The training and development needs of midwives in Indonesia: paper 2 of 3

BACKGROUND: There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/community midwives. METHODS: A psychometrically valid training-needs instrument was administered to 332 midwives from three provinces, covering both hospital and community staff and a range of midwifery grades. The instrument had the capacity to identify occupational roles and education/training needs of the respondents. RESULTS: The occupational roles of the midwives varied significantly by province, indicating regional service delivery distinctions, but very little difference in the roles of hospital and community midwives. The most educated midwives attributed more importance to 35 out of the 40 tasks, suggesting an implicit role distinction in terms of level of activity. All midwives reported significant training needs for all 40 tasks. The most-educated midwives recorded training needs for 24 tasks, while the less-educated had training requirements for all tasks, which suggests that new training programmes are effective. Few differences in training needs were revealed between hospital and community midwives CONCLUSION: The results from this survey suggest important regional differences in how the midwife's role is discharged and underline the importance of this sort of research, in order to ensure the suitability of basic and postbasic educational provision. The study also highlights the need for further development and training of midwives in a wide range of tasks. These results provide a systematic and reliable overview of current midwifery roles and development needs and could serve to inform future training

¿Cuál es su diagnóstico?

ResumenMujer de 30 años que consultó por masa a nivel vulvar, acompañada de crecimiento del perimetro abdominal y pérdida de peso. TenÍa como antecedente dos intervenciones previas por quistes vaginales (1 y 2 años antes), sin informe histopatológico. GOPO con deseos de embarazo

The training and development needs of nurses in Indonesia: paper 3 of 3

BACKGROUND: Indonesia's recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. METHODS: An established and psychometrically valid questionnaire was administered to 524 nurses, covering three grades and coming from five provinces. RESULTS: Significant differences in job profile were found in nurses from different provinces, suggesting that the nature of the role is determined to some degree by the geographical location of practice. The roles of hospital and community nurses, and the different grades of nurse, were fairly similar. All nurses reported significant training needs for all 40 tasks, although these did not vary greatly between grade of nurse. The training needs of nurses from each of the provinces were quite distinct, while those of hospital nurses were greater than those of community nurses. CONCLUSION: The results suggest that the role of the nurse is not as diverse as might be expected, given the different levels of preparation and training and the diversity of their work environments. This may reflect the lack of a central registration system and quality framework, which would normally regulate clinical activities according to qualifications. The differences in training needs between subsections of the sample highlight the importance of identifying skills deficits and using this information to develop customized post-registration education programmes. Together, these results provide a rigorous and reliable approach to defining the occupational roles and continuing education needs of Indonesian nurses

Mycobacterium tuberculosis Beijing Genotype and Risk for Treatment Failure and Relapse, Vietnam

Among 2,901 new smear-positive tuberculosis cases in Ho Chi Minh City, Vietnam, 40 cases of treatment failure and 39 relapsing cases were diagnosed. All initial and follow-up Mycobacterium tuberculosis isolates of these case-patients had (nearly) identical restriction fragment length polymorphism patterns, and the Beijing genotype was a significant risk factor for treatment failure and relapse (odds ratio 2.8, 95% confidence interval 1.5 to 5.2)

Improving the Execution of Supply Chain Management in Organizations

The aim of this paper is to identify areas for improving the level of supply chain management (SCM) execution. A conceptual model was developed that proposes internal and joint SCM conditions and the adoption of SCM processes as the main antecedents of SCM execution. Based on a survey of 174 senior managers representing large organizations structural equation modelling was conducted followed by a three-step importance-performance analysis. The results show that internal SCM conditions, specifically information technology and human resources, are the major drivers for improving the total level of SCM execution

Tourism Firms' Strategic Flexibility: The Case of Slovenia

Strategic flexibility provides an approach for tourism destinations to respond more readily to turbulent environments. It is a management method that can assist tourism suppliers to meet the challenges of achieving competitive advantage. The paper also explores the importance that is accorded to the facilitators or drivers of strategic flexibility by Slovenian tourism industry stakeholders along with their performance in actioning these drivers. Importance performance analysis suggests the priority strategic actions to reduce the risk of strategic drift. The paper concludes with an assessment of the implications of these findings for emerging destinations generally. © 2013 John Wiley & Sons, Ltd

Translating and validating a Training Needs Assessment tool into Greek

<p>Abstract</p> <p>Background</p> <p>The translation and cultural adaptation of widely accepted, psychometrically tested tools is regarded as an essential component of effective human resource management in the primary care arena. The Training Needs Assessment (TNA) is a widely used, valid instrument, designed to measure professional development needs of health care professionals, especially in primary health care. This study aims to describe the translation, adaptation and validation of the TNA questionnaire into Greek language and discuss possibilities of its use in primary care settings.</p> <p>Methods</p> <p>A modified version of the English self-administered questionnaire consisting of 30 items was used. Internationally recommended methodology, mandating forward translation, backward translation, reconciliation and pretesting steps, was followed. Tool validation included assessing item internal consistency, using the alpha coefficient of Cronbach. Reproducibility (test – retest reliability) was measured by the kappa correlation coefficient. Criterion validity was calculated for selected parts of the questionnaire by correlating respondents' research experience with relevant research item scores. An exploratory factor analysis highlighted how the items group together, using a Varimax (oblique) rotation and subsequent Cronbach's alpha assessment.</p> <p>Results</p> <p>The psychometric properties of the Greek version of the TNA questionnaire for nursing staff employed in primary care were good. Internal consistency of the instrument was very good, Cronbach's alpha was found to be 0.985 (p < 0.001) and Kappa coefficient for reproducibility was found to be 0.928 (p < 0.0001). Significant positive correlations were found between respondents' current performance levels on each of the research items and amount of research involvement, indicating good criterion validity in the areas tested. Factor analysis revealed seven factors with eigenvalues of > 1.0, KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy = 0.680 and Bartlett's test of sphericity, p < 0.001.</p> <p>Conclusion</p> <p>The translated and adapted Greek version is comparable with the original English instrument in terms of validity and reliability and it is suitable to assess professional development needs of nursing staff in Greek primary care settings.</p

Protocol of a longitudinal cohort study on physical activity behaviour in physically disabled patients participating in a rehabilitation counselling programme: ReSpAct

Introduction: Stimulating physical activity behaviour in persons with a physical disability is important, especially after discharge from rehabilitation. A tailored counselling programme covering both the period of the rehabilitation treatment and the first months at home seems on the average effective. However, a considerable variation in response is observed in the sense that some patients show a relevant beneficial response while others show no or only a small response on physical activity behaviour. The Rehabilitation, Sports and Active lifestyle (ReSpAct) study aims to estimate the associations of patient and programme characteristics with patients' physical activity behaviour after their participation in a tailored counselling programme. Methods and analysis: A questionnaire-based nationwide longitudinal prospective cohort study is conducted. Participants are recruited from 18 rehabilitation centres and hospitals in The Netherlands. 2000 participants with a physical disability or chronic disease will be followed during and after their participation in a tailored counselling programme. Programme outcomes on physical activity behaviour and patient as well as programme characteristics that may be associated with differences in physical activity behaviour after programme completion are being assessed. Data collection takes place at baseline and 14, 33 and 52 weeks after discharge from rehabilitation. Ethics and dissemination: The study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Groningen and at individual participating institutions. All participants give written informed consent. The study results will provide new insights into factors that may help explain the differences in physical activity behaviour of patients with a physical disability after they have participated in the same physical activity and sports stimulation programme. Thereby, it will support healthcare professionals to tailor their guidance and care to individual patients in order to stimulate physical activity after discharge in a more efficient and effective way

Влияние сернистых выбросов от целлюлозно-бумажных предприятий на здоровье населения в Светогорске в северо-западной части России

The effect of sulfur products in the air on public health was studied in 1992 to 1993. The study was a part of common Finnish Russian investigation named as “IEVA”, there was not published information in Russia about atmosphere pullution effects on health of citizens exposed to chemical wase influence. Air concentrations of stinking wastes of sulfur products and sulfur dioxide in the industrial part of Svetogorsk were controlled by non-stop measuring devices. The special questionaire was proposed for examination in citizens. It contained the query of various information about health, the appearance of sympthoms (headache, eye and nose itching, cough, and dyspnea) during 1.5 years. The questionaires were given to 1100 citizens, and 990 of the questionaires were spread in Svetogorsk. The analysed answers were obtained in 430 persons in Svetogorsk (43%) and 85 persons in Losevo (77%). The greatest instant value of total concentrations of stinking sulfur products in Svetogorsk, as well 144 mkg/m, was 3 times greater than that in Losevo. Average values of hour mean concentrations of stinking sulfur products were 5 mkg/m3 in Svetogorsk (period of 06.01 to 24.06.1992) and 12 mkg/m in Losevo (period of 21.07 to 07.11.1992). The greatest hour mean concentration of sulfur dioxide and the greatest daily value were 540 mkg/m and 125 mkg/m3 respectively in Svetogorsk, and these ones were 123 mkg/m and 33 mkg/m respectively in Losevo. During the whole study period, the mean concentration of sulfur dioxide 16 mkg/m and 10 mkg/m in Svetogorsk and Losevo respectively.Произведенное в г. Светогорске в России с 1992 г. по 1993 г. исследование для выявления влияния сернистых соединений атмосферного воздуха на здоровье населения являлось частью общего финляндско-российского исследования “ИЭВА”. В России раньше не публиковались сведения о влиянии атмосферных загрязнений на здоровье населения, подвергающегося воздействию выбросов. Концентрации дурно пахнущих сернистых соединений и двуокиси серы в промышленном городе Светогорске относительно Лосево контролировались постоянно работающими измерительными приборами. Вместе с этим среди населения распространялся специальный опросник по состоянию здоровья. В анкете запрашивалось о различных, касающихся здоровья, сведениях, о появлении симптомов (головная боль, раздражение глаз и носа, кашель и одышка) в течение прошедших 13 месяцев. Анкеты распространялись среди 1100 человек, при этом 990 анкет пришлось на территорию города Светогорска. Анализируемые ответы были получены у 430 человек в г. Светогорске (43%) и у 85 человек в п. Лосево (77%). Наибольшее моментальное значение общей концентрации дурно пахнущих сернистых соединений (ТRS) в г. Светогорске, 144 кгг/куб.м, было примерно в три раза больше, чем в п. Лосево. Средние величины часовых средних дурно пахнущих сернистых соединений в г. Светогорске были 5 мкг/куб.м (период измерения с 06.0. по 24.06.1992 г.) и в п. Лосево 12 мкг/куб.м (период измерения с 21.07. по 07.11.1992 г.). В г. Светогорске наибольшая часовая средняя концентрация двуокиси серы была 540 мкг/куб.м и наибольшая суточная величина 125 мкг/куб.м, в п. Лосево наибольшая часовая средняя была 123 мкг/куб.м и наибольшая суточная величина 33 мкг/куб.м. Во время всего периода измерения средняя величина концентрации двуокиси серы в г. Светогорске была 16 мкг/куб.м и в п. Лосево 10 мкг/куб.м