Work-related factors affecting the retention of medical officers in the preventive health sector in Sri Lanka.

BACKGROUND: Retention of human resources in the healthcare system, particularly doctors at district level is a great challenge faced by the decentralized health systems in poorly resourced countries. Medical Officers of Health (MOH), medical doctors who provide preventive health services, are a particularly important human resource in the preventive health sector in Sri Lanka. This study explores the relative importance of different factors affecting the retention of MOHs in the preventive health sector of Sri Lanka. METHODS: A descriptive cross-sectional study was carried out among Medical Officers of Health in the Colombo district with 18 MOH Offices with 74 medical officers. A pre-tested self-administered questionnaire was used as the study instrument. Data were analyzed using descriptive statistics, correlation and regression analyses. RESULTS: Of the 74 medical officers 64 responded with a response rate of response rate of 86.5%. Regression analysis showed that all four variables; recognition, work schedule, remuneration and responsibility are positively and significantly correlated with retention of Medical Officers of Health in the preventive health sector. The variable 'work schedule' showed the highest impact on the retention of Medical Officers of Health. CONCLUSIONS: In order to retain trained Medical Officers of Health in the Sri Lankan preventive health sector, health authorities should address the factors identified in this study. If policymakers fail to address these factors, preventive health services will face negative implications due to the shortage of key service providers.

Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.

Importance of the inverted control in measuring holistic face processing with the composite effect and part-whole effect.

Holistic coding for faces is shown in several illusions that demonstrate integration of the percept across the entire face. The illusions occur upright but, crucially, not inverted. Converting the illusions into experimental tasks that measure their strength - and thus index degree of holistic coding - is often considered straightforward yet in fact relies on a hidden assumption, namely that there is no contribution to the experimental measure from secondary cognitive factors. For the composite effect, a relevant secondary factor is size of the "spotlight" of visuospatial attention. The composite task assumes this spotlight can be easily restricted to the target half (e.g., top-half) of the compound face stimulus. Yet, if this assumption were not true then a large spotlight, in the absence of holistic perception, could produce a false composite effect, present even for inverted faces and contributing partially to the score for upright faces. We review evidence that various factors can influence spotlight size: race/culture (Asians often prefer a more global distribution of attention than Caucasians); sex (females can be more global); appearance of the join or gap between face halves; and location of the eyes, which typically attract attention. Results from five experiments then show inverted faces can sometimes produce large false composite effects, and imply that whether this happens or not depends on complex interactions between causal factors. We also report, for both identity and expression, that only top-half face targets (containing eyes) produce valid composite measures. A sixth experiment demonstrates an example of a false inverted part-whole effect, where encoding-specificity is the secondary cognitive factor. We conclude the inverted face control should be tested in all composite and part-whole studies, and an effect for upright faces should be interpreted as a pure measure of holistic processing only when the experimental design produces no effect inverted.

Asia has the global advantage: Race and visual attention.

In studies of visual attention, and related aspects of cognition, race (continent/s of ancestry) of participants is typically not reported, implying that authors consider this variable irrelevant to outcomes. However, there exist several findings of perceptual differences between East Asians and Caucasian Westerners that can be interpreted as relative differences in global versus local distribution of attention. Here, we used Navon figures (e.g., large E made up of small Vs) to provide the first direct comparison of global-local processing using a standard method from the attention literature. Relative to Caucasians, East Asians showed a strong global advantage. Further, this extended to the second generation (Asian-Australians), although weakened compared to recent immigrants. Our results argue participants' race should be reported in all studies about, or involving, visual attention to spatially distributed stimuli: to continue to ignore race risks adding noise to data and/or drawing invalid theoretical conclusions by mixing functionally distinct populations.

Blurry means good focus: myopia and visual attention.

A correlation between myopia and visuo-spatial attention is reported. More severe myopia was found to be associated with better ability to quickly narrow the focus of visual attention to a small region of space (assessed via interference from spatial proximity of to-be-ignored inverted half-faces), in a task where local focus was explicitly required. There was no myopia association with size of the default attentional window, when the need to respond to either small local or larger global regions was equally likely (in a particular Navon figure task). Results suggest that myopics might allocate attention more narrowly than individuals with normal eyesight in certain functionally important visual tasks (eg reading) but not others (eg driving).

Legislation reduces exposure to second-hand tobacco smoke in New Zealand bars by about 90%.

AIM: To measure exposure to second-hand smoke (SHS) in New Zealand bars before and after comprehensive smoke-free legislation enacted on 10 December 2004. METHODS: Cotinine is the main specific metabolite of nicotine and a well-established biomarker for SHS exposure. We measured cotinine levels in saliva of non-smoking volunteers before and after a 3 h visit to 30 randomly selected bars in 3 cities across the country. Two measures of cotinine before the smoke-free law change during winter and spring 2004, and two follow-up measurements in the same volunteers and venues during winter and spring 2005, were included. RESULTS: Before the smoke-free law change, in all bars and in all volunteers, exposure to SHS was evident with an average increase in saliva cotinine of 0.66 ng/ml (SE 0.03 ng/ml). Increases in cotinine correlated strongly with the volunteers' subjective observation of ventilation, air quality and counts of lit cigarettes. However, even venues that were judged to be "seemingly smoke free" with "good ventilation" produced discernable levels of SHS exposure. After the law change, there remained some exposure to SHS, but at much lower levels (mean saliva cotinine increase of 0.08 ng/ml, SE 0.01 ng/ml). Smoking indoors in bars was almost totally eliminated: in 2005 only one lit cigarette was observed in 30 visits. CONCLUSIONS: Comprehensive smoke-free legislation in New Zealand seems to have reduced exposure of bar patrons to SHS by about 90%. Residual exposures to SHS in bars do not result from illicit smoking indoors.

Chlamydia screening in Wellington Family Planning Association (FPA) clinics: a demonstration project.

AIMS: To demonstrate that enhanced screening for Chlamydia over and above the usual opportunistic screening in family planning (FPA) clinics is feasible, practical, and acceptable. METHODS: Over a 6-month period from November 2004 to May 2005, all under-25-year-olds attending three Wellington FPA clinics in New Zealand were offered Chlamydia urine testing. Staff interviews before and after the study were carried out to assess the impact of enhanced screening on clinic routines. Interviews were conducted with 50 clients to assess the acceptability to young persons. Additional questions were asked of 22 Chlamydia-positive clients to ascertain the acceptability of the procedures for follow up. RESULTS: From a total of 4674 participants, a valid urine test was carried out on 2533 (54%). The most common reason for exclusion was having passed urine in the last hour. Positive tests were detected in 212 (8%). A positive result was more likely in those with a history of partner change or in Maori and Pacific ethnic groups; it was least likely in those who always used condoms. For the staff, time constraints were the most important barrier to screening. The procedures were acceptable to clients. CONCLUSIONS: We demonstrated that improvements in Chlamydia screening are feasible, practical and acceptable to clients

Secondhand tobacco smoke exposure in New Zealand bars: results prior to implementation of the bar smoking ban.

AIMS: To measure secondhand smoke (SHS) levels in New Zealand bars prior to smokefree legislation enacted on 10 December 2004. METHODS: Thirty bars were randomly selected from urban, surburban, and surrounding rural areas of Auckland, Wellington, and Invercargill. Bars were visited (on a Friday or Saturday night for a 3-hour stay between 1800 and 2400 hours) in July/August/September 2004 (winter) and again in October/November 2004 (spring). Each bar was visited by a group of 4 or 5 non-smokers participating in the study. All groups of participants spent a 3-hour block of continuous time in the bar. Saliva samples (approximately 0.5-2 mL) were provided immediately prior to entering the bar as well as 5-15 minutes after leaving the bar. Each group recorded the initial impression of air quality and ventilation, the number of observed lit cigarettes over three 10-minute intervals throughout the evening, and the number of patrons at each interval. In addition, any general comments about the venue (relevant to bar attendance or air quality on the evening) was recorded. Cotinine, the main metabolite of nicotine, was measured in saliva samples using Liquid Chromatography with tandem Mass Spectrometry (LC-MS-MS). RESULTS: In all bars, and in all volunteers, exposure to SHS was evident. Saliva cotinine increased after 3 hours in the bar (mean increase=0.66 ng/mL, SE=0.03 ng/mL, p value of <0.0001). The 30 bars randomly selected provided a good spectrum of SHS exposures, with mean cotinine increasing by approximately 8-fold. Smaller population centres showed greater exposures to SHS. A north-south gradient of exposure was also seen (highest exposures were in Southland). Higher exposures were seen in the winter than in the spring. The objective measures of SHS exposure correlated strongly with the volunteers' subjective observation of ventilation, air quality, and counts of lit cigarettes. One exception was where objective salivary markers indicated that even "seemingly smokefree" venues with "good ventilation" produced discernable levels of SHS exposure. CONCLUSIONS: We have utilised an objective, non-invasive scientific approach to assess SHS smoke exposure in patrons of New Zealand bars. Our results clearly indicate exposure to SHS, with regional and seasonal variation, prior to the introduction of smokefree legislation.

A large-scale study of the relationship between blood and breath alcohol concentrations in New Zealand drinking drivers.

Blood alcohol concentrations (BAC) and corresponding breath alcohol concentrations (BrAC) were determined for 21,582 drivers apprehended by New Zealand police. BAC was measured using headspace gas chromatography, and BrAC was determined with Intoxilyzer 5000 or Seres Ethylometre infrared analysers. The delay (DEL) between breath testing and blood sampling ranged from 0.03 to 5.4 h. BAC/BrAC ratios were calculated before and after BAC values were corrected for DEL using 19 mg/dL/h as an estimate of the blood alcohol clearance rate. Calculations were performed for single and duplicate breath samples obtained using the Intoxilyzer (groups I-1 and I-2) and Seres devices (groups S-1 and S-2). Before correction for DEL, BAC/BrAC ratios for groups I-1, I-2, S-1, and S-2 were (mean+/-SD) 2320+/-260, 2180+/-242, 2330+/-276, and 2250+/-259, respectively. After BAC values were adjusted for DEL, BAC/BrAC ratios for these groups were (mean+/-SD) 2510+/-256, 2370+/-240, 2520+/-280, and 2440+/-260, respectively. Our results indicate that in New Zealand the mean BAC/BrAC ratio is 19-26% higher than the ratio of the respective legal limits (2000).

Increase in saliva cotinine after three hours' exposure to second-hand smoke in bars.

OBJECTIVE: To determine whether measurement of cotinine in saliva is a sensitive measure of exposure to second-hand smoke (SHS) among customers in bars. DESIGN: Before/after comparison of saliva cotinine and subjective assessments of SHS. SETTING: Three bars in Wellington, New Zealand, June 2003. PARTICIPANTS: Eleven non-smoking medical students spent three hours in each location. They provided saliva samples before and after the visit, counted numbers of lit cigarettes in each bar, and assessed the smokiness of the venue. Samples were tested for cotinine using liquid chromatography coupled with mass spectrometry. RESULTS: Cotinine levels post-visit were consistently higher than baseline. The mean difference was 1.03 ng/mL with a 95% confidence interval of 0.76-1.30 ng/ mL. Adjustments to post-visit levels for metabolism and clearance of cotinine made very little difference to these results. Males tended to have higher baseline levels than females, and to show smaller increases. The bar with the greatest increase in cotinine was judged to be the smokiest on the basis of averaged cigarette counts and scores for presence of smoke and odour. CONCLUSION: The cotinine in saliva, when tested with the analytic methods described here, provides a means of assessing relatively short-term exposures to SHS.

Sexually transmitted infections in New Zealand in 2003.

AIMS: To describe the current burden and trends of sexually transmitted infections (STIs) in New Zealand (NZ) since 1999, as reported by current surveillance methods. METHODS: Clinic rates were calculated by dividing the number of diagnoses by the total number of clinic visits. Laboratory rates were calculated using the NZ Census 2001 population data for the Auckland, Waikato, and Bay of Plenty regions. RESULTS: In 2003, chlamydia was the most commonly diagnosed STI in sexual health (SHCs) and family planning clinics (FPCs), followed by genital warts. Laboratory surveillance reported a chlamydia rate of 653.0 per 100,000 population and a gonorrhoea rate of 90.2 per 100,000 population. The highest rates of chlamydia and gonorrhoea were in the 15 to 19 years age group. From 2002 to 2003, both chlamydia and gonorrhoea cases have increased by 14.0% in SHCs. In FPCs, chlamydia increased by 25.9% and gonorrhoea increased by 11.4%. Since 2002, numbers of chlamydia and gonorrhoea cases have increased by 14.0% in SHCs and by 25.9% and 11.4%, respectively, in FPCs. Maori and Pacific Peoples continue to be disproportionately affected by STIs. CONCLUSIONS: Current national surveillance methods are unrepresentative of the NZ population and do not provide accurate estimates of the population burden of STIs. Expansion of laboratory surveillance (to accurately reflect all areas of NZ) is needed and is currently under active consideration.