Medical Aspect Research Articles

SOCIAL DETERMINANTS OF TUBERCULOSIS IN DEVELOPING COUNTRIES


 
 
 
 Background: The middle - income countries are the highest TB contributors in the world. The trigger for TB is not only identified from the medical aspect but is also related to social determinants of health. Literature review of relevant studies of social determinants of TB can contribute a more comprehensive understanding than that obtained from individual studies alone. It can support the findings and interpretation of one study; describe differences or friction in the findings of the study; facilitate the emerging of new theories; and disseminate the design of new interventions.
 Methods: The literature search was conducted using the databases of Google Scholar and Scopus. It was performed for a period of one week (12 th–19 th April, 2016). Inclusion criteria were: Articles were published in the period of 2001- 2016, the articles were written in English and studies were conducted in developing countries.
 Results: Malnutrition, poverty, inadequate housing, educational status, urbanization, and unemployment were the themes emerging from the synthesis process.
 
 
 
 
 Conclusions: There were six factors of social determinants of TB that emerged from this literature review. It includes poverty, inadequate housing, malnutrition, educational status, urbanization and unemployment. All the factors are strongly related and tend to have a combined effect as the social determinants of TB

Quantitative Analysis of COVID-19 Pandemic Responses Based on an Improved SEIR-SD Model

In late 2019, the COVID-19 pandemic began to spread over the world, causing millions of deaths. In the first few months of the pandemic, several countries (such as China) prevented the spread of the pandemic successfully. By contrast, the pandemic in many other countries was not controlled well. For example, India encountered a second serious outbreak of COVID-19 from April 2021 due to the poor resistance measures implemented by the government. To figure out the effective countermeasures to the pandemic, this research proposes a COVID-19 pandemic and its response system, which consists of the infection subsystem, the quarantine subsystem, and the medical subsystem. On this basis, an improved SEIR-SD model is established which is utilized to analyze the response measures to the pandemic quantitatively. This model successfully simulates the actual epidemic scenarios in Wuhan, which verifies its effectiveness. Afterward, the impact of hospital administration rate, quarantine rate, average contact number, and contact infection rate on the cumulative number of infections and deaths are analyzed by simulation. The results show that both the medical and administrative efforts, especially in the early stage of the epidemic, are significant in reducing the number of infections and shortening the epidemic period. In the medical aspect, the more stringent quarantine brings the earlier inflection point of the epidemic; more importantly, improving the treatment rate significantly reduces the scale of the epidemic. In the administrative aspect, enforcing individual protection and strict community closure can effectively cut off the transmission of the virus and curb the spread of the epidemic. Finally, this research proposes several practical suggestions in response to the COVID-19 pandemic. The main contribution of this research is that the effects of different response measures on the number of new infections daily and the cumulative number of deaths of a country or region in the COVID-19 pandemic are estimated quantitatively based on modeling and simulation.

A numerical technique for solving infectious disease model

In the medical aspect of life, there are multiple ways of formulating a model that can be used to determine if a disease will become a pandemic or an epidemic. In this research, we discussed how we could use the numerical approach by applying the revised SEQIuIdRF (Susceptible, Exposed, Quarantined, Infected undetected, Infected detected, Recovered, and Failed) model to control or contain an infectious disease (COVID-19) by applying the effective contact rate. MATLAB software was used to solve the SEQIuIdRF model by considering population growth, mortality rate, infection rate, disease-induced death, failed treatment rate, and recovery rate, which gave pictographic diagrams of the increase and decrease of the infectious disease in the community.

Managing rare diseases: examples of national approaches in Europe, North America and East Asia

Around 4% of the global population suffers from a rare disease. Apart from the medical aspect, economic, organisational, and political approaches remain key aspects when it concerns the evolution of the world of rare diseases. We review here the principal specific national initiatives and organisations in Europe, North America and East Asia. Thereafter, we propose the outlines of a possible optimal approach, inspired by the successes of the individual national organisations. This work should be taken into account in the definition of large scale multi-national rare diseases programs, such as the European Joint Programme on Rare Diseases.

A study on the computational hemodynamic and mechanical parameters for understanding intracranial aneurysms of patients with hypertension and atrial fibrillation

ObjectiveIntracranial aneurysms of patients with comorbidities like hypertension and atrial fibrillation have elevated rupture risk. Besides, the height and width of the aneurysm sacs are also essential features for pre-operative planning. However, clinicians still use only medical images and aspect ratios to identify which aneurysm has a higher risk of rupture. The rupture risk assessment often remains incomplete for lack of crucial insights. Therefore, the implication of a computational study on aneurysm diagnosis is analyzed in this study. MethodHere, the two-way fluid-structure interaction method is used to reproduce these effects of clinical conditions and geometry on aneurysms. Wall shear stress, oscillatory shear index, total deformation, and other parameters are calculated. ResultsThe wall shear stress (WSS) is the stress exerted by the wall on the fluid in a direction on the local tangent plane. The WSS inside a larger aneurysm decreases by around 50% compared to the aneurysms with a lower aspect ratio, indicating higher potential growth and rupture risk. However, the maximum pressure during systole for the aneurysm with the highest aspect ratio is 33% lower than the second-largest one during atrial fibrillation because of its unusual geometry. Although these hemodynamic parameters can be used to identify the effects of the size and shape of the aneurysms, they cannot completely depict the impact of the medical conditions. On the other hand, structural parameters like effective stress and total deformation successfully show the influence of size, hypertension, and atrial fibrillation on the aneurysm walls. The time-averaged wall deformation for the largest aneurysm is 1.3 and 2 times higher than the medium and smallest aneurysms, respectively. Moreover, compared to the normal condition, the total deformation at the aneurysm sac walls is 4–8% more for atrial fibrillation and 25–33% more for hypertension. A similar observation is made for the time-averaged value of effective stress exerted on the aneurysm walls, another parameter used to assess the rupture risk of aneurysms. Most importantly, these computational results align with previous clinical studies on patients with hypertension and atrial fibrillation. ConclusionBased on these observations, it is certain that to understand the impact of the comorbidities of the patients with intracranial aneurysms, results obtained from the structural analysis are required alongside hemodynamic parameters.

Основные модели медико-психологической работы по профилактике повторного управления транспортным средством в состоянии опьянения (международный опыт)

The article analyses foreign scientific data and looks into the medical and psychological aspect of modern system of prevention of recurring crimes arising from drunk driving. Eco-nomically developed countries are shown to have obligatory medical and psychological in-terventions as part of their process of re-authorization to drive, and the scale and duration of such interventions depend on the legal framework of a particular state. Generalization of the material studied by the authors of the article led to formulation of a few organizational work models for medical practitioners and psychologists to help them prevent recurring drunk driving. The first model suggests that preventive measures are only aimed to raise of-fending drivers’ awareness of alcohol and drug addiction. The second model demands that the authorities assess the mental health and psychological preparedness for safe driving in offending drivers. The compulsory therapeutic and rehabilitation measures for persons ad-dicted to psychoactive substances in these countries are not included in drunk driving pre-vention system. The third model involves extended and long-term therapeutic and rehabili-tation programs for persons who indulged in drunk driving. Such programs include reveal-ing one’s unconscious motivations along with subsequent transformation of one’s former convictions and customary behavioral patterns. The authors believe that the "extended out-come" of these programs can be seen as an advantage of this model, since overcoming one’s addiction has a positive impact on all social aspects of one’s life activity. The authors point out the social and economical effectiveness of the models under discussion and sub-stantiate their applicability in the domestic system of recurrent drunk driving prevention.

Patient selection for ambulatory laparoscopic cholecystectomy: A systematic review.

Background:Currently, there is no consensus on patient selection for ambulatory laparoscopic cholecystectomy (LC). This study is a systematic review of previously published patient selection for ambulatory LC.Methods:A comprehensive search was done in PubMed, Web of Science, Embase and Google Scholar Database up to March 2020 to summarise previously reported medical or surgical selection criteria used for inclusion and exclusion of patients, as well as successful same-day discharge rates and readmission rate after discharge.Results:Fifty-nine studies with a total of 13,219 patients were included in this systematic review. In total, the median same-day discharge rate was 90% (range: 63%–99.4%), and median readmission rate was 2.22% (range: 0%–16.9%). The most considered medical criteria were American Society of Anesthesiologists classification I and II, age <70, and body mass index <35. Surgical criteria varied greatly. The top three accessible exclusion variables were (1) common bile duct stones, cholangitis, or jaundice (27 publications, 45.8%); (2) history of abdominal surgery (12 publications, 20.3%) and (3) history of pancreatitis (9 publications, 15.3%).Conclusion:The results of the current study showed the variable patient selection in different centres, the medical aspect criteria may be expanded under adequate pre-anaesthetic assessment and preparation and the surgical aspect criteria should include more laboratory or imaging parameters to ensure the surgical safety.

Turning the world on its head: The virus that disrupted “business as usual”

Turning the world on its head: The virus that disrupted “business as usual”

Morphofunctional characteristics of the heart in sudden death of children under 1 year of age in the forensic medical aspect

The aim of this study is to describe the morphological and functional characteristics of the cardiac in sudden infants death syndrome (SIDS) in children under one year of age. Twenty eight cases of SIDS were studied histologically and immunohistochemically. Histological examination of the sectional material was carried out using standard and additional stains. The study of cardiac muscle tissue with routine staining with haematoxylin-eosin revealed interstitial oedema, uneven plethora of blood vessels: dystonia and weak plethora of part of the coronary arteries, excess of red blood cells in the veins as well as microcirculatory plethora with stasis of the erythrocytes. An immunohistochemical study revealed a mild over expression of p53 in cellular elements, small-focal expression of CD68 in cardiomyocytes apoptosis intramural areas, activation of mast cells (CD117), expression of ki-67 in macrophages, proliferation of fibroblasts. Additional forensic criteria for the diagnosis of SIDS were determined in the form of atrial endocardial fibrosis and interventricular septum; the expression of CD68, CD117 in fibroblasts, mast cells and lymphocytes; apoptosis of cardiomyocytes (expression of p53), proliferation of fibroblasts and remodeling of the heart (expression of ki-67).

Preparing AgNPs via Biosynthesis and Chemical Reduction Techniques and Evaluating Their Antibacterial Effects

Silver nanoparticles (AgNPs) is one the most important metal in medical aspect specially as antibiotics. AgNPs show very interesting antimicrobial properties, even when used at low concentrations. Also, these cost-efficient materials have negligible immunological responses and cytotoxicity. In this study evaluation chemical reduction and biosynthesis methods of Synthesis of silver nanoparticles and this affect on antibacterial application. For this reason we prepared both of chemical nano particles and biosynthesied nanoparticles of silver and evaluated the antibacterial effects on Both of gram negative and gram positive bacteria. Size, morphology and composition of NPs were studied by scanning electron microscopy (SEM), laser particle analyzer (LPA) and ultraviolet-visible spectroscopy (UV-Vis). Our results showed that UV-Vis spectroscopy was performed to represent AgNP suspensions’ plasmon bands. The results show a sharp absorbance peak for AgNPs at 430 nm. For the biological synthesis of AgNPs, the preparation process was monitored through the color variations. Afterward, UV-Vis spectrophotometry was performed to measure its optical parameters. The results revealed an absorbance peak at 420 nm for the AgNPs. AgNPs produced by biological and chemical reduction methods were tested for their antimicrobial activity. To this end, Gram-negative and Gram-positive bacteria were taken using the Agar well diffusion technique. presents the diameter of inhibition zones around each well with chemically prepared AgNPs, biologically synthesized AgNPs, and AgNO3. The highest antibacterial activity of NPs was observed in E. coli, which was more than that of S. aureus. In addition, the biosynthesized NPs showed higher antibacterial activity than those prepared using the chemical method. Finally as conclusion The results &nbsp;of our study showed that producing NPs by the biosynthesis technique was more powerful than chemical processes, and the produced NPs offer a higher antibacterial activity against s,arouse.

Obesity: An Ideological and Discursive Analysis

The importance of discourse for society is enormous since they fall into communicative processes which, through reflections, use the elaboration of ideas that appear in the collective imagination, since socio-political and economic conditions dictate the schemes by which the discourse generates processes of meaning, interpretation and reproduction of everyday life. With this approach we can observe that aspects of national interest such as education and health, for example, are crossed by the way in which phenomena in these fields are explained, described or problematized. The objective is to make an analysis on the influence of discourse for the perpetuity of obesity, to account for how groups console and support obesity and to understand the impact that obesity generates on the subject itself, from generic aspects such as aesthetics, identity and belonging and specifics such as health and nutrition. To understand why Obesity is an important phenomenon, it is necessary to highlight the fact that it is not only a medical aspect, Torres and Rojas [1] assure “Although overweight and obesity impact people, it also has consequences on development. economic and human capital of countries, mainly low-income, ranging from productivity to the costs generated by its treatment. "From the social point of view, it is significant to denote the impact that the groups generate on the subject since they insert discourses of" tolerant hedonism ", since for this the practice of any habit is allowed for the benefit of pleasures, obesity discursively it could be part of a pressure to satisfy oneself voraciously, since everyone's dream is to be without prejudice. Obesity is undoubtedly not only a behavior that uncovers the passions for food, it is the duty of health professionals to find the causes even when they are not properly medical.

Anton Vitalievich Nemilov: A Versatile Talent

The article is dedicated to the outstanding Russian histologist Professor Anton Vitalievich Nemilov, who, being a student of St. Petersburg Imperial University, was one of the first students of Alexander Stanislavovich Dogel, the world-famous Russian scientist, the founder of neurohistology. Having so far shown a bright talent of a researcher and experimenter in his student years, Anton Vitalievich was invited to prepare for a professorship at the university and over and above met expectations based on him. He significantly contributed to the development of neurohistology, histophysiology, including histophysiology of the reproductive system. Anton Vitalievich did a lot for development of endocrinology, which he studied in a general biological but not in a purely medical aspect; this was new and valuable for that period. Finally, he made his contribution to the development of cell theory. A talented teacher, an excellent lecturer, an author of a number of brilliant textbooks, a consummate popularizer of science, an active public figure – Anton Vitalievich demonstrated so many diverse talents during his life, which was not really long, that their combination in one person seems simply unbelievable. His life was in full swing, he was full of creative plans, but the Great Patriotic War prevented their implementation. It started when Anton Vitalievich was 62 years old. Professor A.V. Nemilov wanted to continue research at his native Leningrad University, refused to be evacuated, and remained in the besieged city. With his peculiar enthusiasm, Anton Vitalievich joined defense work, angrily denounced fascism in his articles and radio speeches. However, hunger and cold of the blockade undermined his strength, and he died of exhaustion on February 2, 1942. He was under 63 years old. The article dedicated to Anton Vitalievich Nemilov presents milestones of his life and work, his contribution to science, his professional and personal traits. The paper also highlights his participation in the fight against fascism and tragic death during the blockade of Leningrad.

AI-Enabled Framework for Fog Computing Driven E-Healthcare Applications.

Artificial Intelligence (AI) is the revolutionary paradigm to empower sixth generation (6G) edge computing based e-healthcare for everyone. Thus, this research aims to promote an AI-based cost-effective and efficient healthcare application. The cyber physical system (CPS) is a key player in the internet world where humans and their personal devices such as cell phones, laptops, wearables, etc., facilitate the healthcare environment. The data extracting, examining and monitoring strategies from sensors and actuators in the entire medical landscape are facilitated by cloud-enabled technologies for absorbing and accepting the entire emerging wave of revolution. The efficient and accurate examination of voluminous data from the sensor devices poses restrictions in terms of bandwidth, delay and energy. Due to the heterogeneous nature of the Internet of Medical Things (IoMT), the driven healthcare system must be smart, interoperable, convergent, and reliable to provide pervasive and cost-effective healthcare platforms. Unfortunately, because of higher power consumption and lesser packet delivery rate, achieving interoperable, convergent, and reliable transmission is challenging in connected healthcare. In such a scenario, this paper has fourfold major contributions. The first contribution is the development of a single chip wearable electrocardiogram (ECG) with the support of an analog front end (AFE) chip model (i.e., ADS1292R) for gathering the ECG data to examine the health status of elderly or chronic patients with the IoT-based cyber physical system (CPS). The second proposes a fuzzy-based sustainable, interoperable, and reliable algorithm (FSIRA), which is an intelligent and self-adaptive decision-making approach to prioritize emergency and critical patients in association with the selected parameters for improving healthcare quality at reasonable costs. The third is the proposal of a specific cloud-based architecture for mobile and connected healthcare. The fourth is the identification of the right balance between reliability, packet loss ratio, convergence, latency, interoperability, and throughput to support an adaptive IoMT driven connected healthcare. It is examined and observed that our proposed approaches outperform the conventional techniques by providing high reliability, high convergence, interoperability, and a better foundation to analyze and interpret the accuracy in systems from a medical health aspect. As for the IoMT, an enabled healthcare cloud is the key ingredient on which to focus, as it also faces the big hurdle of less bandwidth, more delay and energy drain. Thus, we propose the mathematical trade-offs between bandwidth, interoperability, reliability, delay, and energy dissipation for IoMT-oriented smart healthcare over a 6G platform.

Osteoporotic changes in bone and cartilaginous tissue in women with ovarian hypofunction

Annotation. Osteoporosis is the most common disease of the musculoskeletal system, which ranks 4th in the world as a cause of disability and mortality among non-communicable diseases. This is a polyetiological systemic disease of bone tissue, characterized by a decrease in bone mass and deterioration of bone structure and increased fragility. This problem has not only a medical aspect, but also important socio-economic significance in all countries of the world due to the high cost of treatment of such patients and high disability. The aim of the work is to study and analyze the scientific literature and give a generalized description of etiological factors, pathogenesis, primary and secondary methods of prevention of osteoporosis in women with ovarian hypofunction in the pre- and menopausal periods. An analysis of recent research and publications on the problem of osteoporosis and changes in the skeletal system. The main risk factors, etiology and pathogenesis of osteoporosis in the pre- and menopausal period of a woman's life are determined, the main methods of prevention of osteoporosis are described. The most common form of primary osteoporosis is postmenopausal osteoporosis, the trigger of which is hypogonadal states, estrogen deficiency, which causes a sharp acceleration of bone loss. I guarantee healthy bone tissue and prevention of osteopenia and osteoporosis are: accumulation of bone mass in the first 30 years, mechanical stress contributes to the restructuring and remodeling of bone tissue throughout life, timely and early compensation of hypogonadal conditions, improvement of blood flow, improvement of blood flow stability of mineral metabolism and hormonal background. Not all women with hypogonadal condition develop osteoporosis, so studying the use of methods to prevent osteopenia and strengthen bone tissue from a young age is the basis of quality life of modern women at any time in her life in the XXI century, so it needs further study.

A Review of Legal, Ethical, and Governance Issues for Team Doctors.

To provide a review and discussion of a range of legal and ethical issues commonly faced by team physicians, with reference to high-profile international integrity crises in sport that have involved doctors. The article also presents some recommendations and guidance for team doctors and sporting organizations. Media reports, legal cases, and journal articles describing recent sporting integrity crises that have involved medical issues and governance reforms which are emerging in response. Many of the modern "integrity crises" in sport have a medical aspect (eg, doping cases, catastrophic injuries and illnesses, "Bloodgate" and other "medical cheating," sexual contact between doctors and athletes, harassment/bullying of doctors, concussion mismanagement, and management of the coronavirus pandemic in sport). A key issue is that while doctors bear ultimate responsibility for any perceived medical negligence, they do not always have ultimate power in decision-making. This is common in the traditional governance structure where the coach/manager "outranks" the doctor and can overrule medical decisions. There can be a blurring of the traditional doctor-patient relationship, especially on tour, and conflicts of interests occur when the needs of the employer/sporting organization differ from the player (patient). Further issues can arise in treating other staff members and players' family members. Doctors must be aware of range of important legal and ethical issues that arise in the team setting. Medical integrity crises have inspired governance reforms, such as policy development, appointment of chief medical officers, medical staff reporting to integrity departments, and sanctions of teams that breach medical integrity requirements. Sporting organizations must continue to implement and strengthen frameworks reinforcing doctors' seniority in the medical area.

Vajikara (Aphrodisiac) Potential of herbal drugs described in Vaidyajivana – A Review

Ayurveda has bestowed positive and comprehensive healthcare to mankind since very early times. Several classical litterateurs were created since ancient times, these all are available as a source of knowledge of Ayurveda in the present scenario. Among that classical works of literature, Lolimbariija's 'Vaidyajivana' is a significant work from both a medical and literary aspect. Because of his fundamentalism, brevity, and precision in medical therapy as well as poetic merit, he has placed a higher value on uncomplicated treatments. Vajikarana is often mentioned with synonyms like Vrishya and sukrala and is defined as a procedure or drug which enhances the vigor and vitality of males. Sushruta has given the comprehensive definition by quoting 'Vajikaran tantra' as the science which deals with the treatment or management of Alpa (less), Dusta (diseased), Kshina (less potent), Vishuska (dry) Retas (semen), and also increase pleasure during sex. Vaidyajivana has documented easily accessible and very effective formulations for various ailments. In the 5th chapter of Vaidyajivana, various Vajikara herbs are mentioned for the treatment of male sexual disorders, which are easily available and very practical. Therefore, the need of the hour is critically reviewing these Vajikara herbal drugs which act on recent aphrodisiac and seminal parameters for validating and improving practice.

Transitioning from Pediatric to Adult Care: The Role of an Education Curriculum for Adolescents and Young Adults with Sickle Cell Disease

Introduction: Sickle Cell Disease (SCD) is the most common inherited blood disorder, affecting over 100,000 people in the United States. The latest medical managements have yielded better outcomes in mortality and morbidity among people with SCD. Despite these advancements, emerging young adults have complications transitioning from pediatric care to adult care and remain with the highest mortality rate in the population. Got Transition is a federally funded national resource center that aims to support youth and young adults moving from pediatric to adult care by implementing the Six Core Elements of Transition. At our institution, we established a transition program aimed at improving clinical care, medical management, and improvement in the transition from pediatric to adult medical care. Our goal was to develop a standardized, age appropriate sickle cell education curriculum to implement at clinic visits for our patients aged 13 and older.Hypothesis: We hypothesize that with a structured transition curriculum, we would be able to improve patient knowledge in medical aspect of the disease, academic resources and a better understanding of their complex psychosocial needs.Methods: We developed a transition program called Adolescent and Young Adult Sickle Cell Uplift and Learn Program for Transition (AYA SCULPT) that would focus on patients starting at 13 years old with a multidisciplinary approach of care. We adopted the Got Transition model implementing the Six Core Elements of Transition. Our team not only wanted to address educational topics related to their medical care, but also psychosocial and academic topics. A transition education curriculum was created spanning three age groups on the three major topics and further broken up into three smaller sections for clinic use to accommodate for time restraints (Table 1). A pilot of the medical curriculum was started August 2019 addressing medical topics relating to better understanding of sickle cell disease. We then introduced our psychosocial curriculum in January 2021. A member of our comprehensive sickle cell team provides the four-question pre-test to the patient at the beginning of their regularly scheduled clinic appointment. At the end of the appointment the nurse or provider will grade the pre-test and provide verbal education as well as printed material on the topics for the day. Scoring and topics are tracked in the patient's note as well as in a transition education database. At the patient's next visit, the same test is administered as a post-test in order to determine knowledge acquired and retention of the materials. Post-test scores are also recorded in the patient note and transition education database. Once the patient finishes a module, we move to the next topic at the next regularly scheduled visit. Depending on the patient's genotype and medication management, post-tests can be given between two to six months after the pre-test.Results: Scores from pre-test were compared to those of post-test for patients that had the opportunity to complete the medical curriculum quizzes. One hundred and fifty six patients range from age 13-21 were included in this pilot study. Of patients aged 19-21, 69% have taken at least one pre-test and post-test for the medical education (63 total pre- and post-tests). Forty-three (78%) patients aged 16-18 have taken at least one pre-test and post-test (75 total pre- and post-tests). Thirty-three (67%) patients aged 13-15 have taken at least one pre-test and post-test (53 total pre- and post-tests). Results were categorized as score increased, score unchanged (pre-test score was not 100%), maintained 100% (unable to increase in score), and score decreased. In every age group, the category with the most results was “score increased.” Shown in Table 2.Conclusion: Further extrapolation suggests that the medical curriculum provided in clinic improves the sickle cell knowledge in this adolescent and young adult population. Though all age groups improved, the biggest improvement was noted in knowledge with our 13-15 year olds. These results suggest that early transition education can be impactful even if started at the early phases of adolescence. Studies are still ongoing with our medical curriculum and early psychosocial data is beginning to support our previous findings. As part of transition health care, focusing on disease education can provide better knowledge and hopefully improve patient outcomes. [Display omitted] DisclosuresClay: Novartis: Honoraria; GBT: Membership on an entity's Board of Directors or advisory committees.

Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study

BackgroundPatients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood.MethodsFor this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs.ResultsPatients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation.ConclusionOlder patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.

Non-Therapeutic Circumcision of Boys: Medical, Sociocultural and Ethical View

There is no medical or ethical consensus over the necessity and the ethical statue of nontherapeutic circumcision of boys. From the medical aspect, there are some potential medical benefits like decreased UTI contracture and Human Immunodeficiency Virus (HIV). transmission rates. However, it is an intervention to the child’s bodily integrity and has some surgical complications like bleeding, pain, postoperative infection and inadequate skin removal. Complication rates are low when the surgery is done according to medical standards. When considering the ethical aspects of circumcision, the most important question to be asked is ‘What is the best interest of the child?’ In order to answer this question, all medical, cultural and psychosocial aspects of the circumcision need to be evaluated. It is an important part of sociocultural life especially in Islamic and Jewish societies. Therefore, it is necessary for the child to be integrated to society and to socialize in that environment. Since it is not a fact whether the medical benefits outweigh the risk or vice versa, the right of the parents to raise a child according to their sociocultural and religious beliefs and the right of the child to be a part of the society should not be eliminated.

Caring For The Elderly and Working With The Aging Population

Older people receive care and assistance in both formal and informal ways. About 4% of people aged over 65 are living in institutional care. Most of the help is provided by families and other informal carers. We must arrange assistance for informal carers and direct the care not only to the medical aspect but also to the social component. The social care component helps vulnerable older people to overcome the crisis caused by exclusion from their environment and reduction in their social network. This is an important opportunity for social pedagogical work, either in various institutions or through.