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PubMed2001

Public health physicians: an endangered species.

BACKGROUND: Questions have arisen regarding the competency levels of the various professions within the public health sector, including those of physicians. Protection of the nation's health requires that physicians on the public health team be competent practitioners of both medicine and public health. Physicians practicing in this arena are required to possess a vast array of knowledge, skills, and attitudes to be effective contributors in the field. METHODS: Using focus groups of key informants in public health, the context of practice, inventory of required competencies, current competencies, and identified gaps in these competencies, measures to address the situation were identified and discussed. RESULTS: Recommendations from the focus groups include: use of distance-based learning, development of educational materials and programs, use of the American College of Preventive Medicine as a facilitator, improved remuneration, changes to the certification process, utilization of mentoring programs, introduction of new marketing strategies, use of professional publications, and increased governmental/agency support. Contributors to this endeavor are identified. CONCLUSIONS: While we strive to improve the physician workforce entering the field, creative strategies for continued lifelong learning are urgently needed to facilitate ongoing development of physicians in the current public health workforce. This situation presents a major research agenda for public health practice. Identification of the essential knowledge, skills, and attitudes for public health physicians is the first step toward narrowing gaps in required competencies.

Clinical Competence↗
PubMed1994

Occupational exposures to carcinogens in developing countries.

There have been very few studies of exposure to occupational carcinogens in developing countries, and even fewer studies of the health consequences of such exposures. However, all industrial chemicals, occupations and industrial processes classified by the International Agency for Research on Cancer (IARC) as Group 1 or Group 2A (carcinogenic or possibly carcinogenic to humans) have been described in developing countries, and there is growing concern that the health impact of many chemicals used in the developing world has been underestimated. In all regions a very large workforce is employed in the construction industry, in which substantial exposure to asbestos may occur, and there has been a rapid increase in production in countries such as Brazil and India. There is, for instance, a similar pattern for tyre production with a large increase in production in developing countries in the 1980s. Thus, the number of workers in industries entailing a carcinogenic risk is increasing in developing countries, partly as a result of the transfer of hazardous industry from industrialized countries. There is much that could be achieved in the prevention of occupational cancer in developing countries, and there have been a number of successful initiatives. However, the greatest progress in the prevention of occupational cancer in developing countries is most likely to come from political and economic changes.

Carcinogens↗
PubMed2004

Evolution of the digital revolution: a radiologist perspective.

The transformation from film-based to filmless operation has become more and more challenging, as imaging studies expand in size and complexity. To adapt to these changes, radiologists must proactively develop new workflow strategies to compensate for increasing work demands and the existing workforce shortage. This article addresses the evolutionary changes underway in the radiology interpretation process and reviews changes that have occurred in the past decade. These include a number of developments in soft-copy interpretation, which is migrating from a relatively static process, duplicating film-based interpretation, to a dynamic process, using multi-planar reconstructions, volumetric navigation, and electronic decision support tools. The result is optimization of the human-computer interface with improved productivity, diagnostic confidence, and interpretation accuracy.

Humans↗
PubMed2002

Workplace trauma and the law.

The law places increasing responsibilities on organizations to protect its workforce from psychological injury. This paper looks at the development of British law relating to traumatic stress and explores a growing concern of clinicians that the law and the legal processes themselves may increase the psychological injury of victims of traumatic stress. The statutory requirement for organizations to provide effective support for employees following a traumatic incident is enshrined in law. However organizations are confused by the conflicting statements on the effectiveness of debriefing and trauma counselling.

Accidents, Occupational↗
PubMed2004

Factors affecting the probability of first year medical student dropout in the UK: a logistic analysis for the intake cohorts of 1980-92.

BACKGROUND: In the context of the 1997 Report of the Medical Workforce Standing Advisory Committee, it is important that we develop an understanding of the factors influencing medical school retention rates. AIMS: To analyse the determinants of the probability that an individual medical student will drop out of medical school during their first year of study. METHOD: Binomial and multinomial logistic regression analysis of individual-level administrative data on 51 810 students in 21 medical schools in the UK for the intake cohorts of 1980-92 was performed. RESULTS: The overall average first year dropout rate over the period 1980-92 was calculated to be 3.8%. We found that the probability that a student would drop out of medical school during their first year of study was influenced significantly by both the subjects studied at A-level and by the scores achieved. For example, achieving 1 grade higher in biology, chemistry or physics reduced the dropout probability by 0.38% points, equivalent to a fall of 10%. We also found that males were about 8% more likely to drop out than females. The medical school attended also had a significant effect on the estimated dropout probability. Indicators of both the social class and the previous school background of the student were largely insignificant. CONCLUSIONS: Policies aimed at increasing the size of the medical student intake in the UK and of widening access to students from non-traditional backgrounds should be informed by evidence that student dropout probabilities are sensitive to measures of A-level attainment, such as subject studied and scores achieved. If traditional entry requirements or standards are relaxed, then this is likely to have detrimental effects on medical schools' retention rates unless accompanied by appropriate measures such as focussed student support.

Adult↗
PubMed2005

Multistate worklife expectancies.

This communication reviews the demographic concept of worklife expectancy and draws the epidemiologists' attention to its usefulness in occupational health research and pension policy making. The distinctions between different analytic approaches to the quantification of expected workforce status and mobility are pointed out. A recently developed multivariate large-sample regression method for the analysis of worklife tables is placed into the general context of life tables. Given aggregated data from multiple cross-sectional or longitudinal population surveys, a multistate regression model can be used to estimate consistently marginal probabilities that a person is in a given work-health state or transition probabilities between the states and, thereby, worklife expectancies. The methodology is illustrated through the application to data from Finnish population statistics on employment, disability, retirement, and mortality. The paper closes with a discussion of the methodological issues and empirical findings on pension policy in Finland.

Finland↗
PubMedDate not supplied

Is elderly care research-based?

Nurses working with elderly people, and students considering the specialty as a career option, may develop negative attitudes about the value of the work they do. These often derive from the perception that their efforts do not improve patients' problems, and a misconception that what they do is intuitive rather than based in research. Such tensions can lead to the development of 'burnout' and the rapid demoralisation of the workforce. Roger Watson shows how nursing elderly people, particularly those with dementia who live in continuing care settings, calls on high degrees of technical and interpersonal skills, and demonstrates how the roots of the specialty are deeply entrenched in research.

Aged↗
PubMedDate not supplied

Physician-centered management guidelines.

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

Efficiency, Organizational↗
PubMed2000

Earnings histories of SSI beneficiaries working in December 1997.

Disabling conditions previously considered to be permanent and total are no longer viewed as automatic barriers to work. Medical advances, improved accommodations in the workplace, and changes in the nature of work for the working disabled have allowed many disabled people to rejoin the workforce. The Social Security Administration (SSA) has followed those developments with a view toward encouraging people receiving disability benefits to consider returning to work. To effectively target SSA's efforts and evaluate their success, information about previous work histories of the Supplemental Security Income (SSI) beneficiary population is used to provide baseline data. This article examines the earnings histories of 300,000 disabled SSI beneficiaries--one of the populations targeted by the expanded work-incentive measure under Public Law 106-70--who were working in December 1997. The article also investigates whether beneficiaries who are working have significant lifetime earnings and whether earnings patterns exist that might assist with SSA's work-support activities. SSI program records were matched to data in the Master Earnings File to explore the characteristics and earnings patterns before and after a person applies for benefits. The article addresses several questions: What are the general characteristics of disabled SSI beneficiaries? What are their earnings histories? Did they have an earnings record when they applied for SSI? Of the SSI beneficiaries working in December 1997, most tended to be younger than other disabled beneficiaries, to have some sort of mental disability, and to have earnings well below levels that would suggest their eventual, complete independence from the SSI cash benefits program. A look at past covered earnings revealed that the vast majority of SSI workers had a history of earnings before they applied for SSI benefits. Despite their severe impairments and age at the time of first eligibility, nearly 40 percent had earnings in 11 years or more. The amounts of those earnings were quite low, however, and were usually not high enough to preclude SSI eligibility. Examining the years immediately before and after the point of application indicated whether recent pre-application earnings were consistent with post-application return to work. Results were a bit surprising. They revealed that one-third of the 1997 SSI workers had no earnings, and another 28 percent returned to work despite having no earnings in the 4-year period before application. Persons receiving SSI because of mental retardation seemed to have poorer earnings histories than other workers but were more likely to return to work after application. That may be explained by their younger ages or may reflect the outside assistance they received in responding to SSA work incentives.

Adolescent↗
PubMed1987

Regulations, 30 January 1987.

Regulations adopted by the All-Union Women's Committee give recently established women's councils greater scope to initiate legislation and provide that laws and statutory instruments affecting women's interests cannot be discussed without their participation. The Councils are also to play an active role in representing the interests of the female workforce at the enterprise level through participation in formulating and monitoring collective agreements, planning the allocation of resources on the social and day-to-day needs of the staff, and supervising the work of medical, pre-school and educational institutions, commercial and public catering enterprises, and day-to-day services.

Developed Countries↗
PubMed2006

Educating to improve population health outcomes in chronic disease: an innovative workforce initiative across remote, rural and Indigenous communities in northern Australia.

INTRODUCTION: Like Indigenous populations in other countries, an epidemic of chronic disease has swept across Australia's Indigenous communities in the past decade. The Northern Territory and Queensland health departments initiated preventable chronic disease strategies in 1999 and 2001, respectively. Yet finding innovative ways to translate this to the health workforce was challenging. Through support from the Australian Government, three universities, two health departments and two Indigenous organisations worked in partnership to improve workforce capacity in remote and rural communities through innovative education. METHODS: The methods included: (i) a training needs analysis consisting of 76 semi-structured interviews with key informants, and 35 surveys of remote staff; (ii) a literature and resource review; (iii) the development of a curriculum framework using: the existing competencies and standards across the health disciplines; the identified workforce needs; and what the workforce can impact upon; (iv) a multidisciplinary workshop with 35 educators across northern Australia that resulted in the basis for agreement of the final curriculum content and framework; (v) the development of a chronic disease self-assessment tool that was piloted with remote health staff; (vi) an assisted integration process for key stakeholders. An evaluation framework was also developed, as a separate project, in conjunction with the project partners during this time. RESULTS: This project identified that a paradigm shift is required in the way in which we educate the entire health workforce to deal effectively with the impact of chronic disease across remote, rural and Indigenous populations. In particular a need was found to educate the educators in the chronic care model and in using a population health approach. The training needs analysis identified very little difference between the education and training needs across the rural and remote health disciplines; it was perceived that they managed chronic disease fairly well yet found prevention and early detection to be at the 'hard end'. The main barriers identified were the demands of acute care over chronic disease management, compounded by high workforce turnover in remote areas. The curriculum framework, in particular the domains of remote practice, is being used by several Australian universities, health departments and non-government organisations in adapting their existing or new education programs. The self-assessment tool was based on the curriculum outcomes and was piloted in 2005 and found to be very useful for pre- and post-training purposes and as a discussion starter for all disciplines and groups. CONCLUSIONS: A practical curriculum framework now exists to integrate a population health approach for the prevention and early detection of chronic disease when educating the primary healthcare workforce. It is relevant to all health disciplines and is flexible in that it can be adapted, or adopted, depending on the educational needs of the disciplinary group. It is being imbedded into numerous undergraduate, postgraduate, and professional development programs in Australia. It includes: the core learning outcomes expected of any workforce, resources, and a self-assessment tool in chronic disease. These tools are assisting educators in the required paradigm shift required of the workforce to alter the single disease based practice model towards a comprehensive and integrated population based approach required for the workforce in the 21st century.

Chronic Disease↗
PubMed2006

Why do health professionals work in a community mental health service?

OBJECTIVE: The aim of this pilot study was to determine the reasons why mental health professionals work in a community mental health service. METHODS: A survey of psychiatrists and trainees (n = 13) and other mental health professionals (n = 67) was conducted in an Australian community mental health service with a socioeconomically deprived catchment population. Respondents were asked to list their main reasons for working and to complete measures of job design, well-being, social support, role clarity, teamwork and job satisfaction. The qualitative results were validated using focus groups. RESULTS: The response rate was 53.7% (43/80). Income (31/43), belonging (21/43), self-esteem (30/43) and self-actualization (9/43) were the main reasons given for working. Mental health professionals, who reported self-actualization as a reason for work, had significantly higher well-being and job satisfaction than other subjects. Mental health professionals who cited self-actualization as a reason for work perceived that their work was more significant and had higher task identity compared with other subjects. CONCLUSIONS: This study is limited by a small sample size and the inability to exclude confounding variables. Maslow's hierarchy of needs was a useful framework for categorizing reasons for work. Some practical approaches to meet the needs of the mental health workforce are discussed.

Career Choice↗
PubMed1987

Dominica.

Explore the source record for details and available documents.

Agriculture↗
PubMed1990

Development management for nursing administration.

What are the needs of a nurse administrator in a developing country? For that matter, what are the requirements for a nurse administrator in areas of lesser developed delivery in this country (e.g., care of the homeless, care of indigent populations)? Heyden, Luyas, and Henry look at the educational needs of these nurse managers and compare the needs to the typical education received in nursing administration programs.

Administrative Personnel↗