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OBJECTIVE: To develop a scale of mental toughness among medical doctors. METHODOLOGY: In the current study Mixed-Method research design was used, qualitative design was used to elicit the items for mental toughness and quantitative was used to establish psychometrics. This study was carried out in Govt. hospitals of Lahore. The study was carried out from August 2018-April 2019. The construct of mental toughness was explored from 20 post graduate residents and house officers (10 men and 10 women) through a semi structured interview. After excluding the repetition finalist of 40 items was further validated by 10 experts and based on the 50% agreement from the experts, a list of 30 items was finalized and piloted on 40 doctors (20 men and 20 women) for assessing user friendliness. Finally, a sample of two hundred doctors (100 men and 100 Women) between the ages of 22 to 36 (M =26.17, SD =1.83) from different Government. Hospitals of Lahore were given Mental Toughness Scale, Depression, Anxiety, Stress Scale (DASS-21) along with a Demographic form. RESULTS: Exploratory factor analysis through varimax rotation yielded three factors solution named as Determination, Resilience and Optimism. The MTS was found to have sound psychometric properties as split half reliability was .74 test, retest reliability was .75. CONCLUSION: Mental toughness scale was found high psychometric properties; results were discussed in term of counseling and enhancing positive strengths in medical doctors.

Background: Ethical problems routinely arise in the healthcare profession and more so in hospitals providing cancer diagnosis and care. Literature study indicates that almost all studies addressing ethical issues in cancer have been qualitative and reported from the developed countries, while there has been no study reported from developing countries. For the first time, we performed a questionnaire study to quantify the ethical issues plaguing the healthcare fraternity in the diagnosis and care of people with cancer. Method: This prospective study was conducted under the aegis of UNESCO Bioethics Education and Research Unit of the UNESCO Chair in Bioethics, Haifa at Mangalore Institute of Oncology Mangalore, India. The investigators approached the healthcare professionals involved in diagnosis, treating, and caring for patients with cancer and ascertained various ethical issues they faced. Data were tabulated and subjected to frequency and percentage. Result: The results indicated that discussing end-of-life issues with the patient and breaking bad news were the two most difficult ones while discussing end of life issues with family caregivers was the least. Conclusion: According to this study, oncology treatment involves a series of dilemmatic issues and breaking bad news. Based on the detailed studies and emphasis on handling these issues, it is possible to develop a teaching module for training the health care professionals and workers for managing the ethical issues effectively.

Objective: This study aimed to compare job satisfaction, burnout, and depression scores of medical doctors from different regions in Turkey. Method: A cross-sectional study was performed during October 2013 in three cities from Turkey. Participants were asked to self-administer a demographic information questionnaire, the Minnesota Satisfaction Questionnaire (Internal work satisfactionIWS and External work satisfaction-EWS), the Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI), Maslach Emotional Exhaustion Score (MEES), and Maslach Personal Accomplishment Score (MPAS). Results: Mean (±SD) Total work satisfaction score was 66.2±12.6. 118 participants had BDI scores of 10 or less while 40 participants had 11 or higher scores. Proportions for poor depersonalization, emotional exhaustion, and personal accomplishment were 18.6% (n=29), 5.8% (n=9), and 81.9% (n=127) respectively. There were significant differences concerning some variables between the three cities. Most of the doctors in Şırnak and Hakkari were younger, single, and less experienced compared to the more developed Çanakkale (p

OBJECTIVE: This study assessed the characteristics of medical doctors working in public healthcare institutions and examined differences in some of the characteristics by geographical (urban versus rural) location. METHODS: A cross-sectional study of doctors working in public healthcare institutions using data obtained from 3 centres in Bayelsa, Nigeria. RESULTS: Three-quarters (75.4%) of the 280 medical doctors were males. Most of the doctors (68.6%) were working at tertiary healthcare level, 16.1% at primary and 15.4% at secondary healthcare levels. In terms of their professional positions, there were more medical officers (34.5%) relative to the other cadres while 17.2% were consultants. When their places of practice were dichotomised into rural and urban settings, 88.2% were practising in urban settings. A higher proportion of the 69 female doctors were practising in urban settings compared to rural settings (26.7% versus9.1% respectively, P=0.027). There was a statistically significant relationship between residency status and place of practice (P=0.001). Specialists (i.e. doctors who have completed residency training) were more likely to practice in urban (19.2%) than in rural settings (3.3%). CONCLUSION: Only a quarter of doctors in this study were females. There seemed to be more doctors at tertiary level of care and in urban areas. These findings suggest that there may be a shortage of female doctors, and that there may be unmet personnel needs at primary and secondary healthcare levels and in rural areas.

Malta is the only EU country where abortion remains illegal in all circumstances. This study aims to assess the previously unexplored views of Malta’s medical doctors on the legality of contraception, abortion, assisted reproductive technology and surrogacy. Following ethics approval, 1578 out of a total of 2468 registered medical doctors in Malta were invited for an anonymous survey. The response rate was 28.8% (n = 454), guaranteeing a maximum margin of error of 4.16% assuming a 95% confidence level. Responses consisted of “Yes”, “No”, and “Not sure”. In the abortion section, “Yes” responses were specific to different gestational age limits. A majority supported all contraceptive methods being legal: morning-after pill (59.7%); intra-uterine device (85.9%); surgical sterilisation (>70%). A majority also agreed with in-vitro fertilisation being legal (93.8%). Embryo freezing and surrogacy garnered less support (39.9% and 40.5% respectively). Legalising abortion for “Woman’s life in danger” and “Non-viable fetal anomaly” was supported at least up to 12 weeks gestation by 66.8% and 63.0% respectively, and in all stages of pregnancy by 54.2% and 50.2% respectively. Support, at least up to 12 weeks gestation, was less for other circumstances: “Rape or incest” (35.3%); “Preserve a woman’s physical health” (30.0%); “Preserve a woman’s mental health” (26.8%); “Viable fetal anomaly” (24.6%); “

Patients hunt for genuine empathy from their medical doctor. Empathy is an affective mode of understanding. Empathy involves being enthused by another's experiences. However, a leading group medical doctors defines empathy as 'the act of correctly acknowledging the emotional state of another without experiencing that state oneself'. Beyond the field of medicine, empathy is an approach to understanding that precisely involves emotional resonance. However, mentioned definition of empathy primarily gives emphasis to an intellectual component rather than emotional form. Medical educationist and medical professional bodies increasingly recognise the importance of empathy because there are a lot report published regarding poor empathy level among medical doctors. This article will try to discuss emphasising on educational intervention which improves empathy level and its influence on healthcare.

Background: Healthcare students that refuse to get vaccinated may expose themselves and their patients to several vaccine-preventable diseases, especially during outbreaks or at peak epidemic activity, becoming a threat to themselves and their patients. This study aimed to assess their attitudes towards and perception of vaccines and vaccination. Methods: An anonymous questionnaire was shared with medical students, pharmacy students and medical residents in Hygiene and Preventive Medicine at the University of Florence (Italy), in February 2021. The questionnaire contained 39 questions with open, multi-choice, yes–no, Likert scale answers. A Vaccine Hesitancy Index (VHI) was then calculated. A descriptive statistical analysis was performed. Results: A total of 473 students participated in this study. All students were in favour of vaccination (99.2%) but a relatively low number of participants judged their level of knowledge about vaccinations as “good” (21.8%) or “excellent” (0.6%). About half of students declared that they are not adequately trained during their academic courses. The VHI showed low levels of vaccine hesitancy (mean ± SD 0.38 ± 0.16); moreover, the students were willing to get vaccinated against SARS-CoV-2 when recommended (88.2%) and thought that these vaccines are generally safe. Few students considered the development of SARS-CoV-2 vaccines (13.1%) and the procedures for evaluating clinical trials for marketing authorisation of these vaccines (12.9%) too fast to guarantee their efficacy and safety. Conclusions: Since vaccination and vaccine hesitancy and acceptance topics are being paid increasing attention by the population, new strategies to increase future healthcare professionals’ willingness to promote vaccination and get vaccinated, as well as knowledge on vaccines and vaccination, will be of the utmost importance to fight vaccine preventable diseases.

Purpose: Most of the resilience scales were developed for the non-medical population, therefore the purpose of this study was developing and validating a resilience scale for medical professionals - namely Medical Professionals Resilience Scale (MeRS).Methods: A questionnaire development and validation study was conducted. The resilience domains and items were identified and generated through a literature review. The content validation was carried out by content experts and the content validity index (CVI) was calculated. The face validation was performed by medical officers and the face validity index (FVI) was calculated. The final MeRS was administered to 167 medical officers, exploratory factor analysis (EFA) and reliability analysis were performed to assess MeRS's factorial structure and internal consistency.Results: Four domains with 89 items of medical professionals' resilience were developed. Following that, the content and face validation was conducted, and a total of 41-items remained for construct validation. EFA extracted four factors, namely growth, control, involvement, and resourceful, with a total of 37 items. The items' CVI and FVI values were more than 0.80. The final MeRS's items had factor loading values ranged from 0.41 to 0.76, and the Cronbach's alpha values of the resilience domains ranged from 0.72 to 0.89.Conclusions: MeRS is a promising scale for measuring medical professionals' resilience as it showed good psychometric properties. This study provided validity evidence in terms of content, response process, and internal structure that supported the validity of MeRS in the measurement of resilience domains among medical professionals. [ABSTRACT FROM AUTHOR]

Background: The availability of a skilled health professional (nurse, midwife or doctor) who has been trained and is fit for practice to provide maternity care is fundamental in scaling down and ending preventable maternal and child deaths. Knowing the determinants of the development of ideal skills for effective practice ensures that women and their babies receive quality maternity care services from skilled birth attendants who are fit for practice. This study aimed to find and build on the existing evidence addressing aspects linked to competence and confidence development during training among students, newly qualified nurses, doctors and midwives from a global perspective. Methods: A literature review was undertaken, using the 'SPIDER' search strategy to identify relevant papers from multiple databases. Studies were included if they were written in English and related to midwives, nurses and medical doctors when they were students, newly qualified professionals or after they had been working for 3-4 months. Opinion or non-empirical papers, editorials, conference papers and empirical articles with abstracts were excluded. Search words were used to identify papers that examined competence and confidence development while training these health professionals. A total of 2281 papers were identified, from countries in Europe, Australia, Asia, America and Africa. Overall, 62 papers were analysed. Results: One core category, 'learning environment', emerged, with two overarching subcategories, 'internal environment' and 'external environment' when examining facilitators and barriers to competence and confidence development. Conclusions: Facilitators and barriers to competence and confidence development are centred on the learning and practice environment. These are difficult to separate, as they are driven by either the student's or the newly qualified professional's experience with the learning and practice environment. This highlights the need for diversity and open mindedness among mentors and administrators in manipulating the environment to the benefit of either the student or the newly qualified professional so that mothers and their babies receive quality care. [ABSTRACT FROM AUTHOR]

Background: Increasing feminization of medical professions is well-acknowledged. However, this does not always equate to equitable representation of women within medicine, regarding their socio-demographic indicators, regions, sectors and fields of practice. Thus, this paper quantifies the gap in supply of female medical doctors in relation to demand, towards reaching different gender equity scenarios.Methods: A retrospective review of the Health Professions Council of South Africa's (HPCSA) database on registered medical doctors (medical practitioners and medical specialists) from 2002 until 2019 was utilized as an indicator of supply. Descriptive statistics were used to summarize data, and inferential statistics (considering a significance level of 0.05) were utilized to determine the association between the number of male and female doctors, disaggregated by demographic variables. We forecasted future gaps of South African male and female doctors up to 2030, based on maintaining the current male-to-female ratio and attaining an equitable ratio of 1:1.Results: While the ratio of female doctors per 10 000 population has increased between 2000 and 2019, from 1.2 to 3.2, it remains substantially lower than the comparative rate for male doctors per 10 000 population which increased from 3.5 in 2000 to 4.7 in 2019. Men continue to dominate the medical profession in 2019, representing 59.4% (27,579) of medical doctors registered with the HPCSA with females representing 40.6% (18,841), resulting in a male-to-female ratio of 1:0.7. Female doctors from the Black population group have constantly grown in the medical workforce from 4.4% (2000), to 12.5% (2019). There would be a deficit of 2242 female doctors by 2030 to achieve a 1:1 ratio between male and female medical doctors. An independent-samples t-test revealed that there was a significant difference in the number of male and female doctors. The Kruskal-Wallis test indicated that there was a sustained significant difference in terms of the number of male and female doctors by population groups and geographical distribution.Conclusions: Based on the investigation, we propose that HRH planning incorporate forecasting methodologies towards reaching gender equity targets to inform planning for production of healthcare workers. [ABSTRACT FROM AUTHOR]

Introduction: There is a gap in healthcare literature related to the spiritual competence of physicians and nurses practicing in South Asian Muslim communities. To fill that gap, the Spiritual Care Competence Questionnaire (SCCQ) was applied which was developed to address multi-professional spiritual care competences. Materials and Methods: A cross-sectional study among 294 health professionals (61% physicians, 17% nurses, and 22% other professions) in 10 hospitals in Punjab, Pakistan. Results: The highest scoring competences were “Dealing with patients/Communication competences”, while “Team Spirit” scored lowest. There were no gender related differences, but there were effects related to professions. “Team Spirit”, “Dealing with patients/Communication competences”, and “Empowerment competences” scored significantly higher in nurses as compared to physicians and other health care professionals, while there were no significant differences for their “Perception/Documentation competences”. These competences were not relevantly related to the intensity of their prayer/meditation activity. Conclusions: Health care professional from Punjab were preferred to tolerate the pain and the suffering of patients and their relatives rather than to talk about spiritual care issues. Their spiritual care competences were less developed. Thus, there is a clear need for further specific education and training of health professionals.

This study integrates two competing views to examine whether medical doctors are satisfied with their jobs when they perceive their hospitals as being oriented toward profit (i.e., rational choice theory) or purpose (i.e., public service motivation). Using a sample of 127 doctors from 70 hospitals, this study tests these competing views. The results show that doctors who perceive their hospitals as purpose-driven are likely to experience job satisfaction, and this pattern still holds even if they also perceive their hospitals to be emphasizing profits. However, only the purpose-driven orientation results in job satisfaction via a sense of meaningfulness. Thus, this study offers comprehensive evidence that while medical doctors are likely to be satisfied with their jobs when they work at either purpose-driven or profit-driven hospitals, only purpose-driven hospitals give doctors a sense of meaningfulness. This finding suggests that both rational choice theory and public service motivation perspective are valid; however, public service motivation plays a greater role in terms of a sense of meaningfulness. Theoretical contributions and practical implications are discussed.

The study aimed to investigate the range of experiences and attitudes of Croatian medical doctors (MDs) related to vaccination and vaccine hesitancy. In January 2021 three asynchronous online focus groups were held using MRQual, a web-based platform, which included 46 MDs from all three levels of the healthcare system in Croatia. NVivo, a qualitative data analysis software package, was used for the thematic analysis of collected data. The participants expressed a high level of support for the Croatian immunization program and vaccines in general. However, some skepticism was expressed regarding new vaccines and the regulatory processes of their approval. A significant number of participants raised concerns over the approval of COVID-19 vaccines, especially given their rapid development. The results also revealed that the process of communication with patients is often based on the very elaborate categorizations of patients based on previous experience, which leads to prioritizing and a communication breakup when dealing with “problematic patients”. MDs find themselves in a delicate situation where a fine balance between time-consuming communication with patients and the demands for maintaining satisfying vaccination uptake is needed. The situation arises from a social roles conflict that is embedded in wider social values and expectations, since communication problems do not arise in the doctor’s office, and therefore cannot be solved without addressing the social forces that cause trust deficiencies. To achieve better immunization results public health leaders need to better understand the social contexts and constraints of MDs vaccine-related behaviors.

This study investigated the knowledge, attitudes and desire for continued education among Guyanese doctors with regards to LGBT health. It utilized a mixed methodology of quantitative, self-administered online surveys among 90 doctors, and qualitative semi-structured individual interviews with 8 other doctors. Descriptive and analytic calculations were performed on the quantitative data while thematic analysis was used for the qualitative data. The results show moderate knowledge levels regarding LGBT health, with deficits in awareness of LGBT health disparities; generally nondiscriminatory attitudes; and suboptimal education on LGBT health. Further training and pre-service curricular changes are necessary to address gaps and improve competency. [ABSTRACT FROM AUTHOR]

Introduction: The use of morphine is viewed as an integral part of pain management in cancer patients. The responsibility for pain treatment lies with physicians. Therefore, this study assessed the knowledge of clinical use of morphine in the management of pain in cancer patients among physicians working in Kebbi State, Nigeria. Material and method: A self-administered questionnaire was distributed to all the 110 participants in attendance at the Continuing Medical Education meeting organized by the Nigerian Medical Association, Kebbi State Branch. Data were analyzed using SPSS version 20. Result: A total of 95 physicians participated, including 12 consultants (12.6%), 38 registrars (40.0%), 35 medical officers (36.8%), and 7 house officers (7.4%). Only 30 respondents (31.6%) had ever received professional training on pain management or analgesic use. Overall, only 10 (10.5%) respondents had good knowledge of pain management in cancer patients and morphine use. Conclusion: Physicians knowledge of pain management in cancer patients and clinical use of morphine is poor. There is a need to improve active professional analgesic education programs. [ABSTRACT FROM AUTHOR]

We present arguments for a view of what a clinician-scientist might be like, in the setting of everyday clinical practice. Clinical observations of good quality and completeness may, under suitable context or research framework, be viewed as evidence for claims of causation. Historical examples of clinicopathological observations in which causal claims were made and later confirmed, are briefly mentioned. We present in some detail a more recent causal inference framework in statistics, which is increasing accepted in practice, as well as a brief introduction to causal diagrams. Finally, we briefly present a view of a possible use of causal inference in the near future. [ABSTRACT FROM AUTHOR]

We explored the psychological effects of the COVID-19 pandemic on medical doctors working in hospitals assigned to treat COVID-19 patients. An exploratory, descriptive, qualitative research design was applied with a group of 204 medical doctors working within 40 different hospitals across 15 provinces of Turkey. Results reveal that medical doctors experienced various psychological problems, such as personal stress, anxiety, fear, panic attacks, depressive tendencies, and sleep disturbances, during the pandemic period. To cope with the pandemic, the medical doctors exhibited behaviors such as religious prayer, using antidepressants, undertaking different hobbies, paying attention to social distancing and hygiene rules and guidelines, and having a balanced and healthy diet. Our findings demonstrate that COVID-19 increased medical doctors' psychological pressure and associated physical symptoms. [ABSTRACT FROM AUTHOR]

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout., Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic., Setting: Three public sector hospitals in Gqeberha, South Africa., Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout., Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71-26.40), being in the lowest income band (AOR = 10.78, 2.55-45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12-8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92-13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98-10.18). Low support at work (AOR = 9.99, 3.66-27.23), medium job satisfaction (AOR = 5.38, 2.65-10.93) and medium support at work (AOR = 3.39, 1.71-6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10-0.80) and high levels of resilience (AOR = 0.08, 0.03-0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout., Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors., Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Objective: The present study explored the relationship between empathy, coping strategies and compassion fatigue among doctors. Design: Correlational Survey Design Place and Duration of the Study: Pakistan, July 2019 to January 2020. Subjects and Method: The research was conducted on a sample of 153 doctors (Male=52, Female=101), aged 22-70 (M=34.08, SD=9.914). Purposiveconvenience sampling was used in this research. Coping Response Inventory (Moos, 1993), Toronto Empathy Questionnaire and Professional Quality of Life were used to assess the variables. Results and Conclusion: Findings of the current research highlighted a significant weak positive correlation between Approach Coping and Empathy. Moreover, the results of the current study highlighted a non-significant weak inverse correlation between Approach Coping strategies and Compassion Fatigue. Furthermore, Avoidance Coping was found to have a significant weak positive correlation with Empathy and Compassion Fatigue. Lastly, a nonsignificant weak positive correlation was observed to exist between Empathy and Compassion Fatigue. Linear regression shows that empathy predicts copying approach and avoidance copying styles, whereas avoidance copying predicts compassion fatigue. [ABSTRACT FROM AUTHOR]

Tamaraemumoemi Emmanuella Ambakederemo,1 Eze Uzoechi Chikezie2 1Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa, Nigeria; 2Department of Mental Health, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa, Nigeria Introduction: Almost one third of deaths globally are caused by cardiovascular diseases (CVDs). Certain occupations may promote the development and worsening of risk factor for CVDs. We assessed some traditional cardiovascular risk factors and lifestyle choices that may predispose to CVDs in medical doctors in a tertiary health facility in Southern Nigeria. Study design: Cross-sectional study Participants and methods: One hundred sixty-nine apparently healthy medical doctors were recruited. A structured self-administered questionnaire was used to gather data on CVD risk factors. Anthropometric and blood pressure (BP) measurements were taken. Results: Majority were males (68.0%), aged 20–39 years (43.8%), single (62.7%), and house officers (58.0%) with

Amaç: Hekimlerin human papillomavirus (HPV) ile ilgili farkındalıkları ve HPV aşısının uygulanması konusundaki yaklaşımlarını değerlendirmek amaçlanmıştır.Gereç ve Yöntem: Araştırmaya 147 hekim (98 kadın doğum hekimi, 49 çocuk-aile hekimi dahil edilmiştir. Katılımcılara, araştırmacılar tarafından geliştirilen HPV enfeksiyonu ve HPV aşısı hakkında bilgi ve yaklaşımları değerlendirmek için hazırlanan bir anket formu uygulanmış ve toplanan veriler analiz edilmiştir.Bulgular: Araştırmaya dahil edilen kadın doğum hekimlerinin yaş ortalaması 28.2 yıl, çocuk-aile hekimlerinin 29.2 yıl olup her iki grupta da kadın cinsiyet ağırlıklıdır. Kadın doğum hekimlerinin %74’ü, çocuk hekimlerinin %71’i aşıyı kendilerine yaptırmayı düşündüğünü ifade etmiştir. Kadın doğum hekimlerinin %85’i, çocuk-aile hekimlerinin %78’i aşıyı önerdiklerini ifade etmişlerdir.Sonuç: Toplumda görülen serviks kanserine bağlı ölümler, çocuklara ve ailelere danışmanlık yapacak pozisyonda olan hekimlerin, HPV enfeksiyonu ve HPVaşısı konusunda bilgi düzeylerinin artırılmasıyla, aşının önerilme oranlarını artırarak önlenebilir.

Abstract Background An unequal distribution of health personnel, leading to unfavourable differences in health status between urban and rural populations, is a serious cause for concern globally. Part of the solution to this problem lies in attracting medical doctors to rural, remote communities, which presents a real challenge. The present study therefore explored the factors that influence medical doctors’ decision to practise in rural Ghana. Methods We conducted a cross-sectional descriptive study based on questionnaires. Participants were doctors working in health facilities in the districts and rural areas of the Northern Region, Ghana. The qualitative data analysis consisted of an iterative process of open, axial and selective coding. Results We administered the questionnaires to 40 doctors, 27 of whom completed and returned the form, signalling a response rate of 67.5%. The majority of the doctors were male (88.9%) and had been trained at the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS) (63%). Although they had chosen to work in the remote areas, they identified a number of factors that could prevent future doctors from accepting rural postings, such as: a lack of social amenities, financial and material resources; limited career progression opportunities; and too little emphasis on rural practice in medical school curricula. Moreover, respondents flagged specific stakeholders who, in their opinion, had a major role to play in the attraction of doctors and in convincing them to work in remote areas. Conclusions The medical doctors we surveyed had gravitated to the rural areas themselves for the opportunity to acquire clinical skills and gain experience and professional independence. Nevertheless, they felt that in order to attract such cadre of health professionals to rural areas and retain them there, specific challenges needed addressing. For instance, they called for an enforceable, national policy on rural postings, demanding strong political commitment and leadership. Another recommendation flowing from the study findings is to extend the introduction of Community-Based Education and Service (COBES) or similar curriculum components to other medical schools in order to prepare students for rural practice, increasing the likelihood of them accepting rural postings.

Abstract Background Retention of Human Resources for Health (HRH), particularly doctors at district level is a big challenge facing the decentralized health systems in poorly resourced countries. Tanzania, with 75% of its population in rural areas, has only 26% of doctors serving in rural areas. We aimed to analyze the experiences regarding the retention of doctors at district level in Tanzania from doctors’ and district health managers’ perspectives. Methods A qualitative study was carried out in three districts from June to September 2013. We reviewed selected HRH documents and then conducted 15 key informant interviews with members of the District Health Management teams and medical doctors working at the district hospitals. In addition, we conducted three focus group discussions with Council Health Management Team members in the three districts. Incentive package plans, HRH establishment, and health sector development plans from the three districts were reviewed. Data analysis was performed using qualitative content analysis. Results None of the districts in this study has the number of doctors recommended. Retention of doctors in the districts faced the following challenges: unfavourable working conditions including poor working environment, lack of assurance of career progression, and a non-uniform financial incentive system across districts; unsupportive environment in the community, characterized by: difficulty in securing houses for rent, lack of opportunities to earn extra income, lack of appreciation from the community and poor social services. Health managers across districts endeavour to retain their doctors through different retention strategies, including: career development plans, minimum financial incentive packages and avenues for private practices in the district hospitals. However, managers face constrained financial resources, with many competing priorities at district level. Conclusions Retention of doctors at district level faces numerous challenges. Assurance of career growth, provision of uniform minimum financial incentives and ensuring availability of good social services and economic opportunities within the community are among important retention strategies.

Introduction: Burnout is often used to describe the state or mental process similar to a firearm after shooting or extinguishing spent candles. Aim: The objective of the present research was to value the relation between the socio-demographic data with the presence of the burnout-syndrome in the investigated subjects. Methods: The research was done as cross-sectional study, during May-June 2017 and February-March 2018 at the Emergency Center of Clinical Centre of Serbia. Medical doctors with full work-time who accepted kindly the anonymous pull were evaluated. To precede the measure of subjective perception of health, the Serbian version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used. Results: At the evaluation of the level of burnout (MBI-HSS) in Serbian language, 76 investigated doctors of the Emergency Center completed the inquiry. 35-44 years old category was the most representative with 40.8% respondents. Respondents most often live in community were 52.6% of all and 48.7% have children. 75% respondents showed a low level of depersonalization. There was a significant negative correlation between the years of service and level of depersonalization. Both genders (50.0% respondents) showed a high degree of lack of personal achievements, female 55.3% slightly higher than male respondents 44.7%. High emotional exhaustion was present in 85.5% and showed no significant difference in the degree of emotional exhaustion in relation to gender. A significant difference was observed by respondents who do not have children, they are subjected to higher emotional exhaustion. Conclusion: Burnout should be studded by a team composed of experts (psychiatry, occupational medicine and epidemiology) in order to determine the degree to which burnout is related to work and how to prevent and mitigate it. Respondents with lower years of service have a higher degree of depersonalization and respondents without children are subjected to higher emotional exhaustion.

This article2 describes a group for those bereaved following the death through suicide of a doctor. It describes why it was formed, how it links to Foulkes' matrix and, the conscious and unconscious processes which take place. This was the first gathering of a group of this kind in the United Kingdom. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the association between being a medical doctor (MD) and the risk of incident dementia. DESIGN Cohort study. SETTING Olmsted County, Minnesota. PARTICIPANTS A total of 3460 participants (including 104 MDs), aged 70 years or older, of the population‐based Mayo Clinic Study of Aging. MEASUREMENTS Participants were randomly selected from the community and had comprehensive cognitive evaluations at baseline and approximately every 15 months to assess for diagnosis of dementia. For participants who withdrew from the follow‐up, dementia diagnosis was also assessed using information available in their medical record. The associations were examined using Cox proportional hazards models, adjusting for sex, education, and apolipoprotein E ε4, using age as the time scale. RESULTS: MDs were older (vs "general population"), and most were males (93.3%). MDs without dementia at baseline did not have a significantly different risk for incident dementia (hazard ratio = 1.12; 95% confidence interval = 0.69‐1.82; P =.64) compared to the general population. CONCLUSIONS: Although the study includes a small number of older, mainly male, MDs, it provides a preliminary insight on cognitive health later in life in MDs, while most previous studies examine the health of younger MDs. Larger longitudinal studies are needed to examine these associations and investigate if associations are modified by sex. J Am Geriatr Soc 68:1250–1255, 2020. [ABSTRACT FROM AUTHOR]

The literature identifies that medical students receive little or no formal dental trauma assessment and management teaching during medical school. The result of this is that many medical doctors are unaware of the urgency of emergency dental trauma care for patients. To bridge this important gap in medical education, medical educators should look to introduce basic dental trauma teaching into undergraduates' final year of medical school. This initiative would benefit medical doctors in either general medical practice or specialties that assess and manage trauma. This opinion article aims to present the authors' reasons for strongly supporting dental trauma teaching being included and suggests an e-learning approach for its integration into the medical education curriculum. [ABSTRACT FROM AUTHOR]

Background. Spices (SPS) have proved to be useful also in sports. The objective was to evaluate medical doctors' (MD) opinion before/after a postgraduate medical course (PGC) about SPS and their use in sport (SPS-S). Aim. It was to evaluate medical doctors' (MD) opinion before/after a postgraduate medical course (PGC) about spices (SPS) and SPS in sport (SPS-S). Methods. A number comprising 94-MD answered a detailed questionnaire: 1) What are SPS? 2) How many SPS-PGC did you attend? 3) Which are the native SPS-countries? 4) How many SPS types do you know? 5) What are the main SPS effects/mechanisms? 6) What are the age groups to which SPS can be administered? 7) Which SPS modulate oxidative stress? 8) Which SPS influence endurance? 9) Which SPS are useful in physical fatigue? 10) Which SPS are useful in muscle soreness? 11) Which SPS are useful in exercise performance? 12) Which SPS are useful in sports? 13) On a scale of 1-10 how much dis this course help you know more about SPS/ SPS-S? For data analysis we used the percentage of the total number of participants (% of N) who responded to each subitem. Results. Most MD responses: 1) SPS are plants; 2) None; 3) Asian countries; 4) Four; 5) Increased immunity, antioxidant; 6) All less children; 7) Ginger, Cardamom, Curcumin; 8) I don't know; 9) Ginger; 10) I don't know; 11) Ginger; 12) Ginger. 13) 9.3. Conclusions. 1) This PGC seems to be the first one regarding SPS. 2) Initially, most MDs had little SPS knowledge regarding SPS/SPS-S. 3) At the end of PGC, MDs demonstrated good accumulation of SPS information. 4) This PGC reached the goal of providing basic information about SPS/SPS-S, but additional SPS-related training is needed. [ABSTRACT FROM AUTHOR]

Auch in Deutschland sind durch den Klimawandel bedingte Gesundheitsfolgen u.a. hinsichtlich Hitzeexposition, UV-Strahlung, aerogener Stoffe (Luftschadstoffbelastung, Allergene) und vektorübertragener Erkrankungen (z.B. Dengue-, West-Nil-Fieber) zu beobachten. Um die Gesundheitsprofessionen auf das vermehrte bzw. neue und/oder schwerere Auftreten klimawandel(mit)bedingter Erkrankungen vorzubereiten, konzipierte das Klinikum der Universität München eine ärztliche Fortbildung zu den gesundheitlichen Folgen des Klimawandels. Also in Germany, health consequences due to climate change are observable – amongst others heat exposure, UV radiation, aerogenic substances (air pollution, allergens) and vector-borne diseases. To prepare and make health professions aware of the increased, respectively new and/or more severe appearances of diseases due to climate change, the Klinikum der Universität München drafted a module for continuous medical education on climate change related health consequences. [ABSTRACT FROM AUTHOR]

Background: The past two decades have been marked by impressive growth in the migration of medical doctors. The medical profession is among the most mobile of highly skilled professions, particularly in Europe, and is also the sector that experiences the most serious labour shortages. However, surprisingly little is known about how medical doctors choose their destinations. In addition, the literature is scarce on the factors determining the sharp rise in the migration of doctors from Africa, Asia and Eastern and Southeastern Europe, and how the last economic crisis has shaped the migration flows of health professionals.Methods: We use the new module on health worker migration provided by the Organisation for Economic Co-operation and Development (OECD) for 2000-2016 in order to examine the channels through which OECD countries attract foreign physicians from abroad. We estimate a gravity model using the Pseudo-Poisson Maximum Likelihood estimator.Results: Our results reveal that a lower unemployment rate, good remuneration of physicians, an aging population, and a high level of medical technology at the destination are among the main drivers of physicians' brain drain. Furthermore, an analysis of the mobility of medical doctors from a number of regions worldwide shows that individuals react differently on a country-wise basis to various determinants present in the destination countries. Physicians from African countries are particularly attracted to destination countries offering higher wages, and to those where the density of medical doctors is relatively low. Concurrently, a higher demand for healthcare services and better medical technology in the receiving country drives the inflow of medical doctors from Central and Eastern Europe, while Asian doctors seem to preferentially migrate to countries with better school systems.Conclusions: This study contributes to a deeper understanding of the channels through which OECD countries attract foreign medical doctors from abroad. We find that, apart from dyadic factors, a lower unemployment rate, good remuneration of physicians, an aging population, and good medical infrastructure in the host country are among the main drivers of physicians' brain drain. Furthermore, we find that utility from migration to specific countries may be explained by the heterogeneity of origin countries. [ABSTRACT FROM AUTHOR]

Background: The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology.Methods: In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned.Results: Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21.Conclusion: In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology. [ABSTRACT FROM AUTHOR]

Abstract Background Hungary has been serious facing human resources crisis in health care, as a result of a massive emigration of health workers. The resulting shortage is unevenly distributed among medical specialisations. The findings of research studies are consistent in that the most important motivating factor of the choice of the medical career and of medical specialisations is professional interest. Beyond this, it is important to examine other reasons of why students do or do not choose certain specialisations. The lifestyle determined by the chosen speciality is one such factor described in the literature. Methods Using convenient sampling, first year resident medical doctors from each of the four Hungarian universities with a medical faculty were asked to participate in the study in 2008. In total 391 first year resident medical doctors completed the self-administered questionnaire indicating a 57.3% response rate. On the basis of the work of Schwartz et al. (Acad Med 65(3):207–210, 1990), the specialisation fields were divided into the two main categories of non-controllable (NCL) or controllable lifestyles (CL). We carried out a factor analysis on motivating factors and set up an explanatory model regarding the choice of CL and NCL specialisations. Results Two maximum likelihood factors were extracted from the motivational questions: “lifestyle and income” and “professional interest and consciousness”. The explanatory model on specialisation choice shows that the “professional interest and consciousness” factor increases the likelihood of choosing NCL specialisations. In contrast the “lifestyle and income” factor has no significant impact on the choice of CL/NCL specialisations in the model. Conclusions Our results confirm the important role of professional interest in the choice of medical specializations in Hungary. On the other hand, it seems surprising that we found no significant difference in the “lifestyle and income” related motivation among those medical residents, who opted for CL as opposed to those, who opted for NCL specialisations. This does not necessarily mean that lifestyle is not an important motivating factor, but that it is equally important for both groups of medical residents.

Abstract Background Psychosocial job stressors, such as low control and high demands, have been found to influence the health and wellbeing of doctors. However, past research in this area has relied on cross-sectional data, which limits causal inferences about the influence of psychosocial job stressors on health. In this study, we examine this relationship longitudinally while also assessing whether the relationship between psychosocial job stressors and health is modified by gender. Methods The data source was seven annual waves of the Medicine in Australia: Balancing Employment and Life (MABEL) survey. The outcome was self-rated health (measured using the SF-12), and key exposures reflected job control, job demands, work-life balance variables, employment arrangements, and aggression experienced at work. We used longitudinal fixed and random effects regression models to assess within and between-person changes in health. Results Excessive job demands, low job control, feelings of not being rewarded at work, and work-life imbalance were associated with higher within-person odds of poorer self-rated health. Gender differences were apparent. For female doctors, work arrangements and work-life imbalance were associated with poorer self-rated health whilst task-based job stressors were associated with poorer self-rated health in male doctors. Conclusions These results suggest the importance of addressing adverse working environments among doctors. Trial registration Not applicable.

Abstract Background The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania’s shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms. Methods We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011. Results By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey. Conclusions Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania’s MD crisis.

Aim and Objectives: The aim of this study was to assess the knowledge and attitude of medical doctors towards the emergency management of dental trauma in the state of Himachal Pradesh. Materials and Methods: A cross-sectional survey in which, 500 medical doctors were randomly included in the study and the participation was voluntary. Data regarding the emergency management of avulsed tooth was collected using a self-administered questionnaire having questions which were close ended. Statistical analysis was carried out. Chi-square test was used to analyze the data gathered. Results: It was found that frequency of occurrence of soft tissue injuries of the face was 83%, laceration injuries was 79%, nasal bone fracture was 66%, intraoral soft tissue injuries of the lip was 67%, avulsion was 77%, and frequency of dental trauma of maxillary central incisor was 63%. Furthermore, the frequency of respondents having the knowledge about reimplantation was 46% and frequency of respondents having knowledge about the time of reimplantation was 60%. Frequency of respondents having knowledge about the preservation of tooth for reimplantation was 51%, whereas frequency of respondents having no knowledge about the preference of preservative medium was 47%. Frequency of respondents who have not seen traumatic injuries of primary teeth was 55% and the most frequently administered first aid was tetanus injection having 67%. Conclusion: The results from this study suggest that knowledge of the management of dental injuries among medical professionals/doctors was inadequate. However, appropriate training can significantly increase their knowledge.

Background: Diagnostic investigations using radiation have become a critical feature of medical practice in recent times. However, the possibility of doctors’ underestimation of risks of over-exposure of patients to diagnostic radiation still warrants further evaluation. Objectives: To investigate doctors’ awareness of diagnostic radiation exposure at Dr George Mukhari Academic Hospital, South Africa. Methods: This was a cross-sectional, analytical investigation of the awareness of doctors about radiation exposure in diagnostic radiology investigations. A cluster sampling technique was employed to recruit 217 participants. Consent and approval of the participants were sought and obtained before questionnaire administration during departmental meetings between October 2017 and March 2018. Results: Of the participants, 80% had no formal training on radiation exposure and 33.8% of them correctly estimated natural background radiation. Correct estimates of the effective dose from a single-view abdominal X-ray (AXR) were expressed by 7.5%, quantity of radiation of a single-phase computed tomography (CT) abdomen by 30.3% and dosage from a two-view unilateral mammogram by 29.1% of the participants. More than 75% of participants agreed that children are more sensitive to radiation, but only 10.5% suggested medical termination of pregnancy for a woman who had CT abdomen and pelvis with contrast. Dosage and risk of inducing fatal cancer from common but more complex imaging procedures were poorly understood. Only the doctors of the radiology department showed a statistically significant (p < 0.0001) association with regards to their radiation awareness. Conclusion: Because of the high rate of poor awareness of radiation risks observed in this study, it is important to initiate, early in the medical curriculum for medical students, the need for a rotation in the Department of Radiology, similar to such rotations in other medical specialties.

Background: The global shortage and maldistribution of health care workers, especially medical doctors, pose a significant threat to achieving the United Nations' sustainable development goal 3 of ensuring well-being and healthy lives for all. Low- and middle-income countries (LMICs) are disproportionately affected by this crisis, with a high rate of brain drain from rural to urban areas, as well as to high-income countries. Various retention strategies have been implemented in different settings and organizations. However, their effectiveness remains underexplored, particularly in LMICs., Objective: We aim to review the available retention strategies for medical doctors in LMICs and to determine the effectiveness of the various strategies. This review aims to compile relevant research findings on this issue to generate a thorough summary of all the retention strategies practiced in LMICs and, more importantly, to provide the current state of evidence of the effectiveness of these strategies in retaining medical doctors in countries with limited resources and high disease burden., Methods: The structured framework given by Arksey and O'Malley will serve as the basis for conducting this scoping review. A comprehensive search strategy will be conducted across 4 electronic databases (PubMed, EBSCOHost, Scopus, and ScienceDirect). A systematic approach following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines will be executed to search, screen, review, and extract data from studies that meet predefined inclusion criteria. Data encompassing bibliographical information, study location, retention strategies, influencing factors, and outcomes (effectiveness) will be obtained from the selected studies using standardized data extraction. Endnote and Microsoft Excel will be used for reference management and removal of duplicate studies. A narrative synthesis will be performed after categorizing and analyzing all the extracted data to identify recurrent themes., Results: This ongoing review will generate a comprehensive compilation of retention strategies implemented in LMICs to prevent brain drain among medical doctors. Data extraction is currently in progress, and completion is expected by early 2024. Themes regarding the types of strategies, influencing factors, and outcomes will be synthesized. The findings will highlight effective retention strategies, gaps, and challenges in implementation for the benefits of future research. By identifying common barriers and facilitators, this review will provide insights into enhancing the policies and initiatives for doctor retention in LMICs., Conclusions: This scoping review explores the retention strategies practiced in LMICs and attempts to identify effective strategies from existing research. By evaluating the barriers and challenges that influence the effectiveness of these strategies, policymakers and health care leaders can strive to obtain balanced and optimal health human resources in their respective organizations and countries., Trial Registration: Malaysian National Medical Research Register (NMRR) ID-23-01994-OGW; https://nmrr.gov.my/research-directory/ac4f5b88-8619-4b2b-b6c7-9abcef65fdcd., International Registered Report Identifier (irrid): DERR1-10.2196/52938., (©Norehan Jinah, Ili Abdullah Sharin, Pangie Bakit, Izzuan Khirman Adnan, Kun Yun Lee. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.01.2024.)

A physician's role is critical in fostering patient health literacy (HL) and influencing various aspects, including patient-physician communication and treatment effectiveness. The purpose of this systematic literature review is to analyze physicians' perspectives, comprehension, and management of HL. The focus of this review is on physicians' views, opinions, experiences, and strategies related to HL. We conducted comprehensive searches across seven databases, including PubMed, Scopus, ProQuest, Science Direct, Web of Science, The Cochrane Library, and Google Scholar. Original research articles published between January 1, 2009, and July 31, 2020, were considered for inclusion. This literature review incorporates qualitative studies and mixed-methods studies, with a focus on extracting qualitative data. Among the 22 articles included in our review, we employed the method of inductive thematic analysis for data analysis. A detailed description of the review methodology can be found in a previously published protocol available through PROSPERO (CRD42020212599). The themes that emerged from the thematic analysis include: (a) physicians' perception and management of HL; and (b) barriers. The results of the systematic review reveal that healthcare professionals exhibit varying perceptions of patients' HL levels and ascribe different meanings to it. However, none of them employ a specific measuring tool. While there appears to be no uniform approach to managing patients with low HL, some prioritize certain communication strategies, such as repetition, simplified language, and providing written instructions, among others. Most physicians cited multiple barriers that impede the development of patients' HL, including dysfunctions within the healthcare system, staff shortages, managing a large number of patients, limited time, work-related stress, cultural and socio-economic barriers, medical jargon, and language barriers. Considering the pivotal role of physicians in fostering patient HL, it is crucial to enhance medical education in addressing and managing HL, both within academic curricula and through continuing education seminars. Furthermore, there is a pressing need to improve healthcare professionals' working conditions, ensuring that each physician can allocate the necessary time to each patient based on their individual needs, without being hindered by stress-inducing work environments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Louizou et al.)

Research into the abuse of women during childbirth has increased over recent years. Many studies have focussed on labouring women, how they may be physically maltreated, neglected, or shouted at, and on how their needs are unmet by healthcare practitioners. As part of a larger study focussing on staff responses to stillbirths, we wanted to focus our attention on how medical doctors, working in a district hospital in an impoverished urban setting in the Western Cape Province of South Africa, manage, and feel regarding, stillbirths. This healthcare system experiences an immense patient load, with the poverty of the community it serves, and the numerous traumas, affecting both patients and staff. In order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was interviews with medical doctors regarding their practices with women who have stillbirths. From the interviews, previous findings about this topic are corroborated by our work within the hospital. Additionally, we include and discuss new findings that we discovered in our research, such as frustrations in communication, feeling culturally different, feeling overwhelmed and shame. From our findings we can conclude that dealing with stillbirth is emotionally challenging anywhere in the world, however, in a context like South Africa, there is the added burden of trying to right the wrongs of a brutal and divided society. These medical doctors are dealing not only with stillbirths but also, to a degree, with the stillbirth of the hope that, twenty-five years after becoming a democracy, South Africa is far from becoming a unified and caring society. There is a great irony, of course, in the fact that we see in the data here the re-enactment of dehumanising discourses by the very people who are working very hard to restore humanity in a fractured society. It would be easy simply to condemn these dehumanising, detaching and discriminatory statements and practices. To do so, we believe, would be defensive in itself – for change to occur, we need to understand the complex personal and political roots of what health practitioners do to survive under very difficult circumstances. [ABSTRACT FROM AUTHOR]

Objectives: Hepatitis C virus (HCV) causes both acute and chronic infection, which can potentially develop into cirrhosis and liver cancer. Healthcare systems are struggling to finance costly direct-acting antiviral agents through public funding for uninsured patients, despite the unprecedented high cure rates of these agents. Vulnerable populations are at higher risk of HCV infection. The personal importation scheme is based on the legal right to import any unauthorized generics for personal use. This study was designed to assess the knowledge and perceptions of stakeholders on unauthorized generics. Methods: We conducted an anonymous online survey based on the fictitious situation of a patient diagnosed with HCV who lacked mandatory health insurance and personal financial resources. Results: We obtained a sample of 781 respondents: 445 physicians, 77 pharmacists, 51 patients and 207 non-healthcare professionals. We found that only 36% and 58% of respondents believe that the quality and efficacy, respectively, of unauthorized generics are equivalent to their corresponding brand. An overwhelming majority (98%) favoured quality control upon arrival, and 31% felt they could recognize fraudulent websites. A total of 79% expressed support for financial assistance for vulnerable patients, and support among physicians was 83%. Conclusions: Overall, the limited knowledge of the efficacy and quality of unauthorized generics, despite evidence in peer-reviewed literature, contrasts with the overwhelmingly positive attitudes toward financial assistance for personal import. This finding emphasizes the need for clearer information on imported generics and the potential safety provided by buyers' club schemes to complete the WHO agenda of eradicating viral hepatitis by 2030 within otherwise excluded vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: In many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria. Methods: Descriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons 'who eat from the same pot' or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire—Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application. Main results: Eight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population. Conclusion: The most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons. [ABSTRACT FROM AUTHOR]

Background: Rare diseases (RD) result in a wide variety of clinical presentations, and this creates a significant diagnostic challenge for health care professionals. We hypothesized that there exist a set of consistent and shared phenomena among all individuals affected by (different) RD during the time before diagnosis is established. Objective: We aimed to identify commonalities between different RD and developed a machine learning diagnostic support tool for RD. Methods: 20 interviews with affected individuals with different RD, focusing on the time period before their diagnosis, were performed and qualitatively analyzed. Out of these pre-diagnostic experiences, we distilled key phenomena and created a questionnaire which was then distributed among individuals with the established diagnosis of i.) RD, ii.) other common non-rare diseases (NRO) iii.) common chronic diseases (CD), iv.), or psychosomatic/somatoform disorders (PSY). Finally, four combined single machine learning methods and a fusion algorithm were used to distinguish the different answer patterns of the questionnaires. Results: The questionnaire contained 53 questions. A total sum of 1763 questionnaires (758 RD, 149 CD, 48 PSY, 200 NRO, 34 healthy individuals and 574 not evaluable questionnaires) were collected. Based on 3 independent data sets the 10-fold stratified cross-validation method for the answer-pattern recognition resulted in sensitivity values of 88.9% to detect the answer pattern of a RD, 86.6% for NRO, 87.7% for CD and 84.2% for PSY. Conclusion: Despite the great diversity in presentation and pathogenesis of each RD, patients with RD share surprisingly similar pre-diagnosis experiences. Our questionnaire and data-mining based approach successfully detected unique patterns in groups of individuals affected by a broad range of different rare diseases. Therefore, these results indicate distinct patterns that may be used for diagnostic support in RD. [ABSTRACT FROM AUTHOR]

To enable selection of a safer suspension site to use in face and neck lifting procedures, the spatial relationship between the tympanoparotid fascia and the great auricular nerve should be clarified. In this study, we aimed to elucidate the position of the tympanoparotid fascia and the pathway of the lobular branch of the great auricular nerve traversing the tympanoparotid fascia. Twenty hemifaces from non-preserved bequeathed Korean cadavers (5 males, 7 females; mean age, 77.0 years) were dissected to determine the great auricular nerve distribution close to the tympanoparotid fascia of clinical significance for face and neck lift procedures. We observed the tympanoparotid fascia in all specimens (20 hemifaces). The tympanoparotid fascia was located anteriorly between the tragus and intertragic notch. Regarding the spatial relationship between the tympanoparotid fascia and the great auricular nerve, we found the sensory nerve entering the tympanoparotid fascia in all specimens (100%), and the depth from the skin was approximately 4.5 mm; in 65% of the specimens, the lobular branch was found to run close to the tympanoparotid fascia before going into the earlobe. Provided with relatively safer surface mapping to access the tympanoparotid fascia free of the lobular branch of the great auricular nerve, surgeons may better protect the lobular branch by anchoring the SMAS-platysma flap and thread to the deeper superior and anterior portions of the expected tympanoparotid fascia. [ABSTRACT FROM AUTHOR]