Drug use and social circumstances: a study among different target groups in northwest Bangladesh.

The use of illicit drugs has become an increasingly serious problem among various sections of the Bangladesh population. However, there has been almost no research on the use of illicit drugs by Bangladeshi people. This paper examines drug use patterns and the social circumstances within which drug-taking behaviour took place among a sample of different target groups. The study incorporated a semi-structured qualitative interview and a structured quantitative questionnaire. Demographic and drug use information was collected from a total of 154 drug users. Approximately three-quarters of the subjects reported that they had used alcohol and ganja in the month prior to being interviewed. The findings revealed interesting differences between the groups. For example, the student group was found to use phensidyl syrup (67%) more often than those of other groups and did not differ significantly in the use of ganja. The use of heroin and sedatives was widespread, with nearly one-third of subjects (40%) reporting having injected these drugs. The majority (41%) of most recent drug use occurred in conjunction with a group of people. Drug use was associated with frustration, peer pressure, family problems and curiosity. Peer education programs are likely to be the most effective harm reduction approach among new drug users. The implications of these findings are discussed.

Hepatitis C prevalence and risk behavior of injecting drug users in Sydney: a continuing concern.

This study examines patterns of injecting drug use and hepatitis C (HCV) risk behavior among injecting drug users. A survey of injecting drug users attending needle and syringe programs (NSPs) in the Sydney metropolitan area and members of NSW Users and AIDS Association (NUAA) yielded 336 responses. Demographic, behavioral and drug-use information was collected from injecting drug users aged from 14 to 64 years. The majority of respondents (66%) were HCV positive, 28% had tested negative and 5% did not know their status. Prevalence was higher among men than among women (54% vs 44%). Two thirds of respondents (72%) reported frequent heroin injection. Multivariate analysis identified the following significant risk factors for hepatitis C: being more than 30 years of age, an injecting history of five years or more, and having shared drug injecting equipment with a HCV positive user. The most significant factor associated with needle sharing was having unprotected sex with sexual partners and having a positive hepatitis C test result. Early identification of these factors should be a component of HCV prevention programs. Our data indicate that the promotion of safer injecting continues to be an important public health issue with regard to reducing HCV infections.

Scholarly activities recorded in the portfolios of teacher-clinician faculty.

PURPOSE: To explore what contributions to scholarship teacher-clinician faculty list in the portfolios that they use as evidence for promotion. METHOD: In 1998, the authors randomly selected 15 Harvard Medical School teacher-clinicians (five from each rank of assistant, associate, and full professor) from among 120 such faculty members who had been successfully promoted between 1990 and 1997. Using a descriptive research study design, the authors counted and categorized the contributions to scholarship, teaching, and committee service that the faculty listed in their portfolios. They did not assess the quality or weighting of the contributions. RESULTS: According to the portfolios, the faculty members had contributed to both teaching and scholarships at local, regional, and national levels. They listed not only peer-reviewed original journal articles, but also works that integrated and synthesized knowledge: specifically, chapters, textbooks, editorials, syllabi, newsletters, computer resources, and videotapes. Faculty generally had published in multiple areas of scholarship, which fell in two domains: the faculty member's subspecialty and medical education. The number of publications increased at each promotion level. The faculty also participated in broad-based teaching and education at the student, resident, fellow, and continuing medical education levels. Leadership contributions in education had occurred not only locally and regionally but also at a national level. Finally, faculty participated actively in service to the medical school, hospital, and national organizations, with leadership roles at the associate and full professor levels. CONCLUSION: The academic culture at Harvard Medical School has shifted from promotion based solely on original scholarship to promotion based on a broad array of educational contributions. The faculty, as they seek promotion, create portfolios that list written scholarship, teaching, and service at the local, regional, and national levels and at all ranks of promotion.

Intern learning and education in a short stay unit. A qualitative study.

OBJECTIVE: To study interns' perceptions of their learning during their rotation through a short stay unit (SSU). DESIGN: Case-based, qualitative research study. SETTING: A tertiary care pediatric hospital (The Children's Hospital, Boston, Mass). PARTICIPANTS: Ten interns who had worked in the SSU in the 3 months prior to June 1, 1995, and on a general medical team in the previous 12 months. INTERVENTION: None. MAIN OUTCOME MEASURES: In July 1995, the interns participated in focused, open-ended interviews lasting about 40 to 60 minutes to document their perceptions of their learning during their SSU rotation. The interviews were recorded on audiotape and transcribed prior to analysis. Data were analyzed to discern and categorize themes from the interns' responses. RESULTS: All interns responded favorably to their educational and learning experiences during their rotation through the SSU. Two major themes emerged: (1) the interns' learning, which was affected by the role of the attending physician, the organization and structure of the SSU, and the teaching strategies in the SSU; and (2) the interns' collaborative work with the nursing staff in the SSU, which affected patient care but did not facilitate the interns' learning. CONCLUSION: Clustering in the SSU of patients whose symptoms suggested straightforward diagnoses enhanced interns' educational experiences.

Impact of a short stay unit on asthma patients admitted to a tertiary pediatric hospital.

A short stay unit (SSU) was opened at the Children's Hospital, Boston, with the aim of better fulfilling the needs of pediatric patients with straightforward diagnoses. Using historical and simultaneous comparison groups and controlling for disease severity, the opening of the SSU led to a decrease of between 16.5 and 28.4 percent in the mean length of stay for asthma patients without any increase in the rate of hospital readmission.

A promotion ladder for teachers at Harvard Medical School: experience and challenges.

The authors describe the development, implementation, and institutionalization at Harvard Medical School of a promotion ladder that recognizes the teaching and scholarly contributions of full-time clinical faculty. They also discuss the challenges that arose during this process, for example, how to make the new track creditable and attractive to both the appointed faculty and the faculty at large. The criteria developed for promotion focus on a candidate's skills and accomplishments in teaching, scholarship, clinical work, and departmental service. The authors present the elements of these criteria for the three professional levels of the ladder and outline the appointment process, including the steps for consideration of a given promotion. The development of this teacher-clinician ladder has had a positive influence on faculty who are committed to teaching by allowing recognition of their contributions in a track held to be the equal of the other full-time tracks in a medical faculty traditionally committed to research and patient care. Data are given for the 70 faculty who were promoted over the five years from 1989 to 1994. The true success of this promotion ladder will be measured only over time through its impact on the educational enterprise within the medical school and its hospitals, and its capacity to both successfully advance the careers of qualified medical educators and further the development of the field of medical education.

The pedagogic characteristics of a clinical conference for senior residents and faculty.

OBJECTIVE: To determine the pedagogic characteristics of a clinical conference for senior pediatric residents and selected faculty. PARTICIPANTS AND SETTING: Nineteen senior pediatric residents and 14 selected faculty members participated in a daily clinical conference at Children's Hospital, Boston, Mass. DESIGN: Qualitative research design using videotapes of nine consecutive hour-long sessions to generate pedagogic topics to be investigated using a questionnaire administered to participating residents and faculty. Narrative responses were analyzed to find pedagogic themes. RESULTS: Analysis of videotapes generated the following three topics: What facilitated learning? What was learned? What makes the process of teaching and learning effective? In the questionnaire residents indicated that learning was facilitated by resident-faculty interactions (19/19), faculty participation (19/19), and information resources (12/19). Content learned included information (16/19), approach to diagnosis (11/19), management strategies (14/19), and different perspective (14/19). An effective process of teaching and learning was attributed to case-based resident initiated discussion (19/19), facilitation by the chief resident (16/19), and non-competitive discussions in which expert faculty played a nondominant role (19/19). Faculty identified identical factors relating to all three themes. The mean rating of the conference was 4.5/5 (SD, +/- 0.50) and 4.7/5 (SD, +/- 0.45) by residents and faculty, respectively (Likert scale, 1 to 5). CONCLUSIONS: The pedagogic effectiveness of this conference was attributed to a resident-centered, case-based learning format and a discussion process characterized by noncompetitive interactions among faculty and residents, strong group facilitation by the chief resident, and participation of faculty experts in a nondominant role.

Detecting a history of childhood sexual experiences among women substance abusers.

This article examines a means of detecting a history of childhood sexual experience (CSE) to improve substance abuse treatment outcomes. The symptom profile of women with a history of CSE is discussed in relation to the difficulties it presents in detection of a history of CSE, especially in women who also have a past or current history of substance abuse. A symptom checklist is described, and its validity and reliability are reported as satisfactory. The use of the checklist in client assessment and treatment planning is discussed.

Poison centers, poison prevention, and the pediatrician.

The first poison centers were established in the United States in the early 1950s, stimulated by an American Academy of Pediatrics' survey of office-based pediatric practices which ascertained that its members had no place to turn for ingredient information on medications and household products. With the help of the Academy, pediatrician Dr. Edward Press, the Illinois Department of Health, and several community hospitals, the first poison center emerged. Over the subsequent 40 years, remarkable progress has occurred in the fields of clinical toxicology, poison control, and poison prevention. Yet despite these accomplishments, challenging clouds are appearing on the horizon which threaten these gains. This commentary, by the authors who have viewed and participated in a large part of the history of this progress, will focus on these major accomplishments with an emphasis on (a) poison prevention utilizing the pre-event (primary prevention), (b) the event (secondary prevention), and (c) the postevent (tertiary prevention) model.

Common etiologies and new approaches to management of poisoning in pediatric practice.

Accidental exposure to drugs and household products in young children and self-poisoning by adolescents are common clinical problems of important concern to the general pediatrician. This article reviews new developments in the field of pediatric toxicology including 1) epidemiologic data collected from poison centers and hospital admissions that illustrate the changing spectrum of pediatric poisonings; 2) progress in identifying clinical features or laboratory tests predictive of outcome in specific poisoning; 3) advances in and limitations involving decontamination methods and antidote therapy in different toxic ingestions; and 4) recent investigations toward prevention of pediatric poisoning with an emphasis on barriers to compliance.

Epidemiology of drug overdose in children.

Childhood drug overdoses are a continuing important public health problem. Although drug overdoses are no longer the important cause of childhood mortality they once were, such poisonings account for highly frequent and unacceptable instances of childhood injuries. These poisonings exact a high cost from society. They result in many emergency department visits and hospitalisations, with the attendant indirect costs of suffering, parental anxiety, and lost days of work or school. Childhood drug overdoses are preventable; those children and families at highest risk show identifiable characteristics, and the medications which pose the greatest hazard to children have already been identified. These injuries divert expensive and scarce medical resources from society's other health problems. Thus, clinicians must do more to prevent childhood drug overdoses whenever possible.

Factors influencing the interests, career paths, and research activities of recent graduates from an academic, pediatric residency program.

OBJECTIVE: This study was undertaken to characterize the professional activity of a cohort of young pediatricians who completed an academically oriented residency program, to analyze factors which influenced their interests, career choices, and research activity, and to understand what steps might be effective in attracting more young physicians into academic and research career paths. METHOD: We studied by questionnaire a cohort of 150 pediatric residents from the Children's Hospital in Boston who completed residency training between 1976 and 1981. RESULTS: Questionnaires were returned by 117 (78%) of 150 individuals. Of these, 73% were in academic medicine and 37% were in clinical practice. Individuals were engaged in various activities with a mean of 47% effort in clinical care, 25% effort in administration and teaching, and 28% effort in basic or clinical research. The majority of respondents (71 [61%] of 117) reported at least 10% effort in all three activities. Only 9 (8%) of 117 reported no clinical activity, 8 (7%) of 117 reported no teaching or administrative activity, and 35 (30%) of 117 reported no research activity. Few individuals dedicated more than 50% of their time to research, and none reported a 100% commitment to research. Clinical sources provided 71% of all salary support, research grants 17%, government salaries 7%, and other sources 5%. For most respondents, interest in clinical practice predated medical school, whereas interest in research increased during preclinical training, particularly among those who engaged in research activities. Respondents identified previous research experience as the principle factor enhancing their decision and ability to do research. Factors that adversely influenced their decision or ability to do research included salary expectancy, funding, the perceived competitiveness of academic life, administrative duties, and family responsibilities. CONCLUSIONS: Efforts to encourage more young physicians to enter academic careers should focus on providing research experience during preclinical training and providing long-term support for research which enables physician scientists to maintain their interest and involvement in clinical medicine.