Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

Background. A performance measurement system ­ the Service Quality Measures (SQM) initiative ­ has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation.Objective. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers.Methods. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system.Results. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system.Conclusion. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation

Molecular battles between plant and pathogenic bacteria in the phyllosphere

The phyllosphere, i.e., the aerial parts of the plant, provides one of the most important niches for microbial colonization. This niche supports the survival and, often, proliferation of microbes such as fungi and bacteria with diverse lifestyles including epiphytes, saprophytes, and pathogens. Although most microbes may complete the life cycle on the leaf surface, pathogens must enter the leaf and multiply aggressively in the leaf interior. Natural surface openings, such as stomata, are important entry sites for bacteria. Stomata are known for their vital role in water transpiration and gas exchange between the plant and the environment that is essential for plant growth. Recent studies have shown that stomata can also play an active role in limiting bacterial invasion of both human and plant pathogenic bacteria as part of the plant innate immune system. As counter-defense, plant pathogens such as Pseudomonas syringae pv tomato (Pst) DC3000 use the virulence factor coronatine to suppress stomate-based defense. A novel and crucial early battleground in host-pathogen interaction in the phyllosphere has been discovered with broad implications in the study of bacterial pathogenesis, host immunity, and molecular ecology of bacterial diseases.

The mean levels of adherence and factors contributing to non-adherence in patients on highly active antiretroviral therapy / Niveles medios de adhesión y factores que contribuyen a la no adhesión en pacientes bajo terapia antiretroviral altamente activa

OBJECTIVE: To determine the mean level of adherence and factors contributing to non-adherence in patients on Highly Active Antiretroviral Therapy (HAART). METHODS: An observational study was done on 101 HIV/AIDS patients attending the Centre for HIV/ AIDS Research, Education and Services (CHARES) - University Hospital of the West Indies, between May 2006 and August 2006. A questionnaire was administered asking questions re: prescribed and actual dosing frequency and number of antiretroviral tablets for the previous week, reasons for nonadherence, duration of Highly Active Antiretroviral Therapy, age, employment status and level of education. Mean levels of adherence were calculated using self and social worker/nurse reported dosing frequency and number of tablets. Good adherence was defined as 95% or greater. Multiple regression analysis was used to determine factors impacting on adherence. RESULTS: Ninety-six patients were included for final analysis. Mean levels of adherence were as follows: 87.66%--self-report for tablets; 88.70%--self-report for dosing frequency; 87.02%--social worker/ nurse report for tablets; 88.10%--social worker/nurse report for dosing frequency. There were significant positive correlations between self and social worker/nurse reports using dosing frequency (Spearman Rho correlation coefficient 0.943, p = 0.01) or number of tablets (Spearman Rho correlation coefficient 0.955, p = 0.01). Adherence to self-reported number of tablets and dosing frequency were 58.4% and 56.4% respectively. Duration of HAART was found to have a significant negative correlation with the level of self-reported adherence to tablets (p = 0.002). CONCLUSION: Adherence to HAART is sub-optimum in patients at the CHARES. This must be urgently addressed to prevent the development of resistant HIV strains and treatment failure.

Objetivo: Determinar el nivel medio de adhesión y los factores que contribuyen a la no adhesión en pacientes bajo terapia antiretroviral altamente activa (TARAA). Métodos: Se realizó un estudio observacional a 101 pacientes con VIH/SIDA, que asistían al Centro de Investigación, Educación y Servicios de VIH/SIDA (CHARES), del Hospital Universitario de West Indies, entre mayo del 2006 y agosto del 2006. Se administró una encuesta con preguntas sobre la frecuencia de la dosificación prescrita y real y el número de tabletas antiretrovirales para las razones de la semana previa para la duración de la no adhesión al TARAA, la edad, el estatus de empleo y el nivel de educación. Los niveles medios de adhesión fueron calculados usando frecuencias de dosificación auto-reportadas, o reportadas por enfermeras o trabajadoras sociales, y el número de tabletas. Una adhesión era definida como buena si alcanzaba el 95% o más. Para determinar los factores que tienen un impacto sobre la adhesión se recurrió al análisis de regresión múltiple. Resultados: Noventa y seis pacientes fueron incluidos en el análisis final. Los niveles medios de adhesión fueron los siguientes: 87.66% ­ auto-reportes de tabletas; 88.70% ­ auto-reportes de frecuen-cia de dosificación; 87.02% reportes de tabletas por enfermeras o trabajadoras sociales; 88.10% reportes de frecuencia de dosificación por parte de enfermeras o trabajadoras sociales. Hubo correlaciones positivas significativas entre los auto-reportes y los reportes de las enfermeras y traba-jadoras sociales que usaron frecuencia de dosificación (coeficiente de correlación rho de Spearman 0.943, p = 0.01) o número de tabletas (coeficiente de correlación rho de Spearman 0.955, p = 0.01). Según los autoreportes, la adhesión al número de tabletas y a la frecuencia de dosificación fueron 58.4% y 56.4% respectivamente. Se halló que la duración del TARAA tiene una correlación negativa significativa con el nivel auto-reportado de adhesión a las tabletas (p = 0.002). Conclusión: La adhesión a la Terapia Antiretroviral Altamente Activa es sub-óptima en los pacientes del Centro CHARES. Esto es algo que requiere atención urgente si se quiere prevenir el desarrollo de cepas resistentes de VIH y el fracaso del tratamiento

Data requirements and data sources for biodiversity priority area selection.

The data needed to prioritize areas for biodiversity protection are records of biodiversity features - species, species assemblages, environmental classes - for each candidate area. Prioritizing areas means comparing candidate areas, so the data used to make such comparisons should be comparable in quality and quantity. Potential sources of suitable data include museums, herbariums and natural resource management agencies. Issues of data precision, accuracy and sampling bias in data sets from such sources are discussed and methods for treating data to minimize bias are reviewed.

Representing biodiversity: data and procedures for identifying priority areas for conservation.

Biodiversity priority areas together should represent the biodiversity of the region they are situated in. To achieve this, biodiversity has to be measured, biodiversity goals have to be set and methods for implementing those goals have to be applied. Each of these steps is discussed. Because it is impossible to measure all of biodiversity, biodiversity surrogates have to be used. Examples are taxa sub-sets, species assemblages and environmental domains. Each of these has different strengths and weaknesses, which are described and evaluated. In real-world priority setting, some combination of these is usually employed. While a desirable goal might be to sample all of biodiversity from genotypes to ecosystems, an achievable goal is to represent, at some agreed level, each of the biodiversity features chosen as surrogates. Explicit systematic procedures for implementing such a goal are described. These procedures use complementarity, a measure of the contribution each area in a region makes to the conservation goal, to estimate irreplaceability and flexibility, measures of the extent to which areas can be substituted for one another in order to take competing land uses into account. Persistence and vulnerability, which also play an important role in the priority setting process, are discussed briefly.

Manual de diagnóstico y tratamiento: para los responsables populares de salud / sss

El presente manual tiene como objetivo mejorar los conocimientos y las prácticas de los Responsables Populares de Salud de Yapacaní en la atención de los enfermos en sus comunidades...

Infecçäo experimental de Aedes fluviatilis (Lutz, 1904) por Dirofilaria immitis (Leidy, 1856) / Experimental infection of Aedes fluviatilis (Lutz, 1904) by dlirofiliaria immitis (Leidy, 1856)

Foi testada, experimentalmente, a suscetibilidade de Aedes fluviatilis à infecçäo por larvas de Dirofiloria immitis. Compararam-se os percentuais de sobrevivencia entre mosquitos infectados e näo infectados e observou-se que säo menores nos infectados. O desenvolvimento larvário mostrou-se assincrônico e, muitas vezes, as larvas näo ultrapassaram o primeiro estádio. Em pequena proporçäo dos mosquitos foram encontradas L3, observáveis entre o 14§ e o 22§ dias pós-infecçäo. Encontrou-se, em geral, uma ou duas, no máximo seis L3 por mosquito

Observations on the dipteran fauna in a focus of dermal leishmaniasis in the State of Minas Gerais: II. The distribution of families in relation to their medical, veterinary and economic importance

Foram usadas armadilhas luminosas para coleta de flebotomineos em um foco de leishmaniose tegumentar a leste do Estado de Minas Gerais, Brasil. Durante um periodo de sete meses as 179 amostras de outros Dipteros capiturados com aramdilhas luminosas foram identificadas a nivel de familia. As armadilhas foram colocadas em oito locais constituidos de tres diferentes biotopos: tres areas de floresta, areas cultivadas e peridomicilio. Foi feita uma comparacao entre o total de Dipteros coletados em cada biotopo, o total de familias coletadas em cada biotopo, sendo estimado o indice de diversificacao. Sao apresentados dendrogramas com o grau de associacao entre as familias de Dipteros em diferentes biotopos. Algumas familias de Dipteros foram uniformemente distribuidas atraves da area estudada; poucas familias parecem ter se adaptado as areas onde a atividade humana causou as maiores mudancas ecologicas. E discutido o impacto entre os Dipteros e o bem estar humano. As evidencias obtidas neste trabalho indicam que a transmissao da leishmaniose tegumentar nao esta atualmente ocorrendo nas areas estudadas, apesar da alta densidade de flebotomos capturados

American cutaneous leishmaniasis: disappearance of amastigotes from lesions during antimonial therapy.

Durante o tratamento com antimonial de Nmetil glucamina (Glucantime) dez pacientes com forma cutanea de leishmaniose tegumentar americana foram observados, para se determinar o tempo de desaparecimento de amastigotas das lesoes. Antes do tratamento todos os pacientes apresentavam teste de Montenegro positivo e amastigotas em esfregacos realizados por aposicao de material biopsiado das lesoes. O isolamento de parasitos da lesao em meio de NNN foi positivo em sete pacientes e em oito os cortes histologicos mostraram presenca de amastigotas. Durante as 10 primeiras doses de glucantime todos os pacientes tiveram culturas negativas. Amastigotas foram detectadas em esfregacos por aposicao ate a quarta dose e nos cortes histologicos ate a sexta dose de Glucantime. Os aspectos histopatologicos antes do tratamento sao brevemente descritos. Em apenas 2 pacientes observou-se durante o tratamento modificacoes histopatologicos dignas de nota: com o aparecimento de fibrose extensiva e hiperplasia pseudo carcinomatosa estes casos como os demais evoluiram para a cicatrizacao e cura das lesoes. Em vista dos resultados obtidos, os Autores concluem que a cura clinica das lesoes, pelo menos nas formas de leishmanioses cutaneas no Vale do Rio Doce, e ainda o melhor criterio para interromper o tratamento com antimoniato de N-metil glucamina, no esquema de tratamento utilizado no presente trabalho

Observations on the dipteran fauna in a focus of dermal leishmaniasis in the State of Minas Gerais. I: The families collected and an evaluation of trapping methods.

Em um foco de leishmaniose tegumentar na parte leste do Estado de Minas Gerais durante sete meses, foram utilizadas para coleta de Dptera com atividade noturna dois tipos de armadilha luminosa em miniatura. Cento e oitenta e uma amostras examinadas continham 51.708 individuos que exceto 249 danificados foram identificados ao nivel de familia. O material identificado inclui a especie de treze familias de Nematocera, duas familias de Brachycera e onze familias de Cyclorrhapha A abundancia e diversidade da fauna de dipteros da area estudada e comparada com a escassez de conhecimentos sobre Diptera no Estado de Minas Gerais. O desempenho e utilidade dos dois tipos de armadilha sao examinados, e a posicao de Phlebotominae dentro da fauna de dipteros e discutida. Flebotomineos sao o grupo de Diptera hematofagos predominante na area, mesmo quando nao havia evidencia de transmissao ativa de Leishmania agente da leishmaniose tegumentar humana

Alguns hospedeiros reais de ectoparasitos do municipio de Caratinga, Minas Gerais, Brasil. / Some real hosts of ectoparasites in Caratinga county, Minas Gerais, Brazil

Os autores determinaram os hospedeiros reais para seis especies de ectoparasitos na regiao de Caratinga, Minas Gerais, sendo quatro especies de acaros e duas de pulgas, utilizando-se do indice de infestacao e do coeficiente de associacao interespecifico hospedeiro/ parasito