Formal Medical Care Research Articles

Adoption of outgroup norms provides evidence for social transmission in perinatal care practices among rural Namibian women.

Background and objectivesHow do new ideas spread in social groups? We apply the framework of cultural evolution theory to examine what drives change in perinatal care norms among Himba women in the Kunene region of Namibia. Access to formal medical care is on the rise in this region, and medical workers regularly visit communities to promote WHO-recommended perinatal care practices. This study investigates how various forms of social transmission affect women’s uptake of medical recommendations concerning perinatal care.MethodologyBased on interviews with one hundred Himba mothers, we used Bayesian multi-level logistical regression models to examine how perceptions of group preferences, prestige ascribed to outgroup conformers, interaction with the outgroup and access to resources affect norm adoption.ResultsWomen who perceive medical recommendations as common in their group prefer, plan and practice these recommendations more often themselves. We observed a shift toward medical recommendations regarding birth location and contraception use that was in line with conformity bias predictions. Practices that serve as cultural identity markers persist in the population.Conclusions and implicationsNorm changes, and the cultural evolutionary processes that can lead to them, are not uniform, either in process or pace. Empirical studies like this one provide important examples of how these changes reflect local culture and circumstance and are critical for better understanding the models that currently predominate in cultural evolution work. These cases can also help bridge the gap between evolutionary anthropology and public health by demonstrating where promotion and prevention campaigns might be most effective.Lay SummaryThe recent promotion of WHO-recommended perinatal care practices in Namibia provides an opportunity to empirically study norm change using a cultural evolution framework. We found women adopt medical recommendations when they believe these are common in their social group. Local norms that were not discouraged persisted in the study group.

Self-care habits among people who inject drugs with skin and soft tissue infections: a qualitative analysis

BackgroundInjection drug use is on the rise in the USA, and skin and soft tissue infections (SSTI) are a common complication, resulting in significant morbidity and mortality. Due to structural barriers to care-seeking, many people who inject drugs avoid formal care and resort to self-care techniques, but little is known about the nature of these techniques, or more generally about the accuracy or breadth of this population’s knowledge of SSTIs.MethodsSemi-structured qualitative interviews were conducted with 12 people who inject heroin in two metropolitan areas: Sacramento and Boston, USA.ResultsThese interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers.ConclusionsThe reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials. Harm reduction agencies and health care providers should work to obviate the need for these potentially dangerous practices by improving healthcare access for this population. In the absence of robust solutions to meet the needs of this population, education materials should be developed to optimize the efficacy and minimize the harms of these practices, while empowering and supporting the autonomy of people who use drugs and providing clear guidance on when self-care should be abandoned in favor of formal medical care.

Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Introduction: Primary immune thrombocytopenia (ITP), an autoimmune disorder characterized by low platelet count, can lead to serious bleeding events. Little is known about the current epidemiology of ITP in the US, and even less is known about the current healthcare burden of ITP, especially in the 12-month period following ITP diagnosis.Method: We used a retrospective cohort design and data from two US private healthcare claims databases (2010–2016) to identify persons with evidence of newly diagnosed ITP. We weighted estimates of the annual incidence of ITP by age and sex to reflect the US population, and summarized healthcare utilization and expenditures (2016 US$) during the first 12 months after ITP diagnosis (“follow-up period”).Results: Annual incidence of ITP in the US was 6.1 per 100,000 persons, higher among females versus males (6.7 vs. 5.5), and highest among children aged 0–4 years (8.1) and adults aged ≥65 years (13.7). Patients with ITP averaged 0.33 (95% CI: 0.32–0.35) hospitalizations and 15.3 (15.1–15.6) ambulatory encounters during the follow-up period; mean total healthcare expenditures during this period were $21,290 (20,502–22,031). Hospitalizations were more common during the first 3 months following diagnosis, and were twice as frequent among children versus adults; expenditures for ambulatory encounters were substantially higher for adults versus children aged 0–4 years.Conclusions: Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.

Akan Healthcare Delivery System and Its Effect on Modern Healthcare Practice in Ghana

In many societies, medicinal knowledge including healthcare delivery is associated with cultural and religious traditions. Among the Akan of Ghana, cultural knowledge about healthcare includes beliefs and practices as well as the use of expressions of culture in accordance with indigenous laws and mores. In this paper, we argue that despite the external influence by modernity and scientific developments, Akan cultural and religious traditions in healthcare have proven worthy in addressing many health needs of the countless poor among the Akan and other socio-cultural groups in Ghana. The research approach was qualitative and a cross sectional survey involving a sample size of 200 individuals. The paper identified that Akan religion and cultural knowledge about medicine/healthcare continues to play tremendous roles in many communities, even though it has not been fully officially accepted and acknowledged in Ghana. The existence of indigenous healthcare with other forms of medical care has positive impact on the socio-economic life and total well-being of the people. There is, therefore, the need to tap more into this religio-cultural knowledge on medicine and healthcare.

Economic analysis in behavioral health: Toward application of standardized methodologies.

Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Prevalence and Characteristics of Untreated Hernias in Southwest Cameroon

BackgroundHernias are one of the most commonly encountered surgical conditions, and every year, more than 20 million hernia repairs are performed worldwide. The surgical management of hernia, however, is largely neglected as a public health priority in developing countries, despite its cost-effectiveness. To date, the prevalence and impact of hernia have not been formally studied in a community setting in Cameroon. The aim of this study was to determine the prevalence and characteristics of untreated hernia in the Southwest region of Cameroon. MethodsThis study was a subanalysis of a cross-sectional community-based survey on injury in Southwest Cameroon. Households were sampled using a three-stage cluster sampling method. Household representatives reported all untreated hernias occurring in the past year. Data on socioeconomic factors, hernia symptoms, including the presence of hernia incarceration, and treatment attempts were collected between January 2017 and March 2017. ResultsAmong 8065 participants, 73 persons reported symptoms of untreated hernia, resulting in an overall prevalence of 7.4 cases per 1000 persons (95% confidence limit 4.98-11.11). Groin hernias were most commonly reported (n = 49, 67.1%) and predominant in young adult males. More than half of persons with untreated hernia (56.7%) reported having symptoms of incarceration, yet 42.1% (n = 16) of these participants did not receive any surgical treatment. Moreover, 21.9% of participants with untreated hernias never presented to formal medical care, primarily because of the high-perceived cost of care. Untreated hernias caused considerable disability, as 21.9% of participants were unable to work because of their symptoms, and 15.1% of households earned less money. ConclusionsHernia is a significant surgical problem in Southwest Cameroon. Despite over half of those with unrepaired hernias reporting symptoms of incarceration, home treatment and nonsurgical management were common. Costs associated with formal medical services are a major barrier to obtaining consultation and repair. Greater awareness of hernia complications and cost restructuring should be considered to prevent disability and mortality due to hernia.

Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey

The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. Among 961 respondents, 349 (31·9%, 95% CI 27·4-36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7-29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21-0·22, and 1·40, 1·39-1·42) and seeking formal health care (0·06, 0·05-0·06, and 1·16, 1·15-1·17). The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD. The Harvard Humanitarian Initiative Innovation Fund.

MINIMALLY INVASIVE UROLOGICAL INTERVENTIONS IN OUTPATIENT CLINIC ON THE EXAMPLE OF PROSTATE BIOPSY

One of the main directions of improving medical care was the introduction of inpatient forms of medical care for patients who do not require round-the-clock supervision. Aim of the research: to prove the effectiveness and economic feasibility of minimally invasive procedures in outpatient conditions. Materials and methods. The study included 3524 patients in the period from 2010 to 2017, who underwent transrectal prostate biopsy on the basis of the Department of urology of polyclinic No. 195 of the Western district of Moscow. For comparison, the patients were taken, who underwent a biopsy of the prostate gland at the base hospital No. 31, No. 51, No. 17. Results. The average number of biopsies performed in hospital No. 31, No. 51 and No. 17 for the year amounted to 344 biopsies, and the average detectability of prostate cancer was 142 (41.3 %). The average number of biopsies per year in the urology department of the branch number 2 GP No. 195 amounted to 440.5, and the average detectability of prostate cancer – 152.8 (34.7 %). Thus, with comparable inpatient detection of prostate cancer in one large outpatient urology center, an average of 28 % more biopsies are performed (440.5 versus 344) than in 3 hospitals over a comparable period of time. Conclusions. Inpatient technologies can reduce the burden on hospitals. The development of hospital-replacing forms is determined by the need of the population and for efficient use of financial and technical resources of health care.

Immune Thrombocytopenia in US Clinical Practice: Incidence and Healthcare Utilization/Expenditures in the First 12 Months Following Diagnosis

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet count due to increased platelet destruction and suboptimal platelet production, and can lead to serious bleeding events. While some evidence on the epidemiology of ITP is available, such data are based on ex-US populations or are now over a decade old. Moreover, little data exist on the healthcare burden of ITP, especially in the early (i.e., 12-month) period following diagnosis. Accordingly, a new study was undertaken to characterize the incidence of ITP as well as healthcare utilization and expenditures during the early (e)ITP period in the US.Methods: A retrospective cohort design and data from two healthcare claims repositories were employed; collectively, the repositories comprise claims information from ~50 million geographically diverse persons annually who are enrolled in over 75 US health plans. From the source population (i.e., enrolled persons from January 1, 2012 through December 31, 2015), patients with ITP were identified based on ≥1 hospitalization or ≥2 ambulatory encounters (separated by ≥30 days) with corresponding diagnosis codes (ICD-9: 287.31; ICD-10: D69.3); patients with causes of secondary thrombocytopenia and other selected conditions (e.g., viral hepatitis B, acute/chronic hepatitis C, HIV, lupus, pancytopenia, cancer) were excluded. ITP patients were stratified based on the year of initial diagnosis, and within each year-specific subset, those with ≥2 years of healthcare claims information available prior to their initial diagnosis, and no prior evidence of ITP during this period, were flagged as having newly diagnosed ITP. Annual incidence of ITP (per 100K persons) was weighted by age and sex to reflect the US population. Healthcare utilization and expenditures (2016US$) for eITP (i.e., during the first 12 months following diagnosis) were descriptively analyzed.Results: Among the 198.1 million persons in the source population, 11,028 were newly diagnosed with ITP during the study period. Annual incidence of ITP in the US was estimated to be 6.0 per 100,000 persons, to be higher among women versus men (6.7 vs. 5.4 per 100,000), and to be highest among children aged 0-4 years (8.1 per 100,000) and adults aged ≥65 years (13.7 per 100,000) (Table). ITP patients averaged 0.36 hospitalizations and 15.8 ambulatory encounters during the 12-month period following diagnosis, and corresponding average expenditures were $8,422 and $13,359; including outpatient pharmacotherapy, total healthcare expenditures averaged $22,285. Hospitalizations were more common (0.29 vs. 0.05) and costly ($6,342 vs. $1,468) during the first three months following diagnosis versus the next nine months; numbers (7.6 vs. 7.8) and expenditures ($6,202 vs. $6,758) for ambulatory encounters were roughly comparable between periods. While hospitalizations were twice as common among children versus adults, mean hospital expenditures were similar, and expenditures for ambulatory encounters were substantially higher for adults versus young children.Conclusion: The findings of this study suggest that nearly 20,000 persons are newly diagnosed with ITP each year in the US, and that ITP is much more common than previously reported. The findings also suggest that, among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with US expenditures during this period totaling nearly $450 million. [Display omitted] DisclosuresWeycker:Amgen: Research Funding. Grossman:Amgen: Research Funding. Hanau:Amgen: Research Funding. Wu:Amgen: Research Funding. Hatfield:Amgen: Employment, Equity Ownership. Sharma:Amgen: Employment, Equity Ownership. Bensink:Amgen: Employment, Equity Ownership. Chandler:Amgen: Employment, Equity Ownership. Tarantino:Amgen: Membership on an entity's Board of Directors or advisory committees; Centers for Disease Control and Prevention: Research Funding; Health Resources and Services Administration: Research Funding; Pfizer: Other: Reviews grants; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Grifols: Research Funding, Speakers Bureau; Genentech: Membership on an entity's Board of Directors or advisory committees; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Genome analyses for the Tohoku Medical Megabank Project towards establishment of personalized healthcare

Personalized healthcare (PHC) based on an individual's genetic make-up is one of the most advanced, yet feasible, forms of medical care. The Tohoku Medical Megabank (TMM) Project aims to combine population genomics, medical genetics and prospective cohort studies to develop a critical infrastructure for the establishment of PHC. To date, a TMM CommCohort (adult general population) and a TMM BirThree Cohort (birth+three-generation families) have conducted recruitments and baseline surveys. Genome analyses as part of the TMM Project will aid in the development of a high-fidelity whole-genome Japanese reference panel, in designing custom single-nucleotide polymorphism (SNP) arrays specific to Japanese, and in estimation of the biological significance of genetic variations through linked investigations of the cohorts. Whole-genome sequencing from >3,500 unrelated Japanese and establishment of a Japanese reference genome sequence from long-read data have been done. We next aim to obtain genotype data for all TMM cohort participants (>150,000) using our custom SNP arrays. These data will help identify disease-associated genomic signatures in the Japanese population, while genomic data from TMM BirThree Cohort participants will be used to improve the reference genome panel. Follow-up of the cohort participants will allow us to test the genetic markers and, consequently, contribute to the realization of PHC.

Person-Centricity: Promoting Self-Determination and Responsibility in Health and Health Care.

The transition from a system focused on the delivery of sickness and illness services to one with a heavy focus of helping people become and remain healthier requires a major shift in how we view the patient and person. The health care system attempts to magically transform us from persons to patients in a context of sickness and disease, in need of medical procedures and interventions. Those few hours we spend a year in formal medical and health care contexts do not define us in the broader life space. We contend that "person-centricity" is more reflective of the life space and as such better supports that shift than do models of consumer or patient empowerment, centeredness, engagement, or activation. "Person-centricity" represents the complexity of how individuals make decisions including health and health care decisions, within the broader context of their lives, and accurately addresses the needs and aspirations of people throughout their life journey. This is not simply a shift in semantics, but an entirely new paradigm that frees the individual from assuming and succumbing to the passive and subservient patient role and dramatically changes the way in which we view ourselves and interact with the health care system.The changes required to create a healthier America and affect costs associated with lifestyle-related diseases need to happen on a personal level, coupled with a supportive infrastructure and public policies to promote and sustain them. This shift is critical to our transition from health care to a healthier way of living and of controlling avoidable costs.

Enhancing implementation of measurement-based mental health care in primary care: a mixed-methods randomized effectiveness evaluation of implementation facilitation

BackgroundMental health care lags behind other forms of medical care in its reliance on subjective clinician assessment. Although routine use of standardized patient-reported outcome measures, measurement-based care (MBC), can improve patient outcomes and engagement, clinician efficiency, and, collaboration across care team members, full implementation of this complex practice change can be challenging. This study seeks to understand whether and how an intensive facilitation strategy can be effective in supporting the implementation of MBC. Implementation researchers partnering with US Department of Veterans Affairs (VA) leaders are conducting the study within the context of a national initiative to support MBC implementation throughout VA mental health services. This study will focus specifically on VA Primary Care-Mental Health Integration (PCMHI) programs.MethodsA mixed-methods, multiple case study design will include 12 PCMHI sites recruited from the 23 PCMHI programs that volunteered to participate in the VA national initiative. Guided by a study partnership panel, sites are clustered into similar groups using administrative metrics. Site pairs are recruited from within these groups. Within pairs, sites are randomized to the implementation facilitation strategy (external facilitation plus QI team) or standard VA national support. The implementation strategy provides an external facilitator and MBC experts who work with intervention sites to form a QI team, develop an implementation plan, and, identify and overcome barriers to implementation. The RE-AIM framework guides the evaluation of the implementation facilitation strategy which will utilize data from administrative, medical record, and primary qualitative and quantitative sources. Guided by the iPARIHS framework and using a mixed methods approach, we will also examine factors associated with implementation success. Finally, we will explore whether implementation of MBC increases primary care team communication and function related to the care of mental health conditions.DiscussionMBC has significant potential to improve mental health care but it represents a major change in practice. Understanding factors that can support MBC implementation is essential to attaining its potential benefits and spreading these benefits across the health care system.

On the first occupational medicine initiatives in Mexico: The Real del Monte miners’ hospital.

Despite the legislation of Otto von Bismarck (1815-1898) on social security rights formulated in 1883 in Germany where it is stated that it is the duty of the State to promote the welfare of all members of society, particularly the weakest and most needy, using the means available to them, and the proposals of laws against accidents issued on April 30, 1904 in the State of Mexico in 1904, in the Mexico of the Porfirio Díaz era, providing workers with formal medical care was not contemplated, except in the case of some railway companies, hospitals for the care of patients with occupational diseases were not built. One of these exceptions was the Hospital del Mineral del Real del Monte de Pachuca, founded in the late nineteenth century and after the mining company passed to the Americans in 1906, it was agreed that the company acquired the hospital and equated it with the medical and surgical advances of the time for immediate care of injuries, especially of the orthopedic type, which enabled not only the healing of wounds, but also rehabilitation. This hospital is one of the oldest in Mexico with regard to three disciplines: orthopedics, occupational medicine and rehabilitation. It ceased to operate in 1982, and currently it is a museum with a rich collection of documents and instruments related to the aforementioned disciplines.

Israeli general practitioners' dissatisfaction with their own primary healthcare.

Many physicians treat themselves despite established guidelines against such practice. To examine whether general practitioners (GPs) are satisfied with their personal primary care and how this could be improved. We sent a questionnaire to GPs in Israel. We examined the gap between preference to use formal medical care and use in practice, satisfaction with physicians' primary healthcare, self-prescribing and ways to improve physician access to care. There were 203 respondents (response rate 203/985; 21%). Sixty-one per cent reported not having a GP. Older respondents were less likely to have their own GP. Thirty-seven per cent of physicians reported receiving less formal medical care than they desired. This gap was higher in those reporting self-prescription of benzodiazepines and anti-depressants (P < 0.05) and was significantly associated with dissatisfaction with primary healthcare. Odds for being satisfied with personal care was reduced by more than 85% in GPs who reported receiving less formal medical care than they desired (odds ratio 0.146; 95% confidence interval 0.064-0.333). Our findings inform the profile of physician self-treatment and the dissatisfaction associated with it. Dissatisfaction was associated with a gap between desired and actual care rather than with having or not having a personal GP. There was no consensus regarding what would assist physicians to access GPs.

Rethinking women's experiences of depression and recovery as emplacement: Spatiality, care and gender relations in rural Australia

In Australia and other OECD countries women who are recovering from depression in rural areas find that access to professional care is fraught with difficulties. Despite the emphasis on the social determinants shaping mental ill health and recovery, Australian rural support has been largely defined by biomedical and psy-expertise focused on correcting biochemistry and cognition through different models of formal medical care. Addressing the limitations of individualised biomedical models, this article offers a relational understanding of how recovery from depression is produced through rural and gendered emplacement (Pink, 2011). Theorising recovery through the notion of emplacement shifts attention from an individualised notion of embodied distress (symptoms, emotions, cognition) towards a social understanding of the dynamics of human and non-human relations that are afforded by different care practices (from medical treatment to social support). To date there has been little critical analysis of how women's distress and recovery experiences are gendered in relation to both formal and informal care in rural places. Extending the insights of geographers, social anthropologists and feminist scholars we analyse the recovery stories of women living in rural and regional Australia. We focus specifically on how rural women experienced uncertainty and stigma that emerged through formal care spaces and impeded their recovery -the gendered dynamics of em(dis)placement were identified. In contrast, we identify how particular informal care spaces enabled women's recovery through multiple relations with human and non-human others. Our research aims to contribute a critical understanding of how everyday professional care and self-care practices are intertwined with the complex gendered negotiations of emplacement and displacement that shape rural mental (ill) health.

Socioeconomic differences in self-medication among middle-aged and older people: data from the China health and retirement longitudinal study

ObjectivesSelf-medication with over-the-counter medicines (OTCs) and prescription-only medicines (POMs) are both pervasive in China, although the latter is an inappropriate practice. We examined the relationship between socioeconomic status (SES) and...

Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions

ObjectiveTo determine whether state medical licensure application questions (MLAQs) about mental health are related to physicians' reluctance to seek help for a mental health condition because of concerns about repercussions to their medical licensure. MethodsIn 2016, we collected initial and renewal medical licensure application forms from 50 states and the District of Columbia. We coded MLAQs related to physicians' mental health as “consistent” if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions. We obtained data on care-seeking attitudes for a mental health problem from a nationally representative convenience sample of 5829 physicians who completed a survey between August 28, 2014, and October 6, 2014. Analyses explored relationships between state of employment, MLAQs, and physicians' reluctance to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. ResultsWe obtained initial licensure applications from 51 of 51 (100%) and renewal applications from 48 of 51 (94.1%) medical licensing boards. Only one-third of states currently have MLAQs about mental health on their initial and renewal application forms that are considered consistent. Nearly 40% of physicians (2325 of 5829) reported that they would be reluctant to seek formal medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure. Physicians working in a state in which neither the initial nor the renewal application was consistent were more likely to be reluctant to seek help (odds ratio, 1.21; 95% CI, 1.07-1.37; P=.002 vs both applications consistent). ConclusionOur findings support that MLAQs regarding mental health conditions present a barrier to physicians seeking help.

School health services in Enugu East, Nigeria: perspectives from a resourcepoor setting

School health services (SHS) have widespread impact on the health of a large number of children with implications on access to primary health care especially in developing countries. The aim of this study was to assess health services in primary schools in Enugu East Nigeria. Thirty-three head teachers of primary schools in Enugu east Nigeria and officials of Ministry of Education were interviewed using a questionnaire adapted from school health evaluation scale. Four private schools had health personnel. Only six private schools had a health room. Two public schools had a functional first aid box. There were no health records available in any of the schools. School lunch was given by only one private school. Of a maximum of 45, public and private schools had a mean score of 10.3 and 12.7 respectively on the school health evaluation scale (P=0.01). Three schools only attained the minimum acceptable score of 19. Health services are at a minimal level in primary schools in Enugu East Nigeria. A state school health policy should be developed through inter-sectoral collaboration of the relevant stakeholders to use the platform provided by schools to ensure access to primary health care and also act as bridge for more formal medical care for school children.

Scientific basis of priority directions of the health care development for cardiac patients in city

Objective: the scientific basis of priority directions of the health care development for cardiac patients in city according to public health system. Improving medical and demographic situation, increasing the availability and quality of care to all segments of the population is the priority task of modern health care system in Ukraine. Various aspects of population health due to diseases of the cardiovascular system and the issues of improving public health system and the system of cardiac care for the population, is the subject of many years researches. Cardiovascular diseases are leading causes of premature death, disability, temporary disability. According to the experience of developed countries in recent decades, the prevalence of this pathology and the severity of the harm to public health can reduce significantly in case of effective organization of medical-diagnostic process and prevention system. Specialized in patient care for patients suffering from cardiovascular diseases, is very expensive. At the same time, the number of patients with such pathology is high enough in ambulatory practice. Among them, special attention should be paid to those patients, who require daily monitoring, but do not require the round-the-clock stationary mode. The organization of inpatient forms of medical care for this category of patients is a very urgent task. Equally important are the training of personnel for the cardiology service, the sustainability of human resources, economic motivation, which ensures high quality, the effectiveness of complex labor processes.

Mountain medical kits: epidemiology-based recommendations and analysis of medical supplies carried by mountain climbers in Colorado.

: To provide medical kit recommendations for short mountain wilderness recreation trips (hiking, trekking, backpacking, mountaineering etc.) based on the epidemiology of injury and illness sustained and best treatment guidelines. Additionally, to compare these recommendations to the medical kit contents of mountain climbers in Colorado. : A primary literature review concerning the epidemiology of injury and illness in mountain wilderness settings was performed. This information and literature on the efficacy of given treatments were used to derive recommendations for an evidence-based medical kit. The contents of 158 medical kits and the most likely demographics to carry them were compiled from surveys obtained from mountain climbers on 11 of Colorado's 14000-foot peaks. : Musculoskeletal trauma, strains, sprains and skin wounds were the most common medical issues reported in the 11 studies, which met inclusion criteria. Adhesive bandages (Band-Aids) were the most common item and non-steroidal anti-inflammatory drugs were the most common medication carried in medical kits in Colorado. More than 100 distinct items were reported overall. : Mountain climbing epidemiology and current clinical guidelines suggest that a basic mountain medical kit should include items for body substance isolation, materials for immobilization, pain medications, wound care supplies, and medications for gastrointestinal upset and flu-like illness. The medical kits of Colorado mountain climbers varied considerable and often lacked essential items such as medical gloves. This suggests a need for increased guidance. Similar methodology could be used to inform medical kits for other outdoor activities, mountain rescue personnel, and travel to areas with limited formal medical care.