Health Professionals Research Articles

«Doctors must live»: a care ethics inquiry into physicians' late modern suffering.

In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. This paper discusses this case as an extreme example of physicians' and healthcare workers' suffering in late modern societies, using Vosman and Niemeijer's approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. Thinking along, taking the physicians' stories and arguments literally, reveals an image of an unbearable workload. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. In rethinking, the ambiguity of suffering- its dual potential as both a constraint and an opening- becomes central. Following the physicians' own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.

Applying the Purpose, Autonomy, Confidence, Engrossment Model of Motivational Design to Support Motivation for Continuing Professional Development.

Health professionals' motivation is a key determinant of their continuing professional development (CPD) outcomes. Therefore, CPD providers must ensure that they design CPD activities to support health professionals' motivation; this process is referred to as motivational design. The aim of this article is to introduce CPD providers to the PACE (purpose, autonomy, confidence, engrossment) model of motivational design, and describe how we applied the PACE model to create two online modules for an interprofessional audience. The PACE model builds on other available models of motivation design by offering theoretically informed strategies to support autonomous motivation, a specific quality of motivation that is associated with more effective learning processes and outcomes. Our experience suggests that CPD providers can use the PACE model to guide their motivational design efforts. We also encourage CPD researchers to test the theoretical assumptions that inform the PACE model.

Analysis of Factors Influencing Pregnant Women in the Completeness of Antenatal Care Visits at UPTD Puskesmas Care Kutambaru, Lawe Bulan District, Southeast Aceh Regency

ANC or anteatal care is the care of the mother and fetus during pregnancy. Currently, the proportion of maternal mortality is approximately 305 deaths per 100 thousand live births, where the largest deaths occur in hospitals, around 77% of mothers cannot be saved, one of which is because the mothers who are referred to the hospital are already in a condition of severe complications. The purpose of this study is to analyze pregnant women in the completeness of antenatal care visits in the Working Area of the Kutambaru Care Health Center, Lawe Bulan District, Southeast Aceh Regency. This type of research uses a mixed method. The population in this study was 112 respondents, the sample in the study was 53 respondents with a slovin formula with a random sampling technique for qualitative using 9 informants. The variable results entered the multivariate test because the P value was ≤ 0.25. The results of the Multivariate analysis showed significant values and the variables of Exp(B) were, Knowledge (0.015) Exp(B) (3.572), Education (0.001) Exp(B) (0.007), Attitude (0.018) Exp(B) (1.398), Parity (0.009) Exp(B) (1,786), Income (0.000) Exp(B) (0.008), Distance (0.001) Exp(B) (1,904), Maternal Health (0.005) Exp(B) (1,556), Health Worker Support (0.001) Exp(B) (2,387). Results of Qualitative Data Analysis with Data Reduction, Data Display and Conclusion Drawing/Verification.From the results of in-depth interviews, it was found that there was an influence on the completeness of the ANC visit with factors of knowledge, education, attitude, parity, income, distance, maternal health and support of health workers. The conclusion of this study is that there is a relationship between knowledge, education, attitude, parity, income, distance, maternal health and health worker support for the completeness of ANC visits, the knowledge factor is the most dominant influencing ANC examination in pregnant women with an Exp(B) value of 3.572. It is hoped that health workers at the Kutambaru Health Center will be more routine in delivering health education to pregnant women about the importance of ANC examinations.

The Performance of the Social Worker in Mental Health in Primary Care From the Perspective of the Interdisciplinary Team

Objective: This study aimed to reflect on the work of the social worker in Mental Health in Primary Care, and to investigate and discuss issues related to the concept of the health team in real qualitative research developed with twelve professionals from three Basic Health Units located in the city of Apucarana, Paraná. Data was collected through semi-structured interviews with guiding questions, which were analyzed using content analysis to this activity. Theoretical Framework: Primary Health Care is considered a reorganization of the care model that was centered on illness and hospital treatment. It is the gateway to the SUS, with actions aimed at health promotion, prevention and rehabilitation. It is also an important space to reaffirm the assumptions of the Psychiatric Reform. Method: This is qualitative research developed with twelve professionals from three Basic Health Units located in the city of Apucarana, Paraná. Data collection was carried out through semi-structured interviews with guiding questions, which were analyzed using content analysis, which allowed the identification of three categories of analysis. Results and Discussion: This study revealed that health professionals are unaware of the role of social workers in mental health in Primary Care. Furthermore, they attribute mental health care almost exclusively to psychologists/psychiatrists, reaffirming the care centered on the hegemonic medical model. However, they can perceive the need for this professional to be part of the health team and how much he or she can contribute through his or her broad perspective and training, which provides critical reflection on work processes. Research Implications: The research highlights the need for social workers to work with health teams on the socio-educational axis for the initial process of deconstructing the concepts of mental health and madness that exist and consolidating the principles of psychiatric reform. Originality/Value: This study seeks to reiterate the need for Public Policies in the area of ​​mental health to be implemented and deployed so that this socio-occupational space is occupied by the professional Social Worker more greatly and that it integrates these multidisciplinary health teams.

Cost Analysis of a Scalable Clinician Communication Intervention to Increase HPV Vaccine Initiation.

For a previous longitudinal cluster randomized controlled trial (2018-2019), we randomized 48 primary care pediatric practices to online communication training vs usual care. Online communication training reduced missed opportunities (MOs) for initial human papillomavirus (HPV) vaccination at well-child care (WCC) visits by 6.8 percentage points among children aged 11-17years. The current study estimated implementation costs of the communication training intervention at WCC visits. We analyzed monthly surveys completed by intervention practice lead clinicians to track clinician plus office staff personnel hours devoted to implementing the intervention. We converted personnel time into 2019 US dollars using national median hourly wages for physicians and other health care workers; we tracked nonpersonnel costs. We calculated costs per practice (overall and by practice size) and estimated costs per averted MO for HPV vaccine initiation using an effectiveness estimate determined by grouped logistic regression at the practice level. Practices varied from 1 to 24 clinicians (mean = 7.5) and from 241 to 8866 visits (mean = 2353) during the 6-month intervention. Total intervention costs varied substantially across the 24 intervention practices from $370 to $6653, with a mean of $2003 (95% CI, $1377-$2762) and median of $1305. The incremental cost per averted MO for HPV vaccine initiation at WCC visits averaged $110 ($212 in practices with 1 or 2 physicians and $94 in practices with 3 or more physicians). The implementation cost per averted MO for HPV vaccine initiation at WCC visits of this online communication training intervention was modest, particularly among larger pediatric practices.

Communicating with Deaf Patients in the Clinical Environment through Deaf-Hearing Teams: Lessons Learned from a Virtual Patient Panel

Background Communication and cultural differences predispose Deaf patients to suboptimal healthcare. Despite this disparity, health professionals have historically received little to no training in caring for Deaf patients. Patient panels are an effective tool in medical education to model communication strategies. Objective In this paper, we describe the design, implementation, and results of a virtual patient panel focused on communicating with Deaf patients in clinical contexts. We offer practical suggestions for incorporating similar educational interventions in health professions education to prepare trainees to effectively navigate these conversations with their patients. Methods The panel consisted of a one-hour question and answer discussion facilitated by the authors with Deaf patients and Certified Deaf Interpreters (CDI). The panel was presented to 271 second-year medical students at our institution in November of 2023. Following this discussion, students were encouraged to share one or two key takeaways from the session through a survey link. These results were analyzed using pile-sorting qualitative analysis to identify main themes. Results There were 73 respondents, with a response rate of 27%. After the panel, the most popular takeaway points from student reflections included communication (n=56, 77%) and access to care (n=47, 64%), followed by autonomy (n=17, 23%), the doctor-patient relationship (n=15, 21%), and culture (n=11, 15%). Based on this initiative, we identified and offer twelve tips for developing similar exercises. These tips are thematically presented under three groupings: Virtual Panel Considerations, Curricular Considerations, and Special Considerations with Deaf Panelists. Conclusion This patient panel was the first of its kind in our medical school curriculum. Important considerations in panel design and implementation should focus on delivery time constraints with live-interpreting and further exploring the role of trust and communication in the physician-patient relationship.

Digital health data security practices among health professionals in low-resource settings: cross-sectional study in Amhara Region, Ethiopia

Digital health data security practices among health professionals in low-resource settings: cross-sectional study in Amhara Region, Ethiopia

Considerations for Anthropometry Specific to People with Disproportionate Short Stature.

In the clinical care of people with disproportionate short stature, healthcare practitioners need to accurately collect anthropometric measurements over time, including height, weight, head circumference, and lengths of affected limb and body segments. Accurate anthropometric measurements are important for diagnostic evaluation, tracking growth, measuring response to pharmacologic therapies or surgeries, and monitoring for potential complications. However, for this clinical population, anthropometric measurements may need to be adjusted or modified to accommodate characteristics such as body disproportions, joint contractures, long bone deformities, spinal deformities, or muscle hypotonia. This article provides guidance for key anthropometric measurements in children and adults with disproportionate short stature, with a focus on people with achondroplasia. The measurements described in this article and illustrated in the infographics can be performed without expensive specialized equipment and are suitable for a variety of clinical settings.

Intimate partner violence and maternal antenatal care utilization: is there a dose-response relationship? Findings from the Ethiopian National Demographic and Health Survey.

Maternal mortality in sub-Saharan Africa (SSA) is an enduring public health challenge. Adequate utilization of antenatal care (ANC) services is one strategy to mitigate the problem by identifying and managing pregnancy risks early. Yet, in SSA, uptake of ANC remains low. Intimate partner violence (IPV) may be a deterrent to ANC uptake. We measured the dose-response relationship between IPV and adequate ANC utilization (defined as four or more visits [ANC-4]) using data from the Ethiopia Demographic and Health Survey (EDHS) 2016. We used complex sample logistic regression to measure the impact of three IPV subscales (emotional, sexual and physical) on ANC-4 while controlling for sociodemographic, obstetric and women empowerment factors. A total of 2599 (weighted) currently married or in-union women were included. There was a significant dose-response relationship between IPV and ANC utilization. Emotional (adjusted odds ratio [aOR] 0.78 [confidence interval {CI} 0.64 to 0.97]) and sexual (aOR 0.68 [CI 0.50 to 0.92]) violence decreased ANC-4 uptake while controlling for the covariates. IPV is common, yet often invisible, in Ethiopia. Health workers may begin directly screening pregnant women for IPV in order to increase targeted support of ANC uptake. This is the first known study to confirm IPV has a dose-response relationship with ANC-4 uptake.

Factors Affecting Stunting in Toddlers in the Working Area of the UPTD Puskesmas Deleng Pokhisen Aceh Tenggara

Background: Stuntingis a condition of failure to thrive in children under five years old (babies under five years) resulting from chronic malnutrition so that the child is too short for his age. Stunting has the potential to slow down brain development, with long-term impacts in the form of mental retardation, low learning ability, and the risk of developing chronic diseases such as diabetes, hypertension, and obesity. The aim of this research is to determine and analyze the factors that influence stunting in toddlers in the UPTD Puskemas Deleng Pokhisen Aceh Tenggara. Research Method: This research uses quantitative methods with a cross sectional design and sampling using total sampling. The population and research sample were 210 respondents, namely mothers who had stunted toddlers. This research uses a questionnaire. The research time is June - July 2024. This research analysis uses Univariate, Bivariate and Multivariate. The statistical tests used are the chi-square test and logistic regression. Research Results: Research results regarding the influence of maternal height p value= 0.006, history of diarrheal disease p value= 0.049, family income p value= 0.003, diet p value= 0.001 with stunting in toddlers. Based on the results of the logistic regression test, the most influential variable was a history of diarrhea with an Exp(B) value of 2.769. Conclusion: The conclusion in this study is that there is an influence on maternal height, history of diarrhea, family income, and eating patterns on stunting among toddlers in the UPTD Puskemas Deleng Pokhisen Aceh Tenggara. In order to reduce the prevalence of stunting in toddlers, it is hoped that the Health Service, Community Health Centers, especially health workers, will collaborate to increase health promotion about stunting, the risk of diarrheal disease due to stunting, the benefits of family income and the importance of a good diet for toddlers.

Ultrasound Imaging Equipment for Evaluating Chronic Constipation in Home Healthcare: A Review Article

The purpose of this study was to propose a new diagnostic approach using ultrasound imaging equipment. Many patients suffer from constipation, and medical professionals have difficulty providing treatment and care. The prevalence of constipation increases with age, and this condition strongly impacts the quality of life. Herein, a new diagnostic approach using ultrasound imaging equipment was examined. The study design was a narrative review, and the authors discussed existing knowledge, challenges, and prospects based on previous research. References were obtained by searching PubMed and Centralblatt für die gesammte Medicine. Most of the papers were published in English. Papers with scientific knowledge that has already been published in academic journals were extracted from these documents. No restrictions were placed on the publication date, sample size, study design, or age of subjects, and only published papers reporting scientific knowledge and consensus were cited. As a result, we suggest that this approach classifies the state of fecal retention in the rectum into three patterns. If ultrasound imaging indicates that the rectum is free of feces, there is no need to administer an enema. If hard stool is found, dissection can be performed to prevent complications such as severe intestinal perforation due to subsequent administration of laxatives. If ultrasound imaging reveals normal stool in the rectum, inducing defecation with suppositories may enable treatment for constipation.

Implementing a Transition to Grade 2 Capability Program to support the training of early career Allied Health Professionals

Implementing a Transition to Grade 2 Capability Program to support the training of early career Allied Health Professionals

Practical recommendations to attract and retain Allied Health Professionals in rural health settings

Practical recommendations to attract and retain Allied Health Professionals in rural health settings

The Asia-Pacific Body Mass Index Classification and New-Onset Chronic Kidney Disease in Non-Diabetic Japanese Adults: A Community-Based Longitudinal Study from 1998 to 2023

Background/Objectives: Obesity is a risk factor for chronic kidney disease (CKD) in Asians. The Asia-Pacific body mass index (BMI) classification sets lower obesity cutoffs than the conventional BMI classification for all races, generally reflecting the lower BMIs in Asians. This longitudinal study evaluated the association between BMI, as classified by the Asia-Pacific BMI system, and CKD development in non-diabetic Asian adults. Methods: A population-based longitudinal study (1998–2023) was conducted in non-diabetic Japanese adults (hemoglobin A1c < 6.5%) in Zentsuji City (Kagawa Prefecture, Japan). The generalized gamma model was used to assess the relationship between time-varying BMI categories and CKD development, stratified by sex. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2. BMI was calculated as weight (kg) divided by the square of height (m2) and categorized per the Asia-Pacific classification as overweight (23.0–24.9 kg/m2), obesity class I (25.0–29.9 kg/m2), and obesity class II (≥30.0 kg/m2). Results: CKD developed in 34.2% of 3098 men and 34.8% of 4391 women. The mean follow-up times were 7.41 years for men and 8.25 years for women. During follow-up, the BMI distributions for men were 5.0% underweight, 43.3% normal weight, 25.6% overweight, 24.1% obesity class I, and 2.0% obesity class II; those for women were 7.7%, 50.5%, 20.5%, 18.3%, and 2.9%, respectively. Compared with normal weight, obesity class I was associated with a 6% (95% confidence interval [CI]: 2–10%) shorter time to CKD onset in men and 5% (95% CI: 2–7%) in women. In both sexes, obesity class II showed shorter survival times than normal weight by point estimates, although all 95% CIs crossed the null value. Conclusions: Obesity, as classified by the Asia-Pacific BMI system, shortened the time to CKD onset in non-diabetic Asians. The conventional BMI cutoff for obesity (≥30.0 kg/m2) may be too high to identify CKD risk in this population. The findings of this study may be useful for public health professionals in designing interventions to prevent CKD.

Clinical Characteristics of Health Professions Students with Nitrous Oxide Use Disorder

ABSTRACT Recreational use and misuse of nitrous oxide (N2O) have increased in recent years among young people. The objective of present study was to assess the frequency and the clinical characteristics of N2O use disorder (NUD) in a sample of health professions students. An online survey was distributed to health professions students. Age; sex; frequency (day/week/month/year/lifetime) of N2O use, DSM-5 criteria for NUD; history of mental health treatment; and current use of antidepressant medication were systematically collected. All participants completed the French version of Alcohol Use Disorders Identification Test (AUDIT), and Cannabis Abuse Screening Test (CAST). A total of 2067 students (mean age 21.7 ± 2.6 years, 74.9% female) completed the survey. A total of 38.2% (n = 790) reported lifetime N2O use. Among the 6.6% (n = 137) who fulfilled the DSM-5 criteria for current NUD, 5.5% (n = 114) had mild disorder, 0.8% (n = 16) had moderate disorder (n = 16) and 0.3% (n = 7) had severe disorder. Participants with NUD more frequently reported AUDIT scores > 12 (suggesting alcohol dependence), blackouts, a history of mental health treatment, and current use of antidepressants than did those without NUD. Longitudinal studies using structured interviews are needed to investigate potential associations between NUD and alcohol use disorders or psychiatric disorders in the general population.

Acceptability of telemedicine for early surgical site infection diagnosis after cesarean delivery in rural Rwanda: a qualitative study.

Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context . We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding. All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it. These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings.

Analysis of the Implementation of the First Level Outpatient Referral for Bpjs Kesehatan Participants at the Medan City Exemplary Health Center in 2023

The Social Security Administration Agency or BPJS Kesehatan recorded a total of 267.31 million participants as of December 31, 2023. If they need follow-up services by a specialist doctor, BPJS Kesehatan participants can be referred to second-level health facilities or secondary-level health facilities. The causes of the high number of referrals at the Teladan Health Center are due to: inadequate availability of doctors, delays in the availability of drugs and frequent vacancies in drug stocks, lack of availability of medical facilities and medical equipment and the implementation of the FKTP function as a gatekeeper does not follow the established rules. This research is a qualitative descriptive research, which is a research method that is carried out with the main purpose of making an overview or description of a situation objectively, with a semi-structured interview method, which is a type of interview that includes the category of in-depth interviews recorded using a tape recorder where in its implementation it is freer when compared to structured interviews. The results of the study obtained from this study are that there are still many referrals on their own request because patients do not trust the health center, resulting in a high number of referrals. The number of health workers at the Teladan Health Center has met the standards, but neurologists and cardiologists are needed because many of the patients referred have internal diseases. Medicines, medical devices, medical device facilities and infrastructure facilities at the Teladan Health Center are incomplete and there is a lack of public knowledge about the gatekeeper concept so that there are frequent APS referrals. It is hoped that the Exemplary Health Center to the Head of the Health Center will propose the addition of Specialist Doctors to the Medan City Health Office, re-evaluate drug planning, provide socialization to the public about JKN, especially the tiered referral system and about the gatekeeper concept. The Medan City Health Office is also expected to collaborate with health centers in completing medical equipment and medicine facilities.

What allied health practitioners tell us matters when choosing rural health roles

What allied health practitioners tell us matters when choosing rural health roles

Vitamin C: From Self-Sufficiency to Dietary Dependence in the Framework of Its Biological Functions and Medical Implications

Vitamin C is an organic compound biosynthesized in plants and most vertebrates. Since its discovery, the benefits of vitamin C use in the cure and prevention of various pathologies have been frequently reported, including its anti-oxidant, anti-inflammatory, anticoagulant, and immune modulatory properties. Vitamin C plays an important role in collagen synthesis and subsequent scurvy prevention. It is also required in vivo as a cofactor for enzymes involved in carnitine and catecholamine norepinephrine biosynthesis, peptide amidation, and tyrosine catabolism. Moreover, as an enzymatic cofactor, vitamin C is involved in processes of gene transcription and epigenetic regulation. The absence of the synthesis of L-gulono-1,4-lactone oxidase, a key enzyme in the pathway of vitamin C synthesis, is an inborn metabolism error in some fishes and several bird and mammalian species, including humans and non-human primates; it is caused by various changes in the structure of the original GULO gene, making these affected species dependent on external sources of vitamin C. The evolutionary cause of GULO gene pseudogenization remains controversial, as either dietary supplementation or neutral selection is evoked. An evolutionary improvement in the control of redox homeostasis was also considered, as potentially toxic H2O2 is generated as a byproduct in the vitamin C biosynthesis pathway. The inactivation of the GULO gene and the subsequent reliance on dietary vitamin C may have broader implications for aging and age-related diseases, as one of the most important actions of vitamin C is as an anti-oxidant. Therefore, an important aim for medical professionals regarding human and animal health should be establishing vitamin C homeostasis in species that are unable to synthesize it themselves, preventing pathologies such as cardiovascular diseases, cognitive decline, and even cancer.

Suggestions for the use of the 'yarigai' story in fostering medical professionalism among medical students.

Suggestions for the use of the 'yarigai' story in fostering medical professionalism among medical students.