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Family medicine has recently been introduced into undergraduate training programs after more than 10 years of only being available for postgraduate doctors in Vietnam. The aim of this study was to explore the perceptions of sixth-year medical students towards family medicine and the factors that influence their career choice for - or against - family medicine.The authors used a qualitative approach with a criterion sampling technique, including 36 participants in eight interviews and four focus group discussions, with thematical analysis.Most students could explain well what they had learned about family medicine but showed little interest in it. Only a few of the interviewees indicated they would choose a career in family medicine. The following factors influenced their career choice: valuing continuing care, the doctor-patient relationship and work-life balance; family medicine clinical rotation and teachers' roles; and related health policies offering a clear practice pathway and patient allocation to capable family doctors.The students' perceptions of family medicine were positive, but their interests in and intention to pursue a career in family medicine were still low after a clinical rotation. The authors concluded that the family medicine rotation should be maintained, family medicine should become more prominent in more components of the medical curriculum, and health policies to support and encourage becoming a family doctor are necessary.

Background: To prepare students adequately for the workplace, training on interprofessional practice should be included in the curricula of future health professionals. This study evaluated the effect of an interprofessional education session on undergraduate students' attitudes toward interprofessional collaboration. Methods: A total of 225 medicine, nursing, physiotherapy, and nutrition and dietetics students were randomized to either an intervention (working together interprofessionally, n = 111) or control group (working together with their own profession, n = 114). Pre- and posttest assessment was performed with an adapted version of the Interdisciplinary Education Perception Scale. Results: A statistically significant improvement in attitude for Perception of Competence Own Profession (0.82, p = .008) and Perception of Actual Cooperation (1.10, p = .004) was found for students in the intervention group compared with students in the control group. Conclusion: Interprofessional education sessions were likely to be effective on undergraduate students' attitudes toward interprofessional collaboration. [ J Nurs Educ . 2021;60(9):494–499.]

Objectives Currently maternity care organisation is developing worldwide. Therefore insight in the position of the midwife is important. The 'Midwife Profiling Questionnaire′ (MidProQ) measures women’s preferred perinatal care professional and their knowledge of midwives’ legal competences. MidProQ is based on the European legal framework and was tested in a pilot study. This study aims to determine its content and face validity. Study design. A two-phase validation study with a Delphi method questioning content experts (n = 10) on items relevance and clarity as well as its scale and face validity. Further semi-structured interviews were performed with lay experts (n = 10) to evaluate the questionnaire’s clarity, layout, phrasing and wording. Results After round one, most questions (42/47) were considered content valid for relevance and clarity (Item Content Validity Index 0.80–1.00). Scale (Scale Content Validity Index 0.92) and face validity (Face Validity Index 0.89) of the entire instrument was obtained. Five questions were revised until item content (0.83–1.00), scale content (0.92) and face validity (1.00) were appropriate. Lay experts’ suggestions for improving the readability and usability were taken into account. Conclusions We developed a valid instrument to elicit women’s preferred health professional for uncomplicated pregnancy, labour and childbirth and to determine their knowledge about midwives’ legal competences. Our instrument can be valuable in identifying knowledge gaps and improving the knowledge of the general population about the midwifery profession and maternity care. Finally, the MidProQ may improve research in the domain of maternity care culture, scale up midwifery and facilitate a more women-centred care.

Background Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions. Objective To establish consensus among experts regarding clinical criteria suggestive of a dominance of ‘articular’, ‘myofascial’, ‘neural’, ‘central’, and ‘sensorimotor control’ dysfunction patterns (DPs) in NSLBP patients. Study design A 2-phase sequential design of a focus group and Delphi-study. Methods A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. Results Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two ‘articular’, 20 ‘myofascial’, 21 ‘neural’, 18 ‘central’ and 11 ‘sensorimotor control’ criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify ‘referred pain below the knee’ as a subjective examination criterion suggestive for a predominant ‘neural DP’. Conclusion These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.

IntroductionMeasuring the performance of a primary care system is one of the very first steps to find out whether there is room for improvement. To obtain an objective and comprehensive view, this measurement should come from both the supply and demand sides of the system. Patients' experiences of primary care have been studied around the world, but much less energy has been invested in researching providers' perspectives. This research aims to explore how primary care physicians working at commune health centers in Vietnam evaluate their performance and their opinions on how to improve the quality of primary care services.Materials and methodsFirst, a quantitative study was conducted using the validated Vietnamese PCAT questionnaire-provider expanded version (VN PCAT PE) targeting all primary care physicians (PCPs) working at commune health centers in a province of Central Vietnam. Next, a qualitative study was carried out, consisting of in-depth interviews with PCPs, to better understand the results of the quantitative survey and gain insight on barriers of primary care services and how to overcome them.ResultsIn the quantitative portion of our study, 150 PCPs rated the quality of ongoing care and first contact in CHCs as the best (3.09 and 3.11 out of 4, respectively), and coordination as the worst performing core domain (2.53). Twenty-two PCPs also participated in our qualitative research. In regards to challenges that primary care physicians face during their daily practice, three central themes emerged: 1) patient factors such as client attitude and knowledge, 2) provider factors such as the burden of administrative work and lack of training opportunities, and 3) contextual factors such as low income and lack of resources including medicines and diagnostics. Participants recommended more health promotion campaigns in the media, increasing the number of services available at CHCs (such as being able to take blood samples), reducing the workload related to administration for CHC leaders, greater government subsidies, and providing more training courses for PCPs.ConclusionsFindings from this study offer a valuable view from the supply-side of the primary care system, specifically those who directly deliver primary care services. Along with the earlier study on consumers' evaluation of the Vietnamese primary care system, and literature from other low and middle-income countries, these findings offer emerging evidence for policymakers to improve the quality of primary care in Vietnam.

To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity.There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider's perspective. This study aims at the latter.Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey.The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or 'don't know/don't remember' response rate, and there were no floor or ceiling effects. All scales had a Cronbach's alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70.The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

OBJECTIVE: To investigate whether orthostatic intolerance (OI) is a significant predictor for fatigue in Ehlers-Danlos Syndrome, hypermobility type (EDS-HT). METHODS: Eighty patients with EDS-HT and 52 controls participated in the first part of the study, which consisted of questionnaires. Fatigue was evaluated using the Checklist Individual Strength (CIS). As possible fatigue determinants OI [Autonomic Symptom Profile (ASP)], habitual physical activity (Baecke), affective distress [Hospital Anxiety and Depression Scale (HADS)], pain (SF36), medication use and generalized hypermobility (5-point score of Grahame and Hakim regarding generalized joint hypermobility) were studied. Next, a 20 min head-up tilt (70°) was performed in a subsample of 39 patients and 35 controls, while beat-to-beat heart rate and blood pressure were monitored (Holter, Finometer Pro). Before and after tilt, fatigue severity was assessed using a numeric rating scale. RESULTS: Patients scored significantly higher on the CIS [total score: EDS: 98.2 (18.63)vscontrols: 45.8 (16.62), P < 0.001] and on the OI domain of the ASP [EDS: 22.78 (7.16)vscontrols: 6.5 (7.78)]. OI was prevalent in EDS-HT (EDS: 74.4%, controls: 34.3%, P = 0.001), and frequently expressed as postural orthostatic tachycardia (41.0% of the EDS group). Patients responded to tilt with a higher heart rate and lower total peripheral resistance (p < 0.001; p = 0.032). This altered response correlated with fatigue in daily life (CIS). In the EDS-HT group, tilt provoked significantly more fatigue [numeric rating scale increase: EDS: +3.1 (1.90), controls: +0.5 (1.24), P < 0.001]. Furthermore, the factors OI, pain, affective distress, decreased physical activity and sedative use explained 47.7% of the variance in fatigue severity. CONCLUSION: OI is an important determinant of fatigue in EDS-HT.

Aims Speech (i.e., resonance, nasal airflow and articulation) is one of the primary outcomes in individuals with a cleft of the palate with or without a cleft of the lip (CP ± L). Therefore, it is highly important to obtain information regarding parental perceptions and expectations concerning speech therapy-related cleft care. Literature investigating these parental perspectives is scarce. The present study investigated perceptions and expectations of parents of children with CP ± L concerning (outcomes of) speech therapy. Methods Eleven parents of nine children with CP ± L were recruited from the multidisciplinary craniofacial team at the Ghent University hospital. A qualitative design, using semi-structured interviews, was used to collect data. Data were managed using NVIVO software version 10 and analyzed thematically. Results The analysis resulted in three major themes: (1) service provision, (2) patient-centered care, and (3) seeking health care. Each of these identified themes were divided into three subthemes. Service provision included the effectiveness of the provided service, interdisciplinary collaboration, and expertise of the speech therapist. Information provision, child-friendly attitude and connection were categorized under patient-centered care. Seeking health care included affordability, practical considerations and the selection of a speech therapist. Conclusion The most prominent expectation of the parents was that they wanted to see their children progress during the speech intervention. This finding supported the importance of experienced and specialized speech-language pathologists (SLPs) in the provision of care to children with a CP ± L. Moreover, the results showed that the majority of the parents wanted more clear and comprehensive information particularly about the treatment progress, the transfer to the home environment and the prognosis. The present findings might aid SLPs, and more generally all health professionals, in gaining insight into parental perceptions and expectations concerning speech therapy-related cleft care. Thereby, treatment quality might be improved.

Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

Background: Common cold and influenza result in an increased number of primary care consultations, significant work/school absences and cause a socio-economic burden. Laypeople’s perceptions and knowledge regarding common cold and influenza prevention is poorly understood and under-researched. Objectives: Our study explores laypeople’s knowledge of prevention of common cold and influenza across three European countries. Furthermore, it investigates if there is any distinction between prevention activities focussing on reasons impacting the attitude towards influenza vaccination as well as investigating cross-country variation. Methods: In total, 85 semi-structured individual interviews were performed across three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24). Qualitative thematic content analysis was performed. Results: Most participants across all three countries made no distinction between the prevention of the common cold and influenza and referenced the same preventative measures for both conditions. They mainly expressed negative attitudes towards influenza vaccination possibly effective but only intended for high-risk groups (bedridden/older people, chronic patients or health workers). There were very few cross-country differences in results. Conclusion: The perception of health risk of contracting influenza and a primary healthcare physicians’ recommendation played an important role in shaping participants’ decisions towards vaccination. Primary healthcare physicians are invited to assess and if necessary adjust inappropriate prevention behaviour through their everyday patient consultations as well as add to the knowledge about influenza severity and influenza vaccination benefits to their patients.

Introduction: Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students’ experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium. Methods: A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit. Results: Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors. Conclusions: Factors related to students’ functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards. ispartof: European Journal of Midwifery vol:3 pages:1-8 ispartof: location:Greece status: published

Introduction and aim In the ageing society, a considerable part of the older adults are frail. Frailty has a major impact on the individual’s quality of life, independence and also on his environment. This study aimed to investigate–as a secondary prevention of disability - the effectiveness of a client-centred and activity-oriented intervention program for frail community living older adults. It was hypothesized that this program could be effective in improving basic Activities of Daily Living (b-ADL) and increasing Health Related Quality of Life (HRQoL). Method This study was a single blind randomized controlled trial with an intervention and a control group (pre-test-post-test control group design). Analysis of covariance (ANCOVA) was used to compare the outcome across groups with post-test as outcome and baseline values as a covariate. Data were analysed using the intention-to-treat principle. Results The intervention group (n = 86) experienced more improvement on b-ADL and HRQoL compared with the control group (n = 82). These effects were statistically significant for the b-ADL index (p = 0.013) and the ‘physical subscale pain’ (p = 0.049). Discussion and conclusion These positive results can be seen as promising for further development of intervention strategies, although follow-up study should be conducted to determine long term effectiveness.

A particular allele of the carnosinase gene (CNDP1) is associated with reduced plasma carnosinase activity and reduced risk for nephropathy in diabetic patients. On the one hand, animal and human data suggest that hyperglycemia increases plasma carnosinase activity. On the other hand, we recently reported lower carnosinase activity levels in elite athletes involved in high-intensity exercise compared with untrained controls. Therefore, this study investigates whether exercise training and the consequent reduction in hyperglycemia can suppress carnosinase activity and content in adults with type 2 diabetes. Plasma samples were taken from 243 males and females with type 2 diabetes (mean age = 54.3 yr, SD = 7.1) without major microvascular complications before and after a 6-mo exercise training program [4 groups: sedentary control ( n = 61), aerobic exercise ( n = 59), resistance exercise ( n = 63), and combined exercise training ( n = 60)]. Plasma carnosinase content and activity, hemoglobin (Hb) A1c, lipid profile, and blood pressure were measured. A 6-mo exercise training intervention, irrespective of training modality, did not decrease plasma carnosinase content or activity in type 2 diabetic patients. Plasma carnosinase content and activity showed a high interindividual but very low intraindividual variability over the 6-mo period. Age and sex, but not Hb A1c, were significantly related to the activity or content of this enzyme. It can be concluded that the beneficial effects of exercise training on the incidence of diabetic complications are probably not related to a lowering effect on plasma carnosinase content or activity.

In the literature on the evolution of funding approaches there is criticism of traditional funding strategies and the promotion of inclusive models, such as South-South Cooperation (SSC) and triangular models. The latter are felt to have a number of advantages. This article has four broad objectives: (i) to present a literature review on the evolution of Southern approaches to development co-operation; (ii) to indicate examples of current co-operative programmes in health and health professional education in Africa; (iii) to assess the advantages and disadvantages of these models; and (iv) to mention some emerging issues in monitoring and evaluation. The Boolean logic approach was used to search for applicable literature within three topic layers. Searches were conducted using PubMed, PLoS and other accessible databases. An initial draft of the article was presented to a group of academics and researchers at the Flemish Inter-University Council (VLIR-UOS)-Primafamed annual workshop held in August 2010 in Swaziland. Comments and suggestions from the group were included in later versions of the article. It is important to note that the existence of various funding models implemented by a variety of actors makes it difficult to measure their effects. In health and health professional education, however, SSC and triangular models of aid provide conditions for more effective programming through their focus on participation and long-term involvement. With an eye towards evaluating programmes, a number of salient issues are emerging. The importance of context is highlighted. ispartof: African Journal of Health Professions Education vol:9 issue:1 pages:3-8 status: published

Aim The CAREvent Public Access Resuscitator (PAR) is an electronic, oxygen-driven cardiopulmonary resuscitation (CPR) device allowing volume-controlled ventilation with a face mask and guiding the rescuer through the resuscitation with voice prompts and visual indications. We hypothesized that 1 year after initial training, the efficacy of ventilation skills (primary outcome) and compression skills (secondary outcome) by first responders using the PAR would be superior compared with CPR with only a face mask. Methods Seventy-one first responders were randomized to a group using the PAR (n= 35) and a control group using only a face mask (n= 36). CPR skills were assessed immediately after training and after 3, 7 and 12 months using a Skill Reporter manikin. Differences between groups over time and the interaction between time and groups were assessed using repeated measures models. Results are reported as mean values and number of participants with good ventilation or compression skills. Results Twelve months after training, there were more PAR users with adequate tidal volume than face mask users. Other ventilations skills did not differ between groups. There were more PAR users with an adequate number of compressions and with good hand position. Skill decay over 12 months did not differ between groups, except for hand position, where no decline was observed in the PAR group. Conclusion Compared with the face mask, PAR improved tidal volume, compressions per minute and hand position in a manikin setting. (c) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Aim: This study provides insight into the profile and importance of autonomic symptoms in the hypermobility type (HT) of Ehlers–Danlos syndrome (EDS). The impact of these symptoms is put into perspective by comparing with fibromyalgia (FM) and two other EDS types. Methods: Overall, 80 patients with EDS-HT participated, as well as 11 with classical EDS (cEDS), seven with vascular EDS (vEDS), 38 with FM, and 43 healthy controls. All participants filled out the autonomic symptom profile (ASP). Furthermore, they were inquired about quality of life (QOL, SF-36) and factors contributing to the EDS disease burden, e.g., hypermobility (5-point questionnaire, GHQ), fatigue (checklist individual strength, CIS), pain (pain detect questionnaire, PDQ), affective distress (hospital anxiety and depression scale, HADS), and physical activity (Baecke). Results: The total autonomic symptom burden was higher in EDS-HT (57.9 7 21.57) than in controls (11.3 7 19.22), cEDS (32.3 7 19.47), and vEDS (29.1 7 19.18), but comparable to FM (53.8 7 19.85). Especially orthostatic and gastrointestinal complaints were prevalent. The importance of autonomic symptoms in EDS-HT was emphasized by the correlation with lowered QOL (r ¼� 0.402), fatigue (r ¼ 0.304), and pain severity (r ¼ 0.370). Although affective distress and decreased physical activity are often suggested as possible causes for dysautonomia, the ASP did not correlate with the HADS and Baecke score. By contrast, the correlation of the GHQ (r ¼ 0.298) and PDQ (r ¼ 0.413) with the ASP supports the hypothesis that joint hypermobility and neuropathy may play a role in the development of autonomic symptoms. Conclusion: Autonomic symptoms, especially orthostatic and gastrointestinal complaints, are frequent extraarticular manifestations of EDS-HT and contribute to the disease burden.

Objectives To develop a self-learning station combining a video with computer exercises to learn cardiopulmonary resuscitation (CPR) to novices, and to assess the efficacy of these two components on CPR acquisition.Methods One hundred and twenty-five pharmacy students were trained using learning-while-watching video instructions followed by exercises with voice feedback. The proportion of students with adequate CPR skills (70% compressions with depth 50 mm, 70% compressions with complete release

Background Simulation training is a powerful and evidence-based teaching method in healthcare. It allows students to develop essential competences that are often difficult to achieve during internships. High-Fidelity Perinatal Simulation exposes them to real-life scenarios in a safe environment. Although student midwives’ experiences need to be considered to make the simulation training work, these have been overlooked so far. Aim To explore the experiences of last-year student midwives with High-Fidelity Perinatal Simulation training. Methods A qualitative descriptive study, using three focus group conversations with last-year student midwives (n = 24). Audio tapes were transcribed and a thematic content analysis was performed. The entire data set was coded according to recurrent or common themes. To achieve investigator triangulation and confirm themes, discussions among the researchers was incorporated in the analysis. Findings Students found High-Fidelity Perinatal Simulation training to be a positive learning method that increased both their competence and confidence. Their experiences varied over the different phases of the High-Fidelity Perinatal Simulation training. Although uncertainty, tension, confusion and disappointment were experienced throughout the simulation trajectory, they reported that this did not affect their learning and confidence-building. Conclusion As High-Fidelity Perinatal Simulation training constitutes a helpful learning experience in midwifery education, it could have a positive influence on maternal and neonatal outcomes. In the long term, it could therefore enhance the midwifery profession in several ways. The present study is an important first step in opening up the debate about the pedagogical use of High-Fidelity Perinatal Simulation training within midwifery education.

Background: Many low-income and middle-income countries globally are now pursuing ambitious plans for universal primary care, but are failing to deliver adequate care quality because of intractable human resource problems. Aim: To understand why migrant nurses and doctors from sub-Saharan Africa did not wish to take up available posts in primary and first-contact care in their home countries. Design and setting: Qualitative study of migrant health workers to Europe (UK, Belgium, and Austria) or southern Africa (Botswana and South Africa) from sub-Saharan Africa. Method: Semi-structured interviews with 66 health workers (24 nurses and 42 doctors) from 18 countries between July 2011 and April 2012. Transcripts were analysed thematically using a framework approach. Results: The reasons given for choosing not to work in primary care were grouped into three main analytic streams: poor working environment, difficult living experiences, and poor career path. Responders described a lack of basic medicines and equipment, an unmanageable workload, and lack of professional support. Many had concerns about personal security, living conditions (such as education for children), and poor income. Primary care was seen as lower status than hospital medicine, with lack of specialist training opportunities and more exposure to corruption. Conclusions: Clinicians are reluctant to work in the conditions they currently experience in primary care in sub-Saharan Africa and these conditions tend to get worse as poverty and need for primary care increases. This inverse primary care law undermines achievement of universal health coverage. Policy experience from countries outside Africa shows that it is not immutable. ©British Journal of General Practice.

Background: The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI). South African solo general practitioners (GPs) are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI. Objectives: To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs. Methods: This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted. Results: In all, 819 GPs responded (568 solo GPs and 251 GPs in groups). The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million) for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations) to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses) and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies. Conclusions: GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa. Keywords: Capitation, human resource, primary health care, family medicine, South Africa, health systems

Background: The negative consequences of the brain drain of sub-Saharan African health workers for source countries are well documented and include understaffed facilities, decreased standards of care and higher workloads. However, studies suggest that, if migrated health workers eventually return to their home countries, this may lead to beneficial effects following the transfer of their acquired skills and knowledge (brain gain). The present study aims to explore the factors influencing the intentions for return migration of sub-Saharan African health workers who emigrated to Austria and Belgium, and gain further insight into the potential of circular migration. Methods: Semi-structured interviews with 27 sub-Saharan African health workers in Belgium and Austria were conducted. Results: As mentioned by the respondents, the main barriers for returning were family, structural crises in the source country, and insecurity. These barriers overrule the perceived drivers, which were nearly all pull factors and emotion driven. Despite the fact that only a minority plans to return permanently, many wish to return regularly to work in the healthcare sector or to contribute to the development of their source country. Conclusion: As long as safety and structural stability cannot be guaranteed in source countries, the number of return migrants is likely to remain low. National governments and regional organizations could play a role in facilitating the engagement of migrant health workers in the development of the healthcare system in source countries.

Background The Alberta Infant Motor Scales (AIMS) is a reliable and valid assessment tool to evaluate the motor performance from birth to independent walking. This study aimed to determine whether the Canadian reference values on the AIMS from 1990–1992 are still useful tor Flemish infants, assessed in 2007–2010. Additionally, the association between motor performance and sleep and play positioning will be determined. Methods A total of 270 Flemish infants between 0 and 18 months, recruited by formal day care services, were assessed with the AIMS by four trained physiotherapists. Information about sleep and play positioning was collected by mean of a questionnaire. Results Flemish infants perform significantly lower on the AIMS compared with the reference values (P 6 m: P = 0.013). Infants who are placed often to frequently in a sitting device in the first 6 months of life (P = 0.010) and in supine after 6 months (P = 0.001) performed significantly lower than those who are placed less in it. Conclusion Flemish infants recruited by formal day care services, show significantly lower motor scores than the Canadian norm population. New reference values should be established for the AIMS for accurate identification of infants at risk. Prevention of sudden infant death syndrome by promoting supine sleep position should go together with promotion of tummy time when awake and avoiding to spent too much time in sitting devices when awake.

Poor handwriting has been shown to be associated with developmental disorders such as Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, autism, and learning disorders. Handwriting difficulties could lead to academic underachievement and poor self-esteem. Therapeutic intervention has been shown to be effective in treating children with poor handwriting, making early identification critical. The SOS test (Systematic Screening for Handwriting Difficulties) has been developed for this purpose. A child copies a sample of writing within 5 min. Handwriting quality is evaluated using six criteria and writing speed is measured. The Dutch SOS test was administered to 860 Flemish children (7-12 years). Inter- and intrarater reliability was excellent. Test-retest reliability was moderate. A correlation coefficient of 0.70 between SOS and "Concise Assessment Methods of Children Handwriting" test (Dutch version) confirmed convergent validity. The SOS allowed discrimination between typically developing children and children in special education, males and females, and different age groups.

During the last decennia, social capital has been a popular topic in social sciences. However, the concept is often used as a “catch all” for divers social characteristics. Consensus on how the concept should be measured is lacking. This keeps health researchers from drawing firm conclusions on the influence of social capital on health and hampers the decision on which social capital indicators to use in health research. This study compares five ways to operationalise social capital (generalized trust, a social network index, an expanded social network index, bonding, bridging and linking social capital and a multidimensional social capital index) in their ability to explain self-rated health and pain. To evaluate the models’ capacity to explain health, two logistic regression models were built, resulting in Nagelkerke R2 measures. Data were collected in a cross-sectional study in eight neighbourhoods in the region of Ghent (Belgium) by randomly sampling 50 adult inhabitants per neighbourhood. Findings show that the explanation of the observed variance in health by the studied social capital models ranges from 1.9% to 23.1%, but is more pronounced for self-rated health than for pain. The multidimensional social capital index explains most of the variance in health, but poses an important strain on the respondents due to a large number of surveyquestions. With some prudence, we presume that the explanatory added value of the more extended social capital models is rather limited from a practical point of view as the addition in explained variance of the other models seems not in relation to the number of questions needed. Researchers should weigh up the pros and cons of different manners to measure social capital carefully, taking the goals and focus of their study into account.

The single-item question on self-rated health has been widely used in surveys. This study aims to explore which frames of reference are used by respondents when answering this question, to describe differences in the used frame of reference according to gender, educational background and age, and to determine whether subgroup differences can be explained by differences in prior health experiences. Face-to-face interviews were conducted in a sample of 310 adults who were asked to rate their health using a single-item question with closed-ended answering categories and to explain the reasons for the rating they gave with open-ended probes. Different indicators of prior health experiences were taken into account. Physical health problems were the most utilized referents. However, participants also mentioned reasons that go beyond the physical dimension of health. Subgroup differences were found. Prior health experiences partly explained subgroup differences for some referents, but not for others. Investigators using the single question on self-rated health for comparing health across different population groups should be aware that the meaning of the question varies across different socio-demographic groups.

Background Early identification of children with developmental co-ordination disorder is important. Teachers may be very useful in this identification process. The objective of this study was to develop a motor skill checklist (MSC) for 3- to 5-year-old children to be completed by teachers, and to establish the psychometric properties of this new instrument. Methods An MSC of 28 functional items was constructed in close consideration with clinical experts and teachers. In regular schools, 366 pre-school children were rated with the MSC by their teachers (n= 111). To determine test–retest reliability, each teacher completed 4 weeks later the MSC again for one randomly selected child. In 22 classes with two teachers sharing the job, both teachers were asked to fill in the questionnaire. A subgroup of children was also tested with the Movement Assessment Battery for Children (M-ABC; n= 122). All teachers were invited to complete a questionnaire to evaluate the MSC. Results The internal consistency of the MSC was high. The test–retest reliability was good. Inter-rater reliability was adequate except in the 5-year-old children. There was a strong correlation between the checklist and the M-ABC, establishing concurrent validity. Most teachers judged the MSC as easy or rather easy to complete. Conclusions The MSC is a reliable, valid and useful instrument to identify and assess young children with motor difficulties.

Background Children with hearing impairments have a higher risk for deficits in balance and gross motor skills compared with children who are developing typically. As balance is a fundamental ability for the motor development of children, a valid and reliable assessment to identify weaknesses in balance is crucial. Objective The purpose of this study was to investigate the construct validity of posturography and clinical balance tests in children with hearing impairments and in children who are developing typically. Methods The study involved 53 children with typical development and 23 children with hearing impairments who were between 6 and 12 years of age and without neuromotor or orthopedic disorders. All participants completed 3 posturography tests (modified Clinical Test of Sensory Interaction of Balance [mCTSIB], unilateral stance, and tandem stance) and 4 clinical balance tests (one-leg stance with eyes open and with eyes closed, balance beam walking, and one-leg hopping). Results Three conditions of the mCTSIB, unilateral stance, and 2 clinical balance tests were able to distinguish significantly between the 2 groups. Children with hearing impairments showed more difficulties in balance tasks compared with children who were developing typically when 1 or 2 types of sensory information were eliminated or disturbed. The study showed only low to moderate correlations among the different methods of evaluating balance. Conclusions Clinical balance tests and posturography offer different but complementary information. An assessment protocol for balance consisting of posturography and clinical balance tasks is proposed. Static and dynamic balance abilities could not be differentiated and seem not to be a valid dichotomy.

Summary box The 2016 United Nations-led High-Level Commission on Health Employment and Economic Growth found a nine-dollar return to a one-dollar investment in health, with opportunity for gains across several Sustainable Development Goals.1 The Primary Health Care Performance Initiative, launched in 2015 by the Bill and Melinda Gates Foundation, World Bank and WHO, highlighted the need for primary care that provides first contact care that is comprehensive, coordinated, continuous, people-centred and accessible.2 WHO suggests five interdependent strategies to achieve ‘integrated, people-centred health services’, one of which is re-orienting the model of care, with strong primary care-based systems providing continuity and coordination. It highlights family medicine as a mechanism to achieve this.3 There is a move from the traditional model of general practice, defined principally by the individual doctor–patient interaction, towards a population-oriented model of family medicine, which embraces coordinated multidisciplinary teamwork, appropriate referral pathways, integrated hospital-based health services, and empowered and accountable community health care.4–9 This evolution makes it well placed to provide comprehensive, coordinated and continuous, first contact primary health care, which can help achieve universal health coverage in all countries of the world. Africa is expected to be a land of economic opportunity by 2060, with an increasingly sophisticated …

Background The oxygen uptake efficiency slope (OUES) is a newer ventilatory exercise parameter, used in the evaluation of healthy participants and patients with cardiovascular disease. However, few data about the reliability and reproducibility of OUES are available. Our study assessed intratest reliability and test-retest reproducibility of OUES in healthy participants. Design and methods Eighteen participants (age 28 ± 6 years, BMI 22.1 ± 1.9 kg/m2, 10 men) performed two identical maximal exercise tests on a bicycle ergometer. To assess test-retest reproducibility, we performed Bland-Altman analysis and calculated the coefficient of repeatability of the main ventilatory variables. Results OUES remained stable during the second part of the exercise test. Mean values varied 2.4 ± 4.0% between OUES calculated at 70% (OUES70) and at 100% of exercise duration. Mean variation decreased to 1.4 ± 2.3% when OUES was calculated at 90% of exercise duration (OUES90). The Bland-Altman 95% limits of agreement for OUES90 were +3 and –6%, those for OUES70 were +11 and –8%. The coefficient of repeatability for OUES was 597 ml/min or 18.7% of the average value of repeated OUES measurements. These results were similar to those of peak oxygen uptake and minute ventilation/carbon dioxide output. However, the test-retest reproducibility for submaximal-derived values of OUES was lower, as we noted higher coefficients of repeatability for OUES90 and OUES70, increasing up to 27% of the average of repeated values. Conclusion OUES shows excellent intratest reliability and has a test-retest reproducibility that is similar to that of peak oxygen uptake and minute ventilation/carbon dioxide output slope. However, its reproducibility becomes higher when it is calculated from increasing levels of achieved exercise intensity.

Objective: To determine prospectively gait-related risk factors for lower leg overuse injury (LLOI). Design: A prospective cohort study. Setting: Male and female recruits from a start-to-run (STR) programme during a 10-week training period. Participants: 131 healthy subjects (20 men and 111 women), without a history of any lower leg complaint, participated in the study. Interventions: Before the start of the 10-week STR programme, plantar force measurements during running were performed. During STR, lower leg injuries were diagnosed and registered by a sports physician. Main Outcome Measures: Plantar force measurements during running were performed using a footscan pressure plate. Results: During the STR, 27 subjects (five men and 22 women) developed a LLOI. Logistic regression analysis revealed that subjects who developed a LLOI had a significantly more laterally directed force distribution at first metatarsal contact and forefoot flat, a more laterally directed force displacement in the forefoot contact phase, foot flat phase and at heel-off. These subjects also had a delayed change of the centre of force (COF) at forefoot flat, a higher force and loading underneath the lateral border of the foot, and a significantly higher directed force displacement of the COF at forefoot flat. Conclusions: These findings suggest that a less pronated heel strike and a more laterally directed roll-off can be considered as risk factors for LLOI. Clinically, the results of this study can be considered important in identifying individuals at risk of LLOI.