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Biomedical subjects

Alastair Ager

Publications and source records attributed to Alastair Ager.

9 recordsLinked to original sources
PubMed2006

Physiotherapy in Afghanistan: an analysis of current challenges.

INTRODUCTION: Afghanistan has high levels of disability due to prolonged conflict. An important part of the reconstruction process in Afghanistan is strengthening health service capacity and, within this, rehabilitation services. AIMS: To identify training needs of, and key issues affecting, Afghan physiotherapists. METHODS: 20 interviews and clinical accompaniment of 15 physiotherapists/physiotherapy assistants (APA) carried out in the second quarter of 2003. Analysis was using a grounded theory approach. RESULTS: Five themes emerged: (1) Low professional profile of physiotherapy; (2) Difficult working conditions; (3) Difficulty identifying personal training needs; (4) Difficulty with clinical reasoning at undergraduate level; (5) Variable levels of clinical competence. DISCUSSION: Many of the challenges facing Afghan physiotherapists are not unique to Afghanistan but are exacerbated by a lack of government recognition of the profession. War has isolated Afghan physiotherapists from completed professional links and consequently the undergraduate curriculum had not matched developments in other comparable countries. This has contributed to the difficulties therapists' experience with current clinical reasoning and accessing new practice developments. Culture also influences attitudes towards training and has restricted female travel and access to education. CONCLUSIONS: Core training needs include disability sensitization, reflective practice and clinical reasoning. The physiotherapy curriculum needs updating and links with ongoing research need to be established to keep abreast of new developments.

Afghanistan↗
PubMed2006

A systematic review of structured group interventions with mentally disordered offenders.

BACKGROUND: Over the last 15 years, rehabilitation of offenders has been rigorously researched, resulting in new knowledge and understanding about factors decreasing recidivism amongst them. Typically, such interventions have been based on cognitive behavioural therapy. However, until recently, little research had been carried out on the rehabilitation of offenders with mental disorder. The authors present the first systematic review of the efficacy of structured group interventions with mentally disordered offenders. AIM: To evaluate structured group interventions with mentally disordered offenders through systematic review of the evidence for their efficacy and effectiveness. METHODS: A standardized search strategy, with complementary methods of data retrieval to ensure a high degree of recall, was employed. Meta-analysis was not undertaken due to sample heterogeneity and lack of comparable data. Instead, effect sizes were calculated on all papers with sufficient data. Pooled effect sizes were calculated for groups of interventions with a similar focus. RESULTS: Twenty studies were retrieved that fitted the inclusion criteria. It was possible to categorize these, predominantly British, studies into four main themes: problem-solving; anger/aggression management; self-harm; and other. The mean pooled effect sizes for the first two groups were suggestive of a moderate to high effect, but methodological variation means that these findings should still be treated as preliminary. DISCUSSION AND CONCLUSIONS: Calculated effect sizes give optimism for the efficacy of structured group interventions with mentally disordered offenders. It is important now that more rigorous and consistent research methods be applied, even in secure hospital environments. Some suggestions towards achieving this are offered, drawing from the work to date, inclusive of the need for agreement on common outcome measures and development of networks to improve sample sizes.

Aggression↗
PubMed2006

The impact of structured activities among Palestinian children in a time of conflict.

BACKGROUND: There is growing evidence of the impact on children's well-being of exposure to political conflict in such settings as the Palestinian territories. This study examined the impact of child-focused interventions involving structured activities, supported by provision of equipment and training of facilitators. The focus of interventions was participation in recreational, cultural and other non-formal activities supporting the development of resilience. Impacts were hypothesised on children's social and emotional well-being, relationships with parents and degree of future orientation. METHODS: Two hundred and fifty children from the West Bank and 150 children from Gaza took part in the study. Of these 400 children, 300 comprised the intervention group. Fifty children from Gaza and 50 children from the West Bank comprised the comparison group. There were equal numbers of girls and boys in all groups, with similar proportions of children aged between 6 and 11 years, and between 12 and 17 years. Measures used were the Child Behavior Checklist (CBCL), the Parental Support Scale and the Hopefulness Scale: Youth Version. Assessment was made as children enrolled on the structured activity programmes (T1) and again twelve months later (T2). RESULTS: There was no difference in the CBCL Total, Internalising or Externalising problem scores at baseline (Time 1) between the children who subsequently took the intervention and those who did not. Compared to children in the comparison group, children in the intervention group had lower CBCL total problem scores, externalising problem scores, and internalising problem scores at Time 2 compared to Time 1. Exposure to the intervention was not associated with changes in children's hopefulness, but those receiving the intervention in the West Bank did report improved parental support at Time 2. CONCLUSIONS: The intervention appeared successful in improving children's emotional and behavioural well-being but not hopefulness. It was also linked with increased parental support in some areas (those located in the West Bank).

Adolescent↗
PubMed2005

Psychosocial distress of Tibetans in exile: integrating western interventions with traditional beliefs and practice.

A psychosocial care project for Tibetan torture survivor's and other Tibetan refugees suffering from psychological distress was opened in Dharamsala, North India in 1995 by a western non-government organisation (NGO) in collaboration with the Tibetan government-in-exile. The clinic explicitly sought to integrate western and local traditional approaches to healing. The aim of the present study was to examine the views of key stakeholders of the project in the context of broader cultural and social issues faced by exiled Tibetans. Twenty individual interviews were conducted with 'officials' (members of the Tibetan government-in-exile, religious leaders, other community leaders, and senior medical staff), the staff of the project (Tibetan and western) and the clients themselves. The interviews were taped, transcribed, and analysed using a grounded theory approach. All interviewees considered that mental health was an important issue and that awareness of psychological health in the community had improved since the initiation of the project. Clients and staff of the project, and some of the 'officials', believed that it provided a much-needed service and that it effectively and sensitively combined western psychological approaches with local cultural and religious beliefs and practices. However, a majority of the 'officials' felt that mental health issues were not a top priority in the competing health needs of the community, and that other ways of dealing with such problems (using traditional approaches or local health services) were adequate. Given these and other factors, the longer-term sustainability of the project appears to be a major challenge. According to the users and providers interviewed, the current project has developed an important and beneficial psychosocial support service. However, the continuing debate amongst community leaders regarding the place and future of the project suggests the importance of accommodating the views and priorities of all local stakeholders--and focusing on sustainability and capacity building of relevant community members--from the outset of such projects. This includes acknowledging the perceived threat to traditional beliefs and coping strategies--particularly in the context of wider socio-cultural disruption--posed by initiatives seeking to integrate western intervention approaches with local healing resources.

Attitude to Health↗
PubMed2005

Patterns of health service utilization and perceptions of needs and services in rural Orissa.

Despite emphasis on strengthening local health care provision, concern remains regarding the rates of utilization of state-provided services within Orissa. The reported study examined patterns of service utilization across the rural population of four districts of Orissa, with special reference to perceptions of the availability and quality of state services at the primary care level. Within the selected districts, 219 interviews were conducted across 66 villages. Households reported utilizing a wide range of health care providers, although hospitals constituted the most frequently--and primary health care centres (PHCs) the least frequently--accessed services. Private practitioners (qualified and unqualified) represented a major sector of provision. This included high rates of access by scheduled tribes and castes (running at approximately twice the rate of access to both local and PHC provision). Key factors guiding patterns of utilization were reputation of the provider, cost and physical accessibility. Local health provision through assistant nurse midwives and male health workers was generally perceived of poor quality, with the lowest rates of resolution of health problems of all service providers. The location of a sub-centre base for assistant nurse midwives within a village had no demonstrable impact on access to services. Acknowledging constraints on broader generalization, the implications of the findings for informing health policy and programming within Orissa are noted. This includes support for current efforts to strengthen the capacity of PHC and sub-centre level provision within the state, and acknowledgement of the potentially growing role of effectively regulated private provision in meeting the needs of the rural poor.

Adolescent↗
PubMed2005

Perspectives on disability in Afghanistan and their implications for rehabilitation services.

Twenty years of conflict has severely disrupted the infrastructure and economy of Afghanistan. Disability levels are high and much of the population has little access to health facilities. Re-establishing and strengthening rehabilitation services is therefore an important country priority. The aims of this study were to explore perceptions of the nature of disability in Afghanistan and to identify implications for the development of rehabilitation services. Over a 4-week period, interviews and focus groups, supplemented by field observations, were held with a range of service users and other stakeholders (including physiotherapist service providers and representatives of the Afghan Disability Committee) in the districts of Kabul and Herat. Data analysis identified three core themes in discussions with respondents: the nature of disability, causes of disability and rehabilitation priorities for people with disability (PWD). Afghan society distinguishes between traumatic and congenital disability, but disability awareness is much greater for persons with traumatic disability. This group enjoys much greater representation in disabled people's organizations. There is a strong cultural responsibility to care and provide for PWD rather than to encourage independence. Healthcare professionals reflect a medical model in their attitudes towards PWD. A key priority of PWD is economic. There is a low understanding of rehabilitation practice by PWD and medical staff. Training for rehabilitation workers and wider health professionals needs to reflect greater emphasis on a social model of disability. Public awareness and enablement of people with congenital disability needs to be raised.

Afghanistan↗