Overtreatment of asymptomatic bacteriuria: a qualitative study

BACKGROUND Overtreatment of asymptomatic bacteriuria (ASB) is widespread and may result in antibiotic side-effects, excess costs to the healthcare system, and may potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). AIM To determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. METHODS A qualitative study was conducted at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analysed in an inductive thematic content approach using dedicated software (MAXQDA(®)). FINDINGS In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (i) treating laboratory findings without taking the clinical picture into account (N = 17); (ii) psychological factors such as anxiety, overcautiousness, or anticipated positive impact on patient outcomes (N = 13); (iii) external pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (N = 9); (iv) difficulty with interpreting clinical signs and symptoms (N = 8). CONCLUSION In this qualitative study we identified both physician-centred factors (e.g. overcautiousness) and external pressors (e.g. excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.

Smoking behaviour among Indigenous secondary school students in North Queensland

This study investigated smoking behaviour among Indigenous youth. A sample of schools (n = 12) in north Queensland with large proportions of Indigenous students was selected. Details about the prevalence of smoking behaviour in both Indigenous and non-Indigenous students ( n = 883) were gathered. Data were also collected on the cultural, social, and psychological factors associated with cigarette smoking for Indigenous and non-Indigenous students. This survey indicated smoking rates for Indigenous and non-Indigenous students were 24% and 30%, respectively. The study found similarities between both groups regarding where they obtained their cigarettes ( friends) and their reasons for not smoking ( their parents and health). Results of this survey challenge the belief that Indigenous youth are significantly different in their smoking patterns and behaviours compared to non-Indigenous secondary school students in rural regions. It indicated the potential importance of school communities in promoting non-smoking behaviours among Indigenous students even in the face of strong normative pressures from elsewhere in the community. This survey can be used to monitor smoking prevalence among Indigenous secondary students in north Queensland, help guide the development of culturally appropriate school curriculum resources and contribute to the overall evaluation of smoking prevention and smoking cessation programs which are developed for Indigenous secondary school students.

Effectiveness of hospital-based smoking cessation

Study objectives: Smoking cessation for current smokers is a health-care imperative. It is not clear which approaches to smoking cessation are the most effective in the hospital setting and which factors predict long-term abstinence. We hypothesized that a hospital-based smoking cessation program involving behavioral modification and support would provide an effective intervention for smoking cessation. Design: Prospective cohort study. Setting: Smoking cessation clinics in a tertiary referral, cardiothoracic hospital. Patients or participants: Two hundred forty-three smokers and 187 never-smoker control subjects. Interventions: Smokers underwent specific sessions of individual counseling on behavioral modification, including written information, advice about quit aids, and support during the quit attempt. Abstinence was confirmed by exhaled carbon monoxide measurements. Measurements and results: Compared to never-smoker control subjects, smokers were more likely to have grown up with a smoking father or siblings, and to currently live or socialize with other smokers. Two hundred sixteen smokers attended at least two sessions of the smoking cessation program. Of these, 25% were unavailable for follow-up at 12 months and were assumed to be smoking. The point prevalence abstinence rate at 12 months was 32%. Independent factors associated with abstinence at 12 months were self-belief in quitting ability, having a heart condition, growing up without siblings who smoked, and increasing number of pack-years. Conclusions: This prospective study has demonstrated that this hospital-based smoking cessation program was as effective as programs in other settings. Social and psychological factors were associated with a greater chance of abstinence.

Burning mouth syndrome: an update on recent findings

Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of mucosal abnormality Various local, systemic and psychological factors are associated with BMS, but its aetiology is not fully understood. Recently, significant inroads have been made, producing a better understanding of this complex condition. The aim of the current paper is to explore the condition of BMS in an educational context with the specific outcome of increasing awareness of the condition.

Deceleration affects anticipatory and reactive components of triggered postural responses

Understanding the physiological and psychological factors that contribute to healthy and pathological balance control in man has been made difficult by the confounding effects of the perturbations used to test balance reactions. The present study examined how postural responses were influenced by the acceleration-deceleration interval of an unexpected horizontal translation. Twelve adult males maintained balance during unexpected forward and backward surface translations with two different acceleration-deceleration intervals and presentation orders (serial or random). SHORT perturbations consisted of an initial acceleration (peak acceleration 1.3 m s(-2); duration 300 ms) followed 100 ms later by a deceleration. LONG perturbations had the same acceleration as SHORT perturbations, followed by a 2-s interval of constant velocity before deceleration. Surface and intra-muscular electromyography (EMG) from the leg, trunk, and shoulder muscles were recorded along with motion and force plate data. LONG perturbations induced larger trunk displacements compared to SHORT perturbations when presented randomly and larger EMG responses in proximal and distal muscles during later (500-800 ms) response intervals. During SHORT perturbations, activity in some antagonist muscles was found to be associated with deceleration and not the initial acceleration of the support surface. When predictable, SHORT perturbations facilitated the use of anticipatory mechanisms to attenuate early (100-400 ms) EMG response amplitudes, ankle torque change and trunk displacement. In contrast, LONG perturbations, without an early deceleration effect, did not facilitate anticipatory changes when presented in a predictable order. Therefore, perturbations with a short acceleration-deceleration interval can influence triggered postural responses through reactive effects and, when predictable with repeated exposure, through anticipatory mechanisms.

A review of awareness interventions in brain injury rehabilitation

Unawareness related to brain injury has implications for participation in rehabilitation, functional outcomes, and the emotional well-being of clients. Addressing disorders of awareness is an integral component of many rehabilitation programmes, and a review of the literature identified a range of awareness interventions that include holistic milieu-oriented neuropsychological programmes, psychotherapy, compensatory and facilitatory approaches, structured experiences, direct feedback, videotaped feedback, confrontational techniques, cognitive therapy, group therapy, game formats and behavioural intervention. These approaches are examined in terms of their theoretical bases and research evidence. A distinction is made between intervention approaches for unawareness due to neurocognitive factors and approaches for unawareness due to psychological factors. The socio-cultural context of unawareness is a third factor presented in a biopsychosocial framework to guide clinical decisions about awareness interventions. The ethical and methodological concerns associated with research on awareness interventions are discussed. The main considerations relate to the embedded nature of awareness interventions within rehabilitation programmes, the need for individually tailored interventions, differing responses according to the nature of unawareness, and the risk of eliciting emotional distress in some clients.

Covariation and interference between physiological reflexes: Eye-blink startle cardiac defense, and skin conductance

Comparative studies of autonomic and somatic reflexes, such as cardiac defense and motor startle, are rare. However, examination of the pattern of covariation, independence, or interference among physiological reflexes may help to clarify their functional significance and elucidate their complex modulation by psychological factors. Here we report the results of a study that examined the pattern of interference of eye-blink startle on subsequent cardiac defense. Participants were 63 students (31 women) distributed into three groups according to the sensory modality of the eliciting stimulus during the startle trials: acoustic high intensity (105 dB), acoustic low intensity (65 dB), and visual modality. Startle trials consisted of 12 presentations of the eliciting stimulus with a duration of 50 ms, instantaneous risetime, and a variable inter-stimulus interval of 16 – 20 s.Defense trials began 20 s after the last startle trial and consisted, for all groups, of 3 presentations of the high intensity acoustic stimulus with a duration of 500 ms and an inter-stimulus interval of 215 s. Results showed a clear interference of the startle trials on the subsequent defense trials when both types of trials shared identical sensory modality (acoustic) independently of intensity: the expected pattern of cardiac defense in the first trial only appeared in the visual modality. Similar interference effects were observed in the skin conductance response. Subjective reactivity to the defense stimulus did not detect differences between conditions.

ESPIRITISMO E CONVERSÃO: FATORES MOTIVACIONAIS DA MIGRAÇÃO RELIGIOSA PARA O ESPIRITISMO, NO BRASIL.

Este trabalho faz um estudo analítico do fenômeno da conversão religiosa. Particularmente, dos fatores que motivam o trânsito de fiéis de uma religião qualquer para o Espiritismo, no Brasil. Os grupos em estudo, dos quais são provenientes os novos espíritas foram divididos em sete blocos: Catolicismo, Protestantismo, afro-brasileiras, Umbanda, orientais, outras e, nenhuma. Essa análise privilegia os fatores sociais e psicológicos que levam um indivíduo a mudar de religião. Ao explorar o caso brasileiro, este trabalho aborda também, a multiplicidade de religiões, seitas, crenças e movimentos religiosos presentes no cenário brasileiro, dentro da dinâmica de forças que envolvem esse campo religioso. Para isso, é apresentado um resumo da história dos principais movimentos religiosos no caso brasileiro. Dá-se ênfase ao Espiritismo no Brasil e no mundo, como forma de caracterizar os processos de evolução da Doutrina Espírita e os argumentos com que a essa Doutrina compete nesse mosaico de convicções religiosas. A pesquisa se apoia em um questionário distribuído em todo território nacional, que coleta dos respondentes, dados que permitem qualificá-los sob diversos aspectos: renda, educação, localização regional, conhecimento e prática da Doutrina Espírita, etc. Dentro dos quesitos de consulta estão sugeridas 18 opções, como razões da mudança da religião para o Espiritismo e, em outros vinte quesitos, um aprofundamento da opção que, no conjunto anterior se apresentou como a mais frequente. As opções iniciais se distribuem entre as razões mais frequentes da mudança de religião observadas pelo autor em sua experiência pessoal e na literatura. Os dados estatísticos foram coletados de mais de 2.300 depoentes, em mais de 400 municípios, em todos os Estados do Brasil.

Causal attributions in King-Kopetzky syndrome

At least 10% of people who present for help with hearing difficulties will be found to have normal hearing thresholds. These cases are clinically categorized as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). While recent research has focussed on the possible mechanistic basis for these difficulties, the perceptions of the hearing difficulties that lead people to seek help have not hitherto been identified. This study presents findings from an observational survey of causal attributions of hearing difficulties from 100 people with KKS. The findings suggest that participants regard immunity and risk related causes of hearing difficulties as pre-dominant. Psychological factors were not considered to be causal for hearing difficulties. These factors were not affected by diagnostic classification. These findings inform audiologists about their patient beliefs for the first time. The authors suggest that clinicians take care to ensure that their counselling is responsive to these beliefs. © 2010 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society.

Családi vállalkozás folytatásának tervei a felsőoktatási hallgatók körében (The plans of students on taking over family firms)

Tanulmányában a szerző a felsőoktatási hallgatók vállalkozásindítással kapcsolatos attitűdjeit kétféle szempontból vizsgálja. Kutatása középpontjában a hallgatók családivállalkozás-folytatásának tervei, az ehhez kapcsolódó jellemzők állnak. A fő kérdés az, hogy inkább folytatnák-e a családi vállalkozást (ha van ilyen) vagy indítanának saját vállalkozást? A családi vállalkozás indításával kapcsolatban azonban nemcsak annak a ténye fontos, hogy a hallgatók folytatnák-e a családi hagyományokat, hanem az is, hogy a folytatásnak vagy a saját vállalkozás indításának milyen motivációi vannak, vagyis mennyiben befolyásolja a döntésben a hallgatót a vállalkozásokról alkotott véleménye, a családi háttere, illetve egyéb pszichológiai tényezők. ____ In her study the author analyses the attitudes of the Hungarian higher education students on taking over family firms in two points of view. In the centre of her research there are the plans of students on taking over family firms and its main characteristics. The main question is that students rather take over firms or establish new ones? Besides of these facts it is also very important to know what the main motivations of this decision are: how extent does the following facts influence students’ decisions: family background, psychological factors, opinions about firms etc.

A study of intrablack conflict and work attitudes within an African American organization

The present research evidences a field setting studying attitudinal and behavioral results of five Black group contacts. The research was designed, in part, to determine the demographic, cultural, social, and psychological factors associated with intrablack perceptions of conflict and work attitudes in an African American organization. Two organizational groups, African Americans and Caribbean/West Indians totaling 112 participants were studied. The objective of the research was to gain information about attitudinal levels perceived by each of the two groups. Each group rated the other group on items dealing with conflict and work attitudes. One-way analysis of variances (ANOVAs) were employed to test the overall differences on scale means among the groups. The findings in this study buttress some of the major themes in the impressionistic literature on cultural/multicultural diversity in organizations and Caribbean/West Indian literature. The data are reported and examined, and theoretical implications are discussed. ^

Adaptation of trailing spouses: Does gender matter?

The adaptation to a new country is a complex and stressful process that is compounded when changes in status and identity have to be made. This exploratory study examined the adaptation of international company transferee spouses when they decide to follow the transferee on overseas assignments. Research to date indicates that the spouses’ dissatisfaction with life abroad is the leading cause of transferees breaking contract and prematurely returning home. The causes of this dissatisfaction are still not clear and this study sought greater clarification, particularly examining the experiences of male as well as female trailing spouses. The study, thus, takes gender as a main variable to consider. It explores how gendered expectations inherent in the structures of society inflect and inform the decisions, attitudes, and behaviors that affect the adaptations of trailing spouses living in a foreign habitus. The study is based on eight months of ethnographic research in two culturally different locations, Kuala Lumpur, Malaysia and Brussels, Belgium. Forty-two American international company transferee spouses were recruited (seven males and thirty-five females). The data analysis revolved around five main themes: (1) the comparison of male with female trailing spouses’ experiences, (2) the effect of location on spouses’ adaptation, (3) the communities that spouses integrate into, (4) variations in personal work and family histories, and (5) conditions of exit. The analysis engaged multiple theories regarding gender, sociological adaptation, and psychological adaptation. Results indicate that both socio-cultural and psychological factors affect adaptation and that gender matters very significantly, particularly along two axes: (1) gendered structures in our society create different reasons why males and females become trailing spouses, (2) the gendered social constructions of role expectations make the experience of being a trailing husband different from being a trailing wife. In addition spouses’ status as parents (or not) and their “readiness for change” were found to be important predictors of positive spousal adaptation. In contrast, significant ties with families in the home country and strong professional identity with career projections were important predictors of negative spousal adaptation.

Essays on risk aversion, diversification and non -participation

My dissertation consists of three essays. The central theme of these essays is the psychological factors and biases that affect the portfolio allocation decision. The first essay entitled, “Are women more risk-averse than men?” examines the gender difference in risk aversion as revealed by actual investment choices. Using a sample that controls for biases in the level of education and finance knowledge, there is evidence that when individuals have the same level of education, irrespective of their knowledge of finance, women are no more risk-averse than their male counterparts. However, the gender-risk aversion relation is also a function of age, income, wealth, marital status, race/ethnicity and the number of children in the household. The second essay entitled, “Can diversification be learned ?” investigates if investors who have superior investment knowledge are more likely to actively seek diversification benefits and are less prone to allocation biases. Results of cross-sectional analyses suggest that knowledge of finance increases the likelihood that an investor will efficiently allocate his direct investments across the major asset classes; invest in foreign assets; and hold a diversified equity portfolio. However, there is no evidence that investors who are more financially sophisticated make superior allocation decisions in their retirement savings. The final essay entitled, “The demographics of non-participation ”, examines the factors that affect the decision not to hold stocks. The results of probit regression models indicate that when individuals are highly educated, the decision to not participate in the stock market is less related to demographic factors. In particular, when individuals have attained at least a college degree and have advanced knowledge of finance, they are significantly more likely to invest in equities either directly or indirectly through mutual funds or their retirement savings. There is also evidence that the decision not to hold stocks is motivated by short-term market expectations and the most recent investment experience. The findings of these essays should increase the body of research that seeks to reconcile what investors actually do (positive theory) with what traditional theories of finance predict that investors should do (normative theory).

Essays on Risk Aversion, Diversification and Non-Participation

My dissertation consists of three essays. The central theme of these essays is the psychological factors and biases that affect the portfolio allocation decision. The first essay entitled, “Are women more risk-averse than men?” examines the gender difference in risk aversion as revealed by actual investment choices. Using a sample that controls for biases in the level of education and finance knowledge, there is evidence that when individuals have the same level of education, irrespective of their knowledge of finance, women are no more risk-averse than their male counterparts. However, the gender-risk aversion relation is also a function of age, income, wealth, marital status, race/ethnicity and the number of children in the household. The second essay entitled, “Can diversification be learned?” investigates if investors who have superior investment knowledge are more likely to actively seek diversification benefits and are less prone to allocation biases. Results of cross-sectional analyses suggest that knowledge of finance increases the likelihood that an investor will efficiently allocate his direct investments across the major asset classes; invest in foreign assets; and hold a diversified equity portfolio. However, there is no evidence that investors who are more financially sophisticated make superior allocation decisions in their retirement savings. The final essay entitled, “The demographics of non-participation”, examines the factors that affect the decision not to hold stocks. The results of probit regression models indicate that when individuals are highly educated, the decision to not participate in the stock market is less related to demographic factors. In particular, when individuals have attained at least a college degree and have advanced knowledge of finance, they are significantly more likely to invest in equities either directly or indirectly through mutual funds or their retirement savings. There is also evidence that the decision not to hold stocks is motivated by short-term market expectations and the most recent investment experience. The findings of these essays should increase the body of research that seeks to reconcile what investors actually do (positive theory) with what traditional theories of finance predict that investors should do (normative theory).

Adaptation of Trailing Spouses: Does Gender Matter?

The adaptation to a new country is a complex and stressful process that is compounded when changes in status and identity have to be made. This exploratory study examined the adaptation of international company transferee spouses when they decide to follow the transferee on overseas assignments. Research to date indicates that the spouses’ dissatisfaction with life abroad is the leading cause of transferees breaking contract and prematurely returning home. The causes of this dissatisfaction are still not clear and this study sought greater clarification, particularly examining the experiences of male as well as female trailing spouses. The study, thus, takes gender as a main variable to consider. It explores how gendered expectations inherent in the structures of society inflect and inform the decisions, attitudes, and behaviors that affect the adaptations of trailing spouses living in a foreign habitus. The study is based on eight months of ethnographic research in two culturally different locations, Kuala Lumpur, Malaysia and Brussels, Belgium. Forty-two American international company transferee spouses were recruited (seven males and thirty-five females). The data analysis revolved around five main themes: (1) the comparison of male with female trailing spouses’ experiences, (2) the effect of location on spouses’ adaptation, (3) the communities that spouses integrate into, (4) variations in personal work and family histories, and (5) conditions of exit. The analysis engaged multiple theories regarding gender, sociological adaptation, and psychological adaptation. Results indicate that both socio-cultural and psychological factors affect adaptation and that gender matters very significantly, particularly along two axes: (1) gendered structures in our society create different reasons why males and females become trailing spouses, (2) the gendered social constructions of role expectations make the experience of being a trailing husband different from being a trailing wife. In addition spouses’ status as parents (or not) and their “readiness for change” were found to be important predictors of positive spousal adaptation. In contrast, significant ties with families in the home country and strong professional identity with career projections were important predictors of negative spousal adaptation.