Private Doctors Research Articles

Are workers in construction sites of Mangalore city healthy? a cross-sectional study

Background: Construction site workers are prone to develop health problems due to poor living conditions. This is magnified by lack of timely access to health care. Thus, we sought to explore the health status of construction site workers.Methods: A cross sectional study was conducted in construction sites located in an urban area of Mangalore, from September to November, 2015 among workers aged ≥18 years, with consent. Information was obtained through a pre-designed, pre-tested interview schedule.Results: A total of 178 individuals participated in the study, which included 160 (89.80%) males. Majority, (80.80%), stated that they had experienced fever at least once in the past one year. Other major complaints were blocked nose (17.40%), followed by skin diseases (12.70%) and cough which was present in 12.30%. When the study participants had an illness, 65.70% visited a health facility. Majority (82.50%) preferred private doctors, 62.50% visited the doctor so that they could work better and earn more, and 37.0% were unable to afford the treatment due to high treatment cost.Conclusions: The most common health complaint was found to be fever. Nearly half of the study participants had illness which required treatment in the last one year. More than half visited a health facility when ill. A high proportion (82.50%) preferred private health facility.

Stigma and unmet sexual and reproductive health needs among international migrant sex workers at the Mexico-Guatemala border.

To explore international migrant sex workers' experiences and narratives pertaining to the unmet need for and access to sexual and reproductive health (SRH) at the Mexico-Guatemala border. An inductive qualitative analysis was conducted based on ethnographic fieldwork (2012-2015) including participant observation and audio-recorded in-depth interviews. The participants were female sex workers aged 18years or older and international migrants working at the Mexico-Guatemala border. In total, 31 women were included. The greatest areas of unmet need included accessible, affordable, and nonstigmatizing access to contraception and treatment of sexually transmitted infections. On both sides of the border, poor information about the health systems, services affordability, and perceived stigma resulted in barriers to access SRH services, with women preferring to access private doctors in their destination country or delaying uptake of until their next trip home. Financial barriers prevented women from accessing needed services, with most only receiving SRH services in their destination country through public health regulations surrounding sex work or as urgent care. There is a crucial need to avoid prioritizing vertical disease-specific services and to promote access to rights-based SRH services for migrant sex workers in both home and destination settings.

The consumer choice between the private doctors and the healthcare clinics

There are not many studies on healthcare from the point of view of the healthcare consumers. The study did not reveal substantial difference between the two healthcare service providers in the eyes of the consumers on the basis of their preference for the healthcare attributes included in the study. Higher income groups of consumers did not attach importance to the cost of healthcare and, the time spent by the doctors with them. Similarly, the eldest consumers were not much worried about the cost of the healthcare. The youngest consumers preferred 'convenient location'. The consumers in the middle age belong neither to the youngest nor to the eldest in their preference towards 'convenient location', 'friendly staff', and 'quick appointment'. The study concludes that the consumers cannot be segmented on the basis of 'doctor consumers' and 'clinic consumers', but they can be segmented on the basis of the demographic characteristics of income and age.

The consumer choice between the private doctors and the healthcare clinics

There are not many studies on healthcare from the point of view of the healthcare consumers. The study did not reveal substantial difference between the two healthcare service providers in the eyes of the consumers on the basis of their preference for the healthcare attributes included in the study. Higher income groups of consumers did not attach importance to the cost of healthcare and, the time spent by the doctors with them. Similarly, the eldest consumers were not much worried about the cost of the healthcare. The youngest consumers preferred 'convenient location'. The consumers in the middle age belong neither to the youngest nor to the eldest in their preference towards 'convenient location', 'friendly staff', and 'quick appointment'. The study concludes that the consumers cannot be segmented on the basis of 'doctor consumers' and 'clinic consumers', but they can be segmented on the basis of the demographic characteristics of income and age.

Illness experience and help-seeking behaviors among patients with common mental disorders in a hospital in North 24 Parganas District, West Bengal, India

Background: Common mental disorders (CMDs) are the most frequently encountered mental health problems. A relevant cultural formulation requires consideration of how such patients understand their illness and the kind of help they prefer. We aimed to clarify patient's priority symptoms, perceived causes (PCs), and help-seeking (HS) behavior for CMDs in a psychiatry outpatient clinic in West Bengal, India. Methods: We conducted a cross-sectional survey of consecutive patients with clinically confirmed depression, anxiety, or somatoform disorders in a psychiatry outpatient department in a hospital in North 24 Parganas district. An explanatory model interview based on the Explanatory Model Interview Catalogue was used to assess qualitative and quantitative data regarding sociodemographic characteristics, pattern of distresses, PCs, and HS experience. Results: Among 124 patients, 69% were women, mean age 34.5 years. Half of the patients had monthly income less than USD 32, and 22% were illiterate. Clinically, 42% had depression, 32% somatoform disorder, 10% anxiety, and 17% mixed disorders. Most common symptoms were headache (93%), disturbed sleep (93%) and anxiety or tension (92%). Most common PCs were psychological (96%), family problems (64%), and physical injury (42%). The preferred first providers were private allopathic doctors (50%), traditional healers (28%), and public sector doctors (22%). Conclusions: Clinicians need to recognize both physical and psychological presentations of CMDs. Brief clinical assessment only for pharmacotherapy may be inadequate to address the underlying psychological impact of social and financial causes, which require clinical attention to issues associated with poverty, family, and community.

Étude prospective des facteurs associés à l’acceptation de la substitution des génériques par les patients et leurs médecins libéraux

BackgroundMany prescribers and patients remain reluctant to substitution to generics. MethodsWe conducted a prospective observational study, using semi-structured interviews adapted to identify factors independently associated with the acceptance of alternative to a generic drug by doctors and patients. ResultsBetween December 2014 and August 2015, 108 patients and 73 private doctors from Île-de-France and Nord-Pas-de-Calais were enrolled. Only 48 % of patients thought that the effectiveness and safety of generic were identical to the brand-name, 50 % had a favorable opinion and 36 % said they routinely accept substitution, especially when substitution was proposed by the general practitioner (68 % of patients). Age, gender, occupational status and the presence of a chronic condition were not associated to acceptance of substitution (P>0, 1), unlike the opinion (P<0.001), perception of efficacy (P<0.001) and side effects (P=0.0005). Two thirds of physicians substituted more than 50 % of their brand name prescription to generics. This low figure was due to patient request not to substitute (63.9 %). ConclusionThe acceptance of substitution was independently associated to patient’ opinion about generic drugs, further emphasizing the need for information campaigns dedicated to patients.

Estimating Incidence Rate of Hospital-Treated Self-Harm in Hong Kong Using Capture-Recapture Approach.

A surveillance system for self-harm has not been established in Hong Kong. The existing data source has an unknown degree of underreporting, and therefore a capture-recapture method has been proposed to correct for the incompleteness. To assess the underestimation of the incidence of self-harm cases presenting to hospital in Hong Kong using a capture and recapture method. Two different yet overlapping hospital administrative datasets of self-harm were obtained from all public hospitals in Hong Kong. From 2002 to 2011, 59,473 distinct episodes involving 36,411 patients were identified. A capture-recapture model considering heterogeneous capture probabilities was applied to estimate the number of self-harm episodes. The estimated number of self-harm incidence was 79,923, equally shared by females and males. Cases of self-harm by females were more likely to be ascertained than those by males. The estimated annual incidence rate of self-harm in Hong Kong from 2002 to 2011 ranged from 96.4 in 2010 to 132.7 in 2002. The proposed method does not include patients who required no medical attention and those where the patient consulted private doctors. The capture-recapture model is a useful method for adjusting the underestimation of self-harm cases from existing databases when surveillance system is not available and to reveal some hidden patterns.

‘The more we change, the more we remain the same’: female feticide continues unabated in India

In North India, preference for sons has been blamed for repeated incidents of female feticide, despite the legislation in the form of the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 2002....

Assessment of nutrients intake and morbidity pattern of Government and private doctors

Assessment of nutrients intake and morbidity pattern of Government and private doctors

So near, yet so far: access to safe abortion services remains elusive for poor women in India

In this case study, we describe our experiences with a woman employed as a housemaid who sought unsafe abortion services from a private doctor. This was her sixth pregnancy, after...

A study of self medication among the adult people of the Nanded city, western India

Background: Modern medicines are of prime importance to human being and are potentially hazardous when taken indiscriminately in the form of self medication. The main objective was to study the practice of self medication and the common ailments, drugs used, sources of information and the reasons for it.Methods: A community based cross sectional study was carried out on 300 urban adults. From the four zone of Nanded city, one zone was selected by lottery method and from that zone one pharmacy (medical) shop was selected randomly for data collection. Adult people who bought medicines from the selected shop without any prescription were interviewed for information regarding sociodemographic factors like age, sex, residence, education, occupation etc and information about over the counter drug such as which drug they purchased, what was the main symptom of their illness, reasons for not consulting doctor, sources of information about over the counter drug etc. were collected on predesigned and pretested semi structured proforma.Results: Out of 300 study subjects 78.3% were males and 21.7% were females. Maximum study subjects, 39.0% were from 30-39 years of age group and 23% study subjects were educated up to secondary school level. Most common symptom was fever (21%) followed by headache (15%). The commonest category of drug used for self medication was analgesic drugs (27%) and majority of study subjects said pharmacist was the main source of information about OTC drugs (48.7%). 45% study subject stated that reason for self medication was high consultation fees of private doctors.Conclusions: Active age group male members in the family were more involved in self medication and high consultation fees of private doctors was the main reason for not consulting the doctor and practicing self medication.

Inequalities in the utilization of health care services in a transition European country: results from the national population health survey.

To examine demographic, socio-economic, and health status inequalities in the utilization of health care services (UHCS) in the Republic of Srpska (RS), Bosnia and Herzegovina. Data were retrieved from the 2010 National Health Survey for the RS adult population (n=4128). A complex sample design was taken into account for statistical analysis. As compared to men, a higher percentage of women visited a family physician (FP), urgent care department, dentist and private doctor. Higher educated women and those worse-off (OR 1.17) more frequently visited FP. Hospitalization (OR 4.56 for males; OR 9.17 for females), visit to urgent care department (OR 3.19 for males; OR 2.42 for females) and visits to FP in females (OR 1.46) were associated with poor self-perceived health. No inequalities by wealth index were found for the utilization of FP, hospitalization, urgent care and dentist among persons with poor self-perceived health status. The present study confirmed demographic, socio-economic and health status inequalities in the UHCS in RS. These findings have significant implications for health policy makers that seek to provide equal care for all people living in RS.

Usage of healthcare services and preference for mental healthcare among older Somali immigrants in Finland

ABSTRACTObjectives: The aims of the study were, first, to describe and analyze healthcare services utilization patterns of older immigrants in Finland, and particularly to compare the availability and accessibility of health services between older Somalis and Finns. The second aim was to examine the preferences for mental healthcare within the group of Somalis. The third aim was to test the existence of a service usage gap expected to be characteristic of the Somali group, in which high levels of mental health problems occur alongside simultaneous low levels of mental health service usage.Design: The participants were 256 men and women between the ages of 50–85; half were Somali migrants and the other half Finnish matched pairs. The participants were surveyed regarding their usage of somatic, mental, and preventive health services, as well as symptoms of depression, general distress, and somatization. The Somali participants were also surveyed regarding their usage of traditional healing methods and preferences for mental healthcare.Results: The Somali group had significantly lower access to personal/family doctors at healthcare centers as well as a lower availability of private doctors and occupational health services than the Finns. Instead, they used more nursing services than Finnish patients. The Somali participants attended fewer age-salient preventive check-ups than the Finns. The majority of the Somalis preferred traditional care, most commonly religious healing, for mental health problems. The hypothesized service gap was not substantiated, as a high level of depressive symptoms was not associated with a low usage of health services among the Somalis, but it was found unexpectedly among the Finns.Conclusion: Our findings call for culturally appropriate general and mental health services for older immigrants, which requires awareness of clients’ preferences, needs, and alternative healing practices. Somali participants encountered institutional barriers in accessing healthcare, and they preferred informal mental healthcare, especially religious healing instead of Western practices.

Relationships of work characteristics to job satisfaction, turnover intention, and burnout among doctors in the district public-private mixed health system of Bangladesh

BackgroundWork design integrates work characteristics having organizational, social and job components which influence employees’ welfare and also organizational goals. We investigated the effects of work characteristics and other predictors to job satisfaction, turnover intention, and burnout in doctors of the public primary, public secondary and private facilities of the district health system of Bangladesh.MethodsA quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the public and private doctors with a sample size of 384 from 29 out of a total 64 districts of Bangladesh during October and November 2015. All variables including work characteristics and outcomes of interest were based on literature and measured on 5-point Likert scale. Multivariate analysis of variance, bivariate correlation, and multiple regression were the models operated through SPSS version-21.ResultsA total of 354 doctors responded. No significant differences were found between public primary and secondary level doctors on combined work characteristics and outcomes variables, which however differed significantly between the public and private doctors. Organizational support was the strongest predictor adversely affecting job satisfaction, turnover intention and burnout of both the public and private doctors; private doctors’ experienced more support. The effects of health-professional politics on the public doctors were alarming.ConclusionWork design of the Bangladesh’s health system is in need of ample development. Doing so, improvement in organizational supports is crucial; however, other work characteristics components are also important for enhancing doctors’ welfare and health system productivity.

Epidemiological analysis and control strategy discussion for overseas imported malaria cases reported in Chongqing City from 2011 to 2015

To analyze the epidemiological characteristics of overseas imported malaria reported in Chongqing City from 2011 to 2015, so as to provide the evidence for improving the imported malaria control strategies. The epidemiological data of overseas imported malaria cases were collected and analyzed descriptively for the species, original countries, diagnosis and treatment in Chongqing City from 2011 to 2015. A total of 148 overseas imported malaria cases were reported in Chongqing City from 2011 to 2015, in which 96 (65.54%) cases were falciparum malaria, and 37 (24.32%) cases were vivax malaria; 125 (84.46%) cases were infected in Africa, and the rest of 23 (15.54%) cases were infected in Southeast Asia. Most of the patients were 30 to 50 years old male workmen, and the ratio of male to female was 11.42:1. There was no obvious seasonal distribution among the reported timelines of the cases; however, there were two small peaks from June to August and from January to February. The median interval time of imported malaria cases from malaria onset to see a doctor was 1 day and from seeing the doctor to get malaria diagnosis was 2 days. The patients' first selected institutions were county medical institutions (50 cases, 33.78%), then provincial medical institutions (36 cases, 24.325%) and private doctors (20 cases, 13.51%), and only 79 (53.38%) patients got malaria diagnoses in their first selected institutions. The standard treatment were provided to 142 (95.54%) cases. There were 43 (29.05%) patients had serious complications and three patients were dead. It is very important to enhance the multi-sector's collaboration to establish the collaborative investigation mechanism for screening malaria patients, and strengthen malaria health education for overseas workers and training courses in primary care medical institutions.

Health Care-Seeking Behaviour of Coastal Communities in Banyuwangi, Indonesia: Results of A Cross-Sectional Survey

Introduction: Improving health care-seeking behavior of the coastal communities is a pathway to improve their health. This analysis aims to explore the health care-seeking behavior of the coastal communities in Banyuwangi District to recommend the room for improvement for health promotion and health service improvement for these communities.Method: Data from a cross-sectional survey of metabolic syndrome and mental health conducted in coastal communities in Banyuwangi was used for analysis. Randomly selected participants from a list of members of Family Welfare Development Group (Pembinaan Kesejahteraan Keluarga /PKK) were asked for an interview at corresponding village office in Ketapang, Bangsring, Bulu Agung, Grajagan and Kampung Mandar village. Distribution of health care-seeking behaviors was analyzed individually and where possible were segregated by gender and age.Results: More than half of the coastal communities in Banyuwangi District went to health care service to seek health and 7 out of 10 turned to health care service to seek health for their family members. Women more than men turned to health care service when they or their family members fell ill. Private doctors rather than Puskesmas were more popular. Private midwives were the most popular service for antenatal care (ANC) and delivery. Although there was not a clear increase in health care service utilization over time, we found that contraceptive utilization increased with time.Conclusion: The utilization of health care service in Banyuwangi needs to be more promoted especially for men’s health.

Polymerase chain reaction identification of &lt;i&gt;Trypanosoma brucei rhodesiense&lt;/i&gt; in wild tsetse flies from Nkhotakota Wildlife Reserve, Malawi

Trypanosoma brucei rhodesiense is the causative agent of acute human African trypanosomiasis. Identification of T. b. rhodesiense in tsetse populations is essential for understanding transmission dynamics, assessng human disease risk, and monitoring spatiotemporal trends and impact of control interventions. Accurate detection and characterisation of trypanosomes in vectors relies on molecular techniques. For the first time in Malawi, a molecular technique has been used to detect trypanosomes in tsetse flies in Nkhotakota Wildlife Reserve. A polymerase chain reaction (PCR) technique was used to identify the serum resistance associated (SRA) gene of T. b. rhodesiense in tsetse flies. Of 257 tsetse flies that were randomly caught, 42 flies were dissected for microscopic examination. The midguts of 206 flies were positive and were individually put in eppendorf tubes containing phosphate-buffered saline (PBS buffer) for DNA extraction. Internal transcribed spacer (ITS)-PCR was first used to isolate all trypanosome species from the flies. TBR PCR was then used to isolate the Trypanozoon group. T. brucei-positive samples were further evaluated by SRA PCR for the presence of the SRA gene. Of 257 flies caught, 185 (72%) were Glossina morsitans morsitans and 72 (28%) were Glossina pallidipes. Three were tenerals and 242 were mature live flies. Of the 242 flies dissected, 206 were positive, representing an 85.1% infection rate. From 206 infected flies, 106 (51.5%) were positive using ITS-PCR, 68 (33.0%) being mixed infections, 18 (8.7%) T. brucei, 9 (4.4%) Trypanosoma vivax, 4 (1.9%) Trypanosoma godfrey, 3 (1.5%) Trypanosoma congolense savanna, 3 (1.5%) Trypanosoma simae, and 1 (0.4%) Trypanosoma simaetsavo. When subjected to TBR PCR, 107(51.9%) were positive for T. brucei. Of the 107 T. brucei-positive samples, 5 (4.7%) were found to have the SRA gene. These results suggest that wild tsetse flies in Malawi are infected with human-infective trypanosomes that put communities around wildlife reserves at risk of human African trypanosomiasis outbreaks. Further studies need to be done to identify sources of blood meals for the flies and for surveillance of communities around wildlife reserves.

Epidemiological Feature of the Human Brucellosis Prevalence in People in Southern Cities of Khorasan Razavi, Iran

Background: Brucellosis is one of the most important zoonoses in humans. Objectives: The purpose of our study was to identify factors affecting the incidence of brucellosis in human society and proposing a plan to reduce the burden of disease. Methods: This cross-sectional study collected necessary information of patients admitted to government and private doctors’ clinics, specialist clinics, hospitals, health centers, and health houses. A questionnaire was designed in accordance with the standards of WHO. For data analysis, t-test and non-parametric analysis was performed using the SPSS 20 software and descriptive statistics. Results: A total of 438 cases of brucellosis were reported in 5 years. 60.4% of the patients were from Brajestan city and 39.6% were from Gonabad city. There was a significant difference between age and sex of the patients (P = 0.000). The most incidences of this disease were in patients who were over 50 years old (30%) and the least incidences were in the 31 - 40-ages group (12.3%). Housekeepers (35.3%), farming ranchers (24.2%), students (16.8%), and ranchers (6.6%), respectively, exhibited the most incidences. Conclusions: Based on the results, in order to prevent Brucellosis it’s necessary to educate public, specifically rural, well to promote the use of pasteurized milk products. Keywords: Brucellosis; Livestock; Human; Epidemiology; Disease control

Knowledge, attitudes, and practices on diabetic retinopathy among medical residents and general practitioners in Khartoum, Sudan

Background: Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and is the leading cause of blindness among working people. It constitutes 5% of the global causes of blindness. Knowledge, attitudes, and practices (KAPs) on DR among medical residents (MRs) and general practitioners (GPs) should be well assessed to insure a very good level of DR care. These groups are the most important primary health provider of the diabetic care network. Objectives: The aim is to assess the KAPs on DR among MRs and GPs in Sudan. Materials and Methods: Two hundred and twenty-five doctors, as the study population, were chosen from Khartoum state nonconsultant nonprivate working doctors, who are working in 22 general hospitals distributed across Khartoum state, between August and September 2016. All the selected study Personale were working in these hospitals, and they were exposed to diabetic patient's care which is available within the facilities of these hospitals. Specialist, consultants, and private doctors were excluded from the study. Data were collected through a well-designed self-administered questionnaire. The questionnaire was mainly included closed-ended questions with a few open-ended ones. It contains questions on demographic data, knowledge and awareness levels, practices toward screening DR, and questions on attitudes toward DR. At the end of the survey, the entire data were coded and entered into a Microsoft Excel spreadsheet in a personal computer. The responses were analyzed using Statistical Program for Social Sciences (SPSS) version 20 (Manufactured by IBM SPSS Inc., PASW Statistics for Windows, Version 20.0; 2009. Chicago: SPSS Inc., IL, USA). Results: Two hundred and twenty-five doctors; (GPs and MRs); were included in the current study. One hundred and thirty-seven (61%) of the responded participants were female and 88 (39%) were male. The mean age of the study group was 27.7 ± 8.0 years (range: 20–36 years). Two hundred and twenty-five questionnaires were distributed to all members, only 180 (93.75%) members completed the questionnaires. Fifty-eight (32%) has MBBS and 123 (68%) has MBBS + part one in medicine. Their years of medical practice was ranged from 2 years. One hundred and sixty-one (92.5%) and 155 (89.0%) mentioned eye and kidney, respectively, as the organs affected by DM. One hundred and fifty-eight (90.8%) mentioned retina as the part of the eye that can be affected. One hundred and eighteen (68.0%) mentioned poor glucose control as the factor that influences the presence or severity of DR. Fifty-nine (34.0%) mentioned duration of DM. Fifty-six (32.4%) high blood pressure high and 13 (7.5%) lipid level is important for DR degree. One hundred and sixty-four (95.0%) respondents, mentioned retina as the part of the eye that should be examined first for changes for DR. Ninety-one percent noted that DM can cause eye complications; new vessel formations. Hemorrhages, retinal detachment… etc. Seventy-five percent have the attitude to examine the diabetics when only the vision is affected. Fifty-one percent strongly agreed to do eye examination in diabetic pregnant and to do fundoscopy for any diabetic patient. Thirty-seven percent strongly agree to check eyes when lipid is high. Most of the respondents, i.e., 99 (59%) strongly disagree that ophthalmology training in medical school was enough to detect patients with DR. Seventy-two (42%) do visual acuity for their diabetic patients and 50 (30%) examine the fundus (retina). One hundred and twenty-six (75%) disagree that eye examination is only required in diabetic patients when vision is affected. Conclusion: Participants generally had a poor knowledge on DR although they had good knowledge about relationship between DR and others end organs which can be affected by microvascular complication of diabetes mellitus and good practice in referral of diabetic patients 136(81%). Undergraduate ophthalmology training in medical school is not adequate.

A Case of Primary Biliary Cirrhosis Mimicking Acute Hepatitis B in the Clinic, Republic of Korea.

Primary biliary cirrhosis (PBC) is a slowly progressive cholestatic autoimmune liver disease characterized by progressive bile duct injury. The most common symptoms of this disease include fatigue and pruritus. The diagnosis of PBC is based on cholestatic biochemical liver tests, presence of antimitochondrial antibodies, and characteristic histological biopsy findings. We report a case of a patient with PBS, who was initially suspected to be in the window period of hepatitis B by a private doctor in a local clinic based on the detection of isolated immunoglobulin M antibody against hepatitis B core antigen. The presence of this antibody is the most useful index in diagnosing acute hepatitis B (+) by immunoserological test. The final diagnosis of the patient in Good Gang-An Hospital was PBC through additional tests. The patient is receiving outpatient treatment.