Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

BACKGROUND

Vietnam is undergoing a rapid epidemiological transition with a considerable burden of non-communicable diseases (NCDs), especially hypertension and diabetes (T2DM). Continuity of care (COC) is widely acknowledged as a benchmark for an efficient health system. This study aimed to determine the COC level for hypertension and T2DM within and across care levels and to investigate its associations with health outcomes and disease control.

METHODS

A cross-sectional study was conducted on 602 people with T2DM and/or hypertension managed in primary care settings. We utilized both the Nijmegen continuity of care questionnaire (NCQ) and the Bice - Boxerman continuity of care index (COCI) to comprehensively measure three domains of COC: interpersonal, informational, and management continuity. ANOVA, paired-sample t-test, and bivariate and multivariable logistic regression analysis were performed to examine the predictors of COC.

RESULTS

Mean values of COC indices were: NCQ: 3.59 and COCI: 0.77. The proportion of people with low NCQ levels was 68.8%, and that with low COCI levels was 47.3%. Primary care offered higher informational continuity than specialists (p < 0.01); management continuity was higher within the primary care team than between primary and specialist care (p < 0.001). Gender, living areas, hospital admission and emergency department encounters, frequency of health visits, disease duration, blood pressure and blood glucose levels, and disease control were demonstrated to be statistically associated with higher levels of COC.

CONCLUSIONS

Continuity of primary care is not sufficiently achieved for hypertension and diabetes mellitus in Vietnam. Strengthening robust primary care services, improving the collaboration between healthcare providers through multidisciplinary team-based care and integrated care approach, and promoting patient education programs and shared decision-making interventions are priorities to improve COC for chronic care.

Understanding medical students' interests in family medicine in Vietnam: A qualitative study

BACKGROUND AND OBJECTIVES

Family medicine has recently been introduced into undergraduate training programs after more than 10 years of only being available for postgraduate doctors in Vietnam. The aim of this study was to explore the perceptions of sixth-year medical students towards family medicine and the factors that influence their career choice for - or against - family medicine.

METHOD

The authors used a qualitative approach with a criterion sampling technique, including 36 participants in eight interviews and four focus group discussions, with thematical analysis.

RESULTS

Most students could explain well what they had learned about family medicine but showed little interest in it. Only a few of the interviewees indicated they would choose a career in family medicine. The following factors influenced their career choice: valuing continuing care, the doctor-patient relationship and work-life balance; family medicine clinical rotation and teachers' roles; and related health policies offering a clear practice pathway and patient allocation to capable family doctors.

DISCUSSION

The students' perceptions of family medicine were positive, but their interests in and intention to pursue a career in family medicine were still low after a clinical rotation. The authors concluded that the family medicine rotation should be maintained, family medicine should become more prominent in more components of the medical curriculum, and health policies to support and encourage becoming a family doctor are necessary.

Effectiveness of an Interprofessional Education Model to Influence Students' Perceptions on Interdisciplinary Work

BACKGROUND

To prepare students adequately for the workplace, training on interprofessional practice should be included in the curricula of future health professionals. This study evaluated the effect of an interprofessional education session on undergraduate students' attitudes toward interprofessional collaboration.

METHODS

A total of 225 medicine, nursing, physiotherapy, and nutrition and dietetics students were randomized to either an intervention (working together interprofessionally, n = 111) or control group (working together with their own profession, n = 114). Pre- and posttest assessment was performed with an adapted version of the Interdisciplinary Education Perception Scale.

RESULTS

A statistically significant improvement in attitude for Perception of Competence Own Profession (0.82, p = .008) and Perception of Actual Cooperation (1.10, p = .004) was found for students in the intervention group compared with students in the control group.

CONCLUSION

Interprofessional education sessions were likely to be effective on undergraduate students' attitudes toward interprofessional collaboration. [J Nurs Educ. 2021;60(9):494-499.].

Primary care quality in Vietnam: Perceptions and opinions of primary care physicians in commune health centers - a mixed-methods study

Introduction

Measuring the performance of a primary care system is one of the very first steps to find out whether there is room for improvement. To obtain an objective and comprehensive view, this measurement should come from both the supply and demand sides of the system. Patients’ experiences of primary care have been studied around the world, but much less energy has been invested in researching providers’ perspectives. This research aims to explore how primary care physicians working at commune health centers in Vietnam evaluate their performance and their opinions on how to improve the quality of primary care services.

Materials and methods

First, a quantitative study was conducted using the validated Vietnamese PCAT questionnaire—provider expanded version (VN PCAT PE) targeting all primary care physicians (PCPs) working at commune health centers in a province of Central Vietnam. Next, a qualitative study was carried out, consisting of in-depth interviews with PCPs, to better understand the results of the quantitative survey and gain insight on barriers of primary care services and how to overcome them.

Results

In the quantitative portion of our study, 150 PCPs rated the quality of ongoing care and first contact in CHCs as the best (3.09 and 3.11 out of 4, respectively), and coordination as the worst performing core domain (2.53). Twenty-two PCPs also participated in our qualitative research. In regards to challenges that primary care physicians face during their daily practice, three central themes emerged: 1) patient factors such as client attitude and knowledge, 2) provider factors such as the burden of administrative work and lack of training opportunities, and 3) contextual factors such as low income and lack of resources including medicines and diagnostics. Participants recommended more health promotion campaigns in the media, increasing the number of services available at CHCs (such as being able to take blood samples), reducing the workload related to administration for CHC leaders, greater government subsidies, and providing more training courses for PCPs.

Conclusions

Findings from this study offer a valuable view from the supply-side of the primary care system, specifically those who directly deliver primary care services. Along with the earlier study on consumers’ evaluation of the Vietnamese primary care system, and literature from other low and middle-income countries, these findings offer emerging evidence for policymakers to improve the quality of primary care in Vietnam.

Parental perceptions and expectations concerning speech therapy-related cleft care - a qualitative study

AIMS

Speech (i.e., resonance, nasal airflow and articulation) is one of the primary outcomes in individuals with a cleft of the palate with or without a cleft of the lip (CP ± L). Therefore, it is highly important to obtain information regarding parental perceptions and expectations concerning speech therapy-related cleft care. Literature investigating these parental perspectives is scarce. The present study investigated perceptions and expectations of parents of children with CP ± L concerning (outcomes of) speech therapy.

METHODS

Eleven parents of nine children with CP ± L were recruited from the multidisciplinary craniofacial team at the Ghent University hospital. A qualitative design, using semi-structured interviews, was used to collect data. Data were managed using NVIVO software version 10 and analyzed thematically.

RESULTS

The analysis resulted in three major themes: (1) service provision, (2) patient-centered care, and (3) seeking health care. Each of these identified themes were divided into three subthemes. Service provision included the effectiveness of the provided service, interdisciplinary collaboration, and expertise of the speech therapist. Information provision, child-friendly attitude and connection were categorized under patient-centered care. Seeking health care included affordability, practical considerations and the selection of a speech therapist.

CONCLUSION

The most prominent expectation of the parents was that they wanted to see their children progress during the speech intervention. This finding supported the importance of experienced and specialized speech-language pathologists (SLPs) in the provision of care to children with a CP ± L. Moreover, the results showed that the majority of the parents wanted more clear and comprehensive information particularly about the treatment progress, the transfer to the home environment and the prognosis. The present findings might aid SLPs, and more generally all health professionals, in gaining insight into parental perceptions and expectations concerning speech therapy-related cleft care. Thereby, treatment quality might be improved.

Learning experiences of final-year student midwives in labor wards: A qualitative exploratory study

INTRODUCTION

Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students' experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium.

METHODS

A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit.

RESULTS

Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors.

CONCLUSIONS

Factors related to students' functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards.

Laypersons' perception of common cold and influenza prevention-a qualitative study in Austria, Belgium and Croatia

Background: Common cold and influenza result in an increased number of primary care consultations, significant work/school absences and cause a socio-economic burden. Laypeople’s perceptions and knowledge regarding common cold and influenza prevention is poorly understood and under-researched.

Objectives: Our study explores laypeople’s knowledge of prevention of common cold and influenza across three European countries. Furthermore, it investigates if there is any distinction between prevention activities focussing on reasons impacting the attitude towards influenza vaccination as well as investigating cross-country variation.

Methods: In total, 85 semi-structured individual interviews were performed across three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24). Qualitative thematic content analysis was performed.

Results: Most participants across all three countries made no distinction between the prevention of the common cold and influenza and referenced the same preventative measures for both conditions. They mainly expressed negative attitudes towards influenza vaccination possibly effective but only intended for high-risk groups (bedridden/older people, chronic patients or health workers). There were very few cross-country differences in results.

Conclusion: The perception of health risk of contracting influenza and a primary healthcare physicians’ recommendation played an important role in shaping participants’ decisions towards vaccination. Primary healthcare physicians are invited to assess and if necessary adjust inappropriate prevention behaviour through their everyday patient consultations as well as add to the knowledge about influenza severity and influenza vaccination benefits to their patients.

Patient experiences of primary care quality amongst different types of health care facilities in central Vietnam

Background

Patient experience with primary health care services can vary markedly between different types of health care facilities, even within the same country setting. Given known benefits of high quality primary health care, the performance of these facilities may significantly impact population health. The aim of this study was to compare the quality of primary care in different types of health facilities as experienced by Vietnamese consumers.

Methods

1662 people who utilized primary health care services at least once over the past two years in various types of facilities in central Vietnam were surveyed in a cross-sectional study using the Vietnamese version of the Primary Care Assessment Tool (VN PCAT-AE) to assess overall primary care quality as well as several different domains of high quality primary care services.

Results

Commune health centers were associated with the highest overall primary care quality (PCAT expanded score 21.07, p < 0.001) as well as high scores in nearly all individual domains of primary care quality experienced by consumers compared with other types of facilities. Conversely, private facilities such as private clinics and pharmacies were rated lowest overall (PCAT expanded score 18.45, p < 0.05 and 16.90, p < 0.001 respectively). District hospitals and other government hospitals (PCAT expanded score 20.10 and 19.72 respectively) were reported as the best quality in comprehensiveness of available services (p < 0.001). Polyclinics performed quite well in comprehensiveness of services available (3.11) and first contact-access (2.79) but less so in other domains, especially in cultural competency (1.87).

Conclusions

The high quality of primary care services experienced by consumers in commune health centers compared with other facilities gives Vietnam ample reason to promote greater use of these community-based primary care facilities. Populations may benefit most from building and strengthening grassroots networks of such community-based health centers as an effective solution for overcrowding at hospitals while simultaneously providing better overall health outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4089-y) contains supplementary material, which is available to authorized users.

"With fever it's the real flu I would say": laypersons' perception of common cold and influenza and their differences - a qualitative study in Austria, Belgium and Croatia

Background

There is little research on laypersons’ perceptions regarding common cold and influenza, their symptomatic distinction and considerations of risk. This study investigates understanding of pathogenesis across three European countries and provides a knowledge base from which adequate prevention recommendations and treatment advice can be derived.

Methods

This is a qualitative research study. Semi-structured face-to-face interviews were conducted with 85 participants from three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24) about their experiences, perceptions and risk considerations regarding the common cold and influenza. We performed a qualitative thematic content analysis.

Results

Three main themes were identified: common cold as harmless with individualistic symptoms; influenza as mainly distinguishable by fever, confinement to bed and severity of symptoms, but description about onset and duration are diverse; and views on pathogenesis contain references to disease causing agents and circumstances. Overall we found that risk perception is based largely on personal experience and risk is assumed moderate for both diseases.

Conclusions

Study participants possessed a fairly good understanding of symptoms, differences and pathogenesis of common cold and influenza; but explanations integrated misconceptions, such as misinterpretation of fever, disease continuums, diverse onset ideas etc. Perceptions were largely based on lived experiences and interventions for prevention and treatment should be led by health care workers and focus on these issues. Basic consultations, awareness raising activities and other knowledge disseminations strategies should include aspects of communicableness and the self-limiting nature of both diseases. An informed understanding of both infectious diseases is crucial and may also increase influenza vaccination coverage in the three respective countries effectively.

Development and validation of the Midwife Profiling Questionnaire assessing women's preferred perinatal care professional and knowledge of midwives' legal competences

OBJECTIVES

Currently maternity care organisation is developing worldwide. Therefore insight in the position of the midwife is important. The 'Midwife Profiling Questionnaire' (MidProQ) measures women's preferred perinatal care professional and their knowledge of midwives' legal competences. MidProQ is based on the European legal framework and was tested in a pilot study. This study aims to determine its content and face validity.

STUDY DESIGN

A two-phase validation study with a Delphi method questioning content experts (n = 10) on items relevance and clarity as well as its scale and face validity. Further semi-structured interviews were performed with lay experts (n = 10) to evaluate the questionnaire's clarity, layout, phrasing and wording.

RESULTS

After round one, most questions (42/47) were considered content valid for relevance and clarity (Item Content Validity Index 0.80-1.00). Scale (Scale Content Validity Index 0.92) and face validity (Face Validity Index 0.89) of the entire instrument was obtained. Five questions were revised until item content (0.83-1.00), scale content (0.92) and face validity (1.00) were appropriate. Lay experts' suggestions for improving the readability and usability were taken into account.

CONCLUSIONS

We developed a valid instrument to elicit women's preferred health professional for uncomplicated pregnancy, labour and childbirth and to determine their knowledge about midwives' legal competences. Our instrument can be valuable in identifying knowledge gaps and improving the knowledge of the general population about the midwifery profession and maternity care. Finally, the MidProQ may improve research in the domain of maternity care culture, scale up midwifery and facilitate a more women-centred care.

Development and validation of the Vietnamese primary care assessment tool

Objective

To adapt the consumer version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity.

Design

A quantitative cross sectional study.

Setting

56 communes in 3 representative provinces of central Vietnam.

Participants

Total of 3289 people who used health care services at health facility at least once over the past two years.

Results

The Vietnamese adult expanded consumer version of the PCAT (VN PCAT-AE) is an instrument for evaluation of primary care in Vietnam with 70 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. Sixteen other items from the original tool were not included in the final instrument, due to problems with missing values, floor or ceiling effects, and item-total correlations. All the retained scales have a Cronbach’s alpha above 0.70 except for the subscale of Family Centeredness.

Conclusions

The VN PCAT-AE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the consumer perspective. Additional work in the future to optimize valid measurement in all domains consistent with the original version of the tool may be helpful as the primary care system in Vietnam further develops.

Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions

BACKGROUND

Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal.

METHODS

This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method.

RESULTS

There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team.

CONCLUSIONS

Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by difficulties with formalisation and training of CHWs and appropriate task shifting to nurses. Change management is required to create true integrate PHC teamwork. Policy review requires addressing these issues.

How Competent Are Healthcare Professionals in Working According to a Bio-Psycho-Social Model in Healthcare? The Current Status and Validation of a Scale

BACKGROUND

Over the past decades, there has been a paradigm shift from a purely biomedical towards a bio-psycho-social (BPS) conception of disability and illness, which has led to a change in contemporary healthcare. However, there seems to be a gap between the rhetoric and reality of working within a BPS model. It is not clear whether healthcare professionals show the necessary skills and competencies to act according to the BPS model.

OBJECTIVE

The aim of this study was (1) to develop a scale to monitor the BPS competencies of healthcare professionals, (2) to define its factor-structure, (3) to check internal consistency, (4) test-retest reliability and (5) feasibility.

DESIGN AND SETTING

Item derivation for the BPS scale was based on qualitative research with seven multidisciplinary focus groups (n = 58) of both patients and professionals. In a cross-sectional study design, 368 healthcare professionals completed the BPS scale through a digital platform. An exploratory factor analysis was performed to determine underlying dimensions. Statistical coherence was expressed in item-total correlations and in Cronbach's α coefficient. An intra-class-correlation coefficient was used to rate the test-retest reliability.

RESULTS

The qualitative study revealed 45 items. The exploratory factor analysis showed five underlying dimensions labelled as: (1) networking, (2) using the expertise of the client, (3) assessment and reporting, (4) professional knowledge and skills and (5) using the environment. The results show a good to strong homogeneity (item-total ranged from 0.59 to 0.79) and a strong internal consistency (Cronbach's α ranged from 0.75 to 0.82). ICC ranged between 0.82 and 0.93.

CONCLUSION

The BPS scale appeared to be a valid and reliable measure to rate the BPS competencies of the healthcare professionals and offers opportunities for an improvement in the healthcare delivery. Further research is necessary to test the construct validity and to detect whether the scale is responsive and able to detect changes over time.

Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts

BACKGROUND

Nonspecific neck pain patients form a heterogeneous group with different musculoskeletal impairments. Classifying nonspecific neck pain patients into subgroups based on clinical characteristics might lead to more comprehensive diagnoses and can guide effective management.

OBJECTIVE

To establish consensus among a group of experts regarding the clinical criteria suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central' and 'sensorimotor control' dysfunction patterns distinguishable in patients with nonspecific neck pain.

STUDY DESIGN

Delphi study.

METHODS

A focus group with 10 academic experts was organized to elaborate on the different dysfunction patterns discernible in neck pain patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 distinct dysfunction patterns resulting from the focus group.

RESULTS

A total of 21 musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating neck pain patients completed the 3-round Delphi-survey. Respectively, 33 (response rate, 100.0%), 27 (81.8%) and 21 (63.6%) respondents replied to rounds 1, 2 and 3. Eighteen 'articular', 16 'myofascial', 20 'neural', 18 'central' and 10 'sensorimotor control' clinical indicators reached a predefined ≥80% consensus level.

CONCLUSION

These indicators suggestive of a clinical dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns may help clinicians to assess and diagnose patients with nonspecific neck pain. Future validity testing is needed to determine how these criteria may help to improve the outcome of physical therapy interventions in nonspecific neck pain patients.

The reliability of the Movement Assessment Battery for Children for preschool children with mild to moderate motor impairment

Objectives : To provide further evidence of the test—retest reliability and agreement of the Movement Assessment Battery for Children (M-ABC), a standardized motor test used for identification and evaluation of children with mild to moderate motor impairment. Both the stability of total test scores and classification according to specified cut-off points were examined.

Design and setting : Children were tested on the M-ABC, three times with an interval of three weeks between each assessment.

Participants : Thirty-three 4- and 5-year-old children with poor motor performance, 24 boys and 9 girls.

Results : A systematic practice effect between three consecutive testing sessions was shown. This was significant for the total score and two of the three subscores. Test—retest reliability of the total test score yielded an intraclass correlation coefficient (ICC) of 0.88. The total impairment score ranged between 0 and 40. The standard error of measurement (SEM) of this score was 2.4, resulting in a least detectable difference of 6.6 (with alpha set at 5%). The agreement over three testing sessions ( κ) was 0.72.

Conclusions : The total impairment score of the M-ABC is a reliable measure for identification of mild to moderate motor impairment in young children. Repeated testing on the M-ABC at intervals of three weeks results in a systematic measurement error and is not recommended. The SEM is substantial. Follow-up of preschool children with the M-ABC as a single outcome measure is not appropriate.

The views of migrant health workers living in Austria and Belgium on return migration to sub-Saharan Africa

BACKGROUND

The negative consequences of the brain drain of sub-Saharan African health workers for source countries are well documented and include understaffed facilities, decreased standards of care and higher workloads. However, studies suggest that, if migrated health workers eventually return to their home countries, this may lead to beneficial effects following the transfer of their acquired skills and knowledge (brain gain). The present study aims to explore the factors influencing the intentions for return migration of sub-Saharan African health workers who emigrated to Austria and Belgium, and gain further insight into the potential of circular migration.

METHODS

Semi-structured interviews with 27 sub-Saharan African health workers in Belgium and Austria were conducted.

RESULTS

As mentioned by the respondents, the main barriers for returning were family, structural crises in the source country, and insecurity. These barriers overrule the perceived drivers, which were nearly all pull factors and emotion driven. Despite the fact that only a minority plans to return permanently, many wish to return regularly to work in the healthcare sector or to contribute to the development of their source country.

CONCLUSION

As long as safety and structural stability cannot be guaranteed in source countries, the number of return migrants is likely to remain low. National governments and regional organizations could play a role in facilitating the engagement of migrant health workers in the development of the healthcare system in source countries.

Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

Background

The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI.

Objectives

To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs.

Methods

This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted.

Results

In all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies.

Conclusions

GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa.

Improving Health Related Quality of Life and Independence in Community Dwelling Frail Older Adults through a Client-Centred and Activity-Oriented Program. A Pragmatic Randomized Controlled Trial

INTRODUCTION AND AIM

In the ageing society, a considerable part of the older adults are frail. Frailty has a major impact on the individual's quality of life, independence and also on his environment. This study aimed to investigate - as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults. It was hypothesized that this program could be effective in improving basic Activities of Daily Living (b-ADL) and increasing Health Related Quality of Life (HRQoL).

METHOD

This study was a single blind randomized controlled trial with an intervention and a control group (pre-test-post-test control group design). Analysis of covariance (ANCOVA) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate. Data were analysed using the intention-to-treat principle.

RESULTS

The intervention group (n = 86) experienced more improvement on b-ADL and HRQoL compared with the control group (n = 82). These effects were statistically significant for the b-ADL index (p = 0.013) and the 'physical subscale pain' (p = 0.049).

DISCUSSION AND CONCLUSION

These positive results can be seen as promising for further development of intervention strategies, although follow-up study should be conducted to determine long term effectiveness.

Improving Health Related Quality of Life and Independence in Community Dwelling Frail Older Adults through a Client-Centred and Activity-Oriented Program. A Pragmatic Randomized Controlled Trial

INTRODUCTION AND AIM

In the ageing society, a considerable part of the older adults are frail. Frailty has a major impact on the individual's quality of life, independence and also on his environment. This study aimed to investigate - as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults. It was hypothesized that this program could be effective in improving basic Activities of Daily Living (b-ADL) and increasing Health Related Quality of Life (HRQoL).

METHOD

This study was a single blind randomized controlled trial with an intervention and a control group (pre-test-post-test control group design). Analysis of covariance (ANCOVA) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate. Data were analysed using the intention-to-treat principle.

RESULTS

The intervention group (n = 86) experienced more improvement on b-ADL and HRQoL compared with the control group (n = 82). These effects were statistically significant for the b-ADL index (p = 0.013) and the 'physical subscale pain' (p = 0.049).

DISCUSSION AND CONCLUSION

These positive results can be seen as promising for further development of intervention strategies, although follow-up study should be conducted to determine long term effectiveness.

Diaspora engagement of African migrant health workers - examples from five destination countries

BACKGROUND

Migrant health workers fill care gaps in their destination countries, but they also actively engage in improving living conditions for people of their countries of origin through expatriate professional networks. This paper aims to explore the professional links that migrant health workers from sub-Saharan African countries living in five African and European destinations (Botswana, South Africa, Belgium, Austria, and the United Kingdom) have to their countries of origin.

DESIGN

Qualitative interviews were conducted with migrant doctors, nurses, and midwives from sub-Saharan Africa (N=66). A qualitative content analysis of the material was performed using the software ATLAS.ti.

RESULTS

Almost all migrant health workers have professional ties with their countries of origin supporting health, education, and social structures. They work with non-governmental organizations, universities, or hospitals and travel back and forth between their destination country and country of origin. For a few respondents, professional engagement or even maintaining private contacts in their country of origin is difficult due to the political situation at home.

CONCLUSIONS

The results show that African migrant health workers are actively engaged in improving living conditions not only for their family members but also for the population in general in their countries of origin. Our respondents are mediators and active networkers in a globalized and transnationally connected world. The research suggests that the governments of these countries of origin could strategically use their migrant health workforce for improving education and population health in sub-Saharan Africa. Destination countries should be reminded of their need to comply with the WHO Global Code of Practice for the international recruitment of health professionals.

Aerobic and resistance training do not influence plasma carnosinase content or activity in type 2 diabetes

A particular allele of the carnosinase gene (CNDP1) is associated with reduced plasma carnosinase activity and reduced risk for nephropathy in diabetic patients. On the one hand, animal and human data suggest that hyperglycemia increases plasma carnosinase activity. On the other hand, we recently reported lower carnosinase activity levels in elite athletes involved in high-intensity exercise compared with untrained controls. Therefore, this study investigates whether exercise training and the consequent reduction in hyperglycemia can suppress carnosinase activity and content in adults with type 2 diabetes. Plasma samples were taken from 243 males and females with type 2 diabetes (mean age = 54.3 yr, SD = 7.1) without major microvascular complications before and after a 6-mo exercise training program [4 groups: sedentary control (n = 61), aerobic exercise (n = 59), resistance exercise (n = 63), and combined exercise training (n = 60)]. Plasma carnosinase content and activity, hemoglobin (Hb) A1c, lipid profile, and blood pressure were measured. A 6-mo exercise training intervention, irrespective of training modality, did not decrease plasma carnosinase content or activity in type 2 diabetic patients. Plasma carnosinase content and activity showed a high interindividual but very low intraindividual variability over the 6-mo period. Age and sex, but not Hb A1c, were significantly related to the activity or content of this enzyme. It can be concluded that the beneficial effects of exercise training on the incidence of diabetic complications are probably not related to a lowering effect on plasma carnosinase content or activity.

Human resources for primary health care in sub-Saharan Africa: progress or stagnation?

BACKGROUND

The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years.

METHODS

This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa.

RESULTS

Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers.

CONCLUSION

There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.

Knowledge and attitude of the Flemish primary care physician toward organ donation and transplantation

PURPOSE

Primary care physicians (PCP) might play an important role in the acceptance of organ donation (OD) in the population. This would require both a positive attitude and a good basic knowledge about the organ donation and transplantation (ODT) process. Studies on this subject are very limited however. The objectives of this study are to determine the knowledge and attitude of the PCP towards OD in Flanders.

METHODS

Three-hundred twenty-seven Flemish PCPs completed an electronic questionnaire, comprising 6 sections: demographic factors, practical experience, knowledge, education, attitude and potential role in the ODT process.

RESULTS

Eighty-seven percent of the Flemish PCP agree with the implementation of heart-beating organ donation. Ninety-four percent would agree to donate the organs of their own child. 80% know that even without explicit consent the prelevation of the organs and tissues of each potential Belgian donor will take place. Although they are aware of the current legislation, their knowledge regarding donor criteria showed significant gaps. A minority of the PCP's know that donors can be little brain-dead children (53%) or elderly above 70 years (45%). Only 61% of PCPs know that brain dead is associated with irreversible damage to the brain and only 28% know that more than one physician is involved in making the diagnosis. A majority (91%) is willing to play a role in the ODT process. But about two-thirds (61%) of them doubt their ability to answer questions of patients on this subject. 82.5% of this group would find it useful to participate in a specific training. When they are offered different choices to play a role in the process, the most accepted (84%) one is informing the transplant centre about the donor's medical history and risk behavior.

CONCLUSIONS

The Flemish PCP has a positive attitude towards ODT. He is willing to play a role in the ODT process. However, our study clearly documents deficits in the knowledge about brain death and the need for postgraduate training in the field of ODT. Correcting these deficits may be an important factor in improving the acceptance of organ donation.

Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria

The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, with data from 15,474 individuals. Statistical methods used were descriptive tests, regression models and the calculation of synergistic effects. Both chronic back pain and psychological distress had a positive association with the utilization of the primary (OR for chronic back pain 1.53 and psychological distress 1.33) and secondary (OR for chronic back pain 1.32 and psychological distress 1.24) levels of the health care sector. In the fully adjusted model, the synergistic effect of chronic back pain and psychological distress was significant for the secondary level of care (S 1.99, PAF 0.20), but not for the primary level of care (S 1.16, PAF 0.07). Synergistic effects and associations for chronic back pain and psychological distress on the utilization of both the primary and secondary levels of the ambulatory health care sector were observed, particularly for the secondary level of care. Our results demonstrate the utilization of health care services settings by individuals with these conditions, and offer opportunities to consider reorganization and structuring of the Austrian health care system.

Portrayal of the human resource crisis and accountability in healthcare: a qualitative analysis of ugandan newspapers

BACKGROUND

Uganda is one of the 57 countries with a critical shortage of health workers. The aim of this study was to determine how the human resources and health service crisis was covered in Ugandan newspapers and, in particular, how the newspapers attributed accountability for problems in the health services.

METHODS

We collected all articles related to health workers and health services for the calendar year 2012 in the two largest national newspapers in Uganda (collection on daily basis) and in one local newspaper (collection on weekly basis). These articles were analysed qualitatively regarding the main themes covered and attribution of accountability.

RESULTS

The two more urban national newspapers published 229 articles on human resources and health services in Uganda (on average over two articles per week), whereas the local more rural newspaper published only a single article on this issue in the 12 month period. The majority of articles described problems in the health service without discussing accountability. The question of accountability is raised in only 46% of articles (106 articles). The responsibility of the government was discussed in 50 articles (21%), and negligence, corruption and misbehaviour by individual health workers was reported in 56 articles (25%). In the articles about corruption (n=35), 60% (21 articles) mention corruption by health workers and 40% (14 articles) mention corruption by government officials. Six articles defended the situation of health workers in Uganda.

CONCLUSIONS

The coverage of accountability in the Ugandan newspapers surveyed is insufficient to generate informed debate on what political actions need to be taken to improve the crisis in health care and services. There exists not only an "inverse care law" but also an "inverse information law": those sections of society with the greatest health needs and problems in accessing quality health care receive the least information about health services.

Human resources for health in Botswana: the results of in-country database and reports analysis

Background

Botswana is a large middle-income country in Southern Africa with a population of just over two million. Shortage of human resources for health is blamed for the inability to provide high quality accessible health services. There is however a lack of integrated, comprehensive and readily-accessible data on the health workforce.

Aim

The aim of this study was to analyse the existing databases on health workforce in Botswana in order to quantify the human resources for health.

Method

The Department of Policy, Planning, Monitoring and Evaluation at the Ministry of Health, Ministry of Education and Skills Development, the Botswana Health Professions Council, the Nursing and Midwifery Council of Botswana and the in-country World Health Organization office provided raw data on human resources for health in Botswana.

Results

The densities of doctors and nurses per 10 000 population were four and 42, respectively; three and 26 for rural districts; and nine and 77 for urban districts. The average vacancy rate in 2007 and 2008 was 5% and 13% in primary and hospital care, respectively, but this is projected to increase to 53% and 43%, respectively, in 2016. Only 21% of the doctors registered with the Botswana Health Professions Council were from Botswana, the rest being mainly from other African countries. Botswana trained 77% of its health workforce locally.

Conclusion

Although the density of health workers is relatively high compared to the region, they are concentrated in urban areas, insufficient to meet the projected requirements and reliant on migrant professionals.

What, how and from whom do health care professionals learn during collaboration in palliative home care: a cross-sectional study in primary palliative care

Background

Palliative care often requires inter-professional collaboration, offering opportunities to learn from each other. General practitioners often collaborate with specialized palliative home care teams. This study seeks to identify what, how and from whom health care professionals learn during this collaboration.

Methods

Cross-sectional survey in Belgium. All palliative home care teams were invited to participate. General practitioners (n = 267) and palliative care nurses (n = 73) filled in questionnaires.

Results

General practitioners (GPs) and palliative care nurses learned on all palliative care aspects. Different learning activities were used. Participants learned from all others involved in patient care. The professionals’ discipline influences the content, the way of learning and who learns from whom. Multiple linear regression shows significant but limited association of gender with amount of learning by GPs (M < F; p = 0.042; Adj R² = 0.07) and nurses (M > F; p = 0.019; Adj R² = 0.01).

Conclusions

This study is the first to reveal what, how and from whom learning occurs during collaboration in palliative care. Training professionals in sharing expertise during practice and in detecting and adequately responding to others’ learning needs, could optimize this way of learning.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-014-0501-9) contains supplementary material, which is available to authorized users.

How equal is the relationship between individual social capital and psychological distress? A gendered analysis using cross-sectional data from Ghent (Belgium)

BACKGROUND

Social capital has been related to various aspects of health. While literature suggests that men and women differently access and mobilize social capital, gender has received little attention within social capital research. This study examines whether the association between individual social capital and psychological distress is different for men and women.

METHODS

We made use of data from a representative sample of 1025 adults within 50 neighbourhoods of Ghent (Belgium), collected in the context of the cross-sectional Social capital and Well-being In Neighbourhoods in Ghent (SWING) Survey 2011. Six components of social capital were discerned: generalized trust, social support, social influence, social engagement and attachment, the volume of social capital and the mean occupational prestige in one's network. Multilevel linear regression models were fitted to explore interactions between gender and these components of social capital.

RESULTS

In accordance with previous research, men report lower levels of psychological distress than women (t = 4.40, p < 0.001). Regarding the gender gap in social capital, the findings are mixed. Only for half of the social capital variables (social support, social influence and volume of social capital), a significant gender difference is found, favouring men (t = 4.03, p < 0.001; t = 1.99, p < 0.001 and t = 4.50, p < 0.001 respectively). None of the analysed interaction terms between gender and social capital is significantly related to psychological distress.

CONCLUSION

The analyses indicate that the association between individual social capital and psychological distress is similar for men and women. The relatively low level of gender stratification in Belgium might have influenced this finding. Furthermore, it is possible that social capital is not of greater importance for women in general, but mainly for women who are in an especially vulnerable social situation that deprives their access to alternative resources (e.g. unemployed women, single mothers). Future studies should seek to identify subgroups for whom social capital might be particularly influential, by transcending 'simple' dyads such as 'men versus women'.

Security and skills: the two key issues in health worker migration

BACKGROUND

Migration of health workers from Africa continues to undermine the universal provision of quality health care. South Africa is an epicentre for migration--it exports more health workers to high-income countries than any other African country and imports health workers from its lower-income neighbours to fill the gap. Although an inter-governmental agreement in 2003 reduced the very high numbers migrating from South Africa to the United Kingdom, migration continues to other high-income English-speaking countries and few workers seem to return although the financial incentive to work abroad has lessened. A deeper understanding of reasons for migration from South Africa and post-migration experiences is therefore needed to underpin policy which is developed in order to improve retention within source countries and encourage return.

METHODS

Semi-structured interviews were conducted with 16 South African doctors and nurses who had migrated to the United Kingdom. Interviews explored factors influencing the decision to migrate and post-migration experiences.

RESULTS

Salary, career progression, and poor working conditions were not major push factors for migration. Many health workers reported that they had previously overcome these issues within the South African healthcare system by migrating to the private sector. Overwhelmingly, the major push factors were insecurity, high levels of crime, and racial tension. Although the wish to work and train in what was perceived to be a first-class care system was a pull factor to migrate to the United Kingdom, many were disappointed by the experience. Instead of obtaining new skills, many (particularly nurses) felt they had become 'de-skilled'. Many also felt that working conditions and opportunities for them in the UK National Health Service (NHS) compared unfavourably with the private sector in South Africa.

CONCLUSIONS

Migration from South Africa seems unlikely to diminish until the major concerns over security, crime, and racial tensions are resolved. However, good working conditions in the private sector in South Africa provide an occupational incentive to return if security did improve. Potential migrants should be made more aware of the risks of losing skills while working abroad that might prejudice return. In addition, re-skilling initiatives should be encouraged.

The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

Background

Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues.

Methods

This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method.

Results

Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians.

Conclusions

Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents.

Why sub-Saharan African health workers migrate to European countries that do not actively recruit: a qualitative study post-migration

BACKGROUND

Many studies have investigated the migration intentions of sub-Saharan African medical students and health professionals within the context of a legacy of active international recruitment by receiving countries. However, many health workers migrate outside of this recruitment paradigm. This paper aims to explore the reasons for migration of health workers from sub-Saharan Africa to Belgium and Austria; European countries without a history of active recruitment in sub-Saharan Africa.

METHODS

Data were collected using semistructured interviews. Twenty-seven health workers were interviewed about their migration experiences. Included participants were born in sub-Saharan Africa, had trained as health workers in sub-Saharan Africa, and were currently living in Belgium or Austria, though not necessarily currently working as a health professional.

RESULTS

Both Austria and Belgium were shown not to be target countries for the health workers, who instead moved there by circumstance, rather than choice. Three principal reasons for migration were reported: 1) educational purposes; 2) political instability or insecurity in their country of origin; and 3) family reunification. In addition, two respondents mentioned medical reasons and, although less explicit, economic factors were also involved in several of the respondents' decision to migrate.

CONCLUSION

These results highlight the importance of the broader economic, social, and political context within which migration decisions are made. Training opportunities proved to be an important factor for migration. A further development and upgrade of primary care might help to counter the common desire to specialize and improve domestic training opportunities.

The impact of neighborhood deprivation on patients' unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

BACKGROUND

The use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient's preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient's home to both services.

METHODS

A cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient's home to both types of services, and if the patient has a regular GP.

RESULTS

Patients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient's home address and the location of both types of services on the patient's choice of service is rather small.

CONCLUSIONS

Initiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients' emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, …) and the patient's perspectives on out-of-hours care services is needed.

Validity of self-reported utilization of physician services: a population study

BACKGROUND

Health care utilization is of central interest in epidemiology, and most of the studies rely on self-report. The objectives of this study were to assess the validity of self-reported utilization of general practitioner and specialist physician by correlating self-reported utilization with registered services utilization, and to determine the factors related to that validity.

METHODS

The 1997 Belgian National Health Interview Survey (BNHIS) was linked with registered medical utilization data provided by the Belgian Health Insurance Funds. Valid information on general practitioner and specialist physician utilization during the past 2 months was found for 5869 participants at the BNHIS who were aged ≥25 years. Intra-class correlation coefficients were used to determine the rate of agreement, and multinomial logistic regression to model factors influencing under- and over-reporting.

RESULTS

The results demonstrated a substantial agreement between the self-reported and registered general practitioner contacts, and only a minor bias was found towards under-reporting. There was no significant difference between mean self-reported and registered specialist physician utilization, but the agreement was rather moderate. Gender, age, country of birth, self-rated health, number of chronic illnesses, having functional limitations and having mental health problems, were associated with under- and/or over-reporting.

CONCLUSION

Studies that aim to compare the utilization of different socio-demographic groups have to take into account that the reporting errors vary by respondents characteristics.

New reference values must be established for the Alberta Infant Motor Scales for accurate identification of infants at risk for motor developmental delay in Flanders

BACKGROUND

The Alberta Infant Motor Scales (AIMS) is a reliable and valid assessment tool to evaluate the motor performance from birth to independent walking. This study aimed to determine whether the Canadian reference values on the AIMS from 1990-1992 are still useful tor Flemish infants, assessed in 2007-2010. Additionally, the association between motor performance and sleep and play positioning will be determined.

METHODS

A total of 270 Flemish infants between 0 and 18 months, recruited by formal day care services, were assessed with the AIMS by four trained physiotherapists. Information about sleep and play positioning was collected by mean of a questionnaire.

RESULTS

Flemish infants perform significantly lower on the AIMS compared with the reference values (P < 0.001). Especially, infants from the age groups of 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and of 15 months showed significantly lower scores. From the information collected by parental questionnaires, the lower motor scores seem to be related to the sleep position, the amount of play time in prone, in supine and in a sitting device. Infants who are exposed often to frequently to prone while awake showed a significant higher motor performance than infants who are exposed less to prone (<6 m: P = 0.002; >6 m: P = 0.013). Infants who are placed often to frequently in a sitting device in the first 6 months of life (P = 0.010) and in supine after 6 months (P = 0.001) performed significantly lower than those who are placed less in it.

CONCLUSION

Flemish infants recruited by formal day care services, show significantly lower motor scores than the Canadian norm population. New reference values should be established for the AIMS for accurate identification of infants at risk. Prevention of sudden infant death syndrome by promoting supine sleep position should go together with promotion of tummy time when awake and avoiding to spent too much time in sitting devices when awake.

SOS: a screening instrument to identify children with handwriting impairments

Poor handwriting has been shown to be associated with developmental disorders such as Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, autism, and learning disorders. Handwriting difficulties could lead to academic underachievement and poor self-esteem. Therapeutic intervention has been shown to be effective in treating children with poor handwriting, making early identification critical. The SOS test (Systematic Screening for Handwriting Difficulties) has been developed for this purpose. A child copies a sample of writing within 5 min. Handwriting quality is evaluated using six criteria and writing speed is measured. The Dutch SOS test was administered to 860 Flemish children (7-12 years). Inter- and intrarater reliability was excellent. Test-retest reliability was moderate. A correlation coefficient of 0.70 between SOS and "Concise Assessment Methods of Children Handwriting" test (Dutch version) confirmed convergent validity. The SOS allowed discrimination between typically developing children and children in special education, males and females, and different age groups.

Psychometric properties of a motor skill checklist for 3- to 5-year-old children

BACKGROUND

  Early identification of children with developmental co-ordination disorder is important. Teachers may be very useful in this identification process. The objective of this study was to develop a motor skill checklist (MSC) for 3- to 5-year-old children to be completed by teachers, and to establish the psychometric properties of this new instrument.

METHODS

An MSC of 28 functional items was constructed in close consideration with clinical experts and teachers. In regular schools, 366 pre-school children were rated with the MSC by their teachers (n= 111). To determine test-retest reliability, each teacher completed 4 weeks later the MSC again for one randomly selected child. In 22 classes with two teachers sharing the job, both teachers were asked to fill in the questionnaire. A subgroup of children was also tested with the Movement Assessment Battery for Children (M-ABC; n= 122). All teachers were invited to complete a questionnaire to evaluate the MSC.

RESULTS

The internal consistency of the MSC was high. The test-retest reliability was good. Inter-rater reliability was adequate except in the 5-year-old children. There was a strong correlation between the checklist and the M-ABC, establishing concurrent validity. Most teachers judged the MSC as easy or rather easy to complete.

CONCLUSIONS

The MSC is a reliable, valid and useful instrument to identify and assess young children with motor difficulties.

Reproducibility, validity and predictors of six-minute walk test in overweight and obese adolescents with intellectual disability

OBJECTIVES

To assess the reproducibility and validity of the six-minute walk test (6MWT) and predictors of the six-minute walk distance (6MWD) in adolescents with overweight or obesity and intellectual disability (ID).

STUDY DESIGN

Sixty-one adolescents with overweight or obesity and mild-to-moderate ID (intelligent quotient [IQ] 40-70; age 14-22 years) participated in this study. To test reproducibility, 39 of the participants performed the 6MWT twice with an interval of 1 week. To test validity (n = 39), peak oxygen uptake (peak VO(2)) was measured on a bicycle ergometer. For the predictor study (n = 61), weight, height, peak VO(2) and quadriceps strength were measured, and IQ and orthopedic conditions were collected from the participants' medical records.

RESULTS

There was no significant difference between the means of the two 6MWTs (571.3 vs. 576.5 m; p = 0.452). The intraclass correlation coefficient was 0.82, indicating good reliability. The smallest real difference was 82.6 m. 6MWD correlated significantly with relative peak VO(2) (β = 0.69) indicating validity. Relative peak VO(2), height, IQ, body mass index (BMI) and quadriceps strength are predictors of the 6MWD in this population.

CONCLUSION

6MWT is a reliable and valid test in adolescents with overweight or obesity and ID. Low IQ, overweight/obesity and low physical fitness contribute to the outcome of the 6MWT.

Falls among stroke survivors: an online survey on perceptions and approaches among physiotherapists in Flanders

OBJECTIVE

To describe physiotherapists' perceptions of fall risk and appropriate fall prevention interventions in rehabilitating stroke patients.

METHOD

A web-based survey addressed to physiotherapy units on a stroke unit, general neurology department or rehabilitation ward/centre in Flanders.

RESULTS

Hospital response rate was 66.3%. Sixty-five physiotherapy units were taken into account. About 84.6% recognised falls among stroke patients as an essential problem and 73.8% thought falls interfered with the outcome. About 56.9% agreed with the need of a standardised fall assessment at the beginning of the treatment and only 36.9% reported that on their department stroke patients are screened on risk of falling. The most used fall risk assessments are: Berg Balance scale and Tinetti-test. The most popular fall prevention measures are: specific exercises for balance, gait and functional abilities (100%), informative education (92.3%) and adapting or intensifying the treatment after a fall (81.5%).

CONCLUSIONS

Physiotherapy units acknowledge falls as an essential threat, implying a need for risk screening and prevention. However, results reveal that perception of the necessity of such screening is lower and that the performance is even less. This discrepancy underlines the necessity of guidelines and education of therapists working with stroke patients.

Convergent validity between two motor tests: movement-ABC and PDMS-2

The aim of this study was to investigate the convergent validity of the Movement Assessment Battery for Children (M-ABC) and the Peabody Developmental Motor Scales - 2 (PDMS-2). Thirty-one 4- and 5-year-old children (mean age 4 years 11 months, SD 6 months), all recruited from a clinical setting, took part in the study. Children were tested on the M-ABC and the PDMS-2 in a counterbalanced order on the same occasion. The results showed that the total scores on the two tests correlated well (rs = .76). However, when the ability of the two tests to identify children with difficulties was examined, agreement between them was low (K = .29), with the PDMS-2 being less sensitive to mild motor impairment in this population. Taken together, these findings suggest that clinicians need to be aware that, although measuring a similar construct, these tests are not interchangeable.

Ejaculation latency times and their relationship to penile sensitivity in men with normal sexual function

PURPOSE

There is a need for objective and validated measurements of ejaculation latency time and penile sensitivity in men with normal sexual function. We determined 1) the normal range and repeatability of ELT in a laboratory vs at home masturbation and intercourse in normal men, 2) the threshold and repeatability of penile sensitivity on 6 penile surface areas measured by 2 vibrometers and 3) whether penile sensitivity correlates with ejaculation latency time.

MATERIALS AND METHODS

A total of 58 healthy volunteers between 20 and 40 years old provided ejaculation latency times during 3 procedures and were evaluated with a biothesiometer and SMV-5 vibrometer (Suzuki-Matsuoka, Teknologue, Tokyo, Japan) on 6 penile surface areas.

RESULTS

Ejaculation latency time was highest during intercourse (median 8.25 minutes, range 1.32 to 18.31), lower in the laboratory (median 7.22, range 1.37 to 18.79) and lowest during masturbation (median 4.89, range 1.08 to 14.19). The 3 ELT scores were highly reproducible within subjects (ICC 0.88 to 0.93). There was high variability among subjects. Vibrotactile thresholds on 6 penile surface areas were also similar and highly repeatable for the 2 vibrometers (ICC 0.81 to 0.96). However, there was no correlation between penile sensitivity and ELT (R2 less than 8%).

CONCLUSIONS

ELT in the laboratory is lower than during intercourse and higher than during masturbation. Vibrometers produce reliable and repeatable penile vibrotactile threshold results. However, penile sensitivity measurements do not correlate with ELT in men with normal sexual function.