AFES Miscellaneous Publication 2013-03

Tracking the growth and development of a new industry is critical to the assessment of its success. Growers, industry support groups, government leaders, educational and research organizations and more use basic statistics on crop production, markets, and growth over time to support and fund activities that promote this industry. Annual statistics also provide an indicator of industry health and can be used to develop models of long-term trends in industry growth. Beginning in 2011, the University of Alaska Fairbanks Agricultural and Forestry Experiment Station began compiling industry statistics. We summarize confidential grower information to provide baseline data that the industry can use to obtain funding, make business decisions, and promote their industry

Interventions to Improve Antibiotic Prescribing in Upper Middle Income Countries: A Systematic Review of the Literature 1990 2009

Background: Inappropriate antibiotic use is a global public health problem with serious consequences, including antimicrobial resistance. In response, countries have to take comprehensive action with interventions that improve antibiotic use at various levels. Several reviews have evaluated interventions on antibiotic prescribing practices in different healthcare settings. Objective: To identify interventions targeting antibiotic prescribing by medical doctors in primary health care in upper middle-income countries and to assess intervention effectiveness. Methods: We undertook systematic literature review of studies for the period 1990 – 2009. Studies had to report quantitative data on antibiotic prescribing by primary care doctors using medicines use indicators. Intervention effects were based on data from intervention studies with valid study designs. Results: Eight studies describing ten interventions met all the inclusion criteria. We found that single educational interventions targeting all diseases had low or no impact on percentages of patients prescribed antibiotics. Greater impact on antibiotic prescribing was achieved by multifaceted interventions focusing on specific diseases. Conclusion: The limited evidence on interventions from upper middle-income countries has produced results similar to other reviews. More concerted commitment is needed to monitor antibiotic prescribing regularly and to conduct well designed evaluations of interventions

Images as Metaphors for Desire

To determine the effectiveness of the combinations of images as metaphors for desire I asked the following questions during the course of my exploration: 1. On what basis were the objects chosen? 2. What are the relationships between and among the images in the paintings? 3. How do these relationships constitute a metaphor for desire? 4. What visual devices influence the relationships between the images

Acquiring knowledge prior to diagnosis: a grounded theory of patients’ experiences

© 2019 The Authors. Published by Patient Experience Journal. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.35680/2372-0247.1317This paper will specifically consider one of the major findings of a wider study (previously reported in Roddis, Holloway, Bond and Galvin1), concerning how patients acquired knowledge and information about their condition before being formally diagnosed. The overall purpose of this research was to explore and explain how people make sense of long-term health conditions. Through the use of both purposive and theoretical sampling within a grounded theory design, experiences of individuals with thrombophilia and asthma were explored

Safer injections following a new national medicine policy in the public sector, Burkina Faso 1995 – 2000

BACKGROUND: The common failure of health systems to ensure adequate and sufficient supplies of injection devices may have a negative impact on injection safety. We conducted an assessment in April 2001 to determine to which extent an increase in safe injection practices between 1995 and 2000 was related to the increased access to injection devices because of a new essential medicine policy in Burkina Faso. METHODS: We reviewed outcomes of the new medicine policy implemented in1995. In April 2001, a retrospective programme review assessed the situation between 1995 and 2000. We visited 52 health care facilities where injections had been observed during a 2000 injection safety assessment and their adjacent operational public pharmaceutical depots. Data collection included structured observations of available injection devices and an estimation of the proportion of prescriptions including at least one injection. We interviewed wholesaler managers at national and regional levels on supply of injection devices to public health facilities. RESULTS: Fifty of 52 (96%) health care facilities were equipped with a pharmaceutical depot selling syringes and needles, 37 (74%) of which had been established between 1995 and 2000. Of 50 pharmaceutical depots, 96% had single-use 5 ml syringes available. At all facilities, patients were buying syringes and needles out of the depot for their injections prescribed at the dispensary. While injection devices were available in greater quantities, the proportion of prescriptions including at least one injection remained stable between 1995 (26.5 %) and 2000 (23.8 %). CONCLUSION: The implementation of pharmaceutical depots next to public health care facilities increased geographical access to essential medicines and basic supplies, among which syringes and needles, contributing substantially to safer injection practices in the absence of increased use of therapeutic injections

Antibiotic Use in South East Asia and Policies to Promote Appropriate Use: Reports from Country Situational Analyses

Inappropriate use of antibiotics is rampant in South East Asia1-6 and is a major contributor to antimicrobial resistance.7-9 However, data on antibiotic use are scant, few effective interventions to improve appropriate antibiotic use have been implemented,10 11 and implementation of policies for appropriate use of antibiotics is also poor.12 13 An analysis of secondary data on antibiotic use from 56 low and middle income countries found that countries reporting implementation of more policies also had more appropriate antibiotic use.14 15 Effective policies included having a government health department to promote rational use of medicines, a national strategy to contain antimicrobial resistance, a national drug information centre, drug and therapeutic committees in more than half of all general hospitals and provinces, and undergraduate education on standard treatment guidelines.15 An updated essential medicines list and national formularies were also associated with lower antibiotic use

Prescriber and Dispenser Perceptions About Antibiotic Use in Acute Uncomplicated Childhood Diarrhea and Upper Respiratory Tract Infection in New Delhi: Qualitative Study

DiarrhoeaOBJECTIVE: The objective of the study was to explore the prescribing practices, knowledge, and attitudes of primary care doctors and community pharmacists, regarding antibiotic use in acute upper respiratory tract infections (URTI) and diarrhea in children to better understand causes of misuse and identify provider suggestions to change such behavior. MATERIALS AND METHODS: Two focus group discussions (FGDs) each were conducted with primary care government doctors (GDs), private general practitioners (GPs), pediatricians, and community pharmacists in Delhi. Each FGD had 8–12 participants and lasted 2 h. Furthermore, 22 individual face‑to‑face semi‑structured interviews were conducted with providers of varying type and experience at their workplaces. Thematic and summative qualitative content analysis was done. RESULTS: All groups admitted to overusing antibiotics, GPs appearing to use more antibiotics than GDs and pediatricians for URTI and diarrhea in children. Pharmacists copy the prescribing of neighborhood doctors. Antimicrobial resistance (AMR) knowledge was poor for all stakeholders except pediatricians. Causes for prescribing antibiotics were patient pressure, profit motive, lack of follow‑up and in addition for GDs, workload, no diagnostic facility, and pressure to use near‑expiry medicines. Knowledge was gained through self‑experience, copying others, information from pharmaceutical companies, and for some, training, continuous medical education/conferences. All groups blamed other professional groups/quacks for antibiotic overuse. Interventions suggested were sensitizing and empowering prescribers through training of providers and the public about the appropriate antibiotic use and AMR and implementing stricter regulations. CONCLUSIONS: A package of interventions targeting providers and consumers is urgently needed for awareness and change in behavior to reduce inappropriate community antibiotic use

Prescribing for acute childhood infections in developing and transitional countries, 1990–2009

Background: Evidence of global progress in treating acute paediatric infections is lacking. Objectives: To assess progress over two decades in prescribing for childhood infections and interventions to improve treatment by reviewing empirical evidence in developing and transitional countries. Methods: Data were systematically extracted on the use of medicines for diarrhoea, respiratory infections and malaria from published and unpublished studies (1990–2009) in children under 5 years of age. Medians of each indicator were calculated across studies by study year, geographic region, sector, country income level and prescriber type. To estimate intervention effects from studies meeting methodologically accepted design criteria [randomised controlled trials (RCTs), pre-post with control, and time series studies], the medians of the median effect sizes (median MES) were calculated across outcome measures. Results: Data were extracted from 344 studies conducted in 78 countries with 394 distinct study groups in public (64%), private (22%) and other facilities to estimate trends over time. Of 226 intervention studies, only the 44 (19%) with an adequate study design were used to estimate intervention effects. Over time, use of anti-diarrhoeals for acute diarrhoea decreased significantly (P<0·01). However, treatment of malaria and acute respiratory infection remained largely sub-optimal. Multi-component interventions resulted in larger improvements than single-component ones. The median MES indicated a 28% improvement with community case-management, an 18% improvement with provider education combined with consumer education, but only 9% improvement with provider education alone. Conclusions: While diarrhoea treatment has improved over the last 20 years, treatment of other childhood illnesses remains sub-optimal. Multi-component interventions demonstrated some success in improving management of acute childhood illness

Identifying the Most Effective Essential Medicines Policies for Quality use of Medicines: A Replicability Study Using Three World Health Organisation Data-sets

Suboptimal (irrational, incorrect, inappropriate) use of medicines is widespread, wasteful, and causes poor patient outcomes including anti-microbial drug resistance [1–9]. Interventions to improve quality use of medicines (QUM) in low/middle-income countries have mostly been small-scale, of limited duration, with small to modest effects [10–11]. Evidence from studies that we conducted in public healthcare sectors in developing and transitional countries suggests that implementation of WHO essential medicines (EM) policies is associated with better quality use (rational use) of medicines (QUM), including more appropriate use of anti-microbial agents [12–14]. The original WHO global data-set [12] covered the period 2003–2007 and there was uncertainty about how well EM policies were executed (based on country self-reports), with simultaneous deployment of multiple policies making it difficult to estimate individual impacts. We accessed a second source of data collected during 2-week visits to countries in South-East Asia during 2010–15, where policy implementation was observed independently [14]. The analyses of these data confirmed several of the findings of the earlier studies [12–13], including a correlation between the total numbers of EM policies implemented and composite measures of QUM. However, it remains unclear which policies are associated with the largest beneficial effects on medicines use. The aims of the present work were to analyse an updated global WHO data-set (2007– 2011), which included some policies not previously evaluated, and to test the consistency of our earlier findings of an increased impact with larger numbers of implemented EM policies. In addition, we wished to assess replicability of findings by correlating the rankings of policies that were common to the three studies to determine whether certain policies were consistently associated with the largest effects