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PubMed2001

Models of psychiatric nursing education in developing African countries: a comparative study of Botswana and Nigeria.

BACKGROUND: Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education (PMHNE) in two sub-Saharan African countries--Botswana and Nigeria. METHOD: Examination of the existing PMHNE programmes and responses to a self-reporting questionnaire administered to psychiatric nurse educators from Botswana and Nigeria provided the sources of data. FINDINGS: Findings from both countries revealed that participants used various terms to describe the same model for PMHNE programmes in the countries. Botswana adopted a more functional generalist basic diploma nursing education approach that encouraged an advanced postbasic diploma specialization and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital-based basic specialization with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Although community theme occurred in both countries' curricula, PMHNE in Botswana appeared to be more geared towards the community than in Nigeria. While PMHNE and nursing education generally is affiliated to the University with a clear pathway within the formal higher education system in Botswana, basic and postbasic nursing programmes are mostly run independent of the country's formal higher education system in Nigeria. CONCLUSION: A model that streamlined PMHNE within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of PMHNE in the two countries, and Africa in general, was the need to create a psychiatric-mental health nursing education programme and role that would be appropriate for people's mental health needs and the provision of quality nursing care.

Adult↗
PubMed2000

Evidence for predominant clones in a cyclically parthenogenetic organism provided by combined demographic and genetic analyses.

Aphids are particularly interesting models in the study of genetic and demographic components of plant adaptation because of their breeding system which combines parthenogenesis and sexual reproduction (i.e. cyclical parthenogenesis), and the frequent emergence of host-adapted races reported in this group. In this paper, patterns of host adaptation were assessed on local populations of the aphid Sitobion avenae by following their demographic and genetic structure in a maize field for two consecutive years. The existence of putative generalist (polyphagous) or specialized (host-adapted) genotypes was also investigated by comparing the genotypic distribution of this aphid on maize and other cultivated host plants, using five microsatellite loci. Although population dynamics revealed strong variation in aphid abundance during the colonization period on maize, two genotypes identified at seven additional microsatellite loci were predominant and exhibited stable frequencies over cropping season and between years. Based on present and earlier studies, these two prevalent genotypes were shown to survive on different host plants other than maize, to colonize large geographical zones and to persist parthenogenetically for several years. All these data strongly suggest that these two genotypes are asexual generalist clones that could have been favoured by agricultural practices encountered in western Europe. Besides these two clones, a continual replacement of rare genotypes was observed on maize in both years. Hypotheses involving selection via aphid-plant interactions and natural enemies were proposed for explaining the disappearance of these genotypes on maize.

Alleles↗
PubMed2003

Fine-scale genetic structure of two carabid species with contrasted levels of habitat specialization.

Using microsatellite markers, we compared the genetic structure of populations of two carabid species, one described as a generalist (commonly found in forest and in open habitats) and the other known as a forest specialist. Both species were sampled in the same forest plots, which were separated from each other by either open or forested areas. At the local scale considered (13.6 km separating the most distant plots), genetic differentiation was substantial for both species studied, but populations of the forest specialist Carabus punctatoauratus appeared to be more spatially structured than those of C. nemoralis. Isolation by distance analyses showed that nonforested areas are partial barriers to gene flow for both species studied, although more clearly for the forest specialist. Between and within forests, dispersal capacity of the generalist C. nemoralis was shown to be higher than that of the specialist C. punctatoauratus.

Animals↗
PubMed2000

How definition of mental health problems can influence help seeking in rural and remote communities.

The present study sought to understand the rural and remote influences on people's identification of, and response to, mental health problems. Twenty-two key informants living in northern and western South Australia were interviewed. They included mental health and generalist health professionals, other human service workers and mental health consumers. Three themes are reported here: reluctance to acknowledge mental health problems and the avoidance of appropriate help; stigma and the avoidance of mental health services; and the influence of rural and remote circumstances. Most informants considered that many mental health problems were amenable to help from generalist workers, with backup support from mental health specialists. Informants thought this intervention to be appropriate because a common view of mental health problems as 'insanity' and a culture of self-reliance created a reluctance to seek help from a mental health specialist. These themes need to be taken into account when designing mental health interventions for rural and remote communities.

Australia↗
PubMed2002

A profile of regional psychiatry publishing: home and away.

OBJECTIVE: Previous reports have profiled Australian psychiatry publishing in high-ranking international journals over the last two decades. An audit of selected high ranking and regional psychiatric journals was therefore undertaken to obtain a current profile of Australasian publishing. METHODS: Journals were selected on the basis of impact factors for the year 2000, with the top five regional, generalist and specialist journals being selected, and with publication numbers over a two-year period (1999-2000) compared with numbers from other major geographical regions. RESULTS: Of the 4573 papers identified in the 15 journals, Australasian authors contributed 269 to the regional journals (with two-thirds in the Australian and New Zealand Journal of Psychiatry), 47 to the generalist journals (with two-thirds in Psychological Medicine) and very few (23) to the specialist journals. Representation in the so-called "dominant four" international journals has increased since the 1986-1989 audit. When analysis was made of the "top nine" international journals, the Australasian representation rate was a low 1.8% and lower than most regions examined. CONCLUSIONS: If Australasian psychiatry is to advance its international presence, a greater representation rate in top-ranking international journals should be set as an objective.

Australia↗
PubMed1999

Residency application statements can predict postresidency training.

We sought to evaluate whether residency application statements regarding expected career paths are accurate predictors of early postresidency career paths. We evaluated 162 residents who completed a categorical medicine residency at Georgetown University Hospital between 1990 and 1998 to determine if their stated career plans (generalist practice, subspecialization, or undecided) at application predicted activity immediately after residency. Of 130 residents with defined postresidency plans at application, most 78 (60%) followed those career paths after graduation; 18 (67%) of 27 pursued their initial interest in generalist practice, and 60 (58%) of 103 pursued their stated interest in subspecialty training. We also noted a movement of residents toward generalism (79 [49%] of 162), despite low initial interest (27 [17%] of 162).

Career Choice↗
PubMed2000

Evaluation of a national curriculum reform effort for the medicine core clerkship.

BACKGROUND: In 1995, the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM) developed and disseminated a new model curriculum for the medicine core clerkship that was designed to enhance learning of generalist competencies and increase interest in general internal medicine. OBJECTIVE: To evaluate the dissemination and use of the resulting SGIM/CDIM Core Medicine Clerkship Curriculum Guide. DESIGN: Survey of internal medicine clerkship directors at the 125 medical schools in the United States. MEASUREMENTS AND MAIN RESULTS: The questionnaire elicited information about the use and usefulness of the Guide and each of its components, barriers to effective use of the Guide, and outcomes associated with use of the Guide. Responses were received from 95 clerkship directors, representing 88 (70%) of the 125 medical schools. Eighty-seven (92%) of the 95 respondents were familiar with the Guide, and 80 respondents had used it. The 4 components used most frequently were the basic generalist competencies (used by 83% of those familiar with the Guide), learning objectives for these competencies (used by 83%), learning objectives for training problems (used by 70%), and specific training problems (used by 67%); 74% to 85% of those using these components found them moderately or very useful. The most frequently identified barriers to use of the Guide were insufficient faculty time, insufficient number of ambulatory care preceptors and training sites, and need for more faculty development. About 30% or more of those familiar with the Guide reported that use of the Guide was associated with improved ability to meet clerkship accreditation criteria, improved performance of students on the clerkship exam, and increased clerkship time devoted to ambulatory care. CONCLUSION: This federally supported initiative that engaged the collaborative efforts of the SGIM and the CDIM was successful in facilitating significant changes in the medicine core clerkship across the United States.

Baltimore↗
PubMed2001

What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia?

OBJECTIVE: One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice beliefs. DESIGN: Written survey assessing attitudes about the antibiotic conversion decision. SETTING: Seven teaching and non-teaching hospitals in Pittsburgh, Pa. PARTICIPANTS: Three hundred forty-five generalist and specialist attending physicians who manage pneumonia in 7 hospitals. MEASUREMENTS AND RESULTS: Factors rated as "very important" to the antibiotic conversion decision were: absence of suppurative infection (93%), ability to maintain oral intake (79%), respiratory rate at baseline (64%), no positive blood cultures (63%), normal temperature (62%), oxygenation at baseline (55%), and mental status at baseline (50%). The median thresholds at which physicians believed a typical patient could be converted to oral therapy were: temperature < or =100 degrees F (37.8 degrees C), respiratory rate < or =20 breaths/minute, heart rate < or =100 beats/minute, systolic blood pressure > or =100 mm Hg, and room air oxygen saturation > or =90%. Fifty-eight percent of physicians felt that "patients should be afebrile for 24 hours before conversion to oral antibiotics," and 19% said, "patients should receive a standard duration of intravenous antibiotics." In univariate analyses, pulmonary and infectious diseases physicians were the most predisposed towards early conversion to oral antibiotics, and other medical specialists were the least predisposed, with generalists being intermediate (P <.019). In multivariate analyses, practice beliefs were associated with age, inpatient care activities, attitudes about guidelines, and agreeableness on a personality inventory scale. CONCLUSIONS: Physicians believed that patients could be switched to oral antibiotics once vital signs and mental status had stabilized and oral intake was possible. However, there was considerable variation in several antibiotic practice beliefs. Guidelines and pathways to streamline antibiotic therapy should include educational strategies to address some of these differences in attitudes.

Administration, Oral↗
PubMed2002

Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients.

BACKGROUND: To reduce the prevalence of antibiotic-resistant bacteria in the community, physicians must optimize their use of antibiotics. However, optimal use from the perspective of the community (reserving newer agents for future use) is not always consistent with optimal use from the perspective of the individual patient (prescribing newer, broader agents). OBJECTIVES: To identify preferred patterns of antibiotic prescribing for patients with community-acquired pneumonia (CAP), measure explicit attitudes toward antibiotics and antibiotic resistance, and determine the relationship between these prescribing patterns and attitudes. DESIGN: Cross-sectional anonymous mail survey. PARTICIPANTS: National random sample of 400 generalist physicians (general internal medicine and family practice) and 429 infectious diseases specialists. MEASUREMENTS: Rank ordering of antibiotic preferences for a hypothetical outpatient with CAP and reasons for antibiotic selection. Endorsement of attitudes regarding antibiotic prescribing decisions and resistance. RESULTS: Both generalists and infectious diseases specialists were more likely to prefer newer, broader drugs for the treatment of CAP compared to older agents still recommended by national guidelines. Physicians rated the issue of contributing to antibiotic resistance lowest among 7 determinants of their choices. CONCLUSIONS: Despite national guidelines and increasing public awareness, the public health concern of contributing to the problem of antibiotic resistance does not exert a strong impact on physician prescribing decisions for CAP. Future efforts to optimize antibiotic prescribing decisions will need to consider options for increasing the impact of public health issues on the patient-oriented decisions of individual physicians.

Adult↗
PubMed2002

Gambling: an addictive behavior with health and primary care implications.

Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existing data support the notion that some gambling behaviors, particularly problem and pathological gambling, are associated with nongambling health problems. The purpose of this article is to provide a perspective on the relationship between gambling behaviors and substance use disorders, review the data regarding health associations and screening and treatment options for problem and pathological gambling, and suggest a role for generalist physicians in assessing problem and pathological gambling. A rationale for conceptualization of pathological gambling as an addictive disorder and a model proposing stress as a possible mediating factor in the relationship between gambling and health status are presented. More research is needed to investigate directly the biological and health correlates associated with specific types of gambling behaviors and to define the role for generalist physicians in the prevention and treatment of problem and pathological gambling.

Behavior Therapy↗
PubMed1994

State practice environments and the supply of physician assistants, nurse practitioners, and certified nurse-midwives.

BACKGROUND: Most proposals to increase access to primary care in the United States emphasize increasing the proportion of generalist physicians. Another approach is to increase the number of physician assistants, nurse practitioners, and certified nurse-midwives. METHODS: We analyzed variations in the regulation of nurse practitioners, physician assistants, and certified nurse-midwives in all 50 states and the District of Columbia. Using a 100-point scoring system, we assigned numerical values to specific characteristics of the practice environment in each state for each group of practitioners, awarding a maximum of 20 points for legal status, 40 points for reimbursement for services, and 40 points for the authority to write prescriptions. We calculated coefficients for the correlation of summary measures of these values within states with estimates of the supply of practitioners per 100,000 population. RESULTS: There was wide variation among states in both practice-environment scores and practitioner-to-population ratios for all three groups of practitioners. We found positive correlations within states between the supply of physician assistants, nurse practitioners, and certified nurse-midwives and the practice-environment score for the state (Spearman rank-correlation coefficients, 0.63 [P < 0.001], 0.41 [P = 0.003], and 0.51 [P < 0.001], respectively). Positive associations were also found in the states between the supply of generalist physicians and the supply of physician assistants (r = 0.54, P < 0.001) and nurse practitioners (r = 0.35, P = 0.014). Nevertheless, in the 17 states with the greatest shortages of primary care physicians, favorable practice-environment scores were still associated with higher practitioner-to-population ratios for physician assistants (r = 0.68, P = 0.003), nurse practitioners (r = 0.54, P = 0.026), and certified nurse-midwives (r = 0.42, P = 0.09). CONCLUSIONS: State regulation of physician assistants, nurse practitioners, and certified nurse-midwives varies widely. Favorable practice environments are strongly associated with a larger supply of these practitioners.

Health Services Accessibility↗
PubMed2002

"Oh, that's a bit of a nuisance": community-dwelling clients ' perspectives of urinary continence health service provision.

OBJECTIVE: This study explored clients' perspectives of urinary continence service provision for community-dwelling people from a primary health care perspective. DESIGN: For this interpretive study, data were collected from 11 clients via in-depth interviews and a questionnaire eliciting demographic details and written comment. A focus group was also held with 7 people belonging to an existing continence self-help group. RESULTS: Clients indicated that appropriate and acceptable continence care was accessible, affordable, and based on accurate knowledge. They valued practitioners who were empathetic, interested, had good networks, and could assist in practical ways. They looked for explanation, information, and discussion, often finding this when they accessed continence specialists. However, they often found it difficult to access this type of care, with many clients finding that urinary incontinence was treated as a secondary issue or a nuisance by generalist health practitioners. Clients believed that many health practitioners lacked knowledge and/or interest in urinary incontinence. In particular, there was very poor transitional care between hospital and community. The cost of consulting a health practitioner was seen as secondary to the cost of continence equipment and aids. CONCLUSIONS: This study found that the principles of primary health care were not being realized in generalist continence care. Client- centered services that address individual needs, relationships, psychological factors, emotional needs, financial circumstances, social contexts, and lifestyle factors, particularly in transition between sectors, are needed.

Adolescent↗
PubMed2000

Community nursing and health care in the twenty-first century.

This article reports on research into the changing role of generalist community nurses in Victoria during the 1990's. It provides an analysis of the implications of current policy trends and presents an overview of current practice and trends in contemporary health care delivery in the community. It discusses a vision for community nursing inspired by interviews with generalist community nurses throughout Victoria, and offers creative recommendations and strategies that will facilitate planning for the personal and professional changes necessary to take community services into the twenty-first century.

Community Health Nursing↗
PubMed2005

Monoclonal antibodies reveal the potential of the tetragnathid spider Pachygnatha degeeri (Araneae: Tetragnathidae) as an aphid predator.

The drive towards a more sustainable and integrated approach to pest management has engendered a renewed interest in conservation biological control, the role of natural enemy communities and their interactions with prey. Monoclonal antibodies have provided significant advances in enhancing our knowledge of trophic interactions and can be employed to help quantify predation on target species. The tetragnathid spider Pachygnatha degeeri Sundevall was collected from fields of winter wheat in the UK and assayed by ELISA for aphid proteins. It was demonstrated that this spider did not simply consume greater quantities of aphids because it was bigger. In addition, P. degeeri contained significantly greater concentrations of aphid in their guts than other spiders, showing that aphids comprised a greater proportion of their diet. Although P. degeeri constituted only 6% of the spider population numerically, females and males respectively contained 16% and 37% of total aphid proteins within all spiders screened, significantly more than their density would predict. These spiders also preyed upon aphids at a disproportionately high rate in June, during the aphid establishment phase, theoretically the best time for limiting growth in the aphid population. Although less abundant than other generalist predators, the capability of these hunting spiders to consume large numbers of aphids highlights them as a more significant component of the predator complex than had previously been realized. Limitation of aphid numbers early in the year by generalist predators provides more time for the specialist aphid predators and parasitoids to move in.

Analysis of Variance↗
PubMed2002

Inhibition of the microsomal metabolism of 1,8-cineole in the common brushtail possum (Trichosurus vulpecula) by terpenes and other chemicals.

1. Brushtail possums (Trichosurus vulpecula) ingest large amounts of terpenes in their diet of Eucalyptus leaf. Previously, we showed that dietary terpenes induce the cytochrome P450 enzymes (CYPs) responsible for their metabolism. The present study examined the effects of various CYP inhibitors on the metabolism of 1,8-cineole, the major dietary terpene, by liver microsomes from the possum and rat. 2. Ketoconazole inhibited the major reactions of terpene-induced microsomes in both species: 9-hydroxylation in the possum and 2-hydroxylation in the rat. This suggests the involvement of CYP3A enzymes, although in the possum there was a lack of the expected inhibition by troleandomycin or activation by alpha-naphthoflavone, highlighting the differences between species in CYP forms. Diethyldithiocarbamate also inhibited 9-hydroxylation in the possum, indicating that a CYP2E1-like enzyme contributes to this reaction. 3. Three other dietary terpenes were potent competitive inhibitors of 9-hydroxylation in the possum. K(i) ( micro M) (mean +/- SE, n = 4) were: alpha-pinene, 4.4 +/- 1.1; limonene, 7.8 +/- 2.1; p-cymene, 44.3 +/- 11.2; cuminyl alcohol (a p-cymene metabolite), 6.0 +/- 0.8. It appears likely that p-cymene acts via its metabolite to inhibit 1,8-cineole metabolism. 4. Inhibitory interactions between dietary terpenes, as well as other plant secondary compounds, may impose a significant constraint on foliage consumption in the common brushtail possum, therefore explaining the obligatory generalist nature of this browsing marsupial and other generalist herbivores.

Animals↗
PubMed2004

Principles for development of multi-disciplinary, mental health learning modules for undergraduate, postgraduate and continuing education.

BACKGROUND: People experiencing mental health problems have greater contact with health and welfare professionals in generalist settings than with specialist mental health services. Yet the capacity for generalist professionals to respond effectively to mental health problems is often compromised by inadequate mental health training. The Discipline of Psychiatry at the University of Newcastle developed a series of CD-Rom mental health learning modules for professionals working in non-mental health settings. The paper describes the principles that guided the development of a series and how those principles were applied. DEVELOPMENT PRINCIPLES: The following development principles were adopted. The series should: (i) have a multi-disciplinary application; (ii) be adaptable for presentation in multiple educational domains; (iii) be accessible for rural and remote practitioners; (iv) combine structured solutions-focused lessons (directed learning) with elements of problem-based learning; (v) include working problems that are authentic and relevant; and (vi) describe normal, abnormal and cross-cultural manifestations of problems. APPLICATION OF PRINCIPLES: The model guided the development of a short course series on professional engagement with people who have personality problems. The learning modules provide generic, multi-disciplinary training for a range of practitioners, including nurses, primary care physicians, social workers, psychologists and magistrates. The modules have been adapted for use in undergraduate medical education, postgraduate programs (in population health, nursing, psychology and drug and alcohol studies) and continuing education. CONCLUSION: In contrast to traditional diagnostic-focussed psychiatry training, the model directly addresses the mental health training needs of health and welfare professionals using a multi-disciplinary, problem-based approach.

CD-ROM↗
PubMedDate not supplied

Attitudes of speech and language therapists towards stammering: 1985 and 2000.

BACKGROUND: Past research has indicated that speech and language therapists hold some negative attitudes towards people who stammer, their parents and the treatment of stammering. However, studies on attitudes towards stammering have predominantly focussed on therapists in the USA. Recent trends towards earlier intervention suggest that more therapists in the UK will be involved in working with stammering. AIMS: This study aimed to gather current attitudes of therapists in the UK and to compare them with attitudes measured 15 years previously. It also considered the impact of postgraduate training on attitudes and examined the attitudes of therapists trained in the Lidcombe Programme. METHODS & PROCEDURES: The attitudes of 261 speech and language therapists were measured in a postal survey using the Clinician Attitudes Toward Stuttering (CATS) Inventory. OUTCOMES & RESULTS: The survey revealed an increase in positive attitudes towards early intervention and a reduction in negative attitudes towards people who stammer since the CATS inventory was carried out in 1985. An analysis of generalist and specialist attitudes revealed that generalists were unsure about appropriate treatments to use with people who stammer. Therapists trained in the Lidcombe Programme held some different attitudes about early intervention, people who stammer and the treatment of stammering; however, they continued to view parental counselling as a critical factor in the treatment of the preschool child. CONCLUSIONS: The survey indicated that although therapists were more positive about some aspects of stammering, the treatment of stammering remains a complex issue. All therapists working with clients who stammer would therefore benefit from undertaking ongoing professional development in this area such as additional training, liaison with colleagues and joining a special interest group.

Attitude↗
PubMed2004

A national survey of asthma knowledge and practices among specialists and primary care physicians.

Asthma is a chronic disorder that causes significant morbidity and mortality and requires ongoing chronic care. Approximately two-thirds of people with asthma are receiving care from a primary care clinician, such as an internist, family practitioner, nurse practitioner, or pediatrician. The other one-third of patients are obtaining treatment and ongoing care from specialists, including allergists or pulmonologists. The outcomes of asthma care are a subject of intense investigation. Many studies focus on pharmacotherapy, allergen control, and asthma education as interventions to reduce the morbidity and costs associated with asthma. Fewer studies have explored the differences in outcomes between asthmatic patients cared for by specialists compared with generalists. Even fewer have explored the practice differences between generalists and specialists that may relate to outcomes of care. With the advent of national asthma guidelines and the high prevalence of asthma seen in primary care settings, it is important to investigate the knowledge, attitudes, and practices of primary care physicians with regard to asthma.

Asthma↗