Doping in sport: a review of medical practitioners' knowledge, attitudes and beliefs.

BACKGROUND: Central to the work of many medical practitioners is the provision of pharmaceutical support for patients. Patients can include athletes who are subject to anti-doping rules and regulations which prohibit the use of certain substances in and out of competition. This paper examines the evidence on medical practitioners' knowledge, attitudes and beliefs towards doping in sport. METHODS: A systematic search strategy was followed. Research questions and relevance criteria were developed a priori. Potentially relevant studies were located through electronic and hand searches limited to English language articles published between 1990 and 2010. Articles were assessed for relevance by two independent assessors and the results of selected studies were abstracted and synthesised. Outcomes of interest were knowledge, attitudes and beliefs in relation to doping in sport. RESULTS: Six studies met the inclusion criteria and were examined in detail. Samples reflected a range of medical practitioners drawn from the UK, France (2), Greece, Italy and Ireland. The investigations varied with respect to outcome focus and quality of evidence presented. CONCLUSION: Whilst the extant empirical research posits a negative attitude towards illegal performance enhancement combined with a positive inclination towards doping prevention, it also exposes a limited knowledge of anti-doping rules and regulations. Insufficient education, leading to a lack of awareness and understanding, could render this professional group at risk of doping offences considering Article 2.8 of the World Anti-Doping Agency Code (WADC). Moreover, in light of the incongruence between professional medical codes and WADC Article 2.8, medical professionals may face doping dilemmas and therefore further discourse is required. At present, the current evidence-base makes it difficult to plan developmentally appropriate education to span the exposure spectrum. Addressing this situation appears warranted

A qualitative analysis of the factors that protect athletes against doping in sport

Design: Ten competitive athletes (M = 5, F = 5) representing five different sports (field hockey, boxing, football, triathlon, rugby) were recruited through convenience sampling to undertake a semi-structured interview to enable a qualitative analysis of athletes' lifelong athletic careers. Method: Verbatim transcripts were analysed using an established three-stage coding process to identify the common themes within the narratives. Results: Personal and situational protective factors were identified in the accounts. Personal factors included: (i) a strong moral stance against cheating; (ii) an identity beyond sport; (iii) self-control; and (iv) resilience to social group pressures. Situational factors included secure attachments to people at all stages of the athlete's life. This facilitated both the promotion of moral decision making and assisted in the development of anti-doping attitudes. When situational factors – such as a pro-doping climate – arose, key attachments in the athletes' lives interplayed with personal factors to reduce the risk of doping. Conclusions: These findings offer insights into factors that protect competitive athletes against using PEDs in sport and further our understanding of the complex interaction between risk and protective factors at individual, psychosocial and societal levels among competitive athletes. As a complex behaviour, doping in sport cannot be prevented by solely focussing on the individual athlete; contextual factors beyond the athlete's control also impact on this behaviour. Thus, a paradigm shift is warranted to move beyond an athlete-centred approach to anti-doping

The sleeping beauty motif in the short stories of D. H. Lawrence

In this thesis, ten tales covering almost the whole of D.H. Lawrence's writing career have been analysed in terms of the 'Sleeping Beauty' motif or "the myth of the awakened sleeper" - a motif which has been noted briefly in Lawrence's fiction by several critics. Chapter one begins with a discussion of the Sleeping Beauty legend, its origins and its variants, and leads on to a comparison and contrast of two early tales. The Mitch a la Mode and The Daughters of the Vicar; these are, respectively, examples of Lawrence's treatment of the motif in symbolic and realistic terms. There is a further contrast in that these stories introduce the two types of 'Sleeping Beauty’ women, respectively - i.e. those who reject the awakening which offers liberation, and those who accept "the lover's kiss that awakens the Sleeping Beauty.” In Chapter Two The Horse-Dealer’s Daughter, You Touched We and The Fox are examined; they possess marked similarities of character and setting, but are sufficiently-varied treatments of the motif to warrant individual analysis. Chapter Three is concerned with The Princess and None of That, both variants on the negative aspect of the theme, in that they deal with 'Sleeping Beauty' heroines who ultimately reject any awakening. The Princess is a mature and skilful treatment of this aspect of the theme, whereas None of That is shown to be technically and artistically a regression. With Sun, Glad Ghosts and The Virgin and the Gipsy, all written during the last period, there is a return to the Sleeping Beauty- women who are awakened to new states of being. Symbolism, particularly in Sun, plays an important role, and it is fully discussed. The thesis concludes with a general discussion of the motif as it appears elsewhere in Lawrence's fiction, and of its relevance to his own life; in this connection, evidence is adduced from the novels and the correspondence

What Do We Know About Behavioral Crises in Dementia? A Systematic Review

Background: Behavioral crises in dementia are represented by a wide variety of symptoms, regularly require external intervention from professionals, and are reported as a risk factor for hospital admission. Little is known about the factors that are associated with them. Objective: To determine the factors associated with dementia-related behavioral crises. Methods: We searched MEDLINE, CINAHL, PsycINFO, EMBASE, and AMED databases. An additional lateral search including reference lists was conducted. Two researchers screened all records for potential eligibility. Narrative synthesis was used to bring together the findings. Results: Out of the 5,544 records identified, 24 articles (18 distinct studies) met the eligibility criteria. Aggression and agitation were the most common behaviors present at crises. Delusions, wandering/absconding, and hallucinations were also key behaviors contributing to crises. Behavioral crises predominantly happened in the severe stages of dementia (according to MMSE scores), in people with dementia residing in their own homes and in long-term care, and were the catalyst for admissions to psychiatric inpatient settings, specialist-care units, long-term care settings, or for referrals to psychiatric community services. Lack of consistency in assessment of behavior, and management of agitation/aggression in dementia crises were evident. Conclusion: Interventions to reduce the likelihood of people with dementia-related behaviors reaching crisis point need to focus on both family and care home settings and incorporate aggression and agitation management. Future research should focus on determining the factors that could be addressed to prevent behavioral crises and the interventions and models of care that may help to prevent crises. Keywords: Behavior; behavioral symptoms; crisis intervention; dementia; hospitalization; institutionalization

Whistleblowing versus the code of silence: A qualitative analysis of athletes’ perceptions of reporting doping in sport

Objectives: This paper qualitatively explores national level athletes’ perceptions of their role in keeping sport clean. Design: A qualitative design was utilised to enable an in-depth examination of athletes’ views on reporting doping behaviour. Method: Following ethical approval, semi-structured interviews were conducted with nine national level athletes from rugby league (n = 5) and athletics (n = 4; female = 2). Thematic analysis established the main themes within the data. Results: Contextual differences existed around the role that athletes perceived they would play in keeping sport clean. The track and field athletes indicated that they would adopt the role of a whistleblower whereas the rugby league players would adhere to a code of silence. Specifically, track and field athletes would report individuals who were doping in their sport although it was evident that the majority were unaware of the protocol for doing this. In comparison, the rugby league players highlighted a moral dilemma by suggesting they would refrain from reporting a team mate despite disagreeing with their actions. Conclusions: Prevention programmes should enhance efforts to change broader group and community norms around doping in sport. In doing so, community members’ receptivity to prevention messages may increase. Moreover, developing skills to intervene (i.e., speaking out against social norms that support doping behaviour) or increasing awareness of reporting lines could enhance community responsibility for clean sport. The findings highlight the need to consider the context of sport and emphasise that a one size fits all approach to anti-doping is not appropriate