Professional attitudes towards deliberate self-harm in patients with borderline personality disorder

Objective: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm.

Method: A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service.

Results: Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm.

Conclusions: The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.

Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder : randomized controlled trial

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made.

Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance.

Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings.

Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

Linking attitudes and demographics in a tourist segmentation model : a two-stage approach

Segmentation has been widely studied in tourism research e.g. Dolnicar (2004). Dawley (2006) points that commonly used segmentation variables such as demographics lead to identifiable segments which are not actionable while other useful approaches e.g. psychographics, are actionable but not identifiable. The objective of this paper is to develop a two-stage linkage approach to segmentation whereby cluster analysis using psychographic variables is conducted within demographic group. Demographic groups are selected based on propensity to travel. This research utilizes data generated from a cross-sectional self-completed survey of 49,105 Australian respondents on travel and tourism. The managerial usefulness of this segmentation is assessed. Clearly segments can be directly linked both demographically and psychographically.

Developing a scale to measure season ticket holder attitudes towards the professional sports club offering

Given the importance of season ticket holders (STH) to sporting organisations, we empirically examine a scale for measuring their attitudes to the season ticket product. This involved identifying through qualitative research and past literature, the various elements that are perceived to comprise the season ticket package and developing items to measure STH attitudes to them. The season ticket package was decomposed into six key components, closely mirroring past research. A survey of over 2,500 STH of a professional sporting organisation was then conducted, incorporating items related to these six areas, overall satisfaction and disconfirmation of expectations. The results of Exploratory Factor Analysis on those items is presented here, with results suggesting the items are valid measures of season ticket holder attitudes that capture the breadth of the STH experience.

A longitudinal analysis of the halo effect of team success on season ticket holder attitudes

Although it seems counter-intuitive, past studies have found that the attitudes to the on-field performance of a team have only a small direct impact on the overall satisfaction of members (season ticket holders). By managing other aspects of the package well (e.g., ticketing, customer service, communications), membership can satisfy even when the on-field results do not. In this research, we examine whether on-field performance, measured both objectively and subjectively, has an indirect "halo" effect on attitudes towards those other aspects of the membership offering. An examination of data collected through 63 member satisfaction surveys of 14 different AFL clubs in the period 2003 - 2007 suggests that, predictably, a change to the win-loss ratio has a strong impact on attitudes to on-field performance and overall satisfaction. However, changes in on-field performance are also significantly correlated with changes in attitudes to areas like the extent to which one feels personally involved with the club and the administration of the club. The data allows the determination of the extent ofthis halo effect where a change in on-field performance (win percentage) has a predictable impact on attitudes to other aspects of the clubs activities, allowing club management to benchmark their performance in these areas even when on-field results fluctuate year to year.

The sustainable farm families project: changing farmer attitudes to health

Farm health and safety has focussed on strategies such as injury prevention, audits and fulfilling legislative responsibilities. We know farmer injuries mask deeper health issues such as higher rates of cancer, suicides, cardiovascular disease and stress. The relationship between occupational health and safety and farming family health has not been investigated by other researchers either nationally or internationally. The Sustainable Farm Families (SFF) project attempts to make this connection in order to address the unacceptable rates of premature death, higher morbidity and injury on Australian farms.

The SFF focuses on the human resource in the triple bottom line and is working with farmers, families, industry, and university to collaboratively address and improve the health and well being of farming families. Based on a model of extension that engages farming families as active learners where they commit to healthy living and safe working practices the SFF is proving to be an effective model for engaging communities in learning and change. Health education and information is delivered to farming families using a workshop format with participants reporting positive impacts on their farming business. The SFF project sits across generations and sexes and has a high level of support with the overwhelming majority of participants saying they would recommend the program to others.

This paper discusses the progress of the research outlining the design of the project, the delivery and extension processes used to engage 321 farming families to date. The paper presents key learning’s on intersectoral collaboration, engaging farmers and families in health and the future for this project extending into agricultural industries across the nation.

Three key learnings: (1) The increased health risks faced by farmers and their families need social and political attention. (2) Joint ownership and collaborative partnerships where all partners have a key role within the development and delivery of the project to their relevant representative groups enables resources to be shared and encourages greater in-kind support to augment funding received. (3) Farming families are keen to understand more about their health and farmers who participate in health education programs based around industry collaboration with high levels of individual participation will engage with health professionals and obtain an improved health status if programs are presented to them in personally engaging and relevant ways

Factors influencing attitudes to violence against women

Attitudes toward men's violence against women shape both the perpetration of violence against women and responses to this violence by the victim and others around her. For these reasons, attitudes are the target of violence-prevention campaigns. To improve understanding of the determinants of violence against women and to aid the development of violence-prevention efforts, this article reviews the factors that shape attitudes toward violence against women. It offers a framework with which to comprehend the complex array of influences on attitudes toward violent behavior perpetrated by men against women. Two clusters of factors, associated with gender and culture, have an influence at multiple levels of the social order on attitudes regarding violence. Further factors operate at individual, organizational, communal, or societal levels in particular, although their influence may overlap across multiple levels. This article concludes with recommendations regarding efforts to improve attitudes toward violence against women.

Tissue donation and the attitudes of health care professionals

Since the first corneal transplant in 1905, improved surgical techniques and the development of immunosuppressive drugs have led to excellent success rates for organ and tissue transplantation procedures. This Chapter ,"'ill focus on the cadaveric donation of tissue and the attitudes towards it of health professionals, because they are key players in the donation- transplantation process.

The chapter begins with an overview of cadaveric tissue donation, including what can currently be transplanted. It will then present what is known about health professionals' attitudes to and knowledge of tissue donation and the impact that these have on donation rates. Attitudes, their components and their effect upon behaviour are explored using theories arising from social psychology to explain how these influence actual or intended behaviours associated with the discussion of donation wishes with relatives of the potential donor. Since some tissues, such as blood and bone marrow, can only normally be donated during life, these will be excluded since the behaviours associated with blood donation differ significantly from those associated with cadaveric tissue donation.

Effectiveness of prevention programmes for obesity and chronic diseases amongst immigrants to developed countries - a systematic review

Objective: To determine whether interventions tailored specifically to  particular immigrant groups from developing to developed countries  decrease the risk of obesity and obesity-related diseases.

Design: Databases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.

Results: Thirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).

Conclusions: Due to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.

Consumer knowledge and attitudes to salt intake and labelled salt information

The objective of this study was to investigate consumers’ knowledge of health risks of high salt intake and frequency of use and understanding of labelled salt information. We conducted a cross-sectional survey in shopping centres within Metropolitan Melbourne. A sample of 493 subjects was recruited. The questionnaire assessed salt related shopping behaviours, attitudes to salt intake and health and their ability to interpret labelled sodium information. Four hundred and seventy four valid surveys were collected (65% female, 64% being the main shopper). Most participants knew of the relationship between salt intake and high blood pressure (88%). Sixty five percent of participants were unable to correctly identify the relationship between salt and sodium. Sixty nine percent reported reading the salt content of food products when shopping. Salt label usage was significantly related to shoppers concern about the amount of salt in their diet and the belief that their health could improve by lowering salt intake. Approximately half of the sample was unable to accurately use labelled sodium information to pick low salt options. Raising consumer awareness of the health risks associated with high salt consumption may increase salt label usage and purchases of low salt foods. However, for food labels to be effective in helping consumers select low salt foods a more ‘user friendly’ labelling format is needed.

Improving the uptake of pulmonary rehabilitation in patients with COPD : qualitative study of experiences and attitudes

Background
Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim
To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study
Qualitative interviews with patients.

Setting
Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method
In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results
Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion
A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.