General Doctors Research Articles

Prevalence and Association of Different Levels of Intellectual Disability with Prenatal, Perinatal, Neonatal and Postnatal Factors

Intellectual disability (ID), also called mental retardation, is defined by below-average intelligence or mental aptitude as well as a lack of life skills. It has a significant association with residency, family history, and chromosomal disorder. An analytical cross-sectional study was performed over a period from December 2019 to January 2021 in special educations centers and hospitals of Lahore, Faisalabad, Shahkot, Sialkot, Gujranwala and Sangala, Punjab, Pakistan. This study was aimed to access the prevalence and risk factors of Intellectual disability (ID). Questionnaires were designed and filled with the help of general doctors, pediatricians, and psychiatrists who diagnosed both intellectual and adaptive functioning of individuals Association between these parameters was analyzed by using SPSS software (Chi-square test) between ID and risk factors and the level of significance was considered as P<0.05. The frequency of mild, moderate, severe, and profound ID was 46.7 %, 32.1 %, 14.6 %, and 6.7 % respectively. More males (56.82 %) as compared to females 43.17 % were observed.

Perspectives on paediatric sleep-disordered breathing in the UK: a qualitative study.

There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children. The study comprised in-depth qualitative interviews (n = 22) with parents of children (2-9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically. General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed. Guidelines for the management of paediatric sleep-disordered breathing are needed.

To Assess Knowledge of Glaucoma in General Practitioners, Resident Doctors and Interns in Anand District, Gujarat, India

Introduction: Glaucoma has been established as the second most leading cause of blindness after cataract, which is usually irreversible and accounts for 10.1% of total blindness worldwide. Glaucoma has affected 79.6 million people worldwide by 2020. The estimated prevalence of glaucoma for India is 12 million. The Government of India aims to reduce the prevalence of blindness to 0.25/1000 by 2025 and disease burden by one-third from current levels. In a developing country, like India, ‘physician of first contact’ may be a general practitioner, resident doctor or intern. Aim: To assess knowledge of glaucoma in general practitioners, resident doctors and interns, in Anand district, Gujarat and to identify the level of difference of knowledge in each group and to suggest remedial measures for the same. Materials and Methods: A descriptive semi-structured questionnaire based cross-sectional study was conducted in Pramukhswami Medical College, Karamsad, Gujarat, India, after obtaining ethical clearance from the Institutional Ethics Committee between July-September 2017. Informed written consent was taken from 240 medical doctors comprising of interns (undergoing compulsory rotatory internship), 1st to 3rd year resident doctors (postgraduate students) working in different wards of all the clinical department and general practitioners practising in radius of 15 kilometers of the main hospital located in Anand district of Gujarat state (80 in each category) and a questionnaire was administered. Participants were inquired of about the knowledge of glaucoma, the sneak thief of sight. Residents of Ophthalmology were excluded to avoid bias. Cramer’s V association, Chi-square test and Fisher's-Exact tests were applied. Results: Respondents included general practitioners, residents, interns (80:80:80). Glaucoma knowledge was to be higher in residents as compared to interns and general practitioners. About 78.75% residents scored 7 and above, out of 10 whereas 61.25% interns and 50% general practitioners obtained the same score. Conclusion: The authors found that knowledge about glaucoma in multi-scale medical practitioners is not uniform and reasonably less than it shall be. Resident doctors (fresh graduates and completed compulsory rotatory internship) have better knowledge about various aspects of glaucoma as compared to general practitioners and interns which demands the need for frequent reorientation programme and internship in Ophthalmology guiding about various aspects of disease entities responsible for blindness.

Workforce problems at rural public health-centres in India: a WISN retrospective analysis and national-level modelling study

BackgroundRural India has a severe shortage of human resources for health (HRH). The National Rural Health Mission (NRHM) deploys HRH in the rural public health system to tackle shortages. Sanctioning under NRHM does not account for workload resulting in inadequate and inequitable HRH allocation. The Workforce Indicators of Staffing Needs (WISN) approach can identify shortages and inform appropriate sanctioning norms. India currently lacks nationally relevant WISN estimates. We used existing data and modelling techniques to synthesize such estimates.MethodsWe conducted a retrospective analysis of existing survey data for 93 facilities from 5 states over 8 years to create WISN calculations for HRH cadres at primary and community health centres (PHCs and CHCs) in rural areas. We modelled nationally representative average WISN-based requirements for specialist doctors at CHCs, general doctors and nurses at PHCs and CHCs. For 2019, we calculated national and state-level overall and per-centre WISN differences and ratios to depict shortage and workload pressure. We checked correlations between WISN ratios for cadres at a given centre-type to assess joint workload pressure. We evaluated the gaps between WISN-based requirements and sanctioned posts to investigate suboptimal sanctioning through concordance analysis and difference comparisons.ResultsIn 2019, at the national-level, WISN differences depicted workforce shortages for all considered HRH cadres. WISN ratios showed that nurses at PHCs and CHCs, and all specialist doctors at CHCs had very high workload pressure. States with more workload on PHC-doctors also had more workload on PHC-nurses depicting an augmenting or compounding effect on workload pressure across cadres. A similar result was seen for CHC-specialist pairs—physicians and surgeons, physicians and paediatricians, and paediatricians and obstetricians–gynaecologists. We found poor concordance between current sanctioning norms and WISN-based requirements with all cadres facing under-sanctioning. We also present across-state variations in workforce problems, workload pressure and sanctioning problems.ConclusionWe demonstrate the use of WISN calculations based on available data and modelling techniques for national-level estimation. Our findings suggest prioritising nurses and specialists in the rural public health system and updating the existing sanctioning norms based on workload assessments. Workload-based rural HRH deployment can ensure adequate availability and optimal distribution.

Attitudes and knowledge of pregnant women about oral health.

BACKGROUND:This cross-sectional study aimed to evaluate attitudes and knowledge regarding oral health and infant oral health among pregnant women.MATERIALS AND METHODS:The study involved 325 pregnant women in the Republic of Croatia who completed an anonymous online questionnaire (Google forms) from January to June 2019. The questionnaire was divided into three parts. The first part contained questions about the demographic data experience about oral health in pregnancy. The second part was related to the knowledge of the relationship between oral health and pregnancy. The third section consisted of questions related to knowledge about the oral health of children at the earliest age. The results were analyzed with descriptive statistics, Spearman correlation analysis, and Chi-square test.RESULTS:The women are mostly informed about oral health in pregnancy from their dentists (53.54%) and least from their general doctors (4%). In pregnancy, gingival bleeding was observed by 52.31% of respondents and tooth mobility by 12.31%. The Chi-square test found that there was a difference in attitude regarding the age at which they should stop breastfeeding between respondents who had their first pregnancy and those who already had children. Only 9.23% of respondents are aware that breastfeeding can cause tooth decay.CONCLUSION:Pregnant women in the Republic of Croatia do not have sufficient knowledge, and they are neither aware of the importance of oral health during pregnancy nor infant oral health.

Clavicle Dislocations in Family Physians Practice

Dislocations of the clavicle are one of the most common injuries in people of different age groups, which require prompt diagnosis and timely treatment to prevent the development of complications, therefore, acknowledgment of general practitioners-family doctors in diagnosis and medical care for patients with dislocations of the clavicle is a necessary component of the professional competence. Aim: to provide up-to-date information for distance self-learning of general practitioners – family doctors on the diagnosis and treatment of clavicle dislocations and conduct a test assessment of the acquired knowledge. Materials and methods. The analysis of scientific and methodological medical literature and clinical cases from the practice of orthopedic traumatologists, concerning anatomy, classification, mechanisms of development, diagnosis, clinical picture, conservative and principles of surgical treatment of patients with dislocated clavicle is given in the article. Results. A team of authors – orthopedic traumatologists – presented a review of the literature data and clinical cases of dislocation of the clavicle, on the basis of which educational material was formed for distance self-learning of the general practitioners – family doctors. The modern data on the mechanisms of development of dislocation of the clavicle, classification, clinical picture, depending on the type of dislocation are presented; recommendations for conservative treatment and indications for surgical intervention are given. Tests for self-control of knowledge after studying the presented material are given. Conclusions. Knowledge of the management of patients with clavicle dislocation is a necessary component of the formation of professional competencies of a general practitioner – family doctor. The presented article for distance learning provides all the necessary up-to-date information to provide such knowledge.

Caregivers’ and healthcare professionals’ perspective of barriers and facilitators to health service access for asthmatic children: a qualitative study

BackgroundThere is a high burden of asthma morbidity and mortality in Latin America. It has been proposed that this relates to limited access to diagnostic tests, asthma medications and specialised...

How are guide profession and routine care setting related to adherence and symptom change in iCBT for depression? - an explorative log-data analysis

BackgroundWhile the antidepressant efficacy of guided digital interventions has been proven in randomized controlled trials, findings from routine care are less clear. Low adherence rates are common and limit the potential effectiveness. Adherence has been linked to sociodemographic variables and the amount of guidance, but the role of the guide's profession and their work setting has not yet been studied for routine care. MethodsRoutinely collected log data from a digital intervention for depressed patients (iFightDepression tool) were analyzed in an exploratory manner. The sample is a convenience sample from routine care, where guidance is provided by general practitioners (GP), certified psychotherapists (PT) or medical doctors specialized in mental health. Log data from 2184 patients were analyzed and five usage parameters were extracted to measure adherence (first-to-last login, time on tool, number of sessions, workshops completed and minimal dose). Multiple logistic regression was used to analyze relations between the guide's profession and clinical context as well as other covariates and adherence and symptom change on a brief depression questionnaire (PHQ-9). ResultsThe analyses showed a significant relation of guide profession and adherence. Guidance by PT was associated to the highest adherence scores (reference category). The odds ratios (ORs) of scoring above the median in each usage parameter for patients guided by GPs were 0.50–0.63 (all ps < 0.002) and 0.61–0.80 (p = .002–0.197) for MH. Higher age, initial PHQ-9 score and self-reported diagnosis of depression were also significantly associated with higher adherence scores. In a subsample providing enough data on the PHQ-9 (n = 347), no association of guide profession with symptom reduction was found. Instead, a greater reduction was observed for patients with a higher baseline PHQ-9 (β = −0. 39, t(341.75) = −8.814, p < .001) and for those who had achieved minimal dose (β = −2.42, t(340.34) = −4.174, P < .001) and those who had achieved minimal dose and scored high on time on tool (β = 0.22, t(341.75) = 1.965, P = .050). ConclusionBeing guided by PT was associated with the highest adherence. The lowest adherence was observed in patients who were guided by GP. While no association of guide profession and symptom reduction was found in a subsample, greater adherence was associated with symptom reduction.

General hospital specialists’ attitudes toward psychiatry: a cross-sectional survey in seven countries

ObjectivePsychiatric comorbidities are common in physical illness and significantly affect health outcomes. Attitudes of general hospital doctors toward psychiatry are important as they influence referral patterns and quality of care....

Barriers associated with emergency medical service activation in Italian patients with ST-segment elevation acute coronary syndromes

Abstract Background Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation include patients with any acute coronary syndrome (ACS) without representation of southern European populations. However, barriers are influenced by the ACS type and by socio-demographic and racial factors. Purpose We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy. Methods A prospective, single-center, survey-based study, including all the patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 1st June 2018 to 31st May 2020. Results The questionnaire was filled out by 293 patients. The majority of the participants were males (74%), married (70.4%), with a high-school degree (38.4%) and with a median age of 62 years. Chest pain as a possible symptom related to a cardiovascular attack is known by most of the respondents (89%), and left arm pain/shake by 53.7% of them, whilst the other possible signs and symptoms (i.e. dyspnea, asthenia, sweating, nausea, vomiting, dizziness) were unknown to the majority of the participants. Only 191 (65.2%) of the participants activated the EMS after symptoms onset. The main reasons for not calling EMS were the perception that symptoms were not related to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). The median time to first medical contact was 60 minutes, and it was significantly higher in the patients who did not called EMS compared to those who did (180 [60–420] mins vs 35 [15–120] mins, p&amp;lt;0.001). The patients who called a private doctor after symptoms onset did not called EMS more frequently than those who did not (5.9% vs 8.2%, p=0.3). Moreover, 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred and the main reasons for this were that they think to be faster than EMS (57.1%) and to live close to the hospital (17.9%). Analyzing predictors of EMS activation, only prior history of cardiovascular disease has been demonstrated to be a predictor of calling the EMS in case of symptoms suspected for STEACS. Conclusions Our study, from the southern Europe, showed that a substantial percentage of patients with symptoms suspected for STEACS preferred private vehicle rather than activating the EMS. Our results highlight the need for information campaigns targeted to both the general population and medical doctors, stressing that the EMS is faster than a private vehicle to direct the patient to the right hospital and increasing the awareness of the people on the type of possible heart attack symptoms, which seem to be the most neglected issues by patients who did not call the EMS. Funding Acknowledgement Type of funding sources: None.

An observational study on Awareness of Teratogenic drugs among Undergraduate Medical Students from two medical institutes of Central India

Background: Teratogenicity caused by drugs can be avoided to major extent just by creating more awareness about rational use of drugs among treating doctors. Deleterious effects of a drug upon developing foetus are directly related with the stage of embryological development at the time of exposure. Attainment of right knowledge at right time about teratogenicity of a particular drug is very crucial which requires more awareness among general doctors in a country like India where most of the pregnant females are manged by these doctors only in peripheral regions. Present study was an observational study to assess basic knowledge of undergraduate medical students regarding teratogenicity in order to make necessary changes in existing mode of training of this particular topic.Methods: Present study was a questionnaire based cross sectional observational study to assess basic knowledge of undergraduate medical students regarding different aspects of teratogenicity. It included 250 students of two medical colleges of central India.Results: Out of 250 students 146 students reported on time. Maximum students (71%) were aware about the teratogenicity property of certain harmful drugs. Although 90% of students knew that early first trimester is the most susceptible time, only 21% could state the importance of doing counselling regarding use of drugs even before pregnancy.Conclusions: Based on the findings of present study it is obvious that more emphasis should be put on improving knowledge about teratogenic drugs during early years of medical training in order to bring about necessary changes in existing practices of treating doctors.

Nosocomial infections as one of the most important problems of healthcare system.

Healthcare-associated infections (HAI) are commonly defined as adverse events resulting from the provision of healthcare. The reduction of risk arising from the spread of pathogenic microorganisms in the hospital environment is a considerable challenge in the context of the proper functioning of the medical services sector. The financial costs of hospitals resulting from HAI are a serious problem for the Polish healthcare system. The spread of strains with a high level of drug resistance in individual hospitals is associated with the local epidemiological situation. In 2015-2017, there was a high increase in the number of infections caused by New Delhi strains. The highest increase due to this strain occurred in Mazowieckie and Podlasie provinces. The dynamics of infection caused by New Delhi strains throughout Poland in 2015-2016 indicated an increase of 278.7%. In 2017, the phenomenon of antibiotic abuse in all regions of Poland was 24% higher than the EU average. One of the reasons is the insufficient number of diagnostic tests ordered by both general practitioners and doctors representing hospital care. In 2016-2017, the average number of microbiological tests in diagnosing hospital infections performed annually within the entire territory of Poland was 50% lower than in European Union countries and the number recommended by WHO. Increased, and at the same time inappropriate antibiotic therapy led to a build-upof drug resistance among bacterial species of significant clinical importance. The current epidemiological situation imposes the necessity for constant HAI control and broadly understood rationalization of the guidelines of hospital antibiotic policy.

Comparison of indicators of metacognitive awareness of doctors at different stages of education

Introduction. Metacognition is essential for developing clinical thinking skills. Metacognitive skills are widely regarded as important for doctors, but they are rarely formed and evaluated in higher medical school. To solve this problem, it is required to determine how the cognitive, regulatory and reflexive indicators of metacognitive awareness in doctors change throughout their professional life. This work aims to study the metacognitive awareness of doctors at different stages of professional education. Methods. The study involved 1st-year students of the Department of General Medicine (N=48), medical residents (N=44), and doctors enrolled in advanced training cycles (N=34) of the Yaroslavl State Medical University. To study the cognitive, regulatory and reflexive indicators of metacognitive awareness, the following methods were used: "Metacognitive Awareness Inventory" (G. Schraw, R. Dennison, adaptation by E.Yu. Savin, A.E. Fomin), "Assessment of metacognitive knowledge and metacognitive activity" (Yu.V. Poshekhonova, M.M. Kashapov), "Methodology of the level of expression and direction of reflection" (M. Grant). Research results. Significant differences were revealed in metacognitive awareness indicators at the initial and final stages of higher education (U=800.0, p≤0.05). According to the results of the study, it was found that the higher the stage of higher professional education is, the higher is the ability to manage information (U=783.0, p≤0.05), choose the main ideas (U=800.0, p≤0.05) and control errors (U=790.0, p≤0.05). Moreover, indicators of socio-reflection are more pronounced (U=702.5, p≤0.01). The doctors enrolled in further education courses have a high level of metacognition. The significant differences were found in terms of the following indicators: metacognitive knowledge (U=309.5, p≤0.001), metacognitive activity (U=295.5, p≤0.001), concentration (U=417.5, p≤0.001), acquisition of information (U=275.5, p≤0.001), choice of main ideas (U=528.5, p≤0.05), and time management (U=338.0, p≤0.001). There are no significant differences in the reflexive component of the metacognitive awareness of doctors at the stage of additional professional education and the final stage of higher education. Conclusion. All indicators of metacognitive awareness among doctors are formed at the stage of higher education. The reflexive component of metacognitive awareness helps to adapt to the changing conditions of obtaining additional professional education. Metacognitive awareness, with the help of which doctors are aware of their own thoughts and use the best ways to solve problematic situations, allows them to cope with difficulties in the learning process and in professional activity.

Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study.

BackgroundIn recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role.ObjectiveThis study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future.MethodsThis study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis.ResultsData collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing.ConclusionsThe study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.International Registered Report Identifier (IRRID)DERR1-10.2196/30099

The Role of Socioeconomic Status and Literacy in the treatment delay in Oral Cancer patients Visiting Mayo Hospital

Background: One of the most important prognostic factors of oral cancer is the stage at the time of diagnosis. Unfortunately, most of the patients present in the late stages (stage III and IV). Aim: To assess the role of socioeconomic status and literacy in the treatment delay in patients of oral cancer. By identifying their role, we can educate the general public and healthcare doctors to detect and treat oral cancer. Method: This was a prospective study conducted in the Mayo hospital, a tertiary care hospital of Pakistan, from June 2018 to June 2020. Results: Out of 120 patients, 84 (70%) were males and 36 (30%) were females. The age range was 14 to 85 years. One hundred and eight patients (90%) presented with the late stages (stage III and IV). These late-stage presenter patients belonged to the low socioeconomic status (88.88%) and 83.33% of them were illiterate (&lt;high school education). Only twelve patients (10%) presented with the early stage at the time of diagnosis. Conclusion: Low socioeconomic and lack of education have a significant association with the late presentation of oral cancer patients in the Pakistani population. Keywords: squamous cell carcinoma, treatment delay, socioeconomic status

Marketing and Survey Analysis of Stem Cell Banking in Western Maharashtra

Purpose to check the knowledge of general population and doctors from western Maharashtra about the basics, purpose, utility and capability of stem cells banking and future scopes in medical field. Data was collected from three hospitals from Sangali district. For given study one thousand and two hundred individual from different background and different age group participated between 28th October to 4th January. Among these people 64% of general population heard about stem cell and cord blood banking, only 20% people have detailed information of stem cell banking and 70% medical staff have positive approach toward stem cell banking. Majority of people don’t know importance of cells on deadly disease. Lot of people unaware about technical terms and preservation techniques. Doctors have different opinion on use of stem cells on genetic disorder. 30% doctors though still it need more research and development for use of medical purpose. Hospitals, Institute and young generation need to take action on awareness of stem cell banking. obstetricians and the pediatricians should take a central role in providing the correct information to would be parents to help them in taking a correct decision.

Doctors Strike During COVID-19 Pandemic in Malaysia

Doctors Strike During COVID-19 Pandemic in Malaysia

La prescription des psychotropes en médecine générale

IntroductionThe supply of care in Morocco is characterised by a decrease in the number of psychiatrists [Britt et al., 2016]; collaboration between psychiatrists and general practitioners is necessary given the increase in the demand for care and the prevalence of psychiatric pathologies [Lotrakul & Saipanish, 2006]. The aim of the study is to analyse the prescription of psychotropic drugs in general practitioners. MethodologyThis is a descriptive and analytical survey at the national level in Morocco, during 2017, among general medical doctors through an anonymous self-questionnaire containing 23 items. ResultsIn total, 402 physicians participated in this survey; psychiatric consultations represent 17.3 % on average of medical consultations per day. Physicians’ perception is that their roles are to prescribe psychotropic drugs in 55.5 % of cases and to provide psychotherapy in 31.4 %. Physicians prescribe antidepressants in 67.2 % of cases and anxiolytics in 52.9 %, while neuroleptics are prescribed by only 7.1 % of physicians. Several obstacles to the prescription of psychotropic drugs were mentioned, including the difficulty of monitoring treatment (58.1 %), manipulating prescription (57.6 %), managing adverse reactions (34.9 %) and also the fear of dependence (43.4 %). ConclusionThe results of our study showed that there is a reluctance to manage mental disorders at the primary care service level, especially when there is a lack of collaboration with psychiatrists and training in the field of mental health.

Mental health education in undergraduate medical curricula across Nepalese universities

BackgroundMental and substance use disorders account for 30 % of the non-fatal disease burden and 10 % of the overall disease burden but the treatment gap is daunting. With just one psychiatrist per 200,000 populations in Nepal, the only convincing way to improve access to the services quickly is by mobilizing non-specialized medical practitioner. A robust mental health component within the training curriculum of general medical doctors could produce medical graduates with adequate knowledge and skills to deliver basic mental health service. We reviewed the mental health curricula for medical students of all the medical universities in Nepal.MethodsInformation on existing mental health curricula was collected from the faculty of the respective universities with respect to content coverage, teaching methods and evaluation patterns. The mental health curricula were described in relation to teaching duration, duration of clinical rotation, duration of internship, and the relative weight of mental health in examination marks. Teaching methods were classified broadly as passive and active. Assessment methods were documented. Content coverage of the curricula was evaluated with respect to history taking and general physical examination, the priority mental health conditions, topics on behavioural sciences, and child mental health or other topics.ResultsThe duration of teaching on mental health in general medical doctor training in Nepalese medical universities ranges from 25 to 92 h. All medical universities have a relative focus on the priority mental neurological and substance use disorders. The clinical rotation on mental health is mostly two weeks, except in one university where it can be extended up to 4 weeks with an elective clinical rotation. The relative weight of summative assessment ranges from 0.21 to 2.5 % total marks of the entire training.ConclusionsConsiderable disparities exist in course content, teaching/learning modalities and assessments for mental health across Nepalese medical universities. The relative proportion of mental health in medical curricula as well as teaching/learning and assessments are far below ideal in these universities. These findings suggest a need for increasing time allocation, adopting newer teaching learning methods, and also having a mandatory clinical rotation during training and during internship.

The process of National Health Insurance coverage for Chuna Manual Therapy in Korea: A qualitative study

BackgroundChuna Manual Therapy (CMT) has been widely used in Korea, and coverage in Korean National Health Insurance (NHI) was finally implemented in 2019. The objectives of this study were to analyze the process of NHI coverage for CMT qualitatively, and to summarize important roles, streams, and implications regarding its inclusion in the modern public health insurance system. MethodsRelated literature was collected and 8 key personnel involved in the policy-making process were qualitatively interviewed, and Zahariadis’ version of the Multiple Streams Framework (MSF) was applied to analyze the policy agenda setting and the roles of stakeholders. ResultsThrough the collaborative efforts of various stakeholders, a pilot coverage project for CMT was implemented in 2017, and coverage was expanded nationwide in 2019. MSF showed that it was mainly achieved through three streams: governmental change (political stream), demand from the general public and KM doctors (problem stream), and strengthening/reinforcement of the feasibility and acceptability of the policy (policy steam). Also, the roles of policy entrepreneurs and resulting changes were shown to be significant for the overall process. ConclusionNHI coverage for CMT was realized through collective policy and research efforts from the government and academic sectors. The roles of stakeholders were shown to be significant in the overall process, and documentation of their involvement is hoped to be of use of other countries that utilize traditional and/or manual medicine.