'Wet' care homes for older people with refractory alcohol problems: a qualitative study

Background This study describes a registered care home in England and a registered nursing home in Norway which provide permanent care for alcohol-dependent older people who are unable or unwilling to stop drinking and cannot maintain an adequate standard of self-care and/or live independently. Prior to admission, most residents have been living unsafely in their own home or were homeless. They have high levels of contact with health, social and criminal justice services and complex needs as a result of mental illness, poor physical health and physical disabilities. Most have lost contact with their families. The aim is to stabilise drinking, physical and mental health and improve quality of life. The homes are based on a harm reduction philosophy, that is, they focus on strategies to reduce harm from high-risk alcohol use, rather than insisting on abstinence. Residents can drink as much alcohol as they want on the premises but staff encourage them to drink less and in a less harmful way (e.g. spreading drinking throughout the day and having ‘dry’ days). Method We carried out interviews and focus groups with staff and residents, observed verbal exchanges, experiences and routines in communal areas, took field notes during staff rounds and analysed documents such as care plans for individual residents. Key findings • Most residents’ drinking, physical and mental health stabilises and their use of health, social and criminal justice services reduces following admission. • This is achieved by encouraging less harmful drinking, providing on-site health care, assistance with medication and self-care and provision of nutritious meals and social activities. • Wet care homes are viewed by some residents as a safe refuge which has improved their quality of life. • Other residents are frustrated by a lack of personal autonomy. • Suitable outcomes include improved hygiene and nutrition, increased self-esteem, better compliance with healthcare, healthier living which is not entirely alcohol focused and more hope for the future. • Homes should have processes in place to collect quantitative measures which provide clear evidence of impact.        

Working with older drinkers

Findings presented in this report demonstrate that older drinkers have different stressors, precipitating factors and risk factors for relapse than younger drinkers. They also face a number of unique barriers to treatment and are more likely to remain ‘hidden’ from services. Despite these challenges, age-specific practices required to meet the needs of older people and draw them into treatment are poorly understood. The purpose of this project was to develop guidelines on what strategies and treatment approaches are likely to work best with older drinkers based on synthesis of relevant literature, insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment. A set of concise guidance documents will be prepared for health and social care workers and alcohol service providers in due course

Exploring associations between perceived HCV status and injecting risk behaviors among recent initiates to injecting drug use in Glasgow

The aim of this study was to explore the influence of testing for hepatitis C virus (HCV) and perceived HCV status on injecting risk behavior. A cross-sectional, community-wide survey was undertaken at multiple sites throughout Greater Glasgow during 2001-2002. Four hundred ninety-seven injecting drug users (IDUs) consented to participate and were interviewed using a structured questionnaire to ascertain HCV test history and injecting risk behavior. The average age of participants was 27 years and the majority of the sample were male (70.4%). Participants had been injecting for an average duration of 2.5 years. Logistic regression analysis revealed no significant associations between having been tested and injecting risk behavior. After adjustment for potential confounding variables, HCV-negatives were significantly less likely to borrow needles/syringes and spoons or filters as compared with unawares and were significantly less likely to borrow spoons or filters as compared with HCV-positives. Due to the cross-sectional design of the study, it is uncertain whether this reduction in risk behavior could be attributed to perception of HCV status. Further research is recommended to consolidate the evidence for this relationship

Status of water hyacinth infestation and control in River Kagera

During a regional workshop held in Mukono, Uganda (May 2001) by scientists and technocrats from Kenya, Tanzania and Uganda, working on water hyacinth management under the Lake Victoria Environmental Management Project (LVEMP), it was resolved that a survey of River Kagera be made to study the status of water hyacinth infestation and biological control in the river. Reports at the Mukono Workshop indicated that although Tanzania and Uganda had made serious effort to introduced biological control weevils (Neochefina eichhorniae and Neochetina brucht) on the weed in River Kagera, the level of establishment of biological control in the river was doubtful. Large quantities of water hyacinth biomass drifted down River Kagera into Lake Victoria daily. Similar reports of apparent inability of biological control weevils to fully establish and have effect on water hyacinth in River Nile, especially the Upper Victoria Nile, were also made by Uganda, and large quantities of weed biomass continuously drifted down the Upper Victoria Nile into Lake Kyoga. This was in spite of the successful control of the weed in Lake Victoria between 1998 and 200

Drink wise, age well; reducing alcohol related harm among people over 50: a study protocol

Background: Evidence suggests that the use of alcohol among older adults (defined as those aged 50+) has increased in recent years, with people aged 55-64 now more likely to exceed the recommended weekly guidelines than any other age group. Methods/ design: This is a quasi-experimental study with a before-after design. A postal questionnaire will be sent to 76,000 people aged 50 and over registered with a general practice in five different 'demonstration' (intervention) and control areas in the UK. Multiple interventions will then be delivered in demonstration areas across the UK. At the end of the programme, a postal questionnaire will be sent to the same individuals who completed it pre-programme to establish if there has been a reduction in alcohol use, at-risk drinking and alcohol related problems. Qualitative interviews with clients and staff will explore how the interventions were experienced; how they may work to bring about change and to identify areas for practice improvements. Discussion: This study protocol describes a multi-level, multi-intervention prevention-to-treatment programme which aims to reduce alcohol-related harm in people aged 50 and over

Endoscopic Discectomy versus Microscopic Discectomy

Objective:  A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease. Material and Methods:  A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI). Results:  There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group. Conclusion:  Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain

Importance of Simpson/Shinshu Grading in Meningioma’s Excision, Outcome and Recurrence

Objective:  The study was aimed to determine the recurrence rate and recurrence-free survival of meningioma surgery with reference to Simpson grading of excision. Material and Methods:  The study was conducted in the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. Total 325 patients both male and female of age (13 – 70 years) with supratentorial grade I meningioma operated. The craniotomy with maximum safe excision of the meningioma was done in all patients under general anesthesia. All patients followed-up to one year clinically and radiologically. MRI brain plain and IV contrast were done at 6 months and then annually. The extent of resection was determined with the help of operative notes and post-op MRI and recurrences were studied with help of follow-up MRI. Results:  There were 227 female and 98 male patients in ages 13 – 70 years. The mean age of patients was 53.5 years. 227 (70%) skull base meningioma, 71 (22.0%) convexity meningioma, and 26 (8%) falx or tentorium meningioma were operated. We achieved Simpson grade I excision in 55 (17.45%), grade II in 208 (64%), grade III in 23 (7%), and grade IV in 36 (11%) cases. The median recurrence free survival (RFS) with reference to Simpson grading of excision was 250, 120, 98, 80 months for grades I, II, III, and IV excision; it was statistically significant according to the grading of excision.  Conclusion:  Excision of meningioma up to grades I and II had an excellent outcome with minimum chances of complications

Identification of the Cellular Proteins Which Interact With the Essential HSV-1 Protein IE63

Herpesviruses are involved in a range of prominent medical or veterinary diseases making this one of the most significant virus families. The HSV-1 protein IE63 (ICP27) is essential for viral replication, and is the only HSV-1 IE protein which has homologues in every herpesvirus sequenced so far which infect mammals and birds, indicative of its key regulatory role and making it an excellent antiviral target. The aim of this study was to screen a library of cellular proteins to identify those which interacted with HSV-1 IE63. This information was likely to shed light on the mode of action of this protein. The yeast two-hybrid system was used to identify interacting proteins. This system exploits the ability of a 'bait' protein fused to the binding domain of a yeast transcription factor to interact with a target protein fused to the activation domain of the same yeast transcription factor, bringing the two domains into close enough proximity to reconstitute activity of the transcription factor and subsequent transcription of reporter genes in yeast cells. Proteins that do not interact do not permit activation of reporter gene expression. In this study, a truncated IE63 protein was used to screen proteins expressed from an uninfected HeLa cell cDNA library. The protein was truncated because it was found that that the N-terminal ten amino acids of IE63 caused transcription of reporter genes in the absence of an interacting protein. The screen identified eight cellular proteins which interacted with IE63, four of which were of initial interest. These were heterogeneous nuclear ribonucleoprotein K (hnRNP K), casein kinase II (CKII) p subunit, and the splicing factors Spliceosome Associated Protein 145 (SAP 145) and p32:- these interactions were all subsequently confirmed in virus infected cells by others in our laboratory. Truncation mutants of IE63 were constructed and using these in the two-hybrid assay, the regions of IE63 required for these various interactions were mapped as well as the IE63 region required for dimersation. Similarly, using hnRNP K truncations, regions required for interaction with IE63 were identified A region containing the zinc finger domain of IE63, located towards the C-terminus, was required for interaction with the CKIip subunit, with SAP 145 and for IE63 dimerisation. Dimerisation would permit IE63 to form interactions with multiple partners in a complex of proteins with RNA, allowing cross-talk between these molecules. An IE63 region involved in the interaction with hnRNP K contained a five amino acid sequence (SADET) which is well conserved throughout the alphaherpesviruses, and which is present in a region of hnRNP K required for interaction with IE63 and is necessary for the nuclear export of hnRNP K. This region of IE63 could have a role in nuclear export, perhaps recognising a nucleoporin also recognised by hnRNP K. A further IE63 region with runs of prolines was identified as involved in interactions with hnRNP K and CKIip, and was the only region necessary for the interaction with p32. It is highly probable that IE63 inhibits splicing by interacting with SAP 145 and/or p32, and it appears that CKII is recruited by IE63 to phosphorylate itself, hnRNP K and probably other proteins. The function of hnRNP K in uninfected cells is not completely understood but it is thought that the protein has a role in transcription, pre- mRNA processing, RNA transport and translation. It is proposed that IE63 may alter transcription, mRNA processing and transport in the HSV-1 infected cell via its interaction with hnRNP K. The study also demonstrated that IE63 can form interactions with a transcriptional activator ALY, a glutamine-rich protein, the protein human JTV-1 of unknown function and the nucleoporin RIPl. Furthermore, the nucleoporin CRMl which interacts with HIV-1 Rev and facilitates its export to the cytoplasm did not interact with IE63 in the two-hybrid assay, suggesting that IE63 and Rev may use different pathways to cross the nuclear pore. Finally, the HHV-8 (Kaposi's sarcoma herpesvirus) ORF57 homologue of IE63, which also acts post-transcriptionally, did not interact with the hnRNP K, CKIip, SAP 145 and p32 clones identified in the library screen suggesting that these distantly related homologues, which belong to different herpesvirus subgroups, are likely to possess certain different activities. (Abstract shortened by ProQuest.)

Accessibility and suitability of residential alcohol treatment for older adults: a mixed method study

Background Whilst alcohol misuse is decreasing amongst younger adults in many countries, it is increasing in older adults. Residential rehabilitation (rehab) is a vital component of the alcohol treatment system, particularly for those with relatively complex needs and entrenched alcohol problems. In this study, we sought to find out to what extent rehabs in England have upper age limits that exclude older adults, whether rehabs are responsive to older adults’ age-related needs and how older adults experience these services. Method This is a mixed method study. A search was carried out of Public Health England’s online directory of rehabs to identify upper age thresholds. Semi-structured qualitative interviews were carried out with 16 individuals who had attended one of five residential rehabs in England and Wales since their 50th birthday. A researcher with experience of a later life alcohol problem conducted the interviews. Results Of the 118 services listed on Public Health England’s online directory of rehabs, 75% stated that they had an upper age limit that would exclude older adults. Perceived differences in values, attitudes and behaviour between younger and older residents had an impact on older residents’ experience of rehab. Activities organised by the rehabs were often based on physical activity that some older adults found it difficult to take part in and this could create a sense of isolation. Some older adults felt unsafe in rehab and were bullied, intimidated and subjected to ageist language and attitudes. Conclusion This study identified direct and indirect age discrimination in rehabs contrary to the law. Further research is required to find out if age discrimination exists in rehabs in other countries. Rehabs should remove arbitrary age limits and ensure that they are responsive to the needs of older adults