International Health Professionals Research Articles

Is abstinence really the best option? Exploring the role of exercise in the treatment and management of eating disorders

ABSTRACTExercise prescription is suggested to help manage exercise abuse and improve overall eating disorder (ED) prognosis. This study explored emerging perceptions of ED health professionals concerning the role of exercise as a supportive treatment for EDs. Semi-structured interviews were conducted with international health professionals (n=13) with expertise in ED treatment. Verbatim transcripts were analyzed through thematic analysis. Four themes were revealed and titled 1) understanding the current state; 2) gaining perspectives; 3) barriers and benefits; 4) one size does not fit all. Within these themes, participants described the current state of exercise in ED treatment and suggested there exists a gap in research knowledge and practice. Participants also identified the implications of incorporating exercise into treatment and how an exercise protocol may be designed. Results enhance the understanding of the role of exercise in ED treatment and how it may further benefit individuals with EDs.

Survey on International Health Professional Training and Attitudes on Sexuality After Traumatic Brain Injury

Traumatic brain injury (TBI) is associated with a range of deficits that may negatively impact sexuality. Few studies have explored how professionals respond to sexuality issues among individuals with TBI. The present study aimed to examine the attitudes and level of training of international health professionals working with individuals with TBI and whether guidelines exist in their work settings related to sexual issues. A survey composed of 53 questions was developed to evaluate attitudes, professional training, and assessment related to sexuality among health professionals working with individuals with TBI. The sample consisted of 324 self-identified health care professionals. During their training, 83% of professionals reported not taking any specific courses, and 61% reported not taking any type of clinical practice related to sexuality issues after TBI. Approximately 70% reported knowing little information about sexuality issues related to TBI and believed it affected the way in which they address the topic with their patients. Professionals believed sexual expression among both cognitively intact (100%) and cognitively impaired (90%) patients was healthy. Sixty-nine percent reported their work setting had no guidelines to determine if an individual with TBI can consent to sexual activity or not. Sixty-six percent of professionals believed that a patient with severe TBI could consent to sexual activities; however 58% believed it is not their responsibility to determine that. Results demonstrated a need for enhanced educational curriculums with specific courses related to sexuality after TBI. Furthermore, institutions should develop guidelines for the assessment of capacity to consent to sexual activity.

A Natural Response to a Natural Disaster: The Art of Crisis in Nepal (Une réponse naturelle à une catastrophe naturelle : art de crise au Népal)

ABSTRACTThis article explores the implementation and use of art therapy in the context of emergency and immediate post-emergency phases after a natural disaster. Skill sharing and support sessions were delivered to national and international mental health and well-being professionals living in Nepal both during and immediately after the devastating earthquakes in 2015. A range of sessions for children were offered within United Nations humanitarian disaster relief agencies, Child Friendly Spaces and other community-led initiatives. Through consultation with the local community, natural materials were incorporated into the therapeutic response to this natural disaster. There was an interest in whether working with natural media would support recovery and resilience, particularly through regaining control and reconnecting with the earth, the place we naturally call home. Potential benefits are discussed, drawing on wider art therapy literature and contemporary literature around working with the arts outdoors and working with natural media.

An experience in training international health professionals in people-centred care: the imperative of bridging health and social perspectives

Introduction/Problem statement: Providing quality health care remains a challenge in many low and middle-income countries. The challenges are two-fold: quality of care is often narrowly defined in biomedical terms or technical effectiveness and, health care delivery systems are fragmented in poorly connected subsystems such as preventive and curative care, primary care and disease control programs, health and social care. Additionally, health care providers, health managers and policy makers are mostly trained within a biomedical health framework and often lack experience with people-centred and integrated care.Description /Aim of the intervention: The Institute of Tropical Medicine in Antwerp, Belgium, attempts to address this training gap in its international one-year Master in Public Health programme (1). Every year about forty experienced health professionals from Africa, Asia, Latin America and Europe are taught concepts and models pertaining to the analysis, planning, organization and evaluation of local health systems and their interactions with social services in the four-week course component on “Local Health Systems”. This course endorses people-centred and integrated health and social care as cornerstones of quality health care and aims to enable its participants to understand the strengths and weaknesses of dominant biomedical paradigms and to develop a more holistic vision on health care. Students are expected to use comprehensive models for the analysis of (local) health systems and the organization of health services.To reach these learning outcomes the course uses methods for adult learning that emphasize a participatory approach. The diversity of the participants, in terms of professional experience and academic background, constitutes a unique and rich opportunity for meaningful exchanges and experiential learning. The concepts and models on people-centred and integrated health and social care are taught through different learning activities such as interactive lectures, critical reading of scientific papers and real life case studies introduced by a Belgian general practitioner. In parallel, students are coached in a personal assignment in which they analyse the quality of health care in a local health system in their own or a known context. In this application participants are expected to gain further insights and develop a set of analytical skills from the exchange with their peers, coaches and lecturers.Beyond classroom learning, participants are also given the chance to observe the process of people-centred care in first-line health services and to interview key stakeholders such as doctors, nurses, social workers and psychologists in various Belgian municipalities. This study visit also includes the Public Centres of Social Welfare and other frontline social services. The objective of the visit is to illustrate the complementarity of the health and social sub-sectors in ensuring global and integrated health care. Participants are made aware of the need to go beyond exclusive biomedical answers to adequately address the problems people present with at general practice level.The participants are assessed in several activities: first, they present and discuss their personal analysis of a known local health system with peers and staff; after the study visits they share their analysis of the quality of care and the contribution of the social welfare system to people-centred health system; and finally the participants identify lessons from the Belgian situation that are relevant to their own local health systems and share these reflections in individual blogs. The presentations in the seminars and the blog writing exercise facilitate meaningful interactions amongst participants whilst enhancing their communication skills.Findings/Highlights: Following the training, most participants understand the comprehensive and systemic characteristics of people-centred and integrated health care; as well as the importance of including the social sector when organizing health services at local level. Interesting statements obtained from feedback sessions and blogs are: _“ I experienced a shift in the way I think about the organization of health services to provide quality health care”_,“From the site visit […] I think there are four important elements that promote PCC (people-centred care): sufficient time, qualified personnel, privacy and looking beyond the bio-medical aspects (e.g. social security issues and system barriers) of a patient’s suffering ….”Conclusions: Adequate public health training that broadens the vision on quality of care and allows the development of comprehensive analytical skills can contribute reducing barriers to implementing people-centred and integrated health care. Although the findings obtained during this course are useful, more research is required to define the most desirable skills mix that public health professionals and caregivers should possess.

Clinical and health promotion asthma management: an intervention for children and adolescents.

Asthma is the leading chronic condition among children. Given this international burden, clinicians and public health professionals applied the Expanded Chronic Care Model to address health adversities of pediatric patients with asthma. This study examined the influence of a clinical health promotion initiative on asthma control and appropriate medication management among pediatric patients. Patients (n = 304) were recruited and screened for participation in this study. All the patients participated in a motivational interview, received clinical care, and were monitored longitudinally. Eligible patients (n = 53) were referred to one or more intervention pathways regarding physical activity, nutrition, smoking cessation, and psychosocial wellness. A comparison group (n = 90) was eligible for an intervention but chose not to participate. This analysis focused on patients who were identified as needing a health intervention beyond asthma clinical care. Among patients who were invited to participate in the health promotion pathways, significant decreases in asthma exacerbation were achieved by the patients who participated in the intervention compared with those who did not participate (p = 0.018). Significant improvements in asthma exacerbation, activity limitations, and asthma control were attributed to the time in clinical care (p < 0.001). In this group, asthma control significantly improved with medication (p = 0.002), and age was associated with a significant decrease in asthma exacerbation (p = 0.011). This pilot study demonstrated preliminary benefits in a child asthma population. In addition, this experience addressed the chronicity of pediatric asthma through patient-centered care.

Australian nursing and midwifery educators delivering evidence-based education in Tanzania: A qualitative study

Since 2011, Western Australian nursing and midwifery educators have been providing evidence-based continuing education to Tanzanian health professionals. Despite thorough preparation before departure, differences in local resource levels and available facilities have necessitated impromptu adaptation of curriculum content and delivery methods to ensure an effective program was delivered.This study explored the personal, cultural and teaching strategies utilised by Western Australian nursing and midwifery educators in Tanzania and examined if the transferability of education packages was influenced by the educators' cultural competence. Using a qualitative exploratory approach, data was collected from 15 Western Australian nursing and midwifery educators using a demographic survey and in-depth individual semi-structured interviews. The core themes identified from the analysis were Determination to learn, Assessing needs, Communication skills and Greater understanding. These findings are described using the conceptual framework of Campinha–Bacote's The Process of Cultural Competence in the Delivery of Healthcare Services.With appropriate levels of cultural competence, international health professionals can be effective at providing ongoing professional development to colleagues in developing country contexts, which may help address difficulties with retention and motivation of staff. It is essential that prior to departure cultural competence training is provided to educators to enhance their teaching capacity and effectiveness in international settings.

Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders

As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.

P03.21 Be safe. stay well: four videos to educate international students on sexual health and staying safe in australia

<h3>Background</h3> In recent years there has been a considerable growth in the international student population in Australia driven primarily by university study and vocational training. Studying and living in a new country can bring a range of social challenges, and international students have shown to have limited understanding on sexual health within an Australian context. Following consultation and focus testing with international students and health professionals, the Sexual Health and Blood-borne Virus Program (SHBBVP) have developed a collection of videos titled “Be Safe Stay Well” aimed at providing students with an understanding of sexual health and the health care system in WA. <h3>Methods</h3> Three focus groups were conducted with a total of 36 international students representing 22 different countries. Students reported wanting to know more about sexual health, safe sex and STIs. It was identified that having a resource providing sexual health information would be useful for the target group. In collaboration with the WA Department of Health’s Communications Directorate and an external production company, the four videos titled “Be Safe. Stay Well” were developed. <h3>Results</h3> The videos use animation and kinetic typography to appeal to an international audience whose first language is not usually English. They have been spoken by young people from a range of countries to ensure authenticity. Videos topics include: The importance of safe sex, Discussing STIs, Health service costs, and Sex and the law. <h3>Conclusion</h3> The videos were promoted and have been well received by a number of tertiary education institutes, youth and student organisations and sexual health agencies. The videos were promoted via social media, through relevant websites, newsletters and distributing promotional cards and posters. Conclusions on the effectiveness of the videos will be discussed once preliminary evaluation data is obtained from Google Analytics and the target audience. <h3>Disclosure of interest statement</h3> This paper is supported and funded by the WA Department of Health.

The consequences of English language testing for international health professionals and students: An Australian case study

AimTo discuss the perceptions about the International English Language Testing System (IELTS) and its impact on migration and practice of migrant health professionals in Australia. MethodsThematic analysis of interviews with 14 health industry participants and 35 migrated health professionals in Australia. Results and discussionLanguage testing is a barrier to health professional registration for migrant health workers in Australia. While two English language tests are recognised by the registration authorities in Australia, it is the International English Language Testing System that is most commonly used. This paper reports that study participants had underlying negative perceptions of the International English Language Testing System which they report, affect their move to Australia.These negative perceptions are caused by: frustration due to changes to processes for migration and registration; challenges regarding the structure of IELTS including timing of when test results expire, scoring requirements, cost, and suitability; and the resulting feelings of inadequacy caused by the test itself. ConclusionThis study has shown that some respondents have experienced difficulties in relation to the International English Language Testing System as part of their migration process. It was found that there is very little research into the effectiveness of the IELTS as it is currently administered for overseas health care professionals. Several recommendations are provided including areas for further research.

Mineral composition of commonly consumed local foods in Nigeria

Virtually all biochemical processes in the body require dietary micro‐nutrients and imbalance in any of these essential of the diet have the potential to impair metabolic activities. Deficiencies of several mineral nutrients result in stunting, down‐regulated immune responsiveness and altered metabolic activities. Appropriate dietary intake of these mineral nutrients is currently recommended as part of a lifestyle intervention for the prevention of many metabolism‐related health problems including obesity, high cholesterol and insulin resistance. The present study was designed to analyse the mineral composition of local dishes that are widely consumed in Nigeria given the lack of such data. A list of local foods commonly consumed in Nigeria was generated; composite samples prepared from primary sample collected were analysed for dietary minerals using harmonized standard procedures. A set of new data on the Na, K, Ca, P, Mg, Mn, Cl, Fe, Cl and Zn contents of 25 local dishes were generated for the first time in this study. Overall, there were large variations in the mineral contents of the dishes analysed, ranging from 6.3 mg/kg (Jollof rice) to 22.2 mg/kg (Yam pottage with beans) for Fe; 5.0 mg/kg (Yam with omelette) to 21.6 mg/kg (Eba with Okro soup) for Na; 7.30 mg/kg (Pounded yam with Egusi) to 19.8 mg/kg (Vegetable soup) for Ca; and 2.2 mg/kg (Yam with omelette) to 6.99 mg/kg (Eba with Okazi soup) for Mn. These data will serve as an important resource in future national and international food composition surveys, inform clinicians, health professionals and dieticians to target provision of dietary advice towards the prevention of non‐communicable metabolic diseases due to critical mineral imbalances.

Capacity-building in the management of moderate acute malnutrition.

Evidence from low- and middle-income countries indicates that although there is a willingness to prevent and treat malnutrition at scale, there is very limited capacity to achieve this. Three broad areas of concern are human resources and the quality of services; management systems and supplies; and demand side factors. This paper focuses on building human resources in the context of preventing and managing malnutrition. Training should provide several options and approaches suitable for different settings and focus on core competencies. Preservice training should be the main focus of training, while in-service training should be used for continuing medical education and refresher training. Communities of Practice, in which national and international health professionals come together to deepen their knowledge and pool their skills to pursue a common ambition, are seen as one way forward to building the necessary human resources for scaling up training.

Examining Functioning and Contextual Factors in Individuals with Joint Contractures from the Health Professional Perspective Using the ICF: An International Internet-Based Qualitative Expert Survey.

The aim of this study was to identify disease-related aspects of functioning and disability in people with joint contractures from a health professionals' perspective and to describe the findings, using categories of the International Classification of Functioning, Disability, and Health (ICF). An Internet-based expert survey. We asked international health professionals for typical problems in functioning and important contextual factors of individuals with joint contractures using an Internet-based open-ended questionnaire. All answers were linked to the ICF according to established rules. Absolute and relative frequencies of the linked ICF categories were reported. Eighty experts named 1785 meaning units which could be linked to 256 ICF categories. Among the categories, 24.2% belonged to the component Body Functions, 20.7% to Body Structures, 36.3% to Activities and Participation, and 18.8% to Environmental Factors. Health professionals addressed a large variety of functional problems and multifaceted aspects due to the symptom joint contractures. International health professionals reported a large variety of aspects of functioning and health, which are related to joint contractures.

Recruiting post-doctoral fellows into global health research: selecting NIH Fogarty International Clinical Research Fellows.

From 2008 to 2012, the National Institutes of Health (NIH) Fogarty International Clinical Research Fellows Program (FICRF) provided 1-year mentored research training at low- and middle-income country sites for American and international post-doctoral health professionals. We examined the FICRF applicant pool, proposed research topics, selection process, and characteristics of enrollees to assess trends in global health research interest and factors associated with applicant competitiveness. The majority (58%) of 67 US and 57 international Fellows were women, and 83% of Fellows had medical degrees. Most applicants were in clinical fellowships (41%) or residencies (24%). More applicants proposing infectious disease projects were supported (59%) than applicants proposing non-communicable disease (NCD) projects (41%), although projects that combined both topic areas were most successful (69%). The numbers of applicants proposing research on NCDs and the numbers of these applicants awarded fellowships rose dramatically over time. Funding provided to the FICRF varied significantly among NIH Institutes and Centers and was strongly associated with the research topics awarded.

First Responders: An International Workshop on Collecting and Analyzing Evidence of International Crimes

This report presents major points of discussion and recommendations from an international conference held in September 2014 in Salzburg, Austria. Workshop participants discussed how local and international NGOs, journalists, forensic scientists, health professionals, and other “first responders” to war crimes and human violations can most effectively work with courts — and the International Criminal Court (ICC) in particular — in the collection of evidence of serious war crimes, such as genocide and crimes against humanity.

Foreign–trained medical professionals: Wanted or not? A case study of Canada

Foreign–trained medical professionals: Wanted or not? A case study of Canada

Program evaluation of a model to integrate internationally educated health professionals into clinical practice

BackgroundThe demand for health professionals continues to increase, partially due to the aging population and the high proportion of practitioners nearing retirement. The University of British Columbia (UBC) has developed a program to address this demand, by providing support for internationally trained Physiotherapists in their preparation for taking the National Physiotherapy competency examinations.The aim was to create a program comprised of the educational tools and infrastructure to support internationally educated physiotherapists (IEPs) in their preparation for entry to practice in Canada and, to improve their pass rate on the national competency examination.MethodsThe program was developed using a logic model and evaluated using program evaluation methodology. Program tools and resources included educational modules and curricular packages which were developed and refined based on feedback from clinical experts, IEPs and clinical physical therapy mentors. An examination bank was created and used to include test-enhanced education. Clinical mentors were recruited and trained to provide clinical and cultural support for participants.ResultsThe IEP program has recruited 124 IEPs, with 69 now integrated into the Canadian physiotherapy workforce, and more IEPs continuing to apply to the program. International graduates who participated in the program had an improved pass rate on the national Physiotherapy Competency Examination (PCE); participation in the program resulted in them having a 28% (95% CI, 2% to 59%) greater possibility of passing the written section than their counterparts who did not take the program. In 2010, 81% of all IEP candidates who completed the UBC program passed the written component, and 82% passed the clinical component.ConclusionThe program has proven to be successful and sustainable. This program model could be replicated to support the successful integration of other international health professionals into the workforce.

Introduction to Journal of Nursing and Human Sciences

Introduction to Journal of Nursing and Human Sciences

Health professionals’ perceptions about the adoption of existing guidelines for the diagnosis of fetal alcohol spectrum disorders in Australia

BackgroundDespite the availability of five guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD), there is no national endorsement for their use in diagnosis in Australia. In this study we aimed to describe health professionals’ perceptions about the adoption of existing guidelines for the diagnosis of FASD in Australia and identify implications for the development of national guidelines.MethodsWe surveyed 130 Australian and 9 international health professionals with expertise or involvement in the screening or diagnosis of FASD. An online questionnaire was used to evaluate participants’ familiarity with and use of five existing diagnostic guidelines for FASD, and to assess their perceptions about the adoption of these guidelines in Australia.ResultsOf the 139 participants surveyed, 84 Australian and 8 international health professionals (66.2%) responded to the questions on existing diagnostic guidelines. Participants most frequently reported using the University of Washington 4-Digit Diagnostic Code (27.2%) and the Canadian guidelines (18.5%) for diagnosis. These two guidelines were also most frequently recommended for adoption in Australia: 32.5% of the 40 participants who were familiar with the University of Washington 4-Digit Diagnostic Code recommended adoption of this guideline in Australia, and 30.8% of the 26 participants who were familiar with the Canadian guidelines recommended adoption of this guideline in Australia. However, for the majority of guidelines examined, most participants were unsure whether they should be adopted in Australia. The adoption of existing guidelines in Australia was perceived to be limited by: their lack of evidence base, including the appropriateness of established reference standards for the Australian population; their complexity; the need for training and support to use the guidelines; and the lack of an interdisciplinary and interagency model to support service delivery in Australia.ConclusionsParticipants indicated some support for the adoption of the University of Washington or Canadian guidelines for FASD diagnosis; however, concerns were raised about the adoption of these diagnostic guidelines in their current form. Australian diagnostic guidelines will require evaluation to establish their validity in the Australian context, and a comprehensive implementation model is needed to facilitate improved diagnostic capacity in Australia.

Impacto del mercurio sobre la salud humana y el ambiente

Mercury (Hg) is currently considered a global pollutant. Mercury is a significant environmental toxin and has a huge impact on human health, causing irreversible damage to the central nervous system, especially in the most vulnerable stages of life. Medical centers contribute to 4-5% of the total mercury present in drainage waters. Practices should be introduced to reduce mercury use with the aim of complete elimination. International entities, governments, non-governmental organizations, and health professionals should support all measures taken to achieve this goal.

The Social Life of Psychiatric Practice: Trauma in Postwar Kosova

This article traces the social life of psychiatric practice in the context of war and postwar societies. It is argued that although psychiatric knowledge and practice is situated and grounded in particular cultural, social, and political contexts, it is important to examine how transnational networks situate local systems of meaning in much larger settings. I illustrate this claim by examining discourses and observations concerning health-seeking behaviors of Kosovar Albanian women and ways in which Kosovar health practitioners help them by employing, adapting, and changing the psychiatric tools and lessons learned during (trauma) training provided by international health professionals during the Yugoslav war and postwar eras. Thereby, I hope to contribute to a better understanding of how local health beliefs and practices are nested in the processes involved in international health policymaking and, thereby, relate to higher level structures such as international political economy, regional history, and development ideology.