Factors That Promote and Hinder Medication Adherence From the Perspective of Inmates in a Provincial Remand Center: A Mixed Methods Study.

Effective medication delivery to inmates within correctional facilities is essential for managing symptoms, preventing relapse, slowing disease progression, and enabling recovery. Despite its importance, medication adherence in correctional facilities is poor. This mixed methods study explores the factors that affect medication adherence from the perspective of 20 inmates at a provincial remand center in Alberta, Canada. Themes describing factors that promote or hinder medication adherence emerged: patient-related factors (addiction, social support, insight into disease, and purpose of medications), health care provider-related factors (health care provider attributes and trust in physicians), and correctional setting factors. The findings of this study inform recommendations to improve medication adherence and disease management in correctional facilities.

Ocular metastasis as initial presentation in breast cancer.

Two patients presented to their ophthalmologists with vision disturbances. On ocular examination, retinopathic lesions were observed. On subsequent examination, these lesions were diagnosed as metastases of breast cancer. Neither patient had a history of breast cancer. In patients with breast cancer and multiple metastases, ocular metastases are well described. However, the latter is uncommon as a presenting complaint.

Empirically evaluating the WHO global code of practice on the international recruitment of health personnel's impact on four high-income countries four years after adoption.

BACKGROUND: Shortages of health workers in low-income countries are exacerbated by the international migration of health workers to more affluent countries. This problem is compounded by the active recruitment of health workers by destination countries, particularly Australia, Canada, UK and USA. The World Health Organization (WHO) adopted a voluntary Code of Practice in May 2010 to mitigate tensions between health workers' right to migrate and the shortage of health workers in source countries. The first empirical impact evaluation of this Code was conducted 11-months after its adoption and demonstrated a lack of impact on health workforce recruitment policy and practice in the short-term. This second empirical impact evaluation was conducted 4-years post-adoption using the same methodology to determine whether there have been any changes in the perceived utility, applicability, and implementation of the Code in the medium-term. METHODS: Forty-four respondents representing government, civil society and the private sector from Australia, Canada, UK and USA completed an email-based survey evaluating their awareness of the Code, perceived impact, changes to policy or recruitment practices resulting from the Code, and the effectiveness of non-binding Codes generally. The same survey instrument from the original study was used to facilitate direct comparability of responses. Key lessons were identified through thematic analysis. RESULTS: The main findings between the initial impact evaluation and the current one are unchanged. Both sets of key informants reported no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers. Participants emphasized the existence of previous bilateral and regional Codes, the WHO Code's non-binding nature, and the primacy of competing domestic healthcare priorities in explaining this perceived lack of impact. CONCLUSIONS: The Code has probably still not produced the tangible improvements in health worker flows it aspired to achieve. Several actions, including a focus on developing bilateral codes, linking the Code to topical global priorities, and reframing the Code's purpose to emphasize health system sustainability, are proposed to improve the Code's uptake and impact.

Empirical impact evaluation of the WHO Global Code of Practice on the International Recruitment of Health Personnel in Australia, Canada, UK and USA.

BACKGROUND: The active recruitment of health workers from developing countries to developed countries has become a major threat to global health. In an effort to manage this migration, the 63rd World Health Assembly adopted the World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel in May 2010. While the Code has been lauded as the first globally-applicable regulatory framework for health worker recruitment, its impact has yet to be evaluated. We offer the first empirical evaluation of the Code's impact on national and sub-national actors in Australia, Canada, United Kingdom and United States of America, which are the English-speaking developed countries with the greatest number of migrant health workers. METHODS: 42 key informants from across government, civil society and private sectors were surveyed to measure their awareness of the Code, knowledge of specific changes resulting from it, overall opinion on the effectiveness of non-binding codes, and suggestions to improve this Code's implementation. RESULTS: 60% of respondents believed their colleagues were not aware of the Code, and 93% reported that no specific changes had been observed in their work as a result of the Code. 86% reported that the Code has not had any meaningful impact on policies, practices or regulations in their countries. CONCLUSIONS: This suggests a gap between awareness of the Code among stakeholders at global forums and the awareness and behaviour of national and sub-national actors. Advocacy and technical guidance for implementing the Code are needed to improve its impact on national decision-makers.

A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health.

This study was carried out with eight subjects specifically referred for aromatherapy; each received a standardised aromatherapy massage weekly for 6 weeks. The subjects' levels of anxiety and depression were measured using the Hospital Anxiety and Depression (HAD) Scale prior to the first massage and after the final massage. The subjects' levels of mood, anxiety and relaxation were recorded using a visual analogue before and after each massage and then again 6 weeks after the last massage. Comparison was made between the HAD Scale results for each client and also the visual analogue scale results for before and after massage and also first massage and 6 weeks postmassage for the sample group. Improvements were shown in six out of eight subjects' HAD Scale results. Improvements were also shown in all areas when comparing the visual analogue scale results. The study was carried out over an 8-month period. To date there have been few studies addressing the effect of aromatherapy massage on mood, anxiety and relaxation (Therapist 9 (1996) 38). It is acknowledged that there may be a number of reasons for this such as factors related to obtaining a sample group, informed consent, the interaction of current medication regimes and so forth. It is acknowledged that whilst this is a small pilot study a number of methodological issues are raised concerning research into the use of aromatherapy in this clinical field. By reporting on this work, it is hoped that this paper will generate reflection, discussion and debate so forwarding the knowledge base in this discipline.