Primary Health Care Doctors Research Articles

E-Referral System Modeling Using Fuzzy Multiple-Criteria Decision Making

<p class="Abstract"><span lang="EN-US">Currently, the quality of health services in Indonesia is getting better. However, the referral system still has some problems. The first is the difficulty in determining the referral hospital by the condition of the patient. The second is the different parameters used to determine the referral hospitals between countries. Based on those problems, it is necessary to improve the ability of the current referral system. This study developed a reference system model for assessing the suitability of the patient's background with the referral hospital. Some of the methods used are restful on web service technologies for information exchange between primary health care doctors and referral hospitals, Fuzzy Multiple-Criteria Decision Making (FMCDM) to determine the ranking of referral hospitals that fit the patient's background. The result of this study is an intelligent system model to get the referral hospital that fit the patient's background.</span><em></em></p>

The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia.

BackgroundIn Catalonia, the Fundació TIC Salut Social’s mHealth Office created the AppSalut Site to showcase to mobile apps in the field of health and social services. Its primary objective was to encourage the public to look after their health. The catalogue allows primary health care doctors to prescribe certified, connected apps, which guarantees a safe and reliable environment for their use. The generated data can be consulted by health care professionals and included in the patient's clinical history. This document presents the intervention and the major findings following a five-month pilot project conducted in the Barcelona area.ObjectiveThe objective of the pilot study was to test, in a real, controlled environment, the implementation of AppSalut. Specifically, we tested whether (1) the procedures corresponding to the prescription, transmission, and evaluation of the data functions correctly, (2) users interact successfully and accept the tool, and (3) the data travels through existing pathways in accordance with international standards. The evaluation is not based on clinical criteria, but rather on the usability and technological reliability of the intervention and its implementation in the context of primary care.MethodsThe project was presented to the Primary Care Team participants to encourage the involvement of doctors. The study involved at least 5 doctors and 5 patients per professional, chosen at their discretion and in accordance with their own clinical criteria. An initial consultation took place, during which the doctor discussed the pilot project with the patient and recommended the app. The patient was sent a text message (SMS, short message service) containing an access code. When the patient arrived home, they accessed their personal health record (PHR) to view the recommendation, download the app, and enter the access code. The patient was then able to start using the app. The data was collected in a standardized manner and automatically sent to the system. In a second visit, the patient looked at the data with their doctor on their clinical station screen. The latter was able to consult the information generated by the patient and select what to include in their electronic health record. In order to assess the performance of the system, three focus groups were performed and two ad-hoc case-specific questionnaires, one for doctors and one for patients, were sent by email. Response was voluntary.ResultsA total of 32 doctors made 79 recommendations of apps to patients. On average, the patients uploaded data 13 times per prescribed app, accounting for a total of 16 different variables. Results show that data traveled through the established channels in an adequate manner and in accordance with international standards. This includes the prescription of an app by a doctor, the patient accessing the recommendation via the PHR, app download by the patient from the official app stores, linking of the patient to the public platform through the app, the generation and visualization of the data on the primary care workstation, and its subsequent validation by the clinician.ConclusionsFirst, the choice of apps to be used is fundamental; the user's perception of the utility of the proposed tool being paramount. Second, thorough face-to-face support is vital for a smooth transition towards a more intense model of telemedicine. Last, a powerful limiting factor is the lack of control over people’s ability to use the apps.

Testing a New Tool Assessing Attitude Towards Treatment and Health in Primary Health Care Setting: Senior Patients and Doctors Perspectives.

Patients' attitude towards treatment and health (ATH) is crucial for compliance at all stages of treatment. This study examined the psychometric properties of the developed PRACTA Attitude Towards Treatment and Health questionnaire, designed to measure ATH as perceived by seniors (PRACTA-ATH) and doctors (PRACTA-ATH-D) in primary health care. The data were collected in two waves of the Polish-Norwegian PRACTA project. Exploratory factor analyses (EFAs) were conducted on wave 1 data from senior patients ( n = 3392) and their general practitioners ( n = 491). Confirmatory factor analyses (CFAs) were conducted on wave 2 data. This was a new sample of senior patients ( n = 2765) and a follow-up sample of doctors ( n = 393). The EFAs showed that the 16-item four-factor solution is the best solution reflecting the structure of both seniors and doctors' ATH questionnaires. The CFAs conducted to establish the best unified model for PRACTA-ATH and PRACTA-ATH-D indicated three comparatively good solutions: the 16-item four-factor solution, the 12-item four-factor solution and the 12-item five-factor solution. The questionnaire is found appropriate for use among patients and doctors, and can be used as a good tool to monitor older patients' ATH and concordance between doctors and patients' perspectives.

Burnout syndrome, job satisfaction and associated factors among primary health care doctors in Erzurum, Turkey

Amac: Bu calismanin amaci, Erzurum ilindeki pratisyen hekimler arasinda tukenmislik ve is doyumu duzeylerini ve iliskili faktorleri belirlemektir. Yontemler: Erzurum'da 2012 yilinda birinci basamakta calisan 253 doktordan, 246 tanesi calismaya dahil edilmistir. Veriler Kisisel Bilgi Formu, Maslach Tukenmislik Olcegi (MTO) ve Minnesota Is Doyumu Olcegi (MIDO) kullanilarak toplanmistir. Bulgular: Calismaya katilan hekimlerin %72,8’i erkek, %70,7’si evli ve yas ortalamalari 34,0±5,7 seklindedir. Mesleginin toplumda hak ettigi degeri bulduguna inanmayanlar %92,5 oldugu saptanmistir. 40 yas ustu hekimlerin kisisel basari puanlari 29 yas altindaki doktorlara gore daha dusuk bulunmustur (OR: 2,28, %95 1,50 – 4,92, p=0,03). Duzenli tatil yapmayan hekimlerin duzenli tatil yapmayan hekimlere gore is doyumu ve kisisel basari puanlari daha yuksektir (p<0,05). Hekimlerin, MTO alt boyutlari olan duygusal tukenmislik, duyarsizlasma, kisisel basari puanlari sirasiyla %69,1’inde, %75,6’sinda ve %79,3’unda dusuk saptanmistir. Genel is doyumu puan ortalamasi ise %70,6’sinda orta duzeyde bulunmustur. Sonuc: Birinci basamak saglik kurumlarinda gorev yapan hekimlerin 1/3’unde tukenmislik ve is doyumu yuksek bulunmustur. Bu durum goz onune alinarak, hekimlerin tukenmislik duzeylerini azaltmaya, is doyumu duzeylerini arttirmaya yonelik oneriler yapilmistir.

Is Balint training associated with the reduced burnout among primary health care doctors?

ABSTRACTThe aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory – Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis.Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors

Activation of older patients through PRACTA intervention for primary healthcare doctors: does the method matter?

Activating older adults in medical practice can benefit patients' health and quality of life, as well as the economy and burden of the healthcare system. Placing general practice in the public healthcare system gives the elderly population easy access to the promotion of active attitudes toward health, provided that the doctors have and use relevant activating tools. The aim of this study was to verify the possibility of activating senior patients through an educational intervention for doctors. Two waves of data collection from primary care patients and their doctors were separated by an intervention for doctors. The intervention took the form of an e-learning programme or article and was developed so as to improve general practitioners' (GP) communication and activation skills, especially when working with older adults. The outcome variable was the change between the waves in patients' scores on the PRACTA Attitude Toward Treatment and Health (ATH) Scale and PRACTA Self-efficacy Scale. Data from patients aged 50 + (n = 2175; 55.6% women; age: M = 69.56, SD = 9.10) appointed at the primary care facilities were analysed. The analysis revealed the effect of doctors' e-learning and, to a lesser extent, the effect of article reading on patients' attitudes toward treatment and health as well as on their self-efficacy. In facilities in which the intervention was implemented, patients' attitudes were more active on follow-up than at baseline when compared with facilities without the intervention. Educational intervention among doctors can result in patients' ATH becoming more active. The form of intervention might diversify the impact.

Violência contra mulher em contexto de vulnerabilidade social na Atenção Primária: registro de violência em prontuários

Objetivo: Investigar o registro dos tipos de violência sofridos e as condutas tomadas, por profissionais de saúde, incluindo a notificação, frente ao relato de situação de violência por mulheres em contexto de vulnerabilidade social atendidas na Atenção Primária à Saúde. Método: Estudo quantitativo, transversal, descritivo e observacional, pela análise de prontuários, considerando todos os registros realizados até o último dia do ano de 2015, de mulheres acima de 18 anos que residam nas áreas de abrangência de dois Centros de Saúde, consideradas áreas de vulnerabilidade social. Resultados: A amostra final foi de 769 prontuários, sendo que em 3,77% havia relato de violência sofrida. Destes, 45% foi do tipo física, seguido por 24%, psicológica; o principal agressor foi o parceiro íntimo (41%); 58% dos relatos foram registrados por médicos, em Centros de Saúde. Houve algum tipo de conduta para 89% dos casos (medicação, encaminhamento ou retorno). Apenas 7% dos casos foram notificados. Conclusões: Os dados desse estudo sugerem que possa haver sub-registro das situações de violência em áreas de vulnerabilidade social em Florianópolis, tendo em vista os poucos casos registrados e notificados em um conjunto de 729 prontuários. Observou-se que esteja relacionada a isso a falta ou pouca sensibilização e capacitação dos profissionais para identificar situações de violência, bem como registrar, notificar e dar prosseguimento ao acompanhamento às pessoas que vivem nessa situação. Portanto, é necessário difundir e capacitar os profissionais de saúde para a detecção, registro, condutas, notificação e seguimento das situações de violência.

Did Primary Health Care Doctors Lose the Battle with the Specialist and Consultants?

Did Primary Health Care Doctors Lose the Battle with the Specialist and Consultants?

Equity aspects of the Primary Health Care Choice Reform in Sweden \u2013 a scoping review

BackgroundGood health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms.MethodsWe reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian’s framework for assessing quality of care in terms of structure, process and outcomes.ResultsSince 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced.ConclusionsThe PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored.

A cross-sectional survey on the patterns of primary teeth eruption in 2 581 children

Objective: To investigate the patterns of primary teeth eruption by a cross-sectional survey in 0-40 months old children in Chongqing and to provide normal timetables of tooth eruption that are practical in general physical growth assessment. Method: Data of 2 581 0-40 months old healthy children were collected from January 2014 to January 2016 at Children's Hospital of Chongqing Medical University. General information was recorded by primary child health care doctors, including age, gender, gestation age, birth weight, time and sequence of first primary tooth eruption, number of teeth and age of totally primary teeth emergence. Median and constituent ratio were used in describing the age of tooth eruption and eruption characteristics at different age. Moreover, independent-sample t test, variance analysis, Pearson product-moment correlation and Logistic regression were also involved in data analysis. Result: Totally 2 581 children were involved in this survey, including 506 infants of 0-6 months old, 600 infants of 7-12 months old, 730 toddlers of 13-24 months old and 745 children of 25-40 months old. There were 1 473 boys and 1 108 girls, 89 preterm babies and 2 492 full term babies, 1 829 children with tooth erupted and 626 children with all primary teeth erupted.The age of the first primary tooth eruption was between 2-15 months old ( median age: 8 months old, 95%CI: 2.7-12.7)and for the last primary tooth emergence was between 23-35 months of age (median age: 31 months, 95%CI: 24.7-36.7). The time of first tooth eruption was positively correlated with that of total teeth emergence (r=0.879, P<0.05). Dental charts (number of tooth for age) of different gender were drawn according to teeth eruption information. The first primary tooth eruption was the incisor of mandible in 95.3% (1 743/1 829)infants and was the incisor of maxilla in 4.6% (84/1 829)infants. During the period of tooth emerging actively (number of teeth ≤16), the number of primary teeth might be calculated by formula: number of teeth=chronological age in months-age of first eruption in months+ 1. There was no statistically significant difference between the number of actual teeth and calculated by the present formula(t=-2.957, P=0.05). Conclusion: The median age of first primary tooth eruption and total teeth emergence was 8 and 31 months of age respectively. The first primary tooth eruption is incisor of mandible in most infants.The formula (number of teeth=chronological age in months-age of first eruption in months+ 1 )can be used to estimate the number of primary teeth. Dental charts might provide normal and supplement datasets for evaluating child physical growth.

Teleconsultation on Skin Diseases: The Challenge of Providing Health Care to Isolated Populations in the Amazon Rainforest

This observational study was carried out in the state of Amazonas (Brazil), a huge and remote Rainforest area with only 2.2 inhabitants per square kilometer. This isolation is due to both geographical setting and ethnic-cultural barriers, with the indigenous population representing around 4% (20% of the entire indigenous population of Brazil, 60 ethnic groups and more than 40 languages). The lack of dermatology specialists encourages the few Primary Health Care Doctors (PCD) to apply for asynchronous support on skin disease occurrences through the portal of the Manaus-based Telemedicine and Telehealth Centre (TTC). Subsequently, the TTC counsels the PCD at a distance through his dermatologist-consultants (DC). The performance of such a teleconsultation system was audited by a TTC independent board of experts. They reviewed a 24 months continuous case series by focusing on the quality of PCD applications and DC counseling. The quality of anamnesis, description of physical signs and attached clinical documentation by the PCD was satisfactory in only 56/100, 44/100 and 53/100, respectively. A significantly negative trend (p<0.05) from the first to the second year was also observed. However, the PCD prompted presumptive diagnosis in 87/100, with a 72% of agreement with the DC’s final diagnosis. Indicators of good DC performance were: a) the response to the application within 72 h time occurring in 51/100, with a significantly improving trend (P<0.05); and b) the referrals to the health facilities of the capital of the state being recommended in only 13/100. Teleconsultation represents an opportunity for providing access to isolated populations and minorities. Although DC performance is improving, the high turnover of PCDs and the lack of training in e-health at the undergraduate level result in the poor quality of PCD applications. Thus, instruction in e-health tools should be added to the curriculum of the undergraduate program in medicine.

Proceedings and Quality Indicators of the Primary Health Care Doctor Supporting Medical Teleconsultation System in the State of Amazonas (Brazil)

Economic studies and randomized-control studies are reportedly of poor practicability for evaluating the performance of medical teleconsultation systems, particularly in areas with large rural indigenous populations. Thus, this is an observational case study, focusing on a retrospective audit of the performance of a teleconsultation system by establishing and estimating measurable quality indicators (QI). The inhabitants of the rainforest of the state of Amazonas, partly indigenous, have poor access to the health system facilities, despite government guarantees, due to both cultural and geographical considerations. Nevertheless, the Telemedicine and Telehealth Centre (TTC) provide the Primary Health Care Doctors (PCD) of 22 municipalities with teleconsultation. Whenever the complexity of the health problem of a patient exceeds the PCD’s capacities, the PCD can apply for teleconsultation via satellite antenna Internet connection and the TTC expectedly returns e-mail based (asynchronous) counseling within 72 h through its network of teleconsultants. A board, composed of 5 international TTC-external experts, audited the proceedings, analyzed the series of cases submitted from January to September 2016, established QI, and proposed desirable standards. The results of some QI are that: a) the anamnesis, physical examination, and attached documentation from the PCD are still of poor quality and require improvements through PCD training; b) the TTC provides teleconsultation within 32 h in ordinary cases and twentyone hours in urgent cases; c) the database of teleconsultants (mostly internationals) available covers thirty-nine specialties; d) additional synchronous communication was used in 14%, mostly in traumatology; e) the referral advising ratio is at 16%; f) In the referral process, the flow of clinical data between health providers is unsatisfactory; g) cold cases are at 4% and h) definitive response in counseling is at 44%. Observational case series studies, based on external audit, are supportive in outlining performance and pointing out actions aimed at improvement.

Productive Cough in Children and Adolescents - View from Primary Health Care System.

Cough is one of the most common symptoms that doctor faces in working with pediatric population, and according to some characteristics of cough, doctors can often conclude localization, and sometimes even the nature of the disease that causes it. Cough is not only the physiological defense reaction, but a symptom of a disease. According to duration it can be acute, chronic and recidivist, recurrent and persistent, strong or discreet, caused by changes in body position and changes in outside temperature. Pathoanatomically it is divided into lobar, lobular, alveolar and interstitial, pathogenetically to bronchogenic and hematogenous, as well as in immuno competent and immunocompromised, and clinically on the local and inpatient (72 hours after hospital admission). Considering the contents, cough can be productive–with secretion from the respiratory tract, and unproductive-dry, without secretion. By auscultation bronchial breathing, rattle and crepitus can be heard. The primary diagnostics is radiological, posterior to anterior (P-A) and lateral footage of the chest. Laboratory findings in typical pneumonia, are characterized by leukocytosis, neutrophilia and shift of blood image to the left. Sedimentation is accelerated and C-reactive protein is elevated. The basic bacteriological diagnosis is sputum Gram’s stain and culture of sputum. In atypical pneumonia, leukocytes are usually in the normal range, and it is necessary to do serological tests (IgM and IgG antibodies). The role of doctors in primary health care is auscultation differentiation of murmurs with confirmation of doubt if there is pathological findings by laboratory tests and treatment, depending on the type of cough. Treatment is essentially pharmacological, with irrefutable importance of non-pharmacological measures.

YouTube™ is a feasible tool to disseminate educational toxicology videoconferences: The Global Educational Toxicology Uniting Project (GETUP).

Introduction: GETUP has filled an important void in global education about poisoning management by linking countries with and without toxicology services through videoconferencing and educating primary healthcare doctors and other health professionals. However, timezone incompatibilities among geographically remote sites may mean some parties are unable to attend all videoconferences. Recorded video is one potential solution for asynchronous learning using GETUP case materials, but its utilization has not been adequately defined. We aimed to assess the feasibility of YouTube to disseminate recorded toxicology videoconferences and analyse its usage. Methods: We performed a review of nine recorded videoconferences recorded on Google Hangouts™ and stored on YouTube™ from March 2014 to August 2015. YouTube Analytics™ data were used to measure web traffic and viewer trends. Results: There were 204 views of the nine videoconferences during the study period. The main groups involved in making the recorded conferences included the Austin Toxicology Service, Victoria, Australia; Fresno Toxicology Service, California, USA and the Emergency Department, Suva, Fiji. The majority of views (59%) were by viewers in the 25 to 34 age bracket. Viewers were located in 20 countries over six continents. Thirty-three percent (67 views) were from 18 states in the USA. Devices used to playback these conferences included computer (93%), mobile phone (5.3%), tablet (1%) and unknown (0.7%). Conclusions: Recorded video available over the Internet is feasible method to disseminate toxicology based educational videoconferences around the world and gather important information about how medical professionals tend to consume case-based toxicology educational contents.

Adult T-cell leukemia/lymphoma treatment in Bahia, Brazil.

BackgroundAdult T-cell leukemia/lymphoma is a peripheral disease associated with human T-cell lymphotropic virus type 1. Treatment is carried out according to clinical type with watchful waiting being recommended for less aggressive types. Aggressive adult T-cell leukemia/lymphoma is generally treated with chemotherapy and/or antivirals. The objective of this study was to correlate the survival of patients diagnosed in Bahia, Brazil, with the therapeutic approaches employed and to evaluate what issues existed in their treatment processes.MethodsEighty-three adult T-cell leukemia/lymphoma patients (26 smoldering, 23 chronic, 16 acute, 13 lymphoma and five primary cutaneous tumoral) with available data were included in this study.ResultsComplete response was achieved in seven smoldering patients with symptomatic treatment, in two with chronic disease using antivirals/chemotherapy, in one with acute disease using antivirals and in one lymphoma using the LSG15 regimen [vincristine, cyclophosphamide, doxorubicin, and prednisolone (VCAP); doxorubicin, ranimustine, and prednisolone (AMP); and vindesine, etoposide, carboplatin, and prednisolone (VECP)]. Smoldering patients who received symptomatic treatment presented longer survival. Favorable chronic patients treated with antivirals presented longer survival compared to the unfavorable subtype. However, for the acute form, first-line chemotherapy was better, albeit without significance, than antivirals. Only one of the patients with lymphoma and primary cutaneous tumors responded.ConclusionsWatchful waiting associated with phototherapy represents the best option for smoldering adult T-cell leukemia/lymphoma with survival in Bahia being superior to that described in Japan. There was a trend of better results with zidovudine/interferon-alpha in favorable chronic disease. Excellent results were achieved in the lymphoma type treated with the LSG15 protocol. Patients are diagnosed late probably due to lack of knowledge of adult T-cell leukemia/lymphoma by primary healthcare doctors and a Brazilian treatment protocol needs to be established.

Emergency supply of doctors by the Mais Médicos (More Doctors) Program and the quality of the structure of primary health care facilities.

The health policy context in Brazil has featured a series of measures to improve primary health care (PHC), including a national access and quality improvement program (Programa Nacional de Melhoria do Acesso e Qualidade, PMAQ-AB) and the Mais Médicos Program (More Doctors, PMM) and upgrading PHC centers ('Requalifica UBS'). The paper examines the PMM's placement of doctors, by quality of PHC structure, in an endeavor to identify synergies among the three programs. It reports on a transverse study based on secondary data from PMAQ-AB Cycles 1 and 2, the PMM and 'Requalifica UBS'. The PHC facilities inventoried during PMAQ-AB Cycle 1 were classified, on pre-established typology, into five groups ranked from A (best) to E (failed). They were then compared in terms of PMM personnel allocated and Requalifica UBS proposals. The results point to convergences in investments by the three programs. Incentives targeted predominantly PHC facilities of types B and C, indicating a concentration of efforts on PHC facilities with potential for structural quality improvements. In addition to expanding access, the provision of doctors by the PMM, added to infrastructure upgrades and work process improvements, contributes to addressing high turnover and guaranteeing retention of doctors in PHC.

Primary care in Brazil, and the Mais Médicos (More Doctors) Program in the Unified Health System: achievements and limits.

An historical analysis of Brazil's policies in Primary Healthcare, with emphasis on the Family Health Strategy (FHS), and the Mais Médicos Program (PMM). Studies were made of documents and secondary official data, and the bibliography that has been produced on this theme. It was found that primary healthcare has been established and successfully consolidated as an option in healthcare for a great part of the population of Brazil. There have, however, been structural hurdles, which have tended to compromise the effectiveness and sustainability of this policy. It was identified that these obstacles arise principally from insufficient financing and from inefficient modes of planning and management. The Mais Médicos Program has widened care coverage and made the distribution of primary healthcare doctors more equitable, although it has not resolved the structural problems of the public system.

Integration Between Mental Health-Care Providers and Traditional Spiritual Healers: Contextualising Islam in the Twenty-First Century.

In the United Arab Emirates, neuropsychiatric disorders are estimated to contribute to one-fifth of the global burden of disease. Studies show that the UAE citizens' apathy towards seeking professional mental health services is associated with the 'religious viewpoints' on the issue, societal stigma, lack of awareness of mental health and lack of confidence in mental health-care providers. Mental health expenditures by the UAE government health ministry are not available exclusively. The majority of primary health-care doctors and nurses have not received official in-service training on mental health within the last 5years. Efforts are to be made at deconstructing the position of mental illness and its treatments in the light of Islamic Jurisprudence; drafting culturally sensitive and relevant models of mental health care for Emirati citizens; liaising between Imams of mosques and professional mental health service providers; launching small-scale pilot programs in collaboration with specialist institutions; facilitating mentoring in line with Science, Technology, Engineering and Math (STEM) outreach programmes for senior school Emirati students concerning mental health; and promoting mental health awareness in the wider community through participation in events open to public.

Prevalence of Metabolic Syndrome and Affecting Factors among Individuals Aged 30 and over in Balçova District of İzmir.

The studies have shown that metabolic syndrome (MetS) leads to an increase twice as much in cardiovascular diseases (CVD) and four times as much in diabetes mellitus (DM) prevalence since the second half of the 20(th) century. This study aims to determine and discuss the prevalence of the MetS and co- factors among individuals at the age of 30 and over in Balcova district of İzmir province according to the American National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) and InternationalDiabetes Federation (IDF) criteria. Cross-sectional study. Data obtained from the Balcova Heart Project in İzmir were used in the study. The dependent variable of the study is MetS existence. The independent variables were socio-demographic characteristics (age, gender, education level, and marital status), self-perceived economic status, physical activity, smoking status, healthy nutrition and body mass index (BMI). The prevalence of MetS was 36.9% according to the diagnostic criteria of IDF, while it was 27.4% according to ATP III criteria. According to the both criteria, increasing age, low education, poor economic status perception, physical inactivity, and obesity increase the risk of MetS. Apart from the IDF criteria, being female and a current smoker increase the risk of the MetS in the NCEP-ATP III. Compared to educational studies of MetS as of today, which are community and health-oriented studies, it is challenging that the prevalence of MetS was found to be high for both criteria in our study. Therefore, in particular, primary health care doctors must be prompted to protect the public against DM and CVD in particular.

Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria

BackgroundPatient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. Material and methodsThe data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. ResultsAbout one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. ConclusionsSatisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.