Doctor's Appointment Research Articles

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit

BackgroundMany people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.MethodThroughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs.ResultsIn one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year.ConclusionThis national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

One Day the Emails Will End.

One Day the Emails Will End.

High Rate of Discontinuation May Diminish PrEP Coverage Among Young Men Who Have Sex with Men.

Understanding pre-exposure prophylaxis (PrEP) discontinuation is key to maximizing its effectiveness at the individual and population levels. Data came from the RADAR cohort study of MSM aged 16-29years, 2015-2017. Participants included those who reported past 6-month PrEP use and discontinued its use by the interview date. Of the 197 participants who had used PrEP in the past 6months, 65 discontinued use. Primary reasons for PrEP discontinuation included trouble getting to doctor's appointments (14, 21.5%) and issues related to insurance coverage or loss (13, 20.0%). Few (21%) who discontinued spoke to their doctor first, which has important implications for future long acting formulations.

A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

BackgroundUncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings.MethodsWe enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months.ResultsAt baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury).ConclusionsAmong black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618.)

Navigating the Health Care System: An Adolescent Health Literacy Unit for High Schools

Currently, no intervention concerning transition of health care responsibilities from parents to teens exists for adolescents in the general population. The purpose of this intervention was to evaluate teacher satisfaction and student knowledge gain of a health unit developed for adolescents on becoming their own health care advocates. Throughout the 2014-2015 school year, 13 health and career technical education teachers in 11 Delaware high schools taught the unit to 948 students in 2 90-minute classes in 35 classrooms. Assessments included teacher reflections and student pre- and posttests to measure knowledge transfer and gain and gather feedback. Teacher and student feedback indicated the materials were appropriate and useful in teaching students to navigate the health care system. Student knowledge increased from pretest (64%) to posttest (82%), (p < .001). The educational background of the teacher did not influence this outcome. Students reported they will know what to do better at their next doctor's appointment because of this unit and indicated support for peers to learn this information. The unit resulted in content knowledge increase for students. It was consistently effective throughout all schools regardless of social and demographic characteristics, teacher type, or experience teaching the unit.

Työtapaturmaisten olka- ja polvivammojen hoitotoimenpiteet ja -kustannukset sekä hoidon ja sairauslomien kesto vakuutusyhtiön rekisteriaineistoon perustuen

Polven ja olan alueen vammat ovat tyypillisiä työtapaturmavammoja ja aiheuttavat merkittävän osan työtapaturmavammojen hoitokustannuksista. Tutkimusaineistona käytettiin suomalaisen vakuutusyhtiön keräämää rekisteriaineistoa korvattujen työtapaturmavammojenhoidosta yksityisissä lääkärikeskuksissa vuosilta 2010-2015. Yhteensä 555 (miehiä: 57 %, ikä: 40,9±11,8 vuotta) ICD-10-tautiluokituksen pääluokkaan S83 kuuluvaa polven ja 377 (miehiä: 56 %, ikä: 42,4±12,1 vuotta) pääluokkaan S43 tai S46 kuuluvaa olan alueen vammaa tarkasteltiin tehtyjen hoitotoimenpiteiden, hoitokustannusten, hoidon keston sekä sairauslomien pituuksien suhteen. Lisäksi leikattujen ja/tai kuntoutettujen potilaiden osalta tarkasteltiin suomalaisten hoitosuositusten toteutumista ensisijaisen hoitomuodon sekä leikkausajankohdan suhteen.&#x0D; Polven ja olan alueen vammoista kaksi kolmasosaa aiheutui työpaikkatapaturmissa henkilön kaatuessa, pudotessa tai fyysisesti kuormittuessa ja loput työmatkatapaturmissa jalankulkijan tai pyöräilijän kaatuessa, liukastuessa tai kompastuessa. Suurin osa vammoista oli lieviä: 84 % potilaista hoidettiin tavanomaisilla lääkärinvastaanottokäynneillä ja 54 %:lla potilaista sairausloma oli korkeintaan viikon. Vain 16 % potilaista hoidettiin kuntouttamalla ja/tai leikkauksella, mutta nämä hoidot aiheuttivat 61 % kaikista hoitokustannuksista ja puolilla (51 %) näistä potilaista sairausloma kesti yli 3 kuukautta. Toteutuneessa hoidossa fysioterapeuttista kuntoutusta annettiin ennen leikkaushoitoa neljäsosalle polven ja kolmasosalle olan alueen vammoista. Hoitosuositusten mukaiset leikkausajankohdat toteutuivat aineistossa, kun leikkausajankohdan suositus oli yli 2 kuukautta vammautumisesta. Esimerkiksi 80 % kiertäjäkalvosinvammoista leikattiin hoitosuositusten mukaisesti noin 4 kuukauden kuluessa vammautumisesta, mutta nivelkierukkavammoista vain 5 % leikattiin hoitosuositusten mukaisesti 1-2 viikon kuluessa vammautumisesta.&#x0D; Työtapaturmista aiheutuu vain vähän vakavia polven ja olan alueen vammoja, mutta niiden hoitoon keskittyminen on tärkeää, koska ne aiheuttavat sekä suuria kustannuksia että pitkiä sairauslomia. Ylimääräisten hoitokustannusten ja sairauslomapäivien ehkäisy työtapaturmavammoissa vaatii toisaalta lääketieteellisesti oikeita ja varhaisia diagnooseja sekä optimaalisia hoitokäytäntöjä, mutta myös joustavia ja tapauskohtaisia toimia vakuutusyhtiöltä.

Uber Health To Give Patients A Ride To Doctor's Appointments

Uber Health To Give Patients A Ride To Doctor's Appointments

Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act.

Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.

Biomarker profiling for breast cancer detection: translational research to determine acceptance of a novel breast cancer screening technique

The current study seeks to determine how the psychosocial predictors of the health belief model are related to willingness to adopt biomarker screening practices among women above and below current screening age recommendations, as biomarker profiling can potentially detect cancer much earlier than current breast cancer detection methods. Patients (N = 205) at an Obstetrician/Gynaecology office in a mid-sized Midwest city. Participants completed a survey in the waiting room before their doctor appointment. Results revealed that benefits (p < .001), barriers (p = .02), cancer worry severity (p = .01), and self-efficacy (p = .002) were significant predictors of willingness to adopt biomarker profiling, and susceptibility was marginally related (p = .09). The direct effects are qualified by two interactions between psychosocial predictors of the health belief model and participants’ age. The model predicted willingness to adopt biomarker screening well (R2 = 28%), and may be used successfully as a framework to assess the diffusion of biomarker screening acceptability.

Wild Coast

Wild Coast Holly Beth Pratt (bio) Lizette married Vusi in a small ceremony held on her family's farm when she was six years old. Colonel, Vusi's older brother, officiated, skipping the I do's and instead repeating, You may now kiss the bride, until Lizette and Vusi were done with kissing and, calling their witness—Blommetjie, Lizette's Ridgeback pup—removed their clothes to swim in the algae-scum pond. It was the third time they'd been married that year but neither of them tired of the game. It was practice; they didn't doubt that one day they would be standing up together in a church with real witnesses, rings, and a priest. Already, hidden by the trunks and foliage of the spider gum grove behind the house, Lizette had pulled down her shorts and panties and allowed Vusi to look at her "cookie." When he'd done the same, she'd touched it, saying how like a tiny elephant's trunk it was with its neat creases and wrinkles. They often whispered, I love you, and, lying in the long grass, held hands, letting the warm berg winds sweep over them. ________ Set back against the acacias, away from the main farmhouse, were two wooden huts each with a small kitchen containing a wood-fired stove and a bedroom. An outhouse stood between the two huts, but, since one of the huts had been unoccupied for some years, Luvuyo and Portia now thought of it as their own private bathroom. They'd come to the farm in 1988, answering a need for a general laborer and a maid. They were newly married—Portia, just nineteen, the planes of her body not yet rounded by childbearing, and Luvuyo, thirty-two, his skin rich and dark—and had planned to stay at the farm a short time. They'd hoped to save money and go up to the Wild Coast, asking permission from one of the village chiefs to buy land to make their own small farm, but they'd found the Potgieters—John and Annette—agreeable employers and they'd made friends with Thembi and Linus, the couple who, at the time, occupied the hut next door. What a comfort it had been to Portia, who wasn't from the area, to have Thembi just next door, with whom she could talk and share the cooking of meals. When Portia became pregnant with Colonel, it was a shock to realize that they had been with the Potgieters for five years and that Portia was no longer a teenager. Annette Potgieter bought Portia vitamins and drove her to the hospital for her doctor's appointments, and, when she grew round and cumbersome, Annette had her sit in the house with a book while she did the cleaning. Portia [End Page 9] thought this funny. She would joke with Annette that she was the madam and Annette the maid and she'd issue fake commands—dust the light bulbs, brush the dog's teeth, fluff my pillows—until she and Annette were in tears with laughter. Though Portia and Luvuyo still dreamed of the Wild Coast and their own farm, at night they'd lie in their big, soft bed and whisper how lucky they were to be given such kindness and that, perhaps, it wouldn't hurt to put their plan on hold just a little longer—the Potgieters had been so good to them, it wouldn't be right to leave just yet. On the farm, there'd been a lot of excited talk about the democratic election. It would be the first for all of them, the first in their lifetime. These conversations weren't heated, they didn't doubt that the ANC would win—the ANC has Mandela, Luvuyo had said, and, around the farm, it became a catchphrase—instead they spoke about what would change. We'll see mixed couples on the street, John said. There'll be houses and running water for everyone, Thembi said. Education will be an equalizer again, Annette said. We'll be able to live anywhere, Portia said. We'll be able to go anywhere, Luvuyo said...

MILK CONSUMPTION IN INFANTS UNDER ONE YEAR OF AGE AND VARIABLES ASSOCIATED WITH NON-MATERNAL MILK CONSUMPTION.

ABSTRACTObjective: To verify the type of milk consumed by children under one year of age and identify variables associated with non-maternal milk consumption (formula or cow milk). Methods: Cross-sectional study developed during the 2012 National Vaccination Campaign against Poliomyelitis. The companions of 935 children under one year of age answered a structured questionnaire on the child’s diet in the last 24 hours. The estimates are presented by points, with 95%CI. F-statistics were used to check for differences in the proportion of the types of milk consumption according to the children’s age range (<6 months and 6-11 months) and the association between non-maternal milk consumption and the study variables. Results: The consumption of maternal milk and child formula was higher for children under six months of age - corresponding to 82.8% (95%CI 78.5-86.3) and 70.4% (95%CI 61.4-78.0), respectively -, whereas the consumption of cow milk was higher among children between 6 and 11 months of age - 74.2% (95%CI 66.5-80.6) -, with differences in the consumption proportions (p<0.0001). The variables associated with higher cow milk consumption were lower maternal education (p<0.0001), the fact that the mother does not have a paid occupation (p=0.0015), child doctor’s appointment in the public health network (p<0.0001) and participation in the Child’s Milk Program (p<0.0001).Conclusions: The infants received cow’s milk early (before the first year of life), especially children from families with lower socioeconomic levels and children who took part in a specific social program for milk distribuition.

Selected health behaviours of type 2 diabetes patients

Abstract Introduction. Type 2 diabetes is a chronic disease with an epidemic character. Its prevalence is associated with lifestyle, many environmental factors, and genetic determinants. Implementation of diet therapy is the basis for treatment of the disease. Aim. The aim of the study was to assess health behaviours and differences in these behaviours in type 2 diabetes patients taking their age into consideration. Material and methods. The questionnaire survey was carried out among 120 subjects diagnosed with type 2 diabetes. The original questionnaire comprised questions on selected pro-health behaviours, e.g. prophylactic behaviour or self-monitoring in the disease. The statistical analysis was performed on 111 properly completed surveys. The respondents were divided into three age groups: subjects under 60 (n=24), between 60 and 75 (n=64), and over 75 years old (n=23). Results. Regardless of their age, the patients with type 2 diabetes indicated mainly arteriel hypertension as a coexisting complication. The basic element of patients’ self-monitoring was checking the blood pressure and glycaemia. Half of the patients declared body weight control, however, a majority were characterised by excessive body weight and abdominal fat deposits, irrespective of their age. Walking was the most popular form of physical activity chosen by the respondents. Regardless of their age, the type 2 diabetes patients exhibited similar readiness for self-education related to their disease. Conclusions. The surveyed respondents exhibited similar behaviours undertaken to keep healthy. The increase in the regularity of doctor appointments and in the use of pharmacotherapy was closely related to age of the respondents. The advanced age of the respondents had an impact on the regularity of foot inspection. Respondents over 75 years of age adhered to recommendations on the schedule of food and medicine intake, but used diet therapy less frequently.

Disease and treatment factors associated with lower quality of life scores in adults with multiple endocrine neoplasia type I

Physical and psychosocial morbidity of multiple endocrine neoplasia type-1 is ill-defined. How disease and treatment-related factors relate to patient-reported outcomes including health-related quality of life is unknown. We hypothesized that disease and treatment burden negatively impacts health-related quality of life in adults with multiple endocrine neoplasia type-1. Adults (≥18years) with multiple endocrine neoplasia type-1 completed an online survey of demographics, disease features, treatments, and Patient-Reported Outcomes Measurement Information System 29-item profile measure, and scores were compared with normative US data. Multivariable modeling was performed to evaluate factors associated with decreased health-related quality of life. Multiple endocrine neoplasia type-1 patients (n=207) reported worse health-related quality of life compared with US normative data in all health-related quality of life domains (P<.001). Persistent hypercalcemia after parathyroid surgery was associated with higher levels of anxiety, depression, fatigue, and decreased social functioning (P<.05). Patients <45years of age at diagnosis reported worse physical and social functioning (P<.01). Traveling >50 miles for doctor appointments and ≥20 doctor appointments/year (P<.05) were associated with worse health-related quality of life. History of pancreatic neuroendocrine tumors was not associated with worse health-related quality of life. This is the largest study to assess clinical and treatment factors associated with health-related quality of life in multiple endocrine neoplasia type-1. Persistent hyperparathyroidism, increased travel distance and frequency of doctor appointments were all associated with worse health-related quality of life.

Soziodemografische und gesundheitsbezogene Merkmale der Inanspruchnahme und des Zugangs zu haus- und fachärztlicher Versorgung – Ergebnisse einer deutschlandweiten Bevölkerungsbefragung von 2006 bis 2016

BackgroundThe aim of this paper is to identify systematic differences due to sociodemographic and health-related determinants in outpatient healthcare utilisation and access in Germany for the period from 2006 to 2016. The study focuses on frequent users and those reporting particularly long wait times for their physician appointments, and it contributes to assessing the level of health equity in Germany. MethodsThe investigation draws on nine population surveys conducted by the German National Association of Statutory Health Insurance Physicians (NASHIP), which interviewed 42,925 respondents aged 18 and above. “Frequent users” were operationalised as those respondents who reported more than ten consultations with outpatient general practitioners (GPs) and specialists (SPs) in the preceding twelve months. Respondents who experienced wait times of more than one month for their last doctor appointment were categorised as “very long wait times”. Sociodemographic determinants included age, gender, educational and occupational status, population and region of place of residence, as well as type of health insurance of the respondents. Health-related factors were self-assessed health status and reason for last medical consultation. Statistical analyses were conducted using bivariate and multivariate techniques (logistic regression). ResultsUtilisation: Frequent users of GPs and SPs are predominantly respondents in poor health, retirees and younger persons (18 to 34 years of age). Furthermore, people with a lower educational background consult their GPs significantly more often than people with higher levels of education. Also, patients with statutory health insurance coverage visit GPs more frequently than those having private health insurance, whereas the opposite holds true for SP consultations. Access: Very long wait times for GP and SP appointments were most often experienced by respondents who consult GPs and SPs for preventive medical check-ups or health screenings, have statutory health insurance, live in eastern Germany and who are above 60 years of age. In addition, people with higher levels of education are significantly more likely to experience wait times for SP appointments of more than one month than people with a lower educational background. The proportion of frequent users as well as of those reporting very long wait times for SP appointments has increased in Germany over the period examined. ConclusionThis study reveals that a high frequency of GP and SP consultations is primarily associated with self-assessed poor health, indicating that prioritisation is based on clinical need. In order to ensure the same needs-based prioritisation in the access to outpatient healthcare, regulatory measures are required to decrease wait times of more than one month for SP appointments, with a special focus on people with statutory health insurance coverage, residents of eastern Germany and the elderly.

Andrology on the Internet: Most wanted, controversial and often primary source of information for patients.

The Internet is an important source of health information with relevant impact on the physician-patient relationship. The German urological associations host one of the most comprehensive platforms for patient information on urological diseases. The aim of the study was to characterise its users and their specific needs. We invited users of the website www.urologenportal.de via pop-up to complete a 26-item online survey to evaluate health-related behaviour, distress and decision-making preferences. We received n=551 complete responses. The most frequently requested topics were from the field of andrology (45.4%, n=250). Of these, the most popular topics were circumcision (28.9%, n=159) and erectile dysfunction (18.1%; n=100). Overall, 216 users (39.2%) searched for information prior to their first doctor's appointment, and 89.3% (n=492) preferred autonomous or shared decision-making. Users seeking information on circumcision were less frequently under urological treatment (p<.001), and more self-determined regarding healthcare decisions (p=.01). Circumcision was the only information on the website, which received relevant critical comments. Andrology was the most frequently requested urological topic. The vast majority of patients wanted to take self-determined healthcare decisions and searched for information prior to a doctor's appointment. This might have an impact on the physician-patient relationship and causes a high demand for good-quality health information websites.

Financial crisis and income-related inequalities in the universal provision of a public service: the case of healthcare in Spain

BackgroundThe objective of this paper is to analyse whether the recent recession has altered health care utilisation patterns of different income groups in Spain.MethodsBased on information concerning individuals ‘income and health care use, along with health need indicators and demographic characteristics (provided by the Spanish National Health Surveys from 2006/07 and 2011/12), econometric models are estimated in two parts (mixed logistic regressions and truncated negative binominal regressions) for each of the public health services studied (family doctor appointments, appointments with specialists, hospitalisations, emergencies and prescription drug use).ResultsThe results show that the principle of universal access to public health provision does not in fact prevent a financial crisis from affecting certain income groups more than others in their utilisation of public health services.ConclusionsSpecifically, in relative terms the recession has been more detrimental to low-income groups in the cases of specialist appointments and hospitalisations, whereas it has worked to their advantage in the cases of emergency services and family doctor appointments.

A better model of care after surgery for early endometrial cancer - Comprehensive needs assessment and clinical handover to a woman's general practitioner.

Endometrial cancer is the most common invasive gynaecological cancer in Australia. Despite the fact that review after treatment of early endometrial cancer has not been shown to detect recurrent disease, practice at several hospitals brings women back for specialist hospital review for 5years after definitive cancer surgery. Implement an improved model of follow-up care following hospital treatment for early endometrial cancer. Quantitative and qualitative. Seventy-three of the eligible 81 women undertook the model of care. All general practitioners (GPs) agreed to follow-up care. Thirty-one women (42%) and 37 GPs (51%) returned surveys. All women found the nurse consultation very useful or useful with 77% reporting making lifestyle changes and 87% found the GP consultation very useful or useful with 72% reporting making lifestyle changes. Eighty-nine percent of GPs found the care plan useful, 94% set up patient recall systems, 79% used the care plan to develop their own care plan, 100% felt confident in providing follow-up care with 91% reporting the care plan and hospital processes improved their confidence. Comparison with the pre-cohort women showed: higher rates of communication at various care points to GPs (from P<0.001); more referrals (P<0.001); and a projected decrease of nine hospital doctor appointments per patient. With an increasing number of people surviving cancer, in order to address holistic health needs and maintain tertiary service capacity, general practice will be required to provide more follow-up care. Our model demonstrates an acceptable and quality mechanism for this to occur.

The provision of medical care in English professional football: An update.

To compare the current methods of appointment, qualifications and occupational experience of club doctors and physiotherapists in English professional football with (i) those outlined in a study published in 1999, and (ii) Football Association (FA) medical regulations. Qualitative. Postal questionnaire survey of (head) doctors and physiotherapists at each of the clubs in the English Premiership, Championship and Football Leagues 1 and 2. Response rates of 35.8% and 45.6% respectively were obtained. The majority of football club doctors are GPs who have sports medicine qualifications and relevant occupational experience. Time commitments vary from full time to a few hours per week. Most are appointed through personal contacts rather than job advertisements and/or interview. Almost all football clubs have a chartered physiotherapist, many of whom have a postgraduate qualification. They work full time and long hours. Most are appointed through personal contacts rather than job advertisements. They are frequently interviewed but not always by someone qualified to judge their professional expertise. Football club medical provision has become more extensive and increasingly professional over the last 10-20years, with better qualified, more career-oriented and more formally contracted staff. It is likely that clinical autonomy has subsequently increased. However recruitment procedures still need to be improved, especially in relation to advertising vacancies, interviewing candidates, and including medical personnel on interview panels. In two aspects clubs appear not to be compliant with current FA medical regulations.

Expressive social support buffers the impact of care-related work interruptions on caregivers’ depressive symptoms

ABSTRACTObjective: To assess if expressive and instrumental social support from family and friends moderate the association of care-related work interruptions (e.g. leaving work for the older adult's doctor appointment) with depressive symptoms among working family caregivers of older adults.Methods: Data were from the Singapore Survey on Informal Caregiving (SSIC). A subsample of 662 dyads, each comprising an older care-recipient [home-dwelling Singaporean aged 75 and older receiving human assistance for at least one activity of daily living (ADL)] and his/her working family caregiver, was analysed. Caregiver depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Care-related work interruptions were scaled through the Mokken scaling procedure. Expressive social support was assessed using a scale by Pearlin and co-workers. Instrumental social support was based on the hours of ADL help provided to the care-recipient by any family member or friend, on behalf of the primary caregiver. A linear regression model, with interaction terms, assessed expressive and instrumental social support as moderators of the association of care-related work interruptions with caregiver depressive symptoms.Results: More care-related work interruptions were associated with more caregiver depressive symptoms. And, this association was moderated by expressive, but not instrumental, social support.Conclusion: Our findings conform to previous qualitative work suggesting that caregivers’ mental health may not benefit from instrumental support, but from receiving expressive support instead. Initiatives for improving the care experience of working caregivers of older adults should focus on promoting expressive support from their friends and family.

Qualitative research of the team building of rural doctors in Beijing under different views

Objective To learn from various view points the team building of rural doctors in Beijing. Methods 84 village officials, rural doctors and villagers were enrolled from three townships in district H of Beijing, for an interview to learn the makeup and selection approach of rural doctors, and their recommendations on team building of these doctors. Results 76.19% of the interviewees prefer their own villagers as candidates for their rural doctor.Top three factors for their retention were their medical competence, geo-relations, and service attitude; 60.71% of the interviewees held that the village committee should be the decision maker for appointment of rural doctors; in terms of team building, senior doctors emphasize retirement conditions, while new ones prefer training opportunities. Conclusions The topmost criterion for rural doctor candidates should be their medical competence, instead of sacrificing this criterion for geo-relations.The village committee and the villagers′ congress should play a greater role of supervision and management of the rural doctors.Targeted incentives are recommended for the rural doctors in view of their retention. Key words: Beijing; Rural doctors; Team building; Qualitative research