Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius

Abstract Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.

Health workforce in India: opportunities and challenges

Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.

Structural quality of antenatal clinics in the public health sector in a Northern district in Kerala, India.

Background: To achieve the 5th Millennium Development Goal countries throughout the world are investing more energy and resources in providing equitable, adequate maternal health services. Objectives of the study was to assess the quality of structural attributes in the antenatal clinics in public health sector. Methods: A cross sectional study was conducted in 30% of the institutions at various levels in the public health sector in Kozhikode district during September to February 2010-11. Structural quality was assessed using a checklist. A 3-point score was used. Mean score was used for comparing between different levels. The actual score for each attribute was calculated as percentage of maximum total and standard of 60 % was taken as cut off to categorize facilities as good or poor. Results: Out of the 28 institutions studied, 12 had good score for structural attributes. Attributes like general infrastructure, availability of basic diagnostic equipments and maintenance and cleanliness of health facility scored well at all levels. General Infrastructure was found to be good in 23 health facilities; maintenance was good in 17 facilities and 19 facilities scored well for Basic Diagnostic Equipments. Basic Laboratory Facilities was grossly inadequate in all institutions especially at the PHC level. Only 8 facilities had Adequate Drugs Supply. The overall score for all the structural attributes (p 0.008) was found to be significantly different between the various levels of public health sector with good scores at MCH, TH and BPHC level and difference in scores was found to be significant with regards to availability of Basic Laboratory Services (p 0.032); Basic Diagnostic Equipments (p 0.031) and availability of drugs (p 0.005). Conclusions: Further improvement in this regard is necessary in the PHCs, BPHCs and CHCs.

Cantidad y distribución de otorrinolaringólogos en los sectores público y privado de salud en Chile / Quantity and distribution of otolaryngologists in public and private health sectors in Chile

Introducción: Constantemente se menciona que existe un déficit de otorrinolaringólogos en Chile. Se desconoce la distribución entre el sector público y privado de salud. Objetivo: Determinar la cantidad y distribución de los otorrinolaringólogos que trabajan en el sector público y privado de salud en Chile. Material y método: Estudio de corte transversal para el que se usaron registros del Ministerio de Salud, Sociedad Chilena de Otorrinolaringología, Superintendencia de Salud y del Departamento de Estadísticas e Información en Salud. Resultados: Se aprecia que hay 152 especialistas que trabajan en el sector público, en contraste con los 405 totales del país, correspondiendo a 37,5% de los profesionales que trabajan en el sectorpúblico. Al evaluar el total de otorrinolaringólogos registrados a nivel nacionaly la población total se obtiene una relación de 1 otorrinolaringólogo/42.589 habitantes, mientras que la relación de otorrinolaringólogos que trabajan en sector público con población beneficiaria de FONASA es de 1 otorrinolaringólogo/85.162 habitantes. Discusión: El principal problema en Chile no es la cantidad de otorrinolaringólogos, sino su distribución, la que es muy asimétrica. Esto es considerando sólo el número de otorrinolaringólogos, no su carga horaria, ya que al evaluar esta relación probablemente la asimetría aumentaría aún más. Es necesario fomentar la permanencia de los especialistas en el sector público.

Introduction: Constantly there are mentions that there is a shortage of otolaryngologists in Chile. It is unknown the reality of the distribution between public and private health sector. Aim: The objective of this study was to determine the amount and distribution of otolaryngologists working in the public and private health sector in Chile. Material and method: A cross sectional study that used the records of the Ministry of Health, Chilean Society of Otolaryngology, Superintendent of Health, and Department of Health Statistics and Information. Results: There are 152 specialists working in the public sector, in contrast to the 405 total in the country, corresponding to 37,5(0)% of total professionals working in the public sector. In assessing the relationship between total otolaryngologists in the country with the total population, and otolaryngologists working in the public sector and the beneficiary population of FONASA, there is a relationship of 1 ORL/42.589 and 1 ORL/85.162 inhabitants, respectively. Discussion: The main problem in Chile is not the amount of otolaryngologists, but its distribution, which is very asymmetric between the private and public sector. It is necessary to promote the retention of specialists in the public sector.

Acupuntura en un servicio hospitalario en Argentina: experiencias y perspectivas de los usuarios / Acupuncture in a hospital setting in Argentina: users' experiences and perspectives / Acupuntura em um serviço hospitalar na Argentina: experiências e perspectivas dos usuários

Indagamos las experiencias y perspectivas de los usuarios de un servicio hospitalario público de acupuntura del noroeste argentino. Basamos el análisis en 18 entrevistas semi-estructuradas realizadas en el año 2005. Los entrevistados recurren a la acupuntura por dolencias crónicas, especialmente como paliativo del dolor, aunque varios extienden su uso para otros problemas de salud, frente a la ineficacia y/o efectos adversos de los tratamientos biomédicos, o para evitar cirugías menores. Incorporan la acupuntura a estrategias pluralistas de cuidado que junto con la biomedicina incluyen típicamente otras medicinas no convencionales. El contexto hospitalario facilita que prueben una medicina foránea. Varios usuarios encuentran el servicio de asesoramiento para "negociar" los tratamientos con sus médicos convencionales. Destacan la eficiencia organizativa del servicio y el compromiso de los médicos. Ante la demanda creciente de atención en un contexto de escasez de recursos advierten que ésta puede afectar la disponibilidad de turnos y la interacción médico-paciente.

We investigate the experiences and perspectives of users of a public hospital-based service of acupuncture located in the Northwest region of Argentina. In 2005 we interviewed 18 patients. They use acupuncture for chronic conditions, mostly to alleviate pain-- although several extended its use over time to treat other health problems-because of the limited efficacy experienced with biomedicine and the adverse effects of medications, or to avoid surgical interventions. They incorporate acupuncture into pluralistic health care strategies, which in addition to biomedicine typically include other unconventional medicines. The hospital context facilitates the use of an alternative medicine, and some patients find in the service guidance to "negotiate" treatments with conventional physicians. The organizational efficiency and the doctors' commitment to their work were highly valued. Due to the increasing demand for treatments in a context of scarce resources, patients worry that the availability of appointments and doctor-patient interactions may be affected.

Investigamos experiências e perspectivas dos usuários de um serviço hospitalar público de acupuntura do noroeste argentino. Baseamos a análise em 18 entrevistas semi-estruturadas realizadas no ano 2005. Os entrevistados recorrem à acupuntura por doenças crônicas, especialmente como paliativo da dor, embora vários estendam seu uso para outros problemas de saúde, diante da ineficácia e/ou efeitos adversos dos tratamentos biomédicos, ou para evitar cirurgias menores. Incorporam a acupuntura a estratégias pluralistas de cuidado, que junto com a biomedicina incluem tipicamente outras medicinas não convencionais. O contexto hospitalar facilita o fato de experimentar uma medicina alternativa. Vários usuários buscam o serviço de apoio para "negociar" os tratamentos com seus médicos convencionais. Destacam a eficiência organizacional do serviço e o compromisso dos médicos. Diante da demanda crescente de atenção em um contexto de escassez de recursos os usuários advertem que ela pode afetar a disponibilidade para marcar consultas médicas e a interação médico-paciente.

A regulação no setor público de saúde no Brasil: os (des) caminhos da assistência médico-hospitalar / Regulation in the public health sector in Brazil: the (mis) direction of hospital care provision

A regulação é uma função pública imprescindível para garantir maior efetividade às ações desenvolvidas pelos sistemas de saúde. Nesse estudo, são analisados os principais instrumentos de regulação da assistência à saúde criada pelo Sistema Único de Saúde (SUS), vis-à-vis a evolução histórica da prestação de serviços hospitalares entre 1996 e 2006. Apesar das mudanças políticas e organizacionais exigidas pelo processo de reforma sanitária na implementação do SUS, e dos avanços detectados, evidências e dados empíricos sugerem incipiência e fragilidade dos mecanismos de regulação pactuados, que não foram capazes de mudar os padrões históricos e as características gerais da assistência hospitalar no SUS. O artigo apresenta uma possibilidade explicativa preliminar para a ação de grupos de interesse que teriam participado ativamente do processo de regulação, canalizando recursos públicos para os segmentos dos prestadores privados e filantrópicos de serviços assistenciais, que atuam no setor saúde brasileiro há décadas e se perpetuaram no SUS, distorcendo o processo de implementação do sistema e a prestação de serviços de alta relevância para a sociedade brasileira.

Health care regulation is a fundamental action in order to achieve effectiveness in health system. This article analyses SUS [Unified Health System] main regulatory framework, in relation to historical patterns of health service delivery, observed between 1996 and 2006. Despite all those political and organizational changes required by the Brazilian health sector reform process to implement SUS, which progressed, evidences and empirical data suggest that the agreed regulatory frameworks are weak and fragile and they did not change historical patterns and the main characteristics of SUS health care. This article suggests one possible explanatory reason for this behaviour, that needs to be empirically analysed: interest groups acting inside the Brazilian health system, on behalf of social insurance health care network, could capture the regulatory process, taking public resources to this network which maintain the same pattern of heath care services for decades, jeopardizing SUS implementation and the relevant health service delivery for the Brazilian society.

The Medical Doctors' Opinion of Public Health Center on the Development and Supply of Medical Doctor for Public Health Sector / 農村醫學 地域保健

OBJECTIVES: This study, as for activating measures for capable medical physicians to penetrate into the public health sector, is to provide a basic informations which are used for the enlargement of human resources of physicians in the public health sector, by investigating the perception of physicians, who are now working in the public health center, on the training and development of physicians in the public health sector. METHODS: The subjects of this study were 126 individuals. The data was analyzed by frequency analysis using SPSS ver. 17.0K. RESULTS: According to the investigation of 'how to support physicians in public health sector', the necessity of almost questions is considered to be important. Especially, regarding to investigation on 'obstacles of physicians' entrance to public health sector', 'relatively low salary' and 'lack of promotion chances' were thought to be considerable. The most significant education programs to work for public health sector is to improve the ability of health administration planning and service performance. CONCLUSIONS: The important methods to reinforce and easily obtain the human resources of physicians in public health sector are not only to improve the penetration of physicians to public health sector, but also to enhance the ability of present physicians, even though sufficient recruitment of physicians is essential.