Pub Date : 2019-01-01DOI: 10.29011/2688-7460.100030
Fina Ljp, Lukanu Np, Shomba Lr, Lepira Bf, Ogunbanjo Ga
Background: It is not rare that diabetic patients, motivated by many beliefs, express resistance at the initiation of insulin therapy leading to delays of treatment and subsequent poor control of diabetes. Knowledge of patients’ beliefs towards insulin is essential to better orient the education of diabetics. Methods: This is a cross-sectional study aimed at identifying beliefs about insulin therapy in our community using a psychometric test, “the Ch-ASIQ (The Chinese Attitudes to Starting Insulin Questionnaire)” among 213 diabetic patients in three diabetes management health facilities in Kinshasa. Logistic regression was performed to determine significant beliefs among participants with psychological insulin resistance. The statistical significance level is p <0.05. Results: Out of 213 patients included in the study, 42.7% had psychological insulin resistance. The psychological insulin resistance was motivated by the worry for patients that other people know they have diabetes through the insulin treatment [ORa: 3,44 (1,15-5,56), p: 0,000], the pain caused by insulin injection [ORa: 4.65 (1.42-7.05), p: 0.003], the worry over the need to perform home blood glucose monitoring (OR: 3.55 (1.35-6.87), p: 0.011) and the lack of family support to support them to inject insulin [ORa: 5.43 (2.92) -10.10), p: 0.000]. Conclusion: There is a need for education of both diabetic patients and their entourage in order to successfully remove barriers to insulin adherence. Alleviating financial burden of patients and families will help to face additional obstacles related to cost.
{"title":"Beliefs about Insulin Treatment of Type 2 Diabetic Patients in Kinshasa, Democratic Republic of the Congo","authors":"Fina Ljp, Lukanu Np, Shomba Lr, Lepira Bf, Ogunbanjo Ga","doi":"10.29011/2688-7460.100030","DOIUrl":"https://doi.org/10.29011/2688-7460.100030","url":null,"abstract":"Background: It is not rare that diabetic patients, motivated by many beliefs, express resistance at the initiation of insulin therapy leading to delays of treatment and subsequent poor control of diabetes. Knowledge of patients’ beliefs towards insulin is essential to better orient the education of diabetics. Methods: This is a cross-sectional study aimed at identifying beliefs about insulin therapy in our community using a psychometric test, “the Ch-ASIQ (The Chinese Attitudes to Starting Insulin Questionnaire)” among 213 diabetic patients in three diabetes management health facilities in Kinshasa. Logistic regression was performed to determine significant beliefs among participants with psychological insulin resistance. The statistical significance level is p <0.05. Results: Out of 213 patients included in the study, 42.7% had psychological insulin resistance. The psychological insulin resistance was motivated by the worry for patients that other people know they have diabetes through the insulin treatment [ORa: 3,44 (1,15-5,56), p: 0,000], the pain caused by insulin injection [ORa: 4.65 (1.42-7.05), p: 0.003], the worry over the need to perform home blood glucose monitoring (OR: 3.55 (1.35-6.87), p: 0.011) and the lack of family support to support them to inject insulin [ORa: 5.43 (2.92) -10.10), p: 0.000]. Conclusion: There is a need for education of both diabetic patients and their entourage in order to successfully remove barriers to insulin adherence. Alleviating financial burden of patients and families will help to face additional obstacles related to cost.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480233","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}
Pub Date : 2019-01-01DOI: 10.29011/2688-7460.100028
J. Turabián
The doctor-patient relationship has been and remains a keystone of care. But, there are many ways of understanding, classifying and practicing the doctor-patient relationship. In this scenario, this article begins the task of organizing the different ways of understanding, naming, differentiating, classifying and practicing the doctor-patient relationship. It is concluded that the following concepts can be differentiated: 1) Hierarchy of complexity dimensions of the doctor-patient continuity relationship; 2) According to historical stages; 3) According to the degree of interpersonal relationship; 4) According to the control exercised by the physician or the patient; 5) According to the level of participation; 6) According to the “creators of contexts” models); 7) According to the length of interpersonal continuity; 8) According to pharmacological prescriptions; 9) According to the characteristics of medical service; 10) According to the psychosocial aspects of diseases; 11) According to age; and 12) Doctor-patient relationship with patients and special situations: emigrants, foreigners, patient with ill-defined symptoms, with the insane, with the psychotic, with the patient with visual or hearing impairment, at home, with differences of race, social class, gender, etc.). It is concluded that the doctor-patient relationship is a complex, multiple and heterogeneous concept that cannot be defined in a unique way or generalize the concept of “good” relationship, but there are “many doctorpatient relationships” appropriate according to their contexts, which also implies redefining the instruments for measuring this relationship.
{"title":"Doctor-Patient Relationships: A Puzzle of Fragmented Knowledge","authors":"J. Turabián","doi":"10.29011/2688-7460.100028","DOIUrl":"https://doi.org/10.29011/2688-7460.100028","url":null,"abstract":"The doctor-patient relationship has been and remains a keystone of care. But, there are many ways of understanding, classifying and practicing the doctor-patient relationship. In this scenario, this article begins the task of organizing the different ways of understanding, naming, differentiating, classifying and practicing the doctor-patient relationship. It is concluded that the following concepts can be differentiated: 1) Hierarchy of complexity dimensions of the doctor-patient continuity relationship; 2) According to historical stages; 3) According to the degree of interpersonal relationship; 4) According to the control exercised by the physician or the patient; 5) According to the level of participation; 6) According to the “creators of contexts” models); 7) According to the length of interpersonal continuity; 8) According to pharmacological prescriptions; 9) According to the characteristics of medical service; 10) According to the psychosocial aspects of diseases; 11) According to age; and 12) Doctor-patient relationship with patients and special situations: emigrants, foreigners, patient with ill-defined symptoms, with the insane, with the psychotic, with the patient with visual or hearing impairment, at home, with differences of race, social class, gender, etc.). It is concluded that the doctor-patient relationship is a complex, multiple and heterogeneous concept that cannot be defined in a unique way or generalize the concept of “good” relationship, but there are “many doctorpatient relationships” appropriate according to their contexts, which also implies redefining the instruments for measuring this relationship.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69479358","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}
Pub Date : 2019-01-01DOI: 10.29011/2688-7460.100036
Ann Sedeeq, Akram Al-Salman, Arshdeep Tindni
Membranous Nephropathy (MN) is one of the most common causes of nephrotic syndrome characterized by insidious onset, nephrotic range proteinuria, reduced renal function, and can lead to end stage renal disease. Treatment regimens for MN have been described including steroids treatment in combination with cyclophosphamide or calcineurin inhibitors, cyclosporine or tacrolimus. Adrenocorticotropin (ACTH) has been increasingly studied for various glomerulopathies, most notably MN and growing evidence suggesting that ACTH maybe an effective treatment option.
{"title":"The Use of ACTH Gel in Membranous Nephropathy","authors":"Ann Sedeeq, Akram Al-Salman, Arshdeep Tindni","doi":"10.29011/2688-7460.100036","DOIUrl":"https://doi.org/10.29011/2688-7460.100036","url":null,"abstract":"Membranous Nephropathy (MN) is one of the most common causes of nephrotic syndrome characterized by insidious onset, nephrotic range proteinuria, reduced renal function, and can lead to end stage renal disease. Treatment regimens for MN have been described including steroids treatment in combination with cyclophosphamide or calcineurin inhibitors, cyclosporine or tacrolimus. Adrenocorticotropin (ACTH) has been increasingly studied for various glomerulopathies, most notably MN and growing evidence suggesting that ACTH maybe an effective treatment option.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480187","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}
Pub Date : 2019-01-01DOI: 10.29011/2688-7460.100039
M. Yordanova
Aim: To evaluate the oxidative stress and antioxidant protection in patients with chronic Gastroduodenitis and the relationship between their levels with the etiologic agent H. pylori and how this affects iron homeostasis. Introduction: Several records indicate that oxidative stress plays a significant role in the pathogenesis and progression of chronic inflammatory diseases of the gastrointestinal tract. H. pylori infection generates free oxygen and nitrogen species (ROS/RNS) cause damage to the gastric mucosa. Materials and Methods: 55 patients with gastritis and 80 healthy volunteers were studied, with a mean age of 59.69±11.52 and 53.8 ±0.8 years, respectively. Both groups define routine laboratory parameters (including CRP and Iron). Serum levels of antibodies against H. pylori (ELISA DiaMetra Italy) and antigenic presence in faecal matter were examined. Patients undergo endoscopic examination. Oxidative stress (dROMs) and serum antioxidant capacity (BAP) were determined spectrophotometrically on a semi-automatic Carpe diam analyzer. (Diacron Labs Italy). Statistical methods used: T-test for comparison of mean values, descriptive and correlation analysis. Results: The patient group showed significantly elevated mean dROMs values compared to the control group. Levels in patients with H. pylori infection differ significantly from HP negative ones. The BAP test showed a significant decrease compared to the control group. A similar relationship exists between the two patient groups for the BAP test. A moderate positive correlation between CRP and dROMs was found, and a moderate negative correlation with the BAP test. Increasing dROMs and decreasing BAP results in a decrease in serum iron levels. Conclusion: Determination of oxidative stress levels, antioxidant protection, and iron homeostasis may be used in the monitoring of patients with chronic Gastroduodenitis.
{"title":"Oxidative Stress and the Antioxidant Capacity of Plasma in Patients with Helicobacter pylori -Positive Gastroduodenitis and the Effect on Serum Iron Levels","authors":"M. Yordanova","doi":"10.29011/2688-7460.100039","DOIUrl":"https://doi.org/10.29011/2688-7460.100039","url":null,"abstract":"Aim: To evaluate the oxidative stress and antioxidant protection in patients with chronic Gastroduodenitis and the relationship between their levels with the etiologic agent H. pylori and how this affects iron homeostasis. Introduction: Several records indicate that oxidative stress plays a significant role in the pathogenesis and progression of chronic inflammatory diseases of the gastrointestinal tract. H. pylori infection generates free oxygen and nitrogen species (ROS/RNS) cause damage to the gastric mucosa. Materials and Methods: 55 patients with gastritis and 80 healthy volunteers were studied, with a mean age of 59.69±11.52 and 53.8 ±0.8 years, respectively. Both groups define routine laboratory parameters (including CRP and Iron). Serum levels of antibodies against H. pylori (ELISA DiaMetra Italy) and antigenic presence in faecal matter were examined. Patients undergo endoscopic examination. Oxidative stress (dROMs) and serum antioxidant capacity (BAP) were determined spectrophotometrically on a semi-automatic Carpe diam analyzer. (Diacron Labs Italy). Statistical methods used: T-test for comparison of mean values, descriptive and correlation analysis. Results: The patient group showed significantly elevated mean dROMs values compared to the control group. Levels in patients with H. pylori infection differ significantly from HP negative ones. The BAP test showed a significant decrease compared to the control group. A similar relationship exists between the two patient groups for the BAP test. A moderate positive correlation between CRP and dROMs was found, and a moderate negative correlation with the BAP test. Increasing dROMs and decreasing BAP results in a decrease in serum iron levels. Conclusion: Determination of oxidative stress levels, antioxidant protection, and iron homeostasis may be used in the monitoring of patients with chronic Gastroduodenitis.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480280","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}
Pub Date : 2018-08-07DOI: 10.29011/2688-7460.100020
Aletha W. Tippett
Objective: The objective of this paper is to present observational data to support the premise of using a 650-microsecond Nd:YAG 1064 nm laser for wound healing. Background: Laser light treatment has been reported to stimulate collagen production, the primary reason lasers are useful for cosmetic procedures such as reducing wrinkles and smoothing skin lines [1,2]. This ability to stimulate collagen, the main protein involved in wound healing, provokes the idea that a cosmetic laser could be used to promote wound healing. When working with chronic wounds, one of the main goals is to stimulate dermo-fibroblast synthesis of collagen. A demonstrated way to do this is by serial debridements, plus there are many biotech products are on the market that attempt to aid in this, in addition to, or instead of, serial debridements of the wound [3]. Cold laser therapy has actually been used for years to stimulate wound healing, but the technology has not been widely applied [3]. There have been a number of published articles on using lasers for wound healing [4-6]. Most of these use low level lasers, not cosmetic lasers, but there have been several published studies using Nd: YAG lasers for wound healing [7-9]. Multiple types of laser have been tried, especially for diabetic wound healing and have found low-energy is helpful but more research is needed [10]. The consensus from published articles is that low level laser therapy in the range of 4-8 joules/cm2 is beneficial for wound healing. Some practitioners are seeing results using multiple passes with 11 joules, but there is some study that higher laser power can be harmful to a wound by inducing scarring [7,8,11]. Having a non-invasive simple method that predictably will promote wound healing would be a boon to the millions of people suffering from various chronic wounds and for their caregivers trying to heal these wounds. Case Report The 650-microsecond Nd:YAG 1064 nm laser has been used by this writer for over 10 years for a variety of purposes, including wound stimulation. The Nd:YAG is a cosmetic laser and certainly can be used for a variety of purposes: hair removal, skin rejuvenation, scar reduction, wrinkle removal, lesion ablation, acne, etc. This laser, made by Aerolase, has a unique 650-microsecond pulse duration which enables the pulse to be delivered in a collimated beam, so that skin contact by the handpiece is not necessary (as it is with other lasers), and also it has the ability to dial in the fluence used, down all the way to 4 joules/cm2 at the lowest setting. In 2006 a report was made of using this laser on 17 wound patients over 10 weeks. All patients were treated with 4 joules/cm2, single pass. Patients were treated at various intervals. Overall, 11 or 65% of wounds improved, 3 or 18% had no change, 1 patient was lost to follow-up and 1 patient had increased pain with no improvement in the wound. A variety of wounds were treated, including pressure, neuropathic, radiation fibrosis, an
目的：本文的目的是提供观测数据，以支持使用650微秒Nd:YAG 1064nm激光进行伤口愈合的前提。背景：据报道，激光治疗可以刺激胶原蛋白的产生，这是激光用于美容手术的主要原因，如减少皱纹和平滑皮肤线条[1，2]。这种刺激胶原蛋白（参与伤口愈合的主要蛋白质）的能力引发了美容激光可以用于促进伤口愈合的想法。在处理慢性伤口时，主要目标之一是刺激皮肤成纤维细胞合成胶原蛋白。一种已证明的方法是进行连续清创术，此外，除了或代替伤口的连续清创外，市场上还有许多生物技术产品试图帮助实现这一点[3]。冷激光治疗实际上已经用于刺激伤口愈合多年，但该技术尚未得到广泛应用[3]。已经发表了许多关于使用激光进行伤口愈合的文章[4-6]。其中大多数使用低水平激光，而不是美容激光，但已有几项已发表的研究使用Nd:YAG激光进行伤口愈合[7-9]。已经尝试了多种类型的激光，特别是用于糖尿病伤口愈合，并发现低能量是有帮助的，但还需要更多的研究[10]。从已发表的文章中得出的共识是，4-8焦耳/cm2范围内的低水平激光治疗有益于伤口愈合。一些从业者看到了使用11焦耳多次通过的结果，但有一些研究表明，更高的激光功率可能会导致疤痕，对伤口有害[7，8，11]。有一种非侵入性的简单方法可以预见地促进伤口愈合，这对数百万患有各种慢性伤口的人以及他们试图治愈这些伤口的护理人员来说都是一件好事。病例报告本文作者使用650微秒Nd:YAG 1064nm激光器已超过10年，用于各种目的，包括伤口刺激。Nd:YAG是一种美容激光，当然可以用于多种用途：脱毛、皮肤再生、疤痕减少、除皱、病灶消融、痤疮等。这种由Aerolase制造的激光具有独特的650微秒脉冲持续时间，可以以准直光束传输脉冲，因此不需要手持件与皮肤接触（与其他激光一样），而且它还能够在最低设置下将所使用的注量一直降低到4焦耳/cm2。2006年，一份关于在10周内对17名伤口患者使用这种激光的报告。所有患者均接受4焦耳/平方厘米的单次通过治疗。患者在不同的时间间隔接受治疗。总的来说，11%或65%的伤口得到了改善，3%或18%没有变化，1名患者失去了随访，1名病人疼痛加剧，伤口没有改善。治疗了多种伤口，包括压力性、神经性、辐射性纤维化和烧伤。对650微秒Nd:YAG 1064nm激光用于伤口愈合的回顾性研究表明，它可能是一种有效的辅助仪器，值得进一步研究。执行此程序的风险级别是最低的。使用激光时应佩戴适当的护目镜。使用的激光通量非常低，在这个水平上，大多数人甚至感觉不到，而且手机根本不会接触到皮肤，也没有大多数美容激光常见的麻木或冷却凝胶。不会有人受伤或流血。预计不会出现与激光治疗相关的不适。预期收益证明所涉及的风险最小。650微秒的Nd:YAG激光可能成为伤口护理中的一种有用的辅助手段，同时也为更多的研究确定理想的使用通量开辟了可能性。由于之前的初步工作，预计患者的伤口会比现有的替代方法愈合得更快。对有伤口的患者使用一次4焦耳/cm2的低通量激光治疗。其中两个如下所示。引文：Tippett AW（2018）用650微秒1064nm激光进行伤口愈合治疗。J Family Med Prim Care Open Acc:JFOA-120。DOI:10.29011/JFOA120。100020 2卷2018；问题02一位37岁的糖尿病妇女脚部烧伤。由于周围神经病变，当她用加热器睡觉时，她感觉不到烧伤。有趣的是，她看过五位医生，他们都告诉她脚需要截肢。她看到了我，在做了病史后，我确定她有烧伤，并进行了适当的治疗。我确实在她的伤口上使用了激光，下面的照片显示了治疗的开始和结束。激光治疗极大地改善了她的伤口。她的伤口完全愈合，没有留下疤痕，人们无法判断她是否有过伤口（图1）。
{"title":"Wound Healing Therapy With a 650-Microsecond 1064nm Laser","authors":"Aletha W. Tippett","doi":"10.29011/2688-7460.100020","DOIUrl":"https://doi.org/10.29011/2688-7460.100020","url":null,"abstract":"Objective: The objective of this paper is to present observational data to support the premise of using a 650-microsecond Nd:YAG 1064 nm laser for wound healing. Background: Laser light treatment has been reported to stimulate collagen production, the primary reason lasers are useful for cosmetic procedures such as reducing wrinkles and smoothing skin lines [1,2]. This ability to stimulate collagen, the main protein involved in wound healing, provokes the idea that a cosmetic laser could be used to promote wound healing. When working with chronic wounds, one of the main goals is to stimulate dermo-fibroblast synthesis of collagen. A demonstrated way to do this is by serial debridements, plus there are many biotech products are on the market that attempt to aid in this, in addition to, or instead of, serial debridements of the wound [3]. Cold laser therapy has actually been used for years to stimulate wound healing, but the technology has not been widely applied [3]. There have been a number of published articles on using lasers for wound healing [4-6]. Most of these use low level lasers, not cosmetic lasers, but there have been several published studies using Nd: YAG lasers for wound healing [7-9]. Multiple types of laser have been tried, especially for diabetic wound healing and have found low-energy is helpful but more research is needed [10]. The consensus from published articles is that low level laser therapy in the range of 4-8 joules/cm2 is beneficial for wound healing. Some practitioners are seeing results using multiple passes with 11 joules, but there is some study that higher laser power can be harmful to a wound by inducing scarring [7,8,11]. Having a non-invasive simple method that predictably will promote wound healing would be a boon to the millions of people suffering from various chronic wounds and for their caregivers trying to heal these wounds. Case Report The 650-microsecond Nd:YAG 1064 nm laser has been used by this writer for over 10 years for a variety of purposes, including wound stimulation. The Nd:YAG is a cosmetic laser and certainly can be used for a variety of purposes: hair removal, skin rejuvenation, scar reduction, wrinkle removal, lesion ablation, acne, etc. This laser, made by Aerolase, has a unique 650-microsecond pulse duration which enables the pulse to be delivered in a collimated beam, so that skin contact by the handpiece is not necessary (as it is with other lasers), and also it has the ability to dial in the fluence used, down all the way to 4 joules/cm2 at the lowest setting. In 2006 a report was made of using this laser on 17 wound patients over 10 weeks. All patients were treated with 4 joules/cm2, single pass. Patients were treated at various intervals. Overall, 11 or 65% of wounds improved, 3 or 18% had no change, 1 patient was lost to follow-up and 1 patient had increased pain with no improvement in the wound. A variety of wounds were treated, including pressure, neuropathic, radiation fibrosis, an","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41915925","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}
Pub Date : 2018-08-01DOI: 10.29011/2688-7460.100019
J. Shuval
There is growing evidence that alternative health care practitioners and conventional physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense the issues involved concern processes of accommodation and social change. In an effort to examine the dynamics of the processes involved, data were collected twice: In 2000-2001, in an extensive research undertaking when CAM was beginning to show its presence in hospital settings and again in 2015 when a more modest second round of supplementary research was undertaken in an effort to observe changes over time. In 2000-2001 data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem 19 persons were interviewed including 10 alternative practitioners working in a variety of fields and 9 conventional medical practitioners who worked with them (6 physicians and 3 nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. In 2015-2010 in-depth interviews were carried out with CAM practitioners and policy makers in the Israel Ministry of Health and in a variety of health care institutions. These interviews focused on the role and functions of CAM in Israeli hospitals over the intervening period. Observations were carried out in selected hospital settings. An in-depth literature search regarding research and policy statements on the role of CAM in Israeli hospitals during the intervening period provided an overview of empirical changes. The paper discusses the early modes of entry into Israeli hospitals, the dilemmas faced and the mechanisms used to overcome barriers. The findings of the first wave of interviews suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no cases accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. Considerable increases in the number, activity and visible presence of alternative practitioners in the hospitals occurred by 2016. These are discussed along with the mechanisms utilized to expand their presence in Israeli hospitals. Citation: Shuval JT (2018) Practicing Alterna
{"title":"Practicing Alternative Medicine in Israeli Hospitals","authors":"J. Shuval","doi":"10.29011/2688-7460.100019","DOIUrl":"https://doi.org/10.29011/2688-7460.100019","url":null,"abstract":"There is growing evidence that alternative health care practitioners and conventional physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense the issues involved concern processes of accommodation and social change. In an effort to examine the dynamics of the processes involved, data were collected twice: In 2000-2001, in an extensive research undertaking when CAM was beginning to show its presence in hospital settings and again in 2015 when a more modest second round of supplementary research was undertaken in an effort to observe changes over time. In 2000-2001 data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem 19 persons were interviewed including 10 alternative practitioners working in a variety of fields and 9 conventional medical practitioners who worked with them (6 physicians and 3 nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. In 2015-2010 in-depth interviews were carried out with CAM practitioners and policy makers in the Israel Ministry of Health and in a variety of health care institutions. These interviews focused on the role and functions of CAM in Israeli hospitals over the intervening period. Observations were carried out in selected hospital settings. An in-depth literature search regarding research and policy statements on the role of CAM in Israeli hospitals during the intervening period provided an overview of empirical changes. The paper discusses the early modes of entry into Israeli hospitals, the dilemmas faced and the mechanisms used to overcome barriers. The findings of the first wave of interviews suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no cases accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. Considerable increases in the number, activity and visible presence of alternative practitioners in the hospitals occurred by 2016. These are discussed along with the mechanisms utilized to expand their presence in Israeli hospitals. Citation: Shuval JT (2018) Practicing Alterna","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42664810","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}
Pub Date : 2018-07-23DOI: 10.29011/2688-7460.100018
Holger Olofsson, L. Carlsson, B. Bertilson
Introduction: Multimorbidity is defined as the simultaneous occurrence of several diseases where none of them is considered as the most important one. In Primary Care a large part of the visits consists of patients with pain disorders. Patients with back pain and diseases related to the spine constitute the largest group of these patients. However, little is known if patients with back pain have a higher degree of multimorbidity than patients without back pain. The aim of this epidemiological study was to investigate which were the most frequent simultaneously concurrent diseases together with back pain. Method: We performed a cross-sectional study of all visits involving back pain to one Primary Health Care Centre in Stockholm, Sweden during the period October 2011 to September 2014. Patients over 20 years of age suffering from back pain were compared, concerning all their diagnoses and number of visits with those who were not diagnosed with back pain. Results: Out of 12,017 adult patients, 971 had back pain; 57% women and 43% men. The patients with back pain had a higher degree of multimorbidity, more primary health care visits and more diagnoses compared to those without back pain. For essentially all of the 20 most common diagnoses the patients with back pain had a higher prevalence ratio. Most evident among these diagnoses was abdominal pain, which had twice as high prevalence among patients with back pain compared to those without. Discussion: Our study showed that patients with back pain had a higher degree of multimorbidity compared to those who did not have back pain. The most frequent concurrent diseases were other pain disorders especially abdominal pain. This finding raises the question if there may be some connection between the innervation from the spine and this concurrent disorder.
{"title":"Multimorbidity among Patients with Back Pain: A Study of Records at a Swedish Primary Health Care Centre","authors":"Holger Olofsson, L. Carlsson, B. Bertilson","doi":"10.29011/2688-7460.100018","DOIUrl":"https://doi.org/10.29011/2688-7460.100018","url":null,"abstract":"Introduction: Multimorbidity is defined as the simultaneous occurrence of several diseases where none of them is considered as the most important one. In Primary Care a large part of the visits consists of patients with pain disorders. Patients with back pain and diseases related to the spine constitute the largest group of these patients. However, little is known if patients with back pain have a higher degree of multimorbidity than patients without back pain. The aim of this epidemiological study was to investigate which were the most frequent simultaneously concurrent diseases together with back pain. Method: We performed a cross-sectional study of all visits involving back pain to one Primary Health Care Centre in Stockholm, Sweden during the period October 2011 to September 2014. Patients over 20 years of age suffering from back pain were compared, concerning all their diagnoses and number of visits with those who were not diagnosed with back pain. Results: Out of 12,017 adult patients, 971 had back pain; 57% women and 43% men. The patients with back pain had a higher degree of multimorbidity, more primary health care visits and more diagnoses compared to those without back pain. For essentially all of the 20 most common diagnoses the patients with back pain had a higher prevalence ratio. Most evident among these diagnoses was abdominal pain, which had twice as high prevalence among patients with back pain compared to those without. Discussion: Our study showed that patients with back pain had a higher degree of multimorbidity compared to those who did not have back pain. The most frequent concurrent diseases were other pain disorders especially abdominal pain. This finding raises the question if there may be some connection between the innervation from the spine and this concurrent disorder.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42736692","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}
Pub Date : 2018-01-01DOI: 10.29011/2688-7460.100021
F. Alnasir
Life is becoming too sophisticated, with increasing daily pressure, which might be related to modernization. Everyone is by all accounts occupied and have no time, neither for themselves nor for social bonds. Health problems, on the other hand, are increasing, in particular, non-communicable diseases (NCDs). The latter are prevailing worldwide but more in the developing countries in particular obesity which has reached a scary figure in the Gulf Countries with a prevalence reaching more than 50% [1]. Moreover, the complications of NCDs have escalated leading, in addition, to disabilities and loss of effective workforce, economic constraints that became catastrophic to countries suffering from poverty which may hinder the proper and efficient provision of health care services to the population. Adding to these issues, the fact that the world is aging, and the population trend is changing making more of older people are living in solitary. They at this stage of life need more preventative health attention to be conveyed to them at home, since they may not access health services at the institutions.
{"title":"Is there a Need for Home Health Care Services?","authors":"F. Alnasir","doi":"10.29011/2688-7460.100021","DOIUrl":"https://doi.org/10.29011/2688-7460.100021","url":null,"abstract":"Life is becoming too sophisticated, with increasing daily pressure, which might be related to modernization. Everyone is by all accounts occupied and have no time, neither for themselves nor for social bonds. Health problems, on the other hand, are increasing, in particular, non-communicable diseases (NCDs). The latter are prevailing worldwide but more in the developing countries in particular obesity which has reached a scary figure in the Gulf Countries with a prevalence reaching more than 50% [1]. Moreover, the complications of NCDs have escalated leading, in addition, to disabilities and loss of effective workforce, economic constraints that became catastrophic to countries suffering from poverty which may hinder the proper and efficient provision of health care services to the population. Adding to these issues, the fact that the world is aging, and the population trend is changing making more of older people are living in solitary. They at this stage of life need more preventative health attention to be conveyed to them at home, since they may not access health services at the institutions.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69477941","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}
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