L'objectif de l'étude était de comparer les analyses de cas chassé-croisé (CCO) et de cas-contrôle du temps (CCT) afin d'évaluer la relation entre l'usage de prescriptions et le risque de blessures traumatiques en utilisant des bases de données populationnelles incluant les données du Registre de Traumatisme de Québec, d'hospitalisation du MED-ECHO et la RAMQ. Les cas ayant rapporté une blessure entre janvier-2000 et décembre-2000 ont été inclus dans l'analyse. Pour chaque cas, un contrôle a été apparié sur l'âge, le sexe, le niveau du centre de traumatologie et la date de sortie de l'hôpital. 2,417 cas et 2,417 contrôles ont été appariés dans l'étude. Les résultats ont démontré que l'analyse de CCO est 1,5 fois plus susceptible de produire une association négative pour le risque de blessure comparativement à l'analyse CCT. Un faible niveau d'accord (62.4%) sur les estimations des risques a également été évalué par les deux méthodes.

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This thesis examines the establishment of servitudes by positive prescription in Scots law, with particular reference to the doctrine’s conceptual development and the nature of possession required under section 3 of the Prescription and Limitation (Scotland) Act 1973. The thesis is divided into three main parts. The first provides a historical account of the law of positive prescription as applied to servitudes from the 17th century to the 20th century, culminating in its statutory expression in section 3(1) and (2) of the 1973 Act. The second considers what the 1973 Act means when it says that a servitude must be “possessed” for the prescriptive period. While jurists in Scotland have traditionally thought that a right cannot be possessed as such, since it lacks a physical corpus, they have tended to view the apparent exercise of a right as equivalent to the detention of a corporeal object and concluded that servitudes can be “possessed” (or “quasi-possessed”) by analogy. An alternative approach is to say that, while possession denotes a comprehensive factual control of an object for one’s own benefit, certain lesser degrees of factual control are also protected by the law. On this view, the (apparent) exercise of a servitude constitutes a limited “possession” of the land itself and is protected accordingly. Part two argues that this alternative approach is the more coherent and provides helpful analytical tools for understanding what is really going on when a servitude is “possessed” for the purposes of prescription. The third part of the thesis consists of a detailed analysis of the nature of the possession required to establish a servitude by positive prescription. In particular, possession “as if of right” is shown to consist of two “steps”: firstly, the prescriptive claimant must show sufficient possession to indicate that a servitude is being asserted; and, secondly, the possession must not be “by right”, i.e. referable to another right already held by the claimant. After this, the statutory requirements of openness and peaceableness are considered in detail.

Since the 1990s rates of prescription drug abuse and overdose have skyrocketed to unprecedented levels. As a result states have enacted and implemented new drug control policies in hopes of slowing and reversing this health epidemic. The goals of this study were to (a) determine the impact these state-based drug control policies have on prescription drug abuse and overdose and (b) deduce what leads some states to pass stricter policies than others. Results indicated that the prevalence of prescription drug overdose in 2008 largely impacted the future strength of a state’s drug control policy. States with higher rates of drug overdose and abuse in earlier years tended to develop tougher policy by 2013. In addition, states’ Prescription Drug Monitoring Programs (PDMPs) were found to be strongly related to the growth rate of prescription drug abuse in states. While not significantly differing from national trends at first, after about five years of PDMP operation, states began to see a slow or decrease in their rates of prescription drug abuse. Though much more can be done to combat prescription drug abuse and overdose, PDMPs that provide unsolicited reports to users and are accessible to law enforcement and are an effective step to begin to curb the problem.

Class of 2012 Abstract / Specific Aims: To evaluate the effect on the incidence and nature of pharmacists’ drug utilization review (DUR) interventions of including patient diagnosis on electronic prescription (e-prescription) orders. Methods: This prospective pre-post evaluation was conducted in the outpatient pharmacy of a federally funded community health center over two consecutive four-week periods. During the pre-phase, a clinical pharmacist in the clinic’s onsite pharmacy prospectively reviewed the e-prescriptions received from the clinic’s primary care providers using a standard prospective DUR process and recorded all therapy-related interventions. In the post-phase, providers added a diagnosis on each e-prescription. Interventions were documented using a standard intervention form that has been used in previous research. Chi square and t-tests were used to assess the nominal and interval data, respectively (α=0.05). The Institutional Review Boards of the two collaborating universities approved the study. Main Results: Pharmacist intervention rates on problematic e-prescription orders significantly decreased (4% pre vs. 1% post, p<0.001). Drug-drug interactions (17.5% pre vs. 20% post) and missing information (15% pre vs. 20% post) were the most frequently cited problems that prompted the need for the pharmacist’s intervention. The medication classes most frequently involved in interventions were antibiotics (53% pre vs. 50% post) and central nervous system agents (17% pre vs. 10% post). After receiving clarification, the pharmacist most often dispensed the prescription (33.3% pre vs. 38.4% post) and educated the patient regarding their treatments (18.8% pre vs. 7.7% post). Conclusions: In this small pilot project, including the patient’s diagnosis on e-prescription orders significantly reduced the incidence of pharmacists’ DUR-related interventions. If duplicated in larger studies, our results suggest that providing pharmacists with additional targeted clinical information could reduce confusion and uncertainty thereby decreasing the number of unnecessary pharmacist contacts with prescribers and improving workflow and efficiency for both.

Class of 2008 Abstract / Objectives: To assess pharmacists’ and celiac patients’ knowledge and awareness about gluten in medications. Methods: People diagnosed with celiac disease were eligible to participate in the study. Patient questionnaires were administered at two of the quarterly Southern Arizona Celiac Support group meetings. Patients were surveyed regarding how to check the gluten-free status of prescription medications. Pharmacists from Tucson and Phoenix were included in the study. They were contacted by e-mail and invited to participate in the website questionnaire. Pharmacists were surveyed regarding their knowledge and comfort level of gluten content in medications. Both the patient questionnaires and pharmacist questionnaires utilized a rating scale of 0 to 5 (0=not at all, 5=very much). All other questions were multiple-choice. Results: Patient questionnaires were completed by 20 patients diagnosed for <5 years and 19 patients diagnosed ≥5 years. Seventy percent of patients reported that one of the ways they determine a medications’ gluten content is by asking a pharmacist which was significantly higher than any other method reported (p ≤ .010). Pharmacist questionnaires were completed by 40 clinical/hospital pharmacists and 25 community pharmacists. There were no significant differences in the two pharmacist groups’ reported level of knowledge (2.0±1.4 and 2.2±1.3, p=0.50), confidence in counseling (1.6±1.3 and 1.9 ±1.5 p= 0.41), or willingness to determine gluten content in medications (3.4±1.4 and 3.5±1.5). Conclusions: Celiac patients rely on pharmacists to determine the gluten content in medications. Pharmacists are willing to help patients determine gluten content, but are unconfident in their ability to do this.

Le traitement de la dépression repose principalement sur la prescription d’antidépresseurs chez les personnes âgées. Au Canada, l’adéquation de la prescription d’antidépresseurs dans la population des personnes âgées est peu étudiée. En médecine générale, près de la moitié des personnes âgées ayant une dépression ne reçoivent pas une prescription appropriée d’antidépresseurs. Le but de ce mémoire était (1) : déterminer la proportion des personnes âgées qui reçoivent une prescription d’antidépresseurs selon les recommandations cliniques canadiennes et (2) identifier les facteurs liés au patient et à l’organisation des services susceptibles d’influencer la prescription adéquate d’antidépresseurs chez les personnes âgées qui consultent dans les services de médecine générale. Pour répondre à cet objectif, une étude a été réalisée à partir des données de l'enquête transversale (ESA- services) sur la santé des aînés et l'utilisation des services de santé menée auprès de 1811 personnes âgées de 65 ans et plus qui consultaient dans les services de médecine générale au Québec entre 2011-2013. Près de 20 % de ces personnes, couvertes par le régime public d’assurance médicaments de la Régie d’assurance maladie du Québec avaient une prescription d’antidépresseurs. L’échantillon de cette étude incluait des personnes ayant reçu une prescription d’antidépresseurs pendant au moins 90 jours. En fonction des recommandations cliniques canadiennes, l’adéquation de la prescription d’antidépresseurs a été mesurée à l’aide de 3 critères : la dose adéquate, la durée adéquate et le suivi médical adéquat dans la phase aigüe du traitement. Nos résultats indiquent que 44 % des personnes ont reçu une prescription adéquate d’antidépresseurs selon les 3 critères. En utilisant les régressions multivariées pour examiner les facteurs pouvant expliquer la probabilité de recevoir une prescription adéquate d’antidépresseurs en contrôlant pour l’âge, le sexe, l'état matrimonial, le revenu, la scolarité, aucune de ces variables n'était associée à la probabilité de recevoir une prescription adéquate d’antidépresseurs. Toutefois, lorsque l’on examine l’adéquation de la prescription d’antidépresseurs au niveau de chacun des critères, les résultats de notre étude ont montré que les hommes et les personnes qui vivent en milieu urbain et métropolitain sont moins susceptibles de recevoir une dose adéquate d’antidépresseurs et que la détresse psychologique modérée à sévère était associée à la probabilité d’avoir un suivi adéquat. Aucun des facteurs organisationnels n’était associé à la prescription adéquate d’antidépresseurs.

0107750D Masters Research - Faculty of Health sciences / The prescription habits of general practitioners are continually under the scrutiny of ethical critics. There are numerous factors that influence a practitioner’s decision as to which antihypertensive agents to prescribe for the treatment of hypertension. As outlined in various international and national guidelines for the management of hypertension, the recommended treatment depends on ethnicity, current life-style, diet, smoking, age, gender, family history and possible underlying or secondary conditions such as diabetes mellitus, heart failure, isolated systolic hypertension, myocardial infarction, pregnancy, and evidence of coronary artery disease (CAD), stroke or peripheral vascular disease. Currently the control of blood pressure in patients with hypertension is far from optimal with over 70% of hypertensive patients being reported as having imperfect control. A number of factors related to the patient, the practitioner or the medication may explain the high incidence of inadequate blood pressure control. One possible explanation for the poor control of blood pressure may be that practitioners fail to comply with the guidelines. Hence the aim of my study was firstly to determine whether a practitioner’s decision as to which medication to prescribe in the treatment of hypertension is influenced by the Southern African Hypertension Society Guidelines. Secondly, in an attempt to assess the validity of the results of the primary analysis, the actual prescription habits (MediCross® database) were assessed and compared to the general practitioner’s recall of their prescription habits. Questionnaires were distributed to 320 MediCross® practitioners and prescription habits were identified and substantiated by the screening of an existing MediCross® database. I chose as my sample MediCross® general practitioners, as they are demographically representative of all major urban areas in South Africa; likely to be open-minded to supporting research and answering questionnaires (as MediCross® is part of a Clinical Research Site Management Organisation); and I had access to the database of the prescriptions made by MediCross® practitioners hence enabling me to fulfil my second objective. However, it must be kept in mind that these practitioners are representative of general practitioners in urban areas only (as the title of my research report indicates). My results show that 33.1% adhere to the guidelines (when a non-conservative definition of diuretics is used); 27% have heard of the guidelines and have a copy of them. When asked to give their own opinion however, 39% thought they adhered to the guidelines. The results also show that ACE inhibitors are the most commonly prescribed drug class for uncomplicated hypertension but a comparison to a MediCross® database, of which the quality is questionable, does not support this. As the response rate to the questionnaires was only 24.7%, these results are only a pilot study; however they suggest that few general practitioners use the guidelines or even have a copy of the guidelines. This pilot study suggests that the guidelines need to be distributed more widely. Furthermore the general practitioners that responded to the questionnaire indicated that the management of hypertension is difficult in that there is no single treatment regimen appropriate for all populations and each different - 5 - patient. It was also their view that clinical guidelines for the management of hypertension should more accurately reflect the uncertainty of when to initiate treatment and individual variation if they are going to take these guidelines seriously and comply with them.

Given that childhood obesity has become a public health concern, the development and implementation of effective interventions addressing this issue are needed. Research suggests that the use of a parent-only approach is an effective way to improve the home and family environment to promote healthy weight in children. Moreover, by improving parents’ physical activity and eating behaviours children’s behaviours may also be improved. Primary care interventions have been shown to be effective for enhancing physical activity in adults, especially when using physical activity prescriptions and referrals to community programs. No studies have combined these two interventions to explore the possibility of an added-value effect relative to the promotion of a healthy family environment conducive to healthy weight in children. Therefore, the purpose of this study was to compare the effectiveness of a combined primary care-parent-only intervention with a primary care intervention alone for improving the home and family environment and mothers’ physical activity behaviours relevant to the promotion of healthy weight in children. Female patients (N = 35) were randomly assigned to one of three conditions: Prescription Plus (PP), Prescription Only (PO) and Usual Care (UC). The PP group received a physical activity prescription plus a referral to a parent-only intervention, the PO group received just the prescription, and the UC group, regular health care. Outcome variables were physical activity, the obesogenic home environment, mother’s confidence for making obesity related changes, exercise/physical activity self-efficacy and outcome expectations, and self-regulation and perceived competence for exercise. All the measures were self-reported and were assessed before and eight weeks after the intervention. A 2 x 3 mixed analysis of variance showed no significant group differences at post-intervention. Only a significant time * intervention interaction was observed (p = .03), where the PP group achieved the largest effect (partial ŋ² = .200) in the obesogenic home environment score after receiving the intervention. These findings suggest that the combined primary care-parent-only intervention was effective for improving the home environment and provide preliminary insight into the effectiveness of such an intervention for influencing healthy weight in children. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2010-09-23 16:58:17.208

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 146-156).