Influence of Medical Education Scholarships on Reducing Physician Shortages

For more than 44 years, the study site university and the Government of Grenada, a low- and middle-income country island, have collaborated to provide medical education scholarships for qualified citizens. These scholarships aim to provide an education pathway to medical school and a solution to the island’s physician shortage by having the scholarship recipients return to serve their country as physicians. However, the problem of a physician shortage persists because most recipients migrate to higher income countries, primarily the United States. The purpose of this basic qualitative study was to explore the perspectives of scholarship recipients and providers regarding how the medical education scholarships could influence the physician shortage problem. The theory of planned behavior was used to guide the study. Semistructured interviews were conducted with 12 scholarship recipients and providers who represented university and government administration. Findings from thematic analysis indicated three main themes: scholarship first impressions, managing scholarship expectations, and scholarship culture. Although scholarships were appreciated by recipients, the lack of structure and support and the lure of the United States for physicians prevented the study site from benefiting. Findings indicated that a review of the scholarship processes could be useful and that a collaborative investment is needed to bring about a change in scholarship culture, which could positively influence physician shortages in the area

Ageing in Place in Rural Areas of Western Australia: Actions, Choices and Preferences

The objective of the study was to explore the moving and staying actions and intentions of older people (50+) living in rural areas of Western Australia (WA) and to compare results with those living in metropolitan Perth/Fremantle. The design involved a cross-sectional postal survey of a sample of WA members of National Seniors Australia, living in their own homes in the community, followed by in-depth interviews with a subset of survey respondents (n=39). Most survey respondents lived in metropolitan Perth/ Fremantle (1630), followed by country towns (1092) and more rural locations (291). Interviews were conducted with 39 participants, 19 of whom lived outside the metropolitan area. The main outcome measures consisted of the proportions of respondents by location and age group who had moved, were thinking of moving or were intending to stay put; also the main reasons for such actions and intentions. Rural respondents were 1.3 times more likely to be thinking of moving in the short term compared to metropolitan respondents. A key reason given for moving from rural areas was ‘thinking about where wanted to live for rest of lives’, this tending to be associated with ‘employment’ or ‘retirement’ for those under 65; with ‘retirement’, ‘closer to family/friends’ and ‘upkeep/maintenance difficulties’ being particularly important for those 65+. ‘Wanting a lifestyle change’ was a key reason for moving to a rural location for those aged under 65. The study concluded that there are a number of issues faced by older people living in rural areas of WA which limit the extent to which ‘ageing in place’ is a viable choice for them as they age

Workplace violence in Queensland, Australia: the results of a comparative study

[Abstract]: This paper presents the results on workplace violence from a larger study undertaken in 2004. Comparison is made with the results of a similar study undertaken in 2001. The study involved the random sampling of 3000 nurses from the Queensland Nurses’ Union’s membership in the public (acute hospital and community nursing), private (acute hospital and domiciliary nursing) and aged care sectors (both public and private aged care facilities). The self-reported results suggest an increase in workplace violence in all three sectors. Whilst there are differences in the sources of workplace violence across the sectors, the major causes of workplace violence are: clients/patients, visitors/relatives, other nurses, nursing management and medical practitioners. Associations were also found between workplace violence and gender, the designation of the nurse, hours of employment, the age of the nurse, morale and perceptions of workplace safety. Whilst the majority of nurses reported that policies were in place for the management of workplace violence, these policies were not always adequate

Informatic Tools and Approaches in Postmarketing Pharmacovigilance Used by FDA

The safety profile of newly approved drugs and therapeutic biologics is less well developed by pre-marketing clinical testing than is the efficacy profile. The full safety profile of an approved product is established during years of clinical use. For nearly 40 years, the FDA has relied on the voluntary reporting of adverse events by healthcare practitioners and patients to help establish the safety of marketed products. Epidemiologic studies, including case series, secular trends, case-control and cohort studies, are used to supplement the investigation of a safety signal. Ideally, active surveillance systems would supplement the identification and exploration of safety signals. The FDA has implemented a number of initiatives to help identify safety problems with drugs and continues to evaluate their efforts

Co-infection by human immunodeficiency virus type 1 (HIV-1) and human T cell leukemia virus type 1 (HTLV-1): does immune activation lead to a faster progression to AIDS?

<p>Abstract</p> <p>Background</p> <p>Recent data have shown that HTLV-1 is prevalent among HIV positive patients in Mozambique, although the impact of HTLV-1 infection on HIV disease progression remains controversial. Our aim was to determine the phenotypic profile of T lymphocytes subsets among Mozambican patients co-infected by HIV and HTLV-1.</p> <p>Methods</p> <p>We enrolled 29 patients co-infected by HTLV-1 and HIV (co-infected), 59 patients mono-infected by HIV (HIV) and 16 healthy controls (HC), respectively.</p> <p>For phenotypic analysis, cells were stained with the following fluorochrome-labeled anti-human monoclonal antibodies CD4-APC, CD8-PerCP, CD25-PE, CD62L-FITC, CD45RA-FITC. CD45RO-PE, CD38-PE; being analysed by four-colour flow cytometry.</p> <p>Results</p> <p>We initially found that CD4⁺T cell counts were significantly higher in co-infected, as compared to HIV groups. Moreover, CD4⁺T Lymphocytes from co-infected patients presented significantly higher levels of CD45RO and CD25, but lower levels of CD45RA and CD62L, strongly indicating that CD4⁺T cells are more activated under HTLV-1 plus HIV co-infection.</p> <p>Conclusion</p> <p>Our data indicate that HTLV-1/HIV co-infected patients progress with higher CD4⁺T cell counts and higher levels of activation markers. In this context, it is conceivable that in co-infected individuals, these higher levels of activation may account for a faster progression to AIDS.</p

Interventions targeting social isolation in older people: a systematic review

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.BACKGROUND: Targeting social isolation in older people is a growing public health concern. The proportion of older people in society has increased in recent decades, and it is estimated that approximately 25% of the population will be aged 60 or above within the next 20 to 40 years. Social isolation is prevalent amongst older people and evidence indicates the detrimental effect that it can have on health and wellbeing. The aim of this review was to assess the effectiveness of interventions designed to alleviate social isolation and loneliness in older people. METHODS: Relevant electronic databases (MEDLINE, EMBASE, ASSIA, IBSS, PsycINFO, PubMed, DARE, Social Care Online, the Cochrane Library and CINAHL) were systematically searched using an extensive search strategy, for randomised controlled trials and quasi-experimental studies published in English before May 2009. Additional articles were identified through citation tracking. Studies were included if they related to older people, if the intervention aimed to alleviate social isolation and loneliness, if intervention participants were compared against inactive controls and, if treatment effects were reported. Two independent reviewers extracted data using a standardised form. Narrative synthesis and vote-counting methods were used to summarise and interpret study data. RESULTS: Thirty two studies were included in the review. There was evidence of substantial heterogeneity in the interventions delivered and the overall quality of included studies indicated a medium to high risk of bias. Across the three domains of social, mental and physical health, 79% of group-based interventions and 55% of one-to-one interventions reported at least one improved participant outcome. Over 80% of participatory interventions produced beneficial effects across the same domains, compared with 44% of those categorised as non-participatory. Of interventions categorised as having a theoretical basis, 87% reported beneficial effects across the three domains compared with 59% of interventions with no evident theoretical foundation. Regarding intervention type, 86% of those providing activities and 80% of those providing support resulted in improved participant outcomes, compared with 60% of home visiting and 25% of internet training interventions. Fifty eight percent of interventions that explicitly targeted socially isolated or lonely older people reported positive outcomes, compared with 80% of studies with no explicit targeting. CONCLUSIONS: More, well-conducted studies of the effectiveness of social interventions for alleviating social isolation are needed to improve the evidence base. However, it appeared that common characteristics of effective interventions were those developed within the context of a theoretical basis, and those offering social activity and/or support within a group format. Interventions in which older people are active participants also appeared more likely to be effective. Future interventions incorporating all of these characteristics may therefore be more successful in targeting social isolation in older people.National Institute for Health Researc