Prescribing Practices and Polypharmacy in Kitovu Hospital, Uganda.

This audit of prescribing practices explores recent trends at Kitovu Hospital, Uganda. The average number of drugs prescribed per patient was 2.89 ± 0.11, of which 1.79±0.09 were generics and 0.69±0.06 antibiotics. No injections were prescribed. Patient essential drug knowledge was 100% while the adequacy of labelling was 0%. The number of drugs prescribed correlated positively with patient age, was greater for female patients, similar for doctors and clinical officers but greater in medical (3.30±0.15, n=50) than surgical (2.48±0.13, n=50) outpatient clinics. The mean consultation time was 6.56 min and 10.25 min per patient in medical and surgical outpatient clinics respectively. The patient essential knowledge indicators were greatly improved but only modest reduction in polypharmacy was evident compared to the Ugandan Pharmaceutical Sector national survey of 2002. Antibiotic prescription was high and generic prescribing was found to be low. Policy changes are required to enhance rational drug use in the health sector in Uganda.

Accounting, Regulation and Profitability: The Case of PFI Hospital Refinancing

The refinancing of PFI (Private Finance Initiative) projects represents one of the most contentious aspects of Public Private Partnerships (PPPs) in the UK. The negative publicity associated with UK PFI refinancing deals is associated with several factors, including, evidence of massive private sector profit making, the failure of private sector financiers to share refinancing profits and, lastly, private sector frustration of adequate regulatory intervention in this area. Utilising a dynamic model of capital market and state interaction, this paper explains these outcomes as a function of effective private sector lobbying of bureaucratic state agencies to alter the structure of accounting, accountability and regulation with the goal of securing favourable profit and risk outcomes. These dynamics are illustrated with reference to the history of UK PFI refinancing and a case study of one of the projects where these gains reached extreme levels.

Organizational Change and Employees' Mental Health: The Protective Role of Sense of Coherence

Objective: To examine the impact of sense of coherence (SOC) on psychiatric events in the context of organizational merger. Methods: Data were derived from a prospective

Lack of Predictability at Work and Risk of Acute Myocardial Infarction: An 18-Year Prospective Study of Industrial Employees

Objectives. We examined whether the distinctive components of job control-decision authority, skill discretion, and predictability-were related to subsequent acute myocardial infarction (MI) events in a large population of initially heart disease-free industrial employees.

Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees

Background: In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model - effort, rewards and ERI - are associated with the co-occurrence of lifestyle risk factors.

Relationship between work stress and body mass index among 45,810 female and male employees

Objective: The proportion of overweight and obese people has grown rapidly, and obesity has now been widely recognized as an important public health problem. At the came time, stress has increased in working life. The 2 problems could be connected if work stress promotes unhealthy eating habits and sedentary behavior and thereby contributes to weight gain. This study explored the association between work stress and body mass index (BMI; kg/m(2)). Methods: We used cross-sectional questionnaire data obtained from 45,810 female and male employees participating in the ongoing Finnish Public Sector Cohort Study. We constructed individual-level scores, as well as occupational- and organizational-level aggregated scores for work stress, as indicated by the demand/control model and the effort-reward imbalance model. Linear regression analyses were stratified by sex and socioeconomic status (SES) and adjusted for age, marital status, job contract, smoking, alcohol consumption, physical activity, and negative affectivity. Results: The results with the aggregated scores showed that lower job control, higher job strain, and higher effort-reward imbalance were associated with a higher BMI. In men, lower job demands were also associated with a higher BMI. These associations were not accounted for by SES, although an additional adjustment for SES attenuated the associations. The results obtained with the individual-level scores were in the same direction, but the relationships were weaker than those obtained with the aggregated scores. Conclusions: This study shows a weak association between work stress and BMI.

Job strain and leisure-time physical activity in female and male public sector employees

Background. High work stress could decrease physical activity but the evidence of the relationship has remained equivocal, The present study examined the association between job strain and leisure-time physical activity in a large sample of employees.

Job strain, effort-reward imbalance, and heavy drinking: A study in 40,851 employees

Objective: The objective of this study was to examine the relationship of the job strain model and the effort-reward imbalance model with heavy drinking.

Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees

Study objective: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking.

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

Using bar-code technology to capture clinical intervention data in a hospital with a stand-alone pharmacy computer system

The use of barcode technology to capture data on pharmacists' clinical interventions is described.