A comparative review of palliative care development in six countries represented by the Middle East Cancer Consortium (MECC)

Palliative care development and services were reviewed in the region represented by the six members of the Middle East Cancer Consortium: Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey. The multimethod review synthesized evidence from ethnographic field visits to inpatient units, home care hospice teams and free-standing hospices, including interviews with hospice and palliative care clinicians, administrators, volunteers, policy makers and academic researchers. Public health data and relevant literature were collated together with internet-accessed information on services and health care systems. A total of 69 services were located; two country members have a history of relatively sustained development of hospice and palliative care, but provision across the Middle East Cancer Consortium region is highly variable at a local level. Considerable barriers to service development were identified in a region already struggling with many military and political conflicts. Key problems are a lack of secure funds and government support, inadequate professional training programs, opioid phobia in professionals and the public, and a lack of awareness and understanding of palliative care needs at public, government, and professional levels. Key areas for further attention were increasing national and international professional training and public education programs, improving opioid legislation and health care policies, negotiating for secure government or health insurance funding provision, raising awareness about the need for pediatric services and for patients with other illnesses, as well as for those with cancer, and working to integrate palliative care into mainstream health service provision and education

Utilisation non médicale des médicaments d’ordonnance chez les adolescents utilisant des drogues au Québec

Abstract : OBJECTIVE: To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. METHOD: Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. RESULTS: Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. CONCLUSIONS: The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.OBJECTIF: Déterminer la prévalence de l’utilisation non médicale des médicaments d’ordonnance (UNMMO) et les facteurs qui y sont associés chez les adolescents (de 12 à 17 ans) qui utilisent des drogues au Québec. MÉTHODE: Des analyses de données secondaires ont été exécutées avec les données d’une étude de 6 mois, l’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011, une enquête de grande envergure visant à obtenir une meilleure compréhension de la santé et du bien-être des jeunes québécois du secondaire. Des analyses de régression logistique bivariée et multivariée ont été menées pour étudier l’UNMMO chez les adolescents qui utilisent des drogues, selon les facteurs des caractéristiques sociodémographiques, des caractéristiques des pairs, des indicateurs de la santé (anxiété, dépression, ou trouble de déficit de l’attention [TDA] avec ou sans hyperactivité), de l’autoefficacité, de l’environnement familial, et de l’utilisation de substances (utilisation d’alcool et de drogues). RÉSULTATS: Parmi les adolescents qui avaient utilisé des drogues dans les 12 mois précédents, 5,4 % (IC à 95 % 4,9 % à 6,0 %) déclaraient une UNMMO. Selon les analyses multivariées, un TDA (ratio de cotes ajusté [RCC] 1,47; IC à 95 % 1,13 à 1,91), un trouble anxieux (RCC 2,14; IC à 95 % 1,57 à 2,92), une faible estime de soi (RCC 1,62; IC à 95 % 1,26 à 2,08), un faible autocontrôle (RCC 1,95; IC à 95 % 1,55 à 2,45), une faible supervision parentale (RCC 1,43; IC à 95 % 1,11 à 1,83), une utilisation d’alcool régulière (RCC 1,72; IC à 95 % 1,36 à 2,16), et une utilisation de polysubstances (RCC 4,09; IC à 95 % 3,06 à 5,48) étaient associés à des probabilités accrues de déclarer une UNMMO. CONCLUSIONS: La prévalence observée de l’UNMMO était plus faible que prévu. Cependant, les associations notées entre certains troubles de santé mentale et l’utilisation régulière ou intensive d’autres substances psychoactives sont inquiétantes. Les implications cliniques sont discutées

Access to pain treatment as a human right

<p>Abstract</p> <p>Background</p> <p>Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment.</p> <p>Discussion</p> <p>Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses.</p> <p>Summary</p> <p>According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.</p

Drug policy and the public good: A summary of the second edition

The second edition of Drug Policy and the Public Good presents up-to-date evidence relating to the development of drug policy at local, national, and international levels. The book explores both illicit drug use and nonmedical use of prescription medications from a public health perspective. The core of the book is a critical review of the scientific evidence in five areas of drug policy: 1) primary prevention programs in schools and other settings; 2) treatment interventions and harm reduction approaches; 3) attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; 4) penal approaches, decriminalization and other alternatives; and 5) control of the legal market through prescription drug regimes. It also discusses the trend toward legalization of some psychoactive substances in some countries and the need for a new approach to drug policy that is evidence-based, realistic, and coordinated. The accumulated evidence provides important information about effective and ineffective policies. Shifting the emphasis toward a public health approach should reduce the extent of illicit drug use, prevent the escalation of new epidemics, and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties

The globalisation of breast cancer

Boyle, Peter Howell, Antony eng England 2011/01/05 06:00 Breast Cancer Res. 2010 Dec 20;12 Suppl 4:S7. doi: 10.1186/bcr2736.International audienceno abstrac

Psychodynamik medikalisierter Beziehungen

Konsensuskonferenzen in der Medizin tragen das zu einem bestimmten Zeitpunkt verfügbare Wissen über eine Krankheit zusammen, um Empfehlungen zu formulieren, wie sie erfolgreich diagnostiziert und therapiert werden kann. Für die Aufmerksamkeits und/oder Hyperaktivitätsstörung bei Kindern und Jugendlichen haben entsprechende Bemühungen dazu geführt, einen aufwendigen Diagnoseprozess zu verlangen, der die gesamte Lebenswelt der auffälligen Kinder und Jugendlichen in die Beobachtung einbezieht und Vorsicht walten lässt, um Unaufmerksamkeit, Impulsivität und Hyperaktivität nicht vorschnell als Symptome einer psychischen Störung zu beurteilen (Remschmidt, 2005). Ein solcher Aufwand ist nicht zuletzt deshalb notwendig, weil die Symptomdiagnose einer AD(H)S auf Urteilen sozialer Wahrnehmung beruht, die immer Normalitätsvorstellungen enthalten, die unterschiedlich ausfallen können. Eine andere Möglichkeit der Objektivierung gibt es nicht. Was die Therapie der AD(H)S betrifft, so gilt es inzwischen als Behandlungsstandard, sich nicht auf die Verordnung von Medikamenten zu beschränken, weil eine solche Beschränkung die Ätiologie der Symptome ignoriert. Wenn eine Medikation nach sorgfältiger Prüfung indiziert erscheint, sollte sie gegebenenfalls von psychotherapeutischen, psychoedukativen, ergotherapeutischen, logopädischen, pädagogischen oder anderen geeigneten nichtmedikamentösen Unterstützungen flankiert werden. Ohne eine solche Flankierung wird den Betroffenen die Entwicklung eines angemessenen Selbstverständnisses vorenthalten

An evaluation of a morphine public health programme for cancer and AIDS pain relief in Sub-Saharan Africa

BACKGROUND: Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication. METHODS: A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice. RESULTS: Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorisation rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up. CONCLUSION: The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries

Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

<p>Abstract</p> <p>Background</p> <p>Many health professionals engage in providing health services for drug users; however, there is evidence of stigmatisation by some health professionals. Prescription drug misusers as a specific group, may also be subject to such judgment. This study aimed to understand issues for primary care health practitioners in relation to prescription drug misuse (PDM), by exploring the attitudes and experiences of healthcare professionals with respect to PDM.</p> <p>Methods</p> <p>Tape-recorded interviews were conducted with a purposive sample of general practitioners (17), community pharmacists (16) and 'key experts' (18) in New Zealand. Interviews were transcribed verbatim and a thematic analysis undertaken. Participants were offered vouchers to the value of NZ$30 for their participation.</p> <p>Results</p> <p>A major theme that was identified was that of two different types of patients involved in PDM, as described by participants - the 'abuser' and the 'overuser'. The 'abuser' was believed to acquire prescription medicines through deception for their own use or for selling on to the illicit market, to use the drugs recreationally, for a 'high' or to stave off withdrawal from illicit drugs. 'Overusers' were characterised as having become 'addicted' through inadvertent overuse and over prescribing, and were generally viewed more sympathetically by practitioners. It also emerged that practitioners' attitudes may have impacted on whether any harm reduction interventions might be offered. Furthermore, whilst practitioners might be more willing to offer help to the 'over-user', it seemed that there is a lack of appropriate services for this group, who may also lack a peer support network.</p> <p>Conclusions</p> <p>A binary view of PDM may not be helpful in understanding the issues surrounding PDM, nor in providing appropriate interventions. There is a need for further exploration of 'over users’ whose needs may not be being met by mainstream drug services, and issues of stigma in relation to ‘abusers’.</p

The influence of methylphenidate on the power spectrum of ADHD children – an MEG study

BACKGROUND: The present study was dedicated to investigate the influence of Methylphenidate (MPH) on cortical processing of children who were diagnosed with different subtypes of Attention Deficit Hyperactivity Disorder (ADHD). As all of the previous studies investigating power differences in different frequency bands have been using EEG, mostly with a relatively small number of electrodes our aim was to obtain new aspects using high density magnetoencephalography (MEG). METHODS: 35 children (6 female, 29 male) participated in this study. Mean age was 11.7 years (± 1.92 years). 17 children were diagnosed of having an Attention-Deficit/Hyperactivity Disorder of the combined type (ADHDcom, DSM IV code 314.01); the other 18 were diagnosed for ADHD of the predominantly inattentive type (ADHDin, DSM IV code 314.0). We measured the MEG during a 5 minute resting period with a 148-channel magnetometer system (MAGNES™ 2500 WH, 4D Neuroimaging, San Diego, USA). Power values were averaged for 5 bands: Delta (D, 1.5–3.5 Hz), Theta (T, 3.5–7.5 Hz), Alpha (A, 7.5–12.5 Hz), Beta (B, 12.5–25 Hz) and Global (GL, 1.5–25 Hz).). Additionally, attention was measured behaviourally using the D2 test of attention with and without medication. RESULTS: The global power of the frequency band from 1.5 to 25 Hz increased with MPH. Relative Theta was found to be higher in the left hemisphere after administration of MPH than before. A positive correlation was found between D2 test improvement and MPH-induced power changes in the Theta band over the left frontal region. A linear regression was computed and confirmed that the larger the improvement in D2 test performance, the larger the increase in Theta after MPH application. CONCLUSION: Main effects induced by medication were found in frontal regions. Theta band activity increased over the left hemisphere after MPH application. This finding contradicts EEG results of several groups who found lower levels of Theta power after MPH application. As relative Theta correlates with D2 test improvement we conclude that MEG provide complementary and therefore important new insights to ADHD