scholarly journals Clinical Manifestations and Distribution of Cutaneous Leishmaniasis in Pakistan

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Abaseen Khan Afghan ◽  
Masoom Kassi ◽  
Pashtoon Murtaza Kasi ◽  
Adil Ayub ◽  
Niamatullah Kakar ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cutaneous Leishmaniasis ◽  
Primary Care Physicians ◽  
Health Workers ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Skin Lesions ◽  
Major Public Health Problem ◽  
Local Health

Cutaneous leishmaniasis (CL) is a rising epidemic in Pakistan. It is a major public health problem in the country especially alongside regions bordering the neighboring Afghanistan and cities that have had the maximum influx of refugees. The purpose of our paper is to highlight the diverse clinical manifestations of the disease seen along with the geographic areas affected, where the hosts are particularly susceptible. This would also be helpful in presenting the broad spectrum of the disease for training of health care workers and help in surveillance of CL in the region. The increased clinical diversity and the spectrum of phenotypic manifestations noted underscore the fact that the diagnosis of CL should be not only considered when dealing with common skin lesions, but also highly suspected by dermatologists and even primary care physicians even when encountering uncommon pathologies. Hence, we would strongly advocate that since most of these patients present to local health care centers and hospitals, primary care practitioners and even lady health workers (LHWs) should be trained in identification of at least the common presentations of CL.

scholarly journals A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Reza Naghdi ◽  
Karen Seto ◽  
Carolyn Klassen ◽  
Didi Emokpare ◽  
Brian Conway ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Needs Assessment ◽  
Primary Care Physicians ◽  
Healthcare Providers ◽  
Public Health Problem ◽  
Primary Care Providers ◽  
Educational Needs ◽  
Major Public Health Problem ◽  
Care Providers

Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study

10.2196/16700 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e16700 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

Background Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Mara G Bianchi ◽  
Andre Santos ◽  
Eduardo Cordioli
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Malignant Tumors ◽  
Skin Lesions ◽  
Care Physician ◽  
Pigmentary Disorders ◽  
The World ◽  
Skin Conditions

BACKGROUND Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. OBJECTIVE Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. METHODS This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. RESULTS Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. CONCLUSIONS Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

scholarly journals Opportunities for Improving the Care of Patients with Chronic Renal Insufficiency: Current Practice Patterns

2001 ◽  
Vol 12 (8) ◽  
pp. 1713-1720
Author(s):  
ALLEN R. NISSENSON ◽  
ALLAN J. COLLINS ◽  
JUDITH HURLEY ◽  
HANS PETERSEN ◽  
BRIAN J. G. PEREIRA ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Enzyme Inhibitor ◽  
Health Maintenance Organization ◽  
Public Health Problem ◽  
Care Physician ◽  
Diabetic Patients ◽  
Major Public Health Problem ◽  
Care Providers ◽  
Health Maintenance

Abstract. There are between 2 and 13 million Americans with chronic kidney disease (CKD). Recent reports suggest that their treatment is currently suboptimal. To further investigate this issue, patterns of practice for the treatment of patients with CKD who were enrolled in a large health maintenance organization in New Mexico were analyzed. Among the >200,000 patients who were enrolled in the health maintenance organization between 1994 and 1997, a cohort of 1658 patients who exhibited at least two gender-specific, elevated creatinine concentrations (Cr), separated by at least 90 d, were identified. The proportions of patients with Cr values of <2.0, 2.0 to 2.9, 3.0 to 3.9, and ≥4.0 mg/dl were 73, 17, 3, and 7%, respectively. The majority of patients were treated by a primary care physician until Cr values reached 3.0 mg/dl, at which time a nephrologist was consulted. Care tended to be transferred to the nephrologist when the Cr reached 4.0 mg/dl. Only 7.4% of patients received erythropoietin (EPO). Use of EPO increased as Cr increased. EPO was unlikely to be prescribed unless the patient had visited a nephrologist. Fewer than one half of all patients with CKD and fewer than 20% of patients with CKD with Cr values of ≥4.0 mg/dl received an angiotensin-converting enzyme inhibitor (ACEI). Nephrologists were not more likely to prescribe ACEI than were primary care physicians. Diabetic patients were more likely to receive ACEI than were nondiabetic patients, but ACEI use was quite low even among diabetic patients with CKD. The average number of hospitalizations per patient-year increased as Cr increased and was more than twice as high for patients with Cr values of ≥4.0 mg/dl, compared with those with Cr values of <2.0 mg/dl. The reasons for hospitalization were more likely to be related to comorbidities than to CKD itself, however. There are many opportunities to improve the care of patients with CKD. Better adherence to practices known to be of clinical benefit for patients with CKD not only will improve patient outcomes but also may reduce the costs of care. Providers, policy-makers, and payers should view CKD as a major public health problem and initiate innovative programs to address this growing patient population.

Recognizing and Effectively Treating Depression

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S11) ◽  
pp. 5-9 ◽  
Author(s):  
Yves Lecrubier
Keyword(s):  
Public Health ◽  
Quality Of Life ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Antidepressant Drugs ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
International Survey ◽  
Road Accidents

AbstractIn 2004, more people died in Europe from suicide than from road accidents. The lifetime prevalence of major depression is 20% for women and 10% for men. Depression is a leading cause of disability and decreased quality of life. In spite of this, numerous studies have shown that only ~50% of depressed patients are recognized as such in primary care. In a recent international survey of everyday management of depression we observed that only ~15% of patients became symptom-free following treatment. In spite of this low level of remission primary care physicians and psychiatrist only rarely increased the dose of antidepressant or switched to another medication as unanimously recommended by different guidelines. Numerous studies have demonstrated the importance of maintaining treatment for ≥6 months after remission is obtained in order to prevent relapse and recurrence. However, a recent study reported that only 19% of a cohort of patients in primary care continued treatment for 6 months as recommended. Antidepressants can be very effective but only when used correctly at adequate doses and for a sufficient duration. Although new improved antidepressants are obviously desirable, a greater recognition of depression and its treatment by the correct use of currently available antidepressant drugs could greatly improve the management of this major public health problem.

Correlation of Genetic Heterogeneity with Cytopathological and Epidemiological Findings of Leishmania major Isolated from Cutaneous Leishmaniasis in Southern Iran

2016 ◽  
Vol 60 (2) ◽  
pp. 97-106 ◽  
Author(s):  
Sadegh Shirian ◽  
Ahmad Oryan ◽  
Gholam-Reza Hatam ◽  
Mohammad-Reza Tabandeh ◽  
Ehasan Daneshmand ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Genetic Heterogeneity ◽  
Leishmania Major ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Inflammatory Cells ◽  
Major Public Health Problem ◽  
Sequencing Analysis ◽  
Southern Iran ◽  
Geographical Regions

Objective: Cutaneous leishmaniasis (CL) has recently grown into a major public health problem in 88 countries of the world, including Iran. It is a polymorphic disease which may show various clinicopathological features. Although the effect of the genetic diversity of the parasite has been demonstrated as one of the factors influencing clinical manifestations in CL, no data exist regarding the genetic variation of Leishmania major and its microscopical features. Study Design: Fine-needle aspiration, touch smears and the histological sections of 100 patients were examined for Leishmania amastigotes, using Giemsa and hematoxylin and eosin. Diverse types of inflammatory cells in the 40 positive and 5 negative smears were differentiated. Kinetoplast DNA (kDNA) was amplified using nested PCR and subsequently sequenced. Sequencing analysis of the amplified kDNA was used to investigate the genetic variations among L. major isolates and to correlate the findings with microscopical features and geographical origins. Results: The quantified amastigote density in the 40 positive touch smears was blindly classified by 3 observers. Grade I, II, III and IV had 7, 13, 9 and 11 cases, respectively. The microscopical features, the mean percentage of neutrophils, lymphocytes and other inflammatory cells, and the leishmanial density of the grades and negative cytopathological samples were contrasting. kDNA amplification of L. major was detected from the cutaneous lesion, and 21 of these amplicons were successfully sequenced. Conclusions: These results indicate that L. major strains causing CL in southern Iran are genetically diverse; furthermore, a correlation between the genetic heterogeneity of the parasite, the microscopical manifestation and the geographical regions of the disease in humans was found.

scholarly journals A study on prevalence of diabetes mellitus among adult tuberculosis patients in tertiary health care centre, Hyderabad

2019 ◽  
Vol 6 (3) ◽  
pp. 1225
Author(s):  
S.Bhavana Laxmi ◽  
Sri Harsha Kandikonda ◽  
Jyothi Lakshmi Naga Vemuri ◽  
R. L. Lakshman Rao
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Clinical Manifestations ◽  
Care Facility ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Care Centre ◽  
Health Care Centre ◽  
Tuberculosis Patients ◽  
Prevalence Of Diabetes Mellitus

Background: Tuberculosis is a major public health problem and is among top ten causes of deaths worldwide. People with diabetes are three times at higher risk of getting infected with tuberculosis. Globally 10.4 million TB cases exists of them 10% are linked to diabetes. In India 13% of Tuberculosis cases were diabetic. DM has been reported to modify the clinical features of TB. The objectives were to study the prevalence of diabetes mellitus among adult tuberculosis patients registered in DOTS centre in tertiary health care centre, Hyderabad and to study the clinical profile of tuberculosis in study subjects.Methods: A cross sectional study was conducted in 4 DOTS centres under tertiary health care facility, Hyderabad. Sample size 200 was calculated using formula 4PQ/L2. Study subjects were registered adult tuberculosis patients attending DOTS centre and undergoing anti tuberculosis treatment. Data from study subjects was obtained by interview method using semi structured questionnaire consisting of socio-demographic parameters and clinical parameters.Results: Out of 200 patients, the prevalence of DM was found to be 18% (n=36). Increasing age (p<0.000), male sex (p=0.04), low BMI (p=0.02), family history of TB (p=0.017), Sputum positive severity (p=0.0008) are significantly associated with DM-TB comorbidity and clinical manifestations like bilateral involvement (p=0.151), multi lobes (p=0.243), other associated lung diseases (p=0.154), treatment category (p=0.8203) are not significantly associated with DM-TB comorbidity.Conclusions: Bidirectional screening of TB and DM will detect early and prevent complications of comorbiditiy.

Eliminating Hepatitis B from Bangladesh by the Year 2030

2020 ◽  
Vol 38 (3) ◽  
pp. 145-149
Author(s):  
Md Golam Mustafa ◽  
Md Shahinul Alam ◽  
Md Golam Azam ◽  
Md Mahabubul Alam ◽  
Md Saiful Islam ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Health Workers ◽  
Health Sector ◽  
Public Health Problem ◽  
Integrated System ◽  
Hbv Infection ◽  
Diagnosis And Treatment ◽  
Major Public Health Problem ◽  
Medical Institutions ◽  
The Government

Worldwide, hepatitis B virus (HBV) infection is still a major public health problem. Bangladesh having a large burden of HBV infection, should be a major contributor towards it’s elimination by 2030. The country has been making progress in reducing incidence of HBV infection during the past decades. The progresses are mainly due to large vaccination coverage among children and large coverage of timely birthdose vaccine for prevention of mother-to-child transmission of HBV. However, Bangladesh still faces challenges in achieving target of reduction in mortality from HBV. On the basis of targets of the WHO’s Global health sector strategy on viral hepatitis 2016–2021, we highlight priorities for action towards HBV elimination. To attain the target of reduced mortality we propose that, the service coverage targets of diagnosis and treatment should be prioritized along with vaccination. Firstly, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Secondly, the government needs to reduce the costs of health care. Thirdly, better coordination is needed across existing national program and resources to establish an integrated system for prevention, screening, diagnosis and treatment of HBV infection. In this way, we can make progress towards achieving the target of eliminating HBV from Bangladesh by 2030 J Bangladesh Coll Phys Surg 2020; 38(3): 145-149

Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View

2019 ◽  
Vol 20 (8) ◽  
pp. 658-664 ◽  
Author(s):  
Marco Di Paolo ◽  
Luigi Papi ◽  
Paolo Malacarne ◽  
Federica Gori ◽  
Emanuela Turillazzi
Keyword(s):  
Health Care ◽  
Clinical Medicine ◽  
Methodological Approach ◽  
Care Facility ◽  
Public Health Problem ◽  
Control Measures ◽  
Major Public Health Problem ◽  
Healthcare Associated Infections ◽  
Open Communication ◽  
Healthcare Associated

Background: Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. Methods: The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. Results: Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients’ engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. Conclusion: HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.

scholarly journals Validation and Psychometric Properties of the Spanish Version of the Hopkins Symptom Checklist-25 Scale for Depression Detection in Primary Care

2021 ◽  
Vol 18 (15) ◽  
pp. 7843
Author(s):  
María Rodríguez-Barragán ◽  
María Isabel Fernández-San-Martín ◽  
Ana Clavería-Fontán ◽  
Susana Aldecoa-Landesa ◽  
Marc Casajuana-Closas ◽  
...  
Keyword(s):  
Primary Care ◽  
Psychometric Properties ◽  
Public Health Problem ◽  
Composite International Diagnostic Interview ◽  
Spanish Version ◽  
Major Public Health Problem ◽  
Symptom Checklist ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Hopkins Symptom Checklist

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach’s alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86–0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1–95.1%) and specificity was 76.7% (CI 95%, 73.3–79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

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