Violence in youth sports: hazing, brawling and foul play.

By separating hazing, brawling, and foul play and failing to recognise that their connection to sport binds them together into a cohesive subset of sport injury and youth violence, past research has failed to show how sports-related violence is a broad example of interpersonal violence. The acceptance of violence within the sporting culture may, in part, explain why sports-related violence has not yet been widely recognised as a public health concern. This review shows that sports-related violence, including hazing, brawling and foul play, occurs among youth athletes of all ages and in a variety of different sports. The few studies to address this issue have all acknowledged the dangers of sports-related violence; however, no incident tracking method has been developed. Future research must provide accurate national estimates of the incidence of sports-related violence among youth, identify associated risk factors, evaluate preventive interventions and identify effective methods of distributing and implementing evidence-based interventions. Monitoring the magnitude and distribution of the burden of sports-related violence and building the scientific infrastructure necessary to support the development and widespread application of effective sports-related prevention interventions are essential first steps toward a reduction in the incidence of sports-related violence.

When the rules of the game are broken: what proportion of high school sports-related injuries are related to illegal activity?

OBJECTIVES: To compare sport and gender differences in injury rates and proportions of injuries related to illegal activity and to describe the epidemiology of injuries related to illegal activity. DESIGN: Descriptive epidemiology study. SETTING: 100 US high schools. SUBJECTS: Athletes participating in nine sports: boys' football, soccer, basketball, wrestling, and baseball plus girls' soccer, volleyball, basketball, and softball. MAIN OUTCOME MEASURES: Illegal activity-related injuries were analyzed using data from the 2005-06 and 2006-07 National High School Sports-Related Injury Surveillance Study. RESULTS: Nationally, an estimated 98 066 injuries were directly related to an action that was ruled illegal activity by a referee/official or disciplinary committee, giving an injury rate of 0.24 injuries per 1000 athletic competition-exposures. Boys' and girls' soccer had the highest rates of injuries related to illegal activity, and girls' volleyball, girls' softball, and boys' baseball had the lowest. Overall, 6.4% of all high school sports-related injuries were related to illegal activity, with the highest proportion in girls' basketball (14.0%), girls' soccer (11.9%), and boys' soccer (11.4%). A greater proportion of injuries related to illegal activity were to the head/face (32.3%) and were concussions (25.4%) than injuries not related to illegal activity (13.8% (injury proportion ratio 2.35; 95% CI 1.82 to 3.04; p<0.001) and 10.9% (injury proportion ratio 2.35; 95% CI 1.71 to 3.22; p<0.001), respectively). CONCLUSIONS: Illegal activity is an overlooked risk factor for sports-related injury. Reducing illegal activity through enhanced enforcement of sports' rules and targeted education about the dangers of illegal activity for players, coaches, and referees/officials may reduce sports-related injuries.

The fair sex? Foul play among female rugby players.

Rugby, a full contact sport, exposes participants to a high risk of injury. While several studies have explored injuries among male rugby players, few have investigated injuries among females. We conducted a cross-sectional study of United States of America (USA) female rugby players to assess the players' perception of foul play and the referee response to foul play and to evaluate the association between players' perception of foul play and injury. An anonymous, self-administered questionnaire reporting injury status, history of player perceived foul play and referee response was administered to 258 players recruited at a women's rugby tournament. The overall rate of injury was 4.4 injuries/100 matches, 0.2 injuries/100 practices and 1.4 injuries/100 total rugby exposures (matches and practices), with 107 (41.5%) players classified as injured. While 16.5% of players admitted to perpetrating foul play without an assessed penalty and 13.8% to being penalised for foul play, a smaller proportion reported being sent to the 'sin bin' (temporarily removed from play) or being ejected from a match (3.3% and 1.3% respectively). Of the 107 injured, 24.3% believed they had been injured as a result of foul play. Among all 258 players, self-perception of having been hurt due to unpenalised foul play was associated with study-defined injury (OR = 2.4, 95% CI = 1.0-5.9, p = 0.046). To make the sport safer, efforts should be made to minimise foul play. Suggested preventive methods include educating referees, coaches and players about the prevalence of foul play in women's rugby and the association between foul play and injury.

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico.

BACKGROUND: Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. OBJECTIVES: The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. METHOD: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. RESULTS: Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. CONCLUSIONS: Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

Psychometric properties of an attitude scale measuring physician-nurse collaboration.

This study examined the psychometric properties of an assessment tool for measuring attitudes toward physician-nurse collaboration. A survey addressing areas of responsibility, expectations, shared learning, decision making, authority, and autonomy was administered to first-year medical and nursing students. Factor analysis of the survey indicated that the survey measured four underlying constructs of shared education and collaborative relationships, caring as opposed to curing, nurse's autonomy, and physician's authority. A scale was developed in which 15 items of the survey with large factor loadings were included. The alpha reliability estimates of the scale for medical and nursing students were .84 and .85, respectively. The mean of the scale was significantly higher for nursing than medical students. Results supported the construct validity and reliability of the scale. This scale can be used to evaluate the effectiveness of programs developed to foster physician-nurse collaboration, and to study group differences on attitudes toward interpersonal collaboration.

The relationship between the race/ethnicity of generalist physicians and their care for underserved populations.

OBJECTIVES: The purpose of this study was to examine empirically the relationship between physicians' race or ethnicity and their care for medically underserved populations. METHODS: Generalist physicians who received the MD degree in 1983 or 1984 (n = 1581) were surveyed. The personal and background characteristics of four racial/ethnic groups of physicians were compared with the characteristics of their patients. RESULTS: When the potentially confounding variables of gender, childhood family income, childhood residence, and National Health Services Corps financial aid obligations were controlled, generalist physicians from underrepresented minorities were more likely than their nonminority counterparts to care for medically underserved populations. CONCLUSIONS: Physicians from underrepresented minorities are more likely than others to care for medically underserved populations.

Should half of all medical school graduates enter primary care? Perceptions of faculty members at Jefferson Medical College.

PURPOSE: This study was undertaken to promote communication among faculty regarding the impact of a proposed goal that 50% of the graduates of Jefferson Medical College enter generalist careers. Since the opinions and attitudes of faculty regarding career decisions may directly or indirectly influence students, the authors investigated faculty's views of the optimal ratio of primary care to non-primary care physicians in the workforce and their perceptions of the effect on medical education, research, and health care delivery if the 50% goal were to be mandated. METHOD: A questionnaire was mailed in January 1994 to all 684 salaried faculty of Jefferson Medical College. Respondents' opinions about the optimal primary care to non-primary care ratio and their perceptions of the effects of implementing the 50% goal on 21 areas related to medical education, research, and health care delivery were examined using a Likert-type scale. Obstacles perceived by non-primary care physicians as preventing their practice of primary care were also among the outcome measures. RESULTS: A total of 275 completed questionnaires were received (40% response rate; 72 primary care physicians, 141 non-primary care physicians, and 62 non-physicians). The median and mode of an optimal primary care to non-primary care ratio were both 50/50. Faculty, in general, perceived that implementing the 50% goal would enhance public access to primary care, physician-patient relationships, utilization of non-physicians, and the career satisfaction of generalists. They predicted decreases in costs of care, freedom of career choice, funding, and interest in research. The primary care physicians perceived greater enhancements of the image of physicians, quality of care, and satisfaction of generalists and subspecialists than did the non-primary care physicians. Gender and age did not affect the perceptions. A lack of appropriate training was identified by 45% and a lack of interest by 28% of the non-primary care physicians as major obstacles to their practice of primary care medicine. CONCLUSION: The faculty members' positive and negative views of the proposed reform can provide useful information to the institution in understanding the potential impediments to increasing the numbers of generalist graduates. The generalists had significantly different views from the subspecialists about the impact of increasing the proportion of primary care physicians on health care delivery and research. In general the primary care physicians were more likely to view the proposed changes as beneficial than were the non-primary care physicians.

A national study of the factors influencing men and women physicians' choices of primary care specialties.

BACKGROUND: Despite a recent increase in the percentage of graduating U.S. medical students planning to pursue generalist careers, interest in primary care among students is still far below what it was in the early 1980s and falls well short of the stated goal of the Association of American Medical Colleges that half of all graduates should choose generalist careers. Also during the past decade, the number of women students and physicians has increased. Given the importance of concerns regarding the primary care work force, it is timely to examine the relationship between gender and other factors that influence the decision to enter primary care. METHOD: Totals of 1,038 (65%) men and 558 (35%) women primary care physicians selected from the 1983 and 1984 graduates of all allopathic U.S. medical schools were surveyed in early 1993. Gender comparisons were made on the 19 variables that influenced the physicians' decisions to enter primary care specialties and on the six factor scores derived from a factor analysis of these 19 variables. Also included in the gender comparisons were characteristics of practice, populations served, timing of making the decision to enter primary care, and personal demographic information. RESULTS: Men, more than women, were influenced to become primary care physicians by early role models. Women, more than men, were influenced by personal and family factors. Overall, medical school experience and personal values are two important factors that explained the largest variances of the 19 predictor variables influencing the physicians' choices of primary care disciplines. There was no gender difference in place of origin, family income as a child, timing of the decision to become a primary care physician, or the amount of debt upon graduation. CONCLUSION: This nationwide study of primary care physicians indicates that men and women physicians differ in their perceptions of the relative importances of factors influencing the choice of a primary care specialty. Gender-specific factors should receive more attention in the development of successful strategies to attract more medical students into primary care specialties.

Physicians' intention to stay in or leave primary care specialties and variables associated with such intention.

A national mail survey of primary care physicians was conducted in 1993 to examine the differences between those who planned to leave and those who planned to stay in primary care disciplines. The physicians who planned to stay in primary care were those who, at the time of choosing primary care specialties, were more influenced by factors such as personal social values, religion, and the presence of a role model prior to medical school. Physicians' race, sex, workload, debt, place where they grew up, family income as a child, and timing when they made the decision to enter primary care disciplines are not associated with their plans to stay in or leave primary care disciplines. Findings indicated that personal social values, religious beliefs, and the presence of a role model prior to medical school not only influenced physicians' choice of primary care, but had a lasting effect on their commitment to such choice.

Medical school and student characteristics that influence choosing a generalist career.

OBJECTIVE: To identify predictors in medical schools that can be manipulated to affect the proportion of graduates entering generalist practice. DESIGN AND PARTICIPANTS: Cross-sectional and retrospective studies of medical schools and practicing generalist physicians; surveys of MD-granting and DO-granting medical schools; site visits to nine schools with a high proportion of graduates becoming generalist physicians; surveys of national samples of MD and DO generalist physicians. INDEPENDENT VARIABLES: Characteristics of medical schools, including structural characteristics, financing, mission, admissions policies, student demographics, curriculum, faculty, and the production of generalist physicians; information on personal characteristics, background, perceptions, and attitudes of practicing generalist physicians. DEPENDENT VARIABLE: Estimated proportion of graduates of the classes of 1989, 1990, and 1991 in family practice, general internal medicine, and general pediatrics. RESULTS: Institutional mission, certain admissions policies, characteristics of entering students, and the presence of a primary care-oriented curriculum explained statistically significant variation in the number of physicians choosing generalist careers, even after the structural characteristics of public or private status, age of the school, and class size were controlled for statistically. CONCLUSIONS: Public and institutional policies, where implemented, have had a positive effect on students' choice of generalist careers. The most influential factors under the control of the medical school are the criteria used for admitting students and the design of the curriculum, with particular emphasis on faculty role models. Personal social values was the individual characteristic that most strongly influenced graduates' career choice.