Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies.

Background Swallowing difficulties are common and can affect patients' ability to take solid oral dosage forms, thus compromising medication adherence. Strategies developed by patients to overcome such difficulties while taking medicines have seldom been described. Objective To determine prevalence and characteristics of swallowing difficulties among primary care patients attending their community pharmacies; to explore strategies developed by patients to overcome their difficulties, and health professionals' awareness of these problems. Setting Prospective study with a semi-structured questionnaire in random community pharmacies located in two Swiss regions. Method In each pharmacy, an interviewer asked 16 questions to each consecutive patient (18 years and older) with a prescription for at least 3 different solid oral forms. Main outcome measure Quantification of number of patients with swallowing difficulties and detailed description of difficulties. Results Among 122 pharmacies, 59 (48 %) accepted to join the study and 410 patients were enrolled. Thirty-seven patients (9.0 %) reported ongoing swallowing difficulties, while 55 patients (13.4 %) reported past difficulties. For the majority of patients, difficulties occurred at each single dose (83.7 %), with a single medication (59.8 %) and lasted for less than 12 months (53.8 %). Number of tablets was not the main trigger. Swallowing difficulties impaired extremely daily life in 12 % of the patients. Intentional non adherence (23 % of patients) and altering the oral dose formulation were the most common and potentially harmful strategies used by patients to overcome their swallowing difficulties. According to the patients, pharmacists and physicians rarely inquired about their swallowing difficulties. Conclusion We report a fairly high prevalence of swallowing difficulties in polypharmacy patients attending their community pharmacies. Pharmacists have to interview patients on their swallowing difficulties in a more systematic way, support patients in finding solutions and refer them to their physician if necessary to ensure continuity in care.

Post-adopció i resiliència: l'ajust psicosocial i vivència de l'adopció en infants adoptats internacionalment

Antecedents. Cada cop són més els nens i nenes adoptats internacionalment que creixen en la nostra societat, i el seu ajust psicosocial s’ha convertit en un assumpte d’especial interès i rellevància. Objectius. Estudiar l'ajust psicosocial i la vivència de l'adopció en els infants adoptats internacionalment. Els objectius específics són: 1) estudiar els nivells d’adaptació personal i social en nens i nenes adoptats/des internacionalment, en comparació amb els estàndards de la població normativa; 2) estudiar la vivència de l’adopció en nens i nenes adoptats internacionalment i la percepció que mares i pares en tenen al respecte; 3) analitzar el paper de las variables estrés i estratègies d’afrontament en l’ajust psicosocial dels infants adoptats. Material i Mètode. La mostra està formada per 103 infants adoptats a l’estranger, d’entre 8 i 12 anys, i els seus respectius pares i mares. Els participants completaren les següents proves: BASC (Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992), Qüestionari de punts forts i febles (SDQ; Goodman, 1997, 1999), Escala de la vivència adoptiva (Reinoso, 2008), Kidcope (Spirito, Stara y Williams, 1988). En realitzen anàlisis estadístics de tipus descriptiu, comparatiu, correlacional i exploratori. Resultats. La majoria dels menors adoptats internacionalment presenta bons nivells de funcionament, si bé un 25% d’ells presenta dificultats adaptatives bàsiques. En general s’observa un elevat nivell de convergència en la visió de l’experiència adoptiva entre nens/es i mares i pares. Els infants puntuen més alt en identitat cultural i més baix en discriminació percebuda que els seus pares/mares. Principalment esmenten problemes interpersonals de relació i de salut, malalties i accidents i utilitzen predominantment estratègies d’afrontament aproximatives. Els estressors vinculats amb l’experiència adoptiva són escassament mencionats. Conclusions. L’especificitat de la condició adoptiva requereix d’intervencions ajustades a la realitat d’aquests les necessitats d’aquests nens i les seves families.

Facilitation Process Concerning the Difficulties in Implementing A Vision For Change in the South Tipperary and Carlow Kilkenny Catchment Area Mental Health Service

Facilitation Process Concerning the Difficulties in Implementing A Vision For Change in the South Tipperary and Carlow Kilkenny Catchment Area Mental Health Service Click here to download PDF 4.27MB

Learning Difficulties and Ethnicity

This framework is to help people and organisations (e.g. Learning Disability Partnership Boards) work towards ensuring that local services are culturally competent/appropriate.

HSV-1-derived amplicon vectors: recent technological improvements and remaining difficulties - a review

Amplicons are defective and non-integrative vectors derived from herpes simplex virus type 1. As the vector genome carries no virus genes, amplicons are both non-toxic for the infected cells and non-pathogenic for the inoculated organisms. In addition, the large transgenic capacity of amplicons, which allow delivery of up to 150 Kbp of foreign DNA, makes these vectors one of the most powerful, interesting and versatile gene delivery platforms. We present here recent technological developments that have significantly improved and extended the use of amplicons, both in cultured cells and in living organisms. In addition, this review also discusses the many difficulties still pending to be solved, in order to achieve stable and physiologically regulated transgene expression.

Assessing the link between coping patterns and interpersonal behaviors in depressed women

Aim. Stressful life events are an important contributor to the onset and course of depression. Coping strategies and interpersonal patterns have been found to mediate the effects of stress [1]. Methods. This study examined the relationship between coping patterns and interpersonal interactions in early psychotherapy sessions of 25 female patients with major depression. Transcripts were rated for coping patterns using the Coping Patterns Rating Scale (CPRS; [2]). Interpersonal patterns were assessed using the Structural Analysis of Social Behavior (SASB; [3]). Results. Significant correlations were found between coping patterns and markers of interpersonal functioning in selected contexts. Discussion. The implications of these findings in understanding an important aspect of vulnerability to depression and enhancing treatment outcome are discussed.

Difficulties associated with out-patient management of drug abusers by general practitioners. A cross sectional survey of general practitioners with and without methadone patients in Switzerland

Résumé de l'article Contexte : En Suisse, les médecins de premier recours traitent la plupart des patients dépendants aux opiacés méthadone en tant que traitement de substitution. Méthode : Nous avons étudié les difficultés rencontrées dans la prise en charge des patients toxicodépendants en envoyant par poste un questionnaire d'enquête. Nous avons envoyé ce questionnaire à tous les médecins de premier recours de Suisse Romande prescrivant de la méthadone (556 médecins). Nous avons envoyé un autre questionnaire, plus court, à des médecins de premier recours du Canton de Vaud qui ne prescrivent pas de méthadone. Résultats : le taux de réponse global est de 63,3 %. La plus haute dose de méthadone donnée par les médecins de premier recours est de 120,4 mg/j (moyenne). Questionnés au sujet de l'aide qu'ils désireraient recevoir face à ces patients, les médecins de premier recours avec patients substitués par méthadone ont mentionné premièrement l'importance d'un meilleur remboursement des services prodigués. Les autres éléments demandés ont été une meilleure formation, de meilleures connaissances des pathologies psychiatriques et des groupes de discussion de cas cliniques. Les médecins sans patients sous méthadone refusent de traiter ces patients surtout pour des raisons émotionnelles et relationnelles. En conclusion : les médecins acceptant des patients sous méthadone rencontrent des difficultés relationnelles et émotionnelles. Ils désirent un meilleur remboursement pour les services prodigués.

Some conceptual difficulties regarding "net" multipliers

Multipliers are routinely used for impact evaluation of private projects and public policies at the national and subnational levels. Oosterhaven and Stelder (2002) correctly pointed out the misuse of standard 'gross' multipliers and proposed the concept of 'net' multiplier as a solution to this bad practice. We prove their proposal is not well founded. We do so by showing that supporting theorems are faulty in enunciation and demonstration. The proofs are flawed due to an analytical error but the theorems themselves cannot be salvaged as generic, non-curiosum counterexamples demonstrate. We also provide a general analytical framework for multipliers and, using it, we show that standard 'gross' multipliers are all that is needed within the interindustry model since they follow the causal logic of the economic model, are well defined and independent of exogenous shocks, and are interpretable as predictors for change.

Creatividad y relación interpersonal en el proceso de evaluación

Un planteamiento inadecuado de una actividad de evaluación propició un cambio radical en la manera de plantear la relación pedagógica aplicada a la evaluación por parte del profesor de la asignatura

Etude des liens entre l'alexithymie, l'expérience dépressive et la dépendance interpersonnelle chez des sujets addictifs [Relationships between alexithymia, depression and interpersonal dependency in addictive subjects].

In the scientific literature, the term of addiction is currently used to describe a whole range of phenomena characterized by an irresistible urge to engage in a series of behaviors carried out in a repetitive and persistent manner despite accruing adverse somatic, psychological and social consequences for the individual. It has been suggested that subjects presenting such behaviors would share specific features of personality which support the appearance or are associated with these addictive behaviors. Dimensions such as alexithymia and depression have been particularly well investigated. The aim of this study was to explore the hypothesis of a specific psychopathological model relating alexithymia and depression in different addictive disorders such as alcoholism, drug addiction or eating disorders. Alexithymic and depressive dimensions were explored and analyzed through the statistical tool of path analysis in a large clinical sample of addicted patients and controls. The results of this statistical method, which tests unidirectional causal relationships between a certain number of observed variables, showed a good adjustment between the observed data and the ideal model, and support the hypothesis that a depressive dimension can facilitate the development of dependence in vulnerable alexithymic subjects. These results can have clinical implications in the treatment of addictive disorders.

Bodily perspective taking goes social: the role of personal, interpersonal, and intercultural factors

Mentally placing the self in the physical position of another person might engage social perspective taking because participants have to match their own position with that of another. We investigated the influence of personal (sex), interpersonal (siblings, parental marital status), and cultural (individualistic, collectivistic) factors on individuals' abilities to mentally take the position of front-facing and back-facing figures in an online study (369 participants). Replicating findings from laboratory studies responses were slower for front-facing than back-facing figures. Having siblings, parents' marital status, and cultural background influenced task performance in theoretically predictable ways. The present perspective-taking task is a promising experimental paradigm to assess social perspective taking and one that is free from the response biases inherent in self-report.

The Law of Impersonal Transactions: Meaning and Difficulties

Most economic interactions happen in a context of sequential exchange in which innocent third parties suffer information asymmetry with respect to previous "originative" contracts. The law reduces transaction costs by protecting these third parties but preserves some element of consent by property right holders to avoid damaging property enforcement-e.g., it is they as principals who authorize agents in originative contracts. Judicial verifiability of these originative contracts is obtained either as an automatic byproduct of transactions or, when these would have remained private, by requiring them to be made public. Protecting third parties produces a sort of legal commodity which is easy to trade impersonally, improving the allocation and specialization of resources. Historical delay in generalizing this legal commoditization paradigm is attributed to path dependency-the law first developed for personal trade-and an unbalance in vested interests, as luddite legal professionals face weak public bureaucracies.