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BACKGROUND@#This study aimed to describe the status of alcohol consumption and drug use among young adults as well as their determinants.@*METHODS@#We conducted a cross-sectional study of 356 young adults (aged 18 to 24 years) living in Palau in 2013. The prevalence of self-reported alcohol and marijuana usage were compared within and between sexes, age groups, ethnicities, and education levels.@*RESULTS@#The proportion of current drinking was higher in people aged 21-24 than in those aged 18-20 (73.2% vs. 60.9%, p = 0.09 in men and 48.3% vs. 30.0%, p = 0.02 in women), while that of marijuana use did not differ between the age groups. The proportions of current drinking and marijuana use were higher in Palauan than in other ethnicities (current drinking: 70.6% vs. 40.6%, p = 0.005 in men and 38.8% vs. 16.6%, p = 0.04 in women; lifetime marijuana use: 80.0% vs. 52.9%, p = 0.02 in men and 56.1% vs. 30.6%, p = 0.09 in women). The proportion of frequent (3 times or more) marijuana users was higher for the lower educated than for the higher educated (62.5% vs. 32.1%, p < 0.001 in men and 33.9% vs. 24.4%, p = 0.12 in women).@*CONCLUSIONS@#Sex, age, ethnicity, and education were significant determinants of alcohol and marijuana use.
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Female , Humans , Male , Young Adult , Age Factors , Alcohol Drinking/ethnology , Cross-Sectional Studies , Educational Status , Marijuana Use/ethnology , Palau/epidemiology , Prevalence , Sex FactorsABSTRACT
Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions.Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach.Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues.Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.
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Objective: This study aimed to explore the gender differences in wishes and feelings regarding end-of-life care among Japanese elderly people requiring home care services.Patient/Materials and Methods: This study was a secondary analysis of the qualitative data previously compiled from a total of 102 elderly people living at home. The data was retrospectively collected from the participants’ nursing records, which included a designated advance care planning (ACP) form completed between January and July 2015. Out of the 102 participants, 86 men and women who were either living alone or with a spouse were selected for the present analysis. We reviewed the participants’ ACP forms based on which of the sentiments on the following checklist were expressed: anxiety about the future, abandonment of control, clinging to current daily life, inadequate support from spouse, and a tendency to delegate decision-making.Results: The most commonly expressed feeling was abandonment of control, among both men and women. Among elderly people living alone, women were more likely to want to be surrounded by good, caring people when approaching the end of their lives. Among elderly people living with a spouse, women were more likely to want to delegate decision-making to others.Conclusion: Our results pointed to a gender difference in the attitudes of elderly people toward interactions with the people surrounding them during the end-of-life decision-making process. In order to provide better overall care, health care professionals must come to realize the importance of this gender difference, as it has an impact on the ACP choices made by elderly people living in the community.
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Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment.Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50–69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates.Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.
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<p><b>Introduction:</b> High-quality, community-based dementia care requires a comprehensive, holistic approach. This study aimed to identify the barriers to achieving efficient cooperation and coordination among medical professionals, care managers, and medical social workers, and to improve the management model of community-based, integrated dementia care.</p><p><b>Methods:</b> We collected qualitative data through three focus group discussions at JA Konan Kosei Hospital. Thirteen participants (four directors of nursing service departments, three chief nurses, four medical social workers, and two care managers) were recruited for the discussions. The data were analyzed using an inductive, multi-step approach referred to as the qualitative content analysis.</p><p><b>Results:</b> Nine themes arose as follows: little attention given to patient wishes, lack of time and space to provide high-quality care, disturbing hospital environment, poor compensation for staff members, refusing to visit outpatient clinics, declined admission, daily life support by family members and caregivers, dementia care team, and community bonding.</p><p><b>Conclusion:</b> The participants wanted to launch a dementia care team in their hospital to improve the care environment and the quality of dementia-specific care. The study also suggested that advance care planning could be systematically implemented in clinical practice as a way to honor the decisions made by dementia patients.</p>
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<b>Objective:</b> Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan.<b>Methods:</b> Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (<i>p-</i>value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI).<b>Results:</b> Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99).<b>Conclusion:</b> Receipt of comprehensive medication management services for older people was associated with medication adherence.
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<b>Background and Objective</b><BR> The prevalence of non-communicable diseases (NCD) is increasing in low- and middle-income countries, imposing major public health and development threats. However, there is difference among countries with regard to the patterns of NCD metabolic risk factors. This study aims to categorize the pattern of metabolic risk factors in East Asia, Southeast Asia and Oceania. <BR><b>Methods</b><BR> Age-standardized prevalence of obesity, raised blood pressure, raised blood glucose, and raised blood cholesterol for 2008 were obtained from the World Health Organization (WHO) Global Health Observatory Data Repository. We used hierarchical cluster analysis to categorize countries in East Asia, Southeast Asia and Oceania based on the prevalence of NCD metabolic risk factors of each country. <BR><b>Results</b><BR> Three patterns of NCD metabolic risk factors were identified. The first pattern showed relatively high prevalence of raised blood cholesterol, while prevalence of obesity, raised blood pressure and raised blood glucose remain relatively low. Most high- and upper-middle-income Asian countries were included in this pattern. The second pattern presented relatively high prevalence of raised blood pressure, although prevalence of obesity, raised blood glucose, and raised blood cholesterol stay relatively low. Most low- and lower-middle-income Asian countries were categorized in this pattern. The third pattern presented high prevalence of obesity and relatively high prevalence of raised blood pressure and raised blood glucose. This pattern included most Pacific island countries.<BR><b>Conclusions</b><BR> Policy makers in countries in East Asia, Southeast Asia, and Oceania should take into account for the features of the pattern they are in, when they set priorities for developing effective NCD control measures.
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<B>Introduction</B><BR>The use of medicines among Brazilian workers in Japan has not been documented. This study examines the preferences and use of medicines among Brazilian workers of Japanese origin in Japan.<BR><B>Methods</B><BR>A cross-sectional survey was conducted in 2011 in a community in Nagoya, where many Brazilian workers lived. Questionnaires were distributed to 206 Brazilian households, and asked about preferences and use of Japanese or Brazilian medicines. Associations with socioeconomic factors were analyzed using Fisher's exact test.<BR><B>Results</B><BR>The response rate was 36% (74 households). Of these, 66% had lived in Japan for over 10 years, and 88% held health insurance. Over 80% reported a preference for Japanese medicines. However, Brazilian medicines were used in more than 40% of the households. Employed Brazilians tend to use Brazilian medicines compared to the unemployed. Most respondents answered that Brazilian medicines were more effective, but were more expensive and produced worse side effect than Japanese medicines.<BR>Households with children showed a preference for Japanese medicines for children's illnesses. However, more Brazilian medicines were used when the length of household's stay in Japan was less than 10 years, and when the respondent's perceived listening ability of Japanese language was poor.<BR><B>Conclusion</B><BR>Almost all respondents were using the medicines they preferred, suggesting that access to medicine was generally good in the community. However, 40% of respondents used Brazilian medicines, despite their long stay in Japan, their health insurance status, and their recognition of Japanese medicines as inexpensive and safe. This might be explained by familiarity with Brazilian medicines, or perception of their effectiveness.<BR>Continuous self-administration of medicines without consultation has potential harm to the health. This study also suggests the importance of arranging social environments such as facilitating the taking of sick leaves, so that immigrant workers can secure their access to health services.
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<B>Introduction</B><BR>Health Sector Reform Program (HSRP) in Egypt started in 1997 to improve equity, efficiency, quality and sustainability of Egyptian health systems. This study aims to review reports and publications regarding HSRP in Egypt and to analyze its achievements and problems.<BR><B>Methods</B><BR>Documents of international organizations and other relevant agencies, such as reports of health sector reform programs and statistics, were reviewed and analyzed.<BR><B>Results</B><BR>HSRP aimed to improve quality of health services and equality of access, and to establish sustainable health financing mechanisms, while focusing on primary health care. Major components of HSRP were: health service delivery, health financing, and evaluation. It started in five pilot governorates. Based on the Family Health Model (FHM), each family registered to a physician or a health facility, and was provided with essential medical services called Basic Benefits Package (BBP). Family Health Fund (FHF), the newly established financing agency of FHM, provided health staff with incentives from a pooled fund. Against the original plan, FHF could not function as a health insurance fund, and was financially unsustainable. Mechanisms of health facility accreditation and health services performance evaluation with incentives were installed to ensure the quality of health services.In addition, health staff training programs were enhanced, health facilities and equipment in rural areas were improved, and referral systems were strengthened.<BR><B>Conclusions</B><BR>HSRP introduced a family health model for the first time in Egypt in pilot governorates. Focusing basic health service provision, HSRP succeeded to improve equity, efficiency and quality of health services. However, sustainable health insurance mechanisms were not established yet, and involvement of private health service providers were very limited. It is needed to bring in commitment of Egyptian government across the sectors and to develop health systems that secure good quality of health services for all Egyptians.
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<b>Background</b><br> Under resource-limited circumstances, standard clinical practice for prioritized illnesses and conditions were introduced to nurses and midwives in primary health care (PHC) facilities in Timor-Leste. This research aims to asses the use of medicines and standard treatment guidelines (STGs) in community health centers (CHCs) in Timor-Leste and to analyze factors that influence adherence to STGs.<br><b>Methods</b><br> Randomly sampled 20 CHCs without beds were visited from February to August, 2006. In each CHC, 100 retrospective samples from patient registration books and 30 prospective observations were collected and then quantitatively analyzed. Open-ended interviews to three members of health personnel per CHC were qualitatively analyzed.<br><b>Results</b><br> Use of injections in Timor-Leste was extremely low when compared to results from other countries that used the same international indicators. The percentage of encounters with an antibiotic prescribed was significantly lower for prescribers with clinical nurse training than those without the training. A significantly higher level of prescribing adherence was observed among clinical nurse prescribers. None of the facility characteristics investigated was associated with the CHC's overall prescribing adherence to STGs. Open-ended interviews to CHC health personnel revealed that changes brought about by the introduction of STGs were positively perceived by respondents, especially clinical nurses.<br><b>Discussion</b><br> Unlike previous studies on physician adherence to STGs in western countries, changes brought about by the introduction of STGs were positively perceived by PHC health personnel in Timor-Leste. STGs were developed and introduced in a policy framework that reflected local needs and reality and related with the Basic Package of Health Services policy and other policies and programs, such as human resource development, medicines policy and resource allocation plans. That fact was considered to have produced positive results in this study. Timor-Leste's experience implies a potential of STGs for non-physician health personnel working at PHC level in other resource-limited areas.
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Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages. <br> Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions. <br> Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.
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This study aimed to analyze roles and status of Iraqi female medical doctors in the society and their homes, their career consciousness, influence of conflicts upon health services in Iraq. As Iraq is an Islamic society in conflicts, this study further aimed to provide a basis to consider the feasibility and problems to train them in neighboring countries, as well as possibilities of future training courses. <br>We conducted face-to-face interviews to 16 Iraqi female medical doctors who participated in a four-week-training course in Egypt under the trilateral medical technical cooperation project. We could not carry out our survey in Iraq because of security concerns.<br>Most of the interviewed Iraqi female medical doctors were engaged in obstetrics and gynecology or pediatrics, and they usually examined female patients. These female medical doctors were highly motivated and rarely felt the gender discrimination in their work sites. They tended to choose husbands who would not hinder their professional career. They were also keen to participate in training courses outside Iraq, if the duration of the courses were within a few months. Their family agreed to send wives or daughters abroad alone for the training. Quality of the training was the most important for those doctors. Therefore, the religion or the distance from Iraq to the training places did not matter much. They expected that training courses of the hospital management systems and nurses'awareness raising should be taken place in future. <br>Female health professionals are preferable to provide female patients with health services in Islamic societies. Although, women and children are especially vulnerable in times of conflicts, the current security situation in Iraq prevents them from receiving direct support. Therefore, this study suggests that inviting female medical doctors to abroad for medical training should be a worthwhile alternative to improve the health status of women and children in Iraq.
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Many people have been killed or physically disabled during twenty-year internal conflict in Cambodia. People still get injured due to remained land mines and unexplosive ordnances, even a decade after the cease-fire. This paper aims to examine the situation of the physically disabled and assistance programs in Cambodia by analyzing published documents and visiting activity sites, and to discuss future challenges. In this paper, the physically disabled mainly implies adults and children with orthopedic impairments.<br>The major causes of physical disability are: land mines; unexplosive ordnances; traffic accidents; occupational accidents such as falling down from palm trees; infectious diseases, etc. Casualties of land mines and unexplosive ordnances were 50,915 (13,686 were dead) between 1979 and 2000. Recently, the number of land mine accidents has been declining, while that of traffic accidents has been increasing. <br>Since 1980s, many international NGOs have assisted land mine victims through providing with artificial limbs, prostheses and rehabilitation services. However, the assistance for the disabled people of other categories has been neglected. The international NGOs provide services based on their own interests, therefore, the participation of the disabled people and their family in the assistance programs has been limited. The government plays only limited roles to endorse the activities of the international NGOs, and has not had any specific strategies to prepare for the future withdrawal of the NGOs.<br>Disabled people require assistance not only for health, but also for education, employment, etc. On the other hand, it is also very important to empower and build capacity of them, so that they can contribute to the development of the Cambodian society. Additionally, means of prevention should be considered as one of the key perspectives. Sustainable supporting systems should be established by the government and domestic NGOs through participation of the disabled themselves.
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[Objectives] This study aims to analyze women's health issues in post-conflict Cambodia and to discuss the impacts of conflicts on women's health.<br>[Methods] We collected a wide range of literatures and analyzed the historical background and the situation of health and health services in Cambodia. We visited the Ministry of Health, international agencies and health facilities in urban and rural areas for collecting information. We conducted semi-structured interviews to community women, health staff and married men, as well as focus group discussions (FGD) among women. <br>[Results and Discussions] During Pol Pot regime in the late 1970s, most people were subjected to forced migration and hard labor, and many of them, particularly intellectuals, were killed. As a result, most people are still suffering from physical and mental problems, and the reconstruction of the health services delayed due to shortage of skilled personnel including physicians. Health services have been improved dramatically since 1990s by receiving various international aids. However, gaps between the rich and the poor have been widened.<br>Although most women told that they had some health problems, those who were very poor or separated from their husbands seemed to suffer more seriously than those who had no family problems, and to be unable to control their emotions while talking about experiences during the conflict. This might be caused by unhealed psychological trauma, which, in turn, disturbed the reconstruction of their lives. Most women recognized that conflicts affected their health status and they also admitted that poverty and ill-health formed a vicious cycle. Possible interventions should empower women so that they can develop their latent capacities and rebuild community networks.<br>[Conclusion] It is important to focus on the access to the basic health services for the rural and urban poors. It is also important to improve mental health support, so that the poor women can get over the past experience.