Family medicine and primary care -- open access最新文献

{"title":"Beliefs about Insulin Treatment of Type 2 Diabetic Patients in Kinshasa, Democratic Republic of the Congo","authors":"Fina Ljp, Lukanu Np, Shomba Lr, Lepira Bf, Ogunbanjo Ga","doi":"10.29011/2688-7460.100030","DOIUrl":"https://doi.org/10.29011/2688-7460.100030","url":null,"abstract":"Background: It is not rare that diabetic patients, motivated by many beliefs, express resistance at the initiation of insulin therapy leading to delays of treatment and subsequent poor control of diabetes. Knowledge of patients’ beliefs towards insulin is essential to better orient the education of diabetics. Methods: This is a cross-sectional study aimed at identifying beliefs about insulin therapy in our community using a psychometric test, “the Ch-ASIQ (The Chinese Attitudes to Starting Insulin Questionnaire)” among 213 diabetic patients in three diabetes management health facilities in Kinshasa. Logistic regression was performed to determine significant beliefs among participants with psychological insulin resistance. The statistical significance level is p <0.05. Results: Out of 213 patients included in the study, 42.7% had psychological insulin resistance. The psychological insulin resistance was motivated by the worry for patients that other people know they have diabetes through the insulin treatment [ORa: 3,44 (1,15-5,56), p: 0,000], the pain caused by insulin injection [ORa: 4.65 (1.42-7.05), p: 0.003], the worry over the need to perform home blood glucose monitoring (OR: 3.55 (1.35-6.87), p: 0.011) and the lack of family support to support them to inject insulin [ORa: 5.43 (2.92) -10.10), p: 0.000]. Conclusion: There is a need for education of both diabetic patients and their entourage in order to successfully remove barriers to insulin adherence. Alleviating financial burden of patients and families will help to face additional obstacles related to cost.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctor-Patient Relationships: A Puzzle of Fragmented Knowledge","authors":"J. Turabián","doi":"10.29011/2688-7460.100028","DOIUrl":"https://doi.org/10.29011/2688-7460.100028","url":null,"abstract":"The doctor-patient relationship has been and remains a keystone of care. But, there are many ways of understanding, classifying and practicing the doctor-patient relationship. In this scenario, this article begins the task of organizing the different ways of understanding, naming, differentiating, classifying and practicing the doctor-patient relationship. It is concluded that the following concepts can be differentiated: 1) Hierarchy of complexity dimensions of the doctor-patient continuity relationship; 2) According to historical stages; 3) According to the degree of interpersonal relationship; 4) According to the control exercised by the physician or the patient; 5) According to the level of participation; 6) According to the “creators of contexts” models); 7) According to the length of interpersonal continuity; 8) According to pharmacological prescriptions; 9) According to the characteristics of medical service; 10) According to the psychosocial aspects of diseases; 11) According to age; and 12) Doctor-patient relationship with patients and special situations: emigrants, foreigners, patient with ill-defined symptoms, with the insane, with the psychotic, with the patient with visual or hearing impairment, at home, with differences of race, social class, gender, etc.). It is concluded that the doctor-patient relationship is a complex, multiple and heterogeneous concept that cannot be defined in a unique way or generalize the concept of “good” relationship, but there are “many doctorpatient relationships” appropriate according to their contexts, which also implies redefining the instruments for measuring this relationship.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69479358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of ACTH Gel in Membranous Nephropathy","authors":"Ann Sedeeq, Akram Al-Salman, Arshdeep Tindni","doi":"10.29011/2688-7460.100036","DOIUrl":"https://doi.org/10.29011/2688-7460.100036","url":null,"abstract":"Membranous Nephropathy (MN) is one of the most common causes of nephrotic syndrome characterized by insidious onset, nephrotic range proteinuria, reduced renal function, and can lead to end stage renal disease. Treatment regimens for MN have been described including steroids treatment in combination with cyclophosphamide or calcineurin inhibitors, cyclosporine or tacrolimus. Adrenocorticotropin (ACTH) has been increasingly studied for various glomerulopathies, most notably MN and growing evidence suggesting that ACTH maybe an effective treatment option.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oxidative Stress and the Antioxidant Capacity of Plasma in Patients with Helicobacter pylori -Positive Gastroduodenitis and the Effect on Serum Iron Levels","authors":"M. Yordanova","doi":"10.29011/2688-7460.100039","DOIUrl":"https://doi.org/10.29011/2688-7460.100039","url":null,"abstract":"Aim: To evaluate the oxidative stress and antioxidant protection in patients with chronic Gastroduodenitis and the relationship between their levels with the etiologic agent H. pylori and how this affects iron homeostasis. Introduction: Several records indicate that oxidative stress plays a significant role in the pathogenesis and progression of chronic inflammatory diseases of the gastrointestinal tract. H. pylori infection generates free oxygen and nitrogen species (ROS/RNS) cause damage to the gastric mucosa. Materials and Methods: 55 patients with gastritis and 80 healthy volunteers were studied, with a mean age of 59.69±11.52 and 53.8 ±0.8 years, respectively. Both groups define routine laboratory parameters (including CRP and Iron). Serum levels of antibodies against H. pylori (ELISA DiaMetra Italy) and antigenic presence in faecal matter were examined. Patients undergo endoscopic examination. Oxidative stress (dROMs) and serum antioxidant capacity (BAP) were determined spectrophotometrically on a semi-automatic Carpe diam analyzer. (Diacron Labs Italy). Statistical methods used: T-test for comparison of mean values, descriptive and correlation analysis. Results: The patient group showed significantly elevated mean dROMs values compared to the control group. Levels in patients with H. pylori infection differ significantly from HP negative ones. The BAP test showed a significant decrease compared to the control group. A similar relationship exists between the two patient groups for the BAP test. A moderate positive correlation between CRP and dROMs was found, and a moderate negative correlation with the BAP test. Increasing dROMs and decreasing BAP results in a decrease in serum iron levels. Conclusion: Determination of oxidative stress levels, antioxidant protection, and iron homeostasis may be used in the monitoring of patients with chronic Gastroduodenitis.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69480280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity Patterns in Patients with Back Pain: A Study of Patient Records at a Primary Health Care Centre in Sweden","authors":"L. Carlsson, Holger Olofsson, B. Bertilson","doi":"10.29011/2688-7460.100026","DOIUrl":"https://doi.org/10.29011/2688-7460.100026","url":null,"abstract":"In Primary Care, multimorbidity is the norm in most patients. A large part of these have pain disorders, very often related to the spine. Patients with back pain have a higher degree of multimorbidity than many other groups of patients. The aim of this epidemiological study was to elucidate various patterns of multimorbidity in terms of clusters of diseases among patients with low back pain (LBP). Methods: A retrospective cross-sectional study was performed containing all registered encounters with patients receiving a LBP related diagnosis at one Primary Health Care Centre (PHCC) in Stockholm area, Sweden. The period October 2011 to September 2014 was studied. The Johns Hopkins Case-mix System “Adjusted Clinical Groups” (ACG©) was used for grouping and analysing data. Results: Out of 15,092 patients visiting the PHCC during the 3-year period exactly 10,000 got at least one diagnosis and 1,431 of those patients were diagnosed with LBP. Most common simultaneous groups of diagnoses were in order administrative concerns, hypertension, other musculoskeletal disorders and neurologic signs and symptoms. The proportion of patients with LBP disorders having five or more diagnoses was about 29%, and the equivalent proportion of patients without LBP was 9%. Different types of morbidity in terms of Aggregated Diagnosis Groups (ADGs) showed that about 55% of patients with LBP had three or more ADGs compared to 26% among patients who had no LBP. Patterns of multimorbidity in terms of the ACGs showed that patients with LBP were about twice as common in higher risk categories than patients without those diagnoses (52% vs 26%). Discussion: Our study showed that patients with LBP had a high degree of multimorbidity compared to those who did not have LBP and type of concurrent diseases differed between the two groups. The patterns of diagnosis clusters were analysed further and showed results that differed between various groups of patients with LBP, predominately depending on age. Further analysis is needed in order to understand what causes the various patterns of multimorbidity among patients with LBP.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69478139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound Healing Therapy With a 650-Microsecond 1064nm Laser","authors":"Aletha W. Tippett","doi":"10.29011/2688-7460.100020","DOIUrl":"https://doi.org/10.29011/2688-7460.100020","url":null,"abstract":"Objective: The objective of this paper is to present observational data to support the premise of using a 650-microsecond Nd:YAG 1064 nm laser for wound healing. Background: Laser light treatment has been reported to stimulate collagen production, the primary reason lasers are useful for cosmetic procedures such as reducing wrinkles and smoothing skin lines [1,2]. This ability to stimulate collagen, the main protein involved in wound healing, provokes the idea that a cosmetic laser could be used to promote wound healing. When working with chronic wounds, one of the main goals is to stimulate dermo-fibroblast synthesis of collagen. A demonstrated way to do this is by serial debridements, plus there are many biotech products are on the market that attempt to aid in this, in addition to, or instead of, serial debridements of the wound [3]. Cold laser therapy has actually been used for years to stimulate wound healing, but the technology has not been widely applied [3]. There have been a number of published articles on using lasers for wound healing [4-6]. Most of these use low level lasers, not cosmetic lasers, but there have been several published studies using Nd: YAG lasers for wound healing [7-9]. Multiple types of laser have been tried, especially for diabetic wound healing and have found low-energy is helpful but more research is needed [10]. The consensus from published articles is that low level laser therapy in the range of 4-8 joules/cm2 is beneficial for wound healing. Some practitioners are seeing results using multiple passes with 11 joules, but there is some study that higher laser power can be harmful to a wound by inducing scarring [7,8,11]. Having a non-invasive simple method that predictably will promote wound healing would be a boon to the millions of people suffering from various chronic wounds and for their caregivers trying to heal these wounds. Case Report The 650-microsecond Nd:YAG 1064 nm laser has been used by this writer for over 10 years for a variety of purposes, including wound stimulation. The Nd:YAG is a cosmetic laser and certainly can be used for a variety of purposes: hair removal, skin rejuvenation, scar reduction, wrinkle removal, lesion ablation, acne, etc. This laser, made by Aerolase, has a unique 650-microsecond pulse duration which enables the pulse to be delivered in a collimated beam, so that skin contact by the handpiece is not necessary (as it is with other lasers), and also it has the ability to dial in the fluence used, down all the way to 4 joules/cm2 at the lowest setting. In 2006 a report was made of using this laser on 17 wound patients over 10 weeks. All patients were treated with 4 joules/cm2, single pass. Patients were treated at various intervals. Overall, 11 or 65% of wounds improved, 3 or 18% had no change, 1 patient was lost to follow-up and 1 patient had increased pain with no improvement in the wound. A variety of wounds were treated, including pressure, neuropathic, radiation fibrosis, an","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41915925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practicing Alternative Medicine in Israeli Hospitals","authors":"J. Shuval","doi":"10.29011/2688-7460.100019","DOIUrl":"https://doi.org/10.29011/2688-7460.100019","url":null,"abstract":"There is growing evidence that alternative health care practitioners and conventional physicians are working together in collaborative patterns. The paper examines these collaborative patterns in hospital settings in Israel. On the theoretical level the specific issues relate to theories concerning relationships between dominant institutional structures which enjoy the benefits of epistemological legitimacy as well as extensive, supportive social structures and groups of non-conformists who seek to attain many of the same goals by utilizing different methods based on other epistemologies. In the most general sense the issues involved concern processes of accommodation and social change. In an effort to examine the dynamics of the processes involved, data were collected twice: In 2000-2001, in an extensive research undertaking when CAM was beginning to show its presence in hospital settings and again in 2015 when a more modest second round of supplementary research was undertaken in an effort to observe changes over time. In 2000-2001 data were collected by means of semi-structured, qualitative interviews in four general hospitals in Jerusalem 19 persons were interviewed including 10 alternative practitioners working in a variety of fields and 9 conventional medical practitioners who worked with them (6 physicians and 3 nurses). Interviews focused on background and training, reasons for entry into the hospital, length of practice, status in the hospital system, mode of remuneration, content of work, modes of interaction with others in the hospital and problems encountered. In 2015-2010 in-depth interviews were carried out with CAM practitioners and policy makers in the Israel Ministry of Health and in a variety of health care institutions. These interviews focused on the role and functions of CAM in Israeli hospitals over the intervening period. Observations were carried out in selected hospital settings. An in-depth literature search regarding research and policy statements on the role of CAM in Israeli hospitals during the intervening period provided an overview of empirical changes. The paper discusses the early modes of entry into Israeli hospitals, the dilemmas faced and the mechanisms used to overcome barriers. The findings of the first wave of interviews suggest a dual process of simultaneous acceptance and marginalization of alternative practitioners. While small numbers of alternative practitioners were found to be practicing in a wide variety of hospital departments and in a broad spectrum of specialties, they were in no cases accepted as regular staff members and their marginality was made clear by a variety of visible structural, symbolic and geographical cues. Considerable increases in the number, activity and visible presence of alternative practitioners in the hospitals occurred by 2016. These are discussed along with the mechanisms utilized to expand their presence in Israeli hospitals. Citation: Shuval JT (2018) Practicing Alterna","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42664810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity among Patients with Back Pain: A Study of Records at a Swedish Primary Health Care Centre","authors":"Holger Olofsson, L. Carlsson, B. Bertilson","doi":"10.29011/2688-7460.100018","DOIUrl":"https://doi.org/10.29011/2688-7460.100018","url":null,"abstract":"Introduction: Multimorbidity is defined as the simultaneous occurrence of several diseases where none of them is considered as the most important one. In Primary Care a large part of the visits consists of patients with pain disorders. Patients with back pain and diseases related to the spine constitute the largest group of these patients. However, little is known if patients with back pain have a higher degree of multimorbidity than patients without back pain. The aim of this epidemiological study was to investigate which were the most frequent simultaneously concurrent diseases together with back pain. Method: We performed a cross-sectional study of all visits involving back pain to one Primary Health Care Centre in Stockholm, Sweden during the period October 2011 to September 2014. Patients over 20 years of age suffering from back pain were compared, concerning all their diagnoses and number of visits with those who were not diagnosed with back pain. Results: Out of 12,017 adult patients, 971 had back pain; 57% women and 43% men. The patients with back pain had a higher degree of multimorbidity, more primary health care visits and more diagnoses compared to those without back pain. For essentially all of the 20 most common diagnoses the patients with back pain had a higher prevalence ratio. Most evident among these diagnoses was abdominal pain, which had twice as high prevalence among patients with back pain compared to those without. Discussion: Our study showed that patients with back pain had a higher degree of multimorbidity compared to those who did not have back pain. The most frequent concurrent diseases were other pain disorders especially abdominal pain. This finding raises the question if there may be some connection between the innervation from the spine and this concurrent disorder.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42736692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a Need for Home Health Care Services?","authors":"F. Alnasir","doi":"10.29011/2688-7460.100021","DOIUrl":"https://doi.org/10.29011/2688-7460.100021","url":null,"abstract":"Life is becoming too sophisticated, with increasing daily pressure, which might be related to modernization. Everyone is by all accounts occupied and have no time, neither for themselves nor for social bonds. Health problems, on the other hand, are increasing, in particular, non-communicable diseases (NCDs). The latter are prevailing worldwide but more in the developing countries in particular obesity which has reached a scary figure in the Gulf Countries with a prevalence reaching more than 50% [1]. Moreover, the complications of NCDs have escalated leading, in addition, to disabilities and loss of effective workforce, economic constraints that became catastrophic to countries suffering from poverty which may hinder the proper and efficient provision of health care services to the population. Adding to these issues, the fact that the world is aging, and the population trend is changing making more of older people are living in solitary. They at this stage of life need more preventative health attention to be conveyed to them at home, since they may not access health services at the institutions.","PeriodicalId":93553,"journal":{"name":"Family medicine and primary care -- open access","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69477941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}