Thesis (M. Sc. (Physiotherapy)) -- University of Limpopo, 2011 / Aim of the study To investigate whether the Premier Soccer League Teams (PSL), in South Africa, have an ‘ideal’ medical team structure Objectives of the study Identification of medical professionals involved in the PSL and its leadership, the qualifications and experience of the medical professionals in PSL teams and whether the specialties of the medical professionals were clearly defined in order to avoid conflict within the team. Determination of the protocol that was followed when a player was injured and subsequent management and the influence on a player’s rehabilitation and return to activity. Setting The Premier Soccer League offices were contacted in order to conduct the research. Design The research design for this study was a descriptive survey. Methodology A purposeful sample of team managers and head coaches was chosen from 12 PSL teams. A self-constructed questionnaire was used to collect the data. A questionnaire was faxed to each participant and two follow-ups were made on the questionnaires that were not returned. Results The response rate was 54%. The composition of the medical teams comprised mainly of physiotherapists (85%) followed by sports physicians (77%), massage therapists (62%), dieticians (31%), sports psychologists (15%) and no podiatrist. Eight out of 13 participants reported having a sports physician as the head of the medical team while 4 participants reported the team leader to be a physiotherapist. Four out of 13 participants reported that their medical professionals were not all qualified and experienced in sport. The specialties of the medical professionals were clearly defined and each team had its own protocol for when a player was injured. The medical team had a positive influence on the management of injuries. Conclusion The PSL teams do not have an ‘ideal’ medical team structure. Keywords PSL, Medical team, structure, soccer

Introduction: Short-term medical missions (STMMs) are international service trips of short duration and typically involve teams traveling to provide medical service to low- and middle-income countries. The phenomenon of STMMs is neither well understood nor well defined in the literature. To date, the only published reviews of STMMs focus exclusively on the academic literature. However, these reviews do not capture the characteristics of medical missions conducted by visiting medical teams (VMTs) with no impetus to publish. YouTube, a video sharing platform which launched in 2005, is a novel information source for studying health-related issues. The goal of the present study is to understand the scope of STMMs. Specifically, we aim to characterize the STMMs described in publications listed in PubMed and videos posted to YouTube. We aim to subsequently compare findings from the literature and video review. Methods: We followed PRISMA guidelines to conduct a two pronged search of PubMed-indexed articles and videos posted to YouTube. We created a data extraction form to collect information about short-term medical mission characteristics, including sending and recipient country, sending organization, size of VMT, duration of medical mission, student involvement, and links to the local health system. Additional YouTube video-specific information was extracted including number of views, perspective, quality, operating location of the team, and distribution of medicines and vitamins. The free-text observations of the videos were thematically analyzed. Results: The majority of STMMs described in both PubMed (72%) and YouTube (93%) originate from the USA. The countries receiving the highest number of STMMs identified through literature publications were Haiti, Guatemala, Ethiopia and Peru; among videos, the countries with the highest number of STMMs were Philippines, Haiti, Honduras, and the Dominican Republic. Analysis based on income grouping shows the majority of missions go to lower-middle income countries. Analysis of recipient country based on health workforce density shows that most STMMs go to countries with a health workforce shortage, but this relationship is not linear. The majority of STMMs described in the literature (46%) were organized by secular non-profit organizations whereas the majority of STMMs described in the videos (45%) were organized by faith-based organizations. Out of 49% of articles that specified size, the median was eight members. In comparison, out of 33% videos that specified size, the median was 19 members. Whereas the median size of STMM reported in the literature was 9.5 days, the median duration in videos was 7 days. Student involvement was mentioned in 39% of articles and 18% videos. The majority (87.3%) of articles described a link to the local health system, whereas only 49.8% of videos described any link to the local health system. The median number of views of the videos was 315. Almost all videos (98.6%) were taken from the perspective of the VMT, and 82.2% were of amateur quality (non-professional). Although patients’ faces were shown in 96.1% of videos, only 0.7% of these videos stated that patient consent was obtained. Among the videos that specified the operating location of the STMM, 52.2% took place in a local healthcare facility, 21.5% in a school classroom, and 20.5% in a church. Over half (59%) of the videos portrayed the distribution of medications or vitamins. Of the videos that specified the type of service provided, 80% described STMMs that delivered medical (non-surgical) services. The provision of dental (36%), surgical (29%), and optometric (18%) services was also commonly described. Themes that emerged from the videos included patient privacy issues and long wait times. Discussion/Conclusion: The identified recipient countries of STMMs, when analyzed by income grouping and health workforce density, suggest inadequate distribution of STMMs. Furthermore, the videos highlight aspects of STMMs that have not been clearly explored in the literature including patient privacy, long wait times, and the distribution of medications and vitamins. Additionally, we found considerable variation between STMMs described in the academic literature and in grey data sources, specifically with respect to recipient country, sending organization, size of VMT, duration of STMM, and student involvement. Thus, we recommend caution in using only the academic literature to characterize the scope of medical missions. Future programmatic and policy directions should include improved pre-departure VMT training, rigorous evaluation of STMMs and the creation of a global registry.

The purpose of this study was to describe the reasons of Peng-hu medical team participation in infectious disease prevention program. The study discussed the awareness of importance for medical team engaged in disease prevention of community, and obstacles and intervention faced by medical team self-participation in community infectious disease prevention programs. At the end, it discussed cooperated relationships and the essential factors of public-private partnership and also provided conclusion and suggestion to perfect the abilities for medical team self-participation in community infectious disease prevention programs and to have positive functions. The purposes of this study are as follows: (1)to discuss the awareness of importance and advantages and disadvantages of medical team self-participation in community infectious disease prevention programs (2)to know the obstacles of Peng-hu medical team participation in community infectious disease prevention programs. (3)to study the cooperative relationship and essential factors of public-private partnership participation in community infectious disease prevention programs. (4)to conclude the related factors of medical team participation in community infectious disease prevention programs and to compare with the strategies for motivating community infectious disease prevention programs. This study adopted a quality perspective and in-depth interviews. In the research we use the purposive sampling which aims at medical clinic, institute of pharmacy, leaders of medical team member, directors of public healthy center and the head nurses. Besides, we also visited and asked delegates, town or city mayors, principals of school, director generals of community development association and chiefs of village for their advises on medial team who participated in community infectious disease prevention programs in Peng-hu. The conclusions are as follows: (1) it is important for medical team member to participate in community infectious disease prevention programs, because they have professional knowledge and they are at the cutting edge of disease prevention; public healthy center also has to take the responsibility for such program. However, the medical team is usually more utilitarian, so it is necessary to focus on their medical ethic program. (2) The largest benefit for the participation process is that medical team can learn from each other. (3) The obstacles for medical team to participate in infectious disease prevention programs are insufficient manpower, lack of protective equipment, and insufficient finances; therefore, they need help for these three aspects as well. (4) When medical team member promote community infectious disease prevention programs, patients who refuse to go to hospital and cover their condition will be the big obstruction for the program. (5) The understanding of infectious disease and the threat to health are both main factors to affect clinic in participating disease prevention. For public healthy center, the problems are unclear guidelines and political interventions for entire disease prevention. (6) The cross-professional corporation team has to be established and be conducted and integrated by public sector before reaching the goal of disease prevention program. According to the results given above, we suggest that supervisor of healthy care needs to direct and integrate all medical team member and other relevant sectors to organize a corporative team for disease prevention. The information of infectious disease should be announced widely and update frequently. Disease prevention program should be made compulsory in education and medical ethics should be emphasized. Moreover, Organizations without real functioning should be considered abolished for releasing more manpower in the programs.

[pt] As UTIs se tornaram o lugar frequente de morte para grande parte das pessoas no mundo. A morte ou a ameaça da perda de um ente querido promovem desequilíbrio no sistema familiar, fazendo emergir sensações de impotência, de fragilidade e de vulnerabilidade. Para a equipe médica, a morte do paciente traz a possibilidade de entrar em contato com os próprios processos de morte e finitude, suscitando angústia e desconforto. O processo de medicalização da morte traz em seu bojo questões éticas e bioéticas ligadas à prática médica, principalmente relacionadas aos limites de ação terapêutica. Nesse cenário, os conflitos entre família e equipe de saúde podem surgir com força e de forma descontrolada. O objetivo deste estudo foi compreender as repercussões da terminalidade em terapia intensiva para a família e para a equipe médica. Para tal, desenvolveu-se uma discussão interdisciplinar abordando as seguintes temáticas: o setting da UTI e a integração dos cuidados paliativos aos cuidados finais de vida nessa unidade; o impacto da terminalidade na dinâmica e no funcionamento familiar, compreendido pelo prisma da terapia familiar sistêmica e das teorias sobre o processo de luto na família e os aspectos concernentes à formação médica, ao estresse advindo do exercício da medicina e ao processo de comunicação com as famílias. O cenário deste estudo é uma UTI de um hospital privado, de médio porte, localizado na cidade do Rio de Janeiro. Utilizou-se a metodologia clínicoqualitativa de pesquisa. Foram entrevistados seis familiares de pacientes em situação de terminalidade e seis membros da equipe médica, totalizando 12 participantes. A partir da análise do material discursivo das entrevistas dos participantes, emergiram 11 categorias, 6 das falas dos médicos e 5 das falas dos familiares. Constatou-se que a terminalidade do paciente em UTI é atravessada por questões clínicas, familiares, sociais, culturais, religiosas, econômicas e éticas, abarcando aspectos multidimensionais. A morte iminente do paciente promove grande angústia e sofrimento para os familiares, ocasionando intensas vivências de desamparo. Para o médico intensivista, a morte e o morrer são fenômenos que causam estranheza, apesar de naturalizá-los, pois este espera conseguir salvar a vida do paciente, já que conta com equipamentos de suporte avançado de vida. Foram ressaltados como elementos essenciais para uma boa qualidade de morte, a comunicação empática, afetiva e efetiva entre todos os atores envolvidos e a participação do paciente e da família no processo de tomada de decisões. / [en] ICUs have become a frequent place of death for most people in the world. The death or the threat of loss of a loved one creates imbalance in the family system, giving rise to feelings of impotence, fragility and vulnerability. For the medical staff, the patient s death brings the possibility of contact with their own death and finitude processes, bringing up anguish and discomfort. The process of medicalization of death brings with it ethical and bioethical issues in the medical practice, mainly related to the limits of therapeutic action. In this scenario, conflicts between the family and the health care team may come up with some strength and without control. The objective of this study is to understand the impact of terminal illness in intensive care for the family and the medical staff. This study required an interdisciplinary discussion, in which we developed the following themes: the setting of the ICU and the integration of palliative care for end of life care in that unit; the impact of terminal illness in the family dynamics and functionality under the light of systemic family therapy and the theories about the grieving process in the family. We also discussed the aspects regarding the medical training, the stress arising from this type of work and the process of communication with families. The setting for this study was an ICU of a private hospital, midsize, located in the city of Rio de Janeiro. We used the clinicalqualitative research methodology. There were six interviewed relatives of patients terminally ill and six members of the medical staff, totaling twelve participants. From the analysis of the discursive material, 11 categories emerged, 6 from the doctors speeches and 5 from the families speeches. It was found that the patient s terminal illness in the ICU is crossed by clinical, family, social, cultural, religious, economical and ethical issues, covering multiple dimensions. The imminent death of the patient promotes great anguish and suffering for the family, causing intense experiences of helplessness. Although death and dying are natural processes, they are phenomena that cause strangeness for intensive care physicians, who hope to save the patient s life as they have advanced life support equipment. We have highlighted some elements that are considered essential to a good quality of death, which are empathic, affective and effective communication among all people involved and the participation of the patient and family in the decision-making process.

La prise en charge des urgences vitales préhospitalières en France, est du ressort des SMUR sous l’autorité des SAMU, seuls responsables de l’organisation des soins, du lieu de survenue jusqu’à l’hôpital. L’accessibilité de la population aux équipes médicales des SMUR n’avait jamais été évaluée. Au travers de l’analyse prospective d’une cohorte de 500 patients traumatisés crâniens graves, pris en charge par les SAMU/SMUR en Ile de France, l’apport d’outils SIG a permis d’identifier les caractéristiques d’accessibilité et de disponibilité de l’organisation territoriale des SMUR franciliens. Des territoires ont été identifiés potentiellement à risque, en raison d’une accessibilité des moyens SMUR supérieure à 30 minutes. Cependant, le critère d’accessibilité pris isolément, masque de fortes inégalités dans l’organisation territoriale des SMUR. La disponibilité d’un SMUR est un critère essentiel, rarement évalué. La prise en charge du traumatisme crânien grave illustre parfaitement la situation. La réflexion géographique et l’utilisation des outils SIG permettent de pouvoir évaluer et visualiser objectivement les atouts et faiblesses de l’organisation territoriale d’un système de santé et de proposer des modèles d’organisation pertinents. / In France, the prehospital life threatning emergency are managed by mobile medical team (MMT) and an medical dispatcher service called SAMU. Access to medical mobile team, is a strong criterion but never has been estimated. Throughout a Paris regional study, who concerned five hundred severe traumatic head injury managed during two years by MMT, we perform, with tools GIS , an assessment of accessibility and availability to MMT in Paris area. We concluded that the SAMU organization made strong disparity in the area coverage.

No description available.

中國自1963年向阿爾及利亞派遣第一支醫療隊以來，穩定對非洲發展衛生外交，近年來漸吸引中國及外國學者注意，然基於中國對外援的保密性，以及衛生外交未成顯學，對於中國在非洲衛生外交的狀況因此缺乏資料，本文以現有研究結果為基礎，蒐集和整理中國官方資料，描繪出中國在非洲衛生外交發展、規模及樣態。中國藉由衛生外交在非洲取得可觀利益，包括政治方面，如非洲國家支持中國取代台灣在聯合國席位、為中國人權議題護航以及在兩岸議題上支持中國立場；經濟方面，如以衛生外交打進非洲市場，引入中國製藥品以及以醫療物資換取非洲國家資源；軟實力方面：提升中國形象，促進中非在其他方面的合作。然中國在非洲衛生外交也面臨不少挑戰，包括中國國內醫生不足、語言文化隔閡、中國人大量進入非洲為非洲帶來的威脅感，以及非洲國家效率不佳等問題。 　　本文選用莫三比克為討論個案，主要基於中國對莫國衛生援助穩定，以及莫國非能源出口國，因此正可用以檢視中國官方媒體對中國在非洲衛生外交的「神話」般報導以及有些中國學者對於中國衛生外交不為能源而是傳播道義思想的論述是否真確。研究發現僅管莫國現不具能源，中國藉由提供衛生援助在莫國取得其他重要利益，如政治層面，外科醫生江永生使莫國堅定且明確支持兩岸統一；經濟層面，如熟悉中國藥品的莫國向中國製藥公司購買抗瘧疾藥品，軟實力層面，莫國大部分民眾對中國抱持好感，政府官員也甚讚中莫醫療合作。莫國同時也是第一個曾經拒絕中國醫療隊派遣的國家，也正可藉此檢視中國衛生外交面臨的困境。除語言文化隔閡外，中國醫生不願至莫國偏鄉服務加上其他外國醫生在莫國的競爭使莫國有意降低對中國醫療資源的依賴，是莫國不願續約的主因。中國若不能妥善處理上述問題，莫國可能不會是唯一一個拒絕接受中國醫療資源的國家。 / Since its very first medical team to Algeria in 1963, China has been steadily developing its health diplomacy in Africa. This stably growing flow of medical resources from China to Africa has caught attention from both Chinese and foreign scholars. However, owing to the confidentiality of Chinese foreign aid and the fact that health diplomacy is a term that is relatively new in the academia, there is no clear picture about China’s health diplomacy in Africa. Based on the existing literature, this thesis complies facts and figures principally from Chinese official sources in a bid to draw a clear picture of the development, scale, and pattern of China’s health aid to Africa. Via health diplomacy, China gains considerable benefits. In the political front, African countries that have received medical assistance from China support China’s bid to replace Taiwan in the United Nations, shield China from human right censoring, and stand with China in cross-strait issue. In the economic front, with health diplomacy, China introduces home-manufactured medicine to Africa or simply trades its medical service with Africa’s natural resources, tapping into a continent that is stricken with disease. More than political and economic benefits, health diplomacy most importantly burnishes China’s image in Africa, enhancing its soft power. However, China’s health diplomacy doesn’t go without any obstacles. The lack of volunteer doctors, the barriers of language and culture, a sense of threat conjured by the heavy presence of Chinese in Africa, the inefficiency of African countries and so forth, all present themselves as impediments to China’s health diplomacy in Africa. This thesis chooses Mozambique as the target for further research because China’s medical aid to Mozambique has been very stable. Also, Mozambique is not a major exporter of natural resource; hence it could be used to examine the often mythologized reports from China’s official media on the Chinese doctors serving in Africa, and the claims by some Chinese scholars about how China’s health assistance is not for natural resources but for solidarity. What my research finds however is that despite the lack of energy currently, Mozambique offers some other benefits to China. For political benefits, the Chinese surgeon, Jiang, Yong-Sheng ensures that Mozambique firmly endorses the unification of Taiwan and China. For economic benefits, Mozambique, who is well acquainted with Chinese medicine, purchases anti-malaria medicine from a Chinese medical company. As for soft power, a majority of Mozambicans have favorable opinion toward China. The Mozambican officials for numerous times praise the medical cooperation between China and Mozambique. However, at the same time, Mozambique was the first country that refused to accept a new team of Chinese doctors to come to Mozambique, and thus it is also a good case to analyze the challenges that are facing China now. Apart from language and cultural barriers, Chinese government’s refusal to deploy their doctors in rural areas in Mozambique, and the medical personnel from other countries, make Mozambique tries to gradually reduce its dependence on China’s medical assistance. Being aware of its overdose reliance on China was the main reason why Mozambique didn’t want to renew the contract. If Beijing fails to solve the aforementioned problems, Mozambique might not be the only African country that says no to China’s doctors.