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Varas-Díaz N, Madera SR, Padilla M, Neilands TB, Vertovec J, Rivera-Bustelo K, Santiago-Santiago AJ, Mercado Ríos CA, Reid G, Grove K, Ramos Pibernus A. Beyond financial incentives: a quantitative study on spatial stigma and Puerto Rican physician migration to the United States. Glob Public Health 2025; 20:2467767. [PMID: 39979076 PMCID: PMC11921220 DOI: 10.1080/17441692.2025.2467767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 02/10/2025] [Indexed: 02/22/2025]
Abstract
Puerto Rico faces a significant health crisis due to the mass migration of physicians to the United States, exacerbating the challenge of achieving the World Health Organisation's recommended physician-to-population ratio. While economic factors such as higher salaries in the US have been identified as primary drivers, the complexity of this migration wave requires a deeper exploration. This study quantitatively examines the role of push factors, pull factors, and spatial stigmatisation in physician migration from Puerto Rico. Using data from a randomly selected sample of 550 physicians (255 who had migrated to the US and 295 who lived in Puerto Rico), we analyse how perceptions of Puerto Rico's image and reputation, combined with stigmatisation linked to practicing medicine on the Island, influence migration decisions. Findings highlight that while better economic opportunities in the US are significant, the spatial stigma associated with Puerto Rico's healthcare system plays a crucial role in the decision to migrate. Policies aimed at curbing physician migration must address not only economic incentives but also the broader socio-cultural perceptions that contribute to the stigmatisation of practicing medicine in Puerto Rico. This study provides insights to inform comprehensive policy solutions to the healthcare crisis in Puerto Rico.
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Affiliation(s)
- Nelson Varas-Díaz
- Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, Miami, FL, USA
| | - Sheilla R Madera
- Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, Miami, FL, USA
| | - Mark Padilla
- Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, Miami, FL, USA
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California at San Francisco, UCSF, San Francisco, CA, USA
| | - John Vertovec
- Behavioral Science Research Institute, Coral Gables, FL, USA
| | - Kariela Rivera-Bustelo
- Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, Miami, FL, USA
| | | | - Claudia A Mercado Ríos
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Genevieve Reid
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Kevin Grove
- Global and Sociocultural Studies, School of International and Public Affairs, Florida International University, Miami, FL, USA
| | - Alíxida Ramos Pibernus
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
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Milkano TM, Daka K, Bolado GN, Lukas M, Oshine W, Balcha B. Job motivation and associated factors among health workers providing maternal and child health services in Wolaita Zone public hospitals, Southern Ethiopia; A mixed-method study. PLoS One 2025; 20:e0320672. [PMID: 40343913 PMCID: PMC12063899 DOI: 10.1371/journal.pone.0320672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 02/22/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND The quality of services provided to women, and children is significantly impacted by a lack of motivation and a shortage of competent healthcare staff.Low motivation has a negative impact on the performance of individual healthcare institutions, health workers, patient safety, and the health system as a whole. OBJECTIVES To assess job motivation and associated factors among health workers providing maternal and child health services in Wolaita Zone public hospitals, Southern Ethiopia, 2023. METHODOLOGY A facility-based cross-sectional mixed-method study was conducted on randomly selected 319 maternal and child health service providers followed by a purposive sampling technique for the qualitative study. A pretested, structured, self-administered questionnaire obtained from previously conducted studies and in-depth interviews were used to collect quantitative and qualitative studies, respectively. EpiDataV4.6 and Statistical Package for Social Science version 26 were used for quantitative data entry and analysis, respectively, and both bivariable and multivariable logistic regression were done. For qualitative data, OpenCode 4.03 software was utilized to conduct thematic content analysis. RESULT A total of 319 maternal and child health service providers participated in this study, with a 100% response rate. Of them, 142 (44.5%) (95%, CI: 39% - 50%) were motivated. Female gender, payment other than salary not paid on time [AOR (95% CI) 0.159 (0.046-0.549)], work overload[AOR (95% CI) 0.264 (0.083-0.836)], shortage of resources[AOR (95% CI) 0.385 (0.172-0.860)], limited training opportunities[AOR (95% CI) 0.104 (0.030-0.356)], and poor management and leadership of the organizations were statistically significant association between provider's job motivations. CONCLUSION In this study, nearly forty-five percent of maternal and child health service providers weremotivated. Female gender,payment other than salary not paid on time, work overload, shortage of resources, limited training opportunities, and poor management and leadership of the organizations were significantly associated with providers' job motivation.Therefore, timely paid other benefitpayments, accessing training opportunities, implementing work force strategy, and availing of resources are very important actions that should be taken.
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Affiliation(s)
| | - Kassa Daka
- Schoolof Public Health, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Nigussie Bolado
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Mesafint Lukas
- BitenaPrimary Hospital, Wolaita Zone health department, Sodo, Ethiopia
| | - Woldetsadik Oshine
- Departement of Nursing, School of Nursing and Midwifery, College of Health Science and Medicine, Wachemo University, Hossaina, Ethiopia
| | - Bahilu Balcha
- Schoolof Public Health, Wolaita Sodo University, Sodo, Ethiopia
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Mateen M, Zhu W, Shi F, Xiang D, Nie B, Peng T, Chen X. The role of artificial intelligence in the diagnosis of diabetic retinopathy through retinal lesion features: a narrative review. Quant Imaging Med Surg 2025; 15:4816-4846. [PMID: 40384679 PMCID: PMC12082602 DOI: 10.21037/qims-24-1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 01/15/2025] [Indexed: 05/20/2025]
Abstract
Background and Objective In the field of ophthalmology, diabetic retinopathy (DR) is a diabetes-related eye condition that damages the retina. DR is a serious issue for working-age people and it is important to solve it at an early stage to avoid complete vision loss. The review covers together technical and clinical perspectives of using the artificial intelligence (AI)-based systems in clinical institutes to help the ophthalmologists interpret and diagnose DR at the early stages. Methods AI plays a significant role in assisting ophthalmologists with timely and effective treatment of patients by early and accurate detection and classification of DR. The study selection method followed specified searching criteria to complete the data collection task in the area of DR screening through AI. Key Content and Findings The review covers literature published in the nearest one decade or more for analyzing automated DR diagnostics through the identification of retinal lesions and evaluates the approaches of advanced AI-based models for the development of early and accurate DR diagnostic processes. The DR-related datasets and performance evaluation metrics used for segmentation and classification tasks of DR, are also included in this review. Moreover, the authors performed critical analysis and provided possible solutions against DR-based potential problems. Conclusions Hence, the study serves as a helping guide for the researchers to utilize their skills with advanced AI-based approaches in the technical and clinical perspectives of DR diagnostics. In conclusion, a freely available repository is created to facilitate the relevant researchers with up-to-date articles and open-source implementations for DR screening at https://github.com/muhammadmateen319/progress-of-diabetic-retinopathy-screening.
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Affiliation(s)
- Muhammad Mateen
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Weifang Zhu
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Fei Shi
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Dehui Xiang
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Baoqing Nie
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
| | - Tao Peng
- School of Future Science and Engineering, Soochow University, Suzhou, China
| | - Xinjian Chen
- School of Electronic and Information Engineering, Soochow University, Suzhou, China
- The State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
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Thakur K, Sharma SK, Kant R, Kalyani V. Glycemic Control in Adult Patients With Type 2 Diabetes Mellitus Receiving Care Through a Nurse-Led Diabetic Follow-Up Clinic Versus Conventional Care: A Randomized Controlled Trial. Cureus 2025; 17:e79659. [PMID: 40161188 PMCID: PMC11949854 DOI: 10.7759/cureus.79659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2025] [Indexed: 04/02/2025] Open
Abstract
Background Strengthening the role of diabetes nurse specialists, by expanding their knowledge and clinical expertise, can significantly contribute to managing diabetes mellitus and its complications. Objectives To assess and compare the impact of nurse-led diabetic follow-up clinics compared to conventional care on glycated hemoglobin (HbA1c) levels and diabetes treatment satisfaction among adult patients with type 2 diabetes mellitus (T2DM) seeking treatment in tertiary care settings. Material and methods A prospective, single-center, parallel-group randomized trial was conducted in a routine Diabetic Outpatient Department (OPD) at a tertiary care setting. After accounting for the loss to follow-up, 106 participants completed the trial. Diagnosed cases of T2DM with more than two records of HbA1c outside of the recommended range (>7%) and receiving insulin therapy for treatment were the inclusion criteria. The intervention included insulin titration and regular follow-up with the trained diabetes nurse for diabetes care and management. Endpoint measurements of HbA1c levels and diabetes treatment satisfaction were taken after three to six months of treatment to analyze the impact of the intervention. Results Participants receiving care through a nurse-led diabetic follow-up clinic had a decrease in HbA1c levels after the intervention, with an average paired difference of 1.75 (1.12 to 2.38), statistically significant at the 0.05 level of significance. Although HbA1c levels in the Control Group also decreased after the standard intervention, with a mean paired difference of 0.64 (0.03 to 1.25), it did not reach statistical significance, with a p-value of 0.05 at the 0.05 level of significance. However, patients' HbA1c levels between the Intervention and Control Groups at baseline (p = 0.101) and post-intervention (p = 0.369) were not statistically significant at the 0.05 level of significance. Furthermore, participants in the Intervention Group achieved better glycemic control, as measured by self-reported satisfaction with regards to hyperglycemia (-0.95 ± 1.43 vs. 0.39 ± 1.88, p = 0.001) and hypoglycemia (-0.35 ± 1.02 vs. 0.71 ± 1.1, p < 0.001) levels. Conclusion The nurse-led diabetes follow-up clinic was found to be an invaluable service, and the addition of a diabetes specialist nurse as part of the treatment team can alter the conventional pathway for diabetes treatment.
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Affiliation(s)
- Kalpana Thakur
- Nursing, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Suresh K Sharma
- Nursing, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Ravi Kant
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Vasantha Kalyani
- Nursing, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Nadella N, Edara L. From Primary Care to Super Specialty: A Comparison of Workforce Expansion and Capacity Building in Internal Medicine in India and the United States. Cureus 2025; 17:e77221. [PMID: 39925598 PMCID: PMC11807288 DOI: 10.7759/cureus.77221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2025] [Indexed: 02/11/2025] Open
Abstract
Internal medicine (IM), a cornerstone of healthcare, focuses on diagnosing, treating, and preventing adult diseases. This review explores the training pathways and opportunities in IM in India and the United States (USA), highlighting critical disparities in postgraduate medical education. A combination of statistical analysis, literature review, and policy evaluation was utilized. Data were compiled from government databases, academic literature, and organizational reports to identify the number of postgraduate seats and training opportunities. Comparative metrics, such as per capita seat availability and training ratios, were analyzed to highlight disparities. In India, IM residencies, offered as Doctor of Medicine (MD) or Diplomate of National Board (DNB) programs, account for only a small proportion of postgraduate seats, with significant variations in per capita availability compared to the USA. While the number of undergraduate medical seats in India has grown substantially, postgraduate training opportunities, especially in IM and its subspecialties, remain limited. This discrepancy contributes to a shortage of internists and specialists, particularly in rural and underserved regions, impacting healthcare delivery. The USA offers a more robust IM training framework, with higher per capita residency and fellowship positions, ensuring a more comprehensive distribution of specialists. In contrast, India's lower per capita availability of IM seats has led to an imbalance in the doctor-to-patient ratio and prompted many Indian medical graduates to seek training abroad, resulting in a "brain drain." Addressing this disparity requires a systemic approach, including increasing postgraduate and superspecialty seats, adopting innovative training models, and aligning India's medical education system with global standards. Expanding training capacity, particularly in underserved regions, and transitioning to a residency-based model for certain specialties could improve healthcare outcomes and bridge the gap in IM expertise between India and developed nations.
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Affiliation(s)
- Nirupam Nadella
- Department of General Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Lokesh Edara
- Department of Internal Medicine, Western Michigan University, Kalamazoo, USA
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Santiago-Santiago AJ, Rivera-Custodio J, Mercado-Ríos CA, González-Font Y, R Madera S, Varas-Díaz N, Padilla M, Ramos-Pibernus A, Rivera-Bustelo K, Vertovec J, Matiz-Reyes A, Grove K. Puerto Rican physician's recommendations to mitigate medical migration from Puerto Rico to the mainland United States. HEALTH POLICY OPEN 2024; 7:100124. [PMID: 39099675 PMCID: PMC11296234 DOI: 10.1016/j.hpopen.2024.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/23/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g., hurricanes and earthquakes), there has been a sharp increase in PR residents migrating to the mainland US. Local media and professional health organizations focus on the impact of medical migration on the PR health system (e.g., health personnel shortages and long waiting periods for critical care). According to the PR College of Physicians and Surgeons, 365-500 physicians have left annually since 2014, which represents a crisis of access to health services. However, few studies have focused on ways to mitigate medical migration from PR to the US mainland. This article describes the recommendations provided by migrating and non-migrating Puerto Rican Physicians (PRPs) to mitigate medical migration from PR to the US mainland. We focus on qualitative data from a mixed-methods NIH-funded study (1R01MD014188) to explore factors that motivate or mitigate migration among migrating (n = 26) and non-migrating (n = 24) PRPs. Interviews were analyzed following thematic analysis guidelines. Results show the following themes: 1) strategies to retain early-career medical residents living in PR; 2) recommendations for local government on future health policy; and 3) work environment initiatives for health institutions to mitigate physician migration. Findings suggest multilevel efforts are required to mitigate medical migration in PR.
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Affiliation(s)
| | | | | | | | | | | | - Mark Padilla
- Florida International University, Florida, United States
| | | | | | - John Vertovec
- Florida International University, Florida, United States
| | | | - Kevin Grove
- Florida International University, Florida, United States
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Manguele ALJ, Craveiro I, Sidat M, Sengo DB, Cabral AJR, Ferrinho P. A look back at the strike by Mozambican doctors in 2013: what can we learn? BMC Health Serv Res 2024; 24:1510. [PMID: 39614305 DOI: 10.1186/s12913-024-11998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 11/25/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND The occurrence of strikes in the health sector has been an increasing concern around the world, given their negative impact on the provision of services and care to patients. The Mozambican doctors' strike in 2013 2013 is considered by many to be the largest of a kind in the country's history, and marked the changes which are still a matter of debate. The aim of this study is to understand the causes, strategies and perceived impact of this strike from the perspective of the main actors involved, taking a look back at everything that happened, including the backstage and tense moments during the negotiations. These details have been little covered in similar studies and are important for a better understanding and management of this type of movement. METHODS This is a qualitative study with a phenomelogical approach that consisted of semi-structured interviews with the main players involved in the strike movement, and analysis of documents produced around this movement. Non-probabilistic snowball sampling was used to select participants until data saturation was reached. The interviews were transcribed and imported into Nvivo version 12, and the data was analysed using content analysis to identify themes related to the research questions. RESULTS The doctors were demanding better salaries, career prospects and working conditions. Failure to fulfil agreements, threats from the government and a lack of communication are believed to have precipitated the strike. Faced with staff shortages, the government restricted services, prioritised urgent cases, and patients saw services slowed down, their care delayed, a lack of medicines in health units and a loss of confidence in the healthcare system. Although the strike contributed to the approval of the Doctors' Statute, it led to the interruption of postgraduate studies, transfers and suspensions of professionals. CONCLUSION The strike was motivated by aspects associated with salaries and working conditions. Some of the approaches adopted further distanced the parties and delayed consensus. The strike had negative consequences for everyone, especially patients. This study provides important lessons for improving strike prevention and management strategies in the health sector.
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Affiliation(s)
- Alexandre Lourenço Jaime Manguele
- Instituto Superior de Ciências de Saúde, Maputo, Moçambique.
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal.
| | - Isabel Craveiro
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mohsin Sidat
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
| | | | - António Jorge Rodrigues Cabral
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, GHTM, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisboa, Portugal.
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Saxena S, Rathore B. Striving Through Adversities of Professional Life to Provide Better Care: A Content Analysis of News Articles and Online Blogs on Deteriorating Mental Health of Medicos. Indian J Psychol Med 2024:02537176241273918. [PMID: 39564319 PMCID: PMC11572409 DOI: 10.1177/02537176241273918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2024] Open
Abstract
Background One of the noblest professions is medicine, which comprises ancillary services, medical students, and other paramedics. The challenges faced by the medical fraternity are infinite and uncertain. Aim This study aims to thoroughly understand the professional challenges faced by medical professionals that can lead to mental health issues. Methods A content analysis of 64 news articles and online blogs was done. The articles and blogs that addressed mental health issues among medical professionals were shortlisted. The data retrieved was accessed digitally between 2016 and 2024. Frequency analysis was done using QDA Miner Lite (free version). Results The findings were summarized into six themes and 17 sub-themes, showing a high frequency of rising mental health issues among medicos, lack of organizational support, poor work-life balance, violence, and sacrificed health, with other less frequent codes like toxic seniority, hostile work culture, negative consequences of reporting mental health problems and hiding vulnerability to protect self-efficacy. Conclusion The data retrieved from various news articles and blogs presents the personal experiences and real-life struggles of medical professionals. The outcome of this study is to understand the key issues affecting medicos at personal, professional, social, emotional, and spiritual levels.
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Affiliation(s)
- Swati Saxena
- Dept. of Clinical Psychology, Faculty of Behavioural and Social Sciences, SGT University, Gurugram, Haryana, India
| | - Bhanupriya Rathore
- Dept. of Clinical Psychology, Faculty of Behavioural and Social Sciences, SGT University, Gurugram, Haryana, India
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Muharram FR, Sulistya HA, Swannjo JB, Firmansyah FF, Rizal MM, Izza A, Isfandiari MA, Ariningtyas ND, Romdhoni AC. Adequacy and Distribution of the Health Workforce in Indonesia. WHO South East Asia J Public Health 2024; 13:45-55. [PMID: 39995001 DOI: 10.4103/who-seajph.who-seajph_28_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 11/19/2024] [Indexed: 02/26/2025]
Abstract
BACKGROUND Indonesia faces the challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health status. By examining the distribution patterns and identifying the areas of critical need, the study seeks to inform policy interventions that can more effectively address the health worker (HW) distribution. METHODS We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of HWs: General practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the HW-to-population ratio to quantify the availability of healthcare workers. We employed the Gini Index as a measure of distribution equality. In addition, we conducted a comparative metric approach to assess the quantity and the equity of healthcare worker distribution across the districts. RESULTS In Indonesia, the current HW ratio stands at 3.84 per 1000 people, falling short of the World Health Organization's threshold of 4.45 for achieving 80% universal health coverage. This shortfall translates to a need for an additional 166,000 HWs. While midwives show a relatively equitable distribution, specialists and dentists exhibited significantly unequal distribution, especially at the district level. There were greater disparities at the district than at the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals. CONCLUSION This study shows that human resources for health in Indonesia are both inadequate in terms of quantity, and unevenly distributed. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle each region's unique problems.
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Affiliation(s)
- Farizal Rizky Muharram
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Advanced Research and Collaboration Center, Surabaya, Indonesia
| | - Hanif Ardiansyah Sulistya
- Advanced Research and Collaboration Center, Surabaya, Indonesia
- Medical Professional Education Program, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Julian Benedict Swannjo
- Advanced Research and Collaboration Center, Surabaya, Indonesia
- Medical Professional Education Program, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Fikri Febrian Firmansyah
- Advanced Research and Collaboration Center, Surabaya, Indonesia
- Dental Professional Education Program, Faculty of Dentistry, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Masrur Rizal
- Advanced Research and Collaboration Center, Surabaya, Indonesia
- Medical Professional Education Program, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Alifina Izza
- Advanced Research and Collaboration Center, Surabaya, Indonesia
- Medical Professional Education Program, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Atoillah Isfandiari
- Department of Epidemiology, Biostatistics and Demography, Health Promotion and Behavioral Science, Faculty of Public Health, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ninuk Dwi Ariningtyas
- Department of Medical Education, Faculty of Medicine, Universitas Muhammadiyah, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Achmad Chusnu Romdhoni
- Department of Otorhinolaryngology-Head-and- Neck Surgery, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Abu-Azzam O, Abu-Jeyyab M, Daradkeh M, Eldeen SZ, Zuaiter S, Al-Mseadeen M, Sindiani A, Alshdaifat E. Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo54. [PMID: 38994460 PMCID: PMC11239211 DOI: 10.61622/rbgo/2024rbgo54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/13/2024] [Indexed: 07/13/2024] Open
Abstract
Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.
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Affiliation(s)
- Omar Abu-Azzam
- Department of Obstetrics and GynecologySchool of MedicineMutah UniversityAl-KarakJordanDepartment of Obstetrics and Gynecology, School of Medicine, Mutah University, Al-Karak, Jordan.
| | - Mohammad Abu-Jeyyab
- School of MedicineMutah UniversityAl-KarakJordanSchool of Medicine, Mutah University, Al-Karak, Jordan.
| | - Mohammad Daradkeh
- School of MedicineMutah UniversityAl-KarakJordanSchool of Medicine, Mutah University, Al-Karak, Jordan.
| | - Sadeen Zein Eldeen
- School of MedicineMutah UniversityAl-KarakJordanSchool of Medicine, Mutah University, Al-Karak, Jordan.
| | - Saja Zuaiter
- School of MedicineMutah UniversityAl-KarakJordanSchool of Medicine, Mutah University, Al-Karak, Jordan.
| | - Mohammad Al-Mseadeen
- School of MedicineMutah UniversityAl-KarakJordanSchool of Medicine, Mutah University, Al-Karak, Jordan.
| | - Amer Sindiani
- Department of Obstetrics and GynecologyFaculty of MedicineJordan University of Science and TechnologyIrbidJordanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Eman Alshdaifat
- Department of Obstetrics and GynecologyFaculty of MedicineYarmouk UniversityIrbidJordanDepartment of Obstetrics and Gynecology, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
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Raj K KV, Ransing R, Sethi S, Devraj N. Inequality in Forensic Medicine in India: The Current Scenario and Way Forward. Cureus 2024; 16:e62419. [PMID: 39011208 PMCID: PMC11247417 DOI: 10.7759/cureus.62419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/17/2024] Open
Abstract
Background Forensic Medicine (FM) is one of the core specialties of medicine in India, which serves as a bridge between medical science and India's justice delivery systems. Although FM experts play a crucial role in handling medicolegal cases, there is an increasing deficit of FM experts in India. This may be due to the inadequate postgraduate (PG) seats across the states and the low uptake of PG seats in FM. This study was conducted to explore the current status of PG seats along with the Forensic Medicine Toxicology (FMT)/FM index across Indian states. Methodology In this cross-sectional study, data on the number of PGs in FMT/FM and the institutes offering PG courses in FMT/FM were searched on the official website of the National Medical Commission. The data available on the website until November 2023 were incorporated. The FMT/FM index was calculated at the national and state levels, and the states were graded based on the national FMT/FM index. Results The national FMT/FM PG trainee index was 0.054. Considering this as the reference value, grading of the FMT/FM PG trainee index was done as the highest (1.159 to 0.308), higher than the nation (0.054 but less than 0.308), lower than the nation (0.054 but higher than 0.00), and zero. Among all the states and union territories, Andaman & Nicobar, Arunachal Pradesh, Dadra and Nagar Haveli, Jammu & Kashmir, Lakshadweep, Mizoram, Nagaland, Sikkim, and Ladakh had zero FMT/FM PG index due to non-availability of any PG seats for FMT/FM. In total, 20 states had an FMT/FM PG index higher than India's FMT/FM PG index headed by Pondicherry (1.159), followed by Chandigarh (0.429) and Goa (0.308). Conclusions PG seats were highly deficient in several states, which is more likely to affect justice delivery in the future across these states. This study has a few limitations, as we did not explore the actual intake of these PG seats across different states. We anticipate a lower intake of PG seats due to factors such as low demand, fewer job opportunities, and monetary gain. However, this needs further exploration in future studies.
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Affiliation(s)
- Karthi Vignesh Raj K
- Forensic Medicine, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Ramdas Ransing
- Psychiatry, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Satyaranjan Sethi
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Nilesh Devraj
- Forensic Medicine, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
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Cheema MDA, Shaiq MD, Mirza F, Kamal A, Naeem MA. Adapting multilingual vision language transformers for low-resource Urdu optical character recognition (OCR). PeerJ Comput Sci 2024; 10:e1964. [PMID: 38699211 PMCID: PMC11065407 DOI: 10.7717/peerj-cs.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/06/2024] [Indexed: 05/05/2024]
Abstract
In the realm of digitizing written content, the challenges posed by low-resource languages are noteworthy. These languages, often lacking in comprehensive linguistic resources, require specialized attention to develop robust systems for accurate optical character recognition (OCR). This article addresses the significance of focusing on such languages and introduces ViLanOCR, an innovative bilingual OCR system tailored for Urdu and English. Unlike existing systems, which struggle with the intricacies of low-resource languages, ViLanOCR leverages advanced multilingual transformer-based language models to achieve superior performances. The proposed approach is evaluated using the character error rate (CER) metric and achieves state-of-the-art results on the Urdu UHWR dataset, with a CER of 1.1%. The experimental results demonstrate the effectiveness of the proposed approach, surpassing state of the-art baselines in Urdu handwriting digitization.
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Affiliation(s)
- Musa Dildar Ahmed Cheema
- Department of Artificial Intelligence and Data Science, National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - Mohammad Daniyal Shaiq
- Department of Artificial Intelligence and Data Science, National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - Farhaan Mirza
- School of Computer, Engineering and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ali Kamal
- Department of Artificial Intelligence and Data Science, National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - M. Asif Naeem
- Department of Artificial Intelligence and Data Science, National University of Computer and Emerging Sciences, Islamabad, Pakistan
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Mondal H, Mondal S, Santra S, Naskar A, Dutta R. Comment on: The curious case of the extinction of family physicians from the Indian health system. J Family Med Prim Care 2024; 13:1125-1127. [PMID: 38736818 PMCID: PMC11086787 DOI: 10.4103/jfmpc.jfmpc_1462_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 05/14/2024] Open
Affiliation(s)
- Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, West Bengal, India
| | - Soumya Santra
- Department of Pharmacology, College of Medicine and JNM Hospital, West Bengal, India
| | - Avijit Naskar
- Department of General Medicine, Baruipur SD Hospital, West Bengal, India
| | - Rajib Dutta
- Department of Obstetrics and Gynecology, Diamond Harbour Government Medical College, West Bengal, India
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14
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Calderon Y, Sandigan G, Tan-Lim CSC, De Mesa RYH, Fabian NMC, Rey MP, Sanchez JT, Dans LF, Galingana CLT, Bernal-Sundiang N, Casile RU, Aquino MRN, Poblete KE, Lopez JFE, Zabala H, Dans AL. Feasibility, acceptability and impact of a clinical decision support tool among primary care providers in an urban, rural and remote site in the Philippines. BMJ Open Qual 2024; 13:e002526. [PMID: 38423587 PMCID: PMC10910488 DOI: 10.1136/bmjoq-2023-002526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs). This study aimed to (1) assess the feasibility of using UTD as information source for PCPs in urban, rural and remote settings, (2) determine the acceptability of UTD as an information source for PCPs and (3) examine the impact of UTD access on PCP clinical decision-making. METHODS Four focus group discussions (FGDs) and two key informant interviews (KII) were conducted to gather insights from 30 PCPs. Thematic analysis through coding in NVivo V.12 was done using the technology acceptance model (TAM) as a guiding framework. RESULTS All PCPs had positive feedback regarding UTD use because of its comprehensiveness, accessibility, mobility and general design. The participants relayed UTD's benefit for point-of-contact use, capacity-building and continuing professional development. PCPs across the three sites, including CHWs with no formal medical education, were able to provide evidence-based medical advice to patients through UTD. However, external factors in these settings impeded the full integration of UTD in the PCPs' workflow, including poor internet access, unstable sources of electricity, lack of compatible mobile devices and the need for translation to the local language. CONCLUSION UTD was a feasible and acceptable clinical decision support tool for the PCPs. Factors affecting the feasibility of using UTD include technological and environmental factors (ie, internet access and the lack of translation to the local language), as well as the organisational structure of the primary care facility which determines the roles of the PCPs. Despite the difference in roles and responsibilities of the PCPs, UTD positively impacted decision-making and patient education for all PCPs through its use as a point-of-contact tool and a tool for capacity-building.
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Affiliation(s)
- Ysabela Calderon
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Gillian Sandigan
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Carol Stephanie C Tan-Lim
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines
| | - Regine Ynez H De Mesa
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Noleen Marie C Fabian
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Mia P Rey
- Department of Accounting and Finance, Cesar E.A. Virata School of Business, University of the Philippines Diliman, Quezon City, Philippines
| | - Josephine T Sanchez
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Leonila F Dans
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, Philippines
| | - Cara Lois T Galingana
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Nannette Bernal-Sundiang
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Ray U Casile
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Maria Rhodora N Aquino
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Karl Engelene Poblete
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Johanna Faye E Lopez
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Herbert Zabala
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
| | - Antonio L Dans
- Center for Integrative and Development Studies, University of the Philippines Diliman, Quezon City, Metro Manila, Philippines
- National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
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15
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Jain N, Kourampi I, Umar TP, Almansoor ZR, Anand A, Ur Rehman ME, Jain S, Reinis A. Global population surpasses eight billion: Are we ready for the next billion? AIMS Public Health 2023; 10:849-866. [PMID: 38187896 PMCID: PMC10764969 DOI: 10.3934/publichealth.2023056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 01/09/2024] Open
Abstract
In November 2022, the global population had officially crossed eight billion. It has long been recognized that socioeconomic or health-related problems in the community always accompany an uncontrolled population expansion. International calls have been made regarding lack of universal health coverage, an insufficient supply of healthcare providers, the burden of noncommunicable disease, population aging and the difficulty in obtaining safe drinking water and food. The present health policy paper discusses how to conquer these crowded world issues, including (1) promoting government and international organization participation in providing appropriate infrastructure, funding and distribution to assist people's health and well-being; (2) shifting health program towards a more preventive approach and (3) reducing inequalities, particularly for the marginalized, isolated and underrepresented population. These fundamental principles of health policy delivery as a response to an increasingly crowded world and its challenges are crucial for reducing the burden associated with excessive healthcare costs, decreased productivity and deteriorating environmental quality.
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Affiliation(s)
- Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
| | - Islam Kourampi
- Department of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, Greece, 11527
| | - Tungki Pratama Umar
- UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia 30128
| | - Zahra Rose Almansoor
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Buddha Road, Dharan 56700, Nepal
| | | | - Shivani Jain
- Department of Oral and Maxillofacial Surgery, Genesis Institute of Dental Sciences & Research, Ferozepur-Moga Road, Ferozepur, Punjab, India 152002
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradinš University, 16 Dzirciema street, Riga, Latvia, LV-1007
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Tiwari HC, Mishra R, Singh Y, Khan IA, Srivastava DK. A Study on the Attitude and Perception of Bachelor of Medicine and Bachelor of Surgery (MBBS) Students Regarding Post-MBBS Compulsory Service Bond in Uttar Pradesh, India. Cureus 2023; 15:e44682. [PMID: 37809137 PMCID: PMC10550849 DOI: 10.7759/cureus.44682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background To increase the availability of doctors in the public healthcare delivery system, the state government of Uttar Pradesh, India, has implemented a two-year compulsory service bond since 2018. Students of the 2018 batch are going to complete their Bachelor of Medicine, Bachelor of Surgery (MBBS) in 2023 and are supposed to serve through this bond. There are many dilemmas in the minds of medical students regarding their compulsory service bond. Hence, there is a need to know their attitude and perceptions regarding the compulsory service bond. This study was conducted to assess the attitude and perception of undergraduate medical students toward compulsory service bonds. Methods This was a mixed-method study conducted in July-September 2022 among undergraduate medical students at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. For quantitative data, a structured questionnaire was developed using Google Forms (Google LLC, Mountain View, California, United States) and circulated via WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States) through the random sampling method. Focused group discussions were carried out to collect the qualitative data. Result Regarding the compulsory service bond after MBBS, 100 (31.8%) medical students were found to be interested and 56 (17.8%) were disinterested. The majority (n=158; 50.4%) of participants were neutral, while 278 (88.6%) medical students perceived it as an opportunity to help poor people. Higher possibilities of social recognition and respect were some noticeable perceptions of 243 (77.4%) MBBS students. Lack of confidence to tackle serious cases without a senior doctor's supervision was perceived as an important hurdle by 286 (91%) participants. Non-availability of advanced medical facilities, issues like the safety of doctors, and the lack of availability of electricity, roads, and infrastructure were also perceived as hurdles. Conclusions and recommendations Students perceived the compulsory service bond as an opportunity if met with certain conditions like a transparent method of posting and basic facilities or an incentive for accommodation and transportation. The compulsory service bond for addressing the shortfall of doctors in the public healthcare delivery system may be more effective if these hurdles are corrected and certain opportunities are met, as mentioned in the present study. This will help the government move smoothly towards achieving Universal Health Coverage (UHC).
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Affiliation(s)
| | - Richa Mishra
- Community Medicine, Mahamaya Rajkiya Allopathic Medical College, Ambedkar Nagar, IND
| | - Yogendra Singh
- Anatomy, Baba Raghav Das Medical College, Gorakhpur, IND
| | - Imran Ahmed Khan
- Community Medicine, Baba Raghav Das Medical College, Gorakhpur, IND
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17
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Kansal R, Singla A, Bawa A, Malhotra K, Lalchandan J, Grewal J, Mehta M, Kaur N, Jain S, Mondal H. A nationwide survey on the preference of Indian undergraduate medical students to go abroad for higher studies and residency. J Family Med Prim Care 2023; 12:1997-2002. [PMID: 38024947 PMCID: PMC10657054 DOI: 10.4103/jfmpc.318_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 12/01/2023] Open
Abstract
Context Getting residency training abroad is a critical motivator in the emigration of Indian medical students. Brain drain is an emerging issue, especially for developing countries as it causes a shortage of trained staff in the donor country. Aim We aimed to survey Indian medical students to know about their intentions to get trained abroad and to understand the factors influencing their decision. Materials and Methods In this cross-sectional observational study, we surveyed Indian undergraduate medical students of all professional years, including internship. A validated questionnaire collected data on students' demographics and educational characteristics, intention to study overseas or stay back in India, and factors influencing their decision. Results Out of a total of 1199 responses (51.1% males, 48.9% females), 45.0% partakers had planned to pursue their residency abroad, while 33.8% wanted to stay in India and 21.2% were undecided. Better lifestyle and higher pay grades overseas were viewed as the most significant barriers to staying back in India and a key influencer in decision-making among the maximum number of students (412; 76.3%). On the other hand, a whopping 58.2% of participants opined that they wanted to stay back in India for taking care of their parents. Conclusions Source countries with better healthcare facilities and better incomes tend to attract medical students. Awareness among medical educators regarding constantly changing curricula, a shift to a competency-based education system, better pay grades, limited working hours, and interventions to mitigate workplace violence could help prevent brain drain among Indian medical students and graduates.
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Affiliation(s)
- Rohin Kansal
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ankur Singla
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashvind Bawa
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kashish Malhotra
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Janvi Lalchandan
- Department of Paediatrics, KB Bhabha Hospital, Mumbai, Maharashtra, India
| | - Jasneet Grewal
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Madhav Mehta
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Navreet Kaur
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Samarvir Jain
- Medical Student, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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18
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Salikhanov I, Connor SR, Kunirova G, Khashagulgova F, Nazarova G, Crape BL, Katapodi MC. Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan. Public Health Rev 2023; 44:1605672. [PMID: 37671066 PMCID: PMC10476099 DOI: 10.3389/phrs.2023.1605672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, pain relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan. Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs.
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Affiliation(s)
- Islam Salikhanov
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stephen R. Connor
- Worldwide Hospice Palliative Care Alliance, Fairfax, VA, United States
| | | | | | | | | | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Issa M. The Pathway to Achieving Universal Health Coverage in the Democratic Republic of Congo: Obstacles and Prospects. Cureus 2023; 15:e41935. [PMID: 37583749 PMCID: PMC10425163 DOI: 10.7759/cureus.41935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/17/2023] Open
Abstract
This paper explores the complexities surrounding achieving universal health coverage (UHC) in the Democratic Republic of Congo (DRC) and proposes viable strategies to overcome the obstacles. The study's findings contribute to the global discourse on UHC in resource-limited settings and hold significant implications for policy formulation and implementation in both DRC and similar contexts. The introduction emphasises the importance of UHC in promoting equitable access to quality healthcare services for all individuals. Nevertheless, the DRC faces numerous challenges on its path to UHC. This paper identifies four key challenges: Firstly, the fragile healthcare infrastructure in the DRC necessitates the establishment of better-equipped facilities, an adequate healthcare workforce, and improved access to essential medical supplies. These factors hinder the provision of comprehensive health services and impede progress towards UHC. Secondly, socio-economic barriers such as persistent poverty, income disparities, and regional variations pose significant obstacles to achieving UHC in the DRC. Limited financial resources and widespread poverty prevent individuals from accessing healthcare services, exacerbating health inequities. Thirdly, weak health governance, inadequate policy implementation, and limited coordination among stakeholders impede the effective delivery of healthcare services in the DRC. Thus, strengthening governance structures and enhancing policy implementation are essential for UHC. Lastly, the absence of comprehensive health information systems and poor data management hinder evidence-based decision-making and resource allocation. Addressing these deficiencies is vital for monitoring progress and guiding policy formulation towards UHC. Given these challenges, this paper proposes potential solutions and future perspectives for achieving UHC in the DRC. These include strengthening health systems, implementing social protection mechanisms, enacting policy reforms, enhancing governance structures, and strengthening health information systems. Investments in robust health information systems, data collection and management improvements and the enhancement of capacity for health research and surveillance facilitate evidence-based decision-making and progress towards UHC. In conclusion, the DRC faces obstacles related to healthcare infrastructure, socio-economic factors, governance issues, and deficiencies in health information systems in its pursuit of UHC. However, by addressing these challenges through targeted interventions, policy reforms, and improved governance, the DRC can make strides towards ensuring equitable access to high-quality healthcare for all its citizens. Collaboration between national and international stakeholders is crucial for sustaining progress towards UHC and promoting health equity within the country.
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Affiliation(s)
- Moussa Issa
- Department of Emergency Medicine, Calderdale & Huddersfield National Health Service (NHS) Foundation Trust, Huddersfield, GBR
- Department of Health Research, Lancaster University, Lancaster, GBR
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20
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Mondal H, Soni S, Juyal A, Behera JK, Mondal S. Current distribution of medical colleges in India and its potential predictors: A public domain data audit. J Family Med Prim Care 2023; 12:1072-1077. [PMID: 37636164 PMCID: PMC10451585 DOI: 10.4103/jfmpc.jfmpc_1558_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 08/29/2023] Open
Abstract
Background A teaching hospital or medical college may help provide better health care delivery to the people of the vicinity. Hence, building new medical colleges and upgrading existing hospitals to teaching hospitals are being implemented in India. Objective This study aimed to observe the current distribution of medical colleges in Indian states and find correlation with area, population, and net state domestic product (NSDP). Methods We collected data from public domain websites provided by government agencies. The State-wise number of government and private medical colleges and their annual intake were obtained from the National Medical Commission website. The state-wise number of medical colleges, geographical area, and population were calculated as the percentage of total Indian colleges, area, and population, respectively. Spearman's correlation was calculated to find any correlation of colleges and annual intake versus parameters such as area, population, and NSDP. Results India has a total of 612 [321 (52.45%) government-run and 291 (47.55%) private] medical colleges. Tamil Nadu (70), Uttar Pradesh (67), Karnataka (63), Maharashtra (62), and Telangana (34) are the top five states with 296 (48.37%) medical colleges. States and union territories such as Karnataka, Kerala, Maharashtra, Puducherry, Tamil Nadu, and Telangana have higher medical colleges, and states such as Assam, Bihar, Odisha, Madhya Pradesh, Rajasthan, and Uttar Pradesh have lower medical colleges when compared with their population percentages. There was significant positive correlation of number of medical colleges with area (rs = 0.769, P < 0.0001), population (rs = 0.91, P < 0.0001), and NSDP (rs = 0.91, P < 0.0001). Conclusion The current distribution of medical colleges in India is clustered over some states. Although geographical area and population are major predictors of medical colleges in Indian states, a more population-based balanced distribution of medical colleges would help distribute quality health care to the majority of the population.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sachin Soni
- Department of Anatomy, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Ankita Juyal
- Department of Physiology, Soban Singh Jeena Government Institute of Medical Science and Research, Almora, Uttarakhand, India
| | - Joshil K. Behera
- Department of Physiology, Government Medical College and Hospital, Keonjhar, Odisha, India
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, West Bengal, India
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21
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Debnath A, Alam M, Goyal M, Khokhar A, Lukhmana S. The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India. Cureus 2023; 15:e39116. [PMID: 37332416 PMCID: PMC10272938 DOI: 10.7759/cureus.39116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.
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Affiliation(s)
- Aninda Debnath
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Md Alam
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Mohit Goyal
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Anita Khokhar
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Shveta Lukhmana
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
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22
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Sadiq F, Shafi S, Sikonja J, Khan M, Ain Q, Khan MI, Rehman H, Mlinaric M, Gidding SS, Groselj U. Mapping of familial hypercholesterolemia and dyslipidemias basic management infrastructure in Pakistan: a cross-sectional study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100163. [PMID: 37384054 PMCID: PMC10306043 DOI: 10.1016/j.lansea.2023.100163] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/09/2022] [Accepted: 01/20/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an autosomal inherited disorder characterised by elevated low-density lipoprotein cholesterol and premature cardiovascular events. Despite being declared as a public health priority, FH remains highly underdiagnosed, generally due to the lack of awareness and shortcomings in the available infrastructure, particularly in lower income countries. METHODS To map the existing infrastructure for the management of FH, a survey was conducted among 128 physicians (cardiologists, paediatricians, endocrinologists, and internal medicine specialists) from different regions of Pakistan. FINDINGS The respondents encountered a limited number of adults or children with diagnosed FH. A very small proportion of the population had access to free cholesterol and genetic testing even when indicated by a physician. In general, cascade screening of the relatives was not performed. Uniform diagnostic criteria for FH had not been established even within the same institution or province. The use of statins and ezetimibe in addition to lifestyle changes were the most common recommended treatment option for FH patients. The respondents considered lack of financial resources as a major barrier for the management of FH and stressed on taking relevant measures for a uniform FH screening programs around the country. INTERPRETATION National FH screening programmes are not in place worldwide hence FH is commonly undiagnosed, and many individuals are at a high risk for cardiovascular diseases. Timely screening of population for FH requires knowledge about FH among the clinicians and the availability of fundamental infrastructure coupled with sufficient financial resources. FUNDING The authors confirm independence from the sponsor. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. FS received funding from Higher Education Commission, Pakistan (Grant 20-15760) and UG received grants from Slovenian Research Agency (J3-2536, P3-0343).
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Affiliation(s)
- Fouzia Sadiq
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Saeed Shafi
- Department of Anatomy, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Jaka Sikonja
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva ulica 20, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Madeeha Khan
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Quratul Ain
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Mohammad Iqbal Khan
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
- Department of Vascular Surgery, Shifa International Hospital, Islamabad, Pakistan
| | - Habibur Rehman
- Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan
| | - Matej Mlinaric
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva ulica 20, Ljubljana, Slovenia
| | | | - Urh Groselj
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Bohoriceva ulica 20, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
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23
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Jain P, Singh K, Piplani S, Gulati S, Kour H. Beyond Scrubs: Understanding the Root Causes of Violence Against Doctors. Cureus 2023; 15:e39559. [PMID: 37378246 PMCID: PMC10292170 DOI: 10.7759/cureus.39559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Workplace violence (WPV) against doctors is a growing epidemic in India, with at least two-thirds of doctors facing some form of abuse during their careers. Verbal abuse is common, but doctors are also subjected to brutal attacks that endanger their lives. This review lists abusive incidents reported by the media since 2021. Despite increased respect for healthcare professionals during the COVID-19 pandemic, doctors in India are under significant stress due to inadequate medical infrastructure, mismanagement of young doctors, increasing mistrust between doctors and patients, a shortage of doctors, and overworked healthcare workers, leading to delays in attention and treatment. Additional factors contributing to the situation include the lack of proper insurance coverage, weak primary healthcare with overburdened tertiary care, the lack of an effective grievance redressal system, and the poor state of medical education. To combat this epidemic, collaborative efforts are needed between doctors, hospitals, the government, and society. Improving communication skills and treating patients with empathy are essential for healthcare workers. Meanwhile, hospitals should implement an efficient security system, a transparent billing system, and an active complaint system to prevent incidents. Unbiased reporting and adequate documentation are required to further investigate this occupational health hazard. The government should focus on building better medical facilities and passing a strict law against violence against doctors to ensure the safety of medical professionals. This review presents some solutions, along with the current legal coverage provided to healthcare professionals regarding WPV.
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Affiliation(s)
- Priyanshu Jain
- Medicine, Jawaharlal Nehru Medical College, Belagavi, IND
| | - Kamaldeep Singh
- Cardiology, Government Medical College & Hospital, Chandigarh, IND
| | | | - Shreya Gulati
- Medicine, Jawaharlal Nehru Medical College, Belagavi, IND
| | - Harpreet Kour
- Physiology, Jawaharlal Nehru Medical College, Belagavi, IND
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24
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Varas-Díaz N, Rodríguez-Madera S, Padilla M, Rivera-Bustelo K, Mercado-Ríos C, Rivera-Custodio J, Matiz-Reyes A, Santiago-Santiago A, González-Font Y, Vertovec J, Ramos-Pibernus A, Grove K. On leaving: Coloniality and physician migration in Puerto Rico. Soc Sci Med 2023; 325:115888. [PMID: 37058878 PMCID: PMC10170400 DOI: 10.1016/j.socscimed.2023.115888] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/16/2023]
Abstract
Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the recommended physicians per capita ratio proposed by the World Health Organization (WHO). Existing research has focused on the personal motivations for movement to, or permanence in, a particular setting, and social variables that encourage physicians to migrate (e.g., economic conditions). Few studies have addressed the role of coloniality in fostering physician migration. In this article we examine the role of coloniality and its impact on PR's physician migration problem. The data presented in this paper stem from an NIH-funded study (1R01MD014188) that aimed to document the factors associated with physician migration from PR to the US mainland and its impact on the Island's healthcare system. The research team used qualitative interviews, surveys, and ethnographic observations. This paper focuses on the data from the qualitative interviews with 26 physicians who had migrated to the USA and ethnographic observations, which were collected and analyzed between September 2020 and December 2022. The results evidence that participants understand physician migration as a consequence of three factors: 1) the historical and multidimensional deterioration of PR, 2) the idea that the current healthcare system is rigged by politicians and insurance companies, and 3) the specific challenges faced by physicians in training on the Island. We discuss the role of coloniality in fostering these factors and how it serves as the backdrop for the problem faced by the Island.
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Affiliation(s)
| | | | - Mark Padilla
- Florida International University, United States.
| | | | | | | | | | | | | | - John Vertovec
- Behavioral Science Research Institute, United States.
| | | | - Kevin Grove
- Florida International University, United States.
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25
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Ghia C, Rambhad G. Implementation of equity and access in Indian healthcare: current scenario and way forward. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2194507. [PMID: 36998432 PMCID: PMC10044314 DOI: 10.1080/20016689.2023.2194507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The Indian healthcare system is evolving towards better healthcare implementation and coverage. However, even today, the health-care system faces several challenges, a few of which are yet to be addressed. The present review is aimed to delineate the past and present healthcare scenarios in India, health-care policies, and other initiatives for achieving universal health coverage (UHC). METHODS A literature search was done on various government databases, websites, and PubMed for obtaining data and statistics on healthcare funding, health insurance schemes, healthcare budget allocations, categories of medical expenses, government policies, and health technology assessment (HTA) in India. RESULTS The available data indicates 37.2% of the total population is covered by any health insurance of which 78% are covered by public insurance companies. Around 30% of the total health expenditure is borne by the public sector, and there is high out-of-pocket (OOP) expenditure on healthcare. DISCUSSION Several new health policies and schemes, an increase in 2021 budget for healthcare by 137%, vaccination drives, augmenting manufacturing of medical devices, special training packages, Artificial Intelligence/Machine Learning (AI/ML)-based standard treatment workflow systems to ensure proper treatment and clinical decision-making have been initiated by the government for improving healthcare funding, equity, and access.
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Affiliation(s)
- Canna Ghia
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| | - Gautam Rambhad
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
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26
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Tripathi D, Vikram NK, Chaturvedi S, Bhatia N. Barriers and facilitators in dietary and physical activity management of type 2 diabetes: Perspective of healthcare providers and patients. Diabetes Metab Syndr 2023; 17:102741. [PMID: 36931191 DOI: 10.1016/j.dsx.2023.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND AIMS Type 2 diabetes (T2DM) is a chronic disease that requires continuous management and daily self-care activities. The purpose of the study was to identify the barriers and facilitators in dietary and physical activity management of T2DM by patients. METHOD Two focus group discussions with patients with T2DM (n = 12) and interviews with healthcare providers (HCPs, n = 15) were done, to identify the barriers and facilitators experienced by patients towards lifestyle management in T2DM. Data were analyzed using qualitative data analysis software Atlas ti. version 8. RESULT Three major themes were identified as barriers and facilitators viz., Personal barriers and facilitators, social barriers and facilitators, and barriers and facilitators related to the healthcare provider. Major barriers were denial of illness, low level of knowledge of the disease, excess use of gadgets, poor infrastructure, gender issues, and lack of time. Major facilitators identified were patient education and motivation, continuous counseling and regular follow-up, family and peer support, and recreational and indoor activities. CONCLUSION Based on the findings of the study, a multifaceted approach is required to address these barriers and facilitators. These findings will help in developing novel intervention strategies and making policy-level changes, which are required to improve diabetes self-management practices in people with T2DM.
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Affiliation(s)
- Divya Tripathi
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Swapna Chaturvedi
- Department of Dietetics, All India Institute of Medical Sciences, New Delhi, India.
| | - Neena Bhatia
- Dept of Food and Nutrition, Lady Irwin College, University of Delhi and Senior Specialist, NITI Aayog, Government of India, India.
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27
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Yan F, Li H, Wang W, Zhang J. The trend in density of skilled health personnel in BRICS countries: Implication for China and India. Int J Health Plann Manage 2023; 38:759-772. [PMID: 36820501 DOI: 10.1002/hpm.3623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/26/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The similarities and differences in workforce trends in BRICS (Brazil, Russia, India, China, and South Africa) may offer reciprocal lessons for emerging economies. METHODS We used the Global Health Observatory data to assess the secular trends between 2001 and 2017 in the number of skilled health personnel (SHP: doctors, nurses/midwives) in BRICS compared to the average of Organization for Economic Co-operation and Development (OECD) countries. RESULTS Substantial efforts have been made in BRICS to increase SHP availability, as demonstrated by an average exponential growth rate (AEGR) > 0.03 in Brazil, China, and India compared to 0.01 in OECD. With an AEGR as high as 0.07 after 2008, China reached the level of SHP availability commensurate with the sustainable development goals (SDGs) in 2017. Other than China, BRICS countries had a mean number of nurses and midwives per doctor between 2001 and 2017 higher than or comparable to the OECD average (2.78). The corresponding number in China was 1.04 in 2017, lower than 2.21 in India in 2001. CONCLUSIONS With China as the exception, BRICS countries maintained a sustainable skills mix of SHPs. China reached the level of SHP availability commensurate with the SDGs, but SHP's skill mix was imbalanced.
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Affiliation(s)
- Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.,National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Fudan University, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Hongxia Li
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.,Shanghai East Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, Shanghai, China.,National Key Laboratory of Health Technology Assessment (National Health and Family Planning Commission), Fudan University, Shanghai, China.,Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Jian Zhang
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
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Ahuja N, Rane SR, Pai SA. Lacunae in Laboratory Medicine Services and in Pathology Education in Medical Schools in India. Arch Pathol Lab Med 2023; 147:236-243. [PMID: 35738003 DOI: 10.5858/arpa.2021-0545-ep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Laboratories of many medical college hospitals in India do not offer important diagnostic tests, most of which are routine in the West. This detracts from the service as well as the educational function of the college. OBJECTIVES.— To provide the background to pathology and laboratory medicine services and education in India, and to create a questionnaire that will put the lack of tertiary care laboratory services in perspective. This article will help illustrate the lacunae in laboratory medicine services and in the education of students. For this, we present information on the health services and pathology education facilities in India. We propose a questionnaire comprising 30 questions in various disciplines in pathology and laboratory medicine. These questions will help administrators and bureaucrats evaluate the status of the laboratories with respect to the services provided. DATA SOURCES.— Sources include Web sites of the government of India, including that of the National Accreditation Board for Testing and Calibration Laboratories; indexed medical journal articles; and standard books and white papers on health care in India. We also used our personal experiences and interpretations of the laboratory and medical education sector in India. CONCLUSIONS.— Medical colleges in India need to offer specialized diagnostic services if they are to achieve the targets of universal health care as well as turning out competent doctors. The agencies responsible for health care in India should use the questionnaire as a first step toward improving laboratory services. Other low- and middle-income countries should also adopt this method.
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Affiliation(s)
- Nishtha Ahuja
- From the Department of Histopathology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India (Ahuja)
| | - Sharada R Rane
- From the Department of Pathology, Government Medical College, Baramati, India (Rane)
| | - Sanjay A Pai
- From the Department of Pathology and Laboratory Medicine, Manipal Hospital-Yeshwanthpur, Bangalore, India (Pai)
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29
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Siripanumas C, Suphanchaimat R, Nittayasoot N, Sawaengdee K. Distribution of Physicians to Public Health Facilities and Factors Contributing to New Medical Graduates Serving in Public Facilities, 2016-2020, Thailand. Risk Manag Healthc Policy 2022; 15:1975-1985. [PMID: 36325046 PMCID: PMC9621218 DOI: 10.2147/rmhp.s384507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In Thailand, the shortage and maldistribution of physicians in the public sector is a critical public health problem. The aims of this study are to describe the retention situation of new physicians and to determine factors associated with new physicians' decision to serve in public facilities. METHODS Data of new physicians from the Human Resource Office of the Permanent Secretary System (HROPS) were analysed in order to describe the retention situation of new physicians. A retrospective cohort study was conducted to determine factors associated with new physicians' decision to remain in public service. The data were collected between Oct 2021 and Jan 2022. Cox regression was performed. RESULTS According to the HROPS database, most new physicians remained in hospitals affiliated to the Office of the Permanent Secretary (OPS) of the Ministry of Public Health (MOPH) (83.5%). Among the physicians resigning from MOPH hospitals, 80.6% resigned due to career factors. From a retrospective cohort study, physicians in the special recruitment track had the lowest incidence rate of resigning. In terms of satisfaction, most physicians were least satisfied with salary levels and workload. The majority of physicians felt satisfied with being close to their families. The Cox regression revealed that physicians graduating from private medical schools or from abroad had a higher risk of leaving public facilities. CONCLUSION To lessen the burden of physician shortage and maldistribution, the proportion of students recruited in the special track should be enhanced. High workload and inappropriate income should be addressed. Allocating new physicians to work in their hometown is recommended.
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Affiliation(s)
- Chutima Siripanumas
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand,Correspondence: Chutima Siripanumas, Email
| | - Rapeepong Suphanchaimat
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand,International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Natthaprang Nittayasoot
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Krisada Sawaengdee
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
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30
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Tanwar S, Kumari A, Vekaria D, Kumar N, Sharma R. An AI-based disease detection and prevention scheme for COVID-19. COMPUTERS & ELECTRICAL ENGINEERING : AN INTERNATIONAL JOURNAL 2022; 103:108352. [PMID: 36068837 PMCID: PMC9436917 DOI: 10.1016/j.compeleceng.2022.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The proliferating outbreak of COVID-19 raises global health concerns and has brought many countries to a standstill. Several restrain strategies are imposed to suppress and flatten the mortality curve, such as lockdowns, quarantines, etc. Artificial Intelligence (AI) techniques could be a promising solution to leverage these restraint strategies. However, real-time decision-making necessitates a cloud-oriented AI solution to control the pandemic. Though many cloud-oriented solutions exist, they have not been fully exploited for real-time data accessibility and high prediction accuracy. Motivated by these facts, this paper proposes a cloud-oriented AI-based scheme referred to as D-espy (i.e., Disease-espy) for disease detection and prevention. The proposed D-espy scheme performs a comparative analysis between Autoregressive Integrated Moving Average (ARIMA), Vanilla Long Short Term Memory (LSTM), and Stacked LSTM techniques, which signify the dominance of Stacked LSTM in terms of prediction accuracy. Then, a Medical Resource Distribution (MRD) mechanism is proposed for the optimal distribution of medical resources. Next, a three-phase analysis of the COVID-19 spread is presented, which can benefit the governing bodies in deciding lockdown relaxation. Results show the efficacy of the D-espy scheme concerning 96.2% of prediction accuracy compared to the existing approaches.
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Affiliation(s)
- Sudeep Tanwar
- Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, India
| | - Aparna Kumari
- Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, India
| | - Darshan Vekaria
- Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, India
| | - Neeraj Kumar
- Thapar Institute of Engineering and Technology, (Deemed to be University), Patiala, Punjab, India
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Ravi Sharma
- Centre for Inter-Disciplinary Research and Innovation, University of Petroleum and Energy Studies, P.O. Bidholi Via-Prem Nagar, Dehradun, India
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Shrivastava SR, Shrivastava PS. Strategies to Reduce the Cost of Medical Education in India: A Narrative Review. Avicenna J Med 2022; 12:100-104. [PMID: 36092386 PMCID: PMC9458346 DOI: 10.1055/s-0042-1755333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Abstract
Background The global population is being plagued by several diseases and health conditions, and this calls for the need to adopt a strategy to enable people from all socioeconomic backgrounds to have the freedom and choice to opt for a medical profession as their career. The purpose of the current review is to explore the reasons which make medical education expensive and identify the strategies by which the cost of medical education can be minimized.
Methods An extensive search of all materials related to the topic was performed on the PubMed search engine and web site of the National Medical Commission. Relevant research articles focusing on costs in medical education published in the period 2005 to 2021 were included in the review. A total of 37 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include medical education and cost in the title alone only.
Results We have to accept the fact that medical education is quite expensive and that's not the case with one nation but the trend is worldwide. It is the need of the hour to plan and implement strategies that make medical training accessible and available to people from all socioeconomic classes and regardless of other variables.
Conclusion In conclusion, the process of training medical students is expensive and accounts for a wide range of impacts on the medical aspirants. Thus, there is an indispensable need for the policy makers and the concerned stakeholders to join their hands together and take appropriate steps to minimize the overall cost of medical training, and thereby making it affordable to everyone.
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Affiliation(s)
- Saurabh R. Shrivastava
- Sri Balaji Vidyapeeth–Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
| | - Prateek S. Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth–Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
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Health workforce retention in low-income settings: an application of the Root Stem Model. J Public Health Policy 2022; 43:445-455. [PMID: 35978036 PMCID: PMC9385095 DOI: 10.1057/s41271-022-00361-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/21/2022]
Abstract
The World Health Organization (WHO) recognizes a critical shortage of health workers as a growing global crisis. The shortage persists despite local and global efforts to recruit health workers ethically. Unequal migration of healthcare professionals, most often from low to high-resource countries, overwhelmingly defeats the objective of achieving Universal Health Coverage (UHC). If not addressed, especially given emerging global pandemics like COVID-19, the critical shortage of health workers could decimate vulnerable public health systems. This Viewpoint describes the Root-Stem Model, a six-stage process of strategic factors affecting work life that could help policymakers address the challenge of brain-drain among healthcare workers in low-income countries.
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Naithani L, Sangwan P, Roy SG, Menon S, Azar Z, Lakhera S, Kumar D, Abhilashi MK, Roy R, Vajaratkar V, Taylor C, Patel V, Green J, Divan G. From engagement to competency: The pathway to making disability naïve frontline workers competent in the delivery of an evidence-based autism intervention in New Delhi, India. Front Psychiatry 2022; 13:903341. [PMID: 35966459 PMCID: PMC9372267 DOI: 10.3389/fpsyt.2022.903341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background As countries like India improve access to maternal and infant care, the health systems need to develop services that enable all children to thrive. A key demographic which needs to be supported are children with disabilities, such as autism. With an estimated prevalence of one percent, there are over five million young children who need services to support their needs. However, the paucity of specialist care makes access to interventions difficult. In this context a public health research not-for-profit is evaluating the effectiveness of the task-sharing approach to support the delivery of an evidenced social communication intervention for young children with autism. This paper describes the process of engaging and training the non-specialist frontline Accredited Social Health Activists (ASHAs), who are embedded within the Ministry of Health and Family Welfare under the Delhi State Health Mission, to deliver a complex intervention for autism to inform the future scalability of services for neurodevelopmental disorders. Methods The present study describes the process which included (i) engagement meetings, (ii) recruitment, (iii) training, (iv) internship, and (v) competency evaluation. The shortlisted ASHAs received a 7-day classroom training followed by an internship period with practice cases. Finally, competency assessments, comprising of a test of knowledge and skills through role-plays, was administered. Results Twenty three Primary Urban Health Centers across seven districts of Delhi were approached and 408 ASHAs were engaged in initial meetings. Telephonic screening with 127 ASHAs resulted in 72 ASHAs being selected for in-person interviews. Of the 45 ASHAs who attended, 33 were shortlisted for training and 18 completed it. Fifteen ASHAs entered the internship of which 7 ASHAs achieved competency. Discussion and conclusion There was significant attrition along the pathway to having a competent non-specialist worker deliver a complex autism intervention. The lessons learnt from this process can inform the possibility of developing a cadre of disability specific frontline health workers who can deliver evidence-based interventions for neurodevelopmental disorders under supervision.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Vikram Patel
- Harvard Medical School, Boston, MA, United States
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
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Tiwari A, Chugh A, Sharma A. Ensemble framework for cardiovascular disease prediction. Comput Biol Med 2022; 146:105624. [DOI: 10.1016/j.compbiomed.2022.105624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
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Gupta B, Jain G, Pathak S, Mishra P, Kumar H, Rao S. Airway management training program for nurses via online course in COVID-19 preparedness. World J Methodol 2022; 12:113-121. [PMID: 35721240 PMCID: PMC9157635 DOI: 10.5662/wjm.v12.i3.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/27/2022] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic. AIM To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19. METHODS The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips. RESULTS Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student's t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient's airway. CONCLUSION Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.
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Affiliation(s)
- Bhavna Gupta
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Gaurav Jain
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Sharmishtha Pathak
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Priyanka Mishra
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Hemanth Kumar
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
| | - Shalinee Rao
- Department of Advanced Centre of Continuous Professional Development, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
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Tabassum S, Abedin N, Rahman MM, Rahman MM, Ahmed MT, Islam R, Ahmed A. An online cursive handwritten medical words recognition system for busy doctors in developing countries for ensuring efficient healthcare service delivery. Sci Rep 2022; 12:3601. [PMID: 35246576 PMCID: PMC8897401 DOI: 10.1038/s41598-022-07571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Doctors in developing countries are too busy to write digital prescriptions. Ninety-seven percent of Bangladeshi doctors write handwritten prescriptions, the majority of which lack legibility. Prescriptions are harder to read as they contain multiple languages. This paper proposes a machine learning approach to recognize doctors' handwriting to create digital prescriptions. A 'Handwritten Medical Term Corpus' dataset is developed containing 17,431 samples of 480 medical terms. In order to improve the recognition efficiency, this paper introduces a data augmentation technique to widen the variety and increase the sample size. A sequence of line data is extracted from the augmented images of 1,591,100 samples and fed to a Bidirectional Long Short-Term Memory (LSTM) network. Data augmentation includes pattern Rotating, Shifting, and Stretching (RSS). Eight different combinations are applied to evaluate the strength of the proposed method. The result shows 93.0% average accuracy (max: 94.5%, min: 92.1%) using Bidirectional LSTM and RSS data augmentation. This accuracy is 19.6% higher than the recognition result with no data expansion. The proposed handwritten recognition technology can be installed in a smartpen for busy doctors which will recognize the writings and digitize them in real-time. It is expected that the smartpen will contribute to reduce medical errors, save medical costs and ensure healthy living in developing countries.
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Affiliation(s)
- Shaira Tabassum
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan.
| | - Nuren Abedin
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | | | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Rafiqul Islam
- Global Communication Center, Grameen Communications, Dhaka, Bangladesh.,Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Ashir Ahmed
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan.,Global Communication Center, Grameen Communications, Dhaka, Bangladesh
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Shekhar H, Rautela M, Maqsood M, Paris R, Flores de León RM, Romero-Aguirre MF, Balinos M, Velázquez ME, Amri GS, Rahman T, Asuah AY, Hosni J, Rahman MS. Are leading urban centers predisposed to global risks- A analysis of the global south from COVID-19 perspective. HABITAT INTERNATIONAL 2022; 121:102517. [PMID: 35125583 PMCID: PMC8801593 DOI: 10.1016/j.habitatint.2022.102517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
COVID-19 initially spread among prominent global cities and soon to the urban centers of countries across the globe. While cities are the hotbeds of activities, they also seem highly exposed to global risks including the pandemic. Using the case of COVID-19 and the World Risk Index framework, this paper examines if the leading cities from the global south are inherently vulnerable and exposed to global risks and can they exacerbate the overall risk of their respective nations. Compared against their respective national averages, most of the 20 cities from 10 countries analyzed in this paper, have higher exposure, lower adaptive capacity, higher coping capacity and varied susceptibility. As this relative understanding is based on respective national averages which are often lower than the global standards, even high performance on certain indicators may still result in elevated predisposition. This paper concludes that the leading urban centers from the global south are highly likely to be predisposed to global risks due to their inherent vulnerability and exposure, and many of the drivers of this predisposition are related to the process of urbanization itself. This predisposition can enhance the overall exposure and vulnerability of the nation in which they are located.
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Affiliation(s)
- Himanshu Shekhar
- United Nations University - Institute for Environment and Human Security (UNU-EHS), UN Campus, Platz der Vereinten Nationen 1, Bonn, 53113, Germany
| | | | | | - Ricardo Paris
- Ministry of Science, Technology and Innovation, Brasilia, Brazil
| | | | | | | | | | - Gita Salehi Amri
- Help - Hilfe zur Selbsthilfe, International Humanitarian NGO, Erbil, Iraq
| | | | | | - Jilan Hosni
- Patrimonio Edificado y Contexto Association (PEC), Valdivia, Chile
| | - Md Shahinoor Rahman
- Department of Earth and Environmental Sciences, New Jersey City University, Jersey City, NJ, 07305, USA
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Surendranath M, Wankhedkar R, Lele J, Cintra O, Kolhapure S, Agrawal A, Dewda P. A Modern Perspective on Vaccinating Healthcare Service Providers in India: A Narrative Review. Infect Dis Ther 2022; 11:81-99. [PMID: 34773563 PMCID: PMC8590119 DOI: 10.1007/s40121-021-00558-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 10/28/2022] Open
Abstract
Healthcare providers (HCPs) are at increased risk of acquisition and transmission of infectious disease. Vaccinating HCPs is an essential preventive measure to protect them and their patients against communicable diseases, while positively and directly impacting the functioning of the healthcare system. In India, healthcare represents one of the largest employment sectors with 3.8 million HCPs; however, there is limited awareness of national immunisation guidelines for the Indian HCP population. Data from communicable disease outbreaks across India suggest inadequate vaccination rates amongst HCPs; studies have reported influenza and varicella vaccination rates as low as 4.4% and 16%, respectively. In this review, we discuss data highlighting the impact of insufficient vaccination coverage, barriers to vaccination, and the lack of immunisation guidelines amongst HCPs in India. COVID-19 vaccination programmes for HCPs have been critical in slowing the pandemic in India. This provides an opportunity to raise awareness about the importance of vaccines amongst HCPs in India.
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Affiliation(s)
| | - Ravi Wankhedkar
- World Medical Association and Sitaram Hospital, Dhule, India
| | - Jayesh Lele
- National Hospital Board of India, Mumbai, India
| | | | | | | | - Pavitra Dewda
- Medical Affairs, GSK, Mumbai, India.
- Vaccines Medical, No 252, Dr Annie Besant Rd, Worli Shivaji Nagar, Worli, Mumbai, 400018, Maharashtra, India.
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Nanda L, Anilkumar A. Role of nurse practitioners within health system in India: A case of untapped potential. J Family Med Prim Care 2021; 10:2751-2756. [PMID: 34660400 PMCID: PMC8483105 DOI: 10.4103/jfmpc.jfmpc_2283_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
Nurses form the pillar of India's healthcare system representing 30.5% of the entire health workforce in India. Amidst a significant shortage in the provision of effective primary care, jeopardizing millions of Indians’ access to basic healthcare services, especially the poorest, it is very evident that nurse practitioners are the need of the hour in India. The current scenario of nursing in India warrants policy reforms to facilitate nurses as valuable primary care providers. It also shows the path towards making the Health and Wellness Centre operational by creating a pivotal role for the cadre in such centres, and it will also be important for the nurse practitioner to have a public health leadership role in a country like India. With additional training and qualification and also recognition of nurse practitioners as essential healthcare providers, a complete quality healthcare could be provided. In this research paper we assess the need for nurse practitioners as primary contact providers; reflect on the global evidence on nurse practitioners linking to health outcomes, effective coverage and access to services. We also try to contemplate on the training needs, their role in home-based care and as enablers of the referral mechanism, their untapped potential, and a plan for evaluating their effectiveness. This policy research paper focuses to build an argument for a policy towards making nurse practitioners the first contact providers.
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Affiliation(s)
- Lipika Nanda
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
| | - Aiswarya Anilkumar
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
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Jiwnani S, Ranganathan P, Tiwari V, Ashok A, Niyogi D, Karimundackal G, Pramesh CS. COVID-19 Pandemic and Its Gendered Impact on Indian Physicians. JCO Glob Oncol 2021; 7:1093-1100. [PMID: 34228486 PMCID: PMC8457862 DOI: 10.1200/go.21.00020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The 2018 WHO health workforce report analyzing gender equity in 104 countries reported that although women constituted 70% of the workers, they were less likely to be employed full-time and faced a 28% gender pay gap. The ongoing COVID-19 pandemic has affected professional as well as personal lives of physicians. We conducted a survey among Indian physicians to understand this impact.
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Affiliation(s)
- Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Virendra Tiwari
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Devayani Niyogi
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - George Karimundackal
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Kumari S, Kishore J. Medical Termination of Pregnancy (Amendment Bill, 2021): Is it Enough for Indian Women Regarding Comprehensive Abortion Care?? Indian J Community Med 2021; 46:367-369. [PMID: 34759469 PMCID: PMC8575235 DOI: 10.4103/ijcm.ijcm_468_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
Medical termination of pregnancy (MTP) has been legalized in India since 1971 considering the huge burden of unsafe abortions. Even after about 50 years, Indian women continued to have unsafe abortions and face adverse and fatal consequences. At this point, only legislative amendments may not be sufficient but along with that, many other aspects need to be considered like awareness, availability, accessibility, affordability of quality MTP services, and contraceptives. People should know the adverse effects of taking unsupervised medical termination pills. Comprehensive abortion care should be provided at every level of health care to ensure the good reproductive health of the women.
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Affiliation(s)
- Sneha Kumari
- Department of Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Jugal Kishore
- Department of Community Medicine, VMMC and Safdarjung Hospital, New Delhi, India
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Kishor M, Chandran S, Vinay HR, Ram D. Suicide among Indian doctors. Indian J Psychiatry 2021; 63:279-284. [PMID: 34211222 PMCID: PMC8221226 DOI: 10.4103/psychiatry.indianjpsychiatry_137_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/14/2020] [Accepted: 05/28/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND India has one of the largest numbers of doctors in the world. It is estimated that more than 1 million doctors are in India. Every year more than 80,000 medical students graduate as doctors from 529 medical colleges in India. Medical profession is considered as more stressful, but mental health is still a subject of taboo in medical profession in Indian context. Doctors have higher suicide risk, 2.5 times more than the general population. In the United Kingdom, 430 doctors committed suicide between the years 2011 and 2015. Even though suicide among doctors is reported in Indian media, there is hardly any scientific study that has looked into the suicide among Indian doctors because of many hurdles in the collection of information. MATERIALS AND METHODS All the Indian newspaper that are published in English and are available in the online platform were scrutinized on doctors suicide report from the year 2016 March to 2019 March. RESULTS Thirty suicides were reported between 2016 March and 2019 March, out of which 18 were female and 12 male. More than 80% were younger than 40 years. Twenty-two were from medical education institutions. Seventeen were from south India and 13 from North India. Eight were MBBS students and ten were postgraduate students. Among subspecialties, six doctors were from Anesthesia. Seventeen used hanging as a method for suicide, eight used medications, and five jumped from building to end life. Nineteen of suicide reports about doctors mentioned that they were depressed. CONCLUSION Suicide among Indian doctors is concern. Majority are young undergraduate and postgraduate medical students. Female doctors were more than male doctors. Most doctors were reported to be depressed and used lethal method such as hanging and medications.
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Affiliation(s)
- M Kishor
- Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Suhas Chandran
- Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka, India
| | - H R Vinay
- Department of Psychiatry, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India
| | - Dushad Ram
- Department of Psychiatry, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Kodi S M, Sharma SK. Realities, scope, challenges, and facilitators for implementation of nurse practitioner's role in India: A review. Int J Nurs Sci 2021; 8:237-242. [PMID: 33997140 PMCID: PMC8105548 DOI: 10.1016/j.ijnss.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
India is in dire need of an alternative to general medical practitioners to overcome a severe shortage of doctors, especially in rural and underprivileged regions. Empowering nurses through nurse practitioner (NP) role is the superlative solution to provide quality health care in primary care setting. Based on conceptions and research findings of the NP’ s role, we analyzed and examined the realities, scope, and barriers for implementing the NP’ s role in India and propose future strategies to create a NP cadre.
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Affiliation(s)
- Malar Kodi S
- Department of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K Sharma
- Department of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Chawak S, Chittem M, Maya S, Dhillon HM, Butow PN. The Question-prompt list (QPL): Why it is needed in the Indian oncology setting? Cancer Rep (Hoboken) 2021; 4:e1316. [PMID: 33295152 PMCID: PMC8451377 DOI: 10.1002/cnr2.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Mahati Chittem
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Sravannthi Maya
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phyllis N. Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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Donoghue M. Oral pathology and the problem of plenty that isn't! J Oral Maxillofac Pathol 2021; 24:411-412. [PMID: 33967472 PMCID: PMC8083406 DOI: 10.4103/jomfp.jomfp_445_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Mandana Donoghue
- Director Oral Pathology India, Director Oral Pathology 360, Independent Researcher & Consultant, Belgaum, Karnataka, India. E-mail:
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Noya F, Freeman K, Carr S, Thompson S, Clifford R, Playford D. Approaches to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review Protocol. Int J Health Policy Manag 2021; 10:22-28. [PMID: 32610716 PMCID: PMC7947704 DOI: 10.34172/ijhpm.2020.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/18/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries. METHODS We will utilize the Arksey and O'Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant articles and information, with disagreements resolved by a third. Quantitative and qualitative analyses (thematic) will be conducted to evaluate and categorize the study findings. DISCUSSION The scoping review will aid in mapping the available evidence for approaches implemented to advance the process of recruitment, development, and retention of the medical workforce in the rural and remote areas in developed and developing nations.
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Affiliation(s)
- Farah Noya
- Division of Health Professions Education, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Kirsty Freeman
- Division of Health Professions Education, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Sandra Carr
- Division of Health Professions Education, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia
| | - Rhonda Clifford
- School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Denese Playford
- The Rural Clinical School of WA, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
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Iyengar KP, Jain VK, Vaishya R. Medical doctors in India are on strike: a moral and national conundrum. Postgrad Med J 2020; 98:313-314. [PMID: 33234705 DOI: 10.1136/postgradmedj-2020-139325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/03/2022]
Affiliation(s)
| | - Vijay Kumar Jain
- Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Raju Vaishya
- Orthopaedics, Indraprastha Apollo Hospital, New Delhi, Delhi, India
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Tadavarthi Y, Vey B, Krupinski E, Prater A, Gichoya J, Safdar N, Trivedi H. The State of Radiology AI: Considerations for Purchase Decisions and Current Market Offerings. Radiol Artif Intell 2020; 2:e200004. [PMID: 33937846 DOI: 10.1148/ryai.2020200004] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 01/02/2023]
Abstract
Purpose To provide an overview of important factors to consider when purchasing radiology artificial intelligence (AI) software and current software offerings by type, subspecialty, and modality. Materials and Methods Important factors for consideration when purchasing AI software, including key decision makers, data ownership and privacy, cost structures, performance indicators, and potential return on investment are described. For the market overview, a list of radiology AI companies was aggregated from the Radiological Society of North America and the Society for Imaging Informatics in Medicine conferences (November 2016-June 2019), then narrowed to companies using deep learning for imaging analysis and diagnosis. Software created for image enhancement, reporting, or workflow management was excluded. Software was categorized by task (repetitive, quantitative, explorative, and diagnostic), modality, and subspecialty. Results A total of 119 software offerings from 55 companies were identified. There were 46 algorithms that currently have Food and Drug Administration and/or Conformité Européenne approval (as of November 2019). Of the 119 offerings, distribution of software targets was 34 of 70 (49%), 21 of 70 (30%), 14 of 70 (20%), and one of 70 (1%) for diagnostic, quantitative, repetitive, and explorative tasks, respectively. A plurality of companies are focused on nodule detection at chest CT and two-dimensional mammography. There is very little activity in certain subspecialties, including pediatrics and nuclear medicine. A comprehensive table is available on the website hitilab.org/pages/ai-companies. Conclusion The radiology AI marketplace is rapidly maturing, with an increase in product offerings. Radiologists and practice administrators should educate themselves on current product offerings and important factors to consider before purchase and implementation.© RSNA, 2020See also the invited commentary by Sala and Ursprung in this issue.
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Affiliation(s)
- Yasasvi Tadavarthi
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Brianna Vey
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Elizabeth Krupinski
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Adam Prater
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Judy Gichoya
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Nabile Safdar
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Hari Trivedi
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
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Olumade TJ, Adesanya OA, Fred-Akintunwa IJ, Babalola DO, Oguzie JU, Ogunsanya OA, George UE, Akin-Ajani OD, Osasona DG. Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice. AIMS Public Health 2020; 7:736-757. [PMID: 33294478 PMCID: PMC7719556 DOI: 10.3934/publichealth.2020057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023] Open
Abstract
Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria's experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.
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Affiliation(s)
- Testimony J Olumade
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | | | - David O Babalola
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Judith U Oguzie
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | - Olusola A Ogunsanya
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Uwem E George
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | - Damilola G Osasona
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
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Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. PLoS One 2020; 15:e0239193. [PMID: 32946495 PMCID: PMC7500628 DOI: 10.1371/journal.pone.0239193] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction The incidents of violence against doctors, leading to grievous injury and even death, seem to be on an increasing trend in recent years. There is a paucity of studies on workplace violence against doctors and its effect, in India. The present study was conducted to assess workplace violence faced by doctors, its effect on the psycho-social wellbeing of the treating doctor and, subsequently, on patient management. Methods The present nationwide cross-sectional study was conducted from November 2019 –April 2020. The sample size was calculated assuming the prevalence of workplace violence as 50%, with 20% non-response. Doctors, working in private and/or public set-up, with ≥1 year clinical experience, were included. A pre-tested study tool- Google form—was sent to study participants via social media platforms. The Microsoft Excel spreadsheet was downloaded from google drive and data was analysed using STATA-12 statistical software. Results A total of 617 responses were received from doctors all over India; out of which 477 (77.3%) doctors had ever faced workplace violence. “Actual or perceived non-improvement or deterioration of patient’s condition" (40.0%), followed by “perception of wrong treatment given” (37.3%) were the main causes of workplace violence; and the family members/relatives were the major perpetrators (82.2%). More than half of the participants reported “loss of self-esteem”, “feeling of shame” and “stress/depression/anxiety/ideas of persecution” after the incident. Management by surgical interventions (p-value<0.001) and handling of emergency/complicated cases (p-value<0.001) decreased significantly with an increase in severity of workplace violence; while the suggestion of investigations and referrals increased (p-value<0.001). Conclusions Workplace violence has a significant effect on the psycho-social well-being of doctors, as well as on patient management; which may escalate discontent and distrust among the general public, thereby increasing incidents of workplace violence—in a self-propagating vicious cycle.
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Affiliation(s)
- Amandeep Kaur
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Farhad Ahamed
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Paramita Sengupta
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Jitendra Majhi
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Tandra Ghosh
- Department of Physiology, All India Institute of Medical Sciences, Kalyani, West Bengal, India
- * E-mail:
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