Knowing your allies: Medical education and interprofessional exposure

Collaborative, team-based, interprofessional approaches to patient management are becoming increasingly recognized as beneficial to health outcomes. This project aimed to develop interprofessional skills among 134 third year medical students that were of clinical educational value to the students, and through activities that directly benefited the rural health professionals in their daily work. Placements were undertaken during a six week rural clinical attachment, mainly throughout South-West Queensland. Pre- and post-placement self-report questionnaires completed by both students and health professionals were used to evaluate the project. Results showed that over 80% of the health professional group reported the medical student placements were useful. Similarly, almost 80% of medical students reported positive changes in their attitude to other health professionals from the placement, and 91% indicated they had derived clinical educational benefit from their interprofessional activity. Despite difficulties due to poor communication between the various parties involved, the project proved successful in improving medical students' skills, knowledge and perceptions concerning interprofessional practice, through a placement and educational project which delivered practical benefits to rural health professionals and rural communities.

Public support for sustainable commercial harvesting of wildlife: An Australian case study

This paper surveys a sample of 204 members of the Australian public to determine their attitude to the sustainable commercial harvesting of wildlife generally, and considers their specific support for the sustainable commercial harvesting of each of 24 Australian native species. The general attitude of the sample to wildlife harvesting is related to their attitude to nature conservation. The relationship between respondents’ support for the sustainable commercial harvesting of each of the species and their degree of endangerment based on IUCN Red List rankings is established and found to be an inverse one. Support for the commercial sustainable use of each of the species is compared with the willingness of respondents to pay for their conservation. Support for sustainable commercial harvesting of species is found to be inversely related to the willingness of respondents to pay is for a particular species’ conservation. In turn, this willingness to pay is found to rise with the degree of endangerment of species. While the likeability of a species has some influence on whether there is support or not for its commercial harvesting, it does not seem to be the predominant influence— the degree of endangerment of a species appears to be the major influence here. Even so, this does not imply majority support for the harvest of all species that are not threatened; rather, majority support for harvest was observed only for some species known to be abundant. None of the species that appear in the Red List have majority support for harvesting. Implications are outlined of the results for the policy of promoting wildlife conservation by means of sustainable use.

Antarctic tourists: A case study of their evaluation of Antarctic wildlife and environmental issues

Reports the results of surveys of Antarctic cruise ship passengers on the ‘Akademik Ioffe’ who undertook their Antarctic journey in January 2003. The prime purposes of the surveys were to determine the socio-economic profile of these travellers, evaluate the importance of Antarctic wildlife for their travel, their attitude to Antarctic wildlife conservation as well as environmental issues involving Antarctica, both prior to their tourist visit to Antarctica and following it. This paper reports on the socio-economic profile of respondents, their willingness to pay for their Antarctic trip, and their knowledge of Antarctica. The comparative importance of Antarctic wildlife as a factor motivating respondents to undertake their journey is assessed and the evaluation of travellers following their Antarctic visit is considered. The relative importance of different Antarctic wildlife species is taken into account as well as Antarctic attractions other than wildlife. The attitudes of respondents to several environmental issues involving Antarctica, (eg. the commercial use of its natural resources and global environmental change impacting on Antarctica) are canvassed and summarised. In conclusion, the relevance of the survey results for Antarctic conservation are discussed. Particular attention is given to the question of whether Antarctic tourism favours or threatens Antarctic nature conservation.

Media influence to suicide: The search for solutions

This review explores the influence to suicide in print and electronic media, and considers both real and fictional deaths. The conclusion appears inescapable that reports about celebrities which are multi-modal, repeated, explicit, front page, glorify the suicide, and describe the method lead to an increase in deaths from suicide, particularly in the region in which reports are published. The paper argues that even if there was multi-national agreement to international guidelines, media will continue to report suicide when it is considered to be a matter of public interest. What appears crucial is a collaborative approach between professionals and the media to promote a negative attitude toward suicide without increasing stigma toward those with mental health problems.

An evaluation of the Keep on Talking program for maintaining communication skills into old

Communication skills change with age as a result of sensory deficits, memory loss, and increasing word finding difficulties The Keep on Talking program (L. Hickson, H. Barnett, L. Worrall, & E. Yiu, 1994) was developed to assist older people to develop their own strategies for maintaining communication skills into old age. Two hundred and fifty-two healthy older people were recruited from the community and were assessed on a battery of communication assessments on entry to the study and at 1 year after entry. The experimental group (n = 120) participated in the 5-week group Keep on Talking program run by volunteers A further 130 control subjects were assessed only. The short-term effectiveness of the program was evaluated using a short knowledge based and attitudinal questionnaire and qualitative written feedback. At the I-year follow up, subjects were also asked whether they had taken any action as a result of the project. Results concluded that there was a significant difference between the number of correct questionnaire responses on the knowledge based items and the ratings on the attitudinal items pre- and postprogram questionnaire for the experimental subjects. Qualitative written feedback was positive with many participants remarking on the amount of information that they had acquired. Forty-eight experimental and 69 control subjects (n = 117) were assessed I year later, and there was a significant difference between the groups in terms of the number of subjects who reported having taken action as a result of the program. The Keep on Talking program increased knowledge about communication, produced a positive change in attitude toward the importance of communication, and encouraged participants to take action to maintain their communication skills. Maintaining communication skills may prevent social isolation. This simple 5-hour group program has been effective in empowering participants to maintain. their communication skills as they age.

Prejudiced attitudes, group norms, and discriminatory behaviour

Most current attitude research focuses on range of non-social attitudinal targets, including health-related and consumer outcomes. In this paper, a program of research that considers the relations among intergroup attitudes, group norms, and behavior will be described. The first study examined the effect of ingroup norms relating to multiculturalism on the extent to wich participants hehaviourally enacted their attitudes. Consistent with social identity theory, attitudebehaviour consistency in relation was influenced by ingroup norms, particularly when national identity was salient. The results of a large scale field study that essential replicated this pattern of results will also be discussed.

Volunteer decision making by older people: A test of a revised theory of planned behavior

This study was designed to test the utility of a revised theory of planned behavior in the prediction of intentions to volunteer among older people. Such a perspective allowed for the consideration of a broader range of social and contextual factors than has been examined in previous research on volunteer decision making among older people. The article reports the findings from a study that investigated volunteer intentions and behavior in a random sample of older people aged 65 to 74 years living in an Australian capital city. Results showed that, as predicted by the revised theory of planned behavior, intention to volunteer predicted subsequent reported volunteer behavior. Intention was, in turn, predicted by social norms (both subjective and behavioral), perceived behavioral control, and moral obligation, with the effect of attitude being mediated through moral obligation.

Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial

Background: Sexually transmitted diseases (STD) are important co-factors in HIV transmission. We studied the impact of health worker training and STD syndrome packets (containing recommended drugs, condoms, partner notification cards and information leaflets) on the quality of STD case management in primary care clinics in rural South Africa. Methods: A randomized controlled trial of five matched pairs of clinics compared the intervention with routine syndromic management. Outcomes were measured by simulated patients using standardized scripts, and included the proportion given recommended drugs; correctly case managed (given recommended drugs plus condoms and partner cards); adequately counselled; reporting good staff attitude; and consulted in privacy. Results: At baseline, the quality of STD case management was similarly poor in both groups. Only 36 and 46% of simulated patients visiting intervention and control clinics, respectively, were given recommended drugs. After the intervention, intervention clinics provided better case management than controls: 88 versus 50% (P < 0.01) received recommended drugs; 83 versus 12% (P < 0.005) were correctly case managed; 68 versus 46% (P = 0.06) were adequately counselled; 84 versus 58% experienced good staff attitude (P = 0.07); and 92 versus 86% (P = 0.4) were consulted privately. A syndrome packet cost US$1.50; the incremental cost was US$6.80. The total intervention cost equalled 0.3% of annual district health expenditure. Interpretation: A simple and affordable health service intervention achieved substantial improvements in STD case management. Although this is a critical component of STD control and can reduce HIV transmission, community-level interventions to influence health-seeking behaviour are also needed. (C) 2000 Lippincott Williams & Wilkins.

Undergraduate student experience in dental service delivery in rural South Australia: An analysis of costs and benefits

Background, Rural experience for dental students can provide valuable clinical education, change attitudes to rural practice, and make a valuable contribution to clinical service provision. The aim of this paper is to assess the costs and benefits of service delivery by students through rural training programmes Methods: Groups of two students worked in the public dental clinics in adjacent rural centres where there had been long-term difficulties in recruiting staff. The costs and benefits of the programme were assessed by the impact on waiting lists, the total cost per patient of, a course of care and by the marginal cost of adding service provision by students to existing arrangements. Results: The total costs of emergency and complete treatment provided by students were greater than the costs of treatment provided by public-sector dentists but less than the costs of private providers treating public patients. However, the value of services were greater when care was provided by students or private providers and the marginal cost of students providing services was 50-70 per cent of the cost of care provided by public dentists. Conclusion: This assessment suggests that the service benefits achieved compliment the primary objective of influencing the attitude of students to rural practice.

Investigating the gap between citizens` sustainability attitudes and food purchasing behaviour: empirical evidence from Brazilian pork consumers

Consumers worldwide are increasingly concerned with sustainable production and consumption. Recently, a comprehensive study ranked 17 countries in regard to their environmentally friendly behaviour among consumers. Brazil was one of the top countries in the list. Yet, several studies highlight significant differences between consumers` intentions to consume ethically, and their actual purchase behaviour: the so-called `Attitude-Behaviour Gap`. In developing countries, few studies have been conducted on this issue. The objective of this study is therefore to investigate the gap between citizens` sustainability-related attitudes and food purchasing behaviour using empirical data from Brazil. To this end, Brazilian citizens` attitudes towards pig production systems were mapped through conjoint analysis and their coexistence with relevant pork product-related purchasing behaviour of consumers was investigated through cluster analysis. The conjoint experiment was carried Out with empirical data collected from 475 respondents surveyed in the South and Center-West regions of Brazil. The results of the conjoint analysis were used for a subsequent cluster analysis in order to identify clusters of Brazilian citizens with diversified attitudes towards pig production systems, using socio-demographics, attitudes towards sustainability-related themes that are expected to influence the way they evaluate pig production systems, and consumption frequency of various pork products as clusters` background information. Three clusters were identified as `indifferent`, `environmental conscious` and `sustainability-oriented` citizens. Although attitudes towards environment and nature had indeed an influence on citizens` specific attitudes towards pig farming at the cluster level, the relationship between `citizenship` and consumption behaviour was found to be weak. This finding is similar to previous research conducted with European consumers: what people (in their role of citizens) think about pig production systems does not appear to significantly influence their pork consumption choices. Improvements in the integrated management of this chain would better meet consumers` sustainability-related expectations towards pig production systems.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders

Background: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990-2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no special Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.

The link between prejudiced attitudes and discriminatory behaviour: The role of ingroup norms

In the present research, a reconceptualisation of the role of norms in the link between prejudiced attitudes and discriminatory behaviour — along the lines suggested by the social identity perspective — was tested. In the first study, group salience and group norm were manipulated. As expected, participants ascribed negative traits to significantly fewer Asian university students when they had received consensus information along these lines from a salient ingroup rather than from a salient outgroup. These results were replicated on a measure of strength of motivation to appear nonprejudiced. In a second study, group salience and norm were once again manipulated and strength of attitude and perceived group threat were measured. As predicted, people's negative attitudes towards globalisation were more likely to predict congruent behavioural responses to the extent that the group norm supported the attitude and group salience was high, particularly when high levels of group threat were perceived.

O ACERTO DE CONTAS DE DIDEROT COM O CETICISMO

RESUMO: Este artigo é o segundo de uma tríade que trata do diálogo, mais precisamente do envolvimento, entre a filosofia de Denis Diderot e o ceticismo. O primeiro artigo, intitulado “O jovem Diderot e o ceticismo dos Pensamentos”, foi publicado na revista Dois Pontos, em sua edição dedicada ao tema do ceticismo (cf. PIVA, 2007), e limitou-se a uma análise minuciosa do problema da postura cética nos Pensamentos filosóficos, de 1746. O presente artigo, por seu turno, examina duas questões fundamentais, desta vez em O passeio do cético ou As alamedas, de 1747, último livro em que o ceticismo é evocado com destaque pelo enciclopedista, dois anos antes de ele render-se definitivamente ao materialismo ateu: 1) a interpretação que Diderot desenvolve do ceticismo e 2) sua posição diante dele. Já o terceiro e derradeiro texto da tríade examinará – evidentemente, numa próxima oportunidade – a presença do ceticismo no pensamento diderotiano da maturidade, ou seja, no período que se inicia em 1749, com a redação da Carta sobre os cegos, quando a questão da dúvida cética passa a perder em suas obras a relevância que tinha na origem de suas reflexões, mudando, até mesmo, de registro.

Survey of countertrade practices in Australia

This empirical exploratory study is part of a larger comprehensive study of countertrade practices in the Asia-Pacific region. A mail survey of 600 Australian international trading firms reveals that a positive attitude toward countertrade exists among both countertraders and non-countertraders in Australia. Further the study reveals the major motivating factors, the benefits derived difficulties faced and reasons for not countertrading by Australian firms. In addition, the study identifies the forms of countertrade used, the countries sewed, and the product and service categories countertraded. The results are compared to earlier studies of UK and Canadian firms, and the implications for international marketing managers are discussed. (C) Elsevier Science Inc., 1997.

How can and do Australian doctors promote physical activity?

Background. Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice, Methods. A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia. Results. We received a 71% response (n = 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience, Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems, Conclusions. There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors, Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored. (C) 1997 Academic Press.