The health profile of football/soccer players in Northern Ireland - a review of the uefa pre-participation medical screening procedure.

BACKGROUND:
It is compulsory that domestic football/soccer teams in UEFA competitions organise players' pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding 'normal' data in this population.

METHOD:
Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player's career; other tests are repeated yearly.

RESULTS:
89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation.

CONCLUSIONS:
This study provides important information about 'normal' values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.

Please Don't Make Me Ask for Help: Implicit Social Support and Mental Health in Chinese Individuals Living with HIV

Thesis (Master's)--University of Washington, 2013

The World Health Organization Multi-Professional Patient Safety Curriculum : implementation of key modules and its impact on patient safety knowledge, skills, and attitudes of medical students at the University of Algarve

ABSTRACT - Objectives: We attempted to show how the implementation of the key elements of the World Health Organization Patient Safety Curriculum Guide Multi-professional Edition in an undergraduate curriculum affected the knowledge, skills, and attitudes towards patient safety in a graduate entry Portuguese Medical School. Methods: After receiving formal recognition by the WHO as a Complementary Test Site and approval of the organizational ethics committee , the validated pre-course questionnaires measuring the knowledge, skills, and attitudes to patient safety were administered to the 2nd and3rd year students pursuing a four-year course (N = 46). The key modules of the curriculum were implemented over the academic year by employing a variety of learning strategies including expert lecturers, small group problem-based teaching sessions, and Simulation Laboratory sessions. The identical questionnaires were then administered and the impact was measured. The Curriculum Guide was evaluated as a health education tool in this context. Results: A significant number of the respondents, 47 % (n = 22), reported having received some form of prior patient safety training. The effect on Patient Safety Knowledge was assessed by using the percentage of correct pre- and post-course answers to construct 2 × 2 contingency tables and by applying Fishers’ test (two-tailed). No significant differences were detected (p < 0.05). To assess the effect of the intervention on Patient Safety skills and attitudes, the mean and standard deviation were calculated for the pre and post-course responses, and independent samples were subjected to Mann-Whitney’s test. The attitudinal survey indicated a very high baseline incidence of desirable attitudes and skills toward patient safety. Significant changes were detected (p < 0.05) regarding what should happen if an error is made (p = 0.016), the role of healthcare organizations in error reporting (p = 0.006), and the extent of medical error (p = 0.005). Conclusions: The implementation of selected modules of the WHO Patient Safety Curriculum was associated with a number of positive changes regarding patient safety skills and attitudes, with a baseline incidence of highly desirable patient safety attitudes, but no measureable change on the patient safety knowledge, at the University of Algarve Medical School. The significance of these results is discussed along with implications and suggestions for future research.

Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.

Evaluation of a professional development curriculum in movement education and adapted physical activity for invisible disabilities : a critical cross-case analysis

Movement education and adapted physical activity are content areas not addressed in pre-service education or in-service training for Ontario practitioners working with individuals with disabilities in physical environments. Consequently, physical activity is often overlooked by service providers in programming and intervention for exceptional young learners. A formative evaluation, multiple-case study design was employed in this research in which a purposeful sample of expert practitioners performed a guided, descriptive evaluation of a three-day professional development workshop curriculum designed to supplement these areas lacking in professional preparation within their respective cohorts. Case-by-case and comparative analyses illustrated the inherent assumptions and societal constraints which prioritize the structure of professional development within the education system and other government organizations providing services for school-aged persons with disabilities in Ontario. Findings, discussed from a critical postmodern perspective, illustrate the paradoxical nature of Western values and prevailing mind/body dichotomy that guide professional practice in these fields.

The Effectiveness of Learning Portfolios: A Study of Quality Assurance Programs of Selected Health Regulatory Colleges in Ontario

Health regulatory colleges promote quality practice and continued competence through Quality Assurance (QA) programs. For many colleges, a QA program includes the use of portfolios that incorporate self-directed learning. The purpose of this study was to determine some of the issues surrounding the effectiveness of QA portfolio programs. The literature review revealed that portfolios are valuable tools, but gaps in knowledge include a comparative analysis of QA programs and the perspective of regulatory college administrators. Data were collected through interviews with 6 administrators and a review of 14 portfolio models described on college websites. The results from the two data sources were applied to Robert Stake's responsive evaluation framework to identify issues related to the portfolio's effectiveness (Stake, 1967). The learning components of portfolios were analyzed through the humanist and constructivist lenses. All 14 portfolio models were found to have 3 main components: self-diagnosis, learning plan and activities, and self-evaluation. However, differences were uncovered in learners' autonomy in selecting learning activities, methods of portfolio evaluation, and the relationship between the portfolio and other QA components. The results revealed a dual philosophy of learning in portfolio models and an apparent contradiction between the needs of the individual learner and the organization. Paths for future research include the tenuous relationship between competence and learning, and the impact of technical approaches on selfdirected learning initiatives. A key recommendation is to acknowledge the unique identity of each profession so that health regulatory colleges can address legislative demands and learner needs.

Understanding the Integration of Living Skills Through the Context of Health and Physical Education: A Case Study of Educators’ Experiences

The research presented is a qualitative case study of educators’ experiences in integrating living skills in the context of health and physical education (HPE). In using semi-structured interviews the study investigated HPE educators’ experiences and revealed their insights relative to three major themes; professional practice, challenges and support systems. Professional practice experiences detailed the use of progressive lesson planning, reflective and engaging activities, explicit student centered pedagogy as well as holistic teaching philosophies. Even further, the limited knowledge and awareness of living skills, conflicting teaching philosophies, competitive environments between subject areas and lack of time and accessibility were four major challenges that emerged throughout the data. Major supportive roles for HPE educators in the integration process included other educators, consultants, school administration, public health, parents, community programs and professional organizations. The study provides valuable discussion and suggestions for improvement of pedagogical practices in teaching living skills in the HPE setting.

Mental health treatment seeking by military members with posttraumatic stress disorder : findings on rates, characteristics, and predictors from a nationally representative Canadian military sample

Objective: The goal of this study was to identify rates, characteristies, and predictors of mental health treatment seeking by military members with posttraumatic stress disorder (PTSD). Method: Our sample was drawn from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CF) dataset. The CCHS-CF is the first epidemiologic survey of PTSD and other mental health conditions in the Canadian military and includes 8441 nationally representative Canadian Forces (CF) members. Of those, 549 who met the criteria for lifetime PTSD were included in our analyses. To identify treatment rates and characteristics, we examined frequency of treatment contact by professional and facility type. To identify predictors of treatment seeking, we conducted a binary logistic regression with lifetime treatment seeking as the outcome variable. Results: About two-thirds of those with PTSD consulted with a professional regarding mental health problems. The most frequently consulted professionals, during both the last year and lifetime, included social workers and counsellors, medical doctors and general practitioners, and psychiatrists. Consultations during the last year most often took place in a CF facility. Treatment seeking was predicted by cumulative lifetime trauma exposure, index traumatic event type, PTSD symptom interference, and comorbid major depressive disorder. Those with comorbid depression were 3.75 times more likely to have sought treatment than those without. Conclusions: Although a significant portion of military members with PTSD sought mental health treatment, 1 in 3 never did. Trauma-related and illness and (or) need factors predicted treatment seeking. Of all the predictors of treatment seeking, comorbid depression most increased the likelihood of seeking treatment.

Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

Massive Open Online Courses on health and medicine: review

Background: Massive Open Online Courses (MOOCs) have become immensely popular in a short span of time. However, there is very little research exploring MOOCs in the discipline of Health and Medicine. This paper is aimed to fill this void by providing a review of Health and Medicine related MOOCs. Objective: Provide a review of Health and Medicine related MOOCs offered by various MOOC platforms within the year 2013. Analyze and compare the various offerings, their target audience, typical length of a course and credentials offered. Discuss opportunities and challenges presented by MOOCs in the discipline of Health and Medicine. Methods: Health and Medicine related MOOCs were gathered using several methods to ensure the richness and completeness of data. Identified MOOC platform websites were used to gather the lists of offerings. In parallel, these MOOC platforms were contacted to access official data on their offerings. Two MOOC aggregator sites (Class Central and MOOC List) were also consulted to gather data on MOOC offerings. Eligibility criteria were defined to concentrate on the courses that were offered in 2013 and primarily on the subject ‘Health and Medicine’. All language translations in this paper were achieved using Google Translate. Results: The search identified 225 courses out of which 98 were eligible for the review (n = 98). 58% (57) of the MOOCs considered were offered on the Coursera platform and 94% (92) of all the MOOCs were offered in English. 90 MOOCs were offered by universities and the John Hopkins University offered the largest number of MOOCs (12). Only three MOOCs were offered by developing countries (China, West Indies, and Saudi Arabia). The duration of MOOCs varied from three weeks to 20 weeks with an average length of 6.7 weeks. On average MOOCs expected a participant to work on the material for 4.2 hours a week. Verified Certificates were offered by 14 MOOCs while three others offered other professional recognition. Conclusions: The review presents evidence to suggest that MOOCs can be used as a way to provide continuous medical education. It also shows the potential of MOOCs as a means of increasing health literacy among the public.

Does a continence educational brochure promote health-seeking behavior?

OBJECTIVE: This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure.
METHOD: This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior.
SETTING AND SUBJECT: A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB.
RESULTS: Two thirds of the total sample of participants (n = 111) sought help for their continence problem. Approximately 70.3% (n = 78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people.
CONCLUSIONS: These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

Child protection and public health: nurses' responsibilities

Background. Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children.

Aims. The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse.

Methods. A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis.

Findings. There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities.

Conclusion. In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.

New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.