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s Background Patient-facing health care workers (HCW) experience higher rates of COVID-19 infection, particularly at the start of the COVID-19 pandemic. However, rates of COVID-19 among front-line home health and hospice clinicians are relatively unknown. Methods Visit data from a home health care and hospice agency in New Jersey early in the pandemic was analyzed to examine COVID-19 infection rates separately for clinicians exposed to COVID-19-contagious patients, and those without exposure to known COVID-19 contagious patients. Results Between March 5 and May 31, 2020, among home health clinicians providing in-person care, clinicians treating at least one COVID-19 contagious patient had a case rate of 0.8% compared to 15.7% for clinicians with no exposure to known COVID-19 contagious patients. Among hospice clinicians providing in-person care, those who treated at least one COVID-19 contagious patient had a case rate of 6.5%, compared to 12.9% for clinicians with no known exposure to COVID-19 contagious patients. Non-White clinicians had a higher COVID-19 case rate than White clinicians (10.9% vs 6.2%) Discussion Lower rates of COVID-19 infection among clinicians providing care to COVID-19-contagious patients may result from greater attentiveness to infection control protocols and greater precautions in clinicians’ personal lives. Greater exposure to COVID-19-contagious patients prior to patient diagnosis (“unknown exposures”) may explain differences in infection rates between home health and hospice clinicians with workplace exposures. Conclusion Clinicians providing in-person care to COVID-19-contagious patients experience lower rates of COVID-19 infection than clinicians providing face-to-face care with no known exposure to COVID-19 contagious patients. Our findings suggest there was a low incidence of potential workplace infections

Background We want to analyze the effect of migration background (MB) on physician burnout and work-life balance. Methods In September 2019, physicians from various specialties answered a questionnaire on work and health. We analyzed a subsample of 526 physicians that were working full time in a hospital, 14% with an MB and 47.9% were female. Results Multivariate analysis showed that physicians with an MB exhibit significantly less favorable scores on all three burnout dimensions, and this effect persisted in the regression analysis after adding age, gender, and marital status as control variables. There were no differences with regard to work-life balance. Conclusions To our knowledge, our study is the first one to suggest that MB plays a significant role in physician mental health. Future research will benefit from identifying the factors behind that connection, e.g., problems related to acculturation, communication and social integration, which can then be addressed by policymakers in order to maintain and improve the medical infrastructure.

Background Studies on the impact of the novel SARS-CoV-2 virus (COVID) for healthcare workers (HCWs) rarely include the full spectrum of hospital workers, including less visible patient support roles. In the early days of the pandemic, COVID testing was preferentially available to HCWs. The objective of this study was to understand how individual experiences for all HCWs during the pandemic were associated with perceptions of access to, and receipt of COVID testing . Methods All hospital employees (n = 6736) in a single academic medical center in Boston, Massachusetts were invited to participate in a cross-sectional survey regarding perceived access to, and receipt of COVID testing during the first wave of the pandemic (March – August 2020). Responses were linked to human resources data. Log binomial univariate and multivariable models were used to estimate associations between individual and employment variables and COVID testing. Results A total of 2543 employees responded to the survey (38 %). The mean age was 40 years (± 14). Respondents were female (76 %), white (55 %), worked as nurses (27 %), administrators (22 %) and patient support roles (22 %); 56 % of respondents wanted COVID testing. Age (RR 0.91, CI 0.88–0.93), full time status (RR 0.85, CI 0.79–0.92), employment tenure (RR 0.96, CI 0.94–0.98), changes in quality of life (RR 0.94, CI 0.91–0.96), changes in job duties (RR 1.19, CI 1.03–1.37), and worry about enough paid sick leave (RR 1.21, CI 1.12–1.30) were associated with interest in testing. Administrators (RR 0.64, CI 0.58–0.72) and patient support staff (RR 0.85, CI 0.78–0.92) were less likely than nurses to want testing. Age (RR 1.04, CI 1.01–1.07), material hardships (RR 0.87, CI 0.79–0.96), and employer sponsored insurance (RR 1.10, CI 1.00-1.22) were associated with receiving a COVID test. Among all employees, only administrative/facilities staff were less likely to receive COVID testing (RR 0.69, CI 0.59–0.79). Conclusions This study adds to our understanding of how hospital employees view availability of COVID testing. Hazard pay or other supports for hospital workers may increase COVID testing rates. These findings may be applicable to perceived barriers towards vaccination receipt.

This study explored social factors that are associated with the US deaths caused by COVID‐19 after the declaration of economic reopening on May 1, 2020 by President Donald Trump. We seek to understand how county‐level support for Trump interacted with social distancing policies to impact COVID‐19 death rates. Overall, controlling for several potential confounders, counties with higher levels of Trump support do not necessarily experience greater mortality rates due to COVID‐19. The predicted weekly death counts per county tended to increase over time with the implementation of several key health policies. However, the difference in COVID‐19 outcomes between counties with low and high levels of Trump support grew after several weeks of the policy implementation as counties with higher levels of Trump support suffered relatively higher death rates. Counties with higher levels of Trump support exhibited lower percentages of mobile staying at home and higher percentages of people working part time or full time than otherwise comparable counties with lower levels of Trump support. The relative negative performance of Trump‐supporting counties is robust after controlling for these measures of policy compliance. Counties with high percentages of older (aged 65 and above) persons tended to have greater death rates, as did more populous counties in general. This study indicates that policymakers should consider the risks inherent in controlling public health crises due to divisions in political ideology and confirms that vulnerable communities are at particularly high risk in public health crises., Key Points Counties with higher levels of Trump support did not necessarily experience greater mortality rates due to COVID‐19.The predicted weekly death counts per county tend to increase over time with the implementation of several key health policies.The difference in COVID‐19 outcomes between counties with low and high levels of Trump support grew after several weeks of the policy implementation as counties with higher levels of Trump support suffered relatively higher death rates.Counties with higher levels of Trump support exhibited lower percentages of devices staying at home and higher percentages of people working part time or full time than otherwise comparable counties with lower levels of Trump support.

This study evaluated the self-perception of adolescents' oral health and their oral conditions and the need for treatment in relation to dental caries. An epidemiological survey was carried out in the municipality of Belém, Pará, Brazil, in 2018. The sample consisted of 200 students, aged 11 to 16 years old, from a full-time public school. The data were collected through a questionnaire where their self-perception of their oral health was assessed and an intra-oral examination was carried out to assess oral health conditions in relation to dental caries, using the Dental Caries Index and need for treatment (ICDNT). The data analysis was based on the Chi-square test, and when the npq

Background Commercial growing up milks (GUMs) targeted at children from 12 to 36 months of age are a rapidly growing industry, particularly across the Asia Pacific. Methods The present study assessed the frequency of use and socio‐demographic and child associations of commercial GUM feeding in children, aged between 12 and 36 months, in capital cities in four Asia Pacific countries. Mothers of children aged between 12 and 36 months were surveyed, assessing GUM feeding frequency in the past month. A market research company database was used to survey across Asia Pacific urban cities, including Bangkok Thailand, Jakarta Indonesia, Singapore and Australian Capital Cities (ACC). Results More than 1000 women (n = 1051) were surveyed (Bangkok, n = 263; Jakarta, n = 275; ACC, n = 252; Singapore, n = 261). The mean (SD) age of mothers was 32.4 (5.3) years and that of children was 23.6 (6.7) months. In total, 62.7% of the children were fed GUMs more than once per week with significant country variance. In comparison with ACC, Asian countries were significantly more likely to feed GUMs ≥once per week: Bangkok [odds ratio (OR) = 5.7, 95% confidence interval (CI) = 3.8–8.6]; Jakarta (OR = 3.5, 95% CI = 2.3–5.5); and Singapore (OR = 7.4, 95% CI = 4.9‐11.1). Associations of GUM feeding included: maternal tertiary education; mothers younger than 30 years; working full time; and feeding of commercial infant formula under 12 months. Conclusions This is the first published study to explore commercial GUM feeding in and between countries. The incidence of GUM feeding, in contrast to international recommendations, signals the need for further research into the drivers for GUM feeding and its contribution to the diet.

Objective : Reading is a crucial academic behavior, which directly affects the formation of personality and develops people's thinking. In the higher education environment, reading culture helps students acquire new knowledge quickly and effectively. However, in recent years, young people and students tend to be lazy to read books, afraid of reading academic books while prefer reading comics and novels. At the same time, the dominance of the internet and audio-visual equipment makes reading in schools and universities become less attractive. This study was conducted with two objectives: (1) To describe the current situation of reading culture; and (2) To identify some factors affecting the reading culture of full-time bachelor students in Hanoi University of Public Health in 2019. Thereby, contributing to raise students' awareness about the roles of reading and providing information to help improving the quality and performance of the university’s library. Methods: The study was conducted on 420 full-time bachelor students from the first year to the fourth year, belonging to four majors of the Hanoi University of Public Health in 2019. Main findings: The study results showed that among 420 full-time bachelor students, 41.0% read books on a regular basis and 80.0% liked reading books. With regression bionary logistic analasys, associated factors with reading frequency includes: Going to library weekly (OR=1,87; p=0,004; CI95%: 1,22 – 2,84) and Completed reading the document assigned by teachers (OR=1,61; p=0,043; CI95%: 1,01 – 2,55). In addition, students who were reading addiction were likely to read all the book assigned, which was higher than the students who did not like reading. Conclusions: With full-time Bachelor students at Hanoi University of Public Health, percentages of students with frequent reading behavior were not high in general. However, it could be seen that the reading behavior of students was influenced by the teachers’ activities. Therefore, teachers should enhance checking books and course materials that students have read before classes as well as setting a criteria on the minimum number of academic books students should read while doing their assignments so that students are more aware of the importance of academic reading while studying at university. Keywords: reading books, college students, current situation, associated factor

BACKGROUND: As lockdown measures to slow the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection begin to ease in the UK, it is important to assess the impact of any changes in policy, including school reopening and broader relaxation of physical distancing measures. We aimed to use an individual-based model to predict the impact of two possible strategies for reopening schools to all students in the UK from September, 2020, in combination with different assumptions about relaxation of physical distancing measures and the scale-up of testing.METHODS: In this modelling study, we used Covasim, a stochastic individual-based model for transmission of SARS-CoV-2, calibrated to the UK epidemic. The model describes individuals' contact networks stratified into household, school, workplace, and community layers, and uses demographic and epidemiological data from the UK. We simulated six different scenarios, representing the combination of two school reopening strategies (full time and a part-time rota system with 50% of students attending school on alternate weeks) and three testing scenarios (68% contact tracing with no scale-up in testing, 68% contact tracing with sufficient testing to avoid a second COVID-19 wave, and 40% contact tracing with sufficient testing to avoid a second COVID-19 wave). We estimated the number of new infections, cases, and deaths, as well as the effective reproduction number (R) under different strategies. In a sensitivity analysis to account for uncertainties within the stochastic simulation, we also simulated infectiousness of children and young adults aged younger than 20 years at 50% relative to older ages (20 years and older).FINDINGS: With increased levels of testing (between 59% and 87% of symptomatic people tested at some point during an active SARS-CoV-2 infection, depending on the scenario), and effective contact tracing and isolation, an epidemic rebound might be prevented. Assuming 68% of contacts could be traced, we estimate that 75% of individuals with symptomatic infection would need to be tested and positive cases isolated if schools return full-time in September, or 65% if a part-time rota system were used. If only 40% of contacts could be traced, these figures would increase to 87% and 75%, respectively. However, without these levels of testing and contact tracing, reopening of schools together with gradual relaxing of the lockdown measures are likely to induce a second wave that would peak in December, 2020, if schools open full-time in September, and in February, 2021, if a part-time rota system were adopted. In either case, the second wave would result in R rising above 1 and a resulting second wave of infections 2·0-2·3 times the size of the original COVID-19 wave. When infectiousness of children and young adults was varied from 100% to 50% of that of older ages, we still found that a comprehensive and effective test-trace-isolate strategy would be required to avoid a second COVID-19 wave.INTERPRETATION: To prevent a second COVID-19 wave, relaxation of physical distancing, including reopening of schools, in the UK must be accompanied by large-scale, population-wide testing of symptomatic individuals and effective tracing of their contacts, followed by isolation of diagnosed individuals.FUNDING: None.

Background There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians. Methods Data for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning. Results We received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care. Conclusions Despite a lack of formalized structural reform in British Columbia’s primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.

Introduction: Musculoskeletal symptoms are affections, with or without tissue degeneration, that may present itself in many forms and be presented together with other multiple symptoms. Until the present moment its etiology is multifactorial and its pathological picture presents a great social relevance due to its coverage and magnitude. Objective: The objective of this study is to evaluate and compare the prevalence of musculoskeletal symptoms in academics of full time (daytime) and part-time (nighttime) courses of UNICENTRO. Methods: 120 students of both courses participate in this study and in order to select the individuals there was utilize the method of proportional stratified sampling. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms and the Visual Analogic Scale (VAS) as a way of pain identification were used. Results: Through observation of the results obtained by the questionnaires it was noticed a high prevalence of the symptoms in the analyzed academics, being 49% from Biological Science course and 44.8% from Physiotherapy course, emphasizing the vertebral column, being lumbar (9.42%) in physiotherapy academics and thoracic region (9.14%) in Biological Science academics, it was also noticed a high involvement in multiple regions (53.9%). Besides that, it was observed trough VAS the presence of mild pain (3,78 ± 2,38). Conclusion: It has been concluded that the most involved region was vertebral column, specifically the lumbar and thoracic regions. In this way, assumed that a biomechanical overload is responsible for this finding. Thereby, preventive and ergonomic measures and health promotion must be stimulated between young students, however, for such a propose new studies are necessary.

To examine the impact of full-time equivalent employee (FTEE) allocation to academic detailers on naloxone prescribing at the U.S. Veterans Health Administration (VA).Longitudinal nonequivalent control group posttest-only design using a random effects model.Closed cohort of primary care providers exposed to academic detailing between September 1, 2016, and September 20, 2018, at VA.Previous analysis identified a cutoff of 0.40 FTEE was associated with a greater return on investment. We evaluated whether this level of FTEE allocation was associated with increases in naloxone prescribing rates and compared providers who had an interaction with an academic detailer allocated 0.4 FTEE or greater (high FTEE) to providers who interacted with an academic detailer allocated less than 0.4 FTEE (low FTEE).Among VA primary care providers who received academic detailing, 1770 (68%) had interactions with a high FTEE academic detailer. There were no differences in demographics between providers who interacted with high FTEE and low FTEE academic detailers except for the distribution of provider classes (P = 0.004) and geographic districts (P0.001). Providers who interacted with high FTEE academic detailers had a greater average monthly number of naloxone prescriptions prescribed compared with low FTEE academic detailers (0.60 vs. 0.53; P = 0.005). In the random effects model, there was a 65% greater increase in the average monthly number of naloxone prescriptions prescribed among providers who interacted with a high FTEE academic detailer compared with providers who interacted with low FTEE academic detailers (P = 0.027). We also observed a dose-dependent relationship between the number of naloxone prescribed and the amount of FTEE allocated.This observational study highlights the potential benefits (e.g., increased naloxone prescribing) of academic detailers having more FTEE allocated. Hence, implementation of academic detailing needs to consider the amount of dedicated time for academic detailers, given competing VA priorities.

Recent research indicates 20% of dentists to experience a high degree of stress, physical pain and distress, and insomnia, which is associated with loss of productivity, both in quantity and quality. Physical distress and pain, but also difficulties with colleagues, demanding patients or loss of productivity are clearly associated with the prevalence of stress. Stress complaints are often recognised too late. 2 fictitious cases from the daily practice of occupational health experts/ergonomists are discussed. The first case concerns a 45-year-old dentist who was referred to an occupational health expert regarding severe fatigue, listlessness and a sense of loss of control. After the occupational health expert had inventoried his full workload, it was shown not to have increased. With the help of relaxation therapy, a professional organiser and an organisational and business psychologist, the dentist was able to return to work full time after 9 months. In the second case, a 55-year-old endodontist presented with neck pain. The occupational health expert/ergonomist observed postural problems and stress. The client reported she suffered from fatigue. The endodontist did not acknowledge these stress issues and wanted to address improvement of posture in particular, which was effective. The occupational health expert was nevertheless able to introduce measures to reduce stress and fatigue; after some time, the endodontist enjoyed her return to work.Recent onderzoek geeft aan dat 20% van de tandartsen een hoge mate van stress en fysieke pijn en ongemak ervaart en slecht slaapt, wat wordt geassocieerd met een verlies aan productie, zowel kwalitatief als kwantitatief. Te zien is dat fysiek ongemak en pijn, maar ook moeite met collega’s, lastige patiënten of productieverlies samenhangen met het vóórkomen van stressklachten. Vaak worden klachten te laat herkend. Vanuit de dagelijkse praktijk van 2 arbeidsdeskundigen/ergonomen worden 2 fictieve casussen besproken. Het gaat om een 45-jarige tandarts die was doorverwezen naar een arbeidsdeskundige wegens ernstige vermoeidheid, lusteloosheid en het gevoel van controleverlies. Nadat de arbeidsdeskundige de totaalbelasting van zijn werk had vastgesteld bleek dat deze niet was toegenomen. Met behulp van ontspanningstherapie, een opruimcoach en een bedrijfs- en organisatiepsycholoog kon de tandarts na 9 maanden weer volledig zijn werk hervatten. In een tweede casus meldde een 55-jarige endodontoloog zich met nekklachten. De arbeidsdeskundige/ergonoom nam bij haar een verkeerde houding en spanning waar. De cliënt vertelde dat ze last had van vermoeidheid. De endodontoloog erkende deze stressklachten niet en wilde voornamelijk inzetten op verbetering van houding, hetgeen lukte. Desondanks wist de arbeidsdeskundige enkele zaken om spanning en vermoeidheid te verminderen; na enige tijd ging de endodontoloog weer met plezier naar het werk.

Intimate partner violence (IPV) is a common public health problem that has serious consequences for women in terms of health and functioning. Post-traumatic stress disorder (PTSD) is one of the major health issues that women face after experiencing intimate partner violence. There is evidence that sufficient and sustainable employment might decrease risk for PTSD in women who have experienced violence. The purpose of this study is to investigate if variables related to employment (i.e., income, hours worked per week, job benefits) affect risk for PTSD over 5 years after women left abusive relationships. Data collection took place between 2010 and 2016. To test the hypothesis that present employment variables predict the woman’s PTSD in the future, a series of conditional latent growth curve (LGC) models were conducted. The overall models indicated that there appears to be a consistent impact of economic factors on PTSD symptoms; however, the variable with the greatest impact was the number of hours worked. Women who had full-time or near full-time employment were at less risk to have PTSD in the future. These findings support efforts to increase access to full time work for women who have experienced intimate violence.

Mental health problems among children present an important public health issue worldwide. Early detection, assessment, and support in schools might have a significant impact on mental health outcomes and child health and wellbeing. The purpose of this article is to show the mental health support system and its historical transition in Japan. In general, Japanese schools have a Yogo teacher (a school nurse) who works full time, as well as three types of mental health specialists who work part time: school counselors, advisors, and social workers. The regularity of visits from the three types of specialists depends on schools and regions. In general, school counselors visit schools more often than do other specialists, for approximately 4 h per week. The other specialists either visit the schools rarely or not at all because they are sometimes not hired. The strengths of the Japanese system included much provision of psychological consultations and a small budget compared to Western countries. Almost all school counselors are clinical psychologists with master's degrees who are skillful at handling students' mental problems. Moreover, they are capable of providing intensive psychological counseling in school settings in Japan. The weakness is that there is no specialist available who supports students' academic or school life. General teachers take on the role of the Western countries' "school counselors." There are also few specialists who can be approached for social support compared to Western countries.

Aim We aimed to quantify the work-related physical activity of physiotherapists in Germany. Subjects and methods We included working physiotherapists aged between 18 and 65 years in Germany. We excluded physiotherapists working less than 20 h a week. We measured our primary outcome, work-related physical activity, by the average number of steps taken daily during work, standardized on an 8-h working day. We controlled the main outcome for potential confounders, such as working hours per week, age, weekday, and clinical setting (outpatient vs. inpatient), by multivariate linear regression analysis. We used R statistics for all statistical analyses. Results We included 35 participants (7 outpatient and 28 inpatient), with a median age category of 20–29 years. Our participants had a mean work-related physical activity of 6614 steps (95% confidence interval, CI [6118; 7111]) per workday. Higher age, outpatient clinical setting, and working full time were associated with lower step count, but these associations were not statistically significant. Conclusions The work-related physical activity of physiotherapists in Germany is comparable with results from other countries and can be regarded as ‘low’. Our result, however, might be affected by volunteer bias and gender effects. Further research should identify high-risk groups in the profession for cost-effective prevention.

A pilot survey was created to sample early career child and adolescent psychiatrists (CAPs) and fellows to identify factors contributing to recruitment, satisfaction, and general practice trends. A 44-item survey was developed based on a previous study of early career CAPs and discussion at an early career forum. Participants were recruited at a professional meeting and through emails sent to all 125 US training program directors. Only 184 out of 2209 responses were received. Approximately two-thirds were female and one-third had completed fellowship. Most decided to pursue a career in child psychiatry during medical school and expected full time salaries between $175,000 and $250,000 after fellowship. Forty-five percent owed more than $150,000 in educational debt. The top reasons for pursuing a career in child psychiatry included the following: working with children, working in an interesting field, and helping society. Males (x = 85.7, SD 22.9) compared with females (x = 77.5, SD 25.3) were more interested in pursuing full time work. A higher proportion of participants were confident in prescribing medications (x = 79.9, SD 17.1) compared with providing psychotherapy (X = 63.3, SD 23.9). The vast majority of early career CAPs were recruited during medical school, motivated by altruistic reasons, and rated high confidence in their career choice despite significant student loan debt. Training directors should consider increasing competency in psychotherapeutic skills. Early child psychiatry exposure and a means of addressing physician debt are needed to improve recruitment to this specialty.

More than 37,000,000 US adults smoke cigarettes. Most are interested in quitting, but rates of successful cessation remain low. Developing more and better approaches to tobacco treatment is a public health priority. The evolution of vehicular travel may present an opportunity for tobacco treatment intervention. We recruited individuals who reported previous use of ridesharing services (eg, Uber or Lyft) at 10 sites in the Boston area. They completed an anonymous survey that collected sociodemographic and tobacco use information and assessed participants’ interest in receiving various forms of tobacco treatment during their rideshare rides. Forty-nine adult smokers completed the survey. Mean age = 40.1, 61.2% male, 51.0% white, 16.3% African American/black, 14.3% Latino, and 8.2% Asian. Almost 70% were college graduates, 79.6% worked full time, and 40.8% used ridesharing services ≥ weekly. They smoked a mean of 8.7 cigarettes per day; 35.3% were moderately or highly nicotine dependent, 36.7% also smoked cigars, 34.7% also used e-cigarettes, and 41.7% were in the contemplation or preparation stage of quitting. More than 56% of participants expressed some level of interest in receiving quit-smoking messaging during their rideshare rides. On multivariate analysis, black or Latino race/ethnicity and rideshare frequency of at least once a week were associated with interest in receiving quit-smoking messaging during rideshare rides. The majority of rideshare users who smoke are amenable to the idea of quit-smoking messaging delivered to them during their rides, and interest rates were highest among black or Latino riders and those who used rideshare services most frequently.

Objective To design, implement, and evaluate the effectiveness of an enhanced peer mentoring program (EPMP) for faculty in emergency medicine aimed at overcoming traditional mentoring challenges. Methods Full time faculty (Clinical Instructor, Assistant, and Associate levels) were placed into peer groups (based upon their primary academic roles) led by senior faculty advisors at the Professor level. Peer groups met at least quarterly from 2012 to 2017. In lieu of a structured curriculum, session topics were informed by individual faculty surveys and peer group consensus. Areas of focus included work-life balance, prioritizing academic commitments, identification of mentors (both within and external to the department and university), networking opportunities, promotions goals, and career satisfaction. Results Effectiveness of the EPMP was evaluated by academic productivity and advancement over a 5- year period. A total of 22 faculty members participated in the program. There was an increase in promotions to the next academic level, from 3 promotions in the five years before the program to 7 promotions in the five years of the program. Total grant funding increased 3-fold from $500,000 to $1,706,479 from the first year to the last year of the evaluation period. Conclusions This enhanced peer mentoring program was effective in mitigating many of the traditional mentoring challenges faced by faculty in academia and was successful in improving both academic productivity and advancement.

Educational satisfaction determines the quality of education system which interns affects the performance and achievement of students during study and finally future professional competencies. The objectives of this study were to identify the perceived status of satisfaction on educational conditions and teaching-learning environment and associated factors of it among the public health undergraduates. This was the descriptive cross sectional study carried out among 384 undergraduate students of public health studying in final year/semester of three universities of Nepal using self administered questionnaire. The result of the study showed that satisfactions on various components are below than average. Among the satisfied components, the major were in case of duration of course (46.1%), teaching skills of part time teacher (39.1%), curriculum and overall course of study (36.2%), research/dissertation guidance (34.6%) and teaching skills of full time teacher (33.6%). The satisfaction level was least in case of result timing/procedure (14.1%), tuition fee (23.7%), examination procedure (26.3%) and evaluation system (27.1%). Ethnicity, educational background, course duration, types of teacher, availability of books in library and availability of research papers/journals were found associated with educational satisfaction. The study concluded low educational satisfaction among public health under graduate students. It is recommended to take immediate action for improvements of different components of education system like curriculum structure & contains, teaching methodology, teaching learning materials, admission and examination procedure. Key words: Public health; Education; undergraduate course; satisfaction; Nepal

Introduction The intense training and occupational demands of military personnel place the individual at risk of serious injury. When they do occur, serious personal injuries (SPIs) can lead to medical discharge, mission compromise, and ongoing recurrence of problems. Prior to the implementation of any minimization strategies, an understanding of the causes of SPIs requires development. The aim of this study was to analyze the incidence rates and patterns of SPIs within the Australian Regular Army (ARA) and Australian Army Reserve (ARES). Methods Data for a 2-year period were obtained through the Work Health, Safety, Compensation, and Reporting database of the Australian Department of Defence. Records of SPIs were extracted, with details including: (a) the activity being performed when the injury was suffered; (b) the body location of injury; (c) the nature of injury; and (d) the mechanism of injury. Results were reported as number of SPIs and converted to SPIs/100 full-time equivalent (FTE) years of service. Results In total, 507 SPIs were reported over the two-year period (ARA = 466; ARES = 41). SPIs most commonly: occurred during combat training (n = 80; 0.13 SPIs/100 FTE years) and physical training (n = 66; 0.10 SPIs/100 FTE years); affected the head (n = 63; 0.10 SPIs/100 FTE years) and shoulders (n = 57; 0.09 SPIs/100 FTE years); and comprised fractures (n = 199; 0.19 SPIs/100 FTE years) and soft-tissue injuries (n = 103; 0.16 SPIs/100 FTE years). The most common mechanism of injury was falls (n = 132; 0.21 SPIs/100 FTE years) or contact with objects (n = 114; 0.18 SPIs/100 FTE years). When adjusted for service time, ARES personnel were found to report SPIs more frequently than ARA personnel (0.87 vs. 0.79/100 FTE years, respectively) giving an injury risk ratio (ARA:ARES) of 0.91 [95% CI = 0.66–1.25]. Conclusions Despite higher absolute numbers of SPIs occurring in ARA, ARES in fact report similar rates of SPIs when adjusted for service time. The natures and mechanisms of SPIs are also similar for both service types and therefore should be the focus of targeted programs to reduce such injuries.

Background: Estimation of Quality of life is a useful outcome measure to know about epilepsy care from patient’s perspective. Assessing QOL of epileptic patients is important so as to manage the epilepsy and to implement some interventional programs in order to improve the quality of life of these patients. The study aims to find out the impact of epilepsy on quality of life of epileptic patients Material and method: This was a cross-sectional, questionnaire-based study, conducted from March to August 2019 for a period of 6 months, after approval from Institutional Ethics Committee. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. The quality of life in epilepsy (QOLIE-31) was used for collecting data on health-related QOL. Result: The study group consisted of 65 patients of whom 48 were males (73.84%) and 17 were females (26.15%). Their ages ranged from 19 to 60 years. (mean age: 35.65). Majority of the patients were in the age range of 30-41 (40%). 50.8% participants were from nuclear family and 49.2% were from joint family system. Most of the patients had lower class socioeconomic status (61.5%). As regard to the employment status, 38.4% of patients were full time employed, 13.8% were part time employed. 29.2% were unemployed and 9.23% were retired and 9.23% were students. The medication analysis revealed that 30.6% of the participants were on monotherapy whereas 69.0% were on polytherapy. The mean total QOLIE-31 score was 39.12 (SD-5.00). Conclusion: Epileptic patients had poor QOL with low total QOLIE-31 score, unemployment, use of combination therapy and people belonging to lower class were associated with lower quality of life in individuals with epilepsy. Keywords: Health Related Quality of life, Epilepsy, Quality of Life in Epilepsy (QOLIE-31) questionnaire

Background The Australian wine industry is a valuable part of the wider Australian economy worth approximately A$45 billion annually and employs 163,790 people either full time or part time. Australian agricultural industries are amongst the nation’s most dangerous workplaces with joint, ligament, muscle and tendon injuries being commonplace along with wounds, lacerations and musculoskeletal diseases. It is therefore important to try and minimise the risk of injuries to workers. The aims of this study were to (1) identify whether lower limb problems occur in the Australian wine industry and (2) identify the types of safety footwear worn. Methods Participants were recruited from the Australian wine industry. The study was a cross-sectional anonymous survey of 82 questions with n = 207 respondents. Questions related to job role performed, types of lower limb problems experienced, level of pain, restriction of activities, types of footwear worn, general health and physical health. Results The main working roles were winery (73.4%), vineyard (52.2%), laboratory (39.6%), cellar door (32.4%) and office (8.2%), with 63.3% of participants working in more than one role. Lower back pain was the most commonly reported problem at 56% followed by foot pain (36.7%), knee pain (24.6%), leg pain (21.3%), ankle pain (17.9%), hip pain (15.5%), toe pain (13%) and heel pain (11.1%). The most popular footwear used by participants were elastic sided safety boots, followed by high cut lace up safety boots with side zip. Overall, although the pain experienced was moderate, it did not impact the workers ability to perform their duties and the majority self-reported as being in very good general and physical health. Conclusion To date no data have been published on the types of lower limb problems or the types of safety footwear worn in the Australian wine industry. This study is the first to demonstrate that elastic sided safety boots were the most popular amongst respondents and that lower limb problems occur with workers. Therefore, further research into the safety footwear used in the Australian wine industry is needed to better support workers health while working in their varied roles and conditions.

IntroductionThe impact of the COVID-19 pandemic has disrupted training during the initial peak and partial recovery. Gastroenterology higher speciality training (HST) is reaching an inflection point with a reduction from five years to four. The potential compound impact is a source of concern for HSTs. The BSG Trainees Section biennial survey 2020 aimed to delineate the impact of COVID-19 and opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology HSTs over a three month period from September to November 2020.ResultsIn total, 349 trainees completed the survey (response rate of 51% of 687 HSTs) with representation across all regions. 89%(307/344) of responders were full time trainees and 39%(136/349) female. There was a reduction in access to clinics;48.4%(169/349) reported due to general internal medicine (GIM) duties and 26.6% (93/349) due to reduction in available clinics. Reduction in experience in gastroenterology referrals were also mainly limited by GIM commitments (42.4%) (148/349). No endoscopy training occurred for 88.5(170/192)% of trainees at the peak. Recovery of training lists was reported by 67.3(175/260)% of responders in late summer yet 20.6(72/349)% reported training lists were still ‘not allowed’ in their trust. 71.0 (206/290)% of responders reported their time was predominantly taken by GIM, with 42.1 (110/261)% considering the need to extend their CCT date to compensate for this. 49.0%(128/261) of respondents were considering time out of programme or fellowships and 28.3 (74/261)% considering it in the future. The majority of responders reported virtual or online teaching was provided during the peak of the pandemic.Considering future training;96.8%(245/253) of respondents stated gastroenterology HSTs should have 1 year experience on a GI bleed rota, however only 21.3 (55/258)% reported having experience of this formally during training. 68.8%(174/253) of responders supported the idea of blocks of GIM training during HST to protect gastroenterology training. The majority of trainees (84.2%)(213/253) reported they would not feel ready to be a consultant after 4 years of HST. 46.7(122/261)% of responders would stop GIM training if given the opportunity.ConclusionsIn all aspects of gastroenterology training surveyed, more than half of training time was lost during the pandemic. This included training beyond endoscopy to other aspects of GI work including clinics and referrals. This is mirrored in anticipated concerns about completion of training and the perceived future competence as a consultant at the end of a 4 year higher training programme. Work is now required to ensure training trajectories are restored following the COVID-19 pandemic.

Objectives The caregiving experiences and unique health needs of male caregivers of children and youth with special health care needs (CYSHCN) are not well described. This study seeks to understand potential unmet health needs and attitudes toward supportive resources from the perspective of a sample of male caregivers of CYSHCN. Methods This mixed-methods study recruited a convenience sample of 30 men with CYSHCN who receive care for a chronic medical condition from primary care medical homes in Pennsylvania. We conducted semi-structured interviews (SSI), administered quantitative surveys to caregivers, and produced a thematic analysis. The SSI explored the health needs of male caregivers, assessed attitudes toward and preferences regarding supportive resources, and garnered their advice to other caregivers regarding parenting and health care system navigation. Results Participants' median age is 41 years (IQR: 33, 44), and most (80%) reside full time with their CYSHCN. Most male caregivers deprioritized their own emotional, mental, and physical health needs to support the needs of their families. Many male caregivers articulated interest in seeking emotionally supportive resources (not time-intensive). They advised other male caregivers to remain involved in the medical care and wellbeing of their CYSCHN and to openly seek and receive emotional support despite the daily challenges they face. Conclusions for practice Male caregivers of CYSHCN experience intense daily stress and express the need for emotionally supportive resources. Programs designed to facilitate such support may benefit from flexible formats (time and location) and involve male caregivers of CYSHCN as both facilitators and participants.

Background: The undergraduate program in Public Health of Saint Catherine University is the second most popular major of the institution, drawing students from diverse racial, economic, cultural, and educational backgrounds. This has presented significant opportunities and challenges with regard to providing students and faculty with the needed academic and professional development to ensure graduates embody the skills needed for Public Health workforce of today. The objective of this study was to identify potential structured institutional supports to graduate Public Health professionals from diverse communities to advance health equity. A secondary objective was to determine whether the needed supports for Public Health students might differ from peers in other health programs, specifically Nursing.Methods: Using a mixed methods approach and a convenience sample, data were gathered from Public Health students, nursing students, faculty, and staff from November 2019 through July 2020. The survey assessed stress, grit, and demographic factors. Focus group topics included: academic resilience and professionalism, supports and gaps in the current institutional structure with respect to mitigating student stressors, and opportunities for programmatic solutions.Results: In total, 53 Public Health and 32 in Nursing students completed the survey. Nursing students tended to be farther along in their undergraduate careers, less likely to have failed a class, and more likely to have recently been laid off from a job. Public Health students reported more support from parents, but less support from friends and classmates than their Nursing peers. Most Nursing and Public Health students reported unmanaged stress, and similar average grit scores (3.51 vs. 3.41, p = 0.43), respectively. In focus groups, students described a series of stressors including working full time while attending school, family expectations, difficulty with time management, and learning how to acclimate to college norms. University staff and faculty identified financial pressures as a primary student stressor in addition to complex lives including managing family crises.Conclusions: Study findings are being used to identify or adapt professional development supports in undergraduate Public Health programs. Through supporting a diverse undergraduate student population in Public Health, a future workforce from communities most impacted by health disparities will emerge.

A new generation of children with hearing impairment (HI) has emerged due to introduction of universal neonatal hearing screening, medical-surgical/technical and educational advances in the field of paediatric audiology. AIM The primary aim of the study was to investigate long-term development of language fundamentals of children with HI at school level and analyse associations to several background variables. METHOD AND MATERIAL The project design is prospective, longitudinal and comparative and was conducted over a three-year period with annual testing of core language, expressive language, working memory and pragmatics. Language scores were compared to type of hearing technology, gender, additional disability, diagnosis of HI, level of social well-being and start age of use of hearing technology. A total of 56 children participated (Children with HI N = 47; Children with normal hearing (NH) N = 9). Intervention included early start and full time use of hearing technology and 3 years of Auditory Verbal (AV) guidance at school level. RESULTS Children with HI scored within the norm on all language fundamentals and showed high scores on parental assessments of level of social well-being. No significant association was found between any of the language fundamentals and social well-being. Children with HI and a diagnosed additional disability showed positive progression in terms of language development over the three years. CONCLUSION The new generation of children with HI showed potentials of developing language fundamentals within normal range and thrived in terms of social well-being. Opportunities exist for children to be fully included in their respective local hearing community, if qualitative technical and educational intervention is provided.

This historical review highlights the career of Charles F. Ferguson, MD for whom the annual clinical science awards bestowed by the American Society of Pediatric Otolaryngology are named. Dr. Ferguson was the first full time pediatric otolaryngologist in the United States. His career at Boston Children’s Hospital spanned almost four decades. Disorders of the larynx, trachea and bronchi were his principal professional focus, with a specific expertise in bronchoesophagology. His pioneering work in pediatric airway endoscopy and the development of techniques to diagnose congenital airway malformations led to his receipt of the Chevalier Jackson Award from the American Bronchoesophagological Association, and the James Newcomb Award from the American Laryngological Society. He notably edited the first Pediatric Otolaryngology textbook in 1972. His life’s work help set the foundation for the creation of the American Society of Pediatric Otolaryngology in 1984, six years following his retirement. The Charles Ferguson Clinical Science Awards were established to sustain his legacy.

Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear.A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients' baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1-4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43-0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18-0.78; P for interaction0.01).Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.

Background: Few studies in the past examined student’s health status and lifestyle behaviours, however, none have examined how student’s wellbeing is being influenced by stress and depression among university students in eastern Nigeria. This is the first study in Nigeria to gauge the relationship between students mental health status with wellbeing. The study went further to examined how the relationship of stress and depression transmits through gender among the students. Aims: The aim of this study is to explore the relationship of stress and depression with students’ wellbeing and gender. Method: This is a cross sectional descriptive study. Full time university students were recruited from the department of public health in the University of Calabar, Cross River state Nigeria. Data collection was based on an anonymous questionnaire and the sample size was (n= 291). Descriptive tests and chi-square tests were conducted. Results: The study indicated that female students reported higher stress and depression than their male counterparts. Secondly the study shows that female students had a better wellbeing and health status than male students. Conclusion: This study is the first to gauge the association of stress and depression with wellbeing and gender of university students in Nigeria. The result indicated that though female students reported higher stress and depression than male students however, on the contrary they reported better wellbeing index than their male counterparts that even reported lower stress and depression.

Background Antiviral treatment is recommended to reduce the vertical transmission in women with high viral load for mother-to child-transmission (MTCT). However, most women decline treatment. Objectives We aimed to determine the knowledge and awareness of maternal chronic hepatitis B carriers to antiviral use. Methods A cross sectional study was carried out in a tertiary hospital in National University Hospital of Singapore. Maternal hepatitis B carriers with children less than 5 years old were surveyed on attitudes and knowledge on hepatitis B virus as well as what their reasons were for taking/not taking antivirals. Results Fifty-seven were surveyed; 50.9% had a degree, 64.9% worked full time, 47.4% had 1 child or more. Most were risk averse. Many, 78.9% were not aware of the role of antivirals to reduce MTCT. Only 21.1% knew the risk of vertical transmission with/without antiviral. Reasons for not taking antivirals were attributed to a lack of knowledge. Many, 87.7% are willing to take antiviral therapy during their pregnancy to reduce MTCT from 10% to 1% and 45.6% willing to pay at least S$2 to S$2.90 daily over 12 weeks for it. Conclusions It is the practitioner’s role to update and improve the quality of education programmes that target women of childbearing age about the benefits of antiviral use to reduce MTCT in mothers with high hepatitis B viral load. Additionally, from a health system perspective, providing subsidies for antiviral treatment to ease the financial concerns of parents, is likely to reduce long-term expenses generated by chronic hepatitis B virus complications, thus being more cost-effective.

In Japan, with the rapid increase of breast cancer patients, there has been increasing demand for breast cancer treatment. As the main workforce for breast cancer treatment, women physicians are thought to be in key positions, since the number of women physicians has recently been increasing. To clarify the current statuses and issues of physicians and work conditions at the accredited breast cancer care facilities, a survey was conducted by the Japanese Breast Cancer Society (JBCS). The main workforces engaged in breast cancer care are surgeons, and the number of breast surgeons of all institutions in this survey was 1338 (full time 1124, part time 214). The percentages of women among surgeons, breast specialists accredited by the JBCS, and residents are 22%, 25%, and 38%, respectively. Among breast specialists, more women tended to work at university hospitals and cancer hospitals. Twenty-eight percent of women were married and among those, 76% had at least one child. Many hospitals allow short working hours or exemption from in-house call for women surgeons during pregnancy and child-rearing. In contrast, half of the facilities apply a “single doctor-in-charge system”, where the patient’s primary physician has to be on-call every day. Many institutions convene conferences for breast cancer treatment planning before or after the scheduled working hours. Current systems for treatment of breast cancer should be improved so that all surgeons specializing in the breast can develop their career while maintaining their personal life.

During an influenza pandemic and during seasonal epidemics, more persons have symptomatic illness without seeking medical care than seek treatment at doctor's offices, clinics, and hospitals (1). Consequently, surveillance based on mortality, health care encounters, and laboratory data does not reflect the full extent of influenza morbidity. CDC uses a mathematical model to estimate the total number of influenza illnesses in the United States (1). In addition, syndromic methods for monitoring illness outside health care settings, such as tracking absenteeism trends in schools and workplaces, are important adjuncts to conventional disease reporting (2). Every month, CDC's National Institute for Occupational Safety and Health (NIOSH) monitors the prevalence of health-related workplace absenteeism among full-time workers in the United States using data from the Current Population Survey (CPS) (3). This report describes the results of workplace absenteeism surveillance analyses conducted during the high-severity 2017-18 influenza season (October 2017-September 2018) (4). Absenteeism increased sharply in November, peaked in January and, at its peak, was significantly higher than the average during the previous five seasons. Persons especially affected included male workers, workers aged 45-64 years, workers living in U.S. Department of Health and Human Services (HHS) Region 6* and Region 9,† and those working in management, business, and financial; installation, maintenance, and repair; and production and related occupations. Public health authorities and employers might consider results from relevant absenteeism surveillance analyses when developing prevention messages and in pandemic preparedness planning. The most effective ways to prevent influenza transmission in the workplace include vaccination and nonpharmaceutical interventions, such as staying home when sick, covering coughs and sneezes, washing hands frequently, and routinely cleaning frequently touched surfaces (5).

Summary Background & aims Home parenteral nutrition (HPN) is provided to patients with intestinal failure (IF). HPN can however affect the patients' quality of life and ability to remain in employment. The aim of this study was to determine the effect of HPN on employment and factors associated with the likelihood of maintaining or returning to employment while on HPN. Methods Patients with chronic IF were identified from a prospectively maintained IF Unit database. A structured questionnaire was designed to probe employment both before and after starting HPN, intention to work and social welfare status (benefits & pensions). Results A total of 196 (62.8% females, median age 53 years) patients participated in the study of which 184 (94%) patients were in full or part time employment before their illness. At the time of starting HPN, 102 (52%) patients had the desire to return to work with 19 (18%) and 48 (47%) patients returning to full time or part time employment respectively. Multivariate analysis demonstrated that the frequency of the HPN infusion per week (p = 0.045) and intention to work after starting HPN (p = 0.001) were significantly associated with returning to work. Conclusions Patients on HPN can have their employment status affected. The number of days per week on HPN and the desire of the patient to return to employment are significantly associated with employment.

Although retirement involves a radical change in daily activities, income, social roles and relationships, and the transition from paid work into retirement can, therefore, be expected to affect sleep, little is known about the effects of old-age retirement on changes in sleep disturbances, and how the impact of retirement may vary by gender, age and prior working conditions. This study modelled reported sleep disturbances up to nine years before to nine years following retirement in a sample of 2,110 participants from the Swedish Longitudinal Occupational Survey of Health (SLOSH). Sleep disturbances over the retirement transition were modelled using repeated-measures regression analysis with Generalized Estimating Equations (GEE) in relation to gender, age at retirement, working patterns (night work, full-time/part-time work), control over work hours, and psychological and physical working conditions. The analyses controlled for civil status, education level, income obtained from registers and self-rated health. Retiring from paid work was associated with decreased sleep disturbances. Greater reductions in sleep disturbances were reported by women, as well as by participants who retired before age 65 years, who were working full-time, who lacked control over their work hours and who had high psychological demands. These results, suggesting that old-age retirement from paid work is associated with reductions in disturbed sleep, pose a challenge for governments seeking to increase retirement ages.

To investigate the association between bedtimes, sleep duration, sleep complaints and psychological functioning, we assessed early, middle and late adolescents who attended boarding schools with the same school schedules. Moreover, we studied whether particularly evening types benefit from set bedtimes. A total of 1571 adolescents (age range = 11 to 21 years; mean age = 16.51 years ± 1.83; 55% females) attending boarding schools in German-speaking Switzerland were assessed. Adolescents who slept at the boarding schools (n = 1013, 64%; INTERNS) were compared with adolescents attending the same schools but who slept at home (n = 558, 36%; EXTERNS). INTERNS’ regular bedtimes were supervised by school staff, whereas EXTERNS had variable bedtimes. Participants were split into early, middle and late adolescents and morning and evening types. Participants completed questionnaires covering sociodemographic information, sleep-related information, chronotype and psychological functioning. Irrespective of attending boarding school full time or living at home, older adolescents reported shorter sleep duration compared to younger adolescents. INTERNS, early, middle and late adolescents reported more sleep complaints and more psychological issues than EXTERNS. Under supervised conditions, particularly older adolescents and evening types reported longer sleep duration but did not report less sleep complaints or more favourable psychological functioning. Within a larger sample of adolescents attending boarding schools, longer sleep duration was found among full-board students with supervised set bedtimes, particularly for older adolescents who are evening types. In general, adolescents with earlier set bedtimes reported longer sleep duration, but did not report less sleep complaints or more favourable psychological functioning.

Introduction: Utilization of Health Insurance Scheme services varies for a variety of reasons but it appears that the determining factors are universal.TISHIP was developed to counteract the detrimental effects of user fees which sometimes lead to catastrophic health expenditures. This study aimed to ascertain level of awareness and utilization of TISHIP in tertiary institution in NigeriaMethods: The study was carried out among full time undergraduate studentsEnugu State University of Science and Technology, Enugu state. Nigeria. Analytical cross sectional study design involving use of questionnaire was done. Chi Square test and Binary logistic regression were used to ascertain socio-demographic factors influencing utilization of TISHIP.Results: Majority of respondents were aged 21-25 years 149(48.7%) and lived off-campus 267(87.3%). About 137(44.8%) were aware of TISHIP with major source of awareness from friends/relatives 82(59.8%). Also 60% had positive attitude, 88(28.8%) has registered for the programme and 46(52.3%0 registered >1 year ago.Major factors influencing TISHIP includes; long waiting time 195(63.7%) and poor attitude of the medical staff 186(60.8%). There were statistical significant associations between use of TISHIP with address, education and occupation of both parents. (p< 0.05). Identified predictors were being females (AOR 0.74; 95% CI 0.35-0.96), living in hostel (AOR 3.24; 95% CI 1.52-6.77), father being civil/public servant (AOR 2.34; 95% CI 1.66-5.61) and mother being civil/public servant (AOR 3.13; 95% CI 1.02-7.54).Conclusion: The study showed that knowledge on TISHIP was poor, Also utilization of TISHIP was poor However, majority had positive attitude on TISHIP. There is need for improvement especially as regards sensitization and dissemination on availability of TISHIP to achieve the set objective of the programme.Key words: Tertiary, Health, Insurance, Students

Introduction: Prolonged sitting is often proposed as a risk factor for low back pain development. The purpose of this study was to evaluate the acute effect of full time office work on sensorimotor trunk functions. Methods: Seventeen healthy office workers participated in the study. Maximal lumbar flexion range of motion, anticipatory postural adjustments and postural reflex reactions were tested before and after full time office work in a real life environment. Results: There were longer onset latencies of postural reflexive reactions and decreased response amplitudes of anticipatory postural adjustments after full time office work, but these were significant only for the obliquus externus abdominis muscle. No changes in lumbar range of motion was found. Conclusion: To our knowledge this is the first study that evaluates the effect of full time office work on postural actions and lumbar RoM. We found an absence of normal human circadian flexibility in the lumbar spine and some changes in postural actions. We propose that active trunk stiffness increase to compensate for decreased passive stiffness after prolonged seated work. Further studies are needed to confirm this assumption.

HIV/AIDS cases in Indonesia are still high including the infection from mothers to the babies. Infection cases from mothers to babies in Yogyakarta Special Province is also found on babies. The preliminary study also obtained the result that in 2015 not all of the pregnant women who were willing to have VCT (Voluntary Counseling and Testing) in Sleman Regency working area. The data of VCT in Prambanan Primary Health Center also shows that the prevalence rate of VCT check as a preventive effort was still low. The research is aimed at investigating the correlation between midwife’s support and VCT on pregnant women in Prambanan Primary Health Center in 2016. The study employed observational analytic with a cross-sectional approach. The population of the study was all mothers who did pregnancy examination and got counseling VCT service. The samples used accidental sampling technique. Data analysis used chi-square with the trustworthy rate 95%. The result of the study showed that there was no correlation between midwife and VCT on pregnant women. It can happen because of the midwife as a professional attendant could not attend the pregnant women full time. It can be concluded that there was no correlation between midwife’s support and VCT on pregnant women in Prambanan Primary Health Center in 2016. It is expected that midwives can identify the problem in VCT on pregnant women by giving emotional and respect support to the patients as well as the families.

Background While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown. Aims To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service. Methods Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel. Results Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014. Conclusions The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.

Background: Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work. Aim: To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP. Material and Methods: Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups. Results: There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups. Conclusions: These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.

OBJECTIVE: There is a need for oncology mental health providers to receive training to use empirically supported psychological treatments (ESTs) with their patients. The purpose of this editorial is to describe “lessons learned” from disseminating–conducting EST trainings–and supporting providers' capacity and confidence to use the EST. METHOD: Processes and outcomes from conducting six, 3-days (18 h) EST training institutes from 2012-2016 are discussed. Institutes trained 166 full time oncology mental health providers from more than 100 different settings. The dissemination was intentionally designed to achieve EST implementation, i.e., therapists' sustained usage of the EST for at least 12 months post training. RESULTS: Previously published discussion and findings show the effort was successful in achieving positive EST dissemination outcomes and sustained EST implementation by providers. Thus, “lessons learned” include discussions of (1) orientation to design education/training to achieve EST usage using theory based aims and outcomes of training efficacy; (2) multimodal, educational strategies used to achieve therapists' positive attitudes toward and self-efficacy to implement the EST; (3) guidance to therapists for adapting the EST to their practice settings while maintaining fidelity; (4) assistance to therapists to identify and problem solve implementation challenges; and (5) using patient reported outcome measures to determine clinical change. CONCLUSION: Our discussion of the plan, methods, and goals of EST training contributes to the science of dissemination/implementation by providing support for (1) theory-informed EST dissemination, and (2) mechanisms of EST implementation. For researchers, our experience may guide future EST dissemination/implementation efforts in psycho-oncology. For therapists, lessons learned provide criteria for evaluating future continuing education options.

Objectives Coronavirus disease (COVID-19) contagion at work is well studied for healthcare workers, however it is not enough assessed in other working settings. Very little is known, indeed, about the risk of COVID-19 transmission through occupational exposure in non-health working places. This study aims to describe a COVID-19 cluster among workers in an office in Italy. Methods This was a retrospective observational study on a cluster of COVID-19 that occurred from 20 November through 3 December 2020 in a group of six colleagues (A–F) working in the same office full time 5 days a week, 8 h a day. The workers used the following prevention measures: social distancing (desks were >1 m, 1.76–5.01 m range), plexiglas panels, hands disinfection, and use of face mask. However, they did not wear face mask when in static position sitting at their desk and they did not aerate the place frequently. Results The disease spread from one worker (subject A) to four (80%) of the five colleagues (subjects B–F). Only subject D was negative to COVID-19 on 14 days after last contact with subject A (20 November 2020) as confirmed by nasopharyngeal swab testing. Subject D, in particular, did not contact subject A in the 48 h before symptoms onset. COVID-19 positivity of subject A was promptly communicated to the colleagues, who started self-isolation from their relatives and none of their households were infected. COVID-19 transmission was observed only in households of subject A. Conclusions The rapid communication of COVID-19 positivity to the colleagues and the prompt isolation of index case’s close contacts allowed to eliminate the secondary transmission to their households. The contagion of index case’s colleagues occurred from second day before symptoms onset. Distancing of >1 m, use of plexiglass panels, sanitizing hand gel, and inconstant use of face mask may not be enough for infection prevention in closed places with poor ventilation and high occupancy.

Objectives: This study aimed to investigate workplace measures implemented in response to COVID-19 during the outbreak in Japan from T1 (March 2020) to T2 (May 2020), focusing on the disparities by company size and industry. Methods: A longitudinal study was conducted using a cohort of full-time employees, starting with the baseline online survey on March 19–22, 2020 (T1). An online follow-up survey was conducted on May 22–26, 2020 (T2). The McNemar test was used to assess differences between T1 and T2 in the proportion of implemented measurements. Analysis of covariance was performed to compare the differences in the number of implemented measures across groups classified by company size or industry, adjusting for sex and age. Results: A total of 1,032 participants (response rate: 72.6%) completed the follow-up questionnaire. The final analytic sample comprised n=987. The workplace measures involving the delivery of information on COVID-19 were 88.4% at T2, which significantly increased from T1 (increased 8.6%, p

Background Formal recognition of palliative medicine as a specialty has been one of the main drivers in the development of palliative care. Aim To provide a comparative, comprehensive overview on the status of palliative medicine as medical specialty across Latin America. Methods We conducted a comparative study of 19 Latin American countries. Key informants and persons in charge of the specialization training programs were identified and interviewed. We collected data on general recognition as specialty (title, process of certification) and on training program characteristics (title, start year, requirements, training length, and type full time or part time). Results Eight of 19 countries (42%) Argentina, Brazil, Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Venezuela reported palliative medicine as medical specialty. Thirty-five (sub)specialization training programs in palliative medicine were identified in the region (eight as a specialty and 27 as a subspecialty), the majority in Colombia (43.5%) and Brazil (33.7%). A total of 20% of the programs have yet to graduate their first cohort. Length of clinical training as specialty varied from two to four years, and from 520 hours to three years for a subspecialty. Conclusion Despite long-standing efforts to improve quality of care, and significant achievements to date, most Latin American countries have yet to develop palliative medicine as medical specialty. Specialty and sub-specialty training programs remain scarce in relation to regional needs, and the programs that do exist vary widely in duration, structure, and content.

Background Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants’ RTW processes. Methods/design We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18–60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. Discussion This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process. Trial registration Current controlled trials ISRCTN12033424, 15.10.2014, retrospectively registered.

[EN] This study aimed to investigate the validity of using built-in smartphone accelerometers to estimate the active energy expenditures of full-time manual wheelchair users with spinal cord injury (SCI). Twenty participants with complete SCI completed 10 5-min daily activities that involved the upper limbs, during which their oxygen consumption and upper limb activity were registered using a portable gas analyzer and a smartphone (placed on the non-dominant arm), respectively. Time series of 1-min averaged oxygen consumption and 55 accelerometer variables (13 variables for each of the four axes and three additional variables for the correlations between axes) were used to estimate three multiple linear models, using a 10-fold cross-validation method. The results showed that models that included either all variables and models or that only included the linear variables showed comparable performance, with a correlation of 0.72. Slightly worse general performance was demonstrated by the model that only included non-linear variables, although it proved to be more accurate at estimating the energy expenditures (EE) during specific tasks. These results suggest that smartphones could be a promising low-cost alternative to laboratory-grade accelerometers to estimate the energy expenditure of wheelchair users with spinal cord injury during daily activities., This work was supported by Fundacio la Marato de la TV3, under Projects 201720-10 and 201701-10, and European Union through the Operational Program of the European Regional Development Fund (ERDF) of the Valencian Community 2014-2020 (IDIFEDER/2018/029)

PURPOSE To assess the changing diversity of faculty in specific clinical and basic science departments, stratified by sex and underrepresented in medicine (URM) status, at all Liaison Committee on Medical Education (LCME)-accredited medical schools. METHOD In this retrospective, cross-sectional, observational study, the authors used data from the Association of American Medical Colleges Faculty Roster (data pulled in October 2019) to identify trends in clinical department faculty and in basic science department faculty by sex and URM status. They included full-time faculty at all LCME-accredited medical schools from 1979 to 2018. They compared the proportions of faculty across separate departments according to sex and URM status, and they used 2-independent-sample t test and simple linear regressions for statistical comparisons. RESULTS The number of full-time faculty increased from 49,909 in 1979 to 175,326 in 2018. The largest increase occurred in clinical departments, where the number of faculty increased from 38,726 to 155,677 (a fourfold increase). The number of faculty in basic science departments increased from 11,183 to 19,649 (a 1.8-fold increase). The proportions of faculty who were non-URM females (compared with non-URM males, URM females, and URM males) increased the most-from 14.4% (5,595 of 38,726) to 37.6% (58,478 of 155,677) for clinical departments, and from 14.9% (1,669 of 11,183) to 33.0% (6,485 of 19,649) for basic science departments. Growth was steady but slow among URM faculty, especially for Black males; the absolute number of male URM faculty remained low in both basic science and clinical departments. The proportions of females and URM faculty were highest in the departments of obstetrics and gynecology, pediatrics, and family medicine. CONCLUSIONS The substantial increase in faculty, especially in clinical departments, has led to greater diversity, but mostly among non-URM females. The rise of URM male and URM female faculty has been minimal.

Objectives The objective was to describe the growth of physicians, nurse practitioners (NPs), and physician assistants (PAs) who practice full time in nursing homes, to assess resident and nursing home characteristics associated with receiving care from full-time providers, and describe variation among nursing homes in use of full-time providers. Design Retrospective cohort study. Setting and Participants A 20% national sample Medicare data on long-term care residents in 2008 to 2018 and the physicians, NPs, and PAs who submitted charges to Medicare for their care. Methods We measured the percentage of provider charges for services rendered in nursing homes, in addition to resident and facility characteristics. Results Full-time nursing home providers increased from 26.0% of all nursing home providers in 2008 to 44.6% in 2017. The largest increase was in NPs: from 1986 in 2008 to 4479 in 2017. Resident age, sex, Medicaid eligibility, and race/ethnicity had minimal association with the odds of having a full-time provider, whereas residents with an NP primary care provider were 23.0 times more likely (95% confidence interval = 21.6, 24.6) to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.6% in 2008 to 62.5% in 2018. There was large variation among facilities in the percentage of residents with full-time providers, from 5.72% of residents with full-time providers in the bottom quintile of facilities to 91.44% in the top quintile. Individual nursing homes accounted for 59% of the variation in whether a resident had a full-time provider. Conclusions and Implications The percentage of nursing home residents with full-time providers continues to grow, with very large variation among nursing homes.

Objective:To investigate the extent, quality and challenges of dietetic counselling during the pandemic.Design:A cross-sectional online thirty-six-item Google Survey. The survey queried demographics and information on usage and perceived telemedicine quality.Setting:The survey was distributed to Israeli Dietetic Association (ATID) mailing list between 31 March and 5 May 2020.Participants:Clinical dietitians, members of ATID, who consented to participated in the survey.Results:Three hundred dietitians (12 % of ATID members; 95 % women; mean age 4·41 (sd 10·2) years) replied to the survey. Most dietitians reported a significant ∼30 % decrease in work hours due to the pandemic. The most prevalent form of alternative nutrition counselling (ANC) was over the phone (72 %); 53·5 % used online platforms. Nearly 45 % had no former ANC experience. Both ANC formats were reported inferior to face-to-face nutritional consultation (consultation quality median scores 8 and 7, on a 1–10 scale, for online and phone, respectively). ANC difficulties on either phone or online platforms were technical (56 and 47 %, respectively), lack of anthropometric measurements (28 and 25 %, respectively) and interpersonal communication (19 and 14·6 %, respectively). Older age and former phone counselling experience were associated with higher quality scores, respectively (OR = 1·046, 95 % CI 1·01, 1·08, P = 0·005), (95 % CI 1·38, 4·52, P = 0·02). Those who continued to work full time had five-time greater odds for a higher quality score using online platforms (OR = 5·33, 95 % CI 1·091, 14·89, P = 0·001).Conclusions:Our findings suggest telemedicine holds considerable promise for dietary consultation; however, additional tools and training are needed to optimise remote ANC, especially in light of potential crisis-induced lockdown.