The Massachusetts Commonwealth Health Insurance Connector: Structure and Functions

Describes the role and financing of the Commonwealth Health Insurance Connector Authority, an agency created to help small businesses and individuals buy affordable, high-quality insurance. Considers its potential as a model for national reform

Perspectives on the cross-cultural challenges and coping strategies of sport coaches

As competitive sports become increasingly global, sport coaches engage in multicultural organizations and interact with people from different cultures. These interactions may need sport coaches to have cross-cultural competencies to manage cultural differences. The purpose of this study was to investigate the cross-cultural challenges encountered by sport coaches in multicultural sport environments, and to explore the coping strategies they employ to navigate these challenges. Semi-structured interviews were conducted with twelve coach educators from various sports and nations. Reflexive thematic analysis revealed two themes regarding the cross-cultural challenges faced by sport coaches: (1) unpreparedness to interact with people of different cultures, and (2) adapting to different cultures as a sports coach. In addition, two themes emerged in relation to their coping strategies: (3) being immersed in different cultures; and (4) being open-minded. The results of the study indicate that sport coaches, regardless of whether they are in their home country or abroad, encounter personal and professional challenges related to culture in their interactions with others. It illustrates the need for cross-cultural topics to be addressed in coach development programs

Lambliasis-associated Schönlein-Henoch purpura in an Italian traveller: first case report in Italy

A unique report of Schonlein-Henoch purpura (SHP) associated with a recent Giardia lamblia enteric infec-tion is described and discussed on the ground of the available literature. Tinidazole plus an appropriate probiotic therapy, including Lactobacillus reuteri and vitamin D, proved to be effective in the condition. SHP is an immunocomplex-mediated disorder characterised by a number of differently associated signs and symptoms, leading to the possible involvement of the skin, joints, abdomen and kidneys. Recent bacterial, viral, or protozoan infections may trigger the disease onset in patients of all ages. The paper de-scribes the first case of SHP triggered by a giardiasis. Tinidazole plus an appropriate probiotic therapy, i.e. L. reuteri and vitamin D proved to be effective in this condition. To our knowledge, this is the first reported case of lambliasis-associated SHP described in an international traveller

The social psychology of social prescribing: a toolkit

This toolkit has been developed as a resource for organisations that are involved, or who are considering becoming involved in, Social Prescribing. This toolkit has been designed to be used in a variety of ways. In each section, we provide an overview of theory and evidence relating to a topic of importance to Social Prescribing. These sections are also related to a specific tool that can be used by those developing, commissioning or running Social Prescribing services. Alternatively, you can access the tools straight away, by going to the document Appendices. The tools are a mixture of signposting to additional resources, and/or lessons learned, and best practice guidance

Evaluation of Mental Health First Aid from the Perspective Of Workplace End UseRs—EMPOWER: protocol of cluster randomised trial phase

Background: Mental Health First Aid (MHFA) is a mental health intervention that teaches people how to identify, understand and help someone who may be experiencing a mental health issue. Reviews of the implementation of MHFA found between 68 and 88% of trained Mental Health First Aiders had used their skills when in contact with someone experiencing mental health difficulties. Reviews evaluating the impact of MHFA suggest positive outcomes. However, to date, there has been no systematic, rigorous evaluation of the impact of MHFA on recipients of the intervention, the organisations providing it and the cost-effectiveness of MHFA overall. This trial will evaluate the effectiveness and cost-effectiveness of MHFA. Methods: The study is a multi-centred, two-arm clustered randomised controlled trial. Organisations will be randomly allocated to the control or intervention (estimated sample size 800 recipients). The intervention is the standard MHFA intervention provided by Mental Health First Aid England (MHFAE). The control condition will be organisations having a brief consultation from MHFAE on promoting mental health and well-being in the workplace. The primary outcome is health seeking behaviour, measured using the Actual Help Seeking Questionnaire, at 6 months’ follow-up. Data collection will be undertaken at baseline (T0), post-intervention—up to 3 months (T1), at 6 months (T2), 12 months (T3) and 24 months (T4). The primary analysis will be conducted on those participants who receive MHFA, a per protocol analysis. Discussion: The study is the first to evaluate the effect of MHFA in the workplace on employees with direct and indirect experience of the intervention, when compared with usual practice. Being also the first to assess, systematically, the social impact of MHFA and investigate its cost-effectiveness adds to the originality of the study. The study promises to yield important data, as yet unknown, regarding the effectiveness, cost-effectiveness, implementation issues, and the sustainability of MHFA in the workplace

Characteristics of smokers who have never tried to quit: evidence from the British Opinions and Lifestyle Survey

Background An understanding of the characteristics of smokers who have never tried to quit may be useful to help identify and target these individuals and encourage them to attempt to give up smoking. Using national survey data we investigated variables associated with smokers reporting never having tried to quit. Methods Using data from the 2007 and 2009 UK Office for National Statistics Opinions and Lifestyle Survey we identified all self-reported current smokers aged 16+. The primary outcome was response to the question ‘have you ever tried to quit smoking?’ Univariable and multivariable logistic regression quantified the association between this outcome and several potential explanatory variables, including age, sex, socioeconomic status, health status, smoking behaviour, and knowledge of the dangers of smoking. Results Desire to quit was the most significant independent predictor of whether a smoker reported never having tried to quit. Smokers who reported that their health was good or very good were more likely to report never having tried to quit than those whose health was fair, bad or very bad (OR 1.59, 95% CI 1.05-2.41). Smokers who reported that no family members, friends or colleagues had been trying to get them to quit smoking in the last year were more likely to report never having tried to quit than those who reported that someone was trying to persuade them (OR 1.57, 95% CI 1.09-2.28). Smokers who hadn’t received any cessation advice from a health professional in the last five years which they considered to be helpful were also more likely to report never having tried to quit. Conclusions Smokers who do not want to quit, who are in good health, whose friends and family are not trying to get them to quit, and who do not report receiving helpful advice to quit from a health professional, are more likely to report never having tried to quit

Проба с диаскинтестом при диагностике туберкулеза животных

The objective of the study: to compare the diagnostic value of intracutaneous tests with tuberculin and diaskintest for detection of tuberculosis in cattle.Subjects and methods. In this study, PPD tuberculin for mammals was used, it was made from M. bovis strain AN-5, manufactured by BIOK, and Diaskintest (recombinant tuberculous allergen, solution forintracutaneous administration) manufactured by ZAO FF Lecco, series 030307.Laboratory animals (guinea pigs, rabbits, chickens) and farm animals (pigs and cattle) were used in the study.Results. It has been established on laboratory animals that diaskintest does not cause any adverse events. When assessing sows sensitized with M. avium, it was found that the intracutaneous administration of PPD tuberculin to mammals resulted in up to 8.5% of positive reactions, while diaskintest was negative in all of them. Among cattle sensitized to non-tuberculous mycobacteria, intracutaneous administration of tuberculin for mammals revealed up to 4.6% of positive reactions, and diaskintest – up to 0.6%. In the farm with the unfavorable TB situation where animals infected with M. bovis were previously detected, when examining 177 cows, tuberculin test was positive in 102 (57.6%) of them, and diaskintest in 88 (49.7%). Diaskintest can be used for differential diagnosis of tuberculosis and sensitization by non-tuberculous mycobacteria in pigs and cattle.Цель исследования: сравнение диагностической ценности внутрикожных проб с туберкулином и диаскинтестом для выявления туберкулеза крупного рогатого скота.Материалы и методы. В работе использовали ППД туберкулин для млекопитающих, изготовленный из M. bovis штамма AN-5, производства фирмы «БИОК» и препарат диаскинтест (аллерген туберкулезный рекомбинантный, раствор для внутрикожного введения) производства ЗАО ФФ «Лекко», серия 030307. Исследования проводили на лабораторных животных (морских свинках, кроликах, курах) и сельскохозяйственных животных (свиньях и крупном рогатом скоте).Результаты. На лабораторных животных установлено, что проба с диаскинтестом не вызывает нежелательных реакций. При исследовании сенсибилизированных M. avium свиноматок установлено, что внутрикожное введение ППД туберкулина для млекопитающих выявляет до 8,5% положительных реакций, при этом проба с диаскинтестом была у всех отрицательной. Среди крупного рогатого скота с сенсибилизацией к нетуберкулезным микобактериям внутрикожное введение туберкулина для млекопитающих выявляло до 4,6% положительных реакций, а проба с диаскинтестом – до 0,6%. В неблагополучном по туберкулезу хозяйстве, где ранее выявлялись животные, инфицированные M. bovis, при исследовании 177 коров проба с туберкулином была положительной у 102 (57,6%), а проба с диаскинтестом – у 88 (49,7%). Проба с диаскинтестом может использоваться при дифференциальной диагностике туберкулеза и сенсибилизации нетуберкулезными микобактериями у свиней и крупного рогатого скота

Smoking cessation opportunities in severe mental illness (tobacco intensive motivational and estimate risk — TIMER—): study protocol for a randomized controlled trial

There is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population. In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking.This study receives funding by the Spanish Ministry of Economy, Industry and Competitiveness, Instituto Carlos III (FIS PI16/00802)