These findings suggest that guilt may be a mechanism through which abusive violence is related to PTSD and MDD among combat-deployed Veterans. These findings also suggest the importance of assessing abusive-violence related guilt among combat-deployed Veterans and implementing relevant interventions for such guilt whenever indicated.

No abstract

BackgroundMisuse of codeine available on prescription and over-the-counter (OTC) has been highlighted as a potential problem in South Africa.ObjectiveTo examine the perceptions of medical professionals regarding codeine use (prescribed and OTC), misuse, dependence and treatment options in South Africa.MethodData for the study were obtained using a sample of medical professionals obtained through random and convenience sampling. A quantitative methodology was employed using a structured self-administered questionnaire with closed and open-ended items. Data analysis was conducted using SPSS version 21; 238 medical professionals involved in the prescribing of codeine completed the questionnaire.ResultsTwo-thirds of participants stated that they routinely reviewed patients prescribed codeine, and high levels of concern were expressed about the availability of OTC medicine containing codeine in pharmacies (84.9%) and on the internet (71.3%). There was agreement that medicines containing codeine should be regulated to a prescription-only medicine (85.3%). Only 22% of participants agreed that they had suitable screening methods to help with detection of codeine dependence. Eighty per cent indicated that they would welcome the opportunity for greater instruction on prescribing potentially addictive medicines.ConclusionThere appears to be a need to improve education on consumption and risks associated with codeine use. In addition, screening tools are needed to detect those with codeine dependence. Greater data sources are now needed to examine the sale of and consumption of codeine medicines in the interest of public health.

. Codeine use, dependence and help-seeking behaviour in the UK and Ireland: an online cross-sectional survey. QJM, 110(9), 559-564. https://doi.org/10.1093/qjmed/hcx076Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policyIf you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim.

ObjectivesTo explore prescribing practitioners' perspectives on prescribed codeine use, their ability to identify dependence and their options for treatment in the UK.DesignCross-sectional design using a questionnaire containing closed-ended and open-ended items.SettingA nationally representative sample of prescribing professionals working in the UK.Participants300 prescribing professionals working in primary care and pain settings.ResultsParticipants stated that they regularly reviewed patients prescribed codeine, understood the risks of dependence and recognised the potential for codeine to be used recreationally. Over half the participants felt patients were unaware of the adverse health consequences of high doses of combination codeine medicines. One-quarter of participants experienced patient resentment when asking about medicines containing codeine. Just under 40% of participants agreed that it was difficult to identify problematic use of codeine without being informed by the patient and did not feel confident in identification of codeine dependence. Less than 45% of all participants agreed that codeine dependence could be managed effectively in general practice. Slow or gradual withdrawal was the most popular suggested treatment in managing dependence. Education and counselling was also emphasised in managing codeine-dependent patients in primary care.ConclusionsCommunication with patients should involve assessment of patient understanding of their medication, including the risk of dependence. There is a need to develop extra supports for professionals including patient screening tools for identifying codeine dependence. The support structure for managing codeine-dependent patients in primary care requires further examination.

A comparative exploration of community pharmacists' views on the nature and management of Over-the-Counter (OTC) and Prescription codeine misuse in three regulatory regimes; Ireland, South Africa and the United Kingdom. AbstractMisuse of codeine containing preparations is a public health concern given the potential for associated harms and dependence. This study explores the perspectives of community pharmacists in three regulatory regimes on issues of customer misuse of over the counter (OTC) and prescribed codeine containing preparations. A qualitative design comprising six focus groups (n=45) was conducted in Ireland, United Kingdom, South Africa. Transcripts were analysed using the constant comparative method of content analysis. Pharmacists described popular codeine containing products; the need for improved medicine information and warning labels. Issues around legitimate availability of codeine and regulatory status; presence of therapeutic need; difficulties in customer-pharmacist communication; business environments and retail focus were raised. Participants also discussed how they identified customers potentially misusing codeine; customer pharmacy 'hopping' and difficulties in relationships between pharmacists and prescribers. Specialist training; reimbursement for customer consultation; screening and brief interventions; visible referral structures and assisted community pharmacy detoxification were discussed as ways to manage the issues. The study highlights the difficulties encountered by community pharmacists operating under various regulatory regimes when supplying codeine containing preparations in negotiating patient awareness and compliance and dealing with misuse and dependence. Key WordsCodeine containing preparations; Misuse; Community pharmacy; Pharmacists; RegulationWhat is known about this topic 2  Over-the-counter (OTC) and prescription codeine containing products, as dispensed in pharmacies, have the potential for misuse and dependence. Different countries have different regulations with regards to the provision and display of codeine and level of pharmacist intervention at point of sale. Strategies which prevent and address codeine misuse include screening, information provision and referral. What this paper adds Pharmacists in Ireland, South Africa, and the UK have multiple roles and face a number of challenges related to financial and time resources; perceptions of the pharmacist profession and advising on safe and appropriate use of medication, not only codeine. Pharmacists have their own ways to identify customers who may be misusing codeine, but customers' strategies such as 'pharmacy hopping' and some use of online pharmacies make this challenging. Support and referral interventions are provided by pharmacists, but these are not standard, and more information is needed on which services to refer customers to for codeine misuse.

Background:Sickness certifi cation is a common task undertaken by General Practitioners (GPs) in most developed countries. Research suggests that they fi nd this task complex and diffi cult. Primary health care structures and sickness certifi cation practices diff er across Europe and little research explores GPs certifying practices in the Republic of Ireland. Objectives: The aim of the study was to explore GPs ' views on sickness certifi cation, the strategies used to issue sickness certifi cates to patients and scope for improvement in the current system. Methods: A qualitative thematic approach used one to one in-depth interviews with 14 individual GPs, across 11 primary health care practices in Ireland. Analysis of the data was conducted using NVivo 8 qualitative software. Results: GPs can fi nd their role as certifi er problematic, and a source of confl ict during the consultation process with patients. GPs were concerned with breaching patient confi dentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certifi cation for adverse social circumstances. Sickness certifi cation was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments. Conclusion:This study highlights the various complexities and challenges that GPs face when dealing with patients requiring sickness certifi cation. Issues in assessment of fi tness for work and problems within the social welfare structure were recurrent themes. The study highlights the opportunities to improve the system and how these might be achieved. Further research is now warranted in Ireland.

Background Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties. AimsTo explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland. MethodsA qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used. ResultsThree major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification. ConclusionsGPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.