Cultural capital and professional development experiences of migrant health and social care professionals

In the last decade there has been a systematic growth in the population of skilled migrants entering the UK health and social care sector. In particular, the numbers of social workers possessing qualifications from overseas who come to work in the UK have been increasing annually (Hussein et al., 2010a). Previous research has examined the profile, motivations, experiences and expectations of ?international?, ?overseas? or ?migrant? social workers in the UK. In some of these studies (e.g. McGregor, 2007) the participants were professionals from various fields who entered the care sector out of necessity after their arrival to the UK, while in other studies the participants were qualified social workers who trained in their home countries and then migrated to the UK to join the social care sector (Evans et al., 2006b; Hussein et al., 2010b; Moran et al., 2005; Sale, 2002). Much of this literature focuses on challenges these professionals face as they enter the social work workforce (e.g. difficulties in adapting to the English culture, insufficient induction, limited opportunities for career progression) as well as on adverse experiences at the workplace (e.g. experiences of racism and discrimination). While it is undeniably important to do further research on these challenges and difficulties and suggest effective ways of tackling them, it is also important to explore the resources these professionals activate when faced with such challenges. In particular, it is important to tap into the ways in which they actually utilise their cultural capital both in its formal/institutionalised form (i.e. educational credentials and professional qualifications) but also in its informal/incorporated form (i.e. their own work ethics). In this paper migrant social workers are not perceived as passive employees whose cultural capital is inevitably undermined by institutional and informal forms of exclusion, but as active agents who can shape to a large extent the specific context in which they work. The paper is based on part of a larger original research project, which explored the education and employment-related experiences of three groups of migrant health and social care professionals (doctors, social workers and nurses) before and after migrating to the UK. The presented findings emerged from five in-depth narrative interviews carried out with migrant social workers* who were qualified in their home countries and are currently working full-time as social workers in England. The narrative analysis illustrates certain institutional mechanisms which influence the participants? experiences (e.g. their informal/incorporated cultural capital, that is, their own work ethics, is often undervalued in which case they feel they do ?more managerial tasks and less actual work with people?). The analysis also reveals how certain social norms in the field of social work shape the participants? experiences while interacting with colleagues, employers and service-users (e.g. experiences of bullying or mistreatment). However there are also particular accounts of how they actually utilize their cultural capital both for resolving dilemmas they face at the workplace but also for suggesting general improvements in the services they are employed in. Our analysis therefore highlights not only the employment-related difficulties migrant social workers face but also how individuals themselves effectively deal with professional challenges. *language in this area varies but we use the term ?migrant? to describe social workers who have qualified outside the UK -either from the EU or other countries- and have already significant work experience in the UK social work sector

Cultural health capital and professional experiences of overseas doctors and nurses in the UK

Drawing on autobiographical narratives of a small sample of overseas doctors and nurses working in the UK, this study analysed emerging subjective theories of their professional experiences and explored how these are related to the theoretical framework of cultural health capital, an expert theory on a form of cultural capital which is leveraged in healthcare contexts and may result in more optimal healthcare relationships. The findings of our analysis demonstrate that there is a wealth of expertise and experience among overseas healthcare professionals, and that it is underutilised because of structural and institutional barriers. Healthcare professionals with temporary migration status faced longer delays in their career progression than those with EU citizenship or work permits. Irrespective of migration status, career aspirations were thwarted by external circumstances with negative consequences for individuals’ well-being, with doctors being affected more severely than nurses. Structural and institutional barriers that have an impact on professionals’ ability to progress into the UK healthcare system are discussed. The paper concludes with a discussion of the potential of cultural health capital as a framework for capturing and explaining the career trajectories experienced by overseas healthcare professionals

Predictors of Post-injury Mortality in Elderly Patients with Trauma: A Master\u27s Thesis

Background: Traumatic injury remains a major cause of mortality in the US. Older Americans experience lower rates of injury and higher rates of death at lower injury severity than their younger counterparts. The objectives of this study were to explore pre-injury factors and injury patterns that are associated with post-discharge mortality among injured elderly surviving index hospitalization. Methods: We queried a 5% random sample of Medicare beneficiaries (n=2,002,420) for any hospitalization with a primary ICD-9 diagnosis code for injury. Patients admitted without urgent/emergent admission were excluded, as well as patients presenting from inpatient hospitalization or rehabilitation. The primary endpoint was all-cause mortality. Patients were categorized into three mortality groups: death within 0-30 days, 31-90 days, or 91- 365 days post-discharge from the index hospitalization. These groups were compared with those who survived greater than one year post-discharge. Univariate tests of association and multivariable logistic regression models were utilized to identify factors associated with mortality during the 3 examined periods. Results: 83,439 elderly patients (4.2%) were admitted with new injuries. 63,628 met inclusion criteria. 1,936 patients (3.0%) died during their index hospitalization, 2,410 (3.8%) died within 0-30 days, 3,084 (4.8%) died within 31-90 days, and 5,718 (9.0%) died within 91- 365 days after discharge. In multivariable adjusted models, advanced age, male sex, and higher Elixhauser score were associated with post-discharge mortality. The presence of critical injury had the greatest effect on mortality early after injury (0-30 days, OR 1.81, CI 1.64-2.00). Discharge to anywhere other than home without services was associated with an increased odds of dying. Conclusions: Socio-demographic characteristics, disposition, and co-morbid factors were the strongest predictors of post-discharge mortality. Efforts to reduce injury-related mortality should focus on injury prevention and modification of co-morbidities

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

INTRODUCTION: The utility of hyperbaric oxygen therapy (HBOT) in the treatment for necrotizing soft tissue infections (NSTI) has not been proven. Previous studies have been subject to significant selection bias since HBOT is not universally available at all medical centers and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities. METHODS: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (N=14). Cases of NSTI were identified by ICD-9 diagnosis codes, which included Fournier’s gangrene (608.83), necrotizing fascitis (728.86), and gas gangrene (040.0). HBOT treatment status was identified by the presence (HBOT) or absence (CONTROL) of ICD-9 procedure code (93.95). We then risk stratified and matched our cohort by UHC’s validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression. RESULTS: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Risk stratified univariate outcomes are summarized in the table. There was no difference between HBOT and CONTROL groups in hospital length of stay (LOS), direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p CONCLUSION: At HBOT capable centers, receiving HBOT was associated with a significant survival benefit. HBOT in conjunction with current practices for the treatment of NSTI can be both a cost effective and life saving therapy

The Effect of Oral Antibiotics on the Development of Community Acquired Clostridium Difficile Colitis in Medicare Beneficiaries

Clostridium difficile infection (CDI) is increasingly prevalent among community dwelling Americans. Older Americans are particularly vulnerable to community-acquired Clostridium difficile (CACD), in part to increasing use of antibiotics. We studied the association between outpatient antibiotics and CACD among Medicare beneficiaries. Case-control study utilizing a 5% sample of Medicare beneficiaries (2009-2011). Patients with CACD severe enough to warrant hospitalization were identified by a primary diagnosis code for CDI and no exposure to a healthcare environment within 90-days of admission. 1,514 CACD cases were matched to ten controls each on birth year and sex. Potential controls with exposure to healthcare environment were excluded. Outpatient oral antibiotic exposure was classified into three groups: ≤30 days, 31-60 days, or 61-90 days prior to case subject’s index admission. Metronidazole and Vancomycin were excluded because they are used to treat CDI. Multivariable models were utilized to determine the independent effect of antibiotics on the development of CACD while controlling for several patient associated characteristics. Cases of CACD had more outpatient antibiotic exposure in each time period examined: ≤30 days = 40.0% vs 8.4%; 31-60 = 10.7% vs 5.0%; and 61-90 = 5.5% vs 4.4% (all p-values \u3c 0.05). Subjects exposed to antibiotics ≤30 days prior to admission had a markedly higher risk of being admitted with CACD compared with those not exposed (OR 8.09, 95% CI 7.13, 9.19). Similarly, subjects taking antibiotics 31-60 days and 61-90 days prior to admission had increased risk of CDI admission (OR 3.65, 95% CI 3.02, 4.41) and (OR 2.06, 95% CI 1.61, 2.63) respectively. Recent exposure to outpatient oral antibiotics increases the risk of CACD among community dwelling elderly with the risk persisting as long as 90 days after exposure. Inappropriate antibiotic usage must be minimized and older Americans who require outpatient antibiotic treatment may warrant close observation for signs of CDI

Acute Appendicitis after Liver Transplantation: A Case Report and Review of the Literature

Acute appendicitis is one of the most common etiologies for acute abdomen. However, fewer than 30 cases of acute appendicitis after liver transplantation have so far been reported in the literature. Previous case studies have concluded that acute appendicitis after liver transplantation may present differently than in non-immunosuppressed patients and thus may lead to more complications. Herein, we describe the fourth case of laparoscopic appendectomy in a 40-year-old female presenting with an acute abdomen, 10 years after orthotopic liver transplantation for autoimmune hepatitis. Additionally, we review the literature, and emphasize the importance for laparoscopic, rather than open appendectomy after liver transplantation. Overall, despite the small number of reported cases of appendicitis after orthotopic liver transplantation, we found the incidence and clinical presentation are similar to patients without liver transplantation. The etiologies for appendicitis in patients after liver transplantation may be different than in those not chronically immunosuppressed, with significantly less lymphoid hyperplasia and increased fecalith and cytomegaloviral infections. Preliminary results showed that laparoscopic appendectomy after liver transplantation results in decreased hospital stays and fewer complications