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Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines. 在菲律宾伊富高省马约姚与设施分娩相关的因素。
Q1 Medicine Pub Date : 2013-10-24 DOI: 10.1186/1447-056X-12-5
Azusa Shimazaki, Sumihisa Honda, Marcelyn M Dulnuan, Jennylene B Chunanon, Akiko Matsuyama

Background: The maternal mortality ratio (MMR) in the Philippines is higher than in most other Southeast Asian countries, and home delivery is a major factor contributing to the high MMR. This study aims to explore the determinants for choice of delivery location in Ifugao Province, where people have poor access to health services.

Findings: A household interview survey using a structured questionnaire was conducted to identify the factors associated with delivery location among 354 women. In all, 44.4% of the respondents delivered at a health facility. Using logistic regression analysis, parity (odds ratio [OR] 3.0, 95% confidence interval [C.I.] 1.6-5.6), higher education (OR 5.9, 95% C.I. 2.7-12.9), distance to a health facility (OR 6.9, 95% C.I. 3.4-14.2), health problems identified at antenatal care (OR 2.4, 95% C.I. 1.3-4.6), and the person deciding on the delivery location (e.g., for the husband OR 3.2, 95% C.I. 1.1-9.4) were found to be statistically associated with facility-based delivery.

Conclusion: Involving the husband and other people in the decision regarding delivery location may influence a woman's choice to use facility-based delivery services. Our findings have useful implications for improving the existing Safe Motherhood program in the Philippines.

背景:菲律宾的产妇死亡率(MMR)高于大多数其他东南亚国家,而在家分娩是导致产妇死亡率高的一个主要因素。本研究旨在探讨伊富高省分娩地点选择的决定因素,那里的人们获得卫生服务的机会很少。研究结果:采用结构化问卷对354名妇女进行了家庭访谈调查,以确定与分娩地点相关的因素。总共有44.4%的答复者在卫生机构分娩。采用logistic回归分析,奇偶性(比值比[OR] 3.0, 95%可信区间[C.I.[1.6-5.6])、高等教育程度(比值比5.9,95% C.I. 2.7-12.9)、到医疗机构的距离(比值比6.9,95% C.I. 3.4-14.2)、产前保健时发现的健康问题(比值比2.4,95% C.I. 1.3-4.6)和决定分娩地点的人(例如,对丈夫来说,比值比3.2,95% C.I. 1.1-9.4)在统计上与医院分娩有关。结论:让丈夫和其他人参与决定分娩地点可能会影响妇女选择使用基于设施的分娩服务。我们的研究结果对改善菲律宾现有的安全孕产计划具有有益的意义。
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引用次数: 37
Research consultation clinic: impetus towards facilitating primary care research. 研究咨询诊所:促进初级保健研究的动力。
Q1 Medicine Pub Date : 2013-09-16 DOI: 10.1186/1447-056X-12-4
Ngiap Chuan Tan, Yang Thong Tan, Patricia T Kin

Background: In Singapore, SingHealth Polyclinics (SHP) is an accredited Family Medicine (FM) training centre which managed 1.8 million primary care patient-visits in 2012. To promote research in the institution, research consultation clinics (RCC) are being introduced in 2010 to enable free face-to-face consultation between experienced and novice researchers on specific research topics. Each RCC session allows about an hour or more for the SHP staff, medical undergraduates and general practitioners to seek advice and clarification on key research areas, ranging from research question refinement, study design and execution, data analysis, result presentation to publication. The consultants comprise of two FM researchers with postgraduate research qualification.

Aim: This article aims to review the implementation of RCC from 2010 to 2012 and its impact on research activities and outcome indicators in the same period of time.

Methods: The study comprised of two segments. Part I was a three-year retrospective review of the RCC administrative record. The total number of RCC sessions, hours utilised, participants' profiles, the number of research studies initiated by them and their research presentations at local and overseas scientific meetings/conferences were computed. Part 2 was an anonymous web-based questionnaire survey fielded to RCC participants to collect their feedback on the RCC service and their self-reported initiation and completion of research study after the RCC consultation.

Results: The RCC sessions increased from 17 to 40 sessions, resulting in increment of 2 to 14 research presentations and from 2 to 6 initiations of new research studies per annum from 2010-2012. The response rate to the questionnaire survey was 70.3%, with the majority of multi-disciplinary respondents rated the RCC service to be accessible, adequate and were satisfied with its quality. Study design, data management and study execution were ranked as important areas of research for consultation. 79% of them had started a research project and 36% had completed their studies.

Conclusions: The RCC is a feasible model to catalyse multi-disciplinary research in primary care institutions. Further study is needed to evaluate its relevance when research advances and novice researchers become experienced investigators to take on more complex projects.

背景:在新加坡,新健康综合诊所(SHP)是一家经过认证的家庭医学(FM)培训中心,2012年管理了180万名初级保健患者。为了促进研究所的研究,研究咨询诊所于2010年成立,让有经验的和新入行的研究人员就特定的研究课题进行免费的面对面咨询。每次RCC会议允许SHP员工,医学本科生和全科医生在关键研究领域寻求建议和澄清,从研究问题的改进,研究设计和执行,数据分析,结果展示到发表。顾问包括两名具有研究生研究资格的FM研究人员。目的:本文旨在回顾2010 - 2012年RCC的实施情况及其对同期研究活动和成果指标的影响。方法:研究分为两部分。第一部分是对RCC行政记录的三年回顾性审查。计算研究小组的会期总数、使用时数、参加者简介、他们进行的研究项目数目,以及他们在本地及海外科学会议上的研究报告。第二部分是对RCC参与者进行匿名网络问卷调查,收集他们对RCC服务的反馈,以及他们在RCC咨询后开始和完成研究的自我报告。结果:2010-2012年,RCC会议从17次增加到40次,每年的研究报告从2次增加到14次,新研究的启动从2次增加到6次。问卷调查的回应率为70.3%,大多数多学科的受访者认为RCC的服务是无障碍的,足够的,并对其质量感到满意。研究设计、数据管理和研究执行被列为咨询研究的重要领域。其中79%的学生已经开始研究项目,36%的学生已经完成学业。结论:RCC是促进基层医疗机构多学科研究的可行模式。当研究取得进展,新手研究人员成为有经验的研究人员承担更复杂的项目时,需要进一步的研究来评估其相关性。
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引用次数: 5
Alberta family physicians' willingness to work during an influenza pandemic: a cross-sectional study. 艾伯塔省家庭医生在流感大流行期间的工作意愿:一项横断面研究。
Q1 Medicine Pub Date : 2013-06-26 DOI: 10.1186/1447-056X-12-3
James A Dickinson, Gisoo Bani-Adam, Tyler Williamson, Sandy Berzins, Craig Pearce, Leah Ricketson, Emily Medd

Objective: Effective pandemic responses rely on frontline healthcare workers continuing to work despite increased risk to themselves. Our objective was to investigate Alberta family physicians willingness to work during an influenza pandemic.

Design: Cross-sectional survey.

Setting: Alberta prior to the fall wave of the H1N1 epidemic.

Participants: 192 participants from a random sample of 1000 Alberta family physicians stratified by region.

Main outcome measures: Willingness to work through difficult scenarios created by an influenza epidemic.

Results: The corrected response rate was 22%. The most physicians who responded were willing to continue working through some scenarios caused by a pandemic, but in other circumstances less than 50% would continue. Men were more willing to continue working than women. In some situations South African and British trained physicians were more willing to continue working than other groups.

Conclusions: Although many physicians intend to maintain their practices in the event of a pandemic, in some circumstances fewer are willing to work. Pandemic preparation requires ensuring a workforce is available. Healthcare systems must provide frontline healthcare workers with the support and resources they need to enable them to continue providing care.

目的:有效的大流行应对依赖于一线卫生保健工作者不顾自身风险增加而继续工作。我们的目的是调查艾伯塔省家庭医生在流感大流行期间工作的意愿。设计:横断面调查。背景:在H1N1流感秋季流行之前的艾伯塔省。参与者:192名参与者来自艾伯塔省按地区分层的1000名家庭医生随机抽样。主要结果衡量标准:愿意在流感流行造成的困难情况下工作。结果:纠正有效率为22%。大多数回应的医生愿意在大流行造成的某些情况下继续工作,但在其他情况下,只有不到50%的医生愿意继续工作。男性比女性更愿意继续工作。在某些情况下,南非和英国受过培训的医生比其他群体更愿意继续工作。结论:尽管许多医生打算在大流行的情况下保持他们的做法,但在某些情况下,愿意工作的人很少。大流行防范工作需要确保有人力资源。卫生保健系统必须为一线卫生保健工作者提供所需的支持和资源,使他们能够继续提供护理。
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引用次数: 8
Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia among people living with AIDS in Nigeria, a cross-sectional study. 使用经杀虫剂处理的蚊帐和疟疾预防教育:对尼日利亚艾滋病患者疟疾寄生虫病的影响,一项横断面研究。
Q1 Medicine Pub Date : 2013-06-22 eCollection Date: 2013-01-01 DOI: 10.1186/1447-056X-12-2
Samuel Anu Olowookere, Najemdeen Ajao Adeleke, Emmanuel Akintunde Abioye-Kuteyi, Ijeoma Soromtochi Mbakwe

Background: Malaria and HIV are major causes of morbidity and mortality in sub-Saharan Africa with both diseases highly endemic in Nigeria. This study was conducted to assess the effect of long lasting insecticide treated net (ITN) use and malaria preventive education on burden of malaria parasite among people living with AIDS (PLWHA) at Osogbo southwestern Nigeria.

Method: A descriptive cross-sectional study of newly recruited consenting PLWHA that were screened consecutively for malaria, those positive were treated with artemisinin combination therapy. All PLWHA were educated about malaria infection, given ITN and followed up monthly for three months when they were rescreened for malaria infection. Data collected was analyzed using descriptive and inferential statistics.

Result: A total of 392 (92%) PLWHA completed the study. Mean age of the respondents was 33 ± 11.6 years. They were 120 (31%) males and 272 (69%) females. Majority (80%) were married, over 33% completed secondary education while 21% had tertiary education. Most were traders (40%) and artisans (25%). About 60% had Plasmodium falciparum malaria parasitemia at baseline which drastically reduced to 5% at three months with ITN use and malaria prevention education.

Conclusion: Malaria is a major preventable condition among PLWHA. Preventive education and ITN use reduced malaria parasite burden among this population.

背景:疟疾和艾滋病毒是撒哈拉以南非洲发病率和死亡率的主要原因,这两种疾病在尼日利亚高度流行。本研究旨在评估长期使用经杀虫剂处理的蚊帐(ITN)和疟疾预防教育对尼日利亚西南部Osogbo艾滋病患者(PLWHA)疟疾寄生虫负担的影响。方法:采用描述性横断面研究方法,对新招募的经同意的感染者进行疟疾连续筛查,阳性者给予青蒿素联合治疗。所有艾滋病感染者都接受了疟疾感染方面的教育,给予了ITN,并在对他们进行疟疾感染重新筛查时每月随访三个月。收集的数据使用描述性和推断性统计进行分析。结果:共有392例(92%)感染者完成了研究。受访者平均年龄33±11.6岁。其中男性120人(31%),女性272人(69%)。大多数人(80%)已婚,超过33%完成了中等教育,21%接受过高等教育。大多数是商人(40%)和工匠(25%)。大约60%的人在基线时患有恶性疟原虫疟疾寄生虫病,在使用驱虫蚊帐和进行疟疾预防教育三个月后,这一比例急剧下降至5%。结论:疟疾是艾滋病感染者的主要可预防疾病。预防教育和ITN的使用减少了这一人群的疟疾寄生虫负担。
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引用次数: 5
Women's impressions of their inpatient birth care as provided by family physicians in the Shizuoka Family Medicine Training Program in Japan. 日本静冈县家庭医学培训项目中家庭医生提供的妇女对住院分娩护理的印象。
Q1 Medicine Pub Date : 2013-05-22 DOI: 10.1186/1447-056X-12-1
Mariko Yokota, Shinji Tsunawaki, Keiichiro Narumoto, Michael D Fetters

Background: Even though Japan faces serious challenges in women's health care such as a rapidly aging population, attrition of obstetrical providers, and a harsh legal climate, few family medicine residency training programs in Japan include training in obstetrics, and the literature lacks research on women's views of intra-partum pregnancy care by family physicians.

Findings: In this exploratory study, we conducted semi-structured qualitative interviews with five women who received their admission, intrapartum, delivery and discharge care from family medicine residents in the obstetrics ward of a community training hospital. Four women had vaginal births, and one had a Cesarean section. Three were primiparous, and two multiparous. Their ages ranged from 22-33. They found value in family physician medical knowledge and easy communication style, though despite explanation, some had trouble understanding the family physician's scope of work. These women identified negative aspects of the hospital environment, and wanted more anticipatory guidance about what to expect physically after birth, but were enthusiastic about seeing a family doctor after discharge.

Conclusions: These results demonstrate the feasibility of family medicine residents providing inpatient birth care in a community hospital, and that patients are receptive to family physicians providing that care as well after discharge. Women's primary concerns relate mostly to hospital environment issues, and better understanding the care family physicians provide. This illustrates-areas for family physicians to work for improvements.

背景:尽管日本在妇女保健方面面临着严峻的挑战,如人口迅速老龄化、产科医生的流失和严酷的法律环境,但日本的家庭医学住院医师培训项目中很少包括产科培训,而且文献中缺乏关于家庭医生对妇女分娩期间妊娠护理看法的研究。结果:在本探索性研究中,我们对一家社区培训医院产科病房接受家庭医学住院医师入院、产时、分娩和出院护理的5名妇女进行了半结构化定性访谈。四名妇女顺产,一名剖宫产。三个是初产,两个是多产。他们的年龄在22-33岁之间。他们发现家庭医生的医学知识和轻松的沟通方式很有价值,尽管有解释,但有些人很难理解家庭医生的工作范围。这些妇女发现了医院环境的消极方面,并希望得到更多关于分娩后身体状况的预期指导,但她们热衷于在出院后去看家庭医生。结论:本研究结果表明家庭医学住院医师在社区医院提供住院分娩护理的可行性,以及患者在出院后对家庭医生提供分娩护理的接受程度。妇女主要关心的是医院环境问题,以及更好地了解家庭医生提供的护理。这说明了家庭医生需要改进的地方。
{"title":"Women's impressions of their inpatient birth care as provided by family physicians in the Shizuoka Family Medicine Training Program in Japan.","authors":"Mariko Yokota,&nbsp;Shinji Tsunawaki,&nbsp;Keiichiro Narumoto,&nbsp;Michael D Fetters","doi":"10.1186/1447-056X-12-1","DOIUrl":"https://doi.org/10.1186/1447-056X-12-1","url":null,"abstract":"<p><strong>Background: </strong>Even though Japan faces serious challenges in women's health care such as a rapidly aging population, attrition of obstetrical providers, and a harsh legal climate, few family medicine residency training programs in Japan include training in obstetrics, and the literature lacks research on women's views of intra-partum pregnancy care by family physicians.</p><p><strong>Findings: </strong>In this exploratory study, we conducted semi-structured qualitative interviews with five women who received their admission, intrapartum, delivery and discharge care from family medicine residents in the obstetrics ward of a community training hospital. Four women had vaginal births, and one had a Cesarean section. Three were primiparous, and two multiparous. Their ages ranged from 22-33. They found value in family physician medical knowledge and easy communication style, though despite explanation, some had trouble understanding the family physician's scope of work. These women identified negative aspects of the hospital environment, and wanted more anticipatory guidance about what to expect physically after birth, but were enthusiastic about seeing a family doctor after discharge.</p><p><strong>Conclusions: </strong>These results demonstrate the feasibility of family medicine residents providing inpatient birth care in a community hospital, and that patients are receptive to family physicians providing that care as well after discharge. Women's primary concerns relate mostly to hospital environment issues, and better understanding the care family physicians provide. This illustrates-areas for family physicians to work for improvements.</p>","PeriodicalId":39050,"journal":{"name":"Asia Pacific Family Medicine","volume":"12 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2013-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1447-056X-12-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31541919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients. 马来西亚初级保健患者的失眠症患病率及其对日常功能的影响。
Q1 Medicine Pub Date : 2012-11-27 DOI: 10.1186/1447-056X-11-9
Abu-Hassan Zailinawati, Danielle Mazza, Cheong Lieng Teng

Unlabelled:

Background: Insomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population.

Objectives: To determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia.

Methods: In this cross-sectional survey, 2049 adult patients (≥18 year old) attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria) daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale).

Results: The response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week), 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49), age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01), anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22) and depression symptoms (OR 1.65; 95%CI, 1.21-2.26) were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59) and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68) based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents.

Conclusions: A third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.

无标签:背景:失眠是一个常见的公共健康问题,但在亚洲人群中,有关失眠在初级保健就诊者中的流行率和影响的文献资料并不多:目的:确定成人初级保健就诊者中自我报告的失眠症状的流行率及其与社会人口因素的关系;确定失眠对日常功能的影响,并描述失眠患者的心理状况:在这项横断面调查中,马来西亚半岛7家初级保健诊所的2049名成年患者(≥18岁)填写了调查问卷,询问失眠症状(根据国际睡眠障碍分类和DSM IV标准定义)、日间功能障碍和心理症状(通过医院焦虑和抑郁量表评估):答复率为 86.2%。共有 60% 的人报告了失眠症状,38.9% 的人经常出现失眠症状(每周超过 3 次),30.7% 的人患有慢性失眠,但没有日间症状,28.6% 的人患有慢性失眠,并伴有日间功能障碍。印度裔(OR 1.79;95%CI,1.28-2.49)、年龄≥50 岁或以上(OR 1.82;95%CI,1.10-3.01)、焦虑症状(OR 1.65;95%CI,1.21-2.22)和抑郁症状(OR 1.65;95%CI,1.21-2.26)是慢性失眠伴日间功能障碍的风险因素。在日间功能障碍型慢性失眠患者中,47.8%的人有焦虑症状(OR,2.01;95%CI,1.57-2.59),36.5%的人有抑郁症状(OR,2.74;95%CI,2.04-3.68)。他们还倾向于在开车时打瞌睡并卷入道路交通事故:三分之一的初级保健患者有失眠症状和慢性失眠,与严重的日间功能障碍和心理疾病有关。通过识别有慢性失眠风险的人群,可以开始采取适当的干预措施。
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引用次数: 0
Primary care in the Asia-Pacific region: challenges and solutions. 亚太地区的初级保健:挑战和解决办法。
Q1 Medicine Pub Date : 2012-10-05 DOI: 10.1186/1447-056X-11-8
Richard Hays, Lam Tai Pong, Zorayda Leopando
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引用次数: 7
Self-medication behaviors among Japanese consumers: sex, age, and SES differences and caregivers' attitudes toward their children's health management. 日本消费者自我药疗行为:性别、年龄、社会经济地位差异及照顾者对子女健康管理的态度
Q1 Medicine Pub Date : 2012-09-11 DOI: 10.1186/1447-056X-11-7
Ikuko Aoyama, Shinichi Koyama, Haruo Hibino

Unlabelled:

Background: Since 2009, when the revised Pharmaceutical Affairs Act was enacted in Japan, self-medication practices have increased. Because the concept of self-medication was recently introduced in Japan, few studies exist on this topic. Therefore, it is necessary to explore how self-medication is practiced. This study examined Japanese consumers' self-medication practices and attitudes toward over-the-counter (OTC) medicines based on their sex, age, and socioeconomic status (SES).

Methods: The participants were 403 adults (Mage = 41.1 years, SD = 16.22). A quota sampling method was employed based on age group, and participants completed an online questionnaire.

Results: Participants in the 20-29 age group reported medical costs as an obstacle in seeing a doctor; in contrast, transportation was a mitigating factor for elderly people. Regarding SES, people at lower SES levels chose to rest instead of seeing a doctor or purchasing over-the-counter (OTC) medicines when sick. They also placed more value on national brand OTC medicines than private brands (likely due to advertisements). This finding suggests individuals with a low SES do not select OTC medicines based on their effects or ingredients. Regarding attitudes toward OTC medicines, Japanese participants seemed to be unaware of the potential for abuse and side effects associated with OTC medicines. Finally, in relation to caregivers' self-medication practices for their children, the majority of participants reported taking their children to the hospital since children tend to receive free medical care. Furthermore, caregivers with a high educational background are more confident in being able to help manage their children's health.

Conclusions: Our results suggest that health and medical discrepancies among Japanese consumers pose new social problems. In Japan, universal health care is available, but the cost of receiving medical care is not completely free of charge. Thus, we hope that the government will attempt to meet the various needs of patients and support their well-being. Consumers also have to be more independent and aware of their health management, as self-medication practices will continue to play a more significant role in healthcare. More research is needed to find ways to teach Japanese consumers/patients of both the benefits and risks of over-the-counter (OTC) medicines.

背景:自2009年修订后的《药事法》在日本颁布以来,自我药疗的做法有所增加。由于自我药疗的概念是最近才在日本引入的,因此关于这一主题的研究很少。因此,有必要探讨如何进行自我药疗。本研究调查了日本消费者基于性别、年龄和社会经济地位(SES)的自我药疗实践和对非处方药(OTC)的态度。方法:研究对象为403名成人(年龄41.1岁,SD = 16.22)。采用基于年龄组的配额抽样方法,参与者完成在线问卷调查。结果:20-29岁年龄组的参与者报告医疗费用是就医的障碍;相比之下,交通对老年人来说是一个缓解因素。在经济地位方面,经济地位较低的人在生病时选择休息,而不是去看医生或购买非处方药。他们也更重视国家品牌的非处方药,而不是私人品牌(可能是由于广告)。这一发现表明,社会经济地位低的人不会根据药物的效果或成分来选择非处方药。关于对非处方药的态度,日本参与者似乎没有意识到非处方药的潜在滥用和副作用。最后,关于照顾者为子女自行用药的做法,大多数参与者报告说,他们带子女去医院,因为儿童往往得到免费医疗。此外,受过高等教育的护理人员更有信心能够帮助管理孩子的健康。结论:我们的研究结果表明,日本消费者之间的健康和医疗差异造成了新的社会问题。日本提供全民保健,但接受医疗保健的费用并非完全免费。因此,我们希望政府能够努力满足患者的各种需求,支持他们的福祉。消费者也必须更加独立并意识到自己的健康管理,因为自我药疗实践将继续在医疗保健中发挥更重要的作用。需要更多的研究来找到方法,让日本消费者/患者了解非处方药的好处和风险。
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引用次数: 31
General Practitioners' responses to global climate change - lessons from clinical experience and the clinical method. 全科医生对全球气候变化的反应——来自临床经验和临床方法的教训。
Q1 Medicine Pub Date : 2012-08-08 DOI: 10.1186/1447-056X-11-6
Grant Blashki, Alan Abelsohn, Robert Woollard, Neil Arya, Margot W Parkes, Paul Kendal, Erica Bell, R Warren Bell

Background: Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action.

Discussion: We contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism.

Summary: General practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change.

背景:气候变化是一个全球性的公共卫生问题,如果要实现有意义和有效的解决办法,就需要进行复杂的思考。在这篇概念性论文中,我们认为全科医生可以从他们广泛的临床经验和支持他们临床方法的原则中为气候变化问题带来很多东西。这种经验和思考促使普通合伙人能够而且应该为辩论和行动做出特殊贡献。讨论:我们认为,GP的特殊经验和思维方式在应用于气候变化解决方案时可以做出宝贵的贡献。这些包括一生的经验,反思和认识论的应用,首先不做伤害,管理不确定性,在拥有不完整信息的情况下做出必要决定的能力,对复杂适应系统的欣赏,维持体内平衡,对意外后果的警惕,以及对跨学科和跨专业的重要性的欣赏。摘要:全科医生在公共卫生宣传方面有着悠久的历史,在气候变化的情况下,可能会带来一种解决复杂人类问题的方法,这种方法可以应用于气候变化的困境。
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引用次数: 8
Perception of picky eating among children in Singapore and its impact on caregivers: a questionnaire survey. 新加坡儿童挑食的认知及其对照顾者的影响:一项问卷调查。
Q1 Medicine Pub Date : 2012-07-20 DOI: 10.1186/1447-056X-11-5
Daniel Yt Goh, Anna Jacob

Background: Picky eating is relatively common among infants and children, often causing anxiety for parents and caregivers. The purpose of this study was to determine the key aspects of picky eating and feeding difficulties among children aged 1 to 10 years in Singapore and the impact on their parents or caregivers.

Methods: In this survey, 407 parents or grandparents who are the primary caregivers of children aged 1 to 10 years in Singapore were interviewed via telephone using a structured questionnaire of 36 questions. Respondents were randomly selected from the Singapore Residential Telephone Directory to meet a pre-set interlocked quota of race, sex, and age to represent the population. Quantitative data collected included demographics, body weight and height, respondents' perceptions of the duration of picky eating, the child's eating habits and perceived health status, respondents' attitudes towards picky eating, coping strategies and the impact on family relationships. Bonferroni z-test and t-test were used to indicate significance across groups or demographics, while Pearson correlation coefficient was used to measure the strength of association between variables.

Results: One-half of the respondents reported that the child was 'all the time' (25.1%) or sometimes (24.1%) a picky eater. When aided with a list of typical behaviours, the respondent-reported prevalence of picky eating or feeding difficulties occurring 'all the time' increased to 49.6%. The highest number of respondents first noticed the child's picky eating behaviours or feeding difficulties as early as 1 year (20.0%). Children 3 to 10 years [p = 0.022], children of professional respondents (p = 0.019), and children with a family history of picky eating (p = 0.03) were significantly more likely to be picky eaters. Overall, all 'picky eating' and all 'feeding difficulty' behaviours occurring 'all the time' were significantly associated with caregiver stress when feeding (p = 0.000026 and p = 0.000055, respectively) and with a negative impact on family relationships (p = 0.011 and p = 0.00000012, respectively).

Conclusions: The perceived prevalence and duration of picky eating behaviours and feeding difficulties are high. The impact on the respondent and family relationships appears to be significant in Singapore. Parental concerns about picky eating should be adequately assessed and managed in routine clinic consultations.

背景:挑食在婴儿和儿童中相对常见,经常给父母和照顾者带来焦虑。本研究的目的是确定新加坡1至10岁儿童挑食和喂养困难的关键方面及其对父母或照顾者的影响。方法:在本调查中,通过电话访问了407名新加坡1至10岁儿童的主要照顾者的父母或祖父母,使用了36个问题的结构化问卷。受访者是从新加坡居民电话号码簿中随机抽取的,以满足预先设定的种族,性别和年龄的连锁配额,以代表人口。收集的定量数据包括人口统计、体重和身高、受访者对挑食持续时间的认知、孩子的饮食习惯和健康状况、受访者对挑食的态度、应对策略以及对家庭关系的影响。使用Bonferroni z检验和t检验来表示群体或人口统计学的显著性,而使用Pearson相关系数来衡量变量之间的关联强度。结果:一半的受访者表示孩子“一直”(25.1%)或有时(24.1%)挑食。在典型行为的帮助下,受访者报告的挑食或喂食困难的发生率“一直”增加到49.6%。最多的受访者早在1岁时就注意到孩子的挑食行为或喂养困难(20.0%)。3 ~ 10岁儿童[p = 0.022]、专业被调查者的子女(p = 0.019)和有挑食家族史的儿童(p = 0.03)挑食的可能性显著增加。总体而言,所有“挑食”和所有“喂食困难”行为都与喂食时照顾者的压力显著相关(分别为p = 0.000026和p = 0.000055),并对家庭关系产生负面影响(分别为p = 0.011和p = 0.00000012)。结论:儿童挑食行为和进食困难的发生率和持续时间较高。在新加坡,对受访者和家庭关系的影响似乎是显著的。家长对挑食的担忧应该在常规的临床咨询中得到充分的评估和管理。
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引用次数: 87
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Asia Pacific Family Medicine
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