Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 45
Filtrar
1.
J Clin Microbiol ; 58(4)2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-31969425

RESUMO

Whole-genome sequencing has enhanced surveillance and facilitated detailed monitoring of the transmission of Shigella species in England. We undertook an epidemiological and phylogenetic analysis of isolates from all cases of shigellosis referred to Public Health England between 2015 and 2018 to explore recent strain characteristics and the transmission dynamics of Shigella species. Of the 4,950 confirmed cases of shigellosis identified during this period, the highest proportion of isolates was Shigella sonnei (54.4%), followed by S. flexneri (39.2%), S. boydii (4.1%), and S. dysenteriae (2.2%). Most cases were adults (82.9%) and male (59.5%), and 34.9% cases reported recent travel outside the United Kingdom. Throughout the study period, diagnoses of S. flexneri and S. sonnei infections were most common in men with no history of recent travel abroad. The species prevalence was not static, with cases of S. flexneri infection in men decreasing between 2015 and 2016 and the number of cases of S. sonnei infection increasing from 2017. Phylogenetic analysis showed this recent increase in S. sonnei infections was attributed to a novel clade that emerged from a Central Asia sublineage exhibiting resistance to ciprofloxacin and azithromycin. Despite changes in species prevalence, diagnoses of Shigella infections in England are persistently most common in adult males without a reported travel history, consistent with sexual transmission among men who have sex with men. The trend toward increasing rates of ciprofloxacin resistance in S. sonnei, in addition to plasmid-mediated azithromycin resistance, is of significant public health concern with respect to the transmission of multidrug-resistant gastrointestinal pathogens and the risk of treatment failures.


Assuntos
Disenteria Bacilar , Minorias Sexuais e de Gênero , Shigella , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Disenteria Bacilar/epidemiologia , Inglaterra/epidemiologia , Feminino , Homossexualidade Masculina , Humanos , Masculino , Testes de Sensibilidade Microbiana , Filogenia , Shigella sonnei/genética , Reino Unido
2.
Eur J Dent Educ ; 24(4): 741-752, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32602995

RESUMO

INTRODUCTION: There is a maldistribution of dental professionals working in rural and remote regions of Australia. This study investigates dental graduates from a newly established rural clinical school (RCS) at Charles Sturt University (CSU), New South Wales, Australia, and records graduates' workforce locations and views on working in both metropolitan and rural practice. MATERIALS AND METHODS: In late 2015 to early 2016, CSU graduates of 2013 and 2014 were asked to complete a telephone interview related to their employment choices. Thirty-nine interviews (68% of contactable graduates) were completed. Qualitative framework analysis was applied to identify trends and themes. RESULTS: More than half of the graduates were working rurally, with 67% working full-time and 77% in private practice. Key influencing factors on graduates related to rural employment were as follows: family and personal relationships, developing clinical skills, rural community, lifestyle, professional support, mentorship, job availability, full-time employment and financial incentives. Key barriers to working rurally included leaving family and friends, small patient base, low salary, partner factors, and professional and personal isolation. CONCLUSION: More than half of the CSU graduates were working in rural communities, demonstrating initially positive rural workforce outcomes. Reasons for choosing to work rurally were complex and spanned a broad spectrum of social, personal, professional development and support, community, economic, environmental and lifestyle factors. Future workforce strategies should apply a broad multifactorial approach to consider the complex interrelated employment factors. Furthermore, increased evaluation is required of the CSU programme, with increased workforce outcomes and exploration of employment retention factors.


Assuntos
Serviços de Saúde Rural , População Rural , Austrália , Escolha da Profissão , Educação em Odontologia , Emprego , Humanos , Área de Atuação Profissional , Instituições Acadêmicas
3.
BMC Pregnancy Childbirth ; 19(1): 243, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299937

RESUMO

BACKGROUND: Dien Bien Province in northwest Vietnam is predominantly populated with ethnic minority groups, who experience worse maternal and child health outcomes than the general population. Various factors are associated with maternal health care utilisation in Vietnam, including ethnic minority status, which is recognised as a key determinant of inequity in health outcomes. The aim of this study is to explore how and why ethnic minority women utilise maternal health services, and the factors that influence women and families' decisions to access or not access facility-based care. METHODS: We used a qualitative approach, interviewing primary health care professionals (n = 22) and key informants (n = 2), and conducting focus groups with Thai and Hmong women (n = 42). A thematic analysis was performed. RESULTS: There were three main themes. 1. Prioritising treatment over prevention: women talked about accessing health services for health problems, such as unusual signs or symptoms during pregnancy, and often saw limited utility in accessing services when they felt well, or for a normal physiological event such as childbirth. Health professionals also saw their role as being mainly treatment-oriented, rather than prevention-focused. 2. Modernisation of traditional practices: health professionals and ethnic minority women discussed recent improvements in infrastructure, services, and economic circumstances that had increased access to health services. However, these improvements were less pronounced in Hmong communities, suggesting inequity. 3. Perceptions of quality influenced service utilisation: both health professionals and ethnic minority women perceived primary care facilities to be of lower quality compared to hospital, and some women made decisions about accessing services based on these perceptions, preferring to travel further and spend more to access higher quality services. Health professionals' perceptions of low service quality appeared to influence their referral practices, with even uncomplicated cases referred to higher level services as a matter of course. CONCLUSIONS: Primary health care facilities were technically available and accessible to ethnic minority women, however these services were likely to be underutilised if they were perceived to be of low quality. Some women had the means to access higher quality facilities, but others were limited to lower quality facilities, potentially reinforcing inequities in health outcomes.


Assuntos
Etnicidade/psicologia , Pessoal de Saúde/psicologia , Grupos Minoritários/psicologia , Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Feminino , Grupos Focais , Acessibilidade aos Serviços de Saúde , Humanos , Serviços de Saúde Materna , Gravidez , Atenção Primária à Saúde , Pesquisa Qualitativa , Vietnã , Adulto Jovem
4.
Euro Surveill ; 24(23)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31186079

RESUMO

In 2015, a suspected cluster of two invasive meningococcal disease (IMD) cases of serogroup W Neisseria meningitidis (MenW) occurred in elderly care home residents in England over 7 months; case investigations followed United Kingdom guidance. An incident control team reviewed epidemiological information. Phenotyping of case specimens informed public health action, including vaccination and throat swabs to assess carriage. Whole genome sequencing (WGS) was conducted on case and carrier isolates. Conventional phenotyping did not exclude a microbiological link between cases (case 1 W:2a:P1.5,2 and case 2 W:2a:NT). After the second case, 33/40 residents and 13/32 staff were vaccinated and 19/40 residents and 13/32 staff submitted throat swabs. Two MenW carriers and two MenC carriers were detected. WGS showed that MenW case and carrier isolates were closely related and possibly constituted a locally circulating strain. Meningococcal carriage, transmission dynamics and influence of care settings on IMD in older adults are poorly understood. WGS analyses performed following public health action helped to confirm the close relatedness of the case and circulating isolates despite phenotypic differences and supported actions taken. WGS was not sufficiently timely to guide public health practice.


Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/diagnóstico , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis Sorogrupo W-135/isolamento & purificação , Neisseria meningitidis/isolamento & purificação , Sorogrupo , Idoso , Idoso de 80 Anos ou mais , Portador Sadio/microbiologia , Surtos de Doenças , Inglaterra/epidemiologia , Instituição de Longa Permanência para Idosos , Humanos , Incidência , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/transmissão , Vacinas Meningocócicas/imunologia , Neisseria meningitidis/classificação , Neisseria meningitidis/genética , Neisseria meningitidis Sorogrupo W-135/genética , Casas de Saúde , Fenótipo , Sequenciamento Completo do Genoma/métodos
5.
Euro Surveill ; 24(38)2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31552817

RESUMO

We identified two new Chlamydia trachomatis (CT) variants escaping Aptima Combo 2 (AC2) assay detection, in clinical specimens of two patients. One had a C1514T mutation the other a G1523A mutation, both within the AC2 23S rRNA target region. The prevalence of such variants among persons tested for CT in England was estimated to be fewer than 0.003%.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Variação Genética , Programas de Rastreamento/métodos , Técnicas de Amplificação de Ácido Nucleico , Adulto , Inglaterra/epidemiologia , Reações Falso-Positivas , Feminino , Humanos , Masculino , Prevalência , Adulto Jovem
6.
Eur J Dent Educ ; 23(1): e59-e70, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30358039

RESUMO

INTRODUCTION: Australia has a lack of dental practitioners in rural and remote regions. This study evaluates the impact of a Rural Clinical Placement Program (RCPP) offered to final year students at the University of Sydney (USYD) Dental School on the graduates working locations. MATERIALS AND METHODS: University of Sydney students who graduated between 2009 and 2013 (n = 404) were invited to complete a telephone interview. One hundred and thirty-five graduates were interviewed, 90 RCPP participants and 45 non-participants. RESULTS: The majority of graduates interviewed were from a metropolitan background (87%), 47% were female, 77% worked full time, and 70% were employed in private practice. A higher proportion (33%) of the RCPP participants were working in rural Australia compared with 18% of the non-participants. The graduates reported that the RCPP was a high-quality program with excellent rural clinical supervisors, provided broad clinical dentistry; they met appreciative patients and enjoyed the rural lifestyle. CONCLUSIONS: The RCPP was a valuable and positive experience with many considering it as a highlight of their dental education. A large proportion reported the program positively influenced their employment location choices, and a higher proportion of the RCPP participants were identified as working rurally, compared to the non-participants.


Assuntos
Educação de Pós-Graduação em Odontologia , Área de Atuação Profissional , Serviços de Saúde Rural , Faculdades de Odontologia , Estudantes de Odontologia , Austrália , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Estudos Longitudinais , Masculino
7.
Eur J Dent Educ ; 23(4): 437-447, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31206944

RESUMO

INTRODUCTION: The challenges in the recruitment and retention of dentists in rural Australia have contributed to a lack of dental service provision to rural communities. This paper explores the workforce factors involved in the employment location decisions of dentists' post-graduation. MATERIALS AND METHODS: Graduates between 2009 and 2013 from the University of Sydney, Dental School, were asked to complete a telephone interview related to their employment history. A total of 135 interviews were conducted, with 63% (135/214) of contactable graduates, or 33.4% (135/404) of all the graduates (2009-2013). Interviews followed a semi-structured script. RESULTS: Key factors which positively impacted on rural employment included the following: job competition in metropolitan areas, good rural salaries, financial incentives, clinical experience, rural lifestyle and professional mentorship. Barriers were as follows: proximity to friends and family, building a social and professional network, isolation, less professional support and reduced access to education. CONCLUSION: Recommendations to increase rural employment include: competitive rural salaries, financial incentives and formal mentorship during both recruitment and integration into a rural community. Dental schools should consider advertising identified drivers of rural employment, namely good salaries, full-time employment, clinical experience and rural lifestyle. This study provides important information related to rural employment and rural retention.


Assuntos
Área de Atuação Profissional , Serviços de Saúde Rural , Austrália , Escolha da Profissão , Emprego , Humanos , População Rural
8.
Eur Respir J ; 51(6)2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29748309

RESUMO

We used whole-genome sequencing (WGS) to delineate transmission networks and investigate the benefits of WGS during cluster investigation.We included clustered cases of multidrug-resistant (MDR) tuberculosis (TB)/extensively drug-resistant (XDR) TB linked by mycobacterial interspersed repetitive unit variable tandem repeat (MIRU-VNTR) strain typing or epidemiological information in the national cluster B1006, notified between 2007 and 2013 in the UK. We excluded from further investigation cases whose isolates differed by greater than 12 single nucleotide polymorphisms (SNPs). Data relating to patients' social networks were collected.27 cases were investigated and 22 had WGS, eight of which (36%) were excluded as their isolates differed by more than 12 SNPs to other cases. 18 cases were ruled into the transmission network based on genomic and epidemiological information. Evidence of transmission was inconclusive in seven out of 18 cases (39%) in the transmission network following WGS and epidemiological investigation.This investigation of a drug-resistant TB cluster illustrates the opportunities and limitations of WGS in understanding transmission in a setting with a high proportion of migrant cases. The use of WGS should be combined with classical epidemiological methods. However, not every cluster will be solvable, regardless of the quality of genomic data.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Polimorfismo de Nucleotídeo Único , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Sequenciamento Completo do Genoma , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Surtos de Doenças , Tuberculose Extensivamente Resistente a Medicamentos/transmissão , Humanos , Repetições Minissatélites , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Resistente a Múltiplos Medicamentos/transmissão , Reino Unido/epidemiologia
9.
BMC Med Educ ; 18(1): 196, 2018 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107795

RESUMO

BACKGROUND: Significant investment has been undertaken by many countries into 'Rural Clinical Training Placement Schemes' for medical students in order to deal with shortages of trained health care professionals in rural and remote locations. This systematic review examines the evidence base of rural educational programs within medical education and focusses on workforce intentions and employment outcomes. The study provides a detailed description of the methodological characteristics of the literature, thematic workforce outcomes and key related factors are identified, study quality is assessed, and the findings are compared within an international context. METHODS: A systematic review looking at international literature of rural placement programs within medical education between January 2005 to January 2017 from databases including; Medline, Embase, NursingOVID, PubMed and Cochrane. The study adopted the PRISMA protocol. A quality assessment of the literature was conducted based on the Health Gains Notation Framework. RESULTS: Sixty two papers met the inclusion criteria. The review identified three program classifications; Rural Clinical Placement Programs, Rural Clinical Placement Programs combined with a rural health educational curriculum component and Rural Clinical School Programs. The studies included were from Australia, United States, Canada, New Zealand, Thailand and Africa. Questionnaires and tracking or medical registry databases were the most commonly reported research tools and the majority were volunteer programs. Most studies identified potential rural predictors/confounders, however a number did not apply control groups and most programs were based on a single site. There was a clear discrepancy in the ideal rural clinical placement length. Outcomes themes were identified related to rural workforce outcomes. Most studies reported that an organised, well-funded, rural placement or rural clinical school program produced positive associations with increased rural intentions and actual graduate rural employment. CONCLUSIONS: Future research should focus on large scale methodologically rigorous multi-site rural program studies, with longitudinal follow up of graduates working locations. Studies should apply pre-and post-intervention surveys to measure change in attitudes and control for predictive confounders, control groups should be applied; and in-depth qualitative research should be considered to explore the specific factors of programs that are associated with encouraging rural employment.


Assuntos
Relações Comunidade-Instituição , Intenção , Serviços de Saúde Rural , Saúde da População Rural/educação , Estudantes de Medicina/psicologia , África , Austrália , Canadá , Humanos , Nova Zelândia , Avaliação de Programas e Projetos de Saúde , Tailândia , Estados Unidos
10.
Int J Equity Health ; 16(1): 190, 2017 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-29084545

RESUMO

BACKGROUND: Ethnic minority groups in Vietnam experience economic, social and health inequalities. There are significant disparities in health service utilisation, and cultural, interpersonal and communication barriers impact on quality of care. Eighty per cent of the population of Dien Bien Province belongs to an ethnic minority group, and poor communication between health professionals and ethnic minority women in the maternal health context is a concern for health officials and community leaders. This study explores how ethnic minority women experience communication with primary care health professionals in the maternal and child health setting, with an overall aim to develop strategies to improve health professionals' communication with ethnic minority communities. METHODS: We used a qualitative focused ethnographic approach and conducted focus group discussions with 37 Thai and Hmong ethnic minority women (currently pregnant or mothers of children under five) in Dien Bien Province. We conducted a thematic analysis. RESULTS: Ethnic minority women generally reported that health professionals delivered health information in a didactic, one-way style, and there was a reliance on written information (Maternal and Child Health handbook) in place of interpersonal communication. The health information they receive (both verbal and written) was often non-specific, and not context-adjusted for their personal circumstances. Women were therefore required to take a more active role in interpersonal interactions in order to meet their own specific information needs, but they are then faced with other challenges including language and gender differences with health professionals, time constraints, and a reluctance to ask questions. These factors resulted in women interpreting health information in diverse ways, which in turn appeared to impact their health behaviours. CONCLUSIONS: Fostering two-way communication and patient-centred attitudes among health professionals could help to improve their communication with ethnic minority women. Communication training for health professionals could be included along with the nationwide implementation of written information to improve communication.


Assuntos
Barreiras de Comunicação , Etnicidade/psicologia , Pessoal de Saúde/psicologia , Grupos Minoritários/psicologia , Relações Médico-Paciente , Atenção Primária à Saúde , Adolescente , Adulto , Pré-Escolar , Etnicidade/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Lactente , Recém-Nascido , Serviços de Saúde Materno-Infantil , Grupos Minoritários/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Serviços de Saúde Rural , Vietnã , Adulto Jovem
11.
Euro Surveill ; 22(49)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29233254

RESUMO

Four isolated cases of congenital syphilis born to mothers who screened syphilis negative in the first trimester were identified between March 2016 and January 2017 compared with three cases between 2010 and 2015. The mothers were United Kingdom-born and had no syphilis risk factors. Cases occurred in areas with recent increases in sexually-transmitted syphilis among women and men who have sex with men, some behaviourally bisexual, which may have facilitated bridging between sexual networks.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Comportamento Sexual , Sífilis Congênita/diagnóstico , Adulto , Inglaterra , Feminino , Humanos , Masculino , Gravidez
12.
BMC Med Educ ; 16(1): 206, 2016 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-27530252

RESUMO

BACKGROUND: The successful development and sustaining of professional identity is critical to being a successful doctor. This study explores the enduring impact of significant early role models on the professional identity formation of senior doctors. METHODS: Personal Interview Narratives were derived from the stories told by twelve senior doctors as they recalled accounts of people and events from the past that shaped their notions of being a doctor. Narrative inquiry methodology was used to explore and analyse video recording and transcript data from interviews. RESULTS: Role models were frequently characterised as heroic, or villainous depending on whether they were perceived as good or bad influences respectively. The degree of sophistication in participants' characterisations appeared to correspond with the stage of life of the participant at the time of the encounter. Heroes were characterised as attractive, altruistic, caring and clever, often in exaggerated terms. Conversely, villains were typically characterised as direct or covert bullies. Everyday events were surprisingly powerful, emotionally charged and persisted in participants' memories much longer than expected. In particular, unresolved emotions dating from encounters where bullying behaviour had been witnessed or experienced were still apparent decades after the event. CONCLUSION: The characterisation of role models is an important part of the professional identity and socialisation of senior doctors. The enduring impact of what role models say and do means that all doctors, need to consistently reflect on how their own behaviour impacts the development of appropriate professional behaviours in both students and training doctors. This is especially important where problematic behaviours occur as, if not dealt with, they have the potential for long-lasting undesirable effects. The importance of small acts of caring in building a nurturing and supportive learning atmosphere at all stages of medical education cannot be underestimated.


Assuntos
Educação Médica , Emoções , Relações Interprofissionais , Mentores/psicologia , Médicos/psicologia , Pesquisa Qualitativa , Ensino/normas , Atitude do Pessoal de Saúde , Bullying , Feminino , Humanos , Entrevistas como Assunto , Masculino , Memória Episódica , Narração , Competência Profissional , Identificação Social , Estresse Psicológico , Ensino/psicologia
13.
Postgrad Med J ; 91(1080): 579-87, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26268265

RESUMO

BACKGROUND: Preventable harm is one of the top six health problems in the developed world. Developing patient safety skills and knowledge among advanced trainee doctors is critical. Clinical supervision is the main form of training for advanced trainees. The use of supervision to develop patient safety competence has not been established. OBJECTIVE: To establish the use of clinical supervision and other workplace training to develop non-technical patient safety competency in advanced trainee doctors. DATA SOURCES: Keywords, synonyms and subject headings were used to search eight electronic databases in addition to hand-searching of relevant journals up to 1 March 2014. METHOD: Titles and abstracts of retrieved publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted. Clinical supervision documents were assessed against components common to established patient safety frameworks. Findings from the reviewed articles and document analysis were collated in a narrative synthesis. RESULTS: Clinical supervision is not identified as an avenue for embedding patient safety skills in the workplace and is consequently not evaluated as a method to teach trainees these skills. Workplace training in non-technical patient safety skills is limited, but one-off training courses are sometimes used. CONCLUSIONS: Clinical supervision is the primary avenue for learning in postgraduate medical education but the most overlooked in the context of patient safety learning. The widespread implementation of short courses is not matched by evidence of rigorous evaluation. Supporting supervisors to identify teaching moments during supervision and to give weight to non-technical skills and technical skills equally is critical.


Assuntos
Competência Clínica/normas , Educação Médica/organização & administração , Educação Profissionalizante/organização & administração , Segurança do Paciente/normas , Médicos , Desenvolvimento de Pessoal/organização & administração , Educação , Educação Médica/normas , Educação Profissionalizante/normas , Humanos , Liderança , Local de Trabalho
15.
Med Teach ; 35(1): 4-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23102154

RESUMO

BACKGROUND: Doctors are expected to teach but many are reluctant through lack of training. Busy clinicians have little time to attend faculty development initiatives. We wanted to increase clinical teaching capacity locally. WHAT WE DID: In response to requests from doctors lacking confidence in their teaching skills, we developed a programme tailored to the needs of working clinical teachers. The emphasis is on teaching effectively in a busy clinical environment. There are five 90 min modules: bedside teaching, effective supervision and feedback, teaching physical examination and procedures, effective lectures and facilitating development of clinical reasoning skills. The course is practical, interactive and takes place in a supportive learning environment adjacent to the workplace. A total of 81 clinicians participated in the course. EVALUATION: The main outcomes were increased confidence in bedside teaching, teaching more effectively on ward rounds and reduction in need for support with teaching. Participants reported a better understanding of basic educational theory and its relevance to clinical teaching. There is increased activity in clinical teaching among past participants. CONCLUSIONS: All clinical teachers require guidance and encouragement in developing their teaching skills. An accessible, practical focused teaching course run locally by colleagues with education expertise can improve clinicians' skills and motivation to teach.


Assuntos
Corpo Clínico Hospitalar/educação , Competência Profissional , Desenvolvimento de Pessoal/métodos , Ensino/normas , Currículo , Humanos , New South Wales , Estudos de Casos Organizacionais
16.
Pilot Feasibility Stud ; 8(1): 96, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488183

RESUMO

BACKGROUND: Video-reflexive ethnography (VRE) has been used to record aspects of patient care which are then shared with staff to drive self-identified improvements. Interpersonal interactions between patients and hospital staff are key to high-quality, patient-centred care and mostly occur randomly throughout a patient's hospital stay. One of the most common types of hospital admission is for women giving birth. AIMS: To assess the feasibility of adapting the VRE methodology to capture naturally occurring interactions between patients and health staff over an extended period during hospital admission, and to assess whether the approach would yield useful interaction data. PARTICIPANTS: Twelve women, who had a planned caesarean section at 37+ weeks, were considered low risk (no known medical or obstetric complication) and were admitted to a postnatal unit after giving birth, and the staff who attended them. METHODS: This study took place in a large hospital in Sydney, Australia, where approximately 2200 women give birth each year. Continuous unattended video recordings were made during each woman's hospital stay to capture interactions with hospital staff. The recordings were reviewed to determine what kinds of interaction data could be obtained. RESULTS: In order to recruit 12 eligible women, we needed to invite 45 to participate. The estimated recruitment period of 3-4 months had to be extended to 8 months. A fixed video camera was successfully installed in the hospital room of each woman and a remote control provided. A total of 246.5 h of video recordings was obtained, of which 38 h (15.5%) involved interpersonal interactions with staff. Two women reported negative responses from staff about being video recorded. Both quantitative and qualitative data could be obtained from the recordings. CONCLUSION: Video recordings of interpersonal interactions between patients and staff in an in patient hospital care setting can be obtained and can provide unique insights into the complexity of healthcare delivery. However, significant contextual barriers can exist to engaging staff in quality improvement initiatives that are not part of their usual healthcare activities.

17.
PLoS One ; 17(8): e0269740, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35960717

RESUMO

BACKGROUND: Medical students are known to have higher levels of these issues than the general population but in Vietnam the effects of the pandemic on medical student mental health was not documented. OBJECTIVES: To estimate the prevalence and identify factors associated with self-reported anxiety disorder, depression, and perception of worsening mental health among Vietnamese medical students during the COVID-19 pandemic. METHOD: A cross-sectional study was conducted from April 7th to 29th, 2020. All students in Doctor of General Medicine, Doctor of Preventive Medicine, and Bachelor of Nursing tracks at Hanoi Medical University (3672 students) were invited to participate. Data were collected using an online questionnaire including demographic characteristics, Generalized Anxiety Disorder 7 items, Patient Health Questionnaire 9 items, Fear of COVID-19 scale, and question about worsening mental health status. Robust Poisson regression was used to assess the association between mental health status and associated factors. RESULTS: Among 1583 students (43.1% response rate), the prevalence of students screened positive for anxiety disorder was 7.3%(95%C.I.:6.0-8.7), depression was 14.5%(95%C.I.:12.8-16.3), and perceiving worsening mental health was 6.9%(95%C.I.:5.7-8.3). In multivariable regression models, significant factors associated with self-reported anxiety disorder included being male (PR = 1.99,95%C.I.:1.35-2.92), difficulty in paying for healthcare services (PR = 2.05,95%C.I.:1.39-3.01), and high level of fear of COVID-19 (Q3:PR = 2.36,95%C.I.:1.38-4.02 and Q4:PR = 4.75,95%C.I.:2.65-8.49). Significant factors associated with self-reported depression were difficulty in paying for healthcare services (PR = 1.78,95%C.I.:1.37-2.30), and high level of fear of COVID-19 (Q3:PR = 1.41,95%C.I.:1.02-1.95 and Q4:PR = 2.23,95%C.I.:1.51-3.29). Significant factors associated with perceived worsening mental health status included having clinical experience (PR = 1.83,95%C.I.:1.17-2.88) and having atypical symptoms of COVID-19 (PR = 1.96,95%C.I.:1.31-2.94). CONCLUSION: The prevalence of self-reported depression, anxiety disorder, and worsening mental health among Vietnamese students during the first wave of COVID-19 was lower than in medical students in other countries. Further investigation is needed to confirm this finding.


Assuntos
COVID-19 , Estudantes de Medicina , Ansiedade/psicologia , Transtornos de Ansiedade/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Prevalência , SARS-CoV-2 , Autorrelato , Estudantes de Medicina/psicologia , Universidades
18.
PLoS One ; 17(12): e0279446, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36548356

RESUMO

BACKGROUND: The COVID-19 pandemic and governments' response lead to dramatical change in quality of life worldwide. However, the extent of this change in Vietnamese medical and nursing students has not been documented. OBJECTIVES: The study aims to describe the quality of life and changes in quality of life of medical and nursing students during the COVID-19 pandemic and examine the association of quality of life and changes in quality of life with fear of COVID-19 and other socio-economic and demographic factors. METHODS: The study was a cross-sectional study on all students of Hanoi Medical University from 3 majors: General Medicine, Preventive Medicine, Nursing (3672 invited students); from 7th to 29th of April 2020; using an online questionnaire that included demographic and academic information, the Vietnamese version of the SF-36 Quality of Life questionnaire and the Fear of COVID-19 Scale (FCV-19S). Linear and modified Poisson regression was used to examine the association between quality of life, changes in quality of life and other factors. RESULTS: The number of participants was 1583 (response rate 43%). Among 8 dimensions of the SF-36 (ranged 0-100), Vitality had the lowest score with a median score of 46. The median physical composite score (PCS) of the sample was 40.6 (IQR:20.8-53.2), 33.5% of the sample had an above-population average PCS score. The median mental composite score (MCS) of the sample was 20.3 (IQR:3.8-31.7), and 98.2% had an MCS score below average. 9.9% (95%CI:8.5%-11.4%) of the population reported a significant negative change in the quality of life. Fear of COVID-19 was not associated with significant changes in quality of life, nor MCS while having some association with PCS (Coef:-5.39;95%CI:-3to-7.8). Perceived reduction in quality of life was also associated with: being on clinical rotation COVID-19 (PR:1.5;95%CI:1.05-2.2), difficulties affording health services (PR:1.4;95%CI:1.02-1.95), obesity (PR:2.38;95%CI:1.08-5.25) and chronic disease (PR:1.92;95%CI:1.23-3), typical symptoms (PR:1.85; 95%CI:1.23-2.78) and atypical symptoms of COVID-19 (PR:2.32;95%CI:1.41-3.81). CONCLUSION: The majority of medical and nursing students had below average quality of life, with lower vitality and mental composite health score in the settings of COVID-19. Perceived decrease in quality of life was associated with clinical rotation, difficulties affording healthcare services and was not associated with Fear of COVID-19.


Assuntos
COVID-19 , Estudantes de Enfermagem , Humanos , COVID-19/epidemiologia , Qualidade de Vida , Estudos Transversais , Pandemias , População do Sudeste Asiático
19.
Dev Sci ; 14(5): 1033-45, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21884319

RESUMO

Although there is much research on infants' ability to orient in space, little is known regarding the information they use to do so. This research uses a rotating room to evaluate the relative contribution of visual and vestibular information to location of a target following bodily rotation. Adults responded precisely on the basis of visual flow information. Seven-month-olds responded mostly on the basis of visual flow, whereas 9-month-olds responded mostly on the basis of vestibular information, and 12-month-olds responded mostly on the basis of visual information. Unlike adults, infants of all ages showed partial influence by both modalities. Additionally, 7-month-olds were capable of using vestibular information when there was no visual information for movement or stability, and 9-month-olds still relied on vestibular information when visual information was enhanced. These results are discussed in the context of neuroscientific evidence regarding visual-vestibular interaction, and in relation to possible changes in reliance on visual and vestibular information following acquisition of locomotion.


Assuntos
Orientação , Comportamento Espacial , Vestíbulo do Labirinto/fisiologia , Percepção Visual , Adulto , Feminino , Humanos , Lactente , Masculino , Movimento , Rotação , Percepção Espacial
20.
Int J STD AIDS ; 32(14): 1338-1346, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34545755

RESUMO

Background: To date, evidence on whether sexualized drug use (SDU) and chemsex occur less frequently in rural compared to urban areas in Britain has been conflicting. This study aimed to better measure and understand whether attending urban versus rural sexual health clinics in the United Kingdom was associated with a difference in men who have sex with men's (MSM) experience of SDU or their access to SDU support. Methods: Men from 29 sexual health services across England and Scotland were recruited by self-completing a waiting room survey. Results: A total of 2655 men (864 MSM) took part. There was no statistically significant difference in recent SDU or chemsex identified in MSM attending rural compared to urban clinics. Gamma-Hydroxybutyrate/Gamma-Butyrolactone (GHB/GBL) was the most commonly reported chemsex drug used in a sexual setting, with equal prevalence of use in urban and rural MSM attendees. Distance travelled for SDU was not significantly different for rural compared to urban MSM. Rural MSM reported a higher rate of unmet need for SDU specific services, although this difference was not statistically significant. Conclusion: Within this sample of MSM, there were no significant differences in sexualized drug use behaviours between those attending rural compared to urban sexual health settings.


Assuntos
Saúde Sexual , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Estudos Transversais , Inglaterra/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Escócia/epidemiologia , Comportamento Sexual , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA