Social participation for older people with aphasia: The impact of communication disability on friendships

Purpose: The language changes experienced by a person with aphasia following a stroke often have sudden and long-lasting negative impact on friendships. Friendship relationships are core to social engagement, quality of life, and emotional well-being. The aims of this study were to describe everyday communication with friends for older people with and without aphasia and to examine the nature of actual friendship conversations involving a person with aphasia. Method: This naturalistic inquiry drew data from two phases of research: a participant observation study of 30 older Australians, 15 of whom had aphasia following a stroke, and a collective case study using stimulated recall to examine friendship conversations involving an older person with aphasia. Results: People with aphasia communicated with fewer friends and had smaller social networks. "Friendship" was a core domain of communication for older people and participation in leisure and educational activities was focal in everyday communication with friends. Case study data of conversations between three older people with aphasia and their friends illuminated features of "time," the role of humour, and friends having shared interests. Conclusion: Aphasia has been found to impact on friendships. A need exists for research and intervention programs to address communication with friends for older people with aphasia

A comparison of two methods for expert elicitation in health technology assessments.

BACKGROUND: When data needed to inform parameters in decision models are lacking, formal elicitation of expert judgement can be used to characterise parameter uncertainty. Although numerous methods for eliciting expert opinion as probability distributions exist, there is little research to suggest whether one method is more useful than any other method. This study had three objectives: (i) to obtain subjective probability distributions characterising parameter uncertainty in the context of a health technology assessment; (ii) to compare two elicitation methods by eliciting the same parameters in different ways; (iii) to collect subjective preferences of the experts for the different elicitation methods used. METHODS: Twenty-seven clinical experts were invited to participate in an elicitation exercise to inform a published model-based cost-effectiveness analysis of alternative treatments for prostate cancer. Participants were individually asked to express their judgements as probability distributions using two different methods - the histogram and hybrid elicitation methods - presented in a random order. Individual distributions were mathematically aggregated across experts with and without weighting. The resulting combined distributions were used in the probabilistic analysis of the decision model and mean incremental cost-effectiveness ratios and the expected values of perfect information (EVPI) were calculated for each method, and compared with the original cost-effectiveness analysis. Scores on the ease of use of the two methods and the extent to which the probability distributions obtained from each method accurately reflected the expert's opinion were also recorded. RESULTS: Six experts completed the task. Mean ICERs from the probabilistic analysis ranged between £162,600-£175,500 per quality-adjusted life year (QALY) depending on the elicitation and weighting methods used. Compared to having no information, use of expert opinion decreased decision uncertainty: the EVPI value at the £30,000 per QALY threshold decreased by 74-86 % from the original cost-effectiveness analysis. Experts indicated that the histogram method was easier to use, but attributed a perception of more accuracy to the hybrid method. CONCLUSIONS: Inclusion of expert elicitation can decrease decision uncertainty. Here, choice of method did not affect the overall cost-effectiveness conclusions, but researchers intending to use expert elicitation need to be aware of the impact different methods could have.This paper presents independent research funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula

Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study

Aims: To describe issues noted and recommendations made by community pharmacists during reviews of medicines and lifestyle relating to coronary heart disease (CHD), and to identify and quantify missed opportunities for making further recommendations and assess any relationships with demographic characteristics of the pharmacists providing the reviews. Methods: All issues and recommendations noted by 60 community pharmacists during patient consultations were classified and quantified. Two independent reviewers studied a subsample of cases from every participating pharmacist and identified and classified potential issues from the available data. The findings of the pharmacists and the reviewers were compared. Relevant pharmacist characteristics were obtained from questionnaire data to determine relationships to the proportion of potential issues noted. Results: A total of 2228 issues and 2337 recommendations were noted by the pharmacists in the 738 patients seen, a median of three per patient (interquartile range 2–4). The majority of the recommendations made (1719; 74%) related to CHD. In the subsample of 169 patients (23% of the total), the reviewers identified 1539 potential issues, of which pharmacists identified an average of 33.8% (95% confidence interval 30.1, 36.4). No relationship was found between the proportion of issues noted and potentially relevant factors such as pharmacists' characteristics and their experience of doing reviews. Conclusions: The majority of issues and recommendations noted by pharmacists related to CHD, although pharmacists recorded only a minority of the issues identified by reviewers. Variation between pharmacists in the completeness of reviews was not explained by review or other relevant experience

Workplace friendships between men: gay men's perspectives and experiences

Challenging the heteronormative bias in the current literature on men’s workplace friendships, this article uses qualitative interview data to explore how gay men understand and experience workplace friendships involving other gay and heterosexual men. Developing a Foucauldian approach, this study suggests that gay men’s experiences and perspectives on workplace friendships can supplant negative stereotypes of men’s friendships, by understanding them as relational sites for developing empowering organizational gay sexualities and genders. From a Foucauldian theoretical orientation, we can examine how gay men can(not) avoid falling into the trap of treating gender and sexuality in dichotomous and heterosexist terms, allowing them and their male work friends to explore new possibilities for workplace friendships that are more gender and sexually complex than is currently assumed. This article advocates future research on this matter as it could potentially enrich extant critical scholarship that has often bathed organizational masculinities in a negative light

Clinical and microbiological effects of commercially available dentifrice containing amine fluoride: A randomized controlled clinical trial

Background: The inability of the normal adult population to perform adequate tooth brushing has led to the search for chemotherapeutic agents in order to improve plaque control. This 6 month, single center, randomized controlled clinical trial was conducted to assess the clinical and microbiological effects of a dentifrice containing only amine fluoride (AF) as the active ingredient on gingivitis. Materials and Methods: Ninety subjects diagnosed with chronic generalized gingivitis were selected and randomly divided in three groups: Group 1 - placebo toothpaste, Group 2 - AF containing toothpaste, and Group 3 - triclosan containing toothpaste with polymer and fluoride. Clinical evaluation was undertaken using the gingival index of Loe and Silness and the plaque index and microbiological counts were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks. A subjective evaluation was also undertaken by a questionnaire. Results: AF containing toothpaste showed significant improvement in gingival and plaque index scores as well as microbiologic counts compared with placebo dentifrice. These improvements were comparable to triclosan containing toothpaste. Conclusions: AF containing toothpaste may be a useful formulation for chemical plaque control agent and improvement in plaque and gingival status and add to the list of various therapeutic agents used for maintenance of gingival health

Estudio descriptivo del uso de drogas en adolescentes de educación media superior de la ciudad de Monterrey, Nueva León, México Estudo descritivo do uso de drogas em adolescentes de educação média supeiror da cidade de monterrey, Nova Leon, México Descriptive study of drugs use among adolescents in higher middle education in Monterrey, Nueva León, Mexico

Se buscó establecer el perfil de consumo de drogas lícitas e ilícitas, patrones de consumo y estrategias de afrontamiento y resistencia al alcohol, tabaco y otras drogas en adolescentes de educación media superior. El estudio se sustentó en los conceptos de autores especializados en el tema considerándose las características conductuales, psicológicas y normativas de la persona. La muestra no probabilística consistió de 325 jóvenes. Los resultados indicaron que 67%, 65% y 7% de los adolescentes aceptaron haber usado alcohol, tabaco y marihuana alguna vez en su vida respectivamente y en el último mes el 33%, 38% y 3% esas mismas substancias, 65% consideran que la mayoría de sus compañeros han hecho uso; 56% tuvieron que rechazar una vez el ofrecimiento de alcohol, 64% tabaco y 51% marihuana, en el último mes con base en esos hallazgos. Se recomienda implementar un programa de prevención orientado a apoyar los recursos del adolescente para resistir las presiones para el consumo.<br>Buscou-se estabelecer o perfil de consumo de drogas lícitas e ilícitas, padrões de consumo e estratégias de enfrentamento e resistência ao álcool, tabaco e outras drogas em adolescentes de educação média superior. O estudo fundamentou-se nos conceitos de autores especializados no tema, considerando-se as características comportamentais, psicológicas normativas da pessoa. A amostra, não probabilística, consistiu de 325 jovens. Os resultados indicaram que 67%, 65% e 7% dos adolescentes aceitaram haver usado álcool, tabaco e maconha alguma vez na vida respectivamente e no último mês, 33%, 38% e 3% essas mesmas substâncias; 65% consideram que a maioria de seus companheiros fez uso; 56% tiveram que recusar uma vez a oferta de álcool, 64% tabaco e 51% maconha, no último mês. Com base nesses achados recomenda-se a implementação de um programa de prevenção orientado a apoiar os aportes dos adolescentes para resistir à pressão para o consumo.<br>We aimed to establish the consumption profile of licit and illicit drugs, consumption patterns and strategies for coping and resisting alcohol, tobacco and other drugs among adolescents in higher middle education. This study was based on concepts developed by specialized authors and considered the subject's behavioral, psychological and normative characteristics. The non-probabilistic sample consisted of 325 adolescents. Results indicated that 67%, 65% and 7% of the adolescents, respectively, accepted they had already used alcohol, tobacco and marihuana at some time in their life and that 33%, 38% and 3%, respectively, had used these same substances over the last month; 65% consider most of their colleagues have used these substances; 56% had to reject an offer to consume alcohol, 64% tobacco and 51% marihuana over the last month. On the basis of these findings, we recommend the implementation of a prevention program aimed at supporting the adolescent's resources to resist pressure towards consumption