Summative evaluation on the hospital wards. What do faculty say to learners?

No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was characterized as to whether it was: (a) general or specific; (b) positive versus corrective; (c) elaborative or simple; and (d) for corrective feedback, if an action plan was discussed. 68 evaluation sessions were recorded. 86% of sessions included general, positive statements. On average, seven specific statements were made per feedback session: five were positive and two were corrective. 52% of comments were elaborated. In 41% of cases, the learner was given an action plan for improvement. During a summative evaluation faculty do not elaborate on the learner’s behavior. This is particularly true when giving corrective feedback.     

What drives health policy formulation: Insights from the Nepal maternity incentive scheme?

Although maternal health outcomes have improved considerably in Nepal, continued low levels of skilled attendance and unequal access to safe emergency obstetric care continues to be central policy concern. The financial costs of delivery exacerbated are thought to continue to represent a major barrier to care to accessing services. Policy interest in this area moved swiftly. Skilled birth attendance came under the spotlight in 2001 while research on costs was commissioned in 2003. The resulting conclusions suggested substantial costs particularly on the demand side in the form of transport costs. After the research was completed the Government moved quickly to develop policy on financial barriers to skilled attendance leading to the Maternity Incentive Scheme that was implemented in 2005.We explored the reasons for policy acceptance and implementation based on recent studies in this area and a series of key informant interviews in the country. A variety of reasons can be shown to be important in ensuring that the research was utilised quickly. The conduct of the research process was importance, particularly by ensuring that results were communicated widely in a way that responded to both technical and political policy-making concerns. A convergence of political interests that meant that the policy became an ideal vehicle for improving the flagging fortunes of the government was also seen as crucial in expediting policy change although it also meant that the policy had to be adjusted to cater to political rather purely technical concerns. The experience also underlines the importance of political champions within or close to government in advocating a strong policy line through channels that researchers can rarely access.     

Oxygen and suction in hospital wards: how many outlets?

Current DHSS guidance assumes a close link between patient dependency and the number of oxygen and suction outlets required. Research now puts a question mark against this assumption, reports Dr Carole Rawlinson, of the Medical Architecture Research Unit, Polytechnic of North London.     

The relative effects of determinants on Chinese adults’ decision for influenza vaccination choice: What is the effect of priming?

ObjectivesTo assess the relative effects of altering different factors (attributes) related to adults’ decision for influenza vaccination choice, and whether priming modifies these relative effects.MethodsChinese adults were randomly allocated to either a control condition (non-risk related video), or one of the three health risk-priming conditions (disease (influenza) risk video, intervention (vaccine) risk video, or non-specific (air pollution) risk video), each comprising ∼200 participants, prior to a discrete choice experiment survey. Mixed logit modelling estimated the relative effects of pre-determined attributes influencing vaccination choice.ResultsAcross all four conditions, for determining vaccination choice, Vaccine Efficacy had a greater effect than social cues (community vaccination coverage rate (CVCR) and doctors’ advice) but social cues can compensate for the effect of “uncertain” vaccine safety; influenza case-fatality ratio (CFR) became dominantly important among all included attributes when it reached 20%; vaccination preference increased when a CVCR changed incrementally from 5% to 60% but declined thereafter when the CVCR reached 80%. Compared with Control participants, a CVCR increased by 80% had a smaller effect for participants primed by intervention risk on vaccination choice, while the effect of influenza risk relative to vaccine risk increased following disease risk priming.ConclusionWhile increasing confidence on vaccine efficacy is more important for influenza with less severe consequences, highlighting disease consequences becomes increasingly important when its CFR increases, for promoting vaccination uptake. For a new vaccine with uncertain safety, involving doctors and early vaccine takers to validate vaccine safety should be important. Brief exposure to influenza/vaccine risk didn’t increase the effect of specific risk on vaccination choice but may change the relative weight of disease versus intervention risk when individuals make trade-off for vaccination decision. Free riding on herd immunity may increase when community vaccination coverage is high particularly following intervention risk priming.     

Interprovincial migration of physicians in Canada: What are the determinants?

This paper analyzes factors contributing to interprovincial migration of physicians in Canada. It (1) compares the migration patterns of the general practitioners and specialists (medical and surgical); (2) analyzes the changing patterns of out-migration over time via the interactions between the province of residence and time period; (3) analyzes the effect of language as a determinant of migration out of predominantly French speaking Quebec. A logistic formulation of discrete-time hazard model was employed to estimate the probability of moving from the current province of residence. Sets of physician's individual characteristics variables along with dummy variables to reflect the provincial characteristics and various time-periods were included in the model. The model was extended to allow for interaction effects between the province of residence and time-period, and also between language and Quebec (the only province in Canada which is predominantly French speaking) as province of residence. The results suggest that physician's age, specialty, province of residence have significant impact on interprovincial migration of physicians. The probability of moving differs significantly across province of residences in various time-periods.     

General self-efficacy and the effect of hospital workplace violence on doctors’ stress and job satisfaction in China

Objectives

This study aims at exploring associations of general self-efficacy (GSE), workplace violence and doctors’ work-related attitudes.

Material and Methods

In this study a cross-sectional survey design was applied. Questionnaires were administrated to 758 doctors working in 9 hospitals of Zhengzhou, Henan province, China, between June and October 2010. General information on age, gender, and years of working was collected, and the doctors’ experience and witnessing workplace violence, job satisfaction, job initiative, occupational stress as well as GSE were measured. General linear regression analysis was performed in association analyses.

Results

Both experiencing and witnessing workplace violence were significantly positively correlated with the level of occupational stress but significantly negatively correlated with job satisfaction, job initiative, and GSE. General self-efficacy significantly modified relationships between both experiencing and witnessing workplace violence with occupational stress (β = 0.49 for experiencing violence; β = 0.43 for witnessing violence; p < 0.001) and with job satisfaction (β = ?0.35 and ?0.34, respectively; p < 0.05). However, it did not modify the relationships between both experiencing and witnessing workplace violence with job initiative (p > 0.05). The levels of occupational stress declined significantly with the increase of GSE, while job satisfaction increased significantly along with its increase. The effects of GSE on occupational stress and job satisfaction weakened as the frequency of violence increased.

Conclusions

The findings suggest that GSE can modify effects of workplace violence on health care workers’ stress and job satisfaction. Enhancing GSE in combination with stress reduction may lead to facilitating health care workers’ recovery from workplace violence, and thereby improving their work-related attitudes.     

Farmers’ perceptions of safe use of pesticides: determinants and training needs

Purpose  

With focus on the impact of age, farmers’ perceptions of importance and competence on pesticide safety measures as well as factors that influence these perceptions were explored in Fars Province of Iran. Farmers’ training needs on the pesticide safety measures were also identified and compared using the Borich Needs Assessment Model.     

What drives insurer participation and premiums in the Federally-Facilitated Marketplace?

We investigate determinants of market entry and premiums within the context of the Affordable Care Act’s Marketplaces for individual insurance. Using Bresnahan and Reiss (1991) as the conceptual framework, we study how competition and firm heterogeneity relate to premiums in 36 states using Federally Facilitated or Supported Marketplaces in 2016. Our primary data source is the Qualified Health Plan Landscape File, augmented with market characteristics from the American Community Survey and Area Health Resource File as well as insurer-level information from federal Medical Loss Ratio annual reports. We first estimate a model of insurer entry and then investigate the relationship between a market’s predicted number of entrants and insurer-level premiums. Our entry model results suggest that competition is increasing with the number of insurers, most notably as the market size increases from 3 to 4 entrants. Results from the premium regression suggest that each additional entrant is associated with approximately 4% lower premiums, controlling for other factors. An alternative explanation for the relationship between entrants and premiums is that more efficient insurers (who can price lower) are the ones that enter markets with many entrants, and this is reflected in lower premiums. An exploratory analysis of insurers’ non-claims costs (a proxy for insurer efficiency) reveals that average costs among entrants are rising slightly with the number of insurers in the market. This pattern does not support the hypothesis that premiums decrease with more entrants because those entrants are more efficient, suggesting instead that the results are being driven mostly by price competition.     

What is a ‘generic’ hospital model?—a comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows

The paper addresses the question in the title via a survey of experienced healthcare modellers and an extensive literature review. It has two objectives.

What are the determinants of food security among regional and remote Western Australian children?

Objective: To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. Methods: The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi‐structured interviews with 20 key informants. Results: Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Conclusions: Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills.     

Stakeholders’ perception on the implementation of Developmental Progress Assessment: using the Theoretical Domains Framework to document behavioral determinants

Advances in Health Sciences Education - The widespread implementation of longitudinal assessment (LA) to document trainees’&nbsp;progression to independent practice rests more on...     

How can we increase children’s understanding of the social determinants of health? Why charitable drives in schools reinforce individualism,responsibilisation and inequity

This paper examines the ways in which neoliberal responses to social health issues shape the educational discourses and practices of schools. As schools are increasingly identified as ideal spaces for health promotion, the question of how and why educators and public health practitioners can and should work together continues to be debated. Using Bourdieu’s theory of reproduction, we use this indicative example of emergency food to examine how ‘charity alone’ models reproduce and perpetuate inequitable health outcomes in neoliberal societies. This individualistic view of health continues to work against public health and social justice education initiatives increasingly found in schools, curricula and wider society; creating a dissonance between rhetoric and reality. Revolutionary critical pedagogies are explored to examine the implications of these practices in schools, and how the framework of service learning may offer an approach for involving primary students in empathy, caring and social justice. We seek to extend the existing literature by exploring ways of shifting, rather than reproducing, the current practices of educators and public health practitioners in how children experience health inequality and the social determinants of health.     

The wear and tear on health: What is the role of occupation?

Health is well known to show a clear gradient by occupation. Although it may appear evident that occupation can affect health, there are multiple possible sources of selection that can generate a strong association, other than simply a causal effect of occupation on health. We link job characteristics to German panel data spanning 29 years to characterize occupations by their physical and psychosocial burden. Employing a dynamic model to control for factors that simultaneously affect health and selection into occupation, we find that selection into occupation accounts for at least 60% of the association. The effects of occupational characteristics such as physical strain and low job control are negative and increase with age: late‐career exposure to 1 year of high physical strain and low job control is comparable to the average health decline from ageing 16 and 6 months, respectively.     

Impact of Nutrients and Food Components on Dyslipidemias: What Is the Evidence?

Dyslipidemias have been shown to bear a close association with an increased risk of cardiovascular diseases, atherosclerosis in particular. As efforts are being made to find alternative therapies and ways to prevent disease, there is a corresponding rise in public interest in food and/or active food components that contribute to an improved lipid profile and, thus, to better health. Besides supplying the basic nutrients necessary for well-being, some foods add further physiologic benefits. In fact, specific foods and bioactive components could be beneficial in controlling dyslipidemias. From a review of the literature on foods and bioactive compounds, their recommended quantities, and expected effects, we found that the following nutrients and food components could positively impact the lipid profile: monounsaturated and polyunsaturated fatty acids, soluble fiber, vegetable proteins, phytosterols, and polyphenols. Therefore, incorporating these components into the regular diets of individuals is justified, because they contribute additional positive effects. This suggests that they also be recommended in clinical practice.     

Global governance and the broader determinants of health: A comparative case study of UNDP’s and WTO’s engagement with global health

This comparative case study investigated how two intergovernmental organisations without formal health mandates – the United Nations Development Programme (UNDP) and the World Trade Organization (WTO) – have engaged with global health issues. Triangulating insights from key institutional documents, ten semi-structured interviews with senior officials, and scholarly books tracing the history of both organisations, the study identified an evolving and broadened engagement with global health issues in UNDP and WTO. Within WTO, the dominant view was that enhancing international trade is instrumental to improving global health, although the need to resolve tensions between public health objectives and WTO agreements was recognised. For UNDP, interviewees reported that the agency gained prominence in global health for its response to HIV/AIDS in the 1990s and early 2000s. Learning from that experience, the agency has evolved and expanded its role in two respects: it has increasingly facilitated processes to provide global normative direction for global health issues such as HIV/AIDS and access to medicines, and it has expanded its focus beyond HIV/AIDS. Overall, the study findings suggest the need for seeking greater integration among international institutions, closing key global institutional gaps, and establishing a shared global institutional space for promoting action on the broader determinants of health.     

Just What the Doctor Tweeted: Physicians’ Challenges and Rewards of Using Twitter

More than 75,000 health care professionals worldwide share information and discuss treatments on Twitter, making it one of the most popular and influential social media sites for health. This engaging medium has enormous potential for establishing relationships and disseminating information among physicians, their colleagues, and patients. However, little is known about how physicians navigate Twitter and what challenges and benefits come from using the platform. By conducting in-depth interviews with 17 physicians who interact with Twitter at least once per week, it was revealed that physicians overcome concerns of privacy and time constraints to learn and share new research, connect with colleagues, manage online personas, and develop relationships with patients on a new level that goes beyond the typical office visit. Implications include the possibility of enriched patient–provider relationships due to physicians divulging opinions and personal information in a public forum to minimize established power structures and enable better communication. This exploratory study establishes that Twitter is fertile ground for future research to explore how the medium can influence patient behavior, alter attitudes, and influence communication between patients and providers.