Bakgrunn: Misbruk av vanedannende legemidler er et viktig folkehelseproblem. Enkelte pasienter går fra lege til lege og driver såkalt legeshopping for å skaffe seg mest mulig av denne typen legemidler. Dette er et problem i forhold til å kunne begrense legemiddelmisbruket i befolkningen. Fastlegeordningen, som ble innført i Norge i 2001, er blant annet ment å skulle begrense mulighetene til legeshopping. Det er ikke tidligere gjort studier som kan kartlegge omfanget av legeshopping i en befolkning, verken i Norge eller andre land. FORMÅL: Kartlegge omfanget av legeshopping i befolkningen i Norge, og forsøke å klarlegge i hvilken grad bruk av flere leger kan skyldes shopping etter legemidler eller andre årsaker. MATERIALE OG METODE: Studere data fra det norske Reseptregisteret (NorPD) for kalenderåret 2004, som blant annet viser antallet leger benyttet, mengde utlevert av det aktuelle legemiddelet og samtidig mengde utlevert av benzodiazepiner og opioider for alle brukere av de vanedannende legemidlene diazepam, karisoprodol og kodein kombinasjoner sammenlignet med alle brukere av de ikke-vanedannende legemidlene esomeprazol, metformin og salbutamol. RESULTATER: De aller fleste pasienter bruker kun en eller to leger for å få utlevert samme legemiddel i løpet av ett kalenderår. Andelen som bruker tre eller flere leger er imidlertid mer enn dobbelt så høy for de vanedannende legemidlene som for de ikke-vanedannende, og for de som bruker fem eller flere leger, er andelen nesten ti ganger større. Med økende antall leger som er benyttet, er dessuten økningen i både utlevert mengde av legemidlet og samtidig mengde utlevert av benzodiazepiner og opioider langt mer uttalt for de vanedannende legemidlene enn for de ikke-vanedannende. KONKLUSJON: Det foregår etter innføringen av fastlegeordningen fortsatt en begrenset, men klar legeshopping blant pasienter som ønsker å få tak i mest mulig av vanedannende legemidler. Dette forhold må tas alvorlig av både de forskrivende legene og helsemyndighetene. / BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping. AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons. MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol. RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines. CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities. / <p>ISBN 978-91-85721-60-3</p>

A number of studies have been conducted on the attrition rates of undergraduate and graduate students. However, the body of knowledge concerning attrition for doctoral students, especially those who have attained the level of “all but dissertation” (ABD), is limited. The purpose of this research was to examine retention and attrition factors of doctoral candidates from a typical Higher Education Doctoral Program (Research II Public Institution) who were admitted to candidacy from 1991 through July 2000. Participation of the subject population was limited to those who had attained the level of ABD--those who had previously fulfilled the residency, coursework, foreign language or tool-subject requirements, and successfully completed the comprehensive/qualifying exams. This population included current ABDs, previously attrited ABDs, and graduates of the degree program. The research study was qualitative and intended to identify the effect of specific, predetermined factors that may have influenced or affected the progress of current, previous, and graduated students towards the doctoral degree in higher education. This study obtained responses to questions from the questionnaire/survey instrument concerning factors that affected program completion or attrition. Students had the opportunity to elaborate on factors from their dissertation, advisement, and personal, financial, and employment experiences that affected their ability to complete the program through open-ended question responses. By examining key factors in the doctoral degree experience from the three sample groups (current ABDs, previous ABDs, and graduated Ed.Ds), this study was able to draw some conclusions about doctoral attrition. Reconstructing and comparing the experiences of ABDs from the point of candidacy to the point of attrition or completion of the program determined trends, commonalities, and issues affecting achievement. Results of this study add to the limited research concerning ABD attrition and provide an insight from the student perspective as to the obstacles and support variables in the quest for the doctoral degree.

Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

The job of the local school superintendent is one of the most difficult chief executive undertakings in America today. Of the nation’s roughly 14,000 traditional public school superintendents, a mere 1,984 are women, according to the U. S. Department of Education. Yet, nationally over 75% of all K-12 educators are women. The purpose of this explorative quantitative study is to analyze the demographic profiles of public school districts in four of the nation’s largest states – California, Michigan, New York, and Texas - to see if there is a pattern of district types and sizes that women lead. Then the study will compare those districts that women lead to those that men lead. The districts were identified using the following variables: locale of districts, the size of the districts, diversity of student population, and poverty level. Looking through the lens of Bourdieu’s social reproduction theory, this study sought to show that resources and institutions are reproduced, or passed on, to those sharing similar social capital. Chi-square with cross-tabulations was conducted to determine if certain district characteristics would allow one to infer the gender of the superintendent leading that district. Additionally, a binominal logistic regression was used to see if there was a relationship between the district types and the gender of the superintendent. The results of the study identified that there was no relationship between the locales of the districts and the gender of the superintendents, but female superintendents were more prevalent in smaller districts with high diversity and high poverty.

ABSTRACT SECONDARY-SCHOOL PRINCIPALS’ PERCEPTIONS OF THEIR ROLE IN THE RETENTION OF NOVICE TEACHERS Theresa J. Coker Secondary schools in the U.S. face instructional challenges due in part to novice teacher turnover. Research indicates that new teachers remain in the profession due to: supportive principal leadership, an orderly school environment, classroom autonomy, and significant professional development (Grissom, 2008). The purpose of this study was to understand how secondary-school principals perceived their role in novice teachers’ professional development and retention. Qualitative research using in-depth, semi-structured interviews included 15 secondary-school administrators from an urban district in the southeast United States. Data analysis used Eisner’s (1998) four-part approach to educational criticism—description, interpretation, evaluation, and thematics—supported by Hatch’s (2002) typological analysis. Four typologies organized description and interpretation: principals’ early experiences as educators; principals’ perceptions of the recruitment process; principals’ view of the process of professional development; and life and duties of principals. The thematics dimension of educational criticism indicated that principals’ lack of time led to their delegating leadership tasks to other staff regarding novice teachers’ professional development. Their descriptions of their interactions with novice teachers reflected a transactional leadership style and an approach of “leading from the middle” (Bolman & Gallos, 2011) to respond to both demands from above and needs at the school level. Further, these principals perceived all teachers new to their schools as novice, whether experienced or inexperienced. Implications include considering transformational leadership when working with novice teachers and clarifying hiring and retention responsibilities regarding novice teachers. Such communication among all parties would support novice teachers’ development and commitment to the profession. Further research might focus on observing the interactions of both administrators and faculty with novice teachers to understand the complexity of the process of their professional development.

This paper reviews the prevalence, characteristics, comorbidity, and care of hypochondriac patients in primary care samples in Saxony. Patients with health anxieties don’t get much attention in terms of care and supply due to a lack of knowledge regarding treatment strategies of this health disorder, but also because it is perceived as innocuous in itself by family doctors. On the other hand these patients create high personal and communicative expenditures for the caregiver and high expenses for the healthcare system due to diagnosis and treatment seeking of those patients. The study was performed predominantly in the cities of Saxony at patients consulting their family doctors for any purpose on a randomly chosen testing day and revealed a rate of 10.5% hypochondriac patients. The demographic patient characterization matches the available literature, considering the two determining factors “screened population” and “diagnostic instrument”. There was no gender predominance noticeable; marital status did also not have any impact on the development of hypochondria. A higher age was the strongest associated demographic risk marker for developing health anxiety. A higher educational level is associated with lower levels of hypochondriasis with more impact than the current job situation. The high number of retired patients in the study limits the statistical power of job-associated variables. The most important and prominent comorbidity was depression, followed by panic disorders, matching also with available literature. The overall somatic morbidity of the patients was low. One positive finding of our study was a high stability of the physician-patient relationship over many years. Hypochondriac patients consult their doctors more often, get longer lasting visits, and require more specialist consultations than other patients. The majority of physicians diagnose the psychological disorders of a hypochondriac patient and recommend psychotherapy. Patient´s self-perception differs slightly from the physicians´ evaluation; they may understand the need of a therapy but don´t bring up enough motivation for realizing it. That’s where the dilemma for family doctors starts because they have no problems of diagnosing health anxieties but are not provided with professional tools for a time- and resource effective management of hypochondriac patients. The enormous time pressure in daily clinical practice provokes ignoring of hypochondriac patients and just an attempt of a reserved transfer practice to specialists, which the patients usually handle by transferring themselves. Considering the availability of more efficient screening tools and therapy strategies, practical aid for professional contact with hypochondria patients by family doctors would be desirable and needed. Those should on the one hand help evaluate patients at risk for depression, and also introduce them to therapy, and on the other hand help general practitioners with communication strategies for hypochondria patients to make them understand the need of therapy. Hypochondriasis in education- or advanced training curriculum for general practitioners is explained way too short. Especially requirements concerning the family doctors’ professional communication skills to deal with hypochondria patients are enormous and could eventually be improved by either specialized psychotherapists or through further training programs. This could save costs for multiple diagnostic screenings of patients on the long-term. The study illustrates the interest of family doctors for health anxiety disorders and the topic’s practical relevance. The appropriate medical societies are asked to create training programmes for family doctors and to improve the interface between family doctors and psychotherapists regarding the treatment of hypochondriasis. This work does not cover the impact of digital media on the prevalence of health anxieties. The internet provides a huge amount of unfiltered medical information and leaves patients alone processing with that knowledge. Physicians are challenged by the patients to put the information in a correct perspective to the patients’ individual medical situation. Scientific data about the impact of digital media on the prevalence and course of health anxiety are missing. Research on this topic seems being complex due to the heterogeneity of the interacting internal and external factors. It can be assumed, that the influence of the plentiful medical “superficial knowledge” available from the internet will increasingly influence physicians´ and hypochondriac patients´ interaction. The need of a scientific evaluation of this subject, including the development of professional communication strategies for family doctors with hypochondriac patients has been addressed to the responsible psychological research facilities. Family doctors emphasized the particular need of an improved interface between primary care and specialized psychological treatment for hypochondriac patients. Quickly retrievable communication tools for strategical contact with those patients are demanded. May this study contribute to an increased awareness and an installation of research programmes dealing with this disorder. / Die vorliegende Arbeit stellt eine epidemiologische Erhebung zur Prävalenz, Charakteristik, Komorbidität und Versorgung hypochondrischer Patienten in einem hausärztlichen Patientengut im Land Sachsen dar. Patienten mit Krankheitsängsten erhalten aktuell wenig Aufmerksamkeit in der Versorgungsforschung, da die Krankheit per se als gutartig bei Hausärztinnen und Hausärzten wahrgenommen wird und wenig Wissen zum professionellen Umgang mit solchen Patienten vorhanden ist. Damit inadäquat korrelierend sind die zum Teil hohen Kosten, die solche Patienten durch Überdiagnostik für das Gesundheitssystem verursachen und der hohe personelle und kommunikative Aufwand, der durch diese Patienten für den jeweiligen Hausarzt entsteht. Die Erhebung erfolgte vorwiegend in sächsischen Großstädten und erfasst eine Rate von 10,5% hypochondrischer Patienten in einem unselektierten, allgemeinmedizinischen Patientengut, die wegen beliebiger Beschwerden am jeweiligen Erhebungsstichtag den Hausarzt aufsuchten. Die demografischen Patientencharakteristika stimmen mit der vorliegenden Literatur überein, wenn man die entscheidenden Faktoren „Screeningpopulation“ und „Diagnoseinstrument“ berücksichtigt. Es liegt im Wesentlichen eine Gleichverteilung der Geschlechter vor, auch der Familienstand spielt keine nennenswerte Rolle für die Ausprägung einer Hypochondrie. Einzig ein höheres Alter lässt die Wahrscheinlichkeit pathologischer Krankheitsängste ansteigen. Die Abhängigkeit vom Bildungsgrad ist deutlicher als die von der aktuellen beruflichen Situation, wobei der große Anteil Rentner in der Erhebung die Aussagefähigkeit hierzu einschränkt. Als wichtigste auffällige Komorbidität fand sich die Depression, gefolgt von Panikstörungen, auch dies stimmt mit Daten aus der Literatur überein. Die somatische Morbidität der Patienten zeigte sich insgesamt eher niedrig. Positiv fällt eine hohe Stabilität der Arzt – Patientenbeziehung über viele Jahre in der gesamten untersuchten Patientenpopulation bei den teilnehmenden Ärzten auf. Hypochondrische Patienten weisen längere Visitenzeiten und gehäufte Arztkonsultationen auf als andere Patienten und werden häufiger zu anderen Fachrichtungen überwiesen. Die Ärzte erfassten in einem hohen Ausmaß die Störung der Patienten und stellten die Indikation für eine psychotherapeutische Mitbehandlung. Die Selbstwahrnehmung der Patienten stellte sich naturgemäß anders dar, der Therapiebedarf wird zum Teil von den betroffenen Patienten zwar gesehen, die Motivation hierzu dennoch als wenig ausgeprägt dokumentiert. Hier beginnt das Dilemma der Hausärzte, die offensichtlich geringe Probleme in der Detektion pathologischer Krankheitsängste haben, aber ohne strategisches Rüstzeug das zeit- und ressourcenträchtige Management dieser Patienten bewältigen müssen. Oft genug führt der enorme Praxisalltagsdruck zu einem „Wegschauen“ und allenfalls Versuch der zurückhaltenden Überweisungspraxis, die der Patient vermutlich oft genug durch Eigeninitiative zu umgehen versteht. Angesichts verfügbarer effizienter Screeningtools und Therapiestrategien wären praktische Hilfen zum professionellen Umgang von Hausärzten mit hypochondrischen Patienten wünschenswert. Diese sollten einerseits helfen, Risikopatienten für eine Depression frühzeitig zu evaluieren und einer Therapie zuzuführen und andererseits Kommunikationsstrategien für Allgemeinmediziner zum Umgang mit hypochondrieverdächtigen Patienten und zum Erreichen einer Krankheits- und Therapieeinsicht beinhalten. In Ausbildungs- bzw. Fortbildungscurricula für Allgemeinmediziner kommt dieses Thema bislang zu kurz. Insbesondere die Anforderungen an die kommunikativen Fähigkeiten des Hausarztes im Umgang mit hypochondrischen Patienten sind enorm und könnten durch spezialisierte Psychotherapeuten aufbereitet und in Weiterbildungsprogrammen geschult werden. Beginnen sollte dieser Prozess bereits frühzeitig im Medizinstudium. Wie sich allein an der Anzahl der Überweisungen zu Fachärzten zeigt, ist die Hypochondrie keinesfalls nur ein hausärztliches Thema. Mittel- bis langfristig wäre dies sicher kosteneffizient durch Einsparung der Kosten für Doppel-und Vielfachuntersuchungen dieser Patienten. Unsere Erhebung zeigt das Interesse der Hausärzte und die praktische Relevanz des Themas. Die entsprechenden Fachgesellschaften sind hier gefragt, sich neben der fachlichen Fortbildung der Hausärzte der Schaffung von Versorgungstrukturen zur Verbesserung der Schnittstelle Hausarzt - Psychotherapeut anzunehmen. Bewusst nicht thematisiert wurde in der vorliegenden Arbeit der Einfluss des Internets und der sogenannten „neuen“ Medien auf die Prävalenz krankheitsbedingter Ängste. Dieses Gebiet stellt eine zunehmende Herausforderung an Hausärzte und Patienten bezüglich des Umgangs mit der damit verbundenen Informationsflut dar. Wissenschaftliche Daten zu den Auswirkungen der digitalen Medien auf die Prävalenz und den Verlauf krankheitsbedingter Ängste fehlen bisher, eine wissenschaftliche Evaluation erscheint aufgrund der Heterogenität und schwierigen kausalen Abgrenzbarkeit interner von externen Einflussfaktoren komplex. Nichtdestotrotz ist anzunehmen, dass der Einfluss des massenhaft verfügbaren medizinischen „Halbwissens“ aus dem Internet spürbar Hausärzte und ihren Umgang mit hypochondrischen Patienten beeinflussen wird.

The percentage of women who receive doctorates has increased by over 300 percent during the past three decades. The consequences of pursuing the Ph.D. degree have always been far reaching and profound, serving as an impetus and springboard for the reconfiguration of one's beliefs, values, and professional life. The purposes of this national study were to ascertain and describe marital and social changes that occurred in the lives of women who were awarded the Ph.D. degree at midlife. A questionnaire was distributed to a sample of three-hundred women who hold the Ph.D. degree and were employed in institutions of higher education in the United States. The study sought to identify the effects of the Ph.D. experience upon the marital relationships, friendships, and social activities of women who completed the degree between the ages of thirty-five and forty-five. Demographic data were collected which were related to their marital status before, during, and after the Ph.D. experience. Both closed and open-ended questions were posed which solicited information pertaining to their post Ph.D. experience. This research reports both quantitative and qualitative findings. The majority of women who complete the Ph.D. experience at midlife undergo and initiate changes in their lives which impact their relationships and activities. Many of these changes are the result of employment which follows the award rather than the degree itself. While some women experience negative effects in some areas of their lives, overall, the findings of this study suggest that changes are perceived positively by the majority of women who receive the Ph.D. at midlife.

This paper is dealing with media reflection (manipulative activity that is trying affect form of media texts for its own profit) which is manifesting itself in representative selection of audiovisual works. This has arisen in period from second half of the ninetieth years of 20th century to present day (namely: movies Wag the Dog, Thank You for Smoking and serial House of Cards). This paper assumes that through the analysis of this reflection is possible to learn how knowledge of possible influence of spin doctoring effects interpretation activity of audience and whole media communication. In opening, there is a definition of spin doctoring, brief outline for its history and examination of its contact points with a propaganda. After that there is narrative analysis of selected audiovisual works, comparison of spin doctor strategies in movies with existing methods of public relation and examples of manipulative influences. After that there is breakdown of media reflection of spin doctoring from position of three different theories of representation and final topic of influence of a semiotic power on form of interpretation which anticipates manipulative technologies.

Main focus of my Master's Thesis is to conduct a research of mythological elements and themes that appear within the narrative structure of selected episodes of BBC television series Doctor Who, deriving from the initial hypothesis that such mythological patterns are still recurring and repeating even in the structure of stories produced by modern show-business industries, which renders their content intrinsically more attractive for any audience. We analyse selected episodes from both arks of the Doctor Who's story individually - the old one, which began in the sixties, and the new one, which is considered to be a reboot of the original series and aired in 2005. The originally intended educative element of the series and its sudden disappearance is also a part of our research. Main analysis of our paper consists of a semiotic analysis of the text of the television series utilizing the point of view of the critical reader that was introduced by Umberto Eco, and deriving from the definition of modern myth that appears in works of Roland Barthes, archaic myth, studied for example by Carl Lévi- Strauss, and Jungian archetypes.

La médecine connaît actuellement en France une crise de ses repères et de ses valeurs conséquente aux bouleversements scientifiques, techniques et sociologiques qu'elle a connue au cours du XXe siècle. Cette thèse vise à explorer les tenants et les aboutissants de cette situation, à partir d'une étude historique et philosophique de l'émergence et du développement de la médecine française moderne puis contemporaine, entendue à la fois comme profession, discoursscientifique et pratique sociale. De la formation du corps médical à l'apparition d'un discours autonome des usagers de santé, nous défendons l'idée selon laquelle la genèse et l'évolution du discours médical, depuis le XVIIIe siècle jusqu'à nos jours, repose sur sa capacité à répondre à la question fondatrice des possibilités d'objectivation scientifique et technique de la subjectivité humaine. Ce problème, originairement épistémologique, se révèle au cours de notre généalogie de nature tant philosophique qu'éthique et sociopolitique, nous conduisant finalement àrechercher les outils de problématisation de la crise contemporaine au fondement de la relation médicale moderne. L'étude de la correspondance du médecin des Lumières Samuel-Auguste Tissot (1728-1797) nous offre finalement un contre-point essentiel pour préciser les conditions de possibilités d'une médecine, que nous souhaitons pour le XXIe siècle, et au sein de laquelle est assuré le respect de l'autonomie et de l'identité propres à l'ensemble des sujets, qu'ils soient soignés ou soignants. / Medicine in France is currently undergoing a crisis, with respect to its establishedreferences and values, as a result of the major technical, sociological and scientific changes undergone in the twentieth century. This thesis aims to explore the ins and outs of this crisis through an historical and philosophical study of the emergence and development of modern and contemporary French medicine as a profession, scientific discourse and social practice. From the forming of the medical body to the emergence of an autonomous non-professional discourse, wedefend the idea following which the genesis and evolution of medical discourse, from the eighteenth century to the present day, rests on its ability to answer the foundational problem of the possibility a scientific and technical objectivation of the human subjectivity. Originally of an epistemological nature, this problem reveals itself, through our genealogy, to be rather of a philosophical, ethical and sociopolitical nature, which leads us to conceive a frame of reference by means of which to better understand the contemporary crisis underlying the modern doctorpatient relation. Finally, a case study of the correspondence of Enlightenment's medical doctor Samuel-Auguste Tissot (1728-1797) offers an essential viewpoint from which to reflect on the possibility and conditions of a medical epistemology that ensures the respect of the autonomy andidentity of all subjects, patients and practitioners alike.