Truck drivers' perceptions on wearable devices and health promotion:A qualitative study

Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Yet, only a few studies on health promotion interventions related to mobile health technologies for truck drivers have been conducted. We aimed to explore professional truck drivers views on health promotion delivered via mobile health technologies such as wearable devices.We conducted a phenomenological qualitative study, consisting of four semi-structured focus groups with 34 full-time professional truck drivers in the UK. The focus groups were audio-taped, transcribed verbatim and analysed using thematic content analysis. We discussed drivers perceptions of their health, lifestyle and work environment, and their past experience and expectations from mobile health technologies.The participants viewed their lifestyle as unhealthy and were aware of possible consequences. They expressed the need and wish to change their lifestyle, yet perceived it as an inherent, unavoidable outcome of their occupation. Current health improvement initiatives were not always aligned with their working conditions. The participants were generally willing to use mobile health technologies such as wearable devices, as a preventive measure to avoid prospect morbidity, particularly cardiovascular diseases. They were ambivalent about privacy and the risk of their employers monitoring their clinical data.Wearable devices may offer new possibilities for improving the health and wellbeing of truck drivers. Drivers were aware of their unhealthy lifestyle. They were interested in changing their lifestyle and health. Drivers raised concerns regarding being continuously monitored by their employer. Health improvement initiatives should be aligned with the unique working conditions of truck drivers. Future research is needed to examine the impact of wearable devices on improving the health and wellbeing of professional drivers

Pentecostalism, gerontocratic rule and democratization in Malawi: the changing position of the young in political culture

This chapter explores the relationship between the father-metaphor, gerontocratic power, democratization and religion in the context of changing political culture in Malawi. It argues that democratization in Malawi signalled a change in the nature of the dominant gerontocratic power relations associated with Chewa political traditions, and gave the young an opportunity to escape from their tightly circumscribed sociopolitical space in what for thirty years had been a highly supervised society. It further argues that religion, in particular 'born-again' (often Pentecostal) Christianity, played a significant role in changing the meaning of the crucial root paradigm of gerontocracy in Malawian political culture. The chapter shows that the position adopted by religious youth groups in the 1990s was the outcome of a 'struggle for youth' that Malawian society had faced since colonial times and in which religion played a significant role. In so doing, it deconstructs the so-called 'conservative nature' of Christian fundamentalism-cum- Pentecostalism.ASC – Publicaties niet-programma gebonde

Secret worlds, democratization and election observation in Malawi

ASC – Publicaties niet-programma gebonde

Value of Chiropractic Services at an On-Site Health Center Learning Objectives

Objective: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions. Methods: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes. Results: Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001). Conclusions: These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function. B ack and neck pain and severe headache or migraine comprise several of the most prevalent chronic medical problems. Back and neck pain are found among approximately a quarter of the US population aged 18 to 44 years and a third of the US population aged 45 to 64 years; whereas 20% of the population aged 18 to 44 years and 15% aged 45 to 64 years experience severe headaches or migraines. Moreover, these musculoskeletal problems have considerable and increasing economic burden. Direct costs in the United States for back and neck pain were $86 billion in 2005; a 65$14 billion in lost wages annually between 2002 and 2004. 3,4 In 2007, musculoskeletal cases tended to involve higher percentages of long-term work loss as compared with all nonfatal injuries and illnesses. Learning Objectives r Become familiar with data on the benefits of chiropractic care for common pain problems and the rationale for offering chiropractic services in occupational health settings. r Discuss the authors' experience with offering chiropractic care at onsite health centers and their approach to assessing the value of onsite chiropractic services. r Summarize the findings on how chiropractic care affected utilization of healthcare services and its impact on functional status in patients with musculoskeletal conditions. Previous research has described the benefit of chiropractic care in the occupational setting. 9 Baldwin et al 10 performed a review of the literature and found that effectiveness of physician and chiropractic care for occupational lower back pain was similar, although chiropractic patients were more satisfied with treatment. Likewise, a retrospective analysis 9 of patients with work-related spinal injuries found lower subjective pain scores and improved tolerance for workrelated activities after chiropractic care. Moreover, functional scores after treatment were significantly improved among patients with either an acute or a subacute injury. Cerner Corporation, a health care company with 8500 associates and 11,600 lives (5530 associates, 6070 dependents) covered under its health benefits plan, hosts two on-site health centers designed to provide a range of worksite health care benefits for Cerner associates and their dependents, including chiropractic care. The onsite health centers offer convenience over off-site medical facilities through reductions in time spent away from work and waiting for appointments, as well as longer patient-doctor consultations. The services offered on-site include primary medical care, pharmacy services, health coaching, and condition management counseling; and in 2010, chiropractic services were introduced. It is hypothesized that, like the other services offered on-site, this chiropractic care will offer patients more convenient and quality care than they would receive off-site. This study had two objectives. The first was to determine whether providing chiropractic care at the on-site health centers versus care performed off-site by private practitioners was associated with lower utilization of health care visits (eg, inpatient, outpatient, and physical therapy), radiology procedures, and pain-related medication use. The second was to assess the effectiveness of on-site care through functional outcomes. Evaluating these endpoints will improve understanding of the value of on-site chiropractic care, specifically how it may contribute to the clinical and/or financial benefits provided by on-site health centers by providing effective and costeffective care. Recognizing the benefits of on-site chiropractic care may facilitate increased utilization of these services. METHODS A retrospective claims analysis was performed to evaluate health care utilization trends of patients who received chiropractic care at an on-site health center ("on-site group") compared with those treated at off-site community-based chiropractic offices ("offsite group") at least once durin

Value of Chiropractic Services at an On-Site Health Center Learning Objectives

Objective: Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions. Methods: A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes. Results: Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001). Conclusions: These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function. B ack and neck pain and severe headache or migraine comprise several of the most prevalent chronic medical problems. Back and neck pain are found among approximately a quarter of the US population aged 18 to 44 years and a third of the US population aged 45 to 64 years; whereas 20% of the population aged 18 to 44 years and 15% aged 45 to 64 years experience severe headaches or migraines. Moreover, these musculoskeletal problems have considerable and increasing economic burden. Direct costs in the United States for back and neck pain were $86 billion in 2005; a 65$14 billion in lost wages annually between 2002 and 2004. 3,4 In 2007, musculoskeletal cases tended to involve higher percentages of long-term work loss as compared with all nonfatal injuries and illnesses. Learning Objectives r Become familiar with data on the benefits of chiropractic care for common pain problems and the rationale for offering chiropractic services in occupational health settings. r Discuss the authors' experience with offering chiropractic care at onsite health centers and their approach to assessing the value of onsite chiropractic services. r Summarize the findings on how chiropractic care affected utilization of healthcare services and its impact on functional status in patients with musculoskeletal conditions. Previous research has described the benefit of chiropractic care in the occupational setting. 9 Baldwin et al 10 performed a review of the literature and found that effectiveness of physician and chiropractic care for occupational lower back pain was similar, although chiropractic patients were more satisfied with treatment. Likewise, a retrospective analysis 9 of patients with work-related spinal injuries found lower subjective pain scores and improved tolerance for workrelated activities after chiropractic care. Moreover, functional scores after treatment were significantly improved among patients with either an acute or a subacute injury. Cerner Corporation, a health care company with 8500 associates and 11,600 lives (5530 associates, 6070 dependents) covered under its health benefits plan, hosts two on-site health centers designed to provide a range of worksite health care benefits for Cerner associates and their dependents, including chiropractic care. The onsite health centers offer convenience over off-site medical facilities through reductions in time spent away from work and waiting for appointments, as well as longer patient-doctor consultations. The services offered on-site include primary medical care, pharmacy services, health coaching, and condition management counseling; and in 2010, chiropractic services were introduced. It is hypothesized that, like the other services offered on-site, this chiropractic care will offer patients more convenient and quality care than they would receive off-site. This study had two objectives. The first was to determine whether providing chiropractic care at the on-site health centers versus care performed off-site by private practitioners was associated with lower utilization of health care visits (eg, inpatient, outpatient, and physical therapy), radiology procedures, and pain-related medication use. The second was to assess the effectiveness of on-site care through functional outcomes. Evaluating these endpoints will improve understanding of the value of on-site chiropractic care, specifically how it may contribute to the clinical and/or financial benefits provided by on-site health centers by providing effective and costeffective care. Recognizing the benefits of on-site chiropractic care may facilitate increased utilization of these services. METHODS A retrospective claims analysis was performed to evaluate health care utilization trends of patients who received chiropractic care at an on-site health center ("on-site group") compared with those treated at off-site community-based chiropractic offices ("offsite group") at least once durin