Cancer and Complementary Therapies: Current Trends in Survivors' Interest and Use

Background. Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels. Method. A total of 212 cancer outpatients were surveyed at the Tom Baker Cancer Centre in Calgary, Canada. Results. Overall, up to 75% of survivors already used some form of CTs since their diagnosis. The most highly used were the following: vitamins B12 and D, multivitamins, calcium, and breathing and relaxation exercises. Those who had not used CTs indicated highest interest in massage, vitamin B12, breathing and relaxation, mindfulness-based stress reduction, and antioxidants. The most frequently reported barriers for all CTs were not knowing enough about what a therapy was and not having enough evidence on whether it worked. High PS predicted higher interest for all CTs, but spirituality was not significantly related to any. Physical symptoms, anxiety, and depression were significant predictors of interest for some CTs. Conclusion. These findings provide a blueprint for future clinical efficacy trials and highlight the need for clinical practice guidelines.

Health Literacy and Use and Trust in Health Information

There is a need to investigate which health information sources are used and trusted by people with limited health literacy to help identify strategies for addressing knowledge gaps that can contribute to preventable illness. We examined whether health literacy was associated with people's use of and trust in a range of potential health information sources. Six hundred participants from a GfK Internet survey panel completed an online survey. We assessed health literacy using the Newest Vital Sign, the sources participants used to get health information, and the extent to which participants trusted health information from these sources. We performed multivariable regressions, controlling for demographic characteristics. Lower health literacy was associated with lower odds of using medical websites for health information and with higher odds of using television, social media, and blogs or celebrity webpages. People with lower health literacy were less likely to trust health information from specialist doctors and dentists, but more likely to trust television, social media, blogs/celebrity webpages, friends, and pharmaceutical companies. People with limited health literacy had higher rates of using and trusting sources such as social media and blogs, which might contain lower quality health information compared to information from healthcare professionals. Thus, it might be necessary to enhance the public's ability to evaluate the quality of health information sources. The results of this study could be used to improve the reach of high-quality health information among people with limited health literacy and thereby increase the effectiveness of health communication programs and campaigns.

[Modern research and application of Longgu]

Longgu is the fossil of ancient mammals which was used as a common kind of mineral medicine. Longgu is always used to treat neurological diseases. Currently, the quality standard of Longgu is incomplete. Moreover, because of the non-renewable nature of the resource and the increase of national protection of fossils, the clinical application of Longgu is facing a series of problems. As the discovery of the ingredient and the development of forging technology researchers launched to search the substitutes of Longgu. The article summarizes the usage and the study of Longgu, in order that we can discuss the modern usage and substitutability of Longgu.

Managing Pain in Patients With Chronic Medical Illnesses and Serious Mental Illnesses

OBJECTIVES

This study investigated the use of opioid treatment plans that included the implementation of opioid dependence risk with a validated screening tool and opioid dependence risk tool (UDT) in a noncancer palliative pain clinic.

METHODS

We retrospectively reviewed the medical records for diagnostic information, information on analgesic medications, daily morphine equivalent dose, presence of pain management agreements and opioid dependence risk tools (ORT), and UDT. We recorded hospital days and emergency department visits.

RESULTS

Seventy-four patients were followed for a mean of 15.9 months. Ninety-three percent of patients had pain management agreements and 74% had ORT. The median score was 8: consistent with a high risk. More than half had UDT and 17.6% of patients had unexpected findings. Fifty-nine percent of patients had a psychiatric diagnosis. Hospital days and emergency department visits decreased by more than 30% ( P = .015 and P = .019). Significance of Findings: Both mental health problems and aberrant drug use were common in patients seen in a noncancer palliative care clinic. There were significant reductions in acute care utilization in the 12 months post intake in the clinic.

Cost Offset Associated With Early Start Denver Model for Children With Autism

OBJECTIVE

To determine the effect of the Early Start Denver Model (ESDM) for treatment of young children with autism on health care service use and costs.

METHOD

We used data from a randomized trial that tested the efficacy of the ESDM, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents, for 2 years. Parents were interviewed about their children's service use every 6 months from the onset of the intervention to follow-up (age 6 years). The sample for this study consisted of 39 children with autism who participated in the original randomized trial at age 18 to 30 months, and were also assessed at age 6 years. Of this sample, 21 children were in the ESDM group, and 18 children were in the community care (COM) group. Reported services were categorized and costed by applying unit hourly costs. Annualized service use and costs during the intervention and post intervention for the two study arms were compared.

RESULTS

During the intervention, children who received the ESDM had average annualized total health-related costs that were higher by about $14,000 than those of children who received community-based treatment. The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less applied behavior analysis (ABA)/early intensive behavioral intervention (EIBI) and speech therapy services than children in the comparison group. In the postintervention period, compared with children who had earlier received treatment as usual in community settings, children in the ESDM group used less ABA/EIBI, occupational/physical therapy, and speech therapy services, resulting in significant cost savings in the amount of about $19,000 per year per child.

CONCLUSION

Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs.

CLINICAL TRIAL REGISTRATION INFORMATION

Early Characteristics of Autism; http://clinicaltrials.gov/; NCT0009415.

Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study

PURPOSE

To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation.

METHOD

Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language.

RESULT

At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language.

CONCLUSION

Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use - an observational multi-centre study

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

BACKGROUND

Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances.

MATERIALS AND METHODS

In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the "benchmark-multiplier" method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use.

RESULTS

Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment.

CONCLUSION

RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.

Use of and intentions to use dermoscopy among physicians in the United States

Background

Dermatologists routinely use dermoscopy to improve diagnostic accuracy of skin cancers. Much less is known about its use among other physicians who routinely examine the skin, such as family physicians, internists and plastic surgeons.

Objectives

To document the use of dermoscopy in a sample of US physicians and to examine physician and practice characteristics associated with ever having used a dermascope and having some intentions to incorporate dermoscopy into clinical practice during the next 12 months.

Methods

From September 2015 to February 2016, we recruited 1,466 practicing physicians in person and online to complete an anonymous survey that assessed: demographic factors; physicians and practice characteristics; confidence differentiating skin lesions; knowledge and use of dermoscopy; and intentions and barriers to use dermoscopy. We conducted bivariate analysis to examine the relationship between key factors and the outcomes and entered the significant predictors into two separate logistic regressions.

Results

Fifteen percent of participants had ever used a dermascope and 6% were currently using it. Factors significantly associated with ever having used a dermascope (Model 1) and having intentions to use (Model 2) at the multivariate level were: recent graduation from medical school (strongest predictor in both models), identifying as a family physician, seeing a higher number of patients with skin cancer and having a higher level of confidence differentiating skin lesions. Both models were highly significant.

Conclusion

Use of dermoscopy was low. Promotional efforts to increase dermoscopy use in the US are needed.

Women's knowledge and use of prenatal screening tests

AIMS AND OBJECTIVES

The aim of the study was to determine the rate of use of prenatal screening tests and the factors affecting the decision to have a prenatal screening test in pregnant women in Turkey.

BACKGROUND

Prenatal genetic screening as an optional service is commonly used to determine a level of risk for genetic conditions in the foetus.

DESIGN

A quantitative cross-sectional survey.

METHODS

Pregnant women (n = 274) who sought prenatal care from one hospital in Turkey were recruited and asked to complete questionnaires that were developed by the researchers. Descriptive and inferential statistics were used to analyse the data.

RESULTS

Almost half (44·2) % of the women were primiparas, and the majority (97·8%) were in the third trimester of pregnancy. Only 36·1% of the women reported that they had prenatal screening by either the double test or triple test. Women had a low level of knowledge regarding prenatal screening: the mean knowledge score was 3·43 ± 3·21 of a possible score of 10. Having consanguineous marriage, a history of spontaneous abortion, a child with genetic disorder, multiparity or a longer marriage duration were positively correlated with accepting a prenatal screening test.

CONCLUSIONS

This study has provided baseline data on the uptake and reasons for accepting or declining a prenatal screening in a cohort of Turkish women. There is evidence to suggest that more education is needed to improve knowledge and provide comprehensive nursing care to promote informed consent in this context.

RELEVANCE TO CLINICAL PRACTICE

Perinatal nurses are ideally situated to inform pregnant women about prenatal screening tests to improve access to healthcare services and to ensure informed decisions are made by pregnant women and their partners.

Melatonin in the management of perinatal hypoxic-ischemic encephalopathy: light at the end of the tunnel?

Perinatal hypoxic-ischemic encephalopathy (HIE) affects one to three per 1,000 live full-term births and can lead to severe and permanent neuropsychological sequelae, such as cerebral palsy, epilepsy, mental retardation, and visual motor or visual perceptive dysfunction. Melatonin has begun to be contemplated as a good choice in order to diminish the neurological sequelae from hypoxic-ischemic brain injury. Melatonin emerges as a very interesting medication, because of its capacity to cross all physiological barriers extending to subcellular compartments and its safety and effectiveness. The purpose of this commentary is to detail the evidence on the use of melatonin as a neuroprotection agent. The pharmacologic aspects of the drug as well as its potential neuroprotective characteristics in human and animal studies are described in this study. Melatonin seems to be safe and beneficial in protecting neonatal brains from perinatal HIE. Larger randomized controlled trials in humans are required, to implement a long-awaited feasible treatment in order to avoid the dreaded sequelae of HIE.

An Assessment of Data Availability, Quality, and Use in Malaria Program Decision Making in Nigeria

Abstract-In 2014, Nigeria shifted its malaria policy and strategy from control to elimination. Studies show that data-driven decision making is essential to achieving elimination. It is therefore important that policy makers have access to and use good quality and relevant data to inform program decisions. This article presents findings from an assessment of availability, quality, and use of malaria data in three states in Nigeria, namely, Akwa-Ibom, Cross River, and Niger, as part of a larger study on how organizational structure affects outcomes of malaria programs. A literature search to determine the availability and range of malaria data in Nigeria was conducted, followed by 65 key informant interviews to understand how malaria data are used in the study states. It was observed that the District Health Information System (DHIS) was the major source of data used in managing programs; however, the range of malaria indicators in the DHIS is limited, lacking indicators such as active case detection and entomological data, which are important for surveillance and decision making toward malaria elimination. On data quality, routine data from the DHIS were reviewed using the national protocol for data quality assessment. Data quality was found to be suboptimal, with quality scores ranging from 54% to 64% compared to the national target of 80%. DHIS data were reportedly used most often for performance and/or supply chain management. Overall, the study demonstrates gaps in data availability and quality and highlights the need for more data sources and improved quality data to inform decision making toward malaria elimination in Nigeria.

Delivering insecticide-treated nets for malaria prevention: innovative strategies

The wide-scale adoption of insecticide-treated nets (ITNs) has led to significant reductions in malaria morbidity and mortality worldwide. Delivery of ITNs to the 3.2 billion people at risk of malaria requires multiple steps in diverse settings. The effectiveness of the delivery of ITNs in order to prevent malaria relies on activities that include ITN manufacturing and design, integration into national and international malaria prevention policies, supplying and distributing ITNs to households and individuals, and, finally, programs focused on spurring demand for and use of ITNs by individuals at risk. This paper reviews some recent innovative strategies for ITN delivery across these four domains, places these innovations within the context of the history of ITN deployment, and identifies opportunities to further improve the effectiveness of this ubiquitous public health tool.

What Attracts People to Visit Community Open Spaces? A Case Study of the Overseas Chinese Town Community in Shenzhen, China

A well-designed open space that encourages outdoor activity and social communication is a community asset that could potentially contribute to the health of local residents and social harmony of the community. Numerous factors may influence the use of each single space and may result in a variety of visitors. Compared with previous studies that focused on accessibility, this study highlights the relationship between the utilization and characteristics of community open spaces in China. The Overseas Chinese Town community in Shenzhen is regarded as an example. The association between the number of visitors and space characteristics is examined with multivariate regression models. Results show that large areas with accessible lawns, well-maintained footpaths, seats, commercial facilities, and water landscapes are important characteristics that could increase the use of community open spaces. However, adding green vegetation, sculptures, and landscape accessories in open spaces has limited effects on increasing the outdoor activities of residents. Thus, to increase the use of community open spaces, landscape designers should focus more on creating user-oriented spaces with facilities that encourage active use than on improving ornamental vegetation and accessories.

The Tarunya Project's efforts to improve the quality of adolescent reproductive and sexual health services in Jharkhand state, India: a post-hoc evaluation

Following the International Conference on Population and Development Adolescent Reproductive and Sexual Health (ARSH) was recognized as a top development priority in India's National Population Policy 2000. In 2006 a separate ARSH strategy was articulated within the National Rural Health Mission. In Jharkhand, one of the poorest and least developed states in India, in 2008 the state government launched a Tarunya Project in collaboration with EngenderHealth. The project provided cascading ARSH training to government staff at secondary care facilities and strengthened outreach activities to enhance community engagement. After 5 years of implementation, the project was evaluated by a team from the World Health Organization. The evaluation found that the project provided training and ongoing backstopping support to strengthen the ARSH readiness of health facilities. The project's intervention efforts contributed to improvement in quality and initial use of ARSH services. The performance of health facilities was appreciated by clients. But there was little correspondence between the project's monitoring and the period of exposure of the facilities to the project's interventions and service quality. The evaluation also showed that handholding and backstopping by the project were still very much needed.

Knowledge and use of asthma control measurement tools in the management of asthma: a survey of doctors working in family and internal medicine practice in Nigeria

OBJECTIVE

To investigate the knowledge and use of asthma control measurement (ACM) tools in the management of asthma among doctors working in family and internal medicine practice in Nigeria.

METHOD

A questionnaire based on the global initiative on asthma (GINA) guideline was self-administered by 194 doctors. It contains 12 test items on knowledge of ACM tools and its application. The knowledge score was obtained by adding the correct answers and classified as good if the score ≥ 9, satisfactory if score was 6-8 and poor if < 6.

RESULTS

The overall doctors knowledge score of ACM tools was 4.49±2.14 (maximum of 12). Pulmonologists recorded the highest knowledge score of 10.75±1.85. The majority (69.6%) had poor knowledge score of ACM tools. Fifty (25.8%) assessed their patients' level of asthma control and 34(17.5%) at every visit. Thirty-nine (20.1%) used ACM tools in their consultation, 29 (15.0%) of them used GINA defined control while 10 (5.2 %) used asthma control test (ACT). The use of the tools was associated with pulmonologists, having attended CME within six months and graduated within five years prior to the survey.

CONCLUSION

The results highlight the poor knowledge and use of ACM tools and the need to address the knowledge gap.

Knowledge, sources and use of family planning methods among women aged 15-49 years in Uganda: a cross-sectional study

Introduction

Lack of knowledge of where to obtain correct family planning (FP) information and methods can be a critical barrier to eventual uptake of FP services. We assessed knowledge, sources and use of FP methods among women of reproductive age in rural Uganda.

Methods

This secondary analysis uses data from a larger cross-sectional study conducted to measure changes in perceptions towards long-term and reversible contraceptive use among 2,033 women of reproductive age (15-49years) resident in 34 districts of Uganda. Both users and non-users of FP methods were interviewed. Data were analyzed using STATA statistical software, version 12.

Results

Majority of the women were less than 30 years of age (64.3%). Nearly three-quarters were married (73.1%), 51.1% had primary education and more than half (57%) were engaged in employment. Knowledge of FP methods was universal (98.1%). Clinic providers (60.4%), friends (56.9%) and the media (51.3%) were the most trusted sources of contraceptive information. Government (27.6%) and private (21.1%) health facilities were the main sources of modern FP methods. Sixty two per cent of women reported current use of any FP method. Among non-users of FP, injectables (50.4%), implants (22.8%) and pills (20.2%) were the most preferred FP methods.

Conclusion

Our findings show that knowledge of FP methods is almost universal and that six in ten women use any FP method. Clinic providers, friends and the media are the most trusted sources of FP information. Government and private health facilities are the main sources of FP services.

Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan

BACKGROUND AND AIMS

In addition to some electronic cigarettes (e-cigarettes), new heat-not-burn tobacco products Ploom and iQOS have recently begun to be sold by tobacco companies. These products are regulated differently in Japan, depending on whether the contents are liquid or tobacco leaf. Our objective was to estimate percentages of awareness and use of e-cigarettes and heat-not-burn tobacco products among the Japanese population, including minors.

DESIGN AND SETTING

An internet survey (randomly sampled research agency panellists) with a propensity score adjustment for "being a respondent in an internet survey" using a nationally representative sample in Japan.

PARTICIPANTS

A total of 8240 respondents aged 15-69 years in 2015 (4084 men and 4156 women).

MEASUREMENTS

Adjusted percentages of awareness and use of e-cigarettes (nicotine or non-nicotine e-cigarettes) and heat-not-burn products among total participants; product types and percentages ever used among e-cigarettes ever users.

FINDINGS

Of respondents in Japan, 48% [95% confidence interval (CI) = 47-49] were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% (95% CI = 6.1-7.1) had ever used, 1.3% (95% CI = 1.0-1.5) had used in the last 30 days and 1.3% (95% CI = 1.1-1.6) had experience of > 50 sessions. Seventy-two per cent (95% CI = 69-76) of ever users used non-nicotine e-cigarettes, while 33% (95% CI = 30-37) of them used nicotine e-cigarettes, which has the majority share world-wide; 7.8% (95% CI = 5.5-10.0) and 8.4% (95% CI = 6.1-10.7) of them used the new devices, Ploom and iQOS, respectively, with a relatively higher percentage among the younger population.

CONCLUSIONS

Approximately half the respondents in a Japanese internet survey were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% had ever used. More than 70% of ever users used non-nicotine e-cigarettes, the sale of which is not legally prohibited, even to minors, in Japan, and 33% of them used nicotine e-cigarettes; 3.5% of never smoking men and 1.3% of never smoking women had ever used e-cigarettes. Corresponding figures for use in the last 30 days were 0.6% and 0.3%, predominantly non-nicotine e-cigarettes.

Antimicrobial use at a multi-disciplinary hospital

BACKGROUND

The problem of antimicrobial resistance has become topical and alarming all over the world, including Kazakhstan. Nosocomial strains of microorganisms are widespread, being resistant to the majority of available antimicrobials. This results in longer periods of hospital stay, increases in financial expenditures, and sometimes, in lethal outcomes. The social importance of antimicrobial resistance is preconditioned by the spread of resilient strains of microorganism beyond the hospital environment, which leads to lower effectiveness of antibiotic therapy against infectious diseases and growth in their incidence [1, 2].Our in-patient health facility is a multifunctional one. It provides therapeutic, surgical and oncology and hematology care including organ transplantation. Measures to reduce antibiotic resistance are very important.

OBJECTIVE

To develop a standardized approach to the use of antimicrobial drugs aimed at reducing of antimicrobial resistance, postoperative complications and mortality rates along with financial expenditures. The expected result of this approach should be the enhancement of quality of care.

METHODS

In September 2014 we developed and introduced a local protocol of the antimicrobials use, namely antibiotics for surgical prophylaxis and treatment, based on the evidence of international clinical guidelines evidence-based medicine approach, taking into account the microbial landscape and antibiotic resistance patterns to major pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae [3]. We planned to assess the effectiveness of this policy by the following criteria: the percentage of post-surgical sequela, the number of bed days, the percentage of resistant cases and antibiotic expenditures. In order to improve the quality of bacteriological studies, together with microbiologists we trained the medical staff on the methods of obtaining of biological material for microbiological testing.

RESULTS

We analyzed the indicators of antibiotic resistance from October 2014 to March 2015 (hereafter period I) on the basis of the data from the microbiological laboratory with data of April-August 2015 (hereafter period II). The analysis on the basis of other criteria has yet to be carried out. The bio-material was obtained from different loci, including blood. The results of the oncology and hematology were analyzed separately. We received the following results of sensitivity of the listed microorganisms to various antimicrobials in the period I and the period II respectively expressed as percentages:Staphylococcus aureus: Oxacillin - 95% and 100%, Azythromycin - 62% and 100%, Vancomycin - 100% and 100%, Levofloxacin/Moxifloxacin - 100% and 100%.Pseudomonas aeruginosa: Ceftazidime - 34% and 67%, Piperacillin/Tazobactam - 91% and 84%, Cefepime - 59% and 81%, Amikacin - 95% and 100%, Meropenem - 100% and 100%, Ciprofloxacin - 97% and 100%.Escherichia coli: Gentamicin - 93% and 96%, Piperacillin/Tazobactam - 86% and 92%, Ceftriaxone - 82% and 100%, Amikacin - 99% and 100%,Ciprofloxacin - 69% and 80%, Amoxycillin/Clavulanate - 44% and 46% respectively.Klebsiella pneumoniae: Gentamicin - 50% and 100%, Piperacillin/Tazobactam - 95% and 100%, Cefepime - 100% and 100%, Ceftriaxone - 96% and 100%, Amikacin - 99% and 100%, Ciprofloxacin - 100% and 100%, Amoxycillin/Clavulanate - 22% and 23%.Acinetobacter baumannii: Gentamicin - 83% and 83%, Piperacillin/Tazobactam - 33% and 58%, Cefepime - 0% and 33%, Ceftriaxone - 0% and 33%, Amikacin - 50% and 83%, Ciprofloxacin - 83% and 67%, Meropenem/Imipenem-Cilastin - 83% and 83%.

CONCLUSIONS

During the analyzed periods we observed some improvement in the sensitivity of the main pathogens to antibiotics. At the same time, the resistance of Acinetobacter baumannii to carbapenems and fluoroquinolones increased.Limitations of the studyThere are many other than antibiotic use factors, which influence these results. Further analysis is planned to be carried out. Nevertheless, this analysis makes us believe that we are, probably, on the right path for improving the use of antibacterial drugs.

Access and rational use of psychotropic medications in low- and middle-income countries

Improving access and rational use of psychotropic medications in low- and middle-income countries is an important factor in reducing the public health burden resulting from mental illness. This paper considers each component of the medications management cycle to identify current barriers to improvement. Selection is hindered by a lack of up to date local essential drugs lists, while procurement and distribution can be affected by the type of system used: centralised or decentralised, government-run or independent, push or pull. Rational use involves patients, prescribers and policy-makers and requires consideration of who is able to prescribe, how prescribing decisions are made and how to ensure patient-centred care. We include a number of recommendations based on these issues, while emphasising the importance of ensuring the broader context of mental illness and its management is not overlooked when improving access to psychotropic medications.

Evaluation of the utilization of external radiotherapy in the treatment of localized prostate cancer in Andalusia, Spain

BACKGROUND

Around 27,000 new cases of prostate cancer are diagnosed every year in Spain and 5400 die from this disease. Radiotherapy (RT), alone or combined, has proven to be effective as initial treatment in patients with localized disease. Our objective was to evaluate the use of external beam RT (EBRT) in our region, comparing the indication rate and irradiation rate and examining variability in its application among hospitals.

METHODS

We conducted a review of RT guidelines and indication studies for prostate cancer (% expected irradiation). Data were gathered from all twelve public healthcare centers in Andalusia (Spain) on RT-treated prostate cancer patients during 2013 (% actual irradiation) and from nine of the centers on RT discharge reports. Information was classified according to type of hospital, tumor risk category and RT treatment (technique, dosage, volume, toxicity).

RESULTS

The estimated RT rate was 67 % (1289/1917), 43 % were aged > 70 years, 44.7 % had ECOG performance status of 0); 44.7 % had high-risk tumors; 57 % underwent RT associated with hormone therapy; 70 % of patients receiving RT were treated with 3D planning (30 % IGRT); and doses were 70-76 Gy in 70 % of cases and >76 Gy in 10.7 %. Acute gastrointestinal and genitourinary toxicities were < grade 2 in 79 and 89 % of patients, respectively. An irradiation rate significantly below the mean for the study was found in four provinces. There was a significant difference among provinces in the distribution of risk groups.

CONCLUSIONS

Underutilization of EBRT was estimated to be around 30 % in prostate cancer patients, with an elevated variability in irradiation rates among hospitals related to differences in available technology and in the distribution of patients with different risk levels. These data should be a matter of concern to regional health managers, given the negative and measurable impact on the survival of patients.

Inequalities in medicine use in Central Eastern Europe: an empirical investigation of socioeconomic determinants in eight countries

BACKGROUND

Equitable access to essential medicines is a major challenge for policy-makers world-wide, including Central and Eastern European countries. Member States of the European Union situated in Central and Eastern Europe have publicly funded pharmaceutical reimbursement systems that should promote accessibility and affordability of, at least essential medicines. However, there is no knowledge whether socioeconomic inequalities exist in these countries. Against this backdrop, this study analyses whether socioeconomic determinants influence the use of prescribed and non-prescribed medicines in eight Central and Eastern European countries (Bulgaria, Czech Republic, Hungary, Latvia, Poland, Romania, Slovenia, Slovakia). Further, the study discusses observed (in)equalities in medicine use in the context of the pharmaceutical policy framework and the implementation in these countries.

METHODS

The study is based on cross-sectional data from the first wave of the European Health Interview Survey (2007-2009). Multivariate logistic regression analyses were carried out to determine the association between socioeconomic status (measured by employment status, education, income; controlled for age, gender, health status) and medicine use (prescribed and non-prescribed medicines). This was supplemented by a pharmaceutical policy analysis based on indicators in four policy dimensions (sustainable funding, affordability, availability and accessibility, and rational selection and use of medicines).

RESULTS

Overall, the analysis showed a gradient favouring individuals from higher socioeconomic groups in the consumption of non-prescribed medicines in the eight surveyed countries, and for prescribed medicines in three countries (Latvia, Poland, Romania). The pharmaceutical systems in the eight countries were, to varying degrees, characterized by a lack of (public) funding, thus resulting in high and growing shares of private financing (including co-payments for prescribed medicines), inefficiencies in the selection of medicines into reimbursement and limitations in medicines availability.

CONCLUSION

Pharmaceutical policies aiming at reducing inequalities in medicine use require not only a consideration of the role of co-payments and other private expenditure but also adequate investment in medicines and transparent and clear processes regarding the inclusion of medicines into reimbursement.

Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia

Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of "allowing patients to use the Internet to access parts of their health records." The most frequently cited barrier among all hospitals was "loss of access to medical records transiently if computer crashes or power fails" (88.6 percent). This was followed by "lack of continuous training/ support from information technology staff in hospital" (85.9 percent), "additional time required for data entry" (84.9 percent), and "system hanging up problem" (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended.

A Focus on the Death Kinetics in Predictive Microbiology: Benefits and Limits of the Most Important Models and Some Tools Dealing with Their Application in Foods

Predictive Microbiology (PM) deals with the mathematical modeling of microorganisms in foods for different applications (challenge test, evaluation of microbiological shelf life, prediction of the microbiological hazards connected with foods, etc.). An interesting and important part of PM focuses on the use of primary functions to fit data of death kinetics of spoilage, pathogenic, and useful microorganisms following thermal or non-conventional treatments and can also be used to model survivors throughout storage. The main topic of this review is a focus on the most important death models (negative Gompertz, log-linear, shoulder/tail, Weibull, Weibull+tail, re-parameterized Weibull, biphasic approach, etc.) to pinpoint the benefits and the limits of each model; in addition, the last section addresses the most important tools for the use of death kinetics and predictive microbiology in a user-friendly way.