Use of Sealants in Permanent Molars by Brazilian Dentist: A Comparative Study of Public versus Private

Abstract Objective: To compare the use of sealants in permanent molars between public and private dentists in Brazil. Material and Methods: This was a cross-sectional and analytical web survey study. The convenience sample consisted of dentists in Brazil who answered a pre-tested online form released via social media between July and October 2021. Descriptive analysis was performed using absolute and relative frequencies (%) and associations using the Chi-square test (p<0.05). Results: Brazilian professionals participated in the study (n=2,244). Comparing the professionals from the public service with those from the private service, the former had a higher positive perception of the use of sealants as a preventive (92.4% vs. 81.1%, p<0.00l) and therapeutic procedure (90.7% vs. 82.4%, p=0.00l), higher percentage of non-invasive (91.7% vs. 83.8%, p<0.00l) and invasive (22.8% vs. 12.0%, p< 0.001) techniques. Professionals from the private service reported more frequently that they did not use sealants than those from the public service (14.0% vs. 4.8%, p<0.00l). Resin sealant (97.7% vs. 94.9%, p=0.0l5) and Flow resin (62.0% vs. 54.3%, p=0.013) were the most used by professionals in the private service. The use of glass ionomer cement was not associated with the type of service (75.1% vs. 77.2%, p=0.172), nor was the use of adhesives (0.6% vs. 1.4%, p=0.195) or resin with Giomer technology (1.9% vs. 2.2%, p=0.856) (p>0.05). Conclusion: The percentage of use of sealants among dentists in Brazil is high, especially among professionals in the public service, and the most used materials were resinous sealants and glass ionomer cement.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists? / Fatores subjetivos não clínicos influenciam na tomada de decisão do tratamento de cirurgiões-dentistas brasileiros?

ABSTRACT The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used to analyze the answers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

RESUMO Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantes subjetivas (sociodemográfica e profissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

Fixed-prosthodontics in Nigerian private practice settings

Context: Private practice dentistry is predominant in Nigeria. Audits of fixed-prosthodontic practice in these settings are rare and will highlight capacity and guide training. This study aimed to assess the scope and quality of fixed-prosthodontic practice in such settings in Nigeria. Objectives: The study sought to assess: Participants' sociodemographic and their diagnostic and preoperative practices. The quality of impression making and operative technique, reviews and maintenance, temporization practices and communication with the laboratory.The range of treatments given and provision of advanced treatments. Materials and Methods: An adapted questionnaire was administered electronically on Nigerian dentists practicing fixed-prosthodontics in private practice settings. Retrieved data underwent descriptive statistics and associations were tested with the Fischer's Exact and Chi-Square tests using IBM SPSS Statistics version 21. Statistical significance was set at p≤0.05. Results: A total of 100 valid responses with a male:female ratio of 2.1:1 from 16 states wereretrieved. Fifty-nine participants had only first degrees and mean experience was 14.3±9.5 years. There were 27 adequate responses with regards to range of treatments offered. Sixty-three participants practiced direct temporization. Twenty-one and 14 participants regularly practiced implantology and CAD/CAM dentistry respectively. Direct temporization was significantly associated with increasing education (X2=6.03, p=0,05) and experience (X2=13.2, p=0.03). Conclusion: Only a few Nigerian dentists in private practice gave an adequate range of treatment. Most of them prefer direct temporization. Implantology and CAD/CAM dentistry practice are improving, but are still not very common.

Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.

Concentraciones de 25-hidroxivitamina-D en mujeres que asisten a una consulta externa privada en Medellín, Colombia / 25-hydroxyvitamin-D levels in women attending a private outpatient clinic in Medellín, Colombia

Resumen OBJETIVO Determinar el perfil clínico y epidemiológico de pacientes con bajas concentraciones de vitamina D atendidas en la consulta externa de endocrinología ginecológica de una institución privada de Medellín, Colombia. MATERIALES Y MÉTODOS Estudio transversal, descriptivo y retrospectivo basado en la revisión de historias clínicas (2013-2014). La información se recolectó en un formulario diseñado ex profeso, se almacenó y analizó en SPSS v.21. Para las variables cuantitativas con distribución normal se calculó el promedio y desviación estándar; para la distribución no normal se estimaron medianas y rangos intercuartílicos; a las variables cualitativas se les estimaron frecuencias absolutas y relativas. RESULTADOS Se analizaron 63 pacientes con mediana de edad de 50 años; 77.8% económicamente activas y 71.4% de estratos socioeconómicos altos. El 50.8% tuvo deficiencia de vitamina D (menos de 20 ng/mL) y 49.2% insuficiencia (20-29.9 ng/mL). El 23.8% de las pacientes recibió suplementos de vitamina D; 7.9% reportó exposición solar significativa y 68.3% usaba bloqueador solar diario. El hipotiroidismo (41.3%), la fatiga crónica (30.2%), la dislipidemia (28.6%) y la osteoporosis (19%) fueron las principales comorbilidades encontradas. CONCLUSIÓN La hipovitaminosis D es relativamente frecuente entre las pacientes que consultan en el servicio de endocrinología ginecológica, lo que supone un aumento en el riesgo de padecer ciertas enfermedades; la prevalencia fue mayor que la reportada para la población general.

Abstract OBJECTIVE To determine the clinical and epidemiological profile of patients with low levels of vitamin D that attended the gynecologic endocrinology consultation of a private institution of Medellin. MATERIALS AND METHODS Cross-sectional, retrospective and descriptive study based on the review of medical records of women older than 18 years who attended the gynecologic endocrinology consultation with low levels of vitamin D. The information was collected by filling out a form designed by the researchers, it was stored and analyzed in SPSS vr.21. Quantitative variables with normal distribution, are expressed as mean with standard deviation; those with non-normal distribution, as median with interquartile range, and qualitative variables as absolute and relative frequencies. This study had the support of the Ethics Committee of the institution. RESULTS 63 women were analyzed, their average age was 50 years, 77.8% were economically active and 71.4% were of the highest socioeconomic status. 50.8% had vitamin D deficiency (<20 ng/mL), while 49.2% had insufficiency (20-29.9 ng/mL). 23.8% of patients were being treated with vitamin D, only 7.9% reported significant sun exposure and 68.3% used sunscreen daily. The main comorbidities were hypothyroidism 41.3%, chronic fatigue 30.2%, dyslipidemia 28.6% and osteoporosis 19%. CONCLUSION Vitamin D deficiency is relatively common among patients who attend the gynecologic endocrinology services, representing an increase in the risk of certain diseases, which shows a higher prevalence than that reported for the general population.

Descriptive analysis of mycological examination of patients with onychomycosis treated in private practice

ABSTRACT This is a retrospective study of 160 patients treated in private practice in São Paulo from March 2003 to March 2015. We analyzed 171 results of direct mycological examinations and fungal cultures from nail scrapings. The agreement between direct mycological examination results and fungal culture was satisfactory, consistent with the literature (kappa 0.603). The main agent identified was Trichophyton rubrum (51%). We observed an isolation rate of non-dermatophyte filamentous fungi superior to the literature (34%). Determining the agent is key to defining the appropriate onychomycosis treatment, and knowing the epidemiology of patients treated in private practice helps the dermatologist who works in this context.

Actividad laboral de médicos egresados de la Universidad de Chile generaciones 2007 a 2010: análisis según sede y año de egreso / Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year

Background: The University promotes practices and values that influence their students in the pursuit of their occupational interests. Aim: To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. Material and Methods: Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. Results: The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. Conclusions: The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

Core nursing practice and educational requirements according to nursing unit and clinical career in tertiary hospital / 기본간호학회지

PURPOSE: The purpose of this study was to provide fundamental data to develop an educational program for the development of nurses' core competences, and to improve the curriculum in nursing education institutions. METHODS: This study, based on a descriptive survey, was conducted with 1,019 nurses working in a tertiary hospital in Seoul. Among 47 core nursing practice items, core nursing practices as perceived by the participants and relevant educational requirements were measured on a four-point scale. The collected data were analyzed using descriptive statistics for the mean and standard deviation, one way ANOVA, and Duncan test as post-hoc test. RESULTS: Regarding the core nursing practice perceived as by the nurses, there were statistically significant differences in 43 out of 47 items according to nursing unit, and in 15 items according to clinical career. Regarding the educational requirements for core nursing practice, there were also statistically significant difference for the same items as perception differences according to nursing unit and clinical career. CONCLUSION: The results of this study suggest further study on the development of educational programs to advance the clinical expertise of nurses and for the development of curriculum reflecting the actual conditions and requirements in clinical nursing practice fields.

The Experiences of Nursing Student on Alcoholism Care / 한국간호교육학회지

PURPOSE: The aim of this study was to describe the experiences of student nurses during their clinical practice periods in an alcoholic ward. METHODS: A descriptive phenomenological study design was employed. Individual interviews were conducted and audio-taped. Colaizzi's method of data analysis was applied to inductively determine themes and formulated meanings. Data saturation was achieved and methodological rigor was established. RESULTS: Four themes were identified and these themes included anxiety of nursing practice in unfamiliar setting, sympathy with patients, learning about the inpatient alcoholics care, and self-reflection. CONCLUSION: Nursing students had positive and negative experiences in their clinical practice. The results of this study had important implications regarding clinical practice and research for nursing clinical education.

Psicoterapia Psicodramática grupal em clínica privada: terapeutas e seus desafios / Psychodramatic group psychotherapy in the private practice: therapists and their challenges

Este trabalho investigou como a Psicoterapia Psicodramática Grupal tem acontecido nas clínicas privadas de dez psicoterapeutas brasileiras de Minas Gerais, São Paulo e Goiás. Entre outras categorias criadas a partir da análise dos conteúdos das respostas, foram analisados o tempo de atuação e a idade dessas profissionais Tem havido dificuldades na criação e na manutenção de grupos psicoterapêuticos, em virtude de fatores como dificuldades relacionadas aos próprios clientes, às condições socioeconômicas e culturais, e ao próprio psicoterapeuta. A psicoterapia de grupo em clínicas privadas deverá ser reconfigurada para que possa se difundir mais, atingindo, assim, uma parcela ainda maior da população que busca ajuda profissional para os relacionamentos interpessoais. Cabe aos psicoterapeutas psicodramatistas continuar acreditando no potencial terapêutico dos grupos, para recriá-lo em nossos tempos...

This paper investigates how psychodramatic group psychotherapy has ensued in ten Brazilian psychotherapists' private practice in Minas Gerais, São Paulo and Goiás. Based on the information gathered, aspects such as psychotherapists' age, and work experience were analyzed, among others. The results indicate that psychotherapists experienced difficulties with the setting up and maintenance of psychotherapeutic groups, due to factors such as difficulties related to the clients themselves, to the socioeconomic and cultural environment, and to the psychotherapist themself. Group psychotherapy in private practice needs to be restructured in order to be better disseminated, and to be able and reach an even larger portion of the population who are seeking professional help for their interpersonal relationships. Psychodrama psychotherapists need to keep on believing in the therapeutic potential of groups, in order to re-create them to the needs of our present times...

Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan

OBJECTIVES: To investigate if general dental practitioners (GDPs) in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs). MATERIAL AND METHODS: A sample (n=100) of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36 percent of the preparations, 54 percent demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39 percent. Twenty-nine percent and 12 percent of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18 percent of dies of each type. Only 17 percent of all preparations were found to follow the recommended anatomical labial preparations while 29 percent of the RBC preparations were found to have the recommended axial convergence angle. In total, 43 percent of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

The allure of the private practitioner: Is this the only alternative for the urban poor in India.

The main objective of the study has been to identify trajectories of health seeking behaviour of the urban poor, particularly their use of the private health sector, with the aim to identify strategies to improve quality of health care for this burgeoning population. This article presents findings from a slum settlement in Delhi where ethnographic sub-studies were carried out over two years among private health providers and selected households alongside a survey of household expenditure patterns. The primary research tools were in-depth interviews with practitioners and key informants as well as observations of clinical interactions. Illness narratives and case studies were documented over two years. The software package q.s.r. Nvivo was used for coding and content analysis. It was found that almost 90% of the respondents exclusively depend on local unlicensed and unregistered practitioners for basic primary health care. Long distances, time-consuming procedures, rude behaviour and, in many cases, bribes that had to be paid to staff in the hospitals were cited as major deterrents to utilising government facilities. Despite the public health consequences of inappropriate treatment protocols and misuse of drugs by these untrained private providers, in the absence of a structured urban primary health care system in the country, they seem to be the only alternative for the burgeoning urban poor in vast metros such as Delhi.

Attitude of Korean Primary Care Family Physicians Towards Telehealth / 가정의학회지

BACKGROUND: Recently, a revised telehealth legislation that allows direct doctor to patient teleconsultation was proposed in Korea. However, there have been some debates. This study aimed to examine the attitude of primary care physicians towards telehealth. METHODS: A questionnaire asking attitude towards telehealth and revised telehealth legislation was self-administered to 1,988 registered members of Practitioners Council of Korean Academy of Family Medicine. A total of 218 complete responses by family physicians were included in the study. RESULTS: Large proportion (60.6%) of participants disagreed to the main clause of revised telehealth legislation, which allowed doctor to patient teleconsultation. Participants tended to expect that negative outcomes are more likely to occur than positive outcomes after the enforcement of the revised telehealth legislation. Around 50% of participants had an intention to adopt telehealth just as soon (4.6%) or afterwards (45.4%). The majority of participants suggested that; primary care clinic as the most appropriate telehealth facility (75.4%); patients with low accessibility to medical care (74.3%) as the best target of telehealth service; and tele-radiology (61.9%) or tele-pathology (41.3%) as the most applicable medical field for telehealh service. Around 89% of participants suggested telehealth service fee to be similar or higher than current medical consultation fee. CONCLUSION: The majority of family physicians participating in this study were not in favor of the revised telehealth legislation. However, the majority of the participants had an intention to adopt telehealth to their practice and held clear opinion about practical aspects of telehealth.

Optometric Practice in Private Sector Around Kuala Lumpur and Klang Valley: A Preliminary Study / Jurnal Sains Kesihatan Malaysia

This survey was carried out to examine the habits of practising optometrists in private practice around Kuala Lumpur and the Klang Valley. A questionnaire survey was prepared that encompassed questions on ophthalmic intruments and appliances, services offered, eye examinations carried out and patient management, failure to carry out comprehensive eye examination, community engagements and their opinion on optometrists as primary eyecare practitioners. The questionnaire was sent to 100 registered optometrists practising in Kuala Lumpur and the Klang Valley. About 64 optometrists responded and returned the questionnaire, but 3 of them were excluded because they were incomplete. The results showed almost all optometric practice has all the equipment related to optometry practice except for tonometer and visual field measurement. Forty-four percent (44%) of optometrists undertook comprehensive eye examinations and if necessary referred patients for further examinations. Optometrists who did not perform comprehensive eye examinations give reasons of inadequate equipment and clients who want a quick examination. In conclusion optometric practice provide almost all the equipments required for optometrists to practice as primary health care practioners but only 44% of optometrists carried out comprehensive eye examinations. Optometrists in private practice need to practice all the skills they learned and play important roles in educating the public in an effort to improve the primary eyecare of society

Qualitative Research on Experience of Primary Physicians Operating Their Primary Health Care Centers / 가정의학회지

BACKGROUND: The purpose of the study was to understand how family physicians managed their primary health care centers and to identify the factors for successful management of their privative clinics. METHODS: The data was collected through individual interviews from five family physicians who operated their private clinics. All interviews were tape-recorded and transcribed into verbatim data. The data was analyzed using qualitative content analysis. RESULTS: Three major categories were identified: 1) types of physician based on major value as a doctor; 2) difficulties in operation and management; 3) desirable operating strategies for success. The first category described what kinds of value the physicians pursued as they operated their private clinics. Two different types were identified. One was intrinsic value oriented and the other was extrinsic value oriented. The second category illustrated many difficulties that family physicians faced in operating and managing their private clinics. Lack of private time, social isolation, and gap between mission and reality of practice were identified as major difficulties. Desirable strategies for the successful management were four subcategories: location; self-oriented developmental plan; specialization of the services; and activating network with larger hospitals. CONCLUSION: The results of the study would be helpful in setting up and operating private clinics through understanding the difficulties and strategies of primary physicians and recognizing mission and major value of them.

Changes of Medico-pharmaceutical Profession and Private Practice from the Late 19th Century to the Early 20th Century : Ebb and Flow of Western Pharmacies and Clinics Attached to Pharmacy / 의사학

This article examined i) how traditional medico-pharmaceutical custom from the late 19th century influenced such changes, ii) how medical laws of Daehan Empire and early colonial period influenced the differentiation of medico-pharmaceutical profession, and iii) what the responses of medico-pharmaceutical professionals were like, and arrived at following conclusions. First, in late Chosun, there was a nationwide spread of pharmacies (medicine room, medicine store) as general medical institutions in charge of prescription and medication as well as diagnosis. Therefore, Koreans' perception of Western medicine was not very different from that of traditional pharmacy. Second, Western pharmacies were established by various entities including oriental doctors, Western doctors and drug manufacturers. Their business ranged from medical consultation, prescription, medication and drug manufacture. This was in a way the extension of traditional medico-pharmaceutical custom, which did not draw a sharp line between medical and pharmaceutical practices. Also, regulations on medical and pharmaceutical business of Daehan Empire did not distinguish oriental and Western medicine. Third, clinics attached to pharmacy began to emerge after 1908, as some Western pharmacies that had grown their business based on selling medicine began to hire doctors trained in Western medicine. This trend resulted from Government General's control over medico-pharmaceutical business that began in 1908, following a large-scale dismissal of army surgeons trained in medical schools in 1907. Fourth, as specialization increased within medico-pharmaceutical business following the colonial medical law in early 1910s, such comprehensive business practices as Western pharmacy disappeared and existing businesses were differentiated into dealers of medical ingredients, drug manufacturer, patent medicine businessmen and herbalists. And private practice gradually became the general trend by establishment of medical system with doctors at the pinnacle and spread of modern Western medicine, and support of capitalists.

A Survey of Pediatricians in Private Practices Who Participated in Community-Based Clerkships: An Intellectual, Inspirational and Professional Growth Experience

PURPOSE: To examine how pediatricians in private practices are affected by the process of training medical students in their clinics as part of a community-based clerkship program. MATERIALS AND METHODS: In 2007, a questionnaire was sent to 35 pediatricians who had provided private clinical settings for clerkship training for the previous 3 years. The questionnaire covered a number of points, including the pediatricians' motivation to join and/or reasons to quit the program; if there were changes seen in their stress levels while supervising students; changes in their treatment procedures or attitudes because of the students' presence; responses of patients and/or their guardians in regard to have medical students treating them, and whether the doctors were inspired to grow professionally by participating in the program. RESULTS: Of the 35 pediatricians, 31 (88.5%) responded. Eighteen respondents (58%) selected 'responsibility to cooperate with medical school' as a reason to participate. Fifteen physicians (48.3%) answered that the clerkship program had a positive impact on their treatment procedures and their attitude towards patients. CONCLUSION: Based on the pediatricians' responses, the community-based clerkship program may instill intellectual inspiration and promote professional growth among the pediatricians in private practices, resulting in potentially better treatment for patients.

Male midwives: preferred managers of sexually transmitted infections in men in developing countries? / ¿Se prefieren enfermeros obstétricos para el control de las infecciones de trasmisión sexual en hombres en los países en desarrollo?

OBJECTIVES: To describe demographic and practice characteristics of male and female midwives in private practice (MIPPs) in 10 cities of Peru, and their role in the delivery of reproductive health care, specifically management of sexually transmitted infections (STIs). METHODS: As part of an intervention trial in 10 cities in the provinces of Peru designed to improve STI management, detailed information was collected regarding the number of midwives in each city working in various types of practices. A door-to-door survey of all medical offices and institutions in each city was conducted. Each MIPP encountered was asked to answer a questionnaire regarding demographics, training, practice type(s), number of STI cases seen per month, and average earnings per consultation. RESULTS: Of the 905 midwives surveyed, 442 reported having a private practice, either exclusively or concurrently with other clinical positions; 99.3 percent of these MIPPs reported managing STI cases. Andean cities had the highest density of MIPPs, followed by jungle and coastal cities, respectively. Jungle cities had the largest proportion of male MIPPs (35.5 percent). While both male and female MIPPs reported seeing male patients, male MIPPs saw a significantly greater number than their female counterparts. CONCLUSIONS: In areas of Peru where physicians are scarce, MIPPs provide needed reproductive health services, including STI management. Male MIPPs in particular appear to serve as health care providers for male patients with STIs. This trend, which may exist in other developing countries with similar healthcare workforce demographics, highlights the need for new areas of training and health services research.

OBJETIVOS: Describir las características demográficas y de la práctica profesional del personal de enfermería obstétrica en consultorios privados (ECP) según el sexo en 10 ciudades de Perú y el papel que desempeñan en los cuidados de salud reproductiva, específicamente en la atención de las infecciones de transmisión sexual (ITS). MÉTODOS: Como parte de un ensayo de intervención en 10 ciudades de diferentes provincias de Perú, diseñado para mejorar la atención de las ITS, se recogió información detallada del personal de enfermería obstétrica ocupado en diferentes tipos de consultorios de cada ciudad. Se realizó una encuesta de puerta en puerta en todos los consultorios e instituciones médicas de cada ciudad. A cada ECP localizado se le pidió responder un cuestionario sobre datos demográficos, entrenamiento, tipo(s) de consultorio(s), número de casos de ITS atendidos mensualmente e ingresos medios por consulta. RESULTADOS: De los 905 enfermeros y enfermeras encuestados, 442 informaron tener una consulta privada, ya sea de forma exclusiva o concurrente con otros cargos clínicos; 99,3 por ciento de estos ECP manifestaron atender casos de ITS. Las ciudades andinas presentaron la mayor densidad de ECP, seguidas por las de la selva y la costa, en ese orden. Las ciudades de la selva presentaron la mayor proporción de ECP hombres (35,5 por ciento). Aunque tanto los ECP hombres como las ECP mujeres informaron atender pacientes masculinos con ITS, los ECP hombres atendieron un número significativamente mayor que sus contrapartes mujeres. CONCLUSIONES: En zonas de Perú donde no hay suficientes médicos, los ECP ofrecen los servicios necesarios de salud reproductiva, incluida la atención de las ITS. En particular, los ECP hombres parecen servir como proveedores de atención sanitaria a pacientes masculinos con ITS. Esta tendencia, que podría existir en otros países en desarrollo con personal sanitario con características demográficas similares, resalta la necesidad de establecer nuevas líneas de entrenamiento e investigación en servicios de salud.

Sexually transmitted infections and private physicians in Peru, 2003 / Las infecciones de transmisión sexual y los médicos privados en Perú, 2003

Objectives. To analyze demographic and practice characteristics of private physicians in 10 cities of Peru, and to shed light on the role of private practice in the delivery of medical care to patients with sexually transmitted infections (STIs). Methods. As part of an interventional trial designed to improve physician management of STIs in 10 cities in Peru, detailed information was compiled regarding numbers of physicians in each city. A door-to-door survey was then conducted within each city of all private and public medical offices and institutions. Each physician encountered who had a private practice was asked to answer a questionnaire regarding demographic information, medical education, specialty, type of private and public practices currently engaged in, number of STI cases seen per month, and average earnings per consultation. Results. Of 2 060 physicians working in the 10 cities, 507 reported having a private practice, either exclusively or concurrently with other clinical positions. Almost all the private physicians (97.4%) reported managing cases of STIs. Regional differences among private physicians were found in physician density, gender, and place of medical training. In addition, significant variations by gender were seen in rates of specialization, earnings per consultation, and numbers of female patients with STIs seen per month. Conclusions. Studies of the physician workforce can provide meaningful insights for potential use in addressing public health problems. This study provides valuable information that can help understand the important role of private physicians in managing STIs in Peru

Objetivos. Analizar las características demográficas y profesionales de los médicos privados en 10 ciudades de Perú y esclarecer el papel que desempeña la medicina privada en la atención de pacientes con infecciones de transmisión sexual (ITS). Métodos. Como parte de un ensayo de intervención diseñado para mejorar el control de las ITS en 10 ciudades de Perú, se recopiló información detallada sobre el número de médicos de cada ciudad y se realizó una encuesta de puerta en puerta en todas las instituciones y consultorios, tanto privados como públicos. A todos los médicos contactados que tenían consulta privada se les pidió responder un cuestionario que recogía información demográfica y sobre la formación médica, especialidad, tipo de servicios privados y públicos que prestaba en ese momento, número de casos de ITS que atendía mensualmente y sus ingresos promedio por consulta. Resultados. De los 2 060 médicos que trabajaban en las 10 ciudades estudiadas, 507 informaron tener consulta privada, ya sea de forma exclusiva o compartida con otros trabajos clínicos. Casi todos los médicos privados (97,4%) informaron que atendían casos de ITS. Se encontraron diferencias entre las regiones en cuanto a la densidad y el lugar de entrenamiento de los médicos privados. Además, se observaron variaciones significativas según el sexo en la proporción de médicos especialistas, los ingresos por consulta y el número de mujeres con ITS que atienden mensualmente. Conclusiones. Los estudios sobre la disponibilidad de médicos pueden ofrecer una perspectiva interesante y de gran utilidad para abordar problemas de salud pública. Este estudio brinda una valiosa información que puede contribuir a comprender el importante papel que desempeñan los médicos privados en el control de las ITS en Perú

A Survey of the Controlling System for the Pulmonary Tuberculosis in Jejudo, 2002 / 결핵

BACKGROUND: The nationwide tuberculosis registry system in Korea has been operated with the dual reporting system - public health center (PHC) and private medical services (PMS) - since 2000. While three-fifths of the registered cases in 2002 was reported by PMS, it was reported that the success rate of patients at PMS was lower than that at PHC. To identify the problems of the patients' management at the PMS as well as the PHC in a community is the aim of this paper. METHODS: The subject was selected from the registered cases of the pulmonary tuberculosis in Jejudo, 2002. The needed items for this study were gathered by the reviewing the medical charts directly. METHODS: Of the 262 patients included in the subject, 92 cases (35%) were treated initially at PMS. The sputum smear as an essentially diagnostic test was carried out with 69.2% at private clinics compared with 98.2% at PHC. The success rate of the treatment at PMS was 59.8% so that it had a statistically significant difference from that at PHC (80.0%; p<0.01). CONCLUSION: These results showed that there were several problems in diagnosis and treatment for the patient of pulmonary tuberculosis at PMS. To improve the success rate of the treatment at PMS, the nationwide clinical guideline for control of pulmonary tuberculosis should be systematically disseminated and strongly recommended at PMS by the government.