Showing papers by "Ira Madan published in 2014"

Three-year change in the wellbeing of orphaned and separated children in institutional and family-based care settings in five low- and middle-income countries.

Abstract: Background: With more than 2 million children living in group homes, or ‘‘institutions’’, worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutiondwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6‐12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11‐27% of total variation) or care settings within sites (8‐14%), with most variation attributable to differences between children within settings (60‐75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0‐4% at baseline, 0‐3% at 36-month follow-up, and 0‐4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting.

‘You feel you've been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council

Abstract: Objective To explore the views of sick doctors on their experiences with the General Medical Council (GMC) and their perception of the impact of GMC involvement on return to work. Design Qualitative study. Setting UK. Participants Doctors who had been away from work for at least 6 months with physical or mental health problems, drug or alcohol problems, GMC involvement or any combination of these, were eligible for inclusion into the study. Eligible doctors were recruited in conjunction with the Royal Medical Benevolent Fund, the GMC and the Practitioner Health Programme. These organisations approached 77 doctors; 19 participated. Each doctor completed an in-depth semistructured interview. We used a constant comparison method to identify and agree on the coding of data and the identification of central themes. Results 18 of the 19 participants had a mental health, addiction or substance misuse problem. 14 of the 19 had interacted with the GMC. 4 main themes were identified: perceptions of the GMC as a whole; perceptions of GMC processes; perceived health impacts and suggested improvements. Participants described the GMC processes they experienced as necessary, and some elements as supportive. However, many described contact with the GMC as daunting, confusing and anxiety provoking. Some were unclear about the role of the GMC and felt that GMC communication was unhelpful, particularly the language used in correspondence. Improvements suggested by participants included having separate pathways for doctors with purely health issues, less use of legalistic language, and a more personal approach with for example individualised undertakings or conditions. Conclusions While participants recognised the need for a regulator, the processes employed by the GMC and the communication style used were often distressing, confusing and perceived to have impacted negatively on their mental health and ability to return to work.

Work and mental health in the UK.

Abstract: A case of could do better Psychiatric disorders are the most important cause of absence due to sickness and receipt of health related benefits in the United Kingdom.1 Recipients stay on benefits longer and have worse employment outcomes than those with physical disorders.2 An alarming employment gap now exists—the rate of employment in people with common mental disorders is half that of people without a psychiatric disorder, and this figure is a quarter in those with more “severe” illnesses, such as schizophrenia.2 In 2012 the Organisation for Economic Cooperation and Development (OECD) published Sick on the Job , a substantial and important review of the challenge posed by psychiatric disorders across its member states.3 A series of reports on how individual member countries are meeting these challenges has followed. The UK report on mental health and work, published in February 2014,2 draws on data provided by the Department for Work and Pensions, the psychiatric morbidity survey, the OECD’s Eurostat labour market programme database, and Eurobarometer. It estimates that psychiatric disorders cost the UK economy £70bn (€83.8bn; $115.9bn; 4.5% gross domestic product) a year. Although the UK is more aware of the impact of psychiatric disorders on employment than most OECD countries, much remains …

Evaluating Interactive Fatigue Management Workshops for Occupational Health Professionals in the United Kingdom.

Abstract: Background Disabling fatigue is common in the working age population. It is essential that occupational health (OH) professionals are up-to-date with the management of fatigue in order to reduce the impact of fatigue on workplace productivity. Our aim was to evaluate the impact of one-day workshops on OH professionals' knowledge of fatigue and chronic fatigue syndrome (CFS), and their confidence in diagnosing and managing these in a working population.

Worker expectations of occupational health consultations.

Abstract: Results W orker expectations of professional standards were lower when compared with the OH physician validation score (E = 3.9 versus 4.3, ΔE = 0.48, 95% confidence interval [CI] 0.30–0.66). Perceived manager support and work apprehension were associated with worker expectations (ΔE = 0.58, 95% CI: 0.29–0.86 for least versus most support; ΔE = 0.89, 95% CI: 0.41–1.36 for least versus highest apprehension). Job title, previous OH consultations and recovery expectations were not associated with worker expectations. Conclusions W orker expectations of OH physicians’ professional standards were lower than the standards set by national guidance as validated by the sampled OH physicians. Workers who felt more supported by their manager, and workers who were more apprehensive about the health impact of work had higher expectations of OH physicians’ standards.