No description available.

No description available.

A breach of the skin barrier, due to a burn wound, facilitates colonization by various microorganisms. Burn wounds can become colonized from the patients’ own skin flora, respiratory tract, or with exogenous bacteria from the environment. Strategies to treat burn wound infections are multipronged: removal of the infected necrotic tissue, wound dressing to protect the damaged area, and treatment with specific antimicrobials to prevent reinfection. The development of chronic infections, which could potentially lead to sepsis, depends largely on how well the microorganisms form biofilms within the wound. There are numerous antimicrobial gels and antibiotics that help prevent a burn wound from becoming infected, as well as, eliminate an already infected burn wound. However, global antibiotic resistance by microorganisms to these treatments has greatly increased, and it is imperative that new antimicrobial agents be formulated before infections become untreatable. Staphylococcus, Pseudomonas, Acinetobacter, Escherichia, Candida, Citrobacter, and Klebsiella are common causative agents of burn wound infections and are becoming increasingly resistant to antimicrobial medications. A newly synthesized antimicrobial gel compound (AGC) has shown promise in preventing growth of various bacteria and fungi commonly associated with burn wound infections. This study evaluated the activity of the AGC on a panel of Gram-positive and Gram- negative bacteria, and the fungi, Candida albicans, which represent the top ten causative infectious agents of burn wounds. The AGC reduced, to varying degrees, the microorganism’s growth, cell viability, and cellular metabolism. This novel antimicrobial compound shows promising potential as an effective option for prevention and treatment of infections in burn wound victims to avoid sepsis.

No description available.

Development of antibiotic resistance is an increasingly important issue. It has created some problematic bacterial infections that are extremely difficult to treat. Although, antibiotics remain front-line therapy for conquering bacterial infections, their indiscriminate use is no longer viewed as benign. Many facotrs have contributed to the increased use of antimicrobial agents. Practitioners maintain that they cannot refuse patient demands for antibiotics. The purpose of this proejct is to increase public awareness of the appropriate use of antibiotics. Dorothea Orem's Self-Care Theory of Nurisng is the theoretical basis for this education program created to assist nursing students in educating the public about appropriate antibiotic use. The program includes an assessment tool, learning objectives, and educational module for nurses and health professionals, an educational model for public presentation, a resource guide, and an evaluation tool. Nurses are in a unique position to provide prevention and awareness strategies to the public on the consequences of antibiotic use.

E-cigarettes became available in the United States during 2007. Studies using national data have found an increase in e- cigarette use among adolescents as early as 2011. In 2014, e-cigarettes became the most commonly used tobacco product among adolescents; however, little is known about its association with other tobacco products use. Therefore, the present study aimed to: 1) Examine the association between initiating tobacco use via e-cigarettes and subsequent use of other tobacco products; 2) Examine the association between the exposure to e-cigarettes marketing messages and tobacco use; 3) Describe symptoms of nicotine dependence associated with e-cigarette use, compared with cigarette and dual use of e-cigarettes and cigarettes. All aims were carried out among data from the National Youth Tobacco Survey (NYTS) 2014 and 2015. The participants of NYTS were adolescents, and they self-reported their demographic characteristics and tobacco use in an anonymous 81-item pencil-paper questionnaire. Findings from logistic regression modeling showed that initiating tobacco use via e-cigarettes was significantly associated with subsequent current use of cigarettes (adjusted odds ratio (AOR)=2.7; 95% confidence interval [CI], 1.9-4.0), cigars (AOR= 1.7; 95% CI, 1.2-2.4), smokeless tobacco (AOR= 3.1; 95% CI, 2.2-5.4), or any tobacco products (AOR= 4.4; 95% CI, 3.5-5.6). In addition, living with someone who used e-cigarettes at home significantly increased the likelihood of using tobacco products. Notably, e-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco (i.e. more than one tobacco product) use (AOR: 1.8, 95% CI: 1.5-2.1). Among adolescent daily tobacco users, 35.6% of e-cigarette users and 85.3% of cigarette users reported one or more dependence symptoms. These proportions increased to 74.3% among e-cigarette and 93.3% of cigarette dual (i.e. combined) users. Strong craving was the most commonly reported symptom with a range of 16.1-58.9% among different types of smokers in the study. In conclusion, exposure to e-cigarette marketing messages and e-cigarette use were associated with use of other tobacco products. Furthermore, e-cigarette use is addictive. Despite cigarette and dual (i.e. e-cigarette and cigarette) users being more likely to report dependence symptoms than e-cigarette users, the addictiveness of e-cigarettes occurred at appreciable rates. Collectively, the findings suggest that e-cigarettes are associated with dependence symptoms and use of tobacco products and suggest that stricter regulations are needed to prevent adolescent access to and use of e-cigarettes.

No description available.

Background: There is accumulating evidence that greater availability of neighbourhood green space is associated with better health. One mechanism proposed for this association is that green space provides a venue for, and therefore encourages, physical activity. It has also been suggested that socio-economic health inequalities may be narrower in greener areas because of the equalised opportunity for physical activity green spaces provide. However, research, exploring associations between availability of green space and physical activity has produced mixed results. Failure to account for the type and amount of physical activity which occurs specifically in green space may account for these mixed findings. This thesis therefore explored the extent to which green space is a venue for physical activity and whether this could account for better health and narrower socio-economic health inequalities in greener areas. Methods: Secondary analyses were conducted on two cross-sectional surveys of adults (16+) living in urban areas across Scotland. The first survey included individual level health, total physical activity, physical activity specifically in green space and socio-demographic characteristics. These data were matched to an objective measure of neighbourhood green space availability. The second included self-reported data on green space availability, quality, green space use, health and socio-demographic characteristics. Objective and perceived measures of green space were assessed in relation to (a) health, (b) use of green space and (c) physical activity in green space using logistic regression models. Interactions between socio-economic position and each outcome were assessed. Results: The objective availability of green space in a neighbourhood was not associated with health, total physical activity or that specifically in green space. The perceived availability and quality of green space was positively associated with more frequent use, but only perceived quality was associated with better population health. There was no evidence that socio-economic inequalities in health, use of green space or physical activity within green space were narrower in greener areas of Scotland. Conclusion: There was no evidence that physical activity specifically in green space was associated with better health or narrower socio-economic health inequalities. Further research exploring green space characteristics over and above availability, may help determine whether green space is salutogenic in Scotland.

The hepatitis C virus (HCV) is highly prevalent among people who inject drugs (PWID) in Scotland and the large majority of new HCV infections occurring in Scotland are within this population group. Harm reduction interventions, mainly sterile injecting equipment provision (IEP) and opioid substitution treatment (OST), to prevent the transmission of blood-borne viruses among PWID, were implemented in Scotland in the late 1980s/early 1990s. More recently, government policy initiatives, particularly the Hepatitis C Action Plan for Scotland, have stipulated the scale-up of these interventions. The overarching aim of this thesis was to investigate the impact of harm reduction interventions on the transmission of HCV among PWID in Scotland. Five secondary objectives were addressed in order to fulfil the main aim: (i) to review the international literature on the effectiveness of IEP and OST in preventing HCV transmission; (ii) to determine the association between self-reported sharing of needles/syringes and incident/prevalent HCV infection; (iii) to determine the association between sharing non-needle/syringe injecting paraphernalia and incident HCV infection; (iv) to determine the incidence of HCV among PWID in Scotland; and (v) to determine the association between self-reported uptake of IEP/OST and incident HCV infection. To address the first thesis objective, a systematic review of the literature was undertaken to identify existing international research evidence (published up to March 2007) for the effectiveness of harm reduction interventions. While HCV was the main outcome of interest, HIV and injecting risk behaviour (IRB) were also considered. A review of reviews approach identified: insufficient evidence that sterile needle and syringe provision (NSP) was effective in preventing HCV transmission; tentative evidence that NSP was effective in preventing HIV transmission; sufficient evidence to support the effectiveness of NSP in reducing self-reported IRB; and little to no evidence on needle/syringe vending machines, outreach NSP or the provision of other injecting paraphernalia (spoons, filters, water) in relation to any of the outcomes. With regard to OST, the findings were: insufficient evidence to show that OST has an impact on HCV transmission; sufficient evidence to support the effectiveness of continuous OST in reducing HIV transmission; and sufficient evidence to support the effectiveness of OST in reducing IRB by reducing the frequency of injection, the sharing of injecting equipment and injecting risk scores. An update to the review of reviews was undertaken to include literature published through March 2011, and found that little changed as a result of additional published reviews: in the main, the evidence statement for the effectiveness of OST with regard to HCV was upgraded from insufficient to tentative. The finding of weaker evidence with regard to biological outcomes (e.g. HCV, HIV), as compared with behavioural outcomes, indicated that low levels of IRB may be insufficient to reduce high levels of transmission, particularly for HCV. The subsequent chapter aimed to address the second thesis objective, by summarising, and exploring factors that explained the variation in, the measure of association between self-reported sharing of needles/syringes and HCV prevalence/incidence among PWID. A systematic review and meta-analysis were undertaken to identify and combine the results of European studies of HCV prevalence (or incidence) among those who reported ever/never (or recent/non-recent) sharing of needles/syringes. Among the 16 cross-sectional studies and four longitudinal studies identified, the pooled prevalence of HCV was 59% among PWID who reported never sharing needles/syringes and the pooled incidence of HCV was 11% among PWID who reported not recently sharing needles/syringes. Random effects meta-analysis generated a pooled odds ratio (OR) of 3.3 (95% confidence interval [CI] 2.4-4.6), comparing HCV infection among those who ever (or recently) shared needles/syringes relative to those who reported never (or not recently) sharing. Differences in pooled ORs were found when studies were stratified by recruitment setting (prison vs. drug treatment sites), recruitment method (outreach vs. non-outreach), sample HCV prevalence and sample mean/median time since onset of injecting. High incidence/prevalence rates among those who did not report sharing needles/syringes during the risk period may be a result of a combination of unmeasured risk factors (such as sharing non-needle/syringe injecting paraphernalia) and reporting bias. Study design and population were found to be modifiers of the size and strength of association between HCV and needle/syringe-sharing. To address the third thesis objective, the risk of HCV associated with sharing injecting paraphernalia (spoons, filters and water) was investigated using data from the 2008-09 and 2010 sweeps in a series of national cross-sectional surveys of PWID in Scotland, collectively called the Needle Exchange Surveillance Initiative (NESI). Logistic regression was used to examine the association between recent HCV infection (anti-HCV negative and HCV-RNA positive individuals) and self-reported measures of injecting equipment sharing in the six months preceding interview. Twelve percent of the sample reported sharing needles/syringes and 40% reported sharing paraphernalia in the previous six months. The adjusted odds ratios (AORs) for sharing needles/syringes (with or without paraphernalia) and sharing only paraphernalia in the last six months were 6.7 (95% CI 2.6-17.1) and 3.0 (95% CI 1.2-7.5), respectively. Among those who reported not sharing needles/syringes, sharing spoons and sharing filters were significantly associated with recent HCV infection (AOR 3.1, 95% CI 1.3-7.8 and 3.1, 95% CI 1.3-7.5, respectively); sharing water was not. This cross-sectional approach to the analysis of the association between sharing paraphernalia and incident HCV infection demonstrated consistent results with previous longitudinal studies. The prevalence of paraphernalia-sharing in the study population was high, potentially representing a significant source of HCV transmission. Addressing the fourth and fifth thesis objectives, a method to determine the incidence of HCV among PWID using a cross-sectional design was applied, and the associations between self-reported uptake of harm reduction interventions (OST and IEP) and recent HCV infection were examined. This was undertaken on data from the first sweep (2008-09) of NESI. Twenty-four recent HCV infections (as defined above) were detected, yielding incidence rate estimates ranging from 10.8-21.9 per 100 person-years. After adjustment for confounders, those with high needle/syringe coverage had reduced odds of recent infection (AOR 0.32, 95% CI 0.10-1.00, p=0.050). In the Greater Glasgow and Clyde region only, there were reduced odds of recent infection among those currently receiving OST, relative to those on OST in the last six months but not currently (AOR 0.04, 95% CI 0.001-1.07, p=0.055). The effect of combined uptake of OST and high needle/syringe coverage was only significant in unadjusted analyses (OR 0.34, 95% CI 0.12-0.97, p=0.043; AOR 0.48, 95% CI 0.16-1.48, p=0.203). The final analysis chapter built on the previous chapter investigating the association between uptake of harm reduction interventions and recent HCV infection, by using data from three sweeps of the NESI survey, undertaken in 2008-09, 2010 and 2011-12. A framework to triangulate different types of evidence – ‘group-level/ecological’ and ‘individual-level’ – was applied. Data on service provision (injecting equipment provision and methadone dispensation) were also collated and analysed.

Since 1980, the global prevalence of obesity has more than doubled. According to the World Health Organization (WHO) more than one in ten of the world’s adult population are now obese. The prevalence of obesity is high both in the developed and developing countries, leading to suggestions of an “obesity pandemic” or “globesity”. In Scotland alone, 28% of adults are now obese, and a further 36% are overweight. Historically, the main focus of healthcare has been the avoidance of preventable mortality. As life-expectancy has increased, attention has focused on the need to improve health, as well as longevity. The WHO definition of health encompasses mental and social, as well as physical, well-being. It is widely accepted that obesity causes, or aggravates, a number of medical conditions, and is also associated with reduced life-expectancy. However, the research on adiposity and subjective well-being is still in its infancy and previous studies suggest that the relationship is complex. This thesis starts by demonstrating the importance of subjective well-being in terms of its association with adverse outcomes: all-cause death, coronary heart disease (CHD), cancer incidence, and psychiatric hospitalisations. This is followed by six complementary studies that explore the relationship between adiposity and subjective well-being. Subjective well-being is explored using various approaches including self-reported health (SRH), health-related quality of life (overall, physical and mental/psychosocial), mental health and mood disorder, and adiposity is assessed using four measures: body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and body fat percentage (BF%) across the whole range of adiposity (from underweight to class III obese).