Personal Physician Research Articles

Histories of pervasive gender‐based violence in asylum‐seeking women who have undergone female genital mutilation or cutting

Few studies have described the broader experience of survivors of female genital mutilation or cutting (FGM/C) who have sought asylum in the United States. To gain a better understanding of their exposure to gender-based violence (GBV), the study was conducted to help uncover themes and patterns of co-occurring individual and community factors among women asylum seekers who experienced FGM/C before they arrived in the United States. Following a retrospective chart review of FGM/C cases seen in a human rights clinic, 35 women met the inclusion criteria. The constant comparative method (CCM) was used to develop themes derived from clients' personal declarations and physicians' affidavits. A qualitative analysis revealed extensive histories of violence-physical, psychological, and sexual-demonstrating that FGM/C is only part of a larger arc of violence. Key themes developed via CCM include the experience of FGM/C, cultural attitudes toward FGM/C, cultural attitudes toward women, the lack of agency felt by women, silence around experiences of GBV and the constant reinforcement of that silence, the role of education in women's lives, and acts of resistance and social support. Placing FGM/C within its cultural context allows for a better understanding of its role in society's broader subjugation of women and elucidates how these social structures are maintained. For health care and other service providers, the high frequency of multiple forms of violence and the ingrained nature of women's oppression indicate the need for trauma-informed care and services as well as accessible resources beyond those explicitly related to FGM/C.

Examining drivers of coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare workers.

To assess characteristics and perceptions associated with vaccine hesitancy among healthcare workers to increase coronavirus disease 2019 (COVID-19) vaccine uptake in this population. Cross-sectional quantitative survey. A not-for-profit healthcare system in southwestern Virginia. A convenience sample of 2,720 employees of a not-for-profit healthcare system. Between March 15 and 29, 2021, we conducted an Internet-based survey. Our questionnaire assessed sociodemographic and work-related characteristics, vaccine experience and intentions, agreement with vaccine-related perceptions, the most important reasons for getting or not getting vaccinated, and trusted sources of information about COVID-19. We used χ2 analyses to assess the relationship between vaccine hesitancy and both HCW characteristics and vaccine-related perceptions. Overall, 18% of respondents were classified as vaccine hesitant. Characteristics significantly associated with hesitancy included Black race, younger age, not having a high-risk household member, and prior personal experience with COVID-19 illness. Vaccine hesitancy was also significantly associated with many vaccine-related perceptions, including concerns about short-term and long-term side effects and a belief that the vaccines are not effective. Among vaccine-acceptant participants, wanting to protect others and wanting to help end the pandemic were the most common reasons for getting vaccinated. Personal physicians were cited most frequently as trusted sources of information about COVID-19 among both vaccine-hesitant and vaccine-acceptant respondents. Educational interventions to decrease vaccine hesitancy among healthcare workers should focus on alleviating safety concerns, emphasizing vaccine efficacy, and appealing to a sense of duty. Such interventions should target younger adult audiences. Personal physicians may also be an effective avenue for reducing hesitancy among their patients through patient-centered discussions.

Characteristics and expectations among emergency department patients in India.

In India, and many low-middle income countries (LMICs), emergency medicine (EM) remains a poorly defined specialty and an unregulated field of clinical practice. Recognition of the attitudes, understanding, and expectations of patients presenting to Indian EDs will be crucial to the continued development of EM as a specialty. This is a multicenter, prospective, cross sectional study of adult and pediatric patients presenting to the ED in three geographically distinct regions of India. Participants were surveyed about their expectations regarding the type of care that they expected to receive, previous treatment options they have utilized, basic understanding of ED operations, factors contributing to their decision to seek ED care, and basic demographic information. 779 patients were approached to participate in the study, of which 698 (90%) completed the survey. Common ways that patients reported learning about the ED were referral from another healthcare provider (45%) and recommendation by a family member (61%). Participants chose the ED was because they thought they would be seen quickly (89%), would receive acute pain management (45%), their regular outpatient care was closed (45%), or were sent by another doctor (45%). Patients expected to wait 0.3 hours (18 minutes) on average to see a doctor in the ED. Over 75% or patients expected to see a specialist consultant in the ED and 12% expected to see their personal physician. Eighty-five percent of patients were triaged as moderate or high acuity, and 74% of patients were admitted. This study found that ED in India is utilized by a population with an extremely high acuity of medical illness that attempts to access healthcare through multiple avenues. Patients most frequently visit the ED due to a referral from another healthcare provider or family member. Most patients are aware of the existence of the ED, though understanding of available services may be lacking. Future research should focus on community outreach and education initiatives on ED services.

Implications of COVID-19 Vaccine Hesitancy: Results of Online Bulletin Board Interviews.

Reluctance to accept vaccination against COVID-19 poses a significant public health risk and is known to be a multi-determined phenomenon. We conducted online focus groups, or “bulletin boards,” in order to probe the nature of COVID-19 vaccine hesitancy and its implications. Participants were 94 individuals from three distinct U.S. geographical areas and represented a range of demographic and socioeconomic characteristics. Six themes emerged from the 3 day-long bulletin boards: the most trusted source of health information sought is the personal physician; information about health is nevertheless obtained from a wide variety of sources; stories about adverse side effects are especially “sticky”; government health institutions like CDC and FDA are not trusted; most respondents engaged in individualistic reasoning; and there is a wide spectrum of attitudes toward vaccination.

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey.

BackgroundHigh blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.ObjectiveThe present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).MethodsBased on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.ResultsAs expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.ConclusionsIn summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

Patient Decision-Making Factors in Aggressive Treatment of Low-Risk Prostate Cancer.

BackgroundActive surveillance (AS) is underutilized for low-risk prostate cancer. This study examines decision-making factors associated with AS vs aggressive treatment in a population-based cohort of low-risk patients.MethodsNewly diagnosed patients (n = 599) were enrolled through the North Carolina Central Cancer Registry from 2011 to 2013 and surveyed regarding 5 factors that may impact treatment decision making: perceived cancer aggressiveness, aggressiveness of treatment intent, most important goal (eg, cure, quality of life), primary information source, and primary decision maker. We examined the association between treatment decision-making factors with patient choice for AS vs aggressive treatment using multivariable logistic regression analysis.ResultsThis is a sociodemographically diverse cohort reflective of the population-based design, with 37.6% overall (47.6% among very low-risk patients) choosing AS. Aggressive treatment intent (odds ratio [OR] = 7.09, 95% confidence interval [CI] = 4.57 to 11.01), perceived cancer aggressiveness (OR = 4.93, 95% CI = 2.71 to 8.97), most important goal (cure vs other, OR = 1.72, 95% CI = 1.12 to 2.63), and primary information source (personal and family vs physician, OR = 1.76, 95% CI = 1.10 to 2.82) were associated with aggressive treatment. Overall, 88.4% of patients (92.2% among very low-risk) who indicated an intent to treat the cancer “not very aggressively” chose AS.ConclusionsThese data from the patient’s perspective shed new light on potentially modifiable factors that can help further increase AS uptake among low-risk patients. Helping more low-risk patients feel comfortable with a “not very aggressive” treatment approach may be especially important, which can be facilitated through patient education interventions to improve the understanding of the cancer diagnosis and AS having a curative intent.

The Time Is Now: A Plan to Redesign Family Medicine Residency Education.

A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine's 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

Evaluating diabetic patients' perceptions and attitudes toward telemedicine visits during the period of the COVID-19 pandemic

Background: Coronavirus disease 2019 demands more awareness of telemedicine among the Saudi community. Few studies address the perception of diabetic patients about telemedicine in Saudi Arabia. This study aimed to examine the attitude and perception of diabetic patients regarding telemedicine and to address the factors affecting satisfaction. Methods: A cross-sectional descriptive study was conducted among diabetic patients in Saudi Arabia from March to June 2022. A structured self-prepared questionnaire was developed by Google Forms and distrusted through social media platforms. All statistical calculations were performed using: Statistical Package for the Social Sciences version 26. Results: One hundred diabetic patients completed the questionnaire. About 55% were females. The majority (94.8%) were Saudi, aged more than 40 years (77.6%), married (82%), unemployed (62%), hold a bachelor's degree (51%), and 45% had diabetes more than 5 years. About 56% experienced only audio calls, 30% experienced video calls, and 14% experienced both. Most participants (93%) were not confused during telehealth consultation, 78.8% were satisfied with the experience in general, 83% would recommend it to others, and 49% see that telehealth can be the primary mean of counseling shortly. More than half of the participants (62%) mentioned that they prefer to see a physician in person. Patients younger than 40 reported a significantly higher satisfaction rate with telehealth (95.5%) than older patients (73.3%), p = 0.037. Conclusion: Diabetic patients were generally satisfied with telehealth consultations. Further studies are needed to examine how to enhance patients' experiences and explore their preferences.

How Do Perceptions of Risk Communicator Attributes Affect Emergency Response? An Examination of a Water Contamination Emergency in Boston, USA

AbstractA water main break that contaminated the Boston area's water distribution system prompted a four‐day “boil water” order. To understand risk communication during this incident, 600 randomly sampled residents were mailed questionnaires, yielding 110 valid responses. This article describes how perceptions of different social stakeholders influenced whether respondents complied with the Protective Action Recommendation—PAR (i.e., drank boiled water), took alternative protective actions (i.e., drank bottled water or/and self‐chlorinated water), or ignored the threat (i.e., continued to drink untreated tap water). Respondents perceived technical authorities (i.e., water utility, public health, and emergency management) to be higher on three social influence attributes (hazard expertize, trustworthiness, and protection responsibility) than public (i.e., news media, elected officials) and private (i.e., self/family, peers, and personal physicians) intermediate sources. Furthermore, respondents were most likely to comply with the PAR if they perceived authorities and public intermediates to be high on all three attributes and if they had larger households and lower income. Contrarily, they were more likely to take alternative actions if they were younger and had higher levels of income, risk perception, and emergency preparedness. These results underscore the need for technical authorities to develop credibility with their potential audiences before a crisis occurs.

Diary notes of Matthias Stoius in “Almanach Novum” (1552–1562)

Prague Nostitz Library hides among its 14 000 books 60 volumes from the library fragment once belonging to Matthias Stoius Jr (1526–1583), the personal physician of the first Duke of Prussia Albert of Hohenzollern. The most interesting volume from the Stoius’s heritage is a copy of an astronomical calendar Almanach novum by Pietro Pitati used by Stoius as a diary containing his handwritten notes and comments about weather, income, his activity at the Königsberg University and, the most importantly, his medical records concerning the health condition and problems of his noble patient Albert of Hohenzollern. Stoius also took detailed notes about medicaments he delivered to the ill Duke as well as about treatments he applied especially in November 1559 and December 1560 when the physical condition of the duke of Prussia apparently worsened. In 1572, Stoius published in print his report about the last days of Duke Albert and although the handwritten sources on which the report is based are missing they were presumably recorded in the similar diaries.

The contribution of the Scottish doctor Robert Erskine to the development of Russian medicine in the 18th century.

The Scottish doctor Robert Erskine (1677-1718) became Chief Doctor of Russia and personal physician to Tsar Peter the Great. Extensive archival material documents his remarkable career. From schooling in the village of Alva and apprenticeship to an Edinburgh apothecary, he went on to study medicine in Paris and Utrecht and was admitted to the Royal Society in London. Recruited into the service of the Tsar, to whom he became a trusted friend and counsellor, Erskine played a central role in the modernisation of Russian medicine, pharmacy and natural science in the early 18th century. His untimely death at age 41 was marked with a state funeral in St Petersburg. Some historians in Russia assert that in their country, the development of medicine and the natural sciences took place without the transitional stages of iatrochemistry and iatrophysics which characterised the shift in scientific thinking throughout Europe in the early modern period. This study of archival records shows that Erskine held iatrophysical and iatrochemical views in common with his European contemporaries. His influence ensured that Russia was thoroughly involved in European developments in science and medicine in the 18th century.

ОСОБЛИВОСТІ МЕДИЧНОГО СТРАХУВАННЯ: АНАЛІЗ ДОСВІДУ НІМЕЧЧИНИ

The article examines the models of health insurance in Western countries. A comparative analysis of forms of social insurance and sources of financing payments for four models of medical insurance is carried out. The practical aspects of the functioning of compulsory health insurance in Germany are investigated, its positive features are revealed. Attention is paid to medical insurance, which provides insurance in case of loss of health for any reason. It provides greater accessibility, quality and completeness to meet the diverse needs of the population in the provision of medical services, and is more effective than government funding of the health care system. In addition, the social and economic efficiency of health insurance related to reimbursement of citizens' expenses related to receiving medical care, as well as other expenses aimed at maintaining health, depends on how comprehensively the concept of developing insurance medicine in the country has been worked out. The positive and negative aspects of health insurance are analyzed. The forms of health insurance are considered: compulsory health insurance and voluntary health insurance. It was found that one of the first countries where health insurance was introduced was Germany. There are two types of health insurance in Germany: public and private. Germany's state health insurance is compulsory. That is, every employee, as well as persons trained in production (Auszubildende), are subject to compulsory state health insurance and must be members of one of their freely chosen state health insurance funds. At the same time, if a person wishes to receive medical services that are not included in the list of compulsory health insurance, he can conclude a supplementary health insurance contract with the insurance company. Voluntary health insurance allows you to choose an inpatient medical institution and the conditions of stay in it, special services of a personal physician.

Adverse drug events during transitions of care : Randomized clinical trial of medication reconciliation at hospital admission.

During transitions of care, patient's medications are prone to medication errors. This study evaluated the impact of pharmacist-led medication reconciliation at hospital admission on unintentional medication discrepancies and adverse drug events. Arandomized controlled clinical trial was conducted in 120 adult medical patients hospitalized in atertiary hospital in Slovenia. In the intervention group, apharmacist-led medication reconciliation was performed on admission, while the control group received usual care. Patient's drug treatment before admission was compared with their admission and inpatient treatment to identify discrepancies. The intention of discrepancies and related adverse drug events were assessed as aconsensus of an expert panel. Included patients were elderly (median 72years) and treated with polypharmacy (median 7medications). Upon admission, discrepancies and unintentional discrepancies, representing amedication error, were identified in 61.2% (825/1347) and 18.3% (247/1347) of medications, respectively. In the intervention group, only 29.1% (37/127) of unintentional discrepancies were reported to the physicians in person. The majority of admission discrepancies (88%) persisted through hospitalization. Unintentional discrepancies resulted in 51adverse drug events even during hospitalization. There were no differences between the intervention and control group in the occurrence of unintentional discrepancies (p = 0.481) or adverse drug events (p = 0.801). Medication reconciliation at hospital admission failed to reduce unintentional discrepancies and adverse drug events, possibly due to its poor integration into clinical practice. Discrepancies resulted in patient harm even during the short period of hospitalization, which warrants the implementation of medication reconciliation at hospital admission.

Heath literacy, illness perception and NAFLD/NASH awareness in primary care patients in Crete, Greece

Abstract Background and Aims Patient health literacy (HL), illness perception and awareness are key factors driving health behaviour. This observational study aims to assess the level of HL, illness perception and awareness about non-alcoholic fatty liver disease (NAFLD)/steatohepatitis (NASH) in high-risk primary care (PC) patients in Greece, Spain and the Netherlands. Methods Eligibility criteria included: 1) aged ≥50 years, and 2) obesity, and/or metabolic syndrome, and/or diabetes. Patients consecutively visiting PC practices completed a questionnaire assessing socio-demographic characteristics and health habits. HL, illness perception and NAFLD/NASH awareness were assessed using the European Health Literacy Survey Questionnaire, the Brief Illness Perception Questionnaire and the Public Awareness of NAFLD Questionnaire respectively. Results Data are available at this moment from the Greek setting. Among the Greek participants (N = 141, 53.2% females, mean age 66 years) 66.7% had diabetes, 78% obesity and 71.6% metabolic syndrome, with 22.7% reporting active smoking. Most (71.6%) had heard about NAFLD by their personal physician. Obesity (78%), excess alcohol intake (45.8%), lack of exercise (38.7%) and diabetes (32.4%) were recognized as the commonest determinants of fatty liver disease, while 78% were aware of ultrasound as the main diagnostic modality and 47% did not know whether there is an available treatment. Only 39% of the participants find information of their treatments easily. Conclusions Our preliminary results show that the majority of patients seem to be aware about NAFLD/NASH and their determinants. It's alarming that a lot do not know about treatment, although they are high-risk. Key messages Our preliminary results show that the majority of patients seem to be aware about NAFLD/NASH and their determinants. It’s alarming that a lot of patients do not know about their treatment, although they are high-risk.

What motivates patients to change general practitioners in the Pleven region, Bulgaria?

Abstract Problem The World Health Organization's 2008 World Health Report, entitled ‘Primary care now more than ever,' clearly states the need of knowledge about primary care not as one of the ordinary structures of the national health system, but as its leading priority. Description of the problem Since the start of health reform in Bulgaria, the choice and change of a GP by patients is most often spontaneous, random, and without enough specific information about the qualities of the GP. This reduces the effectiveness of the free choice of a doctor. The purpose of this study was to analyze the patient's motives for changing their GP. A survey was conducted among respondents in the period from September 1st to 30th, 2018 in the Pleven Region, Bulgaria. Patients who visited their GPs during the study period were interviewed. The results were processed using Microsoft Office Excel 2007. Results It was established that 830 (78.8%) of the 1053 respondents in the territory of Pleven Region have changed their personal doctor. The three leading motives were: long waiting times in front of the GP's office - 30.2%, change of residence - 19%, and lack of sufficient referrals from a physician to the specialist - 11.7%. Most of the surveyed patients assessed their GP as having a positive attitude toward them. 132 (12.6%) of the participants rate their personal doctor as rude, always being in a hurry, and nervous or not giving them any answers at all. Lessons When choosing a GP, the patient's prior information about the qualities and competencies of the personal physician of his\her choice is very low. It is necessary to create a system for the informed choice of a personal physician which will have a double effect, 1) a more adequate and more critically justified choice of a GP by the patient, and 2) a clearer, more stable commitment and responsibility of the GPs to the patients who chose them. Key messages It is necessary to improve the overall organization of the work of GPs. Healthcare is a type of interaction between the doctor and the patient during the diagnostic and treatment process.

The impact that family members\u2019 health care experiences have on patients\u2019 trust in physicians

BackgroundA family member’s negative experiences with medical care have long-term effects on a patient’s attitudes and emotions. However, the impact of family members’ experiences on patients’ trust in their own physicians and in physicians generally is poorly understood. This study aims to quantify these associations.MethodsA cross-sectional online survey involving adults with non-communicable diseases (cardiac disease, diabetes, cancer, depression, and rheumatic disease) was conducted in Japan during April 2020. The main exposure variable was dissatisfaction with the medical care that family members had received. The main outcomes were patients’ (N = 661) own trust in their personal physicians and in physicians generally. The study adopted the Japanese version of the Abbreviated Wake Forest Physician Trust Scales. Both 5-item scales (general and individual physician trust) were translated and validated for the study. The total scores were transformed into a scale of 0-100 points. A series of linear mixed-effects models with consideration for clustering effect by prefectures were fit.ResultsThe results showed a lower rating for trust in physicians generally as compared to trust in the respondent’s personal physician (mean 57.0 vs. 66.4 points; p < 0.001). Furthermore, dissatisfaction with a family member’s medical care was associated with lower trust in physicians generally (mean difference − 9.58, 95 %CI -12.4 to -6.76). Interestingly, dissatisfaction with a family member’s care was also associated with lower trust in the respondent’s personal physician (mean difference − 3.19, 95 %CI -6.02 to -0.36), but the magnitude of this association was weaker. The lower trust in personal physicians may be mediated by reduced trust in physicians generally.ConclusionsWe suggest that physicians enquire about past patients’ negative experiences, including dissatisfaction with family members’ medical care, to repair hidden loss of trust, when they sense that patients doubt them or physicians generally.

Berlin Congress 1878 Through the Eyes of Phanariot Alexander Karateodori Pashi

The article contributes to the historical literature on the Berlin Congress; it shows the events of the summer of 1878 through the eyes of the diplomats of the defeated Otto man Empire. The primary source for the article is the “Rapport” by the head of the Turkish delegation to the Сongress, Alexander Karathéodori Pasha (1833–1906), a Phanariote with Greek and Bulgarian roots, the son of the personal physician of Sultan Mahmud II and the first Ottoman lawyer. He graduated from the Sorbonne law faculty with a doctorate in law. Until recently, Turkish historians wrote about him more as a diplomat. However, in recent years, they started to pay attention to his extraordinary fate, the history of his family, in which there were many famous Phanariots. “Rapport” only in recent years began to attract the at tention of historians. The history of its creation is still unclear. It contains fascinating details of the relationship between representatives of a collective Europe at that time, the nature of their interests, and factors that outlined the fate of the Balkan region for decades to come. The report was written by Ottoman dignitaries when the Balkans finally became a “border area.” Its author noticed how the “big players” ’s geopolitical contradictions pushed the local people’s historical evolution along the “path” of future cataclysms. Alexander Karathéodori Pasha conveys, through seemingly minor details, the discord between the representatives of the “collective West” “and their desire to stop the attempts of the Ottoman Empire to follow the European paradigm of development. Against the background of the events in Berlin, Karathéodori eased the participants’ desires to start the quickest part of the “Ottoman inheritance” and drew attention to the beginning process of restructuring of international relations. He viewed the Berlin Congress analytically and realized its long-term implications.

Telemedicine in Geriatric Psychiatry: Relevance in India.

Telemedicine has evolved as a novel tool in delivering health care in the modern world. With the advancement in video conferencing technology at an affordable price and innovative digital medical instruments, it has grown from guiding paramedics in managing patients to aiding physicians in providing direct consultation. Delivering care for older adults has always been challenging due to comorbidities that may warrant a multidisciplinary approach leading to frequent visits across specialties. As per the preliminary reports of the Longitudinal Aging Study in India, 55% of this population suffers from any chronic illness, of which 40% have some form of disability and 20% deal with mental health issues. Over the years, telepsychiatry care for older adults has received increasing acceptability. Videoconferencing with improved connectivity and transmission rates has aided in evaluating, assessing, and providing mental health interventions at ease. The recent regulation of telemedicine practice in the country by rolling out the Telemedicine Practice Guidelines 2020 and Telepsychiatry Operational Guidelines 2020 has fast-tracked its utility during the COVID-19 pandemic. Concerns of physical examination, psychological satisfaction of consulting physician in person, confidentiality, and security of information shared are points that need better addressing in the future. However, Telemedicine is recommended to be used judiciously, taking the risk and benefit of older adults on a case basis as it can significantly bring down the financial and emotional burden.

Reasons for and Scenarios Associated with Failure to Cease Smoking: Results from a Qualitative Study Among Polish Smokers Who Had Unsuccessfully Attempted to Quit.

PurposeMost smokers attempt to quit smoking, but few are successful. Data regarding the reasons for this relapse and the course of the relapse process may be helpful for determining efficient methods of smoking cessation. This study aimed to identify the causes of and scenarios associated with smoking relapse after effective smoking cessation.Patients and MethodsWe conducted 20 semi-structured interviews with smokers who had previously unsuccessfully attempted to quit. The data underwent qualitative content analysis.ResultsThree major themes were identified: reasons for smoking relapse; smoking relapse scenarios; and perception of the influence of personal environments, including family and physicians, on refraining from smoking after cessation. The first theme comprised the following subthemes: insufficient willpower and self-discipline, contact with smokers, exposure to stressful situations, lack of family support, weight gain, and insufficient improvement in one’s mental and physical well-being. The second theme contained enjoyable social events, professional life, critical events, and encouragement to smoke from family members. The respondents frequently emphasized the large role of interaction with other smokers.ConclusionThe predominant factors underlying smoking relapse include insufficient willpower and self-discipline and exposure to stress. The most frequent relapse scenario concerned experiencing negative or positive emotions when interacting with other smokers.

Medieval Turkic healing traditions and written artifacts

A special place in the modern scientific direction is occupied by ethnographic research of the tradi- tions of traditional medicine on the basis of different ethnic groups, their practical application through popularization among the population. One of the most important issues in the study of the “Seven Facets of the Great Steppe” and the ethnocultural system of the peoples of Central Asia and Kazakhstan is the ethnomedicine of nomadic peoples, which was used on the territory of medieval Kazakhstan. In the period of rapid development of modern science, it is necessary to supplement the study of medieval folk medicine with new ethnographic materials and a comprehensive study of the history of field ethnomedi- cine. One of these medieval writings in a medical context is Dastur al-’ilaj (Tradition of Medicine), writ- ten in the first half of the 16th century by Sultan Ali al-Khorasani, the personal physician of a nomadic khan. The aim of the study is to analyze the relationship between the healing arts and the culture of the peoples of the Great Steppe based on the written heritage by studying the culture and history of no- madic peoples. During the study of the topic, the number of sources with information about traditional medicine was increased and unpublished manuscripts were introduced, analyzed on the materials of published studies using comparative historical and linguocultural methods to study the morphological structures, meaning and content of words, including text analysis. Key words: manuscripts, folk medicine, medieval written monuments, Chagatai language, healing tradition. &nbsp