Evaluation of violence against primary care healthcare professionals through different dimensions.

BACKGROUND: Violence is common in emergency departments and is also increasing in primary care settings. It is important to research the factors that cause violence to prevent incidents. OBJECTIVE: The aim of this study is to determine the frequency, causes, and effects of violence in the workplace of primary care physicians in a province in Turkey. METHODS: This cross-sectional study was conducted among 303 family physicians working in Family Health Centers. The subjects completed a questionnaire consisting of questions designed to elicit healthcare professionals' perspectives on violence. The analysis was performed using SPSS 15.0 software, with p < 0.05 considered significant. RESULTS: The participants' mean age was 48.05±6.11. The majority (82%) stated that they had been subjected to violence throughout their professional life. Although the rate of exposure to violence was 56.4% in the previous year, they did not report these incidents to the appropriate authorities. The main reason for failing to report violent acts was "not caring" (40.1%). Respondents who believed "violent incidents should be reported" were under 50 years old (p = 0.045). The impact of violence on their lives was expressed as "losing interest in their profession" (40.8%). The most commonly cited cause of violence was "educational problems" (74.9%). CONCLUSION: Violence is prevalent in primary healthcare settings. It is suggested that there can be numerous reasons for violence, primarily a lack of education, and its effects, such as professional disengagement, are notable. Measures should be implemented to provide physicians with safe working conditions and reduce the risk of violence.

Frequency of Irritable Bowel Syndrome Among Children Aged 4 to 9 Years: A Cross-Sectional Study.

The purpose of this study is to determine the frequency of irritable bowel syndrome (IBS) and the influencing factors in children aged 4 to 9. The cross-sectional descriptive study included 1176 children between the ages of 4 and 9 who applied for Family Medicine Centers between March 1, 2017 and April 30, 2017 for various reasons. Pediatric Gastrointestinal Symptoms Questionnaire, Roma III Version (QPGS-RIII) was applied to the volunteers (children's parents or caregivers), and Beck Anxiety Scale was applied to the mothers accompanying their children. A total of 603 (51.9%) of the children included in the study were female and 559 (48.1%) were male. When the applied QPGS-RIII was evaluated with IBS diagnostic criteria, IBS was found in 137 children and IBS frequency was found to be 11.8% (95% confidence interval [CI]). Significant differences were found in socioeconomic level, eating habits, TV-watching habits, and IBS status (P < .05).

"Never Judge a Book by its Cover"-The socio-cultural aspects of non-epileptic seizures in India-A case study.

"Health for All" will never be attained if sociocultural bias and pervasive hypocrisy are not eliminated. The patient mentioned in this case study had difficulty gaining access to health care for more than two decades. The seizure history was modified due to social pressure. The primary healthcare workers' ability to provide timely access to healthcare regardless of caste, religion, or gender, even in the most remote regions of the country, is of paramount importance. The patient was diagnosed with hypoparathyroidism and treated with calcium and vitamin D in high oral doses. The case also illustrates the significance of medical examination in preventing future difficulties in patients with presenile cataract.

Digital Well-being Through the Use of Technology-A Perspective.

"No man is an island unto himself" - John Donne According to the World Health Organization, health is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity." Our healthcare industry, public behaviors, and environment have grown exponentially with digital technologies in the era of the 4th industrial revolution. Due to rapid digitalization and easy availability of the internet, we are now online round the clock on our digital devices, leaving behind digital traces/information. These digital footprints serve as an increasingly fruitful data source for social scientists, including those interested in demographic research. The collection and use of digital data (quantitative and qualitative) also present numerous statistical and computational opportunities, further motivating the development of new research approaches to address health issues. In this paper, we have described the concept of digital well-being and proposed how we can use digital information for good health.

Evaluation of functional constipation frequency and related factors.

BACKGROUND/INTRODUCTION: The aim of this study is to determine the prevalence of functional constipation (FC) in Izmir using ROME IV criteria, as well as to investigate the relationship of FC with various factors, particularly obsessive-compulsive disorder (OCD) and personality traits. METHODS: This study was designed as cross-sectional analytical research. The participants were those aged 18 and over who applied to Family Health Centers (FHC). Participants were randomly selected from 11 FHC. Data were collected via a face-to-face interview, a questionnaire designed by the researcher using ROME IV criteria, the OCD module in the Mini-International Neuropsychiatric Interview, and the Ten-Item Personality Inventory. RESULTS: The study included 990 participants, 502 (50.7%) women and 488 (49.3%) men. According to the ROME IV criteria, 7% (n = 69) of the participants in our study had FC. OCD was found to be present in 13% of the cases. This rate was found to be significantly higher (P = 0.003). The emotional stability scores of FC patients were found to be significantly lower (P = 0.038). CONCLUSIONS: FC is a common gastrointestinal system complaint in primary care and emphasizes the importance of the diagnostic approach, particularly in patients presenting with constipation due to treatment differences. Individuals with FC diagnoses had a significantly higher incidence of OCD, and their emotional stability levels were significantly lower. It should be noted that psychiatric diseases and personality traits may also play a role in this situation in individuals diagnosed with FC.

Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries.

INTRODUCTION: Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. METHODS: A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. RESULTS: A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). CONCLUSION: Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants.

Determining the Attitudes of Medicine Faculty Instructors Toward LGBT Individuals.

INTRODUCTION: It has been shown that lesbian, gay, bisexual, transgender (LGBT) patients are not able to receive the health care they need due to in part homophobia among health care providers. The aim of this study is to determine the attitudes toward LGBT people by medical school faculty members, the educators of the health care providers. METHODS: The study was designed as cross-sectional, using the Hudson-Ricketts homophobia scale and a questionnaire prepared by the researchers and conducted in two different medical schools. RESULTS: A medium level of homophobia was found among the faculty of medical schools. A greater tendency to homophobia was found in men, assistant professors, those working at the university smaller in size, and those think who believe that there is no discrimination against LGBT students. DISCUSSION: Recognizing homophobic attitudes of medical faculty and lack of LGBT health issues in the medical curriculum are problems needing resolution.

Domestic Violence: Rehabilitation Programme for the Victim and Violent / Predator.

Evan Stark claims that "partner-perpetrated physical abuse and other forms of violence against women ought to be understood as a human rights violation. Domestic violence effects not only the women involved, but the whole of society. Thus, the identification of the victims and perpetrators is necessary, not only to prevent further abuse and injury to the victims, but also to create a violence-free society. In this paper we aim to identify the patterns, the financial and social burden of domestic violence, and ongoing rehabilitative programmes within low- and middle-income countries. A literature search was conducted using "PubMed, Google scholar, and Scopus" databases for the key terms "domestic violence," "partner abuse," "rehabilitation programmes," and/or "partner-perpetrated physical abuse." All relevant articles were included in this narrative review. According to a "Survey of Violence against Women in Turkey," there is high exposure to domestic violence at all ages. Globally, violence against women, children, and the elderly are much more common than is reflected in forensic medicine. Domestic violence in some communities is often considered as a socially normal phenomenon, and is often underreported or unreported for various reasons, such as lack of awareness, lack of security, and feelings of shame and fear. For individuals injured physically and psychologically, timely referral to health organizations for treatment/ rehabilitations and judicial authorities is important for physical as well as mental health reasons; it is also important to provide crucial medical evidence to ensure prosecution of the perpetrator. It is important for all countries to have proper rehabilitation programmes to protect victims of domestic violence, implemented through family physicians at primary care centers. However, we have observed that some programmes have bottlenecks, such as long wait times for child victims. This problem can be addressed by the appropriate measures taken at individual, community, and national level. Policymakers should urgently implement sustainable and well-structured preventive and rehabilitation programmes for the sake of both the victims and the abusers/individuals engaging in violence. Corrective programmes pertaining to the domestic violence have the potential to reveal the extent of the problem, shed light on issues underlying the violence and increase awareness of the damage caused to society.

Dietary salt consumption pattern as an antecedent risk factor for hypertension: Status, vision, and future recommendations.

Multiple salt reduction strategies have been devised from time to time, addressing the issues of hypertension without considering the other essential factors, like the variability of salt sensitivity from the person to person. In this paper, we discuss how high salt consumption is one modifiable risk factor associated with hypertension among Indians, and there needs to be updated cut-off values. A thorough literature search on salt consumption articles on well-known search engines like Cochrane Library, PubMed, Google Scholar and Embase electronic database revealed a paucity of data in this field for India. Several studies revealed that the mean salt intake among the Indian populations ranges between 5.22 and 42.30 g/day. Moreover, among other risk factors analysed, salt intake (≥ 5 gm/day) was significantly associated with the development of hypertension. Although the need to address reduced salt intake for primordial prevention of hypertension and related cardiovascular diseases (CVDs) in India is well acknowledged by the key stakeholders, social and cultural beliefs, unorganized food retail sector and lack of existing food policing are some of the potential barriers that affect the progress and employment of such effective strategies. Some multinational food companies have already research is warranted to evaluate the contextual barriers and facilitators and to adopt effective strategies to improve awareness among consumers, to encourage the endorsement of salt reduction by the food industry, and to facilitate the adoption of countrywide consumer-friendly food labelling. We concluded that salt consumption is high in India, although this assessment has been done primarily by subjective methods in India. People all across are recommended the same cut-off value of dietary salt consumption regardless of the diversity in dietary patterns and environmental conditions across the country. There is an urgent need to address these issues through evidence-based population research.

Role of vaccine science diplomacy in low-middle-income countries for eradicating the vaccine-preventable diseases: Targeting the "LAST MILE".

The meaning of "vaccine diplomacy (VD)" is defined as "the use of vaccines to increase a country's diplomatic relations and influence over other nations." The golden era of vaccine science diplomacy started during the time of Cold War between the United States (US) and the Union of Soviet Socialist Republics (USSR) with the development of a prototype of oral polio vaccine by the US Scientist Dr Albert Sabin working along with his Soviet counterparts. The foundation stone was already laid down by Edward Jenner when he shared his technique of the smallpox vaccine with other major countries to curb the spread of smallpox. Eventually, such a step led to the eradication of such a deadly disease. Only time has changed, not the tide. Even today, vaccines continue to remain as one of the important tools for achieving Millennium Developmental Goals (MDGs) and other targets in developing countries like India. During the wake of the Corona Virus Diseases-19 (COVID-19) pandemic, India's role in developing its vaccine science diplomacy has been a point of attraction. The phase-3 trial of Covaxin being developed by Bharat Biotech started in Lucknow and Gorakhpur in October 2020, and it is widely considered as the forerunner for the Indian vaccine market. As per the Union Health Ministry of India- "The Union Government is working on at least five distinct ways, ranging from free vaccines to guaranteed supply, in which it can help its immediate neighbours and countries in West Asia, Africa and even Latin America-officials familiar with the plan said on conditions of anonymity. The idea is to leverage the country's standing as the world's vaccine factory to merge diplomatic ties. Historically, it is observed that by the development and introduction of newer vaccines from time to time, many dismaying hurdles to vaccine science diplomacy (VSD) arise from ongoing wars and political instability. The current scenario is that both VSD and VD are at crossroads, and there is a possibility of getting a good direction if we make a piggyback policy approach of vaccine diplomacy along with the foreign policy. The lessons learned from the past must be followed now and, in the future, to make a better world for all. We acknowledge that the COVID-19 episode has again highlighted the dire need for VSD, and we assume that not only COVID-19 but in future, emerging and re-emerging diseases will occur so we have to prepare ourselves for combatting those future emerging and re-emerging diseases.

Optimizing the impact of health and related programmes / policies to address the issue of Childhood Obesity in India----A narrative review.

Non-communicable diseases are already acknowledged as a double burden, and now childhood obesity is putting extra strain on our health system. The current paper aimed to analyze the ongoing health and related programmes/policies in India, and we discussed the existing opportunities in the programmes to address the issue of childhood obesity in India. We searched the "MEDLINE," "PsycINFO," "Scopus," "Web of Science," and "Google Scholar" databases using the following keywords: ("overweight") and ("obesity"), ("childhood obesity"), ("nutritional programmes in India"), ("Health policies in India"), ("malnourished children in India") in combination with each other and in truncated form. All the relevant articles and policy documents (MOHFW, INDIA) available in the public domain were included to support the argument for this narrative review. We found that we have programme gaps like guidelines issues by Food Safety Standards Authority of India to tackle childhood obesity and it has not been strictly implemented due to multiple reasons. School health programme has an opportunity to address the issue of childhood obesity, but at the ground level the outcomes are not very promising. The National Nutrition Mission have only focussed on undernutrition and anemia problem, ignoring the overweight/childhood obesity. Primary care physicians are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke is dealing with health promotion and prevention, early diagnosis, and management of all ages, except children. Diet provided in Integrated Child Development Scheme is calculated based on calories, not by the quality which is a concern to us. The breastfeeding promotion programme named Mothers Absolute Affection programme has not been implemented with letter and spirit. Other than health programmes, we assume that Ministry of Urban Planning, Foreign Direct Investment policy, Advertisement Council of India and many more sector/policy/programme are indirectly responsible for the increasing burden of childhood obesity in India. Lack of awareness and wrong perception also responsible for the development of childhood obesity. We have multiple National Health Programmes and Policies to address the childhood malnutrition, but are focussing the undernutrition component only, ignoring overnutrition problem in the children, which is emerging as quadruple burden to our health system. Appropriate actions and inclusion of suggestions provided in this study for the improvement of the programmes at the practical level needs to be considered by the policy makers to halt the ever-rising trend of childhood obesity and primary care physicians should play a leadership role.

Is it the Right Time to Introduce the Hepatitis B Booster Vaccine in National Immunization Schedule? An Analysis from the Available Evidence.

Hepatitis B virus (HBV) infection is a global health concern, and it is considered one of the deadliest infections in the world, having nearly 1.2 million deaths annually. Around 75% of all global HBV carriers live in the Asia-Pacific region. In this regard, India has a prevalence ranging between 2% and 7% with exposure rates of 10%-60%. Hepatitis B is a vaccine-preventable disease. In India, the World Health Organization protocol for hepatitis B vaccination has been followed, and it is given free of cost in public health facilities under the National Immunization Schedule. Despite the free hepatitis vaccination program in India, coverage and awareness are low. Low awareness, followed by low coverage of hepatitis vaccination, can prove dangerous for the Indian population in the long run. A majority of chronic hepatitis cases progress silently to end-stage liver disease without having many signs and symptoms. Once occurred, a complete cure is not possible with currently available drugs. The studies from neighboring countries such as China and Taiwan documented that the impact of single-dose booster for children of 10 years has made a significant difference from the cost-effectiveness perspective. They have also included the booster dose in their national vaccination program. Considering the low level of vaccination awareness, small coverage, high disease burden, and high treatment cost, now, it is high time for India to introduce hepatitis B booster vaccine.

On the importance of primary and community healthcare in relation to global health and environmental threats: lessons from the COVID-19 crisis.

In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system's weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of 'planetary health'. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.

Family Physicians' Knowledge about and Attitudes towards COVID-19 - A Cross-sectional Multicentric Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected every country on earth, and family physicians (FPs) have helped patients at every stage. The first objective of our study was to study the FPs' knowledge about COVID-19 and second objective was to assess their attitudes, stress and death anxiety surrounding the current pandemic. MATERIALS AND METHODS: An online questionnaire was prepared to collect responses from FPs between March-April 2020. A descriptive and correlational design was utilized. RESULTS: 240 FPs from eight countries were evaluated. The majority reported that they received most information from medical journals (77%). Most of the respondents also noted that the most common symptoms were acute respiratory syndrome and fever - with the most effective treatment in most cases consisting of symptomatic treatment (41%). Although FPs generally had a positive attitude, most of them (68%) were concerned about contacting COVID-19 from patients and as a result, they experienced increased stress (64%). CONCLUSION: The research was conducted during the COVID-19 outbreak while the FPs were working on the frontline of the pandemic. This research revealed that most of the FPs had good knowledge of, and a positive attitude towards COVID-19 treatment. It was observed that participants who tended towards conscientiousness, emotional stability, and openness to experience, and who had higher life satisfaction, and lower levels of death anxiety also reported more positive attitudes towards COVID-19. While the main target population of COVID-19 disease were the older age groups, FPs' attitudes and fear levels were not associated with age, gender, or years of experience.

Leveraging Unmanned Aerial Vehicle Technology to Improve Public Health Practice: Prospects and Barriers.

Unmanned aerial vehicle (UAV) is increasingly being used in different sectors, including public health. Common applications of UAVs in public health are delivering logistics in remote areas, transporting biomedical samples, providing community-based health care, and public health surveillance. UAVs have contributed to efficient public health ensuring better health services activities at a lower cost. Across diverse health-care settings, UAVs are used to minimize human labor and physical barriers such as distance or hazards associated with different tasks. This technology has shown notable success in advancing public health in resource-constrained countries. In Rwanda, the use of UAVs has resulted in robust logistic support and improved vaccine coverage. Faster transportation and coordination between points of health services have facilitated the overall health service delivery. Despite these advancements, there are several challenges in using UAVs in public health, which include technical difficulties in operating UAVs, maintenance of devices and systems, regulatory challenges, safety concerns, air traffic congestion, and cost of using UAVs. These challenges should be addressed with empirical research and innovative interventions to leverage UAVs in preventing health-care problems and saving lives around the world.

Collaborative global health E-learning: A Massive Open Online Course experience of young family doctors.

Massive Open Online Courses (MOOCs) are unlimited web-based courses accessed through computers, smartphones, or other digital devices. Although they have multiple advantages, a common challenge is the low course completion rates. Young family doctors of the World Organization of Family Doctors (WONCA) from more than 20 countries recently completed an initiative that combined social media platforms with a MOOC offered by Harvard University. This resulted in a completion rate five times greater than the baseline rate. We propose perfecting and expanding this method to augment continued medical education, collaboration, and best practice exchange among WONCA's members and participating organizations worldwide.

Caregiver reasons for tertiary health-care seeking for children aged ≤12 years.

BACKGROUND: In Turkey, a mandatory referral system is not used. Caregivers, for their children, present directly to health-care providers at all levels. This allows patients to present directly to university hospitals. In this study, reasons for university hospital-treatment seeking by caregivers for child health problems is discussed. METHODS: This was a cross-sectional descriptive study at Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, of 235 caregivers whose children were admitted to the outpatient clinic of the General Pediatrics Department between 4 and 11 April 2013. They completed a questionnaire on demographic data and reasons for presentation to the university hospital. Mann-Whitney U-test was used to compare group means, and Pearson chi-squared test for ratios between groups. P <0.05 was considered to be statistically significant. RESULTS: A total of 54.5% of participants lived far from the hospital. The most frequent complaints involved the respiratory tract, among which the most frequent complaint was cough. Time from symptom onset to presentation was ≥7 days in 58.3% of patients, and 48.9% had never presented to another institution. The most common reason for choosing the university hospital was the availability of the necessary tests (88.1%). CONCLUSIONS: Despite common use of primary health-care systems, with regard to tertiary hospital presentation, the most important factors for preferring tertiary hospital presentation were caregiver trust in tertiary hospital resources for diagnosis and treatment.