Private Practitioners Research Articles

The composition and mode of delivery of diabetes‐related footcare education provided by podiatrists in Australia and Aotearoa (New Zealand): A systematic review

AbstractIntroductionDiabetes‐related foot disease (DFD) is a significant and costly complication of diabetes in Australia and Aotearoa New Zealand (NZ). Diabetes footcare education is considered a cornerstone of DFD prevention and management, with podiatrists playing a key role in education provision. This systematic review evaluated the nature and composition of diabetes footcare education provided by podiatrists to people living with diabetes in Australia and NZ.MethodsMedline, EBSCO, Megafile Ultimate and Cochrane library databases were conducted from inception until January 31, 2024 to identify studies reporting on the mode of delivery and composition, including frequency, of diabetes footcare education provided to people with diabetes by podiatrists in Australia and NZ.ResultsFrom a total of 226 abstracts screened, 4 studies with 878 participants were included. Three studies were from Australia and 1 from NZ. Studies included podiatrists in both private and public health sectors and used cross‐sectional web‐based surveys or observation. Components of diabetes footcare education included education on neuropathy and vascular foot health, footwear and general foot health/hygiene. This education was provided by podiatrists from both countries routinely. Verbal education was the most frequently used method of delivery. There was no significant difference between content, mode of delivery and frequency of diabetes footcare education between private and public practitioners in either country. No studies reported on culturally responsive content or education delivery methods.ConclusionThere are little available data on the composition or mode of delivery of diabetes footcare education provided by podiatrists in Australia and NZ to people living with diabetes. A range of footcare education is provided, most frequently verbally. Further qualitative research is required to conclusively establish the composition and delivery methods used for diabetes footcare education provided by podiatrists. In addition, the provision of culturally responsive diabetes footcare education and availability of related culturally responsive supporting resources is yet to be established.

Quantitative Evaluation of Enamel Thickness in Maxillary Central Incisors in Different Age Groups Utilizing Cone Beam Computed Tomography a Retrospective Analysis

Background/Objectives: The presence of enamel on the tooth surface is crucial for the long-term success of minimally invasive adhesive restorations such as dental veneers. Our study aims to evaluate the enamel thickness in the incisal, middle, and cervical portions of the labial surface of the upper central incisors using cone beam computed tomography (CBCT). This imaging method provides detailed and accurate three-dimensional images with a low radiation dose, allowing an accurate assessment of enamel thickness. The analysis aims to identify variations in enamel thickness depending on the age and different levels of the labial tooth surface. Methods: 800 CBCT scans performed for diagnostic or therapeutic purposes on patients aged 18–60 years were analyzed. The data were gathered from the imaging archives of private practitioners from Targu Mures and the “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures. Enamel thickness measurements were conducted using the OnDemand3D Communicator CBCT evaluation program, with subsequent statistical analysis performed using GraphPad Instat Prism software. Results: Results showed significant variation in enamel thickness between the incisal, middle, and cervical segments of the labial surface of the upper central incisors. A decrease in enamel thickness with age has been observed. In patients aged 18–40, mean values of enamel thickness 1 mm and 3 mm above the cementoenamel junction (CEJ) were 0.48 ± 0.092, respectively, 0.819 ± 0.158. In patients over 40, the mean values were 0.454 ± 0.116 and 0.751 ± 0.067 at 1 mm, respectively, 3 mm above the CEJ. Statistically significant differences were found between the two age groups at 1 mm and 3 mm above the CEJ, with p < 0.0001 and p = 0.0214. Conclusions: A statistically significant decrease can be observed in enamel thickness in almost the entire labial surface of the upper central incisors with aging. The varied thickness of the enamel at different tooth levels requires individualized planning for each patient to maximize the long-term aesthetic and functional results.

Use Of Digital Technologies In Prosthodontic Clinical Practice Among Prosthodontists In Tamilnadu And Pondicherry

Background: Digital dentistry includes treatments performed by means of digital or computer-controlled components rather than using mechanical or electrical equipment. The advancement of digital technology and the commencement of Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) and 3D printing has brought large changes to the traditional manufacturing method, where manual work is carried out after oral impression taking. Aim: To conduct a questionnaire survey on use of digital technology in prosthodontic clinical practice among Prosthodontists in Tamilnadu and Pondicherry. Materials and methods: A cross-sectional questionnaire based online survey was undertaken amongst 183 Prosthodontists in Tamilnadu and Pondicherry (Group 1 – Both private practitioners and teaching faculty, Group 2 – Private practitioners, Group 3 – Teaching faculty). The questionnaire consisted of 21 questions which evaluated their awareness, knowledge and practices towards digital dentistry. Statistical analysis was done using Chi-square test in each group, using Statistical Package for the Social Sciences (SPSS) version 23.0. The p-value 0.05 was considered significant. Results: Majority of the study participants were private practitioners in the age group of 25 – 45 years(93%).Among the three groups private practitioners had good knowledge, practice and awareness about the application of digital technologies. Conclusion: Most of the participants were aware about digital technology in dentistry. The private practitioners showed better understanding about the digital technology. However, to make them familiar with CAD/CAM, dental education programs, workshops and hands on program should be conducted which will enable an emerging dentists who will be well versed with digital dentistry.

Is Completeness and Timeliness of Public Health Action (PHA) a Robust Tool to Improve the TB Treatment Outcome in the Private Sector?

Background: Public health action (PHA) in tuberculosis (TB) includes six components: doing screening for HIV/diabetes, carrying out drug susceptibility testing, counseling on tobacco, counseling on nutrition, benefits of Nikshay Poshan Yojana, and contact tracing. All the patients notified by the private practitioners (PPs) and missing any of the above components are intervened by the government staff to cover all the above components. Objectives: The aim of the article is (1) to assess the timeliness and completeness of PHA and (2) to assess the impact of PHA on the quality of care for TB patients in the private sector. Methods: A sequential mixed-method (cross-sectional study followed by qualitative study) study was carried out in the Patan district, North Gujarat for a period of one year. Quantitative data were collected through home visits to patients residing in three randomly selected talukas out of nine talukas in the Patan district. Qualitative data were collected purposively from selected clinics of PPs (including a mix of PP notifying and not notifying TB till saturation is achieved) from the above talukas. Results: Out of a total of 176 patients from the private sector, 48 patients took all six components of PHA. Out of them, 98% were cured compared to 82% who did not receive PHA. None of the PP had heard about PHA or its components. Conclusion: The Public–private model for TB management needs strengthening. Regular and mandatory training of PPs on the latest TB management guidelines including importance of timely and complete PHA should be carried out.

Strategic changes and challenges of private dental clinics and practitioners in Israel: adapting to a competitive environment

BackgroundIn the 21st century’s digital age, health organizations face challenges from reduced public healthcare spending, creating a competitive market that impacts healthcare management. The struggle is hardest for small organizations, such as private clinics. Competing under unfavorable conditions, these small businesses must run as independent, profitable units in a government-regulated market where they are subject to numerous restrictions yet receive no financial support. In a world of increasing dependence on digital technologies, these small businesses must adopt competitive business models and be adaptive and flexible in embracing change.MethodsThis qualitative study is based on a thematic qualitative analysis of 20 in-depth, 45-minute-long interviews with dentists and owners of private dental clinics in various specialties. The study employs the strategic change model to examine how dentists who run private dental clinics implement new strategies and technologies to adjust to changes and create a competitive edge.ResultsSix main categories emerged from the analysis of the interviews: changes in the organization’s environment; instituting and assimilating changes; obstacles in embracing change; added value obtained from embracing the change; quality of care and service; and cost-benefit considerations. The categories were map and evaluated in light of the strategic change model. The analysis indicated that digital strategies have been only partially adopted, suggesting an absence of a cohesive, long-term strategic vision for the organizations.ConclusionsThe study explored the actions, perceptions, and challenges of adapting to a competitive digital market in dental private clinics. Based on these insights, recommendations have been provided for global change management, aiming for a sustainable and stable healthcare system that benefits the broader community.

Understanding the diversity of private conservation in the Peruvian Amazon

AbstractGlobal awareness about the threats of ecosystem degradation in the Amazon is growing. While state‐managed protected areas remain key instruments for forest conservation, private actors are increasingly funding and implementing a broad range of conservation initiatives. Private actors are transforming the Amazonian conservation landscape and its governance, however, many aspects of private conservation, especially the diversity of local practitioners and the challenges they face, remain understudied. Drawing on a case study of Madre de Dios in the Peruvian Amazon, we aim to generate a better understanding of private conservation practitioners and their various approaches to conservation on private and public land. We used an extensive review of literature and databases, in addition to 13 semi‐structured interviews with various private conservation practitioners, to map privately conserved areas, and to gather perceptions about challenges, opportunities, and future pathways for private conservation. A total of 590 privately conserved areas, covering over one million hectares, were identified and mapped in Madre de Dios. We find that, while most initiatives are managed by individuals and families, for‐profit companies manage half of the total area privately protected. Furthermore, we find that private conservation initiatives face significant barriers and pressures. These barriers include complex bureaucratic processes, legal contradictions and incoherencies, corruption, weak law enforcement, and financial insecurity. Conservation policies largely favor national and international actors and less so local, grassroots initiatives run by individuals and communities. Finally, we highlight the need for more accessible and inclusive policies that recognize the contribution of less powerful actors, to foster more effective conservation efforts for the future of the Amazon.

Perceptions, attitudes, and clinical experiences of Brazilian dental practitioners towards molar incisor hypomineralisation: a cross-sectional study.

To evaluate perceptions, attitudes, and clinical experience of Brazilian dental practitioners regarding molar incisor hypomineralisation (MIH). An online survey with 27 questions, covering professional profile data, perceptions, and knowledge on clinical management of MIH, was employed. Descriptive analyses, chi-square, Fisher's exact, and Cramer's V tests were used. Sample comprised 100 participants, equally distributed between those working in private or public sectors. Most private sector practitioners had 21-30years of clinical experience (28%) and master's degree (50%), while most public sector practitioners had 11-20years of clinical experience (32%) and a PhD degree (32%). Most participants (86%) recognized MIH in their practice. Statistically significant differences were observed in frequency (p = 0.001), incidence (p = 0.039), and lesion type (p = 0.043) between practitioners from both sectors. Uncertainly in management was reported by 49%, mainly in public sector. For mild MIH in incisors, no treatment was chosen (43%), and the treatment longevity was the only significant factor reported (p = 0.012). In cases of mild MIH in first permanent molars (FPMs), 51% of respondents opted to keep the affected tissue and apply fissure sealant. Glass ionomer (GI) restoration was commonly indicated for FPMs with severe MIH with moderate loss of structure and sensitivity (38%). In cases with substantial structural loss and pulpal involvement, the most chosen treatment was endodontic intervention combined with preformed crowns. Brazilian dental practitioners face MIH in clinical practice. Although, public sector professionals are less confident in diagnosis and treatment, no significant differences in treatment preferences between public and private sector dental practitioners were identified.

Biological and ecological determinants of Hand Foot and Mouth Disease (HFMD) in Coastal District of Northeastern Peninsular Malaysia: A 5-Year retrospective study

Hand, foot, and mouth disease (HFMD) is a common viral communicable disease in Malaysia, characterized by its self-limiting nature, yet it leads to numerous outbreaks and fatalities, particularly among young children. The current study aimed to determine the prevalence, geographic distribution, temporal patterns, and associated factors of HFMD cases within the Bachok District of Kelantan, spanning the years 2018 to 2022. A retrospective cohort study analysed extract data on independent factors and notification status from the Communicable Disease Control Information System (CDCIS). Simple and multiple logistic regression analyses were employed on a cohort of 1351 HFMD’s notifications. The retrospective analysis reveals a predominant HFMD’s notification were males (56.7%). Outpatient care was common (98.4%), with primary health care being the main choice. Logistic regression indicates higher odds for HFMD in those attending primary health care or private practitioners, daycare attendees, during the Southwest Monsoon season, and before the Movement Control Order (MCO) implementation, emphasizing key risk factors for HFMD. This study’s integrative approach recognizes that health and disease are often influenced by a combination of factors spanning the ecological, biological, and clinical domains. Thus, emphasizing the need for a comprehensive understanding when formulating public health strategies particularly in primary healthcare settings and daycare facilities during the Southwest Monsoon season.

Prescription of psychotropic drugs by non-psychiatrist specialists in Morocco: current practices and educational needs

IntroductionMental health is considered a major public health issue. Non-psychiatric physicians often engage in the treatment of mental disorders. The aim of this study was to describe psychiatric drug prescription knowledge and practices among non-psychiatric specialists and evaluate their training needs.MethodsA descriptive cross-sectional study was conducted from September 1st to October 15th, 2021, in 3 Moroccan healthcare facilities and among private practitioners in Kenitra. We asked non-psychiatric specialists about their knowledge and current practices regarding psychotropic drugs, and their needs in psychiatric training.ResultsThe study included a total of 150 participants. The majority of participants demonstrated insufficient knowledge regarding the selection of psychotropic drugs and the duration of pharmacotherapy. Specifically, 61.3% were unaware of the average duration of treatment for depression. 22.7% of participants did not feel comfortable when prescribing psychotropic drugs. Anxiolytics were the most commonly prescribed class of psychotropic drugs, accounting for 30.7% of prescriptions. The most common indications for psychotropic drugs prescription were anxiety (35.3%), followed by insomnia (34.7%) and depression (31.3%). The majority of participants (72%) reported receiving clinical training in psychiatry, with 74.7% expressing varying levels of satisfaction with their undergraduate psychiatry training, while 7.3% expressed dissatisfaction. Regarding CME, only 11.3% of participants engaged in at least one psychiatry-related CME session in the past two years. 54.7% of participants expressed interest in expanding their knowledge of prescribing psychotropic drugs. Around 40% of participants preferred trainings in psychotropic drugs prescription related to their specialty, while 34% were not interested in receiving further training.ConclusionsOur study shows gaps in knowledge of non-psychiatric specialists, which raises concern regarding their ability to care for mental disorders. Educational efforts should be made to improve teaching of psychiatry from the undergraduate level. Continuing Medical Education should be tailored to the specific needs and preferred learning methods of non-psychiatric physicians.

PRIVATE SECTOR INVOLVEMENT IN TUBERCULOSIS CONTROL IN A TRIBAL DISTRICT OF MAHARASHTRA, INDIA

Introduction: In India, the private sector caters about seventy percent of TB patients. The majority of private practitioners (PPs) are not updated with current National Tuberculosis Elimination Program (NTEP) guidelines resulting in wrong diagnosis and treatment leading to irrational use of the anti-tuberculosis drugs favoring the emergence and spread of drug resistance. Objectives: 1)To assess the knowledge of PPs about diagnosis and management of tuberculosis as per NTEP guidelines 2)To know the difficulties faced by PPs during the treatment of TB patients and measures to address them as per their perspective. Methodology: Study design & study setting:- a cross-sectional study was undertaken in a tribal district of Maharashtra. 86 PPs interviewed with the help of a structured questionnaire and later conducted focused group discussion (FGD). The data was analyzed with percentages and proportions. Results: The majority 65(75%) of PPs had knowledge about NTEP guidelines but only 21(25%) PPs were updated with the latest changes in the program. PPs expressed concern over the non-availability of diagnostics for extra-pulmonary TB, occasional shortage of drugs, unawareness of patients about the gravity of the disease, and treatment compliance. To address it, they felt the need for awareness activities on social media continuously, round-the-clock services for investigations, incentive for successfully completing treatment to patients along with timely updating PPs about recent updates on NTEP. Conclusion: Continuous quality training regarding basic knowledge and recent updates in NTEP for PPs should be imparted NTEP implementation at the district needs to be strengthened to overcome the difficulties mentioned by PPs.

Finding the Missing Men with Tuberculosis: A Participatory Approach to Identify Priority Interventions in Uganda.

Gender impacts exposure and vulnerability to TB, evidenced by a higher prevalence of both TB disease and missed TB diagnoses among men, who significantly contribute to new TB infections. We present the formative research phase of a study which used participatory methods to identify gender-specific interventions for systematic screening of TB among men in Uganda. Health facility level data was collected at four Ugandan general hospitals (Kawolo, Gombe, Mityana, and Nakaseke) among 70 TB stakeholders, including healthcare workers, TB survivors, policymakers, and researchers. Using health seeking pathways, they delineated and compared men's ideal and actual step-by-step TB health seeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a 'river' and each 'steppingstone' as a solution, was employed to identify interventions which would help link men with TB symptoms to care. These insights were then synthesized in a co-analysis meeting with 17 participants including representatives from each health facility to develop a consensus on proposed interventions. Data across locations revealed the actual TB care pathway diverted from the ideal pathway due to health system, community, health worker and individual level barriers such as delayed health seeking, unfavourable facility operating hours and long waiting times that conflicted with men's work schedules. Stakeholders proposed to address these barriers through the introduction of male-specific services; integrated TB services that prioritize X-ray screening for men with cough; healthcare worker training modules on integrated male-friendly services; training and supporting TB champions to deliver health education to people seeking care; and engagement of private practitioners to screen for TB. In conclusion, our participatory co-design approach facilitated dialogue, learning, and consensus between different health actors on context-specific, person-centred TB interventions for men in Uganda. The acceptability, effectiveness and cost effectiveness of the package will now be evaluated in a pilot study.

The Extent of Delay in Diagnosis, Treatment and their Associated Factors among Tuberculosis Patients Attending Government Hospitals of Rishikesh, Uttarakhand: A Cross-Sectional Study.

"Tuberculosis (TB) remains a major public health problem" worldwide, affecting almost all age groups. "Early diagnosis and prompt treatment are essential to significantly reducing the TB burden." However, a significant proportion of cases remain undiagnosed and untreated, which plays a vital role in the transmission of the disease and severity of the illness in the community in most developing countries. This study aimed to assess "the extent of delay in diagnosis and treatment of TB patients" and to identify the major factors associated with such delays (whether patient or health system-related) among TB patients in Rishikesh. This descriptive cross-sectional study was conducted in Rishikesh Town, Dehradun District, Uttara khand, India. Total of 130 newly diagnosed TB patients were recruited as study participants who attended the government hospitals of Rishikesh, All India Institute of Medical Sciences, Rishikesh and S P S Government Hospital, Rishikesh. A universal sampling technique was used in this study. The mean age of the study participant was 36.75 (Standard Deviation (SD), 17.6), and the median age was 34 years. Of the patients, 64.6% were men, and 35.4% were women. The extent of various delays, such as patient delay (median 16 days), diagnostic delay (median 78.5 days), treatment delay (median 4 days), health system delay (43 days), and total delay (median 81 days). The misconception of any chronic disease may lead to a false diagnosis or long treatment for symptomatic relief; the absence of proper diagnostic tests and doctor shopping could be the reasons for the prolonged diagnostic delay. Therefore, by strengthening the collaboration between private and public practitioners in order to meet the expectations of the Government of India to achieve the goals of the "National Strategic Plan for ending TB" in India by providing good quality care for all patients.

Survey of screw-retained versus cement-retained implant restorations used in both education and private dental practices.

In the literature, it is still unclear if the decisions for selecting the type of implant crown-retaining system are based on scientific-based research or if the Universities' choices, Implant marketing trends, or finances could have a major influence on the private dentists' decisions. Therefore, this study aimed to evaluate the crown-retaining system (cement- or screw-retained) used in dental schools and private dental practices. A 13-item questionnaire was sent to Canadian dental schools (n=10) and dental offices in London (n=298), Canada. The questionnaire included demographic questions and questions to reveal the dentists' perspectives on prosthetic implant treatment between the two-retaining systems. Results were analyzed using descriptive statistics and multinomial logistic regression (p=0.05). Twenty-four private dentists and five dental schools responded to the survey - 62.5% of private practitioners and 60% of universities reported using both systems. A trend was observed in using screw-retained systems by dentists who graduated 5-10 years ago. Straumann, Astra, and Nobel Biocare were the private practices and dental schools' preferred implant systems. The use of platform switching for all cases was selected by 54.2% of the private practitioners and 40% of the dental schools. Resin cement was the private practice's preferred cementation method; the dental schools used glass ionomer and zinc phosphate cement. The multinomial logistic regressions showed no statistical difference between the crown-retaining system chosen and the decision factors. The laboratory technician's recommendations and cost influenced the decision-making process for private dentists. For the universities, perio-restorative outcome, implant position, survival rates, institute preferences, and evidence-based research influenced the crown-retaining system's decision-making process. CONCLUSION: The Canadian dental schools and private practice reported using both screw- and cement-retaining systems. However, there was a difference in the selection criteria as the universities showed a tendency towards a more research-based approach in their decision, while for the private practices, the technicians' recommendations and cost played a major role in the decision process. It was noted that the implant systems preconized by the Universities were observed to be used in private practices.

Acceptability, usability, and willingness to pay for HIV self-test kits distributed through community-based, PLHIV network-led and private practitioners models in India: Results from the STAR III Initiative.

HIV self-testing (HIVST) has been shown to increase the uptake of HIV testing and help achieve the UNAIDS 95-95-95 targets. This study assessed the acceptability, usability (ease of use and result interpretation) and the willingness to pay for HIVST kits distributed through three distribution models, namely the community-based, PLHIV network-led and private practitioners models, in India. This cross-sectional study was implemented across 14 states in India between September 2021 and June 2022. All participants could choose between blood-based or oral-fluid-based test kits. Participants were shown a test-kit usage demonstration video, and pre- and post-test counselling was provided for all. Participants were followed-up after testing, and if reported reactive, were further supported for linkage to confirmatory testing and antiretroviral therapy (ART) initiation. Among the 90,605 participants found eligible, 88,080 (97%) accepted an HIVST kit. Among the 87,976 who reported using an HIVST kit, 45,207 (51%) preferred a blood-based kit, and 42,120 (48%) reported testing for the first time. For future testing, 77,064 (88%) reported preferring HIVST over other HIV testing methods. Among those who used the kit, 83,308 (95%) found the kit easy to use, and 83,237 (95%) reported that the test results were easy to interpret. Among those who preferred HIVST for future use, 52,136 (69%) were willing to pay for the kit, with 35,854 (69%) of those willing to pay less than US$ 1.20. Only one instance of social harm was reported, with a participant reporting suicidal tendencies due to discord with their partner. Out of 328 participants (0.4%) who tested reactive with HIVST, 291 (89%) were linked to confirmatory testing; of these, 254 were confirmed HIV positive, and 216 (85%) successfully initiated ART. Overall, we report that nearly all participants were willing to accept HIVST, found the test kits easy to use and interpret, and about two-thirds were willing to pay for HIVST. Given the high levels of acceptance and the ability to reach a large proportion of first-time testers, HIVST in India could contribute to achieving the UNAIDS first 95 and ending the HIV epidemic.

Osteosynthesis for mandibular reconstruction with fibula free flap: Which type and why? A French national survey

We explored the most suitable osteosynthesis type for mandibular reconstruction using fibula free flap (FFF) given the lack of robust data available. For this, an anonymous survey was e-mailed to 853 head-and-neck surgeons (France) asking about their practices and criteria guiding their osteosynthesis material and method choices. Questions assessed: (1) the most frequently used osteosynthesis type, (2) the explanatory variables related to surgeon career status/surgical specialty, and (3) justifications for osteosynthesis type (scientific, technical, "misuse"). Multivariate logistic regression was performed to test for associations of explanatory variables with plate type or misuse. Overall, 118 (13.8%) surgeons responded, among which flexible non-locking osteosynthesis was preferred (59%). Career status and surgical specialty were significantly associated with material choice. University professors/senior lecturers (OR 5.96 vs academic clinical associates; p = 0.02), but not ear-nose-throat/reconstructive plastic surgeons (OR 0.22 vs maxillofacial surgeons; p = 0.04), were more likely to opt for rigid locking osteosynthesis. Private practitioners preferred flexible non-locking osteosynthesis (OR = 5.03; p = 0.04). Only 18% of surgeons scientifically justified their choices. We considered misuse among 65% of surgeons and this was significantly associated with irregular practice of FFF surgery (OR 2.28 vs > 10 surgeries/year; p = 0.04). Overall, >50% of surgeons mainly rely on habits without scientific arguments assisting in decision-making.

Facilitators and Barriers for Private Health Sector Engagement for TB Care in India: A Systematic Review and Meta-Synthesis of Qualitative Research.

Private sector engagement is recognized as one of the most critical interventions to achieve the End TB goals in India. We conducted a systematic review and a meta-synthesis of qualitative studies to identify the barriers and facilitators for private sector engagement in TB care in India. A systematic search in electronic databases was done. We assessed the methodological limitations of individual studies, synthesized the evidence using thematic analysis, and assessed our confidence in each finding. Of the 19 eligible articles included for the qualitative synthesis, 31.5% (6/19) were conducted in northern states of India. Included studies had details from 31 focus group discussions and 303 in-depth interviews conducted among various stakeholders. The synthesis revealed that barriers to engaging the private sector were lack of coordination mechanisms, lack of the National TB Elimination Program (NTEP) staff capacity to deal with the private sector, lack of private practitioners' knowledge on various programmatic aspects, and perceived complexity of the data exchange mechanism. The private sector felt that NTEP was not sensitive to the patient's confidentiality and demanded too much patient data. The private sector considered nonfinancial incentives like recognition, feedback, involving them in planning, and giving them equal status in partnership as powerful enablers for their engagement in TB care. Factors related to the context in which the engagement occurs, the architecture of the engagement, and interaction among the actors contribute to barriers to engaging the private sector for TB care in India. Strengthening policies to protect patient confidentiality, using behavior change communication to NTEP program managers, providing managerial and soft-skill training to NTEP staff, promoting nonfinancial incentives to private providers, establishing a coordination mechanism between the sectors, and simplifying the data exchange mechanisms need to be done to further strengthen the private-sector engagement.

Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Fisher’s Exact Test test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.

Evaluation of Outbreak Preparedness to Prevent the Reintroduction of Malaria in Ramanagara District: A Descriptive Epidemiological Study.

Background Malaria is a vector-borne disease transmitted by female anopheline mosquitoes. It is also a multidimensional disease influenced by social factors such as poor environmental conditions and awareness gaps. India has witnessed a substantial reduction in malaria cases and has declared three regions as malaria-free, with Karnataka being one of the states. However, Karnataka witnesses significant population movement and migration, which influences the spread of malaria. Ramanagara, a district in Karnataka, reported zero indigenous cases over the past three years. Hence, we selected this district to evaluate outbreak preparedness to prevent the reintroduction of malaria. This choice underscores the district's significance as a valuable model for preventing the reintroduction of malaria. Methodology Baseline survey data on malaria cases and vector survey data were evaluated for the period spanning 2018 to 2022. The data were gathered from both the regional office and the Ramanagara district health office. In addition to the documenting system, because there was no regular submission of Form-P and Form-L of the Integrated Disease Surveillance Project and Integrated Health Information Platform from the private sector, to complete the missing data, across-sectional study was conducted among private sector practitioners and pharmacies in Ramanagara from April 2023 to June 2023. Data was collected via interviews using a malaria surveillance assessment toolkit sourced from the National Centre for Vector Borne Diseases Control and World Health Organization protocols to assess six core areas of malaria elimination. Data collected via interviews were compiled in MS Excel and analyzed using SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Results Malaria control measures in the selected district achieved >80% coverage with notable improvements in the National Health Mission-National Vector Borne Disease Control Programme fund utilization, logistics availability, and physical performance over the past five years. The Annual Parasite Index was <1 at 0.0061 in 2018 and 0.0017 in 2022. The annual blood examination rate was consistently >10 from 22.05 in 2018 to 24.36 in 2022. The primary vectors identified were Anopheles culicifacies and Anopheles stephensi. In 2018, there were six cases of Plasmodium vivax and one case of Plasmodium falciparum reported as imported cases. In 2021 and 2022, two cases of P. vivax were reported. Notably, there were no instances of mixed infections or indigenous cases documented from 2018 to 2022 Conclusions Although the level of outbreak preparedness in the region is satisfactory, the effectiveness of vector control measures appears to be lacking. Increased government funding is needed along with comprehensive training and workshops for healthcare workers. Adequate financial resources and enhanced skills among healthcare workers are crucial to reinforce the existing efforts to control vectors and prevent potential outbreaks effectively.

Tuberculosis care provided by private practitioners in an urban setting in Indonesia: Findings from a standardized patient study.

In Indonesia, government-owned Community Health Centers (CHCs) spearhead tuberculosis (TB) care at the primary level, but a substantial proportion of individuals with pulmonary TB also seek care from Private Practitioners (PPs). However, little is known about PPs' practice in managing patients with TB-associated symptoms. To avoid bias associated with self-administered surveys, we used standardized patients (SPs) to evaluate PPs' adherence to the national TB guidelines. Four clinical scenarios of individuals presenting complaints suggestive of TB, accompanied by different sputum smear results or TB treatment histories were developed. We assigned 12 trained SPs to PPs practicing in 30 CHC catchment areas in Bandung city, Indonesia. For comparison, two scenarios were also presented to the CHCs. A total of 341 successful SP visits were made to 225 private general practitioners (GPs), 29 private specialists, and 30 CHCs. When laboratory results were not available, adherence to the recommended course of action, i.e., sputum examination, was low among private GPs (31%) and private specialists (20%), while it was requested in 87% of visits to the CHCs. PPs preferred chest X-ray (CXR) in all scenarios, with requests made in 66% of visits to private GPs and 84% of visits to private specialists (vs. 8% CHCs). Prescriptions of incorrect TB drug regimens were reported from 7% and 13% of visits to private GPs and specialists, respectively, versus none of the CHCs. Indonesian PPs have a clear preference for CXR over microbiological testing for triaging presumptive TB patients, and inappropriate prescription of TB drugs is not uncommon. These findings warrant actions to increase awareness among PPs about the importance of microbiological testing and of administering appropriate TB drug regimens. SP studies can be used to assess the impact of these interventions on providers' adherence to guidelines.

Impact Assessment of Covid19 pandemic on operational aspect of national tuberculosis elimination program in Bhavnagar district

PurposeIndia account more than one forth tuberculosis cases. Covid 19 affect health condition like tuberculosis. We aim to assess impact of covid 19 on National Tuberculosis Elimination Program. MethodIn depth interviews of district tuberculosis officer, private practitioner and tuberculosis patients (who registered in District Tuberculosis Centre during April 2020–September2020) were conducted in Bhavnagar district. Notification rate during covid 19 was obtained from District Tuberculosis Centre of Bhavnagar district. All interviews were audio-recorded after obtaining written informed consent, transcribed in English, and analyzed in the form of codes and categories. ResultHealth care providers perceived covid 19 lockdowns, fear among patients, difficult transportation, diversion of resources and reduced concerns towards tuberculosis were the reason for low notification during the COVID-19 pandemic. ConclusionCOVID-19 lockdown had detrimental effects on notification rate. During such testing time patients felt proper supervision by front line worker, no issued in direct benefit transfer for nutrition support and adequate supply of medicine. Telemedicine, awareness through social media, collaboration with other agencies, bidirectional screening implementation, coping of covid 19 fear among patients, separate tuberculosis facility were the expectation from higher authority if next wave of covid 19 will come. Future studies can evaluate the feasibility, impact, and cost-effectiveness of such interventions.