Classification and coding of commercial fishing injuries by work processes: an experience in the Danish fresh market fishing industry

BACKGROUND: Work-related injuries in commercial fishing are of concern internationally. To better identify the causes of injury, this study coded occupational injuries by working processes in commercial fishing for fresh market fish. METHODS: A classification system of the work processes was developed by participation in fishing vessel trips where observations and video recordings of the work operations on board were collected. Subsequently the system was pilot tested using the Danish Maritime Authority injury reports. RESULTS: The developed classification system contains 17 main categories and up to 13 sub-categories of the work processes for each of the five different types of fishing. A total of 620 injury reports were reviewed and coded. Five percent (n = 33) of these were fatal injuries. The working processes were identified and coded according to the developed classification system for 553 (89%) injury reports: Danish seiner (n = 83), gill-netter (n = 122), beam trawler (n = 71), twin-trawler 2-T (n = 96), single/pair trawler 1-T (n = 181). Sixty-seven (11%) of the reports were unclassifiable due to lack of information. Preparing, shooting, and hauling of the gear and nets accounted for 50% of the injuries; they were most serious type of injuries such as fractures and sprains. Walking about the ship, in particular embarking and disembarking, climbing and descending ladders accounted for nearly one-fifth of the injuries. CONCLUSION: We found that the working processes related to working with the gear and nets vary greatly in the different fishing methods. Coding of the injuries to the specific working processes allows for targeted prevention efforts.     

Challenges in residential fall prevention: insight from apprentice carpenters

BACKGROUND: Falls remain a serious source of morbidity and mortality in residential construction despite considerable knowledge of risk factors and prevention strategies. While training is universally viewed as positive, we know little about its effectiveness in preventing residential falls. METHODS: A series of focus groups were conducted with union apprentice carpenters (n = 36) at varied levels of training to elicit input on factors that might influence the effectiveness of residential fall prevention training, including hazard awareness, timing of elements of formal instruction, jobsite mentoring, and workplace norms. RESULTS: While apprentices identified many residential fall hazards, they voiced little concern about work near unprotected vertical or horizontal openings such as stairwells, window openings or leading edges. On residential jobs, apprentices worked at heights immediately and were often exposed to hazards they had not yet been trained to handle. The quality of mentoring varied tremendously, and things they had been taught in school were often not the norm on these small worksites. Use of fall arrest equipment was uncommon. Job insecurity in this fast-paced work environment influenced behaviors even when apprentices reported knowledge of safe procedures; this was more of a problem for less experienced apprentices. CONCLUSIONS: These data provide compelling evidence that apprentices often do not apply safety principles they have been taught in school in the actual work environment, illuminating how attempts to empower workers through training alone can fall short. The findings have policy implications and demonstrate the importance of measuring more than knowledge when evaluating effectiveness of training.     

Adolescents' perceptions of violence and its prevention

OBJECTIVE: To explore aspects of aggression, in particular fighting and weapon carrying, among high school students. This was in response to an earlier survey of Dunedin young people and will assist in the development of a broader quantitative study on aggression among high schools students. METHODS: A qualitative investigation using eight focus groups of 41 participants was conducted in Otago, New Zealand, between November 2004 and February 2005. The focus groups were analysed to identify common themes and critical issues. RESULTS: Results suggest there are different levels of fighting, but participants agreed that a fight should be defined as serious as opposed to a play fight. Fights often begin as verbal and escalate to physical. Differences were found in fighting at school and outside of school. Whether an item was considered a weapon or not depended on the intended use of the item. Participants suggested that some items may be reported as weapons, even though they are not being carried for such purposes. If so, the estimates provided in the prior Dunedin survey may be unduly high. CONCLUSIONS: Surveys such as the Youth Risk Behaviour Survey provide a snapshot of youth aggression, but may hide significant differences in the nature of the aggression being reported. IMPLICATIONS: Prevention should concentrate on changing the social environment of our schools and communities. Further research should include more in-depth questions on fighting and weapon carrying, both at school and outside of school, to better estimate the prevalence of these behaviours and the context in which they occur.     

Health service providers' perceptions of barriers to tuberculosis care in Russia

The Russian Federation has witnessed a marked rise in rates of tuberculosis (TB) over the past decade. Public health TB control institutions remain broadly modelled along pre-1990 lines despite substantial programmes of investment and advocacy in implementing the World Health Organization's 'Directly Observed Treatment--short course' (DOTS) strategy. In 2002, we undertook a qualitative study to explore health care providers' perceptions of existing barriers to access to TB services in Samara Oblast in Russia. Six focus group discussions were conducted with physicians and nurses from facilities in urban and rural areas. Data were analyzed using a framework approach for applied policy research. Barriers to access to care were identified in interconnected areas: barriers associated with the health care system, care process barriers, barriers related to wider contextual issues, and barriers associated with patients' personal characteristics and behaviour. In the health care system, insufficient funding was identified as an underlying problem resulting in a decrease in screening coverage, low salaries, staff shortages, irregularities in drug supplies and outdated infrastructure. Suboptimal collaboration with general health services and social services limits opportunities for care and social support to patients. Worsening socioeconomic conditions were seen both as a cause of TB and a major obstacle to access to care. Behavioural characteristics were identified as an important barrier to effective care and treatment, and health staff favoured compulsory treatment for 'noncompliant' patients and involvement of the police in defaulter tracing. TB was profoundly associated with stigma and this resulted in delays in accessing care and barriers to ensuring treatment success.     

Community health‐care planning in Western Australian Country Health Service‐South West: An evaluation of patient views

Aims: To investigate community health patients' impressions of care planning and their relationship with allied health professionals in a rural town in Western Australia. Methods: Focus groups were conducted followed by a survey to identify patients' opinions on care planning and their relationships with health professionals. Results: Focus groups and a survey identified that patients generally had positive attitudes towards their experiences with community‐based allied health professionals. Participants identified some of the attributes that they valued in allied health professionals. Many participants (39%) believed that they had a partnership with the health professional and also valued having a shared decision‐making power with the health professional (46%); however, 17% identified that they would prefer the health professional to assume more of the decision‐making power. Conclusions: More work is needed to create a health culture in which patients want to manage their own health and can develop a relationship with their health professional that allows them to achieve this.     

The process and impact of implementing injury prevention projects in smaller communities in New Zealand

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.     

杭州市2004年幼儿园儿童意外损伤发生情况分析

【目的】了解杭州市7岁以下儿童意外伤害发生情况,以采取相应的预防措施,防止意外伤害发生。【方法】根据2004年卫生部统一的调查表与调查方法对杭州市4个县市和7个区11所幼儿园437名幼儿家长进行问卷调查,资料用χ2和χ2趋势检验分析。【结果】杭州市幼儿园意外伤害年发生率达7.32%,各年龄组发生率随年龄增加而呈下降趋势(P<0.05)。男童发生率为7.28%,女童7.36%;城市发生率6.75%。农村发生率8.11%,差异均无显著性(P>0.05)。2~3岁组入托儿童意外伤害发生率10.63%,散居儿童为3.90%,入托儿童明显高于散居儿童(P<0.05)。意外伤害分类构成前三位依次为:外伤、烫伤、动物咬伤。意外伤害发生地构成前三位依次为:家中、户外、幼儿园内。【结论】学龄前儿童意外伤害发生率较高,且主要在园外发生,做好幼儿及家长对儿童意外伤害预防的宣传教育,相当重要。     

Occupational therapy managers' perceptions of challenges faced in early intervention service delivery in South Australia

This article reports on the results of the first phase of a doctoral study aimed at investigating the change processes occurring in occupational therapy service delivery in the field of early intervention in South Australia. The change management process was utilised as the framework for development of the study. The first phase focused on exploring the current status of service delivery in South Australia, as the first step in the change management process. Data was collected from 14 occupational therapy managers by means of an initial questionnaire, an online focus group, followed by a short questionnaire. Results illustrate a number of challenges faced in service delivery related to the nature of services (such as the intensity of specialist intervention), and service delivery aspects (such as inadequate staffing levels and long waiting lists). Recommendations are made for lobby groups, practice and further research.     

Stress perceptions in community clinic: a pilot survey of patients and physicians

This pilot survey of 103 patients and 17 physicians in an urban family medicine clinic gathered information pertinent to the design of a feasible stress intervention for patients bothered by stress, but who did not have a psychiatric diagnosis. Among patients, 45% reported being excessively bothered by stress in the preceding month, with the chief stressors being job (70 reporting), financial worries (58%) and family concerns (50%). Patients reported a variety of problems perceived to be related to stress, such as headaches, insomnia, eating control, and gastrointestinal symptoms. Although about 80% reported using positive coping methods (e.g., talking, exercising, and relaxing), 42% reported using alcohol, and 10% used non-prescribed drugs to cope with stress. Only 37% of patients had sought help for stress from their physician. The wide variety of responses from the physicians reflected a lack of standardized approaches, inadequate training, and a reluctance to engage patients about their stress problems. About 42% of the physicians reported routinely asking patients about stress, and 77% felt that dealing with patient stress was a significant burden on their practice of medicine. Overall, the findings indicate that opportunities are being missed for helping patients to deal with stress constructively, and that a standardized stress self-management program might be one solution.G. Ken Goodrick, PhD, is Associate Professor, Suzanne Kneuper, MA, is Research Assistant, and Jeffrey R. Steinbauer, MD, is Associate Professor, all in the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.This work was supported in part by a Grant (HL69397) from NHLBI. Editorial assistance was provided by Pamela Tice. Presented in poster form at the 30th Annual Meeting of the North American Primary Care Research Group, New Orleans, November 17, 2002.Requests for reprints should be addressed to G. Ken Goodrick, Ph.D, Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600 Houston, TX 77098; e-mail: goodrick@bcm.tmc.edu.     

Perspectives of normal child development in rural Malawi – a qualitative analysis to create a more culturally appropriate developmental assessment tool

Background Child development in developing countries is often evaluated using assessment tools created for ‘Western’ settings. Recent work has demonstrated that, for certain developmental milestones, ‘Western’ tools may be inaccurate as they include items unfamiliar to children of different cultural settings. Methods We used qualitative methods to gather information about normal development in an African setting. Ten village and two professional focus group discussions (FGDs) were conducted. We used purposive sampling methods to recruit groups of mothers, grandmothers and men in four areas of Southern Malawi for village FGDs. Separate FGDs were carried out with professionals working in areas relating to child development. A thematic content analysis established main patterns and themes and dissemination of results and continued feedback allowed for respondent validation and reflection of results. The information then gathered was used to create questions for a revised Malawian developmental assessment tool. Results Social and gross motor milestones were the main focus of interest for village and professional FGDs with the latter creating new language and fine motor concepts. Social milestones highlighted included ‘duties and chores’, ‘sharing’ and ‘taking up leadership roles’. Language milestones included ‘reporting events’ and ‘shrugging to indicate no’ and fine motor milestones included ‘peeling bananas’, ‘sorting maize’ and ‘making patterns with bottle tops’. Intelligence was described in relation to social and community integrity rather than ‘Western’ concepts of numeracy and literacy. Conclusions Concepts, ideas and language relating to normal development in a sub‐Saharan African setting have been gathered in this study. These have been used to create items for a more culturally appropriate developmental assessment tool.     

我国商业医疗保险的现状及发展策略

在卫生费用不断增长的今天，我同商业保险公司面对需求旺盛的医疗保险市场却出现了停滞不前的情况。本文对此展开探讨，分析其原因，并对商业医疗保险的进一步发展提出看法。     

A cluster analysis of road traffic-related childhood knee injuries

BACKGROUND: Knee injuries represent an important category of road traffic injuries among children, and they are heterogeneous in their aetiology. The aims of this study were to estimate the incidence of road traffic childhood knee injuries in Greece by age and gender, point out their time, place and person co-ordinates and identify clusters with distinct characteristics with a view to potential preventive interventions. METHODS: During a 3-year period, 305 children with knee injuries resulting from a road traffic accident were identified among the 66,870 children with injuries recorded in the Emergency Department Injury Surveillance System (EDISS) of Greece. Using previously derived sampling ratios and national data on childhood population, incidence data by age and gender were estimated. Hierarchical analysis was undertaken for cluster identification. RESULTS: The incidence of road traffic knee injuries was 97.5 per 100,000 children-years. The incidence increased with age and was higher among boys than among girls. Most childhood knee injuries (50.2%) occur among pedestrians, and the majority (90.9%) of the children or their guardians admitted responsibility in crossing the road. Of the 31 children injured as car passengers, the vast majority (87.1%) were unrestrained, and a large fraction (38.7%) were front seat passengers. Two clusters were identified: the first consisted of younger children who resided mostly in the Athens area and suffered less serious knee injuries as pedestrians or car passengers during the colder months; the second consisted of older children, frequently tourists, who suffered more serious injuries as cyclists while vacationing. CONCLUSIONS: Many of the children who suffered road traffic knee injuries as pedestrians admitted responsibility in road crossing, whereas a large proportion of children who were injured as car passengers were injured while improperly seated in the front and without seatbelt protection. Older children, frequently tourists, were at high risk of knee injuries while using motorcycles and bicycles.     

Exploring family physicians' reactions to multisource feedback: perceptions of credibility and usefulness

PURPOSE: Physician performance is comprised of several domains of professional competence. Multisource feedback (MSF) or 360-degree feedback is an approach used to assess these, particularly the humanistic and relational competencies. Research studying responses to performance assessment shows that reactions vary and can influence how performance feedback is used. Improvement does not always result, especially when feedback is perceived as negative. This small qualitative study undertook preliminary exploration of physicians' reactions to MSF, and perceptions influencing these and the acceptance and use of their feedback. METHODS: We held focus groups with 15 family physicians participating in an MSF pilot study. Qualitative analyses included content and constant comparative analyses. RESULTS: Participants agreed that the purpose of MSF assessment should be to enhance practice and generally agreed with their patients' feedback. However, responses to medical colleague and co-worker feedback ranged from positive to negative. Several participants who responded negatively did not agree with their feedback nor were inclined to use it for practice improvement. Reactions were influenced by perceptions of accuracy, credibility and usefulness of feedback. Factors shaping these perceptions included: recruiting credible reviewers, ability of reviewers to make objective assessments, use of the assessment tool and specificity of the feedback. CONCLUSION: Physicians' perceptions of the MSF process and feedback can influence how and if they use the feedback for practice improvement. These findings are important, raising the concern that feedback perceived as negative and not useful will have no or negative results, and highlight questions for further study.     

Community Integration of Transition-Age Individuals: Views of Young with Mental Health Disorders

This qualitative study examines the perceptions of young adults with mental health disorders of community integration. Fifty-nine young men and women participated in 12 focus groups whose aim was to gain understanding of what community integration means to them. Focus group questions also explored barriers and supports for their community integration, as well as their goals for the future and advice to others facing similar challenges. Themes that emerged were reported within the multiple domains that participants used to describe their experiences of community integration (or the lack thereof). This study highlights the desires of these young people to achieve goals in education and employment and to have friendships. Participants identified a pervasive lack of understanding of mental health and prevalent stigmatizing attitudes as resulting in challenges to their community integration. Implications of the study discuss roles for behavioral health services in encouraging empowerment, choices, and connections so that young people with mental health disorders may achieve their preferred levels of community integration.     

Student perceptions of effective small group teaching

PURPOSE: The goal of this study was to assess student perceptions of effective small group teaching during preclinical training in a medical school that promotes an integrated, systems-based undergraduate curriculum. In particular, students were asked to comment on small group goals, effective tutor behaviours, pedagogical materials and methods of evaluation. METHODS: Six focus groups were held with 46 Year 1 and 2 medical students to assess their perceptions of effective small group teaching in the 'Basis of Medicine' component of the undergraduate curriculum. Ethnographic content analysis guided the interpretation of the focus group data. RESULTS: Students identified tutor characteristics, a non-threatening group atmosphere, clinical relevance and integration, and pedagogical materials that encourage independent thinking and problem solving as the most important characteristics of effective small groups. Tutor characteristics included personal attributes and the ability to promote group interaction and problem solving. Small group teaching goals providing included opportunities to ask questions, to work as a team, and to learn to problem solve. CONCLUSION: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students' emphasis on group atmosphere and facilitation skills underscored the value of the tutor as a 'guide' to student learning. Similarly, their comments on effective cases emphasised the importance of clinical relevance, critical thinking and the integration of basic and clinical sciences. This study also suggested future avenues for research, such as a comparison of student and teacher perceptions of small group teaching as well as an analysis of perceptions of effective small group learning across the educational continuum, including undergraduate, postgraduate and continuing professional education.