This thesis applies the econometric projection approach to forecast the numbers of general practitioners (GPs) in Saskatchewan for the next 15 years at both provincial and the Regional Health Authorities (RHAs) levels. The projection results will provide the estimated level of GPs up to 2021 for policy makers to adjust their decision on health professionals planning.<p> Three hypothesized scenarios, which include the changes in population proportion, average income for GPs and a combination of both, are used for projections based on the regression results. The projections suggest a 4.34% expected annual increase of GPs if the proportions of children and seniors increase or decrease according to prediction for the next 15 years for Saskatchewan. At the RHAs level, 4.5% to 10.7% expected annual rate of increase for numbers of GPs is projected for the northern RHAs and Saskatoon RHA, while the expected increase for other urban RHAs will experience less than 1.5% increases.<p> The predicted changes in average income for GPs show insignificant effect for the expected changes in numbers of GPs. However, the second and third scenarios are not extended to the RHAs level due to lack of information, which requires additional data for both Saskatchewan physicians and population for further projection analysis.

Abstract Background The National Health and Medical Research Council and the Royal Australian College of General Practitioners recommend exclusive breastfeeding for the first six months of an infant’s life and continued breastfeeding with the addition of appropriate complementary food until at least 12 months. While most Australian women initiate breastfeeding, many wean earlier than recommended due to breastfeeding difficulties. As most women consult their GP frequently in the first six months postpartum, GPs are in an ideal position to provide encouragement, evidence-based information and advice that breastfeeding women need. In addition, women are more likely to initiate and continue to breastfeed if their doctor supports and encourages them to do so. The limited Australian data available question whether GPs have the skills to be able to effectively assist breastfeeding women, although no research has specifically addressed the breastfeeding knowledge or attitudes of Australian GPs. Additionally, there are no data detailing the breastfeeding training available to medical students, GP registrars or GPs. Aim This study aimed to identify the breastfeeding educational needs of Australian GP registrars and to develop a relevant and applicable breastfeeding educational resource within the context of these identified needs. Research design Triangulation methodology, using more than one data source and qualitative and quantitative data-collection methods, was chosen for this study to give a richer, more inclusive and wider reaching understanding of the issues involved than could be obtained by using one method alone. Therefore, to meet the aims of the study, a three phase mixed-method project with triangulation of data was designed. Phase 1 had three distinct data-collection arms: a quantitative survey of medical school curricula; focus groups with medical students from two Queensland medical schools; and interviews with eight GP registrars. Data from Phase 1 provided information about breastfeeding attitudes, knowledge needs and learning opportunities, and informed the development of a questionnaire sent to final-year GP registrars Australia-wide (Phase 2). The aim of this phase was to ascertain the GP registrars’ breastfeeding attitudes and knowledge gaps. Phase 3 used the outcomes of Phases 1 and 2 to design an educational resource that would meet the needs of GP registrars. Results Breastfeeding was included in the curricula of most of the Australian medical schools surveyed (n = 10). Many medical schools relied on contact between the student and patients to provide clinical experience and practical knowledge. Medical students and GP registrars reported marked variability in breastfeeding learning opportunities. Although both groups had positive breastfeeding attitudes, participants had differing opinions regarding doctors’ involvement in infant feeding decisions and the type of support and information offered to women. Overall, the breastfeeding attitudes of the 161 GP registrars who returned the questionnaire were positive (mean 3.99, 1 = least positive, 5 = most positive). However, while the mean breastfeeding knowledge score was 3.40, (1 = minimum score, 5 = maximum score) 40 percent of the knowledge items were incorrectly answered by more than half the cohort. Approximately 40 percent of the registrars were confident and thought they were effective assisting breastfeeding women. Nevertheless, only 23 percent thought they had had sufficient breastfeeding training. Registrars who thought their previous training was inadequate had lower knowledge scores, were less confident and perceived that they were less effective than the remainder of the cohort. A new finding from this study was that Australian-born registrars had more positive breastfeeding attitudes and higher knowledge scores than their overseas-born counterparts. In addition, while parents with more than 26 weeks’ personal breastfeeding experience (self or partner) had more positive breastfeeding attitudes and higher breastfeeding knowledge, confidence and perceived effectiveness scores, parents with less experience had less positive attitudes and poorer knowledge than non-parent participants. Similar to previous studies, gender had no effect on breastfeeding knowledge or attitudes. Using adult learning principles, a five-session, case-based breastfeeding educational resource addressing the knowledge deficits identified in the previous phases of the study was developed. Evaluation activities before and after each session, as well as exercises designed for reflection and critical thinking, were an integral part of the resource. Conclusion This study found that the breastfeeding training of Australian medical students and GP registrars was inadequate and, regardless of their positive breastfeeding attitudes, resulted in registrars being ill-prepared to assist breastfeeding women. Based on the training needs identified in the study and in the literature, an educational resource was developed that presented information within real-life case-based scenarios. Additional background information provided logic and rationale for diagnosis, management and treatment. While the implementation of the resource is outside the scope of this thesis (but will be the focus of post-doctoral work), it is believed that the resource has the potential to provide GP registrars with training opportunities to improve their breastfeeding knowledge and skills, thus better meeting the needs of breastfeeding women.

Submitted by ANANDA GHELFI RAZA LEITE null (ananda_rzleite@outlook.com) on 2017-07-10T14:53:36Z No. of bitstreams: 1 Dissertacao de Ananda Ghelfi Raza Leite 19maio 2017 - PJFVB (1).pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-07-13T20:14:53Z (GMT) No. of bitstreams: 1 leite_agr_me_bot.pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) / Made available in DSpace on 2017-07-13T20:14:53Z (GMT). No. of bitstreams: 1 leite_agr_me_bot.pdf: 4614865 bytes, checksum: e2c5970793560c04e57c5c3f23235a62 (MD5) Previous issue date: 2017-06-23 / Pró-Reitoria de Pós-Graduação (PROPG UNESP) / Introdução: As demências são comuns nos idosos e sua prevalência aumentou nas últimas décadas. Em 2025, o Brasil estará na sexta posição mundial em número absoluto de idosos. No país, a grade curricular do curso de graduação em Medicina, de acordo com as Diretrizes Curriculares para este curso, contempla o ensino de demência e seu manejo, havendo poucos relatos na literatura cientifica sobre a qualidade do ensino oferecido ou sobre o conhecimento e a capacidade de identificação da demência. Diante disso, propõe-se estudo sobre os conhecimentos e atitudes a respeito de questões relacionadas ao declínio cognitivo em idosos por parte de estudantes e residentes de Medicina. Objetivo: Avaliar os conhecimentos e atitudes em demências por parte de estudantes de medicina e dos médicos residentes das áreas que mais atuam com demência em idosos. Métodos: Estudo transversal no qual foi realizada a aplicação aos estudantes e residentes de um questionário contendo itens sobre o aprendizado em demências durante a graduação médica e um instrumento britânico, adaptado transculturalmente ao Brasil, sobre conhecimentos e atitudes em demências em idosos. Os resultados de conhecimento e atitudes sobre demência foram comparados entre especialistas e generalistas e entre os momentos de suas carreiras. Resultados: Dos participantes deste estudo, 57% eram do sexo feminino, 60,3% relataram ter tido base em alterações cognitivas durante a graduação, e destes, 57% relataram ter tido base teórica e prática; 89,8% dos participantes afirmaram ter realizado curso extracurricular durante a graduação no qual foi abordado o tema. Com relação ao questionário de conhecimentos, os graduandos acertaram menos questões do escore “epidemiologia” do que os residentes iniciantes e menos do que os residentes finalistas. No escore “diagnóstico”, os alunos do sexto ano acertaram menos do que os residentes iniciantes e finalistas, assim como os residentes iniciantes acertaram menos do que os residentes finalistas. Observou-se que as os alunos do sexto ano concordaram mais com as afirmações referentes às atitudes “2” (“As famílias preferem ser informadas a respeito da demência de seu parente o mais rápido possível”) e “4” (“Fornecer diagnóstico geralmente é mais útil do que prejudicial”) do que os residentes iniciantes. Já na atitude “6” (“Os pacientes com demência podem esgotar recursos com resultado pouco positivo”), os graduandos concordaram menos com a afirmação do que os residentes iniciantes. Conclusão: Os resultados permitiram uma leitura mais detalhada dos tópicos envolvidos na capacitação médica para a detecção de alterações cognitivas em idosos, assim como a avaliação do perfil do especialista e do generalista quanto à avaliação dos quadros demenciais e das atitudes frente ao paciente, sendo que os graduandos, apesar de acertarem menor quantidade de questões no questionário de conhecimentos, apresentaram atitudes mais positivas frente ao paciente com demência. / Introduction: Dementias are common in the elderly and its prevalence has increased in the recent decades. By 2025, Brazil will rank sixth among countries with the highest numbers of elderly persons. In Brazil, the curriculum of the undergraduate course in Medicine, according to the Curricular Guidelines for this course, include dementia education and its management, but there are few reports in the scientific literature about the quality of education offered. Therefore, we propose a study on the knowledge and attitudes about issues related to cognitive decline in the elderly by students and medical residents. Objective: To assess the knowledge and attitudes about dementia by medical students and medical residents of the areas that the most act with dementia in the elderly. Methods: Crosssectional study; questionnaires containing topics about dementia education during medical graduation and knowledge and attitudes about dementia were used. The results of the knowledge and attitudes about dementia were compared between: students and residents, residents of the different programs and residents in different moments of their residency. Results: Of the participants of this study, 57% were female, 60.3% reported having basis on dementia during graduation, and of these, 57% reported having both theoretical and practical basis; 89.8% of the subjects attended extracurricular courses on dementia during graduation in which the topic was addressed Regarding the knowledge questionnaire, medical students’scores on “epidemiology” were lower than the scores of the residents in the beginning and in the end of the residency. Considering the scores on "diagnosis", the medical students’ scores were lower than the scores of the residents in the beginning of the residency and the latters’ scores were lower than the scores of the residents in the end of the residency. It was observed that the medical students agreed more with the statement of the attitude 2 (The families prefer to be informed about the dementia of their relative as rapidly as possible) and 4 (Providing the diagnosis is generally more useful than harmful.) than junior residents. Considering attitude 6(The patients with dementia can drain resources with little positive result), the medical students agreed less than the residents of the beginning of the programs. Conclusion: The results allowed a more detailed reading of the topics involved in medical training for the detection of cognitive alterations in the elderly, as well as the evaluation of the expert and generalist profile regarding the evaluation of dementia and attitudes towards the patient, although they answered less questions in the knowledge questionnaire, presented more positive attitudes towards the patient with dementia.

The aim of this licentiate thesis was to describe the experiences of medical interns and general practitioners (GPs) communicating with and writing referrals to the radiology department. The referral is a major communication tool between medical professionals to establish an accurate diagnosis.    Data were collected by means of qualitative research, using focus group interviews with three groups of medical interns during their internship in hospitals and with three groups of general practitioners in their health care centre. Data were analysed using qualitative thematic content analysis.      The study showed some differences between the groups in that the medical interns required more support in both referral writing situations and the decision portion of the process, choosing imaging modality. The general practitioners were more confident in the narrative process of the referral, writing facts and formulating diagnostic questions, but similarly they needed additional support in decisions concerning the imaging portion of the process. The GPs even advised an evident share of responsibility by letting the radiologists control the choice of imaging method. Both groups suggested different opportunities for dialogue and education as crucial to achieving improvements. The results can be discussed in relation to the specific radiology knowledge and are characterized by a combination of specific expert knowledge and tacit knowledge. The means of communication could be evaluated from different perspectives in relation to what referents and staff in the radiology department perceive and expect. The results can also be assessed in relation to the demand-control-support theory. In this respect, the medical interns experienced high demands and poor control and support, while the GPs experienced demands differently; they often controlled their situation but still needed enhanced radiological support.

Background: Primary care may be a key setting for suicide prevention as many patients visit their General Practitioner (GP) in the weeks leading up to their death. Comparatively little is known about GPs’ perspectives on risk assessment, treatment adherence, management of and interactions with suicidal patients prior to the patient’s suicide and the services available in primary care for suicide prevention. Aim: This study aimed to explore primary care data on a clinical sample of individuals who died by suicide and were in recent contact with mental health services in order to: investigate the frequency and nature of general practice consultations; examine risk assessment, treatment adherence and management in primary and secondary care; gain GPs’ views on patient non-adherence to treatment and service availability for the management of suicidal patients. Method: A mixed-methods study design including data from the National Confidential Inquiry on 336 patients who died by suicide, data from 286 patient coroner files, primary care medical notes on 291 patients and 198 semi-structured face–to-face interviews with GPs across the North West of England. We collected data on GPs' views on the treatment and management of patients in the year prior to suicide, suicide prevention generally and local mental health service provision. Quantitative data were analysed using SPSS. Interviews were transcribed verbatim and analysed using a thematic approach. Results: Overall, 91% of individuals consulted their GP on at least one occasion in the year before suicide. GPs reported concerns about their patient’s safety in 27% of cases, but only 16% of them thought that the suicide could have been prevented. The overall agreement in the rating of risk between primary and specialist care was poor (overall kappa = 0.127; p = 0.10). Non-adherence was reported for 43% of patients. The main reasons for non-adherence were lack of insight, reported side effects and multiple psychiatric diagnoses. We obtained qualitative data from GPs on their interpretations of suicide attempts or self-harm, professional isolation and GP responsibilities when managing suicidal patients. Limitations: Our findings may not be generalisable to people who died by suicide and were not under the care of specialist services. GPs recruited for the study may have had different views from GPs who have never experienced a patient suicide. Our findings may not be representative of the rest of the UK although many of the issues identified are likely to apply across services. Conclusion: Suicide prevention in primary care is challenging. Possible strategies for future suicide prevention in general practice include: increasing GP awareness of suicide-related issues and improving training and risk assessment skills; increasing awareness in primary care about why patients may not want treatments offered by focusing on each individual’s situational context; removing barriers to accessing therapies and treatments; and, better liaison and collaboration between services to improve patient outcomes.

Background: Inequity in general practice workforce distribution remains a significant issue despite the increasing numbers of general practitioners (GPs) in the UK. Problems with recruitment and retention in England are particularly evident in urban deprived areas. The aim of the current study was to explore affinity for working in urban deprived areas, focusing on practitioners’ background, values and care orientation. Methods: There were two stages to the research: 1) semi-structured qualitative interviews with 25 GPs and practice nurses to explore their background, values and care orientation in relation to location; 2) questionnaire survey with approximately 1200 GPs and practice nurses to determine the association between affinity factors and current location. The sample of practitioners was drawn from general practices located in the most and least deprived areas in the northwest region of England. Results: 25 qualitative interviews were conducted and the data analysed using a framework analysis approach. The analysis indicated that location preferences were formed early in practitioners’ careers. While an overt affinity for deprived areas was more likely among GPs, pragmatism could dominate location decisions for all. The narrative of practitioners in deprived areas suggested benevolent, universalistic and stimulation personal values, and a patient-centred care orientation. Satisfaction derived from making a difference, having a challenge, addressing social injustice, and having a sense of belonging. Coping strategies included: structure and organisation, support from colleagues, emotional detachment, reassessment of expectations, and distraction. The response rate to the postal questionnaire survey was 30.9% for GPs and 41.2% (practice level) for nurses. Although there were few differences in the personal values of practitioners working in deprived and affluent areas, there were more differences in specific work values. Stepwise logistic regression showed that for GPs, determinants of working in a deprived area included: having trained in a deprived area; not being influenced by the convenience of the location in choosing their current practice; and valuing control in decision-making. For nurses, determinants included: having worked in a deprived area before; not being influenced by quality of care in the practice when choosing their current practice; and not valuing being respected by practice colleagues. Subgroup analyses suggested different predictors for practitioners with different role status: GP principals were more likely to work in a deprived area if they valued providing care to those in greatest need of help, in addition to having trained in a deprived area. Discussion: The training location of GPs was a consistent factor in determining current location. This differs from the literature on location choice in rural and remote areas, for which childhood exposure is considered to be the dominant factor. Differences in personal values were reflected more clearly in specific work values. Future research should look at how GPs choose their training practice and how such experiences could be exploited to enhance recruitment to underserved urban areas. Strategies to aid retention could look to the coping strategies employed by practitioners to deal with the demands of working in a deprived area.

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: As demências são comuns nos idosos e sua prevalência aumentou nas últimas décadas. Em 2025, o Brasil estará na sexta posição mundial em número absoluto de idosos. No país, a grade curricular do curso de graduação em Medicina, de acordo com as Diretrizes Curriculares para este curso, contempla o ensino de demência e seu manejo, havendo poucos relatos na literatura cientifica sobre a qualidade do ensino oferecido ou sobre o conhecimento e a capacidade de identificação da demência. Diante disso, propõe-se estudo sobre os conhecimentos e atitudes a respeito de questões relacionadas ao declínio cognitivo em idosos por parte de estudantes e residentes de Medicina. Objetivo: Avaliar os conhecimentos e atitudes em demências por parte de estudantes de medicina e dos médicos residentes das áreas que mais atuam com demência em idosos. Métodos: Estudo transversal no qual foi realizada a aplicação aos estudantes e residentes de um questionário contendo itens sobre o aprendizado em demências durante a graduação médica e um instrumento britânico, adaptado transculturalmente ao Brasil, sobre conhecimentos e atitudes em demências em idosos. Os resultados de conhecimento e atitudes sobre demência foram comparados entre especialistas e generalistas e entre os momentos de suas carreiras. Resultados: Dos participantes deste estudo, 57% eram do sexo feminino, 60,3% relataram ter tido base em alterações cognitivas durante a graduação, e destes, 57% relataram ter tido base teórica e prát... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Dementias are common in the elderly and its prevalence has increased in the recent decades. By 2025, Brazil will rank sixth among countries with the highest numbers of elderly persons. In Brazil, the curriculum of the undergraduate course in Medicine, according to the Curricular Guidelines for this course, include dementia education and its management, but there are few reports in the scientific literature about the quality of education offered. Therefore, we propose a study on the knowledge and attitudes about issues related to cognitive decline in the elderly by students and medical residents. Objective: To assess the knowledge and attitudes about dementia by medical students and medical residents of the areas that the most act with dementia in the elderly. Methods: Crosssectional study; questionnaires containing topics about dementia education during medical graduation and knowledge and attitudes about dementia were used. The results of the knowledge and attitudes about dementia were compared between: students and residents, residents of the different programs and residents in different moments of their residency. Results: Of the participants of this study, 57% were female, 60.3% reported having basis on dementia during graduation, and of these, 57% reported having both theoretical and practical basis; 89.8% of the subjects attended extracurricular courses on dementia during graduation in which the topic was addressed Regarding the knowledge questionnaire, me... (Complete abstract click electronic access below) / Mestre

Unguided and free e-mental health platforms can offer a viable treatment and self-help option for depression. This study aims to investigate, from a public health perspective, the real-world uptake, benefits, barriers, and implementation support needed by general practitioners (GPs). The study presents data from a spin-off GP survey conducted 2.5 years subsequent to a cluster-randomized trial. A total of N = 68 GPs (intervention group (IG) GPs = 38, control group (CG) GPs = 30) participated in the survey (response rate 62.4%). Data were collected via postal questionnaires. Overall, 66.2% of the GPs were female. The average age was 51.6 years (SD = 9.4), and 48.5% of the GPs indicated that they continued (IG) or started recommending (CG) the e-mental health intervention under real-world conditions beyond the trial. A number of benefits could be identified, such as ease of integration and strengthening patient activation in disease management. Future implementation support should include providing appealing informational materials and including explainer videos. Workshops, conferences, and professional journals were identified as suitable for dissemination. Social media approaches were less appealing. Measures should be taken to make it easier for health care professionals to use an intervention after the trial and to integrate it into everyday practice.

Les inégalités de participation au dépistage du cancer du col de l’utérus (CCU) sont multifactorielles et la prévention primaire du CCU par la vaccination contre les papillomavirus humains (HPV) oncogènes pourrait présenter des similarités. Médecin de premier recours de l’ensemble de la population, le médecin généraliste (MG) pourrait avoir une place importante dans la limitation de ces inégalités et nous voulions l’explorer avant l’implémentation du dépistage organisé national français (DONF) du CCU.La comparaison des données de remboursement de deux départements français dont l’un participait à l’expérimentation de dépistage organisé, a mis en évidence une participation au dépistage plus importante dans le département d’expérimentation. Le gradient de participation diminuant avec l’augmentation du niveau de défavorisation était plus fort dans le département d’expérimentation, et plus encore en milieu rural. Nos données ne nous ont pas permis d’explorer ces aspects pour la vaccination contre les HPV.Interrogés sur leurs préférences pour limiter ces inégalités dans le cadre du DONF, gynécologues et MG étaient favorables au ciblage des femmes non dépistées, par invitations centralisées impliquant le médecin traitant déclaré ou en leur fournissant la liste des femmes non dépistées de leur patientèle. Le ciblage des femmes de plus de 50 ans ou défavorisées, de même que les autoprélèvements de dépistage des HPV, étaient rejetés par les praticiens.L’ensemble de nos travaux confirmaient l’importance d’un universalisme proportionné lors de l’implémentation du DONF. L’adhésion des praticiens, dont les MG, nécessitera une information sur la motivation des mesures proposées. / Unequal participation in uterine cervical cancer screening (UCC) is multifactorial and primary prevention of UCC by vaccination against oncogenic human papillomavirus (HPV) may have similarities. As primary care physicians for the overall population, general practitioners (GPs) could be a major contributor in limiting these inequalities. We aimed to explore these contributions before the implementation of the French national organized screening (FNOS) of UCC.The comparison of reimbursement data from two French departments, one of which experimented a regional organized screening, revealed a greater participation in screening in the experimental department. The participation gradient decreasing with the increase of deprivation was stronger in the experimental department, and moreover in rural areas. Our data did not allow us to explore these aspects for HPV vaccination.Asked about their preferences to limit these inequalities when implementing the FNOS, gynecologists and GPs were in favour of targeting unscreened women, by centralized invitations involving the declared attending physician, or by providing them with a list of unscreened women among their patients. Targeting women over 50 years old or deprived women, as well as HPV self-sampling, were options rejected by practitioners.Our results confirmed the importance of a proportionate universalism when implementing the FNOS. The involvement of practitioners, including GPs, will require information on the rational of the proposed measures.

No description available.