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1.
Medicine (Baltimore) ; 99(17): e19812, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332624

RESUMO

The European Higher Education Area was implemented more than a decade ago with the aim of improving internationally the competitiveness of European university education putting the spotlight on skills and competence development (and not only on knowledge acquisition). This work intends to analyze the impact of competence-based teaching methodologies on university students, as well as to contribute to the study of the individual personality traits differences regarding this impact. For this, a descriptive, quantitative, cross-sectional study was conducted with a non-randomised sample of university students. The sample was composed of a total of 499 students of the University of Huelva (350 from the Health Sciences degree, and 149 form other degrees), who completed a questionnaire on professional skills and teaching methods developed ad hoc for this research, as well as the brief version of the Spanish adaptation of the NEO Five-Factor Inventory. The results show that Health Sciences students feel more satisfied with the most participative and active methodologies, and they consider these better contribute to their future professional competence development. On the other hand, in relation to the big 5 personality traits studied, links have been found between competence development perception and personal preferences and the dimensions of extraversion, agreeableness, conscientiousness and openness to experience. This last factor, openness to experience, appears when analyzing the main differences among both groups, being Health Sciences students more intellectually curious, showing more openness and diversity of interests, in addition to being more creative, innovative, and flexible.


Assuntos
Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/psicologia , Inventário de Personalidade/estatística & dados numéricos , Adolescente , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Educação Baseada em Competências/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Personalidade/estatística & dados numéricos , Inquéritos e Questionários
2.
BMC Health Serv Res ; 20(1): 105, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041600

RESUMO

BACKGROUND: There is consistent evidence highlighting the mal-distribution of the health workforce between urban and rural and remote regions. To date, addressing this mal-distribution has focused on medicine and nursing with limited initiatives targeted at allied health. Therefore, the aim of this research was to explore the enablers of and barriers to transition to rural practice by allied health professionals across South Australia in Australia. METHOD: Qualitative descriptive methodology was used to underpin this research. Individual, in-depth semi-structured interviews were conducted with employers, managers and allied health professionals from rural regions of South Australia who were identified using purposive maximum variation sampling strategy. RESULTS: A total 22 participants shared their perspectives on the enablers of and barriers to transition to rural practice by allied health professionals across South Australia. Thematic analysis of the interview data resulted in a number of key issues impacting transition to rural-based practice. These findings could be broadly categorised into three stages during the transition: 'before'; 'during' and 'after'. DISCUSSION: This study identified a range of enablers of and barriers to transition to rural practice by allied health professionals. Five overarching themes - nature of rural practice, exposure to rural 'taster', social/lifestyle, job availability/characteristics, and mentor and support were identified. In particular, exposure to rural 'taster', social/lifestyle, and mentor and support were the key themes reported by the stakeholders. The multifactorial nature of the barriers and enablers highlight the complexity underpinning how AHPs transition to rural-based practice. These barriers/ enablers are often inter-linked and continually evolving which pose significant challenges for health care stakeholders to successfully addressing these. CONCLUSION: This research sheds light on the complexities that confront and successful strategies that are required for health care stakeholders when considering how best to support allied health professional transition to rural practice.


Assuntos
Pessoal Técnico de Saúde/psicologia , Atitude do Pessoal de Saúde , Serviços de Saúde Rural/organização & administração , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Feminino , Mão de Obra em Saúde , Humanos , Masculino , Pesquisa Qualitativa , Austrália do Sul , Serviços Urbanos de Saúde/organização & administração , Adulto Jovem
3.
BMC Health Serv Res ; 19(1): 812, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699084

RESUMO

BACKGROUND: Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics' workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number. METHODS: Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload. RESULTS: A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient's body weight and the transfer of patients with transmittable pathogens. CONCLUSION: The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.


Assuntos
Pessoal Técnico de Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
4.
Int J Occup Environ Med ; 10(4): 185-193, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31586383

RESUMO

BACKGROUND: World Health Organization's Healthy Workplace Framework and Model has emphasized addressing psychosocial work stressors as one of the important avenues toward creating a conducive workplace. Management and interventions of these adverse stressors have been unremarkable; impairing work productivity. OBJECTIVE: To explore the effect of psychosocial work stressors on health service productivity. METHODS: Using Copenhagen Psychosocial Questionnaire II and Healthcare Productivity Survey, a cross-sectional study was conducted on 225 health and allied health professionals in the largest referral hospital in Brunei. Multiple linear regression was used to explore the relationship of each domain of work productivity to indicators of psychosocial work stressors. RESULTS: Psychosocial work stressors explained more than 50% of the variance for health care productivity. Influence at work, role clarity, rewards and job satisfaction were among the factors with the highest contributions to this relationship. CONCLUSION: Crucial factors were identified and discussed, however, due to complexity of this relationship, international collaborations and efforts are required to ameliorate adverse effects of psychosocial stressors and improve health service productivity.


Assuntos
Estresse Ocupacional , Estresse Psicológico , Desempenho Profissional , Adulto , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Corpo Clínico/psicologia , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Estresse Ocupacional/complicações , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/psicologia , Estresse Psicológico/complicações , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Desempenho Profissional/estatística & dados numéricos , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos
5.
BMC Health Serv Res ; 19(1): 753, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653211

RESUMO

BACKGROUND: The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. METHODS: Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. RESULTS: 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. CONCLUSIONS: Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Tradução , Adulto , Pessoal Técnico de Saúde/economia , Criança , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Inquéritos e Questionários , Suíça
6.
Br J Hosp Med (Lond) ; 80(8): 456-460, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437039

RESUMO

Ulnar-sided wrist pain is often unfairly labelled as the 'back pain' of the wrist. This reputation comes from the complexity of diagnosing problems related to this area of the wrist. This article summarizes the anatomy and biomechanics of the wrist and presents a logical approach to diagnosing the aetiology of the pain. The problems are categorised based on the anatomical structure from which the pain arises: either bony, soft tissue-related or arising from nerves or vascular structures. The article also outlines the relevant examination findings and the most appropriate investigation that would yield a diagnosis with any given presentation. A linked article detailing the imaging of ulnar-sided wrist pain is included in this issue (10.12968/hmed.2019.80.8.461).


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Artralgia/diagnóstico , Dor/diagnóstico , Radiologia/métodos , Ulna/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Fenômenos Biomecânicos , Competência Clínica , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Medição da Dor , Exame Físico/métodos , Amplitude de Movimento Articular/fisiologia , Traumatismos do Punho/diagnóstico
7.
BMC Public Health ; 19(1): 1096, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409317

RESUMO

BACKGROUND: Culturally competent health care service delivery can improve health outcomes, increasing the efficiency of clinical staff, and greater patient satisfaction. We aimed to explore the experience of patients with limited English proficiency and professional interpreters in an acute hospital setting. METHODS: In-depth interviews explored the experiences of four culturally and linguistically diverse communities with regards to their recent hospitalisation and access to interpreters. We also conducted focus group with professional interpreters working. Data were analysed using an inductive thematic approach with constant comparison. RESULTS: Individual interviews were conducted with 12 patients from Greek, Chinese, Dari and Vietnamese backgrounds. Focus groups were conducted with 11 professional interpreters. Key themes emerged highlighting challenges to the delivery of health care due distress and lack of advocacy in patients. Interpreters struggled due to a reliance on family to act as interpreters and hospital staff proficiency in working with them. CONCLUSIONS: In an era of growing ethnic diversity this study confirms the complexity of providing a therapeutic relationships in contemporary health practice. This can be enhanced by training towards the effective use of professional interpreters in a hospital setting. Such efforts should be multidisciplinary and collective in order to ensure patients don't fall through the gaps with regards to the provision of culturally competent care.


Assuntos
Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente , Necessidades e Demandas de Serviços de Saúde , Idioma , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Austrália , Diversidade Cultural , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/psicologia , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa , Tradução
8.
Work ; 63(4): 623-633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282455

RESUMO

BACKGROUND: The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance. OBJECTIVE: Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates. METHODS: A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups. RESULTS: Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power. CONCLUSIONS: Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Avaliação de Desempenho Profissional/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Aptidão Física , Treinamento de Resistência/métodos , Adulto , Pessoal Técnico de Saúde/normas , Avaliação de Desempenho Profissional/normas , Emprego/normas , Feminino , Humanos , Masculino , Ontário , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
9.
Emerg Med J ; 36(10): 582-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31320333

RESUMO

OBJECTIVE: To characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit. METHODS: We performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018. RESULTS: The most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%). CONCLUSIONS: Emergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.


Assuntos
Barreiras de Comunicação , Serviço Hospitalar de Emergência/organização & administração , Relações Profissional-Paciente , Tradução , Adulto , Pessoal Técnico de Saúde/organização & administração , Pessoal Técnico de Saúde/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Admissão do Paciente/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Telefone , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
10.
Medicina (Kaunas) ; 55(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31277516

RESUMO

: Background and Objectives: Medical staff is rarely trained in structured decision-making, relying instead on intuition without due consideration for the associated pros and cons. Materials and Methods: We adopted a model for decision-making to improve reasoning and risk assessment and carried out a prospective simulation study using paramedic students in a three-year training program. We conducted a training session in which participants were lectured on decision-making using the FAR-BEK model (German abbreviation for facts, alternatives, risks, competence, decision, control), physiological processes in decision-making under stress, as well as medico-legal aspects for the comprehension and justification of medical decisions. We analyzed pre- and post-training scenarios to elucidate the influence of training on decision-making. Results: Twenty paramedic students, with a mean age of 22.0 ± 1.7 years, took part in the study. The question of whether decision aids can be applied, initially affirmed by 40% of participants, rose to 71.4% (p = 0.011) following our training. Confidence in decision-making increased on a 7-point Likert scale from 4.5 to 4.8 points (p < 0.394). The reasoning behind the decisions rose from 5.3 to 5.6 points (p < 0.081). Indication, options, and risks rose significantly, from 5.4 to 6.1 points (p = 0.045). Overall, our simulation training significantly increased the points of decision support taken into account (57.8% vs. 88.9%, p < 0.001). Viewed individually, the largest increase of 180% was seen in risk assessment (33.3% vs. 93.3%, p < 0.002). The second largest increase of 150% was seen in the question of one's own permissions (26.7% vs. 66.7%, p < 0.066). Also, the control increased (40.0% vs. 86.7%, p < 0.021). Conclusions: With a brief training course, both the awareness and the implementation of a structured decision-making model in paramedic students can be significantly increased. Nevertheless, no definitive conclusions can be made with respect to the implementation of real patient care. The application of structured, standardized decision-making tools may need to be further consolidated in routine medical use.


Assuntos
Pessoal Técnico de Saúde/psicologia , Técnicas de Apoio para a Decisão , Medição de Risco/normas , Pensamento/fisiologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Simulação por Computador , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco/métodos , Adulto Jovem
11.
Prehosp Disaster Med ; 34(3): 335-339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31204643

RESUMO

OBJECTIVE: The objective of this study was to explore preferred self-care practices among paramedics and emergency medical technicians (EMTs) who responded to the September 11, 2001 terrorist attack (9/11) in New York City (New York USA). DESIGN, SETTING, AND PARTICIPANTS: Qualitative research methodology with convenience and subsequent snowball sampling was utilized. Participants were adult (at least 18 years of age) paramedics or EMTs who self-reported as responding to the 9/11 terrorist attack in New York City. MAIN OUTCOME MEASURES: Preferred self-care practices; participant characteristics; indications and patterns of self-care use; perceived benefits and harms; and views on appropriate availability of support and self-care services were the main outcome measures. RESULTS: The 9/11 paramedic and EMT participants reported a delay in recognizing the need for self-care. Preferred physical self-care practices included exercise, good nutrition, getting enough sleep, and sticking to routine. Preferred psychosocial self-care practices included spending time with family and friends, participating in peer-support programs and online support forums, and routinely seeing a mental health professional. Self-care was important for younger paramedics and EMTs who reported having less-developed supportive infrastructure around them, as well as for retiring paramedics and EMTs who often felt left behind by a system they had dedicated their lives to. Access to cooking classes and subsidized gym memberships were viewed as favorable, as was the ability to include family members in self-care practices. CONCLUSION(S): A range of physical and psychosocial self-care practices should be encouraged among paramedic students and implemented by Australian ambulance services to ensure the health and well-being of paramedics throughout their career and into retirement.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Auxiliares de Emergência/estatística & dados numéricos , Autocuidado/métodos , Ataques Terroristas de 11 de Setembro , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Auxiliares de Emergência/psicologia , Socorristas/psicologia , Socorristas/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Cidade de Nova Iorque , Pesquisa Qualitativa , Medição de Risco , Amostragem , Autocuidado/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Fatores de Tempo
12.
Eur J Cancer Care (Engl) ; 28(5): e13124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31222849

RESUMO

OBJECTIVE: The aim of this study is to examine the relationship of empathy and professional quality of life in cancer healthcare professionals. METHODS: A Professional Quality of Life instrument measuring compassion satisfaction and compassion fatigue, and the Interpersonal Reactivity Index measuring empathy were distributed to healthcare professionals working in cancer care in the Republic of Ireland. Final analysis was conducted on 117 participants. RESULTS: A quarter of participants experience high levels of compassion satisfaction, and a quarter are at risk of compassion fatigue. A positive correlation was found between personal distress and compassion fatigue, and a negative correlation was found between personal distress and compassion satisfaction. A positive correlation was found between empathic concern and secondary traumatic stress. CONCLUSION: These findings suggest that healthcare professionals working in cancer care are at risk of compassion fatigue. Also, healthcare professionals working in cancer care experience personal distress that may impact negatively on professional quality of life. Implications for practice include a need to identify those HCPs who are at risk of compassion fatigue. The implication for further research suggests further exploration of the impact of personal distress felt by cancer healthcare professionals during empathic engagement.


Assuntos
Pessoal Técnico de Saúde/psicologia , Esgotamento Profissional/psicologia , Fadiga por Compaixão/psicologia , Empatia , Neoplasias/terapia , Enfermeiras e Enfermeiros/psicologia , Oncologistas/psicologia , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Esgotamento Profissional/epidemiologia , Fadiga por Compaixão/epidemiologia , Estudos Transversais , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Irlanda/epidemiologia , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermagem Oncológica/estatística & dados numéricos , Adulto Jovem
13.
Ergonomics ; 62(8): 1033-1042, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31092138

RESUMO

The Ottawa Paramedic Physical Ability Test (OPPAT) is a physical employment standard (PES) that candidates must pass as a pre-hire requirement and that incumbents may have to pass prior to returning to work after absence, to demonstrate their physical capabilities as required to safely meet the demands of paramedic work. Consistent with best practice guidelines for PES development, it is important to establish reliability and to investigate sex-based performance differences. Active duty paramedics completed the OPPAT twice while candidates completed the OPPAT six times. Across all participants, a median improvement of 76.0 s was observed in OPPAT performance (922.0-846.0 s) between trial 1 and trial 2. Among candidates, OPPAT performance stabilised by the fourth trial confirming reliability. Sex-based analyses revealed median differences in OPPAT performance time of 39.0 and 63.0 s between males and females during the first and second trials respectively. Practitioner summary: Active duty paramedics and candidates performed the Ottawa Paramedic Physical Ability Test (OPPAT) faster following familiarisation. Among candidates, performance time stabilised by the fourth trial. Performance time was slower among females, but this had less impact on females' ability to meet the OPPAT standard.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Seleção de Pessoal/normas , Fatores Sexuais , Avaliação da Capacidade de Trabalho , Desempenho Profissional/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/normas , Emprego/normas , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas
14.
Gen Hosp Psychiatry ; 59: 20-29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096165

RESUMO

OBJECTIVES: (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS: This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS: Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS: Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Recursos Humanos de Enfermagem/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Quênia , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Projetos Piloto , Organização Mundial da Saúde , Adulto Jovem
15.
Prehosp Disaster Med ; 34(3): 288-296, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31030709

RESUMO

BACKGROUND: Emergency Medical Services (EMS) professionals face high physical demands in high-stress settings; however, the prevalence of cardiovascular health (CVH) risk factors in this health care workforce has not been explored. The primary objective of this study was to compare the distribution of CVH and its individual components between a sample of emergency medical technicians (EMTs) and paramedics. The secondary objective was to identify associations between demographic and employment characteristics with ideal CVH in EMS professionals. METHODS: A cross-sectional survey based on the American Heart Association's (AHA; Dallas, Texas USA) Life's Simple 7 (LS7) was administered to nationally-certified EMTs and paramedics. The LS7 components were scored according to previously described cut points (ideal = 2; intermediate = 1; poor = 0). A composite CVH score (0-10) was calculated from the component scores, excluding cholesterol and blood glucose due to missing data. Multivariable logistic regression was used to estimate odds ratios (OR; 95% CI) for demographic and employment characteristics associated with optimal CVH (≥7 points). RESULTS: There were 24,708 respondents that were currently practicing and included. More EMTs achieved optimal CVH (n = 4,889; 48.8%) compared to paramedics (n = 4,338; 40.6%). Factors associated with higher odds of optimal CVH included: higher education level (eg, college graduate or more: OR = 2.26; 95% CI, 1.97-2.59); higher personal income (OR = 1.26; 95% CI, 1.17-1.37); and working in an urban versus rural area (OR = 1.31; 95% CI, 1.23-1.40). Paramedic certification level (OR = 0.84; 95% CI, 0.78-0.91), older age (eg, 50 years or older: OR = 0.65; 95% CI, 0.58-0.73), male sex (OR = 0.54; 95% CI, 0.50-0.56), working for a non-fire-based agency (eg, private service: OR = 0.68; 95% CI, 0.62-0.74), and providing medical transport service (OR = 0.81; 95% CI, 0.69-0.94) were associated with lower odds of optimal CVH. CONCLUSIONS: Several EMS-related characteristics were associated with lower odds of optimal CVH. Future studies should focus on better understanding the CVH and metabolic risk profiles for EMS professionals and their association with incident cardiovascular disease (CVD), major cardiac events, and occupational mortality.Cash RE, Crowe RP, Bower JK, Foraker RE, Panchal AR. Differences in cardiovascular health metrics in emergency medical technicians compared to paramedics: a crosssectional study of Emergency Medical Services professionals. Prehosp Disaster Med. 2019;34(3):288-296.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Serviços Médicos de Emergência , Auxiliares de Emergência/estatística & dados numéricos , Nível de Saúde , Adulto , Fatores Etários , Doenças Cardiovasculares/diagnóstico , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Fatores Sexuais , Inquéritos e Questionários , Texas
16.
Infez Med ; 27(1): 40-45, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882377

RESUMO

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.


Assuntos
Patógenos Transmitidos pelo Sangue , Pessoal de Saúde/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Feminino , Humanos , Incidência , Itália , Masculino , Pessoal de Laboratório Médico/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Recursos Humanos de Enfermagem/estatística & dados numéricos , Profilaxia Pós-Exposição , Estudos Retrospectivos , Risco , Estudantes de Ciências da Saúde/estatística & dados numéricos , Centros de Atenção Terciária
17.
Rev Bras Enferm ; 72(1): 3-8, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916261

RESUMO

OBJECTIVE: To point out limits and possibilities involved in the teaching and learning process of undergraduate students from Health of a Federal Public Higher Education Institution on breastfeeding. METHOD: Instantaneous photography study carried out in undergraduate courses in the area of Health with professors and students involved in the teaching and learning process on breastfeeding. For data collection, the Focal Group technique was used with the students and the semi-structured interview with the professors. The speeches were submitted to the thematic content analysis of Bardin. RESULTS: It was identified the thematic category: Limits and possibilities for the teaching and learning process on breastfeeding, from two sub-categories: Structural limitations of the courses; and Advances and obstacles in the relationship between theory and practice. FINAL CONSIDERATIONS: Limits indicated as workload deficit and professor-centered teaching made progress in learning about breastfeeding difficult, and interdisciplinarity was a step forward in this process.


Assuntos
Pessoal Técnico de Saúde/educação , Aleitamento Materno/métodos , Currículo/normas , Estudantes/psicologia , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Brasil , Aleitamento Materno/tendências , Coleta de Dados , Grupos Focais/métodos , Educação em Saúde/métodos , Educação em Saúde/tendências , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades/organização & administração , Universidades/estatística & dados numéricos
19.
Br J Surg ; 106(2): e129-e137, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30620069

RESUMO

BACKGROUND: Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task-sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors. METHODS: All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non-inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity. RESULTS: Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42). CONCLUSION: Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task-sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Cesárea/efeitos adversos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Recém-Nascido , Mortalidade Materna , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Serra Leoa
20.
Appl Ergon ; 74: 177-185, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30487098

RESUMO

Few studies have quantified the risk of musculoskeletal disorders during patient transfers in total assistance mode in real-life prehospital emergency care situations. An index to assess the overall risk of patient transfers was created; it makes it possible to quantify risk based on the patient's position and the height of the patient's location. An analysis of 71 transfers executed by paramedics in actual work situations showed that moving a patient from the ground was characterized by acute sagittal flexions and axial rotations, respectively, 42% and 12% of the time. When the patient was lying on a raised surface, the lifting index and perceived exertion were the lowest (2.55; easy). According to the overall risk index, patient transfers from the ground are the riskiest. Paramedics execute many risky lifts even in favorable patient handling contexts.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Movimentação e Reposicionamento de Pacientes/efeitos adversos , Doenças Musculoesqueléticas/etiologia , Doenças Profissionais/etiologia , Medição de Risco/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Movimentação e Reposicionamento de Pacientes/métodos , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Postura , Adulto Jovem
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