ADHD is the most commonly diagnosed neurobehavioral disorder among children. While ADHD in Western countries has long been recognized and increasingly diagnosed in recent years, there is a growing recognition of this disorder as a significant cross-cultural phenomenon. Saudi studies to date vary in their estimation of prevalence of ADHD, with overall prevalence estimated to be between 3.5% and 6.5%, while the worldwide prevalence of ADHD is 5.29%.This study is a thesis by three articles. The first article examines the representations of ADHD by the Saudi ADHD Society members on Twitter because, as the only charity serving people with ADHD in Saudi Arabia, they have come to define how ADHD is talked about there. The Society’s Twitter account (@adhdarabia) has over 13,500 followers. Tweets posted between December 1st, 2016 and January 31st, 2017 were collected, with those announcing events and retweets from other accounts eliminated. This resulted in 141 tweets discussing the nature, causation, and treatment of ADHD. The content of these tweets was analyzed using Foucauldian discourse analysis. Findings reveal that the Society’s Twitter account shows members constructing ADHD as an experience of suffering; their comments position children with ADHD as sufferers, often subject to additional problems. An alternative discursive construction of ADHD is that caring for a child with ADHD is a ‘different’ kind of responsibility for parents and teachers, who must be advised by ‘experts’. The implications of these discourses are discussed in this paper.The second article uncovers the lived experience of parents with a child who has had an ADHD diagnosis in Saudi Arabia, and examines how their experiences can be understood in relation to the multiple and competing discourses of ADHD that frame their daily lives. Which discourses do parents draw upon – and reinforce – as they describe their experiences of ADHD, and which discourses do they resist? This study carried out in-depth interviews with seven Saudi parents who have at least one child diagnosed with ADHD, or any of its subtypes, between the ages of two and 11. Foucauldian discourse analysis (FDA) is applied in analyzing parental ADHD discourses, uncovering how these parents made sense of ADHD pre- and post-diagnosis. Four main discourses emerged in the process: ADHD as normal behavior (pre-diagnosis), and ADHD as emerging from supernatural/religious, medical, and social environment contexts (post-diagnosis). This paper also emphasises that the causes of ADHD must be considered in the wider context of misconceptions and uncertainty among Saudi parents. All the participants in this research were influenced by a combination of discourses in their attempts to make sense of their children’s symptoms.The third article explores the discourses drawn upon, reinforced and resisted by six Saudi teachers and four clinicians as they describe their experiences and understanding of ADHD. Saudi clinicians approach ADHD as an extension of American medical views in terms of its causes, diagnosis and treatment. Alarmingly, in light of the shortage of recommended ADHD medications, there are accounts of antipsychotic medications being prescribed for children. Saudi teachers’ views of ADHD were an extension of the medical discourse; this meant that students’ strengths were ignored and the focus was entirely on negative behavioral patterns. Despite a tendency to attribute ADHD to genetics, teachers objectified students who ‘acted out’ as having ADHD or even other disorders (when the child’s behavior or symptoms diverged from their limited understanding of ADHD). Parents who do not comply with teachers’ suggestions are blamed for any lack of improvement in the child’s behavior or academic attainment. Teachers’ accounts also revealed some serious pressures on them as a result of large class sizes and a lack of training in how to teach and manage students with ADHD. These findings have implications for individuals and institutions providing ADHD education to both doctors and teachers, and reinforce calls for researchers to examine ADHD outside of the genetic ‘box’.

Abstract available through the Clinical Journal of Sport Medicine.

Background & Rationale: Burnout syndrome (BOS) is a psychological state resulting from prolonged exposure to job stressors. It is commonly observed in occupations with human interaction. The most visible impact of burnout is a decrease in work performance and the overall quality of service, and within healthcare professionals, BOS correlates with reported medical errors. Academic healthcare workers are particularly predisposed to experience BOS given the high level of work-related stress that characterizes their jobs. There is a scarcity of studies investigating burnout in academic clinicians. Objective: The goal of this study is to identify the prevalence of burnout in academic clinicians in the Faculty of Health Sciences at McMaster University and investigate potential demographic and workload variables that contribute to self-reported measures of burnout. Methods: A novel modification to the MBI (Maslach Burnout Inventory) scale was distributed to all academic clinicians at McMaster University through an internet-based survey. The MBI scale was modified to reflect three hypothesized sources of burnout for academic clinicians: interactions with students/trainees, interactions with patients and interactions with administration. The scale comprised of three dimensions of burnout: Emotional Exhaustion (EE), Depersonalization (DP) and Personal accomplishment (PA). Demographic and workload data were also collected. Results: Factor analysis and internal consistency showed that the modified MBI scale was associated with valid and reliable scores, respectively, within this population. Results showed that academic clinicians experienced high levels of burnout due to administration interactions relative to that attributed to patients and students. The prevalence of burnout for the EE subscale are: administration = 51.8%;, patients = 26.4%, students = 11.7%); for the DP subscale: administration = 44.8%, patients, = 24.5%, students, = 9.8%); and the PA subscale: administration =16.3%, patients = 33.4%, students =33.7%). Regression analyses suggested that young age, surgical specialty, low academic rank, academic main practice, female gender, numerous night shifts and living alone contribute to EE and DP subscales. Meanwhile, high number of patients under their care was shown to contribute to increasing PA. Conclusion: Burnout Syndrome is prevalent among academic clinicians at McMaster University. The major source of burnout was attributed to interactions with administration. Surgical specialties and young faculty staff members correlated with burnout. Further studies are needed to further characterize the nature of administrative interactions that contribute to burnout and to solidify other contributing variables. / Thesis / Master of Health Sciences (MSc) / Burnout syndrome (BOS), is a syndrome characterized by depleted energy resources, dealing with people as if they were impersonal objects and with decreased personal accomplishment. Physicians and educators are at risk of the syndrome. BOS has been linked to providing suboptimal care and medical errors. Our study investigated the prevalence of BOS in academic clinicians (physicians who work in a teaching hospitals) since they have two roles; physicians and educators. We also investigated any demographic variables related to BOS. We have created a novel modifications to Maslach Burnout Inventory ( one of the main scales used to measure BOS). We have established its validity and reliability. Our study showed that almost 50% of academic clinicians have burnout. Major source is due to their interaction with administration, followed by interaction with patients and lastly interaction with studens. Surgeons, females, young age, single, increased night on-call and low academic rank were predictors for burnout. A larger scale study is needed to pinpoint the kind if administrative interaction that is related to BOS. The ultimate goal is to make our teaching hospital work environment more friendly and transpiring to better patient care.

This is a research paper submitted for LIBR220 (Medical and Health Sciences Librarianship), a graduate course in Library and Information Sciences at San Jose State University. / PURPOSE: To evaluate ways in which hospital librarians can help clinicians keep up with the rapid growth of genetic information and incorporate it into patient care as we enter the era of genomic medicine. SETTING: Hospital medical libraries DESCRIPTION: The fast-growing new field of genomic medicine applies human genetic information to the understanding and treatment of disease. Historically, evidence-based healthcare has been informed by studies on large populations. Breakthroughs in genetic analysis technologies are presenting healthcare providers with new opportunities to diagnose and customize clinical treatment based on the genetic structure of individual patients. In the hospital setting, access to genomic medicine information resources, clinical guidelines, and continuing education will be critical in the near future. This research paper will explore resources and programs that hospital librarians can offer to clinicians, to serve their genomic medicine information needs and help them navigate through unfamiliar territory.

Master of Public Health - MPH / Introduction: Tuberculosis (TB) is one of the most infectious diseases globally and is a huge public health concern. In 2016, the Western Cape Province had the fourth highest incidence of TB in South Africa, with 728 new cases per 100 000 population. Effective management of TB includes screening, diagnosis, treatment, control and elimination. The local health authority (municipality) has historically managed tuberculosis in the Cape Metropole but due to the increased TB burden, primary health care (PHC) facilities managed by Metro Health Services (MHS) (provincial government) have recently commenced providing TB services. The challenge that the Cape Metropole is facing, is whether the clinicians in MHS facilities are equipped to manage these patients effectively. Aim: To determine the knowledge, attitude and practices of clinicians in the screening, diagnosis and treatment of tuberculosis in the MHS PHC facilities in the Northern Tygerberg Sub-structure, Cape Town between mid-March 2018 and mid- June 2018.

Magister Scientiae Dentium - MSc(Dent) / The Gauteng province is divided into 5 districts each of which have a public based oral health programme. Each district provides oral health treatments such as dental extractions with treatment of pain and sepsis, preventive dentistry, simple restorations, removable prosthodontics (complete and partial dentures) and minor oral surgery in selected facilities. The main treatment modality in most government based dental clinics is dental extractions (Department of Health, 2003). This indicates the poor status of the population’s teeth. Dental caries is a condition that can be prevented if adequate efforts are made to practice preventive dentistry. Preventive dentistry has been a treatment modality that has been practiced poorly or almost completely ignored in several oral health facilities for many years. This neglect could be due to several factors such as in adequate knowledge regarding preventive dentistry procedures, poor attitude towards preventive dentistry, lack of motivation, or lack of resources (Clark, 2011). The purpose of this study is to determine why preventive dentistry has been neglected for so many years.

The purposes of this survey were (1) to determine the nature of the case load of speech clinicians in Texas public school speech and hearing therapy programs, (2) to determine the type and condition of facilities in which the therapy described in item one above is being conducted, (3) to ascertain what the speech and hearing clinicians of the state believed to be essential for the effective practice of therapy, and (4) to find out what the clinicians believed to be special problems in their present facilities.

Infertility is a disease that can cause psychological impairments in women, and the inability to achieve motherhood brings about cultural and social stigma. Spirituality is a protective element that may provide consolation to women experiencing infertility, yet the literature has shown that few clinicians conduct spirituality assessments or provide spiritual care to patients. The objectives of this scholarly project were to conduct an assessment to determine the needs of health care clinicians in regard to spirituality and spiritual patient care and to develop an educational module based on identified knowledge deficits. Guided by the knowledge-to-action cycle, a needs assessment was conducted in a small fertility clinic with 2 clinicians. The results of the assessment showed that the clinicians had not conducted spirituality assessments on their infertile patients and only sometimes provided spiritual care. An educational module and a posttest were developed and then validated by 3 doctorally-prepared nursing faculty members using a self-developed 10-question Likert-type evaluation scale. The materials were found to be clear, accurate, and easy to read by the nursing faculty. An implication of this scholarly project is that it will give clinicians the resources needed to create social change in health care by addressing the spirituality needs of women experiencing infertility. Future research includes a pilot study to implement the educational module with clinicians at the fertility clinic and to evaluate its effectiveness for enhancing spiritual care in practice.

The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).

The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).