Use of the internet by Italian pediatricians: habits, impact on clinical practice and expectations

<p>Abstract</p> <p>Background</p> <p>Medical professionals go online for literature searches and communication with families.</p> <p>We administered a questionnaire to members of the Italian Society of Pediatrics to assess determinants of their use of the Internet, of social platforms and of personal health records during clinical practice.</p> <p>Methods</p> <p>All the 9180 members of the Italian Society of Pediatrics were invited to fill in a questionnaire concerning use of the Internet and usefulness of Internet-based tools during clinical practice. The questionnaire was administered through the SurveyMonkey^®web platform. Logistic regression analysis was used to study factors affecting use and influence of the Internet in clinical practice.</p> <p>Results</p> <p>A total of 1335 (14.5%) members returned the questionnaire. Mean age was 49.2 years, 58.6% were female. 32.3% had access to the Internet through a Smartphone. 71.9% of respondents used the Internet during clinical practice, mainly searching for guidelines and drug references. Use of the Internet during clinical practice was more frequent among younger pediatricians (OR 0.964; 95% CI 0.591-0.978), males (OR 1.602; 95% CI 1.209-2.123) and those living in Northern and Central Italy (OR 1.441; 95% CI 1.111-1.869), while it was lower among family pediatricians. 94.6% of respondents were influenced in their clinical practice by information found on the Internet, in particular younger pediatricians (OR 0.96, 95% CI 0.932-0.989), hospital pediatricians (OR 2.929, 95% CI 1.708-5.024), and other pediatric profiles (OR 6.143, 95%CI 1.848-20.423). 15.9% of respondents stated that social networks may be useful in pediatric practice. Slightly more than half (50.5%) of respondents stated that personal health records may be clinically relevant. Registrars and hospital pediatricians were more likely to perceive personal health records as useful tools for clinical practice. Additional resources pediatricians would like to access were free bibliographic databases and tools for interacting with families.</p> <p>Conclusions</p> <p>Italian pediatricians frequently use the Internet during their practice. One-third of them access the Internet through a Smartphone. Interaction with families and their empowerment can be improved by the use of Internet tools, including personal health records, toward which respondents show a significant interest. Though, they show a general resistance to the introduction of social networks in clinical practice.</p

The predicament of primary physical education: a consequence of 'insufficient' ITT and 'ineffective' CPD?

Background: Research on primary physical education (PE) in England and other countries has shown that it is an aspect of the curriculum that has suffered from sparse initial teacher training (ITT). As a consequence of ‘insufficient’ time spent on PE in ITT (PE-ITT), primary teachers often have low levels of confidence and competence with respect to teaching the subject. Evidence also points to inadequacies in traditional forms of professional development in PE (PE-CPD), leading to calls for more effective ways of developing teachers' competence to deliver high quality PE. Purpose: To explore primary school teachers' experiences of PE during ITT and the PE context in their schools prior to them engaging in a national PE-CPD programme, and their perceptions of the immediate and longer-term effects of this programme. Setting and participants: Primary school teachers in five local education authorities in England. Research design and data collection: A combination of quantitative and qualitative methodological approaches were adopted, including: pre-course audits, course evaluations, focus groups and semi-structured interviews. The pre-course audits captured information about the teachers' experiences of PE-ITT and the PE context in their schools prior to them engaging in the CPD. The course evaluations focused on initial impressions of the PE-CPD, and the focus groups and interviews captured the teachers' perceptions of its longer-term effects. Findings: For up to half of the teachers, their PE-ITT was ‘insufficient’ in terms of the time dedicated to it and the breadth of coverage of the subject. The PE-CPD programme, which was designed in the light of ‘insufficient’ PE-ITT, demonstrated features of ‘effective’ CPD in that it was considered relevant to classroom practice and partially addressed some of their many needs (especially in relation to content ideas and inclusive practice). However, its effectiveness was undoubtedly limited due to: its short time span and minimal engagement with teachers; a heavy reliance on resources; and the absence of follow-up support. In addition, it did not adequately address known areas of development for primary PE (such as medium to long-term planning and assessment) and was challenged in meeting the diverse needs of primary teachers of 5–11 year olds. Furthermore, inadequate PE time and reduced opportunities to teach PE in some schools limited implementation of learning from the PE-CPD. Conclusions: The findings of this study confirmed that PE-ITT continues to be ‘insufficient’ for many primary teachers and that the PE-CPD in question, whilst partially ‘effective’, was not, and could never have been, the panacea for the inherent issues within and predicament of primary PE. In effect, this PE-CPD programme with its limited duration and engagement with teachers, a heavy reliance on resources, and no planned follow-up support was not sufficiently different to forms of CPD described in the literature as ‘ineffective’; consequently, it could not hope to compensate for long-term systemic weaknesses such as inadequate primary PE-ITT. These weaknesses need to be addressed through a dual approach of ‘sufficient’ PE-ITT followed by ‘effective’ PE-CPD which engages teachers and their colleagues in long-term collaborative endeavours that support transformative practice

The Achievement of a Decentralized Water Management Through Stakeholder Participation: An Example from the Drôme River Catchment Area in France (1981–2008)

International audienceDifferent water Acts (e.g., the European Water Framework Directive) and stakeholders involved in aquatic affairs have promoted integrated river basin management (IRBM) over recent decades. However, few studies have provided feedback on these policies. The aim of the current article is to fill this gap by exploring how local newspapers reflect the implementation of a broad public participation within a catchment of France known for its innovation with regard to this domain. The media coverage of a water management strategy in the Drôme watershed from 1981 to 2008 was investigated using a content analysis and a geographic information system (GIS). We sought to determine what public participation and decentralized decision-making can be in practice. The results showed that this policy was integrated because of its social perspective, the high number of involved stakeholders, the willingness to handle water issues, and the local scale suitable for participation. We emphasized the prominence of the watershed scale guaranteed by the local water authority. This area was also characterized by compromise, arrangements, and power dynamics on a fine scale. We examined the most politically engaged writings regarding water management, which topics each group emphasized, and how the groups agreed and disagreed on issues based on their values and context. The temporal pattern of participation implementation was progressive but worked by fits and starts

What's law got to do with it Part 2: Legal strategies for healthier nutrition and obesity prevention

This article is the second in a two-part review of law's possible role in a regulatory approach to healthier nutrition and obesity prevention in Australia. As discussed in Part 1, law can intervene in support of obesity prevention at a variety of levels: by engaging with the health care system, by targeting individual behaviours, and by seeking to influence the broader, socio-economic and environmental factors that influence patterns of behaviour across the population. Part 1 argued that the most important opportunities for law lie in seeking to enhance the effectiveness of a population health approach

A qualitative investigation of the role of sport coaches in designing and delivering a complex community sport intervention for increasing physical activity and improving health

© The Author(s). Background Community sport can potentially help to increase levels of physical activity and improve public health. Sport coaches have a role to play in designing and implementing community sport for health. To equip the community sport workforce with the knowledge and skills to design and deliver sport and empower inactive participants to take part, this study delivered a bespoke training package on public health and recruiting inactive people to community sport for sport coaches. We examined the views of sport coach participants about the training and their role in designing and delivering a complex community sport intervention for increasing physical activity and improving health. Methods Semi-structured interviews were conducted with paid full-time sport coaches (n = 15) and community sport managers and commissioners (n = 15) with expertise in sport coaching. Interviews were conducted by a skilled interviewer with in-depth understanding of community sport and sport coach training, transcribed verbatim and analysed using thematic analysis. Results Three key themes were identified showing how the role of sport coaches can be maximised in designing and delivering community sport for physical activity and health outcomes, and in empowering participants to take part. The themes were: (1) training sport coaches in understanding public health, (2) public involvement in community sport for health, and (3) building collaborations between community sport and public health sectors. Conclusion Training for sport coaches is required to develop understandings of public health and skills in targeting, recruiting and retaining inactive people to community sport. Public involvement in designing community sport is significant in empowering inactive people to take part. Ongoing knowledge exchange activities between the community sport and public health sector are also required in ensuring community sport can increase physical activity and improve public health.Sport England’s Get Healthy Get Active Award UR

Identifying the participant characteristics that predict recruitment and retention of participants to randomised controlled trials involving children : a systematic review

Background Randomised controlled trials (RCTs) are recommended as the ‘gold standard’ in evaluating health care interventions. The conduct of RCTs is often impacted by difficulties surrounding recruitment and retention of participants in both adult and child populations. Factors influencing recruitment and retention of children to RCTs can be more complex than in adults. There is little synthesised evidence of what influences participation in research involving parents and children. Aim To identify predictors of recruitment and retention in RCTs involving children. Methods A systematic review of RCTs was conducted to synthesise the available evidence. An electronic search strategy was applied to four databases and restricted to English language publications. Quantitative studies reporting participant predictors of recruitment and retention in RCTs involving children aged 0–12 were identified. Data was extracted and synthesised narratively. Quality assessment of articles was conducted using a structured tool developed from two existing quality evaluation checklists. Results Twenty-eight studies were included in the review. Of the 154 participant factors reported, 66 were found to be significant predictors of recruitment and retention in at least one study. These were classified as parent, child, family and neighbourhood characteristics. Parent characteristics (e.g. ethnicity, age, education, socioeconomic status (SES)) were the most commonly reported predictors of participation for both recruitment and retention. Being young, less educated, of an ethnic minority and having low SES appear to be barriers to participation in RCTs although there was little agreement between studies. When analysed according to setting and severity of the child’s illness there appeared to be little variation between groups. The quality of the studies varied. Articles adhered well to reporting guidelines around provision of a scientific rationale for the study and background information as well as displaying good internal consistency of results. However, few studies discussed the external validity of the results or provided recommendations for future research. Conclusion Parent characteristics may predict participation of children and their families to RCTs; however, there was a lack of consensus. Whilst sociodemographic variables may be useful in identifying which groups are least likely to participate they do not provide insight into the processes and barriers to participation for children and families. Further studies that explore variables that can be influenced are warranted. Reporting of studies in this field need greater clarity as well as agreed definitions of what is meant by retention

Surgery for persistent otitis media with effusion: generalizability of results from the UK trial (TARGET). Trial of Alternative Regimens in Glue Ear Treatment.

TARGET (Trial of Alternative Regimens in Glue Ear Treatment) is a multicentre UK randomized controlled trial (RCT) comparing bilateral ventilation tubes with and without adjuvant adenoidectomy against non-surgical management in children with bilateral, persistent otitis media with effusion (OME). This paper compares the recruited and randomized children with those that, although eligible, were not included in the RCT for various reasons. This is necessary to identify any potential bias in the overall estimate of treatment effectiveness. At the first visit, 1315 children with OME satisfied the criteria of age (3 years 3 months-6 years 9 months), no previous ear or adenoid surgery, tympanometric evidence of fluid (bilateral B or B + C2) and a hearing loss (conductive loss in both ears of > or =20 dBHL). Of these children, 151 (11%) were not followed up because of overriding concern and 70 (5%) because of parental refusal. Of the 506 children eligible for randomization, because of persistence over 12 weeks of watchful waiting of bilateral OME with the same criteria, 20 (4%) were not randomized because of overriding concern and 75 (15%) because of parental refusal. The distribution of the potential effect modifiers was determined for each group. At the first visit, the only significant differences (P < 0.05), comparing those not recruited because of overriding concern with those recruited, were in respect of sex (61% girls compared with 52% boys) and hearing level (34.6 compared with 33.0 dBHL). At the second visit, the only significant difference involved less frequent upper respiratory tract infections (URTIs) in children whose parents refused to allow randomization (8% compared with 18% had had episodic URTI more often than once every 3 months). It is probable that the findings from the TARGET trial will translate to the entire clinic population in this age group as long as they meet the same audiometric and tympanometric criteria. The differences found can be handled by presentation of disaggregated results