Alarcos Cieza

University of Southampton, Southampton, England, United Kingdom

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Publications (299)742.87 Total impact

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    ABSTRACT: Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated OPEN ACCESS Int. J. Environ. Res. Public Health 2015, 12 3775 with " any community HSU " (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not " any community HSU ". Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.
    International Journal of Environmental Research and Public Health 04/2015; 12(4):3774-3792. DOI:10.3390/ijerph120403774 · 1.99 Impact Factor
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    ABSTRACT: Communities of practice (CoP) can facilitate collaboration between people who share a common interest, but do not usually work together. A CoP was initiated and OPEN ACCESS Int. J. Environ. Res. Public Health 2015, 12 4440 developed including stakeholders from clinical, research, community and governmental backgrounds involved in a large multidisciplinary and multi-sectorial project: the Rehabilitation Living Lab in a Mall (RehabMaLL). This study aimed to evaluate the structure, process and outcomes of this CoP. A single case-study, using mixed-methods, evaluated the RehabMaLL CoP initiative after one year, based on Donabedian's conceptual evaluation model. Forty-three participants took part in the RehabMaLL CoP with 60.5% (n = 26) participating at least once on the online platform where 234 comments were posted. Four in-person meetings were held. Members expressed satisfaction regarding the opportunity to share knowledge with people from diverse backgrounds and the usefulness of the CoP for the RehabMaLL project. Collaboration led to concrete outcomes, such as a sensitization activity and a research project. Common challenges included lack of time and difficulty finding common objectives. A CoP can be a useful strategy to facilitate knowledge sharing on disability issues. Future research is necessary to determine strategies of increasing knowledge creation between members.
    International Journal of Environmental Research and Public Health 04/2015; 12(4):4439-4460. DOI:10.3390/ijerph120404439 · 1.99 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-39. DOI:10.1016/S0016-5085(15)30135-9 · 13.93 Impact Factor
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    ABSTRACT: Introduction: Social-medical expert reports from the German statutory pension insurance are essential for the German statutory pension regulatory authority to decide whether to grant services regarding participation as well as retirement pensions due to incapacity to work.The objective of this investigation is to determine whether the ICF Core Sets and other international approaches, such as the EUMASS Core Sets or ICF Core Set for vocational rehabilitation cover the content of the social-medical expert reports as well as to propose an approach how the ICF can be economically used by the social medicine practitioner when writing a social-medical expert report. Method: A retrospective quantitative study design was used to translate a total of 294 social-medical expert reports from patients with low back pain (LBP) or chronic widespread pain (CWP) into the language of the ICF (linking) by 2 independent health professionals and compare the results with the ICF Core Sets for specific health conditions and other international approaches. Results: The content of social-medical expert reports was largely reflected by the condition specific brief ICF Core Sets, brief ICF Core Sets for vocational rehabilitation and EUMASS Core Sets. The weighted Kappa statistic for the agreement between the 2 health professionals who translated the expert reports were in CWP 0.69 with a bootstrapped confidence interval of 0.67-0.71 and in LBP 0.73 (0.71-0.74). Discussion: The analyses show that the content of social-medical expert reports varies enormously. A combination of a condition specific brief ICF Core Set as well as vocational rehabilitation and EUMASS ICF Core Sets as well as all ICF-categories from the expert reports that were named at least in 50% of it can largely provide a basis for preparing expert reports. Within the scope of implementation the need for a specific ICF Core Set for expert reports of the German statutory pension insurance should be further analyzed and discussed. © Georg Thieme Verlag KG Stuttgart · New York.
    Die Rehabilitation 04/2015; 54(2):92-101. DOI:10.1055/s-0035-1545359 · 0.95 Impact Factor
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    ABSTRACT: The poster briefly outlines a methodology proposed to give impetus to a collaborative effort involving integral stakeholders to determine whether Web accessibility facilitation measures must be adapted for people with depression and anxiety, and if so, in what way(s). The methodology has three-phases: (1) identification of Web accessibility barriers using two data sources: a systematic review of pertinent literature and focus group interviews with people with depression and anxiety; (2) validation of current Web accessibility facilitation measures for this population using experimental user-testing; (3) provision of expertise-based recommendations for the improvement of Web accessibility facilitation measures using a delphi method. If adopted, the study’s findings are expected to make a significant contribution towards ensuring full and effective participation and inclusion in society, and equality of opportunity for people with mental disorders by improving their access to the Web.
    2nd MARATONE ESR Conference 2015, Munich, Germany; 03/2015
  • European Journal of Psychological Assessment 01/2015; 1(-1):1-9. DOI:10.1027/1015-5759/a000210 · 2.53 Impact Factor
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    ABSTRACT: Traumatic brain injury is a sudden and unexpected condition that gives rise to different impairments in body functions and structures leading to dramatic life changes, not only to the patient but also to his or her family and ultimately in the wider society. As a health strategy, rehabilitation aims to reduce disability and increasing the quality of life of those people that suffer from TBI but also to reduce the social burden associated with it. Functioning is the starting point of rehabilitation and the use of measurement instruments and classifications are commonly used tools for its definition. Within the endorsement of the ICF by WHO, there is now a classification and a conceptual framework for the description of functioning providing an opportunity of a full understanding of the experience of TBI. This paper aims to identify the utility of ICF in TBI as well as bringing new challenges for further clinical practice and research. ICF has shown itself to be useful in the content comparison of measurement instruments. It has also been used to describe the functional profile of individuals with TBI in both acute and chronic phases making it possible to draw comparisons across other health conditions. Furthermore, the development of the TBI ICF Core Sets provided an item bank to describe not only functional status but also to set goals and plan interventions. Overall, we now have a potentially useful tool in rehabilitation of TBI that allows us to understand the full burden of traumatic brain injury.
    Neurorehabilitation 12/2014; DOI:10.3233/NRE-141189 · 1.74 Impact Factor
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    ABSTRACT: Background Major depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD.Method Data from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively.ResultsAnalyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group.Conclusions Chronic MD and chronic AUDs are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.
    Health and Quality of Life Outcomes 12/2014; 12(1):186. DOI:10.1186/s12955-014-0186-0 · 2.10 Impact Factor
  • Developmental Medicine & Child Neurology 11/2014; 57(2). DOI:10.1111/dmcn.12639 · 3.29 Impact Factor
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    ABSTRACT: To examine the relevance of social skills and their different dimensions (i.e. expressivity, sensitivity and control) in relation to social support, depression, participation and quality of life (QoL) in individuals with spinal cord injury (SCI).
    Archives of Physical Medicine and Rehabilitation 09/2014; 96(3). DOI:10.1016/j.apmr.2014.09.006 · 2.44 Impact Factor
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    ABSTRACT: Background: When comparing the health of two populations, it is not enough to compare the prevalence of chronic diseases. The objective of this study is therefore to propose a metric of health based on domains of functioning to determine whether the English are healthier than the Americans. Methods: We analysed representative samples aged 50 to 80 years from the 2008 wave of the Health and Retirement Study (N = 10 349) for the US data, and wave 4 of the English Longitudinal Study of Ageing (N = 9405) for English counterpart data. We first calculated the age-standardized disease prevalence of diabetes, hypertension, all heart diseases, stroke, lung disease, cancer and obesity. Second, we developed a metric of health using Rasch analyses and the questions and measured tests common to both surveys addressing domains of human functioning. Finally, we used a linear additive model to test whether the differences in health were due to being English or American. Results: The English have better health than the Americans when population health is assessed only by prevalence of selected chronic health conditions. The English health advantage disappears almost completely, however, when health is assessed with a metric that integrates information about functioning domains. Conclusions: It is possible to construct a metric of health, based on data directly collected from individuals, in which health is operationalized as domains of functioning. Its application has the potential to tackle one of the most intractable problems in international research on health, namely the comparability of health across countries.
    International Journal of Epidemiology 09/2014; 44(1). DOI:10.1093/ije/dyu182 · 9.20 Impact Factor
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    ABSTRACT: The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for MS was developed to capture functioning in people with multiple sclerosis (pwMS). This study examined whether categories in the Brief ICF Core Set for MS best capture different levels of functioning in pwMS. We used data of a multicenter cross-sectional study collected from 205 pwMS using the ICF categories of the MS-specific WHO ICF Checklist and the individual rating of functioning. ICF categories to be entered in an initial regression model were selected following a systematic procedure in accordance with the ICF structure. Based on the initial regression model using stepwise Ordinary Least-Squares regression analyses, additional models were designed by substituting the ICF categories in final model. The selected set of categories was compared with the Brief ICF Core Set for MS. Eleven ICF categories were identified that best differentiate among different levels of functioning. Four were part of the Brief ICF Core Set. ICF categories identified in this study may be used as outcome measures in further study, parameters to monitor functioning along the continuum of health care and lifespan, and to define different subgroups of pwMS.
    Journal of Neurology 09/2014; DOI:10.1007/s00415-014-7467-8 · 3.84 Impact Factor
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    ABSTRACT: Medical evaluations of work capacity provide key information for decisions on a claimant's eligibility for disability benefits. In recent years, the evaluations have been increasingly criticized for low transparency and poor standardization. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive spectrum of categories for reporting functioning and its determinants in terms of impairments and contextual factors and could facilitate transparent and standardized documentation of medical evaluations of work capacity. However, the comprehensiveness of the ICF taxonomy in this particular context has not been empirically examined. In this study, we wanted to identify potential context-specific additions to the ICF for its application in medical evaluations of work capacity involving chronic widespread pain (CWP) and low back pain (LBP).
    BMC Health Services Research 08/2014; 14(1):361. DOI:10.1186/1472-6963-14-361 · 1.66 Impact Factor
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    ABSTRACT: AimThe objective of this article is to report on the Core Sets developed for children and youth aged 0 to 18 years, with cerebral palsy (CP) based on the pediatric International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO).MethodA formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed. Preparatory studies included: a systematic literature review; an international expert survey; a qualitative study of children and youth with CP and their caregivers; and a clinical study. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. Twenty-six international experts chosen by WHO region with expertise in CP attended the consensus meeting.ResultsOverall, five ICF Core Sets were developed: a Comprehensive Core Set (135 ICF categories); a Common Brief (25 ICF categories); and three age-specific Core Sets: under 6 years (31 ICF categories), from 6 to <14 years (35 ICF categories) and from 14 to 18 years (37 ICF categories).InterpretationThese ICF Core Sets for children and youth with CP are the first ICF-based tools developed for this population. The ICF Core Sets for children and youth with CP can be applied in clinical practice, research, teaching and administration. The application of the ICF Core Sets to this population will standardize the functional assessments of CP worldwide.
    Developmental Medicine & Child Neurology 08/2014; 57(2). DOI:10.1111/dmcn.12551 · 3.29 Impact Factor
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    ABSTRACT: Objective: To determine which environmental factors are associated with performance when controlling for capacity, using the International Classification of Functioning, Disability and Health (ICF). Methods: A psychometric study using a sample of 296 persons with musculoskeletal health conditions as a case in point. The following steps were carried out: (i) Rasch analyses created 2 interval measurement scales, capacity and performance, based on 22 Activities and Participation ICF categories that had been rated as capacity and performance. Capacity and performance scores, ranging from 0 (low level) to 100 (high level) were calculated; (ii) group lasso regression was used to identify the environmental factors associated with a person's performance when controlling for capacity. Gender, age and health condition were forced to remain in the model. Results: A capacity scale based on 16 ICF categories (rated as capacity) and a performance scale based on 18 categories (rated as performance) were created. Thirteen environmental factors ICF categories covering the physical, social, attitudinal and political environment were identified as highly associated with patient's performance. Conclusion: Using an exclusively statistical approach this study identified environmental factors associated with a person's performance.
    Journal of Rehabilitation Medicine 07/2014; 46(8). DOI:10.2340/16501977-1839 · 1.90 Impact Factor
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    ABSTRACT: Objective: To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of lesion level, health care context, sex, age, and resources of the country. Design: A multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and splits of the activity and participation component described in the ICF. Setting: Secondary analysis of data from an international, cross-sectional, multicentric study for the Development of ICF Core Sets for Spinal Cord Injury. Participants: Persons with SCI (N= 1048) from the early postacute and long-term living context from 14 middle/low- and high-resource countries. Interventions: Not applicable. Main Outcome Measure: Ratings of categories of the ICF relevant for SCI were analyzed. Results: Five models were tested on the complete sample and 5 subgroups. The overall reliability of all models and reliability within dimensions of the unidimensional and 2-dimensional models were good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the 2-dimensional and from the 2-dimensional to the 3-dimensional model was significant in all groups (P<.0001). The improvement, however, from a unidimensional to a 2-dimensional structure was markedly better than from a 2-dimensional to a 3-dimensional one. Conclusions: We propose that a 2-dimensional structure separating body functions and body structures from the activity and participation categories should serve as a basis for developing clinical measures in SCI in the future. (C) 2014 by the American Congress of Rehabilitation Medicine
    Archives of Physical Medicine and Rehabilitation 07/2014; 95(11). DOI:10.1016/j.apmr.2014.07.004 · 2.44 Impact Factor
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    ABSTRACT: Background The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) is a comprehensive framework to structure the information obtained in multidisciplinary clinical settings according to the biopsychosocial perspective of the International Classification of Functioning, Disability and Health (ICF) and to guide the treatment and rehabilitation process accordingly. It is now undergoing validation from the user perspective for which it has been developed in the first place.AimsTo validate the content of the Comprehensive ICF Core Set for MS from the perspective of speech and language therapists (SLTs) involved in the treatment of persons with MS (PwMS).Methods & ProceduresWithin a three-round e-mail-based Delphi Study 34 SLTs were asked about PwMS’ problems, resources and aspects of the environment treated by SLTs. Responses were linked to ICF categories. Identified ICF categories were compared with those included in the Comprehensive ICF Core Set for MS to examine its content validity.Outcomes & ResultsThirty-four SLTs named 524 problems and resources, as well as aspects of environment. Statements were linked to 129 ICF categories (60 Body-functions categories, two Body-structures categories, 42 Activities-&-participation categories, and 25 Environmental-factors categories). SLTs confirmed 46 categories in the Comprehensive ICF Core Set. Twenty-one ICF categories were identified as not-yet-included categories.Conclusions & ImplicationsThis study contributes to the content validity of the Comprehensive ICF Core Set for MS from the perspective of SLTs. Study participants agreed on a few not-yet-included categories that should be further discussed for inclusion in a revised version of the Comprehensive ICF Core Set to strengthen SLTs’ perspective in PwMS’ neurorehabilitation.
    International Journal of Language & Communication Disorders 07/2014; 49(6). DOI:10.1111/1460-6984.12086 · 1.39 Impact Factor
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    ABSTRACT: We discuss two-sample global permutation tests for sets of multivariate ordinal data in possibly high dimensional set-ups, motivated by the analysis of data collected by means of the World Health Organization's ‘International classification of functioning, disability and health’. The tests do not require any modelling of the multivariate dependence structure. Specifically, we consider testing for marginal inhomogeneity and direction-independent marginal order. As opposed to max-t-tests, which are known to have good power against alternatives with few strong individual effects, the tests proposed have good power against alternatives with many weak individual effects. Permutation tests are valid only if the two multivariate distributions are identical under the null hypothesis. By means of simulations, we examine the practical effect of violations of this exchangeability condition. Our simulations suggest that theoretically invalid permutation tests can still be ‘practically valid’. In particular, they suggest that the degree of the permutation procedure's failure may be considered as a function of the difference in group-specific covariance matrices, the proportion between group sizes, the number of variables in the set, the test statistic used and the number of levels per variable.
    Journal of the Royal Statistical Society Series C Applied Statistics 07/2014; 64(1). DOI:10.1111/rssc.12070 · 1.42 Impact Factor
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    ABSTRACT: Study design: Secondary data analysis of a questionnaire-based, cross-sectional survey in persons with spinal cord injury (SCI) in Switzerland. Objective: To describe the frequency of participation in sport (PiS) and to identify correlates for PiS in persons with SCI in Switzerland. Setting: Community sample Methods: Frequency of PiS was assessed retrospectively for the time before the onset of SCI and the time of the survey using a single-item question. A comprehensive set of independent variables was selected from the original questionnaire. Descriptive statistics, bivariate analyses and ordinal regressions were carried out. Results: Data from 505 participants were analyzed. Twenty independent variables were selected for analyses. PiS decreased significantly from the time before the onset of SCI to the time of the survey (P<0.001). Sport levels were significantly lower in women than men for the time of the survey (P<0.001), whereas no difference was observed before onset of SCI (P=0.446). Persons with tetraplegia participated significantly less often in sport than persons with paraplegia (P<0.001). Lesion level, active membership in a club, frequency of PiS before the onset of SCI and the subjective evaluation of the importance of sport correlate with PiS. When controlling for gender differences, only the subjective importance of sport for persons with SCI determines PiS, particularly among women. Conclusions: Persons with tetraplegia and women need special attention when planning interventions to improve PiS. Furthermore, the subjective importance of sport is important for PiS, particularly among women, whereas most other factors were only weakly associated with PiS.
    Spinal Cord 06/2014; · 1.70 Impact Factor
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    ABSTRACT: Study design: Secondary data analysis of a questionnaire-based, cross-sectional survey in persons with spinal cord injury (SCI) in Switzerland. Objective: To describe the frequency of participation in sport (PiS) and to identify correlates for PiS in persons with SCI in Switzerland. Setting: Community sample Methods: Frequency of PiS was assessed retrospectively for the time before the onset of SCI and the time of the survey using a single-item question. A comprehensive set of independent variables was selected from the original questionnaire. Descriptive statistics, bivariate analyses and ordinal regressions were carried out. Results: Data from 505 participants were analyzed. Twenty independent variables were selected for analyses. PiS decreased significantly from the time before the onset of SCI to the time of the survey (P<0.001). Sport levels were significantly lower in women than men for the time of the survey (P<0.001), whereas no difference was observed before onset of SCI (P=0.446). Persons with tetraplegia participated significantly less often in sport than persons with paraplegia (P<0.001). Lesion level, active membership in a club, frequency of PiS before the onset of SCI and the subjective evaluation of the importance of sport correlate with PiS. When controlling for gender differences, only the subjective importance of sport for persons with SCI determines PiS, particularly among women. Conclusions: Persons with tetraplegia and women need special attention when planning interventions to improve PiS. Furthermore, the subjective importance of sport is important for PiS, particularly among women, whereas most other factors were only weakly associated with PiS.
    Spinal Cord 06/2014; 52(9). DOI:10.1038/sc.2014.102 · 1.70 Impact Factor

Publication Stats

7k Citations
742.87 Total Impact Points

Institutions

  • 2012–2014
    • University of Southampton
      • Faculty of Social and Human Sciences
      Southampton, England, United Kingdom
  • 2006–2014
    • World Health Organization WHO
      Genève, Geneva, Switzerland
  • 2004–2014
    • Technische Universität München
      München, Bavaria, Germany
    • Hannover Medical School
      Hanover, Lower Saxony, Germany
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
  • 2003–2014
    • Ludwig-Maximilians-University of Munich
      • • Department of Medical Informatics
      • • Department of Physical Medicine and Rehabilitation
      • • Institute of Medical Psychology (IMP)
      München, Bavaria, Germany
  • 2013
    • Universität Luzern
      Luzern, Lucerne, Switzerland
  • 2009–2012
    • Swiss Paraplegic Research Group
      Nottwil, Lucerne, Switzerland
  • 2011
    • Jönköping University
      • Department of Nursing Science
      Jönköping, Joenkoeping, Sweden
  • 2008–2010
    • INTERNATIONAL HEALTH, RACQUET & SPORTSCLUB ASSOCIATION
      Boston, Massachusetts, United States
    • University of Geneva
      Genève, Geneva, Switzerland
    • Haute école de santé Genève
      Genève, Geneva, Switzerland
  • 2004–2010
    • Servicio de Salud del Principado de Asturias (SESPA)
      Oviedo, Asturias, Spain
  • 2007
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo County, Norway
    • Leiden University
      Leyden, South Holland, Netherlands
    • Inselspital, Universitätsspital Bern
      Berna, Bern, Switzerland
  • 2004–2007
    • German Institute Of Medical Documentation And Information
      Köln, North Rhine-Westphalia, Germany