Table of Contents
Editorial in Health Policy
Combatting the shortage of physicians to alleviate work-related strain
Author: Francesco Chirico1
1M.D., Health Service Department, State Police, Ministry of Interior, Italy.
Keywords: Health policy; health care economics and organizations; mental health; occupational health psychology; physicians; psychosocial risks; psychology, industrial.
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Original Article in Occupational Health Psychology
Depressive symptoms and overwork among physicians employed at a university hospital in Japan
Author: Toru Maruyama1
1 M.D., Prof, Kyushu University Campus, Faculty of Arts and Science, Kasuga, Fukuoka, Japan
Introduction: The excessive workload of Japanese hospital physicians is a serious social problem due to effects on their mental health status, as well as the potential for medical errors and lawsuits. The extent of overwork among resident physicians employed at national university hospitals in Japan is unknown and needs to be investigated.
Methods: This study used a questionnaire recommended by the Japanese Ministry of Health for hospital physicians working overtime, administered through an interview carried out by an occupational physician during the health surveillance to evaluate: 1) the severity of chronic fatigue; 2) the burden of work; 3) an overwork score derived from these two measures; and 4) presence of depressive symptoms. After the feasibility of the questionnaire was confirmed, both a cross-sectional and a longitudinal study were performed, while statistics analysis included multiple linear regression analysis and chi-square test set at P < 0.05.
Results: Most of the overworked physicians were young medical staffs (48%), whereas postgraduate residents formed a small group (10%). In the cross-sectional study (n = 135; mean age 32.7 years ± 5.6), the histograms of scores for the four factors investigated showed a strong positive skewness, while overtime histograms showed a negative skewness at 4, 3, and 2 months prior to the interview with occupational physician, but positive skewness 1 month prior to the interview. The longitudinal study
(n = 26) showed an increase or reduction of overtime respectively having a significant impact on exacerbation or improvement of the overwork score (P = 0.028) and depressive symptoms (P = 0.025).
Discussion and Conclusions: A strong positive skewness of the histograms for items related to overwork might indicate fear of stigma of mental illness amongst young physicians. Physicians employed at Japanese national university hospitals should be protected by the institution, and the roles of occupational physician and health surveillance are crucial and should be effectively implemented.
Keywords: Legislation, hospital; Japan; physicians; preventive psychiatry; psychology, industrial; social stigma; occupational health physicians; overtime work.
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Original Article in Environmental Public Health
An ensemble prediction approach to weekly Dengue cases forecasting based on climatic and terrain conditions
Authors: Sougata Deb1, Cleta Milagros Libre Acebedo1, Gomathypriya Dhanapal1, Chua Matthew Chin Heng2
1 M. Tech students, Institute of Systems Science, National University of Singapore, Singapore
2 Lecturer, Institute of Systems Science, National University of Singapore, Singapore
Introduction: Dengue fever has been one of the most concerning endemic diseases of recent times. Every year, 50-100 million people get infected by the dengue virus across the world. Historically, it has been most prevalent in Southeast Asia and the Pacific Islands. In recent years, frequent dengue epidemics have started occurring in Latin America as well. This study focused on assessing the impact of different short and long-term lagged climatic predictors on dengue cases. Additionally, it assessed the impact of building an ensemble model using multiple time series and regression models, in improving prediction accuracy.
Materials and Methods: Experimental data were based on two Latin American cities, viz. San Juan (Puerto Rico) and Iquitos (Peru). Due to weather and geographic differences, San Juan recorded higher dengue incidences than Iquitos. Using lagged cross-correlations, this study confirmed the impact of temperature and vegetation on the number of dengue cases for both cities, though in varied degrees and time lags. An ensemble of multiple predictive models using an elaborate set of derived predictors was built and validated.
Results: The proposed ensemble prediction achieved a mean absolute error of 21.55, 4.26 points lower than the 25.81 obtained by a standard negative binomial model. Changes in climatic conditions and urbanization were found to be strong predictors as established empirically in other researches. Some of the predictors were new and informative, which have not been explored in any other relevant studies yet.
Discussion and Conclusions: Two original contributions were made in this research. Firstly, a focused and extensive feature engineering aligned with the mosquito lifecycle. Secondly, a novel covariate pattern-matching based prediction approach using past time series trend of the predictor variables. Increased accuracy of the proposed model over the benchmark model proved the appropriateness of the analytical approach for similar epidemic prediction research.
Keywords: Climate; Covariate Pattern Matching; Dengue; Ensemble Prediction; Multiple Linear Regression; Statistics.
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Original Article in Pneumology
Prediction of spirometry parameters using chest circumference in Sri Lankan boys aged 8-16 years
Authors: Guwani Liyanage1, Bernard Deepal Wanniarachchi Jayamanne2
1 Senior Lecturer, Department of Paediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka.
2 M.D., Department of Health Informatics, National Dengue Control Unit, Ministry of Health, Sri Lanka.
Introduction: Most normative standards for spirometry are established based on height, weight and body mass index. We have investigated chest circumference as an alternative to height for interpretation when accurate height measurements cannot be obtained.
Methods: This is a cross-sectional study conducted in Sri Lankan boys aged 8-16. Spirometry measurements were taken adhering to American Thoracic Society/European Respiratory Society 2005 recommendations. Data analysis was performed with SPSS Version 18 for Windows. Correlations (Pearson correlation coefficient) between lung volumes and chest circumference were evaluated. Subsequently, multiple regression analysis was performed between lung volumes and the predictor variables.
Results: Six hundred and eighty-two (n = 682) boys with acceptable spirograms were included in the final analysis. Chest circumference was significantly correlated to height as well as spirometry parameters. Therefore, reference equations were established based on chest circumference and age.
Discussion and Conclusions: Chest circumference could be considered as competent as height in predicting lung flows and volumes in Sri Lankan males aged 8 to 16, and it could be used as an alternative parameter in situations where height cannot be measured precisely.
Keywords: Chest circumference; reference standards; spirometry; Sri Lanka.
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Original Article in Health and Social Behavior
Identifying barriers that prevent US insured adults at-risk for and diagnosed with type 2 diabetes from accessing primary care services: An exploratory study
Author: Tamara Crawford1
1 DBH, MPH, Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Tempe, AZ, United States.
Introduction: Type 2 diabetes is a condition that affects millions of individuals within the United States and it is one of the leading causes of death. Access to quality care is necessary to decrease the risk of developing type 2 diabetes and associated complications. This study focused on assessing the barriers that prevented insured individuals, identified through a community health screening as at-risk for or suffering from type 2 diabetes, from accessing primary care services.
Methods: A quali-quantitative design was used in this study. Participants were recruited through convenience sampling and 64 participants were identified through community outreach events sponsored by the Florida Atlantic University’s (FAU) Community Health Center. Barriers were measured through the ‘Barriers to Care’ Survey Instrument, which was administered face-to-face at community outreach events.
Results: Descriptive analyses indicated that participants identified cost of care as the most reported barrier (73.4% of sample) to accessing care. Lack of family and friend support was the least reported barrier (7.8% of sample). Regression analyses showed a significant association between reported barriers and participants’ access to primary care services by measuring participants’ last primary doctor’s appointment (R2 = 0.47, P = 0.001). Three factors significant resulted in predicting participants’ last primary doctor’s appointment: ‘not having time to go to the doctor’ (P = 0.022), ‘feeling too sad about disease to see a doctor’ (P = 0.021), and ‘not feeling sick’ (P = 0.001).
Discussion and Conclusions: Findings have important clinical implications since addressing identified barriers can lead to increased access to primary care services and enhanced health outcomes. Future research should focus on the significant impact of self-management techniques, sociocultural factors, and psychosocial factors to help inform researchers how they impact the barriers associated with individuals at-risk for or suffering from type 2 diabetes. Having health insurance is not the only answer to accessing primary care.
Keywords: Barriers to care; behavior; community health screening; diabetes mellitus; healthcare; health care system; primary care services.
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Original Article in Diabetology and Sociology of Health
Teenagers with type 2 diabetes mellitus as a hidden population: A qualitative study of the representations and experiences related to the disease in Mazatlán, Mexico
Authors: Nathaly Llanes-Díaz1, Dewi Hernández-Montoya2
1 PhD, Consejo Nacional de Ciencia y Tecnología-Instituto Nacional de Pediatría, Departamento de Investigación en Epidemiología, Ciudad de México, México
2 PhD, Instituto Nacional de Pediatría, Departamento de Investigación en Epidemiología, Ciudad de México, México.
Objective: To analyze the representations that adolescents with type 2 diabetes mellitus living in Mazatlán, Mexico have of the disease.
Methods: The study design was qualitative and based on an analytical approach of narrative research. In-depth interviews and participant observation were conducted with eight adolescents (four females and four males). The sample was theoretical-intentional according to age (10-19 years), diagnosis of type 2 diabetes mellitus, and residence in Mazatlán.
Results and Discussion: Adolescent experiences and representations regarding the disease were associated with six themes: 1) knowledge of the disease; 2) self-care practices; 3) identity construction; 4) significance of the disease; 5) family support; and 6) gender as a transversal category. Social stigma that is associated with diabetes and its management leading to self-management barriers, the abandonment of treatment and hiding the disease make adolescents with diabetes to be a hidden population. Identity construction is strongly affected by the disease; indeed, diabetes implied a reconstruction of male identity, while for females the disease was associated with overweight that affects their self-esteem. All of the adolescents lived in a constant dichotomy between present and future, with the fear of dying or getting worse. The absence of intergenerational communication and family support within the adolescents’ families limited adolescent care practices, exacerbating their emotional distress and living the disease with the feeling of loneliness.
Conclusions: Our study showed that adolescents affected by type 2 diabetes mellitus, did not experience nor they did face the disease homogeneously but accordingly to the gender and level of family support, which, therefore, should be specifically considered by care programs and health professionals to encourage adherence to treatment, taking into account the emotional well-being and psychological needs of adolescents.
Keywords: Adolescent; Diabetes Mellitus, Type 2; Health Beliefs; Self-care; Self-Efficacy.
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Original Article in Infectious Diseases
Home management of malaria among caregivers of under-five children in Owo, Ondo State, Nigeria
Authors: Liasu Adeagbo Ahmed1, Olubankole Akinboboye2, Olayinka Stephen Ilesanmi3, David Akintayo Oguntuase4
1 FMCFM, FWACP, Department of Family Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
2 FMCFM, FWACP, Department of Family Medicine, Federal Medical Centre, Owo, Ondo State, Nigeria
3 MBA, MSc, MPH, FWACP, Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
4 FWACP, Department of Paediatrics, Federal Medical Centre, Owo, Ondo State, Nigeria.
Introduction: Home management of fever by caregivers is particularly relevant for ensuring effective care to under-five children in Sub-Saharan countries with high-transmission of malaria like Nigeria. Our study aimed to assess home management of fever among mothers and other caregivers of under-five children attending Federal Medical Centre in Owo, Ondo State, Nigeria.
Methods: A descriptive, cross-sectional hospital-based study was carried out. A systematic random sampling technique was used to recruit participants (mothers and other caregivers). A structured interviewer administered questionnaire was used. Clinical findings and malaria test were performed on children using standard methods. Data were analyzed with SPSS version 15.
Results: Prevalence of home treatment of fever was 98.4%. Most of the caregivers bought anti-fever drugs from patent medicine shops and only 11.9 % of them got a prescription drug from pharmacies. Despite good knowledge about causes of malaria by caregivers (72.6%) and a prompt medical treatment within 24 h of fever onset (84.2%), many of their children were treated with only paracetamol (45%) and, therefore, they presented to the hospital febrile (61.8%), tachycardic (63.7%), and tachypnoic (83.9%). Almost all of the children were diagnosed with malaria (98%) associated with some types of complication such as convulsion (29.6%) and anaemia (52.7%). Chi square test showed a significant (P < 0.005) difference between treatment modality (inpatient versus outpatient) with regards to educational level, type of caregivers, place of domicile, use of antimalarial in combination with paracetamol, and presence of complications.
Discussion and Conclusion: In our study, home management of malaria by caregivers of under-five children was ineffective. Indeed, the effectiveness of home management of malaria depends not only on the early diagnosis, but also on a prompt and appropriate treatment. Therefore, proper health education programmes on this disease should be implemented among caregivers of under-five children.
Keywords: Antimalarials; Caregivers; Child; Fever; Malaria.
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Case Report in Cardiology of Sport
A case of asymptomatic ST segment changes in cyclist with two myocardial bridges
Authors: Stefano Giraudi1, Barbara Severgnini1, Paolo Valli1, Anna Teresa Pandiscia2, Lucrezia Marchetti2, Silvana Scarpini1
1 M.D., Department of Cardiology, “Uboldo” Hospital, Cernusco sul Naviglio, Milano, Italy
2 M.D., Department of Radiology, “Uboldo” Hospital, Cernusco sul Naviglio, Milano, Italy
A 65-year-old male regularly involved in competitive cycling came to our sports medicine laboratory for the annual mandatory pre-participation screening. Cycling screening protocol includes a cardiological examination, basal ECG and cardiac stress test. The clinical examination was unremarkable, and the patient’s blood pressure was 120/75 mmHg. The rest-ECG was normal. The cardiac exercise stress test showed a 2 mm ST-segment inversion in the anterior leads (V3-V4-V5-V6) at peak exercise. No presence of arrhythmias or symptoms were reported. Due to an ST segment depression recorded during the cardiac exercise stress test, we performed a coronary computed tomography angiography (CCTA) that showed two myocardial bridges of the left coronary artery. However, we observed no atherosclerotic plaque of the coronary lumen. A dobutamine stress echocardiogram and a bicycle stress echocardiogram were normal. We concluded for ventricular repolarisation abnormalities during maximal exercise testing due to the electrocardiographic findings in an asymptomatic athlete without any coronary artery disease. In literature, myocardial bridging is regarded as a common anatomic variant rather than a congenital anomaly. Nevertheless, some reports show that myocardial ischemia and myocardial infarction or sudden death could be caused by myocardial bridging. In addition, intramyocardial bridging is a recognised cause of sudden death in athletes. Therefore, according to the Italian cardiological guidelines for competitive sports (COCIS 2009), we recommended the patient avoid physical overload and sport practice.
Keywords: Athletes; coronary artery anomalies; coronary computed tomography angiogram; exercise stress test; myocardial bridge.
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Case Report in Internal Medicine
A case of possible Kounis syndrome as a complication of scombroid syndrome
Authors: Stefano Rusconi1, Antonio Villa1
1 Department of Emergency, ASST Monza, PO Desio, Monza, Italy. Via G. Mazzini,1 20832 Desio (MB), Italy.
Kounis syndrome is defined as the concurrence of acute coronary syndromes such as coronary spasm or acute myocardial infarction with conditions associated with activation of inflammatory mediators such histamine, arachidonic acid and various cytokines and chemokines. Recently, a variety of unusual etiologies have been reported, including scombroid syndrome. We present a case of a woman without previous history of cardiac diseases or cardiovascular risk factors, who presented to emergency department after the onset of flushing, asthenia, palpitations, burning sensation in the mouth having just eaten tuna. The electrocardiogram revealed a sinus tachycardia with diffuse ST segment depression. After therapy, in a short time symptoms recovered and a second electrocardiogram no longer showed any ST changes. These electrocardiographic changes observed in our case were probably due to transitory coronary vasospasm as described in type I variant of Kounis syndrome.
Keywords: Electrocardiographic changes; histamine poisoning; Kounis syndrome; myocardial ischemia; scombroid syndrome.
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