General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Parker Magin ◽  
Georga Cooke ◽  
Amanda Tapley ◽  
Susan Wearne ◽  
Elizabeth Holliday ◽  
...  
Keyword(s):  
Information Seeking ◽  
Multivariable Analysis ◽  
Functional Adaptation ◽  
Hard Copy ◽  
Cross Sectional ◽  
Clinical Supervisors ◽  
Logistic Regression Models ◽  
Clinical Uncertainty ◽  
Clinical Encounters

Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding diagnosis/management’ (OR 1.03; 95% confidence intervals [CIs] [1.01, 1.05], p = 0.003) and ‘concern about a bad outcome’ (OR 1.03; 95% CIs [1.01, 1.06], p = 0.008) were significantly associated with seeking supervisor assistance. There was no association with ‘behavioural’ subscales ‘reluctance to disclose uncertainty to patients’ and ‘reluctance to disclose mistakes to physicians’.None of the PRU subscales were significantly associated with information-seeking from electronic or hard copy sources.Research implications: Further research is required to explore the role of uncertainty within registrar–supervisor interactions and to define the role of supervisors in registrars’ functional adaptation to clinical uncertainty (including how best to support and train supervisors in this role).Practical implications: GP registrars’ ‘affective’ responses to clinical uncertainty are associated with assistance-seeking from clinical supervisors. While in-consultation assistance-seeking may promote registrars’ tolerance of uncertainty, it may also contribute to supervisor workload.Originality/value: This is the first study to examine trainees’ levels of uncertainty and their seeking of information and assistance.Limitations: We have not investigated whether registrars’ seeking assistance resolved or attenuated, for the index problem, their anxiety or concern.

scholarly journals The role of physician assistants in pediatric emergency medicine: the physician's view

CJEM ◽  
2013 ◽  
Vol 15 (06) ◽  
pp. 321-329 ◽  
Author(s):  
Quynh Doan ◽  
Shalea Piteau ◽  
Sam Sheps ◽  
Joel Singer ◽  
Hubert Wong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Work ◽  
Physician Assistants ◽  
Pediatric Emergency ◽  
Cross Sectional ◽  
Survey Tool ◽  
Clinical Encounters ◽  
Clinical Conditions ◽  
Selection Of

ABSTRACTObjective:To define the range of clinical conditions Canadian emergency pediatricians consider appropriate formanagement by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).Methods:We conducted a cross–sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N = 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions.Results:Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had ≥ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7–89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5–91.5% v. 82.2–84.7%).Conclusion:This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician.

scholarly journals Consumption of ultra-processed foods is associated with abdominal obesity in rotating shift workers

2021 ◽  
Author(s):  
Luiz Antônio Alves de Menezes Júnior ◽  
Virgínia Capistrano Fajardo ◽  
Jonathas Assis de Oliveira ◽  
George Luiz Lins Machado-Coelho ◽  
Fausto Aloísio Pedrosa Pimenta ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Multivariable Analysis ◽  
Saturated Fat ◽  
Cross Sectional Study ◽  
Processed Foods ◽  
Cross Sectional ◽  
Shift Workers ◽  
Logistic Regression Models ◽  
Body Adiposity ◽  
Increased Risk

Abstract Background and aims: Higher intake of ultra-processed foods might be associated with an increased risk of obesity. Our objective was to evaluate the consumption of ultra-processed foods and their association with nutrient intake and excess body adiposity in shift workers.Design: Cross-sectional study conducted in 2016 with 238 male rotating shift workers. Dietary data is obtained by the 24-hour recall and classified according to processing by the NOVA classification system. Body adiposity indicators assessed were waist circumference and body mass index. Logistic regression models were built and adjusted for sociodemographic, lifestyle, and dietary variables.Results: Ultra-processed foods represented on average 22.3% of the total caloric value of the individuals' food consumption, with a maximum value of 66.9%. Participants with the highest tercile of ultra-processed foods consumed more carbohydrate (57%), protein (35%), total fat (96%), saturated fat (79%), cholesterol (68%), and sodium (44%) intake compared to the first tercile (p < 0.001). The most frequencies of ultra-processed foods consumed were bread (81.0%), followed by cookies (45.9%), sweetened beverages (45.7%), processed meats (46.8%), and margarine (46.8%). In multivariable analysis, the highest consumption of ultra-processed foods had 183% higher odds of abdominal obesity (OR = 2.83, 95%CI 1.29-6.22), compared with the lowest consumption. Conclusion: Ultra-processed foods are important contributors to the energy intake of these workers, and higher consumption of ultra-processed foods was associated with abdominal obesity.

scholarly journals Digital health literacy and online information queries in Portuguese university students

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
R Rosário ◽  
C Augusto ◽  
MJ Silva ◽  
S Martins ◽  
A Duarte ◽  
...  
Keyword(s):  
Public Health ◽  
Health Literacy ◽  
University Students ◽  
Information Seeking ◽  
Online Survey ◽  
Digital Health ◽  
Cross Sectional Study ◽  
Online Information ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Background Worldwide there is an overwhelming amount of information about COVID-19 circulating online, also named infodemic. Misinformation (the unintentional) and disinformation (the intentional) spreading of false information have proven to be very dangerous to public health. Hence, more than ever, people need skills for searching, evaluating and integrating information related to health in daily life, i.e., health literacy. Until now, little is known about the digital health literacy of university students and their information-seeking behaviour. Hence, this study aimed to analyse the associations between university students' digital health literacy and online information queries during the beginning of the COVID-19 pandemic (and infodemic) in Portugal. Methods A cross-sectional study of 3.084 Portuguese university students (75.7% females), with an average age of 24.2 (SD = 7.5), was conducted using an online survey. We used sociodemographic data (sex, age, subjective social status) and the digital health literacy questionnaire adapted to the specific COVID-19 context. Online information queries included the topics related to SARS-CoV-2 and COVID-19 searched by students. Logistic regression models were performed. Results Online information queries (e.g., individual measures to protect against infection, current spread of the virus, current situation assessments and recommendations) were associated with an increased odds of achieving sufficient digital health literacy. Conclusions Online information queries related to epidemiological and public health topics are significantly associated with digital health literacy in times of COVID-19. Further studies are needed, including programs that improve digital health literacy among university students and increase the availability of high-quality content information.

scholarly journals Gender Inequalities in the Health of Immigrants and Workplace Discrimination in Czechia

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Dagmar Dzúrová ◽  
Dušan Drbohlav
Keyword(s):  
Binary Logistic Regression ◽  
Workplace Discrimination ◽  
Gender Inequalities ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Interview Survey ◽  
Cross Sectional Design ◽  
Using Data ◽  
Fair Poor

This study analyses the relationship between immigrants’ self-reported/rated health (SRH) and their perceived working conditions in Czechia materialized via discrimination, based on the example of Ukrainian immigrants analyzed by gender dimension. The role of age, education, and marital status is also analyzed. A sample of native-born Czechs serves as a reference frame. A cross-sectional design was applied. Using data from two surveys of Ukrainian immigrants in Czechia and a countrywide health interview survey for Czechs, we analyse inequalities in SRH and workplace discrimination loads. Four binary logistic regression models were computed separately for women and men from Ukraine and Czechia to identify the determinants of fair/poor SRH. We found that only Ukrainian immigrant females were heavily exposed to all four measured types of workplace discrimination, thereby modifying and worsening the quality of their SRH. Determinants which are behind respondents’ SRH differ between Ukrainian immigrants vis-à-vis Czechs with one exception. The “oldest age group” (41–62) contributes to poorer assessment of SRH among Ukrainian females, Czech females, and Czech males too. The lowest educational level (primary education) correlates with poor SRH within the sample of Czech males.

scholarly journals Job Satisfaction Among Employees After a Merger: A Cross-Sectional Survey in the Local Health Unit of Sardinia Region, Italy

2021 ◽  
Vol 9 ◽  
Author(s):  
Claudia Isonne ◽  
Angelo Nardi ◽  
Pasquale de Soccio ◽  
Alessandro Zerbetto ◽  
Monica Giffi ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Multivariable Analysis ◽  
Local Health ◽  
Health Unit ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Local Health Unit ◽  
Logistic Regression Models ◽  
Organization And Management ◽  
The Impact

Job satisfaction plays an important role in healthcare organization and management; it is critical for maintaining and improving staff efficiency and consequently the quality of care provided. Organizational restructuring processes, including mergers, are likely to affect job satisfaction levels, but evidence of the impact they have is surprisingly scarce. The aim of the study was to describe a methodology used to measure job satisfaction of the employees at a Local Health Unit (LHU) in Italy immediately after a merger and to assess the determinants associated with any reduction in worker satisfaction. The study was conducted among employees of the LHU of the Sardinia Region in July 2018, after a merger of eight subregional LHUs had taken place. The entire staff was enrolled, of which a total of 1,737 employees were surveyed. We used a questionnaire exploring socio-demographic and working characteristics of the employees, the various areas related to job satisfaction and interviewee opinions on the merger process. Multivariable stepwise backward logistic regression models were built to identify factors independently associated with lower job satisfaction. The results of a multivariable analysis showed that lower job satisfaction was more likely in employees with an administrative role (aOR: 2.34, 95% CI: 1.37–4.00) or a career demotion (aOR: 1.84, 95%CI: 1.11–3.03). High levels of mental stress were strongly associated with lower job satisfaction (aOR: 5.64, 95%CI: 4.16–7.64). “More equity of employee rewards” was the only example of a set of responder suggestions found to be associated with lower job satisfaction (aOR: 2.30, 95%CI: 1.51–3.47). Generally, responders showed a good level of job satisfaction—and this was also the case following the merger—but some job profile determinants were strongly associated with low employee satisfaction. The results of the study highlighted several challenging areas and critical issues relating to working conditions. Further surveys are required to confirm these results and to monitor their evolution over time.

scholarly journals Gambling Among Finnish 14–16-Year-Old Adolescents Before (2008–2009), During (2010–2011), and After (2013–2017) Setting the Legal Age Limit of 18 for Gambling and the Role of Socio-Economic Status

2021 ◽  
Author(s):  
Tiina Latvala ◽  
Tomi Lintonen ◽  
Pauliina Luopa ◽  
Susanna Raisamo
Keyword(s):  
School Health ◽  
Economic Status ◽  
Health Concern ◽  
Adolescent Gambling ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Socio Economic Status ◽  
Permanent Effect ◽  
Age Limit

AbstractLegislation prohibiting minors from engaging in gambling is a gambling policy measure set to protect adolescents from the harmful effects of gambling. The Finnish gambling system is based on a state monopoly, regulated by the Lotteries Act. After an amendment to the Lotteries Act, the new minimum legal gambling age was raised to 18 years old between 2010 and 2011. The main purpose of this study was to discover how the amendment to the act altered adolescents’ gambling (14–16-year-olds) and to examine whether the amendment decreased socio-economic differences. Adolescents gambling was studied before (2008–2009), during (2010–2011), and after (2013–2017) the age limit of gambling was raised in Finland. The study based on five waves (2008–2009, 2010–2011, 2013, 2015, 2017) of the national repeated cross-sectional School Health Promotion Study. Cross-tabulations where gambling was studied by study year and socio-economic status (SES) were formulated, and the statistical differences were studied by using χ2-tests. Percentage change in gambling frequency was also examined by study year and SES. Study years were analyzed separately to model the weekly gambling via logistic regression models. Adolescent gambling significantly decreased over time. It appears that raising the legal gambling age had a permanent effect on under-aged gambling. However, differences in gambling by adolescents’ family’s SES increased during the study period, indicating widening inequalities in gambling among adolescents. Diminishing inequalities in adolescent gambling is likely to require both societal action and consensus on adolescent gambling being a significant social and public health concern.

scholarly journals Ingesting Self-Grown Produce and Seropositivity for Hepatitis E in the United States

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Thomas M. Diehl ◽  
Daniel J. Adams ◽  
Cade M. Nylund
Keyword(s):  
United States ◽  
Multivariable Analysis ◽  
Hepatitis E ◽  
The United States ◽  
Test Results ◽  
Industrialized Countries ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Health And Nutrition ◽  
Dietary Interview

Background. Hepatitis E virus (HEV) is a major cause of hepatitis in developing and industrialized countries worldwide. The modes of HEV transmission in industrialized countries, including the United States, remain largely unknown. This study is aimed at evaluating the association between HEV seropositivity and consumption of self-grown foods in the United States. Methods. Cross-sectional data was extracted from the 2009–2012 National Health and Nutrition Examination Survey (NHANES). Data from the dietary interview and the serum HEV IgG and IgM enzyme immunoassay test results were linked and examined. Univariate and multivariable logistic regression models were used to evaluate the significance and effect size of an association between self-grown food consumption and hepatitis E seropositivity. Results. The estimated HEV seroprevalence in the civilian, noninstitutionalized US population was 6.6% in 2009–2012, which corresponds to an estimated hepatitis E national seroprevalence of 17,196,457 people. Overall, 10.9% of participants who ingested self-grown foods had positive HEV antibodies versus 6.1% of participants who did not consume self-grown foods (P<0.001; odds ratio (OR) 1.87; 95% CI 1.41–2.48). In the age-stratified multivariable analysis, the correlation between ingesting self-grown foods and HEV seropositivity was significant for participants 40–59 years old, but not overall, or for those < 40 years or ≥60 years. Conclusions. Ingesting self-grown food, or simply the process of gardening/farming, may be a source of zoonotic HEV transmission.

scholarly journals Association Between Maternal Lifestyle and Risk of Metabolic Syndrome in Offspring—A Cross-Sectional Study From China

2020 ◽  
Vol 11 ◽  
Author(s):  
Yanhui Li ◽  
Zhaogeng Yang ◽  
Xijie Wang ◽  
Di Gao ◽  
Zhiyong Zou ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Lower Risk ◽  
Healthy Lifestyle ◽  
Cross Sectional Study ◽  
Lifestyle Factors ◽  
Sectional Study ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Offspring Health

BackgroundThe prevalence of MS among children and adolescents continues to rise, which has become an escalating serious health issue worldwide. It had been reported that maternal current lifestyle had a strong independent correlation with offspring health. However, it is not clear whether comprehensive lifestyle of mother has an impact on the MS risk in offspring and the role of offspring’s lifestyle in it.Methods and ResultsWe included 4,837 mother-child pairs from a multi-centered cross-sectional study conducted in China. The information of maternal lifestyle was obtained by self-reported questionnaire, and metabolic syndrome (MS) in offspring was determined by anthropometric measurements and blood tests. Logistic regression models were employed to evaluate the association between maternal lifestyle and risk of MS in offspring. We found maternal healthy lifestyle was independently associated with lower risk of offspring MS, and the risk of MS in offspring decreased with the increased number of maternal ideal lifestyle factors. Although adolescents’ lifestyle did not fully explain the relationship between maternal lifestyle and risk of offspring MS, compared with those had less ideal lifestyle factors in both mothers and offspring, the risk of offspring MS was lower in those had more ideal lifestyle factors in both mothers and adolescents.ConclusionsHealthy lifestyle in mothers was associated with a lower risk of MS in offspring, which was independent of offspring’s lifestyle. These findings support mother-based lifestyle intervention could be an effective strategy to reduce the MS risk in adolescents.

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