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What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan. 是什么决定了医学生对全科住院医师培训的职业偏好?
Q1 Medicine Pub Date : 2018-01-27 eCollection Date: 2018-01-01 DOI: 10.1186/s12930-018-0039-9
Kenya Ie, Akiko Murata, Masao Tahara, Manabu Komiyama, Shuhei Ichikawa, Yousuke C Takemura, Hirotaka Onishi

Background: Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.

Methods: From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item.

Results: A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration.

Conclusions: Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

背景:很少有研究系统地探讨影响医学生全科医生职业选择的因素。日本已决定将全科医学正式确认为一门新学科,我们在全国范围内开展了一项多中心调查(日本医学生职业生涯调查:JMECS),以研究与学生全科医学职业抱负相关的因素:2015年4月至12月,我们向17所医学院的应届医学生发放了一份包含21个项目的调查问卷。调查询问了学生们对 19 个专业领域中前三个职业的偏好、他们的人口统计学特征以及他们的职业优先级。采用多变量逻辑回归法确定每个项目的影响:共有 1264 份回复被纳入分析。选择最多的三个专业是内科:833人(65.9%)、全科医生408(32.3%)人选择了内科,372(29.4%)人选择了儿科:372 (29.4%).在人口统计学因素中,"计划继承他人的诊所 "与选择全科诊所呈正相关,而 "父母是医生 "与选择全科诊所呈负相关。在控制了潜在的混杂因素后,认为以下项目非常重要的学生更有可能选择全科医生:"临床诊断推理(调整赔率比(aOR):1.65,95% CI 1.40-1.94)"、"面向社区的实践(aOR:1.33,95% CI 1.13-1.57)"和 "参与预防医学(aOR:1.18,95% CI 1.01-1.38)"。相反,"急性病护理而非慢性病护理"、"掌握高级程序 "和 "执业深度而非广度 "与全科执业愿望相关的可能性较小:我们的全国性多中心调查发现了与全科医生职业理想相关的几个特征:临床诊断推理、面向社区的实践和预防医学。这些结果对今后的研究和招聘策略的制定具有重要意义。
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引用次数: 0
Exploration of the administrative aspects of the delivery of home health care services: a qualitative study. 探索提供家庭保健服务的行政方面:一项定性研究。
Q1 Medicine Pub Date : 2018-01-24 eCollection Date: 2018-01-01 DOI: 10.1186/s12930-018-0038-x
Hooman Shahsavari, Alireza Nikbakht Nasrabadi, Mohammad Almasian, Heshmatolah Heydari, Abdolrahim Hazini

Background: Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task.

Objectives: The purpose of this study was to explore the administrative aspects of the delivery of home health care services.

Methods: This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method.

Results: 23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories.

Conclusion: Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.

背景:由于提供家庭保健服务和资源的多样性,其管理是一项具有挑战性和困难的任务。目的:本研究的目的是探讨提供家庭保健服务的行政方面。方法:2015年,在传统的含量分析方法的基础上,对伊朗进行定性研究。参与者的选择采用有目的的抽样方法,并通过深入的半结构化个人访谈和焦点小组讨论收集数据。收集的数据使用Lundman和Graneheim方法进行分析。结果:23人参与了个人访谈,收集的数据分为政策制定和基础设施两大主题,每个主题由一些子类别组成。结论:卫生政策制定者可以利用本研究的结果作为基线信息来决定提供家庭卫生保健服务,考虑家庭卫生保健服务的情境维度,从而改善家庭卫生保健服务。
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引用次数: 17
Cancer-related post-treatment pain and its impact on health-related quality of life in breast cancer patients: a cross sectional study in Palestine. 癌症相关治疗后疼痛及其对乳腺癌患者健康相关生活质量的影响:巴勒斯坦的一项横断面研究
Q1 Medicine Pub Date : 2017-11-21 eCollection Date: 2017-01-01 DOI: 10.1186/s12930-017-0037-3
Nader H Abu Farha, Mohammed T Khatib, Husam Salameh, Sa'ed H Zyoud

Background: Post-treatment pain has been suggested as an important indicator for health-related quality of life (HRQOL) in patients with breast cancer. Therefore, this study was performed to examine the association between pain and its impact on HRQOL among breast cancer patients in Palestine. Also, this study aimed to determine the QOL profile for breast cancer patients and stated the factors associated with QOL.

Methods: A correlational cross-sectional study was conducted from May 2016 to November 2016 at Al-Watani Hospital and An-Najah National University Hospital in the Nablus district in Palestine. The five-level EuroQol five-dimensional instrument (EQ-5D-5L) was used to examine HRQOL. Pain severity and interference were assessed using the Brief Pain Inventory (BPI). Multiple linear regression analysis was performed to determine the most important variables related with HRQOL.

Results: One hundred and seventy patients were involved in this study. Overall, all participants were female, with a mean ± SD for age of 51.71 ± 11.11 years. The reported HRQOL of this study was measured by using the median EQ-5D-5L index score, which was 0.67 (interquartile range: 0.51-0.84). There were moderate negative correlations between EQ-5D-5L index score and pain severity score (r = - 0.58, p value < 0.001), and pain interference score (r = - 0.604, p-value < 0.001). Furthermore, univariate analysis showed that age, marital status, employment status, income, current condition of cancer, and post-treatment pain were associated with quality of life (p-value < 0.05). Regression analysis revealed that patients with high income (p-value = 0.003), patients with lower pain severity score (p-value < 0.001), and lower pain interference score (p-value = 0.018) were independently associated with high QOL.

Conclusions: This is the first study to present important data regarding QOL by using the EQ-5D-5L instruments that may help healthcare providers to identify patients at risk of low QOL. Healthcare providers and health strategy makers should be alerted to low level HRQOL among breast cancer patients with low income level, patients with post-treatment pain, especially in the state of severe pain, and the state of pain interfering with daily life to improve their HRQOL.

背景:治疗后疼痛已被认为是乳腺癌患者健康相关生活质量(HRQOL)的重要指标。因此,本研究旨在研究巴勒斯坦乳腺癌患者疼痛及其对HRQOL的影响之间的关系。此外,本研究旨在确定乳腺癌患者的生活质量概况,并阐明与生活质量相关的因素。方法:2016年5月至11月在巴勒斯坦纳布卢斯地区Al-Watani医院和An-Najah国立大学医院进行相关横断面研究。采用五级EuroQol五维仪(EQ-5D-5L)检测HRQOL。使用简短疼痛量表(BPI)评估疼痛严重程度和干扰程度。采用多元线性回归分析确定与HRQOL相关的最重要变量。结果:170例患者参与了本研究。总体而言,所有参与者均为女性,平均±SD年龄为51.71±11.11岁。本研究报告的HRQOL采用EQ-5D-5L指数得分中位数,为0.67(四分位数范围:0.51-0.84)。EQ-5D-5L指数评分与疼痛严重程度评分之间存在中度负相关(r = - 0.58, p值)。结论:这是第一个通过使用EQ-5D-5L仪器提供关于生活质量的重要数据的研究,可以帮助医疗保健提供者识别低生活质量风险的患者。低收入水平的乳腺癌患者、治疗后疼痛尤其是疼痛严重的患者、疼痛干扰日常生活的患者的HRQOL水平较低,应引起医疗服务提供者和健康策略制定者的注意,以提高其HRQOL水平。
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引用次数: 26
Knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Pakistan. 巴基斯坦女医学院新生关于骨质疏松症的知识、信仰和做法。
Q1 Medicine Pub Date : 2017-09-18 eCollection Date: 2017-01-01 DOI: 10.1186/s12930-017-0036-4
Muhammad Bilal, Abdul Haseeb, Aleena Zehra Merchant, Abdur Rehman, Mohammad Hussham Arshad, Maarij Malik, Asad Hammad Ur Rehman, Pallavi Rani, Emaan Farhan, Taha S Rehman, Umer Sultan Shamsi, Sadia Aminah

Background: Osteoporosis is a growing health problem around the world. The increasing incidence of osteoporotic fractures coupled with the lack of knowledge about the disease in the general community means that the disease is continuously increasing the burden on health sector and the general population. The purpose of the study is to assess knowledge, attitudes and practices about osteoporosis among female medical school entrants in Karachi.

Methods: This is a descriptive cross-sectional study conducted amongst 400 female medical school entrants of DOW University of Health Sciences (DUHS) and Jinnah Sindh Medical University (JSMU). A pre validated questionnaire, Osteoporosis Knowledge Assessment Tool (OKAT), was distributed amongst the participants. A food frequency questionnaire was also distributed to determine calcium intake. Descriptive statistics and Chi square test were used to compare the two groups of students with SPSS (20.0) being utilized for analysis. A p value of <0.05 was considered as significant.

Results: The mean age of the participants was 19.4 ± 1.2 years. Only 8.0% of the participants had a good score pertaining to knowledge about osteoporosis whereas majority of the participants (49.0%) had a poor score. Perceived susceptibility was low as only 14.0% of the participants believed that they were at a high risk for osteoporosis. The RDA for calcium was equal to or greater than 700 mg per day which was met by only 29.0% of the participants despite of the high motivation towards consuming a calcium rich diet. Exercise levels were insufficient in terms of both, duration and the recommended type of exercise. Only 12.0% of the participants engaged in exercises according to the recommended guidelines. Moreover, only 5.5% subjects were involved in definitive behaviors to improve bone health.

Conclusions: Participants possessed an insufficient knowledge of the disease and that too was not adequately applied in preventative practices. There is a serious lack of adoption of preventative practices for osteoporosis. This was primarily due to little appreciation of the seriousness of osteoporosis. Hence, this study highlights the dire need for awareness about practices and attitudes related to the disease. Furthermore, it could be of paramount importance to future studies conducted on practices and beliefs related to osteoporosis.

背景:骨质疏松症是世界范围内日益严重的健康问题。骨质疏松性骨折的发病率不断增加,加上普通社区对该疾病缺乏了解,这意味着该疾病正在不断增加卫生部门和普通人群的负担。这项研究的目的是评估卡拉奇女医学院新生对骨质疏松症的知识、态度和做法。方法:对陶氏健康科学大学(DUHS)和真纳信德医科大学(JSMU)的400名女医学院新生进行了描述性横断面研究。预验证问卷,骨质疏松知识评估工具(OKAT),分发给参与者。还分发了一份食物频率问卷,以确定钙的摄入量。两组学生的比较采用描述性统计和卡方检验,分析采用SPSS(20.0)软件。结果的p值:参与者的平均年龄为19.4±1.2岁。只有8.0%的参与者在骨质疏松知识方面得分良好,而大多数参与者(49.0%)得分较差。感知易感性很低,只有14.0%的参与者认为他们有患骨质疏松症的高风险。钙的RDA等于或大于每天700毫克,只有29.0%的参与者满足,尽管他们对摄入富含钙的饮食有很高的动机。运动水平、持续时间和建议的运动类型都不足。只有12.0%的参与者按照建议的指导方针进行锻炼。此外,只有5.5%的受试者参与了改善骨骼健康的明确行为。结论:参与者拥有的疾病知识不足,也没有充分应用于预防措施。骨质疏松症的预防措施严重缺乏。这主要是由于对骨质疏松症的严重性认识不足。因此,这项研究强调迫切需要认识到与疾病有关的做法和态度。此外,它可能对未来有关骨质疏松症的实践和信念的研究具有至关重要的意义。
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引用次数: 30
Patients' willingness to pay for their drugs in primary care clinics in an urbanized setting in Malaysia: a guide on drug charges implementation. 马来西亚城市化背景下初级保健诊所患者支付药费的意愿:药费实施指南。
Q1 Medicine Pub Date : 2017-04-04 eCollection Date: 2017-01-01 DOI: 10.1186/s12930-017-0035-5
Sharifa Ezat Wan Puteh, Siti Nurul Akma Ahmad, Azimatun Noor Aizuddin, Ramli Zainal, Ruhaini Ismail

Background: Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients' willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population.

Methods: A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012-2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses.

Results: Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p = 0.009; 95% CI 1.27-5.44) predictor to drugs' WTP.

Conclusion: The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.

背景:马来西亚是一个中高收入国家,提供补贴医疗保健,以确保全民覆盖。包括马来西亚在内的大多数国家都面临保健费用不断上升的挑战,原因是疾病流行率上升,导致药品支出增加。2009年,卫生部为补贴药品拨款14.02亿林吉特(约3.9亿美元)。本研究旨在测量城市化人口中慢性疾病或急性疾病治疗的患者支付意愿(WTP)。方法:2012-2013年在某城市州采用面对面访谈的横断面研究方法。系统随机抽样从10个设有家庭医学专科服务的公立基层医疗机构的病人名单中抽取324名病人。使用最高金额(最高产量研究)的竞价技术询问患者是否患有慢性或急性疾病的WTP。结果:患者多为年轻女性,文化程度较低,收入较低。有234人(72.2%)不愿意支付药费。慢性或急性疾病药物的WTP较低,每次就诊的中位数为10林吉特(3.8美元)。双变量分析显示,受抚养子女数量较少(≤3个)、个人和家庭收入较高与WTP相关。多因素分析显示,仅受抚养子女数量(≤3)有统计学意义(p = 0.009;95% CI 1.27-5.44)是药物WTP的预测因子。结论:初级保健患者对药物的WTP较低,无论是慢性疾病还是急性疾病。公民舒适地生活在舒适区,通过全民覆盖,卫生服务得到高度补贴。因此,人们不愿为药品付费。
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引用次数: 15
Patients' experience of using primary care services in the context of Indonesian universal health coverage reforms. 在印度尼西亚全民健康覆盖改革背景下患者使用初级保健服务的经验。
Q1 Medicine Pub Date : 2017-03-21 eCollection Date: 2017-01-01 DOI: 10.1186/s12930-017-0034-6
Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn

Background: The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN.

Aim: This research aimed to explore patients' views on the implementation of JKN and factors that influence a person's decision to enroll in the JKN scheme.

Methods: This study was informed by interpretative phenomenological analysis (IPA) methodology to understand patients' views. The interview participants were purposively recruited using maximum variation criteria. The data were gathered using in-depth interviews and was conducted in Yogyakarta from October to December 2014. The interviews were transcribed, translated and analyzed using IPA analysis.

Result: Twenty three participants were interviewed from eight primary care clinics. Three superordinate themes: access, trust, and separation anxiety were identified which impacted on the uptake of JKN. Participants acknowledged that whilst primary care clinics were conveniently located, access was often complicated by long waiting times and short opening hours. Participants also expressed lower levels of trust with primary care doctors compared to hospital and specialist care. They also reported a sense of anxiety that the current JKN regulation might limit their ability to access the hospital service guaranteed in the past.

Discussion: This study identified patients' views that could challenge the implementation of the gate-keeper role of primary care in Indonesia. While the patients valued the availability of medical care close to home, their lack of trust in primary care doctors and fear that they might lost the hospital care in the future appears to have impacted on the uptake of JKN. Unless targeted efforts are made to address these views through sustained public education and further capacity building in primary care, it is unlikely that the full potential of the JKN scheme in primary care will be realized.

背景:世界卫生组织(世卫组织)关于全民覆盖的建议已在印度尼西亚作为Jaminan Kesehatan Nasional (JKN)得到实施。它的目的是通过加强初级保健作为医院的看门人,为人民提供公平和高质量的保健。然而,在实施的第一年,联合保健协会成员的招募进展缓慢,初级保健转介到二级保健的比率仍然很高。对于公众如何看待JKN的引入,以及影响他们决定加入JKN的因素,我们知之甚少。目的:本研究旨在探讨患者对实施JKN计划的看法,以及影响患者决定参加JKN计划的因素。方法:本研究采用解释现象学分析(IPA)方法了解患者的观点。使用最大变异标准有目的地招募访谈参与者。数据是通过深度访谈收集的,并于2014年10月至12月在日惹进行。对访谈进行转录、翻译并使用国际音标分析进行分析。结果:对来自8个初级保健诊所的23名参与者进行了访谈。三个上级主题:访问,信任和分离焦虑被确定影响JKN的吸收。与会者承认,虽然初级保健诊所位置便利,但由于等待时间长,开放时间短,就诊往往很复杂。与医院和专科护理相比,参与者对初级保健医生的信任度也较低。他们还报告了一种焦虑感,即目前的JKN规定可能会限制他们获得过去保证的医院服务的能力。讨论:本研究确定了患者的观点,这些观点可能会挑战印度尼西亚初级保健门卫角色的实施。虽然患者重视离家近的医疗服务,但他们对初级保健医生缺乏信任,并担心将来可能失去医院护理,这似乎影响了JKN的采用。除非通过持续的公共教育和进一步的初级保健能力建设作出有针对性的努力来解决这些观点,否则JKN计划在初级保健方面的全部潜力不太可能实现。
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引用次数: 33
Primary care patient experience and cancer screening uptake among women: an exploratory cross-sectional study in a Japanese population 女性初级保健患者体验和癌症筛查率:日本人群的一项探索性横断面研究
Q1 Medicine Pub Date : 2017-02-07 DOI: 10.1186/s12930-017-0033-7
T. Aoki, M. Inoue
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引用次数: 10
Manual for primary health care on Basic Occupational Health Services. Encouraging publication from India, focused on informal occupations 初级卫生保健基本职业卫生服务手册。鼓励印度出版以非正规职业为重点的出版物
Q1 Medicine Pub Date : 2017-01-19 DOI: 10.1186/s12930-017-0032-8
F. van Dijk, P. Buijs
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引用次数: 2
Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan 家庭医学教育新兴国家住院医师培训中自我能力评级的效用:来自日本的调查结果
Q1 Medicine Pub Date : 2017-01-10 DOI: 10.1186/s12930-016-0031-1
M. Fetters, Satoko Motohara, Lauren E. Ivey, Keiichiro Narumoto, K. Sano, Masahiko Terada, Tsukasa Tsuda, M. Inoue
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引用次数: 10
Family characteristics and the use of maternal health services: a population-based survey in Eastern China 家庭特征与孕产妇保健服务的使用:华东地区人口调查
Q1 Medicine Pub Date : 2016-10-22 DOI: 10.1186/s12930-016-0030-2
Ling Zhang, Chengbing Xue, Youjie Wang, Liuyi Zhang, Yuan Liang
{"title":"Family characteristics and the use of maternal health services: a population-based survey in Eastern China","authors":"Ling Zhang, Chengbing Xue, Youjie Wang, Liuyi Zhang, Yuan Liang","doi":"10.1186/s12930-016-0030-2","DOIUrl":"https://doi.org/10.1186/s12930-016-0030-2","url":null,"abstract":"","PeriodicalId":39050,"journal":{"name":"Asia Pacific Family Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12930-016-0030-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66316695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 10
期刊
Asia Pacific Family Medicine
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