Amount Of Doctors Research Articles

Ovarian cancer mortality: implications of income-inequality and availability of medical doctors in Brazil.

e22520 Background: Ovarian cancer mortality varies by region and age group in Brazil. However, it is still unknown if socioeconomic inequalities may affect its outcome even if indirectly as it happens for other gynecologic neoplasms in the country. Methods: Ecological study conducted with secondary data from 2016-2018 to examine the relationship between income-inequality and the amount of doctors per inhabitant on ovarian cancer mortality in Brazil. All data were gathered from Brazil’s public health system. Mortality was analyzed by sex and age, which was standardized according to the World Health Organization’s population. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and was also calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite income inequality as measured by the Gini index not having any statistically significant relationship with ovarian cancer mortality rates, we found that the amount of doctors per inhabitant was positively associated with ovarian cancer mortality rates (β 0.037, IC95% 0.028;0.045), whereas the amount of clinical oncologists (β-0.426, IC95% -0.805; -0.047) and higher income (β -0.004, IC95% -0.005; -0.003) were all negatively associated with those rates (p < 0.05), meaning that the higher those variables, the lower the mortality. Conclusions: Ovarian cancer mortality differs among federative units in Brazil. Higher mortality is associated with a greater amount of doctors per inhabitant, whereas lower mortality rates were found to be associated with higher income and more clinical oncologists available.

Colorectal cancer mortality rates and socioeconomic factors in Brazil: Association with income inequality and availability of medical doctors.

e22516 Background: Colorectal cancer mortality is expected to rise in the upcoming years in Brazil, especially in less developed regions. It is also known that socioeconomic factors play a role not only in the development, but also in the outcome of this disease. Methods: Ecological study that analyzed secondary data from 2016-2018 to examine the relationship between both income-inequality and the amount of doctors per inhabitant on colorectal cancer mortality in Brazil and its Federative Units. All data were gathered from Brazil’s public health system. Mortality was standardized by the World Health Organization’s population and analyzed by sex and age. Income-Inequality was measured using the Gini index, obtained from the United Nations Development Programme. The number of doctors was obtained from the Unified Health System and also calculated as the rate per 100,000 inhabitants. For this study, linear regression was performed using stepwise selection/backward elimination. Results: In the present study, we found that female sex (β -0.616, IC95% -1.308;0.075), the number of gastroenterologists (β -2.506, IC95% -3.702;-1.309), clinicians (β -0.107, IC95% -0.155; -0.0600), and the number of general surgeons (β -0.845, IC95% -1.188; -0.501) were negatively associated with colorectal cancer mortality, whereas higher income (β 0.02, IC95% 0.001;0.003), the amount of doctors in the public health system as a whole (β 0.090, IC95% 0.064;0.116), generalists (β 1.760, IC95% 0.987; 2.533) and oncology surgeons (β 14.252, IC95% 3.937; 24.566), were positively associated with cancer mortality. Conclusions: Colorectal cancer presents different mortality rates depending on sex, socioeconomic status and availability of medical doctors and specialists, whether for diagnosis and higher notifications or treatment and lesser deaths form the disease.

Income-inequality and rate of doctors per inhabitant and their influence on esophageal cancer mortality in Brazil.

e16089 Background: There are substantial disparities in esophageal cancer mortality across different social groups, including sex, race/ethnicity, geographical location and socio-economic status. Methods: This is an ecological study with secondary data from 2016 to 2018 that evaluated the effects of income-inequality and number of doctors per inhabitant on esophageal cancer mortality in Brazil and its Federative Units. The amount of deaths and the overall number of doctors were obtained from the Department of Informatics of the Unified Health System. Mortality was estimated per 100,000 individuals and age-standardized through the World Health Organization’s population, whereas the rate of doctor per inhabitant was calculated per 1,000 inhabitants. Income-Inequality was measured by the Gini index, obtained from the United Nations Development Programme. Linear regression was performed by the stepwise backward method. Results: Sex, Gini index values and oncology surgeons were all related to lower mortality rates (p < 0.05), whereas clinical oncologists and general surgeons were both associated with higher mortality (p < 0.05). Conclusions: Esophageal cancer mortality rates were influenced by both the type and amount of doctors per inhabitant of any given administrative region in Brazil, however there was no association found with regards to income inequality.[Table: see text]

Death Announcement: Difficulties and Pediatricians’ Experiences

Notification of death is a shock for the family but also for the caregiver. However, there is a tendency to forget the feelings of caregivers about this theme. The objective of our study is to evaluate doctors feelings and the difficulties during the announcement of deaths. Methods: A qualitative, exploratory study involving 34 doctors exercising at the pediatric center of the Mohammed VI university hospital in Marrakesh. To explore doctors' experiences in providing care, their emotional reactions to the patient's death, and their use of coping and social resources to manage their emotions. Results: An amount of doctors reported death between 5 to 10 times in 35.3% and between 10 to 20 times in 26.4%; 41.2% of the cases reported a feeling of sadness during the notification, 29.4% felt dizzy and 29.4% revealed a stress. Twenty-one doctors had felt the need of support and a psychologist consultation to talk and express themselves. A percentage of 97% of physicians said they had never received any training on the death notification and felt that training in this sense was useful and necessary. Conclusion: notification of death remains a difficult test, it requires preparation as well as learning by training especially when it comes to announcing the death of a child.

Features of relationships of patients and the doctor in the clinic of tuberculosis

With the scientific, technological and industrial potential of humanity on the rise, as well as advancement in the ability to improve the environment and significantly change its conditions of existence, the moral question of our exact actions becomes more acute. As time goes, more meaning is given to the concepts and values of humanity. Formerly, if the dominating principles in culture were based off of religious, esthetic and utilitarian-practical values, as well as curiosity, then today, the main principles for the well being of humanity should be dictated by ethics, as they will be crucial for the development of both culture and society.Other than moral and ethical individual qualities, a doctor must have the required professional training, have the skills and knowledge needed in practice, know how to adequately evaluate the patient as well as their own practical abilities and risks, be able to endure and have confidence in their own capabilities, as well as have communicative aspects — such as personal appeal, kindness, respect for surrounding people, tactfulness, being observant, available, and trustful, as well as being able to obtain trust easily. However, despite the considerable amount of doctors who patients avoid, or only visit in dire need, a large amount of practitioners not only effectively do their job, but also come close to the depiction of the «perfect doctor». Our opinion is that psychological preparation as well the doctors readiness is of utmost importance. Physicians should have affection to both the ill and the healthy. Concerning the ill, doctors must feel more respect and be more understanding. First of all, any emotion might harm rational thinking, thus worsen potential results of intervention. Second, we inherently don’t want to harm our loved ones, this way close relationships might inhibit both diagnostics and treatment. In current conditions with the popularity of nihilistic and pragmatic ideas in society, the refusal of moral constructs creates certain professional, social and juristic problems. The issue of medical ethics and deontology has become more acute in the end of the previous century. This happened on the back of changes in the sphere of social economics and medicine, fueled by low pay rates, improper financing and the creation of a market in the field, something that isn’t characteristic of medicine. Growing are occurrences of dehumanization, as well as the distance between doctor and patient expanding, which is caused by new laboratory research methods and instrumental diagnostics.

Abstract P4-11-07: Shared decision making (SDM) in routine care treatment of breast cancer patients – a survey of patients following surgery

Abstract Introduction: The aim of shared decision making (SDM), defined as an interaction between patient and attending physician(s), is a treatment decision in which patients are meaningfully involved. Based on mutual agreement and active participation the awareness of a choice should be created and the choice respected. Many preference-sensitive decisions have to be made in breast cancer treatment. However, little is known about the implementation of SDM in German breast cancer care. We therefore investigated the process of SDM from the patients' perspective. Methods: All breast cancer patients who underwent surgery in one of four certified breast cancer centers in Germany between 07/2016 and 12/2016 were invited by mail to participate in the survey. The experienced decision-making process was assessed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9). SDM-Q-9 items were rated on a 6-point scale ranging from "completely disagree" to "completely agree", added together and transformed into a scale ranging from 0 to 100. The higher the total score the higher the experienced degree of participation in the decision-making process. The survey also assessed patients' satisfaction with treatment, satisfaction with decisions and decisional control preferences, and included a range of demographic and clinical questions. For most items we asked the participants to separately rate decision-making consultations with their inpatient hospital doctors, outpatient gynecologists, outpatient oncologists and primary care providers (PCP). The project is still ongoing, data of approximately 300 patients will be presented at the meeting in December. Results: Of 289 patients approached by mail, 143 filled in the survey (response rate: 49%). Median age at the time of the survey was 62 years (36-89). 83% had breast conserving surgery, 17% mastectomy. 74% were treated with radiation, 31% received neo-/adjuvant chemotherapy. 14% were off-treatment at the time of survey participation, 67% still received antihormonal therapy, 9% anti HER2 treatment, 7% chemotherapy and 2% radiation. Inpatient hospital doctors achieved the highest SDM-Q-9 score (mean of 75, standard deviation of 22) indicating the highest degree of SDM. Oncologists, gynecologists and PCP were rated quite comparable with a mean score of 72 each and standard deviations (SD) of 27, 22 and 31. The mean score for all groups of doctors was 73. For items concerning satisfaction with quality and amount of doctors' information and participation in medical decisions patients showed a high degree of satisfaction, resulting in mean values of 3.6 and 3.5 with SD of 0.6 on a 4-point scale ranging from "1" "very unsatisfied" to "4" "very satisfied". Conclusions: A considerable number of patients took part in the survey. Overall, patients reported to have experienced SDM in many situations where treatment decisions were necessary. Patients were quite satisfied with the quality of information and their participation in medical decisions. However, we do not know whether non-respondents might have had different experiences regarding their treatment decision-making. Further research should include SDM expert observations of breast cancer treatment decisions to validate these findings. Citation Format: Feiten S, Scholl I, Schmidt M, Dünnebacke J, Franzen A, Ernst W, Weide R. Shared decision making (SDM) in routine care treatment of breast cancer patients – a survey of patients following surgery [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-07.

Health workforce governance in Italy

More precise health workforce governance has become a prominent issue in healthcare systems. This issue is particularly important in Italy, given its strongly doctor-centered healthcare system and the dramatic aging of its physicians’ labor force. Using different sources of information (statistical data, official planning documents and interviews with key informants), the article attempts to answer two questions. Why has the Italian healthcare systems found itself in the situation of a potential drastic reduction in the amount of doctors in the medium term without a rebalancing through a different mix of skills and professionals? How good is the capacity of the Italian healthcare system to plan healthcare workforce needs? The widespread presence of ‘older’ physicians is the result of the strong entry of doctors into the Italian healthcare system in the 1970s and 1980s. Institutional fragmentation, difficulties in drafting broad healthcare reforms, political instability and austerity measures explain why Italian health workforce forecasting and planning are still unsatisfactory, although recent developments indicate that changes are under way. In order to tackle these problems it is necessary to foster closer cooperation among a wide range of stakeholders, to move from uni-professional to multi-professional health workforce planning, and to partially re-centralise decision making.

The real world of cosmetic practice

Non-surgical cosmetics is a booming, lucrative industry. Demand is higher than ever, with the market expected to double in the next five years, and an increasing amount of doctors, dentists, nurses and other healthcare professionals getting involved in cosmetic practice. It’s easy to see why. But there should be more to it than money, and more to being a cosmetic practitioner than a one-day training course… a full-time cosmetic doctor speaks candidly about this thriving yet troubled industry.

The Effect of Malaria and Hookworm upon Physical and Mental Development of School Children

Previous articleNext article FreeThe Effect of Malaria and Hookworm upon Physical and Mental Development of School ChildrenTruman L. KelleyTruman L. Kelley Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by The Elementary School Journal Volume 18, Number 1Sep., 1917 Article DOIhttps://doi.org/10.1086/454590 Views: 63Total views on this site Citations: 4Citations are reported from Crossref PDF download Crossref reports the following articles citing this article:Josselin Thuilliez Malaria and Primary Education: A Cross-country Analysis on Repetition and Completion Rates, Revue d'économie du développement Vol. 17, no.55 (Apr 2010): 127–157.https://doi.org/10.3917/edd.235.0127Josselin Thuilliez L'impact du paludisme sur l'éducation primaire : une analyse en coupe transversale des taux de redoublement et d'achèvement, Revue d'économie du développement Vol. 17, no.11 (May 2009): 167–201.https://doi.org/10.3917/edd.231.0167Mabgaret Schell Infection by Intestinal Protozoa in Relation to the Intelligence of Siblings1, Child Development 4, no.33 (Sep 1933): 253–258.https://doi.org/10.1111/j.1467-8624.1933.tb05871.x Chapter IV: Relationships in Physical and Mental Development, Review of Educational Research 3, no.22 (Jun 2016): 150–162.https://doi.org/10.3102/00346543003002150