Li, Huizhen. / "March 2008." / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 139-150). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgement --- p.vii / Abbreviations --- p.ix / Introduction --- p.1 / Chapter 1.1 --- HIV and AIDS --- p.4 / Chapter 1.1.1 --- HIV Transmission Routes --- p.5 / Chapter 1.1.2 --- HIV Related Risk Behaviors --- p.6 / Chapter 1.2 --- HIV Burden --- p.7 / Chapter 1.2.1 --- HIV Infection in China --- p.7 / Chapter 1.2.2 --- HIV Infection in Hong Kong --- p.9 / Chapter 1.2.3 --- Methadone Treatment in Hong Kong --- p.10 / Chapter 1.3 --- Objectives and Hypothesis --- p.14 / Chapter 1.4 --- Organization of This Thesis --- p.15 / Literature Review --- p.16 / Chapter 2.1 --- Search Methods --- p.18 / Chapter 2.1.1 --- Formulating Review Questions --- p.18 / Chapter 2.1.2 --- Search Strategy --- p.19 / Chapter 2.1.3 --- Inclusion and Exclusion Criteria --- p.21 / Chapter 2.2 --- Assessing the Quality of Studies --- p.22 / Chapter 2.3 --- Search Results --- p.23 / Chapter 2.3.1 --- Descriptive Summary --- p.25 / Chapter 2.3.2 --- Critique of Reviewed Articles --- p.33 / Chapter 2.4 --- Implication on Planning of Current Study --- p.37 / Chapter 2.4.1 --- Summary of Reviewed Articles --- p.37 / Methods for Exploring Predictors of HIV Risk --- p.40 / Chapter 3.1 --- Data Source --- p.42 / Chapter 3.1.1 --- Data Management in Methadone Clinics --- p.42 / Chapter 3.1.2 --- Source of Data --- p.43 / Chapter 3.2 --- Data Transformation --- p.45 / Chapter 3.3 --- Framework for assessing outcome --- p.48 / Chapter 3.3.1 --- Study population in different analyses --- p.48 / Chapter 3.3.2 --- Risk Score --- p.49 / Chapter 3.3.3 --- Independent Variables --- p.50 / Chapter 3.4 --- Generalized Linear Model --- p.52 / Chapter 3.5 --- Logistic Regression Model --- p.54 / Chapter 3.6 --- Multilevel Analyses --- p.55 / Chapter 3.6.1 --- Variables --- p.56 / Chapter 3.6.2 --- Definition of 'Neighborhood' --- p.56 / Chapter 3.6.3 --- Individual Variables --- p.60 / Chapter 3.6.4 --- Framework for Analyses --- p.60 / Chapter 3.7 --- Field Study --- p.63 / Results: Community Variation of HIV Risk --- p.65 / Chapter 4.1 --- Demographic Description --- p.67 / Chapter 4.1.1 --- Age distribution --- p.67 / Chapter 4.1.2 --- Gender Distribution --- p.68 / Chapter 4.1.3 --- Proportion of New Admission --- p.72 / Chapter 4.2 --- Drug Taking Profile --- p.74 / Chapter 4.2.1 --- Heroin Use --- p.74 / Chapter 4.2.2 --- Injecting Heroin Users --- p.77 / Chapter 4.3 --- HIV related risk behaviors --- p.81 / Chapter 4.3.1 --- Injection History --- p.81 / Chapter 4.3.2 --- Risky Injection Practices --- p.87 / Chapter 4.3.3 --- Sexual Behaviors --- p.93 / Chapter 4.4 --- Correlation between Demographics and Risk Score --- p.94 / Chapter 4.4.1 --- General Linear Regression Model Coefficient --- p.94 / Chapter 4.4.2 --- Risk Predictors in Logistic Regressions --- p.95 / Chapter 4.5 --- Neighborhood Effect --- p.100 / Chapter 4.6 --- On-site Observation --- p.103 / Chapter 4.6.1 --- Demographic Variations --- p.103 / Chapter 4.6.2 --- Drug Use Variations --- p.104 / Chapter 4.6.3 --- Social Background --- p.105 / Discussion --- p.111 / Chapter 5.1 --- Neighborhood Effect --- p.113 / Chapter 5.1.1 --- Variation across Communities --- p.113 / Chapter 5.1.2 --- Implication on Social Network of IDUs --- p.115 / Chapter 5.2 --- Decline of Admissions --- p.117 / Chapter 5.2.1 --- Decrease of New Admissions --- p.117 / Chapter 5.2.2 --- Decline of Readmission in 2003 --- p.119 / Chapter 5.3 --- Female IDU Population --- p.121 / Chapter 5.4 --- Limitations --- p.125 / Chapter 5.4.1 --- Importance of Individual Level Variables and Community Level Variables --- p.125 / Chapter 5.4.2 --- Reliability of Self-reported Data --- p.126 / Chapter 5.4.3 --- Duplicates of Readmissions --- p.126 / Chapter 5.4.4 --- Definition of Syringe Reuse --- p.127 / Chapter 5.4.5 --- Choice of Models --- p.129 / Conclusion and Future Directions --- p.131 / Chapter 6.1 --- Summary of Results --- p.133 / Chapter 6.2 --- Implication of results --- p.134 / Chapter 6.3 --- Future Directions --- p.136 / Bibliography --- p.139

In the USA, approximately 15% of women smoke tobacco cigarettes during pregnancy. In utero tobacco smoke exposure produces somatic growth deficits like intrauterine growth restriction and low birth we

Orientador: Carlos Alberto Hussni / Resumo: A venografia é um exame radiográfico contrastado utilizado para identificar ou avaliar a função venosa de membros, órgãos ou região anatômica. A lidocaína é um anestésico local que possui efeito vasodilatador. O objetivo do trabalho foi avaliar o efeito da lidocaína (2%), na venografia distal do membro torácico de equinos hígidos, por meio da descrição e contagem dos vasos contrastados distalmente ao membro, comparou-se a aplicação de 40 mL de contraste diatrizoato de meglumina 60% associado à lidocaína 2% com a associação de solução salina 0,9% e os volumes entre 40 e 60 mL de solução, questionando-se se a variação de volume ou a associação com a lidocaína pela vasodilatação podem diferir sobre no preenchimento venoso. Em cinco equinos adultos hígidos procedeu-se a venografia em ambos os membros torácicos com estase a partir de torniquete aplicado na região distal do rádio, aplicando-se para cada membro torácico os protocolos 40S (20 mL de meio de contraste + 20 mL de solução salina 0,9%), 40L (20 mL de meio de contraste + 20 mL de lidocaína 2%) e 60S (30 mL de meio de contraste + 30 mL de solução salina 0,9%) com intervalo de cinco dias entre cada exame. Os exames radiográficos foram realizados nas projeções dorso-palmar (DPa) e látero-medial (LM) (70 kV, 8 mAs e 70 cm distância foco-filme). As medianas foram calculadas a partir da contagem de vasos nas duas posições radiográficas e nas regiões distal de metacarpo e média das falanges proximal e média. Foi observado a distr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Venography is a contrasted radiographic examination used to identify or evaluate venous function in limbs, organs or other anatomic regions. Lidocaine is a local anesthetic that has a vasodilator effect. The aim of this study was to evaluate the effect of lidocaine (2%), in the distal venography of the distal forelimb of horses, through the description and counting of regional distal vessels, comparing the application of contrast solution associated with lidocaine and saline solution in total volumes of 40 or 60 mL, aiming to evaluate whether the volume variation or the association with lidocaine would interfere in the results. Venography was performed on both forelimbs of five adult horses, with stasis from a tourniquet applied to the distal radius, applying three different combinations of fluids: group 40S received 20 mL of contrast + 20 mL of saline solution 0,9%; group 40L received 20 mL of contrast + 20 mL of lidocaine 2% and group 60S received 30 mL de contrast + 30 mL of solution saline 0,9%. An interval of five days between every utilization was respected. The radiographs were made in the dorsopalmar and lateromedial projections (70kV, 8 mA and 70 cm of distance). The medians were calculated using the vessel count of both radiographic projections, in the distal metacarpal and middle regions of the proximal and middle phalanges. Axial distribution to the distal phalanx was observed in all protocols, with more evidence of the larger caliber of the vessels when lidocaine... (Complete abstract click electronic access below) / Mestre

Intravenous immunoglobulin (IVIG) is a common treatment for the neurological autoimmune diseases multiple sclerosis, multifocal motor neuropathy, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy. However, there is scant literature regarding the psychological effects of this treatment on quality of life (QOL). Using illness intrusiveness theory and personal control theory, this correlational, cross-sectional study examined the relationship between the IVIG treatment experience and QOL in neurological autoimmune patients. Surveys were employed to collect data from 79 patients at a neurological infusion center in Phoenix, AZ. Quantitative analyses included correlation, multiple regression, and mediation analyses to determine whether (a) IVIG treatment experience predicted QOL measured by 10 Neuro-QOL scales, (b) illness intrusiveness mediated the relationship between IVIG treatment experience and QOL, and (c) personal control mediated the relationship between illness intrusiveness and QOL. IVIG treatment experience predicted QOL in 1 Neuro-QOL subscale; illness intrusiveness mediated 9 of the Neuro-QOL subscales using bias-corrected bootstrapping for statistical significance; and personal control did not mediate the relationship between illness intrusiveness and QOL. These results may affect social change by increasing the understanding of physicians, nurses, and patients regarding the psychosocial impact of IVIG treatment. Results from the study may provide insight for interventions to assist patients in adjusting to this form of treatment.

This study addressed an increasing number of peripheral intravenous catheter infiltrations within hospitals, leading to problems such as phlebitis and cellulitis, which may result in a longer length of hospital stay. The purpose of this project was to determine how to reduce infiltrations in order to increase the longevity of the catheter. A quantitative, description design was used, guided by Abdellah's classification framework for identifying nursing problems. The target population was 50 patients experiencing incidents of peripheral intravenous catheter infiltration, identified in a patient safety event log used across a 252-bed hospital. Each incident was assessed for several risk factors, such as age, diagnosis, length of time of catheter use, co-morbidities, size of catheter used for insertion, and how many medications were being administrated intravenously. Using descriptive statistics, the combination of patient co-morbidities had a direct correlation with increased probability of infiltration before 96 hours. Among 82% of patients, co-morbidities included hypertension in 56% of subjects, advancing age, and placement of the catheter in the upper arm. Data play a significant role in decisions to change clinical practice and protocols. Findings from this study related to peripheral intravenous catheter insertions, and their maintenance can drive changes across a healthcare organization.

The research presented in this dissertation harnesses two secondary data sources, administrative databases of patient-level healthcare data and adverse event (AE) data reported in randomized clinical trials (RCTs), to assess the relationship between intravenous immune globulin (IVIg) and the risk of clinically serious thromboembolic adverse events (TEEs). Since 2013, IVIg products have carried a boxed warning concerning TEE risk, a determination supported by numerous case reports, a large claims-based risk assessment, and laboratory evaluations of the thrombogenecity of IVIg products. Questions remain concerning the magnitude of the risk overall and across subgroups of IVIg users. Taken together, our results are compatible with the conclusion that the absolute risk of TEE following IVIg use is likely to be low overall. While these results are reassuring, a clinically meaningful elevation in risk cannot be ruled out in certain patient sub-groups, such as older adults and others with a high baseline risk of TEE. A limitation of our research is that differences in TEE risk across products could not be evaluated with sufficient statistical power.

O uso de dispositivos para infusões intravasculares representa um desafio, principalmente, pela possibilidade da dispersão microbiana do local de inserção até a ponta do cateter. O procedimento de desinfecção poderá reduzir a colonização no sítio de inserção desses dispositivos, entretanto instiga uma série de questionamentos acerca da possibilidade de dispersão para o interior do lúmen, espectro de ação do antimicrobiano, e a técnica do procedimento de desinfecção. O objetivo deste estudo foi avaliar in vitro o procedimento de desinfecção das dânulas/torneiras de três vias contaminadas propositalmente com Staphylococcus aureus e Pseudomonas aeruginosa, bem como a dispersão de soluções para o interior dos lúmens. Trata-se de um experimento laboratorial in vitro, controlado e desenvolvido em duas etapas: avaliação da dispersão bacteriana por meio da contaminação intencional com cepas padrão: S. aureus (ATCC 25923) e P. aeruginosa (ATCC 27853), e a dispersão de líquidos para o interior do conector por meio do corante cristal violeta a 1%, após a fricção com solução fisiológica ou álcool etílico a 70%, visando simular o processo de desinfecção. Todos os experimentos foram realizados em triplicata por três pesquisadores distintos. A fricção dos conectores com solução fisiológica demonstrou crescimento bacteriano (P. aeruginosa e S. aureus) no interior de 41,7% dos lúmens, no entanto não houve crescimento bacteriano nas amostras após a desinfecção com solução alcoólica a 70% (p<0,001). Com relação aos percentuais das ausências de dispersão de soluções para o interior dos lúmens das dânulas, observou-se que a fricção com as soluções fisiológica e alcoólica foram de 81,5% e 66,7%, respectivamente (p=0,079). Assim, a ausência do crescimento bacteriano no lúmen das dânulas após a fricção com solução alcoólica a 70% está associada a uma série de variáveis controladas as quais remetem a preocupação, principalmente, na possibilidade de dispersão de soluções desinfetantes para o seu interior. Nesse sentido, infere-se sobre os riscos que ameaçam a segurança das pessoas submetidas a infusões intravenosas, especialmente, no que concerne a execução do procedimento de desinfecção das dânulas / The use of intravascular infusion devices presents a challenge, mainly, due to the possibility of microbial dispersion of insertion site up to catheter tip. Disinfection procedure can reduce colonization at insertion site of these devices, but it instigates a series of questions about the possibility of dispersion into the lumen, antimicrobial action spectrum, and the technique of the disinfection procedure. The objective of this study was to evaluate in vitro disinfection procedure of three-way taps purposely contaminated with Staphylococcus aureus and Pseudomonas aeruginosa as well as the dispersion of solutions into the lumens. This is an in vitro laboratory experiment, it was controlled and developed in two steps: evaluation of bacterial dispersion by intentional contamination with standard strains: S. aureus (ATCC 25923) and P. aeruginosa (ATCC 27853), and liquid dispersion into the connector through 1% violet crystal dye, after friction with physiological solution or 70% ethyl alcohol, in order to simulate disinfection process. All experiments were performed in triplicate by three distinct researchers. The friction of connectors with physiological solution showed bacterial growth (P. aeruginosa and S. aureus) within 41.7% of the lumens, but there was no bacterial growth in the samples after disinfection with 70% alcoholic solution (p<0.001). Regarding the absence of dispersion percentages of solutions into the lumens from three-way taps, it was observed that the friction with physiological and alcoholic solutions were 81.5% and 66.7%, respectively (p=0.079). Thus, the absence of bacterial growth in the lumen from three-way taps after the friction with 70% alcoholic solution is associated to a series of controlled variables which refer, mainly, to the possibility of dispersion of disinfectant solutions to its interior. In that sense, it is inferred about risks that threaten the safety of people undergoing intravenous infusion, especially, concerning the disinfecting procedure execution for three-way taps

Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

<p>Syftet med studien var att öka kunskapen om och förståelsen för hiv-smittade narkomaner i kriminalvård. Den övergripande frågeställningen löd; Hur beskriver ett mindre urval av hiv-smittade narkomaner i föremål för kriminalvård sina tankar och känslor kring sin sjukdom och sin livssituation? Studien var av kvalitativ design och den vetenskapliga positionen av hermeneutisk karaktär. Det empiriska materialet bestod av intervjuer med fem hiv-smittade narkomaner i kriminalvård. Tre teman var grundläggande i intervjuerna; Tankar, känslor och reaktioner kring hiv-diagnosen, Existentiella frågor, drivkraft och copingstrategier samt Bemötande i och utanför kriminalvården. Studiens teoretiska perspektiv; kristeori, existentialistisk teori, upplevelseteori och hälsoteori, valdes i syfte att nå en ökad förståelse för intervjupersonernas upplevelse av sin livssituation. Studiens resultat och analys visade att hiv-smittan fått olika konsekvenser för de intervjuade. För tre personer blev livet bättre genom sjukdomen; två av dem menade att de annars skulle varit döda. För de övriga två innebar sjukdomen i stället att döden kommit närmare och grusat alla förhoppningar om ett bättre liv. Tolkningen visade att en möjlig förklaring till de olika förhållningssätten kunde bero på skillnader i vilken inre privat betydelse sjukdomen haft för de intervjuade, samt i vilken mån de lyckats komma igenom krisen.</p>

<p>Syftet med studien var att undersöka om sjuksköterskans information till patienter, vid inläggning av perifer venkateter, följde gällande riktlinjer från Handbok för hälso- och sjukvårdspersonal. Författarna samlade in data genom att delta vid 60 inläggningar av perifer venkateter vilka genomfördes av femton olika sjuksköterskor. Insamlingen ägde rum på en dagkirurgiavdelning. Man observerade ett antal områden, resultatet på dessa kunde bli ja eller nej, där ja var det resultat man eftersökte. Antal ja-svar summerades och analyserades med oberoende t-tester för att se eventuella skillnader i yngre/äldre och män/kvinnor, inga skillnader påfanns. Resultatet visade att sjuksköterskornas information till patienter vid insättande av perifer venkateter hade uppenbara brister och inte följde gällande riktlinjer. I över hälften av observationsmomenten gavs bristande information eller ingen information alls. Det som sjuksköterskorna flitigast informerade om var att patienten vid insticket kunde känna smärta, denna information gavs till så gott som alla patienter. Två foldrar, en gällande patientinformation och en gällande sjuksköterskeinformation, har utformats av författarna för att kunna urskilja vad som kan vara nödvändigt när det gäller patientinformation.</p> / <p>The aim of this study was to investigate if given information to patients regarding insertion of a peripheral intravenous line was following national guidelines. The writers collected data by observing 60 insertions of peripheral intravenous lines that was performed by fifteen different nurses. The observations took place on a surgical ward. A specific number of areas were observed and the result of each observation could be answered with a yes or no, where yes was the result that was preferred. The yes-answers were summarized and analyzed using independent t-tests to find possible differences regarding gender and age, no differences were found. The result showed that given information to patients regarding the insertion of a peripheral intravenous line had obvious limitations and did not follow the national guidelines. In almost half of the observation areas the information was limited or none existing. The most common information that was given by the nurses was how the insertion of the peripheral intravenous line would feel, this information were given to almost every patient. Two information folders, one to the patients and one to the nurses, have been made by the writers to discern what can be necessary to inform the patient of.</p>