Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: analyzing the attitudes of midwifery experts

Background In recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran. Methods This was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method. Results The main themes extracted from the participants’ statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making. Conclusion This study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

Association between road safety habits and risky health behaviours in Latvian adult population

The study examined the road safety habits of the adult population of Latvia in relation to risky health behaviours (smoking, excessive alcohol consumption, no regular health check-ups at the family doctor). Data of Health Behaviour among the Latvian Adult Population for five consecutive surveys for the years 2010–2018 were analysed. Results: The use of seat belts has increased slightly – from 93.5% to 95.6% in the front seat of the vehicle, from 52.4% to 56.3% in the rear seat of the vehicle (p < 0,001). Of the 10,731 respondents, 30.8% (N = 3309; 95% CI 30.0–31.7) were daily smokers, 14.8% (N = 1593; 95% CI 14.2–15.5) had excessive alcohol consumption habits, 25.9% (N = 2779; 95% CI 25.1–26.7) had not visited their family doctor during the last year. Higher odds for seat belt use were observed among respondents without excessive alcohol consumption (OR = 2.1), non-smokers (OR = 1.5–1.8), and those, who had visited their family doctor last year (OR = 1.2–1.3). Multivariate regression analysis showed risky behaviour is an independent factor associated with road safety habits.

Idiopathic pulmonary fibrosis in the practice of a family doctor

Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology, mainly characterized by a progressive deterioration in lung function due to active fibrosis. It is a variant of chronic progressive fibrosing interstitial pneumonia. The disease most often occurs between the ages of 50 and 70. According to the disease register in the Russian Federation, the prevalence of the disease in the Russian Federation is 4-7 people per hundred thousand of the population [1].Worldwide, the IPF incidence, prevalence and mortality increases over time [2, 3]. In a systematic review of the study by Hutchinson et al. [2] based on data on IPF morbidity and mortality in 21 countries between 1968 and 2012, it was determined that both morbidity and mortality have increased worldwide since 2000.

Trends in Family Physician Usage among Canadians from 2001 to 2016: An Age-Period-Cohort Analysis

As primary health care providers, family physicians play a critical role in Canada’s health care system by providing first-level contact for patients and acting as advocates for preventative medicine. Due to their essential role in population health, public health practitioners are concerned about temporal trends surrounding family physician visits. This study uses eight cycles of the Canadian Community Health Survey, a nationally representative survey, to conducing an age-period-cohort analysis with the bounding method, while controlling for sex and race. Most notably, we discover a declining cohort trend indicating that later cohorts are less likely to visit a family doctor over a 12-month period. These results suggest that health promotion policies surrounding family physician use should not only be targeted towards middle and older-aged adults who experience declining health, as the cohort effect implies that a portion of health care avoidance behaviour is molded in youth and young adulthood.

The algorithm for providing paliative care by general practitioners - family doctors

Background. In Ukraine, as in the rest of the world, the majority of people who face life-threatening or life-limiting illnesses and who need palliative care are at home [1]. It is estimated that palliative care is needed in 40–60 % of all deaths [2]. According to the State Statistics Service of Ukraine, 616 840 persons died in 2020 [3], respectively, approximately 250 to 370 thousand patients needed palliative care in Ukraine. The management of patients throughout the progression/development of the disease and the final phase of life is assigned to the doctors who are closest to the patient – general practitioners – family doctors. The main goal of palliative care is to ensure the most attainable quality of life for patients. At the same time, the doctor must determine in a timely manner when the volume of palliative care provided exclusively from a general practitioner – family doctor is not enough and in a timely manner to involve specialized palliative care services. Purpose of the research: to develop an algorithm for the providing of palliative care by gene­ral practitioners – family doctors with the definition of patients for whom the volume of palliative care goes beyond primary health care. Materials and methods. The current legal framework governing the provision of palliative care by general practitioners – family doctors, scientific literature, questionnaires of sociological research of patients (n = 25). Methods of system analysis, synthesis, abstraction, sociological and medical-statistical methods were used. Results. The current orders of the Ministry of Health of Ukraine and sectoral standards for the provision of medical care, which are guided by general practitioners – family doctors in the provision of palliative care, were studied and the lack of consistency in the implementation of the norms determined by different standards was revealed. It was found that the use of tools to determine the level of quality of life (QOL) as the main purpose of palliative care is not proposed. The duty of the general practitioner – family doctor is the timely involvement of specialized services in the provision of palliative care. At the same time, there is no specific indicator or criterion that may indicate an insufficient provision of palliative care at the level of primary health care. Questionnaires have been proposed for determining the QOL of patients (EORTC QLQ-C30) and self-assessment of depression (PHQ-9). It has been shown that indicators of less than 50 points on the functional scales of the EORTC QLQ-C30 questionnaire and / or 10 or more points on the PHQ-9 depression scale are evidence of the need to accompany the patient by a psychologist, clergyman and social worker, that is the basis for the involvement of a multidisciplinary team of mobile palliative care. A unified algorithm of actions for the provision of palliative care by general practitioners – family doctors has been developed. Conclusions. To ensure the implementation of the rules and regulations defined for general practitioners – family doctors by various regulatory documents, instructions and sectoral standards, it is necessary to introduce an algorithm (unified scheme) of doctor's actions in the provision of palliative care. Therefore, general practitioners – family doctors need to timely apply an algorithm for identifying patients for whom the provision of palliative care provided exclusively by general practitioners – family doctors is insufficient and to establish interaction with mobile palliative services.

Earning opportunities and informal payment as influencing factors in medical students’ speciality choice

Background The Hungarian primary care system faces a severe shortage of family physicians. Medical students’ perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students’ knowledge about their future earning opportunities and their attitudes towards informal payment. Methods A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. Results Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = ‘no influence’, 10 = ‘very big influence’) 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. Conclusions Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs – this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.

Evaluation of the quality of contracted family doctor services based on patient perceptions and expectations: a follow-up analysis from the elderly with chronic diseases in rural Jiangsu, China

IntroductionThe policy focus of contracted family doctor services (CFDS) has been shifting to improve quality and efficiency in China. The study’s objective was to establish a quality evaluation scale for CFDS based on the perceived service quality model and to assess the service quality from the perspective of patient perceptions and expectations.MethodsData were obtained from a 2-year follow-up survey of CFDS in Jiangsu, China. A total of 1264 elderly people with chronic diseases were tracked. The self-developed scale was designed based on the perceived service quality model. The product scale method was used to assign weighted values, the Wilcoxon signed-rank test was used to compare the differences over the 2 years, and pooled cross-sectional regression was conducted to evaluate the associated factors with the gap scores of service quality.ResultsThere were significant differences between perceptions and expectations in each dimension in the 2 years (p<0.05), and the service quality gaps existed. Over the 2 years, Accessibility and Horizontal continuity were the first-ranked and second-ranked in expectations; the top three scores in perception were Horizontal continuity, Comprehensive service and Accessibility dimensions. The service quality gap in 2020 was smaller than that in 2019 (p<0.05). There were differences in the perception scores in the Vertical continuity, Technical and Economic dimensions and in the expectation scores in the Horizontal continuity, Vertical continuity and Technical dimensions between the 2 years (p<0.05). The factors that were significantly associated with each dimension score included the Jiangsu region, gender, age and education levels (p<0.05).ConclusionThe quality evaluation scale of CFDS has good reliability and validity. Policy efforts should be focused on accelerating the development of medical alliances, optimising medical insurance policies and improving the capacity of family doctor services to meet the needs of the elderly with chronic diseases.

Risk factors of deforming osteoarthritis in the family doctor practice

Osteoarthritis (OA) is the most common bone and joint pathology, affecting, according to the American College of Rheumatology ACR (2019), about 302 million people worldwide and is the leading cause of disability in the elderly.Objective. To investigate the role of additional risk factors in patients with OA in the practice of family physicians for secondary prevention.Material and methods. A retrospective analysis of 50 outpatient records and electronic medical records (EMC) of patients with OA for 2019-2020 was performed: 30 women, 20 men; aged 35-75 years. Concomitant risk factors were studied by epidemiological analysis: obesity / overweight, burdensome family history, traumatic factor, occupational exposure.Results. The respiratory and circulatory systems diseases dominate in the structure of the primary morbidity of the Northern Bukovina inhabitants in 2020. The incidence of bone and joint is 4.04% in the general structure, which does not differ significantly from the European average. The structure of the primary morbidity of the bone and joint sphere is dominated by arthrosis and deforming OA (DOA). The injuries and occupational factors dominated in structure of DOA risk factors at the age under 50, but after 50 years – obesity and burdened heredity prevailed, with a significant impact of the occupational factor. Absence of injuries in the anamnesis and occupational factors reduce the risk of DOA 8 and 3.5 times, respectively (p<0.05). Age over 60 years increases the relative risk of DOA 2.5 times as much (p=0.013), especially in women to almost 4 times.Conclusions. Additional risk factors should be considered in patients with DOA for secondary prevention.

Hypomenstrual syndrome in adolescent girls as a result of reproductive dysfunction in their mothers

In recent years in Ukraine and in the world there has been a clear tendency towards deterioration in the indicators of the somatic health of children and adolescents, that is negatively affects the processes of reproductive health formation and it state in the future. Concern for adolescent girl's health, including their reproductive system, forms an enormous contribution to the society future. That's why big attention is paid to the formation and saving reproductive health of adolescent girls. The period of sexual development is defining in a woman's life and is considered a key moment on the path of reproductive maturity. Today it has been established that the reproductive health formation is influenced by environmental, socio-economic factors and the presence of somatic diseases. Despite the fact that the pathogenetic mechanisms of the reproductive system formation are extremely complex and sensitive to the effects of negative factors, the appearance of destructive factors at this time can disrupt the physiological chain of functioning of the hormonal mechanisms which regulate the reproductive system. Disorders of the menstrual cycle is one of the most common pathological conditions, combining pathogenetically different diseases, which are manifested by a violation of the menstrual duration and frequency, amount of menstrual flow. According to domestic literature, hypomenstrual syndrome (oligomenorrhea, amenorrhea) is in the first place among menstrual dysfunctions in adolescent girls in the structure of gynecological morbidity and is up to 45%. Menstrual irregularities that occur during adolescence often persist into the future, causing infertility, obstetric pathology, perinatal loss and other reproductive health problems during childbearing years. The problem of the menstrual cycle formation has been little studied, but it is socially significant, very relevant and requires further study.Thus, girls with menstrual disorders constitute a group of increased risk of gynecological diseases in women of reproductive age, since many chronic diseases of adults are a protracted pathology of adolescents. Therefore, adolescent girls should be examined and treated by a specialist in pediatric and adolescent gynecology, pediatric endocrinologist, pediatrician and family doctor.