bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription drug misuse: quantifying the experiences of New Zealand GPs
Authors: Sheridan Janie , Jones Sophie , Aspden Trudi
Published: November 2018

INTRODUCTION: The misuse of prescription drugs for their psychoactive effects is an international problem. To date, there is a paucity of quantitative data on prescription drug misuse (PDM) in New Zealand, especially data investigating the experiences of general practitioners (GPs). AIM: To quantify GPs experiences regarding PDM in New Zealand in terms of the extent of the problem, challenges faced, problem drugs, and actions taken by GPs once PDM is suspected. METHOD: A cross-sectional postal survey of a random sample of 300 GPs in New Zealand was undertaken. RESULTS: A 45.7% response rate was achieved. Approximately two-thirds of GPs (65.9%) had diagnosed at least one patient with a PDM problem in the last 12 months. Thirty percent of respondents indicated that they had been faced with at least one challenge in the past 12 months, with verbal threats being the most common of these (16.3%). Benzodiazepines and opioids were identified as the most problematic drug classes. The action usually taken by the greatest number of GPs once they suspected PDM was to document it (97.9%) followed closely by suggest an alternative drug (96.7%) and refrain from prescribing the drug (91.9%). DISCUSSION: PDM is an issue for GPs. The findings from this study have highlighted the need for further research into this concerning issue, specifically further quantification of the size of the problem in the New Zealand general population. There is also a need for the development and implementation of interventions to help minimise and better manage PDM in New Zealand. KEYWORDS: Prescription drugs; pharmaceutical; drug abuse; drug misuse; general practitioners; New Zealand; questionnaires; quantitative
The Green Prescription programme and the experiences of Pacific women in Auckland
Authors: Tavae Nicola , Nosa Vili
Published: November 2018

INTRODUCTION: Extensive research has shown the effectiveness and cost-effectiveness of the Green Prescription (GRx) but none has focused on the experiences of Pacific women who have been through the GRx programme. The research aim was to investigate the experience of the GRx programme for Pacific women in Auckland, New Zealand. METHODS: Qualitative data from in-depth interviews with 20 Pacific women aged 40 years and older, who had been members of a GRx programme in Auckland City and Counties Manukau and had been discharged as independently active. FINDINGS: Pacific women had positive experiences of the GRx programme and identified an improvement in their physical activity, lifestyle behaviours and consequent health improvements. Positive experiences can be attributable to the social and friendly atmosphere created by their peers and staff, exercise options, and education workshop components. The social aspect of the GRx programme was the primary reason the women enjoyed and completed the programme. CONCLUSION: Pacific women reported health improvements from participation in the GRx programme. Further research is indicated to explore the health impact of the GRx for Pacific people and the benefits and acceptability of the programme for Pacific ethnic groups. KEYWORDS: Exercise referral schemes; Green Prescription; Pacific women; physical activity
Forgone health care among secondary school students in New Zealand
Authors: Denny Simon , Farrant Bridget , Cosgriff John , Harte Mo , Cameron Toby , Johnson Rachel , McNair Viv , Utter Jennifer , Crengle Sue , Fleming Theresa , Ameratunga Shanthi , Sheridan Janie , Robinson Elizabeth
Published: November 2018

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services. KEYWORDS: Access to health care; adolescent health services; general practice; preventive health services
Miscommunication between patients and general practitioners: implications for clinical practice
Authors: Morgan Sonya
Published: November 2018

INTRODUCTION: Effective communication is integral to the general practice consultation, yet it is acknowledged that problems commonly occur. Previous research has shown that misunderstandings with potentially significant consequences occur frequently, but does not provide a clear picture of how and why miscommunication occurs, or how such problems can be prevented or resolved. This study explored the occurrence and management of specific examples of miscommunication in two routine general practice consultations. METHODS: A multi-method case study approach was used. The primary data collected for each case included a video-recorded consultation and post-consultation interviews with each general practitioner (GP) and patient. Instances of communication mismatch were examined using in-depth interaction analysis techniques. FINDINGS: GPs and patients may not be aware when misunderstandings have occurred. In-depth analysis of the case studies revealed the complexity of miscommunication: it was not a straightforward matter to locate when or why instances of communication mismatch had occurred, and each of the mismatches was quite distinctive: (1) they were identified in different ways; (2) they occurred at different points in the communication process; (3) they arose because of problems occurring at different levels of the communication, and (4) they had different consequences. CONCLUSION: Given the frequency and complexity of miscommunication in general practice consultations, GPs need to consider adopting various strategies, at both the practice/systems level and the level of the consultation interaction to minimise the risk of communication problems. KEYWORDS: Communication; general practice; physician-patient relations
Transient ischaemic attack and stroke risk: pilot of a primary care electronic decision support tool
Authors: Ranta Annemarei
Published: November 2018

INTRODUCTION: Transient ischaemic attacks (TIAs) indicate high risk for stroke and rapid management reduces stroke burden. Rapid specialist access to initiate timely management is often challenging to achieve. AIM: To assess the feasibility of implementing a TIA/Stroke electronic decision support (EDS) tool intended to aid general practitioners (GPs) in the timely management of TIAs. METHODS: An eight-week pilot provided access to the TIA/Stroke EDS to selected GPs in the MidCentral district, with subsequent patient record review and a post-pilot user satisfaction survey. RESULTS: Eleven patients from eight practices were entered into the tool and when EDS-rendered advice was followed, diagnosis was accurate and management was in accordance with New Zealand TIA guidelines. No adverse outcomes resulted and user feedback was positive. DISCUSSION: Results indicate that wider implementation of the TIA/Stroke EDS tool is feasible. KEYWORDS: Decision support systems; primary health care; software; stroke; transient ischaemic attack
Abortion services in a high-needs district: a community-based model of care
Authors: Snook Simon , Silva Martha
Published: November 2018

INTRODUCTION: In 2009, a high-deprivation district health board in New Zealand set up a community-based abortion clinic in order to provide a local service and to avoid out-of-region referrals. The service offers medical abortions for women with pregnancies of up to 63 days gestation, and surgical abortion with local anaesthetic for women with pregnancies of up to 14 weeks gestation. AIM: To describe the services developed and assess safety and timeliness for the first year of community-based services. METHODS: An audit of clinical records for patients seen in 2010 was performed in order to obtain data on location of services, timeliness, safety and complications. RESULTS: Eighty-two percent of locally provided abortions in 2010 were medical abortions, completed on average less than two days after referral to the service. One percent of patients experienced haemorrhaging post abortion, and 4% had retained products. These rates are within accepted standards for an abortion service. DISCUSSION: This report illustrates that a community-based model of care can be both clinically and culturally safe, while providing a much-needed service to a high-needs population. KEYWORDS: Abortion, induced; community health services; delivery of health care; New Zealand
Implementing a Continuity of Cancer Care nursing role into a New Zealand primary health organisation  the patients perspective
Authors: Scrymgeour Gill , Forrest Rachel , Marshall Bob
Published: November 2018

INTRODUCTION: A Continuity of Cancer Care pilot project was established in two urban general practices, with the goal of improving cancer care and patient access to services. Practice nurses were engaged as coordinators to implement a model of care and patient navigation to offer continued and consistent care, and to assist the patient to navigate their cancer experience. AIM: The aim was to evaluate the effectiveness of the Continuity of Cancer Care pilot project. METHODS: Patients enrolled in the pilot project were invited to participate. Each participant completed a Patient Satisfaction Questionnaire and SF-12 Health Survey, and was then invited to take part in an interview. The evaluation framework utilised concepts of informational, management and relational continuity. RESULTS: The SF-12 subcategories of physical functioning, role physical, bodily pain and role emotional were lower than other results from cancer patients in the literature. The Patient Satisfaction Questionnaire and interviews indicated patients were satisfied with the relational continuity components of the project, but that gaps existed within the management and informational continuity aspects of care. DISCUSSION: Overall, the participants were satisfied with the Continuity of Cancer Care programme and valued the support, clarification and listening aspects of the programme. However, when evaluated in relation to a more comprehensive definition of continuity of care, there were distinct gaps. While the relational aspects of continuity of care were mostly achieved, the management and informational aspects appeared to be limited primarily to nurses acting to interpret hospital and general practitioner comments for patients. KEYWORDS: Cancer; continuity of patient care; general practice; nurses; nursing evaluation research; primary health care
Equity in statin use in New Zealand
Authors: Norris Pauline , Horsburgh Simon , Becket Gordon , Keown Shirley , Arroll Bruce , Lovelock Kirsten , Crampton Peter , Cumming Jackie , Herbison Peter
Published: November 2018

INTRODUCTION: Preventive medications such as statins are used to reduce cardiovascular risk. There is some evidence to suggest that people of lower socioeconomic position are less likely to be prescribed statins. In New Zealand, Maori have higher rates of cardiovascular disease. AIM: This study aimed to investigate statin utilisation by socioeconomic position and ethnicity in a region of New Zealand. METHODS: This was a cross-sectional study in which data were collected on all prescriptions dispensed from all pharmacies in one city during 2005/6. Linkage with national datasets provided information on patients age, gender and ethnicity. Socioeconomic position was identified using the New Zealand Index of Socioeconomic Deprivation 2006. RESULTS: Statin use increased with age until around 75 years. Below age 65 years, those in the most deprived socioeconomic areas were most likely to receive statins. In the 5564 age group, 22.3% of the most deprived population received a statin prescription (compared with 17.5% of the mid and 18.6% of the least deprived group). At ages up to 75 years, use was higher amongst Maori than non-Maori, particularly in middle age, where Maori have a higher risk of cardiovascular disease. In the 4554 age group, 11.6% of Maori received a statin prescription, compared with 8.7% of non-Maori. DISCUSSION: Statin use approximately matched the pattern of need, in contrast to other studies which found under-treatment of people of low socioeconomic position. A PHARMAC campaign to increase statin use may have increased use in high-risk groups in New Zealand. KEYWORDS: Ethnic groups; New Zealand; prescriptions; socioeconomic status; statins
Potion or Poison? Nasal saline for chronic rhinosinusitis
Authors: Scahill Shane
Published: November 2018

SUMMARY MESSAGE: There is evidence to support nasal saline flushing for symptom management in chronic rhinosinusitis and in the treatment setting, as an adjunct to intranasal steroid therapy. Although relatively well tolerated, minor side effects are common and relate to the local effect of the saline, including burning, irritation, nose bleeds, and headache. There is a commercially available preparation that delivers a high volume rinse. Studies suggest significant effort is involved in preparing and delivering solutions and that excessive drainage subsequent to administration can occur. According to a Cochrane review, the beneficial effect of saline appears to outweigh these drawbacks for the majority of patients.
A patient-centred clinical approach to diabetes care assists long-term reduction in HbA1c
Authors: Titchener Janet
Published: November 2018

INTRODUCTION: Patient-centred care has proven to be cost-effective, with a positive impact on health outcomes. A patient-centred approach is recognised as a desirable component of diabetes care. AIM: The aim of this audit was to determine if the specific patient-centred intervention offered by a clinical service (GPSI Diabetes service) improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). METHODS: The GPSI Diabetes service is a community-based service, run by a general practitioner with a specific interest (GPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their general practitioner (GP) and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their GP. Baseline HbA1c was recorded at intake and for two years after discharge from the service. Patient and GP satisfaction questionnaires were also completed. RESULTS: New Zealand (NZ) Europeans and Maori with Type 2 diabetes and Type 1 diabetes experienced immediate and sustained (two-year) improvements in HbA1c. At intake, baseline HbA1c for Maori was higher than that of NZ Europeans. However, following this patient-centred intervention, this difference was reduced. None of the returned GP or patient questionnaires contained negative feedback, although the patient response rate was low. DISCUSSION: A patient-centred clinical approach to diabetes can contribute to significant and sustained reductions in HbA1c. This clinical approach is potentially reproducible in other clinical settings and could also be applied to the management of other chronic conditions. KEYWORDS: Chronic disease; clinical audit; diabetes mellitus; patient-centered care; self-management
Primary health care nurses and heart failure education: a survey
Authors: Gilmour Jean , Strong Alison , Chan Helen , Hanna Sue , Huntington Annette
Published: November 2018

INTRODUCTION: Heart failure education contributes to effective self-management. New Zealand primary health care nurses contributions to heart failure educational activities have not been researched. AIM: To identify primary health care nurses heart failure educational activities in terms of duration and frequency, topics covered, resources used and strategies for Maori and other ethnic groups. METHODS: A cross-sectional survey of a random sample of 961 primary health care nurses using a postal questionnaire. RESULTS: Of 630 respondents (65.5%), 369 worked with patients with heart failure and 339 provided heart failure education. One-third of respondents providing education (33.3%; n=113) delivered sessions from 16 to 60 minutes. The main educational topics covered were on the physical aspects of heart failure; prognosis, spiritual/existential and psychosocial topics were least often addressed. One-quarter of the group providing education did not use educational resources (n=86). The majority of respondents reported they would find more education about heart failure useful or very useful (80.2%; n=292), along with nurse practitioner support (64.7%; n=229). Maori-centred services and resources and involving whanau/family in education were the most frequently mentioned Maori-specific education strategies. DISCUSSION: A consistent approach to heart failure education is important to address knowledge gaps in a timely manner. This study affirms the contribution made by primary health care nurses in chronic illness education and highlights the need for further development and investment in ongoing heart failure nursing education and specialist nursing support. KEYWORDS: Health education; heart failure; Maori; nurses; primary health care; self care
Medication use in community-dwelling older people: pharmacoepidemiology of psychotropic utilisation
Authors: Schäfers Anna , Martini Nataly , Moyes Simon , Hayman Karen , Zolezzi Monica , McLean Chris , Kerse Ngaire
Published: November 2018

INTRODUCTION: Psychotropic medications have a significant adverse drug event profile, particularly in older adults, and appropriate use is paramount. Patterns of prescribing in community-dwelling older adults in New Zealand remain unknown. AIM: This study aimed to determine the prevalence and the pattern of psychotropic use amongst community-dwelling older people in New Zealand and to identify any association between depressive symptomatology and psychotropic medication use. METHODS: Data were collected on the demographics, medication use and mood status of community-dwelling older adults from two New Zealand studies: the BRIGHT trial, which recruited potentially disabled participants (N=141) and the DeLLITE trial, which recruited potentially depressed participants (N=193). The prevalence and the pattern of psychotropic use were established and the gender, age and level of depression assessed using regression analysis. RESULTS: The use of any psychotropic medication was 28.9% in the BRIGHT trial and 43.5% in the DeLLITE trial. Antidepressants were the most commonly used psychotropic medication in the two studies, followed by hypnotics and sedatives. Psychotropic use was highly correlated with the presence of depressive symptoms in the BRIGHT trial and with female gender in the DeLLITE trial. Age was not associated with psychotropic medication use. In both studies, there is possible underdiagnosed, undertreated and inappropriately treated depression. DISCUSSION: The prevalence of psychotropic medication use is high in community-dwelling older people with disability and very high in community-dwelling older people with depressive symptoms, but varies by gender and level of depression. KEYWORDS: Aged; depression; independent living; New Zealand; psychotropic drugs
Changing trends in pregnancy registration for New Zealand women
Authors: Dixon Lesley , Andrews Alison , Eddy Alison , Guilliland Karen , Hendry Chris , Houston Jo
Published: November 2018

INTRODUCTION: Early pregnancy registration is recommended and provides an opportunity for screening, risk assessment and health promotion. AIM: To determine the gestation at pregnancy registration for a cohort of pregnant New Zealand women who received maternity care from a midwife Lead Maternity Carer (LMC) and to determine if women are registering earlier in pregnancy. METHODS: The gestation of pregnancy at registration was reviewed for the 81 821 women who registered with a midwife LMC between 2008 and 2010 and had data recorded in the New Zealand College of Midwives Clinical Outcomes Research Database (COMCORD). RESULTS: Over the three-year period, there was a trend towards earlier registration with 22.0% of women registering before 10 weeks' gestation in 2008 increasing to 29.9% in 2010. Women of New Zealand European ethnicity were more likely to register before 10 weeks' gestation compared to women who identified as Maori or Pacific ethnicity. Women under 20 or over 40 years of age were more likely to register in the second or third trimester than other age groups. DISCUSSION: Groups that were slower to register with a midwife LMC were women under 20 years or over 40 years of age and women of Maori or Pacific ethnicity. These groups have higher perinatal mortality rates, higher rates of smoking and lower uptake of antenatal Down syndrome screening. Further research is required to explore the barriers to earlier registration for these groups. KEYWORDS: Midwifery; pregnancy; pregnancy trimester, first; prenatal care
The effect of ethnicity on different ways of expressing cardiovascular treatment benefits and patient decision-making
Authors: Raval Manjri , Goodyear-Smith Felicity , Wells Susan
Published: November 2018

INTRODUCTION: The way information is presented to communicate risk and treatment benefit affects patients' understanding and perception of their risk and can influence their decisions. AIM: To assess the effect of ethnicity on patient preferences for different ways of expressing risk and treatment benefits. METHODS: Using tailored questionnaires, we surveyed Maori, Pacific and Indian peoples of known CVD risk to assess format preferences encouraging them to take medication or assist their understanding of possible treatment benefits. Statistical analysis determined any association of ethnicity with patient preferences. RESULTS: Of the 376 participants, 50% identified as New Zealand (NZ) European; 15% Maori; 25% Pacific and 10% Indian ethnicity. Patients preferred positive framing of risk (66%). Relative risk was the format reported as most encouraging to take medication and to understand risk, with natural frequencies least preferable, although Pacific people significantly preferred natural frequencies (p<0.0001) compared with other ethnic groups. The majority (55%) preferred pictures to numbers for explaining risk. Maori, Pacific and Indian participants significantly preferred 100-people chart formats over bar graphs compared with NZ Europeans/Others (p=0.002). Most (68%) preferred doctors to give their opinion on taking medication instead of explaining risks using numbers and/or pictures. Pacific and Indian peoples significantly preferred doctors to make decisions on treatment compared to NZ European/Other and Maori participants (p<0.0001). DISCUSSION: Ethnic differences in patient preferences for communication formats and decision-making should be considered when tailoring effective communication in primary care. However, individual preferences cannot be presumed and a combination of methods should routinely be used. KEYWORDS: Decision making; ethnicity; health communication; patient preference; primary health care; risk assessment
The rural medical generalist workforce: The Royal New Zealand College of General Practitioners’ 2014 workforce survey results
Authors: Wong Deanne L. , Nixon Garry
Published: November 2018

ABSTRACT

INTRODUCTION
Previous surveys have revealed a New Zealand rural medical generalist workforce that is mainly male, older and dependent on international medical graduates (IMGs).

AIMS
To provide a snapshot of the New Zealand rural medical generalist workforce in 2014 and to make comparisons with the urban medical generalist workforce. To assess future workforce losses and find ways to address them.

METHODS
In March/April 2014, a survey of members of The Royal New Zealand College of General Practitioners used the SurveyMonkey tool. A comparative analysis was undertaken ofself-identified rural and urban respondents.

RESULTS
The response rate was 55.9% (2525/4514). Of the 2203 working respondents, 17.1% self-identified as rural, working in rural general practice or rural hospital medicine. Compared with urban respondents, more rural generalists were male (57.5% rural vs 45.5% urban; P < 0.01), aged ≥ 55 years (38.2% rural vs 32.6% urban; P = 0.04) and involved in teaching (53.0% rural vs 30.0% urban; P < 0.01). IMGs were an integral part of the rural generalist workforce (52.8% rural vs 38.7% urban; P < 0.01). More rural generalists worked ≥ 36 h per week (66.8% rural vs 50.4% urban; P
< 0.01) and they were more likely to retire within the next 10 years (40.4% rural vs 34.7% urban; P = 0.0417).

DISCUSSION
The rural medical generalist workforce continues to be mainly male, older and consist of a high proportion of IMGs. Findings confirm the fragility of this workforce and highlight the need for renewed efforts to improve recruitment and retention.
Viewpoint: Peer support workers: an untapped resource in primary mental health care
Authors: Perez Juan , Kidd Jacquie
Published: November 2018

The treatment of moderate to severe mental illness in a primary health care setting is an area under development and can be contentious. The capacity, capability, resourcing and willingness of staff and organisations all feature in the discussions among specialist services and primary health care providers about the opportunities and barriers associated with primary mental health care. This paper presents the peer support worker as an untapped resource that has the potential to support the patient, primary health care staff, and general practitioner in the care of people who fall outside the current understanding of 'mild' mental health problems, but who would nonetheless benefit from receiving their care in a primary health care setting. KEYWORDS: General practice; mental health; mental health services, community; primary health care
Audit of a Services to Improve Access project to improve access for skin cancer surgery
Authors: Mayne A. S. D.
Published: November 2018

ABSTRACT
Like many general practices in low decile communities with a high percentage of elderly patients, the Paeroa Medical Centre was relying heavily on secondary care to provide skin cancer surgical services, which led to delays in treatment and under-utilisation of the skills available in primary care. A new system utilising Services to Improve Access (SIA) funding was developed to provide partially funded skin cancer surgery within primary care. A 6-month period of this work by one general practitioner (GP) was audited. This has demonstrated that the majority of minor dermatological surgery can be successfully managed in primary care, with more timely and convenient treatment and substantial cost savings to the health system.
Effect of Al content on hot tearing behaviour of Mg–xAl–2Ca–2Sm alloys
Authors: Chen Yanhong , Wang Liping , Feng Yicheng , Wang Lei , Guo Erjun
Published: November 2018

Mg– xAl–2Ca–2Sm ( x = 3, 5, 9 and 15) alloys were tested using an ‘L’-shaped sand mould serving as a hot tearing testing system. The experimental results showed that the solidification range of the Mg– xAl–2Ca–2Sm alloys first decreased and then increased as the Al content was increased. Furthermore, by increasing the Al content, the dendritic arms of the α-Mg phase become more developed, and the hot tearing tendency of the Mg– xAl–2Ca–2Sm alloys increased. In addition, the variety of precipitated phases was seen to be affected by the Al content and the tendency for hot tearing depended on the precipitated phase. The tendency of the Mg– xAl–2Ca–2Sm alloys for hot tearing first decreased and then increased with increasing Al content.
Synthetic Cannabinoid use among a Sample of Individuals Enrolled in Community-Based Recovery Programs: Are Synthetic Cannabinoids Actually Preferred to other Drugs?
Authors: Smith Kirsten Elin , Staton Michele
Published: November 2018

Background: Over the past decade, availability and use of novel psychoactive substances such as synthetic cannabinoid receptor agonists (SCRA) have proliferated globally. However, the prevalence of SCRAs use remains uncertain, as does the degree to which individuals reporting SCRA use prefer SCRA to other drugs. Methods: In April 2017, a total of 500 anonymous surveys were completed by clients enrolled in a residential drug recovery program. Chi-square and t tests were used to examine significant differences between those who had ever used SCRA and those who had not. Logistic regression analysis was conducted in order to determine which other substances used within the past 12 months were significantly associated with past-12-month SCRA use. Results: About 69% (68.4%) of clients reported lifetime SCRA use. Those reporting SCRA use were predominantly younger ([Formula: see text] vs. 40.7, P < .001), single (60.3% vs. 48.1%, P = .011), and white (87.1% vs. 77.7%, P = .008) and were more likely to have experienced past-12-month homelessness (6.5% vs. 3.2%, P = .004). This group had higher rates of probation/parole involvement (79.2% vs. 61.8%, P < .001) and incarceration (91.8% vs. 79.6%, P < .001). Individuals reporting SCRA use also showed extensive substance use histories and favored heroin, opioids, and amphetamines compared with SCRA. Only 5.2% of the SCRA-using group stated that SCRA was a preferred substance, and only 11.8% reported that they would try SCRA again. E-cigarettes (adjusted odds ratio [AOR] = 1.88), traditional cannabis (AOR = 3.87), amphetamines (AOR = 2.20), and synthetic cathinones (AOR = 3.51) were significantly associated with past-12-month SCRA use. Motivations for use included circumnavigating drug screens and peer influence. Approximately half of those who tried SCRA reported adverse effects associated with use. Conclusions: Prevalence of SCRA use among individuals with a history of substance misuse and criminal justice system involvement is high; however, SCRA are not indicated as a preferred drug.
Propionibacterium acnes related anti-inflammation and skin hydration activities of madecassoside, a pentacyclic triterpene saponin from Centella asiatica
Authors: Shen Xueqing , Guo Miaomiao , Yu Haiyuan , Liu Dan , Lu Zhi , Lu Yanhua
Published: November 2018

Madecassoside is a major pentacyclic triterpene saponin from Centella asiatica with multiple pharmaceutical activities. In this study, we focused on its Propionibacterium acnes related anti-inflammation and skin hydration activities, both of which play important roles in skin homeostasis and barrier function. Madecassoside significantly inhibited the pro-inflammatory cytokine IL-1β, TLR2 and nuclear translocation of NF-κB in P. acnes stimulated THP-1 human monocytic cells. In addition, madecasssoside exhibited significant effects on enhancement of skin hydration through increasing the key moisturizing contributors of aquaporin-3, loricrin and involucrin in HaCaT keratinocytes as well as hyaluronan (HA) secretion in human dermal fibroblasts. The upregulation of HA synthases (HAS1, HAS2, HAS3) and inhibition to ROS formation accounted for the increment of HA content. Together, the in vitro study implied the potential medical and cosmetic application of madecassoside in skin protection.
What’s law got to do with it?: A reply to Baldez and Bunting
Authors: DeLaet Debra L.
Published: November 2018

This reply explores points of agreement, tensions, and lingering questions related to a scholarly conversation among the pieces by DeLaet, Baldez, and Bunting on the potential and limits of international human rights law as a tool for promoting women's rights and equality as part of this special edition of Global Discourse on Gender, Sexuality, and the Law. DeLaet's piece takes a macro view of this question and points to the failure of international human rights law to generate systemic change globally. In her examination of Cuba's participation in the Convention on the Elimination of Discrimination against Women, Baldez offers a relatively more positive assessment of the potential for international human rights law to transform human rights outcomes when states participate in treaty reporting processes. Focusing specifically on international criminal law, Bunting's exploration of Ugandan victim survivors’ views on the prosecution of crimes against humanity at the International Criminal Court offers a mixed perspective, whereby international criminal trials may provide political space for meaning-making and historical documentation even if they do not provide for restorative justice, healing, or gender equality. Each of these pieces indicates that law in and of itself is insufficient to generate transformative change in support of women's rights and equality. They differ in the extent to which they view law as a primary tool for mobilizing change.
Ethics, Rhetoric, and Culture
Authors: Arnett Ronald C.
Published: November 2018

Signification of human meaning dwells in ethics and culture, finding expression in and through rhetorical practices. Ethics and culture consist of goods and practices that gather the meaningful and the important together, yielding urgency for rhetorical employment of those practices. The union of ethics, culture, and rhetoric offers a coherent dwelling for the protection and promotion of the consequential. Ethics and culture house actions of meaningfulness that compel rhetorical expression, announcing a stance attentive to the vital, reminding self and informing other of a particular account of the consequential. Ethics and culture adjudicate a sense of ground that nourishes rhetorical understanding and engagement with the world. Rhetoric explicates practices of import that reflect the performative reality of ethics and culture, retelling self and other about the crucial. Rhetoric permits self and other to interrogate a ground of distinctive goods and practices that structure the noteworthy. Rhetoric facilitates discovery, testing, and knowledgeable implementation. It moves ethics and culture from points of abstraction to knowing public coordinates in a communicative social world that is impactful on self and others. The interplay of ethics, culture, and rhetoric in their triconstruction and enactment engenders human meaning. Rhetoric thrusts unique versions of ethics and culture into the public domain, and such action renders practical awareness of the existence of contrasting content of import. Acknowledging dissimilarity exposes and probes contrasting goods and practices. Rhetoric enhances public knowledge of differences undergirding juxtaposed ethical and cultural stances.
Homi Bhabha and Communication Studies
Authors: Elam J. Daniel
Published: November 2018

Homi Bhabha (b. 1949) is among the founding generation of scholars of “postcolonial theory” as it emerged in the U.S. and U.K. academies in the 1980s and 1990s, and is currently the Anne F. Rothenberg Professor of English and American Literature and Language.

Bhabha’s intellectual emergence coincided with the emergence of “postcolonial theory” in the 1980s and 1990s. Bhabha’s particular contribution to postcolonial critique is unique in successfully combining the fields of post-structuralism, history, and psychoanalysis, and in relationship to the texts and histories of British rule in South Asia. Bhabha is best situated within an often-overshadowed strain of postcolonial theory committed to the recovery of universality rather than the demand for particularity, a lineage that includes Frantz Fanon and Edward Said.

Bhabha’s key concepts and terms, especially “ambivalence” and “hybridity,” have been taken up across many fields under the rubrics of postcolonial and/or diasporic intervention. Bhabha’s writing and theoretical arguments are based primarily in perpetual negotiation, in opposition to negation. Understanding this key intervention makes it possible to grasp the full scale of Bhabha’s driving concerns, theoretical conceptions, and political commitments.
Communication Apprehension
Authors: Sawyer Chris R.
Published: November 2018

Communication scholarship has profited greatly by the rise of social science during the mid-20th century. This scientific progress has been marked by increased outlets for peer-reviewed research, thriving sub-disciplines, and a rapidly accumulating corpus of findings. Social scientists have accomplished this feat largely by conducting tests of empirical models and their associated constructs. Over the same span of time, the discipline’s most prolific researcher, James C. McCroskey, pioneered the study of the construct with which he is most closely associated. Communication apprehension (CA) has impelled generations of scholars to investigate possibly the greatest impediment to successful communication, namely the fear of interacting with fellow humans. Tracing its development reveals that CA meets the standards for theory bridges: truth, abstraction, progress, and applicability. Consequently, describing CA as a bridge construct rests on four interrelated claims. First, the primary aim of CA research is to discover the truth about social anxiety. Studies of CA have outstripped competitor explanations for speaker anxiety by yielding an extensive literature of peer-reviewed articles, books, and doctoral dissertations. These writings are predicated on the presumption that CA taps into the true nature of social anxiety. Second, self-reported measures of CA, such as the PRCA-24, allow for enough abstraction to support scientific generalization. This makes it possible for CA researchers to connect concrete observations to abstract principles. Third, CA research contributes to scientific progress in communication. Explanations for CA have generally reflected theories and perspectives at the horizon of the field. Last, CA research impacts on the quality of everyday life. Ultimately, CA researchers seek to develop treatment and educational strategies for the one-fifth of the general population afflicted with this condition. Taken together, CA has served as a bridge construct that enables scholars to pursue truth, formulate testable generalizations, achieve scientific progress, and potentially improve the quality of human life.
Research Methods in Sport and Exercise Psychology
Authors: Liu Sicong , Tenenbaum Gershon
Published: November 2018

Research methods in sport and exercise psychology are embedded in the domain’s network of methodological assumptions, historical traditions, and research themes. Sport and exercise psychology is a unique domain that derives and integrates concepts and terminologies from both psychology and kinesiology domains. Thus, research methods used to study the main concerns and interests of sport and exercise psychology represent the domain’s intellectual properties.

The main methods used in the sport and exercise psychology domain are: (a) experimental, (b) psychometric, (c) multivariate correlational, (d) meta-analytic, (e) idiosyncratic, and (f) qualitative approach. Each of these research methods tends to fulfill a distinguishable research purpose in the domain and thus enables the generation of evidence that is not readily gleaned through other methods. Although the six research methods represent a sufficient diversity of available methods in sport and exercise psychology, they must be viewed as a starting point for researchers interested in the domain. Other research methods (e.g., case study, Bayesian inferences, and psychophysiological approach) exist and bear potential to advance the domain of sport and exercise psychology.
Cognitive Rehabilitation in Mild and Moderate Dementia
Authors: Kudlicka Aleksandra , Clare Linda
Published: November 2018

The number of people living with dementia is growing, and with limited pharmacological treatment options the importance of psychosocial interventions is increasingly recognized. Cognitive rehabilitation is particularly well placed to address the needs of people living with mild and moderate dementia and their family supporters, as it offers a range of tools to tackle the complexity of the condition. It utilizes powerful approaches of problem solving and goal setting combined with evidence-based rehabilitative techniques for managing cognitive impairments. It also incorporates strategies to address emotional and motivational aspects of dementia that may affect a person’s well-being. It is provided on an individual basis, usually in people’s homes, making it directly applicable to everyday life. It is also genuinely person-centered and flexible as the therapy goals are agreed in a collaborative process between the therapist, person with dementia, and family members. Cognitive rehabilitation does not claim to address underlying pathology, but instead focuses on a person’s functional ability and enjoyment of life.

Evidence for effectiveness of cognitive rehabilitation in the context of mild and moderate dementia, mostly Alzheimer’s disease (AD), is gradually accumulating with a number of randomized control trials demonstrating that people with mild and moderate dementia can significantly improve their functioning in targeted areas. For example, the GREAT trial with 475 people with mild to moderate Alzheimer’s, vascular, and mixed dementia completed in 2017 in the United Kingdom demonstrated that cognitive rehabilitation improves everyday functioning in relation to individual therapy goals.

There is a growing interest in cognitive rehabilitation and the focus shifts to extending evidence to less-common forms of dementia, particularly in people with non-amnestic presentation. Future efforts need to concentrate on promoting the approach and optimizing application in real-life settings with the aim of maximizing benefits for people living with dementia and their families.
Economic Crises, Common Crime, and Penality
Authors: Brandariz José A. , González-Sánchez Ignacio
Published: November 2018

The influence of economic crises on crime and penality is one of the fundamental issues in economic analysis of the punitive field, and the topic has been explored from various perspectives in a wide range of criminology theories. From a criminal-motivation viewpoint, economic crises are seen to favor crime-rate growth because of their serious effects of increasing unemployment, increasing in poverty, and generating inequality. Similarly, diverse economic approaches to penality (though not all of them, for example, law- and economics-based theses) hold that economic crises usually produce a rise in punitiveness and a consequent rise in incarceration rates.

However, specialized academic literature has highlighted that the generally accepted view is far from accurate in all cases. Economic crises do not necessarily produce an increase in crime (at least not in all types of crime), nor do they always lead to an increase in punitiveness. Indeed, empirical studies about the effect of diverse economic crises (the Great Depression, the oil crisis of the 1970s, and the recent Great Recession) reveal an ambiguous panorama of the evolution in crime and penality.

The impact of economic turmoil on crime and punishment should be examined in all its complexity. Crime rates and incarceration rates are hardly correlated, and the latter are far more influenced by a variegated set of political, social, cultural, and economic forces than by changes in crime patterns themselves. To scrutinize the effect of economic determinants on the penal field, the analysis of economic crises and crime should therefore be separated from the analysis of economic crises and penality. Unfortunately, there is a shortage of academic literature and empirical data on the implications of pre-21st-century financial crises for crime and punishment. The recent Great Recession thus has great utility for delving into the consequences of periods of economic chaos on crime and punitiveness.
Teaching and Learning in the Art Museum
Authors: Pringle Emily
Published: November 2018

Activities that actively and deliberately support museum visitors’ engagement with art and promote learning occupy a distinct, though contested, place in the history and current framing of the art museum across the globe. Despite its many benefits, educational work in art museums has grown erratically, frequently without formal structures, systems, or strategies, and it has been critiqued in the past for lacking a robust theoretical framework and consistent methodological principles. It remains the case that the field is broad, diverse, and continually evolving; in the early 21st century, the boundaries are shifting, for example, between what constitutes curatorial practice and learning practice in contemporary art museums. This fluidity and heterogeneity has enabled the emergence of creative and responsive practice that encourages visitors to learn with, through, and about art, but it poses challenges when the goal is to present a coherent overview. Therefore any summary of this complex domain will necessarily be selective. Nonetheless, taking the practice as it has been developed in the United Kingdom and the United States, where this work has been theorized and communicated to the greatest extent (and with reference to the practice in Europe, Canada, and Australia), it is possible to identify common historical developments, shared philosophical and pedagogical principles, and collective challenges and opportunities that contribute to a comprehensible picture, albeit one that is replete with contradictions. As a field, art-museum education continues to define itself. And although valuable research and theorization have been undertaken, in part by practitioners drawing on their own experiences, further work is required, not least to broaden the understanding of the practice as it is manifest globally and to make explicit the increasingly important role of art education within the art museum.