Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study

BACKGROUND High-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients' failing discontinuation treatment. While there is some data supporting its effectiveness, patients' perceptions of such an intervention have not been investigated. METHODS An exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. RESULTS Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: "Only if I can try to discontinue…and please don't call it that," "More stability and less criminal activity…and that is why I would try it," and "No cure, no brain and no flash…and thus, just for everybody else!" CONCLUSIONS Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Attitudes toward end-of-life decision making in South Texas

Advance care planning has the potential to create positive outcomes in the realm of end-of-life health care. The completion of advance directives and living wills are vital in equipping patients with autonomy and ensuring that their end-of-life wishes are respected. However, there remains a lack of knowledge and low completion rates of advance directives despite their possible improvements and ramifications on health care at the end of life. This study seeks to determine the knowledge of and attitudes towards end-of-life decision-making in South Texas. The study is designed as a cross-sectional, exploratory survey using a descriptive survey instrument to query 71 subjects in South Texas. The setting for the study includes three distinct groups, two in San Antonio, Texas and one in Brownsville, Texas. Unique differences in demographics between the three groups, such as variability in age, ethnicity, language and religious affiliation allowed for preliminary associations to be concluded in describing the results of the survey instrument. Ultimately, this study describes the attitudes and perceptions of advance care planning in South Texas and reveals the need for further education and awareness of the topic, perhaps indicating the need for a public health initiative in this regard.^

Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^

Attitudes toward psychiatry among students entering medical school

Objective: To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialities, and against findings from a North American study. Method: We surveyed 655 first-year medical students attending six Australian Universities. Results: Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. Conclusion: Our findings suggest that psychiatry has an image problem that is widespread, reflecting Community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.

An analysis of the attitudes of dental patients attending general dental practice in Galway

Aim: To describe the patterns of dental attendance and attitudes towards tooth loss of general dental practice patients in Galway. Objectives: 1. To determine the pattern of adult dental attendance in general practices in Galway; and, 2. To examine the oral health attitudes of these patients. Method: Questionnaires were distributed to 311 consecutive adult patients in the waiting rooms of ten general dental practices in Galway, which were randomly selected from the telephone directory. Results: A total of 254 of the 311 questionnaires distributed were fully completed, returned and included in the results, giving a response rate of 81.7%. A total of 59% of dentate participants attended their dentist for annual or biannual examinations compared to 23% of edentate patients. Some 10.5% of medical card holders and 0.5% of non-medical card holders were edentulous. Conclusions: The data from the survey indicated that medical card holders in Galway were more likely to be edentulous than nonmedical card holders. Edentate patients were less likely to be regular dental attenders than dentate patients.

Attitudes of Elements of the Academic Community in Regard to the Rapid Test of HIV/AIDS

Background: Knowing one’s own seropositivity status of HIV/AIDS is important. Seropositivity can be determined by a rapid HIV/AIDS test. Attitudes towards a rapid test of HIV/AIDS show a predisposition to perform the analysis.

. Attitudes of Elements of the Academic Community in Regard to the Rapid Test of HIV/AIDS

Background: Knowing one’s own seropositivity status of HIV/AIDS is important. Seropositivity can be determined by a rapid HIV/AIDS test. Attitudes towards a rapid test of HIV/AIDS show a predisposition to perform the analysis. Objective: This study investigated, the attitudes of students and staff in a Portuguese university toward rapid HIV/AIDS test. Methods: In a convenience sample, the data was collected on campus in three consecutive years. A selfadministered structured questionnaire was used for data collection. A validated scale for Portuguese students was applied. A sample of 947 (86.3%) students and 150 (13.7%) teaching and non-teaching staff participated. The average age was 24.30 years-old (SD=8.64). Non-parametric tests were applied. Results: Attitudes of professors and non-teaching staff are more favorable in relation to the rapid test of HIV/AIDS, compared to students. Attitudes are also more favorable in the first year in which the study was conducted with both employees and students. The male students express more traditional attitudes. Students of nursing polo have expressed more favorable attitudes to the rapid test of HIV/AIDS. Conclusion: The attitudes towards rapid test of HIV/AIDS are generally favorable. It is necessary to conduct further research considering professors and other university staff. Improving favorable attitudes toward rapid HIV/AIDS test must be a positive fact for health.

Integrating complementary and alternative therapies into psychological practice : A qualitative analysis

Although complementary and alternative therapies (CATs) are utilised widely for treating psychological disorders, little research has examined psychologists' beliefs about integrating CAT into psychological practice. Six practicing psychologists and six psychology students were interviewed about their CAT integration beliefs, in particular integrating CAT into clinical practice via recommending CATs, offering referrals to CAT practitioners, or undertaking training to utilise CATs within psychological practice. Guided broadly from a theory of planned behaviour perspective, participants raised a number of costs and benefits, discussed referent groups who would influence their decisions, and suggested motivators and barriers for integration. A number of additional themes were raised, including risks, such as the possibility of litigation and the need for clear Society guidelines, as most participants were unclear about what constitutes appropriate practice. Identifying these themes serves as an important initial step to informing discussion and policy for this emerging practice issue within psychology.

Achieving safe road use in a rapidly motorising country : The influence of longstanding beliefs on risky driver behaviour in Pakistan

Road crashes are one of the most significant public health problems in Pakistan; however the factors that contribute to road crashes in Pakistan are not well-researched. Traditional beliefs and values can act as a barrier to health-promoting and injury prevention behaviours, in general and especially in relation to road safety, and may also contribute to risk-taking behaviours. Such beliefs can present significant challenges for health advocates who aim to change behaviour in order to avert road crashes and diminish their consequences. Qualitative research was undertaken in Islamabad, Rawalpindi and Lahore with a range of drivers, religious orators, police and policy makers to explore cultural and religious beliefs and their association with risky road use, and to understand how they might affect development of road safety interventions. The findings highlight a range of issues, including the identification of aspects of beliefs that have complex social implications when designing safety intervention strategies. The pervasive nature of religious and superstitious beliefs in Pakistan can affect road user behaviour by reinforcing the presumption that the individual has no part to play in safety, thereby supporting continued risk taking behaviour. It is anticipated that the findings could be used to inform the design of interventions aimed at influencing broad-spectrum health attitudes and practices among the communities where such beliefs are prevalent.

Fatalism, superstition, religion, and culture : road user beliefs and behaviour in Pakistan

Road traffic crashes have emerged as a major health problem around the world. Road crash fatalities and injuries have been reduced significantly in developed countries, but they are still an issue in low and middle-income countries. The World Health Organization (WHO, 2009) estimates that the death toll from road crashes in low- and middle-income nations is more than 1 million people per year, or about 90% of the global road toll, even though these countries only account for 48% of the world's vehicles. Furthermore, it is estimated that approximately 265,000 people die every year in road crashes in South Asian countries and Pakistan stands out with 41,494 approximately deaths per year. Pakistan has the highest rate of fatalities per 100,000 population in the region and its road crash fatality rate of 25.3 per 100,000 population is more than three times that of Australia's. High numbers of road crashes not only cause pain and suffering to the population at large, but are also a serious drain on the country's economy, which Pakistan can ill-afford. Most studies identify human factors as the main set of contributing factors to road crashes, well ahead of road environment and vehicle factors. In developing countries especially, attention and resources are required in order to improve things such as vehicle roadworthiness and poor road infrastructure. However, attention to human factors is also critical. Human factors which contribute to crashes include high risk behaviours like speeding and drink driving, and neglect of protective behaviours such as helmet wearing and seat belt wearing. Much research has been devoted to the attitudes, beliefs and perceptions which contribute to these behaviours and omissions, in order to develop interventions aimed at increasing safer road use behaviours and thereby reducing crashes. However, less progress has been made in addressing human factors contributing to crashes in developing countries as compared to the many improvements in road environments and vehicle standards, and this is especially true of fatalistic beliefs and behaviours. This is a significant omission, since in different cultures in developing countries there are strong worldviews in which predestination persists as a central idea, i.e. that one's life (and death) and other events have been mapped out and are predetermined. Fatalism refers to a particular way in which people regard the events that occur in their lives, usually expressed as a belief that an individual does not have personal control over circumstances and that their lives are determined through a divine or powerful external agency (Hazen & Ehiri, 2006). These views are at odds with the dominant themes of modern health promotion movements, and present significant challenges for health advocates who aim to avert road crashes and diminish their consequences. The limited literature on fatalism reveals that it is not a simple concept, with religion, culture, superstition, experience, education and degree of perceived control of one's life all being implicated in accounts of fatalism. One distinction in the literature that seems promising is the distinction between empirical and theological fatalism, although there are areas of uncertainty about how well-defined the distinction between these types of fatalism is. Research into road safety in Pakistan is scarce, as is the case for other South Asian countries. From the review of the literature conducted, it is clear that the descriptions given of the different belief systems in developing countries including Pakistan are not entirely helpful for health promotion purposes and that further research is warranted on the influence of fatalism, superstition and other related beliefs in road safety. Based on the information available, a conceptual framework is developed as a means of structuring and focusing the research and analysis. The framework is focused on the influence of fatalism, superstition, religion and culture on beliefs about crashes and road user behaviour. Accordingly, this research aims to provide an understanding of the operation of fatalism and related beliefs in Pakistan to assist in the development and implementation of effective and culturally appropriate interventions. The research examines the influence of fatalism, superstition, religious and cultural beliefs on risky road use in Pakistan and is guided by three research questions: 1. What are the perceptions of road crash causation in Pakistan, in particular the role of fatalism, superstition, religious and cultural beliefs? 2. How does fatalism, superstition, and religious and cultural beliefs influence road user behaviour in Pakistan? 3. Do fatalism, superstition, and religious and cultural beliefs work as obstacles to road safety interventions in Pakistan? To address these questions, a qualitative research methodology was developed. The research focused on gathering data through individual in-depth interviewing using a semi-structured interview format. A sample of 30 participants was interviewed in Pakistan in the cities of Lahore, Rawalpindi and Islamabad. The participants included policy makers (with responsibility for traffic law), experienced police officers, religious orators, professional drivers (truck, bus and taxi) and general drivers selected through a combination of purposive, criterion and snowball sampling. The transcripts were translated from Urdu and analysed using a thematic analysis approach guided by the conceptual framework. The findings were divided into four areas: attribution of crash causation to fatalism; attribution of road crashes to beliefs about superstition and malicious acts; beliefs about road crash causation linked to popular concepts of religion; and implications for behaviour, safety and enforcement. Fatalism was almost universally evident, and expressed in a number of ways. Fate was used to rationalise fatal crashes using the argument that the people killed were destined to die that day, one way or another. Related to this was the sense of either not being fully in control of the vehicle, or not needing to take safety precautions, because crashes were predestined anyway. A variety of superstitious-based crash attributions and coping methods to deal with road crashes were also found, such as belief in the role of the evil eye in contributing to road crashes and the use of black magic by rivals or enemies as a crash cause. There were also beliefs related to popular conceptions of religion, such as the role of crashes as a test of life or a source of martyrdom. However, superstitions did not appear to be an alternative to religious beliefs. Fate appeared as the 'default attribution' for a crash when all other explanations failed to account for the incident. This pervasive belief was utilised to justify risky road use behaviour and to resist messages about preventive measures. There was a strong religious underpinning to the statement of fatalistic beliefs (this reflects popular conceptions of Islam rather than scholarly interpretations), but also an overlap with superstitious and other culturally and religious-based beliefs which have longer-standing roots in Pakistani culture. A particular issue which is explored in more detail is the way in which these beliefs and their interpretation within Pakistani society contributed to poor police reporting of crashes. The pervasive nature of fatalistic beliefs in Pakistan affects road user behaviour by supporting continued risk taking behaviour on the road, and by interfering with public health messages about behaviours which would reduce the risk of traffic crashes. The widespread influence of these beliefs on the ways that people respond to traffic crashes and the death of family members contribute to low crash reporting rates and to a system which appears difficult to change. Fate also appeared to be a major contributing factor to non-reporting of road crashes. There also appeared to be a relationship between police enforcement and (lack of) awareness of road rules. It also appears likely that beliefs can influence police work, especially in the case of road crash investigation and the development of strategies. It is anticipated that the findings could be used as a blueprint for the design of interventions aimed at influencing broad-spectrum health attitudes and practices among the communities where fatalism is prevalent. The findings have also identified aspects of beliefs that have complex social implications when designing and piloting driver intervention strategies. By understanding attitudes and behaviours related to fatalism, superstition and other related concepts, it should be possible to improve the education of general road users, such that they are less likely to attribute road crashes to chance, fate, or superstition. This study also underscores the understanding of this issue in high echelons of society (e.g., policy makers, senior police officers) as their role is vital in dispelling road users' misconceptions about the risks of road crashes. The promotion of an evidence or scientifically-based approach to road user behaviour and road safety is recommended, along with improved professional education for police and policy makers.

Satisfação profissional dos médicos dentistas na utilização do cheque-dentista : um estudo exploratório no concelho de Lisboa

RESUMO - A satisfação profissional é um fenómeno amplamente estudado e esse interesse decorre da influência que a mesma pode exercer sobre o trabalhador, afetando a sua saúde, atitudes, comportamento profissional e social, com repercussões tanto para a sua vida privada como para as organizações. Considerando a tendência mundial de se aproximarem os perfis da profissão para um perfil único e de que a investigação sobre a satisfação profissional dos médicos dentistas em vários países estar presentemente a ser divulgada, seria importante avaliar a situação em Portugal para fins comparativos. O presente estudo teve como objetivo investigar o grau de satisfação profissional dos médicos dentistas na utilização do cheque-dentista no concelho de Lisboa, procurando estabelecer relações entre as diferentes dimensões da satisfação profissional e variáveis socioprofissionais. Um questionário de autopreenchimento foi enviado por e-mail para as clínicas onde os médicos dentistas trabalham, num total de 99 obtendo-se uma taxa de resposta de 24,2%. Verificou-se que em relação à satisfação profissional em geral nas várias dimensões questionadas, é a relação profissional/paciente que os médicos dentistas consideram como mais importante logo seguida da realização pessoal e profissional. Como menos importante os médicos dentistas referiram o status/prestígio e a segurança profissional. Já no campo da satisfação profissional no âmbito do cheque-dentista concluiu-se que mais próximo do grau de satisfeito se encontra a relação estabelecida com o paciente assim como a relação de trabalho com a equipa. No grau de satisfação mais baixo, de total insatisfação encontra-se o número de tratamentos que são permitidos efetuar em cada cheque-dentista e um último lugar encontrase o valor remuneratório do cheque-dentista. Comparando a satisfação profissional com o cheque-dentista entre géneros, verificou-se que apenas na dimensão do valor remuneratório do cheque-dentista existem diferenças estatisticamente significativas (p=0,026), sendo que o género feminino demonstra maior satisfação que o género masculino. O número de participantes não foi suficiente para que se possa generalizar os resultados para a população. É necessária a realização de mais estudos neste âmbito com um maior número de profissionais de forma a que os resultados sejam estatisticamente significativos.