, 7-24 scale), and perceived risk (M = 3.14 ± .6, 0-4 scale). Total precaution use during HD administration and disposal was low (M = 1.9, SD = 1.1, 0= never to 5 = 100%). Nurse characteristics did not predict HD precaution use. In the final model (R2 = .29, F (2, 155) = 24.6, p < .000), fewer patients per day, fewer barriers and better workplace safety climate were independent predictors of higher precaution use. Conclusions: Results emphasize the importance of organizational influence on nurses’ HD safe handling precaution use and suggest fostering a positive workplace safety climate and reducing barriers as interventions.

Second year psychology students (N=176) from Rhodes University were surveyed using an anonymous questionnaire to obtain information on sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS) among young people. The following information was obtained: Knowledge of safe sex practices and HIV transmission was high although a number of misconceptions were noted. Only fifty six percent of students viewed oral sex with a condom as safe and thirty one percent do not consider mutual masturbation with a condom safe. Thirteen percent and twenty five percent respectively identified insects and saliva as being routes of HIV transmission. Magazines (96%), informal discussions with friends (95%), public pamphlets (86%) and public television (79%) were preferred sources of information. The students' knowledge did not appear to significantly affect sexual behaviour. Eighty percent of respondents were intimately involved with another person during the past twelve months, and only fifteen percent always made use of a latex barrier when being sexually intimate. Despite high rates of alcohol and/or drug consumption (80% of students use such substances), and the belief by the majority of respondents that alcohol and/or drugs facilitate higher risk behaviours, no support for the alcohol/risky sex hypothesis was found. Students were found to score highly on proneness to psychological and behavioural risk taking, and no significant relationship between this and unprotected sex was found. It can be concluded that educational programmes need to focus on what constitutes safe sexual practices in order to equip young adults with the knowledge they need to make informed choices regarding the relative risks of various sexual activities.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

Darbo tikslas. Įvertinti vyresnio amžiaus pacientų vaistų vartojimo valdymą. Uždaviniai: išanalizuoti vaistų vartojimo ypatumus vyresniame amžiuje; nustatyti gaunamos informacijos, susijusios su saugiu vaistų vartojimu, įtaką pagyvenusiems pacientams; įvertinti pagalbinių technologijų reikšmę vyresnių pacientų vaistų vartojimo valdymui. Tyrimo metodika. Tiriamųjų apklausa, dokumentacijos analizė, statistinė analizė. Anketavimo bei struktūrizuoto interviu metu buvo naudojamas klausimynai, skirti pacientams bei slaugytojoms, sudaryti pačios tyrėjos, remiantis literatūra. Tiriamųjų grupę sudarė 178 respondentai, besigydantys VšĮ II Kauno klinikinės ligoninės vidaus ligų skyriuje nuo 2009 metų rugsėjo mėn. iki 2010 vasario mėn. bei 14 bendrosios praktikos slaugytojų, dirbančių tame pačiame skyriuje. Statistinė duomenų analizė atlikta naudojant statistinės analizės programą "SPSS for Windows 15.0". Rezultatai statistiškai reikšmingi, jei paklaidos tikimybės reikšmė p<0,05. Kokybinių požymių pasiskirstymas buvo skaičiuojamas absoliučiu skaičiumi bei procentais, kiekybiniams požymiams skaičiuotas vidurkis ir standartinis nuokrypis, standartinė vidurkio paklaida. Ryšiai tarp požymių buvo vertinami chi kvadrato (χ²) kriterijumi bei laisvės laipsnių skaičiumi (lls). Rezultatai. Lietuvoje kaip ir visame pasaulyje vis didėja vyresnio amžiaus žmonių skaičius. Tai sąlygoja didesnį sergamumą ir su juo susijusį saugų vaistų vartojimą. Dažniausios problemos yra: širdies ir kraujagyslių ligos... [toliau žr. visą tekstą]
Aim of the study. To evaluate the managament of older patients medicines consumption. Objectives. To assess the pecularities of drug use by older patients; to identify the influence of available information of safe medicines consumption on senior patients behaviour; to evaluate the importance of supporting technologies to the management of senior patients medicines consumption. Research methods. Questionnaires for patients and nurses were created by researcher using literature. The study groups consisted of 178 respondents, which were hospitalized in 2nd Kaunas Clinical Hospital Internal Medicine Department since September, 2009, till February , 2010, and 14 general practice nurses, which are working in this department. Statistical data analyse was performed by using statistical analyse programme “SPSS for Windows 15.0“. The distribution of qualitative indicators was calculated in absolute number and percentage. For quantitative indicators an average and standard deviation were calculated. Relations between features were valued by chi square criterion ((χ²). Results. The most frequent conditions of older patients were cardiovascular diseases and respiratory diseases. Patients for a variety of problems could not use medicines on their own. Side effects of medications were frequent. From side effects more common were: dizziness (33,7 %), palpitations (30,3 %), general weakness (29,2 %), constipation (26,4 %). Aged patients used frequently over-the-counter medications, they... [to full text]

Background: Unsafe injection practices remain a significant source of morbidity and mortality among people who inject drugs (IDU), this thesis sought to: review the literature outlining the ways in which people inject unsafely, the health consequences associated with unsafe practices, the factors that influence injection practices, and the interventions that have been designed to address these problems; describe a drug user-led safer injecting education campaign; and finally, examine the facilitators’ and participants’ perceptions of a unique user-led intervention. Methods: Qualitative data was derived from semi-structured qualitative interviews conducted with eight members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops and 20 individuals who participated in these workshops. Interviews were transcribed verbatim and a thematic analysis was conducted. Results: A literature review identified numerous specific unsafe injection practices, which are associated with negative health outcomes, including HIV, hepatitis C, bacterial infections, and venous damage. Research demonstrates that various individual, physical, social, and structural factors influence injection practices, and has identified a number of interventions (e.g. syringe distribution, education) that reduce negative health consequences. Results indicate that IDU typically learn about injecting by watching or sharing experiences with other IDU and that significant gaps in knowledge regarding safer injecting practices persist. Accounts of IDU suggest that the unique process and structure of IS Team workshops enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants, most of whom expressed that they prefer user-led interventions to other approaches. Facilitators reported gaining knowledge, skills, and positive feelings about themselves from their involvement in the campaign, while many participants reported that they acquired new knowledge that would alter their future injecting practices. Discussion: The IS Team education campaign focuses on health issues relevant to IDU that are not being adequately addressed by existing public health programs. This study demonstrates the feasibility and benefits of involving IDU in educational initiatives targeting unsafe injecting. Increased involvement of IDU in interventions designed to address unsafe injecting is urgently required.

A automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento, que considere adequado para resolver um problema de saúde. Esta prática, ainda, é pouco explorada em idosos, principalmente a partir de dados populacionais. Desse modo, o objetivo do presente estudo foi analisar a pratica de automedicação em idosos no Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo SABE - Saúde, Bem-estar e Envelhecimento. A amostra foi constituída de 1.257 idosos que utilizaram medicamentos com idade de 60 anos e mais. Para coleta de informações utilizaram-se as seções do questionário sobre Informações pessoais (A), Estado de saúde (C), Medicamento (E), Uso e Acesso a serviços (F) e Historia de trabalho e fontes de renda (H). Os medicamentos consumidos na automedicação foram classificados de acordo com a Anatomical Therapeutical Chemical Classification System (ATC). Na análise dos dados utilizou-se o pacote estatístico STATA com realização de regressão logística. Considerou-se nível de significância de p<0,05. A prevalência de automedicação foi de 42,3%. Entre os medicamentos mais usados estão os analgésicos/antiinflamatórios (40,0%) e vitaminas (8,7%). No grupo de idosos que usou automedicação 45,0% pertenciam ao sexo feminino, 44,4% apresentaram 60 a 74 anos, 46,2% utilizaram o serviço público de saúde, 50,8% não consultaram o médico nos últimos 12 meses, 48,4% consumiram cinco ou mais medicamentos e 50,7% relataram não possuir doenças cronicas. O idoso foi o principal responsável pela indicação da automedicação (65%). Na análise múltipla, observou-se que empregar cinco ou mais medicamentos (OR=1,75) e possuir baixa escolaridade aumentou a chance dos idosos usarem a automedicação e possuir plano de saúde privado (OR=0,72), ter uma e mais doenças (OR=0,57) e idade igual ou superior a 75 anos (OR=0,69) diminuiu a chance de usar a automedicação. As intervenções educativas com o objetivo de reduzir a automedicação na população geriátrica devem contemplar, especialmente os usuários de polifarmácia, aqueles com baixa escolaridade e indivíduos na faixa etária dos 60 74 anos, tendo em vista que o próprio idoso é o principal responsável pela decisão de praticar a automedicação.
Self-medication depicts the principle of the individual seeking spontaneously by some drug, which it deems appropriate to resolve a health problem. This practice, though, is little explored in the elderly, primarily using population data. Thus, the objective of this study was to analyze self-medication in the elderly in São Paulo. It is a cross-sectional, population-based, whose data were obtained from the SABE Study - Health, Welfare and Ageing. The sample consisted of 1,257 seniors who used drugs at the age of 60 years and more. To collect the information we used sections of the questionnaire on personal information (A) Health status (C), drug (E), Use and Access to services (F) and work history and income sources (H). The drugs used in self-medication were classified according to the Anatomical Therapeutic Chemical Classification System (ATC). In the data analysis used the STATA statistical package with performance of logistic regression. It was considered a significance level of p <0.05. The prevalence of self-medication was 42,3%. Among the most commonly used drugs are analgesics, anti-inflammatory drugs (40.0%) and vitamins (8.7%). In the elderly group that used self-medication 45.5% were female, 44.4% had 60 to 74 years, 50.8% did not consult the doctor in the last twelve months, 46.2% used public insurance, 48,4% used five or more drugs and 50.7% reported not having chronic diseases. The senior was the main responsible for the appointment of self-medication (65%). In the multivariate analysis, we observed that employ five or more medications (OR = 1.75) and have low education increased the likelihood of using self-medication and the elderly have private health insurance (OR = 0.72), and have a more diseases (OR = 0.57) and age less than 75 years (OR = 0.69) decreased the chance of using self-medication. Educational interventions aimed at reducing self-medication should include in the geriatric population, especially those using polypharmacy, those with low education and individuals aged 60 to 74 years, given that the elderly person is mainly responsible for the decision to practice self-medication.

Background: Dispossession and dislocation of Aboriginal people in Canada through the reserve, residential school and child welfare systems have contributed to the gross overrepresentation of HIV/AIDS infection, substance use, and housing instability in Aboriginal communities. Ensuring young Aboriginal people who use illicit drugs have access to safe spaces, including places to live, is a fundamental part of dismantling structural injustices that lead to their elevated vulnerability to HIV infection. Objective: This thesis investigates access to safe spaces among young Aboriginal men and women who use illicit drugs in Vancouver and Prince George, British Columbia, Canada within the context of historical and intergenerational trauma. It examines how accessibility of safe spaces, and housing in particular, affects young Aboriginal people’s vulnerability to HIV infection. Methods: Baseline categorical variables were compared based on participants’ housing status using Pearson’s Chi-squared test and Fisher’s exact tests when expected cell values were five or less. Continuous variables were analyzed using a Student t test and all p values are two sided. Longitudinal analyses utilized data collected every six-months between November 2005 and January 2010. Generalized linear mixed models fitted with a Gauss-Hermite approximation were used to find odds ratio (ORs) for associations between trauma, housing status, and sex- and drug-related HIV vulnerabilities over time. Results: We found an independent association between historical trauma and housing status: childhood sexual abuse was independently associated with 2.76 greater odds of living in an unstable type of housing over the study period. We uncovered important associations between sub-optimal housing status and drug- and sex-related HIV vulnerability, including sex work, sexual assault, use of injection drugs, high frequency opiate and cocaine injection, and public injection. Conclusions: Our findings reveal that both material and spatial dimensions of housing are closely linked to HIV vulnerability among young Aboriginal people. Further, the links between housing status and historical trauma indicate that addressing the legacy of historical trauma is a crucial component of tackling the underlying causes of housing instability among young Aboriginal people who use illicit drugs.

Le contexte de la prescription médicamenteuse chez l’enfant est complexe : évolution physiologique et métabolique, prescription hors et sans AMM, formes galéniques non adaptées. Les enfants sont exposés à un risque iatrogène plus important que l’adulte. Un outil de détection des prescriptions inappropriées (POPI : Pédiatrie - Omissions et Prescriptions Inappropriées) a été développé en pédiatrie. Nous avons évalué rétrospectivement la prévalence des prescriptions inappropriées (PI) en ville et à l’hôpital. Le taux de prévalence des PI et des omissions de prescriptions (OP) étaient respectivement de 2,9% et 2,3% aux urgences pédiatriques et 12,3% et 6,1% en ville. L’étude de reproductibilité a permis de constater un excellent accord inter-juge entre les médecins dans la détection des PI et entre les pharmaciens dans la détection des OP. Les PI et les OP avaient une bonne concordance entre les différents professionnels de santé. Enfin, nous avons pu adapter notre outil pour une utilisation internationale en utilisant une méthode Delphi. Sur les 105 critères évalués, 80 critères ont obtenu plus de 75% d’accord après le premier tour, 16 items ont été modifiés et 25 ont été supprimés. L’outil POPI international final est composé de 73 items de PI et d’OP. Les principales raisons de modification ou de suppression étaient des différences entre les recommandations des différents pays et l’indisponibilité du médicament. Ces différents travaux ont permis d’évaluer la prévalence des PI en pédiatrie, de montrer que l’outil est utilisable par différents professionnels. La facilité d’utilisation de l’outil a été approuvée par la majorité des utilisateurs qui étaient prêts à l’utiliser dans leur pratique quotidienne. L’outil doit donc permettre d’aider les professionnels de santé à détecter les PI/OP et d’améliorer la prise en charge médicamenteuse des enfants
The context of drug prescription in children is complex : physiological evolution and metabolic changes, off-label prescription, unsuitable dosage forms. Children are at greater iatrogenic risk than adults. A tool for detecting inappropriate prescriptions in paediatrics (POPI : Paediatric - Omission Prescriptions and Inappropriate prescriptions) has been developed. We retrospectively evaluated the prevalence of inappropriate prescriptions (IP) in community setting and in hospital. The prevalence of IP and omitted prescriptions (OP) were respectively 2.9% and 2.3% in emergency department and 12.3% and 6.1% in community setting. The reproducibility study showed excellent inter-judge agreement between doctors in the detection of IP and between pharmacists in the detection of OP. The IP and OP had a good agreement between the different healthcare professionals. Finally, we proposed an adaptation of our tool for use in worldwide. Of the 105 criteria evaluated, 80 criteria obtained more than 75% agreement after the first round, 16 items were modified and 25 were deleted. The final international POPI tool is composed of 73 IP and OP. The main reasons for modification or deletion were differences between the recommendations of the different countries and the unavailability of the drug. This work has allowed us to assess the prevalence of IP in paediatrics and to show that the tool is usable by different professionals. The ease of use of the tool was approved by the majority of users and they were ready to use it in their daily practice. This tool can help healthcare professionals to detect IP/OP and improve the medication management of children

Nos últimos anos, o uso dos psicotrópicos em idosos, aumentou expressivamente em decorrência da ampliação das indicações terapêuticas dessa classe, do lançamento de agentes com menor perfil de toxicidade e do reconhecimento de que determinados quadros clínicos, prevalentes nessa faixa etária, podem ser tratados com esses medicamentos. Todavia, o uso de psicotrópicos pode estar relacionado a eventos adversos que causam impacto no perfil de morbi-mortalidade desse grupo de indivíduos. Desse modo, os objetivos do presente estudo foram identificar a prevalência e os fatores associados ao uso de psicotrópicos entre os idosos do Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo Saúde, Bem-estar e Envelhecimento SABE. A amostra foi constituída de 1.115 idosos de 65 anos ou mais, que foram reentrevistados no ano de 2006. Para coleta de informações utilizaram-se as seções do questionário sobre Informações pessoais (A), Avaliação cognitiva (B), Estado de saúde (C), Estado funcional (D), Medicamentos (E) e Uso e acesso a serviços (F). Os psicotrópicos foram classificados de acordo com a Anatomical Therapeutical Chemical Classification System (ATC). Na analise dos dados utilizou-se o pacote estatístico STATA com realização de regressão logística. Considerou-se nível de significância de p<0,05. A prevalência de uso de psicotrópicos de 12,2%, a qual foi representada por antidepressivos (7,2%), benzodiazepínicos (6,1%) e antipsicóticos (1,8%). No grupo que usou psicotrópicos, 15,9% pertenciam ao sexo feminino, 15,1% apresentaram 75 anos ou mais, 21% relataram possuir quatro e mais doenças e 27,5% usar cinco ou mais medicamentos. Os fatores associados ao uso de psicotrópicos foram : sexo feminino (OR = 1,70; IC95% 1,05 - 2,74), limitação de atividade instrumental de vida diária (OR = 1,871; IC95% 1,16 - 3,04), presença de declínio cognitivo (OR = 1,76; IC95% 1,02 - 3,03), depressão (OR = 5,36; IC95% 3,34 - 8,61) e uso de cinco ou mais medicamentos (OR = 1,28; IC95%1,16 - 1,42). Cerca de um em cada dez idosos do SABE utilizou psicotrópicos, principalmente os antidepressivos. O conjunto dos fatores de risco associados ao uso de psicotrópicos pode indicar que os idosos mais vulneráveis foram aqueles com maior grau de dependência, seja em decorrência de comprometimento clínico causado por doenças, seja pelo uso de psicotrópicos inapropriados
Over the last years, the use of psychotropic drugs in the elderly has risen expressively, due to the increasing of the therapeutic indications of this class, the launching of agents with a profile of low level of toxics, and to the acknowledgement that certain clinical conditions, dominant within this age group, can be treated with this medicine. However, the use of psychotropic drugs can be linked to adverse events which cause impact in the profile of morbid-mortality of this age group. Therefore, the aim of the present study has been to identify the prevalence and factors associated to the use of psychotropic drugs among elderly people in São Paulo City. It is a transversal, population based study, obtained from the Estudo Saúde, Bem-estar e Envelhecimento SABE. The sample was constituted of 1.115 elderly people, aging 65 and over, who were re-interviewed in 2006. For the gathering of information, the sections of the questionnaire on Personal Information (A), Cognitive Evaluation (B), Health State (C), Functional State (D), Medicine (E) and Use and Access to Facilities (F) were used. Psychoactive drugs were classified according to the Anatomical Therapeutical Chemical Classification System (ATC). In the data analysis, it was used the statistic component STATA with logistic regression. A level of significance was considered of being p<0,05. The prevalence of the use of psychotropic drugs of 12,2%, which was represented by anti-depressants (7,2%), benzodiazepine (6,1%) and anti-psychotics (1,8%). In the group that used psychotropic drugs, 15,9% were female, 15,1% were 75 years old and older, 21% claimed having four or more different diseases, and 27,5% making use of five or more different sorts of medicine. The factors associated to the use of psychotropic drugs were: female gender (OR = 1,70; IC95% 1,05 - 2,74), limitation of daily life instrumental activity (OR = 1,871; IC95% 1,16 - 3,04), presence of cognitive decreasing (OR = 1,76; IC95% 1,02 - 3,03), depression (OR = 5,36; IC95% 3,34 - 8,61) and use of five or more sorts of medicine (OR = 1,28; IC95%1,16 - 1,42). About one in ten elderly people in SABE used psychotropic drugs, mainly anti-depressants. The range of risk factors associated to the use of psychotropic drugs may indicate that the most vulnerable elderly people were those with higher level of dependency, whether in consequence of a clinical implication caused by diseases, or by the use of inappropriate psychotropic drugs

Pilot studies of supervised injecting facilities (SIF) are under consideration in Canada, but it is elemental to first establish acceptability among the injecting drug use (IDU) population that are potential attendees. This study aimed to assess SIT acceptability and to determine factors associated with the willingness of public injectors to use SIF in a city considering their establishment. From April 2001--February 2002, qualitative, key informant interviews and survey data collection methods were employed. Questions were appended to a study monitoring HIV risk among Montreal IDU. Univariate and bivariate analyses preceded logistic regression. 11 key informants and 251 IDU participated in the study. Key informants generated specific SIT models subsequently presented to IDU. Overall, SIF acceptability was high. Two logistic regression models presented factors independently predictive of potential SIF use including drug use characteristics and SIF attributes. Initial community and user consultations are essential in assessing relevance and planning of SIF.

Introdução - Os efeitos prejudiciais envolvendo medicamentos pela cres- cente população idosa impulsionaram pesquisas para desenvolvimento e aplicação de diversos métodos e instrumentos para identificar padrões inadequados de prescrição/ uso e problemas farmacoterapêuticos envolvendo este grupo populacional. Objetivo - Verificar a prevalência do uso de medicamentos potencialmente inapropriados listados nos Critérios de Beers 2003 pelas pessoas idosas de 60 anos ou mais do município de São Paulo, entrevistadas pelo Estudo SABE no ano de 2006. Métodos - Trata-se de um estudo transversal de base populacional, com utilização de dados secundários obtidos do Estudo SABE. A amostra constituída de 1258 idosos de 60 anos ou mais. Os dados finais foram ponderados e expandidos de modo a representar a população idosa no ano de 2006. Os medicamentos foram classificados de acordo com a Anatomical Therapeutic Chemical Classification System. Para análise dos dados utilizou-se o pacote estatístico Stata com realização de regressão logística. Considerou-se nível de significância de p<0,05. Resultados Verificou-se a prevalência de 28 por cento de uso de MPI entre os idosos. Na análise pelo modelo de regressão logística multivariada as variáveis associadas ao consumo de MPI foram polifarmácia (p = 0,001), comorbidade (p = 0,011) e sexo (p = 0,007); ajustadas por fragilidade, idade e dificuldade em ABVD. Este estudo identificou 41 medicamentos ou classes potencialmente inadequados segundo os Critérios de Beers sendo utilizados pelos idosos moradores de São Paulo em 2006. Ao se analisar os MPI agrupados por sistema ATC notou-se que o de maior prevalência foi o grupo com os medicamentos que atuam no sistema cardiovascular (11,1 por cento ). Conclusões Entre outros problemas, os idosos, em especial as idosas, têm ainda a dificuldade de conviver com várias doenças o que leva a complexidade da terapêutica, em geral com polifarmácia e uso de medicamentos inadequados fatores ratificados pelo presente estudo situação agravada pelo contexto de alteração da farmacocinética, farmacodinâmica e as alterações relacionadas à composição corporal e fisiologia da idade avançada. Sugere-se a elaboração de método baseado em critérios explícitos de avaliação do uso de medicamentos por idosos adaptada a realidade nacional, levando-se em conta os medicamentos disponíveis no país, a opinião dos especialistas brasileiros e a literatura baseada em evidências na área de utilização de medicamentos
Introduction - The damaging effects involving drugs boosted by the growing elderly population research for developing and implementing a variety of methods and tools to identify patterns of inappropriate prescribing / use and drug related problems involving this population group. Objective - To assess the prevalence of potentially inappropriate medications (PIM) listed in the 2003 Beers criteria for people aged 60 or more of São Paulo, interviewed by the SABE survey in 2006. Methods - This is a population-based crosssectional study, using secondary data obtained from the SABE survey. The sample consisted of 1258 elderly aged 60 years or more. The final data were weighted and expanded to represent the elderly population in 2006. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System. For data analysis it was used the Stata® with performance of logistic regression. It was considered a significance level of p <0.05. Results - There was a prevalence of 28 per cent using MPI among the elderly. In the analysis by multivariate logistic regression model the variables associated with consumption of PIM were polypharmacy (p = 0.001), comorbidity (p = 0.011) and female gender (p = 0.007) adjusted for frailty, age and difficulty in ADL. This study identified 41 PIM or classes according to the Beers criteria being used by the elderly residents of Sao Paulo in 2006. When analyzing the PIM grouped by the ATC system was noted that the most prevalent was the group with drugs that act on the cardiovascular system (11.2 per cent ). Conclusion - Among other problems, the elderly, especially elderly women, still have the difficulty of living with various illnesses leading to the complexity of therapy, usually with polypharmacy and inappropriate drug use - factors that are ratified by this study - a situation exacerbated by the context of altered pharmacokinetics, pharmacodynamics and changes related to body composition and physiology of aging. We suggest the preparation method based on explicit criteria for evaluating the use of medications by elderly adapted for the national reality, taking into account the available drugs in the country, the opinions of Brazilian experts and evidence-based literature in the area of drug use

Introdução: O crescente aumento da população idosa faz aumentar a necessidade de recursos de saúde, entre eles o uso de medicamentos.Objetivo: Estudar os riscos de polifarmácia em idosos no município de São Paulo, Brasil. Métodos: Este estudo faz parte do projeto SABE – Saúde,Bem-estar e Envelhecimento – através de questionários por amostra em domicílios de 2143 idosos com 60 anos e mais composta por sorteio. Os dados finais foram ponderados e expandidos de modo que representem a população idosa no ano de 2000. A polifarmácia foi definida como o uso de quatro ou mais medicamentos, e utilizado o estudo de regressão logística por passos (IC 95%). Resultados: A média do número de medicamentos foi de 2,72 e a prevalência de polifarmácia de 31,5%. A polifarmácia foi mais prevalente em mulheres com 75 anos e mais (52,1%), religião espírita(51,2%), que declaram estado de saúde ruim (40,2%) e escolaridade acima de 12 anos (46,9%). Verificou-se que 71,1% adquirem medicamentos do próprio bolso, 15,95% se automedicam e a não adesão é devida ao custo (9,1%). Os riscos para polifarmácia foram mulheres (OR 2,2), idade acima de 75 anos (OR 1,5), consulta e internação em quatro meses (OR de 1,9 e 3,8) e problemas cardíacos (OR 3,8). Quanto ao medicamento impróprio a prevalência foi de 15,6%. Conclusão: Os riscos identificados na polifarmácia mostram uma necessidade de políticas públicas que visem promover o uso racional de medicamentos.
Introduction: The continuous growth of the elderly population increases the need for further health resources; amongst them is the use of drugs.Object: Study the risks’ Polypharmacy in the population of elderly people within the city of São Paulo, Brasil. Method: This study is part of the ‘SABE’ project – Health, Well-being and aging. This survey is carried out by using a sample questionnaire in the residence of 2143 people aged 60 and over. The final data are pondered and expanded to represent the population of elderly people in the year 2000. In order to analyze, polypharmacy was defined as four or more drugs, using the study of stepwise logistical regression (IC95%). Results: The average number of drug stays at 2,72, with a prevalence of polyfarmacy of 31,5%. Polyfarmacy is more prevalent amongst women aged 75 and over (52,1%); spiritualists (51,2%); those who claim poor self perceived health status (40,2%); those whose level of education is at least 12 years (46,9%). It has been observed that 71,1% use their own money to buy drugs; 15,9% practice self-medication; the cost of treatment being the cause of nonadherence (9,1%). Women are more at risk (OR 2,2), aged 75 and over (OR 1,5), visit to the physician and hospitalization within four months(OR from 1,9 to 3,8), cardiovascular conditions (OR 3,8). As for inappropriate use of medications, the prevalence is 15,6%. Conclusion: The identified risks in polypharmacy show a need for public policies that would promote a more rational use of medications.

Problem: Nurses are potentially exposed to hazardous drugs (HDs) in their practice. HD exposure is associated with adverse outcomes (reproductive problems, learning disabilities in offspring of nurses exposed during pregnancy, and cancer occurrence). Safe handling precautions (safety equipment and personal protective equipment, [PPE]) minimize exposure to HDs and decrease the potential for adverse outcomes. Despite existing OSHA recommendations, adherence to precautions is below recommendations. The purpose of this study was to examine relationships among factors affecting nurses’ use of HD safe handling precautions, to identify factors that promote or interfere with HD precaution use, and to determine nurse managers’ perspectives on use of safe handling precautions. This study used a conceptual model which proposes that both individual and organizational factors influence precaution use. Methods: A cross-sectional, correlational design was used. Nurses (N = 165; 46% response rate) from oncology centers across the US who reported handling chemotherapy completed a mailed survey. Instruments measured HD precaution use, knowledge, self efficacy, barriers, perceived risk, conflict of interest, interpersonal influences and workplace safety climate. Hierarchical regression was used. Twenty managers of nurses handling chemotherapy were interviewed. Results: Nurses were experienced in oncology (M = 15.8 ± 7.6) yrs, well-educated (62.5% ≥BSN), certified in oncology nursing (85%), worked in outpatient settings (69%), and on average treated 6.8 ± 5.2 patients per day. Chemotherapy exposure knowledge was high (M = 10.9, ± 1, 0-12 scale); as was self efficacy for using PPE (M = 20.8 ± 3, 7-24 scale), and perceived risk (M = 3.14 ± .6, 0-4 scale). Total precaution use during HD administration and disposal was low (M = 1.9, SD = 1.1, 0= never to 5 = 100%). Nurse characteristics did not predict HD precaution use. In the final model (R2 = .29, F (2, 155) = 24.6, p < .000), fewer patients per day, fewer barriers and better workplace safety climate were independent predictors of higher precaution use. Conclusions: Results emphasize the importance of organizational influence on nurses’ HD safe handling precaution use and suggest fostering a positive workplace safety climate and reducing barriers as interventions.

The controversy surrounding the use of LSD as an adjunct to psychotherapy for alcoholics in Saskatchewan has not been explored by social or medical historians. From 1950 to 1967, Saskatchewan psychiatrists developed new treatments for chronic alcoholism by using LSD on themselves, on volunteers and finally on patients. Despite early success and praise, the use of LSD in psychotherapy was later condemned by the media, the general public, the medical profession and eventually the federal government and was discontinued after being banned in 1967. The reasons for the ban were far-reaching and diverse. LSD was exploited by the counter-culture for "kicks" and was later abandoned by pharmaceutical companies because of the negative reputation lay-professionals and the media had bestowed upon its therapeutic use. As it turned out, legitimate LSD research became too clouded in controversy to survive the 1960s as researchers failed to convince the masses that the drug did not pose a threat to the well-being of society. In many respects, the LSD controversy can be seen as more of a moral panic than a scientific debate. Nevertheless, the LSD controversy provides a unique and much needed look into the history of medicine from a social perspective, illustrating that social values often have more impact on medical research than empirical validity. As recent evidence suggests, the psychotherapeutic potential of LSD -- as developed by Saskatchewan psychiatrists -- has not been forgotten. Indeed, a renewal of interest in LSD research has surfaced in several U.S. states as American psychiatrists are discovering, once again, that LSD can be a valuable psychiatric research tool.

博士
國立臺灣大學
護理學研究所
107
Background. Research demonstrates that the nurses’ perceptions regarding workplace safety climate and perception to personal protective equipment use are common factors affecting their compliance with safety precautions. However, to date, no study has empirically examined a structural model to identify the factors related to nurses’ compliance with hazardous drug (HD) safe handling precautions. In this study, we aim to verify whether the ability of predict variables to explain and predict nurses’ compliance with HD safe handling precautions by using partial least squares structural equation modeling (PLS-SEM); the results provide recommendations for nursing clinical practice, education, research, and policy. Aims. This study aims to explore the relationship among nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior in complying with HD safe handling precautions during the intravenous administration and disconnection of HDs by PLS-SEM. Methods. This study included a cross-sectional survey of nurses recruited in the northern, northwestern, and south-central branches of a university medical system in Taiwan, in which 484 (of 506) self-administrated questionnaires were returned by respondents (response rate, 95.7%). Each participant was asked to complete the structured questionnaire developed by the author. It comprises the following four main parts: nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior regarding their compliance with HD safe handling precautions during the intravenous administration and disconnection of HDs. The data (N = 484) were randomly split into two groups, one group (N = 237) for exploratory factor analysis, and the other (N = 247) for confirmatory factor analysis. The exploratory factor analysis resulted in seven factors related to the workplace safety climate, and the result of the confirmatory factor analysis verified the acceptability of the model. The seven factors, with 31 items of the workplace safety climate, were “Clinical Care Situation,” “Colleagues Remind Each Other,” “Creation of a Safe Working Environment by the Head Nurse.,” “Creation of a Safe Working Environment by the Organization Manager,” “Ease of Use of Personal Protective Equipment,” “Perception of Comfortable Level of the Workplace,”and “Perception of Comfortable Level of Use of Personal Protective Equipment.” We used the samples (N = 247) for confirmatory factor analysis to verify the model by PLS-SEM 3.2.8. Result. The descriptive statistical results showed that nurses recorded the highest score for the “Creation of a Safe Working Environment by the Organization Manager” (Mean ± SD: 4.58 ± 0.52) of workplace safety climate and lowest for “Perception of Comfortable Level of Use of Personal Protective Equipment” (Mean ± SD: 3.24 ± 1.03). The mean frequency of the nurses’ compliance with HD safe handling precautions during intravenous administration (Mean ± SD: 4.25 ± 0.84) was higher than that during the disconnection of HDs (Mean ± SD: 2.92 ± 1.22). The PLS-SEM analyses revealed that workplace safety climate can explain 29.3% of the variance in nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration and 30.5% of the variance during the disconnection of HDs. In addition, workplace safety climate can predict the outcome variable, and the results showed an acceptable model fit. Among the aforementioned variables, the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate were significantly associated with nurses’ behavior regarding their compliance with HD safe handling precautions. We added nurses’ personal factors and the workplace background in the model; the result showed that nurses’ years of experience in administering chemotherapy, familiarity with the policy and procedure for the safe handling of HDs, and chemotherapy workload may significantly affect nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration. Suggestions. We suggest that managers of hospitals and researchers should design interventions according to the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate, such as enhancing nurses’ awareness of the importance of personal protective equipment use, creating opportunities for nurses to share with peers their opinions regarding the safe handling of HDs, and purchasing personal protective equipments that are easy to use and comfortable to wear and placing them at optimal locations for easy access. To increase nurses’ frequency of adherence to the HD safe handling precautions, we suggest that hospital managers should provide multifaceted learning resources, update the skills checklist, and invite nurses who are highly experienced in HD handling to conduct regular audits.

One third of the population of North America uses nutrient supplements, spending billions of dollars per year on these products. Yet only a minute portion of individuals need vitamins supplements to correct physiological deficiencies. This thesis explores the underlying reasons for this huge discrepancy, trying to determine what it is about North American culture and lifestyle that causes people to take so many vitamins that they supposedly do not 'need'. Four major findings emerged from this research, which is based principally on data taken from fifty interviews. First, individuals are incited to take vitamins because they lack confidence in the food supply and their diet. Second, few deterrents to taking vitamins exist. Third, individuals easily establish vitamin taking routines ensuring consistent consumption. Finally, high supplementation can be attributed to normalisation of vitamin ingestion

Background: Much of the research on injection drug use practices has focused on adult populations and relatively little is known about safer and/or unsafe injection practices among youth who use injection drugs (YWID). Unsafe practices may be risk factors for blood borne illnesses, abscesses or other infections, and overdose. Multiple factors may create barriers to the access of clean supplies and the ability to practice safer injection. It is important to understand how YWID engage in safer and/or unsafe injection practices so that use of safer practices may be supported. Purpose: The purpose of this study was to explore the understandings and practices of safer and/or unsafe injection drug use among YIWD, as well as key social factors influencing these understandings and practices. Methods: Ten semi-structured qualitative interviews were conducted with YWID aged 18 to 29 in Halifax, Nova Scotia. Voluntary informed consent was obtained prior to conducting the interviews. All interviews were audio-taped and transcribed, then analyzed using a modified approach to grounded theory for key themes and subthemes. Results: The experiences of the YWID can be categorized into two overarching themes. The first theme relates to the power of the drugs and the control (or, at times, lack of control) YWID have over safer practices. This theme explores how access to clean supplies and understandings of safer use can influence the control YWID have over safer practices. The second theme describes experiences YWID have with “getting clean,” or gaining power over drugs, including experiences with methadone maintenance treatment. Discussion: YWID can and do practice safer use, however multiple factors, such as the perception of cleanliness in injection practices and the availability of clean needles in the community, impact how YWID understand and practice safer injection drug use. Barriers that impede YWID’s ability to practice safer use need to be addressed.

The purpose of this qualitative research study was to understand the facilitators and/or barriers to safer drug use and sexual practices among a sample of young female injection drug users (IDUs) who live in small towns/rural communities in Cape Breton, Nova Scotia. This study examined how economic status, relationships, social roles, small town/rural living, and stigma function as facilitators and/or barriers to safer practices. Eight female IDUs aged 20-31, living in small towns/rural communities in Cape Breton, engaged in face-to-face, semi-structured interviews. The women described what day-to-day life is like for female IDUs living in small towns/rural communities. They spoke about managing drug addiction, their understanding of safer and unsafe injection drug use and risky and safer sexual practices, as well as their experiences with services/supports. The information obtained from this study will help to inform harm reduction policy and program initiatives.