How does small group continuing medical education (CME) impact on practice for rural GPs and their patients, a mixed-methods study.

Studies which report outcomes of continuing medical education (CME) interventions for rural general practitioners (GPs) are limited. This mixed methods study recruited GPs from four CME small group learning (SGL) tutor groups based in different rural locations in the Republic of Ireland. A two-hour teaching module on deprescribing in older patients was devised and implemented. Assessment of educational outcomes was via questionnaires, prescribing audits and qualitative focus groups. All GPs (n = 43) in these CME-SGL groups agreed to participate, 27 of whom (63%) self-identified as being in rural practice. Rural GPs were more likely to be male (56%), in practice for longer (19 years), and attending CME for longer (13 years). The questionnaires indicated learning outcomes were achieved knowledge increased immediately after the education, and was maintained 6 months later. Twenty-four GPs completed audits involving 191 patients. Of these, 152 (79.6%) were de-prescribed medication. In the qualitative focus groups, GPs reported sharing experiences with their peers during CME-SGL helped them to improve patient care and ensured that clinical practice is more consistent across the group. For rural GPs, CME-SGL involving discussion of cases and the practical implementation of guidelines, associated with audit, can lead to changes in patient care.

Impact of participation in continuing medical education small group learning (CME-SGL) on the stress, morale, and professional isolation of rurally-based GPs: a qualitative study in Ireland.

BACKGROUND: The pressures of general practice contribute to high levels of stress, low morale, and burnout in some GPs. In addition, rurally-based doctors may experience significant professional isolation. Participation in continuing medical education (CME) appears to reduce stress, and may improve the retention of rural GPs. AIM: As part of a larger study devised to examine the effectiveness of regular participation in CME small group learning (SGL) on rurally-based Irish GPs, this study explored whether CME-SGL had any impact on GP stress, morale, and professional isolation. DESIGN & SETTING: This was a qualitative study involving four CME-SGL groups based in rural Ireland. METHOD: Semi-structured focus group interviews were conducted in established CME-SGL groups in four different rural geographical locations. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. RESULTS: All members of these CME-SGL groups (n = 43) consented to interview. These GPs reported that regular meetings with an established group of trusted colleagues who are 'in the same boat' provided a 'safe space' for discussion of, and reflection on, both clinical concerns and personal worries. This interaction in a supportive, non-threatening atmosphere helped to relieve stress, lift morale, and boost self-confidence. The social aspect of CME-SGL sustained these rural GPs, and served to alleviate their sense of professional isolation. CONCLUSION: Delivery of CME through locally-based SGL provides as an important means of supporting GPs working in rural areas. The non-educational benefits of CME-SGL, as described by these Irish GPs, are of relevance for rural doctors in other countries.

A Social Support Intervention to Reduce Intentions to Drop-out from Youth Sport: The GAA Super Games Centre / Una intervención basada en el apoyo social para reducir la intención de abandonar el deporte juvenil: el Centro de Superjuegos GAA

Research has highlighted that drop-out from youth sport has emerged to become a global trend with drop-out rates exceeding 30% in some countries. This study aimed to investigate the effect of a change in perceived support on intentions to drop out from youth sport at the end of a social support intervention. A pre-intervention examination of the Gaelic Athletic Association (GAA) in 2012 identified a 19.38% drop-out rate involving 3,491 participants between the ages of 12-16 years. A psychosocial intervention developed for the GAA called the Super Games Centre was delivered and evaluated over a 24-week period to 103 participants. The findings demonstrated that higher perceived available support was significantly associated with lower levels of intentions to drop out at the end of the intervention. Furthermore, social identity emerged as a significant mediating factor in explaining the association between changes in perceived support and intentions to drop out. A post-intervention examination in 2018 found that the GAA had established 95 Super Games Centres since 2015, and this has led to an increase in 7,012 new participants between the ages of 12-16 years. Future research and implications for social support intervention methodology are discussed

La investigación ha destacado que el abandono del deporte juvenil se ha convertido en una tendencia mundial con tasas que superan el 30% en algunos países. Este estudio tiene como objetivo investigar el efecto de un cambio en el apoyo percibido sobre la intención de abandonar el deporte juvenil al finalizar una intervención basada en el apoyo social. La Asociación Atlética Gaélica (GAA) en 2012 identificó una tasa de abandono del 19.38% que involucraba a 3,491 participantes de edades comprendidas entre 12-16 años. Una intervención psicosocial desarrollada para la GAA, llamada Centro de Superjuegos (Super Games Centre), se realizó con 103 participantes y se evaluó durante un período de 24 semanas. Los resultados muestran que la percepción de una mayor disponibilidad de apoyo social se asocia significativamente a niveles más bajos de intención de abandono al final de la intervención. Además, la identidad social demostró ser un importante factor de mediación para explicar la asociación entre los cambios en el apoyo percibido y la intención de abandono. Un examen posterior a la intervención en 2018 encontró que la GAA había creado 95 Centros de Superjuegos desde 2015, lo que ha llevado a un aumento de 7,012 nuevos participantes en el mismo rango de edad (12-16 años). Se debaten las investigaciones futuras y las implicaciones para la metodología de intervención basada en el apoyo social

Physiological Profile and Activity Pattern of Minor Gaelic Football Players.

Cullen, BD, Roantree, M, McCarren, A, Kelly, DT, O'Connor, PL, Hughes, SM, Daly, PG, and Moyna1, NM. Physiological profile and activity pattern of minor Gaelic football players. J Strength Cond Res 31(7): 1811-1820, 2017-The purpose of this study was to evaluate the physiological profile and activity pattern in club- and county-level under-18 (U-18) Gaelic football players relative to playing position. Participants (n = 85) were analyzed during 17 official 15-a-side matches using global positioning system technology (SPI Pro X II; GPSports Systems, Canberra, Australia) and heart rate (HR) telemetry. During the second part of this study, 63 participants underwent an incremental treadmill test to assess their maximal oxygen uptake (V[Combining Dot Above]o2max) and peak HR (HRmax). Players covered a mean distance of 5,774 ± 737 m during a full 60-minute match. The mean %HRmax and %V[Combining Dot Above]O2max observed during the match play were 81.6 ± 4.3% and 70.1 ± 7.75%, respectively. The playing level had no effect on the distance covered, player movement patterns, or %HRmax observed during match play. Midfield players covered significantly greater distance than defenders (p = 0.033). Playing position had no effect on %HRmax or the frequency of sprinting or high-intensity running during match play. The frequency of jogging, cruise running, striding (p = 0.000), and walking (p = 0.003) was greater in the midfield position than in the forward position. Time had a significant effect (F(1,39) = 33.512, p-value = 0.000, and (Equation is included in full-text article.)= 0.462) on distance covered and %HRmax, both of which showed a reduction between playing periods. Gaelic football is predominantly characterized by low-to-moderate intensity activity interspersed with periods of high-intensity running. The information provided may be used as a framework for coaches in the design and prescription of training strategies. Positional specific training may be warranted given the comparatively greater demands observed in the midfield playing position. Replicating the demands of match play in training may reduce the decline in distance covered and %HRmax observed during the second half of match play.

Fitness profiling of elite level adolescent Gaelic football players.

The purpose of this study was to evaluate the anthropometric characteristics and fitness levels of elite level under 18 (U-18) Gaelic football players to establish normative centile scores for selected fitness parameters and to compare the physical and fitness characteristics relative to each playing position. A total of 265 male U-18 Gaelic football players (age: 16.96 ± 0.7 years; height: 178.11 ± 6.27 cm; weight: 72.07 ± 8.68 kg) participated in the study. According to positional roles, players were categorized as goalkeepers (n = 13), defenders (n = 113), midfielders (n = 30), and forwards (n = 109). Height and weight were measured, and skinfolds were taken before participants sequentially performed a sit and reach test (S&R), countermovement jump (CMJ), standing long jump (SLJ), 5- and 20-m speed test, and the Yo-Yo Intermittent Recovery Test Level 1 (YYIRT1). The percentage body fat was higher (p < 0.01) in goalkeepers than the other playing positions. Goalkeepers had a higher body mass index than defenders (p < 0.05) and forwards (p < 0.01). Midfielders and goalkeepers were taller (p < 0.01) and heavier (p < 0.01) than defenders and forwards. The total distance covered in the YYIRT1 was significantly lower (p < 0.01) in goalkeepers than the other playing positions. There was no significant positional difference in the performance scores in the S&R test, CMJ, SLJ, and 5- and 20-m running speed. The study findings indicate minimal differences in the anthropometric and physiological characteristics between playing positions in elite youth level Gaelic football players. The norm-referenced percentile scores will enable conditioning coaches to benchmark elite performance and design training programs.

Advancing newborn health and survival in developing countries: a conceptual framework.

Four million newborns die every year at home, often without skilled care at delivery or any other contact with the formal health system. Improved household practices and use of services, often in the community, should improve survival. We developed a conceptual framework for household and community newborn and maternal care that acknowledges the inseparability of the mother and neonate, yet stresses elements relating to the newborn, heretofore underemphasized in safe motherhood and child-survival programs. The framework identifies five paths that, if implemented well, would generally improve newborn outcomes: (1) use of routine maternal and newborn care and good-quality services; (2) response to maternal danger signs; (3) response to the nonbreathing newborn; (4) care for the low birth weight baby; and (5) response to newborn danger signs, particularly those of infection. This model, balancing preventive (19 routine behaviors) and curative care (14 special behaviors), is rooted in the community, bridges safe motherhood and child survival, and provides a framework for newborn health research, programmatic, and advocacy agendas for developing countries.