Search

Identifying subgroups of citizens with varying levels of self-sufficiency in a large local or regional population provides local government with essential input for providing matching services and well-grounded spending of health and well-being expenditures. This paper identifies self-sufficiency levels of citizens by segmenting a broad adult population. We used data from a citizen survey based on a randomly selected response group containing questions on a wide range of topics, including finances, health and living conditions, and complemented these data with registration data, including information on housing type and household composition. We conducted a latent class cluster analysis using six indicators: perception of making ends meet, perceived health, quality of life, self-efficacy, access to socialsupport and social network. High scores on the indicators translate to high levels of self-sufficiency. We used a biased-adjusted, three-step approach to characterise the segments. Six meaningful segments were identified and labelled as 'highly self-sufficient,' 'self-sufficient - medium access to social support,' 'self-sufficient - medium self-efficacy,' 'moderately self-sufficient - low self-efficacy & high social network,' 'moderately self-sufficient - low access to social support/social network & high perceived health' and 'not self-sufficient.' At a macro level, perception of making ends meet and quality of life have discriminating value in assessing self-sufficiency. For a more detailed differentiation between groups with similar levels of self-sufficiency, perceived health, self-efficacy, access to socialsupport, and social network are valuable indicators. Overall, this study introduces a comprehensive tool to assess self-sufficiency in larger groups of citizens by using a parsimonious number of indicators. Local and regional governments can apply this tool to effectively assess the self-sufficiency levels of their population and signal potentially vulnerable groups. In this way, the tool makes the identification of self-sufficiency levels of larger populations more feasible and more efficient and can be widely adopted in different contexts., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: We sought to study the impact of the change in gender balance and the shift in generational beliefs on the practice of surgery., Methods: We used in-depth, individual, semistructured interviews to explore the ideas, perceptions and experiences of recently recruited academic surgeons regarding the role of gender and the influence of the changing attitudes of this generation on the work environment. All the interviews were audiotaped and transcribed verbatim. The data analysis was both iterative and interpretative., Results: Nine women and 8 men participated in the study. All participants stated that departmental expectations regarding their performance as clinicians and as academics were not influenced by gender. However, further exploration revealed how gender did influence the way they sought to balance their personal and professional lives. Women in particular struggled with attaining this balance. While maternity leave was endorsed by both men and women, the challenging logistics associated with such leave were noted. Our data also revealed a generational shift among men and women in terms of the importance of the balance between their personal and professional lives. Participants saw this priority as radically different from that of their senior colleagues., Conclusion: Gender and the shift in generational attitudes are changing the culture of academic surgery, often described as the prototypical male-dominated medical environment. These changes may reflect the changing face of medicine.

Purpose: This study describes the experiences of academic surgeons in seeking a balance between their personal and professional lives., Method: This phenomenological study, conducted in 2009-2010 at the University of Western Ontario, used in-depth individual semistructured interviews to explore the ideas, perceptions, and experiences of 17 recently recruited academic surgeons (nine women/eight men) about seeking balance between their personal and professional lives. All the interviews were audiotaped and transcribed verbatim. The data analysis was both iterative and interpretative., Results: All the participants expressed a passion and commitment to academic surgery, but their stories revealed the complexity of making choices in seeking a balance between their personal and professional lives. This process of making choices was filtered through influential values in their lives, which in turn determined how they set boundaries to protect their personal and family time from the demands of their professional obligations. Intertwined in this process were the trade-offs they had to make in order to seek balance. Some choices, boundary-setting strategies, and trade-offs were dictated by gender. Finally, the process of making choices was not static; instead, the data revealed how it was both dynamic and cyclical, requiring reexamination over the life cycle, as well as their career trajectory. Thus, seeking a balance was an ever-changing process., Conclusions: Understanding how members of an academic department of surgery navigate the balance between their personal and professional worlds may provide new insights for other disciplines seeking to enhance the development of the next generation of academics.

Background: To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the Internatio-nal Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA., Methods: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline., Results: In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Ästrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and morning stiffness were recommended., Conclusion: This physiotherapy practice guideline for RA included seven recommendations on the initial assessment, treatment and evaluation, which were all based on the ICF and the ICF Core Set for RA. The implementation of the guideline in clinical practice needs further evaluation.