Ecole d'été de l'A.C.E.M.I.—Haïti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

Health-related experimental learning for college undergraduates

Guided service experience commonly enriches medical education at the doctoral and postdoctoral levels but rarely has been offered to premedical students. Internships in health agencies were individually arranged for 198 self-selected college undergraduates in 101 different settings which emphasized the social, economic, and interpersonal factors in health care. Students served as nursing aides, clinical assistants, and health educators and in other nontechnical roles; each wrote an analytical report based upon a study plan and firsthand observations. The expectations of both students and host institutions were usually exceeded. Benefits included help in career decisions, exercise in self-directed learning, and demonstration of noncognitive qualities desired in professional work. The authors conclude that undergraduate students are competent to deal with sensitive ethical and social issues in patient care and to provide needed health services of high quality.     

Facilitating the acceptance of employment of older registered nurses among Japanese female registered nurses younger than 65 years old

Objective: In Japan, policies to ensure employment for persons aged 65 and older are being implemented. To facilitate the employment of older registered nurses working in hospitals, the understanding of registered nurses younger than 65 is necessary. We investigated the factors associated with the acceptance of employment of older registered nurses among registered nurses younger than 65.Materials and Methods: The subjects were female registered nurses younger than 65 working in 34 hospitals in Mie Prefecture. We distributed anonymous self-administered questionnaires. We conducted factor analyses of both respondents’ opinions on the employment of “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. Multiple regression analysis was conducted to examine the associations between the “Acceptance of employing registered nurses aged 65–69” and “Opinions on the employment of registered nurses aged 65–69” (Statistical model 1). Moreover, multiple regression analysis was also conducted to examine the associations between the “Acceptance of employing registered nurses aged 70–74” and the “Opinions on the employment of registered nurses aged 70–74” (Statistical model 2).Results: Using factor analyses, the same factors were extracted for both, “Registered nurses aged 65–69” and “Registered nurses aged 70–74”. These factors were: “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, “Reducing the workload burden of registered nurses”, and “Manners of older registered nurses”. Using multiple regression analyses, “Health and job performance”, “Utilization of the knowledge and experience of older registered nurses”, and “Reducing the workload burden of registered nurses” were significantly associated with “Acceptance of employing registered nurses aged 65–69” (Statistical model 1). The same 3 factors were also significantly associated with “Acceptance of employing registered nurses aged 70–74” (Statistical model 2).Conclusion: Hospital managers must pay careful attention to these 3 factors.     

Clinical inter-professional education activities: Students' perceptions of their experiences

Background and purposeStudents from different health disciplines should learn together during certain periods of their education to acquire skills necessary for solving the health problems. The Faculty of Health Sciences of University of the Witwatersrand created inter-professional education (IPE) activities for students to assess clinical IPE groups'' perceptions of IPE experiences and to identify lessons learnt during IPE sessions.MethodsThis was a qualitative study with review of the students'' post IPE feedback forms. The students were granted ‘protected time’ of three full days over a period of two months to participate in IPE activities.ResultsStudents felt that knowledge about health team members was gained and that IPE groups should have more than one person from each field with the same level of clinical exposure. The students indicated the need to have regular IPE activities and if possible to incorporate this into clinical practice for them to experience it in daily clinical practice.ConclusionParticipating in the IPE activity made students gain appreciation and respect for other health professionals'' roles and scope. When student groups are big, patient observations can be done as this does not compromise IPE learning outcomes. Group composition should be kept in mind to cater for the learning needs of all students. If it is not possible to meet the needs of all professions, smaller groups with professions applicable to case can be created.     

医学院校大学毕业生就业能力培养策略

大学生就业能力的提升对于解决医学院校大学生就业难、提高大学生就业率具有重要意义。分析了大学生就业能力的构成及大学生就业能力提升的意义,通过用人单位对大学生就业能力的期望和评价着手,从大学生角度提出了医学大学生就业能力的培养策略。     

Preventive Psychiatry: The Psychiatric Team as Consultant to the Public Health Nurse

Various forms of collaboration between the disciplines of public health and psychiatry are briefly reviewed and the 25-year-old mental health program of the Vancouver Health Department is described. The public health nurse has prime responsibility in all children with emotional disorders. She is supported by a psychiatric team which provides active treatment and educational and consultative help for the nurse and the school. During the year 1963, six social workers had 2357 contacts with nurses and school personnel but only 1049 treatment interviews. Of 401 children referred to the psychiatric team, 138 received active clinic treatment, 141 remained under supervision by the public health nurse, and 122 were referred elsewhere. In addition, 1330 children were identified as “mental hygiene cases” in the caseload of the 170 public health nurses in the community. By close co-ordination, the public health nurse and the psychiatric team can enhance each other's contributions to community mental health.     

Problems Related to the Use of Food Additives in the United States

Major problems encountered by enforcement agencies and by regulated industries, respectively, in implementing and conforming to recent food additive laws are reviewed. Decisions as to which substances fall within the broad terms of the legal definition, and which escape by virtue of “generally recognized as safe” (GRAS) status, are often difficult and complex. Distinctions cannot be made solely on the basis of whether substances are old or new, natural or synthetic. Registration of pesticides on a “no residue” basis and establishment of “zero tolerances” for food additives have created an anomalous situation as a result of improvements in sensitivity of analytical techniques which revealed the presence of minute amounts of substances where none were believed to exist. A solution has been recommended by a specially appointed committee of the National Academy of Sciences-National Research Council (U.S.A.). Enforcement of the new food additive laws warrants revision of present labelling requirements to provide for designating chemical ingredients by functional categories rather than by confusing chemical terminology.     

Misdiagnosis: Burnout,moral injury,and implications for the electronic health record

Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. Burnout in clinicians is receiving significant attention. Some have proposed that clinicians are experiencing symptoms of moral injury, defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Current efforts to improve the electronic health record (EHR) have focused on improving the user experience to reduce burden that has been identified as a contributing factor to provider burnout. However, if EHRs are contributing to moral injury, improvements to user experience will not eliminate the effects on providers. Current research has not evaluated the risk for moral injury resulting from the use of EHRs. This Perspective reviews the differences between burnout and moral injury, discusses the implications for clinicians using EHRs, and highlights the need for research to better define the problem.     

Parathion Poisoning from Flannelette Sheets

Two small boys were admitted to the Lions Gate Hospital in coma and acute respiratory distress. They improved and the first boy was sent home; after two nights he was back in hospital in a worsened state. Poisoning with organic phosphate was suspected, and after investigation some flannelette sheets were taken from his home for testing. They proved to have been contaminated with parathion (“nerve gas”) in the hold of a ship sailing from Antwerp to Vancouver; the parathion had been offloaded in California. The remainder of the sheets were traced. The symptomatology and treatment of organic phosphate ester poisoning and the chemical testing of parathion are discussed.     

积极心理学视野下师范院校留守经历学生心理健康现状研究

目的以留守经历为切入口,探讨积极心理学视野下,师范院校大学生心理健康水平现状,以期从实证角度帮助促进大学生心理健康和谐发展。方法选取安徽省阜阳市、安庆市部分师范院校大学生为被试,调查学生留守经历状况,并综合运用SCL-90症状自评量表了解学生心理健康状况。结果父母外出情况、父母外出打工年限、学生开始留守年龄段、与父母团聚频率的不同,学生的心理健康水平也存在显著差异,父母双方均外出、父母外出打工年限超过1年、学生开始留守年龄段在小学及以前、与父母团聚频率在半年以上的学生心理健康水平低于父母其中一人外出、父母外出打工年限在1年以下、学生开始留守年龄段在初中以上、与父母团聚频率在半年以内的学生（P < 0.01）。结论曾经的留守经历对师范院校大学生心理健康存在一定影响,作为教育者应有针对性地对学生进行心理健康教育。     

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident: results from the Fukushima health management survey

Introduction: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children’s experience of the nuclear disaster. Methods: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS); FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the “Strengths and Difficulties Questionnaire (SDQ)” scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster — “nuclear disaster (+)” and “nuclear disaster (−)” — were also compared. Results: Our effective response was 93 (59.6%); the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between “elementary school” and “junior high school” or “nuclear disaster” (+) and (−). There was no significant difference between these items. Conclusions: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.     

The Business Value of Health Care Information Technology

The American health care system is one of the world''s largest and most complex industries. The Health Care Financing Administration reports that 1997 expenditures for health care exceeded one trillion dollars, or 13.5 percent of the gross domestic product. Despite these expenditures, over 16 percent of the U.S. population remains uninsured, and a large percentage of patients express dissatisfaction with the health care system. Managed care, effective in its ability to attenuate the rate of cost increase, is associated with a concomitant degree of administrative overhead that is often perceived by providers and patients alike as a major source of cost and inconvenience. Both providers and patients sense a great degree of inconvenience and an excessive amount of paperwork associated with both the process of seeking medical care and the subsequent process of paying for medical services.Traditionally, health practitioners have sought a return to traditional fee-for-service payment to mitigate the inconvenience associated with managed care. More populist proposals include universal health insurance or mandatory enrollment in health maintenance organizations. Advocates of managed care argue that the business methods required for effective trials of this approach are only beginning to be realized. By all accounts, information technology is a necessary part of these initiatives, but there is universal consensus that our current systems are inadequate to the task. (Oxford Health System''s difficulties in 1998, for example, have been attributed in part to inadequate deployment of information technology.) To this author, the model for the current generation of health care information systems is strikingly similar to that for the information systems employed by the Internal Revenue Service. In each case, the system allows for low-cost changes to administrative code brought about by legislation, but in both cases the “ripple effects” of additional complexity and administrative burden far exceed the cost of immediate change. To paraphrase a quotation attributed to Major Richard Dailey, made about his police force during the 1998 Chicago Democratic Convention, our information systems “are not here to create disorder; they are here to preserve disorder.”This case explores one alternative source for models in health care delivery. Through an examination of a typical patient experience, we explore Porter''s notion of the value chain and “just-in-time” logistics common to successful organizations like Wal-Mart and Amazon.com (see Suggested Readings). We close with a brief discussion of how these logistics and inventory systems apply to health care. Clearly, logistics are important in patient care, accounts receivable are a cause of severe working capital problems in health care, and the logistics of caring for patients are becoming more complex. But the concepts we discuss have an even greater importance: Effective management of these issues through information technology may restore our most precious commodity—time.     

Buffeted by harsh economic winds, medical schools turn a wary eye to the future

All parts of Canada's health care system are facing fiscal pressures these days, but they are particularly great at Canada's medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada's medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don't just turn out students — we raise the standard of health care in a whole community,” he says.     

引导医学生面向基层就业刍议

引导和鼓励医学生到基层就业,需要强化政府工作职能,加强医学高校就业指导,健全基层医疗单位用人机制和医学生自身观念的转变。     

心理健康与自杀行为的影响因素： 基于对三所高校10 340名医学生的调查

目的 了解并探讨医学生的心理健康及自杀行为的影响因素,为提高医学生的心理健康水平、降低自杀行为提供科学依据。方法 以某省南部、北部和中部三个地区的省属医学院校的一、二年级11270名在校大学生为调查对象,经过对回收的问卷进行核查并摒弃填写质量较差的问卷后保留10 340份有效问卷,并采用多因素Logistic回归分析焦虑、抑郁和自杀行为的影响因素,尤其是家庭环境因素对医学生心理健康状况的影响。结果 女生、二年级医学生、对所学专业不满意、家庭经济状况差、父母间有暴力打斗行为、家庭功能存在障碍的医学生更容易发展出抑郁和焦虑情绪;被父母/监护人殴打、儿童时期有留守经历的医学生也更易出现焦虑情绪（P<0.05）。同时,女性、被父母/监护人殴打、存在焦虑情绪、存在抑郁情绪、家庭功能存在障碍的医学生更容易出现自杀未遂和自杀意念;对所学专业不满意、父母间有暴力打斗行为、儿童时期有留守经历者也更易出现自杀意念（P<0.05）。结论 医学生的心理健康与自杀行为受家庭关系、成长经历等多方面的影响,因此应加强父母和相关部门对医学生心理健康与自杀行为的重视。     

A novel approach to improve undergraduate surgical teaching

Background:

Undergraduate surgery is at an important crossroads. Many departments report significant difficulties delivering effective teaching. Our student feedback indicated a dated surgical curriculum lacking structure, quality and uniformity. We report on a new ”blended” approach employing a combination of professional DVDs, case based discussions, online material and traditional bedside teaching designed to provide structure, standardization, and equality of learning .

Methods:

Year 4 students who had undertaken the new course and year 5 students who had participated in the traditional teaching programme were compared. Students completed a 20 item questionnaire about their experiences of the surgical teaching programme.

Results:

One hundred and seventy-one year 4 (70%) and148 year 5 students (66%) responded. Domains relating to “Overall Satisfaction with the course”, “Approval of innovative teaching methods and interactivity” and “Satisfaction with the clarity of course information” showed improvements when comparing the new and old programmes. However bedside teaching was not rated as highly in the new programme (p<0.05).

Conclusion:

This blended approach has resulted in improved student understanding and engagement. The apparent compromise of bedside teaching may be a reflection of higher expectations. We believe that a similar blended approach has the potential to re-invigorate surgical teaching elsewhere.     

学生毕业前的心态调查

调查了一所中等卫校两个专业毕业生的心态，并与低年级在校生心态比较，发现多数学生关心的问题是毕业分配（占６９％），而学生中存在着毕业后去向基层的思想有距离。本文讨论了这一问题。     

“PHC Leadership: Are Health Centres in Good Hands? Perspectives from 3 districts in Malawi”

Aim

The study aimed to document the kinds of leadership styles are practiced at health centres (H/C) and how these styles can be explained by the contexts, characteristics of the health centre in charge (IC) and subordinate trained health staff (STHS).

Methods

A well-researched leadership style model was applied, which included task, relation and change styles. This is a cross-sectional study using self-administered questionnaires in 47 H/C in 3 districts. 347 STHSs (95%) and 46 ICs (98%) responded. Questions explored background data and perceived leadership behaviour. Style items were factor analysed, and bivariate analyses and hierarchical regressions determined how styles could be explained.

Results

Two leadership styles were revealed: “Trans” style contained all relation and the majority of task and change items; “Control” style focused on health statistics (Health Management Information System), reporting and evaluation. STHS and IC had a median age/median work experience of 34/5 years and 38,5/2 years, respectively. 48% of IC reported having no management training. CHAM H/Cs had the lowest score on “Control” style. Distance to referral hospital had no impact on style scores. No contexts or STHS characteristics predicted any leadership styles. For ICs, young age and increasing work experience were significant predictors for both styles, while Nurse ICs were negative predictors for “Control style”. Management training was not a significant predictor for any style.

Conclusion

Frontline PHC leadership may be forced by situation and context to use a comprehensive style which could lack the diversity and flexibility needed for effective leadership. The missing associations between staff characteristics and leadership styles might indicate that this group is not sufficiently considered and included in leadership processes in the PHC organization. Leadership competency for the ICs seems not to be based on formal training, but substituted by young age and work experience. Health centre organization could also influence the options for leadership behaviour. In conclusion this calls for a reassessment of H/C leadership and formal leadership training.     

Burnout and Characteristics of Mental Health of Caregivers of Elderly Dementia Patients

Objective: The purpose of this study was to clarify burnout and the characteristics of mental health of caregivers of elderly dementia patients, which have been little studied.Methods: The subjects of this study were 107 caregivers who were engaged in the care of dementia patients at 12 facilities in northern Kyushu. We examined age, sex, status of nursing-care related qualifications, years of working experience, physical health (Present state of health and Presence of perceived ill health), status at work (Problems at work and Job stress) and satisfaction with life using the Maslach Burnout Inventory (MBI) and WHO Subjective Well-Being Inventory (SUBI). The period of survey was five months, between June 1 and October 31, 2006.Results: The most severe level of burnout was found in 27.1% of the subject. When subjects were classified into the burnout and nonburnout groups, the burnout group represented 53.3% of the subjects. In a comparison of the scores of the SUBI subscales between the burnout and nonburnout group, significant differences were observed in almost all subscales without “Deficiency in Social Contacts” and “Social Support”.Conclusion: This study clarified that self-care of physical and mental health, and family support were very important in maintaining mental health and preventing burnout in caregivers of dementia patients.