Search

This review describes standardized ergonomics assessment based on pen-and-paper observational methods for assessing ergonomics risk factors.The three main objectives are to analyze published pen-and-paper observational methods, to extract and understand the risk levels of each method and to identify their associated health effects.The authors searched scientific databases and the Internet for materials from 1970 to 2013 using the following keywords: ergo, posture, method, observational, postural angle, health effects, pain and diseases. Postural assessments of upper arms, lower arms, wrists, neck, back and legs in six pen-and-paper-based observational methods are highlighted, extracted in groups and linked with associated adverse health effects.The literature reviewed showed strengths and limitations of published pen-and-paper-based observational methods in determining the work activities, risk levels and related postural angles to adverse health effects. This provided a better understanding of unsafe work postures and how to improve these postures.Many pen-and-paper-based observational methods have been developed. However, there are still many limitations of these methods. There is, therefore, a need to develop a new pen-and-paper-based observational method for assessing postural problems.

A position paper on the use of whole bowel irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) and updated in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data and recommendations.A systematic review of the literature from January 2003 to February 28, 2013 was conducted using multiple online databases for articles concerning WBI for gastrointestinal decontamination. An evidence table was created for applicable articles. The authors produced the initial draft that was reviewed by AACT and EAPCCT.The literature search produced 60 articles with the possibility of applicable human data. Based mainly on volunteer studies, WBI can be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting later than 2 h after drug ingestion when activated charcoal is less effective. WBI can be considered for patients who have ingested substantial amounts of iron, lithium, or potassium as the morbidity is high and there is a lack of other potentially effective options for gastrointestinal decontamination. WBI can be considered for removal of ingested packets of illicit drugs in "body packers." However, controlled data documenting improvement in clinical outcome after WBI are lacking. WBI is contraindicated in patients with bowel obstruction, perforation, or ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients and in patients with medical conditions that might be further compromised by its use. The concurrent administration of activated charcoal and WBI might decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain.WBI can facilitate removal of select toxicants from the gastrointestinal tract in some patients, but there is no convincing evidence from clinical studies that it improves the outcome of poisoned patients. There is no new evidence that would require a major revision of the conclusions of the 2004 position statement.

Do probiotic preparations for humans really have efficacy? by Marika Mikkelsaar et al. is the result of hard work throughout almost two years. The 4 authors are/have been distinguished members of the board or in the inner circle of SOMED. Ever since the Rome Workshop on Probiotics February 25-27, 2010 they have worked on the answer to the difficult question they had been given, reflected in the title above. Everyone working in the probiotic field knows the many difficulties when evaluating experimental and clinical reports. The experienced authors were of course aware of that, and they have handled the data in a very balanced way, making the report a very valuable Position Paper. It is a pleasure for me recommending readers of MEHD to carefully go through this paper as well as the relevant references given. I am sure they will find a lot of valuable information for their own research as well as for their clinical practice. It goes without saying that if anyone has comments or questions, please feel free to address them to MEHD. I can promise a rapid publishing. Tore Midtvedt Editor-in-Chief (Published: 6 December 2011) Citation: Microbial Ecology in Health & Disease 2011, 22 : 11620 - DOI: 10.3402/mehd.v22i0.11620

Objectives. To analyze the ratio of utilization of medical records used in writing medical papers for the medical staff. Methods. Papers published in the Chinese Medical Series Journals and the Core Journals are subjected to statistical analysis by using the method of proportion in the statistical description, so as to analyze the utilization of clinical articles, case reports and so on. Results. The clinical articles written utilizing medical records accounted for 35.45% in the Chinese Medical Series Journals and 55.00% in the Core Journals. The figure is a little low for a comprehensive tertiary hospital. Conclusions. Increasing the utilization of medical records is a prerequisite in papers, as it enhances their number and quality in a stable manner. It is an important problem which needs attention and study.

MedEdPublish has been launched as a repository of ideas and an e-library for papers relating to education in the health professions that have not previously been published. In line with the move to open access publication, the e-library provides an easy-to-search, open access resource that addresses both a mismatch between papers meriting publication and the space available in established journals, and problems with the traditional approach to peer reviewing by an editorial board and two or three selected reviewers. It is argued that with advances in technology, the time is right to look at a fresh approach to quality control that involves the wider education community.

Objective. The Minority AIDS Initiative (MAI) was launched in 1998 to address the disproportionate rates of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among racial and ethnic minorities in the United States. The Centers for Disease Control and Prevention (CDC) conducted an evaluation to assess the influence of MAI in four communities, and the extent to which these communities increased their capacity to meet the HIV prevention needs of racial and ethnic minorities. Design. Retrospective data were collected annually through individual interviews over three years. Individual interviews were conducted with community stakeholders across the three waves of data collection. Data were analyzed using standardized qualitative methods including codebook development, coding, inter-coder agreement assessments, and data interpretation. This paper will highlight one area of inquiry—community stakeholders’ perceptions of the impact of MAI in their communities. Results. Community stakehold...

Case studies on stakeholder involvement in opioid substitution treatment undertaken in six European countries are an excellent example of the tradition of trans-disciplinary research. Fortunately, they seem to come away with the conclusion that, despite the difficulty of walking through mud, as one of the studies puts it, evidence based practices that promote the common good prevail.

Zusman (Zusman M. Mechanisms of musculoskeletal physiotherapy. Phys Ther Rev 2004;9:39–49) offers a welcome paper hypothesising potential neurophysiological mechanisms (habituation and extinction) underpinning musculoskeletal physiotherapy. The strong review of clinical and physiological evidence relating to cellular learning offers a potential theoretical base to practice, supplementing recent physiotherapy literature in this field. His paper raises several themes that relate to the ways in which physiotherapists interpret evidence and the discussion here will focus on these contextual themes.

Trisha Greenhalgh is a doctor, not a statistician, and she is writing about a topic, evidence-based medicine (EBM), that might appear at first to be irrelevant to us statisticians. It is not irrele...

Objective: There have been numerous national and international attempts to define the management of H. pylori infection, largely characterised by a consensus approach and a predominantly specialist perspective. Most patients with H. pylori infection are managed in primary care where the approach is patient centred and often symptom based. The aim of this project was to develop evidence-based guidelines that were relevant and valid for general practitioners (GPs) across all of Europe.Method: A consensus meeting of 48 GPs from nine European countries identified key issues through the structured consideration in small groups of a series of case scenarios. The process was supported by access to national prevalence data, key research literature and on-line databases. It featured an immediate and a later postal feedback round. Consensus scores were calculated for each decision point, together with a rating of the supporting evidence. The output was combined with a systematic review of the literature.Results: Th...

Objectives: It is well recognised that the results of research evidence are frequently not implemented in clinical practice. Intervention studies have shown that doctors' habits are relatively resistant to change. A qualitative approach may provide new insights to understand the barriers and facilitators to change, and the role that evidence plays in the decision-making of general practitioners. We sought to understand general practitioners' perspectives on facilitators and hindrances to the implementation of evidence-based change in general practice and their attitudes towards the concept of evidence-based medicine.Method: Thematic analysis of 44 in-depth interviews with general practitioners from four health authorities. The interviews were focused on change in general practitioners' prescribing decisions in response to evidence.Results: Most general practitioners were aware of advice about recommended, evidence-based changes, but fewer were acting upon it. The main obstacles to full implementation were...

Four decades have passed since a “rights-based” body of literature on sexuality and intellectual and developmental disability began to form in concert with the 1975 UN Declaration on the Rights of ...

(1985). “Art Therapy in the Schools” A Position Paper of the American Art Therapy Association. Art Therapy: Vol. 2, No. 1, pp. 19-21.

(1998). Gillam SJ, Murray SA, Needs Assessment in General Practice (Occasional Paper 73) European Journal of General Practice: Vol. 4, No. 1, pp. 26-26.

(1985). Two papers on work in a baby clinic: (i) Standing next to the weighing scales. Journal of Child Psychotherapy: Vol. 11, No. 2, pp. 77-85.

Introduction: Vaccinations are referred to as one of the greatest achievements of modern medicine. However, their effectiveness is also constantly denied by certain groups in society. This results in an ongoing dispute that has been gradually moving online in the last few years due to the development of technology. Our study aimed to utilize social media to identify and analyze vaccine-deniers’ arguments against child vaccinations. Method: All public comments posted to a leading Polish vaccination opponents’ Facebook page posted between 01/05/2019 and 31/07/2019 were collected and analyzed quantitatively in terms of their content according to the modified method developed by Kata (Kata, 2010). Sentiment analysis was also performed. Results: Out of 18,685 comments analyzed, 4,042 contained content covered by the adopted criteria: conspiracy theories (28.2%), misinformation and unreliable premises (19.9%), content related to the safety and effectiveness of vaccinations (14.0%), noncompliance with civil rights (13.2%), own experience (10.9%), morality, religion, and belief (8.5%), and alternative medicine (5.4%). There were also 1,223 pro-vaccine comments, of which 15.2% were offensive, mocking, or non-substantive. Sentiment analysis showed that comments without any arguments as well as those containing statements about alternative medicine or misinformation were more positive and less angry than comments in other topic categories. Conclusions: The large amount of content in the conspiracy theory and misinformation categories may indicate that authors of such comments may be characterized by a lack of trust in the scientific achievements of medicine. These findings should be adequately addressed in vaccination campaigns.

This study engaged health professionals in in-depth, semi-structured interviews to explore their opinions concerning the issues surrounding vaccine hesitancy in Malaysia and strategies to improve vaccination to stamp the rise of vaccine preventable diseases (VPDs). Opinions on how to address the resurgence of VPDs in the era of increasing vaccine hesitancy were obtained. Eight health professionals, including geriatricians, pediatricians, microbiologists, public health specialists, and family medicine specialists were interviewed. The influence of anti-vaccination propaganda, past-experience of adverse event following immunization (AEFI), perceived religious prohibition, a belief that traditional complementary and alternative medicine (TCAM) use is safer, pseudoscience beliefs, and anti-vaccine conspiracy theories were identified as reasons for refusing to vaccinate. The interplay of social, cultural and religious perspectives in influencing perceived religious prohibition, pseudoscience beliefs, and the use of TCAM contributing to vaccine refusal was found. Five broad themes emerged from the health professionals regarding strategies to address vaccine hesitancy, including establishing an electronic vaccination registry, increasing public awareness initiatives, providing feedback to the public on the findings of AEFI, training of front-line healthcare providers, and banning the dissemination of anti-vaccine information via social media. With regards to identifying strategies to address the resurgence of VPDs, mandatory vaccination received mixed opinions; many viewed supplementary immunization activity and the prevention of travel and migration of unvaccinated individuals as being necessary. In conclusion, the present study identified unique local cultural, traditional and religious beliefs that could contribute to vaccine hesitancy in addition to issues surrounding vaccination refusal similarly faced by other countries around the world. This information are important for the formulation of targeted intervention strategies to stamp vaccine hesitancy in Malaysia which are also a useful guide for other countries especially in the Southeast Asia region facing similar vaccine hesitancy issues.

Objectives: Vaccine hesitancy is a global phenomenon that needs to be measured and addressed. This study aimed to identify the determinants of vaccine hesitancy among a large regional population. Methods: A structured telephone survey was administered to a random digit sample in Quebec’s Eastern Townships region. In addition to socioeconomic information, respondents were asked questions on several health topics such as knowledge and beliefs about immunization, medical consultations, health status, and life habits. Data were weighted according to age, sex, and territories. Statistically significant variables in the univariate analysis were introduced into a multivariate logistic regression model to determine independent factors for vaccine hesitancy (adjusted odds ratios [aOR] and 95% confidence intervals). Results: A total of 8,737 interviews were conducted (participation rate 48.3%). Among all respondents, 32.2% were vaccine-hesitant. Several beliefs were significantly associated with vaccine hesitancy: belief that children receive too many vaccines (aOR = 2.72; 2.32–3.18), belief that a healthy lifestyle can eliminate the need for vaccination (aOR = 2.48; 2.09–2.93), and belief that the use of alternative medicine practices can eliminate the need for vaccination (aOR = 1.39; 1.16–1.68). Other determinants associated with vaccine hesitancy were having consulted a massage therapist (aOR = 2.34; 1.46–3.75), not being vaccinated against influenza (aOR = 1.80; 1.49–2.16), having a low (

OBJECTIVES: Physical therapists (PTs) may practice in direct access or act as primary care practitioners, which necessitate patients’ screening and management for red, orange and yellow flags. The objective of the project was to assess the American PT’s ability to manage red, orange and yellow flags in patients with low back pain (LBP), and to compare this ability among PTs with different qualifications. METHODS: The project was an electronic cross-sectional survey. The investigators contacted 2,861 PTs. Participants made clinical decisions for three vignettes: LBP with red flag for ectopic pregnancy, with orange flag for depression and with yellow flag for fear avoidance behaviour (FAB). The investigators used logistic regression to compare management of warning flags among PTs with distinct qualifications: orthopaedic clinical specialists (PTOs), fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and PTs without clinical specialization (PTMSs). RESULTS: A total of 410 PTs completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs and 84 PTMSs). Two hundred and seventeen PTs (53%) managed the patient with LBP and symptoms of ectopic pregnancy correctly, 115 PTs (28.5%) of them managed the patient with LBP and symptoms of depression correctly, and 177 (43.2%) managed the patient with LBP and FAB correctly. DISCUSSION: In general, PTs with specialization performed significantly better than PTMSs in all three clinical vignettes. PTs ability to manage patients with warning flags was relatively low. Based on our results, further education on patients with LBP and warning flags is needed. The survey had the potential for non-response and self-selection bias. LEVEL OF EVIDENCE: 3b.

During the influenza vaccination campaign 2014-2015, the reporting of 3 deaths within 48 hours of vaccination with Fluad brought the Italian Medicines Agency (AIFA) to pronounce the withdrawal of 2 batches of vaccine, based on the precautionary principle. Investigations by the Italian National Institute of Health, and by the Pharmacovigilance Risk Assessment Committee (PRAC), the committee at the European Medicines Agency (EMA) responsible for monitoring and assessing the safety profiles of human drugs, concluded that there was a lack of causality between the reported deaths and the vaccines administered. However, the media impact of the decision taken by AIFA, resulted in a lower influenza vaccination coverage compared with the previous years. The aim of our study was to identify possible critical points that may have led to a non-perfect management of the event. A review of the regulatory framework in place was performed, with a particular focus on the Guidelines on Good Pharmacovigilance Practices developed by the EMA to facilitate the signal management process. The management of reports involves the following steps: signal detection, its validation and confirmation, analysis and prioritization, assessment, recommendations for action and the exchange of information. In our opinion, both the signal detection phase and the phase of validation have been critical: the withdrawal of vaccine batches is possible even in case of a single suspected serious adverse reaction. However, aspects such as the biological plausibility, the presence of potential alternative causes and previous awareness should also be considered. Furthermore, the number of reported deaths was consistent with the expected background mortality rate in the vaccinated cohort. The disproportionate media coverage given to the AIFA decision resulted in a reduced vaccine confidence in the general population and in a decreased immunization coverage. Improving the communication on vaccine safety issues is crucial at this stage to restore a climate of trust in this powerful tool for primary prevention.

Contains fulltext : 153603.pdf (Publisher’s version ) (Open Access) BACKGROUND: The tempos framework provides GPs with a flexible and practical guide to reflect on their organization and practices in the analysis of adverse events and supplement existing classification systems. The tempos framework specifies five timescales that need to be managed by physicians: the disease's tempo (unexpected rapid changes, slow reaction to treatment); the office's tempo (day-to-day agenda and interruptions); the patient's tempo (time to express symptoms, compliance, and emotion); the system's tempo (time for appointments, exams, and feedback); and the time to access to knowledge. OBJECTIVE: This paper reviews the tempos framework and two studies that underpin its conceptual development. METHODS: Two databases were used. RESULTS: The use of the framework as a mechanism for analysing insurance claims is described. A comparison of using the tempos framework and standard patient safety classifications for analysing insurance claims is also described and showed that the concordance among coders was better for the tempos framework. The tempos framework fits closely with key principles of general practice and has potentially high relevance for analysing a patient's journey and continuity of care. The tempos framework seems most useful for GPs when analysing adverse events in their practice. CONCLUSION: Further work needs to be done to assess its generalizability and to formally assess its validity and reliability.

In China, the hepatitis B virus (HBV) is a particularly challenging public health issue, with an estimated 90 million chronic hepatitis B carriers accounting for almost 7% of the population. Health-related discrimination can serve as a barrier to prevention and care for infectious diseases, such as HBV, degrade the HBV sufferers' quality of life and limit HBV patients' employment opportunities. While rural migrants account for up to 40% of the total urban population in the developed cities in China, there has been no study of the discrimination behavior of rural migrant workers toward HBV carriers.This study evaluates the discrimination behavior of rural migrant workers toward HBV carriers and patients and proposes public policy recommendations to address discrimination and stigma.The sample comprised 903 rural adults, aged over 18 years old, who migrated to Beijing. Using a face-to-face interview, we surveyed rural migrants' demographic characteristics, knowledge of HBV and discrimination against HBV carriers. Descriptive statistics were used to characterize the study population, HBV stigma and knowledge of HBV. Three discrimination levels (no-mild, medium and severe discrimination) were modeled using multiple logistic regression.Rural migrants to Beijing had a mean age of 36 years, were overwhelmingly married (91.58%), mostly with a junior high school or lower education (78.05%) and mainly engaged as temporary workers (42.52%) or self-employed (33.78%). Only 30.56% reported that they had been vaccinated against HBV. On the 0-10 discrimination scale, rural migrants rated 6.24, with only 4.54% displaying no sign of HBV-related discrimination. The high discrimination score occurred alongside a low mean knowledge of HBV (7.61 on the 1-22 ranking of HBV knowledge). Multiple logistic regression results suggest an inverse relationship between discrimination levels and HBV knowledge, especially knowledge about treatment and transmission routes. The "fear of being infected with HBV" and being HBV vaccinated was positively associated with HBV-related discrimination. Unemployed rural migrants were more likely to exhibit severe HBV-related discrimination than other occupational groups. Personal attributes, such as gender, age, marital status and education level were not associated with the level of discrimination.Knowledge of HBV, its transmission and treatment, and the fear of HBV infection were key features in understanding HBV discrimination by rural migrant workers. To reduce discrimination, HBV public health education campaigns need to focus on both knowledge about HBV and the fear of HBV infection. Such campaigns should target rural migrant subgroups, such as unemployed rural migrant workers.

Purpose: We describe HPV vaccine attitudes among students of different education levels. Methods: High school, college, and graduate-level health care professional students were surveyed regarding HPV vaccine knowledge, attitudes, and receipt. Relationships between categorical variables were analyzed using chi-square tests of independence and z-tests for proportions. Means for quantitative variables were compared using t-tests and one-way analysis of variance. Results: 57% and 42% of the 889 students reported starting and completing HPV vaccine series, respectively, with no statistical difference by education level. 61% of students who reported receiving a provider recommendation had completed the series, compared to 6% of those who did not receive recommendation (p

Background:Use of alternative medications and herbal remedies is widespread in the United States and across the globe. These traditional medications can be contaminated with toxic metals. Despite several case reports of poisoning from such contamination, the epidemiological data are still limited.Objectives:To report on a cluster of lead and mercury toxicity cases in 2011 among a community of adherents of traditional medical practice of Ayurveda.Methods:Adherents of Ayurveda were offered heavy metals screening following the identification of the index case.Results:Forty-six of 115 participants (40%) had elevated blood lead levels (BLLs) of 10 μg/dl or above, with 9.6% of BLLs at or above 50 μg/dl.Conclusions:This is the largest cluster of lead and mercury toxicity following use of Ayurvedic supplements described in the literature in the US. Contamination of herbal products is a public health issue of global significance. There are few regulations addressing contamination of “natural” products or supplements.

Physical therapists have used continuing education as a method of improving their skills in conducting clinical examination of patients with low back pain (LBP). The purpose of this study was to evaluate how well the pathoanatomical classification of patients in acute or subacute LBP can be learned and applied through a continuing education format. The patients were seen in a direct access setting.The study was carried out in a large health-care center in Finland. The analysis included a total of 57 patient evaluations generated by six physical therapists on patients with LBP. We analyzed the consistency and level of agreement of the six physiotherapists' (PTs) diagnostic decisions, who participated in a 5-day, intensive continuing education session and also compared those with the diagnostic opinions of two expert physical therapists, who were blind to the original diagnostic decisions. Evaluation of the physical therapists' clinical examination of the patients was conducted by the two experts, in order to determine the accuracy and percentage agreement of the pathoanatomical diagnoses.The percentage of agreement between the experts and PTs was 72-77%. The overall inter-examiner reliability (kappa coefficient) for the subgroup classification between the six PTs and two experts was 0.63 [95% confidence interval (CI): 0.47-0.77], indicating good agreement between the PTs and the two experts. The overall inter-examiner reliability between the two experts was 0.63 (0.49-0.77) indicating good level of agreement.Our results indicate that PTs' were able to apply their continuing education training to clinical reasoning and make consistently accurate pathoanatomic based diagnostic decisions for patients with LBP. This would suggest that continuing education short-courses provide a reasonable format for knowledge translation (KT) by which physical therapists can learn and apply new information related to the examination and differential diagnosis of patients in acute or subacute LBP.

No study has described low back pain (LBP) treatment choices among physical therapists (PTs) in the United States (US) in the new millennium. Intervention for LBP in the new millennium is largely based on evidence-based practice (EBP) recommendations. The purpose of this study was twofold: (a) to describe PTs' preferences for treating acute and subacute non-specific LBP in Florida and to compare these preferences to EBP guideline recommendations and (b) to compare outpatient musculoskeletal therapist (MSPT) choices for management of acute and subacute LBP to non-outpatient musculoskeletal therapist (NMSPT) choices.The data were collected with an electronic survey. Study participants selected treatment choices for acute and subacute LBP clinical vignettes.A total of 327 PTs participated in the study, of which 128 worked in outpatient musculoskeletal settings. The most common treatment choices for acute and subacute LBP were home exercise program, exercise in the clinic, back care education, joint mobilization, ice/heat, and interferential current. The EBP adherence rate for acute LBP was 30% for MSPTs and 15% for NMSPTs. Thirty-seven percent (37%) of MSPTs and 30% of NMSPTs adhered to EBP guidelines for subacute LBP.The EBP adherence rate for management of acute and subacute LBP was low. Spinal manipulation was underutilized for management of acute LBP, and passive therapeutic procedures were overutilized for subacute LBP. Physical Therapy schools and professional associations should reemphasize the benefits of spinal manipulation to manage non-specific acute LBP and active interventional procedures to manage subacute LBP.

Babies' parents and people who look for information about vaccination often visit anti-vaccine movement's websites, blogs by naturopathic physicians or natural and alternative medicine practitioners. The aim of this work is to provide a quantitative analysis on the type of information available to Italian people regarding vaccination and a quality analysis of websites retrieved through our searches. A quality score was created to evaluate the technical level of websites. A research was performed through Yahoo, Google, and MSN using the keywords "vaccine" and "vaccination," with the function "OR" in order to identify the most frequently used websites. The 2 keywords were input in Italian, and the first 15 pages retrieved by each search engine were analyzed. 149 websites were selected through this methodology. Fifty-three per cent of the websites belonged to associations, groups, or scientific companies, 32.2% (n = 48) consisted of a personal blog and 14.8% (n = 22) belonged to some of the National Health System offices. Among all analyzed websites, 15.4% (n = 23) came from anti-vaccine movement groups. 37.6% reported webmaster name, 67.8% webmaster e-mail, 28.6% indicated the date of the last update and 46.6% the author's name. The quality score for government sites was higher on average than anti-vaccine websites; although, government sites don't use Web 2.0 functions, as the forums.: National Health System institutions who have to promote vaccination cannot avoid investing in web communication because it cannot be managed by private efforts but must be the result of Public Health, private and scientific association, and social movement synergy.

In 2011-2012 partners in the provision of health in social care came together in North West London from five local authorities, two major acute trusts, two community trusts, two mental health trusts, two 'third sector' organisations and over 100 general practices. Their aim was to support collaborative working in geographic areas of about 50 000 population for improved patient experience, quality of outcomes and cost-efficiency. Patients with diabetes and those over 75 were targeted with care plans and locally-led innovation. Through monthly workshops practitioners from different organisations shared their insights into ways to improve care for specific individuals and also to improve the functioning of the system as a whole. The pilot is still under review and evaluation but has produced some positive results so far both in patient and clinician experience and the suggestion that this way of working results in reduced emergency admissions to hospital.

The systematic review has become an increasingly popular method of synthesizing findings on a topic in order to inform clinical practice, commissioning of care, and future research. A central component of the systematic review is an assessment of study quality or risk of bias, i.e. an assessment of how near to the 'truth' the findings of the study are. While undertaking a recent systematic review, it became apparent that the outcomes of the quality appraisal process were somewhat different across systematic reviews where the same randomized controlled trials had been included. The quality of the report writing of the randomized controlled trials included was identified as one possible reason for this discrepancy. This had implications upon the conclusions drawn by the review. It is suggested that reasonable attempts to contact study authors should be made in order to inform the quality appraisal process while undertaking systematic reviews of randomized controlled trials and that the presence or absence of this process should be considered by research consumers when appraising the quality of a systematic review. This process enables a full assessment of study quality rather than simply an assessment of the quality of report writing.

It is still not clear how the public health workforce will work with future clinical commissioning groups. Is it enough we are told that ‘Public Health England will ‘ensure appropriate population advice is available to the NHS’? Should we wait until we are invited? Should we wait until we are told what to do? The public health workforce should aspire to be central to population health, from prevention to care pathways through to establishing outcomes and evaluation measures, and to exert influence beyond the joint strategic needs assessment. In Hounslow, public health is currently an integral part of the workforce in both the local authority and the emerging clinical commissioning group, providing an example of the so-called ‘public health core offer’. This is an example of public health working in new ways, building effective and lasting partnerships across primary care, social care and all public health boundaries.

This Position Paper is based on the formal presentations and the subsequent discussions that took place at this specially convened Expert Workshop

A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P < 0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P < 0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer.

A dengue vaccine in large-scale clinical trials could be licensed in several years. We estimated the potential vaccine demand for different introduction strategies in 54 dengue-endemic countries and for travelers from non-endemic countries to enable vaccine producers and public health agencies to better prepare for timely utilization of the vaccine.Under our assumptions, 2.4-3.5 billion dengue vaccine doses would be needed in the first five years after introduction with75% delivered in the public sector. Among 20 potential 'early-adopter' countries, an estimated 0.9-1.4 billion doses would be needed for the same introduction approach. For the private sector, covering 10% of children and 30% of adults an estimated 443-664 million doses would be required. In non-endemic countries, travelers could use an estimated 59-89 million vaccine doses, although the present product profile would make it unlikely to be able to administer vaccine in a timely manner.Calculations were based on 2015-2020 population projections for endemic countries in Asia and the Americas with populations100,000. For dengue-endemic countries we assumed country-wide routine 12-23 month-old vaccination and catch-up vaccination among 2-14 year-old children employing a 2 or 3-dose schedule. Assumptions on expected vaccination coverage were based on country-specific public, private and travelers' sectors immunization performance.Our results project an upper-limit estimate of vaccine demand, with actual demand depending on country priorities, cost and product profile. Given the potential for a dengue vaccine, policymakers in endemic and nonendemic countries should consider appropriate implementation strategies in advance of licensure.

SummaryWhen C. S. Lewis was asked his views about the promise and ability of a young poet, he dismissed his interrogator with the words, ‘We have not seen the contents of his waste paper basket.’

In contemporary Portugal and Greece, the number of individuals who resort to alternative medicine continues to rise. From yoga, meditation and energy therapies to healing based on various religio-spiritual traditions, there is a variety of therapeutic practices one can choose from. The main objective of this paper is to show how a therapeutic and spiritual pluralism is produced through the implementation of transnational influences on spirituality and healing. It investigates the diverse ways in which the practice of spirituality through healing leads to a better understanding of how current processes of globalisation, transnationalism and multiculturalism affect, develop and negotiate one’s individual, social, spiritual and medical identity. Based on ethnographic fieldwork in Lisbon and Athens, the Portuguese and Greek capital equivalently, the paper explores the pluralistic and transnational character of alternative medicine and the spiritual creativity with which such therapies are practised. Taking the role of the (spiritual) holistic practitioner as healer as a point of departure, it provides an empirical account of the shifting status of both religiosity and healthcare in two southern European countries that are still followed by the stereotype of being predominantly linked to Christianity as the denominational religion, and to biomedicine as the predominant healthcare system. info:eu-repo/semantics/acceptedVersion

This paper, based on fieldwork conducted in a Jerusalem yeshiva, describes how the yeshiva, a traditional institute of religious studies, also serves as an institution of healing and personal therapy in which sacred religious texts assume a central place. The article focuses on personal sessions between the rabbi who heads the yeshiva, and his audience of believers who turn to him for help in coping with personal hardships and tribulations. The paper contextualizes and elaborates upon the concept of 'deep healing' to describe how the rabbi uses his regular 'tool kit' to diagnose the problems of the person facing him and to offer optimal, personalized therapy. The rabbi uses religious texts to create textual deep healing processes that are tailor-made for the individual supplicant and are intended to accompany supplicants for a long period of time.

Background: A systematic review was conducted to critically evaluate and synthesize literature investigating mental health practitioners' attitudes towards transgender people.Objective: Three primary objectives were outlined; first, establish whether overall attitudes are positive or negative. Second, explore whether training, education or experience influences attitudes and finally, examine participant demographics in relation to attitude trends.Method: A systematic electronic search was carried out in March 2017 using Medline, PsycINFO, PsycArticles, CINAHL, ASSIA, and Web of Science electronic databases. Manual citation and ancestral searches were conducted on identified papers. Qualitative, quantitative and mixed method studies were eligible for inclusion. A total of 13 papers of mixed quality were identified.Results: Existing literature is limited to cross-sectional, quantitative data and fails to investigate differences between implicit and explicit attitudes. Small to moderate convenience s...

Introduction: While prescribing biosimilars to patients naive to a biologic treatment is a well- accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies. Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included. Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped.

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: Mindfulness practices provide numerous benefits for individuals with a variety of health issues. Recent research has highlighted the benefits of mindfulness for health professionals. The potential benefits for physical and occupational therapists or students however, are currently unclear. Objectives: To perform a scoping review on the effects of mindfulness practices among physical (PT) and occupational therapists (OT) and students of those disciplines. Methods: Eligible published articles in English were identified through a literature search of MEDLINE, PsycINFO, Cochrane Library, and AMED from the inception of databases to November 2015. Titles, abstracts, and full-text articles were screened for the selection of relevant papers. Articles identified as editorials, correspondences, commentaries, case reports, abstracts alone, and review papers were excluded. Results: Six studies (two qualitative studies, one quantitative study, one mixed-method study, and two experimental studies) met the inclusion criteria. Three studies focused on PT/OT students, two on clinicians and one on current clinicians who had previously failed a course. These studies highlighted the potential benefits of mindfulness for physical and occupational therapists. They should be interpreted with caution however, due to the small number of relevant studies, high heterogeneity in mindfulness interventions and methodological limitations. Conclusions: There is a paucity of research on the effects of mindfulness among physical and occupational therapists and students of those disciplines. The lack of relevant studies makes a systematic review challenging but the findings of the current studies suggest potentially promising effects.

Different approaches to treatment for mental health problems in military veterans continue to attract research attention. In addition to the NICE-approved treatments for post-traumatic stress disorder such as trauma-focused cognitive behavioural therapy and eye-movement desensitisation and reprocessing, a number of novel and innovative approaches have recently been developed. One such approach is encapsulated under the emerging paradigm of ‘exercise as/is medicine’. Following recent calls to strengthen the evidence base for new and emerging mental health treatments for veterans, this paper presents a commentary on current evidence in support of ‘exercise as medicine’ derived from qualitative research studies. It is concluded that qualitative research has made a significant contribution to the emerging evidence base for exercise-based interventions. This evidence base can be used to inform current debates about quality assurance in the area of veterans’ mental health-care and to underpin quality provision for service users. Qualitative research also has a significant future contribution to make towards improving the evaluation of novel treatment approaches, generating more impactful research and increasing the applicability of research findings in ‘exercise as/is medicine’. The paper closes with some critical reflections on the role of exercise-based interventions as a means of helping veterans improve their mental health.

© 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group. The potential for harms from adverse drug reactions (ADR) constitutes a critical patient safety and public health challenge, especially with increased medication usage as populations age. The research reported here explores explanations for a sudden increase in ADR reporting in New Zealand after a new formulation of a medication to treat hypothyroidism, Eltroxin® (levothyroxine), was phased in. The formulation was adjudged to be bioequivalent to the old formulation, yet following its introduction, a sharp increase in the reporting of adverse reactions to this drug occurred. The paper analyses public engagement and the role of print media coverage, press releases and minutes of meetings of relevant agencies in order to describe the unfolding of this health controversy. Early interpretations of the sharp increase in reporting of reactions explained it as an outcome of a combination of factors, including a mistrust of state drug subsidising agencies and media attention that provoked anxiety in this vulnerable population. This paper offers an alternative explanation arguing that, as adverse drug reactions are known to be significantly underreported, the Eltroxin® ‘health scare’ illustrates enhanced pharmacovigilance triggered by the interaction between patients and the media. The Eltroxin® controversy is an illustrative case example of the amplification of ADR reporting by patients following increased media attention in the context of a low consumer reporting environment. The case of Eltroxin® indicates that drug safety can be enhanced by actively using media sources and by encouraging patient engagement and reporting of ADRs.

The aim of this systematic review was to summarize and systematize the information about physical symptoms and its relation with work activity on female Breast Cancer Survivors (BCS).A systematic search was performed on the databases MEDLINE/PubMed (via National Library of Medicine), SCOPUS (Elsevier), Web of Science (Thomson Reuters Scientific) and CINAHL with full text (EBSCO), including papers about physical impairments experienced by female workers who have had breast cancer.The search retrieved 238 studies, and another 5 were identified in the articles' references, totaling 243 papers. After removing duplicates and applying the inclusion criteria and a full text reading, 13 articles were included for qualitative analysis. Concerning physical limitations, most complaints were related to the elevation of upper limbs, carrying heavy objects, driving and holding manual movements. The most referred symptoms were breast/arm pain, fatigue, lymphedema, reduced range of motion and weakness in the upper limbs, scar tissue adherence in the breast/axilla and paresthesia in the arm/breast.These symptoms and physical limitations led to the difficulty or impossibility of performing work tasks, which also diminished work productivity, as well as the increase in time to return to work. The present results suggest higher unemployment rates and the need for modifying work conditions. Implication for Rehabilitation Health professionals should include risk assessment at daily routine to identify possible sources of physical impairments for upper limbs. Provide the support and orientations according to personal and job characteristics of the patient. Focus the aims of treatment over upper limbs impairments, reducing the prevalence and the gravity of symptoms.

In the current healthcare environment, pressure on physician time is greater than ever. Centers for Medicare and Medicaid Services (CMS) regulations require that hospitals that receive physician remuneration costs complete time study analyses to support the allocation of physician time for cost reporting purposes. Physicians' administrative, research, and teaching activities are typically recorded 1 week per month or 2 weeks per quarter using paper booklets. This paper describes the creation of a novel online application (accessible via desktop PC, and Apple iPad®, and iPhone®) and our early experience with its use. A survey of our physicians (n = 1440) showed a high level of satisfaction with the physician time study (PTS) application. One-fifth of the physicians responded to the survey, and, of those, 83% indicated that the application is easy to use, and 76% indicated an overall preference over the paper booklet. We estimate $24 000 savings in printing and booklet distribution costs and another...