Perspectives of physicians in Sri Lanka on periodic abstinence

Since physicians strongly influence both national family planning policy and individuals' contraceptive choice, a survey was conducted to learn about the perspectives of Sri Lankan physicians (n-100) regarding periodic abstinence methods of family planning (PA). Female doctors (28% of the sample) were twice as likely to have ever provided PA advice to their clients as their male counterparts. Providers of PA were more likely to have ever personally used this form of contraception than PA non-providers. Regardless of PA provider status, all physicians most frequently recommended pills, injectables and IUDs to their clients. They had very good knowledge of the temperature method. The scientific foundation of this method is studied in medical school, suggesting that if the other modern methods (Billings and sympto-thermal) were incorporated into medical school curricula, physicians might be more willing to discuss, refer or provide other modern, scientific forms of PA to their clients.     

围绝经期及绝经期妇女取环的临床观察及体会

目的探讨影响围绝经期及绝经期妇女取环困难度的相关因素及有效方法。方法对235例要求取环的围绝经期及绝经期妇女行取环术,对个人基本情况、取环过程及结局进行观察,分析患者年龄、绝经年限、宫颈萎缩程度、置环年限、文化程度、工作情况、居住环境、体检情况、妊娠史及流产史与取环困难度的关系。结果患者年龄、绝经年限、重度宫颈萎缩与取环困难度呈正相关(P<0.05);无稳定工作、未定期体检者取环困难率高于有稳定工作、定期体检者(P<0.01);置环年限≥20年者取环困难率高于置环年限<20年者(P<0.05)。结论绝经期妇女应尽早取环,最好围绝经期妇女症状稳定后即取环;对于宫颈萎缩严重、组织坚硬的妇女,可用米非司酮与米索前列醇软化宫颈,降低取环难度;做好宣教工作,普及节育环相关知识,督促妇女定期体检。     

Identification of emotional problems in postpartum women by health visitors

One hundred mothers of babies aged under 15 weeks who attended well baby clinics were rated for the presence of emotional disorders by health visitors. These assessments were compared with the mothers' scores on the General Health Questionnaire (GHQ), a screening instrument for identifying psychiatric cases in the general population. The results indicate that symptoms of minor psychiatric disorder are a problem for an appreciable number of postpartum women, although the health visitors showed a misclassification rate of roughly 40%. It is suggested that routine screening using the questionnaire at the time of the baby's six week check would both improve the detection rate and also enable the health visitors to give extra support to those mothers who were most in need of it.     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association's activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.

Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.

Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.

There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.

     

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

The Dental Practitioner''s Role in Emergency Health Services

In a national disaster, the medical profession would lose physicians and auxiliary personnel and would need assistance. Canada's 22,000 physicians and 85,000 nurses are located for the most part in potential target areas. Survivors among Canada's 6396 dentists could supply 30% reinforcement. The dentist's training, his manual dexterity and experience acquired in the management of hemorrhage, shock, débridement, suturing, reduction and immobilization of fractures, and control of pain and infection would be valuable. Additional functions he could perform would be first-aid, including but not limited to artificial respiration, early management of chest wounds, preparation of casualties for movement, and assistance in general surgical procedures. Dentists with special training in anesthesia, oral surgery or public health could be of particular value in relieving anesthetists, surgeons, radiologists and public health officers of some of their duties. Joint training of physicians and dentists in mass casualty care could increase the efficiency of the team work in disaster and is being considered by many medical and dental faculties.     

Physicians'' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved?

We designed this study to determine whether an intensive 1-day educational workshop involving family physicians in establishing essential criteria for hypertension management would significantly affect the short-term outcomes of hypertensive patients in their practices. Forty randomly selected physicians were separated into three groups: those who would be involved in establishing the criteria (15), those who would receive the criteria by mail (15) and those who would act as controls and not be aware of the criteria (10). We found no significant difference between the three groups in the number of hypertensive patients whose condition remained uncontrolled after the intervention. We conclude that physicians' participation in the establishment of standards of care for conditions such as hypertension or their awareness of such standards does not independently result in significantly better patient outcomes. Consequently, we recommend that physicians and health care planners concerned with improving outcomes not rely on any single intervention strategy when planning change.     

参加住院医师规范化培训的医师心理健康状况调查

目的：了解参加住院医师规范化培训的医师心理健康状况。方法：应用症状自评量表（SCL-90）对某三甲医院参加住院医师规范化培训的医师,共计40人进行问卷调查。结果：参加住院医师规范化培训的医师SCL-90各因子得分与中国常模差异无显著性（P〉0.05）。结论：参加住院医师规范化培训医师的心理健康状况与中国正常人群无明显差异。     

四川省1994年至1998年宫内节育器使用状况调查

目的 掌握四川省IUD换代时期宫内节育器使用状况。方法 采用分层整群随机抽样方法。调查四川省1994年至1998年间放置IUD的妇女，调查人数12804。收集背景情况、孕产次、IUD类型、放置时机及使用中的问题等数据。使用STATA统计软件包进行数据分析。结果 平均放置年龄为26．8岁，85．92％为农民，97.22％至少接受过小学教育，99．54％具有生产史。IUD异常为2.05％，产后放置占所有放置时机的65．94％。活性IUD种类以Tcu和宫铜为主。9．13％抱怨月经改变，6．0％抱怨有感染症状。结论 活性IUD具有更高的避孕有效性。今后，还应强调掌握好使用适应症，坚持定期随访，作好咨询及技术服务,保障使用者的生殖健康。     

The copper-7 intrauterine contraceptive device: 5-year evaluation.

Over a 5-year period a family practitioner inserted copper-7 (Cu-7 intrauterine contraceptive devices (IUDs) in 134 women. The rates of continued use after 2 years, 53.0% for the women's first IUD and 63.9% for all their IUDs, and of accidental pregnancy, 2.4%, are comparable to those in the literature. However, in this series the rate of expulsion was 0.8%, much lower than that in the literature. Fertility did not appear to be reduced in women who planned to have pregnancies after the device was removed. A carefully scrutinized technique of insertion and conscientious follow-up make the Cu-7 IUD an acceptable form of contraception for many patients in a family practice.     

Computers a cornerstone of evidence-based care, conference told.

Computers are poised to become key players in the delivery of health care, but are physicians ready for them? A recent conference on medical communication in the electronic era examined the potential of computers to assist in diagnosis, provide continuing medical education, disseminate evidence and research findings, and simplify practice management. However, delegates were told that even though many medical practices are computerized, it is often staff members and not physicians who use the technology. For computers to gain wider acceptance for medical purposes, physicians need to be made comfortable with their use at an early stage of training.     

Opinion survey of physicians on ethical issues in medical research

A total of 3622 physicians registered in the Association of Physicians of India were contacted through mail and requested to respond to a semistructured questionnaire pertaining to different aspects of medical ethics, with particular focus on informed consent. Six hundred twenty-nine physicians (17.4%) responded to the questionnaire; 86% of the respondents reported having had no formal training in medical ethics; 49% of the subjects who undertook research obtained oral consent only. Majority of the respondents noted the relevance of ethics in different medical situations, though in certain areas like community health and research using animals ethical issues were felt to be less important. Patients' inability to come for regular follow-up and illiteracy were opined to be the main constraints in obtaining consent. Opinion on the amount of information to be imported to research participants as part of informed consent was at variance with standard guidelines. Physicians who reported having had an orientation course in medical ethics and those with prior research experience were more aware of ethical issues. Majority of the professionals desired for inclusion of ethics in medical curriculum.     

社区联络医师再教育模式的研究与实践

目的探讨某高等院校附属医院糖尿病专科医师对社区糖尿病联络医师糖尿病知识培训的作用。方法以糖尿病专科医师及护士为主导,成立高等院校附属医院糖尿病知识培训小组,小组共5人。以该医院附近社区卫生服务站的医师为对象成立社区糖尿病联络医师小组,并对其进行糖尿病知识的培训。结果经过糖尿病知识培训小组培训6个月后,社区糖尿病联络医师对糖尿病相关知识及操作技能的掌握程度显著提高(P<0.01)。结论糖尿病知识培训小组提高了社区糖尿病联络医师对糖尿病知识的掌握,从而为社区糖尿病患者提供了方便,平衡了医疗资源分配。     

Complementary health care services: a survey of general practitioners' views.

OBJECTIVE: To determine the referral practices, perceived usefulness, knowledge, prior training and desire for training of general practitioners (GPs) in Quebec with regard to complementary health care services such as acupuncture, chiropractic and hypnosis. DESIGN: Cross-sectional mail survey. SETTING: Province of Quebec. PARTICIPANTS: Random sample of 200 GPs. Of the 146 who responded, 25 were excluded because they were no longer in practice; this left 121 (83%). OUTCOME MEASURES: Self-reported referral practices for complementary health care services, perceived usefulness and self-assessed knowledge of such services, and prior training and desire for training in these services. RESULTS: Sixty percent (72/121) of the GPs knew at least one practitioner of a complementary health care service for referral; 59% (70/119) reported referring patients to physicians who practise such services and 68% (80/118) to nonmedical practitioners. At least one of the three services studied were regarded as having some use by 83% (101/121). Overall, self-reported knowledge was poor: the proportions of GPs who reported knowing a lot about acupuncture, chiropractic and hypnosis were 11% (13/121), 10% (12/121) and 8% (10/121) respectively. Prior training was also lacking: only 8% (9/118) of the GPs had received previous training in acupuncture, 2% (2/111) in chiropractic and 3% (3/103) in hypnosis. In all, 48% (57/118) indicated that they would like further training in at least one of the services studied, and 13% (16/121) indicated that they currently provided one service. CONCLUSIONS: Referral of patients by GPs to practitioners of complementary health care services is common in Quebec. Although self-assessed knowledge about such services is relatively poor, interest in learning more about them is high. These findings identify a demand for future educational initiatives.     

Career changes among Saskatchewan physicians.

OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring.     

Quality of care in family planning clinics in Jamaica. Do clients and providers agree?

This paper uses data from 199 providers and 20 simulated clients collected at 50 public sector and Non Governmental Organization (NGO) health facilities islandwide in 1995 to compare the two groups' views on quality of care of family planning services. Each of the five components of quality of care studied can be improved in Jamaica. Nearly two-thirds of the simulated clients felt able to freely choose a contraceptive method; however, more adequate and appropriate information needs to be imparted to clients through improved counselling, including promotion of dual method use (against STD/HIV/AIDS and conception). The requirement that a woman must be menstruating to receive services has inadvertently resulted in many clients going away empty-handed (without counselling or condoms) when they visit family planning clinics. While providers generally treat clients well, training and service delivery practices need to be revised to improve the technical competence of providers. All of the providers would recommend these clinics to others, compared to a little over half of the simulated clients. Both the providers and simulated clients said that privacy should be strengthened, particularly in small facilities in rural areas. Many of these aspects of quality of care are being improved in Jamaica's public sector health facilities. Managers can learn more about quality of care by seeking the knowledge, opinions and experiences of both providers and clients.     

Quality of care in family practice: does residency training make a difference?

As the proportion of physicians who enter residency training in family practice steadily increases, so does the need to evaluate the impact of their training and postgraduate education on the quality of care in their practices. We audited the practices of 120 randomly selected family physicians in Ontario, who were separated into four groups: nonmembers of the College of Family Physicians of Canada (CFPC), members of the CFPC with no certification in family medicine, certificated members without residency training in family medicine and certificated members with residency training in family medicine. The practices were assessed according to predetermined criteria for charting, procedures in periodic health examination, quality of medical care and use of indicator drugs. Generally the scores were significantly higher for CFPC members with residency training in family medicine than for those in the other groups, nonmembers having the lowest scores. Patient questionnaires indicated no difference in satisfaction with specific aspects of care between the four groups. Self-selection into residency training and CFPC membership may account for some of the results; nevertheless, the findings support the contention that residency training in family medicine should be mandatory for family physicians.     

Evaluation of Training Course Effects on Integrated Sexual and Reproductive Health Counseling

Since the International Conference on Population and Development held in Cairo in 1994, and the Fourth World Conference on Women held in Beijing in 1995, the international organizations and public health communities have paid more attention to reproductiv…     

Occupational-health training at the University of Hawaii

Occupational-health training at the University of Hawaii School of Public Health (UH-SPH) is a graduate-level program focusing on industrial hygiene; it also offers courses of interest to other health professionals, particularly physicians and nurses. The current training at the UH-SPH is designed primarily to prepare occupational-health practitioners at the master's degree level. The occupational-health program elective is considered to be an area of emphasis within a broader program of study in public health. The program offers special opportunities for occupational-health training and research in cross-cultural and international settings. Post-graduate and continuing-education occupational-health training in the community is also discussed.     

绝经后妇女取器术中应用尼尔雌醇配伍普尔丁和利多卡因效果观察

目的探讨尼尔雌醇配伍普尔丁、利多卡因在绝经后妇女取出宫内节育器(IUD)手术中的临床效果。方法要求取器而无禁忌症者60例,均为绝经0.5 a以上妇女,随机分为观察组与对照组各30例。观察组均于术前1周服尼尔雌醇4 mg,术前30-60 min口服普尔丁40 mg,宫颈扩张前颈管内灌注2%盐酸利多卡因3 ml,3 min后按节育手术常规行取器术。对照组于术前30-60 m in单纯口服普尔丁40 mg,按节育手术操作常规行取器术。结果术中观察组宫颈软化、扩张程度、止痛效果、取器顺利情况均明显优于对照组(P<0.01)。结论本方法能有效地减轻患者的痛苦,提高手术安全性及取器成功率。