<p>Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors&rsquo / physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical&nbsp / doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students&rsquo / t-test was used to compare mean physical activity between different groups. Furthermore students&rsquo / t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p&lt / 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of&nbsp / physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p&lt / 0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility&rsquo / s schedules, fatigue and tiredness to be their&nbsp / barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel.&nbsp / Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and&nbsp / long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and&nbsp / counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.<br /> &nbsp / </p>

<p>Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors&rsquo / physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical&nbsp / doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students&rsquo / t-test was used to compare mean physical activity between different groups. Furthermore students&rsquo / t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p&lt / 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of&nbsp / physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p&lt / 0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility&rsquo / s schedules, fatigue and tiredness to be their&nbsp / barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel.&nbsp / Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and&nbsp / long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and&nbsp / counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.<br /> &nbsp / </p>

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age, economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development. Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05). Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors, physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored. / South Africa

Tese aborda, inicialmente, a mobilidade de médicos pelo mundo a partir de levantamento bibliográfico em base de dados. Identifica a escassez de informações referentes aos médicos brasileiros, apesar de existirem algumas evidências a respeito da emigração destes profissionais para exercerem sua profissão em outros países. OBJETIVO: analisar aspectos que determinam a emigração de médicos brasileiros para os EUA. METODOLOGIA: a principio foi realizada uma etapa exploratória, seguida de levantamento de dados em conselhos de classe brasileiros e sites norte-americanos. Utilizou-se uma amostra por conveniência através da técnica \"bola de neve\"; identificou-se a existência de médicos que emigraram; foi enviado, via e-mail, questionário elaborado pela autora com questões fechadas e abertas a respeito dos motivos pelos quais escolheram os EUA para emigrar, por que foram, por que ficaram, por que voltariam e por que não voltariam a morar no Brasil. Realizadas algumas entrevistas por Skype. Foi realizada a tabulação dos dados quanti e qualitativos. RESULTADOS: inicialmente os médicos escolhem emigrar por motivos pessoais (família, oportunidades profissionais, oportunidades em geral, facilidade do idioma); ao se estabelecerem nos EUA vivenciam uma nova forma de vida, o que os faz escolher permanecer (melhores condições de trabalho, qualidade de vida, família e oportunidades gerais); as causas do não retorno ao Brasil passam a ter motivos externos (insegurança, cenários profissional, politico e econômico). CONCLUSÃO: existe um processo emigratório de médicos brasileiros para os EUA; a principio a vontade de emigrar não está bem definida; o salário não é citado como questão primordial para emigrar; a presença da família facilita a permanência no país; fluência na língua inglesa é fundamental e é necessário recomeçar a vida profissional como um recém-formado em medicina pois não existe processo de validação de diploma ou de especialidades / OBJECTIVE: to analyze aspects that determine the emigration of Brazilian doctors to the United States of America. METHODOLOGY: at first there was an exploratory stage, followed by a data collection in Brazilian professional associations and North American websites. A sample by convenience was used through the \"snowball\" technique; the existence of doctors that emigrated was identified; a questionnaire, elaborated by the author with closed and open questions, was sent by e-mail, regarding their motives to choose the USA to emigrate, why they have gone, why they stayed and why they would or wouldn\'t come back to live in Brazil. A few interviews were made by Skype. A tabulation of the quantitative and qualitative data was made. RESULTS: initially the doctors choose to emigrate for personal motives (family, professional opportunities, general opportunities, no language barriers); when established in the USA, they experience a new way of life that makes them stay (better work condition, quality of life, family and general opportunities); external motives become the cause not to come back to Brazil (the lack of security, professional, political and economic scenarios). CONCLUSION: there is an emigrational process of Brazilian doctors to the USA; at first the will to emigrate is not well defined; the salary is not mentioned as a primal reason to emigrate; the presence of the family eases the stay in the country; the proficiency in the English language is fundamental and it is necessary to restart the professional life as a recently graduated in med school since there isn\'t an university degree or medical specialty degree validation.

Tese aborda, inicialmente, a mobilidade de médicos pelo mundo a partir de levantamento bibliográfico em base de dados. Identifica a escassez de informações referentes aos médicos brasileiros, apesar de existirem algumas evidências a respeito da emigração destes profissionais para exercerem sua profissão em outros países. OBJETIVO: analisar aspectos que determinam a emigração de médicos brasileiros para os EUA. METODOLOGIA: a principio foi realizada uma etapa exploratória, seguida de levantamento de dados em conselhos de classe brasileiros e sites norte-americanos. Utilizou-se uma amostra por conveniência através da técnica \"bola de neve\"; identificou-se a existência de médicos que emigraram; foi enviado, via e-mail, questionário elaborado pela autora com questões fechadas e abertas a respeito dos motivos pelos quais escolheram os EUA para emigrar, por que foram, por que ficaram, por que voltariam e por que não voltariam a morar no Brasil. Realizadas algumas entrevistas por Skype. Foi realizada a tabulação dos dados quanti e qualitativos. RESULTADOS: inicialmente os médicos escolhem emigrar por motivos pessoais (família, oportunidades profissionais, oportunidades em geral, facilidade do idioma); ao se estabelecerem nos EUA vivenciam uma nova forma de vida, o que os faz escolher permanecer (melhores condições de trabalho, qualidade de vida, família e oportunidades gerais); as causas do não retorno ao Brasil passam a ter motivos externos (insegurança, cenários profissional, politico e econômico). CONCLUSÃO: existe um processo emigratório de médicos brasileiros para os EUA; a principio a vontade de emigrar não está bem definida; o salário não é citado como questão primordial para emigrar; a presença da família facilita a permanência no país; fluência na língua inglesa é fundamental e é necessário recomeçar a vida profissional como um recém-formado em medicina pois não existe processo de validação de diploma ou de especialidades / OBJECTIVE: to analyze aspects that determine the emigration of Brazilian doctors to the United States of America. METHODOLOGY: at first there was an exploratory stage, followed by a data collection in Brazilian professional associations and North American websites. A sample by convenience was used through the \"snowball\" technique; the existence of doctors that emigrated was identified; a questionnaire, elaborated by the author with closed and open questions, was sent by e-mail, regarding their motives to choose the USA to emigrate, why they have gone, why they stayed and why they would or wouldn\'t come back to live in Brazil. A few interviews were made by Skype. A tabulation of the quantitative and qualitative data was made. RESULTS: initially the doctors choose to emigrate for personal motives (family, professional opportunities, general opportunities, no language barriers); when established in the USA, they experience a new way of life that makes them stay (better work condition, quality of life, family and general opportunities); external motives become the cause not to come back to Brazil (the lack of security, professional, political and economic scenarios). CONCLUSION: there is an emigrational process of Brazilian doctors to the USA; at first the will to emigrate is not well defined; the salary is not mentioned as a primal reason to emigrate; the presence of the family eases the stay in the country; the proficiency in the English language is fundamental and it is necessary to restart the professional life as a recently graduated in med school since there isn\'t an university degree or medical specialty degree validation.

It has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the educational backgrounds of the foreign-schooled physicians may contribute to an increase in medical board disciplining. Furthermore, graduates of medical schools where the instruction is not conducted in the English language may receive increased medical board disciplining when compared to the graduates of medical schools where English is the language of instruction. Finally, domestic medical schools that are ranked low according to The Gourman Report, 8th Edition may provide a substandard medical education, causing their graduates to have increased rates of discipline when compared to peers who have graduated from higher ranked medical schools. This study examines the effects of undergoing foreign medical training as opposed to domestic medical training and receiving medical school instruction in the English language or another language, on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (N = 39,559). Also examined are the effects of attending domestic medical schools that are ranked lower than other domestic medical schools on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (n = 25,479). Control variables used in this logistic regression analysis include whether the medical doctor is specialty board certified or not, the specialty practiced and the medical doctor's race and gender. Archival data from the Florida Department of Health were used for this study. This study found that the graduates of medical schools where the instruction is not in the English language are more likely to receive discipline and are more likely to receive more severe types of discipline than graduates of medical schools where the instruction is in the English language. It was also found that medical doctors who are ABMS certified, are practicing either a surgical specialty, obstetrics, gynecology, psychiatry, emergency medicine, family medicine or diagnostic radiology, or are male have increased odds of being disciplined by the Florida Board of Medicine.

Background: Poor health costs the Swedish society billions a year and affects every individual who lives with poor health. By a close collaboration between medical doctors, nurses and other health professions there are good opportunities to work with health promotion and for the individual patient’s health.  One way to work with health promotion in health care is to work with Physical activity on referral, FaR®.  Physical activity on referral was created to improve the health among the Swedish population and has been effective against diseases like cardiovascular disease and diabetes. Research has been done on which professional groups that makes the most prescriptions of Physical activity on referral and why patients don’t follow them. Objective: The aim of the study was to investigate the frequency of and the attitude toward prescribing Physical activity on referral, among medical doctors and medical students and to investigate if there were any differences between genders. Method: A web survey was designed and sent to 45 medical doctors at Akademiska Sjukhuset in Uppsala and to 286 medical students in semester 7-9 at Uppsala University. Results: The majority of the participants thought that physical activity had an important role in health promotion and knew about Physical activity on referral. Even though few of the participants had made a prescription of Physical activity on referral, the majority thought that it was an important part in the work with health promotion. The participants thought that more education in Physical activity on referral was needed. The participants prioritized to prescribe Physical activity on referral to patients at risk to get cardiovascular diseases, while patients who were less physical active than the recommendations of Livsmedelsverket got the lowest priority. Conclusion: Physical activity on referral was created to increase physical activity among the Swedish population and to reduce the risk to get diseases that can be related to low physical activity. It is therefore alarming that the participants were less prioritizing patients who were less physical active than the recommendations of Livsmedelsverket when it comes to prescribing Physical activity on referral, than other patients. By medical doctors and nurses working as a team, preventive actions can be taken early and therefore the risk for the individuals to develop secondary diseases can be reduced.

>Magister Scientiae - MSc / Many South African Deaf people use their mobile phones for communication with SMSs yet they would prefer to converse in South African Sign Language. Deaf people with a capital `D' are different from deaf or hard of hearing as they primarily use sign language to communicate. This study explores how to design and evaluate a prototype that will allow a Deaf person using SASL to tell a hearing doctor how s/he is feeling and provide a way for the doctor to respond. A computer{based prototype was designed and evaluated with the Deaf people in a previous study. Results from the user trial of the computer{based mock{up indicated that Deaf users would like to see the prototype on a cell phone. Those user trial results, combined with our own user survey results conducted with Deaf people, are used as requirements. We built a prototype for a mobile phone browser by embedding SASL videos inside XHTML pages using Adobe Flash. The prototype asks medical questions using SASL videos. These questions are arranged in an organized way that helps in identifying a medical problem. The answers to the questions are then displayed in English and shown to the doctor on the phone. A content authoring tool was also designed and implemented. The content authoring tool is used for populating the prototype in a context free manner allowing for plug and play scenarios such as a doctor's office, Department of Home A airs or police station. A focus group consisting of Deaf people was conducted to help in the design and pilot trial of the system. A final user trial was conducted with more than thirty Deaf people and the results are presented and analyzed. Data is collected with questionnaires, semi-structured interviews and video recordings. The results indicate that most of the Deaf people found the system easy to learn, easy to navigate through, did not get lost and understood the sign language in the videos on the mobile phone. The hand gestures and facial expressions on the sign language videos were clear. Most of them indicated they would like to use the system for free, and that the system did not ask too many questions. Most of them were happy with the quality of the sign language videos on the mobile phone and would consider using the system in real life. Finally they felt their private information was safe while using the system. Many South African Deaf people use their mobile phones for communication with SMSs yet they would prefer to converse in South African Sign Language. Deaf people with a capital `D' are different from deaf or hard of hearing as they primarily use sign language to communicate. This study explores how to design and evaluate a prototype that will allow a Deaf person using SASL to tell a hearing doctor how s/he is feeling and provide a way for the doctor to respond. A computer{based prototype was designed and evaluated with the Deaf people in a previous study. Results from the user trial of the computer{based mock{up indicated that Deaf users would like to see the prototype on a cell phone. Those user trial results, combined with our own user survey results conducted with Deaf people, are used as requirements. We built a prototype for a mobile phone browser by embedding SASL videos inside XHTML pages using Adobe Flash. The prototype asks medical questions using SASL videos. These questions are arranged in an organized way that helps in identifying a medical problem. The answers to the questions are then displayed in English and shown to the doctor on the phone. A content authoring tool was also designed and implemented. The content authoring tool is used for populating the prototype in a context free manner allowing for plug and play scenarios such as a doctor's office, Department of Home A airs or police station. A focus group consisting of Deaf people was conducted to help in the design and pilot trial of the system. A final user trial was conducted with more than thirty Deaf people and the results are presented and analyzed. Data is collected with questionnaires, semi-structured interviews and video recordings. The results indicate that most of the Deaf people found the system easy to learn, easy to navigate through, did not get lost and understood the sign language in the videos on the mobile phone. The hand gestures and facial expressions on the sign language videos were clear. Most of them indicated they would like to use the system for free, and that the system did not ask too many questions. Most of them were happy with the quality of the sign language videos on the mobile phone and would consider using the system in real life. Finally they felt their private information was safe while using the system. / South Africa

No description available.

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.