Although many researchers have studied language attitudes in the last three decades, none of the studies have been conducted in the hospital setting, where there are more serious consequences for those working with patients being labeled linguistically "incompetent," as charges of incompetence in language are apt to lead to charges of incompetence in other areas of mastery as well (e.g., Ryan, 1983). This study examines the attitudes of a sample of nurses from three Portland-area hospitals towards nonnative English speaking physicians. The subjects, 156 medical-surgical nurses, listened to three anonymous audiotaped physicians who were from three different ethnic backgrounds: American, Japanese and Persian. The physicians were first all recorded reading a short patient history and giving a verbal order directed toward a nurse. This was the formal context. For the informal context, the physicians gave an impromptu response to a question regarding their future plans. The nurses rated each physician twice, once for each context, using the Speech Evaluation Instrument (SEI), a semantic differential scale using bipolar adjectives developed by Zahn and Hopper (1985). Results indicated that there was a significant positive relationship between a physician's pronunciation and a nurse's perceptions of his medical competency, as measured by the SEI, with the native English speaking physician receiving a higher rating than the two nonnative English speaking physicians. The native Japanese speaking physician, who had the strongest accent, received the lowest ratings on the SEI. There was also a significant positive relationship between the context the physician was speaking in and the ratings he received on the SEI, with the informal context receiving a higher rating for all three physicians than the formal context. If a physician's pronunciation or speech style causes nurses, not to mention patients, to evaluate him/her negatively, then one implication of this study is for the need for more pronunciation work and accent reduction exercises not only in the English as a second/foreign language classroom, but also as a continued offering for nonnative English speaking hospital personnel in teaching hospitals. Another implication relates to the need for better preparing nurses to work and communicate successfully with nonnative English speaking physicians, other hospital personnel, and patients by offering transcultural nursing classes in nursing school and making it a mandatory part of every nurse's education.

The number of adults aged 65 years and over has been rising quickly, as has the rate of new onset sexually transmitted diseases within this population. Discussions of sexual health between physicians and older adults are currently lacking in frequency and effectiveness. Using the foundation of stereotype embodiment theory, the purpose of this study was to identify the factors that predict frequency of discussing sexual health with older adult patients. A comparative sample of geriatric physicians and family practitioners completed 2 researcher-developed questions and the Sexual Health Care Scale-Attitude tool that assessed their stereotype beliefs toward discussing sexual health with older adults using the 4 subscales--personal, patient, environmental, and colleague--and the frequency with which they discussed sexual health with their older adult patients. It was hypothesized that non-ageist attitudes would increase the frequency of discussions, and increase the personal factors, such as comfort level, of having such discussions. Multiple regression analysis and the chi-square test were used in data analysis. Frequency of sexual health discussions with older adult patients was dependent upon the physician type, age and gender, and how well the physician believed he or she had been educated to discuss sexual health with older adults. Comparatively, the geriatric physicians had more frequent discussions of sexual health with older adults than the family practitioners. The implications for social change include identifying the need for more specialized physician training in discussing sexual health with older adults to improve overall physical and emotional well-being of older adults and the study's recommendations for future research.

Many studies have reported that the training for practitioners does not stimulate reflexes that contribute to the tenets of teamwork and collaboration. No studies were found to investigate relational intelligence (RQ) in pharmacist-physician relationships as a catalyst for collaborative and hence cost effective quality care. This study addressed the role and potential opportunity to promote RQ as a critical leadership skill in the collaboration between pharmacists and physicians. Using RQ as the conceptual framework, this phenomenological study explored how pharmacists and physicians in a hospital setting perceive RQ as a leadership skill when working collaboratively. A total of 10 participants (5 pharmacists and 5 physicians) from a 443-bed comprehensive hospital in Michigan were selected using purposive sampling. Pharmacists and physicians included had at least 4 years of hospital experience. Data were collected through semistructured in-depth interviews and analyzed using the hierarchical approach. Results indicated interest among both pharmacists and physicians to use RQ as a leadership skill to work collaboratively. Further findings highlighted the need for face-to-face communication between pharmacists and physicians, better collaboration, accountability, feedback, focus and alignment, promotion of positive relationships, and a leadership position directed by a PhD-prepared practitioner with expertise in RQ. These findings bring awareness to both pharmacists and physicians of barriers to collaboration; these findings also suggest the need for multidisciplinary training that incorporates RQ theory as a foundation for both pharmacists and physicians, which may decrease health care costs while improving communication, trust, mutual understanding, collaboration, and quality care.

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 using the Administrative Claims Data in Chronic Condition Warehouse (CCW). The results for the first research question revealed that an increase in the number of primary care physicians was correlated with a decrease in ED visits; thus, persons living in areas with higher PCPs also had lower ED visits therefore the first null hypothesis was rejected (Ï?2 = 3.85, p=.05) . The results for the second research question revealed that ED visits had no significant relationship with death in a given year; thus, patients may be diverted to less expensive care sites to minimize cost and ED overcrowding, therefore the second null hypothesis was not rejected (Ï?2 = 0, p=.98). In both cases, the confounding variables of gender, age, and race had significant effects upon the relationship. Health Professionals and policy makers may use the findings to develop strategies to increase supply of PCPs, adapt patient centered interventions and modify existing chronic disease care strategies to minimize or prevent lifestyle and environmental factors that affect chronic disease outcomes. Such improvements could contribute to positive social change by eliminating or reducing the overcrowding that occurs in emergency departments in Maryland and other states.

The past few decades have witnessed an increased focus on the importance of oral health on the social, psychological and developmental well-being in children. Although effective and advanced dental prevention measures and treatment options are increasingly available, dental decay remains one of the most common chronic childhood diseases in the United States and around the world. Recently, the World Health Organization Assembly called attention to the significant burden oral disease has maintained in all countries around the world. Additionally, multiple studies have described disparities in oral health with a disproportionate amount of dental disease concentrated in children with special health care needs, those that live with poor families or that live in isolated or rural communities. In response to this issue there has been renewed focus on combating access to oral health care issues. One approach that has been suggested is the utilization of non-dental health professionals in assessing oral health, performing basic preventive steps and referral of high-caries risk children for further care. These non-dental professionals are often in a better position to evaluate children at an early age, are more likely to see poor children early and to provide care for them on a continuing basis when compared to dentists. However, several barriers have been mentioned in the literature that prevent or deter these non-dental health professionals from taking on a more active role in this access to care issue. Of which has been a reported lack in oral care education and training for medical care professionals. Additionally, collectively few studies have specifically identified the importance of different suggested influencing factors. In our present study, three main analyses were conducted. The first analysis assessed the oral-health knowledge, practices, and factors influencing the ability and willingness of Iowa pediatricians' to assess and refer high caries-risk children. In which, a 22-item survey was mailed to all licensed pediatricians in Iowa. Chi-square statistics and logistic regression models were used to analyze data. On questions regarding comfort levels when performing oral-health related practices on children under 3, physicians reported high levels of comfort with all specified issues. The majority of respondents routinely gave the name of a dentist to the caregiver when referring, where as only 4% made use of local care coordination services and only 9% actually made the dental appointment. Sixty-five percent referred all children 12 months or older to a dentist in accordance with AAPD and AAP guidelines. The ability to locate a dentist willing to accept Medicaid or uninsured children was noted as the major referral barrier. Bivariate and multivariate logistic regression analyses indicated that pediatricians who had higher frequency of seeing oral-health problems (p=0. 0.0488), greater mean total number of children seen per week (p=0.0431), and believed that children should have their 1st dental visit no later than 12 months of age (p=0.0196) were more likely to make frequent referrals to a dentist compared to their counterparts. The second analyses assessed Saudi medical interns' oral-health knowledge, and other factors influencing their ability and willingness to perform oral-health related practices for high caries-risk children. In which, a 15-item survey was emailed to all eligible graduating fifth year medical students at King Khalid University Hospital to address these areas of interest. Chi-square statistics and logistic regression models were used to analyze data. Similar to our first study physicians noted high levels of comfort with all specified oral health practices. However, students generally rated their medical training fair or poor in preparing them for oral-health assessments compared. Additionally, although 90% of respondents noted that the role of primary physicians in counseling/referring children with oral health was important; 60% did not agree with the AAPD and AAP guidelines that state that all children should be referred to a dentist by 12 months of age. Multivariate logistic regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health related practices. The choice of public-health oriented future clinical goals, the level of oral-health knowledge, how interns rated their oral health training in medical school, and the average number of children seen per week, all - to varying degrees - proved important predicator variables for the likelihood of performing them once in practice. In our third study focus was placed on assessing the effectiveness of an electronic educational intervention on improving primary care practitioners' knowledge, willingness, and comfort levels in identifying children who are at high risk for developing dental caries. Following the educational program, a 16-item survey was emailed to all participants to address the areas of interest. Bivariate correlation and linear regression were used to analyze data. Respondents gave a higher percentage of correct responses to the knowledge questions post-intervention compared to pre-intervention with an average increase of 63%. Additionally, nearly all respondents agreed with the statement that all children 12 months and older should be seen by a dentist in accordance the AAP & AAPD. Furthermore, physicians noted improved levels of comfort with all specified oral health practices. Most notable, following the educational intervention, 91% of respondents rated them-selves as comfortable in counseling, compared to only 25.6% that did so before the educational program. The only exception on comfort issues pertained to performing emergency treatments on young children with a majority of interns (92%) still considering themselves as neutral or uncomfortable in doing so. Multiple linear regression analyses revealed several statistically significant variables that predict the likelihood of performing various oral-health related practices. Increased oral health knowledge, higher self-perceived comfort levels and seeing oral-health problems more frequently all proved important predicator variables for the likelihood of performing oral-health related services. Collectively, these three analyses lead us to several main conclusions and future education recommendations. Educating medical practitioners and students about basic oral health recommendations and referral guidelines provides an excellent opportunity to alert medical professionals about the importance and timing of these dental referrals. Ultimately, earlier referrals by physicians can help improve dental utilization among high risk children, especially among lower income and rural families. Additionally, providing these medical professionals with experience opportunities in assessing the oral health of young children may improve both physician willingness and likelihood to perform various oral health practices for young children. Overall, increasing both knowledge and personal experience of training physicians' could lead to greater comfort levels in dealing with oral health issues affecting young children. Furthermore, establishing effective care coordinator services to assist in linking various health care professionals more directly; may also increase physician willingness to assess and refer high-caries-risk children by making the referral process easier for physician offices. This step helps in saving time and effort, two deterrents noted by physicians.

Abstract not available

The development of community health services (CHS), characterised in particular by the emergence of general practitioners and the establishment of community health centres, is one of the top priorities on the policy agenda for urban health reform in China. The primary and secondary levels of hospitals are being urged to change functions, shifting from traditional hospital services to CHS. This study aimed to contribute to the development of training strategies for CHS through documenting the policy, administrative and institutional arrangements of the CHS programs, identifying performance problems, and analysing relevant determinants that underpin the practice and performance of CHS. Document analysis, indepth interview and questionnaire survey were adopted as main methodological approaches. The study was undertaken in Chengdu and Panzhihua, which included observation of 14 community health centres, interview with 23 general practitioners and managers, and a random sample survey among 1041 residents. This study revealed that the top priority of the CHS programs was to try to stay alive through competing with other health institutions for consumers who could afford medical charges and to provide clinical services that would generate good revenues. The accessibility to medical care for the community residents had not been improved significantly. Poor response to local population health issues, inefficient use of resources and poor quality of services were amongst the key performance problems. There was little prospect of the CHS institutions achieving sustainable development. There was a widespread agreement among the CHS managers and practitioners that training is an essential strategy in improving the CHS performance. However, when policy, system, and cultural barriers are not properly addressed, training means little. There were evident organisational failings and lack of inter-governmental collaborations and leaderships in developing CHS. The lack of policy coherence with respect to organisational incentives impeded the achievement of the goals of CHS. There was also a lack of consumer participation and support. These findings have implications for both policy development and training arrangements. The development of CHS needs to be considered as a system change rather than in terms of isolated institutional developments. Training arrangements for CHS need to offer competencies for a wide range of organisations and professionals to enable them to improve their daily works and also to contribute to solving some of the system problems. The training programs developed for governmental officials, hospital and CHS managers, general practitioners, community nurses, public health workers, pharmacists and other CHS practitioners need to be aligned with a unified goal and facilitate the development of the supportive environments and inter-organisational collaborations (partnerships).

"June 2002" / Bibliography: p. 347-360. / xiii, 360, [200] p. : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.Med.Sc.)--University of Adelaide, Dept. of Public Health, 2002

<p>During the last decade, there has been a renewed interest in physicians´ working conditions at a time when health care is undergoing major structural and financial changes. Physicians report decreasing work satisfaction and at the same time increasingly contemplate on leaving their profession. Despite an increasing proportion of female physicians, they are underrepresented in management positions. Very often, female physicians also report worse personal health and less organisational influence than their male colleagues. Management programs have been viewed as an important vehicle to improve working conditions and career development for female physicians.</p><p>The aim of the present thesis was to evaluate the effects on individual health, professional development, perception of organisational structure and career development. Fifty-two female physicians participated in structured 1-year management programs. The control group consisted of 52 physicians not participating in any formal management education during the study period. The female physicians were compared with 157 male physicians in order to evaluate possible gender and manager-reported differences on individual and organisational well-being. The study also assessed occupational predictors of individual well-being, health and professional development for managers.</p><p>Participants in management programs reported a clearer organisational structure and improved professional development and influence. However, there were no significant effects with regard to health, sickness absenteeism, nor career development. Male and female physicians differed in several areas when assessed as a group, but stratifying for management level, most of the gender-related differences disappeared. When managers rated clearer organisational structure, this was associated with higher ratings on individual well-being and professional development.</p><p>Management programs for female physicians might have some beneficial effects but these programs need to be better defined and targeted to the most important issues at hand to recruit future managers. Furthermore, these programs must be better integrated with other processes to create efficient and able managers.</p>

The dissertation deals with the infant mortality decline in Iceland during the 19th and early 20th Century. It shows that despite its low degree of urbanization, pre-transitional Iceland displayed higher infant mortality rates than most other European countries. Levels are only comparable with a few areas in Europe, all of whom were known for a tradition of artificial feeding of newborns. In the Icelandic case, infants were either not breastfed at all or were weaned at a very young age. Another characteristic of infant mortality in Iceland were huge fluctuations during epidemics. Because of the isolation of the country, several diseases that had become endemie in other societies, such as measles, became dangerous epidemics in Iceland and affected all age groups. After 1850 the effects of epidemics declined and 20 years later there was a steep decline in infant mortality. By the beginning of the 20th Century infant mortality in Iceland was lower than in most other societies. Although epidemics often had important temporary consequences upon infant mortality level in pretransitional Iceland, being breastfed or not was without doubt the most important determinant of infant survival. There were huge differences in infant mortality levels between areas where breastfeeding was common and those where newborns were artificially fed. Towards the turn of the 20th Century significant changes occurred. Even though there were still differences in infant mortality between those babies who were breastfed and those who were not, infant survival had improved greatly and survival chances of Icelandic newborns that were fed artificially became in an international perspective relatively good. Midwives played a central role in the infant mortality decline in Iceland. Growing secularization during the second part of the 19th Century improved educational opportunities for women and also changed the content of education. Improved educational opportunities were reflected in changes in the education of midwives. At the same time there was growth in the publication of books that directly dealt with the issue of infant health. The increase in the number of educated midwives was a factor of central importance. The interaction between midwives and a literate population was most likely the key to infant survival in the Nordic countries. This study shows that that the custom to breastfeed spread earlier in areas with higher literacy. Not only is it plausible that the interest in changing prevailing traditions was directly related to literaey levels of individuai mothers, it is also shown that midwives had the best education in areas where literacy rates were high. On the other hand, the remarkable improvements in infant survival obtained towards the end of the 19th Century were scarcely linked to changes in the economic structure. Those factors only started to play an important role in the 20th Century. In its initial stages, changes in infant feeding and improvements in personal hygiene were more important / digitalisering@umu