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Drug Testing and Analysis 3, 515-523, 2011.
Abstract: New psychoactive substances pose a particular challenge to those formulating drugs policy and related public health responses. This paper outlines some of the main issues arising from their use, with a particular focus on user perspectives. Such substances are often (at least initially) produced and distributed for different reasons than controlled drugs. They emerge in users' repertoires undetected by most monitoring systems and general population drug surveys. While reasons for use by innovators and early adopters are often in the spirit of self-experimentation, such substances may rapidly diffuse to the recreational arena as a result of enthusiastic user propagation where they act as substitutes or complements to controlled drugs. The majority of substances are believed to be sourced, albeit not exclusively, from manufacturers based in China. They are retailed to consumers through the Internet and physical shops (such as 'head' and 'smart' shops), as well as traditional 'street dealers' (although data on the significance of this latter route of supply are limited). The data required for risk assessment of the harms such substances may pose, as well as information required for accurate user-derived harm reduction advice, are often limited. Moreover, some involved in the commercial supply have deliberately misbranded products, including substituting the active substance, in apparent attempts to circumvent regulatory frameworks. This leaves users susceptible to both health and criminal justice harms. Despite various attempts to restrict the supply, they often continue to be available through the illicit market, although it is not yet possible to predict whether they will join other drugs such as MDMA and LSD as mainstays of the recreational pharmacopeia.
Education & Development 2011 Special Issue, pp. 17-33, 2011.
Dr Bibha Simkhada, Maureen Porter, Edwin van Teijlingen
The Official Magazine of Royal College of Midwives Issue 4, pp. 34-36, 2011.
Many will know of Mount Everest, Sherpas and Gurkha soldiers in the British Army, but probably very little else about the south Asian state of Nepal. It is a landlocked country between China and India, and one of the poorest in the world, with about one-third of its people living below the poverty line (Demographic and Health Surveys (DHS), 2006).
Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support
Anne Rogers, Ivaylo Vassilev, Caroline Sanders, Sue Kirk, Carolyn Chew-Graham, Anne Kennedy, Joanne Protheroe, Peter Bower, Dr Christian Blickem, David Reeves, Dharmi Kapadia, Helen Brooks, Catherine Fullwood, Gerry Richardson
Implementation Science 2011, 6:56, 2011.
Abstract: Background: Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Methods: Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support. Discussion: The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.
A systematic review of parent and family-based intervention effectiveness on sexual outcomes in young people
Health Educ Res, 26(5):808-833, 2011.
Abstract: Limited evidence exists about the effectiveness of parent/family-based interventions for preventing poor sexual health outcomes, thus a systematic review was conducted as part of a wider review of community-based sex and relationships and alcohol education. Method guidance from the UK’s National Institute for Health and Clinical Excellence was adhered to. Overall, 18 databases were searched. In total, 12 108 references were identified, of which 440 were retrieved and screened. Overall, 17 studies met the inclusion criteria. Findings showed that parent-based interventions were inconsistently effective at reducing young people’s sexual risk behaviours. Parent-based interventions had greater impact on parent/child communication than family-based interventions, which showed no evidence of effectiveness. However, increasing parent/child communication showed no effect on sexual risk behaviours. Preliminary evidence suggests that effectiveness was greater in those studies aiming to affect multiple risk behaviours. However, this may be due to longer programme delivery and follow-up times; further evidence is required. Sexual health communication was sensitive to intervention. Studies addressing multiple risk behaviours may be as effective as targeted interventions at affecting sexual risk behaviours. Longitudinal controlled studies, examining broader sexual activity outcomes, are needed in countries such as the United Kingdom to inform the evidence base, which is primarily US based, and contribute to related policies and practices.
Vanessa Lockyer, Dr Lorna Porcellato
Community Practitioner, Volume 83, Issue 3, pp 23-26(4), 2011.
Abstract: Within the UK rickets is emerging as a national public health issue, particularly among at-risk groups. There is concern that health professionals are overlooking recommendations for vitamin supplementation and opportunities for prevention. This paper reports on a study that aimed to identify current knowledge and practice regarding vitamin D deficiency and supplementation among community midwifery and health visiting teams employed in one NHS trust. A questionnaire was distributed to all health visiting and community midwifery team members (n=96), with a 76% response rate (n=73). Results suggest varying levels of awareness about vitamin D deficiency and groups at increased risk. Only 52% reported that they were aware of health department recommendations for vitamin supplementation. Health visiting teams recommended supplements more frequently than community midwives, but overall the recommendations were implemented inconsistently. Participants identified families eligible for the government Healthy Start scheme, but fewer were recommending Healthy Start vitamins. A deeper understanding of vitamin D deficiency and health department recommendations for vitamin supplementation is required by health professionals to ensure families are advised about appropriate prevention messages and to implement recommendations effectively.
In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal?
Sharada Wasti, Julian Randall, Professor Padam Simkhada, Edwin van Teijlingen
Health Science Journal, 5 (1), 37-47, 2011.
Abstract Individuals’ self administration of medication is an essential component of disease management because incorrect and incomplete medication can result in increased morbidity, mortality and healthcare costs and also spreads drug resistance. Its impact is necessarily wider than just medical and includes the cultural and managerial considerations which govern success in medical interventions. This review paper is aimed at how Nepalese cultural factors (beliefs, religious practices, customs and traditions) may affect adherence to antiretroviral (ARV) medication among people living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Results: Cultural factors (individual beliefs and perceptions) are notoriously complex concepts and shape people’s identities and influence their attitude and behaviours. The individual behaviours and beliefs about health and seeking treatment can adversely affect health care utilization and adherence to medication. These factors create a complicated and unforgiving environment for patients who are struggling to endure a chronic, life-threatening illness with life-long treatment. We cannot disregard patients’ cultural beliefs or practices in order to provide ARV treatment and their adherence because patients and clinicians come from different cultural groups. Conclusion: It is the purpose of this paper to contribute to the policy makers by exploring the pertinent cultural factors relating to the uptake of ARV treatment and its adherence.
Suresh Joshi, Professor Padam Simkhada, Gordon Prescott
BMC International Health and Human Rights 2011, 11, 3, 2011.
Background Nepal is one of the largest suppliers of labour to countries where there is a demand for cheap and low skilled workers. In the recent years the Gulf countries have collectively become the main destinations for international migration. This paper aims to explore the health problems and accidents experienced by a sample of Nepalese migrant in three Gulf countries. Methods A cross-sectional survey was conducted among 408 Nepalese migrants who had at least one period of work experience of at least six months in any of three Gulf countries: Qatar, Saudi Arabia and United Arab Emirates (UAE). Face to face questionnaire interviews were conducted applying a convenience technique to select the study participants. Results Nepalese migrants in these Gulf countries were generally young men between 26-35 years of age. Unskilled construction jobs including labourer, scaffolder, plumber and carpenter were the most common jobs. Health problems were widespread and one quarter of study participants reported experiencing injuries or accidents at work within the last 12 months. The rates of health problems and accidents reported were very similar in the three countries. Only one third of the respondents were provided with insurance for health services by their employer. Lack of leave for illness, cost and fear of losing their job were the barriers to accessing health care services. The study found that construction and agricultural workers were more likely to experience accidents at their workplace and health problems than other workers. Conclusion The findings suggest important messages for the migration policy makers in Nepal. There is a lack of adequate information for the migrants making them aware of their health risks and rights in relation to health services in the destination countries and we suggest that the government of Nepal should be responsible for providing this information. Employers should provide orientation on possible health risks and appropriate training for preventive measures and all necessary access to health care services to all their workers
National five-year examination of inequalities and trends in emergency hospital admission for violence across England.
Professor Mark Bellis, Professor Karen Hughes, Sara Wood, Sacha Wyke, Clare Perkins
Journal of Injury Prevention, 03/2011; 17(5):319-25..
Abstract: Objectives: To examine relationships between violence, age (0–74 years), and deprivation, and to explore in which communities, age groups, and gender the potential for transmission of violent tendencies between individuals is greatest. Methods: Five year (2004/2005 to 2008/2009) ecological study of emergency admissions resulting from violence (n=170 074) into all English hospitals using trend and logistic regression analyses. Results: Hospital admissions for violence peak as individuals achieve legal adulthood (18 years). Risks of admission increase exponentially with increasing quintile of deprivation of residence, with odds overall being 5.5 times higher in the poorest quintile compared with the richest. The greatest absolute difference in violence admissions by deprivation quintile is seen in males aged 18 (218/100 000, richest; 698/100 000, poorest). However, the highest deprivation rate ratios (quintile 5:1) are seen at ages 0–10 years in both sexes and at all ages after 40 years in males (40–58 years, females). In males aged 17–19 years, violence accounts for 20% of the entire gap between wealthiest and poorest quintiles in all cause emergency hospital admissions. Conclusions: Analyses identify four lifetime periods for violence: up to 10 years (prepubescent), 11–20 years (adolescence), 21–45 years (younger adults), and over 45 years (older adults). While violence is most common in adolescence, its concentration in poorer areas during prepubescence and in younger adulthood (parenting age) suggests that poorer children are exposed to much more aggressive communities. This is likely to contribute to the disproportionate escalation in violence they experience during adolescence. Effective interventions to prevent such escalations are available and need to be implemented particularly in poor communities.
Teenage Thinking on Teenage Drinking: 15- to 16- year olds’ experiences of alcohol in Northern Ireland
Dr Michael McKay, Jon Cole, Professor Harry Sumnall
Drugs: Education, Prevention and Policy 18, 323-332, 2011.
Abstract: Focus groups were conducted with 15- to 16-year olds in Northern Ireland looking at reasons for alcohol consumption and reflections on specific attitudes towards alcohol and behaviours resulting from alcohol use. Participants reported greater concern with ‘being caught’ drinking by parents than with any negative short- or long-term health impact from alcohol use. The results would also suggest that once initiated, young people are unlikely to stop drinking and therefore are in need of harm reduction advice and skills. Participants reported a desire to engage meaningfully with school teachers and parents concerning their use of alcohol; however, fear of being labelled as problematic by teachers and fear of disappointing their parents means that they would be more likely to keep their drinking secretive. Participants repeatedly reported that intoxication (or consumption of alcohol, more broadly) could be used to excuse both risky and illegal behaviours. Interventions with young drinkers might look to address some of the harms and attitudes discussed.