Barriers to the provision of smoking cessation assistance:A qualitative study among Romanian family physicians

BACKGROUND: Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). AIM: To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. METHODS: A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. RESULTS: Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients' inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. CONCLUSIONS: Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption

Psychopharmacology for Substance Use Disorders

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder. This review contains 3 tables, and 31 references. Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal</jats:p

Improving the Health of Northeastern Pennsylvania through Medical Education and Community Engagement

Medical schools have been charged with the responsibility for increased emphasis on social accountability. The Commonwealth Medical College (TCMC) is playing a critical role in educating future physicians to help alleviate the region’s severe health professional shortage by training community physicians who will work in this region to improve its health status.TCMC partners with community organizations and health professionals to ensure that students learn the fundamentals of community engagement and service-based practice. The curriculum involves student research projects that foster commitment to community involvement and participatory research. TCMC also collaborates with several educational partners in the region. An example is the partnership with a regional university to develop a public health certificate program and a combined MD/MPH program. Interprofessional training is another feature of the curriculum and TCMC is partnering with dental professionals in the region to incorporate oral health into the medical school curriculum,with a focus on preventive oral health care. Through these and several other programs, TCMC aspires to train community- oriented physicians who will practice medicine in a holistic manner and ultimately contribute to improving health in Northeastern Pennsylvania and beyond.</jats:p

Community annotation and the evolution of cooperation: How patience matters

We investigate why biologists fail to contribute to biological databases although almost all of them use these databases for research. We find, using evolutionary game theory and computer simulations, that (a) the initial distribution of contributors who are patient determines whether a culture of contribution will prevail or not (b) institutions (where institution means “a significant practice, relationship, or organization in a society or culture”) that incentivize patience and therefore limit free riding make contribution more likely and, (c) a stable institution, whether it incentivizes patience or not, will increase contribution. As a result we suggest there is a trade-off between the benefits of changing institutions to incentivize patience and the costs of the change itself. Moreover, even if it is possible to create institutions that incentivize patience among scientists such institutions may nevertheless fail. We create a computer simulation of a population of biologists based on our theory. These simulations suggest that institutions should focus more on rewards rather than penalties to incentivize a culture of contribution. Our approach therefore provides a methodology for developing a practical blueprint for organizing scientists to encourage cooperation and maximizing scientific output

Determinants Of Loan Repayment Ability Of Farmers In Kogi State

This study evaluates socio-economic factors that could predict repayment ability, quantify the effects of those factors and device a method to curb or manage default in agriculture and/or other credit lending. Data for the analysis were obtained by interviewing a sample of loan beneficiary farmers cooperative society members and non cooperative society members in three local government areas in Kogi State. The major factors that affect repayment ability were identified and the extent of the effect was assessed using the marginal and elasticity of probability. Participation in cooperative societies, non-farm income; farming experience had major effect on repayment ability while family size, farm size and return on investment, had a minimal effect on repayment ability. Poor record keeping, low literacy, and fear of high interest rates were some of the problems and constraints encountered by the farmers and the credit institutions. it is recommended that farmers should be encouraged to keep good records, financial institutions should also ease the process of loan acquisition to enable farmers with low educational background better access to funds. It is also recommended that credit worthiness of to be beneficiaries should be calculated in advance to reduce the frequency of loan default

Forcasting Acha production in Nigeria: A comparison of grafted polynomial and linear models

Paucity of functional forms is one of the problems associated with forecasting economic time series data because not all economic time series correlate linearly to trend over an entire sample period. This paper attempt to investigate the performance of grafted polynomials in forecasting Acha production in Nigeria. The observed trend in Acha production in Nigeria from 1970-2004 provides the database for the study. A grafted model (Quadratic-Quadratic-Linear) was estimated to forecast Acha output for periods outside the sample. The estimated structural parameters gave an R squared values of 0.81 and 0.99 for the linear and grafted respectively. Forecast were generated to evaluate the predictive performance of the estimated models, the grafted model performed better than the linear because the forecast were closer in values to the observed values.Theil inequality coefficient of 0.015714 and 0.129091 was obtained for the grafted and linear respectively, this further reinforces the superiority of the grafted polynomial. It is better therefore to fuse the entire local trend in forecasting of this nature to achieve a better time series prediction.br> Journal of Agriculture, Forestry and the Social Sciences Vol. 3 (2) 2005: pp.42-5