A survey on attitudes and practice concerning International Health

OBJECTIVE: A survey was conducted to help understanding of the attitudes and practice of Japanese medical students concerning "International Health". MATERIALS AND METHODS: One thousand seven hundred and ninety six students from eleven medical schools responded in the questionnaire study. One thousand and ninety seven were males and 699 were females with average ages of 22 and 21 years, respectively. RESULTS: 32.3% of the students answered that they have/had an interest in "International Health". About half of the students answered that they wanted to have a lecture on "International Health" and they also had a willingness to engage in activities for "International Health" someday. Further, 4% of the students had experience of participation in activities related to "International Health". Female students showed that they have a stronger willingness to take part in the "International Health activities" than males. CONCLUSION: Human resources that can work in the field of international cooperation are required because ODA from Japan has ranked first in the world for nine years in succession. However, the willingness to participate in "International Health activities" among students decreased conversely with their years of learning in medical school. This result might be a basic material when we look at the education toward "International Health" in the medical school.     

Physician knowledge and adherence to prescribing antibiotic prophylaxis for sickle cell disease.

OBJECTIVE: The purpose of this research was to examine how physician characteristics were associated with: (i). physician knowledge of and adherence to sickle cell guidelines; and (ii). the types of educational programs about sickle cell disease desired by physicians. METHODS: A survey was developed to assess the research objective. After the survey was pre-tested and an institutional review board exemption was obtained, it was sent to a systematic random sample of 375 pediatricians and all 125 practicing hematologists in North Carolina. They were asked to answer a six-item knowledge test relating to the antibiotic prophylaxis guidelines. RESULTS: The response rate was 57%, of which 61% were pediatricians. Over half (56%) were in a practice with at least one pediatric sickle cell patient. Fifty-nine percent of physicians answered five or more questions correctly on the knowledge test. The question most physicians answered correctly (97%) pertained to the necessity of antibiotics for children with sickle cell disease. The question most frequently answered incorrectly (62%) pertained to prescribing antibiotics to a child with unconfirmed sickle cell disease. Logistic regression results indicated that the number of sickle cell patients seen in practice influenced the number of questions answered correctly. Sixty-six percent of physicians prescribed prophylactic antibiotics for 100% of their patients with sickle cell disease and therefore were 100% adherent. Eighty-one percent of pediatricians compared with 12% of hematologists were 100% adherent in prescribing antibiotics. Hematologists and those practicing at a medical school or university were less likely to be 100% adherent in prescribing antibiotic prophylaxis. CONCLUSION: The majority of physicians surveyed were relatively knowledgeable about sickle cell guidelines, however there may be a need for continuing education programs that focus on the issues of prescribing antibiotics to a child with unconfirmed sickle cell disease and penicillin dosage.     

Stigma, discrimination, and HIV/AIDS knowledge among physicians in Barbados.

OBJECTIVE: To determine the extent of clinical knowledge of HIV/AIDS that physicians in Barbados have and their attitudes towards persons living with HIV/AIDS. METHODS: In 2000 the Barbados Association of Medical Practitioners conducted a survey in order to assess its members' views on HIV/AIDS issues. Over a two-month period 203 physicians (76% of all those practicing in the country) were interviewed. The survey included physicians working in private practice and the public sector. They were surveyed individually concerning their attitudes towards counseling as well as their clinical knowledge, perception of safe practices, fear of occupational exposure, views on ethical issues, experience treating HIV/AIDS patients, and background with HIV/AIDS continuing education. RESULTS: In comparison to physicians who had graduated in later years, physicians who had graduated in 1984 or earlier had seen fewer HIV/AIDS clients, had lower levels of knowledge about the disease, were more likely to test for HIV/AIDS without informed consent, and were less likely to have ever attended a continuing education training course on HIV/AIDS. Overall, knowledge of the clinical indications of HIV/AIDS was low, and 76% of the physicians did not think they had adequate counseling skills. Over 80% of the physicians were comfortable looking after HIV/AIDS patients. While 95% of the physicians would not release HIV test results without a patient's consent, 33% would test, without consent, a seriously ill patient, and 15% would test without consent a patient upon whom they had to perform an invasive procedure if they perceived the patient to be from a high-risk population such as gay men or commercial sex workers. Only 53% of the physicians had attended an HIV/AIDS in-service training program between 1995 and 1999. CONCLUSIONS: Physician training in Barbados should focus on all aspects of HIV/AIDS care, including clinical and emotional factors. Attendance at such training should be mandatory for public sector physicians, and medical school curricula need to be examined to ensure their HIV/AIDS content is current and comprehensive.     

An estimation of foodborne illness in populations with HIV/AIDS infection,United States, 1987–93

The purpose of this research is to arrive at an approximation of the level of foodborne/waterborne illness in the United States for persons with HIV/AIDS infection and to determine trends in these patterns by age of patient. The National Hospital Discharge Survey in the United States is used to identify HIV/AIDS patients by ICD‐9–3CM codes. These codes are used to link these persons with codes for foodborne/waterborne illness. Odds ratios are calculated to estimate the elevated chance of foodborne/waterborne illness for this population. Analysis shows that hospital discharge certificates with mention of HIV/AIDS infection have 4–6 times greater chance of foodborne/waterborne illness than do certificates without mention of HIV/AIDS infection. When age is considered, relative risks increase to 8.6 times greater for HIV/AIDS patients. Trend data show increased in odds ratios from 1988 to 1993. These estimates establish the elevated association of foodborne/waterborne illness with HIV/AIDS patients discharged from hospitals in the United States and the risks are related to age and are increasing over the period.     

Physician and infection control practitioner HIV/AIDS reporting characteristics.

We surveyed a random sample of South Carolina physicians and infection control practitioners about the reporting of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) cases. Of physicians surveyed, 79% indicated that HIV infection as well as AIDS should be reported by name. The following characteristics were associated with those physicians who do not report AIDS cases: not feeling responsible for reporting, not reporting a case perceived to have been reported in another state, believing that information required for reporting is not on the chart, and residing in an urban setting. Targeted education can address these underreporting factors.     

Relationship between referral and patient characteristics

In order to evaluate the relationship between referral and patient characteristics, 594 new patients utilizing Saga Medical School general clinic were studied using a questionnaire and chart review. Results obtained are as follows: 1) Fifty-eight patients (10%) came for follow-up of mass screening tests, 174 patients (29%) were self-referral, the remaining 362 patients (61%) were under previous care by other physicians. Only 64 patients (11%) had a referral letter. 2) Those patients who were not advised to visit our clinic by non-medical personnel, patients who were seriously ill, elderly patients, residents in distant area, and those with medical problems tended to have a referral letter. 3) Of the 64 patients having referral letters, 15 (23%) took the initiative in asking their previous doctor to write a referral letter. Patients who were highly educated had a greater tendency to request referral letters. 4) The reasons cited by the patients without a referral letter included "Did not think of the necessity" (22%), "Wanted to confirm diagnosis" (22%), "Did not want to make the doctor lose face" (16%), "No improvement in symptoms" (14%) These results indicate that education of patients and the general public, and establishing good physician-patient communication and trust are necessary for increasing the use of referral letter.     

Does experience improve hospital performance in treating patients with AIDS?

This paper examines how experience affects hospital performance in treating patients with AIDS. The most common life-threatening medical complication of AIDS is Pneumocystis carinii pneumonia (PCP). Studies of patients with PCP demonstrate that patients who received care at hospitals that were more experienced with AIDS had lower immediate mortality. These higher volume medical facilities did not use more resources but used resources more efficiently and provided better medical care. Better outcomes for experienced providers suggest three policy implications for improving quality of patient care: (1) create regionalized centers where large numbers of patients with a particular illness are treated; (2) encourage low volume providers to rapidly increase their experience; or (3) establish targeted educational programs for low volume providers. Historical review of experience with other medical problems such as tuberculosis indicate that one policy option, creating regional medical centers, did not have the desired effect of better patient outcomes. These facts support policies to provide targeted educational programs and opportunities for low volume facilities to rapidly increase their familiarity with AIDS. Outcomes could be improved by such policies.     

Does disclosure of medical records to patients influence medical care?

Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University. RESULTS: Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.     

Variables associated with underreporting of AIDS patients in Rio de Janeiro, Brazil, 1996

OBJECTIVE: The underreporting of AIDS cases in the municipality of Rio de Janeiro, Brazil, is significant. The study intends to analyze the factors associated to this event. METHODS: Using data provided by the Hospital Information System for the year of 1996, in Rio de Janeiro city, and by the National Surveillance System, patients were randomly selected and their medical records reviewed to verify an AIDS diagnosis. A multinomial model was used to perform an analysis of the variations on the chances of underreporting of AIDS cases versus reporting and on the chances of underreporting without evidences to fulfill the case definition of AIDS versus reporting. RESULTS: No significant associations were found between the variables such as "age", "marital status", "level of education", "occupation", and "severity of illness" and the underreporting of AIDS cases. The variable "female gender" showed a strong association with hospitalization without evidence of an AIDS diagnosis. A strong association was found between two or more admissions in an inpatient unit care and reporting. The existence of a epidemiological surveillance department in the hospital is inversely associated with the underreporting of AIDS cases. CONCLUSION: The significant association between organizational variables and underreporting of AIDS cases found in the study point out to the need of standardization of the surveillance procedures, the especial need for the creation and maintenance of surveillance departments in hospitals to improve the quality of the health information system and, therefore, AIDS prevention and care.     

Preliminary information to patients and presentation by Burkinabe physicians of the results of HIV detection test in Burkina Faso

BACKGROUND: The action of individuals and their family is determining in the result of AIDS control and the knowledge of people's serological situation facilitates their involvement in AIDS control. This study was carried out in order METHODS: A transversal investigation through a self-administered anonymous questionnaire was carried out among the 250 Burkinabe physicians working in a public, private or religious health care sector. The questionnaire was sent by mail, attached to a response coupon. A response of 74% was obtained. RESULTS: Seventy seven physicians, that is 48.7% of the sample, informed patients who were likely to be HIV infected about their intention to ask for an HIV test. Seventy five physicians, that is 47.5% of the sample informed patients on the results of their serological tests on HIV infection. The characteristics of physicians who informed customers on the results of their serological test were similar to those of physicians who informed their patients on the demand for test concerning them. There were often specialists, physicians with long experience in medical practice and physicians more involving in curative consultations than in preventive ones (respectively 54.7% versus 23.3%, p=0.002). CONCLUSIONS: These results show the necessity of providing young physicians with counselling training, especially general practitioners who should be working in prevention services. Moreover, they constitute a basis for an objective discussion between physicians working in hospital, officials in charge of the national program for AIDS control and medical training schools.     

STD screening,testing, case reporting,and clinical and partner notification practices: a national survey of US physicians

OBJECTIVES: This study presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection. METHODS: Surveys were mailed to a random sample of 7300 physicians to assess screening, testing, reporting, and partner notification for syphilis, gonorrhea, chlamydia, and HIV. RESULTS: Fewer than one third of physicians routinely screened men or women (pregnant or nonpregnant) for STDs. Case reporting was lowest for chlamydia (37 percent), intermediate for gonorrhea (44 percent), and higher for syphilis, HIV, and AIDS (53 percent-57 percent). Physicians instructed patients to notify their partners (82 percent-89 percent) or the health department (25 percent-34 percent) rather than doing so themselves. CONCLUSIONS: STD screening levels are well below practice guidelines for women and virtually nonexistent for men. Case reporting levels are below those legally mandated; physicians rely instead on patients for partner notification. Health departments must increase collaboration with private physicians to improve the quality of STD care.     

Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians

OBJECTIVES: This study aimed to explore Kuwaiti family physicians' attitudes and knowledge about HIV/AIDS. METHODS: One hundred and sixty-two Kuwaiti family physicians (95 females and 67 males) from all four health catchment areas have completed a 30-item self-administered questionnaire to measure HIV/AIDS-related attitudes and knowledge. RESULTS: Knowledge was lacking in areas dealing with HIV-related neuropsychiatric complications and other issues concerning HIV/AIDS, special populations and range of normal sexuality. The majority of physicians expressed negative attitudes toward homosexuality and about AIDS patients in general. Eighty-three per cent of Kuwaiti family physicians would opt out of treating AIDS patients. More than half of the physicians would avoid coming into social contact with HIV-seropositive persons. No significant difference was found for the total knowledge and attitude scores for gender. CONCLUSION: The results of this survey revealed that even in the second decade of the AIDS epidemic, some Kuwaiti family physicians continue to have a lack of proper knowledge about HIV and harbour negative attitudes toward AIDS patients. There is a need to promote an AIDS education early in the medical internship training years which addresses many underlying socio-cultural factors.     

The underreporting of disease and physicians' knowledge of reporting requirements

Previous studies of underreporting of disease have mainly addressed the attitudes of physicians toward reporting of communicable disease to public health agencies and have not examined adequately the physicians' knowledge of the reporting system as a cause of underreporting. To investigate, the authors designed a questionnaire and distributed it to 345 physicians at two hospitals. One hundred and sixty-nine questionnaires, which examined knowledge of reporting requirements and reasons for not complying with those requirements during 1978-81, were returned (a 49 percent response rate). Most of the respondents knew that reporting is required, but their knowledge in specific areas, such as which diseases are reportable, varied greatly. The number of physicians who knew which diseases they are required to report ranged from a low of 63 physicians (37 percent) for trachoma to 163 (96 percent) for syphilis. Of the 169 physicians, only 50 believed they knew how to report reportable diseases, and only 40 of them knew the correct procedures. Thirty-six percent of the 169 physicians indicated that they had not reported any cases at all during 1978-81. On the average, physicians recalled reporting 28 percent of their reportable cases. When they indicated why they had not complied with reporting requirements, the physicians chose reasons that reflected a lack of knowledge of the reporting system. The most common reasons were "did not know how to report" and "did not know it was a reportable disease." The results suggest that a major factor in physician underreporting is a lack of knowledge of the morbidity reporting system.     

Self-reported HIV and AIDS experience, practices, and knowledge of Pennsylvania family physicians.

BACKGROUND: Patients with disease caused by the human immunodeficiency virus (HIV), while still more commonly treated in urban settings, are being seen in nonurban areas in numbers rapidly outstripping the local availability of specialists with expertise in HIV or acquired immunodeficiency syndrome (AIDS). METHODS: A questionnaire designed to measure self-assessed experience, practices, and knowledge regarding basic aspects of HIV was mailed in 1989 to the 2177 members of the Pennsylvania Academy of Family Physicians. RESULTS: The response rate was 72 percent. Approximately 95 percent of physicians surveyed had been asked questions by patients about AIDS, 30 percent had a patient with a confirmed positive blood test, and 27 percent had a patient with symptomatic HIV disease in their practice. CONCLUSIONS: Although most family physicians indicated that they were comfortable in recognizing persons at risk, counseling, and using tests to diagnose HIV and AIDS, more than one-half reported practice patterns at variance with published guidelines. Respondents were most uncomfortable with their knowledge and skills regarding legal issues, state and community resources, and caring for patients with AIDS. Continuing medical education courses at local hospitals and written materials were the two methods of AIDS education most likely to be used by respondents.     

内江市执业医生法定传染病报告知识的调查

目的 :了解内江市执业医生掌握法定传染病报告知识的情况。方法 :对收回的执业机构中 10 0名执业医生调查表进行统计分析。结果 :对报告病种、类型的回答正确率为 5 7% ,对报告时限的回答正确率为 36 % ,对义务报告人的回答正确率为 2 9% ,对报告疫情机关的回答正确率为 89% ;服务于不同的医疗机构、不同的学历、不同技术职称的执业医生间 ,对法定传染病报告知识的掌握差异有显著性 ,不同服务年限的执业医生间无差异。结论 :提高疫情报告质量的重要环节是 :不断开展对执业医生专门培训 ,进一步强化依法管理和监督。     

Stigmatization of AIDS patients by physicians.

A randomly selected sample of physicians in three large cities was asked to read one of four vignettes describing a patient. They then completed a set of objective attitude measures eliciting their reactions to the patient described in the vignette. The vignettes were identical except that the patient's illness was identified as either acquired immunodeficiency syndrome (AIDS) or leukemia and the patient's sexual preference as either heterosexual or homosexual. Harsh attitude judgements were associated with the AIDS portrayals, as well as much less willingness to interact even in routine conversation when the patient's illness was identified as AIDS. Increasing numbers of AIDS patients will be seeking medical attention from physicians in all areas of the country and it will be important for health care professions to develop programs which counter unreasonable stigma and prejudicial attitudes that may be associated with this illness.     

Characteristics Associated with Differences in Reported Versus Measured Total CholesterolAmong Male Physicians

We studied 4,543 male physicians to assess accuracy of self-reported cholesterol level. The rate of accurate reporting improved over 14 years (25% to 62%), while failing to report a cholesterol level decreased. Overweight, current or past smoking, and physical inactivity were significantly associated with not reporting or inaccurately reporting cholesterol level. Though an increasing proportion of physicians accurately reported their cholesterol level over time, those at increased risk for developing cardiovascular disease tended to underestimate or fail to report their cholesterol level. Knowledge may be a critical factor in empowering physicians and patients to advocate for and adopt healthier lifestyles.Editors Strategic Implications: Rates of sedentary behavior and obesity in the U.S. continue to rise. In this promising study with a large sample, a longitudinal design, and multi-method assessments, we find that—even among this sample of highly educated medical professionals—those individuals who are at greatest cardiovascular risk might require different types of monitoring, motivational interventions, or health education.     

Social rehabilitation experiences of people with a history of Hansen's disease: interviews of readmitted residents in a sanatorium

PURPOSE: This study focused on the reflections of people with a history of Hansen's disease who once experienced social life and then returned to their sanatorium again. The purpose was to clarify what they think about their experiences of social life outside of institutions. METHOD: Study participants were people with a history of Hansen's disease who had experienced social life outside of the sanatorium and are now living in a national sanatorium with good ADL. The study was based on a semi-structured interview, the data being categorized with the focus on "situations or topics affect by Hansen's disease". Thirteen people agreed to participate in the study. RESULTS AND DISCUSSION: Six categories were abstracted: "maintaining a good condition," "anxiety about relapse or illness," "medical service," "coping with Hansen's disease in social life," "relationships with others," and "means of livelihood." Hansen's disease affected their lives in 2 aspects; one was "sawagu (recurrence of the disease)" and the other "kakusu (concealing the disease)." "Sawagu" was related to "anxiety of the disease" and "intention of maintaining a good condition." "Kakusu" affected the way of "coping with the disease in social life" and "the relationship with others." "Medical service" was important for both "sawagu" and "kakusu." Patients were visiting hospitals and taking medicine to avoid "sawagu," while trying to "kakusu" when they consulted with physicians. Similarly, both "sawagu" and "kakusu" interacted with each other when the participants needed to work and earn a living. All participants looked back at their social life as a "good experience" because they were satisfied with the sense of accomplishment or fulfillment the experience had given them. CONCLUSION: Participants of the study looked back at their social life as a "good experience." Hansen's disease affected their social life in 2 aspects; "sawagu" and "kakusu." It is necessary to alleviate difficulties with both of these so that people with stigmatized disease such as Hansen's disease can maintain normal lives in society.     

Self-Management Services

For people with chronic illness, day-to-day responsibilities for care fall most heavily on patients and their families. Organising healthcare to strengthen and support self-management in chronic illness while assuring that effective medical, preventative and health maintenance interventions take place is key to effective disease management.This paper discusses the behavioural principles and empirical evidence about healthcare designed to maximise positive patient participation in chronic disease care. Four main essential elements are key: (i) collaborative definition of problems, in which patient-defined problems are identified along with medical problems diagnosed by physicians; (ii) targeting, goal-setting and planning, where patients and providers together agree on realistic objectives and set an action plan for attaining them; (iii) availability of a continuum of self-management training and support options that teach patients the skills needed to carry out medical regimens, guide health behaviour change and provide emotional support; (iv) active and sustained follow-up during which patients are contacted at specified intervals to monitor health status and reinforce progress in meeting care plan objectives. These elements constitute a common core of services and approaches that do not need to be replicated for each chronic condition.     

Do Physicians Discuss HIV and AIDS with Patients? A Survey of Physician Practices

HIV and AIDS continue to be major concerns to the health care community and the world around them. Preventive efforts and education have been the focus of the fight against AIDS thus far. By the year 2000, 75% of physicians are expected to conduct risk-reduction counseling for patients regularly. Previous studies show that a smaller percentage routinely follow this recommendation. The purpose of our study was to assess with what percentage of patients physicians discuss several HIV/AIDS-related topics, what percentage of their patients are considered at risk for infection, and how comfortable the physicians are with their knowledge level and discussing the subject matter. We sent surveys to the last five graduating classes from St. Louis University School of Medicine and to 169 physician preceptors in the community. The survey asked about patients considered at risk, physician comfort level with HIV/AIDS, the percentage of patients they discuss various HIV/AIDS topics with, and his or her preparedness for these discussions. Total responses were 464 (53.7%) representing all areas of medicine. Most of the physicians (72.9%) consider 0–25% of their patients at risk for HIV/AIDS. Eighty-one percent claim they are moderately or very comfortable discussing the material with patients and more than 90% feel they have at least adequate knowledge. Most of the respondents discuss the HIV/AIDS topics with 0–25% of patients. Recent medical school graduates and primary care physicians are more comfortable with HIV/AIDS and discuss the surveyed topics with a higher percentage of patients.