Abortion providers,stigma and professional quality of life

Objectives

The Providers Share Workshop (PSW) provides abortion providers safe space to discuss their work experiences. Our objectives were to assess changes in abortion stigma over time and explore how stigma is related to aspects of professional quality of life, including compassion satisfaction, burnout and compassion fatigue for providers participating in the workshops.

Study Design

Seventy-nine providers were recruited to the PSW study. Surveys were completed prior to, immediately following and 1 year after the workshops. The outcome measures were the Abortion Provider Stigma Survey and the Professional Quality of Life (ProQOL) survey. Baseline ProQOL scores were compared to published averages using t tests. Changes in abortion stigma and aspects of professional quality of life were assessed by fitting a two-level random-effects model with repeated measures at level 1 (period-level) and static measures (e.g., demographic data) at level 2 (person-level). Potential covariates included age, parenting status, education, organizational tenure, job type and clinic type (stand-alone vs. hospital-based clinics).

Results

Compared to other healthcare workers, abortion providers reported higher compassion satisfaction (t= 2.65, p=.009) and lower burnout (t= 5.13, p<.0001). Repeated-measures analysis revealed statistically significant decreases in stigma over time. Regression analysis identified abortion stigma as a significant predictor of lower compassion satisfaction, higher burnout and higher compassion fatigue.

Conclusions

Participants in PSW reported a reduction in abortion stigma over time. Further, stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue, suggesting that interventions aimed at supporting the abortion providing workforce should likely assess abortion stigma.

Implications

Stigma is an important predictor of compassion satisfaction, burnout and compassion fatigue among abortion care providers. Therefore, strengthening human resources for abortion care requires stigma reduction efforts. Participants in the PSWs show reductions in stigma over time.     

Prevalence and factors associated with HIV/AIDS-related stigma and discriminatory attitudes: A cross-sectional nationwide study

ObjectiveThe prime purpose of this study is to assess HIV/AIDS-related self-stigma and discrimination (S&D) attitudes and associated factors using multivariate analysis of data from the 2010–11 National Survey of Understanding the Root of HIV/AIDS Related Stigma and Discrimination.MethodA national telephone survey was carried out with 2271 of the Malaysian public aged 18–60 years. The sample was contacted by random digit dialing covering the whole of Peninsular Malaysia from December 2010 to May 2011. The HIV-transmission knowledge, HIV-related self-stigma, and public stigma were investigated.ResultsDespite high level of HIV-transmission knowledge [mean (SD) = 10.56 (2.42), mean score at 70th percentile] the respondents in this study had moderate levels (mean scores near midpoints) of self-stigma and public stigma attitudes. HIV-transmission knowledge score was not significantly correlated with self-stigma score, but showed a significantly small positive effect (r < 0.2) for public stigma scores. Ethnicity is the strongest correlate of HIV-transmission knowledge, self-stigma, and public stigma attitudes in the multivariate analyses. Other significant correlates were age, socioeconomic group, and urban–rural setting.ConclusionsThe root causes of HIV stigma and discriminatory attitudes were not associated with knowledge deficiency. Interventions should be oriented towards promoting de-stigmatization of HIV/AIDS, and tailored socio-culturally.     

Burnout among mental health professionals: A Tunisian experience

BackgroundBurnout syndrome consists in physical as well as mental exhaustion observed in professionals whose work involves continuous contact with other people. Psychiatrists and psychiatry nursing staff are considered to be vulnerable to experiencing burnout. The purposes of this study aim to investigate the prevalence of burnout syndrome in practitioners, residents and nurses working in the psychiatric hospital of Tunisia. It also aims to investigate the relationship between burnout, depression, and a variety of personal variables, including age, gender, marital, parental and personal difficulties within this population.MethodsA cross-sectional study was conducted among the nursing staff (n = 54), residents (n = 41) and practitioners (n = 11) in Razi hospital in Tunisia. The Maslach Burnout Inventory, the Beck depression inventory and a general questionnaire on demographic data were used.ResultsHigh levels of burnout were detected among nurses. This was true for the emotional tiredness sub-scale (mean score: 26.18); the depersonalization subscale (mean score: 10.20) and for the alteration of personal achievements (mean score: 32.94). High scores in emotional tiredness were correlated to depression (P = 0.000; R = 0.56) and to personal difficulties (P = 0.021; R = 0.31) in this group. Residents showed high scores in personal achievements (mean score: 32.56), and practitioners did not reach the cutoff scores on the Maslach Burnout Inventory.ConclusionOur results are somewhat comparable to those of studies in other countries. Burnout syndrome was highly prevalent among nurses and residents. This study corroborates former results of a relation between depression and burnout. A strong relationship was found between personal difficulties and burnout, but seemed to be more specific to the nursing sample.     

The Well-Being of Peer Supporters in a Pandemic: A Mixed-Methods Study

BackgroundPeer support is an effective, well-received approach to caring for health care professionals who face stress, challenges, and reduced well-being. Peer supporters may be at risk for emotional exhaustion and secondary traumatic stress due to their primary roles and involvement as peer supporters during the COVID-19 pandemic.MethodsPeer supporters from five well-established peer support programs completed surveys (ProQOL and a five-item emotional exhaustion measure) to assess secondary traumatic stress, compassion satisfaction, and burnout during the pandemic. Analysis of variance models analyzed differences in these well-being outcomes by role, age, years in health care, and working in high-risk areas. Qualitative content analysis was performed for open-response questions about challenges, needs, and successful well-being strategies using Braun and Clarke's six-phase thematic analysis.ResultsA total of 375 peer supporters completed the survey between spring and summer 2021 for a response rate of about 38%. Most participants had low secondary traumatic stress and moderate to high compassion satisfaction; nearly 44% had concerning levels of emotional exhaustion. Compassion satisfaction was significantly lower (p = 0.003) and emotional exhaustion significantly higher (p < 0.001) among the youngest cohort, and both compassion satisfaction and emotional exhaustion differed across career stages (p = 0.003 and p = 0.04, respectively). Emotional exhaustion was significantly higher in peer supporters working in COVID units than in non-COVID units (p = 0.021). Peer supporters identified numerous protective and risk factors associated with serving as a peer supporter.ConclusionDespite having moderate to high levels of compassion satisfaction, peer supporters report high levels of burnout and numerous challenges and needs to sustain their well-being. To maintain effective peer support programs during the ongoing pandemic, health care organizations must study and support the well-being of health care professional peer supporters.     

Television use and binge eating in adults seeking weight loss treatment

ObjectiveBinge eating has a complex etiology and is likely influenced by a wide range of biological, psychological, social, and environmental factors. Among the environmental and behavioral contributors, television use has been strongly linked to obesity and unhealthy eating behaviors. The current study tested whether television use predicts binge eating symptomatology in adults seeking behavioral weight loss treatment.MethodParticipants (N = 116) were adults seeking weight loss treatment in group-based behavioral weight loss programs. Average body mass index was 38.5; average age was 45.3. They completed measures of binge eating symptomatology, television use, internalized weight stigma, depression, body satisfaction, and habitual physical activity.ResultsThe amount of television participants watched per week was associated with binge eating symptomatology even after controlling for relevant covariates. Binge eating symptomatology was positively associated with television use, internalized weight stigma, depression, and decreased body satisfaction.DiscussionThe findings of the current study support the hypothesis that television use is a significant predictor of binge eating symptomatology for adults attempting weight loss. Determining the causal nature of the relationship and whether binge eating is occurring during television viewing will be important areas of future inquiry.     

Specific instructions for estimating unclearly reported blinding status in randomized trials were reliable and valid

ObjectiveTo test the reliability and validity of specific instructions to classify blinding, when unclearly reported in randomized trials, as “probably done” or “probably not done.”Study Design and SettingWe assessed blinding of patients, health care providers, data collectors, outcome adjudicators, and data analysts in 233 randomized trials in duplicate and independently using detailed instructions. The response options were “definitely yes,” “probably yes,” “probably no,” and “definitely no.” We contacted authors for data verification (46% response). For each of the five questions, we assessed reliability by calculating the agreement between the two reviewers and validity by calculating the agreement between reviewers’ consensus and verified data.ResultsThe percentage with unclear blinding status varied between 48.5% (patients) and 84.1% (data analysts). Reliability was moderate for blinding of outcome adjudicators (κ = 0.52) and data analysts (κ = 0.42) and substantial for blinding of patients (κ = 0.71), providers (κ = 0.68), and data collectors (κ = 0.65). The raw agreement between the consensus record and the author-verified record varied from 84.1% (blinding of data analysts) to 100% (blinding of health care providers).ConclusionWith the possible exception of blinding of data analysts, use of “probably yes” and “probably no” instead of “unclear” may enhance the assessment of blinding in trials.     

Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria

Objective

To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals.

Compassion satisfaction and compassion fatigue among medical social workers in Korea: the role of empathy

ABSTRACT

Medical social workers are affected by their clients’ suffering, which has an impact on social workers’ professional quality of life. This study examined the role of empathy in relation to professional quality of life among medical social workers in South Korea. Using the Professional Quality of Life Scale and Interpersonal Reactivity Index, we found that empathic concern and personal distress were significant components of empathy and were correlated with professional quality of life. Empathic concern was positively associated with compassion satisfaction and negatively associated with burnout. Personal distress was correlated with all components of quality of life: compassion satisfaction, secondary traumatic stress, and burnout. Women had significantly higher levels of burnout than men; religious affiliation was associated with higher levels of compassion satisfaction; and longer years of employment was associated with higher levels of secondary traumatic stress. Medical social workers should be educated on and trained in how empathy can help them address compassion fatigue and promote compassion satisfaction.     

Summary-of-findings tables in Cochrane reviews improved understanding and rapid retrieval of key information

ObjectiveTo measure the effects of a summary-of-findings (SoF) table on user satisfaction, understanding, and time spent finding key results in a Cochrane review.Study Design and SettingWe randomized participants in an evidence-based practice workshop (randomized controlled trial [RCT] I) and a Cochrane Collaboration entities meeting (RCT II) to receive a Cochrane review with or without an SoF table. In RCT I, we measured user satisfaction. In RCT II, we measured correct comprehension and time spent finding key results.ResultsRCT I: Participants with the SoF table (n = 47) were more likely to “agree” or “strongly agree” that it was easy to find results for important outcomes than (n = 25) participants without the SoF table—68% vs. 40% (P = 0.021). RCT II: Participants with the SoF table (n = 18) were more likely to correctly answer two questions regarding results than (n = 15) those without the SoF table: 93% vs. 44% (P = 0.003) and 87% vs. 11% (P < 0.001). Participants with the SoF table spent an average of 90 seconds to find key information compared with 4 minutes for participants without the SoF table (P = 0.002).ConclusionIn two small trials, we found that inclusion of an SoF table in a review improved understanding and rapid retrieval of key findings compared with reviews with no SoF table.     

The influence of health insurance towards accessing essential medicines: The experience from Shenzhen labor health insurance

ObjectivesDue to major problems of accessing essential medicines, this paper will evaluate the impact of the new Shenzhen labor health insurance on accessing essential medicines among migrant workers.MethodsMedicines data and revenues–expenditures reports from 19 community health service centers in Shenzhen city were collected. Insurance indicators within two periods before and after 1st June 2006 were compared. Paired t-tests using month-values of indicators were performed. P value <0.05 considered statistically significant.ResultsThe proportion of EMs in Medicine List of Shenzhen Labor health insurance is 88.5%. For each period, percentage costs of EM procured (P_eem) was 43.1% and increased to 46.1%; costs of medicines per outpatient visit (E_mpv) was 24.94 RMB and decreased to 22.20 RMB; percentage costs of medicine per outpatient visit (P_e) were 49.1% and decreased to 45.9%; number of outpatient visits (N_ov) was 428,328 and increased to 490,305. Values of t for differences in P_eem, E_mpv, P_e and N_ov between the two periods were −1.125 (P = 0.285), 3.096 (P = 0.010), 1.458 (P = 0.173) and −2.069 (P = 0.063), respectively.ConclusionsShenzhen labor health insurance had improved accessibility to EMs for migrant workers, and ensured for them basic health services. Popularization of this insurance will benefit more people.     

The Impact of First-Person Abortion Stories on Community-Level Abortion Stigma: A Randomized Trial

ObjectiveWe aimed to assess the impact of first-person abortion stories on community-level abortion stigma.MethodsBetween November 2018 and March 2019, we recruited participants and analyzed data from a nationally representative, probability-based online panel of U.S. adults, randomized to watch three first-person abortion video stories (intervention, n = 460) or three nature videos (control, n = 426). We measured community-level abortion stigma using the Community Abortion Attitudes Scale, Reproductive Experiences and Events Scale, and Community Level Abortion Stigma Scale at baseline, immediately after video exposure, and 3 months later. We dichotomized stigma change scores as decreased stigma compared with no change or increased stigma. Bivariate and logistic regression analysis accounted for complex survey methodology and sample weighting.ResultsSample demographics reflected U.S. Census benchmarks (51% female, 68% White, 47% aged 18–44 years). Most participants (83.1%) completed the 3-month follow-up. Viewing the intervention videos was not associated with decreased stigma measured by Community Abortion Attitudes Scale or Community Level Abortion Stigma Scale immediately (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.59–1.09; OR, 1.28; 95% CI, 0.93–1.75) or at the 3-month follow-up (OR, 0.86; 95% CI, 0.62–1.19; OR, 0.98; 95% CI, 0.70–1.37). Intervention exposure was associated with decreased stigma as measured by Reproductive Experiences and Events Scale immediately (OR, 1.74; 95% CI, 1.23–2.46); however, this association was not observed at the 3-month follow-up (OR, 0.98; 95% CI, 0.70–1.37).ConclusionsExposure to first-person video stories may not decrease community-level abortion stigma among U.S. adults.     

Impacto sobre el cuidador principal de una intervención realizada a personas mayores dependientes

ObjectiveTo evaluate the impact of joining a home care program on primary caregivers of dependent elderly people.DesignNon-randomised “before-after” intervention study.SettingPrimary Care.ParticipantsPrimary carers of elderly dependent people included in a home care program (n = 156; 7.8% loss to follow up).InterventionsInclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year.Variables assessedperceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received.ResultsThere were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p < 0.05) and the percentage of overusers (30.1 vs 6.9%, P < .01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P < .05) and caregiver overburden (56.4 vs 44.4%, P < .05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P < .05).ConclusionsJoining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support.     

Evaluación de un modelo formativo para profesionales sanitarios en la atención del paciente crítico: Estudio AIPCAP

ObjectiveTo evaluate the validity, acceptability, and impact on the level of knowledge and skills of Primary Care health professionals of a training model aimed at improving the care of critical patients.DesignA quasi-experimental interventional, multicentre study.LocationEight health care teams in Barcelona.ParticipantsA total of 272 professionals.InterventionsA training program consisting of 48 simulations of acute myocardial infarction and stroke.Main measurementsA checklist was used to evaluate critical patient skills, effect of training on the knowledge of the participants, and a satisfaction survey. The training was carried out after 2 series of simulations (AMI + Stroke). In the second series, 3 evaluations were made: in situ, one week after, and at 3 weeks. Concordance and reliability were measured. The differences in means were analysed using the Student t test for paired data.ResultsA total of 449 knowledge tests were answered, with a higher score being obtained at the end of each simulation (3.89 -SD 1.01 vs. 3.21 -SD 1.09). Doctors obtained better medical scores than nurses (3.81 - SD 0.87 vs. 3.32 - SD 1.15), and professionals with a specialty completed scored more than those in training (MIR) (3.6 - SD 1.08 vs. 3.4 - SD 1.18).The mean score was 7.7 points (SD 1.56) in the first evaluation, and improved to 9.1 points (SD 0.78). The kappa index was greater than 0.40 in all cases.ConclusionsA training methodology in the management of emergencies in Primary Care based on simulations is valid, reliable and well accepted, achieving an improvement in the level of knowledge and skills of the participating professionals.     

An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia

ObjectiveWe evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia.MethodsA 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children <2 y old (n = 698) were purposively sampled from three health facilities (n = 459) and four community posts (n = 77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n = 162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n = 6), health workers (n = 35), and mothers whose children attended all follow-up visits (n = 27).ResultsAnthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score ?0.8 ± 0.7), followed by trained (?0.5 ± 0.6) and untrained (–0.3 ± 0.47; P < 0.05) health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices.ConclusionsThe GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.     

Hábitos saludables y prevención de la osteoporosis en mujeres perimenopáusicas de un ámbito rural

ObjectiveThe probability of developing osteoporosis decreases with an adequate supply of vitamin D, a balanced diet, and increased physical activity. In this study, we evaluated whether an educational intervention improves osteoporosis-related behavior in perimenopausal women from rural areas.MethodsA randomized experimental evaluation was performed of an educational intervention. The variables were physical activity, calcium intake and sun exposure in women from rural areas aged 45-54 years (n = 216) at time 0 and 12 months after the educational intervention. In the control group (n = 106), the information was sent by surface mail (month 0). In the intervention group (n = 110), two interactive workshops were given (month 0). The topic of the workshops and the information sent by surface mail was healthy habits for osteoporosis prevention.ResultsAfter 12 months, the intervention group, but not the control group, had increased their physical activity (p = 0.006), sun exposure (p = 0.029), and calcium intake (53% to 64%).ConclusionA simple educational intervention in perimenopausal women from rural areas improved healthy habits for osteoporosis prevention.     

Perceived effectiveness of HPV test as a primary screening modality among US providers

BackgroundThe human papillomavirus (HPV) test, administered alone without the Papanicolaou (Pap) test, was recently recognized as a cervical cancer screening option in the United States by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology, and the Food and Drug Administration has approved an HPV test for primary screening.MethodsSurveys of US internists, family practitioners, nurse practitioners, and obstetrician–gynecologists were conducted in 2009 and 2012 to investigate providers' perceptions of the effectiveness of the HPV test administered alone as a population-based screening modality (2009: N = 1040, 141–494 per provider group; 2012: N = 1039, 155–435 per provider group).ResultsThe majority in each provider group agreed that the HPV test administered alone is an effective screening modality in 2009 (75.3%–86.1%) and 2012 (79.5%–91.8%), and agreement rose significantly during this time period among family practitioners (χ² = 15.26, df = 1, p < 0.001) and nurse practitioners (χ² = 4.53, df = 1, p = 0.033).ConclusionsAgreement that the HPV test administered alone is an effective cervical cancer screening modality was widespread among providers in both 2009 and 2012, however implementation of guidelines for screening with the HPV test may be influenced by many other factors including reimbursement and patient preferences.     

Intention to accept pertussis vaccine among pregnant women in Karachi,Pakistan

BackgroundMaternal immunization against pertussis is a potential strategy to protect young infants from severe disease. We assessed factors associated with intention to accept pertussis vaccination among pregnant women in Karachi, Pakistan.MethodsWe conducted a cross-sectional survey between May and August 2013 in pregnant women who visited healthcare centers in urban slums of Karachi city. Women completed a survey examining socio-demographic factors, vaccination history, knowledge on pertussis disease, perception of vaccine recommendation sources, and potential influences on vaccine decision-making.ResultsOf the 283 participants, 259 (92%) provided their intention to either accept or decline pertussis vaccination. Eighty-three percent women were willing to accept the pertussis vaccine if offered during pregnancy. About half (53%) of the participants had ever heard of pertussis disease. Perceptions of pertussis vaccine efficacy, safety, and disease susceptibility were strongly associated with intention to accept pertussis vaccine (p < 0.01). Healthcare providers, Ministry of Health, and mass media were considered as highly reliable sources of vaccine recommendation and associated with intention to accept antenatal pertussis vaccination (p < 0.001). Healthcare provider recommendation was a common reason cited by respondents for pregnant women to accept antenatal pertussis vaccination (p = 0.0005). However, opinion of primary decision-makers in the family (husbands and in-laws) was a crucial reason cited by respondents for pregnant women to reject pertussis vaccination in pregnancy (p = 0.003).ConclusionAntenatal pertussis vaccination initiatives in South Asia should strongly consider inclusion of family members, healthcare providers, national health ministries, and mass media to help implement new vaccination programs.     

Athletic identity, affect, and peer relations in youth athletes with physical disabilities

BackgroundTheory-based investigations of the psychosocial aspects of youth participation in disability sport are underresearched, suggesting a need for more scholarly inquiry in this area. We sought to examine athletic identity, affect, and peer relations of youth athletes with physical disabilities and selected relationships among these variables.MethodsParticipants (N = 36) completed the Private-Public Athletic Identity Scale, the Positive and Negative Affect Schedule, and the Peer Relations Scale.ResultsParticipants reported stronger private athletic identity individual item scores (mean ≈ 4.0) compared with a public (mean = 2.4) athletic identity and expressed much positive (mean = 4.4) affect and low negative affect (mean = 1.7). They also expressed strong peer relations (mean = 5.0). A significant relationship (r = 0.34, p < .05) between positive affect and peer relations existed.ConclusionsFriendships in and outside of disability sport may contribute to quality of life by promoting positive affective states such as feelings of joy, satisfaction, inspiration, excitement, and enthusiasm. In general, our results supported the potentially positive role that adapted sport can have on the well-being of youth with physical disabilities.     

Parent reported outcomes to measure satisfaction,acceptability, and daily life impact after vaccination with whole-cell and acellular pertussis vaccine in Chile

AimTo compare parental satisfaction and impact on daily life among parents of children receiving whole-cell pentavalent + oral polio vaccine (Arm 1) with an acellular hexavalent vaccine (Hexaxim; Arm 2).MethodsSelf-administered electronic questionnaire at vaccination and one week later in six community health clinics of metropolitan Santiago, Chile, exploring parent-reported outcomes on satisfaction, acceptability, and impact on daily life after immunization. Univariate and multivariate analyses were conducted to determine differences in the responses in both groups (α = 0.05).ResultsThe study enrolled 800 participants and 65% (222 in Arm 1, 296 in Arm 2) were included for according-to-protocol analysis. Demographic characteristics were comparable, except for a higher proportion of mothers answering the questionnaire at the 6-month visit. Regardless of the study arm, parental knowledge and perception of the immunization practices were good, and there were no differences in vaccination experiences in the prior 5 years. However, satisfaction with vaccination and intention to vaccinate were statistically significantly higher in Arm 2 after the 6-month visit. Also, more parents in Arm 2 reported no disruption in several aspects of the everyday activities of the parent, the child, and other children in the household. Parents in Arm 2 were more likely to be satisfied with the vaccine received (OR 2.82; 95% CI, 1.22–7.07); return for other vaccine dose (OR 2.62; 95% CI, 1.45–4.84); follow a healthcare professional recommendation (OR 2.24; 95% CI, 1.57–3.21); and, to be confident that the vaccine will not disrupt the family’s daily routine (OR 1.89; 95% CI, 1.32–2.71).ConclusionsOverall, satisfaction, intention for future vaccination, and lower impact on the family daily routine were significantly better in the group receiving the hexavalent vaccine. We also found that health care providers’ recommendations to vaccinate and participants’ access to health services were important factors favoring immunization.     

Factors affecting physicians’ perception of the overuse of antibiotics

ObjectiveWe aimed to determine the reasons for irrational antibiotic use, to evaluate knowledge, attitudes, and behaviors of physicians regarding such use, to find factors affecting knowledge of physicians, and to explore precautions that need to be taken to stop irrational antibiotic use.Material and methodsWe performed the study between January 2014 and June 2014. We included 202 physicians who answered a questionnaire with 22 multiple-choice questions about knowledge (eight questions), behavior and attitudes of physicians (nine questions), and recommendations for reducing antibiotic consumption (five questions). Answers to all questions were assessed according to the physician's age, educational status, metropolitan areas, and healthcare facilities.ResultsThe effects of parents’ expectations and satisfaction (7.4%–40.0%) (P < 0.0001) and socioeconomical status of families (33%–62%) (P = 0.007) increased as the participants’ age decreased. Participants working at public hospitals (42.6%) considered expectations and satisfaction of parents more important than other participants (10.5%–26.9%; P = 0.002). Rapid recovery of patients was not an essential determinant for administering antibiotics for pediatricians (25.7%) and pediatric assistants (26.9%). However, it was important for emergency physicians (55.6%) and family physicians (60%, P = 0.016). Physicians working at university hospitals did not consider this determinant as important as physicians working in other healthcare facilities (P = 0.001).ConclusionTo determine the obstacles associated with promoting rational antibiotic usage, every country should assess the attitudes, behavior, and knowledge of physicians related to such use. The present study is one of the few in Turkey to address the problems associated with irrational antibiotic use.