Funds for Treatment of Hospitalized Patients: Evidence from Bangladesh.

This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. ‘Distress’ selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals.

Pedestrians' Beliefs about Road Crossing in Bogotá: Questionnaire Development / Puntos de Vista de peatones en un cruce de vías en Bogotá: desarrollo de cuestionario

Understanding the pedestrian choices is essential for the design of safe road systems. This study develops methods for self-reported assessment of pedestrian behavior. A self-report instrument was developed to investigate the Theory of Planned Behavior (TPB) constructs in relation to pedestrians' road crossing using a convenient sample. Internal consistency and factor analysis were conducted to test the reliability and construct validity of the instrument. Self-reported intention to execute risky behavior was compared with observed behaviors. The developed questionnaire showed high internal consistency for most of the TPB constructs (Chronbach's alpha>0.7). Factor analyses confirmed that questions grouped in constructs, as hypothesized. Pedestrians' intention to execute risky behavior was related to pedestrians' perceived physical capability and to the simultaneous crossing of other pedestrians. However, this intention correlated moderately with observed risky behavior (Rs = 0.35). The potential to understand the mechanisms of pedestrian choices using the developed instrument are considered exploratory, yet promising.

El poder entender las decisiones que toma un peatón es esencial para el diseño de sistemas viales seguros. Este estudio desarrolla métodos para la medición del comportamiento del peatón por medio de auto-reportes. Se desarrolló un instrumento de auto-reporte para investigar los constructos de la Teoría del Comportamiento Planeado (TPB, por sus siglas en inglés) en relación al cruce de las vías por parte de los peatones, usando una muestra conveniente. Se condujeron análisis de consistencia interna y de factores para probar la confiabilidad y validez de constructos del instrumento. La intención auto-reportada de ejecutar comportamientos riesgosos fue comparada con los comportamientos observados. El desarrollo del cuestionario mostró una alta consistencia interna para la mayoría de los constructos del TPB (alfa de Cronbach > 0.7). El análisis de factores confirmó que las preguntas se agrupaban en constructos, tal y como se hipotetizó; la intención de los peatones de ejecutar comportamientos riesgosos estuvo relacionada con la posibilidad física percibida por los peatones y con el cruce simultáneo de otros peatones. Sin embargo, esta intención se correlacionó solo moderadamente con el comportamiento riesgoso observado (Rs = 0.35). En conclusión, el potencial para entender los mecanismos de las elecciones de los peatones, usando el instrumento desarrollado, se considera aún exploratorio, pero sin embargo prometedor.

The history of laparoscopic general surgery in the Caribbean / Historia de la cirugía general laparoscópica en el Caribe

OBJECTIVE: The first world witnessed a laparoscopic revolution in the 1990s. At the start, laparoscopic surgery was heavily criticized and ridiculed. Despite this, the specialty has blossomed where almost any procedure can be done laparoscopically with the now obvious tremendous benefit to the patients. The objective of this paper is to examine where the Caribbean is placed relative to the rest of the world in terms of laparoscopic surgery and to understand why we are here. DESIGN AND METHODS: The literature written on laparoscopy in the region was reviewed and contributions were taken from key surgeons in three main islands, Trinidad and Tobago, Barbados and Jamaica. RESULTS: Though the first laparoscopic cholecystectomy in the Caribbean, in most islands, took place in the early 1990s like the rest of the world, there was relative dormancy for at least a decade in Trinidad and Tobago and even longer in other islands with regards to implementing advanced procedures or increasing case volumes. Reasons for this included lack of funding, lack of operating time in public facilities, lack of information of the public and the medical fraternity but most importantly lack of trained laparoscopic surgeons. This last factor was proven to be the key one in Trinidad and Tobago in 2003, Jamaica 2005 and Barbados 2011/12, when the return of trained personel engineered the transition from basic to advanced laparoscopy. CONCLUSION: Despite the delay of approximately 10 years in Trinidad and Tobago and 15 years in other islands, the return of trained surgeons has seen a rapid increase in case variety and volumes in laparoscopy. The wheels of motion of the laparoscopic revolution in the Caribbean have finally begun.

OBJETIVO: El primer mundo fue testigo de una revolución laparoscópica en los años 1990. Al comienzo, la cirugía laparoscópica fue muy criticada y ridiculizada. A pesar de ello, la especialidad ha florecido, siendo el caso que ahora casi cualquier procedimiento puede hacerse laparoscópicamente, con evidentes grandes beneficios para los pacientes. El objetivo de este trabajo es examinar donde se encuentra el Caribe en relación con el resto del mundo en lo que se refiere a la cirugía laparoscópica, y asimismo el por qué nos hallamos en ese lugar. DISEÑO Y MÉTODOS: Se examinó la literatura sobre laparoscopia escrita en la región, y se tomaron contribuciones de cirujanos claves de tres islas principales, a saber, Trinidad y Tobago, Barbados y Jamaica. RESULTADOS: Aunque las primeras colecistectomías laparoscópicas en la mayoría de las islas del Caribe, tuvieron lugar a principio de los años 1990 como en el resto del mundo, hubo un período de relativa inactividad por espacio de casi una década en Trinidad y Tobago, y aun por más largo tiempo en otras islas, en relación con la implementación de procedimientos avanzados o el aumento del volumen de casos. Las razones para esta relativa inactividad incluyeron la falta de fondos, la falta de tiempo de operación de los centros públicos, la falta de información del público y la fraternidad médica, pero sobre todo la falta de cirujanos entrenados en laparoscopia. Esto ultimo resultó ser el factor clave en Trinidad y Tobago en 2003, Jamaica en 2005 y Barbados en 2011/12, cuando el regreso del personal entrenado hizo técnicamente posible la transición de una laparoscopia básica a una avanzada. CONCLUSIÓN: A pesar de la demora de aproximadamente 10 años en Trinidad and Tobago, y de 15 años en las otras islas, el regreso de los cirujanos entrenados ha visto un rápido aumento en la variedad casos y los volúmenes de laparoscopia. El motor de la revolución laparoscópica en el Caribe ha por fin echado a andar.

An academic emergency department:residents' perspective / 世界急诊医学杂志（英文）

BACKGROUND: Since demographic changes have contributed to the growth of emergency medicine, a highly populous nation such as India needs to give physicians associated due credit and recognition. The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians. METHODS: The data were collected by direct interaction with residents of the department. Additional information was gathered by observation. The data were verified for validity. RESULTS: This study was to bring out the benefits of proactive decisions that could further enhance the emergency department. But such decisions did not always result in positive responses and improved morale. When such decisions were retracted as it causes misalignment with the existing system. An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine. CONCLUSIONS: The problems faced by emergency department might be similar but the way in which one tackles the situation would be different. Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.