Bakgrund: Personer som injicerar droger har i tidigare studier visat sig ha en lägre livskvalitet än andra populationer och många lider av psykisk ohälsa. Spridning av blodsmittor som hiv och hepatiter och andra blodburna infektioner kan vara en risk vid injicering. Tillgång till sterila sprutor och kanyler genom sprututbyte är en åtgärd för att minska spridning av infektionssjukdomar. Centralt för psykiatrisk omvårdnad, i likhet med harm reduction, är att värna mänskliga rättigheter, att erbjuda vård på lika villkor och stärka förmågan till egenvård. Syfte: Syftet med denna studie var att undersöka om livskvalitet hos personer som injicerar droger förbättras över tid efter inskrivning på Stockholms sprututbyte samt om det fanns någon skillnad mellan könen. Metod: Denna studie genomfördes som en prospektiv icke-experimentell longitudinell kvantitativ studie. Urvalet bestod av besökare på Stockholms sprututbyte som valde att delta. Studiedeltagarna svarade på livskvalitetsenkäten EQ-5D vid tre mättillfällen. EQ-5D mäter graden av tillfredsställelse i fem dimensioner (indexpoäng) samt innehåller en global skattning av nuvarande hälsotillstånd (EQ VAS). Förändring över tid analyserades med hjälp av ANOVA för upprepade mätningar. Resultat: Resultatet visade på en signifikant förbättring av livskvalitet över tid avseende EQ VAS för hela gruppen. Resultatet visade vidare att kvinnor skattade sitt nuvarande hälsotillstånd EQ VAS signifikant lägre än män. Slutsats: Deltagande i sprututbyte verkar ha betydelse och inverka positivt på hälsorelaterad livskvalitet hos personer som injicerar droger men mer behöver studeras för att få en bredare kunskap om vad det är som gör att det förhåller sig så. / Background: People who inject drugs have shown in previous studies to have a lower quality of life than other populations and many suffer from mental illness. The spread of blood infections such as hiv and hepatitis and other blood borne infections can be a risk when injecting. Access to sterile syringes and needles through syringe exchange is a measure to reduce the spread of infectious diseases. Central to psychiatric care, like harm reduction, is to protect human rights, to offer care on equal terms and to strengthen the capacity for self-care. Aim: The purpose of this study was to investigate whether the quality of life of people who inject drugs improves over time after enrollment in Stockholm needle and syringe exchange program and if there were any gender differences. Method: This study was conducted as a prospective non-experimental longitudinal quantitative study. The selection consisted of visitors at the Stockholm exchange who chose to participate. The study participants answered the quality of life questionnaire EQ-5D on three occasions. EQ-5D measures the degree of satisfaction in five dimensions (index points) and contains a global estimate of the current state of health (EQ VAS). Change over time was analyzed using ANOVA for repeated measurements. Results: The results showed a significant improvement in quality of life over time with regard to EQ VAS for the entire group. The results further showed that women estimated their current state of health EQ VAS significantly lower than men. Conclusions: Participation in needle and syringe exchange programs appears to have significance and a positive impact on health-related quality of life but further studies needs to gain a broader knowledge of what it is that makes it so.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Sample preparation is often a bottleneck in systems for chemical analysis. The aim of this work was to investigate and develop new techniques to address some of the shortcomings of current sample preparation methods. The goal has been to provide full automation, on-line coupling to detection systems, short sample preparation times and high-throughput. In this work a new technique for sample preparation that can be connected on-line to liquid chromatography (LC) and gas chromatography (GC) has been developed. Microextraction in packed syringe (MEPS) is a new solid-phase extraction (SPE) technique that is miniaturized and can be fully automated. In MEPS approximately 1 mg of sorbent material is inserted into a gas tight syringe (100-250 μL) as a plug. Sample preparation takes place on the packed bed. Evaluation of the technique was done by the determination of local anaesthetics in human plasma samples using MEPS on-line with LC and tandem mass spectrometry (MS-MS). MEPS connected to an autosampler was fully automated and clean-up of the samples took about one minute. In addition, in the case of plasma samples the same plug of sorbent could be used for about 100 extractions before it was discarded. A further aim of this work was to increase sample preparation throughput. To do that disposable pipette tips were packed with a plug of porous polymer monoliths as sample adsorbent and were then used in connection with 96-well plates and LC-MS-MS. The evaluation of the methods was done by the analysis of local anaesthetics lidocaine and ropivacaine, and anti-cancer drug roscovitine in plasma samples. When roscovitine and lidocaine in human plasma and water samples were used as model substances, a 96-plate was handled in about two minutes. Further, disposable pipette tips may be produced at low cost and because they are used only once, carry-over is eliminated.

Dans cette étude, la stabilité de préparations intraveineuses de cyclosporine (0.2 et 2.5 mg/mL dans NaCl 0.9% ou dextrose 5%) entreposées dans des seringues de polypropylène, des sacs de polypropylène-polyoléfine et des sacs de vinyle acétate d’éthylène a été évaluée. Une méthode HPLC indicatrice de la stabilité à base de méthanol a été développée et validée suite a des études de dégradation forcée. Les solutions évaluées ont été préparées de façon aseptique, puis entreposées à 25°C. La stabilité chimique a été évaluée par HPLC et la stabilité physique a été évaluée par inspection visuelle et aussi par diffusion dynamique de la lumière (DLS). Tous les échantillons sont demeurés stables chimiquement et physiquement dans des sacs de polypropylène-polyoléfine (>98% de cyclosporine récupérée après 14 jours). Lorsqu’entreposés dans des seringues de polypropylène, des contaminants ont été extraits des composantes de la seringue. Toutefois, aucune contamination n’a été observée après 10 min de contact entre la préparation de cyclosporine non-diluée et ces mêmes seringues. Les préparations de 2.5 mg/mL entreposées dans des sacs de vinyle acétate d’éthylène sont demeurés stables chimiquement et physiquement (>98% de cyclosporine récupérée après 14 jours). Toutefois, une adsorption significative a été observée avec les échantillons 0.2 mg/mL entreposés dans des sacs de vinyle acétate d’éthylène (<90% de cyclosporine récupéré après 14 jours). Une étude cinétique a démontré une bonne corrélation linéaire entre la quantité adsorbée et la racine carrée du temps de contact (r2 > 0.97). Un nouveou modèle de diffusion a été établi. En conclusion, les sacs de polypropylène-polyoléfine sont le meilleur choix; les seringues de polypropylène présentent un risque de contamination, mais sont acceptables pour un transfert rapide. Les sacs de vinyle acétate d’éthylène ne peuvent être recommandés à cause d’un problème d’adsorption. / In the present study, the stability of intravenous cyclosporine preparations (0.2 and 2.5 mg/mL in 0.9% sodium chloride injection or 5% dextrose injection) stored in polypropylene (PP) syringes, polypropylene–polyolefin (PP-PO) bags and ethylene vinyl acetate (EVA) bags was evaluated. A methanol-based high-performance liquid chromatography (HPLC) method was developed and validated to be stability-indicating by stress degradation tests. The test solutions were aseptically prepared and stored at 25 °C. Chemical stability was evaluated by HPLC assay. Physical stability was assessed by visual inspection and a dynamic light scattering (DLS) method. All samples were chemically stable (> 98% of recovered cyclosporine) and physically stable when stored in polypropylene–polyolefin bags for 14 days. When stored in polypropylene syringes, some impurities were leached. However, no leaching was detected when the syringes were exposed to undiluted intravenous cyclosporine for 10 minutes. The preparations of 2.5 mg/mL were chemically and physically stable as stored in ethylene vinyl acetate bags for a period of 14 days (> 98% of recovered cyclosporine), while significant cyclosporine adsorption occurred on the samples of 0.2 mg/mL (< 90 % of recovered cyclosporine) after 14 days. Kinetic study showed that good linear correlations were achieved by plotting the adsorption amount versus square root of contact time (r2 > 0.97). A novel diffusion model was established and successfully predicted long-term drug stability. In conclusion, polypropylene–polyolefin bags were the best choice; syringes were inferior because of leachables. However, they were safe for preparation and transferring undiluted intravenous cyclosporine. Ethylene vinyl acetate bags cannot be recommended due to cyclosporine adsorption.

The most common and enduring explanation for the way research is used (or abused or not used) in policy is the ‘two communities’ theory. According to this theory, the problematic relationship between research and policy is caused by the different ‘cultures’ inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these ‘two communities’. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australia—breast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisons—are used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, ‘regimes of truth’ and ‘regimes of practices’ found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisation’s principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of ‘research transfer’ between ‘two communities’ is a flawed way of understanding the research–policy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.

This study was conducted to compare animal performance, presence of skin reactions and immune response following vaccination of beef calves via needle-free (NF) and needle-syringe (NS) vaccination techniques. Spring-born (Study A) and fall-born (Study B) calves were vaccinated against bovine viral diarrhea virus (BVDV) and Clostridium chauvoei (C. chauvoei) via NF and NS vaccination techniques. The parameters measured in this study included body weight (BW), skin reactions and serum antibodies. Animal performance and antibody levels against BVDV and C. chauvoei did not differ between vaccination techniques. However, NF vaccinated calves had a greater frequency of skin reactions when compared to NS vaccinated calves, except for day 42 of Study B. It can be concluded that a needle-free injection device (NFID) can be used effectively to stimulate an immune response without impacting animal performance, but may cause a greater frequency of skin reactions.

About 35 years ago the WHO advocated that countries with injecting drug users should introduce the so-called needle exchange programs (NEP) to curb the spread of infection by blood-borne diseases. In Sweden the first NEP started 1985 in Lund, but the program was extremely controversial in a country with such a restrictive drug policy like Sweden. The study you are about to read shall process this controversy, when a NEP opened in Stockholm, by analyzing the articles published in the newspapers Dagens Nyheter and Svenska Dagbladet. By using discourse analysis as a processing tool we’ll try to see the difference between the two chosen newspapers. We will identify and analyze the different participant’s, such as doctors, politicians, user associations and media, arguments in the needle exchange issue.   Our results show that the liberal DN articles were supportive of the NEP and that they considered it to be an infectious disease control issue. The liberal conservative newspaper SvD had a different view of the issue and considered NEP to be a question about drug policy. Even after the decision was made the city had problems to find suitable premises for the NEP to operate from.

This study was conducted to compare animal performance, presence of skin reactions and immune response following vaccination of beef calves via needle-free (NF) and needle-syringe (NS) vaccination techniques. Spring-born (Study A) and fall-born (Study B) calves were vaccinated against bovine viral diarrhea virus (BVDV) and Clostridium chauvoei (C. chauvoei) via NF and NS vaccination techniques. The parameters measured in this study included body weight (BW), skin reactions and serum antibodies. Animal performance and antibody levels against BVDV and C. chauvoei did not differ between vaccination techniques. However, NF vaccinated calves had a greater frequency of skin reactions when compared to NS vaccinated calves, except for day 42 of Study B. It can be concluded that a needle-free injection device (NFID) can be used effectively to stimulate an immune response without impacting animal performance, but may cause a greater frequency of skin reactions.

Dans cette étude, la stabilité de préparations intraveineuses de cyclosporine (0.2 et 2.5 mg/mL dans NaCl 0.9% ou dextrose 5%) entreposées dans des seringues de polypropylène, des sacs de polypropylène-polyoléfine et des sacs de vinyle acétate d’éthylène a été évaluée. Une méthode HPLC indicatrice de la stabilité à base de méthanol a été développée et validée suite a des études de dégradation forcée. Les solutions évaluées ont été préparées de façon aseptique, puis entreposées à 25°C. La stabilité chimique a été évaluée par HPLC et la stabilité physique a été évaluée par inspection visuelle et aussi par diffusion dynamique de la lumière (DLS). Tous les échantillons sont demeurés stables chimiquement et physiquement dans des sacs de polypropylène-polyoléfine (>98% de cyclosporine récupérée après 14 jours). Lorsqu’entreposés dans des seringues de polypropylène, des contaminants ont été extraits des composantes de la seringue. Toutefois, aucune contamination n’a été observée après 10 min de contact entre la préparation de cyclosporine non-diluée et ces mêmes seringues. Les préparations de 2.5 mg/mL entreposées dans des sacs de vinyle acétate d’éthylène sont demeurés stables chimiquement et physiquement (>98% de cyclosporine récupérée après 14 jours). Toutefois, une adsorption significative a été observée avec les échantillons 0.2 mg/mL entreposés dans des sacs de vinyle acétate d’éthylène (<90% de cyclosporine récupéré après 14 jours). Une étude cinétique a démontré une bonne corrélation linéaire entre la quantité adsorbée et la racine carrée du temps de contact (r2 > 0.97). Un nouveou modèle de diffusion a été établi. En conclusion, les sacs de polypropylène-polyoléfine sont le meilleur choix; les seringues de polypropylène présentent un risque de contamination, mais sont acceptables pour un transfert rapide. Les sacs de vinyle acétate d’éthylène ne peuvent être recommandés à cause d’un problème d’adsorption. / In the present study, the stability of intravenous cyclosporine preparations (0.2 and 2.5 mg/mL in 0.9% sodium chloride injection or 5% dextrose injection) stored in polypropylene (PP) syringes, polypropylene–polyolefin (PP-PO) bags and ethylene vinyl acetate (EVA) bags was evaluated. A methanol-based high-performance liquid chromatography (HPLC) method was developed and validated to be stability-indicating by stress degradation tests. The test solutions were aseptically prepared and stored at 25 °C. Chemical stability was evaluated by HPLC assay. Physical stability was assessed by visual inspection and a dynamic light scattering (DLS) method. All samples were chemically stable (> 98% of recovered cyclosporine) and physically stable when stored in polypropylene–polyolefin bags for 14 days. When stored in polypropylene syringes, some impurities were leached. However, no leaching was detected when the syringes were exposed to undiluted intravenous cyclosporine for 10 minutes. The preparations of 2.5 mg/mL were chemically and physically stable as stored in ethylene vinyl acetate bags for a period of 14 days (> 98% of recovered cyclosporine), while significant cyclosporine adsorption occurred on the samples of 0.2 mg/mL (< 90 % of recovered cyclosporine) after 14 days. Kinetic study showed that good linear correlations were achieved by plotting the adsorption amount versus square root of contact time (r2 > 0.97). A novel diffusion model was established and successfully predicted long-term drug stability. In conclusion, polypropylene–polyolefin bags were the best choice; syringes were inferior because of leachables. However, they were safe for preparation and transferring undiluted intravenous cyclosporine. Ethylene vinyl acetate bags cannot be recommended due to cyclosporine adsorption.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Nursing In the Faculty of Health and Wellness Sciences At the Cape Peninsula University of Technology, 2013 / The syringe driver is a battery-operated device which accurately delivers a continuous subcutaneous infusion of a combination of medication to alleviate symptoms, such as pain, nausea and vomiting, noisy moist breathing and preterminal restlessness. The researcher who works in a palliative care unit in Cape Town noticed the ambivalence and negative attitudes from family members regarding the use of the syringe driver. This gave rise to distress, conflict and ambivalence in patients and between family members. This study aimed to gain insight into the understanding, perceptions and expectations of families of terminally ill patients commenced on a syringe driver in a palliative care unit. A descriptive, qualitative research method was employed using semi-structured interviews, diaries, observation and documentation as the data collection methods. Data was coded and arranged into themes. Thematic analysis and coding were used to analyse the data during this study. This study found that the lack of education and written information were the two major contributing factors towards negative attitudes causing ambivalence in family members whose relatives were on a syringe driver. This study also highlighted the need for quality improvement control when using the syringe driver in the palliative care unit. The need for continuous education and written information and support for the immediate and extendedfamily members was evident. KEY WORDS: Syringe driver, Symptom control, Family members, Terminally ill, Palliative care unit.