Medical tourism and health worker migration in developing countries

In developing countries of tourist destinations, an increase in medical tourism raises the wages in the medical tourism sector, thereby retaining skilled medical workers who otherwise leave the country. However, the expansion of medical tourism contracts the domestic healthcare services sector, causing lower labor productivity in the economy. Medical tourism can increase domestic welfare if the benefits from migration retention and tourism exports outweigh the losses in revenue and productivity declines.

Clinical placements in mental health: a literature review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

Evaluation of a filmed clinical scenario as a teaching resource for an introductory pharmacology unit for undergraduate health students: A pilot study.

BACKGROUND: Simulation is frequently being used as a learning and teaching resource for both undergraduate and postgraduate students, however reporting of the effectiveness of simulation particularly within the pharmacology context is scant. OBJECTIVES: The aim of this pilot study was to evaluate a filmed simulated pharmacological clinical scenario as a teaching resource in an undergraduate pharmacological unit. DESIGN: Pilot cross-sectional quantitative survey. SETTING: An Australian university. PARTICIPANTS: 32 undergraduate students completing a healthcare degree including nursing, midwifery, clinical science, health science, naturopathy, and osteopathy. METHODS: As a part of an undergraduate online pharmacology unit, students were required to watch a filmed simulated pharmacological clinical scenario. To evaluate student learning, a measurement instrument developed from Bloom's cognitive domains (knowledge, comprehension, application, analysis, synthesis and evaluation) was employed to assess pharmacological knowledge conceptualisation and knowledge application within the following fields: medication errors; medication adverse effects; medication interactions; and, general pharmacology. RESULTS: The majority of participants were enrolled in an undergraduate nursing or midwifery programme (72%). Results demonstrated that the majority of nursing and midwifery students (56.52%) found the teaching resource complementary or more useful compared to a lecture although less so compared to a tutorial. Students' self-assessment of learning according to Bloom's cognitive domains indicated that the filmed scenario was a valuable learning tool. Analysis of variance indicated that health science students reported higher levels of learning compared to midwifery and nursing. CONCLUSION: Students' self-report of the learning benefits of a filmed simulated clinical scenario as a teaching resource suggest enhanced critical thinking skills and knowledge conceptualisation regarding pharmacology, in addition to being useful and complementary to other teaching and learning methods.

Exploring nurses' reactions to a novel technology to support acute health care delivery

AIMS AND OBJECTIVES: To explore nurses' reactions to new novel technology for acute health care. BACKGROUND: Past failures of technology developers to deliver products that meet nurses' needs have led to resistance and reluctance in the technology adoption process. Thus, involving nurses in a collaborative process from early conceptualisation serves to inform design reflective upon current clinical practice, facilitating the cementing of 'vision' and expectations of the technology. DESIGN: An exploratory descriptive design to capture nurses' immediate impressions. METHODS: Four focus groups (52 nurses from medical and surgical wards at two hospitals in Australia; one private and one public). RESULTS: Nursing reactions towards the new technology illustrated a variance in barrier and enabler comments across multiple domains of the Theoretical Domains Framework. Most challenging for nurses were the perceived threat to their clinical skill, and the potential capability of the novel technology to capture their clinical workflow. Enabling reactions included visions that this could help integrate care between departments; help management and support of nursing processes; and coordinating their patients care between clinicians. Nurses' reactions differed across hospital sites, influenced by their experiences of using technology. For example, Site 1 nurses reported wide variability in their distribution of barrier and enabling comments and nurses at Site 2, where technology was prevalent, reported mostly positive responses. CONCLUSION: This early involvement offered nursing input and facilitated understanding of the potential capabilities of novel technology to support nursing work, particularly the characteristics seen as potentially beneficial (enabling technology) and those conflicting (barrier technology) with the delivery of both safe and effective patient care. RELEVANCE TO CLINICAL PRACTICE: Collaborative involvement of nurses from the early conceptualisation of technology development brings benefits that increase the likelihood of successful use of a tool intended to support the delivery of safe and efficient patient care.

The acute and sub-chronic effects of cocoa flavanols on mood, cognitive and cardiovascular health in young healthy adults: a randomized, controlled trial.

Cocoa supplementation has been associated with benefits to cardiovascular health. However, cocoa's effects on cognition are less clear. A randomized, placebo-controlled, double-blind clinical trial (n = 40, age M = 24.13 years, SD = 4.47 years) was conducted to investigate the effects of both acute (same-day) and sub-chronic (daily for four-weeks) 250 mg cocoa supplementation on mood and mental fatigue, cognitive performance and cardiovascular functioning in young, healthy adults. Assessment involved repeated 10-min cycles of the Cognitive Demand Battery (CDB) encompassing two serial subtraction tasks (Serial Threes and Sevens), a Rapid Visual Information Processing task, and a mental fatigue scale over the course of half an hour. The Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) was also completed to evaluate cognition. Cardiovascular function included measuring both peripheral and central blood pressure and cerebral blood flow. At the acute time point, consumption of cocoa significantly improved self-reported mental fatigue and performance on the Serial Sevens task in cycle one of the CDB. No other significant effects were found. This trial was registered with the Australian and New Zealand Clinical Trial Registry (Trial ID: ACTRN12613000626763). Accessible via http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12613000626763&ddlSearch=Registered.

Health-care costs of underweight, overweight and obesity: Australian population-based study

AIM: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. METHODS: Participants: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. OUTCOME: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. PREDICTOR: biennial BMI measurements over the same period. RESULTS: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. CONCLUSIONS: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

A telephone support program to reduce costs and hospital admissions for patients at risk of readmissions: lessons from an evaluation of a complex health intervention

This study aimed to evaluate the effectiveness of a telephone health coaching and support service provided to members of an Australian private health insurance fund-Telephonic Complex Care Program (TCCP)-on hospital use and associated costs. A case-control pre-post study design was employed using propensity score matching. Private health insurance members (n=273) who participated in TCCP between April and December 2012 (cases) were matched (1:1) to members who had not previously been enrolled in the program or any other disease management programs offered by the insurer (n=232). Eligible members were community dwelling, aged ≥65 years, and had 2 or more hospital admissions in the 12 months prior to program enrollment. Preprogram variables that estimated the propensity score included: participant demographics, diagnoses, and hospital use in the 12 months prior to program enrollment. TCCP participants received one-to-one telephone support, personalized care plan, and referral to community-based services. Control participants continued to access usual health care services. Primary outcomes were number of hospital admission claims and total benefits paid for all health care utilizations in the 12 months following program enrollment. Secondary outcomes included change in total benefits paid, hospital benefits paid, ancillary benefits paid, and total hospital bed days over the 12 months post enrollment. Compared with matched controls, TCCP did not appear to reduce health care utilization or benefits paid in the 12 months following program enrollment. However, program characteristics and implementation may have impacted its effectiveness. In addition, challenges related to evaluating complex health interventions such as TCCP are discussed.

The National Perinatal Depression Initiative: An evaluation of access to general practitioners, psychologists and psychiatrists through the Medicare Benefits Schedule

OBJECTIVE: To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness. METHOD: Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative. RESULTS: The proportion of women giving birth who accessed at least one mental health item during the perinatal period increased from 88 to 141 per 1000 between 2007 and 2010. The difference-in-difference analysis showed that while there was an overall increase in Medicare Benefits Schedule mental health item access as a result of the National Perinatal Depression Initiative, this did not reach statistical significance. However, the National Perinatal Depression Initiative was found to significantly increase access in subpopulations of women, particularly those aged under 25 and over 34 years living in major cities. CONCLUSION: In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies.

Low-volume high-intensity interval training in a gym setting improves cardio-metabolic and psychological health

Background Within a controlled laboratory environment, high-intensity interval training (HIT) elicits similar cardiovascular and metabolic benefits as traditional moderate-intensity continuous training (MICT). It is currently unclear how HIT can be applied effectively in a real-world environment. Purpose To investigate the hypothesis that 10 weeks of HIT, performed in an instructor-led, groupbased gym setting, elicits improvements in aerobic capacity (VO2max), cardio-metabolic risk and psychological health which are comparable to MICT. Methods Ninety physically inactive volunteers (42±11 y, 27.7±4.8 kg.m-2) were randomly assigned to HIT or MICT group exercise classes. HIT consisted of repeated sprints (15-60 seconds, >90% HRmax) interspersed with periods of recovery cycling (≥25 min.session-1, 3 sessions. week-1). MICT participants performed continuous cycling (70%HRmax, 30-45 min.session-1, 5 sessions.week-1). VO2max, markers of cardio-metabolic risk, and psychological health were assessed pre and post-intervention. Results Mean weekly training time was 55±10 (HIT) and 128±44 min (MICT) (p<0.05), with greater adherence to HIT (83±14% vs. 61±15% prescribed sessions attended, respectively; p<0.05). HIT improved VO2max, insulin sensitivity, reduced abdominal fat mass, and induced favourable changes in blood lipids (p<0.05). HIT also induced beneficial effects on health perceptions, positive and negative affect, and subjective vitality (p<0.05). No difference between HIT and MICT was seen for any of these variables. Conclusions HIT performed in a real-world gym setting improves cardio-metabolic risk factors and psychological health in physically inactive adults. With a reduced time commitment and greater adherence than MICT, HIT offers a viable and effective exercise strategy to target the growing incidence of metabolic disease and psychological ill-being associated with physical inactivity.

Use of focus groups to identify health promotion strategies for the early detection of diabetic retinopathy

BACKGROUND: People with diabetes do not regularly utilise eye services for the early prevention of vision loss due to diabetic eye disease. A community-based screening program has been initiated in Victoria to address this issue. To encourage people to take preventive eye health care measures, the most effective health promotion strategies were identified. METHODS: Thirty-three health professionals were invited to attend focus groups. A sample of 35 people with diabetes was approached by their GPs or diabetes educators because of their motivation to participate in diabetes activities. Each group consisted of 10 members. Discussion points included the type of education messages available to people with diabetes; use of eye services among the participants with diabetes; and strategies required promoting the screening service. RESULTS: Five focus groups were conducted. The discussions highlighted that a great deal could be achieved by using local community networks to promote the benefits of early detection of diabetic retinopathy and local screening program. The group members recommended that particular attention be directed to general practitioners and their distribution of materials to patients. Key issues for planning and implementing the program were highlighted. The groups urged development of strategies to encourage people with diabetes in rural Victoria to participate in a program for the early detection of diabetic retinopathy.