Barriers to the provision of asthma services and perceived practice towards asthma management among urban community pharmacists in Selangor, Malaysia

This study aims to assess the perceived practice and barriers towards the provision of asthma management services among urban community pharmacists in Selangor, Malaysia. The study also highlights both pharmacist and patient-related barriers in asthma counseling. One hundred fifty urban community pharmacists in Selangor, Malaysia, were randomly selected and recruited for the present cross sectional baseline study. Previous studies have explored pharmacists' perception on their roles in asthma management in different parts of the world. The data was collected through self-explanatory questionnaires (containing 47 items). The extracted data from the completed questionnaires were analyzed descriptively and inferentially using Statistical Package for Social Science (SPSS) version 19. Results showed that pharmacists perceived their roles in asthma management along three major dimensions: 'patient self-management', 'medication use' and 'asthma control', mean (±SD) score of the perception towards asthma management was 99.29 ± 4.58 over a maximum possible score of 110 with 90.26%. There were significant differences between the pharmacy education level and perceived practice of asthma management while there were insignificant differences between age, gender, ethnicity, number of practicing year and perceived practice of asthma management among respondents. Most common barriers towards asthma counselling including lack of time, lack of asthma knowledge, lack of counselling space and cost of asthma drugs. Conclusively, urban community pharmacists in Selangor, Malaysia, demonstrate good perceived practice of better management of asthma with multidimensional dimensional role against in disease care.

Factores que se relacionan con la adherencia al tratamiento de la obesidad en un dispositivo grupal: estudio exploratorio / Factors associated with adherence to treatment of obesity in a group device: an exploratory study

Objetivo: explorar los factores que obstaculizan y/o facilitan el tratamiento de la obesidad en adultos participantes de un dispositivo de abordaje grupal. Métodos: estudio cualitativo mediante grupos focales y entrevistas individuales, realizado entre 2010 y 2011 en Buenos Aires, Argentina, con pacientes del Programa Saludable del Hospital Italiano. Resultados: los factores asociados al éxito fueron: 1) la aceptación de la obesidad como condición crónica cuyos resultados del tratamiento aparecerán en el largo plazo; 2) la búsqueda de objetivos globales de bienestar y no de descenso de peso; 3) el compromiso con el grupo y con la actividad física; 4) el cumplimiento del plan y el registro alimentario; 5) el desarrollo de habilidades para cambiar hábitos y soportar presiones del contexto. Conclusiones: es necesario optimizar intervenciones motivacionales para que los pacientes puedan redefinir sus objetivos terapéuticos y sostener cambios de su estilo de vida.

Objective: to explore the factors that impede and / or facilitate the treatment of obesity in adult participants of a device group approach. Methods: qualitative study using focus groups and individual interviews, conducted between 2010 and 2011 in Buenos Aires, Argentina, with patients from the Hospital Italiano Healthy Program. Results: factors associated with success were: 1) the acceptance of obesity as a chronic condition whose treatment results appear in the long term; 2) the search for global objectives of well-being and not of weight loss; 3) commitment to the group and physical activity; 4) compliance with the plan and dietary record; 5) development of skills to change habits and withstand pressures of context. Conclusions: it is necessary to optimize motivational interventions so that patients can be able to redefine their therapeutic goals and sustain changes in their lifestyle.

Inequidades de género, abuso de sustancias y barreras al tratamiento en mujeres en prisión / Gender inequities, substance abuse and treatment barriers in women in prison

The vast majority of women in Mexican prisons have several mental health disorders and addictions, as well as problems obtaining access to treatment for this type of problems. These women's personal background and prison conditions reflect the unresolved problems of the country, such as education and illiteracy, access to health and housing and inequity in the justice systems. The literature has shown that substance abuse affects female prisoners to a greater extent than other women, and that their disadvantaged socio-economic status makes them more likely to engage in and continue substance abuse. Other aspects that exacerbate this vulnerability are their low educational attainment, lack of job skills, and exposure to stigmatization and discrimination in addition to the physical and psychological consequences of addictive behavior. One aspect that has been internationally acknowledged is that gender inequities make women's health more vulnerable, particularly that of female prisoners, since they have greater health deficits and more treatment barriers. International literature has shown that female users of psychoactive substances in general face more barriers than men in seeking or continuing treatment. Research has also shown that the most common personal barriers in women are denial, shame and guilt. Likewise, women's anxiety and depressive disorders tend to be more prevalent and severe, which in turn prevents them from seeking help when they have substance abuse problems. The most common family-related barriers are the difficulty of attending treatment due to family, partner or childcare obligations, pregnancy or fear of losing custody of their children. The main barriers faced by women regarding treatment institutions are the insensitivity or inadequate training of the staff that work there, prejudice and negative attitudes towards women, lack of information on available treatment and extremely long waiting lists. As a result of the above, the aim of this study is to document the barriers to the treatment of addictions of female prisoners, a disadvantaged group that has rarely been studied in Mexico, in order to understand certain aspects related to this population's access to treatment and continuation of the latter. The design used for this research is an ex post facto, descriptive, non-experimental, cross-sectional field study. The sample consisted of 213 women, chosen for convenience, who met the following criteria: alcohol and drug users, ages 18 to 65, able to read and write and with no psychiatric disorders or handicaps that would prevent the interview. The women that participated in this study were drawn from two Mexico City prisons: the Centro Preventivo Femenil Oriente, which houses women that have been accused, tried and sentenced, and the Centro de Readaptación Social Femenil Tepepan, where the inmates are women who have been sentenced and also have psychiatric problems. The ethical care observed included informing the interviewees of the objectives of the study, voluntary participation, confidential handling of the information and the use of witnesses, as well as guaranteeing participants the right to abandon the study and not to answer questions they found uncomfortable. The instrument was designed as a semi-structured interview with 242 questions covering various areas including Allen's Questionnaire on Treatment Barriers. It can be self-administered by the respondents, has internal consistency, construct and content validity and was adapted by Romero (2002). Some of the respondents had to have the questionnaire read out to them because of their low educational attainment. This questionnaire consists of 41 items, 30 of which are divided into three categories: 1. characteristics of treatment services, 2. beliefs, feelings or thoughts, and 3. socio-environmental aspects. Each category also includes an open question to discover other types of barriers not included in the three categories. The results yielded the following socio-demographic profile of the interviewees: 45.5% were in the 28 to 40 year age group; and had had 6 or less years' education (41.3%) or completed junior high school (36.2%). The majority were single (48.6%) or common law (21.6%), while 50.7% had children under the age of 18. Certain other characteristics of this sample such as depression, violence and alcohol and drug use have been reported in other studies. Of the total group of women that had received treatment at some time in their lives, 52.6% (n = 112) mentioned some type of barrier to treatment for addictions. A total of 29.1% (n = 62) of these women mentioned some type of barrier to treatment for alcohol use, while 44.1 % (n = 94) cited some type of barrier to treatment for drug use. Lastly, 39.2% (n = 44) mentioned some type of barrier to treatment for both types of consumption. An analysis of the treatment sub-scale by socio-demographic variable showed greater difficulty in obtaining treatment among women ages 28 to 40 and among those with children under 18. Statistically significant differences were observed regarding the type of offense (robbery) and availability of treatment. As for the beliefs, feelings and thoughts sub-scale, statistically significant differences were found among women with children under 18 and those finding it hard to abandon consumption. The sub-scale related to situational aspects, such as rejection from friends, proved to be the main barrier to enter treatment and was statistically significant among single women. The results of this study pose challenges to the health and mental health service sector regarding the timely treatment and rehabilitation of marginalized women. Likewise, acknowledging gender inequities is crucial when it comes to designing health promotion strategies. Without this perspective, their effectiveness could be jeopardized and gender inequalities actually exacerbated.

La gran mayoría de las mujeres recluidas en las prisiones de México presentan una gran cantidad de trastornos de salud mental y adicciones, así como dificultades para acceder al tratamiento para este tipo de problemas. Los antecedentes personales y las condiciones de reclusión de estas mujeres reflejan los problemas no resueltos del país como son educación y analfabetismo, acceso a la salud, vivienda e inequidad en los sistemas de procuración de justicia. En la bibliografía se ha señalado que el abuso de sustancias afecta a las mujeres presas en mayor medida que a otras mujeres y que su situación socioeconómica desfavorable las hace más susceptibles de incidir y prevalecer en la conducta de abuso de sustancias. Otros aspectos que acentúan esta vulnerabilidad son el bajo nivel educativo, las pocas habilidades para el trabajo, la exposición a la estigmatización y la discriminación, además de las consecuencias físicas y psicológicas de la conducta adictiva. Un aspecto reconocido internacionalmente es que las inequidades de género vulneran de manera particular la salud de las mujeres, lo cual es aún más evidente en las mujeres presas, pues presentan mayores déficits en su salud y mayor número de barreras al tratamiento. Se ha documentado en la bibliografía internacional que las usuarias de sustancias psicoactivas en general se enfrentan a un mayor número de barreras que los hombres para buscar o seguir un tratamiento. Por lo anterior, el objetivo del estudio es documentar las barreras al tratamiento de adicciones de mujeres en prisión, una población desfavorecida poco estudiada en México a fin de entender algunos aspectos relacionados con el acceso a tratamientos de esta población y su permanencia en ellos. El diseño utilizado para esta investigación corresponde a un estudio de campo transversal no experimental, descriptivo, ex post facto. La muestra se conformó de 213 mujeres, seleccionadas por conveniencia, con los siguientes criterios: usuarias de alcohol y drogas, edad de 1 8 a 65 años, que supieran leer y escribir, sin trastorno psiquiátrico o discapacidad que impidiera la entrevista. Las mujeres que participaron en este estudio se seleccionaron de dos prisiones de la Ciudad de México: el Centro Preventivo Femenil Oriente, donde se encuentran mujeres indiciadas, procesadas y sentenciadas, y el Centro de Readaptación Social Femenil Tepepan, donde se encuentran mujeres sentenciadas y con problemas psiquiátricos. Los cuidados éticos observados en el estudio fueron: información de los objetivos a las entrevistadas, participación voluntaria, confidencialidad de la información, empleo de testigos, así como el derecho de abandonar el estudio y de no responder aquellas preguntas que les resultasen incómodas. El instrumento empleado tuvo un formato de entrevista semiestructurada con 242 preguntas que abarcan diversas áreas, entre ellas, el <