Sample records for asylum physician scientific

  1. Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system

    Directory of Open Access Journals (Sweden)

    Pécoud Alain


    Full Text Available Abstract Background Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. Methods This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1 use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral, 2 provision of access to treatment meeting medical needs, and 3 absence of unnecessary medical procedures. Results In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p Conclusion Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.

  2. [Scientific publications: a resource for the physician's intellectual development]. (United States)

    Zárate, Arturo


    The physician's professional life involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches intellectual development, through the creation of a culture of writing and reading scientific publications.

  3. Church Asylum


    Birgit Neufert


    Church asylum, or sanctuary, is a practice to support, counsel and give shelter to refugees who are threatened with deportation to inhumane living conditions, torture or even death. This practice can be located at the interface of benevolence and politics.

  4. Church Asylum

    Directory of Open Access Journals (Sweden)

    Birgit Neufert


    Full Text Available Church asylum, or sanctuary, is a practice to support, counsel and give shelter to refugees who are threatened with deportation to inhumane living conditions, torture or even death. This practice can be located at the interface of benevolence and politics.

  5. Scientific writing training for academic physicians of diverse language backgrounds. (United States)

    Cameron, Carrie; Deming, Stephanie P; Notzon, Beth; Cantor, Scott B; Broglio, Kristine R; Pagel, Walter


    Research articles are the coin of the realm for anyone working in academia, and success or failure to publish determines a biomedical researcher's career path. At the same time, the dramatic increase in foreign faculty and trainees in U.S. academia, as well as in international scientific collaboration, adds another dimension to this developmental vacuum: limited English-language skills. Paradoxically, few programs exist to develop and support the skills needed to accomplish the vital task of writing English-language research articles, which does not come naturally to most. To better prepare all trainees for research careers, editors in the Department of Scientific Publications at The University of Texas M. D. Anderson Cancer Center created an in-depth training program that would target the writing skills gap effectively. Instruction focused on structure, rhetorical organization, and the conventions of biomedical publishing. More than 300 trainees have participated in 22 workshops. Results of a survey of 46 participants at 6 months to 2.5 years after workshop completion indicated that participants from all language backgrounds believed the course to have improved their writing (97.8% strongly agreed or agreed), made it easier to begin a manuscript (80.4%), and helped them to get published (56.8%), with nonnative speakers of English reporting somewhat greater perceived benefit than native English speakers. On the basis of these results, the authors conclude that researchers of varied linguistic backgrounds appreciate the need for, and benefit from, instruction in the conventions of scientific writing.

  6. Why are physicians not persuaded by scientific evidence? A grounded theory interview study

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    Ishizaki Tatsuro


    Full Text Available Abstract Background The government-led "evidence-based guidelines for cataract treatment" labelled pirenoxine and glutathione eye drops, which have been regarded as the standard care for cataracts in Japan, as lacking evidence of effectiveness, causing great upset among ophthalmologists and professional ophthalmology societies. This study investigated the reasons why such "scientific evidence of treatment effectiveness" is not easily accepted by physicians, and thus, why they do not change their clinical practices to reflect such evidence. Methods We conducted a qualitative study based on grounded theory to explore physicians' awareness of "scientific evidence" and evidence-supported treatment in relation to pirenoxine and glutathione eye drops, and to identify current barriers to the implementation of evidence-based policies in clinical practice. Interviews were conducted with 35 ophthalmologists and 3 general practitioners on their prescribing behaviours, perceptions of eye drop effectiveness, attitudes toward the eye drop guideline recommendations, and their perceptions of "scientific evidence." Results Although few physicians believed that eye drops are remarkably effective, the majority of participants reported that they prescribed eye drops to patients who asked for them, and that such patients accounted for a considerable proportion of those with cataracts. Physicians seldom attempted to explain to patients the limitations of effectiveness or to encourage them to stop taking the eye drops. Physicians also acknowledged the benefits of prescribing such drugs, which ultimately outweighed any uncertainty of their effectiveness. These benefits included economic incentives and a desire to be appreciated by patients. Changes in clinical practice were considered to bring little benefit to physicians or patients. Government approval, rarity of side effects, and low cost of the drops also encouraged prescription. Conclusion Physicians occasionally

  7. Health issues of asylum seekers and refugees. (United States)

    Kisely, Stephen; Stevens, Margaret; Hart, Bret; Douglas, Charles


    This paper is written on behalf of the West Australian Branch of the Australasian Faculty of Public Health Medicine. As public health physicians, we feel it is important that public health professionals should contribute constructively to address the needs of a socially deprived, marginalised group with high rates of physical and psychiatric morbidity. Depending on the definition, there are between 18 and 48 million asylum seekers and refugees in the world. Most seek protection in neighbouring countries, largely in Africa and Asia, rather than coming to North America, Europe and Australasia. Contrary to popular belief, numbers of successful applications to Australia's humanitarian program have actually fallen. This article attempts to correct misperceptions and misapprehensions about the effect of asylum seekers on the public health. Public health professionals should lobby for changes to Govemment policy that at present leave asylum seekers vulnerable to a cycle of poverty, ill-health and limited access to health services.

  8. [Public Health initiative for improved vaccination for asylum seekers]. (United States)

    Brockmann, Stefan O; Wjst, Stephanie; Zelmer, Ursula; Carollo, Stefanie; Schmid, Mirjam; Roller, Gottfried; Eichner, Martin


    The number of asylum seekers in Germany has increased dramatically in 2015. Their medical care includes the officially recommended vaccinations; yet, no detailed information on this is yet available in Germany. In light of the rising number of asylum seekers, we have developed a concept to facilitate their vaccination. This concept includes the coordination of different partners, the supply of vaccines and other materials through the local health office, and the cooperation with the local physicians' association. To evaluate and accelerate progress, we compared the number of vaccinations conducted by physicians independently of the vaccination concept with those conducted within the new concept. For the period of investigation, 2,256 new asylum seekers were temporarily accommodated in the facilities. The vaccination concept was applied in only some of the facilities. Twenty-eight percent of all asylum seekers (642) were vaccinated at least once; 89 % of the vaccinees (571) were vaccinated within the newly developed concept. In the facilities that were not included in this concept, only 6 % of the refugees were vaccinated, whereas in the facilities that were included up to 58 % were vaccinated. Even though the new concept has started successfully, further innovations are required to reach sufficient vaccination coverage among asylum seekers. In view of the large number of new asylum seekers expected, the adjustment and expansion of the new concept requires professional planning and coordination. Furthermore, additional resources are required.

  9. The Right to Asylum and EU Asylum Procedure in Greece



    Greece, under intense criticism over its asylum management by local NGO actors and European member states, has established a new asylum service, in 2013. In this article we explore the practice and the discourses that occur at the Appeals Authority, an independent authority in the determination of refugee eligibility at second instance, of the newly established Asylum Service in Greece. As members of appeal committees engage with each other and with the asylum seekers in deciding who is entit...

  10. [The guidelines and other scientific technical instruments for improving, updating and validating the Occupational Physician activities]. (United States)

    Apostoli, P


    From 2002 to 2007 the Italian Society of Industrial Medicine and Industrial Hygiene (S.I.M.L.I.I.) produced, in the context of the specific Education and Accreditation Programme for occupational physicians, more than 20 guide lines and consensus document on the most important and controversial themes for our Discipline. These instruments have aimed not only to improve the effectiveness of preventive actions but also to constantly adopt rigorous methodologies based where possible on evidence based medicine procedures. The Italian Occupational physicians agree with guidelines of our Scientific Society, but it appears now to be necessary to critically evaluate our experience, at the light of the new Framework Act for the occupational safety and health "Decreto legislativo 81/08" signed by the President of the Italian Republic on April 9, 2008, which firstly included in a legislative act terms such as technical normative, good practices, guide lines. Another important, mandatory reference, for a Medical Discipline as Occupational Medcine remains, in this debate is, in our Country, the National Program for Guide Lines edited By Italian National Health Institute since 2002 and part of current National System of Guide Lines concerning preparation, dissemination, updating, implementation of guide lines in Medicine. In this paper the main aspects related to different kind of instruments such as guide lines, consensus conference reports, technology assessment, good practices, technical normative, focusing in particular the argument identification, methodology, relationship between different instruments and their production and diffusion, economical and ethical issues and possible conflict of interest.

  11. Self-reported vicarious trauma in asylum evaluators: a preliminary survey. (United States)

    Mishori, Ranit; Mujawar, Imran; Ravi, Nirmal


    Hundreds of clinicians in the US conduct asylum evaluations, to document evidence of torture and persecution of people fleeing their home countries. Participating in these encounters puts clinicians at risk for vicarious trauma (VT). Little research addressed VT in physicians. Even less is known about VT among asylum evaluators. A survey was distributed to members of the asylum network of Physicians for Human Rights in Spring 2012. The majority (65%) of survey participants denied having experienced VT. However, being female, being a mental health professional and having performed a greater number of evaluations was associated with a higher likelihood of reporting VT. We present preliminary data about VT in asylum evaluators. Recruiters and trainers should make every effort to address the issue and educate their volunteers about means of identifying and managing symptoms. Formal and informal support services and resources should be developed and shared with volunteers.

  12. Impact of asylum interviews on the mental health of traumatized asylum seekers



    Background: Asylum interviews within the asylum procedure are associated with psychological stress for traumatized asylum seekers. This study investigates the impact of asylum interviews on the mental health in a sample of 40 traumatized asylum seekers. The comparison group consisted of refugees (N=10) that had not been invited to an asylum interview. Additionally, the moderating effects of trial-related variables such as perceived justice of the trial, stress of giving testimony, and stress ...

  13. Ethical and professional considerations providing medical evaluation and care to refugee asylum seekers. (United States)

    Asgary, Ramin; Smith, Clyde L


    A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient-physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the judiciary system; concerns about the consistency of asylum seekers' claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers' significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.

  14. Seeking asylum in the UK: lesbian perspectives

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    Claire Bennett


    Full Text Available Many aspects of the UK asylum process can be confusing,disempowering and traumatic for lesbian asylum seekers. Recentresearch examines the impacts of this process on their experiences,their identity and their well-being.

  15. Dermatological problems of asylum seekers arriving on boats: a case report from Australia and a brief review. (United States)

    Cheng, Hui Mei; Kumarasinghe, Sujith Prasad


    Assessing the skin of asylum seekers, immigrants, migrant workers, tourists or even locals who return from abroad, can be a confronting task due to the possibility of such people having non-autochthonous diseases. Primary-care physicians and dermatologists need to have a systematic approach in the assessment of such dermatoses. This article describes an interesting case of possible kerosene-induced and diesel-induced skin injury in an asylum seeker arriving on a boat. Dermatological conditions in asylum seekers and a suggested template for skin assessment are discussed.

  16. [Philosophers, physicists and physicians in defense of the unity of the scientific method]. (United States)

    Antiseri, D


    The falsifiability of scientific knowledge is an acquired result of contemporary philosophy of science and yet there is not a universal consensus upon the idea of the unity of scientific method. Albeit there are differences in techniques of testing (methodics) hypotheses in the vast field of research, the author, following the critical rationalism of Karl Popper, favors the perspective of the unity of method in natural as well in social and philological sciences.

  17. Daily Occupations among asylum seekers

    DEFF Research Database (Denmark)

    Morville, Anne-Le


    which might even influence their identity. Such deprivation can eventually lead to dissatisfaction with everyday life and to occupational dysfunction, i.e. a decline in ADL ability. Asylum seekers are a group who are more likely to suffer from health problems than the background population. Especially...... occupations on three levels – the experience of occupational deprivation, satisfaction with daily occupations and performance of ADL tasks – and whether occupational satisfaction and performance changed over a ten-month period. As there are often torture survivors among asylum seekers, another aim...... was to assess whether torture had an influence on the occupational satisfaction and performance, and whether this had changed after ten-months. Forty-three asylum seekers from Afghanistan, Iran and Syria participated at baseline and ten months later 17 were available for inclusion in follow-up studies. Study I...

  18. 8 CFR 208.13 - Establishing asylum eligibility. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Establishing asylum eligibility. 208.13... FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 208.13 Establishing asylum eligibility. (a) Burden of proof. The burden of proof is on the applicant for asylum to establish that he...

  19. Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark

    DEFF Research Database (Denmark)

    Hallas, Peter; Hansen, Anne R; Staehr, Mia A;


    The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group...... of asylum seekers to study if the incidence of mental disorders increased with length of stay....

  20. Length of stay in asylum centres and mental health in asylum seekers

    DEFF Research Database (Denmark)

    Hallas, Peter; Hansen, Anne R; Staehr, Mia A


    BACKGROUND: The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic...... group of asylum seekers to study if the incidence of mental disorders increased with length of stay. METHODS: The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical...... new applications (n = 4516) to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression...

  1. Applying principles from "Scientific Foundations for Future Physicians" to teaching chemistry in the department of medicine at Chang Gung University. (United States)

    Lou, Bih-Show


    Similar to the current trends in America that were recognized by the Association of American Medical College and the Howard Hughes Medical Institute in their 2009 report titled "Scientific Foundations for Future Physicians," Taiwanese medical students are lacking in their ability to apply their knowledge of basic sciences to real-life situations. The report recommended developing a competency-based approach to learning and also called for an increase in integrated and interdisciplinary courses in the education of medical students. Such a class, which would encourage students to look at biological concepts through chemical and physical principles, has been developed at Chang Gung University, and it strives to develop the medical student's ability to work in groups, think critically, and clearly and convincingly present ideas. The course requires students to present biological topics in groups after working closely with a teacher, and it trains the students to identify useful and trustworthy sources, to constructively criticize each other, and work together to present a cohesive and informative presentation for their peers. From my teaching experience, classes such as this have led me to conclude that the teacher's role does not simply encompass that of the informant, but also the facilitator of the academic success of the students, and this has led me to create certain class policies for teachers that help students of any field success in class.

  2. 8 CFR 1208.13 - Establishing asylum eligibility. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Establishing asylum eligibility. 1208.13... IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 1208.13 Establishing asylum eligibility. (a) Burden of proof. The burden of proof is on the...

  3. Occupational deprivation in an asylum centre:

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Erlandsson, Lena-Karin


    explored the participants’ occupational history and its influence on their occupations in the asylum centre. A thematic analysis showed that the participants had been subjected to occupational disruption and deprivation by politically oppressive systems even before their flight. Their occupations...

  4. FGM: challenges for asylum applicants and officials

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    Christine Flamand


    Full Text Available Asylum authorities in the European Union need to establish better procedures to help address the specific vulnerabilities and protection needs of women and girls who have undergone or are at risk of female genital mutilation.

  5. Impact of asylum interviews on the mental health of traumatized asylum seekers

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    Katrin Schock


    Full Text Available Background: Asylum interviews within the asylum procedure are associated with psychological stress for traumatized asylum seekers. This study investigates the impact of asylum interviews on the mental health in a sample of 40 traumatized asylum seekers. The comparison group consisted of refugees (N=10 that had not been invited to an asylum interview. Additionally, the moderating effects of trial-related variables such as perceived justice of the trial, stress of giving testimony, and stress of waiting for the asylum interview were examined. Method: Participants were assessed on average 10 days before (t1 and 16 days after (t2 the asylum interview. Chi-square tests for dichotomous and categorical variables were used to compare the descriptive statistics of the two groups. To investigate symptom changes from t1 to t2, paired t-tests were calculated. The magnitude of effects was measured by Cohen's effect size d within groups. Hierarchical regression analyses were conducted for demographic and trial variables predicting posttraumatic intrusions, avoidance, and hyperarousal. Results: Data showed a significant increase in posttraumatic intrusions and a significant decrease in posttraumatic avoidance and hyperarousal symptoms from t1 to t2. No significant symptom changes in the posttraumatic stress disorder subscales were found in the comparison group. The results of hierarchical regression analyses revealed perceived justice of the interview to predict the increase of intrusions and the number of experienced traumata and testimony stress to predict posttraumatic avoidance. Conclusions: The present findings underline the stressful impact of asylum interviews on traumatized refugees. They indicate that the asylum interview might decrease posttraumatic avoidance and trigger posttraumatic intrusions, thus highlight the importance of ensuring that the already vulnerable group of traumatized refugees needs to be treated with empathy during their asylum

  6. Impact of asylum interviews on the mental health of traumatized asylum seekers (United States)

    Schock, Katrin; Rosner, Rita; Knaevelsrud, Christine


    Background Asylum interviews within the asylum procedure are associated with psychological stress for traumatized asylum seekers. This study investigates the impact of asylum interviews on the mental health in a sample of 40 traumatized asylum seekers. The comparison group consisted of refugees (N=10) that had not been invited to an asylum interview. Additionally, the moderating effects of trial-related variables such as perceived justice of the trial, stress of giving testimony, and stress of waiting for the asylum interview were examined. Method Participants were assessed on average 10 days before (t1) and 16 days after (t2) the asylum interview. Chi-square tests for dichotomous and categorical variables were used to compare the descriptive statistics of the two groups. To investigate symptom changes from t1 to t2, paired t-tests were calculated. The magnitude of effects was measured by Cohen's effect size d within groups. Hierarchical regression analyses were conducted for demographic and trial variables predicting posttraumatic intrusions, avoidance, and hyperarousal. Results Data showed a significant increase in posttraumatic intrusions and a significant decrease in posttraumatic avoidance and hyperarousal symptoms from t1 to t2. No significant symptom changes in the posttraumatic stress disorder subscales were found in the comparison group. The results of hierarchical regression analyses revealed perceived justice of the interview to predict the increase of intrusions and the number of experienced traumata and testimony stress to predict posttraumatic avoidance. Conclusions The present findings underline the stressful impact of asylum interviews on traumatized refugees. They indicate that the asylum interview might decrease posttraumatic avoidance and trigger posttraumatic intrusions, thus highlight the importance of ensuring that the already vulnerable group of traumatized refugees needs to be treated with empathy during their asylum interview. PMID:26333540

  7. Age assessment of young asylum seekers

    DEFF Research Database (Denmark)

    Hjern, Anders; Brendler-Lindqvist, Maria; Nørredam, Marie Louise


    During 2009, 15,100 unaccompanied children sought asylum in Europe. Many of them came from 'failed states' like Somalia and Afghanistan where official documents with exact birth dates are rarely issued. This has led to requests to health care professionals in many countries to assist migration au....... CONCLUSION: To improve care for young asylum seekers with undetermined age, we suggest better legal procedures for the determination of age and a more flexible approach to chronological age....

  8. Resilience among asylum seekers living with HIV

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    Orton Lois


    Full Text Available Abstract Background A small body of evidence demonstrates the challenges faced by migrant communities living with HIV but has yet to consider in-depth the experience of asylum seekers whose residency status is undetermined. The overall aim of our study was to explore the experiences of those who are both living with HIV and seeking asylum. This paper focuses on the stressors precipitated by the HIV diagnosis and by going through the asylum system; as well as participants’ resilience in responding to these stressors and the consequences for their health and wellbeing. Methods We conducted an ethnographic study. Fieldwork took place in the UK between 2008–2009 and included: 350 hours of observation at voluntary services providing support to black and minority ethnic groups living with HIV; 29 interviews and four focus group discussions with those who were seeking asylum and living with HIV; and 15 interviews with their health and social care providers. Data were analysed using the constant comparative method. Results There were three main stressors that threatened participants’ resilience. First, migration caused them to leave behind many resources (including social support. Second, stigmatising attitudes led their HIV diagnosis to be a taboo subject furthering their isolation. Third, they found themselves trapped in the asylum system, unable to influence the outcome of their case and reliant on HIV treatment to stay alive. Participants were, however, very resourceful in dealing with these experiences. Resilience processes included: staying busy, drawing on personal faith, and the support received through HIV care providers and voluntary organisations. Even so, their isolated existence meant participants had limited access to social resources, and their treatment in the asylum system had a profound impact on perceived health and wellbeing. Conclusions Asylum seekers living with HIV in the UK show immense resilience. However, their isolation

  9. Morbidity of asylum seekers in a medium-sized German city. (United States)

    Führer, Amand; Eichner, Friederike; Stang, Andreas


    Asylum seekers constitute a particularly vulnerable group. Not only is their physical and mental health exposed to multiple stresses, but also their access to health care in Germany is legally restricted. Up to now, there is very limited scientific literature investigating the health-outcomes of asylum seekers in Germany. The aim of this study was to provide prevalence data on the morbidity and vaccination status of asylum seekers in a medium-sized German city. We used a structured questionnaire in a cross-sectional study on 214 adult asylum seekers (182 males, 24 females, 8 unknown) in Halle, Germany, 2015. The questionnaire inquired about the respondent's self-reported physical health and vaccination status and assessed their mental health using the Hopkins-Symptom-Checklist-25 and the Harvard Trauma Questionnaire. Pain (37.9 %) and psychological illness (depression: 54.7 %, anxiety disorder: 40.2 %; post-traumatic stress disorder: 18.2 %) were the most prevalent complaints. Among asylum seekers with psychological complaints, co-morbidity was high (64.2 % had more than one psychological disease). 5.6 % of the respondents mentioned suicidal thoughts. The prevalence of chronic diseases was low. We suggest interventions to improve asylum seekers' health on two levels: first, the obligatory initial medical examination after the refugees' arrival at the reception centre should be complemented with questions related to the vaccination status and the most common complaints including pain and psychological diseases. Second, medical infrastructure should be expanded to better serve the needs of culturally and linguistically diverse patient populations, so that those screened positive can be referred for early diagnosis and treatment.

  10. Asylum for persecuted homosexuals in the Republic of Korea

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    Andrew Wolman


    Full Text Available Two recent successful claims for asylum suggest that the Republic of Korea may be prepared to serve in the future as an important country of asylum for those suffering persecution due to their sexual orientation.

  11. 77 FR 76352 - Procedures for Asylum and Withholding of Removal (United States)


    ... SECURITY 8 CFR Part 208 Procedures for Asylum and Withholding of Removal CFR Correction In Title 8 of the...) introductory text before paragraph (1) to read as follows: Sec. 208.24 Termination of asylum or withholding of removal or deportation. (a) Termination of asylum by USCIS. Except as provided in paragraph (e) of...

  12. European Asylum Law : and its Relation to International Law

    NARCIS (Netherlands)

    Battjes, H.


    In Chapter 1 I introduce the question of enquiry, the relation between Community and international law on asylum. Further, I sketch the content of the Refugee Convention, other relevant international law, the historical background of current Community asylum law (i.e. the asylum acquis from before 2

  13. Asylum vs sovereignty in the 21st century: How nation-state's breach international law to block access to asylum.



    Asylum was created by the international community in the 20th century to provide legal protection to individuals fleeing persecution by nation states; but the ability to secure asylum has been fundamentally reshaped by sovereign national interests in the 21st century. This paper has two objectives. First it explores the various ways in which nation-states have adopted policies and pursued agendas which prevent asylum seekers from gaining access to countries of asylum, which criminalize many w...

  14. 8 CFR 208.24 - Termination of asylum or withholding of removal or deportation. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Termination of asylum or withholding of... IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 208.24 Termination of asylum or withholding of removal or deportation. (a) Termination of asylum...

  15. A safe and healthy future? Epidemiological studies on the health of asylum seekers and refugees in the Netherlands

    NARCIS (Netherlands)

    Goosen, E.S.M.


    The main aim of this thesis is to describe the distribution of diseases and conditions among asylum seekers in the Netherlands and to analyse a number of risk factors that affect their health. Based on this knowledge and the scientific literature, the thesis explores the implications for policies an

  16. Unaccompanied Asylum-Seeking Children: Whose Perspective? (United States)

    Wernesjo, Ulrika


    Recent years have seen increasing attention being paid to unaccompanied asylum-seeking children. This article provides an overview of research in the field and its implications for an understanding of these children as a particularly vulnerable category. The existing research focuses primarily on investigating the children's emotional well-being…

  17. ['Being a mother is a science': women, physicians, and the construction of scientific maternity in the 1920's]. (United States)

    Freire, Maria Martha de Luna


    The article analyzes the construction of the notion of scientific maternity in Brazil in the 1920s as part of the broad republican reform project meant to build nationhood. With the active participation of women, multiple social agents were involved in configuring the maternalist discourse and in reshaping relations between women and doctors into a partnership negotiated around a mutual interest in valuing maternity. Special attention is paid to the essential role played by women's magazines in this process.

  18. The Politics of Gender Asylum in the U. S.: Protection of Women Asylum Seekers in the Context of Global Inequalities

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    Marina Matešić


    Full Text Available This article examines the changes towards more gender-sensitive interpretations of refugee status in international and national asylum laws and policies within the context of contemporary and historical global power relations. It also analyzes the changes in the language that can be found in the international UNHCR guidelines for the protection of women asylum seekers, U.S. national guidelines for assessing gender-related asylum claims, and recent U.S. court decisions assessing the gendered claims of women. Among the analyzed court cases, the focus is on the 2005 Mohammed case due to its problematic court decision and legal interpretations. Finding the Western countries’ instrumentalization of the international refugee protection system crucial for understanding the contemporary asylum system and women asylum seekers, the argument connects the historical conditions with the way in which the protection of women refugees from “cultural” gendered violence has been articulated in asylum politics in the U.S. The author’s overall findings are that international law, governmental organizations, and liberal women’s human rights NGOs have shaped the international and national legal protection of (women asylum seekers in such a way that it reproduces global inequalities in its representation of “Third World” women and their culture, uses women asylum seekers fleeing from violence for the purpose of exercising Western cultural superiority, and covers up the restrictive and racist Western asylum politics towards immigrants and asylum seekers.

  19. A refugee camp in the centre of Europe: clinical characteristics of asylum seekers arriving in Brussels (United States)

    van Berlaer, Gerlant; Bohle Carbonell, Francisca; Manantsoa, Sofie; de Béthune, Xavier; Buyl, Ronald; Debacker, Michel; Hubloue, Ives


    Background In the summer of 2015, the exodus of Syrian war refugees and saturation of refugee camps in neighbouring countries led to the influx of asylum-seekers in European countries, including Belgium. This study aims to describe the demographic and clinical characteristics of asylum seekers who arrived in a huddled refugee camp, in the centre of a well-developed country with all medical facilities. Methods Using a descriptive cross-sectional study design, physicians of Médecins du Monde prospectively registered age, gender, origin, medical symptoms and diagnoses of all patients presenting to an erected field hospital in Brussels in September 2015. Diagnoses were post hoc categorised according to the International Classification of Diseases. Results Of 4037 patients examined in the field hospital, 3907 were included and analysed for this study. Over 11% of patients suffered from injuries, but these were outnumbered by the proportion of patients with respiratory (36%), dental (9%), skin (9%) and digestive (8%) diagnoses. More than 49% had features of infections at the time of the consultation. Conclusions Asylum seekers arriving in a refugee camp in Brussels after a long and hazardous journey suffer mostly from respiratory, dental, skin and digestive diseases. Still, one in seven suffers from injury. These findings, consistent with other reports, should be anticipated when composing emergency medical teams and interagency emergency health or similar kits to be used in a field hospital, even in a Western European country. Trial registration number ISRCTN13523620, Results. PMID:27884856

  20. The association between acculturation patterns and mental health symptoms among Eritrean and Sudanese asylum seekers in Israel. (United States)

    Nakash, Ora; Nagar, Maayan; Shoshani, Anat; Lurie, Ido


    Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher depressive symptoms. Findings draw attention to the paradox of assimilation, and the mental health risks it poses among those wishing to integrate into the new culture at the expanse of their original culture. Asylum seekers may be particularly vulnerable to the risks of assimilation in the restrictive policies that characterize many industrial countries in recent years.

  1. The Politics of Childhood and Asylum in the UK (United States)

    Giner, Clotilde


    This article considers the general treatment of asylum-seeking families with children in the UK, focusing on the government's practices and public reactions to these measures. It first describes both the exclusive asylum framework, based on institutionalised suspicion, welfare restrictions and detention, and the inclusive child policy framework,…

  2. LGBTI asylum claims: the Central and Eastern European perspective

    Directory of Open Access Journals (Sweden)

    Krzysztof Śmiszek


    Full Text Available Recent research indicates that CEE countries still lag far behind therest of Europe in their asylum practices in relation to LGBTI asylumclaims. Low levels of awareness, lack of guidance and cultural hostility are jeopardising asylum seekers’ prospects for fair treatment.

  3. The Education of Asylum Seekers: Some UK Case Studies (United States)

    Reakes, Angharad


    The body of literature examining the educational needs of asylum-seeker children is limited. Extending the body of knowledge has become increasingly important because of the increasing number of asylum seekers in the UK, with significant implications for local education authorities and schools. The main focus of the research was the situation in…

  4. Primary care for asylum seekers in the Netherlands.

    NARCIS (Netherlands)

    Oort, M. van; Devillé, W.; Bakker, D. de


    In 2000 policymakers decided that primary care for asylum seekers should be organized as it is for Dutch residents. Nurses of the Community Health Services organize selection and referral to primary care. General practitioners have practice in the different Centres of Asylum Seekers or in their own

  5. Applied Linguistics and Language Analysis in Asylum Seeker Cases (United States)

    Eades, Diana


    When asylum seekers flee persecution or war in their home countries, they often arrive in a new country seeking asylum, without documentation that can prove their nationality. They are thus open to the accusation that they are not actually fleeing persecution and/or war, but they are from another country and they are merely seeking "a better…

  6. EU asylum procedures and the right to an effective remedy

    NARCIS (Netherlands)

    Reneman, Anne Marcelle


    Adequate and fair asylum procedures are a precondition for the effective exercise of rights granted to asylum applicants, in particular the right not be expelled to a country where they face the risk of being subjected to human rights violations. In 1999 the EU Member States decided to work towards

  7. Explaining Inequality in the Implementation of Asylum Law

    NARCIS (Netherlands)

    P. Mascini (Peter)


    textabstractAbstract Th e goal of this research was to identify factors that account for procedural and substantive inequality in implementing asylum law. Th e decisions of ninety-eight caseworkers of the Dutch Immigration and Naturalization Service on an asylum application were related to their ans

  8. 'No "Sane" Person Would Have Any Idea': Patients' Involvement in Late Nineteenth-century British Asylum Psychiatry. (United States)

    Chaney, Sarah


    In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage's book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding's unusual status, this paper argues that the notion of nineteenth-century 'asylum patient' needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding's active engagement with their physicians provides insight into this lesser-known aspect of psychiatry's history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of 'psychiatric power'; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.

  9. Outcomes among Asylum Seekers in Atlanta, Georgia, 2003--2012. (United States)

    Evans, Dabney P; Donato, Caitlin E; Malewezi, Bridget A; Li, Anyie J; Corea, Mario J; Mitchell, Andrew B


    INTRODUCTION Asylum seekers face a wide array of challenges, including the need for a fair and just adjudication process. In the state of Georgia, the Atlanta Asylum Network addresses the needs of such individuals by providing them physical, psychological and gynecological assessments, the results of which are presented to the courts in the asylum appeal process. OBJECTIVE As a component of the Network's program evaluation, assess outcomes among asylum seekers using its services, as well as relation of outcomes to type of service provided, the individual's geographic origin and English language proficiency. METHODS A retrospective examination was conducted of program data gathered by the Network between 2003 and 2012. Subjects included asylum seekers who received assessments by the Network during this period. The primary variable of interest was the final case outcome, defined as determination of asylum status: granted, withholding of removal, administrative closure and prosecutorial discretion, denied or voluntary departure. Outcomes were subsequently collapsed into a single positive or negative outcome variable. Positive outcomes included asylum granted, removal withheld, administrative closure and prosecutorial discretion. Negative outcomes included asylum denied and voluntary departure. We conducted bivariate and multivariate analyses, relating final case outcomes to Network services, geographic origin and English language proficiency, among the key variables. RESULTS A total of 69 of 120 asylum seekers in the study had a known final case outcome, and of those, 63.8% (44) had a positive outcome; or 37% of the total number of asylum seekers (n = 120). Among the 20 who received 2 of the 3 types of assessment (physical, psychological, gynecological), 16 (80%) received a positive case outcome. Most persons with a known final outcome came from Africa (41), where 78% (32) of cases resulted positive. Asylum seekers not proficient in English were 2.4 times more likely

  10. 8 CFR 208.20 - Determining if an asylum application is frivolous. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Determining if an asylum application is... REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 208.20 Determining if an asylum application is frivolous. For applications filed on or after April 1, 1997,...

  11. 8 CFR 1208.24 - Termination of asylum or withholding of removal or deportation. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Termination of asylum or withholding of... REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 1208.24 Termination of asylum or withholding of removal...

  12. 75 FR 409 - Privacy Act of 1974; United States Citizenship and Immigration Services-010 Asylum Information... (United States)


    ...--010 Asylum Information and Pre-Screening System of Records AGENCY: Privacy Office; DHS. ACTION: Notice... Security's inventory, entitled Unites States Citizenship and Immigration Services-010 Asylum Information... systems: The Refugees, Asylum, and Parole System and the Asylum Pre-Screening System. Refugees,...

  13. 8 CFR 1208.9 - Procedure for interview before an asylum officer. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Procedure for interview before an asylum... OF JUSTICE IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 1208.9 Procedure for interview before an asylum officer. (a) The Service...

  14. 8 CFR 1208.20 - Determining if an asylum application is frivolous. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Determining if an asylum application is..., DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 1208.20 Determining if an asylum application is frivolous. For applications filed...

  15. 8 CFR 208.9 - Procedure for interview before an asylum officer. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Procedure for interview before an asylum... REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 208.9 Procedure for interview before an asylum officer. (a) The Service shall adjudicate the claim of each...

  16. A longitudinal study of change in asylum seekers Activities of Daily Living ability while in asylum centre

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Amris, Kirstine; Eklund, Mona;


    Abstract WFOT Title: Occupational performance amongst asylum seekers in Denmark Introduction: Increased health problems are reported among asylum seekers, often related to torture, but there is no knowledge regarding occupational performance and whether there are any changes in asylum seekers...... occupational performance during time spent in a centre. Objectives: Our aim was to assess if newly arrived asylum seekers had impaired occupational performance and if this was associated with previous exposure to torture and/or self-reported psychological symptoms and pain measures. We also wanted to evaluate...... changes in occupational performance and general health over time. Methods: At baseline 43 newly arrived asylum seekers, age 20-43, were consecutively enrolled in the study. All participants were assessed using AMPS and the questionnaires WHO-5, Major Depression Inventory, Pain Detect Questionnaire...

  17. Problems Faced by Mexican Asylum Seekers in the United States

    Directory of Open Access Journals (Sweden)

    J. Anna Cabot


    Full Text Available Violence in Mexico rose sharply in response to President Felipe Calderón’s military campaign against drug cartels which began in late 2006. As a consequence, the number of Mexicans who have sought asylum in the United States has grown significantly. In 2013, Mexicans made up the second largest group of defensive asylum seekers (those in removal proceedings in the United States, behind only China (EOIR 2014b. Yet between 2008 and 2013, the grant rate for Mexican asylum seekers in immigration court fell from 23 percent to nine percent (EOIR 2013, 2014b. This paper examines—from the perspective of an attorney who represented Mexican asylum seekers on the US-Mexico border in El Paso, Texas—the reasons for low asylum approval rates for Mexicans despite high levels of violence in and flight from Mexico from 2008 to 2013. It details the obstacles faced by Mexican asylum seekers along the US-Mexico border, including placement in removal proceedings, detention, evidentiary issues, narrow legal standards, and (effectively judicial notice of country conditions in Mexico. The paper recommends that asylum seekers at the border be placed in affirmative proceedings (before immigration officials, making them eligible for bond. It also proposes increased oversight of immigration judges.

  18. Cultural competence among nurse practitioners working with asylum seekers. (United States)

    Suurmond, Jeanine; Seeleman, Conny; Rupp, Ines; Goosen, Simone; Stronks, Karien


    Asylum seekers often have complex medical needs. Little is known about the cultural competences health care providers should have in their contact with asylum seekers in order to meet their needs. Cultural competence is generally defined as a combination of knowledge about certain cultural groups, as well as attitudes towards and skills for dealing with cultural diversity. Given asylum seekers' specific care needs, it may be asked whether this set of general competences is adequate for the medical contact with asylum seekers. We explored the cultural competences that nurse practitioners working with asylum seekers thought were important. A purposive sample of 89 nurse practitioners in the Netherlands completed a questionnaire. In addition, six group interviews with nurse practitioners were also conducted. A framework analysis was used to analyse the data of the questionnaires and the interviews. From the analysis, several specific competences emerged, which were required for the medical contact with asylum seekers: knowledge of the political situation in the country of origin; knowledge with regard to diseases common in the country of origin; knowledge of the effects of refugeehood on health; awareness of the juridical context in the host country; ability to deal with asylum seekers' traumatic experiences; and skills to explain the host country's health care system. Apart from these cultural competences specific for the situation of asylum seekers, general cultural competences were also seen as important, such as the ability to use interpretation services. We conclude that insight into these cultural competences may help to develop related education and training for health care providers working with asylum seekers.

  19. Physician Compare (United States)

    U.S. Department of Health & Human Services — Physician Compare, which meets Affordable Care Act of 2010 requirements, helps you search for and select physicians and other healthcare professionals enrolled in...

  20. Detention in Kenya: risks for refugees and asylum seekers

    Directory of Open Access Journals (Sweden)

    Lucy Kiama


    Full Text Available Refugees and asylum seekers detained in Kenya risk multiple convictions and protracted detention due to poor coordination between immigration officials, police and prison officers, coupled with lack of interpreters and low levels of knowledge among government officers.

  1. Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    Full Text Available Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria.Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East.In total, 880 patients were included in the study. Of these, 625 (71.0% were male and 255 (29.0% female. The median age was 34 (range 16-84. 222 (25.2% of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%, followed by medical (321, 36.5% and psychiatric (137, 15.6%. In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%. Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%, followed by neurological problems (n = 70, 21.8% and gastrointestinal problems (n = 47, 14.6%. There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%, followed by chronic musculoskeletal problems (n = 108, 12.3% and chronic headaches (n = 78, 8.9%. Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively.Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population

  2. The psychiatric profession and the Australian government: the debate over collective depression syndrome among asylum-seeking detainees

    Directory of Open Access Journals (Sweden)

    William W Bostock


    Full Text Available William W BostockSchool of Government, University of Tasmania, Hobart, Tasmania, AustraliaAbstract: Psychiatrists have long had involvement with the political process, both individually and as a profession. They have made valuable contributions to debate over such issues as war, conflict, terrorism, torture, human rights abuse, drug abuse, suicide and other public health issues. However, they have also been complicit in some gross atrocities. Over several years there has been debate over the Australian Government’s treatment of asylum seekers, and the Royal Australian and New Zealand College of Psychiatrists took the unusual step of publicly criticizing the Australian Government’s policy on grounds of its toxicity leading to a diagnosis of collective depression syndrome, particularly among child detainees, but also adult detainees. The official Ministerial response was to deny that collective depression exists and to assert that the concept is meaningless. Can this intervention by psychiatrists be interpreted as a product of earlier political behaviors by psychiatrists? The willingness of psychiatrists to cooperate with other professions, notably psychologists, pediatricians, physicians and lawyers, is noted, as is presence of minority voices within the Australian psychiatric profession. The significance of the debate over the mental condition of asylum-seeking detainees is that its outcome has implications for how Australia sees itself and is seen by the rest of the world, that is, its national identity.Keywords: collective depression syndrome, psychiatric profession, political intervention, asylum seeker, Australian national identity

  3. 77 FR 76352 - Adjustment of Status of Refugees and Aliens Granted Asylum (United States)


    ... Status of Refugees and Aliens Granted Asylum CFR Correction In Title 8 of the Code of Federal Regulations... follows: Sec. 209.2 Adjustment of status of alien granted asylum. * * * * * [[Page 76353

  4. Suffering and the struggle for recognition : lived experiences of the U.S. political asylum process



    This dissertation is an ethnographic study of seeking political asylum in the United States. With the implementation of restrictive immigration measures, particularly following September 11, 2001, seeking asylum in the U.S. has become increasingly onerous and protracted. From an institutional standpoint, the goal of the asylum process is to discern 'deserving' migrants ('authentic' refugees) from 'undeserving' migrants ('bogus' asylum seekers, economic migrants), and the process is undergirde...

  5. European Asylum Law and Policy: The EU and Slovak Perspectives The EU and Slovak Perspectives

    NARCIS (Netherlands)

    O. Ferguson Sidorenko


    textabstractThe right of asylum is rooted in the history of mankind (religious right of asylum (sanctuary)) and since the beginning of the modern State it has been rooted in the sovereignty of the State itself (the right of territorial asylum). The State retains the right to grant its protection

  6. 8 CFR 1240.33 - Applications for asylum or withholding of deportation. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Applications for asylum or withholding of... asylum or withholding of deportation. (a) If the alien expresses fear of persecution or harm upon return... referred to the immigration judge by an asylum officer in accordance with § 1208.14(b) of this chapter,...

  7. 8 CFR 240.67 - Procedure for interview before an asylum officer. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Procedure for interview before an asylum... Procedure for interview before an asylum officer. (a) Fingerprinting requirements. The Service will notify.... (1) The asylum officer shall conduct the interview in a non-adversarial manner and, except at...

  8. 8 CFR 1240.67 - Procedure for interview before an asylum officer. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Procedure for interview before an asylum... 203 of Pub. L. 105-100 § 1240.67 Procedure for interview before an asylum officer. (a) Fingerprinting... been rejected. (b) Interview. (1) The asylum officer shall conduct the interview in a...

  9. 28 CFR 0.23b - Office of Asylum Policy and Review. (United States)


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Office of Asylum Policy and Review. 0.23b...-Office of Legal Policy § 0.23b Office of Asylum Policy and Review. There is established, in the Office of Legal Policy, the Asylum Policy and Review Unit, headed by a Director, under the general supervision...

  10. 32 CFR 700.939 - Granting of asylum and temporary refuge. (United States)


    ... 32 National Defense 5 2010-07-01 2010-07-01 false Granting of asylum and temporary refuge. 700.939... Officer Present Contents § 700.939 Granting of asylum and temporary refuge. (a) If an official of the Department of the Navy is requested to provide asylum or temporary refuge, the following procedures...

  11. Should she be granted asylum? Examining the justifiability of the persecution criterion and nexus clause in asylum law

    Directory of Open Access Journals (Sweden)

    Noa Wirth Nogradi


    Full Text Available The current international asylum regime recognizes only persecuted persons as rightful asylum applicants. The Geneva Convention and Protocol enumerate specific grounds upon which persecution is recognized. Claimants who cannot demonstrate a real risk of persecution based on one of the recognized grounds are unlikely to be granted asylum. This paper aims to relate real-world practices to normative theories, asking whether the Convention’s restricted preference towards persecuted persons is normatively justified. I intend to show that the justifications of the persecution criterion also apply to grounds currently lacking recognition. My main concern will be persecution on the grounds of gender.The first section introduces the dominant standpoints in theories of asylum, which give different answers to the question of who should be granted asylum, based on different normative considerations. Humanitarian theories base their claims on the factual neediness of asylum-seekers, holding that whoever is in grave danger of harm or deprivation should be granted asylum. Political theories base their justifications on conceptions of legitimacy and membership, holding that whoever has been denied membership in their original state should be granted asylum. Under political theories, Matthew Price’s theory will be discussed, which provides a normative justification of the currently recognized persecution criterion. The second section provides a descriptive definition of persecution based on Kuosmanen (2014, and evaluates the normative relevance of the different elements of this definition based on the theories presented previously. The third section is devoted to the examination of the normative justifiability of the nexus clause’s exclusive list of the bases (grounds upon which persons might be persecuted. The section argues that while the clause does not recognize that persecution might be based on gender, in fact many women experience harms based on

  12. Usage of psychiatric emergency services by asylum seekers

    DEFF Research Database (Denmark)

    Reko, Amra; Bech, Per; Wohlert, Cathrine


    predominantly male and married. The group consisted primarily (61%) of failed asylum seekers. Most patients (81%) presented with relevant mental health problems. The main reasons for presenting to the acute psychiatric emergency service were suicidal ideation and/or behaviour (60%). The most frequent diagnosis...... given at the initial evaluation was ICD-10 F43.9 "reaction to severe stress, unspecified" (50%). Evaluations were made primarily by non-psychiatrists. No standardized screening or diagnostic instrument was used. CONCLUSION: This first description of the use of an acute psychiatric emergency service...... by asylum seekers in Denmark shows some of the acute mental health needs asylum seekers present with. The findings of high levels of suicidal ideation and possible diagnostic difficulties are discussed, as well as possible improvements of the referral and psychiatric evaluation processes....

  13. Satisfaction with daily occupations amongst asylum seekers in Denmark

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Erlandsson, Lena-Karin; Danneskiold-Samsøe, Bente;


    -up. Associations between AMPS process skills--education, worst pain and activity level--were present at baseline, as was a relationship between AMPS process skills and satisfaction. At follow-up, associations between WHO-5 and satisfaction and activity level and between MDI scores and activity level were found......AIM: The aim of this study was to describe asylum seekers' satisfaction with daily occupations and activity level while in a Danish asylum centre, and whether this changed over time. Another aim was to describe whether exposure to torture, self-rated health measures, and ADL ability were related...... to their satisfaction with daily occupations and activity level. METHODS: A total of 43 asylum seekers at baseline and 17 at follow-up were included. The questionnaires Satisfaction with Daily Occupations, Major Depression Inventory, WHO-5 Wellbeing, Pain Detect, a questionnaire covering torture, and basic social...

  14. Perspectives on Erving Goffman's "Asylums" fifty years on. (United States)

    Adlam, John; Gill, Irwin; Glackin, Shane N; Kelly, Brendan D; Scanlon, Christopher; Mac Suibhne, Seamus


    Erving Goffman's "Asylums" is a key text in the development of contemporary, community-orientated mental health practice. It has survived as a trenchant critique of the asylum as total institution, and its publication in 1961 in book form marked a further stage in the discrediting of the asylum model of mental health care. In this paper, some responses from a range of disciplines to this text, 50 years on, are presented. A consultant psychiatrist with a special interest in cultural psychiatry and mental health legislation, two collaborating psychotherapists in adult and forensic mental health, a philosopher, and a recent medical graduate, present their varying responses to the text. The editors present these with the hope of encouraging further dialogue and debate from service users, carers, clinicians, and academics and researchers across a range of disciplines.

  15. Safeguarding vulnerable families: work with refugees and asylum seekers. (United States)

    Burchill, John


    This paper will highlight one of the key findings of a qualitative study based on the analysis of in-depth interviews with 14 health visitors describing their experiences working with refugees and asylum seekers. Despite changes in government legislation to improve children's services in order to prevent harm to children, this recent study demonstrated that health visitors were working with the complexities of needs among refugees and asylum seekers related to safeguarding both children and vulnerable women. The health visitors often worked with families and individuals with no support from other professional services, they worked with failed asylum seekers who were unable to access other forms of support and they worked with women and children who were caught in a cycle of domestic abuse due to their immigration status. They were also working with families who would disappear from the systems in place to safeguard children.

  16. Church Asylum - new strategies, alliances and modes of resistance

    DEFF Research Database (Denmark)

    Jørgensen, Martin Bak


    This article discusses the possibilities for democratic transformation in a landscape of political closure. Taking the case of Church Asylum [Kirkeasyl] as an example of new ways of resistance and participation in contemporary Denmark the articles argues that although the established political...... channels are characterised by closure alternatives may be formulated outside the parliamentarian system. Using contemporary perspectives on social critique and mobilization the article looks back at Church Asylum in 2009 and discuss the alliances, strategies and modes of resistance used during the event...

  17. Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D

    Directory of Open Access Journals (Sweden)

    Pécoud A


    Full Text Available Abstract Background Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D. Methods Design: A pre- and post-intervention observational study. Setting: A network comprising an academic primary care centre and nurse practitioners. Participants: Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH vitamin D Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only. Main outcome measures: We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis. Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0. Results Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%. The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20. Twenty-two patients (66.7% responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08 six months before diagnosis to 0.39 (SD 0.83 after (P = 0.027. The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD

  18. Iron deficiency among children of asylum seekers in the Netherlands

    NARCIS (Netherlands)

    Stellinga-Boelen, A. A. M.; Storm, H.; Wiegersma, P. A.; Bijleveld, C. M. A.; Verkade, H. J.


    Objectives: To investigate, in asylum seekers' children in the Netherlands, biochemical iron status and the prevalence of iron deficiency (ID) and anemia in relation to age, region of origin, length of stay in the Netherlands, body mass index (BMI), and dietary iron intake. Patients and Methods: Hem

  19. Othered Voices: Asylum-Seeking Mothers and Early Years Education (United States)

    Whitmarsh, Judy


    Strengthening the home-school partnership is a strategy to raise achievement levels and to engage "hard-to-reach" parents with education in the UK, however this political ideal has been critiqued as exclusive and based on a white, middle class model. This article explores how six asylum-seeking mothers manage their children's early years…

  20. Performing Like an Asylum Seeker: Paradoxes of Hyper-Authenticity (United States)

    Jestrovic, Silvija


    This essay investigates performance events that feature actual refugees, asylum seekers and immigrants, but in instances where presence and embodiment are mediated and made ambiguous. My focus is a fashion show by Catalan designer Antonio Miro, who uses refugees from Senegal as models, and Christoph Schlingensief's public art project…

  1. Female genital mutilation: a case for asylum in Europe

    Directory of Open Access Journals (Sweden)

    Fadela Novak-Irons


    Full Text Available With some 71% of female EU asylum applicants from FGM-practising countries estimated to be survivors of this harmful traditional practice, it is time to accept that this subject demands greater scrutiny and a more dedicated response.

  2. Inspecting asylum seekers upon entry: a medico-ethical complex.

    NARCIS (Netherlands)

    Francois, G.; Hambach R.; Sprundel, M. van; Devillé, W.; Hal, G. van


    In September 2007, the UN Refugee Agency UNHCR summarized the main asylum application levels and trends during the first six months of the year in 36 industrialized countries, including 26 European Union (EU) Member States. Based on the assumption of unchanged yearly patterns, the total number of ne

  3. The American College of nuclear physicians 18th annual meeting and scientific sessions DOE day: Substance abuse and nuclear medicine abstracts

    Energy Technology Data Exchange (ETDEWEB)


    Despite the enormous personal and social cost Of substance abuse, there is very little knowledge with respect to the mechanisms by which these drugs produce addiction as well as to the mechanisms of toxicity. Similarly, there is a lack of effective therapeutic intervention to treat the drug abusers. In this respect, nuclear medicine could contribute significantly by helping to gather information using brain imaging techniques about mechanisms of drug addiction which, in turn, could help design better therapeutic interventions, and by helping in the evaluation and diagnosis of organ toxicity from the use of drugs of abuse. This volume contains six short descriptions of presentations made at the 18th Meeting of the American College of Nuclear Physicians -- DOE Day: Substance Abuse and Nuclear Medicine.

  4. U.S. asylum policy and the New World Order. (United States)

    Briggs, V M


    US policy on refugees was developed as an ad hoc response to the problem of displaced persons in Europe following the Second World War and quickly became a foreign policy tactic to be manipulated in the context of the Cold War political struggle. It was not until 1980 that the US formally adopted an asylee policy in legislative forum. That policy, too, was affected by the Cold War. The dismantlement of the Berlin Wall in 1989 and the subsequent collapse of the Soviet Union in 1991, however, have radically changed the dynamics of refugee and asylee issues. Refugee and asylee pressures are increasingly being linked with the broader worldwide issues of population growth, unbalanced economic development, and migration pressures. New refugee and asylum policies are required in the new world order which are not predicated upon the need to respond to communism. These policies must be reserved for truly persecuted individuals. The author discusses the creation of an asylum policy, mass asylum, and pending policy reforms. The refugee system provides a means of access for many people looking to escape the poverty, unemployment, and destitution of their homeland. Asylum policy is the most vulnerable element of refugee policy for exploitation. To alleviate the economic forces which lie at the core of asylum abuse will require more fundamental policies than the procedural changes currently under consideration by Congress or those proposed by President Clinton. Among them must be policies which promote family planning and provide the means for its practice; expand commitments to economic development assistance; and link trade access to the US marketplace and the receipt of foreign aid to the strict adherence of internationally specified human rights practices.

  5. Multimorbidity in adult asylum seekers: a first overview.

    Directory of Open Access Journals (Sweden)

    Carmen A Pfortmueller

    Full Text Available PRINCIPALS: Over the last two decades, the total annual number of applications for asylum in the countries of the European Union has increased from 15,000 to more than 300,000 people. The aim of this study was to give a first overview on multimorbidity of adult asylum seekers. METHODS: Our retrospective Swiss single center data analysis examined multimorbidity of adult asylums seekers admitted to our ED between 1 January 2000 and 31 December 2012. RESULTS: A total of 3170 patients were eligible for the study; they were predominantly male (2392 male, 75.5% versus 778 female, 24.5. The median age of the patients was 28 years (range 28-82. The most common region of origin was Africa (1544, 48.7%, followed by the Middle East (736, 23.6%. 2144 (67.6% of all patients were not multimorbid. A total of 1183 (37.7% of our patients were multimorbid. The mean Charlson comorbidity index was 0.25 (SD 1.1, range 0-12. 634 (20% of all patients sufferem from psychiatric diseases, followed by chronic medical conditions (12.6%, 399 and infectious diseases (4.7%, 150. Overall, 11% (349 of our patients presented as a direct consequence of prior violence. Patients from Sri Lanka/India most often suffered from addictions problems (50/240, 20.8%, p<0.0001. Infectious diseases were most frequent in patients from Africa (6.6%, followed by the Balkans and Eastern Europe/Russia (each 3.8%. CONCLUSION: The health care problems of asylum seekers are manifold. More than 60% of the study population assessed in our study did not suffer from more than one disease. Nevertheless a significant percentage of asylum seekers is multimorbid and exhibits underlying psychiatric, infectious or chronic medical conditions despite their young age.

  6. 'Insane criminals' and the 'criminally insane': criminal asylums in Norway, 1895-1940. (United States)

    Dahl, Hilde


    This article looks into the establishment and development of two criminal asylums in Norway. Influenced by international psychiatry and a European reorientation of penal law, the country chose to institutionalize insane criminals and criminally insane in separate asylums. Norway's first criminal asylum was opened in 1895, and a second in 1923, both in Trondheim. Both asylums quickly filled up with patients who often stayed for many years, and some for their entire lives. The official aim of these asylums was to confine and treat dangerous and disruptive lunatics. Goffman postulates that total institutions typically fall short of their official aims. This study examines records of the patients who were admitted to the two Trondheim asylums, in order to see if the official aims were achieved.

  7. Medical and psychological examination of women seeking asylum: documentation of human rights abuses. (United States)

    Laws, A; Patsalides, B


    Human rights abuses of women are ubiquitous throughout the world. Those perpetrated by governments entitle women to seek political asylum, and many women refugees do so in the United States. The asylum process often requires medical or psychological evaluations to corroborate women's reports of torture or other abuses. This article provides an overview of how to conduct such examinations and how to document findings for the asylum process.

  8. The ideal physician entrepreneur. (United States)

    Bottles, K


    How does the sometimes elusive and high-stakes world of venture capital really work? How can physician executives with innovative ideas or new technologies approach venture capitalists to help them raise capital to form a start-up company? These important questions are explored in this new column on the physician as entrepreneur. The ideal physician executive is described as: (1) an expert in an area that Wall Street perceives as hot; (2) a public speaker who can enthusiastically communicate scientific and business plans to a variety of audiences; (3) a team leader who is willing to share equity in the company with other employees; (4) a recruiter and a motivator; (5) an implementer who can achieve milestones quickly that allow the company to go public as soon as possible; and (6) a realist who does not resent the terms of the typical deal. The lucrative world of the venture capitalists is foreign territory for physician executives and requires a great idea, charisma, risk-taking, connections, patience, and perseverance to navigate it successfully.

  9. Physician unionization. (United States)

    Lebowitz, P H


    Typically, doctors have seemed unsuited for and uncomfortable with the idea of unions but with the current changes in practices and referral patterns, doctors are looking--at least warily--at unions. Two sets of laws apply to possible unionization of physicians; one, federal antitrust laws, the other, both federal and state labor laws as they apply to changes in the medical profession. Antitrust laws are designed to protect competition by prohibiting price fixing. Another typical antitrust issue that applies to healthcare is that of a group boycott or refusal to deal, where competitors try to coerce a third party to set prices where competitors want them set. Congress' earliest legislation to aide the labor movement involved exceptions to the antitrust laws. Some provisions of the laws are limited to workers who are employees, defined as someone who is employed by any person. Doctors are searching for solutions that provide the collective power of the labor laws without offending the antitrust laws. The question is whether doctors can form unions under these two conflicting forces. The first main issue is whether the doctor is or is not an employee. Although radiologic technologists, typically employees of hospitals or provider groups, have been unionized for years, doctors are usually not employees, at least not if they have their own practices. Although not employees, physicians may affiliate with a larger union to use that broader bargaining power, a purpose that is permissible under current law. Membership in a union does have its responsibilities and disadvantages. Some have suggested that the definition of employee be broadened to cover physician duties under managed care payer agreements, for example. Meanwhile, the Federal Trade Commission and the Justice Department are watching that non-employee physicians not use the union label to mask price fixing, boycotts or refusals to deal.

  10. Asylum seekers and refugees in Indonesia: Problems and potentials

    Directory of Open Access Journals (Sweden)

    Muzafar Ali


    Full Text Available In the Indonesian West Java town of Cisarua, asylum seekers and refugees face prolonged periods of waiting in limbo. Australian government policies have contributed to the lengthy waiting times, particularly Operation Sovereign Borders. Those in protracted situations have found ways to ensure that during their time in Cisarua their basic needs are met and they demonstrate creativity and resilience in difficult circumstances. Education for children is a priority for asylum seeker and refugee communities and a learning centre developed by the community has provided hope for children and their families. The paper draws on the experiences of Author One during his waiting time in Cisarua and research conducted by Authors Two and Three in late 2013.

  11. Forensic dental investigations and age assessment of asylum seekers. (United States)

    Nuzzolese, Emilio; Di Vella, Giancarlo


    Age estimation is useful in forensic investigations to aid in the process of identifying unknown victims as well as living individuals. In many countries age estimation is commonly used to assist immigration authorities in deciding whether refugees or illegal migrants have reached that designated age that separates a juvenile from an adult. This is particularly important for the protection of unaccompanied minors. Italy is a country of great appeal for immigration as people from other Mediterranean countries can easily reach Italian coasts. In Italy, as in other western world countries, unaccompanied asylum seekers deemed to be under 18 face a very different path through the immigration system. They cannot be deported and are sent through a juvenile system where they have access to education programmes and may be granted a residence permit. The Section of Legal Medicine of the University of Bari was approached by Judges and Immigration Police with the question to assess the age of unaccompanied asylum seekers who claim to be below 18 years of age. The contribution of forensic odontologists for age estimation was recognised and since November 2006 age estimation of asylum seekers in Bari (Italy) relies on clinical and dental examination together with skeletal maturation as seen on radiographs of the left hand and wrist, the pelvis for iliac crests and root development and mineralisation of third molars as seen on an orthopantomogram.

  12. An Overview of Pending Asylum and Refugee Legislation in the US Congress

    Directory of Open Access Journals (Sweden)

    Melanie Nezer


    Full Text Available There has been no significant legislation related to the asylum process enacted in Congress in nearly a decade.  In 1996, the Illegal Immigration Reform and Immigration Responsibility Act (IIRIRA became law, rolling back protections for asylum seekers by including a one-year deadline for filing asylum applications, subjecting asylum seekers to “expedited removal” procedures, and expanding the detention of asylum seekers. In 2005, Congress enacted the REAL ID Act, which created additional legal barriers to asylum, including new requirements for proving an asylum claim. During the past several sessions of Congress, bills have been introduced that would make significant changes to the country’s asylum laws and refugee admissions program. This paper provides an overview of the pending legislation and the changes proposed.  This overview is instructive in understanding (1 which members of Congress have demonstrated interest and leadership in refugee and asylum issues; (2 which refugee and asylum reform issues have been of most interest to members of Congress in recent years; (3 the different approaches to refugee and asylum issues by members of Congress who have shown leadership on these issues; and (4 which provisions have been enacted, which have gained traction, and which remain pending without significant movement through the legislative process.While it is difficult to imagine in the current partisan climate how any asylum or refugee legislation could be enacted into law, some legislative provisions have been reintroduced over a number of sessions of Congress and some have a history of bipartisan support.  Legislation focused on a group of particular interest or concern to members of Congress could gain traction.  A more comprehensive legislative approach framed by the need generally to improve the system could be less effective, particularly in the context of the years-long stalemate on comprehensive immigration reform

  13. Psychosocial problems in asylum seekers' children : the parent, child, and teacher perspective using the strengths and difficulties questionnaire

    NARCIS (Netherlands)

    Wiegersma, P.A.; Stellinga-Boelen, A.A.M.; Reijneveld, S.A.


    Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and diffe

  14. Gender stereotyping in the Dutch asylum procedure: ‘independent’ men versus ‘dependent’ women

    NARCIS (Netherlands)

    Mascini, P.; van Bochove, M.


    Attention for discrimination against women in asylum law has grown considerably during the last few decades. Yet it is male claimants who have had smaller success Rates in the asylum procedures of different countries. Using administrative data from the Dutch INS, we show this difference is caused by

  15. Occult Genres and the Certification of Madness in a 19th-Century Lunatic Asylum (United States)

    Berkenkotter, Carol; Hanganu-Bresch, Cristina


    Using archival admissions records and case histories of patients at a British asylum from the 1860s to the 1870s, the authors examine the medical certification process leading to the asylum confinement of individuals judged to be "of unsound mind." These institutional texts are, the authors suggest, "occult genres" that function as complex acts of…

  16. Family Support through Childcare Services: Meeting the Needs of Asylum-Seeking and Refugee Families (United States)

    Dolan, Nicola; Sherlock, Catherine


    This article is a summary of the research carried out in relation to the experiences of asylum-seeking and refugee families regarding access and participation in local childcare services. Focus groups and interviews were carried out with 16 refugee and asylum-seeking parents, five childcare practitioners, and two support and development staff in a…

  17. Brief Report: British Adolescents' Views about the Rights of Asylum-Seeking Children (United States)

    Ruck, Martin D.; Tenenbaum, Harriet R.; Sines, Jennie


    The present study examined 60 (30 early-to-middle adolescents and 30 late adolescents) British adolescents' understanding of the rights of asylum-seeker children. Participants completed semi-structured interviews designed to assess judgments and evaluations of hypothetical asylum-seeker children's nurturance and self-determination rights in…

  18. Occult Genres and the Certification of Madness in a 19th-Century Lunatic Asylum (United States)

    Berkenkotter, Carol; Hanganu-Bresch, Cristina


    Using archival admissions records and case histories of patients at a British asylum from the 1860s to the 1870s, the authors examine the medical certification process leading to the asylum confinement of individuals judged to be "of unsound mind." These institutional texts are, the authors suggest, "occult genres" that…

  19. 76 FR 67099 - Forwarding of Asylum Applications to the Department of State (United States)


    ... Forwarding of Asylum Applications to the Department of State AGENCY: Executive Office for Immigration Review... regulations to alter the process by which the Executive Office for Immigration Review (EOIR) forwards asylum applications for consideration by the Department of State (DOS). Currently, EOIR forwards to DOS all...

  20. Coercion, prohibition and great expectations: The continuing failure of the Common European Asylum System

    NARCIS (Netherlands)

    M. den Heijer; J. Rijpma; T. Spijkerboer


    This contribution explains the European asylum policy crisis from three structural weaknesses of the Common European Asylum System: its reliance on coercion within the EU, its unrealistic expectations of what borders can achieve and the premise of prohibition of refugee movement in its external dime

  1. 8 CFR 209.2 - Adjustment of status of alien granted asylum. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of alien granted asylum. 209.2 Section 209.2 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS ADJUSTMENT OF STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM § 209.2 Adjustment of status of...

  2. 8 CFR 1209.2 - Adjustment of status of alien granted asylum. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of alien granted asylum. 1209.2 Section 1209.2 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS ADJUSTMENT OF STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM §...

  3. Child Poverty as Public Policy: Direct Provision and Asylum Seeker Children in the Republic of Ireland (United States)

    Fanning, Bryan; Veale, Angela


    This paper evaluates responses to asylum seeker children in Ireland from a child poverty perspective and from that of the United Nations Convention on the Rights of the Child. It draws upon research undertaken in early 2001 on behalf of the Irish Refugee Council among asylum seeker families with children in Cork, Limerick and Ennis on their…

  4. Psychosocial problems in asylum seekers' children: the parent, child, and teacher perspective using the Strength and Difficulties Questionnaire. (United States)

    Wiegersma, P Auke; Stellinga-Boelen, Annette A M; Reijneveld, Sijmen A


    Children of asylum seekers are at risk for psychosocial problems because of their flight history and exceptional living circumstances. This study aims to assess the association of sociodemographic factors and asylum procedural factors with psychosocial problems of asylum seekers' children, and differences herein by informant (parents, teachers, and children). To this end, we obtained data on psychosocial problems among a random sample of 267 children aged 4 to 16, living in Dutch asylum seekers' centers, using the multi-informant Strength and Difficulties Questionnaire. The results show that the prevalence rate of psychosocial problems among asylum seekers' children was high. The occurrence was not associated with asylum-procedural variables but only with child-contextual factors such as mental health of the mother and leaving behind a parent in the country of origin. The associations varied in strength by informant. Therefore, preventive and supportive measures to improve psychosocial health of young asylum-seekers should concentrate on these contextual issues.

  5. Activity of daily living performance amongst Danish asylum seekers

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Erlandsson, Lena-Karin; Eklund, Mona;


    be lower in individuals exposed to torture as compared to the non-tortured. SUBJECTS: Forty-three newly arrived asylum seekers aged 20-50 years, from Iran, Afghanistan and Syria, were consecutively included in the study. METHOD: ADL ability was assessed with the observation-based test Assessment of Motor...... and Process Skills (AMPS). Interviews were based on questionnaires about torture exposure, WHO-5 Wellbeing Index, Major Depression Inventory and Pain Detect Questionnaire. All participants were interviewed and tested using a linguistic interpreter. RESULTS: Thirty three (77%) participants reported exposure...

  6. Discursive Representations of Asylum Seekers and Illegal Immigrants in Ireland

    Directory of Open Access Journals (Sweden)

    Elaine Burroughs


    Full Text Available Migrants are often referred to as an all encompassing group of people and the “many faces of migration”, the variety of people, legalities and complexities involved, can be overlooked. The same can be said for non-EU migrants in the Irish context. Non-EU migrants (or those that are not Caucasian are generally viewed to be a distinct cohort of comparable migrants. Indeed, these migrants are often portrayed in a broadly negative way by key Irish institutions (such as the parliament or the media, and these representations impact upon how Irish society views non-EU migration and indeed migration in general. While Ireland is by no means the only European country in which this type of practice occurs, this paper aims to draw attention to generalized, inaccurate and misleading representations of non-EU migrants in Ireland, by specifically examining representations of asylum seekers and illegal immigrants. There can be an overlap in how these “types” of migrants are conceptualized and this paper therefore aims to develop an understanding of the implications involved for migrants categorized as an “asylum seeker” or an “illegal immigrant.” Furthermore, these topics are under-researched within the Irish context, yet they receive much political and public attention. At the same time however, this paper aims to challenge the labels assigned to non-EU migrants and the terminology that is used to define their identity so concretely. In the Irish context there is much confusion in relation to the multiple “faces” of non-EU migration, as a range of terminology is used to refer to them. This terminology is often used in an interchangeable manner, in an array of societal contexts. There is a consistent (whether this happens intentionally or unintentionally is debatable misuse of categories and migration terminology in Irish institutional discourses. Quite often those seeking asylum are referred to as illegal immigrants and vice versa

  7. [Sherlock Holmes as amateur physician]. (United States)

    Madsen, S


    The medical literature contains numerous articles dealing with Sherlock Holmes and his companion Dr. Watson. Some of the articles are concerned with the medical and scientific aspects of his cases. Other articles adopt a more philosophical view: They compare the methods of the master detective with those of the physician--the ideal clinician should be as astute in his profession as the detective must be in his. It this article the author briefly reviews the abilities of Sherlock Holmes as an amateur physician. Often Holmes was brilliant, but sometimes he made serious mistakes. In one of his cases (The Adventure of the Lion's Mane) he misinterpreted common medical signs.

  8. Emergency mental health nursing for self-harming refugees and asylum seekers. (United States)

    Procter, Nicholas G


    This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

  9. Rediscovering the Concept of Asylum for Persons with Serious Mental Illness. (United States)

    Lamb, H Richard; Weinberger, Linda E


    Treating persons with serious mental illness is a complex and challenging endeavor. One intervention that has received little attention in recent years is the need for asylum. Asylum means a sanctuary, a place that lowers levels of stress and provides protection, safety, security, and social support, as well as an array of treatment services. The concept of "asylum" may have lost favor because it was equated with the abysmal conditions found in the state psychiatric hospitals of the past. Among the reasons persons with serious mental illness have been arrested and incarcerated is society's failure to provide adequate levels of asylum. With the release of tens of thousands of mentally ill inmates from state and federal jails and prisons, it is time to revisit this concept, not only for these persons but for those who have not been criminalized. Asylum can be found in various settings, including with family in the patient's home, in a board-and-care facility, or in a psychiatric hospital if necessary. Not all persons with a major mental illness are capable of achieving high levels of social and vocational functioning; however, living in a place that provides asylum can promote a higher quality of life. The value of asylum for many persons with serious mental illness should not be underestimated.

  10. A longitudinal study of change in asylum seekers Activities of Daily Living ability while in asylum centre

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Amris, Kirstine; Eklund, Mona;


    The aim was to assess change in Activities of Daily Living (ADL) ability amongst asylum seekers and if there were any difference between tortured and non-torture following a 10 months post-arrival period, and if self-reported health and exposure to torture were factors related to changes in ADL...... participated. ADL-ability was measured using Assessment of Motor and Process Skills and questionnaires about exposure to torture, self-reported mental health and pain. ADL motor and process measures, well-being and self-rated health declined from baseline to follow-up. Measures of pain and depression increased...

  11. 'Good in all respects': appearance and dress at Staffordshire County Lunatic Asylum, 1818-54. (United States)

    Wynter, Rebecca


    Dress was integral to the ideals and practice of Staffordshire County Lunatic Asylum, an institution catering for all social classes. Lunatics' appearance was used to gauge the standard of care inside the asylum and beyond. Clothing was essential for moral treatment and physical health. It helped to denote social and institutional class: clothes were integral to paupers' admission; rich patients spent time and money dressing; for disturbed inmates and those who destroyed asylum attire, the consequence could be'secure dress', which was fundamental to therapeutics. Later, when an ethos of non-restraint was introduced, the superintendent used patients' appearance to propagate an image of his enlightened care.

  12. Will a Quota Plan for Asylum Seekers Plan Work —and Why Not?

    DEFF Research Database (Denmark)

    Seeberg, Peter


    The article describes the recent situation in the Mediterranean, where the number of asylum seekers arriving from countries south and east of the Mediterranean Sea is increasing significantly. The European Commission has suggested a plan, “A European Agenda on Migration”, which will redistribute...... the EU-Commission of a mandatory quota plan for asylum seekers will not work, because too many states will pretend, that the problem does not really belong to them. They fear that accepting a system according to which each state has to accept a fixed quota of asylum seekers in a recent context might...

  13. [Asylum-seekers' mental and physical health problems: practices and recommendations]. (United States)

    Kórász, Krisztián


    The Hungarian health care system faces new challenges with the unprecedented increased rate of migration. Asylum-seekers arriving are a heterogeneous group. Their health care needs vary depending on their country of origin and the quality of the health care they received prior to arrival, not to mention the impact of the migration process on their health. Described within this paper are the challenges an asylum seeker might face in obtaining care on arrival into the host country and the challenges clinicians face in providing that care. This review is designed to give health professionals the necessary knowledge to care for asylum-seekers in a culturally aware and clinically informed manner.

  14. La relación médico-paciente, la medicina científica y las terapias alternativas Physician-patient relationship, scientific medicine and alternative therapies

    Directory of Open Access Journals (Sweden)

    J. a. Franco


    (p<0.00001, self-medication (p<0.0002, pain and concern during over 6 months due to disease or disability (p<0.00001, lack of confidence in scientific medicine (p<0.00001, the belief that «spiritual problems» (p<0.00001, «mental conditions» (p<0.003, and «emotional conditions» (p<0.00001, popular beliefs, particularly daño & envidia (p<0.00001, and mal de ojo (p<0.001 have triggered the disease. One third of the patients attended the hospital while undergoing an alternative therapy that may pose an interference or interaction hazard. Emphasis is placed on the importance of medical education to assess physician-patient relationship and the ability to convey trust in medical procedures and treatments, and scientific consulting for other practices.

  15. Not the Promised Land: African Asylum Seekers and Refugees in Israel. (United States)

    Shamai, Michal; Amir, Yair


    The phenomenon of African asylum seekers in Israel is relatively new. The purpose of the study was twofold: (a) to investigate how the asylum seekers construct their life stories and (b) to discover which aspects of the constructed life stories can be taken into consideration by various mental health professionals when providing help to asylum seekers. In this study, we interviewed 16 asylum seekers residing in Israel using the narrative method. Based on holistic analysis, we collected three groups of stories: "Then see what course life takes in the future," "I'm not yet free," and "Open prison." In the discussion of the findings, we focus on the similarities and differences among the groups of stories, with reference to the role of the sociopolitical context and to the private and social self as part of the participants' well-being. We make implementation suggestions for mental health interventions.

  16. Unaccompanied asylum-seeker children: flawed processes and protection gaps in the UK

    Directory of Open Access Journals (Sweden)

    Katia Bianchini


    Full Text Available My experience of working as an immigration lawyer on unaccompanied asylum-seeker children’s cases has highlighted a number of serious flaws in the processes which determine their futures....

  17. Serbian migration policy concerning irregular migration and asylum in the context of the EU integration process

    Directory of Open Access Journals (Sweden)

    Marta Stojić-Mitrović


    Full Text Available In this paper I would like to present Serbian migration policy concerning irregular migration and asylum in the context of the attempts of the Serbian state to become a member of the European Union. I would describe the history of the asylum system prior and after the implementation of the independent asylum system in Serbia in 2008. My presentation of the Serbian migration policy would be channelled by the analysis of some particular political issues, such as the externalization of the EU borders’ control, as well as some relevant elements of the European integration process, like visa liberalization. The second, more culturally specific dimension of the issue would be accessed through the demonstration of both legislative and public conceptualizations of the irregular migrants, asylum seekers and refugees in Serbia.

  18. [Beyond the asylum -An other view on the history of psychiatry in the modern age]. (United States)

    Fauvel, Aude


    If one thinks medicine, madness and the past, one image immediately pops into mind: that of the mental asylum. Following the famous work by Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, many historians have thus considered that the medicalization of insanity in the modern age had mostly led to a "great confinement" and a greater segregation of all individuals deemed mentally unfit during the "asylum era': However, new research demonstrates that this classic narrative of the psychiatric past needs to be revised. It discloses that, ever since the 191h century, a whole other medical culture existed as a challenge to asylums, a culture that advocated the integration of the mad and fought to disassociate psychiatry from the dominant model of confinement all throughout the occidental world. This article aims at presenting the results of these historical works that depict another aspect of the psychiatric history, exploring "boarding out" practices, instead of asylum ones.

  19. [Psychopathology of asylum seekers in Europe, trauma and defensive functioning]. (United States)

    Mazur, V M-L; Chahraoui, K; Bissler, L


    Refugees seeking asylum are a particularly vulnerable population. It has been observed that among the most commonly-occurring disorders exhibited in this population, there is a high incidence of post-traumatic stress disorder, generalized anxiety disorder, and depression. These disorders may be linked to the difficult paths that refugees are forced to undertake, as well as to different traumatic events which are particularly destructive psychologically (deliberate physical, sexual and/or psychological violence, traumatic bereavements in the context of war, or social and political instability, socio-economic, familial or administrative difficulties), which compromise their view of their short-term futures. In the face of the weight of these life events, the question of the psychological resources of the individual is at the forefront of our understanding of mental health and the capacity to adjust to trauma. Our study aims to apprehend in a dynamic way, the different strategies used by asylum seekers in our western countries to adjust psychologically to traumatic and stressful events. The aim of this research is to study the links between mental health and anxious and depressive psychopathologies as well as the defensive modalities of these subjects. One hundred and twenty adult asylum seekers, living in refugee centres in Slovakia, France and Norway have agreed to participate in this study. We tried to assess the psychopathological disorders manifesting in these populations, notably PTSD, major depression and generalized anxiety disorder. Using the DSQ-60 we also tried to establish the links between the psychopathologies observed in this population and the defence mechanisms employed. Our results reveal that 60% of subjects do indeed suffer from psychopathological disorders with an important comorbidity of PTSB and depression (64.2%). Furthermore, the seriousness of the symptoms is correlated with less adaptive defence mechanisms (a higher incidence of defence

  20. Seroprevalence of Hepatitis B, C and HIV/AIDS in Asylum Seekers in Istanbul

    Directory of Open Access Journals (Sweden)

    Kadriye Kart Yaşar


    Full Text Available Objective:This study aimed to determine prevalence of hepatitis B, C and HIV/AIDS in asylum seekers in Istanbul, Turkey. Methods: The data about asylum seekers who applied in Istanbul between March 2008 and March 2010 were evaluated retrospectively. Demographic features and markers of blood borne infections (HBsAg, anti-HCV and anti-HIV results of asylum seekers were reviewed. Results: In total 3043 asylum seekers were included into the study. The leading origin countries of the refugees were from Afghanistan, Turkmenistan and Azerbaijan and majority of them (2328 people, 77% were male. The young adults between 25 and 45 years constituted the most crowded group. Overall prevalence of HCV, HBsAg and HIV/AIDS were 12.2%, 5.9% and 0.7%, respectively. The highest seropositivity rate for anti-HCV, HBsAg and anti-HIV were found in Georgian males (47.1%; in Moldovan males (13.2% and in Somali males (3.1%, respectively. Conclusion:Mostly asylum seekers who have migrated to our country were young adult males from Asia. The highest prevalence rate of HCV was found in Georgian males. Therefore, the increased potential of migration to our country along the recent years necessitates development of an appropriate health approach concerning asylum seekers. J Microbiol Infect Dis 2014;4(1: 20-25

  1. [Taking Care of Asylum Seekers: Occupational Health Aspects with a Special Focus on Vaccination]. (United States)

    Kolb, S; Hörmansdorfer, S; Ackermann, N; Höller, C; Brenner, B; Herr, C


    Employees and volunteers often feel insecure about the potential transmission of infectious diseases when taking care of asylum seekers. It could be shown that overall only a minor risk of infection emanates from asylum seekers. However, aspects of occupational health and vaccination should be kept in mind.Besides the standard vaccination the Standing Committee on Vaccination (STIKO) recommends for occupational indication, which is given for employees and volunteers in asylum facilities, vaccination against hepatitis A, hepatitis B, polio (if the last vaccination was more than 10 years before) as well as influenza (seasonal).According to the German Occupational Safety and Health Act taking care of the employer has to determine which exposures might occur at the workplace (risk assessment) and define necessary protection measures. Depending on task and exposure when taking care of asylum seekers different acts (e. g. biological agents regulation) and technical guidelines for the handling biological agents (e. g. TRBA 250 or TRBA 500) have to be applied.The Bavarian Health and Food Safety Authority (LGL) has published several information sheets regarding "asylum seekers and health management" for employees and volunteers from the non-medical as well as the medical area ( search term "Asylbewerber"). With theses publications insecurities in taking care of asylum seekers should be prevented. Furthermore the employer gets support in the implementation of legal obligations to ensure occupational safety for the employees.

  2. Opportunities and Limitations for Collective Resistance Arising from Volunteering by Asylum Seekers and Refugees in Northern England


    Vickers, T


    This article asks whether volunteering by refugees and asylum seekers holds potential to foster collective resistance to the British state’s increasingly punitive asylum policies. It draws on research that included four organizational case studies and in-depth qualitative interviews with refugees and asylum seekers volunteering in a city in Northern England, and analyses this data using inter- related concepts of contradiction, hegemony and social capital. This research found that volunteerin...


    Directory of Open Access Journals (Sweden)

    Angelina Stanojoska


    Full Text Available Starting the Arab spring in 2010 and going through the latest and ongoing Syrian conflict and crises, Balkans and Macedonian railways have been and are a place where many human destinies cross their paths walking to the Member States of the European Union. On the other side, Macedonia is struggling with an influx of refugees, finding itself in a status quo position, even looking as it does not know how to solve the situation. Migrants were killed on railways every day not being able to use any kind of public transportation; their smuggling became a normal business for organized crime groups; Macedonian citizens started to earn money on refugees’ misfortune. The paper using the comparative method and document analysis, gives an overview of the EU’s legislation in the area, its improvement and current impact on things, all of it concluded with the Macedonian legal solutions regarding asylum and authors’ recommendations.

  4. Physician Fee Schedule Search (United States)

    U.S. Department of Health & Human Services — This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services,...

  5. Narrative survival: personal and institutional accounts of asylum confinement. (United States)

    Hanganu-Bresch, Cristina; Berkenkotter, Carol


    This essay has been conceptually eclectic in that we have integrated concepts from genre theory and discourse analysis. In our interpretation of Merivale and Marshall's narratives, we have also drawn upon Frye's Anatomy of criticism, a canonical text in literary genre theory. Such an eclectic approach seems warranted by both the contextual and textual features of Merivale's and Marshall's narratives, and in particular by Merivale's use of Mennipean satire with its encyclopedic detail. In our discussion of Merivale and Marshall's Admissions Records we have drawn on speech act theory to suggest that the Order (to admit a patient), the two medical certificates that follow, and finally, the notice to admit a patient constitute a constellation of texts, a genre suite, with a powerful illocutionary force. These texts are the prelude to and the means of confinement; they are both act and process. At the heart of our comparison of the asylum records of Merivale and Marshall with their "survivor narratives" is our analytic conclusion that the Ticehurst case histories can be said to constitute a linear "chronicle" of what Hayes Newington, the writer of the two case histories observed and inferred about his two patients. As chronicles, the Ticehurst Asylum case histories are linear representations or realistic accounts. As such, these archival documents provide a genuine insight into the "ways that that reality offers itself to perception". The institutional accounts exist in--and mark a--"flat time," equalized by each dated entry depicting the writer's mechanical act of observing/noting in brief, stereotypical sentences, e.g., "Patient is better [or, conversely, no] better today." We dubbed this metronomic time: beating regularly and evenly, flattening out the individual trajectories of each patient's illness. Metronomic time is normative. Each beat is calculated precisely to be the same as next. The dispassionate nature of clinical observations and the metronymic rhythms of

  6. No Time for Nostalgia!: Asylum-Making, Medicalized Colonialism in British Columbia (1859-97) and Artistic Praxis for Social Transformation (United States)

    Roman, Leslie G.; Brown, Sheena; Noble, Steven; Wainer, Rafael; Young, Alannah Earl


    This article asks: How have disability, indigenous arts and cultural praxis transformed and challenged the historical sociological archival research into relationships among asylum-making, medicalized colonialism and eugenics in the Woodlands School, formerly the Victoria Lunatic Asylum, the Provincial Asylum for the Insane in Victoria, BC 1859-72…

  7. 8 CFR 1240.68 - Failure to appear at an interview before an asylum officer or failure to follow requirements for... (United States)


    ... asylum officer or failure to follow requirements for fingerprinting. 1240.68 Section 1240.68 Aliens and... appear at an interview before an asylum officer or failure to follow requirements for fingerprinting. (a... application or waiver of the right to an adjudication by an asylum officer. A written request to...

  8. 8 CFR 208.10 - Failure to appear at an interview before an asylum officer or failure to follow requirements for... (United States)


    ... asylum officer or failure to follow requirements for fingerprint processing. 208.10 Section 208.10 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS PROCEDURES FOR ASYLUM AND WITHHOLDING OF REMOVAL Asylum and Withholding of Removal § 208.10 Failure to appear at an interview before...

  9. 8 CFR 240.68 - Failure to appear at an interview before an asylum officer or failure to follow requirements for... (United States)


    ... asylum officer or failure to follow requirements for fingerprinting. 240.68 Section 240.68 Aliens and... Removal Under Section 203 of Pub. L. 105-100 § 240.68 Failure to appear at an interview before an asylum... an adjudication by an asylum officer. A written request to reschedule will be granted if it is...

  10. [Refugees, migrants, language barrier: opinion of physicians on translation aids]. (United States)

    Graz, B; Vader, J P; Raynault, M F


    When the patient and caregiver do not share a common language, an interpreter is not always the best solution, and in any case, one cannot be present for every visit, especially in the case of an emergency. According to a questionnaire that was sent to all of the physicians who are members of a health care network for asylum seekers in the Swiss canton of Vaud (n = 169), it appears that 45% of practitioners found a telephone translation service to be a practical solution, and 58% would like medical glossaries with phonetic pronunciation and visual illustrations made available. With a response rate of 91%, it is estimated that these two types of services would be used as often as qualified interpreters, if they were made available. Other translating aids are also proposed.

  11. [Jonathan Swift's asylum in Dublin--Ireland's introduction to institutional psychiatry 250 years ago]. (United States)

    Reuber, M


    250 years ago, the satirical writer and clergyman Jonathan Swift from Dublin (1667-1745) founded the first Irish lunatic asylum. Rejecting the theories put forward by the English philosopher Thomas Hobbes and the doctor Thomas Willis, he was influenced by the ideas of the Scottish doctor and the "enlightened" thinker John Locke. Swift's St. Patrick's Hospital did not, however, realise a new philosophical concept: architecture and therapeutic approach of the new institution were clearly modelled on the much older Hospital of St. Mary of Bethlehem ( = Bedlam). Despite its conservative conceptual basis, the first institution dedicated to the mentally ill and intellectually subnormal in Ireland became a starting point for the apparantly unstoppable expansion of the, at one time, most comprehensive asylum system in the world. After Swift's Hospital had been enlarged twice at the tax-payers' expense (1778, 1793), the administration decided to relieve the institution by erecting the Richmond Asylum (1810), the first public asylum in Ireland. When this establishment also became overcrowded, in 1817, legislation was passed which led to the establishment of the oldest system of public asylums in Europe.

  12. The common European asylum system and the rights of the child : an exploration of meaning and compliance

    NARCIS (Netherlands)

    Smyth, Ciara Mary


    This thesis addresses the question of whether the EU Common European Asylum System (CEAS) complies with the rights of the child. A significant proportion of people seeking asylum in EU countries are children. These children may be totally alone, with people who are not their customary caregivers o

  13. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands.

    NARCIS (Netherlands)

    Gerritsen, A.A.M.; Bramsen, I.; Devillé, W.; Willigen, L.H.M. van; Hovens, J.E.; Ploeg, H.M. van der


    CONTEXT: Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiologica

  14. The Immigration and Asylum Act Support for Children and Families: Setting a "Fairer, Faster and Firmer" Agenda? Policy Review. (United States)

    Chunilal, Naomi


    Discusses the intent, goals, successes and failures of England's Immigration and Asylum Act and its provisions for the support of children and families. Urges accelerating decision making process for asylum claims, and argues against placing refugees into a financially disadvantaged situation upon arrival, and against negative government policies…

  15. British Adolescents' and Young Adults' Understanding and Reasoning about the Religious and Nonreligious Rights of Asylum-Seeker Youth (United States)

    Tenenbaum, Harriet R.; Ruck, Martin D.


    This study examined British young people's understanding of the rights of asylum-seeking young people. Two hundred sixty participants (11-24 years) were read vignettes involving asylum-seeking young people's religious and nonreligious self-determination and nurturance rights. Religious rights were more likely to be endorsed than nonreligious…

  16. Seroprevalence of Antibodies against Measles, Rubella and Varicella among Asylum Seekers Arriving in Lower Saxony, Germany, November 2014-October 2015. (United States)

    Toikkanen, Salla E; Baillot, Armin; Dreesman, Johannes; Mertens, Elke


    The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres.

  17. Credibility Assessments as 'Normative Leakage': Asylum Applications, Gender and Class

    Directory of Open Access Journals (Sweden)

    Hanna Wikström


    Full Text Available Based on the assumption that credibility assessments function as 'normative leakage' within the asylum process, we analyse how narratives of gender and class are articulated, rendered meaningful, or silenced in credibility assessments. Two cases concerning male applicants are selected in order to illustrate these processes. In relation to the existing concepts of internal/external credibility, we wish to introduce the concept of social credibility, which focuses on how the assessors read different socio-cultural narratives. While previous research has shown that the postcolonial will to protect women favours women as victims of patriarchal cultures, we wish to point out the continuity of this line of argumentation in relation to male and female applicants by adopting a theoretical generalization: male applicants instead become situated at the other end of the spectrum of postcolonial notions of modernity as non-victims, victims of other circumstances or perpetrators. We argue that these processes are accentuated in relation to credibility assessments. In order to prevent processes of social exclusion and to enhance inclusive practice, authorities need to acknowledge the 'normative leakage' associated with the assessment process.

  18. Interactions between physicians and drug industry

    Directory of Open Access Journals (Sweden)

    Begul Yagci Kupeli


    Full Text Available Ethical issues involving drug industry physician relationship have resulted in an ongoing debate about its appropriateness for many years in medical World. The most familiar marketing strategies of drug companies include individual gifts for physicians and sponsorship for educational and social activities. This interaction begins during medical school years of doctors and types of interactions are modified according to factors such as physician's position, title and number of patients. Although data reveal the opposite, most doctors deny or underestimate the influence of drug companies on their drug prescription. Both sides have common interests such as effective drug usage and observation, conduction of creative scientific studies. However, they have conflict of interests in some aspects. Physicians mostly care about patients' well-being and scientific improvement while drug companies are mostly involved in commercial benefit. Furthermore, some of the marketing strategies may have significant consequences on health of society such as rising drug costs, wrong or excessive usage of drugs. Regulations and guidelines have been designed in order to overcome these issues. However, the most important role in modelling of physician-drug industry interaction belongs to physicians. [Cukurova Med J 2016; 41(4.000: 777-781

  19. Do supranational EU institutions make a difference? EU asylum law before and after 'communitarization'. (United States)

    Ripoll Servent, Ariadna; Trauner, Florian


    This article examines whether the empowerment of the European Union's (EU) supranational institutions has had an impact on the development of EU asylum. By systematically investigating EU asylum law before and after 'communitarization', it argues that its 'policy core' has maintained a high degree of continuity. An advocacy coalition under the leadership of the interior ministers managed to co-opt pivotal actors in the newly empowered European Commission and European Parliament. By contenting themselves with changes of secondary order, these EU institutions accepted and institutionalized the restrictive and weakly integrated core of EU asylum set by the Council in the first negotiation round. Their role and decisions were driven not only by the negotiation dynamics and political expediency, but also by new inter- and intra-institutional norms fostering consensual practices.

  20. Mental health and legal representation for asylum seekers in the ‘legacy caseload’

    Directory of Open Access Journals (Sweden)

    Mary Anne Kenny


    Full Text Available This article examines processes and challenges attendant upon an asylum seekers arriving by boat to Australia obtaining legal assistance for their claims. The authors set about explaining the experiences of asylum seekers in the ‘legacy caseload’ who have been waiting for around 4 years to have their protection claims assessed. The provision of legal assistance for this group will be essential to ensuring that the refugee status determination process is fair and allows asylum seekers to understand and participate more fully in the process.  It describes the complex interplay between legal assistance to support refugee claims and the way those making claims inevitably struggle to understand, engage and participate in the process. Recent changes to the assessment of claims combined with a reduction in funding for legal assistance create significant hurdles and combine to compound existing stress and adversity.

  1. Postpartum depression in refugee and asylum-seeking women in Canada: A critical health psychology perspective. (United States)

    Brown-Bowers, Amy; McShane, Kelly; Wilson-Mitchell, Karline; Gurevich, Maria


    Canada has one of the world's largest refugee resettlement programs in the world. Just over 48 percent of Canadian refugees are women, with many of them of childbearing age and pregnant. Refugee and asylum-seeking women in Canada face a five times greater risk of developing postpartum depression than Canadian-born women. Mainstream psychological approaches to postpartum depression emphasize individual-level risk factors (e.g. hormones, thoughts, emotions) and individualized treatments (e.g. psychotherapy, medication). This conceptualization is problematic when applied to refugee and asylum-seeking women because it fails to acknowledge the migrant experience and the unique set of circumstances from which these women have come. The present theoretical article explores some of the consequences of applying this psychiatric label to the distress experienced by refugee and asylum-seeking women and presents an alternative way of conceptualizing and alleviating this distress.

  2. Barriers to effective practice for health visitors working with asylum seekers and refugees. (United States)

    Burchill, John; Pevalin, David


    The objective of this study was to determine the barriers to effective practice that health visitors experience when working with refugees and asylum seekers. This was a qualitative study based on the analysis of in-depth interviews with a purposive sample of 14 health visitors describing their experiences working with refugees and asylum seekers. These were analysed using the Framework process, a thematic matrix-based analytical method. The findings identified that the barriers to effectiveness for health visitors when working with refugees and asylum seekers were underpinned by ineffective use of services and stretched resources. The results imply that commissioners of services need to have an understanding of these barriers to commission effectively.

  3. The Moral Economy of Lying: Subjectcraft, Narrative Capital, and Uncertainty in the Politics of Asylum. (United States)

    Beneduce, Roberto


    Based on narratives of asylum-seekers from sub-Saharan Africa in northern Italy, in this article I analyze the narrative strategies used by immigrants to meet the eligibility criteria established by asylum law. For many of them, this means "arranging" biographical details within what I call "a moral economy of lying." The first question I discuss is what types of experience and 'subject positions' these narrative strategies reveal or generate. I then examine the arbitrariness and the bureaucratic violence of the asylum evaluation process, and the role of these procedures in the making of nation-language and current technologies of citizenship. Finally, I consider the politics of testification, recognition, and memory these discourses and practices combine to shape. I analyze these issues from an historical point of view of the politics of identity, truth, and falsehood as imposed in a recent past by colonizers onto the colonized.

  4. The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers. (United States)

    Li, Susan S Y; Liddell, Belinda J; Nickerson, Angela


    Refugees demonstrate high rates of post-traumatic stress disorder (PTSD) and other psychological disorders. The recent increase in forcible displacement internationally necessitates the understanding of factors associated with refugee mental health. While pre-migration trauma is recognized as a key predictor of mental health outcomes in refugees and asylum seekers, research has increasingly focused on the psychological effects of post-migration stressors in the settlement environment. This article reviews the research evidence linking post-migration factors and mental health outcomes in refugees and asylum seekers. Findings indicate that socioeconomic, social, and interpersonal factors, as well as factors relating to the asylum process and immigration policy affect the psychological functioning of refugees. Limitations of the existing literature and future directions for research are discussed, along with implications for treatment and policy.

  5. 'The Head Carver': Art Extraordinary and the small spaces of asylum. (United States)

    McGeachan, Cheryl


    This paper uses the unique collection of Scottish outsider art, labelled Art Extraordinary, as a window into the often neglected small spaces of asylum care in the early twentieth century. By drawing upon materials from the Art Extraordinary collection and its associated archives, this paper demonstrates the importance of incorporating small and everyday spaces of care - such as gardens, paths, studios and boats - into the broader historical narratives of psychiatric care in Scotland. Examples of experiential memorialization and counterpoints to asylum surveillance culture will be illuminated. The significance of using 'outsider' art collections as a valuable source in tracing geographical histories will be highlighted.

  6. Moving images: psychoanalytically informed visual methods in documenting the lives of women migrants and asylum seekers. (United States)

    Haaken, Janice K; O'Neill, Maggie


    While feminist arts-based projects have gained legitimacy, theory guiding the use of visual images in field research has lagged. Drawing on psychoanalytic-feminist theory and participatory action research methods, the article presents a study carried out with women refugee and asylum seekers that focuses on their experiences in seeking a place of safety in the United Kingdom. The aim was to produce through photography and videography a collective account of asylum as a daily process. In discussing the study, the authors provide a psychoanalytic framework for working through ethical, political, and methodological dilemmas in the use of visual imagery in feminist research.

  7. Behavior Modification: A Patient and Physician's Perspective. (United States)

    Swanson, Elizabeth; Primack, Craig


    This article, co-authored by a patient affected by obesity and an obesity medicine specialist, discusses the patient's experience of living with the disease and using many different weight loss approaches until finding a lifestyle program that was appropriate for her metabolism. The physician discusses the scientific basis of insulin resistance, and why the chosen lifestyle program worked so well for this individual.

  8. Physicians, unions, and antitrust. (United States)

    Hirshfeld, E B


    The increasing consolidation of our healthcare delivery systems and the concomitant push for perceived efficiencies, speed, and profits has laid the foundation for a renewed interest in unionization by many physicians. This Article analyzes the barriers to such unionization that are posed by the antitrust laws, and provides an analysis of how to proceed with unionization without violating those laws. The Article also analyzes the current status of physician ability to unionize, and surveys the present status of physician unions.

  9. Confronting the disruptive physician. (United States)

    Linney, B J


    Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.

  10. [Advanced online search techniques and dedicated search engines for physicians]. (United States)

    Nahum, Yoav


    In recent years search engines have become an essential tool in the work of physicians. This article will review advanced search techniques from the world of information specialists, as well as some advanced search engine operators that may help physicians improve their online search capabilities, and maximize the yield of their searches. This article also reviews popular dedicated scientific and biomedical literature search engines.

  11. The laboratory and the asylum: Francis Walker Mott and the pathological laboratory at London County Council Lunatic Asylum, Claybury, Essex (1895-1916). (United States)

    Buklijas, Tatjana


    London County Council's pathological laboratory in the LCC asylum at Claybury, Essex, was established in 1895 to study the pathology of mental illness. Historians of psychiatry have understood the Claybury laboratory as a predecessor of the Maudsley Hospital in London: not only was this laboratory closed when the Maudsley was opened in 1916, but its director, Frederick Walker Mott, a champion of the 'German' model in psychiatry, was instrumental in the establishment of this institution. Yet, as I argue in this essay, for all the continuities with the Maudsley, the Claybury laboratory should not be seen solely as its predecessor - or as a British answer to continental laboratories such as Theodor Meynert's in Vienna. Rather, as I show using the examples of general paralysis of the insane and 'asylum colitis', the Claybury laboratory is best understood as an attempt to prevent mental illness using a microbiological model.

  12. A longitudinal study of changes in asylum seekers ability regarding activities of daily living during their stay in the asylum center. (United States)

    Morville, Anne-Le; Amris, Kirstine; Eklund, Mona; Danneskiold-Samsøe, Bente; Erlandsson, Lena-Karin


    The aim was to assess change in activities of daily living (ADL) ability amongst asylum seekers and if there were any difference between tortured and non-torture following a 10 months post-arrival period, and if self-reported health and exposure to torture were factors related to change in ADL-ability. The study was a combined baseline, follow-up correlational study amongst individuals from Afghanistan, Iran and Syria, living in Danish asylum centers. Forty-three persons aged 20-50, were invited and participated in the baseline study. Twenty-two were still in asylum center at the follow-up and 17 of them participated. ADL-ability was measured using Assessment of Motor and Process Skills and questionnaires about exposure to torture, self-reported mental health and pain. ADL motor and process measures, well-being and self-rated health declined from baseline to follow-up. Measures of pain and depression increased. Exposure to physical torture and change in ADL motor (r = 0.525) measures were associated, as well as change in current pain and change in ADL process (r = 0.525) measures. Due to preponderance of torture survivors analysis of group difference was not applicable. Health care workers should be aware of ADL concerns and exposure to torture in this population to best address their needs within rehabilitation settings.

  13. Negotiation for physicians. (United States)

    Hill, Micah J; DeCherney, Alan H


    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools.

  14. Disciplinary power and the role of the subject at a nineteenth-century Danish asylum

    DEFF Research Database (Denmark)

    Hamre, Bjørn


    the study draws upon Foucauldian concepts like disciplinary power, confession, pastoral power and subjectivation. I will argue that the critique of the patient provides us with an example of the way that disciplinary power works in the case of an informal indictment of the methods and practice at an asylum...

  15. Language Analysis in the Context of the Asylum Process: Procedures, Validity, and Consequences (United States)

    Reath, Anne


    In 1993, the language section of the Swedish Migration Board initiated the production of documents they called "language analyses" to aid in the processing of asylum seekers. Today, 11 years later, 2 privately owned companies in Stockholm produce these documents. These companies have produced language analyses not only for the Swedish Migration…

  16. A foot in the door: access to asylum in South Africa

    NARCIS (Netherlands)

    D. Vigneswaran


    Asylum seekers in South Africa experience extreme difficulties lodging their claims at the Department of Home Affairs. This paper utilizes new survey data to measure the extent of the Department’s failures to provide access to the status determination process. The principal finding is that South Afr

  17. U.S. grants political asylum to woman who fled female genital mutilation. (United States)


    Fauziya Kasinga fled to the US from Togo in 1994 at the age of 17 years after an aunt forced her to marry a 45-year-old man with three wives. From the time of her arrival to the US in December 1994 to April 24, 1996, Kasinga was detained at two correctional facilities awaiting a decision by the US Board of Immigration Appeals (BIA) on her request for political asylum. That asylum was granted in a 11-1 decision issued on June 13 on the grounds of Kasinga's fear of being forced to undergo female genital mutilation (FGM) if sent back to Togo. This is the first time that the BIA has ruled that FGM can be grounds for asylum. 50% of women in Togo are estimated to have undergone FGM. The BIA decided that the young woman met the criteria for receiving refuge because she is a member of a particular social group, the unmutilated women of the Tchamba-Kunsuntu tribe who face but oppose FGM, which has a well-founded fear of persecution which is country wide. Moreover, Kasinga's husband has influence with the police in Togo, a rather small country. This decision not only sets precedent with regard to FGM, but also is the first gender-based asylum claim to be considered since the Immigration and Naturalization Service revised its guidelines in May 1995 to cover such persecution.

  18. Telling Tales of Torture: Repositioning Young Adults' Views of Asylum Seekers (United States)

    Watts, Michael F.


    This paper explores the changing attitudes of a group of young adults towards asylum seekers in the UK. Based on the experience of sixth form students attending a workshop hosted by a former refugee from Pinochet's Chile, it argues for the importance of personal stories and their wider contexts and suggests that each is necessary to enable…

  19. Inclusive Democracy: A Consideration of Playback Theatre with Refugee and Asylum Seekers in Australia (United States)

    Dennis, Rea


    Community-based performance often facilitates participation through story-based processes and in this way could be seen as enacting a form of inclusive democracy. This paper examines a playback theater performance with a refugee and asylum seeker audience and questions whether inclusive, democratic participation can be fostered. It presents a…

  20. Politicised Notions of Professional Identity and Psychosocial Practice among Practitioners Working with Asylum Seekers and Refugees (United States)

    Apostolidou, Zoe


    This is the first study undertaken in the UK that investigates the notion of professional identity among practitioners who work with asylum seekers and refugees. Drawing on a social constructionist epistemology and a Foucauldian theoretical and methodological framework of power and discourse, I analysed extracts from semi-structured interviews…

  1. Home Journeys: Im/mobilities in Young Refugee and Asylum-Seeking Women's Negotiations of Home (United States)

    Sirriyeh, Ala


    Research with refugees and asylum seekers tends to be divided into research with adults or research with children under the age of 18. This is despite relational approaches to studying age that contest such dichotomous and fixed understandings of "life-stages". This article seeks to provide an insight into the experiences of young women…

  2. Asylum, Participation and the Best Interests of the Child: New Lessons from Norway (United States)

    Liden, Hilde; Rusten, Hilde


    This article discusses Norway's implementation of the Convention on the Rights of the Child (CRC) in relation to the field of asylum. In particular, we explore the dilemmas and challenges posed by efforts to realise children's right to express their views and have these views given due weight in decision-making processes as stipulated in Article…

  3. The Circumstances and Needs of Separated Children Seeking Asylum in Ireland (United States)

    Abunimah, Ali; Blower, Sarah


    The study reported here is the first systematic attempt to examine empirically the needs and characteristics of separated children seeking asylum (SCSA) in Ireland. Case files for a random sample of 100 separated children entering Ireland in 2003-2004 were scrutinised. The findings indicate that SCSA are not a homogeneous group; they face a…

  4. Language Testing in the Context of Citizenship and Asylum: The Case of Estonia (United States)

    Zabrodskaja, Anastassia


    The focus of the current article is language testing in the context of citizenship and asylum in Estonia, a country that regained independence in 1991. Estonian as the single official language of the country (according to the new language legislation laws) and a new political system have caused changes in use of and attitudes toward Estonian among…

  5. Waiting Time: The De-Subjectification of Children in Danish Asylum Centres (United States)

    Vitus, Kathrine


    This article analyses the relationship between time and subjectification, focusing on the temporal structures created within Danish asylum centres and politics, and on children's experiences of and reactions to open-ended waiting. Such waiting leads to existential boredom which manifests in the children as restlessness, fatigue and despair. The…

  6. No Place: Small Children in Norwegian Asylum-Seeker Reception Centres (United States)

    Seeberg, Marie Louise; Bagge, Cecilie; Enger, Truls Andre


    Drawing on empirical material from fieldwork among young children living with their families in two Norwegian reception centres for asylum-seekers, this article compares their realities to the norms and realities for other children in Norway. Children's spatial and social situations within the centres stand out in stark contrast to Norwegian…

  7. People Seeking Asylum in Australia and their Access to Employment: Just What Do We Know?

    Directory of Open Access Journals (Sweden)

    Caroline Fleay


    Full Text Available Public and political claims about the employment of people from a refugee background in Australia do not always reflect the research findings in this area. For example, recent claims by a senior Coalition Government Minister about people seeking asylum who arrived to Australia by boat during the previous Labor Government’s terms in office (2007-13 posit that many have limited employment prospects. However, given there is little research or government reporting on the experiences of asylum seekers who arrived during this time, and none that focuses specifically on their employment, there is no evidence to support this. A review of research on the employment experiences of people from a refugee background, and Australian policies, suggests a more nuanced picture. This includes research that found while initially people from a refugee background are more likely to be unemployed, have temporary jobs and lower incomes than other newly arrived immigrants, second-generation refugees have higher levels of labour market participation than the general population. Research also highlights that refugees may experience a range of barriers to accessing employment, including discrimination, and a review of Australian policies indicates these are likely to have exacerbated some of these barriers for asylum seekers who arrived to Australia by boat. In addition, given previous findings that public attitudes can be influenced by representations made in public and political discourses, the public statements of senior Ministers may be further deepening barriers to accessing employment faced by asylum seekers who arrived by boat.

  8. [A state without memory. The ideological abolition of the insane asylum in Mexico (1945-1968)]. (United States)

    Sacristán, Cristina


    The present article analyzes a campaign by the Mexican government, among the public and the medical profession, to disseminate a health care reform that culminated with the opening of thirteen Farms for the mentally ill and the ideological abolition of the insane asylum in the sixties of the twentieth century. To do this, renowned psychiatrists who held public positions built a black legend over the most emblematic insane asylum of the country, pointing out as the main cause of failure the constraint to which patients were subjected. In doing so, they resembled the mental hospital to a prison and the insane to a social threat, because they reduced that institution's function and denied the many experiences that would ?t in it: a place of confinement and refuge, a therapeutic and knowledge production space. Even though Mexican psychiatry was professionalized in the space of the asylum, the State wanted to erase the memory of that past to suggest the establishment of a new era in mental health, where the patients would no longer be subject to any restrictions which could curtail their freedom. Overcoming the asylum model meant creating "open door" therapeutic alternatives, but the decision was to distort the past to exalt the future.

  9. Sovereign Borders: The Militarisation of Asylum Seeker Discourses in Australian Television News Media

    Directory of Open Access Journals (Sweden)

    Leicha Stewart


    Full Text Available While the democratic paradigm of governance and its constituent political processes are well established in Australia, consistently negative media representations of people seeking asylum may be viewed as justification for institutional decisions allowing continued punitive treatment of people seeking asylum on Australian shores. Historically, notions of Australian sovereignty exist as a changing discourse with reference to land claims and the Australian Indigenous population (O’Dowd 2011; Due 2008. However, in terms of contemporary political claims about Australia’s need to enforce border protection policies, notions of sovereignty are consistently framed through the themes, images and language of military discourses. Media scholar, John Street suggests that although there is disagreement about whether specific political outcomes can be attributed to press influence, the role of television in politics has been more comprehensively established as shaping broader world views in regards to ideas, values and practices that are considered ‘common-sense’ (Street 2011; Craig 2013. This paper argues that the increasing role of the military in the treatment and processing of people seeking asylum may be justified, through repetitive negative media representations of asylum seekers which secures public support for such practices, thereby undermining the very principles of the democratic paradigm, and indeed the role of the media or ‘fourth estate’(Schultz 1998 in a functioning democracy.

  10. Asylum Seekers and Resettled Refugees in Australia: Predicting Social Policy Attitude From Prejudice Versus Emotion

    Directory of Open Access Journals (Sweden)

    Lisa K. Hartley


    Full Text Available While most of the world's refugees reside in developing countries, their arrival to western countries is highly politicised, giving rise to questions about the types of entitlements and rights that should, or should not, be granted. In this study, using a mixed-methods community questionnaire (N = 185, we examined attitudes towards social policies aimed at providing assistance to two categories of new arrivals to Australia: resettled refugees (who arrive via its official refugee resettlement program and asylum seekers (who arrive via boat and then seek refugee status. Social policy attitude was examined as a consequence of feelings of anger, fear, and threat, as well as levels of prejudice. Participants felt significantly higher levels of anger, fear, threat, and prejudice towards asylum seekers compared to resettled refugees. For both resettled refugees and asylum seekers, prejudice was an independent predictor of more restrictive social policy attitudes. For resettled refugees, fear and perceived threat were independent predictors for more restrictive social policy whereas for asylum seekers anger was an independent predictor of restrictive social policy. The qualitative data reinforced the quantitative findings and extended understanding on the appraisals that underpin negative attitudes and emotional responses. Practical implications relating to challenging community attitudes are discussed.

  11. When Children Seek Asylum from Their Parents: A Canadian Case Study (United States)

    Bossin, Michael; Demirdache, Laila


    When children seek asylum from alleged abuse by a custodial parent, the notion that family reunification is always in the best interests of independent child migrants is undermined. In this chapter, the authors discuss the legal tensions between the Refugee Convention, the Convention on the Civil Aspects of International Child Abduction (the…

  12. Sexual and gender-based violence in the European asylum and reception sector: a perpetuum mobile?

    NARCIS (Netherlands)

    Keygnaert, I.; Dias, S.F.; Degomme, O.; Devillé, W.; Kennedy, P.; Kováts, A.; De Meyer, S.; Vettenburg, N.; Roelens, K.; Temmerman, M.


    Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and discuss

  13. Sexual and gender-based violence in the European asylum and reception sector: a perpetuum mobile?

    NARCIS (Netherlands)

    Keygnaert, I.; Dias, S.F.; Degomme, O.; Devillé, W.; Kennedy, P.; Kovats, A.; Meyer, S. de; Vettenburg, N.; Roelens, K.; Temmerman, M.


    Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and discuss

  14. Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy?

    NARCIS (Netherlands)

    Slobodin, O.; de Jong, J.T.V.M.


    Background: The prevalence of trauma-related problems among refugees and asylum seekers is extremely high due to adverse experiences associated with forced migration. Although the literature presents a considerable number of guidelines and theoretical frameworks for working with traumatized refugees

  15. EMDR versus Stabilization in traumatized Asylum Seekers and Refugees: Results of a pilot-study

    NARCIS (Netherlands)

    ter Heide, F.J.J.; Mooren, T.M.; Kleyn, W.; de Jongh, A.; Kleber, R.J.


    Background: Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD) should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye Mov

  16. Experiences of Young (Minor) Asylum Seekers in Further Education in Malta (United States)

    Spiteri, Damian


    This study appraises the particular challenges that minor asylum-seeking migrants who are in the 16-18 age category confront when pursuing their studies in a vocational college in Malta, a central Mediterranean island which is the smallest EU member state. The study explores how they exercise resilience in their desire to forge a future for…

  17. Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study.

    LENUS (Irish Health Repository)

    Toar, Magzoub


    BACKGROUND: Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. METHODS: Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety\\/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. RESULTS: Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression\\/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression\\/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression\\/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P < 0.001).In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found between these groups

  18. Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study

    Directory of Open Access Journals (Sweden)

    Fahey Tom


    Full Text Available Abstract Background Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD, depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. Methods Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60 and refugees (n = 28 from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36, presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. Results Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2–17.9 and depression/anxiety (OR 5.8, 95% CI: 2.2–15.4, while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3–12.7; OR 3.4, 95% CI: 1.2–10.1, high levels of pre migration stressors (OR 3.6, 95% CI: 1.1–11.9; OR 3.3, 95% CI: 1.0–10.4 or post migration stressors (OR 17.3, 95% CI: 4.9–60.8; OR 3.9, 95% CI: 1.2–12.3 were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (χ2 = 19.74, df = 1, P In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found

  19. Involve physicians in marketing. (United States)

    Randolph, G T; Baker, K M; Laubach, C A


    Many everyday problems in medical group practice can be attacked by a marketing approach. To be successful, however, this kind of approach must have the full support of those involved, especially the physicians, since they are the principal providers of healthcare services. When marketing is presented in a broad context, including elements such as patient mix, population distribution, and research, physicians are more likely to be interested and supportive. The members of Geisinger Medical Center's Department of Cardiovascular Medicine addressed their patient appointment backlog problem with a marketing approach. Their method is chronicled here and serves as a fine example of how physician involvement in marketing can lead to a positive outcome.

  20. "Their Stories Have Changed My Life": Clinicians' Reflections on Their Experience with and Their Motivation to Conduct Asylum Evaluations. (United States)

    Mishori, Ranit; Hannaford, Alisse; Mujawar, Imran; Ferdowsian, Hope; Kureshi, Sarah


    Many clinicians perform asylum evaluations yet no studies describe the motivation to perform them or their perceived rewards. The number of asylum seekers in the US is increasing and more clinicians are needed as evaluators. A survey to an asylum evaluators' network asked participants to qualitatively reflect on their experience and motivation. Answers were analyzed for themes and sentiment. Respondents cited commitment to humanistic and moral values, noted personal and family experiences, having skills, expertise, and career interests as drivers. They found the experience very rewarding personally and professionally, and in their perceived benefit to asylees. Negative sentiment was less frequent and centered on emotions related to client narratives. Process-oriented frustrations were also noted. This is the first published study describing clinicians' motivation and experience with asylum evaluations. It may illuminate clinicians' drive to volunteer, and serve as a resource for organizations for recruitment and education.

  1. Asylum migration and the construction of the European Common Foreign and Security Policy: evidence from the Greek case

    Directory of Open Access Journals (Sweden)

    Silvia Lucía Forero Castañeda


    Full Text Available This article examines how the recent evolution of asylum migration has affected the construction of the European Common Foreign and Security Policy (EU-CFSP, taking the Greek case during the 2001-2012 period as a starting point. With this in mind, the normative progress of the EU-CFSP facing the reception of asylum seekers in Greece is analyzed, under the scope of what Barry Buzan and Ole Waever would call Securitization Process. Both legal and political frameworks on asylum migration in Greece and in the European Union are approached, in the context of the evolution of the EU-CFSP in three main areas: Neighborhood Policy, Development and Cooperation Policy, and Human Rights Protection. The conclusión points toward the partial influence of asylum migration in the configuration of the UE-CFSP during the studied period.

  2. Zen and the art of physician autonomy maintenance. (United States)

    Reinertsen, James L


    The miracles of scientific medicine propelled physicians to an unparalleled level of clinical autonomy during the 20th century. During the past 20 years, physician autonomy has been declining, in part because the public has become aware that physicians are not consistently applying all of the science they know. One of medicine's most cherished professional values, individual clinical autonomy, is an important cause of the sometimes suboptimal performance in the timely and consistent application of clinical science; thus, it contributes to the decline in overall professional autonomy. This paper calls for physicians to practice the science of medicine as a profession so that society will allow physicians to continue practicing the art of medicine as individual professionals. In a Zen-like paradox, physicians must give up autonomy in order to regain it.

  3. Hitler's Jewish Physicians. (United States)

    Weisz, George M


    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.

  4. Physician-Owned Hospitals (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  5. Physician Referral Patterns (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  6. Physician Compare Data (United States)

    U.S. Department of Health & Human Services — This is the official dataset associated with the Physician Compare Website provided by the Centers for Medicare and Medicaid Services (CMS). These data...

  7. Physician Shared Patient Patterns (United States)

    U.S. Department of Health & Human Services — The physician referral data linked below was provided as a response to a Freedom of Information Act (FOIA) request. These files represent the number of encounters a...

  8. The Principle of Non-Refoulement and Access to Asylum System: Two Sides of the Same Coin

    Directory of Open Access Journals (Sweden)

    Goranka Lalić Novak


    Full Text Available The European Union and other countries on the Balkan route for migrants have recorded a large increase in the number of asylum seekers. In parallel with the increased number of refugees trying to enter the territory of the EU, measures for migration management have tightened, and the right to asylum at the level of the Member States has been interpreted more and more restrictive. Search for protection from persecution has become a reason for closing borders and disabling access to territory and asylum system. However, access to asylum system is the first step in the realization of the right to asylum as guaranteed by international, European and national law. In addition to allowing access to territory and asylum system, which implies an obligation of states to accept refugees in order to confirm the need for international protection in a fair and efficient procedure, the states are obliged to respect the principle of non-refoulement. The aim of this paper is to clarify the connection between providing access to asylum system and respect for the principle of non-refoulement. Analysis in the paper was done by legal-dogmatic method of research and interpretation of legal acts and other authorities, as well as of UNHCR relevant recommendations and documents. The assumption is that without the provision of access to territory and asylum system the principle of non-refoulement cannot be respected. Apart from the international refugee law and doctrinal interpretations, it derives from the practice of the European Court of Human Rights regarding the prohibition of torture or other inhuman treatment or punishment guaranteed by the Convention for the Protection of Human Rights and Fundamental Freedoms. The conclusion is that the states must take into account international and European standards regarding the protection of the principle of non-refoulement when considering the introduction of new measures to manage migration movements.

  9. Stool screening of Syrian refugees and asylum seekers in Germany, 2013/2014: Identification of Sabin like polioviruses. (United States)

    Böttcher, Sindy; Neubauer, Katrin; Baillot, Armin; Rieder, Gabriele; Adam, Maja; Diedrich, Sabine


    Germany is a partner of the Global Polio Eradication Initiative. Assurance of polio free status is based on enterovirus surveillance, which focuses on patients with signs of acute flaccid paralysis or aseptic meningitis/encephalitis, representing the key symptoms of poliovirus infection. In response to the wild poliovirus outbreak in Syria 2013 and high number of refugees coming from Syria to Germany, stool samples from 629 Syrian refugees/asylum seekers aged refugees and asylum seekers at that time.

  10. A longitudinal study of changes in asylum seekers ability regarding activities of daily living during their stay in the asylum center

    DEFF Research Database (Denmark)

    Morville, Anne-Le; Amris, Kirstine; Eklund, Mona;


    The aim was to assess change in activities of daily living (ADL) ability amongst asylum seekers and if there were any difference between tortured and non-torture following a 10 months post-arrival period, and if self-reported health and exposure to torture were factors related to change in ADL...... participated. ADL-ability was measured using Assessment of Motor and Process Skills and questionnaires about exposure to torture, self-reported mental health and pain. ADL motor and process measures, well-being and self-rated health declined from baseline to follow-up. Measures of pain and depression increased...

  11. The Impact of Detention on the Health of Asylum Seekers: A Systematic Review

    DEFF Research Database (Denmark)

    Filges, Trine; Montgomery, Edith; Kastrup, Marianne


    with government policies aimed at reducing the numbers of asylum seekers. OBJECTIVES The main objective of this review is to assess evidence about the effects of detention on the mental and physical health and social functioning of asylum seekers. SEARCH STRATEGY Relevant studies were identified through...... electronic searches of bibliographic databases, internet search engines and hand searching of core journals. Searches were carried out to November 2013. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies...... and relevant reviews were also searched. SELECTION CRITERIA All study designs that used a well-defined control group were eligible for inclusion. Studies that utilized qualitative approaches were not included. DATA COLLECTION AND ANALYSIS The total number of potential relevant studies constituted 11,376 hits...

  12. Asylum-seeking children's experiences of detention in Canada: A qualitative study. (United States)

    Kronick, Rachel; Rousseau, Cécile; Cleveland, Janet


    Children and parents seeking asylum are regularly detained in Canada, however little is known about the experiences of detained families. International literature suggests that the detention of children is associated with significant morbidity. Our study aims to understand the experiences of detained children and families who have sought asylum in Canada by using a qualitative methodology that includes semistructured interviews and ethnographic participant observation. Detention appears to be a frightening experience of deprivation that leaves children feeling criminalized and helpless. Family separation further shatters children's sense of well-being. Children's emotional and behavioral responses to separation and to detention suggest that the experience is acutely stressful and, in some cases, traumatic--even when detention is brief. Distress and impairment may persist months after release. Given the burden of psychological suffering and the harmful consequences of separating families, children should not be detained for immigration reasons and parents should not be detained without children.

  13. Making Sense of Pain: Delusions, Syphilis, and Somatic Pain in London County Council Asylums, c. 1900

    Directory of Open Access Journals (Sweden)

    Louise Hide


    Full Text Available During the late nineteenth century, a high percentage of male deaths in asylums was attributed to various forms of tertiary syphilis, most notably General Paralysis of the Insane (GPI and tabes dorsalis. It was not unusual for patients to present symptoms of both conditions, the latter of which could be agonizingly painful. Some patients also suffered from persecutory delusions, believing that electricity was running through them or that their limbs were gnawed by lions and wolves at night. Drawing on a theory advanced by a number of key alienists and pathologists of the period, I suggest that these delusions were misinterpretations of felt sensations and, as such, illusions rather than delusions. Despite the well-known problems around using these historical sources, I contend that recorded delusions in asylum case notes can be treated as narratives of pain that provide invaluable insights into patients' subjective experiences.

  14. Mental health of asylum seekers: a cross-sectional study of psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Heeren Martina


    Full Text Available Abstract Background Asylum procedures are known to be protracted, stretching to over ten years in many host countries. International research shows high levels of distress for asylum seekers. Little is known about actual psychiatric morbidity in this population, especially during the first few years postmigration. Methods The mental health status of two groups of asylum seekers was assessed: Group 1 (n = 43 had arrived in Switzerland 2.9 (SD 1.1 months prior to assessment, while Group 2 (n = 43 had arrived 15.5 (SD 3.2 months prior to assessment. Psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI. Symptom severity of posttraumatic stress disorder (Posttraumatic Diagnostic Scale, anxiety (Hopkins Symptom Checklist, depression (Hopkins Symptom Checklist, and pain (Verbal Rating Scale were assessed using self-report questionnaires. Postmigratory factors such as German language proficiency and social contacts were also assessed. Interviews were conducted with the assistance of trained interpreters. Results Four out of ten participants met diagnostic criteria for at least one DSM-IV disorder. Groups did not differ with respect to psychiatric morbidity or symptom levels. Major depression (31.4% and PTSD (23.3% were diagnosed most frequently. The number of experienced traumatic event types was highly correlated with psychiatric morbidity. Conclusions Psychiatric morbidity in asylum seekers in the first two years after arrival is high, with no indication of a decrease in mental distress over time. Traumatic experiences seem to play a major role in morbidity during this time. Considering the magnitude of clinically relevant distress, a short psychological screening upon arrival with a focus on traumatic experiences may be warranted.

  15. Reducing Homeland Insecurities: Ending Abuse of the Asylum and Credible Fear Program (United States)


    Clearing House UNHCR United Nations High Commissioner for Refugees U.S. United States USCIS United States Citizenship and Immigration Services...and the United States is only one of the countries experiencing an expanding influx. The United Nations High Commissioner for Refugees ( UNHCR ...AdditionalStatisticRequestedApril2014 AsylumStakeholderEngagement.pdf. United Nations High Commissioner for Refugees ( UNHCR ). “Convention and Protocol Relating to the

  16. EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study


    ter Heide, F. Jackie June; Trudy M. Mooren; Kleijn, Wim; de Jongh, Ad; Kleber, Rolf J.


    Background: Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD) should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye Movement Desensitisation and Reprocessing (EMDR) should be applied, or whether a phased model starting with stabilisation is preferable. Some clinicians fear that trauma-focused interventions may lead...

  17. EMDR versus Stabilization in traumatized Asylum Seekers and Refugees: Results of a pilot-study


    ter Heide, F.J.J.; Mooren, T.M.; W. Kleyn; de Jongh, A; Kleber, R.J.


    Background: Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD) should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye Movement Desensitisation and Reprocessing (EMDR) should be applied, or whether a phased model starting with stabilisation is preferable. Some clinicians fear that trauma-focused interventions may lead...

  18. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier


    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  19. Marital stability among physicians. (United States)

    Rose, K D; Rosow, I


    Analysis of 57,514 initial complaints for divorce, separate maintenance, and annulment filed in California during the first six months of 1968 reveals that physicians are considerably less prone to marital failure than men of comparable age in the general population. Furthermore, when compared to professionals in general, doctors also appear less prone to marital collapse. For physicians, marriages break down in the greatest numbers and at the greatest rate between the ages of 35 and 44. Women doctors are at least 40% more prone to marital instability than men, and black physicians are nearly 70% more prone to divorce than their white colleagues. Of the individual specialists, orthopedists and psychiatrists possibly have the highest rates of marital demise.

  20. Instrumentation problems for physicians. (United States)

    Turner, G O


    The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.

  1. When lives are put on hold: Lengthy asylum processes decrease employment among refugees. (United States)

    Hainmueller, Jens; Hangartner, Dominik; Lawrence, Duncan


    European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population.

  2. When lives are put on hold: Lengthy asylum processes decrease employment among refugees (United States)

    Hainmueller, Jens; Hangartner, Dominik; Lawrence, Duncan


    European governments are struggling with the biggest refugee crisis since World War II, but there exists little evidence regarding how the management of the asylum process affects the subsequent integration of refugees in the host country. We provide new causal evidence about how one central policy parameter, the length of time that refugees wait in limbo for a decision on their asylum claim, affects their subsequent economic integration. Exploiting exogenous variation in wait times and registry panel data covering refugees who applied in Switzerland between 1994 and 2004, we find that one additional year of waiting reduces the subsequent employment rate by 4 to 5 percentage points, a 16 to 23% drop compared to the average rate. This deleterious effect is remarkably stable across different subgroups of refugees stratified by gender, origin, age at arrival, and assigned language region, a pattern consistent with the idea that waiting in limbo dampens refugee employment through psychological discouragement, rather than a skill atrophy mechanism. Overall, our results suggest that marginally reducing the asylum waiting period can help reduce public expenditures and unlock the economic potential of refugees by increasing employment among this vulnerable population. PMID:27493995

  3. Leasing physician office space. (United States)

    Murray, Charles


    When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria.

  4. [Hippocrates' treatise physician]. (United States)

    Frøland, Anders


    This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.

  5. Meeting the health and social needs of pregnant asylum seekers, midwifery students' perspectives: part 1; dominant discourses and midwifery students. (United States)

    Haith-Cooper, Melanie; Bradshaw, Gwendolen


    Current literature has indicated a concern about standards of maternity care experienced by pregnant women who are seeking asylum. As the next generation of midwives, it is important that students are educated in a way that prepares them to effectively care for these women. To understand how this can be achieved, it is important to explore what asylum seeking means to midwifery students. This article is the first of three parts and reports on one objective from a wider doctorate study. It identifies dominant discourses that influenced the perceptions of a group of midwifery students' about the pregnant asylum seeking woman. The study was designed from a social constructivist perspective, with contextual knowledge being constructed by groups of people, influenced by underpinning dominant discourses, depending on their social, cultural and historical positions in the world. In a United Kingdom University setting, during year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning scenario as a trigger for discussion were conducted. In addition, three students were individually interviewed to explore issues in more depth and two students' written reflections on practice were used to generate data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way in which asylum seekers were perceived. The findings suggested an underpinning ideology around the asylum seeker being different and of a criminal persuasion. Although the pregnant woman seeking asylum was considered as deserving of care, the same discourses appeared to influence the way in which she was constructed. However, as the study progressed, through reading alternative sources of literature, some students appeared to question these discourses. These findings have implications for midwifery education in encouraging students to challenge negative discourses

  6. Physicians in transition. (United States)

    Bluestein, P


    The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.

  7. Information for travellers' physicians. (United States)

    Allison, D J; Blinco, K


    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs.

  8. Information for Travellers' Physicians


    Allison, David J; Blinco, Kimberley


    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs.

  9. Medication counselling: physicians' perspective. (United States)

    Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Eskildsen, Anette Gjetrup; Saedder, Eva Aggerholm; Nielsen, Lars Peter


    Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record.

  10. Physicians and Insider Trading. (United States)

    Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven


    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.

  11. Counties Without a Physician. (United States)

    Getz, Virginia


    Uses a budgeting technique to determine if free-market incentives or forces would provide an economic base sufficient to support medical professionals who might practice in the approximately 140 U.S. counties that lack a physician (located mainly in a narrow band from west Texas north through South Dakota). (AH)

  12. Physician Satisfaction and Physician Well-Being: Should Anyone Care?

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    Lawrence P. Casalino


    Full Text Available We present a model of hypothesized relationships between physician satisfaction, physician well-being and the quality of care, in addition to a review of relevant literature. The model suggests that physicians who are stressed, burned out, depressed, and/or have poor self-care are more likely to be dissatisfied, and vice-versa. Both poor physician well-being and physician dissatisfaction are hypothesized to lead to diminished physician concentration, effort, empathy, and professionalism. This results in misdiagnoses and other medical errors, a higher rate of inappropriate referrals and prescriptions, lower patient satisfaction and adherence to physician recommendations, and worse physician performance in areas not observed by others. Research to date largely supports the model, but high quality studies are few. Research should include studies that are prospective, larger, and have a stronger analytic design, ideally including difference in differences analyses comparing quality of care for patients of physicians who become dissatisfied to those who remain satisfied, and vice versa.Keywords: physician satisfaction, physician dissatisfaction, quality of care, physician well-being, physician burnout 

  13. Tuberculosis screening and follow-up of asylum seekers in Norway: a cohort study

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    Garåsen Helge


    Full Text Available Abstract Background About 80% of new tuberculosis cases in Norway occur among immigrants from high incidence countries. On arrival to the country all asylum seekers are screened with Mantoux test and chest x-ray aimed to identify cases of active tuberculosis and, in the case of latent tuberculosis, to offer follow-up or prophylactic treatment. We assessed a national programme for screening, treatment and follow-up of tuberculosis infection and disease in a cohort of asylum seekers. Methods Asylum seekers ≥ 18 years who arrived at the National Reception Centre from January 2005 to June 2006, were included as the total cohort. Those with a Mantoux test ≥ 6 mm or positive x-ray findings were included in a study group for follow-up. Data were collected from public health authorities in the municipality to where the asylum seekers had moved, and from hospital based internists in case they had been referred to specialist care. Individual subjects included in the study group were matched with the Norwegian National Tuberculosis Register which receive reports of everybody diagnosed with active tuberculosis, or who had started treatment for latent tuberculosis. Results The total cohort included 4643 adult asylum seekers and 97.5% had a valid Mantoux test. At least one inclusion criterion was fulfilled by 2237 persons. By end 2007 municipal public health authorities had assessed 758 (34% of them. Altogether 328 persons had been seen by an internist. Of 314 individuals with positive x-rays, 194 (62% had seen an internist, while 86 of 568 with Mantoux ≥ 15, but negative x-rays (16% were also seen by an internist. By December 31st 2006, 23 patients were diagnosed with tuberculosis (prevalence 1028/100 000 and another 11 were treated for latent infection. Conclusion The coverage of screening was satisfactory, but fewer subjects than could have been expected from the national guidelines were followed up in the community and referred to an internist. To

  14. Attitudes towards Immigrant Workers and Asylum Seekers in Eastern Croatia: Dimensions, Determinants and Differences

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    Margareta Gregurović


    Full Text Available Croatia’s accession to the EU has brought new challenges and issues in researching and analysing migration flows and trends as well as attitudes and perceptions of real and potential newcomers. The aim of this paper is to explore attitudes of the residents of the two most easterly Croatian counties towards two distinct categories of newcomers: immigrant workers and asylum seekers. The research was conducted shortly after Croatia’s entry into the EU, in September 2013, and the presented data are a part of a larger survey that included various migration and ethnicity issues. The survey was applied on a convenience sample of 1 110 adult respondents in two counties: Osijek-Baranja and Vukovar-Srijem. Data were analysed in a series of multivariate procedures. Results indicated significant perceptions of immigrant workers within the dimension of cultural threat, along with the expression of a considerable degree of social distance towards them. Asylum seekers were further perceived as a security and economic threat. Within two analysed regression models, the effects on attitudes towards immigrant workers and asylum seekers were similar. Among the spectrum of socio-demographic variables, a statistically significant effect on both dependent variables came from age and political orientation, indicating that older and politically right-oriented respondents expressed more negative attitudes towards both groups. Among other socio-demographic variables, education was significant in predicting attitudes towards immigrant workers, while ethnicity was significant in predicting the attitudes towards asylum seekers. The second model analysed the effect of selected political attitudes and value orientations resulting in significant prediction of negative attitudes towards both groups by pronounced conservativism, support of aggression and submission, social-dominance, dominant submissive authoritarianism and social alienation, rejecting socially oriented

  15. The Impact of Externalization of Migration Controls on the Rights of Asylum Seekers and Other Migrants

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    Bill Frelick


    Full Text Available Wars, conflict, and persecution have forced more people to flee their homes and seek refuge and safety elsewhere than at any time since the end of World War II. As displaced people and other migrants increasingly move out of the conflict-ridden and less developed regions of their displacement and into relatively rich and stable regions of the world, the countries of destination are increasingly working to contain and even stem the migration flow before it reaches their shores. Perversely, countries that have developed generally rights-sensitive standards and procedures for assessing protection claims of asylum seekers within their jurisdictions have simultaneously established barriers that prevent migrants, including asylum seekers, from setting foot on their territories or otherwise triggering protection obligations. Consequently, those who would otherwise have been able to avail themselves of asylum procedures, social support, and decent reception conditions are often relegated to countries of first arrival or transit that have comparatively less capacity to ensure protection of human rights in accordance with international standards.This paper seeks to develop a working definition of the externalization of migration controls and how such externalization of the border implicates the human rights of migrants, and asylum seekers in particular. Although the majority of those migrants seeking legal protections stay in countries neighboring their own, hundreds of thousands continue their journeys in search of protection and stability in more distant states, including in the European Union, the United States, and Australia. In response to the significant increase in asylum seekers arriving at their borders, all three entities have significantly increased deterrence measures with the hopes of keeping new arrivals from entering. This paper will thus highlight a number of the most troubling externalization strategies used by the European Union, the

  16. Suicide death and hospital-treated suicidal behaviour in asylum seekers in the Netherlands: a national registry-based study

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    van Oostrum Irene EA


    Full Text Available Abstract Background Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide and hospital-treated non-fatal suicidal behaviour in asylum seekers in the Netherlands and to identify factors that could guide prevention. Methods We obtained data on cases of suicide and suicidal behaviour from all asylum seeker reception centres in the Netherlands (period 2002-2007, age 15+. The suicide death rates in this population and in subgroups by sex, age and region of origin were compared with the rate in the Dutch population; the rates of hospital-treated suicidal behaviour were compared with that in the population of The Hague using indirect age group standardization. Results The study included 35 suicide deaths and 290 cases of hospital-treated suicidal behaviour. The suicide death rate and the incidence of hospital-treated suicidal behaviour differed between subgroups by sex and region of origin. For male asylum seekers, the suicide death rate was higher than that of the Dutch population (N = 32; RR = 2.0, 95%CI 1.37-2.83. No difference was found between suicide mortality in female asylum seekers and in the female general population of the Netherlands (N = 3; RR = 0.73; 95%CI 0.15-2.07. The incidence of hospital-treated suicidal behaviour was high in comparison with the population of The Hague for males and females from Europe and the Middle East/South West Asia, and low for males and females from Africa. Health professionals knew about mental health problems prior to the suicidal behaviour for 80% of the hospital-treated suicidal behaviour cases in asylum seekers. Conclusions In this study the suicide death rate was higher in male asylum seekers than in males in the reference population. The incidence of hospital-treated suicidal behaviour

  17. The Wright Institute Sanctuary Project: Development and Proposed Evaluation of a Graduate Training Program Providing Clinical Services to Asylum Seekers in the Bay Area (United States)

    Padilla, Brenda Lisa


    This study highlights the development of a graduate training program at The Wright Institute in Berkeley, CA, which provides assessment services for undocumented immigrants seeking asylum. This program focuses on the needs of a general asylum seeking population, with a specific relevance to some of the populations that may be served in the…

  18. Physician Information Seeking Behaviors: Are Physicians Successful Searchers? (United States)

    Swiatek-Kelley, Janice


    In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to…

  19. The future for physician assistants. (United States)

    Cawley, J F; Ott, J E; DeAtley, C A


    Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.

  20. Interference with the patient-physician relationship

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    Robbins RA


    Full Text Available No abstract available. Article truncated at 150 words. “Life is like a boomerang. Our thoughts, deeds and words return to us sooner or later, with astounding accuracy.”-Brant M. Bright, former project leader with IBM A recent sounding board in the New England Journal of Medicine discussed legislative interference with the patient-physician relationship (1. The authors, the executive staff leadership of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons believe that legislators should abide by principles that put patients’ best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient-physician relationship. According to the authors, lawmakers are increasingly intruding into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care. The article goes on to cite examples including: The Florida ….

  1. Changing physician prescribing behaviour. (United States)

    Gray, J


    Didactic approaches to educating physicians and/or other health professionals do not produce changes in learner behaviour. Similarly, printed materials and practice guidelines have not been shown to change prescribing behaviour. Evidence-based educational approaches that do have an impact on provider behaviour include: teaching aimed at identified learning needs; interactive educational activities; sequenced and multifaceted interventions; enabling tools such as patient education programs, flow charts, and reminders; educational outreach or academic detailing; and audit and feedback to prescribers. Dr. Jean Gray reflects over the past 25 years on how there has been a transformation in the types of activities employed to improve prescribing practices in Nova Scotia. The evolution of Continuing Medical Education (CME) has resulted in the creation of the Drug Evaluation Alliance of Nova Scotia (DEANS) program, which is one exemplar of an evidence-based educational approach to improving physician prescribing in that province. Key words: Evidence-based, education, prescribing.

  2. Physicians in literature: three portrayals. (United States)

    Cameron, I A


    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients.

  3. Scientific publication

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    Getulio Teixeira Batista


    Full Text Available The necessary work for developing a scientific publication is sometimes underestimated and requires the effective participation of many players to obtain a result in good standard. Initially it depends upon the determination of the authors that decide to write the scientific article. Scientific writing is a very challenging and time consuming task, but at the same time essential for any scientist. A published scientific article is unquestionably one of the main indicators of scientific production, especially if published in a qualified scientific journal with highly qualified editorial committee and strict peer review procedure. By looking at evaluation criteria for scientific production of the several Thematic Scientific Committees of the Brazilian Council for Scientific and Technological Development (CNPq it becomes clear publications in scientific journals that has certified quality is the most important item in the evaluation of a scientist production.

  4. Physician practice management companies: should physicians be scared? (United States)

    Scott-Rotter, A E; Brown, J A


    Physician practice management companies (PPMCs) manage nonclinical aspects of physician care and control physician groups by buying practice assets. Until recently, PPMCs were a favorite of Wall Street. Suddenly, in early 1998, the collapse of the MedPartners-PhyCor merger led to the rapid fall of most PPMC stock, thereby increasing wariness of physicians to sell to or invest in PPMCs. This article explores not only the broken promises made by and false assumptions about PPMCs, but also suggests criteria that physicians should use and questions would-be PPMC members should ask before joining. Criteria include: demonstrated expertise, a company philosophy that promotes professional autonomy, financial stability, freedom from litigation, and satisfied physicians already in the PPMC. The authors recommend that physicians seek out relatively small, single-specialty PPMCs, which hold the best promise of generating profits and permitting professional control over clinical decisions.

  5. Emaciated, Exhausted and Excited: The Bodies and Minds of the Irish in Nineteenth-Century Lancashire Asylums. (United States)

    Cox, Catherine; Marland, Hilary; York, Sarah


    Drawing on asylum reception orders, casebooks and annual reports, as well as County Council notebooks recording the settlement of Irish patients, this article examines a deeply traumatic and enduring aspect of the Irish migration experience, the confinement of large numbers of Irish migrants in the Lancashire asylum system between the 1850s and the 1880s. This period saw a massive influx of impoverished Irish into the county, particularly in the post-Famine years. Asylum superintendents commented on the impact of Irish patients in terms of resulting management problems in what became, soon after their establishment, overcrowded and overstretched asylums. The article examines descriptions of Irish patients, many of whom were admitted in a poor state of health. They were also depicted as violent and difficult to manage, though reporting of this may have been swayed by anti-Irish sentiment. The article suggests that a hardening of attitudes took place in the 1870s and 1880s, when theories of degeneration took hold and the Irish in Ireland exhibited exceptionally high rates of institutionalization. It points to continuities across this period: the ongoing association between mental illness and migration long after the massive Famine influx had abated, and claims that the Irish, at one and the same time referred to as volatile and vulnerable, were particularly susceptible to the challenges of urban life, marked by their intemperance, liability to general paralysis, turbulence and immorality. Asylum superintendents also noted the relative isolation of the Irish, which led to their long-term incarceration. The article suggests that commentary about Irish asylum patients provides traction in considering broader perceptions of the Irish body, mobility and Irishness in nineteenth-century England, and a deeper understanding of institutionalization.

  6. Screening for tuberculosis infection among newly arrived asylum seekers: Comparison of QuantiFERON®TB Gold with tuberculin skin test (United States)

    Winje, Brita Askeland; Oftung, Fredrik; Korsvold, Gro Ellen; Mannsåker, Turid; Jeppesen, Anette Skistad; Harstad, Ingunn; Heier, Berit Tafjord; Heldal, Einar


    Background QuantiFERON®TB Gold (QFT) is a promising blood test for tuberculosis infection but with few data so far from immigrant screening. The aim of this study was to compare results of QFT and tuberculin skin test (TST) among newly arrived asylum seekers in Norway and to assess the role of QFT in routine diagnostic screening for latent tuberculosis infection. Methods The 1000 asylum seekers (age ≥ 18 years) enrolled in the study were voluntarily recruited from 2813 consecutive asylum seekers arriving at the national reception centre from September 2005 to June 2006. Participation included a QFT test and a questionnaire in addition to the mandatory TST and chest X-ray. Results Among 912 asylum seekers with valid test results, 29% (264) had a positive QFT test whereas 50% (460) tested positive with TST (indurations ≥ 6 mm), indicating a high proportion of latent infection within this group. Among the TST positive participants 50% were QFT negative, whereas 7% of the TST negative participants were QFT positive. There was a significant association between increase in size of TST result and the likelihood of being QFT positive. Agreement between the tests was 71–79% depending on the chosen TST cut-off and it was higher for non-vaccinated individuals. Conclusion By using QFT in routine screening, further follow-up could be avoided in 43% of the asylum seekers who would have been referred if based only on a positive TST (≥ 6 mm). The proportion of individuals referred will be the same whether QFT replaces TST or is used as a supplement to confirm a positive TST, but the number tested will vary greatly. All three screening approaches would identify the same proportion (88–89%) of asylum seekers with a positive QFT and/or a TST ≥ 15 mm, but different groups will be missed. PMID:18479508


    Scheen, A J


    The clinician has to cope with new advances in medicine. Traditional medicine, which is based upon pathophysiological reasoning and clinical experience, has been reinforced by evidence-based medicine, which relies on levels of evidence provided by controlled clinical trials carried out on cohorts of patients. Since a few years, personalized medicine has been put at the forefront. A therapy tailored to every patient, if possible characterized by biomarkers, among which, since the achievement of the whole human genome sequencing, an increasing number of genetic markers. Personalized medicine should be used as a complement of traditional and evidence-based medicine. Physicians should progressively integrate this new strategy in their therapeutic approach. Hence, clinicians have to face new challenges as far as scientific knowledge, practical applications and physician-patient relationship are concerned.

  8. Non-clinicians’ judgments about asylum seekers’ mental health: how do legal representatives of asylum seekers decide when to request medico-legal reports?

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    Lucy Wilson-Shaw


    Full Text Available Background : Procedures for determining refugee status across Europe are being speeded up, despite the high prevalence of mental health difficulties among asylum seekers. An assurance given is that ‘‘vulnerable applicants’’ will be identified and excluded from accelerated procedures. Although experts have recommended assessments to be undertaken by experienced clinicians, this is unlikely to happen for political and financial reasons. Understanding how non-clinically qualified personnel perform assessments of mental health issues is timely and crucial. Misrecognition of refugees due to the inappropriate use of accelerated procedures involves the risk of returning the very people who have the right to protection from further persecution. Objective : To examine the decision making of immigration lawyers, who are an example of a group of nonclinicians who decide when and whether to refer asylum-seekers for psychiatric assessment. Method : Semi-structured interviews were conducted with 12 legal representatives working with people seeking refugee or human rights protection in the United Kingdom. The resultant material was analysed using Framework Analysis. Results : Themes clustered around the legal case, the client, the representative and the systems, all with sub-themes. A mapping exercise integrated these themes to show how representatives brought together questions of (1 evidential reasons for a report, influenced by their legal, psychological and case law knowledge, and (2 perceived evidence of mental distress, influenced by professional and personal experiences and expectations. Conclusions : The legal representatives interviewed were well-informed and trained in psychological issues as well as clearly dedicated to their clients. This helped them to attempt quasi-diagnoses of common mental health problems. They nonetheless demonstrated stereotypical understanding of post-traumatic stress disorder and other possible diagnoses and the

  9. "What if No One Had Spoken out Against this Policy?" The Rise of Asylum Seeker and Refugeee Advocacy in Australia

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    Diane Gosden


    Full Text Available This paper examines the rise of an asylum seeker and refugee advocacy movement in Australia in recent years. It situates this phenomenon within Alberto Melucci's understanding of social movements as variable and diffuse forms of social action involved in challenging the logic of a system. Following this theoretical framework, it explores the empirical features of this particular collective action, as well as the struggle to redefine the nature of the relationship between citizens of a sovereign state and 'the other' in the personage of asylum seekers and refugees.

  10. What do language barriers cost? An exploratory study among asylum seekers in Switzerland

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    Bischoff Alexander


    Full Text Available Abstract Background Language barriers have a major impact on both the quality and the costs of health care. While there is a growing body of evidence demonstrating the detrimental effects of language barriers on the quality of health care provision, less is known about their impact on costs. This purpose of this study was to investigate the association between language barriers and the costs of health care. Methods The data source was a representative set of asylum seekers whose health care was provided by a Swiss Health Maintenance Organisation (HMO. A cross-sectional survey was conducted: data was collected on all the asylum seekers' health care costs including consultations, diagnostic examinations, medical interventions, stays in the clinic, medication, and interpreter services. The data were analysed using path analysis. Results Asylum seekers showed higher health care costs if there were language barriers between them and the health professionals. Most of these increased costs were attributable to those patients who received interpreter services: they used more health care services and more material. However, these patients also had a lower number of visits to the HMO than patients who faced language barriers but did not receive interpreter services. Conclusion Language barriers impact health care costs. In line with the limited literature, the results of this study seem to show that interpreter services lead to more targeted health care, concentrating higher health care utilisation into a smaller number of visits. Although the initial costs are higher, it can be posited that the use of interpreter services prevents the escalation of long-term costs. A future study specially designed to examine this presumption is needed.

  11. School and community-based interventions for refugee and asylum seeking children: a systematic review.

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    Rebecca A Tyrer

    Full Text Available Research for effective psychological interventions for refugee and asylum-seeking children has intensified. The need for interventions in environments more easily accessed by children and families is especially relevant for newly arrived populations. This paper reviews the literature on school and community-based interventions aimed at reducing psychological disorders in refugee and asylum-seeking children.Comprehensive searches were conducted in seven databases and further information was obtained through searching reference lists, grey literature, and contacting experts in the field. Studies were included if they reported on the efficacy of a school or community-based mental health intervention for refugee or asylum-seeking children. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively. The marked heterogeneity of studies excluded conducting a meta-analysis but study effect-sizes were calculated where possible. Twenty one studies met inclusion criteria for the review reporting on interventions for approximately 1800 refugee children. Fourteen studies were carried out in high-income countries in either a school (n = 11 or community (n = 3 setting and seven studies were carried out in refugee camps. Interventions were either primarily focused on the verbal processing of past experiences (n = 9, or on an array of creative art techniques (n = 7 and others used a combination of these interventions (n = 5. While both intervention types reported significant changes in symptomatology, effect sizes ranged from 0.31 to 0.93 and could mainly be calculated for interventions focusing on the verbal processing of past experiences.Only a small number of studies fulfilled inclusion criteria and the majority of these were in the school setting. The findings suggest that interventions delivered within the school setting can be successful in

  12. Experiences of refugees and asylum seekers in general practice: a qualitative study

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    Wallace Paul


    Full Text Available Abstract Background There has been much debate regarding the refugee health situation in the UK. However most of the existing literature fails to take account of the opinions of refugees themselves. This study was established to determine the views of asylum seekers and refugees on their overall experiences in primary care and to suggest improvements to their care. Methods Qualitative study of adult asylum seekers and refugees who had entered the UK in the last 10 years. The study was set in Barnet Refugee Walk in Service, London. 11 Semi structured interviews were conducted and analysed using framework analysis. Results Access to GPs may be more difficult for failed asylum seekers and those without support from refugee agencies or family. There may be concerns amongst some in the refugee community regarding the access to and confidentiality of professional interpreters. Most participants stated their preference for GPs who offered advice rather than prescriptions. The stigma associated with refugee status in the UK may have led to some refugees altering their help seeking behaviour. Conclusion The problem of poor access for those with inadequate support may be improved by better education and support for GPs in how to provide for refugees. Primary Care Trusts could also supply information to newly arrived refugees on how to access services. GPs should be aware that, in some situations, professional interpreters may not always be desired and that instead, it may be advisable to reach a consensus as to who should be used as an interpreter. A better doctor-patient experience resulting from improvements in access and communication may help to reduce the stigma associated with refugee status and lead to more appropriate help seeking behaviour. Given the small nature of our investigation, larger studies need to be conducted to confirm and to quantify these results.

  13. Roles of the Team Physician. (United States)

    Kinderknecht, James


    The roles of the team physician are much more than providing medical coverage at a sport's event. The team physician has numerous administrative and medical responsibilities. The development of an emergency action plan is an essential administrative task as an example. The implementation of the components of this plan requires the team physician to have the necessary medical knowledge and skill. An expertise in returning an athlete to play after an injury or other medical condition is a unique attribute of the trained team physician. The athlete's return to participation needs to start with the athlete's safety and best medical interests but not inappropriately restrict the individual from play. The ability to communicate on numerous levels needs to be a characteristic of the team physician. There are several potential ethical conflicts the team physician needs to control. These conflicts can create unique medicolegal issues. The true emphasis of the team physician is to focus on what is best for the athlete.

  14. Patients' and physicians' attitudes regarding the physician's professional appearance. (United States)

    Gjerdingen, D K; Simpson, D E; Titus, S L


    Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.

  15. A mixed-method study of expert psychological evidence submitted for a cohort of asylum seekers undergoing refugee status determination in Australia. (United States)

    Tay, Kuowei; Frommer, Naomi; Hunter, Jill; Silove, Derrick; Pearson, Linda; San Roque, Mehera; Redman, Ronnit; Bryant, Richard A; Manicavasagar, Vijaya; Steel, Zachary


    The levels of exposure to conflict-related trauma and the high rates of mental health impairment amongst asylum seekers pose specific challenges for refugee decision makers who lack mental health training. We examined the use of psychological evidence amongst asylum decision makers in New South Wales, Australia, drawing on the archives of a representative cohort of 52 asylum seekers. A mixed-method approach was used to examine key mental health issues presented in psychological reports accompanying each asylum application, including key documents submitted for consideration of asylum at the primary and review levels. The findings indicated that the majority of decision makers at both levels did not refer to psychological evidence in their decision records. Those who did, particularly in the context of negative decisions, challenged the expert findings and rejected the value of such evidence. Asylum seekers exhibiting traumatic stress symptoms such as intrusive thoughts and avoidance, as well as memory impairment, experienced a lower acceptance rate than those who did not across the primary and review levels. The findings raise concern that trauma-affected asylum seekers may be consistently disadvantaged in the refugee decision-making process and underscore the need to improve the understanding and use of mental health evidence in the refugee decision-making setting. The study findings have been used to develop a set of guidelines to assist refugee decision makers, mental health professionals and legal advisers in improving the quality and use of psychological evidence within the refugee decision-making context.

  16. Family physicians and patients: is effective nutrition interaction possible? (United States)

    Truswell, A S


    This article summarizes presentations from an international workshop held in Heelsum, Netherlands, 14-16 December 1998 that was sponsored by the Dutch Dairy Foundation on Nutrition and Health, the Department of Nutrition at Wageningen Agricultural University, the Dutch College of General Practitioners, and the International Union of Nutritional Sciences. Twenty-one speakers and 12 other participants were invited from 9 countries: the Netherlands, the United States, the United Kingdom, Australia, Canada, Denmark, New Zealand, Spain, and Sweden. The workshop was chaired by GJAJ Hautvast and the scientific secretary was GJ Hiddink. Family physicians are highly trusted. Many consultations include a nutritional aspect, but physicians do not discuss nutrition with their patients as often as they could. Major barriers include short visit times, the paucity of nutrition teaching in medical schools, and poor compliance of patients with physicians' dietary prescriptions. Problems, practicalities, operational research, and some solutions were discussed at this meeting of leading family doctors with interested nutritionists. Family physicians have to distill the essentials for their patients from many different specialties ranging from ophthalmology to podiatry. They look for clarity of recommendations from nutrition researchers. Among developments discussed at the meeting that can increase nutritional work in family medicine are 1) new opportunities to teach nutrition in vocational training programs, 2) some manuals and a new journal specially written by nutritional scientists for family physicians, 3) nutritional advice being incorporated into computer software for family physicians, 4) more dietitians working with family physicians, and 5) nutrition training for practice nurses in some countries.

  17. The role of the physician-scientist in our evolving society. (United States)

    Rosen, Michael R


    The physician-scientist represents the medical-scientific version of the "triple threat" athlete. Yet, in medicine as in sports, specialization and business are ever more in the forefront. As the field of medicine evolves, it is likely that the role of the physician, the scientist, and the physician-scientist will continue to change. Whether this is for the good or bad will only be known in hindsight.

  18. Social factors ameliorate psychiatric disorders in community-based asylum seekers independent of visa status. (United States)

    Hocking, Debbie C; Kennedy, Gerard A; Sundram, Suresh


    The impact of industrialised host nations' deterrent immigration policies on the mental health of forced migrants has not been well characterised. The present study investigated the impact of Australia's refugee determination process (RDP) on psychiatric morbidity in community-based asylum-seekers (AS) and refugees. Psychiatric morbidity was predicted to be greater in AS than refugees, and to persist or increase as a function of time in the RDP. The effect on mental health of demographic and socio-political factors such as health cover and work rights were also investigated. Psychiatric morbidity was measured prospectively on five mental health indices at baseline (T1, n=131) and an average of 15.7 months later (T2, n=56). Psychiatric morbidity in AS significantly decreased between time points such that it was no longer greater than that of refugees at T2. Caseness of PTSD and demoralisation reduced in AS who gained protection; however, those who maintained asylum-seeker status at T2 also had a significant reduction in PTS and depression symptom severity. Reduced PTS and demoralisation symptoms were associated with securing work rights and health cover. Living in the community with work rights and access to health cover significantly improves psychiatric symptoms in forced migrants irrespective of their protection status.

  19. Multi-levelling and externalizing migration and asylum: lessons from the southern European islands

    Directory of Open Access Journals (Sweden)

    Anna Triandafyllidou


    Full Text Available Southern European countries have come to constitute the most vulnerable external border of the European Union (EU over the last decade. Irregular migration pressures have been acutely felt on the EU’s southern sea borders, and particularly on four sets of islands: Canary Islands (Spain, Lampedusa and Linosa (Italy, Malta, and Aegean Islands (Greece. This quartet is, to a large extent, used as stepping stones by irregular migrants and asylum seekers to reach the European continent. This paper studies the role of these islands as ‘outposts’ of a framework of externalization. It starts by discussing the notion of externalization and its different facets. It considers how externalization is linked to both fencing and gate-keeping strategies of migration and asylum control. The second part of the paper focuses on the special role of the island quartet with respect to the externalization web cast by national and EU-wide migration policies. It concludes with a critical reflection on the multi-level character of externalization policies and practices that occur both within the EU and between the EU and third countries.

  20. Sleeping patterns of Afghan unaccompanied asylum-seeking adolescents: a large observational study.

    Directory of Open Access Journals (Sweden)

    Israel Bronstein

    Full Text Available Unaccompanied asylum-seeking children (UASC have experienced multiple traumas and are a high-risk group for posttraumatic stress disorder (PTSD. The effects of trauma are known to be associated with sleep problems; indeed sleeping problems are core features of PTSD. However, there has been no systematic research examining the sleep of this high risk group of children. This study presents the first evidence on the sleeping patterns of Afghan UASC living in the UK. A total of 222 male Afghan children, aged 13-18, were interviewed using validated self-report questionnaires measuring sleeping patterns and PTSD. Overall, UASC patterns for bed time and rise time appear acculturated to the country of asylum. Mean UASC sleep onset latency scores were approximately 20 minutes greater compared with normative scores, which may be a reflection of UASC pre-migration and post-migration experiences. As expected, UASC who screened above the clinical cut-off for PTSD reported significantly greater sleep onset latency, increased nightmares, and less total sleep time compared to the non-PTSD group. The results may be of particular interest to clinicians given that, compared to screening for PTSD, screening for sleep problems may be a less culturally disputed form of initial assessment indicating distress in UASC. Similarly, the field of UASC and refugee child interventions is largely focused on trauma, yet sleep may provide a novel avenue for equally or more effective treatment.

  1. Gender and offender status predicting treatment success in refugees and asylum seekers with PTSD

    Directory of Open Access Journals (Sweden)

    Håkon Stenmark


    Full Text Available Background: Current knowledge is limited regarding patient characteristics related to treatment outcome of posttraumatic stress disorders (PTSD in refugees and asylum seekers. Objective: Gender, torture status, offender status, level of anger, and level of depression were investigated for possible effects on the treatment outcome. Method: Patient characteristics were explored in 54 refugees and asylum seekers who had completed a treatment program for PTSD. Non-responders (10, those who had the same or higher levels of symptom severity after treatment, were compared with responders, those who had lower symptom severity after treatment (44. Symptom severity was measured by Clinician-Administered PTSD Scale. The non-responders and responders constituted the dichotomous, dependent variable. The independent variables were gender, torture status, offender status, level of anger, and level of depression. T-tests and Exact Unconditional Homogeneity/Independence Tests for 2X2 Tables were used to study the relationship to treatment outcome. Results: Being male and reporting to have been a violent offender were significantly more frequent characteristics among the non-responders compared to the responders. The levels of pretreatment anger, depression and torture status did not affect the treatment outcome. Conclusions: The study adds support to findings that females benefit more from treatment of PTSD than males and that violent offenders are difficult to treat within the standard treatment programs.

  2. The physician leader as logotherapist. (United States)

    Washburn, E R


    Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.

  3. Reconstructing Harry: a genealogical study of a colonial family 'inside' and 'outside' the Grahamstown Asylum, 1888-1918. (United States)

    Wilbraham, Lindy


    Recent scholarship has explored the dynamics between families and colonial lunatic asylums in the late nineteenth century, where families actively participated in the processes of custodial care, committal, treatment and release of their relatives. This paper works in this historical field, but with some methodological and theoretical differences. The Foucauldian study is anchored to a single case and family as an illness narrative that moves cross-referentially between bureaucratic state archival material, psychiatric case records, and intergenerational family-storytelling and family photographs. Following headaches and seizures, Harry Walter Wilbraham was medically boarded from his position as Postmaster in the Cape of Good Hope Colony of South Africa with a 'permanent disease of the brain', and was committed to the Grahamstown Asylum in 1910, where he died the following year, aged 40 years. In contrast to writings about colonial asylums that usually describe several patient cases and thematic patterns in archival material over time and place, this study's genealogical lens examines one white settler male patient's experiences within mental health care in South Africa between 1908 and 1911. The construction of Harry's 'case' interweaves archival sources and reminiscences inside and outside the asylum, and places it within psychiatric discourse of the time, and family dynamics in the years that followed. Thus, this case study maps the constitution of 'patient' and 'family' in colonial life, c.1888-1918, and considers the calamity, uncertainty, stigma and silences of mental illness.

  4. Unaccompanied adolescents seeking asylum - Poorer mental health under a restrictive reception : poorer mental health under a restrictive reception

    NARCIS (Netherlands)

    Reijneveld, S.A.; de Boer, J.B.; Bean, T.; Korfker, D.G.


    We assessed the effects of a stringent reception policy on the mental health of unaccompanied adolescent asylum seekers by comparing the mental health of adolescents in a restricted campus reception setting and in a setting offering more autonomy (numbers [response rates]: 69 [93%] and 53 [69%], res

  5. Use of health care services by Afghan, Iranian, and Somali refugees and asylum seekers living in The Netherlands

    NARCIS (Netherlands)

    Gerritsen, A.A.M.; Bramsen, I.; Devillé, W.; Willigen, L.H.M. van; Hovens, J.E.; Ploeg, H.M. van der


    BACKGROUND: Although asylum seekers have been coming to The Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants, or on the refugees who have resettled in this country. The objective of this study is to estimate the use of health care services by re

  6. Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study.

    NARCIS (Netherlands)

    Gerritsen, A.A.M.; Bramsen, I.; Devillé, W.; Willigen, L.H.M. van; Hovens, J.E.; Ploeg, H.M. van der


    BACKGROUND: This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of th

  7. Objections to asylum seeker centers: Individual and contextual determinants of resistance to small and large centers in the Netherlands

    NARCIS (Netherlands)

    Lubbers, M.; Coenders, M.T.A.; Scheepers, P.L.H.


    Over the last 15 years, numerous asylum seeker centres (ASCs) have been founded in the Netherlands, often preceded and followed by neighbourhood unrest. In this contribution we show to what extent people object to the foundation of ASCs of different sizes. We set out to answer the question of which

  8. Objections to Asylum Seeker Centres : Individual and Contextual Determinants of Resistance to Small and Large Centres in the Netherlands

    NARCIS (Netherlands)

    Lubbers, Marcel; Coenders, Marcel; Scheepers, Peer


    Over the last 15 years, numerous asylum seeker centres (ASCs) have been founded in the Netherlands, often preceded and followed by neighbourhood unrest. In this contribution we show to what extent people object to the foundation of ASCs of different sizes. We set out to answer the question of which

  9. Monitoring for Equality? Asylum Seekers and Refugees' Retention and Achievement in English for Speakers of Other Languages (ESOL) (United States)

    Phillimore, Jenny


    Interest in the integration of refugees has grown with the increase in numbers of asylum seekers dispersed across the UK. The ability to communicate effectively in English is seen as the key priority in facilitating integration, while a lack of English language is seen as one of the major barriers to refugee employment. Some 267 million British…

  10. Enhancing Educational Support: Towards Holistic, Responsive and Strength-Based Services for Young Refugees and Asylum-Seekers (United States)

    Hughes, Nathan; Beirens, Hanne


    The importance of early school experiences in the personal and social development of young refugees and asylum-seekers has been documented by researchers and enshrined in practice guidelines. The capacity of schools to implement these guidelines is, however, limited, in terms of the availability of appropriate knowledge and skills, financial…

  11. Local Conceptualisations of the Education of Asylum-Seeking and Refugee Students: From Hostile to Holistic Models (United States)

    Pinson, Halleli; Arnot, Madeleine


    Sociological research on the presence and yet invisibility of asylum-seeking and refugee pupils in the educational system in the UK is noticeably absent. This article offers insights into the ways in which the presence and the needs of such pupils are conceptualised by local authorities and schools. It draws on the results of a survey of 58…

  12. Refugees and Asylum Seekers in the UK: The Challenges of Accessing Education and Employment. NIACE Briefing Sheet 91 (United States)

    National Institute of Adult Continuing Education, 2009


    This briefing paper endeavours to highlight the challenges facing refugees and asylum seekers in the United Kingdom in accessing education, training and employment. It does not claim to cover all the issues but is intended as a starting point for providers of adult learning and/or advice. It initially sets out the facts about definitions and…

  13. Moral Treatment of the Insane: Provisions for Lifelong Learning, Cultural Engagement, and Creativity in Nineteenth-Century Asylums (United States)

    Park, Maureen; Hamilton, Robert


    The current interest in the role of lifelong learning and cultural engagement for change is not new. This article looks at a most unusual precedent and a neglected area in the historiography of adult education--the use of cultural education provision in asylums in the nineteenth century to promote cure and restoration of the "insane" to…

  14. Vitamin D levels in children of asylum seekers in The Netherlands in relation to season and dietary intake

    NARCIS (Netherlands)

    Stellinga-Boelen, Annette A. M.; Wiegersma, P. Auke; Storm, Huub; Bijleveld, Charles M. A.; Verkade, Henkjan J.


    Low dietary intake and limited sun exposure during Dutch winters, in particular when combined with highly pigmented skin, could compromise the vitamin D status of asylum seekers' children in The Netherlands. We determined the vitamin D status of children living in The Netherlands, but originating fr

  15. The Central Asylum for the Instruction of the Deaf and Dumb, Canajoharie, New York, 1823-1835. (United States)

    Campbell, Colin D.


    This case study describes the Central Asylum for the Instruction of the Deaf and Dumb in Canajoharie, NY, a public school that existed from 1823 to 1835. The study illustrates how a small group of communities with limited funds met a need for the education of persons who were deaf. (Contains references.) (CR)

  16. "Confinement of the higher orders": the social role of private lunatic asylums in Ireland, C. 1820-60. (United States)

    Mauger, Alice


    The period 1820-60 marked an era of transition and diversity in Ireland that rapidly transformed the face of Irish society. Inextricably linked with these processes was the expansion of Ireland's private asylum system. This system diverged from its British counterpart both in the socioeconomic cohort it served and in the role it played within the mental health-care system as a whole. The implementation of the 1842 Private Asylums (Ireland) Act, the first legislative measure geared exclusively toward the system, highlighted the growing importance of private care in Ireland as well as providing for the licensing and regulation of these institutions for the first time. To date, historians of Irish medicine have focused almost exclusively on the pauper insane. This article aims to shift this emphasis toward other categories of the Irish insane through exploration of the Irish private asylum system, its growth throughout the period, and the social profile of private patients. I shall also interrogate the trade in lunacy model through exploration of financial considerations, discharge and recovery rates, and conditions of care and argue that while Irish private institutions were a lucrative business venture, the quality of care upheld was apparently high. Finally, I shall argue that Irish private asylums catered primarily for the upper classes and briefly explore alternative provisional measures for other non-pauper sectors of society.

  17. Physicians in Nursing Homes: Effectiveness of Physician Accountability and Communication (United States)

    Lima, Julie C; Intrator, Orna; Wetle, Terrie


    Objectives To develop a measure of the perceptions of nursing home (NH) Directors of Nursing (DON) on the adequacy of physician care and to examine its variation as well as its construct validity. Design A nationwide cross-sectional study with primary data collection Setting 2043 NHs surveyed August 2009 – April 2011 Participants Directors of Nursing (DONs) and NH Administrators responded to questions pertaining to their perceptions of the care provided by physicians in their NH. Measurements Ten items were used to create three domains: medical staff attentiveness, physician communication, and staff concerns about physician practice. These were combined into an overall summary score measure called “Effectiveness of Physician Accountability and Communication” (EPAC). EPAC construct validity was ascertained from other DON questions and from a complementary survey of NH Administrators. RESULTS The established EPAC score is the first measure to capture specific components of the adequacy of physician care in NHs. EPAC exhibited good construct validity: more effective practices were correlated with greater physician involvement in discussions of Do-Not-Resuscitate orders, the frequency that the Medical Director checked on the medical care delivered by attending physician, the tightness of nursing home's control of its physician resources, and the DON's perception of whether or not avoidable hospitalizations and ER visits could be reduced with greater physician attention to resident needs. Conclusion As increased attention is given to the quality of care provided to vulnerable elders, effective measures of processes of care are essential. The EPAC measure provides an important new metric that can be used in these efforts. The goal is that future studies could use EPAC and its individual domains to shed light on the manner through which physician presence is related to resident outcomes in the NH setting. PMID:25858283

  18. Fractals for physicians. (United States)

    Thamrin, Cindy; Stern, Georgette; Frey, Urs


    There is increasing interest in the study of fractals in medicine. In this review, we provide an overview of fractals, of techniques available to describe fractals in physiological data, and we propose some reasons why a physician might benefit from an understanding of fractals and fractal analysis, with an emphasis on paediatric respiratory medicine where possible. Among these reasons are the ubiquity of fractal organisation in nature and in the body, and how changes in this organisation over the lifespan provide insight into development and senescence. Fractal properties have also been shown to be altered in disease and even to predict the risk of worsening of disease. Finally, implications of a fractal organisation include robustness to errors during development, ability to adapt to surroundings, and the restoration of such organisation as targets for intervention and treatment.

  19. Physician revalidation in Europe. (United States)

    Merkur, Sherry; Mossialos, Elias; Long, Morgan; McKee, Martin


    Despite the increasing attention on patient mobility, there remains a lack of European-level interest in assuring the sustained competence of health professionals. Specifically, the existing European legal framework fails to recognise the introduction of periodic revalidation and requirements to participate in continuing professional development in some countries. This study shows that the definitions and mechanisms of revalidation vary significantly across member states. While some countries, eg Austria, Germany and Spain, look to continuing medical education as a means to promote recertification and quality of care, other countries, eg Belgium, France and the Netherlands, also incorporate peer review. In the UK the proposed revalidation scheme would include elements of relicensure through appraisal and feedback as well as physician recertification. Divergence between countries also exists in monitoring and enforcement. The European Commission should explore the implications for professional mobility of the diversity in the regulation of the medical profession.

  20. Physician Requirements-1990. For Cardiology. (United States)

    Tracy, Octavious; Birchette-Pierce, Cheryl

    Professional requirements for physicians specializing in cardiology were estimated to assist policymakers in developing guidelines for graduate medical education. The determination of physician requirements was based on an adjusted needs rather than a demand or utilization model. For each illness, manpower requirements were modified by the…

  1. Abortion and compelled physician speech. (United States)

    Orentlicher, David


    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading.

  2. Communicating Drug Information to Physicians (United States)

    Herman, Colman M.; Rodowskas, Christopher A.


    Reviews the studies of researchers who have attempted to identify the sources of drug information, both professional and commercial, utilized by physicians, discussing relationship between physicians' sources and the choice of drugs and severity of conditions being treated. Also notes new sources of drug information being considered by the Food…

  3. Protecting and assisting refugees and asylum-seekers in Malaysia : the role of the UNHCR, informal mechanisms, and the 'Humanitarian exception'


    Lego, Jera Beah H.


    This paper problematizes Malaysia's apparently contradictory policies – harsh immigration rules applied to refugees and asylum seekers on the one hand, and the continued presence and functioning of the United Nations High Commissioner for Refugees (UNHCR) on the other hand. It asks how it has been possible to protect and assist refugees and asylum seekers in light of such policies and how such protection and assistance is implemented, justified, and maintained. Giorgio Agamben's concept of th...

  4. What makes a physician revenue cycle tick. (United States)

    Freeman, Thomas; Stephen, Stan


    Hospitals should boost the revenue cycle performance of acquired physician practices by: Effectively assimilating the physician practice into the overall organization. Standardizing revenue cycle processes, policies, and tools between the hospital and physician practice. Enhancing physician/patient scheduling policies and procedures. Regularly auditing physician documentation and periodically comparing hospital charges against practice charges. Improving procedures for responding to denials.

  5. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J


    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  6. Scientific news

    NARCIS (Netherlands)



    The Rijksherbarium/Hortus Botanicus acquired funds through NWO (Netherlands Organisation for Scientific Research) to participate in a 7-year interdisciplinary cooperative programme of Indonesian and Dutch scientific institutions aiming at research in Irian Jaya, Cenderawasih province (the Bird’s Hea

  7. Physicians' strikes and the competing bases of physicians' moral obligations. (United States)

    MacDougall, D Robert


    Many authors have addressed the morality of physicians' strikes on the assumption that medical practice is morally different from other kinds of occupations. This article analyzes three prominent theoretical accounts that attempt to ground such special moral obligations for physicians--practice-based accounts, utilitarian accounts, and social contract accounts--and assesses their applicability to the problem of the morality of strikes. After critiquing these views, it offers a fourth view grounding special moral obligations in voluntary commitments, and explains why this is a preferable basis for understanding physicians' moral obligations in general and especially as pertaining to strikes.

  8. Psychiatric care in restricted conditions for work migrants, refugees and asylum seekers: experience of the Open Clinic for Work Migrants and Refugees, Israel 2006. (United States)

    Lurie, Ido


    In the last few decades, the State of Israel has become a target for work migrants, refugees, asylum seekers and victims of human trafficking, as part of the trend of world immigration. Immigration is a process of loss and change with significant socio-psychological stress, with possible effects on the immigrants' mental health. The Physicians for Human Rights - Israel (PHR) Association operates a psychiatric clinic as part of the Open Clinic for Work Migrants and Refugees. This article will present major clinical issues regarding psychiatry and immigration in Israel according to the data collected at the clinic. Trauma and stress-related psychopathology was found to have a high prevalence in immigrant patients treated at the clinic; prevalence of PTSD (post-traumatic stress disorder) in immigrants was high (23%) and even higher in refugees (33%). Female immigrants are at higher risk for psychiatric hospitalization. The relative rate of African patients at the clinic is significantly higher than patients from other continents. A significant association was found between psychiatric hospitalization and suicide attempts. Immigrant patients present a combination of psychiatric, socio-economic and general medical conditions, which demands a holistic view of the patient. The evaluation of an immigrant patient must take into account the stress related to immigration, gender, culture of origin and the risk for suicide and hospitalization. Treatment recommendations include awareness of cultural diversities, acquiring information regarding the pre-immigration history, preferably using cultural consultants with background in the immigrants' culture and community. Decision-making about medication and diagnostic evaluation should be as inexpensive as possible. Basic human needs (food, shelter) and family support should be included in the decisions about treatment.

  9. Indo-Muslim Physicians


    Speziale, Fabrizio


    Encyclopaedia Iranica, E. Yarshater, éd., (; Medicine (ṭebb, pezeški) constitutes the scientific field on which the largest corpus of works has been composed in Muslim India. Most of these works were written in Persian, and to a lesser extent in Arabic, and later in Urdu from the Colonial period. Main scholars and authors were often attached to the courts of Indian sultans and many composed medical works for Muslim nobles. Several medical scholars occupied also importan...

  10. Seeking asylum in Denmark: Refugee children's mental health and exposure to violence

    DEFF Research Database (Denmark)

    Montgomery, Edith; Foldspang, Anders


    , the parents of 311 Middle-Eastern children answered a structured interview on their children’s exposure to organized violence and their mental health. The families were followed-up as concerns receipt of a residence permit. Results: At arrival in Denmark, the children’s patterns of previous exposure......Aims: The aim of this study was to compare profiles of present mental health and previous exposure to violence among refugee children from the Middle East, whose asylum seeking families either did or did not obtain permission to stay in Denmark. Methods: Shortly after arrival in Denmark...... to violence and present mental health was generally similar irrespective of the family getting a residence permit, as was the case for 90 families (60.4%) with 190 children (61.1%). In both groups an overwhelming majority, eight to nine out of 10 children, had been exposed to conditions of war and had stayed...

  11. Human lead exposure in a late 19th century mental asylum population

    Energy Technology Data Exchange (ETDEWEB)

    Bower, Nathan W. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States)]. E-mail:; McCants, Sarah A. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States); Custodio, Joseph M. [Department of Chemistry, Colorado College, Colorado Springs, CO 80903-3294 (United States); Ketterer, Michael E. [Departments of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ 86011-5698 (United States); Getty, Stephen R. [Biological Sciences Curriculum Study, Colorado Springs, CO 80918 (United States); Hoffman, J. Michael [Department of Anthropology, Colorado College, Colorado Springs, CO 8090-3294 (United States)


    Lead isotope ratios and lead (Pb) levels were analyzed in 33 individuals from a forgotten cemetery at the Colorado Mental Health Institute at Pueblo, Colorado dating to 1879-1899. Isotopic ratios from healing bone fractures, cortical bone, and tooth dentine provide information about sources of Pb exposures over a range of time that illuminates individual's life histories and migration patterns. Historical records and Pb production data from the 19th century were used to create a database for interpreting Pb exposures for these African, Hispanic and European Americans. The analysis of these individuals suggests that Pb exposure noticeably impacted the mental health of 5-10% of the asylum patients in this frontier population, a high number by standards today, and that differences exist in the three ancestral groups' exposure histories.

  12. Representation of Refugees, Asylum-Seekers and Refugee Affairs In Hungarian Dailies

    Directory of Open Access Journals (Sweden)

    Lilla VICSEK


    Full Text Available How does the press in Hungary write about refugees, asylum-seekers and refugee affairs? We sought to answer this question. Articles appearing in 2005 and 2006 in two leading national Hungarian dailies were examined with quantitative content analysis. The results show that the articles analyzed often treat refugee affairs as an “official” political matter. The high proportion of legislation and political positions conveys the image that refugee affairs are a state or intergovernmental matter, an “official”, legal, political issue rather than for example a humanitarian question. Most of the articles published in both papers write about problems and conflicts in connection with refugee affairs. The negative media image has different significance for different topics. We argue that the question of refugee affairs is a topic where the image shown by the media is of great relevance: the media can be a more important source of information on this subject than personal contacts.

  13. The City of Others: Photographs from the City of London Asylum Archive

    Directory of Open Access Journals (Sweden)

    Caroline Bressey


    Full Text Available This photographic essay presents images from the City of London Asylum archive as a example of how the visual can be used to expand our investigations of social histories of Victorian London, particularly the multi-cultural nature of the city. The essay argues that images are an essential part of the research process, but also discusses some of the disadvantages and ethical tensions encountered through the use of such portraits for historical recovery. Despite these caveats, the paper concludes that we have much to learn from the images that present images of the city that would otherwise be difficult, if not impossible, for twenty-first-century researchers to access.

  14. Unaccompanied & Denied: Regional Legal Framework for Unaccompanied Minors Asylum Seekers (UMAS

    Directory of Open Access Journals (Sweden)

    Rohaida Nordin


    Full Text Available Unaccompanied minor asylum seekers are vulnerable and thus, provided special international law protections. However, in reality, they are being mistreated as illegal immigrants and on thereceiving end of ethnic violence, discrimination, restrictions in enjoyment of their rights duly recognised by international human rights law. This article identifies legislative, policy and supportmechanisms which encompass the minimum UMAS guardianship standards at international law and which are evidence-based from best practice models for the provision of guardians for UMASinternationally. It presents situation of UMAS in relation to human rights violations with emphasis on the legal framework and practices in Australia and five ASEAN State Members. This article also highlights the various stands taken by various countries providing better legal framework and practices regarding the terms for protection and enforcement of human rights for UMAS. Finally, this article provides recommendations for Australia and ASEAN Member States to adopt in order to realise the international human rights of UMAS with respect to guardianship.

  15. [Dangerous liaisons--physicians and pharmaceutical sales representatives]. (United States)

    Granja, Mónica


    Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class.

  16. Special article: physician burnout-the experience of three physicians

    Directory of Open Access Journals (Sweden)

    Raschke RA


    Full Text Available No abstract available. Article truncated at 150 words. Our fellowship held a discussion on physician burnout which was facilitated by Kris Cooper PhD, a psychologist who has long experience working with struggling physicians. We were joined by three physicians who volunteered to share their personal experiences regarding burnout. Each of these three physicians are exceptional in their devotion to their profession, high self-expectation, and level of professional achievement. Yet the commendable personal characteristics they share may have actually set them up to ultimately suffer burnout. Each of them responded to burnout in a different way. The first physician is an intensivist who left work suddenly 6 months ago, likely never to return. Over a long career, this physician had earned the respect of his colleagues and was beloved by the nurses for seeming to always knowing the right thing to do and dedicating himself fully to the care of the sickest patients and their families. For most of ...

  17. Physician wellness: a missing quality indicator. (United States)

    Wallace, Jean E; Lemaire, Jane B; Ghali, William A


    When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

  18. "But my doctor recommended pot": medical marijuana and the patient-physician relationship. (United States)

    Nussbaum, Abraham M; Boyer, Jonathan A; Kondrad, Elin C


    As the use of medical marijuana expands, it is important to consider its implications for the patient-physician relationship. In Colorado, a small cohort of physicians is recommending marijuana, with 15 physicians registering 49% of all medical marijuana patients and a single physician registering 10% of all patients. Together, they have registered more than 2% of the state to use medical marijuana in the last three years. We are concerned that this dramatic expansion is occurring in a setting rife with conflicts of interest despite insufficient scientific knowledge about marijuana. This system diminishes the patient-physician relationship to the recommendation of a single substance while unburdening physicians of their usual responsibilities to the welfare of their patients.

  19. Unique Physician Identification Number (UPIN) Directory (United States)

    U.S. Department of Health & Human Services — The Unique Physician Identification Number (UPIN) Directory contains selected information on physicians, doctors of Osteopathy, limited licensed practitioners and...

  20. Physician Compare National Downloadable File (United States)

    U.S. Department of Health & Human Services — The Physician Compare National Downloadable File is organized at the individual eligible professional level; each line is unique at the professional/enrollment...

  1. Working with Generation X physicians. (United States)

    Shields, Mark C; Shields, Margaux T


    Learn ways to integrate Generation X physicians into your hospital or practice. Discover how their career goals differ from the earlier generation's and find out how health care organizations can help meet those goals.

  2. Access to mental health services and psychotropic drug use in refugees and asylum seekers hosted in high-income countries. (United States)

    Nosè, M; Turrini, G; Barbui, C


    In the populations of refugees and asylum seekers hosted in high-income countries, access to mental health care and psychotropic drugs, is a major challenge. A recent Swedish cross-sectional register study has explored this phenomenon in a national cohort of 43 403 young refugees and their families from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan. This register study found lower rates of dispensed psychotropic drugs among recently settled refugees, as compared with Swedish-born residents, with an increase in the use with duration of residence. In this commentary, the results of this survey are discussed in view of their global policy implications for high-income countries hosting populations of refugees and asylum seekers.

  3. The psychiatric asylum in Bnei-Brak and "The Society for the Help of the Insane," 1929-1939. (United States)

    Zalashik, Rakefet

    The article explores the activity of the Bnei-Brak psychiatric asylum and "The Society for the Help of the Insane" in the years 1929-1939 and its role in the development of mental health care in mandatory Palestine. Based on archival materials from the municipal archive of Tel-Aviv-Jaffa and the Israeli State Archive, as well as on the Hebrew daily press, the article concentrates on the administrative, the medical and the political aspects of the Bnei-Brak asylum and on the activities of "The Society for the Help of the Insane" discussing the central problems of the psychiatric field and the mentally ill people in the country during the reviewed period.

  4. Physician motivation, satisfaction and survival. (United States)

    Zimberg, S E; Clement, D G


    Physicians are working harder today and enjoying it less. What has happened to create such dissatisfaction among those in one of the most autonomous professions? What can be done to address the anger, fear and unhappiness? This article is an analysis of the factors influencing human motivation. Maslow's hierarchy of needs--physiological, safety/security, social/affiliation, esteem and self-actualization--is used to suggest ways physicians can satisfy their needs in turbulent financial and professional times.

  5. Responses to language barriers in consultations with refugees and asylum seekers: a telephone survey of Irish general practitioners.

    LENUS (Irish Health Repository)

    MacFarlane, Anne


    BACKGROUND: Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients\\' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. METHODS: Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. RESULTS: There was a 70% (n = 56\\/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. CONCLUSION: The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners\\' choices are responsive to the needs of patients with limited English.

  6. Responses to language barriers in consultations with refugees and asylum seekers: a telephone survey of Irish general practitioners

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    Mosinkie Phillip I


    Full Text Available Abstract Background Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends. However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Methods Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. Results There was a 70% (n = 56/80 response rate to the telephone survey. The majority of respondents (77% said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. Conclusion The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.

  7. Hepatitis A among refugees, asylum seekers and migrants living in hosting facilities, Greece, April to December 2016. (United States)

    Mellou, Kassiani; Chrisostomou, Anthi; Sideroglou, Theologia; Georgakopoulou, Theano; Kyritsi, Maria; Hadjichristodoulou, Christos; Tsiodras, Sotirios


    An increased number of hepatitis A cases among refugees, asylum seekers and migrants residing in hosting facilities in Greece were recorded between April and December 2016. In total, 177 laboratory-confirmed symptomatic cases were reported; of these, 149 (84%) occurred in hosting camps mostly among Syrian children under 15 years. All cases reported symptom onset after their entry into the country. Public health interventions focused on hygiene measures and vaccination.

  8. [From the asylums to the community: the reform process of National Colony "Dr. Manuel A. Montes de Oca"]. (United States)

    Rossetto, Jorge


    Since 2004, a profound transformation of the asylum care model, characterized by overcrowding, lack of discharge and absence of rehabilitation programs, and social reinsertion, has been developed at National Colony "Dr. Manuel A. Montes de Oca". During this period, a plan that contemplates several programs and projects aimed at restoring the rights of institutionalized people with mental disabilities and promoting opportunities for social inclusion has been implemented.

  9. Turning Asylum Seekers into ‘Dangerous Criminals’: Experiences of the Criminal Justice System of those Seeking Sanctuary

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    Monish Bhatia


    Full Text Available Since the events of 9/11 in the US in 2001 and, four years later, the 7/7 London bombings in the UK, warnings of terrorist attacks are high on the public agenda in many western countries. Politicians and tabloid press in the UK have continued to make direct and indirect connections between asylum seekers, terrorism and crime. This has increasingly resulted in harsh policy responses to restrict the movement of ‘third-world’ nationals, criminalisation of immigration and asylum policy, and making the violation of immigration laws punishable through criminal courts. This paper largely highlights the narratives of five asylum seekers who committed ‘crime’ by breaching immigration laws and were consequently treated as ‘dangerous criminals’ by the state authorities. More importantly it shows how these individuals experienced this treatment. The aim of this paper is to give voice to the victims of state abuse, claim space for victim agency, gather victim testimonies, challenge official explanations and in the process confront criminal and racist state practices.

  10. Transnational entanglements in the history of psychiatry. South Tyrolian patients in German asylums, c. 1940-1945

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    Thomas Müller


    Full Text Available Object of this article is the destiny of psychiatric inmates in Wuerttemberg asylums, 1940-1945. These patients from Italian regions of Vicenza, Udine, Trento, Alto Adige and various locations more were delegated and, to a substantial number, illegally deported to the German asylums Zwiefalten, Schussenried and Weissenau, all in South Wuerttemberg, in 1940 and 1943. Attention is focused on the pioneering state pre-negotiations, and the so-called option treaties between the German Reich and Fascist Italy as part of the general aspect of National Socialist bio-Politics. The treatment of these South Tyrol patients in the asylums themselves, as well as their fate will be put into the context of the resettlement actions at the margins of the Third Reich, which started in 1939 and widely affected the European continent. It is referred to other sub-groups of migrating population from Italy to the German Reich as well, as a contrasting aspect of this contribution

  11. Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study

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    Devillé Walter


    Full Text Available Abstract Background This article discusses the design of a study on the prevalence of health problems (both physical and mental and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services. Methods/Design The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600, as these are among the largest groups within the reception centres and municipalities in the Netherlands. The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization, mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire, utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose. This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.

  12. [The clinic and the general physician]. (United States)

    Jinich, Horacio


    The clinician's activity consists of in the simple words of Dr. Gonzalo Castañeda "knowledge, good deeds and bread winning ". The respective value that clinicians grant to each of these, is variable, but even those whose priority is the latter of the three are obliged to accomplish the other two. Knowledge requires continuous medical education. Effective education requires the ability to separate the "wheat from the chaff". It is important to know how to study. Knowing the patient requires careful collection of symptoms, signs, and paraclinical data, as well as awareness of the sensitivity, specificity, and positive and negative predictive value of the data, but acknowledgment of the important discrepancies that occur among different observers as well as in the same observer at different times should not be disregarded. Clinical medicine is a scientific art that challenges the reasoning and decision-making abilities of the practitioner, who must apply various diagnostic strategies, the hypothetic-deductive strategy usually being the most important of all. Knowing the disease that the patient bears is not enough: it is equally important to know the patient who bears the disease. In clinical medicine there are no diseases, only diseased people. The biological approach to the patient must be substituted by a biopsycho-social one. The clinician's main objective--to heal, has become enormously fiacilitated by the dramatic progress of modern scientific medicine, which has provided the physician with powerful but dangerous tools. The old Hippocratic aphorism, primum non nocere, should never beforgotten. Equally essential for the clinician is application of evidence-based knowledge applied to diagnostic and therapeutic measures; there should be no room for past attitudes that were supported by empires and the advice of "authorities". A solid and warm patient-physician relationship is a tremendously important aspect of the healer's behavior.

  13. Development of a Scale for Measuring Physician Perception: Physician Related Health Care Perception Scale

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    Meryem Heybet1


    Full Text Available Aim: Recently increased incidence of workplace violence in health care highlights the need for investigating the causes of such changes in clinical practice settings. The focus on the changes in attitudes of patients let us wonder whether the physician perception of the patients has changed and what the current perception is. The objective was to build up a scale to measure patients’ perceptions of health care. Methods: For developing a new scale we decided eight factors to be included in the scale; respect, trust, patient-doctor relation, medical practice skills, being knowledgeable about the medicine as a job, the perceptions and reflections of doctors in media, thoughts about violence against physicians and comply to rules of hospital. 77 attitude sentences were created. The draft scale with these attitude sentences were reviewed by two psychiatrists and a family physician who have experience with scale development. According to received feedbacks, the attitude sentences were further revised. Randomly selected 93 patients, who are above 18 years of age and who are willing to participate, were included in the study. We measured sentences by 5 fold Likert scale. We analyzed data by factor and reliability methods in SPSS 13.00 for Windows and evaluated for validity. Principal Component Analysis and Varimax rotation were used. Results: We obtained a scale with 6 factors and 34 attitude sentences. Cronbachalpha value was 0.891 (corrected 0.894. Factors were; respect, trust, patientdoctor relation, being knowledgeable about the medicine as a job, thoughts about violence against physicians and comply to rules of hospital. According to Principal Component Analysis, total variance explained rate 58.8%. Conclusions: There is no scale in the literature to measure patients’ perception of health care, so this scientific scale makes a high contribution to the current literature.

  14. Retaining physicians in Lithuania: integrating research and health policy. (United States)

    Starkiene, Liudvika; Macijauskiene, Jurate; Riklikiene, Olga; Stricka, Marius; Padaiga, Zilvinas


    Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuania's success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions.

  15. Uterine cancer in the writings of Byzantine physicians. (United States)

    Karamanou, Marianna; Tsoucalas, Gregory; Laios, Konstantinos; Deligeoroglou, Efthimios; Agapitos, Emmanouil; Androutsos, George


    Byzantine physicians recognized uterine cancer as a distinct disease and tried to suggest a therapeutic approach. The work of Oribasius, Aetius of Amida, Paul of Aegina, Cleopatra Metrodora and Theophanes Nonnus reflects the Hippocratic-Galenic scientific ideas as well as their own concept on this malignancy. According to their writings uterine cancer was considered an incurable disease and its treatment was based mainly on palliative herbal drugs.

  16. Evaluation of Physicians and Physician Extenders: Manpower Resources (United States)


    47 61 32 Physician 126 64,195 !5__35 Physical therapist 62 2,251 5,767 2,303 Radiation therapy technologist 92 848 437 310 Rad i ographer 795 26,715...percent (combining medicine and osteopathy graduates). The projected increase in physician graduates from 1975 to 1990 represents a far greater...23,683 24,196 24,689 Ch iId Psychiatry 2,067 2,242 2,384 2,557 2,618 2,877 Physical t’ledicine anid Rehabil itation ---------- 1,443 1,:503 1,557 1,615

  17. How to motivate physicians and develop a physician champion. (United States)

    McGrath, Debra


    Physician champions and leaders are essential to the success ofa CCIS implementation. Physician champions or leaders can be developed by recognizing the qualities of a leader and cultivating them. Finally, sustainable second-order change is facilitated bv a transformational leader--a leader who is charismatic, considers individual characteristics and needs of the constituency, and stimulates the constituency intellectually. A transformational leader does not accept the status quo but rather is continually questioning and offering constructive problem solutions. Transformational leadership may require more patience, time, tolerance, and resources, but it is worth the effort.

  18. Psychiatric rehabilitation education for physicians. (United States)

    Rudnick, Abraham; Eastwood, Diane


    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination ( Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011).

  19. O movimento antimanicomial no Brasil The anti-asylum movement in Brazil

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    Lígia Helena Hahn Lüchmann


    Full Text Available O presente trabalho visa resgatar a trajetória histórica do movimento nacional da luta antimanicomial no Brasil, bem como analisar algumas de suas dificuldades, realizações e desafios. A teoria dos movimentos sociais é aqui considerada como importante chave analítica para se compreender esta ação coletiva, na medida em que possibilita a avaliação deste tipo de ação social a partir de suas múltiplas configurações, atestando o grau de complexidade do mundo contemporâneo. O movimento antimanicomial constitui-se como um conjunto (plural de atores, cujas lutas e conflitos vêm sendo travadas a partir de diferentes dimensões sócio-político-institucionais. Trata-se de um movimento que articula, em diferentes momentos e graus, relações de solidariedade, conflito e de denúncias sociais tendo em vista as transformações das relações e concepções pautadas na discriminação e no controle do "louco" e da "loucura" em nosso país.This study reviews the history of the national anti-asylum struggle in Brazil. It analyzes some of the movement's difficulties, achievements and challenges. The theory of social movements is used here as an important analytical tool to understand this collective action, to the degree in which theory allows an appraisal of this type of social action rooted in its many configurations, evidencing the complexity of the contemporary world. The anti-asylum movement is composed of many stakeholders whose struggles and conflicts have been developed through different social-political-institutional dimensions. It encompasses at different moments and to different degrees, a movement which articulates solidarity and conflict relations and social denunciations in an attempt to transform relations and conceptions that are discriminatory and which are intended to control the "insane" and "insanity" in our country.

  20. Seroprevalence of Antibodies against Measles, Rubella and Varicella among Asylum Seekers Arriving in Lower Saxony, Germany, November 2014–October 2015

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    Salla E. Toikkanen


    Full Text Available The number of asylum seekers arriving in Germany has increased rapidly since 2014 and cases of vaccine-preventable diseases at reception centres were reported. Asylum seekers 12 years and older arriving in Lower Saxony were serologically screened for antibodies against measles, rubella and varicella between November 2014 and October 2015. We calculated the seroprevalence from the screening data by disease, country of origin and age group and compared them to literature-based herd immunity thresholds in order to identify immunisation gaps. In total, 23,647 specimens were included in our study. Although the vast majority of asylum seekers tested positive for antibodies against measles, rubella and varicella, the seroprevalences were not sufficient to ensure herd immunity. The seroprevalences varied substantially between countries of origin and increased with age. Immunisation of asylum seekers against measles, rubella and varicella is needed and the detailed information on seroprevalences among subgroups of asylum seekers can be used for targeted immunisations at reception centres.

  1. Fleeing the Drug War Next Door: Drug-related Violence as a Basis for Refugee Protection for Mexican Asylum-Seekers

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    Holly Buchanan


    Full Text Available The death toll in Mexico due to drug-related violence has continued to rise since President Felipe Calderón initiated the Mexican Government's crackdown on drug trafficking organizations in 2006. Pervasive corruption among state and local government officials and alleged human rights violations by the Mexican military have added to the gravity of the endemic drug-related violence in Mexico. In response to the continuous violence in Mexico perpetrated by drug trafficking organiza- tions, a substantial number of Mexican citizens have fled to the United States seeking asylum. Due to the strict requirements for refugee status under international law and asylum protection under U.S. law, individuals seeking protection based on drug-related violence face several legal obstacles. This Article addresses the extent to which drug-related violence may con- stitute a basis for refugee status protection under international refugee law and U.S. asylum law. It seeks to provide insight into the potential viability of claims for refugee status brought by Mexican asylum-seekers fleeing drug-related violence. This Article concludes with a discussion on complementary protection under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment for Mexican asylum-seekers.  

  2. Fleeing the Drug War Next Door: Drug-related Violence as a Basis for Refugee Protection for Mexican Asylum-Seekers

    Directory of Open Access Journals (Sweden)

    Holly Buchanan


    Full Text Available The death toll in Mexico due to drug-related violence has continued to rise since President Felipe Calderón initiated the Mexican Government's crackdown on drug trafficking organizations in 2006. Pervasive corruption among state and local government officials and alleged human rights violations by the Mexican military have added to the gravity of the endemic drug-related violence in Mexico. In response to the continuous violence in Mexico perpetrated by drug trafficking organiza- tions, a substantial number of Mexican citizens have fled to the United States seeking asylum. Due to the strict requirements for refugee status under international law and asylum protection under U.S. law, individuals seeking protection based on drug-related violence face several legal obstacles. This Article addresses the extent to which drug-related violence may con- stitute a basis for refugee status protection under international refugee law and U.S. asylum law. It seeks to provide insight into the potential viability of claims for refugee status brought by Mexican asylum-seekers fleeing drug-related violence. This Article concludes with a discussion on complementary protection under the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment for Mexican asylum-seekers.

  3. 42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians. (United States)


    ... teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.172 Physician fee schedule payment for services of teaching physicians....

  4. Erving Goffman's asylums and institutional culture in the mid-twentieth-century United States. (United States)

    Gambino, Matthew


    Sociologist Erving Goffman based his seminal work Asylums (1961) on a year of field research at St. Elizabeths Hospital in Washington, DC. Goffman described the mental hospital as a "total institution," in which regimentation dominated every aspect of daily life and patients were denied even the most basic means of self-expression; rather than promote recovery, such conditions produced the sorts of disordered behavior for which men and women were ostensibly admitted. A closer look at the changes transforming St. Elizabeths around the time of Goffman's research reveals a far richer portrait of institutional culture. Group therapy, psychodrama, art and dance therapy, patient newspapers, and patient self-government-each of which debuted at the hospital in the 1940s and 1950s-provided novel opportunities for men and women to make themselves heard and to take their fate into their own hands. While these initiatives did not reach all of the patients at St. Elizabeths, surviving documentation suggests that those who participated found their involvement rewarding and empowering. Goffman explicitly set out to describe "the social world of the hospital inmate." His failure to appreciate fully the capacities of his subjects, however, appears to have led him to underestimate the importance of these developments.

  5. The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers. (United States)

    Oppedal, Brit; Idsoe, Thormod


    There is a lack of knowledge about psychosocial resources that may sustain post-resettlement psychological adjustment among unaccompanied minor asylum-seekers. The aim of this study is to investigate the impact of social support from family abroad and friends on acculturation, discrimination, and mental health among these vulnerable children and youth. Questionnaire data were collected from a population-based multi-ethnic sample involving 895 unaccompanied minors resettled in municipalities in all regions of the country. They met in groups in their local communities. The informants were on average 18.6 years, and had an average length of stay in Norway of 3.5 years. The findings showed that the participants suffered from high levels of ongoing war related intrusive symptoms and depression. Still, at the same time they engaged in adaptation processes that are normative to youth with immigrant backgrounds, in terms of constructing supportive networks and developing culture competence. In accordance with the main effect hypothesis, social support had direct effects on depression and indirect effects by increasing culture competence that may aid the young refugees in dealing with discrimination. However, there were no effects of social support on symptoms of PTSD. The findings give direction to areas of interventions, beyond dealing with the sequel of the traumas the unaccompanied minors have been exposed to, not only for clinicians, but also social workers and school personnel.

  6. Vicarious resilience and vicarious traumatisation: Experiences of working with refugees and asylum seekers in South Australia. (United States)

    Puvimanasinghe, Teresa; Denson, Linley A; Augoustinos, Martha; Somasundaram, Daya


    The negative psychological impacts of working with traumatised people are well documented and include vicarious traumatisation (VT): the cumulative effect of identifying with clients' trauma stories that negatively impacts on service providers' memory, emotions, thoughts, and worldviews. More recently, the concept of vicarious resilience (VR) has been also identified: the strength, growth, and empowerment experienced by trauma workers as a consequence of their work. VR includes service providers' awareness and appreciation of their clients' capacity to grow, maintaining hope for change, as well as learning from and reassessing personal problems in the light of clients' stories of perseverance, strength, and growth. This study aimed at exploring the experiences of mental health, physical healthcare, and settlement workers caring for refugees and asylum seekers in South Australia. Using a qualitative method (data-based thematic analysis) to collect and analyse 26 semi-structured face-to-face interviews, we identified four prominent and recurring themes emanating from the data: VT, VR, work satisfaction, and cultural flexibility. These findings-among the first to describe both VT and VR in Australians working with refugee people-have important implications for policy, service quality, service providers' wellbeing, and refugee clients' lives.

  7. A versatile variable field module for Asylum Cypher scanning probe system (United States)

    Liu, Hongxue; Comes, Ryan; Lu, Jiwei; Wolf, Stuart; Hodgson, Jim; Rutgers, Maarten


    Atomic force microscopy (AFM) has become one of the most widely used techniques for measuring and manipulating various characteristics of materials at the nanoscale. However, there are very limited option for the characterization of field dependence properties. In this work, we demonstrate a versatile variable field module (VFM) with magnetic field up to 1800 Oe for the Asylum Research Cypher system. The magnetic field is changed by adjusting the distance between a rare earth magnet and the AFM probe. A built-in Hall sensor makes it possible to perform in-situ measurements of the field. Rotating the magnet makes it possible to do angular field dependent measurements. The capability of the VFM system is demonstrated by degaussing a floppy disk media with increasing magnetic field. The written bits are erased at about 800 Oe. Angular dependence measurements clearly show the evolution of magnetic domain structures. A completely reversible magnetic force microscopy (MFM) phase contrast is observed when the magnetic field is rotated by 180°. Further demonstration of successful magnetic switching of CoFe2O4 pillars in CoFe2O4-BiFeO3 nanocomposites will be presented and field dependent MFM and piezoresponse force microscopy (PFM) will be discussed. The work at University of Virginia was supported by DARPA under contract no. HR-0011-10-1-0072.

  8. Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike. (United States)

    Kenny, Mary A; Silove, Derrick M; Steel, Zachary


    The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry. An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge. Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their "ethical, moral or religious convictions". The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent. If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

  9. Refugee, Asylum, and Related Legislation in the US Congress: 2013–2016

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    Tara Magner


    Full Text Available Members of Congress have introduced numerous pieces of legislation in recent years related to refugees, asylum seekers, and other populations of migrants seeking protection in the United States. These bills were drafted in reaction to dramatic events within the United States, at its borders, and around the world. For example, roughly 400,000 children traveling alone and mothers with children have arrived at the southern US border since 2013, many seeking protection from organized crime, gang violence, and threats of human trafficking. Similarly, more than a million refugees from the Middle East, North Africa, and Asia sought to reach safety on the European continent in 2015 alone. Terrorist attacks fueled attempts to curtail the US commitment to offer protection to those fleeing persecution, even when those attacks had no connection to refugees or only tenuous links. And yet existing US law has been left virtually unchanged throughout this tumultuous period. This article describes the significant attempts to enact legislation related to refugees and international migrants since 2013 and examines the reasons why those attempts have not succeeded. It also describes American attitudes toward refugees and assesses whether those attitudes affected the fate of legislation.

  10. Hitler’s Jewish Physicians

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    George M. Weisz


    Full Text Available The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.

  11. Hitler’s Jewish Physicians (United States)

    Weisz, George M.


    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler. PMID:25120923

  12. TQM: a paradigm for physicians. (United States)

    Snyder, D A


    Change, even when for the better, is always accompanied by apprehension and even outright fear. It is therefore not surprising to hear health care workers, especially physicians, expressing their concerns about this "new" management philosophy through a spectrum of reactions that vary from skeptical or grudging acceptance to outright dismissal of all of the new "alphabet soup" associated with TQM.

  13. Business plan writing for physicians. (United States)

    Cohn, Kenneth H; Schwartz, Richard W


    Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.

  14. Physician Requirements-1990. For Nephrology. (United States)

    Rosenbach, Joan K.

    Professional requirements for physicians specializing in nephrology were estimated to assist policymakers in developing guidelines for graduate medical education. In estimating service requirements for nephrology, a nephrology Delphi panel reviewed reference and incidence-prevalence and utilization data for 34 conditions that are treated in the…

  15. The Mindful Physician and Pooh (United States)

    Winter, Robin O.


    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  16. Incest and the family physician. (United States)

    Boekelheide, P D


    This paper is a review of incest from epidemiologic, familial, and individual points of view. The incest taboo has characterized almost every culture and society throughout the ages. Respect for the incest barrier is a cultural demand made by society and is not a physiological or biological imperative. Overt incest occurs in a dysfunctional family through tension-reducing "acting out." The family physician is in a unique position to observe and understand the family dynamics which both help maintain defenses against the incestuous wishes as well as, in some families, contribute to the practice of incest. For 2,000 years physicians have taken the Hippocratic oath, with its explicit love relationship clause, as a reminder of their ethical responsibilities towards their patients. Examples of para-incestuous relationships between vulnerable individuals and authoritative helping figures are cited. A psychodynamic rationale is offered as to why sexual relationships between patients and their family physicians are not therapeutically beneficial. Clues for assessment and ten preventive measures are presented to enable physicians to monitor themselves and the families in their practice.

  17. Choosing among the physician databases. (United States)

    Heller, R H


    Prudent examination and knowing how to ask the "right questions" can enable hospital marketers and planners to find the most accurate and appropriate database. The author compares the comprehensive AMA physician database with the less expensive MEDEC database to determine their strengths and weaknesses.

  18. Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. (United States)

    Keygnaert, Ines; Vettenburg, Nicole; Temmerman, Marleen


    Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.

  19. Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers. (United States)

    McCarthy, G J


    The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them.

  20. Ethical principles for physician rating sites. (United States)

    Strech, Daniel


    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites' effects on physicians' performance, patient outcomes, or the public's trust in health care, most contributions refer to normative arguments, hypothetical effects, or indirect evidence. This paper aims, first, to structure the ethical debate about the basic concept of physician rating sites: allowing patients to rate, comment, and discuss physicians' performance, online and visible to everyone. Thus, it provides a more thorough and transparent starting point for further discussion and decision making on physician rating sites: what should physicians and health policy decision makers take into account when discussing the basic concept of physician rating sites and its possible implications on the physician-patient relationship? Second, it discusses where and how the preexisting evidence from the partly related field of public reporting of physician performance can serve as an indicator for specific needs of evaluative research in the field of physician rating sites. This paper defines the ethical principles of patient welfare, patient autonomy, physician welfare, and social justice in the context of physician rating sites. It also outlines basic conditions for a fair decision-making process concerning the implementation and regulation of physician rating sites, namely, transparency, justification, participation, minimization of conflicts of interest, and openness for revision. Besides other issues described in this paper, one trade-off presents a special challenge and will play an important role when deciding about more- or less-restrictive physician rating sites regulations: the potential psychological and financial harms for

  1. Gender and the professional career of primary care physicians in Andalusia (Spain

    Directory of Open Access Journals (Sweden)

    Luna Juan de Dios


    Full Text Available Abstract Background Although the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities. Methods Descriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS, patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses. Results Response: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked. Conclusions There are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study.

  2. A physician's due: measuring physician billing performance, benchmarking results. (United States)

    Woodcock, Elizabeth W; Browne, Robert C; Jenkins, Jennifer L


    A 2008 study focused on four key performance indicators (KPIs) and staffing levels to benchmark the FYO7 performance of physician group billing operations. A comparison of the change in the KPIs from FYO3 to FYO7 for a number of these billing operations disclosed across-the-board improvements. Billing operations did not show significant changes in staffing levels during this time, pointing to the existence of obstacles that prevent staff reductions in this area.

  3. Physician participation in clinical research and trials: issues and approaches

    Directory of Open Access Journals (Sweden)

    Sami F Shaban


    research culture’. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives, adequate training, research questions that are in line with physician interests and have clear potential to improve patient care, and regular feedback. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among medical students is now a high priority in order to develop more and better clinician-researchers.Keywords: physician, clinical research, clinical trial, medical education

  4. Scientific Growth

    Institute of Scientific and Technical Information of China (English)


    As one of the world's largest grain consumers,food security has always been a major concern for the Chinese nation.China must confront the challenge of feeding a fifth of the world's population with less than 9 percent of the planet's arable land.In 2011,China's grain output recorded growth for the eighth successive year,and total production reached an all-time high of 571million tons.In terms of food security,China's goal is to maintain a self-sufficiency rate of above 95 percent.However,an annual net population growth of 7.39 million and the effective decline of the area of farmland in the country,as a result of urbanization,make achieving such selfsufficiency a serious challenge.Given the heavy burden placed on Chinese agriculture,constantly raising productivity by relying on scientific and technological progress has become a priority for China's agricultural sector.The Ministry of Agriculture,for example,has worked to raise China's annual grain yield per-unit area by 1 percent,on average,over the past decade.Last year,the contributory rate of scientific and technological development to China's agriculture reached 52 percent,surpassing the contribution made by land,labor and other production factors for the first time in history.

  5. Memory frictions and reconciliation: Neo-victorian gothic and gender violence in Katy Darby’s The Whores’ Asylum (2012)


    Romero Ruiz, María Isabel


    Katy Derby’s first novel, The Whores’ Asylum (2012), is an attempt to deal with the issue of prostitution and rescue work in Oxford in the 1880s. Jericho is an area where, away from the prestigious university colleges, drunkards, thieves and prostitutes loiter around in depraved houses of accommodation and taverns. The protagonists, Stephen Chapman –a brilliant medical student --, Edward Fraser –a Theology student –, and Diana – the woman who runs a refuge for fallen women – are the three ang...

  6. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series]. (United States)

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan


    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care.

  7. [Habitus, capital and fields: the search for an acting head of the Hamburg Asylum Friedrichsberg in 1897]. (United States)

    Sammet, Kai


    In 1897 Hamburg was in search of an Oberarzt for the asylum Friedrichsberg who should function as the acting head of the head Wilhelm Reye (1833-1912). This search was part of the intended reformation of the outmoded psychiatric care in Hamburg. During this application procedure the Hamburg Physikus John Wahncau examined all possible candidates and applicants. The article explores the election process by using some sociological categories developed by Pierre Bourdieu (habitus, capital, field). The author argues that not only meritocratic attributes led to the choice of one candidate, but also his functional "fitting" into the field in Hamburg.

  8. Patient–physician communication regarding electronic cigarettes

    Directory of Open Access Journals (Sweden)

    Michael B. Steinberg


    Discussion: Physician communication about e-cigarettes may shape patients' perceptions about the products. More research is needed to explore the type of information that physicians share with their patients regarding e-cigarettes and harm reduction.

  9. Medicares Physician Quality Reporting System (PQRS)... (United States)

    U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...

  10. Organizational aspects of physician joint ventures. (United States)

    Rublee, D A; Rosenfield, R H


    This article describes organizational forms of physician joint ventures. Four models are described that typify physician involvement in health care joint ventures: limited partnership syndication, venture capital company, provider network, and alternative delivery system. Important practical issues are discussed.

  11. Physician Asthma Management Practices in Canada

    Directory of Open Access Journals (Sweden)

    Robert Jin


    Full Text Available OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.

  12. AMA Physician Select: Online Doctor Finder (United States)

    ... Membership | JAMA Network | AMA Store DoctorFinder This online physician Locator helps you find a perfect match for ... with basic professional information on virtually every licensed physician in the United States. This includes more than ...

  13. Medicare Provider Data - Physician and Other Supplier (United States)

    U.S. Department of Health & Human Services — The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare...

  14. Physicians under the influence: social psychology and industry marketing strategies. (United States)

    Sah, Sunita; Fugh-Berman, Adriane


    Pharmaceutical and medical device companies apply social psychology to influence physicians' prescribing behavior and decision making. Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence - reciprocation, commitment, social proof, liking, authority, and scarcity - are key to the industry's routine marketing strategies, which rely on the illusion that the industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame rather than gratitude will reduce conflicts of interest. If greater academic prestige accrues to distant rather than close relationships with industry, then a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession's improper dependence on industry.

  15. A physician's guide to the world of medical publications

    Directory of Open Access Journals (Sweden)

    Karishma Rosann Pereira


    Full Text Available Introduction: It is thrilling for any physician to write and publish a paper, because it reflects their study and expertise. It has become imperative in today's ever evolving world of medical science to keep abreast with academia by actively engaging in publication of scientific literature. The number of publications a physician has to his/her credit speaks volumes about their subject interest, command and passion. On the other hand, medical journals serve as sources of the most recent up-to-date information, which aids physicians in providing their patients with latest care in their specialty. Method: Having worked closely with a wide array of practicing physicians, right from fresh graduates to seasoned consultants; I have gained useful insight into the lacuna aspects when it comes to medical publications. Results: This paper aims to help every medical practitioner by bridging the gap between possessing vast amounts of data to structurally organising it and getting your information successfully published. I attempt to bring forth a ready reckoner that could serve as a step-wise checklist and guide to simplify the process of getting medical literature published; keeping in mind the time crunched and hectic schedules of medical practitioners.

  16. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

    Directory of Open Access Journals (Sweden)

    Vaughan-Sarrazin Mary S


    Full Text Available Abstract Background The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served. Methods We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR (N = 10,478 and total knee replacement (TKR (N = 15,312 in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999–2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR, hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data. Results Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P Conclusion Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.

  17. Cholesterol treatment practices of primary care physicians.


    Hyman, D J; Maibach, E W; Flora, J A; Fortmann, S.P.


    The active involvement of primary care physicians is necessary in the diagnosis and treatment of elevated blood cholesterol. Empirical evidence suggests that primary care physicians generally initiate dietary and pharmacological treatment at threshold values higher than is currently recommended. To determine current treatment thresholds and establish factors that distinguish physicians who are more likely to initiate therapy at lower cholesterol values, 119 primary care physicians in four nor...

  18. Transitioning to value-based physician compensation. (United States)

    Epstein, Johanna


    An effective strategy for creating a viable physician compensation plan should include nine key steps or tactics: Get physicians on board early. Engage a physician champion. Create a compensation committee. Address department-level issues and differences. Verify the plan's affordability. Adopt a routine review schedule. Understand the payer environment and keep in contact with payers. Stay abreast of industry trends. Maintain an ongoing dialogue with physicians.

  19. Liver transplantation for nontransplant physicians

    Directory of Open Access Journals (Sweden)

    Amany AbdelMaqsod Sholkamy


    Full Text Available Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.

  20. Organizational commitment of military physicians. (United States)

    Demir, Cesim; Sahin, Bayram; Teke, Kadir; Ucar, Muharrem; Kursun, Olcay


    An individual's loyalty or bond to his or her employing organization, referred to as organizational commitment, influences various organizational outcomes such as employee motivation, job satisfaction, performance, accomplishment of organizational goals, employee turnover, and absenteeism. Therefore, as in other sectors, employee commitment is crucial also in the healthcare market. This study investigates the effects of organizational factors and personal characteristics on organizational commitment of military physicians using structural equation modeling (SEM) on a self-report, cross-sectional survey that consisted of 635 physicians working in the 2 biggest military hospitals in Turkey. The results of this study indicate that professional commitment and organizational incentives contribute positively to organizational commitment, whereas conflict with organizational goals makes a significantly negative contribution to it. These results might help develop strategies to increase employee commitment, especially in healthcare organizations, because job-related factors have been found to possess greater impact on organizational commitment than personal characteristics.

  1. 22 CFR 62.27 - Alien physicians. (United States)


    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Alien physicians. 62.27 Section 62.27 Foreign... Provisions § 62.27 Alien physicians. (a) Purpose. Pursuant to the Mutual Educational and Cultural Exchange... Foreign Medical Graduates must sponsor alien physicians who wish to pursue programs of graduate...

  2. Scientific integrity

    DEFF Research Database (Denmark)

    Merlo, Domenico Franco; Vahakangas, Kirsi; Knudsen, Lisbeth E.


    Environmental health research is a relatively new scientific area with much interdisciplinary collaboration. Regardless of which human population is included in field studies (e.g., general population, working population, children, elderly, vulnerable sub-groups, etc.) their conduct must guarantee...... well acknowledged ethical principles. These principles, along with codes of conduct, are aimed at protecting study participants from research-related undesired effects and guarantee research integrity. A central role is attributed to the need for informing potential participants (i.e., recruited...... to know or not know. This is specifically relevant for studies including biological markers and/or storing biological samples that might be analysed years later to tackle research objectives that were specified and communicated to participants at the time of recruitment or that may be formulated after...

  3. Clinical guidelines: Involvement of peers increases physician adherence

    Institute of Scientific and Technical Information of China (English)

    Pascal Vignally; Jean Charles Grimaud; Roland Sambuc; St(e)phanie Gentile


    The literature illustrates the important issue of physician adherence to guidelines in their daily practice. In a quantitative study, we asked a random sample of 100 hospital gastroenterologists to evaluate their knowledge of guidelines and awareness of promoters. The degree to which guidelines were considered reliable was not related to the scientific evidence but was significantly associated with the promoter. The French Society of Gastroenterology was considered to be a more reliable promoter than national health agencies and pharmaceutical industries. Gastroenterologists become aware of guidelines mainly through their specialty society (62%). Specialty societies appear to be a more important source of information on guidelines for physicians. National health agencies should involve the specialty societies in the guideline development process to achieve changes in clinical practice.

  4. Review article: burnout in emergency medicine physicians. (United States)

    Arora, Manit; Asha, Stephen; Chinnappa, Jason; Diwan, Ashish D


    Training and the practice of emergency medicine are stressful endeavours, placing emergency medicine physicians at risk of burnout. Burnout syndrome is associated with negative outcomes for patients, institutions and the physician. The aim of this review is to summarise the available literature on burnout among emergency medicine physicians and provide recommendations for future work in this field. A search of MEDLINE (1946-present) (search terms: 'Burnout, Professional' AND 'Emergency Medicine' AND 'Physicians'; 'Stress, Psychological' AND 'Emergency Medicine' AND 'Physicians') and EMBASE (1988-present) (search terms: 'Burnout' AND 'Emergency Medicine' AND 'Physicians'; 'Mental Stress' AND 'Emergency Medicine' AND 'Physicians') was performed. The authors focused on articles that assessed burnout among emergency medicine physicians. Most studies used the Maslach Burnout Inventory to quantify burnout, allowing for cross-study (and cross-country) comparisons. Emergency medicine has burnout levels in excess of 60% compared with physicians in general (38%). Despite this, most emergency medicine physicians (>60%) are satisfied with their jobs. Both work-related (hours of work, years of practice, professional development activities, non-clinical duties etc.) and non-work-related factors (age, sex, lifestyle factors etc.) are associated with burnout. Despite the heavy burnout rates among emergency medicine physicians, little work has been performed in this field. Factors responsible for burnout among various emergency medicine populations should be determined, and appropriate interventions designed to reduce burnout.

  5. Enhancing physician engagement: an international perspective. (United States)

    Kaissi, Amer


    The purpose of this article is to provide specific recommendations to enhance physician engagement in health care organizations. It summarizes the evidence on physician engagement, drawing on peer-reviewed articles and reports from the gray literature, and suggests an integrative framework to help health care managers better understand and improve physician engagement. While we examine some other international examples and experiences, we mainly focus on physician engagement in Canada, the United States, and the United Kingdom. Physician engagement can be conceptualized as an ongoing two-way social process in which both the individual and organizational/cultural components are considered. Building on several frameworks and examples, we propose a new integrative framework for enhancing physician engagement in health care organizations. We suggest that in order to enhance physician engagement, organizations should focus on the following strategies: developing clear and efficient communication channels with physicians; building trust, understanding, and respect with physicians; and identifying and developing physician leaders. We propose that the time is now for health care managers to set aside traditional differences and historical conflicts and to engage their physicians for the betterment of their organizations.

  6. Physician unionization efforts gain momentum, support. (United States)

    Keating, G C


    Physicians increasingly are assuming the status of employees in healthcare organizations. Physicians also are seeing restrictions imposed on their practices by healthcare organizations seeking to control costs of care delivery. These trends have led a growing number of physicians to attempt to organize into unions. Obstacles to physician unionization efforts have included Federal antitrust laws that prohibit physicians from organizing, as well as physician reluctance to engage in organized activities they see as antithetical to their professional duties (e.g., strikes). In addition, physicians' attempts to unionize frequently have failed due to provisions of the National Labor Relations Act, which authorize collective bargaining only among individuals designated as "employees." Physicians seeking to form unions often are thwarted by the argument that they are not employees, but rather students, independent contractors, or supervisors, and therefore not entitled to protection under the act. Nonetheless, a number of recent developments, such as the American Medical Association's decision to endorse unionization by physicians and the National Labor Relations Board's decision that attending physicians should be regarded as employees, not supervisors, are creating a climate more conducive to physician unionization in the United States.

  7. Is legal status impacting outcomes of group therapy for posttraumatic stress disorder with male asylum seekers and refugees from Iran and Afghanistan?

    NARCIS (Netherlands)

    B. Droždek (Boris); A.M. Kamperman (Astrid); W.A. Tol (Wietse); J.W. Knipscheer (Jeroen); R.J. Kleber (Rolf)


    textabstractBackground: Legal status and other resettlement stressors are known to impact mental health of asylum seekers and refugees. However, the ways in which they interact with treatment of posttraumatic stress disorder (PTSD) with these populations is still poorly understood. The aim of this s

  8. Geographical distribution of torture: An epidemiological study of torture reported by asylum applicants examined at the Department of Forensic Medicine, University of Copenhagen

    DEFF Research Database (Denmark)

    Busch, Johannes Rødbro; Hansen, Steen Holger; Hougen, Hans Petter


    Using reports from 154 examinations of alleged torture victims among asylum applicants to Denmark conducted by the Department of Forensic Medicine, Univer- sity of Copenhagen, between 2001 and 2013, we have categorized the victims into four geographical regions, as well as according to the conflict...

  9. Assessing the Relationship between Community Education, Political Efficacy and Electoral Participation: A Case Study of the Asylum Seeking Community in Cork (United States)

    Harris, Clodagh; Murphy, Philip


    This paper assesses the relationship between community education and internal political efficacy. In particular it examines the association between voter/civic programmes run in advance of the 2009 local elections in Ireland and internal political efficacy amongst the asylum seeking community in Cork. A survey is used to test this relationship.…

  10. Sexual Maltreatment of Unaccompanied Asylum-Seeking Minors from the Horn of Africa: A Mixed Method Study Focusing on Vulnerability and Prevention (United States)

    Lay, Margaret; Papadopoulos, Irena


    Objectives: The study described in this paper sought to identify the social, cultural, and political factors that effect African unaccompanied asylum-seeking minors' (UASM) vulnerability to sexual maltreatment in England. It aimed to illuminate how child protection measures could be strengthened for this highly marginalized group. Methods: A mixed…

  11. Physicians' attitudes about their professional appearance. (United States)

    Gjerdingen, D K; Simpson, D E


    Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.

  12. Gender, family status and physician labour supply. (United States)

    Wang, Chao; Sweetman, Arthur


    With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis. Although both male and female physicians have statistically indistinguishable hours of market work when never married and without children, married male physicians have higher market hours, and their hours are unchanged or increased with parenthood. In contrast, female physicians have lower market hours when married, and much lower hours when a parent. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcomes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician's spouse is much less likely to be employed, and if employed, has lower market hours in the presence of children. In contrast, a female physician's spouse is more likely to be employed if there are three or more children. Both male and female physicians have lower hours of work when married to another physician. Overall, there is no gender difference in physician market labour supply after controlling for family status and demographics.

  13. Adding flexibility to physician training. (United States)

    Mahady, Suzanne E


    Demographic changes among junior doctors are driving demand for increased flexibility in advanced physician training, but flexible training posts are lacking. Suitable flexible training models include flexible full-time, job-share and part-time positions. Major barriers to establishing flexible training positions include difficulty in finding job-share partners, lack of funding for creating supernumerary positions, and concern over equivalence of educational quality compared with full-time training. Pilot flexible training positions should be introduced across the medical specialties and educational outcomes examined prospectively.

  14. Cuidadores del adulto mayor residente en asilos Caretakers of elderly persons living in asylums

    Directory of Open Access Journals (Sweden)

    Zoila Edith Hernández Zamora


    Full Text Available Se reitera el incremento que en los últimos años ha tenido la población de adultos mayores, hecho que repercute en el número también cada vez más alto de personas residentes en asilos para ancianos, lugares que por lo regular dependen del estado y cuyas características tanto materiales como su infraestructura en cuanto a personal especializado para atender a las personas que ahí viven, deja mucho que desear. Este último aspecto es el punto cardinal de este trabajo, ya que los cuidadores, trátese de enfermeras, psicólogo, médicos, trabajadoras sociales, entre otros, realizan un papel crucial en el funcionamiento de tales instituciones. El cuidador, al igual que los residentes, es un ser humano, con una carga inherente a la labor que realiza y que, además, transita por todas las emociones o conflictos que implica desempeñar su puesto, al igual que los que cuida, necesita ser cuidado y atendido para el logro del bienestar de ambos.This article underlines the increase in the population of elderly persons that has occurred in recent years and has resulted in ever-increasing numbers of residents living in asylums for the aged, or old people’s homes. Such institutions are generally dependent on the state, and their material characteristics as well as their infrastructure in regard to the specialized personnel for attending to the people residing there leave much to be desired. This last aspect is the central point of this work since the caretakers, be they nurses, psychologists, doctors, social workers or others, perform a crucial role in the functioning of such institutions. The caretaker, like the residents, is a human being with a duty that is inherent in his/her work and who, in addition, is subject to all the emotions or conflicts that the job implies. Just like the persons under his care, he requires care and attention in order to maintain the well-being of all those concerned.

  15. EMDR versus stabilisation in traumatised asylum seekers and refugees: results of a pilot study

    Directory of Open Access Journals (Sweden)

    Rolf J. Kleber


    Full Text Available Traumatised asylum seekers and refugees are clinically considered a complex population. Discussion exists on whether with this population treatment guidelines for post-traumatic stress disorder (PTSD should be followed and Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT or Eye Movement Desensitisation and Reprocessing (EMDR should be applied, or whether a phased model starting with stabilisation is preferable. Some clinicians fear that trauma-focused interventions may lead to unmanageable distress or may be ineffective. While cognitive-behavioural interventions have been found to be effective with traumatised refugees, no studies concerning the efficacy of EMDR with this population have been conducted as yet.In preparation for a randomised trial comparing EMDR and stabilisation with traumatised refugees, a pilot study with 20 participants was conducted. The objective was to examine feasibility of participation in a randomised trial for this complex population and to examine acceptability and preliminary efficacy of EMDR.Participants were randomly allocated to 11 sessions of either EMDR or stabilisation. Symptoms of PTSD (SCID-I, HTQ, depression and anxiety (HSCL-25, and quality of life (WHOQOL-BREF were assessed at pre- and post-treatment and 3-month follow-up.Participation of traumatised refugees in the study was found feasible, although issues associated with complex traumatisation led to a high pre-treatment attrition and challenges in assessments. Acceptability of EMDR was found equal to that of stabilisation with a high drop-out for both conditions. No participants dropped out of the EMDR condition because of unmanageable distress. While improvement for EMDR participants was small, EMDR was found to be no less efficacious than stabilisation. Different symptom courses between the two conditions, with EMDR showing some improvement and stabilisation showing some deterioration between pre-treatment and post-treatment, justify the conduct

  16. Promoting Scientific Spirit to Cultivate Scientific Culture

    Institute of Scientific and Technical Information of China (English)


    Scientific culture is an advanced culture that is based on scientific knowledge and supported by the scientific method, with scientific thinking as its core and scientific spirit as its soul. During the process of modernization, it has profound impacts on human society in terms of values, ethics, mode of thinking, lifestyle and code of conduct, offering human civilization an important ideological source, physical foundation, technological tool and effective carrier.

  17. Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. (United States)

    Swensen, Stephen; Kabcenell, Andrea; Shanafelt, Tait


    The process of creating healthy organization-physician relationships is critical to organizational success. Partnerships in process improvement can nurture these relationships and mitigate burnout by meeting physicians' psychological needs. To flourish, physicians need some degree of choice (control over their lives), camaraderie (social connectedness), and an opportunity for excellence (being part of something meaningful). Organizations can provide these opportunities by establishing constructive organization-physician relationships and developing physician leaders. We present a case study from the Mayo Clinic that supports the foundational principles of a physician-engagement model. We developed the Listen-Act-Develop model as an integrated strategy to reduce burnout and engage physicians in the mission of the organization. The intent of the model is to maximize physician wellness by fostering engagement and mitigating the drivers of burnout. This model provides a path to increase physician satisfaction and meaning in work and to improve organizational effectiveness.

  18. Views of United States Physicians and Members of the American Medical Association House of Delegates on Physician-assisted Suicide. (United States)

    Whitney, Simon N.; Brown, Byron W.; Brody, Howard; Alcser, Kirsten H.; Bachman, Jerald G.; Greely, Henry T.


    Ascertained the views of physicians and physician leaders toward legalization of physician-assisted suicide. Results indicated members of AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is adversarial, most physicians are…

  19. Physician-Assisted Dying: Acceptance by Physicians Only for Patients Close to Death. (United States)

    Zenz, Julia; Tryba, Michael; Zenz, Michael


    This study reports on German physicians' views on legalization of euthanasia and physician-assisted suicide, comparing this with a similar survey of UK doctors. A questionnaire was handed out to attendants of a palliative care and a pain symposium. Complete answers were obtained from 137 physicians. Similar to the UK study, about 30% of the physicians surveyed support euthanasia in case of terminal illness and more support physician-assisted suicide. In contrast, in both countries, a great majority of physicians oppose medical involvement in hastening death in non-terminal illnesses. The public and parliamentary discussion should face this opposition to assisted suicide by pain and palliative specialists.

  20. Physician communication in the operating room. (United States)

    Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew


    In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

  1. Psychotherapy, a concept for the nonpsychiatric physician. (United States)

    KAHN, J P


    Patients tend to repeat with their physician, as with other significant people in their lives, their earlier previous patterns of behavior. The physician as well as the patient is involved in the physician-patient relationship. He will tend to respond to his patients in accordance with his earlier life experiences and his characteristic repetitive behavioral pattern. For both physician and patient, the relationship between them extends beyond the immediate reality situation. Psychotherapy is the utilization of psychological measures in the treatment of sick persons and the deliberate utilization by the physician of the physician-patient relationship for the benefit of the patient. The kind of psychotherapy that is practical and utilizable by the nonpsychiatric physician is that which uses education, reassurance, support and the management of the patient's problems either directly or indirectly or through the intermediary of other people or agencies. The symbolic aspect of the physician-patient relationship is based essentially on the fact that a sick person, because of his anxiety and because of the threat to his physical and psychic integrity, is more dependent and more anxious than he would be if he were well, and therefore he has a correspondingly greater need for the authoritative and protective figure he finds in the physician. Psychotherapy is not directed exclusively to the treatment of flagrantly or obviously neurotic or psychotic patients. It should be and is directed to all sick persons. Limitations in psychotherapy are set by various determinants, among which are the nature of the precipitating factor in the illness, the nature of the sick person, the skill, knowledge and abilities of the physician, and the nature of the physician-patient relationship. In psychotherapy, as in all medicine, the physician should not do anything which may disturb the patient if the disturbance is of no value or if it cannot be followed through with special skills.

  2. Still on physicians' attitude to medical marijuana


    Olukayode Abayomi; Emmanuel Babalola


    Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescrip...

  3. Teaching Home Environmental Health to Resident Physicians


    Zickafoose, Joseph S.; Greenberg, Stuart; Dorr G Dearborn


    Healthy Homes programs seek to integrate the evaluation and management of a multitude of health and safety risks in households. The education of physicians in the identification, evaluation, and management of these home health and safety issues continues to be deficient. Healthy Homes programs represent a unique opportunity to educate physicians in the home environment and stimulate ongoing, specific patient-physician discussions and more general learning about home environmental health. The ...

  4. Service motives and profit incentives among physicians. (United States)

    Godager, Geir; Iversen, Tor; Ma, Ching-To Albert


    We model physicians as health care professionals who care about their services and monetary rewards. These preferences are heterogeneous. Different physicians trade off the monetary and service motives differently, and therefore respond differently to incentive schemes. Our model is set up for the Norwegian health care system. First, each private practice physician has a patient list, which may have more or less patients than he desires. The physician is paid a fee-for-service reimbursement and a capitation per listed patient. Second, a municipality may obligate the physician to perform 7.5 h/week of community services. Our data are on an unbalanced panel of 435 physicians, with 412 physicians for the year 2002, and 400 for 2004. A physician's amount of gross wealth and gross debt in previous periods are used as proxy for preferences for community service. First, for the current period, accumulated wealth and debt are predetermined. Second, wealth and debt capture lifestyle preferences because they correlate with the planned future income and spending. The main results show that both gross debt and gross wealth have negative effects on physicians' supply of community health services. Gross debt and wealth have no effect on fee-for-service income per listed person in the physician's practice, and positive effects on the total income from fee-for-service. The higher income from fee-for-service is due to a longer patient list. Patient shortage has no significant effect on physicians' supply of community services, a positive effect on the fee-for-service income per listed person, and a negative effect on the total income from fee for service. These results support physician preference heterogeneity.

  5. Ethical Principles for Physician Rating Sites


    Strech, Daniel


    During the last 5 years, an ethical debate has emerged, often in public media, about the potential positive and negative effects of physician rating sites and whether physician rating sites created by insurance companies or government agencies are ethical in their current states. Due to the lack of direct evidence of physician rating sites’ effects on physicians’ performance, patient outcomes, or the public’s trust in health care, most contributions refer to normative arguments, hypothetical ...

  6. An exploration of the connection between two meaning perspectives: an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context. (United States)

    Ekblad, Solvig; Linander, Andrea; Asplund, Maria


    The right to health care is significant for asylum seekers, particularly as many of them have experienced traumatic life events in their home country, during flight or in their host country. Post-migration living conditions have more impact than pre-migration conditions on ill health among asylum seekers, which underscores the importance of health care-related refugee reception policies. The purpose of this article is to explore the perceived meaning of comprehensive health information provided by a nurse to Arabic- and Somali-speaking adult asylum seekers, in a Swedish context, during its introduction at the Migration Board. In our study, the endpoint was whether asylum seekers found such health information relevant, understandable and respectful. Following an oral presentation, participants filled in a questionnaire consisting of three close-ended questions. A total of 39 groups of presentation attendees included 626 asylum seekers (415 Arabic- and 211 Somali-speaking). Data were analysed with descriptive statistics. Comments underwent content analysis. We also present some socio-demographic data on these asylum seekers. Independently of gender and language, the participants expressed their gratitude for and the meaningfulness of receiving professional, fact-based information, as well as being treated with concern and respect. They indicated a great need for this and felt relieved by being listened to. They liked the pedagogic group method, the opportunity for dialogue and to practice exercising their rights. These promising results indicate that exercising the asylum-seekers' right to receive such health information would improve future reception policies not only in Sweden, but throughout the EU. A renewed focus on communication and pedagogic skills, instead of just cultural training, should be considered for health care professionals assisting asylum seekers.

  7. No exodus: physicians and managed care networks. (United States)

    O'Malley, Ann S; Reschovsky, James D


    After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.

  8. Difficulties facing physician mothers in Japan. (United States)

    Yamazaki, Yuka; Kozono, Yuki; Mori, Ryo; Marui, Eiji


    Despite recent increases in the number of female physicians graduating in Japan, their premature resignations after childbirth are contributing to the acute shortage of physicians. Previous Japanese studies have explored supportive measures in the workplace, but have rarely focused on the specific problems or concerns of physician-mothers. Therefore, this study explored the challenges facing Japanese physician-mothers in efforts to identify solutions for their retention. Open-ended questionnaires were mailed to 646 alumnae of Juntendo University School of Medicine. We asked subjects to describe their opinions about 'The challenges related to female physicians' resignations'. Comments gathered from alumnae who graduated between 6 and 30 years ago and have children were analyzed qualitatively. Overall, 249 physicians returned the questionnaire (response rate 38.5%), and 73 alumnae with children who graduated in the stated time period provided comments. The challenges facing physician-mothers mainly consisted of factors associated with Japanese society, family responsibilities, and work environment. Japanese society epitomized by traditional gender roles heightened stress related to family responsibilities and promoted gender discrimination at work environment. Additionally, changing Japanese society positively influenced working atmosphere and husband's support. Moreover, the introduction of educational curriculums that alleviated traditional gender role was proposed for pre- and post- medical students. Traditional gender roles encourage discrimination by male physicians or work-family conflicts. The problems facing female physicians involve more than just family responsibilities: diminishing the notion of gender role is key to helping retain them in the workforce.

  9. Contributions of ancient Indian physicians - Implications for modern times

    Directory of Open Access Journals (Sweden)

    J Singh


    Full Text Available Ayurveda traces its origins to contributions of mythological and real physicians that lived millennia earlier. In many respects, Western medicine also had similar origins and beliefs, however, the introduction of anatomical dissection and progressive application of scientific evidence based practices have resulted in divergent paths taken by these systems. We examined the lives, careers, and contributions made by nine ancient Indian physicians. Ancient texts, translations of these texts, books, and biographical works were consulted to obtain relevant information, both for Indian traditional medicine as well as for Western medicine. Ayurveda has retained principles enunciated by these physicians, with minor conceptual advances over the centuries. Western medicine separated from ancient Indian medicine several hundred years ago, and remains the foundation of modern medicine. Modern medicine is evidence based, and randomized clinical trials (RCTs are the gold standard by which efficacy of treatment is evaluated. Ayurvedic medicine has not undergone such critical evaluation to any large extent. The few RCTs that have evaluated alternative medical treatment recently have shown that such therapy is no better than placebo; however, placebo treatment is 30% effective. We suggest that foreign domination, initially by Mughals, and later by the British, may have contributed, in part, to this inertia and protracted status quo.

  10. Spirituality and the physician executive. (United States)

    Kaiser, L R


    The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.

  11. The physician of the future. (United States)

    Thomas, E L


    The good physician of the future will need to master not only the basic and traditional medical skills but many new concepts and techniques as well. He will need to be, as always, a compassionate and intelligent man. If he is to retain his status as a healer in the eyes of his patients, he will have to be fully aware of what is happening in the social and technological environment, or he will run the risk of being relegated to the position of a high-grade technician.He will have new physical tools and new thinking tools to help him. To understand and use these, and also to understand the technical world of the future, he will need a sound knowledge of the physical sciences and some fluency in the language of modern mathematics.

  12. Social Support from Sponsorships as a Moderator of Acculturative Stress: Predictors of Effects on Refugees and Asylum Seekers. (United States)

    Renner, Walter; Laireiter, Anton-Rupert; Maier, Marco J


    N = 63 refugees and asylum seekers, 27 women and 36 men with a mean age of 33.08 years (SD = 10.3) from Chechnya and Afghanistan were granted sponsorships for six months and were randomized to an intervention and a waiting-list control group. Only participants with a history of traumatization benefited from the intervention. For the traumatized sub-sample, sponsorships led to a significant and stable decrease in anxiety, depression, and psychological problems as compared to the control group, with effect sizes comparable to those of psychotherapy. The effects being rather palliative than instrumental, however, sponsorships did not instigate improvements in acculturation, societal contact, or coping capability. Women benefited more from the intervention than men, and Afghans more than Chechen.

  13. Violence Against Women and Asylum Seeking: Global Problems and Local Practices Applied to Guatemalan Women Immigrating for Safety

    Directory of Open Access Journals (Sweden)

    Roselyn Costantino


    Full Text Available This paper, based on broader discussions surrounding gender violence and immigration in the U.S., provides critical information on the historical context of extreme violence against women and femicide plaguing Central American societies today. Drawing on experiences of precedent setting cases of Guatemalan women, the authors offer suggestions for culturally specific treatment of and support for women who seek asylum in the U.S. out of justified fear for their and their family members’ lives should they return to their country of origin. The arguments presented are predicated on the belief that women worldwide share experiences of myriad forms of male domination and gender inequality which, however, play out differently on their bodies and lives in ways that must be accounted for in our attempt to offer them appropriate care and assist them in creating the tools they need to change their circumstances.

  14. Evaluating physicians' professionalism and humanism: the case for humanism "connoisseurs". (United States)

    Misch, Donald A


    Physicians' professionalism and humanism have become central foci of the efforts of medical educators as the public, various accrediting and licensing agencies, and the profession itself have expressed concerns about the apparent erosion of physicians' competency in these aspects of the art, rather than the science, of medicine. Of the many obstacles to enhancing trainees' skills in these domains, one of the most significant is the difficulty in assessing competency in physicians' professionalism and humanism. The author suggests that the assessment of these aspects of the art of medicine has more in common with the approaches used in criticism of the arts than with the quantitative assessment tools appropriate to the scientific method and the medical model. Quantitative and semi-quantitative tools, so effective in elucidating the etiology, pathophysiology, and treatment of disease, are often in-appropriate and invalid when applied to evaluation of professional and humanistic competencies. The author proposes that humanism "connoisseurs" be employed to qualitatively evaluate medical trainees' professionalism and humanism. Such connoisseurs would possess expert knowledge, training, and experience in the interpersonal aspects of the art of medicine, allowing them to deconstruct concepts such as empathy, compassion, integrity, and respect into their respective key elements while evaluating physicians' behaviors as an integrated, cohesive whole. Through the use of a rich descriptive vocabulary, humanism connoisseurs would provide valid formative and summative feedback regarding competency in medical professionalism and humanism. In the process, they would serve to counteract the relative marginalization of professionalism and humanism in the informal and lived curricula of medical trainees.

  15. Estimation of physician supply by specialty and the distribution impact of increasing female physicians in Japan

    Directory of Open Access Journals (Sweden)

    Yasunaga Hideo


    Full Text Available Abstract Background Japan has experienced two large changes which affect the supply and distribution of physicians. They are increases in medical school enrollment capacity and in the proportion of female physicians. The purpose of this study is to estimate the future supply of physicians by specialty and to predict the associated impact of increased female physicians, as well as to discuss the possible policy implications. Methods Based on data from the 2004 and 2006 National Survey of Physicians, Dentists and Pharmacists, we estimated the future supply of physicians by specialty, using multistate life tables. Based on possible scenarios of the future increase in female physicians, we also estimated the supply of physicians by specialty. Results Even if Japan's current medical school enrollment capacity is maintained in subsequent years, the number of physicians per 1000 population is expected to increase from 2.2 in 2006 to 3.2 in 2036, which is a 46% increase from the current level. The numbers of obstetrician/gynecologists (OB/GYNs and surgeons are expected to temporarily decline from their current level, whereas the number of OB/GYNs per 1000 births will still increase because of the declining number of births. The number of surgeons per 1000 population, even with the decreasing population, will decline temporarily over the next few years. If the percentage of female physicians continues to increase, the overall number of physicians will not be significantly affected, but in specialties with current very low female physician participation rates, such as surgery, the total number of physicians is expected to decline significantly. Conclusion At the current medical school enrollment capacity, the number of physicians per population is expected to continue to increase because of the skewed age distribution of physicians and the declining population in Japan. However, with changes in young physicians' choices of medical specialties and as the

  16. Person-centered approach to enhancing cross-cultural competence of general physicians in the system of postgraduate education

    Directory of Open Access Journals (Sweden)

    Тетяна Ярославівна Пилип


    Full Text Available The work presents the essence of the person-centered approach to enhancing cross-cultural competence of general physicians in the system of postgraduate education based on the conducted analysis of scientific pedagogical and psychological literature. The author has analysed the main tasks of the training process from person-centered perspective and its content; there were distinguished major practical concepts and tools of implementation of cross-cultural competence development of general physicians in teaching practice

  17. Nurse-physician communication: an organizational accountability. (United States)

    Arford, Patricia H


    Dysfunctional nurse-physician communication has been linked to medication errors, patient injuries, and patient deaths. The organization is accountable for providing a context that supports effective nurse-physician communication. Organizational strategies to create such a context are synthesized from the structural, human resource, political, and cultural frameworks of organizational behavior.

  18. Urban-Rural Flows of Physicians (United States)

    Ricketts, Thomas C.; Randolph, Randy


    Context: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. Purpose: To determine whether there was a significant flow of…

  19. Physician Behaviors that Correlate with Patient Satisfaction. (United States)

    Comstock, Loretto M.; And Others


    The behavior of 15 internal medicine residents was observed through a one-way mirror and ratings by the patients of satisfaction with their physicians were obtained. The teaching of caring skills and which physician caring skills affect the patients' satisfaction are discussed. (Author/MLW)

  20. 10 CFR 712.32 - Designated Physician. (United States)


    ... Designated Physician must be qualified to provide professional expertise in the area of occupational medicine... school of medicine or osteopathy; (2) Have a valid, unrestricted state license to practice medicine in... requirements; and (4) Be eligible for the appropriate DOE access authorization. (c) The Designated Physician...

  1. Tailoring hospital marketing efforts to physicians' needs. (United States)

    Mackay, J M; Lamb, C W


    Marketing has become widely recognized as an important component of hospital management (Kotler and Clarke 1987; Ludke, Curry, and Saywell 1983). Physicians are becoming recognized as an important target market that warrants more marketing attention than it has received in the past (Super 1987; Wotruba, Haas, and Hartman 1982). Some experts predict that hospitals will begin focusing more marketing attention on physicians and less on consumers (Super 1986). Much of this attention is likely to take the form of practice management assistance, such as computer-based information system support or consulting services. The survey results reported here are illustrative only of how one hospital addressed the problem of physician need assessment. Other potential target markets include physicians who admit patients only to competitor hospitals and physicians who admit to multiple hospitals. The market might be segmented by individual versus group practice, area of specialization, or possibly even physician practice life cycle stage (Wotruba, Haas, and Hartman 1982). The questions included on the survey and the survey format are likely to be situation-specific. The key is the process, not the procedure. It is important for hospital marketers to recognize that practice management assistance needs will vary among markets (Jensen 1987). Therefore, hospitals must carefully identify their target physician market(s) and survey them about their specific needs before developing and implementing new physician marketing programs. Only then can they be reasonably confident that their marketing programs match their customers' needs.

  2. A history of physician suicide in America. (United States)

    Legha, Rupinder K


    Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.

  3. Physician Performance Assessment: Prevention of Cardiovascular Disease (United States)

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.


    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  4. Can complexity science inform physician leadership development? (United States)

    Grady, Colleen Marie


    Purpose The purpose of this paper is to describe research that examined physician leadership development using complexity science principles. Design/methodology/approach Intensive interviewing of 21 participants and document review provided data regarding physician leadership development in health-care organizations using five principles of complexity science (connectivity, interdependence, feedback, exploration-of-the-space-of-possibilities and co-evolution), which were grouped in three areas of inquiry (relationships between agents, patterns of behaviour and enabling functions). Findings Physician leaders are viewed as critical in the transformation of healthcare and in improving patient outcomes, and yet significant challenges exist that limit their development. Leadership in health care continues to be associated with traditional, linear models, which are incongruent with the behaviour of a complex system, such as health care. Physician leadership development remains a low priority for most health-care organizations, although physicians admit to being limited in their capacity to lead. This research was based on five principles of complexity science and used grounded theory methodology to understand how the behaviours of a complex system can provide data regarding leadership development for physicians. The study demonstrated that there is a strong association between physician leadership and patient outcomes and that organizations play a primary role in supporting the development of physician leaders. Findings indicate that a physician's relationship with their patient and their capacity for innovation can be extended as catalytic behaviours in a complex system. The findings also identified limiting factors that impact physicians who choose to lead, such as reimbursement models that do not place value on leadership and medical education that provides minimal opportunity for leadership skill development. Practical Implications This research provides practical

  5. Pharmaceutical marketing research and the prescribing physician. (United States)

    Greene, Jeremy A


    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

  6. [Dis/arranged medical histories à la Friedrichsberg. Explorations of foreign patients by multilingual fellow patients in a German asylum about 1900]. (United States)

    Wulf, Stefan; Schmiedebach, Heinz-Peter


    This paper deals with two examples of a particular patient's activity at the Friedrichsberg Asylum in Hamburg in the beginning of the 20th century. Two multilingual patients assumed the function of interpreters in each case for a foreign fellow patient. They were involved to a great extent in the documentation of the medical histories. Conversations and interrogations carried out by them and recorded by their own hand are passed down in the medical files of their foreign-language fellow patients. After some preliminary remarks about the Friedrichsberg Asylum and its patients, the various activities of patients in the psychiatric institution and the importance of the patients' manner of speaking for the psychiatric diagnosis, the two cases are described in detail. The patient-interpreters were perceived as border-crossers, as "Figures of the Third".

  7. [The experience of a 'weak and sick childhood' far from home: the experience of the Maritime Asylum, Mar del Plata (1893-1920)]. (United States)

    Alvarez, Adriana


    The objective of this work is to analyze the daily life of 'tubercular children'" coming from the city of Buenos Aires. They were hospitalized in the Maritime Asylum located in the seaside city of Mar del Plata, 400 kilometers from the capital. In 1893, in the Charitable Society of the Federal Capital, the idea arose of founding a hospital and maritime asylum for children ill with osseous tuberculosis in general, weak and convalescing children and the treatment of patients with extra-pulmonary tuberculosis. This paper attempts to advance the understanding of two inter-related topics: on the one hand, the characteristics of the institutionalized meddling of the Charitable Society, and, on the other, the experience that these tubercular children had in this institution.

  8. [The occupational physician in France]. (United States)

    Matsuda, Shinya


    The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information.

  9. Walter sutton: physician, scientist, inventor. (United States)

    Ramirez, Gregory J; Hulston, Nancy J; Kovac, Anthony L


    Walter S. Sutton (1877-1916) was a physician, scientist, and inventor. Most of the work on Sutton has focused on his recognition that chromosomes carry genetic material and are the basis for Mendelian inheritance. Perhaps less well known is his work on rectal administration of ether. After Sutton's work on genetics, he completed his medical degree in 1907 and began a 2-year surgical fellowship at Roosevelt Hospital, New York City, NY, where he was introduced to the technique of rectal administration of ether. Sutton modified the work of others and documented 100 cases that were reported in his 1910 landmark paper "Anaesthesia by Colonic Absorption of Ether". Sutton had several deaths in his study, but he did not blame the rectal method. He felt that his use of rectal anesthesia was safe when administered appropriately and believed that it offered a distinct advantage over traditional pulmonary ether administration. His indications for its use included (1) head and neck surgery; (2) operations when ether absorption must be minimized due to heart, lung, or kidney problems; and (3) preoperative pulmonary complications. His contraindications included (1) cases involving alimentary tract or weakened colon; (2) laparotomies, except when the peritoneal cavity was not opened; (3) incompetent sphincter or anal fistula; (4) orthopnea; and (5) emergency cases. Sutton wrote the chapter on "Rectal Anesthesia" in one of the first comprehensive textbooks in anesthesia, James Tayloe Gwathmey's Anesthesia. Walter Sutton died of a ruptured appendix in 1916 at age 39.

  10. [Ethical principles in human scientific research]. (United States)

    Cruz-Coke, R


    Hippocrates was the first physician to use the scientific method to find rational and not religious or mythic causes, for the etiology of diseases. Hippocrates and Aristoteles did not dare to dissect the human body. Afterwards however, many scientists such as Herophilus, Erasitastrus, Vesalus and Fallopio, performed experiments in human beings using vivisection. According to that age's ideas, there was no cruelty in performing vivisection in criminals, since useful knowledge for the progress of medicine and relief of diseases was obtained. Only during the nineteenth century and with Claude Bernard (1865), the ethical principles of systematic scientific research in humans were defined. These principles were violated by nazi physicians during Hitler's dictatorship in Germany (1933-1945). As a response to these horrors, the Ethical Codes of Nuremberg (1947) and Geneva (1948), that reestablished all the strength of Hippocratic principles, were dictated. The Nuremberg rules enact that a research subject must give a voluntary consent, that the experiment must by necessary and exempt of death risk, that the research must be qualified and that the experiment must be discontinued if there is a risk for the subject. The Geneva statement is a modernized hippocratic oath that protects patient's life above all. These classical rules, in force at the present time, are the essential guides that must be applied by physicians and researchers.

  11. Sexual health is dead in my body: participatory assessment of sexual health determinants in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands


    Keygnaert, Ines; Vettenburg, Nicole; Roelens, Kristien; Temmerman, Marleen


    Background: Although migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants' sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexu...

  12. The physician expert witness and the U.S. Supreme court--an epidemiologic approach. (United States)

    Norton, Martin L


    It is a fact of life that the physician is occasionally called upon to provide Expert Witness evidence. This is clearly distinct from evidence of a participatory nature where the physician is a party to the act by virtue of the doctor-patient relationship. The purpose of this presentation is to alert the physician to new criteria, imposed by the court, for acceptance of Expert Testimony. Prior to March 23, 1999, expert witness testimony fell into three categories, Scientific, technical, and other specialized knowledge. Scientific knowledge included the conclusions that could be subjected to analysis of a statistical nature, or could be validated by methodology such as epidemiologic criteria. Technical knowledge was based on factors such as mechanical or stress analysis utilized in engineering. Other "specialized knowledge" could be based on experiential data and information not necessarily subject to epidemiologic or other scientific analysis. Therefore, the physician presented his reasoning often based on years of professional practice and publication in journals of clinical practice. On March 23rd 1999, the Supreme Court of the United States changed the criteria for all categories stating that there is "no relevant distinction between 'scientific' knowledge' and 'technical' or 'other specialized knowledge' in Federal Rule of Evidence 702. This momentous decision [Kumho Tire Co. v. Carmichael, (97-1709), 131 F.3d 1433) reversed.] referred back to a previous case [Daubert v. Merrell Dow Pharmaceuticals Inc., 509 US. 579,589], which established four criteria based on methods of analysis for t he courts, and was now extended for all expert evidence. Thus the area of expert witness evidence was changed by this momentous act placing the judge as arbiter of all expert evidence, including that of the physician. This paper will offer a brief review and an analysis of the significance of this for the professional involved in the legal system as an expert witness.

  13. 煤矿井下避难硐室建设探讨%Discussion on Coal Mine Asylum Cavern Construction Scheme

    Institute of Scientific and Technical Information of China (English)

    赵纯发; 何飞


    本文通过分析避难硐室钻孔、专用管路、自备氧等不同供氧方式的特点,认为专用管路供氧方式具有安全可靠、操作简单、投资少、维护、运行费用低等优点,同时指出避难硐室专用管路的布置应与矿井压风自救系统紧密结合,使避难硐室成为煤矿安全生产的助推器。%This article through the analysis of drilling,dedicated line,should bring along their own oxygen asylum cavern,such as the characteristics of the different ways of oxygen,oxygen to dedicated line method is safe and reliable, simple operation,less investment,maintenance,and low operation cost,at the same time points out that the asylum cavern dedicated line layout should be combined with mine pressure wind self -help system closely,make asylum cavern of coal mine safety production of the booster.

  14. Regulatory focus affects physician risk tolerance. (United States)

    Veazie, Peter J; McIntosh, Scott; Chapman, Benjamin P; Dolan, James G


    Risk tolerance is a source of variation in physician decision-making. This variation, if independent of clinical concerns, can result in mistaken utilization of health services. To address such problems, it will be helpful to identify nonclinical factors of risk tolerance, particularly those amendable to intervention-regulatory focus theory suggests such a factor. This study tested whether regulatory focus affects risk tolerance among primary care physicians. Twenty-seven primary care physicians were assigned to promotion-focused or prevention-focused manipulations and compared on the Risk Taking Attitudes in Medical Decision Making scale using a randomization test. Results provide evidence that physicians assigned to the promotion-focus manipulation adopted an attitude of greater risk tolerance than the physicians assigned to the prevention-focused manipulation (p = 0.01). The Cohen's d statistic was conventionally large at 0.92. Results imply that situational regulatory focus in primary care physicians affects risk tolerance and may thereby be a nonclinical source of practice variation. Results also provide marginal evidence that chronic regulatory focus is associated with risk tolerance (p = 0.05), but the mechanism remains unclear. Research and intervention targeting physician risk tolerance may benefit by considering situational regulatory focus as an explanatory factor.

  15. Hospitals' marketing challenge: influencing physician behavior. (United States)

    MacStravic, R C


    Physicians' referring and admitting behavior as well as their clinical management practices are major determinants of hospitals' profitability under prospective payment. Four techniques are available to hospitals that seek to increase market share: Recruitment and retention strategies. In planning the mix of specialties represented on staff, hospitals should consider the effects of a physician's practice on the hospital's case mix. Peer pressure. Peer review programs in hospitals as well as through medical or specialty societies may help persuade physicians to alter their use of services. Education and information programs. Hospitals can assist physicians in patient management by conducting economic grand rounds, developing committees to study and communicate cost data to physicians, and providing information on alternatives to hospitalization. Incentives. Putting physicians at risk by linking planned expenditures to hospital financial performance can influence practice patterns. Other techniques include offering limited partnerships to medical staff members and merging the hospital and medical staff into one corporation. Hospitals may also need to influence physicians away from ventures that compete directly with the institution, such as ambulatory surgery centers.

  16. Philosophy on astronaut protection: A physician`s perspective

    Energy Technology Data Exchange (ETDEWEB)

    Holloway, H.


    The National Aeronautics and Space Administration has a responsibility to assure that proper ethical standards are applied in establishing and applying limits for the control of radiation doses to the astronauts. Such a responsibility obviously includes assuring that the astronauts are properly informed of the hazards associated with individuals missions and that they agree to accept the associated risks. The responsibility, however, does not end there. It includes a need to discuss how to initiate a discourse for developing the related ethical standards and how to determine who should be involved in their establishment. To assure that such proper communications on matters that encompass the realms of policy, science, politics, and ethics. There is also a need to mesh public perceptions with those of the scientific and technical community. This will be a monumental undertaking.

  17. Development of the physician satisfaction survey instrument. (United States)

    Soo Hoo, W E; Ramer, L


    Continuous quality improvement (CQI) activities depend on valid and reliable instruments to generate data. An evaluation of internal and external customer satisfaction is one of the pillars of the CQI process. This article describes the development of a valid and reliable instrument for measuring physicians' satisfaction with the orthopedic nursing units at a major medical trauma center. The physician satisfaction survey instrument was found to be internally consistent (alpha = .95). Confirmatory factor analysis revealed that 68% of the variance in physician satisfaction scores (eigenvalue = 8.14) was explained by using a single-factor model.

  18. Education and the physician's office laboratory. (United States)

    Fischer, P M; Addison, L A; Koneman, E W; Crowley, J


    The field of physicians' office laboratory testing has witnessed an increase in test volume and advances in technology, but little attention to educational issues. If this field is to continue to grow and to perform high-quality testing, primary care physicians will need to be trained in the role of laboratory director. Office staff will require "in the office" continuing education. Formal technician and technologist training will need to focus some attention on office test procedures. The development of these new educational programs will require the cooperative efforts of primary care physician educators, pathologists, allied health faculty, and the diagnostic equipment industry.

  19. A qualitative analysis of lung cancer screening practices by primary care physicians. (United States)

    Henderson, Susan; DeGroff, Amy; Richards, Thomas B; Kish-Doto, Julia; Soloe, Cindy; Heminger, Christina; Rohan, Elizabeth


    Lung cancer is the leading cause of cancer death in the United States, but no scientific organization currently recommends screening because of limited evidence for its effectiveness. Despite this, physicians often order screening tests such as chest X-rays and computerized tomography scans for their patients. Limited information is available about how physicians decide when to order these tests. To identify factors that affect whether physicians' screen patients for lung cancer, we conducted five 75-min telephone-based focus groups with 28 US primary care physicians and used inductive qualitative research methods to analyze their responses. We identified seven factors that influenced these physicians' decisions about screening patients for lung cancer: (1) their perception of a screening test's effectiveness, (2) their attitude toward recommended screening guidelines, (3) their practice experience, (4) their perception of a patient's risk for lung cancer, (5) reimbursement and payment for screening, (6) their concern about litigation, and (7) whether a patient requested screening. Because these factors may have conflicting effects on physicians' decisions to order screening tests, physicians may struggle in determining when screening for lung cancer is appropriate. We recommend (1) more clinician education, beginning in medical school, about the existing evidence related to lung cancer screening, with emphasis on the benefit of and training in tobacco use prevention and cessation, (2) more patient education about the benefits and limitations of screening, (3) further studies about the effect of patients' requests to be screened on physicians' decisions to order screening tests, and (4) larger, quantitative studies to follow up on our formative data.

  20. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety. (United States)

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian


    Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of medicine. In late 2007, at the behest of the US Congress, the Institute of Medicine embarked on a year-long examination of the scientific evidence linking resident physician sleep deprivation with clinical performance deficits and medical errors. The Institute of Medicine's report, entitled "Resident duty hours: Enhancing sleep, supervision and safety", published in January 2009, recommended new limits on resident physician work hours and workload, increased supervision, a heightened focus on resident physician safety, training in structured handovers and quality improvement, more rigorous external oversight of work hours and other aspects of residency training, and the identification of expanded funding sources necessary to implement the recommended reforms successfully and protect the public and resident physicians themselves from preventable harm. Given that resident physicians comprise almost a quarter of all physicians who work in hospitals, and that taxpayers, through Medicare and Medicaid, fund graduate medical education, the public has a deep investment in physician training. Patients expect to receive safe, high-quality care in the nation's teaching hospitals. Because it is their safety that is at issue, their voices should be central in policy decisions affecting patient safety. It is likewise important to integrate the perspectives of resident physicians, policy makers, and other constituencies in designing new policies. However, since its release, discussion of the

  1. First and foremost, physicians: the clinical versus leadership identities of physician leaders. (United States)

    Quinn, Joann Farrell; Perelli, Sheri


    Purpose - Physicians are commonly promoted into administrative and managerial roles in US hospitals on the basis of clinical expertise and often lack the skills, training or inclination to lead. Several studies have sought to identify factors associated with effective physician leadership, yet we know little about how physician leaders themselves construe their roles. The paper aims to discuss these issues. Design/methodology/approach - Phenomenological interviews were performed with 25 physicians at three organizational levels with physicians affiliated or employed by four hospitals within one health care organization in the USA between August and September 2010. A rigorous comparative methodology of data collection and analysis was employed, including the construction of analytic codes for the data and its categorization based on emergent ideas and themes that are not preconceived and logically deduced hypotheses, which is characteristic of grounded theory. Findings - These interviews reveal differences in how part- vs full-time physician leaders understand and value leadership roles vs clinical roles, claim leadership status, and identify as physician leaders on individual, relational and organizational basis. Research limitations/implications - Although the physicians in the sample were affiliated with four community hospitals, all of them were part of a single not-for-profit health care system in one geographical locale. Practical implications - These findings may be of interest to hospital administrators and boards seeking deeper commitment and higher performance from physician leaders, as well as assist physicians in transitioning into a leadership role. Social implications - This work points to a broader and more fundamental need - a modified mindset about the nature and value of physician leadership. Originality/value - This study is unique in the exploration of the nature of physician leadership from the perspective of the physician on an individual, peer

  2. Physician Fee Schedule Carrier Specific Files (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has condensed all 56 Physician Fee Schedule (PFS) carrier specific pricing files into one zip file. It is...

  3. Medicare Physician and Other Supplier Interactive Dataset (United States)

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data - Physician and Other...

  4. Facilitating Physician Access to Medical Reference Information



    Context: Computer-based medical reference information is augmenting—and in some cases, replacing—many traditional sources. For Kaiser Permanente (KP) physicians, this change presents both advantages and obstacles to finding medical reference information.

  5. Marketing to physicians in a digital world. (United States)

    Manz, Christopher; Ross, Joseph S; Grande, David


    Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made.

  6. Access to care: the physician's perspective. (United States)

    Tice, Alan; Ruckle, Janessa E; Sultan, Omar S; Kemble, Stephen


    Private practice physicians in Hawaii were surveyed to better understand their impressions of different insurance plans and their willingness to care for patients with those plans. Physician experiences and perspectives were investigated in regard to reimbursement, formulary limitations, pre-authorizations, specialty referrals, responsiveness to problems, and patient knowledge of their plans. The willingness of physicians to accept new patients from specific insurance company programs clearly correlated with the difficulties and limitations physicians perceive in working with the companies (p<0.0012). Survey results indicate that providers in private practice were much more likely to accept University Health Alliance (UHA) and Hawaii Medical Services Association (HMSA) Commercial insurance than Aloha Care Advantage and Aloha Quest. This was likely related to the more favorable impressions of the services, payments, and lower administrative burden offered by those companies compared with others.

  7. Measuring the health impact of human rights violations related to Australian asylum policies and practices: a mixed methods study

    Directory of Open Access Journals (Sweden)

    Mulholland Kim


    Full Text Available Abstract Background Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes. Methods We designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV refugees and 60 Iraqi Permanent Humanitarian Visa (PHV refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes. Results Forty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003. After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p ≤ 0.001 amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice. Conclusion Government asylum policies

  8. Physician Burnout: Coaching a Way Out



    Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-oriented a...

  9. Physician Burnout: Coaching a Way Out



    ABSTRACT Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-o...

  10. Physician alignment strategies and real estate. (United States)

    Czerniak, Thomas A


    When addressing locations of facilities after acquiring physician practices, hospitals should: Acknowledge the hospital's ambulatory plan is the driver rather than real estate assumed with the physician practices, Review the hospital ambulatory service plan for each submarket, Review the location of facilities within the service area and their proximity to one another, Sublease or sell existing facilities that are not appropriate, Ensure that the size and characteristics of each facility in the market are appropriate and consistent with the hospital's image.

  11. Sigmund Freud's physicians and "the monster". (United States)

    Tainmont, J


    Freud received treatment from several physicians--including rhinologists, oro-facial surgeons or radiotherapists--for a cancer of the palate. Furthermore, as a consequence of his operation, Freud was required to wear a prosthesis that he probably named "the monster". This paper provides some details about the physicians who cured Freud and looks at the prosthesis he was forced to wear until his death.


    Intrator, Orna; Lima, Julie; Wetle, Terrie Fox


    Objective Physician services are increasingly recognized as important contributors to quality care provision in nursing homes (NHs), but knowledge of ways in which NHs manage/ control physician resources is lacking. Data Primary data from surveys of NH Administrators and Directors of Nursing from a nationally representative sample of 1,938 freestanding U.S. NHs in 2009–2010 matched to Online Survey Certification and Reporting (OSCAR), aggregated NH Minimum Data Set (MDS) assessments and Medicare claims, and data from the Area Resource File (ARF). Methods The concept of NH Control of Physician Resources (NHCOPR) was measured using NH Administrators’ reports of management implementation of rules, policies, and procedures aimed at coordinating work activities. The NHCOPR scale was based on measures of formal relationships, physician oversight and credentialing. Scale values ranged from weakest (0) to tightest (3) control. Several hypotheses of expected associations between NHCOPR and other measures of NH and market characteristics were tested. Principal Findings The full NHCOPR score averaged 1.58 (SD=0.77) on the 0–3 scale. Nearly 30% of NHs had weak control (NHCOPR 2). NHCOPR exhibited good face- and predictive-validity as exhibited by positive associations with more beds, more Medicare services, cross coverage and number of physicians in the market. Conclusions The NHCOPR scale capturing NH’s formal structure of control of physician resources can be useful in studying the impact of NH’s physician resources on residents’ outcomes with potential for targeted interventions by education and promotion of NH administration of physician staff. PMID:24508327

  13. Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

    Directory of Open Access Journals (Sweden)

    Nir Eyal


    Full Text Available Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician clinicians (NPCs, resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.

  14. U.K. physicians' attitudes toward active voluntary euthanasia and physician-assisted suicide. (United States)

    Dickinson, George E; Lancaster, Carol J; Clark, David; Ahmedzai, Sam H; Noble, William


    A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

  15. Family physician perspectives on primary immunodeficiency diseases

    Directory of Open Access Journals (Sweden)

    Jordan eOrange


    Full Text Available Primary immunodeficiency diseases (PID include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed family practice physicians, of whom 44% reported following ≥1 patient with a PID. Selective immunoglobulin A (IgA, deficiency (21%, and chronic granulomatous disease (11% were most common and were followed by significantly more subspecialist immunologists (P<.0001. Use of intravenously administered Ig, and live viral vaccinations across PID was significantly different (P<.0001. Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4% vs. 79% of subspecialist immunologists, P<.0001. Family practice physicians will likely encounter patients with a PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care.

  16. The professional responsibility model of physician leadership. (United States)

    Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L


    The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the professional responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the professional medical ethics of Drs John Gregory and Thomas Percival. Four professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical professionalism, and to prevent and respond effectively to organizational dysfunction. The professional responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills.

  17. Discussion of “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”

    DEFF Research Database (Denmark)

    Bates, D. W.; Baysari, M. T.; Dugas, M.


    With these comments on the paper “Attitude of Physicians Towards Automatic Alerting in Computerized Physician Order Entry Systems”, written by Martin Jung and coauthors, with Dr. Elske Ammenwerth as senior author, the journal wants to stimulate a broad discussion on computerized physician order...... entry systems. An international group of experts have been invited by the editor of Methods to comment on this paper. Each of the invited commentaries forms one section of this paper....

  18. The Importance of Resources and Security in the Socio-Economic Integration of Refugees. A Study on the Impact of Length of Stay in Asylum Accommodation and Residence Status on Socio-Economic Integration for the Four Largest Refugee Groups in the Netherlands

    NARCIS (Netherlands)

    L. Bakker (Linda); J.M. Dagevos (Jaco); G.B.M. Engbersen (Godfried)


    textabstractIn many European countries, including the Netherlands, refugees stay in asylum accommodation pending a decision on their asylum request. While it seems evident that the lack of resources and insecurity about the future experienced during this stay will impact refugees' subsequent ability

  19. Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department. (United States)

    Colt, H G; Solot, J A


    To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

  20. Scientific integrity in Brazil. (United States)

    Lins, Liliane; Carvalho, Fernando Martins


    This article focuses on scientific integrity and the identification of predisposing factors to scientific misconduct in Brazil. Brazilian scientific production has increased in the last ten years, but the quality of the articles has decreased. Pressure on researchers and students for increasing scientific production may contribute to scientific misconduct. Cases of misconduct in science have been recently denounced in the country. Brazil has important institutions for controlling ethical and safety aspects of human research, but there is a lack of specific offices to investigate suspected cases of misconduct and policies to deal with scientific dishonesty.

  1. [Use of information sources by recently graduated physicians of Lima]. (United States)

    Mejia, Christian R; Caceres, Onice J; Vera, Claudia A; Nizama-Vía, Ayar; Curioso, Walter H; Mayta-Tristán, Percy


    In order to determine the use of information sources by recently graduated physicians of Lima, Peru in 2011, a survey was conducted among graduated physicians at seven universities. They were asked about the use of search engines in the health area during their year of medical internship [last year of medical school]. Regular use was defined as the source being used once a week or daily. For 490 respondents, regularly used information sources were SciELO, accessed by 173 (36.4%); PubMed 165 (34.4%); HINARI 117 (25.5%); UpToDate 98 (22.3%); Cochrane Library 94 (20.6%); LILACS 91 (19.8%); a hospital institutional library 70 (15.0%); LIPECS 39 (8.7%); and Peru BVS 42 (9.3%). Only a minority regularly accessed information sources related to health. It is necessary to improve capacity in the efficient use of various resources of scientific information in a continuous way and that reaches students and health professionals.

  2. [On the history of one form of social psychiatric care: family care exemplified on the Leipzig-Dösen asylum]. (United States)

    Lerner, Astrid; Steinberg, Holger


    On the basis of archival sources and primary literature the study exemplifies the history of one form of extramural social psychiatric care on the example of one particular institution, the town asylum of Leipzig-Dösen. Family care was introduced in Leipzig in 1904 by Georg Lehmann, primarily as an alternative treatment option. After initial opposition among the local population had been defeated, this form of treatment was soon quite accepted. Due to the socioeconomic changes as a result of World War I, the extent of family care was downsized. From 1940 family care in Dösen was abolished, due to a change in ideology. Part of the patients previously in family care fell victim to the National socialist T-4 programme to murder chronically mental ill. However, this study could also prove that at least one third of these patients survived. It can only be presumed to which extent this was due to their physical work being needed as a result of war shortages.

  3. A group-based approach to stabilisation and symptom management in a phased treatment model for refugees and asylum seekers

    Directory of Open Access Journals (Sweden)

    Mary E. A. Robertson


    Full Text Available Background: Traumatised asylum seekers and refugees may present with significant and complex mental health problems as a result of prolonged, extreme, and multiple traumatic events. This is further complicated by ongoing complex social circumstances. Concepts: In our work at the Traumatic Stress Clinic (TSC, the understanding afforded by the concept of complex posttraumatic stress disorder (PTSD together with the related notion of a phased treatment model, provides a useful framework for organising our work with this population. Clinical Applications: An explication of complex PTSD as it applies to our client group is presented, followed by a description of our phased treatment model and an outline of the core principles, which guide our clinical approach. Our symptom management and stabilisation groups have been developed and refined over time and draw on techniques from a variety of cognitive behavioural therapies. These are described in some detail with illustrative clinical case vignettes. Conclusion: This paper concludes with some reflections on the challenges inherent to working with this complex client group.

  4. Political representation for social justice in nursing: lessons learned from participant research with destitute asylum seekers in the UK. (United States)

    Cuthill, Fiona


    The concept of social justice is making a revival in nursing scholarship, in part in response to widening health inequalities and inequities in high-income countries. In particular, critical nurse scholars have sought to develop participatory research methods using peer researchers to represent the 'voice' of people who are living in marginalized spaces in society. The aim of this paper is to report on the experiences of nurse and peer researchers as part of a project to explore the experiences of people who find themselves destitute following the asylum process in the UK. In seeking to explore social injustice, three challenges are identified: lack of a robust political theory, institutional/professional constraints and an absence of skills to engage with the politics of social (in)justice. Each challenge is presented, opposing voices outlined and some possible solutions are suggested. The work of political theorist Nancy Fraser is used as a conceptual framework, in particular her focus on mis/framing and political representation for social justice. In addition, it is suggested that social justice needs to be further embedded in nursing policy and curriculum. Finally, nurses are encouraged to develop practical political skills to engage with both politics and the media in a neoliberal globalizing world.

  5. Exploring the potential of refugees and asylum seekers for social care work in England: a qualitative study. (United States)

    Hussein, Shereen; Manthorpe, Jill; Stevens, Martin


    Literature highlights the potential for refugees to contribute to the labour force of receiving countries. Such a contribution may be welcomed in sectors, such as social care, where demand for labour is increasing and high vacancy rates exist. This article reports on empirical data examining the potential of refugee communities to work in social care in England. The analysis is based primarily on 20 interviews with refugees and asylum seekers and five representatives of refugee support groups, conducted in 2008-2009. The findings of this sub-study are set within results obtained from other interviews as part of a multi-methods study examining the contribution of migrants to the English care sector. In-depth interviews were analysed thematically, guided by a theoretical framework linking employment, migration and the nature of care work. The findings highlight a general willingness of refugee participants to join the care workforce. Individual and structural barriers to increased employability were identified, as well as possible strategies to overcome them. Although the findings and discussions presented are based on data collected in England and are specific to the care sector, most are more generalisable and may inform strategies aiming at maximising refugees' employability in other sectors and in other developed states.

  6. Migrants and asylum seekers: policy responses in the United States to immigrants and refugees from Central America and the Caribbean. (United States)

    Mcbride, M J


    This article analyzes the complex political environment of US immigration and refugee policies in which tensions exist, especially with regard to Central America and the Caribbean. Recommendations for managing it more effectively in the future are discussed. Several western countries, including the US, have implemented stricter restriction policies as a result of the perceived threats to their economies and cultural homogeneity. In general, US immigration policy has addressed both economic concerns and domestic pressures, whereas US refugee policy has reflected foreign policy concerns. As a result of these policies, there has been an increasing number of immigrants from Mexico, as well as huge numbers of refugees from Cuba and Nicaragua. Yet, there has been limited acceptance of asylum seekers from Haiti, El Salvador and Guatemala. Among the policies passed by the US Congress to reduce illegal immigration and limit assistance to legal immigrants were the Welfare Reform Act, Illegal Immigration Reform, Immigration Responsibility Act of 1996, and the Proposition 187 movement. Revisions in the procedures of the Immigration and Naturalization Service were also made.

  7. Clinical Criteria for Physician Aid in Dying. (United States)

    Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A


    More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period.

  8. [Physician practice patterns and attitudes to euthanasia in Germany. A representative survey of physicians]. (United States)

    Kirschner, R; Elkeles, T


    Growing life expectancy and increasing pharmaceutical and technical methods in medicine are leading to more and more discussions among the general population and among physicians as to whether methods to shorten the sufferings of mortally ill persons should be legalised further. In Australia 60% of physicians wish to be able to perform active euthanasia if this would be legal. In the Netherlands physicians do not commit an offence if they perform euthanasia on the basis of ethically consented rules. In the FRG the National Board of Physicians (Bundesärztekammer) still rejects any liberalisation concerning active euthanasia. However, little is known of the attitudes and behaviour of physicians concerning the questions of active and passive euthanasia. Sponsored by Gruner and Jahr publishers for a magazine "Stern" publication we conducted a representative study among physicians working in hospitals and their colleagues in free practices concerning this topic. Beginning with qualitative interviews with 50 physicians we tested the questionnaire developed and looked for the data production method best fitting for this difficult matter resulting in telephone interviews or a self-administered questionnaire. In the main study a representative sample of n = 282 physicians in free practices and n = 191 physicians in hospitals were interviewed. The response rates were 94% and 51% respectively. Analysis of non-responses did not indicate any bias. Half of the physicians think that a broader discussion on euthanasia is necessary, 34% disagree and 17% consider even a discussion already dangerous. 6% of the physicians in hospitals and 11% in free practices have already experienced methods of active euthanasia. Half of the physicians have seen patients who strongly wished euthanasia, a situation which happens once in every two years. The majority of physicians feel a deep understanding but only a minority of 4% comply with the wish. The vast majority of physicians advocate

  9. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda

    Directory of Open Access Journals (Sweden)

    Vasan Ashwin


    Full Text Available Abstract Background The scarcity of physicians in sub-Saharan Africa – particularly in rural clinics staffed only by non-physician health workers – is constraining access to HIV treatment, as only they are legally allowed to start antiretroviral therapy in the HIV-positive patient. Here we present a pilot study from Uganda assessing agreement between non-physician clinicians (nurses and clinical officers and physicians in their decisions as to whether to start therapy. Methods We conducted the study at 12 government antiretroviral therapy sites in three regions of Uganda, all of which had staff trained in delivery of antiretroviral therapy using the WHO Integrated Management of Adult and Adolescent Illness guidelines for chronic HIV care. We collected seven key variables to measure patient assessment and the decision as to whether to start antiretroviral therapy, the primary variable of interest being the Final Antiretroviral Therapy Recommendation. Patients saw either a clinical officer or nurse first, and then were screened identically by a blinded physician during the same clinic visit. We measured inter-rater agreement between the decisions of the non-physician health workers and physicians in the antiretroviral therapy assessment variables using simple and weighted Kappa analysis. Results Two hundred fifty-four patients were seen by a nurse and physician, while 267 were seen by a clinical officer and physician. The majority (> 50% in each arm of the study were in World Health Organization Clinical Stages I and II and therefore not currently eligible for antiretroviral therapy according to national antiretroviral therapy guidelines. Nurses and clinical officers both showed moderate to almost perfect agreement with physicians in their Final Antiretroviral Therapy Recommendation (unweighted κ = 0.59 and κ = 0.91, respectively. Agreement was also substantial for nurses versus physicians for assigning World Health Organization Clinical

  10. Getting Healthy Scientifically

    Institute of Scientific and Technical Information of China (English)


    Recently,Zhao Zhixin,a Beijing-based instructor on scientific bodybuilding and public sport,was interviewed by China Youth Daily,sharing his views on how to get healthy scientifically.Edited excerpts follow:

  11. Opinions of Primary Care Family Physicians About Family Medicine Speciality Training Program

    Directory of Open Access Journals (Sweden)

    Hamit Sirri Keten


    Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304

  12. Patient Trust in Physicians: Empirical Evidence from Shanghai, China

    Directory of Open Access Journals (Sweden)

    Da-Hai Zhao


    Conclusions: Patient trust in physicians in Shanghai, China is higher than previously reported. Furthermore, the most crucial reason for patient distrust in physicians is the information asymmetry between patients and physicians, which is a natural property of the physician–patient relationship, rather than the so-called for-profit characteristic of physicians or patients' excessive expectations.

  13. Extensional scientific realism vs. intensional scientific realism. (United States)

    Park, Seungbae


    Extensional scientific realism is the view that each believable scientific theory is supported by the unique first-order evidence for it and that if we want to believe that it is true, we should rely on its unique first-order evidence. In contrast, intensional scientific realism is the view that all believable scientific theories have a common feature and that we should rely on it to determine whether a theory is believable or not. Fitzpatrick argues that extensional realism is immune, while intensional realism is not, to the pessimistic induction. I reply that if extensional realism overcomes the pessimistic induction at all, that is because it implicitly relies on the theoretical resource of intensional realism. I also argue that extensional realism, by nature, cannot embed a criterion for distinguishing between believable and unbelievable theories.

  14. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety


    Blum AB; Shea S; Czeisler CA; Landrigan CP; Leape L


    Long working hours and sleep deprivation have been a facet of physician training in the US since the advent of the modern residency system. However, the scientific evidence linking fatigue with deficits in human performance, accidents and errors in industries from aeronautics to medicine, nuclear power, and transportation has mounted over the last 40 years. This evidence has also spawned regulations to help ensure public safety across safety-sensitive industries, with the notable exception of...

  15. [Martin Luther and his physicians. A contribution to Luther year 1983]. (United States)

    Völker, A


    The Luther memorial year 1983 gives rise to describe the reformer's life from the point of view of his diseases as well as of the measures of the physicians treating him. The description of the work of these persons at the same time mediates insights into the level of the therapeutic measures of the 16th century as well as especially into the medico-scientific activities of the University of Wittenberg, where Martin Luther worked for about 35 years.

  16. Motivational determinants among physicians in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Souares Aurélia


    Full Text Available Abstract Introduction Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. Methods A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Results Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Conclusion Motivational determinants differed

  17. What is scientific misconduct?

    DEFF Research Database (Denmark)

    Hansen, Vagn Lundsgaard


    Selected examples from history are discussed to illustrate the many difficulties in judging scientific behavior. Scientific misconduct is not an a priori given concept but must first be defined. The definitions of scientific misconduct used in the USA and in Denmark are discussed as examples....


    Directory of Open Access Journals (Sweden)

    Narendra P


    Full Text Available PURPOSE: The purpose of the study was to assess the awareness of physicians in rural Kolar district towards diabetes and diabetic retinopathy. MATERIALS AND METHODS: A cross sectional survey was conducted in rural Kolar district during May 2013. The study participants were 38 physicians and 2 general practitioners who had special training in diabetes. The data were collected by means of filling up of pre-tested specially designed questionnaires focused on awareness towards Diabetes Mellitus and Diabetic retinopathy. The assessment was done by total score as satisfactory (Diabetic retinopathy awareness index >12, moderately satisfactory (DRAI 9-11 or unsatisfactory if index 12 was attained by only 55% (22/40 practitioners. Nearly 62.5% of physicians refer the diabetics to ophthalmologists only when they develop significant vision problems. CONCLUSION: This survey highlighted some of the lacunae in the knowledge about referral system of the general physicians and identified the need for improvement in awareness regarding the management of the patients with diabetes and diabetic retinopathy. To improve patient compliance, physician needs to educate their diabetic patients about the importance of setting an annual eye examination routinely before the development of vision loss.

  19. The physician in the technological age. (United States)

    Jaspers, K


    Translator's summary and notes: Karl Jaspers (1883-1969) argues that modern advances in the natural sciences and in technology have exerted transforming influence on the art of clinical medicine and on its ancient Hippocratic ideal, even though Plato's classical argument about slave physicians and free physicians retains essential relevance for the physician of today. Medicine should be rooted not only in science and technology, but in the humanity of the physician as well. Jaspers thus shows how, within the mind of every medical person, the researcher contests with the physician and the technician with the humanist. Jaspers therefore opposes all modern tendencies that regard men as abstractions. As a creative existentialist influenced by Kierkegaard, Nietzsche, and Husserl, he reasons that clinical medicine should always treat patients as irreducable individuals, and his thinking on psychotherapy argues for a realm of interiority, freedom, intelligibility, and existential communication that transcends the reach of the causal thinking of natural science. This essay, written in 1959, reflects Jaspers' lifelong preoccupation with the philosophical meaning of medicine (he received his MD degree in 1909) and the totality of the human person. It should significantly enhance our own comprehension of medical power, dangers, reasoning, and accomplishments.

  20. Patient attitudes toward emergency physician attire. (United States)

    Li, Siu Fai; Haber, Marc


    Previous studies have suggested that Emergency Department (ED) patient satisfaction is unaffected by physician attire. We conducted a before-and-after trial to test this hypothesis. A convenience sample of ED patients was surveyed during a 2-week period. In the first week, emergency physicians wore white coats and formal attire. In the second week, the same physicians wore scrubs. Patients were asked to indicate on a 100-mm visual analog scale (VAS) their ratings of physician appearance, satisfaction, and professionalism. The primary outcome was the difference in VAS scores between the two dress styles. There were 111 patients surveyed. There were no significant differences between patients' evaluation of appearance (Delta=-.68 mm VAS, 95% confidence interval [CI] -5.5 to 4.1), satisfaction (Delta=.83 mm VAS, 95% CI -3.0 to 4.6), or professionalism (Delta=-.46 mm VAS, 95% CI -3.6 to 2.6) between the two dress styles. Emergency physician attire does not affect patient satisfaction.

  1. Physician-Hospital Alignment in Orthopedic Surgery. (United States)

    Bushnell, Brandon D


    The concept of "alignment" between physicians and hospitals is a popular buzzword in the age of health care reform. Despite their often tumultuous histories, physicians and hospitals find themselves under increasing pressures to work together toward common goals. However, effective alignment is more than just simple cooperation between parties. The process of achieving alignment does not have simple, universal steps. Alignment will differ based on individual situational factors and the type of specialty involved. Ultimately, however, there are principles that underlie the concept of alignment and should be a part of any physician-hospital alignment efforts. In orthopedic surgery, alignment involves the clinical, administrative, financial, and even personal aspects of a surgeon's practice. It must be based on the principles of financial interest, clinical authority, administrative participation, transparency, focus on the patient, and mutual necessity. Alignment can take on various forms as well, with popular models consisting of shared governance and comanagement, gainsharing, bundled payments, accountable care organizations, and other methods. As regulatory and financial pressures continue to motivate physicians and hospitals to develop alignment relationships, new and innovative methods of alignment will also appear. Existing models will mature and evolve, with individual variability based on local factors. However, certain trends seem to be appearing as time progresses and alignment relationships deepen, including regional and national collaboration, population management, and changes in the legal system. This article explores the history, principles, and specific methods of physician-hospital alignment and its critical importance for the future of health care delivery.

  2. Can price controls induce optimal physician behavior? (United States)

    Wedig, G; Mitchell, J B; Cromwell, J


    Recently, budget-conscious policymakers have shifted their attention to the physician services market and have begun to consider a wide variety of price regulatory schemes for moderating expenditures in this market. In a recent article in this journal, Feldman and Sloan warned that price controls on physician services may cause undesirable declines in service quality, independent of their budgetary ramifications. Our aim in this article is to reconsider the effects of price controls in the broader context of insurance coverage and moral hazard. Our ultimate goal is to assess the benefits of price controls independent of specific assumptions about the controversial issues of demand inducement and income targeting. Using a simple extension of the Feldman/Sloan model, we find that price controls can be and almost certainly are welfare-improving as long as consumers are sufficiently well insured, regardless of where one stands on the inducement issue. The salutary effects of price controls, on the other hand, can be compromised by income-targeting behavior on the part of physicians. We also introduce evidence from Medicare's recent fee freeze to evaluate the possibility of income-targeting behavior empirically. While formal studies of income targeting suggest that its magnitude is small in cross-section, we warn that its effects may be larger over time; this is what our descriptive evidence suggests. We conclude that more dramatic short-term progress on physician fee inflation will require stronger measures, such as putting physicians at risk for consumer expenditures.

  3. 2012 financial outlook: physicians and podiatrists. (United States)

    Schaum, Kathleen D


    Although the nationally unadjusted average Medicare allowable rates have not increased or decreased significantly, the new codes, the new coding regulations, the NCCI edits, and the Medicare contractors' local coverage determinations (LCDs) will greatly impact physicians' and podiatrists' revenue in 2012. Therefore, every wound care physician and podiatrist should take the time to update their charge sheets and their data entry systems with correct codes, units, and appropriate charges (that account for all the resources needed to perform each service or procedure). They should carefully read the LCDs that are pertinent to the work they perform. If the LCDs contain language that is unclear or incorrect, physicians and podiatrists should contact the Medicare contractor medical director and request a revision through the LCD Reconsideration Process. Medicare has stabilized the MPFS allowable rates for 2012-now physicians and podiatrists must do their part to implement the new coding, payment, and coverage regulations. To be sure that the entire revenue process is working properly, physicians and podiatrists should conduct quarterly, if not monthly, audits of their revenue cycle. Healthcare providers will maintain a healthy revenue cycle by conducting internal audits before outside auditors conduct audits that result in repayments that could have been prevented.

  4. [Physician-assisted suicide in dementia?]. (United States)

    Lauter, H


    Physician-assisted suicide in Germany is limited by criminal law and disapproved by professional authorities. A physician who is willing to help a demented patient in terminating his life has to be definitely sure that the disease does not interfere with the patient's capacity for decision-making. In cases of early dementia the reason why assisted suicide will usually be requested is not the actual suffering of the patient but his negative expectations for the future. As long as there are sufficient opportunities for palliative care, the progressive course of the dementia process does not imply a state of unbearable suffering which could justify an assisted suicide. Nevertheless there may be certain circumstances--as for instance the value that an individual attributes to his integrity or to the narrative unity of his life--which might possibly provide an ethical justification for the assistance in life termination. A physician who helps a demented person in performing a suicidal act does not necessarily oppose essential principles of medical ethics. Yet, especially with regard to possible societal consequences of physician-assisted suicide in dementia, the rejecting attitude of medical authorities against that activity must be considered as well founded and legitimate. Deviations from these general guidelines ought to be respected as long as they are limited to exceptional situations and correspond to a thorough consideration of a physician's professional duties. They should remain open to public control, but not be ultimately specified by unequivocal normative regulations.

  5. Nurses and Physicians Attitudes toward Nurse-Physician Collaboration: A Survey from Gaza Strip, Palestine

    Directory of Open Access Journals (Sweden)

    Aymen Elsous


    Full Text Available Interprofessional collaboration and teamwork between nurses and physicians is essential for improving patient outcomes and quality of health services. This study examined the attitudes of nurses and physicians toward nurse-physician collaboration. A cross-sectional study was conducted among nurses and physicians (n=414 in two main referral public hospitals in the Gaza Strip using the Arabic Jefferson Scale of Attitude toward Physician-Nurse Collaboration. Descriptive statistics and difference of means, proportions, and correlations were examined using Student’s t-test, one-way ANOVA, and Pearson correlation and p<0.05 was considered as statistical significant. Response rate was 42.8% (75.6% for nurses and 24.4% for physicians. Nurses expressed more positives attitudes toward collaboration than physicians (M ± SD on four-point scale: 3.40±0.30 and 3.01±0.35, resp. and experience duration was not proved to have an interesting influence. Teamwork approach in the professional practice should be recognized taking into consideration that the relationship between physicians and nurses is complementary and nurses are partners in patient care.

  6. Nurses and Physicians Attitudes toward Nurse-Physician Collaboration: A Survey from Gaza Strip, Palestine (United States)

    Elsous, Aymen


    Interprofessional collaboration and teamwork between nurses and physicians is essential for improving patient outcomes and quality of health services. This study examined the attitudes of nurses and physicians toward nurse-physician collaboration. A cross-sectional study was conducted among nurses and physicians (n = 414) in two main referral public hospitals in the Gaza Strip using the Arabic Jefferson Scale of Attitude toward Physician-Nurse Collaboration. Descriptive statistics and difference of means, proportions, and correlations were examined using Student's t-test, one-way ANOVA, and Pearson correlation and p < 0.05 was considered as statistical significant. Response rate was 42.8% (75.6% for nurses and 24.4% for physicians). Nurses expressed more positives attitudes toward collaboration than physicians (M ± SD on four-point scale: 3.40 ± 0.30 and 3.01 ± 0.35, resp.) and experience duration was not proved to have an interesting influence. Teamwork approach in the professional practice should be recognized taking into consideration that the relationship between physicians and nurses is complementary and nurses are partners in patient care. PMID:28326194

  7. Using internal communication as a marketing strategy: gaining physician commitment. (United States)

    Heine, R P


    In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.

  8. Still on physicians' attitude to medical marijuana

    Directory of Open Access Journals (Sweden)

    Olukayode Abayomi


    Full Text Available Desai and Patel highlighted in a recent review that and ldquo;there are several issues related to medical marijuana, which concern public health such as its medical use, harmful effects, laws and physicians role. and rdquo; Certainly, physician's perspectives and position on the relative harm and benefits of marijuana contribute to the growing controversy over its legalization in western countries. Interestingly, the seeming resistance of physicians in western countries to marijuana prescription appears to mirror the position of psychiatrists in developing countries. For instance, in a recent survey of psychiatrists in Nigeria, up to 55% of psychiatrists were against the medical use of marijuana. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1098-1098

  9. Physician unionization: a threat to integration? (United States)


    Physicians, primarily those salaried by hospitals and health systems, are increasingly turning to labor unions to help them in their frustration over what they see as eroding clinical autonomy as well as diminishing compensation. Significantly, non-salaried physicians are also looking to the concept of collective bargaining as a tool in their negotiations with health insurers. The pro-labor doctors may get some of what they're looking for in the coming months and years, with a combination of economic and political forces driving the nascent trend forward regionally and nationwide. But victory won't come without a struggle and some major legal and regulatory hassles. And what will physician unionization mean for integrated health systems and other large healthcare organizations? Plenty, say industry observers and those in the trenches.

  10. Strategies for selling and consolidating physician practices. (United States)

    Mancino, D M


    The changing dynamics of healthcare service delivery is forcing many physicians to consider selling their practices to hospitals or health plans or consolidating them with other practices. Besides being subject to the corporate and tax requirements that apply to the sale of any business, the sale of physician practices is also subject to Federal fraud and abuse and self-referral laws. Several sale strategies are available to physicians who desire to sell or consolidate their practices, including asset sales, stock sales, forward mergers, drop down consolidations, spinoffs, and statutory mergers. Each strategy has advantages and disadvantages, but whichever strategy is chosen, both sellers and buyers must ensure that tax issues are addressed and that the transaction complies with the requirements of Federal anti-kickback and self-referral laws.

  11. Physician manpower expansionism: a policy review. (United States)

    Bloom, B S; Peterson, O L


    A lack of national health goals has allowed physician manpower policy to be dominated by an expansionist philosophy. Scarce resources have been channeled into the production of specialist physicians trained to provide complex and expensive care for uncommon diseases, using other scare and expensive resources and adding to the steep rise in medical care costs. Society seems to want access to primary care--a lack it views with dismay--and simultaneously fears increasing costs of care. Lack of access plus high cost might lead to rash implementation of other inappropriate policies. Success of policy decisions is pure serendipity if made without reliable and relevant information or based on inappropriate data, such as opinions alone. If information is unavailable, then physician manpower decisions should be delayed or, if made, implemented cautiously.

  12. Physician dual practice: A review of literature

    DEFF Research Database (Denmark)

    Socha, Karolina; Bech, Mickael


    of dual practice effects for the public health care. Methods A systematic literature review identified 23 positions on the subject consisting of journal articles, academic working papers, book chapter, and publications of the WHO. Results The subject is short on evidence. Theoretical analyses indicate......Objectives A combination of public and private practice by physicians, referred to as physician dual practice, has been receiving attention in connection with arguments about its negative impact for the public health care. This paper aims to review and critically discuss findings on the subject...... both positive and negative effects of dual practice. Some of the effects depend, however, on assumptions that are undermined in the broader literature. The analyses assume that the dual practitioners’ objective is to maximise income. Yet, while physicians seem to engage in a private practice on top...

  13. Euthanasia and physician-assisted suicide in cases of terminal cancer: the opinions of physicians and nurses in Greece. (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Govina, Ourania; Vlahos, Lambros


    The aim of this study was to investigate the opinions of physicians and nurses on euthanasia and physician-assisted suicide in advanced cancer patients in Greece. Two hundred and fifteen physicians and 250 nurses from various hospitals in Greece completed a questionnaire concerning issues on euthanasia and physician-assisted suicide. More physicians (43.3%) than nurses (3.2%, p physicians and 3.6% of nurses agreed on physician-assisted suicide. Forty-seven per cent of physicians and 45.2% of nurses would prefer the legalization of a terminally ill patient's hastened death; in the case of such a request, 64.2% of physicians and 55.2% of nurses (p = 0.06) would consider it if it was legal. The majority of the participants tended to disagree with euthanasia or physician-assisted suicide in terminally ill cancer patients, probably due to the fact that these acts in Greece are illegal.

  14. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis. (United States)

    Nosè, Michela; Ballette, Francesca; Bighelli, Irene; Turrini, Giulia; Purgato, Marianna; Tol, Wietse; Priebe, Stefan; Barbui, Corrado


    Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.

  15. Meeting the health and social needs of pregnant asylum seekers: midwifery students' perspectives. Part 2: Dominant discourses and approaches to care. (United States)

    Haith-Cooper, Melanie; Bradshaw, Gwendolen


    Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with "midwifery discourse" being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.

  16. The Impact of Direct Provision Accommodation for Asylum Seekers on Organisation and Delivery of Local Primary Care and Social Care Services: A Case Study

    LENUS (Irish Health Repository)

    Pieper, Hans-Olaf


    Abstract Background Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.

  17. Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis (United States)

    Nosè, Michela; Ballette, Francesca; Bighelli, Irene; Turrini, Giulia; Purgato, Marianna; Tol, Wietse; Priebe, Stefan; Barbui, Corrado


    Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future. PMID:28151992

  18. Physicians and architects - not an odd couple. (United States)

    Ohry, Avi


    One may think that there is no apparent interface between so different occupations as medicine and architecture. The historical and present-day connections between these academic fields resulted in the creation of healthy environment, housing and hospital. This article also speaks about another meeting point of these professions: physicians who became architects (or amateur-architects) and personal friendships between physicians, scientists, and architects which resulted in fruitful and progressive architectural creations. Both professions may be regard as art and science as well.

  19. Strategic integration of hospitals and physicians. (United States)

    Cuellar, Alison Evans; Gertler, Paul J


    A striking development in the healthcare market place has been the formation of strategic relationships between hospitals and physicians. Hospital-physician integration appears to be a response to rapidly expanding managed care health insurance. We examine whether integration lead to efficiency gains from transaction cost economies thereby allowing providers to offer managed care insurance plans lower prices or whether integration is really a strategy to improve bargaining power and thereby increase prices. We find that integration has little effect on efficiency, but is associated with an increase in prices, especially when the integrated organization is exclusive and occurs in less competitive markets.

  20. Screening for hepatocellular carcinoma by Egyptian physicians

    Institute of Scientific and Technical Information of China (English)

    Sahar; M; Hassany; Ehab; F; Abdou; Moustafa; Mohamed; El; Taher; Afaf; Adel; Abdeltwab; Hubert; E; Blum


    AIM: To assess the practice of Egyptian physicians in screening patients for hepatocellular carcinoma(HCC). METHODS: The study included 154 physicians from all over Egypt caring for patients at risk for HCC. The study was based on a questionnaire with 20 items. Each questionnaire consisted of two parts:(1) personal information regarding the physician(name, age, specialty and type of health care setting); and(2) professional experience in the care of patients at risk for HCC development(screening, knowledge about the cause and natural course of liver diseases and HCC risk). RESULTS: Sixty-eight percent of doctors with an MD degree, 48% of doctors with a master degree or a diploma and 40% of doctors with a Bachelor of Medicine, Bachelor of Surgery certificate considered the hepatitis C virus(HCV) genotype as risk factor for HCC development(P < 0.05). Ninety percent of physicians specialized in tropical medicine, internal medicine or gastroenterology and 67% of physicians in other specialties advise patients to undergo screening for HCV and hepatitis B virus infection as well as liver cirrhosis(P < 0.05). Eighty-six percent of doctors in University Hospitals and 69% of Ministry of Health(MOH) doctors consider HCV infection as the leading cause of HCC in Egypt(P < 0.05). Seventy-two percent of doctors with an MD degree, 55% of doctors with a master degree or a diploma, 56% of doctors with an MBBCH certificate, 74% of doctors in University Hospitals and 46% of MOH hospital doctors consider abdominal ultrasonography as the most important investigation in HCC screening(P < 0.05). Sixty-five percent of physicians in tropical medicine, internal medicine or gastroenterology and 37% of physicians in other specialties recommend as HCC screening interval of 3 mo(P < 0.05). Seventy-one percent of doctors with an MD degree, 50% of doctors with a master degree or diploma and 60% of doctors with an MBBCH certificate follow the same recommendation.CONCLUSION: In Egypt, physicians

  1. Physicians practicing other occupations, especially literature. (United States)

    Green, J P


    Literature has been the favored nonmedical pursuit of physicians probably because the practice of medicine is suffused with narratives, the patient's history being one. Arthur Conan Doyle regarded medicine as a "grim romance," Somerset Maugham as an opportunity to see "life in the raw," and William Carlos Williams treated "the patient as a work of art." These sentiments may be linked to humanistic medicine. At some medical schools, literature is taught in the context of and integrated with medicine in an attempt to enhance ethics and empathy which were explicitly expressed by some physician-writers.

  2. Automatization of physicians' phone-in hours. (United States)

    Turunen, J; Loula, P; Soininen, H


    In this paper we present a computer-based system that is designed to reduce the number of patient calls in physicians' phone-in hours. Simultaneously it will offer a parallel alternative channel for the patients to listen to their laboratory results. The system requirements were reliability, security and the low costs. The results showed after a two-month test period that the tailored system proved extremely successful. The average time that the physician saved by using this system was over 4 minutes and doctors can leave the messages to the server also outside the phone-in hours.

  3. [Quality in microbiology: contribution of the physician]. (United States)

    Fracheboud, Dominique; Chuard, Christian


    It is not always easy to choose the right microbiology test to order. Which pathogens to look for? What is the best-fitted method: microscopy, culture, tests for antigens, antibodies, genes or toxins? How to sample and transport the specimen? This article brings some answers to the questions the physician often asks when prescribing microbiology exams on stools, deep respiratory tract secretions, blood and wounds. By selecting the appropriate tests and respecting the guidelines for sampling and transporting specimens, the physician greatly contributes to the quality of results.

  4. Scientific dishonesty and good scientific practice. (United States)

    Andersen, D; Axelsen, N H; Riis, P


    Scientific dishonesty has been the subject of much public interest in recent years. Although the problem has had a low profile in Denmark, there is no reason to believe that it is non-existent. Several preconditions known to be important prevail here as well as in other countries, such as pressure to publish and severe competition for research grants and senior academic positions. The Danish Medical Research Council (DMRC) decided to respond to this problem by preparing a report on scientific dishonesty with suggestions to the research institutions on rules for good scientific practice and procedures for investigation of suspected dishonesty. To this end, an investigatory system was suggested. The system should consist of two regional committees and one national committee. They should be headed by high court judges and experienced health sciences researchers as members. The committees will investigate cases reported to them and conclude on whether dishonesty has been established and on whether the scientific work should be retracted. Sanctions shall remain the task of the institutions. Preventive measures comprise open access to and a long storage period for scientific data.

  5. [Ethics and occupational physicians: ethics and mission required for occupational physicians]. (United States)

    Fujino, Akihiro


    The ethics of occupational physicians are considered from the following three viewpoints: (1) their legal standing and ethics in job execution; (2) ethics in research in occupational medicine; and (3) ethics in the 21st century and fundamental issues. We discuss: in (1), the contract types of occupational physicians and their independency and neutrality, the protection of health information and privacy, and the use of authority and the security measures; in (2), ethical standards of medical research in Japanese and international organizations, the significance and role of ethics committees, and issues characteristic of occupational health research; and in (3), occupational physicians and politic ethics, the practical abilities and ethics necessary for occupational physicians, and the practice and philosophy of occupational medicine as an art. These considerations suggest that occupational physicians, who have a special status based on the governmental policy of the occupational physician system, should develop an ethical consciousness at the core of their duties and perform their mission with responsibility to employees and employers, all of whom are Japanese citizens. Finally, we propose that the ultimate mission of occupational physicians is "to practice occupational medicine as a branch of the humanities."

  6. A instituição asilar como fator potencializador da disfagia The asylum as worsening factor for dysphagia

    Directory of Open Access Journals (Sweden)

    Ana Maria Furkim


    Full Text Available OBJETIVO: verificar se as condições referentes à estrutura geral dos asilos, recursos humanos e rotinas diárias de alimentação em instituições asilares, podem potencializar alterações da dinâmica da deglutição em idosos. MÉTODOS: foi aplicado questionário aos dirigentes de cinco instituições asilares do município do Rio de Janeiro, no qual constavam perguntas em relação aos recursos materiais, humanos e rotina alimentar. RESULTADOS: o asilo do sistema privado foi o único a aproximar-se das condições ideais da estrutura geral para o atendimento do idoso. Em relação aos recursos humanos existentes, nenhum dos asilos possuía todos os profissionais exigidos pela portaria nº810/89. Em relação às rotinas diárias de alimentação, em uma das instituições pesquisadas, cuja maioria dos residentes não faziam uso de próteses dentárias, não havia restrição na consistência alimentar oferecida. Outro fator significativo diz respeito à negligência referente à higiene bucal, favorecendo a colonização de bactérias na cavidade oral, podendo agravar infecções pulmonares no caso de microaspirações. O fato dos idosos deitarem para dormir logo após o término das refeições, como ocorrido em três das instituições pesquisadas, tem grande importância na medida em que favorece a ocorrência de episódios de refluxo gastroesofágico. CONCLUSÃO: foram observados que em todas as instituições pesquisadas há fatores que podem potencializar um distúrbio de deglutição, como problemas em relação à estrutura geral e ou aos recursos humanos e ou relativos à rotina alimentar estabelecida.PURPOSE: to check if the conditions related to general structure, human resources and daily routine of feeding in asylums can increase the chances for an alteration in the deglutition process of the elderlies. METHODS: a questionnaire was elaborated to be applied to the directors of five institutions in the city of Rio de Janeiro

  7. Factors influencing consumers' selection of a primary care physician. (United States)

    McGlone, Teresa A; Butler, E Sonny; McGlone, Vernon L


    There is a growing body of literature regarding patient choice of health care plans, patient satisfaction, and patient evaluation of health care quality, but there is little information concerning the factors that influence the initial selection of a primary care physician (PCP). This exploratory study identifies and conceptualizes the physician selection dimensions which include: physician reputation/manner, physician record, physician search, consumer self-awareness, physician location, physician qualifications, physician demographics, office atmospherics, house calls/insurance, and valuing patient opinion. The study also develops and tests a scale for PCP selection using factor analysis which is demonstrated to be valid, and determines significant differences of variables, which include education level, gender, and age, using a summated scale. The study is of use to physicians in their targeting and communication strategies, and to researchers seeking to refine the scale.

  8. Patient and house officer attitudes on physician attire and etiquette. (United States)

    Dunn, J J; Lee, T H; Percelay, J M; Fitz, J G; Goldman, L


    To study patient preferences on physician attire and etiquette, we interviewed 200 patients on the general medical services of teaching hospitals in Boston and San Francisco. Of these 200 patients, 65% believed physicians should wear a white coat, 27% believed physicians should not wear tennis shoes, 52% believed physicians should not wear blue jeans, 37% believed male physicians should wear neckties, and 34% believed female physicians should wear dresses or skirts. Forty percent of patients wanted physicians to address them by first name, but only 10% of patients wanted to address their physicians by first name. A concurrent mailed survey of 74 medical house staff members at the two hospitals revealed wide variability in physicians' attire and in how patients were addressed at each institution. Thus, many house officers had habits that were less formal than a substantial portion of their patients preferred.

  9. When the foundations of life have been upset... An integrated clinical and experimental study with refugees an asylum seekers

    Directory of Open Access Journals (Sweden)

    Schiltz, Lony


    Full Text Available Aim Recent research results in clinical psychology, health psychology and neurobiology underline the relationship between dissociative states, complex posttraumatic syndromes and borderline functioning [11]. Our study is meant to investigate the traumatic hypothesis of borderline functioning and to develop appropriate psychotherapeutic measures based on artistic mediations.Material and Methods.To estimate the effect of traumatic events, from the beginning of life up to recent stressors, linked to natural catastrophes, war, political persecution and migration, we undertook an integrated clinical and experimental study with a sample of 73 refugees and asylum seekers. In a second stage, those who suffered from PTSD or complex post-traumatic states were offered to attend arts psychotherapeutic sessions.To investigate the personality functioning at the structural level, we used a mixed quantitative and qualitative methodology, combining a semi-structured biographical interview, a projective test, i.e. the Sentences Completion Test, for which we developed a new manner of interpretation, and psychometric scales, i.e. the HADS and the Index of Wellbeing . Furthermore, we analysed the artistic production (pictures, stories written under musical induction with the help of rating scales constructed in the phenomenological and structural tradition.Results. With the help of non parametric multidimensional statistics, we extracted two profiles of personality functioning, linked either to repeated breaks, negligence and maltreatment from the beginningof life, or either to a recent external catastrophe, interrupting a continuous life course. Through the evaluation of the arts therapeutic sessions, we could note the first signs of resumption of the blocked process of subjectivation.Discussion.The results of the study support the traumatogenic hypothesis of borderline functioning, as well as current clinical considerations concerning the defensive role of

  10. From the Horn of Africa to the Middle East: Human trafficking of Eritrean asylum seekers across borders

    Directory of Open Access Journals (Sweden)

    Laurie Lijnders


    Full Text Available Each month hundreds of men, women, and children flee Eritrea as a result of grave violations of human rights committed by the Eritrean government. Travelling across borders, an estimated 36,000 Eritreans have been smuggled to Israel over the past seven years. For 31 per cent of those interviewed for this research, their migration involved abduction and forced movement for extortion among other abuses. Migrants have been abducted in Eastern Sudan near the border with Eritrea and then sold to criminal gangs along the Sudan-Egypt border. The gangs forcibly hold the migrants captive in the Northern Sinai desert. Many who made the journey reported being held hostage and subjected to brutal treatment in Eastern Sudan and the Northern Sinai desert, including gang rape of men and women, whipping, and various other methods of physical and psychological torture. Although not a traditional trafficking scenario, this paper explores the phenomenon in relation to borders. Intricate trafficking networks have exploited refugee outflows from Eritrea, turning the area around the Sudanese side of the Eritrea-Sudan border into a breeding ground for abductions, aggravated smuggling, and trafficking. While crossing borders to claim asylum may facilitate some protection from abuses perpetrated by the Eritrean government, it has created a new set of challenges for Eritrean migrants who now must find protection and safety from kidnappers. While refugees must cross borders to find safety, those same borders create the circumstances for trafficking networks to operate. Unless the dynamics of those involved changes, human rights abuses such as extortion, torture and human trafficking in Eastern Sudan and Sinai are expected to continue.

  11. The Changing Distribution of Physicians in Regionville. (United States)

    Sorensen, Andrew A.; Kunitz, Stephen J.


    The consequences of medical reform, the myth of the family doctor, the importance of foreign medical graduates in providing medical care, the importance of facilities and innovative practice settings for the attraction of physicians, and the significance of suburbanization in influencing the growth of the local service sector are addressed in this…

  12. Administrative Management of Small Group Physician Practice. (United States)


    life. If you can get it right, three is the magic number. Newman’s attitude is supported by Freidson who says, "Physician’s satisfaction may be more...anization--The Social Construction of Professional Work, Ed. Blankenship, R. L., Wiley, 1977. 16. Freidson , E., "The Organization of Medical Practice

  13. Physicians' Preferences for Asthma Guidelines Implementation



    Purpose Patient care based on asthma guidelines is cost-effective and leads to improved treatment outcomes. However, ineffective implementation strategies interfere with the use of these recommendations in clinical practice. This study investigated physicians' preferences for asthma guidelines, including content, supporting evidence, learning strategies, format, and placement in the clinical workplace. Methods We obtained information through a questionnaire survey. The questionnaire was distr...

  14. Navigating Government Service as a Physician (United States)

    Koh, Howard K.


    Working in government can be a remarkable life experience for anyone but particularly for those who have trained in the worlds of medicine and public health. This article describes some lessons learned from a physician initially based in academic medicine and public health who has since spent more than a decade serving in leadership positions at…

  15. The physician's perception of health care. (United States)

    Lawrence, R S


    A general malaise appears to have settled on the American medical scene; most Americans continue to trust their own physicians but do not trust the medical profession or the health system as a whole, while many physicians feel harassed by the regulatory, bureaucratic, or litigious intrusions upon the patient-doctor relationship. The strains on mutual trust among physicians, their patients, and the public are being played out against a background of contradictions. The advances of biomedicine are offset by the neglect of social and behavioural aspects of medical care. Preoccupation with specialized, hospital-based treatment is accompanied by isolation of public health and preventive interests from medical education and practice. Society remains uncertain whether health care is a right or a privilege while accepting public responsibility for financing the health care of certain groups such as the indigent sick (Medicaid), the elderly (Medicare), Native Americans, or members of the armed forces and veterans. Rising expectations about better outcomes through advances in technology are accompanied by rising anxieties about cost, appropriateness of care, access, and quality. Physicians must alter their perception of health care by adopting a population-based approach to need, a commitment to restoring equity in staffing patterns and compensation between primary care and specialty care, and adoption of a social contract that provides for full access by all Americans to basic cost-effective preventive and clinical services before spending on less cost-effective services.

  16. The Nation's Physician Workforce and Future Challenges. (United States)

    Grover, Atul; Orlowski, Janis M; Erikson, Clese E


    There is much debate about the adequacy of the U.S. physician workforce and projections of its future size, distribution and composition. Beginning with 3 observations about the workforce we believe are largely not subject to dispute, we address the debate by providing an overview of the current state of the workforce and Graduate Medical Education in the United States; a brief history of both calls for graduate medical education reform since 1910 and the recent, intense debate about the reliability of workforce projections; and a discussion of the challenges to understanding the physician workforce. We draw 3 concluding observations: (1) Precisely because projections can be unpredictable in their impact on both physician workforce behavior and public policy development, policy makers need to devote more attention to workforce projections, not less. (2) More research devoted specifically to the workforce implications of delivery and payment reforms is strongly needed. (3) Such research must be pursued with a sense of urgency, given the rapid aging of the Baby Boom generation, which will put a disproportionate demand on the nation's physician workforce.

  17. [Physicians--victims or promoters of corruption?]. (United States)

    Kind, M


    According to the media the recent physician bribery scandal in Germany draws ever further sets. The public prosecutor determines against hospital physicians and coworkers of a pharmaceutical firm. The suspicion: Physicians were recompensed for using up medicines particularly with pleasure trips. Which is qualified in Germany regularly as bribery and advantage grant as well as aid for tax evasion, is punishable in Austria as unfaithfulness, gift acceptance as well as bribery. The following contribution lights up--from Austrian view--the criminal page of the narrow burr between permitted sponsoring and undue corruption in the medicine. Bribery is globally punishable in Austria. Allowances to physicians can be for the payee in particular gift acceptance (section 153a StGB) or gift acceptance by leading employees of a public enterprise (section 305 StGB), for the giver in particular bribery (section 307 StGB). Occasional allowances, which are not located in connection to a concrete business, but only promoted the sympathetic consideration of the recipient, are not usually punishable. The punishing frameworks for offensces reach up to three years imprisonment. In addition still the absorption of enriching comes (section 20 StGB).

  18. Physicians' appraisal of mobile health monitoring

    NARCIS (Netherlands)

    Okazaki, Shintaro; Castaneda, J. Alberto; Sanz, Silvia; Henseler, Jörg


    This study addresses what factors influence and moderate Japanese physicians' mobile health monitoring (MHM) adoption for diabetic patients. In light of the multilevel sequential check theory, the study tests whether novelty seeking, self-efficacy, and compatibility moderate the effects of overall q

  19. Instrumental and affective aspects of physician behavior.

    NARCIS (Netherlands)

    Bensing, J.M.; Dronkers, J.


    In a semi-replication study, 103 videotaped real-life general practice consultations of patients with hypertension were observed with Roter's interaction Analysis System (RIAS). RIAS consists of a detailed category system meant to measure each verbal utterance of physician and patient (distinguished

  20. Integrating hospital and physician revenue cycle operations. (United States)

    Lockett, Kevin M


    Standardized revenue cycle processes should be a key component of the coordinated care delivery strategy organizations will require to complete the transition to population health management. Integrating hospital and physician revenue cycle operations can help organizations better navigate new payment models, reduce costs, and improve value. The most comprehensive approach involves integrating patient access and registration, coding operations, and receivables management across different settings.

  1. 42 CFR 410.20 - Physicians' services. (United States)


    .... (a) Included services. Medicare Part B pays for physicians' services, including diagnosis, therapy...) of the Act. (2) A doctor of dental surgery or dental medicine. (3) A doctor of podiatric medicine. (4... list, provided by CMS, of plastic and dental surgeries that may be covered by Medicare and that have...

  2. Physician Self-Audit: A Scoping Review (United States)

    Gagliardi, Anna R.; Brouwers, Melissa C.; Finelli, Antonio; Campbell, Craig E.; Marlow, Bernard A.; Silver, Ivan L.


    Introduction: Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The…

  3. Using financial ratios to assess physician practices. (United States)

    Doelling, P M


    Purchasing physician practices has become commonplace in the health care environment today. The most commonly used method to evaluate a physician's practice is the medical practice assessment. Although assessments include examining revenues, expenses, staffing ratios, collection ratios and other pertinent statistics, one of the often overlooked financial areas is the balance sheet. Evaluating a business, such as a medical practice, requires a thorough examination of the total financial picture including assets, liabilities, owner's equity or net worth, and the relationship of all the variables to each other. Ratios put the numbers into perspective by creating relationships between the balance sheet variables of assets, liabilities and owner's equity, and key income statement components of revenues, expenses and net income. As a result, ratios provide a unique perspective to the assessment process and enable a more complete analysis. This article examines the types and uses of ratios to assist physicians, managers, and hospital executives to better evaluate the financial viability of a physician's solo or group practice.

  4. Physician joint ventures: new opportunities and risks. (United States)

    Miller, Jeremy N


    Joint ventures involving physicians and institutions or lay investors had fallen out of favor in recent years because of concerns about transgressing government regulations. These regulations have now been clarified leading to a resurgent interest in these arrangements. This article outlines the business principles, control issues, legal setting, and the various modalities for joint venturing.

  5. Physician-assisted death and the anesthesiologist. (United States)

    Mottiar, Miriam; Grant, Cameron; McVey, Mark J


    Although physician-assisted death (PAD) is established in certain countries, the legality and ethics of this issue have been debated for decades in Canada. The Supreme Court of Canada has now settled the issue of legality nationally, and as a result of the decision in Carter v. Canada, PAD (which includes both physician-assisted suicide and euthanasia) will become legal on February 6, 2016. It is difficult to predict the potential demand for PAD in Canada. This paper highlights other countries' experiences with PAD in order to shed light on this question and to forecast issues that Canadian physicians will face once the change to the law comes into effect. At present, there is no legislative scheme in place to regulate the conduct of PAD. Physicians and their provincial colleges may find themselves acting as the de facto regulators of PAD if a regulatory vacuum persists. With their specialized knowledge of pharmacology and interdisciplinary leadership, anesthesiologists may be called upon to develop protocols for the administration of PAD as well as to administer euthanasia. Canadian anesthesiologists currently have a unique opportunity to consider the complex ethical issues they will face when PAD becomes legal and to contribute to the creation of a regulatory structure that will govern PAD in Canada.

  6. Physician Fee Schedule National Payment Amount File (United States)

    U.S. Department of Health & Human Services — The significant size of the Physician Fee Schedule Payment Amount File-National requires that database programs (e.g., Access, dBase, FoxPro, etc.) be used to read...

  7. Depression-Burnout Overlap in Physicians.

    Directory of Open Access Journals (Sweden)

    Walter Wurm

    Full Text Available Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three "core" components (emotional exhaustion, depersonalization and low personal accomplishment are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians.In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI, the Hamburg Burnout Inventory (HBI, as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8% participated. The data of 5897 participants were suitable for analysis.Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21-4.06 for physicians with mild, 10.14 (95% CI 7.58-13.59 for physicians with moderate, 46.84 (95% CI 35.25-62.24 for physicians with severe burnout and 92.78 (95% CI 62.96-136.74 for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components. The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92 explained more HBI_sum variance than the three "core" components (adj.R2 = 0.85 of burnout combined. Cronbach's alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three "core" components.This study demonstrates the

  8. Depression-Burnout Overlap in Physicians (United States)

    Wurm, Walter; Vogel, Katrin; Holl, Anna; Ebner, Christoph; Bayer, Dietmar; Mörkl, Sabrina; Szilagyi, Istvan-Szilard; Hotter, Erich; Kapfhammer, Hans-Peter; Hofmann, Peter


    Background Whether burnout is a distinct phenomenon rather than a type of depression and whether it is a syndrome, limited to three “core” components (emotional exhaustion, depersonalization and low personal accomplishment) are subjects of current debate. We investigated the depression-burnout overlap, and the pertinence of these three components in a large, representative sample of physicians. Methods In a cross-sectional study, all Austrian physicians were invited to answer a questionnaire that included the Major Depression Inventory (MDI), the Hamburg Burnout Inventory (HBI), as well as demographic and job-related parameters. Of the 40093 physicians who received an invitation, a total of 6351 (15.8%) participated. The data of 5897 participants were suitable for analysis. Results Of the participants, 10.3% were affected by major depression. Our study results suggest that potentially 50.7% of the participants were affected by symptoms of burnout. Compared to physicians unaffected by burnout, the odds ratio of suffering from major depression was 2.99 (95% CI 2.21–4.06) for physicians with mild, 10.14 (95% CI 7.58–13.59) for physicians with moderate, 46.84 (95% CI 35.25–62.24) for physicians with severe burnout and 92.78 (95% CI 62.96–136.74) for the 3% of participants with the highest HBI_sum (sum score of all ten HBI components). The HBI components Emotional Exhaustion, Personal Accomplishment and Detachment (representing depersonalization) tend to correlate more highly with the main symptoms of major depression (sadness, lack of interest and lack of energy) than with each other. A combination of the HBI components Emotional Exhaustion, Helplessness, Inner Void and Tedium (adj.R2 = 0.92) explained more HBI_sum variance than the three “core” components (adj.R2 = 0.85) of burnout combined. Cronbach’s alpha for Emotional Exhaustion, Helplessness, Inner Void and Tedium combined was 0.90 compared to α = 0.54 for the combination of the three

  9. Are Physicians Good Candidates For Recommending Diet?

    Directory of Open Access Journals (Sweden)

    S Hosseini


    Full Text Available Background: Primary prevention status and goals in 2010 are promoting healthy weight and eating habits and dietary ma­nipula­tion considered in all reports to be the cornerstone of prevention and management of chronic diseases. Since in de­velop­ing countries physicians are in the front line of responding patients' questions regarding their diet, we decided to evalu­ate their necessary nutritional knowledge for accomplishing this mission and to identify consideration for improving the paucity of nutrition education and the nutrition literacy in medical training program, we did the same education in medi­cal students.Methods: Applied nutritional knowledge of 150 general, specialist and sub specialist physicians and 202 medical students was evaluated by structured self administrative questionnaire. Eighteen questions which could be self completed in less than 5 minutes were filled by each subject. Results: The percentage of physicians who gave dietary recommendations to their patients was 73% but the mean correct re­sponds to questions were 3.73±2.15 and 5.87±2.14 out of 14 questions in physicians and medical students respectively. Conclusions: Our data show deficient applied nutritional knowledge of physicians is one of   the main problems of hospital mal­nu­trition. As the same results were shown in medical students, this can not be due to forgetting what was learned but can be related to the quality of nutrition training.  

  10. Adoption of information technology by resident physicians. (United States)

    Parekh, Selene G; Nazarian, David G; Lim, Charles K


    The Internet represents a technological revolution that is transforming our society. In the healthcare industry, physicians have been typified as slow adopters of information technology. However, young physicians, having been raised in a computer-prevalent society, may be more likely to embrace technology. We attempt to characterize the use and acceptance of the Internet and information technology among resident physicians in a large academic medical center and to assess concerns regarding privacy, security, and credibility of information on the Internet. A 41-question survey was distributed to 150 pediatric, medical, and surgical residents at an urban, academic medical center. One hundred thirty-five residents completed the survey (response rate of 90%). Responses were evaluated and statistical analysis was done. The majority of resident physicians in our survey have adopted the tools of information technology. Ninety-eight percent used the Internet and 96% use e-mail. Two-thirds of the respondents used the Internet for healthcare-related purposes and a similar percentage thought that the Internet has affected their practice of medicine positively. The majority of residents thought that Internet healthcare services such as electronic medical records, peer-support websites, and remote patient monitoring would be beneficial for the healthcare industry. However, they are concerned about the credibility, privacy, and security of health and medical information online. The majority of resident physicians in our institution use Internet and information technology in their practice of medicine. Most think that the Internet will continue to have a beneficial role in the healthcare industry.

  11. ["What do physicians really read?" Medical journals and pharma-marketing between 1900 and the late 1970s]. (United States)

    Thoms, Ulrike


    Scientific Journals are widely used sources in the history science. First and foremost they are analyzed under the aspect of professionalization and the development of scientific topics. However, the impact of the increasing number of advertisements on the journals has been almost systematically excluded from historical analysis. The paper analyses the relations between pharma marketing and medical journals. However, the emphasis here is not so much on the development of print advertisements. Instead the paper uses sources, which were produced in the process of marketing to access the history of the medical scientific journal, its change and its reception by physicians.

  12. The attitudes of Greek physicians and lay people on euthanasia and physician-assisted suicide in terminally ill cancer patients. (United States)

    Parpa, Efi; Mystakidou, Kyriaki; Tsilika, Eleni; Sakkas, Pavlos; Patiraki, Elisabeth; Pistevou-Gombaki, Kyriaki; Galanos, Antonis; Vlahos, Lambros


    The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide (P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death.

  13. Sleep and recovery in physicians on night call: a longitudinal field study

    Directory of Open Access Journals (Sweden)

    Malmberg Birgitta


    Full Text Available Abstract Background It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call. Methods Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons. Results Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p Conclusions Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.

  14. Robotics and medicine: A scientific rainbow in hospital. (United States)

    Jeelani, S; Dany, A; Anand, B; Vandana, S; Maheswaran, T; Rajkumar, E


    The journey of robotics is a real wonder and astonishingly can be considered as a scientific rainbow showering surprising priceless power in the era of future technologies. The astonishing seven technologies discussed in this paper are da Vinci Robotic surgical system and sperm sorters for infertility, Veebot for blood investigation, Hanako the robotic dental patient for simulating the dental patient and helping a trainee dentist, RP-7 robot who is around-the-clock physician connecting the physician and patient, Robot for Interactive Body Assistance (RIBA) who is a RIBA serving as a nurse, Bushbot serving as a brilliant surgeon, and Virtibot helping in virtual autopsy. Thus, robotics in medicine is a budding field contributing a great lot to human life from before birth to afterlife in seven forms thus gracefully portraying a scientific rainbow in hospital environment.

  15. The Relationships among Physician Nonverbal Immediacy and Measures of Patient Satisfaction with Physician Care. (United States)

    Conlee, Connie J.; And Others


    Examines the relationship among four dimensions of patient satisfaction with physician care and nonverbal immediacy. Finds a significant positive correlation between nonverbal immediacy and overall patient satisfaction, with the strongest correlation to the attention/respect factor. (SR)

  16. Free Telling in the Total Space?—On the Procedures of Power in the Asylum Procedure and Their Relevance for Biographical Interviews of Refugees

    Directory of Open Access Journals (Sweden)

    Marc Thielen


    Full Text Available Based on a research project with migrants from Iran this paper focuses on the influence of a strictly regulated German asylum life situation on autobiographical telling in research contexts. Regardless of the specific research topic the interview situation and the relationship between interviewer and interviewee always influence shape, form and fashion of the biographical narration. As a result of the strict regimentation of the asylum procedures and their far-reaching impact on biographies in the "total refugee space," an intensification of the hierarchical structure in the interview situation can be observed. Considering the empirical results this paper calls for a reflexive biographical research. This approach has to analyze the power relations in the transnational space and their consequences on the research process. It also has to recognize that researchers and interviewees are not only confined to their culture differences, but that the setting comprises all intersectional localizations, which are defined by social and economic status, nationality, gender, sexuality etc. URN: urn:nbn:de:0114-fqs0901393

  17. The Christian physician in the non-Christian institution: objections of conscience and physician value neutrality. (United States)

    Peppin, John F


    Christian physicians are in danger of losing the right of conscientious objection in situations they deem immoral. The erosion of this right is bolstered by the doctrine of "physician value neutrality" (PVN) which may be an impetus for the push to require physicians to refer for procedures they find immoral. It is only a small step from referral to compelling performance of these same procedures. If no one particular value is more morally correct than any other (a foundational PVN premise) and a physician ought to be value neutral, than conscientious objection to morally objectionable actions becomes a thing of the past. However, the argument for PVN fails. Therefore, Christian physicians should state their values openly, which would allow patients the ability to choose like-minded physicians. Some possible responses to this erosion of conscientious objection include, disengagement from non-Christian institutions, the formation of distinctly Christian medical institutions and political action. However, for the Christian the initial focus should be on a life of holiness which requires each of us to avoid evil.

  18. 'They first killed his heart (then) he took his own life'. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers. (United States)

    Procter, Nicholas G


    This is the first in a two-part series of papers examining mental health issues for refugees and asylum seekers. Beginning with the suicide of an asylum seeker in Scotland, the paper emphasizes mental health issues for adult and child asylum seekers, stress and memory, suicide, self-harm, risk and protective factors, compulsory health treatments and the prevention of mental illness. It sets the scene for the second paper by drawing implications for nursing practice in the community. Although most literature on refugee and asylum seeker mental health exists outside of nursing scholarship, a majority of the issues reviewed in this paper are mutual challenges for all in the health and helping professions. Nurses interested in refugee and migration issues face two intertwined challenges: that of how to assist migrants with their diverse mental health needs and how, at the same time, to contribute to a society that can promote mental health for all by taking on both the difficulties and opportunities posed by cultural diversity.

  19. If You Want to Go Fast Go Alone, If You Want to Go Far Go Together: On Context-Sensitive Group Treatment of Asylum Seekers and Refugees Traumatized by War and Terror

    NARCIS (Netherlands)

    Drozdek, B.


    This thesis presents a model for understanding psychological consequences of exposure to war, torture and political violence in asylum seekers and refugees. This contextual, developmental, and culture-sensitive model is based on theoretical and empirical findings and implies framing and interpreting

  20. Scientific rigor through videogames. (United States)

    Treuille, Adrien; Das, Rhiju


    Hypothesis-driven experimentation - the scientific method - can be subverted by fraud, irreproducibility, and lack of rigorous predictive tests. A robust solution to these problems may be the 'massive open laboratory' model, recently embodied in the internet-scale videogame EteRNA. Deploying similar platforms throughout biology could enforce the scientific method more broadly.