Storage and disposal of expired medicines in home pharmacies: emerging public health problems / Armazenamento e descarte dos medicamentos vencidos em farmácias caseiras: problemas emergentes para a saúde pública

ABSTRACT Objective To characterize storage and disposal practices associated with expired medicines in home pharmacies of Primary Care users. Methods Cross-sectional study based on data collected from 423 users of 15 Primary Care units located in a Brazilian city, between August 2014 and July 2016. Data were collected via face-to-face interviews. Categorical (demographic and socioeconomic characteristics) and continuous variables were expressed as proportions and means and standard deviations, respectively . Storage behaviors and disposal practices associated with unused and expired medicines were described as frequencies. Results Most (83%) interviewees were female and approximately 70% had completed high school. The kitchen was the most common medicine storage place (58.6%). Approximately 75% of participants reported inappropriate medicine disposal practices. Conclusion This study revealed high rates of inappropriate medicine disposal practices with direct impacts on pharmacological treatment and the environment. Continuing education of healthcare professionals and the general public is required to raise awareness about proper medicine use and disposal.

RESUMO Objetivo Caracterizar o armazenamento e o descarte de medicamentos vencidos contidos em farmácias caseiras de usuários da Atenção Primária à Saúde. Métodos Estudo transversal, realizado com 423 usuários de 15 unidades de saúde da Atenção Primária em um município brasileiro. Os dados foram coletados de agosto de 2014 a julho de 2016, por meio de entrevistas face a face. As características demográficas e socioeconômicas foram descritas por meio de proporções para as variáveis categóricas. As formas de armazenamento e o descarte de medicamentos vencidos ou não vencidos foram descritos em forma de frequência. Resultados Dentre os entrevistados, 83% eram do sexo feminino e aproximadamente 70% possuíam Ensino Médio completo. A cozinha foi o local mais citado para armazenamento de medicamentos (58,6%). Cerca de 75% dos participantes relataram descartar os medicamentos de forma incorreta. Conclusão O estudo evidenciou que grande proporção dos entrevistados possui hábitos incorretos de descarte, que, por sua vez, impactam diretamente no tratamento medicamentoso e na natureza. Assim, é necessária a educação continuada dos profissionais de saúde e da população, a fim de conscientizar a população sobre a correta utilização e o descarte de medicamentos.

Perdas físicas de imunobiológicos no estado do Ceará, 2014-2016 / Pérdidas físicas de inmunobiológicos en el estado de Ceará, Brasil, 2014-2016 / Physical wastage of immunobiological products in the state of Ceará, Brazil, 2014-2016

Objetivo: descrever as perdas físicas, por descarte, dos imunobiológicos fornecidos pelo Programa Nacional de Imunizações (PNI) ao estado do Ceará no período 2014-2016, e os custos das doses perdidas. Métodos: estudo descritivo, com dados dos formulários de avaliação de imunobiológicos sob suspeita e dos pareceres favoráveis de descarte. Resultados: foram incluídos 317 formulários, dos quais 72,0% obtiveram parecer de descarte; foram identificadas 160.767 doses perdidas, totalizando um custo de R$ 1.834.604,75; as perdas representaram 0,45%, 0,93% e 0,53% do custo total das vacinas nos anos de 2014, 2015 e 2016, respectivamente; o principal motivo das perdas físicas identificadas foi a falta de energia elétrica (54,9%). Conclusão: identificou-se grande número de doses descartadas por perdas físicas, com elevado custo absoluto; faz-se necessário um controle mais rigoroso, pois falhas na dinâmica de conservação podem interferir na oferta dos imunobiológicos.

Objetivo: describir las pérdidas físicas por eliminación de inmunobiológicos proporcionados por el Programa Nacional de Inmunización (PNI) al estado de Ceará, en el periodo 2014-2016, y los costos de las dosis omitidas. Métodos: estudio descriptivo, con datos de formula-rios de evaluación de los inmunobiológicos sospechosos y de las opiniones favorables de descarte. Resultados: se incluyeron un total de 317 formularios, de los cuales el 72,0% obtuvo una opinión de descarte, y se identificaron 160.767 dosis omitidas, con un costo total de R$ 1.834.604,75; las pérdidas representaron el 0,45%, el 0,93% y el 0,53% del costo total de las vacunas en 2014, 2015 y 2016, respectivamente; la razón principal de las pérdidas físicas identificadas fue la falta de electricidad (54,9%). Conclusión: iden-tificamos un gran número de dosis descartadas por pérdidas físicas, con un alto costo absoluto; es necesario un control más estricto, ya que las fallas en la dinámica de conser-vación pueden interferir con el suministro de inmunobiológicos.

Objective: to describe discarded wasted immunobiological products provided by the National Im-munization Program (PNI) to the State of Ceará between 2014 and 2016, and the costs of discarded doses. Methods: this was a descriptive study using data from suspect im-munobiological product evaluation forms and data from disposal approval forms. Results: a total of 317 forms were included, 72.0% of which had a disposal approval form, and 160,767 discarded doses were identified, at a total cost of BRL 1,834,604.75; wastage accounted for 0.45%, 0.93% and 0.53% of the total cost of vaccines in 2014, 2015 and 2016, respectively; the main reason for the wastage identified was electric power shortage (54.9%). Conclusion: we identified a large number of discarded wasted doses, with high absolute cost; tighter control is necessary, as failures in conservation dynamics may interfere with the supply of immunobiologicals.

Direct Cost Comparison of Open Carpal Tunnel Release in Different Venues.

Background: The increased efficiency and cost savings have led many surgeons to move their practice away from the traditional operating room (OR) or outpatient surgery center (OSC) and into the clinic setting. With the cost of health care continuing to rise, the venue with the lowest cost should be utilized. We performed a direct cost analysis of a single surgeon performing an open carpal tunnel release in the OR, OSC, and clinic. Methods: Four treatment groups were prospectively studied: the hospital OR with monitored anesthesia care (OR-MAC), OSC with MAC (OSC-MAC), OSC with local anesthesia (OSC-local), and clinic with local anesthesia (clinic). To determine direct costs, a detailed inventory was recorded including the weight and disposal of medical waste. Indirect costs were not included. Results: Five cases in each treatment group were prospectively recorded. Average direct costs were OR ($213.75), OSC-MAC ($102.79), OSC-local ($55.66), and clinic ($31.71). The average weight of surgical waste, in descending order, was the OR (4.78 kg), OSC-MAC (2.78 kg), OSC-local (2.6 kg), and the clinic (0.65 kg). Using analysis of variance, the clinic's direct costs and surgical waste were significantly less than any other setting (P < .005). Conclusions: The direct costs of an open carpal tunnel release were nearly 2 times more expensive in the OSC compared with the clinic and almost 7 times more expensive in the OR. Open carpal tunnel release is more cost-effective and generates less medical waste when performed in the clinic versus all other surgical venues.

Lean and Green Hand Surgery.

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system.

Hospital waste: can we reduce the environmental impact of a large university hospital?

Introduction: As technology advances, society must reflect on the destination of materials which are no longer needed. Hospital waste requires special attention due to the associated risk of disease transmission and biological accidents. Also, it tends to increase proportionally to the economic development and is associated with increased use of disposable material. The purpose of this study is to analyze the management of hospital waste at the Hospital de Clínicas de Porto Alegre (HCPA) and to evaluate the effectiveness and feasibility of the measures adopted by the institution to mitigate the impact of its waste on the environment. Methods: Observational study with field research. Hospital waste management is divided into generation, disposal, storage and final destination. Results: Between 2010 and 2015, the HCPA produced 21.4 tons of biological and sharps waste, 23,000 liters of chemical waste and 113,9 tons of solid waste per month. The main improvements include the implementation of a inspection of the hospital's waste bins every 2 months, a reduction from 29.42% to 2.79% in the rate of inappropriate disposal of hazardous waste, a 313% increase in investments in staff training, the expansion and adaptation of external areas for temporary storage of hospital waste and the collection of more than 1 ton of waste generated by the local community (sharps, X-ray films, kitchen oil, batteries), as well as the establishment of contracts which will guarantee the appropriate treatment of all types of health care waste. Conclusions: These results demonstrate that mitigating the impact of hospital waste on the environment is possible and should encourage the adoption of similar measures at other institutions (AU)

Greening of orthopedic surgery.

Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care.

Factors influencing oncology nurses' use of hazardous drug safe-handling precautions.

PURPOSE/OBJECTIVES: To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions. DESIGN: Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers. SETTING: Mailed invitation to oncology centers across the United States. SAMPLE: 165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy. METHODS: Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis. MAIN RESEARCH VARIABLES: Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate. FINDINGS: Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use. CONCLUSIONS: Circumstances in the workplace interfere with nurses' use of HD precautions. IMPLICATIONS FOR NURSING: Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.

Hazardous medical waste generation rates of different categories of health-care facilities.

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively.

[Solid healthcare waste: a snapshot of the commitment of the nursing staff]. / Resíduos sólidos de serviços de saúde: uma fotografia do comprometimento da equipe de enfermagem.

This work investigated knowledges and attitudes of nurses from the staff of Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil, on solid healthcare waste (SHCW). This is an exploratory descriptive research with a qualitative approach. The data were obtained from semi-structured interviews applied to 24 nurses from the staff. Content analysis was used to categorize the data. Four categories were identified: Meaning of the phrase solid healthcare waste; Separation of solid healthcare waste; Realization of the course/knowledge; and Professionals who do not separate. Results confirmed the importance to treat this issue more seriously, emphasizing the need of access to appropriate guidance.

Resíduos sólidos de serviços de saúde: uma fotografia do comprometimento da equipe de enfermagem / Residuos sólidos de servicios de salud: una fotografía del comprometimiento del equipo de enfermería / Solid waste of health services: a photograph of the commitment of nursing staff

O presente trabalho investigou os conhecimentos e atitudes dos profissionais da equipe de enfermagem do Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, em relação ao descarte dos resíduos sólidos dos serviços de saúde (RSSS). Realizou-se uma pesquisa de natureza exploratória descritiva, através de uma abordagem qualitativa. Os dados foram obtidos a partir de entrevistas semi-estruturadas aplicadas a 24 profissionais da equipe de enfermagem. Os dados foram categorizados através da análise de conteúdo, tendo sido identificadas quatro categorias: Significado da expressão resíduos sólidos de serviços de saúde; Separação dos resíduos sólidos dos serviços de saúde; Realização do curso/conhecimento e Profissionais que não realizam a separação. Os resultados ratificaram a importância de tratar com maior seriedade a questão apresentada, reforçando a necessidade do acesso às orientações adequadas.

El presente trabajo pretiende investigar los conocimientos y actitudes de los profesionales del equipo de enfermería del Hospital de Clínicas de Porto (HCPA), Rio Grande do Sul, Brasil, en relación al descarte de los residuos sólidos de los servicios de salud (RSSS). Fue realizada una pesquisa de naturaleza exploratoria descriptiva, a través de un abordaje cualitativo. Los datos fueron obtenidos a partir de encuestas semi estructuradas aplicadas a 24 profesionales del equipo de enfermaje. Se buscó la categorización de los datos a través del análisis de contenido. Fueron identificadas cuatro categorías: Significado de la palabra residuos sólidos de servicios de salud; Separación de los residuos sólidos de los servicios de salud; Realización del curso/conocimiento y Profesionales que no realizan la separación. Con los resultados, se ratificó la importancia de tratar con mayor seriedad la cuestión presentada, reforzando la necesidad del acceso a las orientaciones adecuadas.

This work investigated the knowledges and attitudes of the professionals of the nursing group of the Hospital de Clínicas de Porto Alegre (HCPA), Rio Grande do Sul, Brazil, on solid residues in health services (SRHS). Was realized a search for exploratory descriptive nature, through a qualitative approach. The data were obtained from semi-structured interviews applied to 24 professionals of the nursing group. The categorization of the data came through content analysis. Four categories were identified: Meaning of the word solid residues in health services; Separation of solid residues of the health services; Realization of the course/knowledge and professionals who not do the separation. With the results, was confirmed the importance to treat more seriously this question presented, emphasizing the need for access to appropriate guidance.

Modelo para avaliação de planos de gerenciamento de resíduos de serviços de saúde (PGRSS) para Secretarias Municipais da Saúde e/ou do Meio Ambiente / Model for evaluating plans for health service waste management (MPHSW) for use by local health and environmental protection authorities

O gerenciamento inadequado de resíduos de serviços de saúde produzidos diariamente, aliado ao aumento significativo de sua produção, vem agravando os riscos à saúde e à população. Cada responsável por estabelecimento gerador destes resíduos deve implementar o Plano de Gerenciamento de Resíduos de Serviços de Saúde - PGRSS. Cabe às Secretarias da Saúde e do Meio Ambiente municipais a principal responsabilidade por orientar e monitorar a construção e a sustentação dos PGRSS. A proposta deste trabalho é a apresentação de um modelo que pode ser utilizado por Secretarias da Saúde e/ou do Meio Ambiente municipais para análise de PGRSS dos estabelecimentos de saúde dos municípios. A análise (incluindo gráficos com os percentuais de questões enquadradas em cada critério pré-estabelecido) é devolvida para que cada estabelecimento de saúde municipal possa proceder a ajustes. Esta análise favorece um retorno para os estabelecimentos de saúde municipais com orientações precisas para melhora da qualidade do plano. Permite ainda que a Secretaria da Saúde ou do Meio Ambiente obtenha parâmetros para o direcionamento das ações de capacitação para a elaboração do plano. O modelo permite um retorno rápido, facilita a avaliação dos PGRSS, é de fácil aplicação e auxilia seu constante aprimoramento.

The inadequate management of the waste the health services are producing day by day and the considerable increase in quantity of this waste are increasingly posing hazards to the health of the population. Thus, the managers in charge of establishments that originate this waste should adopt a Management Plan for Health Service Waste - MPHSW. The main responsibility of guiding and monitoring the construction and implementation of the waste management plan falls on the local health and environmental protection authorities. This paper presents a model for a questionnaire to be used by the local authorities for analyzing the MPHSW of the health services in their respective jurisdictions. The result of this analysis (including graphs and tables with the percentages of questions fitting into each criterion set in advance) will be returned to the health institution with precise instructions for improving the quality of the plan. The necessary software is easily available and allows adapting the questionnaire to the conditions and needs of each municipality. The model provides parameters enabling the involved authorities to direct their capacity-building actions, allows quick evaluation of the MPHSWs and is easily updated.

Accidents with biological material and immunization against hepatitis B among students from the health area / Accidente con material biológico y la vacunación contra la hepatitis B en estudiantes del área de la salud / Acidente com material biológico e vacinação contra hepatite B entre graduandos da área da saúde

Undergraduate students from the health area often handle piercing-cutting instruments in their academic activities, which exposes them to the risk of contracting infections. This study aimed to analyze accidents with biological material among these students. Out of 170 accidents registered, 83 (48.8 percent) occurred with Dentistry students, 69 (40.6 percent) with Medical students, 11 (6.5 percent) with Nursing students and in 06 (3.5 percent) of the cases there was no such information in the files. Most accidents, 106 (62.4 percent), occurred with students from private schools and 55 (32.3 percent) with those from public schools. Percutaneous accidents occurred in 133 (78.2 percent) exposures and there was immediate search for specialized health care in only 38 (21.3 percent) accidents. In 127 (74.7 percent) accidents, the immunization schedule against hepatitis B was complete. Therefore, schools need to offer courses and specific class subjects regarding biosafety measures, including aspects related to immunization, especially the vaccine against hepatitis B.

La manipulación de instrumentos punzo cortantes por estudiantes del área de la salud es frecuente en la actividad académica, lo que los expone al riesgo de adquirir infecciones. Este estudio tuvo como objetivo analizar los accidentes con material biológico ocurridos en alumnos del área de la salud. De los 170 accidentes registrados, 83 (48,8 por ciento) ocurrieron con alumnos del curso de Odontología, 69 (40,6 por ciento) de Medicina, 11 (6,5 por ciento) de Enfermería y en 06 (3,5 por ciento) no había información en la ficha de atención. La mayoría, 106 (62,4 por ciento), ocurrió con alumnos de escuelas privadas y 55 (32,3 por ciento) de públicas. Los accidentes percutáneos ocurrieron en 133 (78,2 por ciento) exposiciones y en 38 (21,3 por ciento) accidentes la búsqueda por atención especializada fue inmediata. En 127 (74,7 por ciento) accidentes el esquema de vacunas contra hepatitis B estaba completo. Así es imprescindible que las escuelas ofrezcan cursos y/o disciplinas específicas sobre medidas de bioseguridad incluyendo aspectos relacionados a campañas de vacunación y en especial la vacuna contra hepatitis B.

O manuseio de instrumentos perfurocortantes por estudantes da área da saúde é freqüente na atividade acadêmica, o que os expõe ao risco de adquirir infecção. Este estudo teve como objetivo analisar os acidentes com material biológico, ocorridos com alunos de graduação da área da saúde. Dos 170 acidentes registrados, 83 (48,8 por cento) ocorreram com alunos do curso de odontologia, 69 (40,6 por cento) de medicina, 11 (6,5 por cento) de enfermagem e em 6 (3,5 por cento) não havia a informação na ficha de atendimento. A maioria (106-62,4 por cento) ocorreu com alunos de escolas privadas e 55(32,3 por cento) de escolas públicas. Os acidentes percutâneos ocorreram em 133 (78,2 por cento) exposições e em apenas 38 (21,3 por cento) acidentes a procura pelo atendimento especializado foi imediata. Em 127 (74,7 por cento) acidentes o esquema vacinal contra hepatite B estava completo. Assim, torna-se imprescindível que as escolas ofereçam cursos e/ou disciplinas específicas sobre medidas de biossegurança, incluindo aspectos relacionados à vacinação e em especial à vacina contra hepatite B.

[Medical waste management in healthcare centres in the occupied Palestinian territory].

Medical waste management in primary and secondary healthcare centres in the occupied Palestinian territory was assessed. The overall monthly quantity of solid healthcare waste was estimated to be 512.6 tons. Only 10.8% of the centres completely segregated the different kinds of healthcare waste and only 15.7% treated their medical waste. In the centres that treated waste, open burning was the main method of treatment. The results indicate that Palestinians are exposed to health and environmental risks because of improper disposal of medical waste and steps are needed to improve the situation through the establishment and enforcement of laws, provision of the necessary infrastructure for proper waste management and training of healthcare workers and cleaners.

[Occupational risk for blood exposure and staff behaviour: a cross-sectional study in 3 Moroccan healthcare centers]. / Comportement et conditions de travail exposant au sang: analyse des pratiques dans trois établissements de soins du Maroc.

OBJECTIVE: As in other countries, Moroccan health-care workers are exposed to occupational blood exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and hygiene conditions determining the OBE risk for health-care workers. WORKERS AND METHODS: In March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals and health centers, as well as in a Rabat public medical analysis laboratory. RESULTS: The participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of 41.4 years (+/-7 years). Health-care workers answered that: occupational hygiene and safety were inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of OBE was 1.5 (+/-4.3) per capita. If we consider the whole career of health-care workers, the incidence reached about 14.3+/-28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule. CONCLUSION: The study shows that there is a need to improve occupational hygiene and safety conditions for Moroccan health-care workers in order to reduce OBE hazards.

Medication knowledge and self-management by people with type 2 diabetes.

OBJECTIVE: To explore medication knowledge and self-management practices of people with type 2 diabetes. DESIGN: A one-shot cross sectional study using in-depth interviews and participant observation. SETTING: Diabetes outpatient education centre of a university teaching hospital. SUBJECTS: People with type 2 diabetes, n=30, 17 males and 13 females, age range 33-84, from a range of ethnic groups. OUTCOME MEASURES: Ability to state name, main actions and when to take medicines. Performance of specific medication-related tasks; opening bottles and packs, breaking tablets in half, administering insulin, and testing blood glucose. RESULTS: Average medication use > or = 10years. Respondents were taking 86 different medicines, mean 7 +/- 2.97 SD. Dose frequency included two, three and four times per day. All respondents had > or = 2 diabetic complications +/- other comorbidities. The majority (93%) were informed about how and when to take their medicines, but only 37% were given information about side effects and 17% were given all possible seven items of information. Younger respondents received more information than older respondents. Older respondents had difficulty opening bottles and breaking tablets in half. Twenty percent regularly forgot to take their medicines. Increasing medication costs was one reason for stopping medicines or reducing the dose or dose interval. The majority tested their blood glucose but did not control test their meters and 33% placed used sharps directly into the rubbish. CONCLUSION: Polypharmacy was common. Medication knowledge and self-management were inadequate and could lead to adverse events.

Correlates of unsafe syringe acquisition and disposal among injection drug users in Baltimore, Maryland.

Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among injection drug users (IDUs), safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. We examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal.

Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.