Knowledge, attitudes, and practices of cardiopulmonary rehabilitation among physiotherapists in Lebanon

Background Insufficient physical activity is one of the leading mortality risks worldwide for cardiovascular and pulmonary diseases. Physiotherapists (PT) are core healthcare professionals who play a major role in the prevention of disease complications and in inspiring a healthy lifestyle. To identify challenges in the promotion of cardiopulmonary rehabilitation (CR) in Lebanon, a survey was conducted among PT and physiotherapy students. The aim was to assess the knowledge, attitudes, and practices of CR in Lebanon. Results The response rate was 46.1% (N = 322). Results show that 24.5% of respondents have good to excellent knowledge about CR. More than 60% of the respondents indicate possible barriers to starting a CR program, and one of two respondents identify the absence of skills as a main barrier. Findings highlight the importance of the role of PT as a mediator to increase a healthy lifestyle among patients and to promote the prevention of cardiovascular diseases and pulmonary diseases in the country. Conclusions and recommendations Our results support the evidence and clinical guidelines that PT play a major role by increasing the participation of patients in CR. A cost-effective CR program needs to be covered by the private and public system in Lebanon.

Does the perceived healthcare quality provided by full-time government employee doctors in the public system differ from the perceived care quality in their own privately managed facilities in Nigeria?

Objective: Although the differences in the quality levels between the public and private sectors have been identified in literature not much is known about the level of quality differences that exist when full time government employee doctors offer the same clinical services in their own privately managed facilities. The objective of this study was to compare service user perceived quality of care provided by full-time government employee doctors in the public system and in their own privately managed facilities in Nigeria.Methods: A cross-sectional multistage sampling design was used to elicit service user views on process, structure and outcome elements of quality identified in the Donabedian’s care quality model. The software for population surveys in EPI Info 7 was used to calculate the required sample. A total of 407 questionnaires were administered and completed after a pre-test.Results: Respondents reported better health outcomes in private practice than in the public system and a majority would recommend visiting a dual physician’s private practice than the public system where they work full-time. Process aspects of quality, including better rapport with doctors, greater perceived confidentiality, shorter wait times, and absence of bureaucratic impediments were said to be better in privately managed facilities of government doctors. However, respondents said that the public sector was superior in respect of the structure element of quality as reflected in better infrastructure, equipment, and availability of drugs.Conclusions: Despite the relatively lower cost of care in government hospitals the outcome and process elements are still crucial in determining which sector patients prefer. These two elements seem to have influenced patronage for private practices of dual practitioners.

MONGOLIAN SPOTS CAN MIMIC BODY INJURIES: CASE REPORT

Mongolian spots are congenital dermatological conditions often observed in the neonatal period resulting from the migration of melanocytes to the dermis during embryogenesis. They are bluish grey spots typically located in the lumbosacral region, which tend to regress in the first years of life. As skin lesions are frequent signs in infant maltreatment, Mongolian spots can be misinterpreted as ecchymoses, which would lead to a false diagnosis. This can culminate in serious and dramatic consequences for the patient and family, as well as overloading the public system. Therefore, it is essential that health professionals know how to differentiate Mongolian stains from injuries resulting from child abuse. This study aims to describe a case that was mistakenly attributed to mistreatment for the presence of Mongolian spots in atypical places.

Medical genetics workforce in Brazil: practitioners, services, and disease distribution

Purpose In anticipation of the implementation of personalized medicine (PM) in Brazil we assessed the demographic characteristics of its medical genetics workforce together with the distribution of rare genetic diseases (RGD) and hereditary cancer syndromes (HCS) across municipalities in the country. Methods We used demographic data from an earlier report on medical specialties, and open databases providing summarized data on the public and private healthcare systems, for the years 2019 and 2020. In the public system we considered RGD live births and hospitalizations, and HCS mortality. In the private system we obtained data on RGD, HCS and genetic counselling appointments. Results The 332 registered medical geneticists (MGs) were mostly female, attended a public medical school, and were predominantly registered in the Southeast. The distribution of MGs overlapped the country-wise distribution of all types of genetic disease and service examined, indicating that ~30% of the patient population has access to a MG specialist. Conclusion The Brazilian MG workforce is concentrated in the richest and most populated areas and while it covers a significant proportion of the population there are vast regions with very limited services. The public health system should address these inequalities for a successful transition to PM.

Cycling Tourism and Revitalization in the Sicilian Hinterland: A Case Study in the Taormina–Etna District

This study aims to present a strategy for the revitalization of the Sicilian “internal areas”, recognizing a directional tool, together with the integration of self-centered actions of slow tourism. The design was specifically located in the Taormina–Etna tourist district (an area of north-eastern Sicily that includes 60 municipalities) which, in rethinking the post-pandemic restart, aims at the development of a mobile system of cycling tourism able to interconnect cultural peculiarities, environmental characteristics, and landscape values. This paper also examines key features and interpretations, and develops a strategy based on a slow travel framework as an alternative means of achieving success in the Sicilian hinterland. Starting from the current financial and environmental crisis, therefore, the paper finds explanations and solutions, in which we try to conceive of the economy and ecology as systems that not only open to one another, but mutually determine one another in defining new, self-sustaining local development processes. In order to build a competitive alternative to help less favorable regions, it is necessary to move within the scope of investments by a public system capable of planning resilient strategies based on sustainable principles.

Funding health in developing countries: foreign aid, FDI, or personal remittances?

PurposeThis paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.Design/methodology/approachThe authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.FindingsFindings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.Social implicationsPublicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.Originality/valueThis paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.